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Mismatched libidos: What do you do?
01:15 - Source: CNN

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Low desire can have many causes, such as side effects of medication or one's body image

Changes to your relationship -- even positive ones, such as pregnancy or a new baby -- can drain libido

CNN  — 

As a sex therapist, the No. 1 complaint I hear from both women and men is low libido. They visit me on their own or as couples, perplexed by the seemingly inexplicable drop in desire, either their own or that of their partner.

Many people are hopeful that this decrease in sex drive has a simple cause and therefore a simple solution. While that’s true in some cases, low libido is more often the complex result of several intertwining factors.

Low desire can have many causes, whether biological influences such as the side effects of medication, psychological factors such as body image or relational triggers such as being angry with your partner. Addressing the problem means viewing it through multiple lenses at once, taking what we call a bio-psychosocial-relational approach. Here’s a look at some common factors that can contribute to low libido.


“Not tonight, dear. I have a headache.” There’s more truth to this stereotypical excuse than you might expect. In fact, a wide range of biological and physical concerns can drain your desire, including pain, lack of sleep, disability and injury.

“Illness often impacts sexual desire,” sex therapist Rachel Needle said. “Depending on the illness and the impact both physically and emotionally, you might have trouble getting in the mood to be sexual. In addition, the medications used to treat many conditions can lead to sexual side effects that can impact your desire to be sexual.”

Hormonal issues can also play a role. The female sex hormones estrogen and progesterone plummet at menopause, but they can also fluctuate during breastfeeding, leading to low libido and decreased vaginal lubrication. The male sex hormone testosterone can fluctuate over time.


It’s well-known that mental health can impact libido: If you’re feeling stressed out, depressed or anxious, sex is probably the last thing on your mind. “Under any stress, sexual desire can be the first to suffer,” sex therapist Deborah Fox said. “Busy schedules, work deadlines, untreated depression and feelings resulting from unresolved conflict in your relationship all can lead to a drop in libido.” 

Another surprising factor in low desire: adult attention-deficit disorder.

“Erotic desire begins in our brains,” sex therapist Lisa B. Schwartz explained. “Some adults with ADD have a hard time quieting their minds long enough to think about being sexual or are unable to identify the feeling of being turned on. Other ADD-related issues that can impact desire include making time, planning and, for some, tolerating the routine of sex.”

The way you feel about yourself can have an effect on sexual desire, too. “Research shows that our body image impacts how we experience sex,” sex therapist Jennifer Valli said. For instance, author and researcher Thomas Cash found that women who were focused on their body image during sex reported having orgasms 42% of the time, but women who weren’t body-conscious climaxed 73% of the time.

Interestingly, you might be avoiding sex without realizing it. “If we look at sex not from a performance model but from a pleasure model, you may see that you have been looking at pleasure as a luxury and putting it at the bottom of your list of things that you think you deserve,” sex therapist Tammy Nelson said. “Avoiding sexual pleasure can feel similar to avoiding eating a cookie: It gives you a feeling of having control over your own urges and needs.” Similarly, you might reject sexual pleasure if it triggers feelings of past trauma or abuse.

Cultural and social

If your cultural or religious background frowns upon premarital sex or your sexual orientation, for example, it may be difficult to have a healthy enjoyment of sex.

“Negative societal and familial messages around identity and orientation can have a negative impact on sex drive,” sex therapist Yamonte Cooper said. “Sex drive or expression can either be suppressed or hidden out of fear of confirming societal and familial beliefs steeped in bias and religiosity. It is difficult to entertain a sex drive when you are living a life of fear.”  


Multiple studies have found a positive correlation between general relationship satisfaction and sexual satisfaction. “I see this in my practice all the time,” sex therapist Emily deAyala said. “Both women and men are guilty of buying into the idea that men should want to hop into bed at any time, but if the relationship is suffering, sex may not feel as good. It’s like sitting down to a wonderful meal with a nasty cold. Just as food seems less appealing when the sense of smell is dulled, sex doesn’t feel as satisfying when our emotions are out of whack or our relationship is suffering.”

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    Changes to your relationship – even positive ones, such as pregnancy or a new baby – can drain your libido, too. “These life transitions affect hormones, but they can also bring psychological changes,” sex therapist Stephanie Buehler said. “New mothers sometimes complain of feeling ‘touched out’ after caring for an infant all day, so the last thing they want is to have sex with their partner.”

    Likewise, men and women can both find their interest in sex drops when they are trying to have a baby. “The longer the couple tries, the more discouraged they may become, which can lead them to avoid sex,” Buehler said. “Couples trying for a pregnancy often complain that sex becomes ‘mechanical’ or ‘robotic,’ leading to low drive.”

    Because the causes and influences can be myriad, the best way to address low desire is to make an appointment with a sex therapist. Working alone or with your partner, you can get to the root of the problem and then approach low libido from multiple angles, using strategies tailored to your specific concerns.

    Ian Kerner is a licensed psychotherapist and sexuality counselor in New York City.