If you or your partner don’t want to have sex — not tonight, not next week, not ever — there’s help out there for both of you. Here’s what women and men need to know about causes, treatments, and more.
When your significant other gives you that “come hither” look, is your first thought, “Didn’t we do that once this year already?” Do you pray that if you have sex on New Year’s Eve it can count for two years?
If so, you may be experiencing low libido, a lack of desire for sexual intimacy in any form. Desire is the first part of the sexual response cycle, followed by arousal (excitement), orgasm, and resolution (the body returns to normal functioning).
The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) calls low libido Sexual Desire Disorder, a term encompassing two conditions: Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder.
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Research published in Sexual Medicine Reviews in April 2016 reveals that a significant percent of women reported a lack of desire: about 9 percent ages 18 to 44; around 12 percent ages 45 to 64; and more than 7 percent over age 65.
Men are having less sex than in the past, and some research suggests they are feeling less desire as well. A study published in the May 2018 issue of The Journal of Sexual Medicine found that the proportion of men reporting sexual activity within the past four weeks decreased from 81 percent in 2005 to 73 percent in 2016, while lack of sexual desire increased from 8 to 13 percent.
Sexual Desire Disorder: It’s Only a Problem if You Think It’s a Problem
While low sex drive is not a concern in and of itself (barring underlying physical illness), it can cause personal distress or lead to relationship issues for people whose partners want more sex. “Most couples do report some level of desire discrepancy, so that's considered typical,” says clinical psychologist and sex therapist Marianne Brandon, PhD, host of the webinar Reinventing Your Love Life. "The challenge, then, is finding a way to compromise that respects each individual’s needs and preferences.”
Causes of Sexual Desire Disorder: Why You May Not Be Feeling It
Men and women may lack sexual desire because of issues in three separate and competing areas, says Kimberly Resnick Anderson, a sex therapist and assistant professor of psychiatry at UCLA's David Geffen School of Medicine.
- Biologic/physiologic causes A number of medical conditions can diminish libido, including diabetes, heart disease, hormonal disorders,chronic pain, urinary tract disorders, substance abuse, and chronic physical and psychiatric illnesses. Some medications used to treat depression, anxiety, and psychosis can reduce desire. Women may be affected by menopause; men, by decreased testosterone or problems affecting blood flow (these can be caused by smoking, drinking, obesity, or lack of exercise). Erectile dysfunction can cause men to lose confidence, which takes a toll on their sexual desire.
- Social causes These factors can include cultural or religious beliefs, media and peer influences, family messages about sexuality, and overscheduling.
- Psychosocial causes A person’s sex drive can be affected by the quality of their relationship with a partner (including poor communication), past trauma, stress, poor body image, perceptions about aging, depression, and anxiety.
How to Rediscover Desire
Reclaiming desire can be a complex process. “Everyone wants a quick fix — ‘Just give me a shot and I’ll be good,’” says gynecologist and sex counselor Terri Vanderlinde, DO. “But if you focus just on sex, you are missing the point; you are not looking at yourself and addressing underlying issues. There are a hundred reasons why people have low desire at any time, and you have to look at all of them and how they work together.”
First, Check in With Your Doctor
If you or your partner are concerned about lack of libido, your first stop should be with a healthcare practitioner for a thorough examination that can ascertain whether undiagnosed disease is part of the problem.
Even when there is no diagnosable condition, medications can help improve desire, though none are cure-alls:
- Vyleesi (bremelanotide).Approved by the Food and Drug Administration (FDA) in 2019, Vyleesi is a drug that premenopausal women inject before sex. Addyi (flibanserin), another FDA-approved medication for premenopausal women, is a pill taken every night before bedtime.
- Testosterone. This can be helpful for men but requires close monitoring by a physician. Some women may benefit from off-label use of testosterone, taken under the close supervision of a physician with special expertise in this area, says Dr. Vanderline.
- Wellbutrin (buproprion). This antidepressant raises norepinephrine levels, which may increase desire in some men and women. (It does not work for everyone.) It can be used alone or to counteract the libido-suppressing action of SSRI antidepressants.
Working with a Sex Therapist or Counselor
No, there is no touching, demonstrating, or “practicing” with a sex therapist. Instead, these professionals help patients figure out what’s dampening their desire.
You can go with a partner, or go alone and bring what you learn back home, but it’s important that both you and your partner are on board. “A lot of times the men send the women in, because ‘You have to get fixed.’ But it takes two,” says Vanderlinde. “We have to fix the whole team; you can’t just fix the goalie. How do they relate to one another? How is the communication?”
In the best-case scenario, the therapist and physician work closely together to tease out the interwoven physical, emotional, and psychological issues. Each case is unique: A patient might have low desire for significant others but feel aroused by casual partners, say, or may not feel desire for others but still masturbate.
“There is a situational component” to low desire, says Resnick Anderson, “which is where sex therapy can help.” Has low libido always been a problem for the patient, the therapist will ask, or did it develop because of a specific issue such as a recent bout of depression or the discovery that a partner is cheating? Sex therapists can help determine if low desire is organic — related to physical issues and requiring a doctor’s care — or psychologic. “Conversely, doctors can rule out organic issues and then refer the patient to a sex therapist,” Resnick Anderson says.
Note: Groups such as the American Association of Sexuality Educators, Counselors and Teachers (AASECT) certify sex therapists. A “sex coach” is not a sex therapist or counselor.
Orgasmic Meditation May Help You Learn to Connect
Orgasmic meditation (OM) involves the gentle stroking of a woman’s clitoris by her partner for 15 minutes a session. The goal is not to create arousal or build towards orgasm, but to help the person being stroked let go and feel connected to her body and her partner’s body and learn to communicate her needs.
The person doing the stroking often reports that touching this way, done without a specific sexual goal, helps them feel closer to their partner. “Just feeling genuine intimacy and connection without trying to make something happen helps both partners with desire,” says Marissa Ward, OM coach with the Institute of OM.
The Takeaway
“Bottom line: Talk to your doctor, ask for help, and start the discussion,” says Vanderlinde.