Reviewed June 2019
Low libido in women: how to tell if it’s a physical problem
For many, sex is considered an important part of a person’s relationship or sexual expression, so finding ourselves no longer wanting it or not wanting as much can be very distressing. In some cases, it can affect our personal relationships.
Most women will experience a decreased libido at some point in their life. In a US study performed in 2008, 26% of premenopausal women and 52% of menopausal women reported having a low libido.1 The exact percentage is probably much higher, but given the stigma attached to not wanting sex, many are unlikely to report this. A ‘normal’ sex drive means different things to different people, of course, making it hard to know what is ‘right’.
But what is it exactly that causes our sex drive to drop? There is often not a single answer. Libido is affected by our mental, physical, and social well-being — three things which are not mutually exclusive. Where it comes to physical causes, however, you can sometimes draw on secondary symptoms to help determine why you’re experiencing low libido.
Pregnancy and childbirth
An obvious example of this is the decreased sex drive that often occurs after pregnancy and childbirth. The effects of birth on the vagina coupled with hormonal changes and an extreme change in day-to-day life (and amount of sleep you’re getting) means that not fancying sex as much is entirely normal. The good news is that this is usually temporary and will normally improve with time.
If there is severe scarring, infection, or dryness, however, you may need further treatment. Having stitches following tears during childbirth can leave very painful scar tissue at the entrance to the vagina. This will present itself as sharp pain when a partner tries to penetrate the lower part of the vagina. Soothing creams and massage will often solve this problem, but on occasion the scar tissue may need to be removed. If the pain is deeper or associated with discharge, abnormal bleeding, or fever, this can be a sign of infection, which would require a simple course of antibiotics.2
Using lubrication can help when the vagina feels dry but you shouldn’t persist with trying to have sex if it is uncomfortable. If the problem is also associated with feelings of worthlessness, lack of enjoyment or interest, and persistent sadness then this could be a sign of postnatal depression, which shouldn’t be ignored. If you believe you may have postnatal depression, it is important to seek help from your doctor, who will be able to advise you on the best course of action.
The normal surges and dips within the menstrual cycle can also have a significant effect on your desire to have sex. Have you ever noticed you feel more like having sex about two weeks before your period? This happens because when you ovulate (release an egg) the body’s natural response is to try to get the egg fertilised — both surges in oestrogen and testosterone have been observed during this time. However, there is still disagreement as to which plays a more significant role in boosting libido.3 Conversely, the time period leading up to and after the menopause causes a drop in progesterone, oestrogen, and testosterone — hormone changes which can lead to a low libido.
While these changes are entirely natural, there are occasions where an underlying hormone imbalance may be an issue. There are around nine different chemicals and hormones that can affect libido. Symptoms of a hormone imbalance can range from difficulty sleeping, to mood swings, to changes in the skin. One example of this is insufficiency in the adrenal glands which sit on top of the kidneys. This can lead to a lack of a hormone called cortisol, also known as the stress hormone. Along with lack of libido, a decreased amount of this this can cause weakness, weight loss, and dehydration.
Another example is an underactive thyroid. This is a gland in the neck that is responsible for producing hormones that influence our metabolism, and is deemed underactive if it isn’t producing enough of these hormones. This can lead to symptoms of tiredness, weight gain, depression, dry skin and hair, and a low libido. An underactive thyroid gland can be diagnosed with a simple blood test and treated with replacement hormones. Hormone imbalances are less likely to cause a low libido than psychological or social reasons but can be detected by blood test. If you are experiencing any combination of the aforementioned symptoms, you should seek help from your doctor who will be able to carry out the required tests.
Different medications can also affect the sex drive so it’s worth thinking about whether the change happened after starting to take a new tablet or course of medication. Particular culprits are antipsychotics and the combined and mini contraceptive pills. Certain antipsychotics (particularly risperidone and amisulpride) cause an increase of a hormone called prolactin,4 which is thought to suppresses our sexual desire.5
Many contraceptive pills and devices work by preventing ovulation or altering the natural hormones that would normally support a pregnancy. Long term alcohol overuse also suppresses sexual desire by damaging the liver, which is responsible for regulating the amount of sex hormone in our blood and producing proteins to bind these.
Sometimes it’s a simple problem down below inhibiting our sexual desire. If sex is painful, uncomfortable, or leads to recurrent urine infections, then this can put women off having sex. The most common cause of painful sex is an infection, which can be easily treated with antibiotics if identified early. Sexually transmitted infections like chlamydia or gonorrhoea can spread to the Fallopian tubes or ovaries if left untreated, and cause significant pain. Symptoms can include discharge or itching, but often there are no symptoms. If you have had unprotected sex it is best to get tested regularly to avoid spreading infection.
Other causes of painful sex can include variations in the structure of the female anatomy or more rarely can be a sign of ovarian, uterine, vaginal, or cervical cancer. Although painful sex is very rarely caused by cancer it is important to look out for other symptoms such as bleeding after sex, weight loss, and bloating, which can also be a sign of something more serious. If you are having any of these symptoms, you should go and get advice from your GP, even if just to put your mind at rest.
So, how can you tell if your low libido is a physical problem? As discussed, low libido can be due to a variety of underlying causes, some physical and some mental, some of which are temporary, and some of which can be solved with simple treatment. In truth, as with most issues affecting the human body, there is no single straightforward answer and any concerns should be looked at and tackled on a case-by-case basis.
For many, fears about what may constitute a low libido can be a big source of worry, but given that it is likely to affect us all at some point, you can rest assured you’re not alone. If you have any concerns or worries, and even if your low libido doesn’t seem to be accompanied by any other symptoms, it is always important to seek the help of your GP if you are concerned.
Last updated June 2019
Next update due 2021
- S. L. West et al., ‘Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women’, Arch Intern Med, vol. 168, no. 13, 2008, pp. 1441-9.
- NICE, ‘Pelvic inflammatory disease’, Clinical knowledge summary, National Institute for Health and Care Excellence, June 2019, [online], https://cks.nice.org.uk/pelvic-inflammatory-disease#!scenarioRecommendation:1 (accessed 4 July 2019)
- Cappelletti, M., and Wallen, K., Increasing women’s sexual desire: the comparative effectiveness of estrogens and androgens, Hormones and Behaviour, February 2016, vol 78, pp 178-193
- Bargiota, S.L., et al., The effects of antipsychotics on prolactin levels and women’s menstruation, Schizophrenia Research and Treatment, December 2013, [online], https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886401/ (accessed 4 July 2019)
- Krysiak, R., et al., Sexual function and depressive symptoms in young women with elevated macroprolactin content: a pilot study, Endocrine, February 2016, issue 53, pp 291-298