Low Libido in Women: A Gynaecologist's Perspective on a Taboo Subject

A loss of interest in sex is one of the most common concerns I hear in my practice, yet it remains one of the least discussed. Many women suffer in silence, assuming that a declining libido is simply something they must accept — a natural consequence of ageing, motherhood, or the demands of modern life. In reality, low libido is a medical issue with identifiable causes and, in many cases, effective treatments.

You are not alone

Studies suggest that up to one in three women experience low sexual desire at some point in their lives. It can affect women of any age, though it becomes more prevalent during and after the menopause. Despite being so widespread, it is rarely volunteered during medical consultations, and even more rarely asked about by healthcare professionals. This silence can leave women feeling isolated, frustrated, or convinced that something is fundamentally wrong with them. It is not. A change in desire is a medical symptom like any other, and it deserves proper attention.

Hormonal causes

Hormones play a central role in female sexual desire. The most significant hormonal contributors to low libido include:

• Declining testosterone: Although thought of as a male hormone, testosterone is essential for sexual desire in women. Levels decline steadily from the late 20s onwards and drop more sharply during perimenopause and menopause.
• Falling oestrogen: Particularly around the menopause, reduced oestrogen can lead to vaginal dryness, discomfort during sex, and a consequent loss of interest in intimacy.
• Hormonal contraception: The combined oral contraceptive pill and other hormonal methods can suppress testosterone levels and reduce libido in some women.
• The postpartum period: A combination of hormonal shifts, breastfeeding, sleep deprivation, and the physical recovery from childbirth can significantly impact desire.

Physical causes

Several physical factors can contribute to a reduced sex drive, either directly or by making sexual activity uncomfortable:

• Vaginal dryness and pain during sex: If intercourse is painful, it is entirely natural that the desire for it diminishes. This is particularly common after the menopause but can occur at any age.
• Chronic illness and fatigue: Conditions such as thyroid disorders, diabetes, and chronic pain syndromes can all reduce energy and interest in sex.
• Medications: Certain commonly prescribed drugs, including some antidepressants (particularly SSRIs), blood pressure medications, and antihistamines, are known to affect sexual desire as a side effect.

Psychological and relational factors

Desire does not exist in a vacuum. Emotional wellbeing and the quality of a relationship are intimately connected to sexual interest:

• Stress and mental health: Anxiety, depression, and chronic stress are among the most common causes of reduced libido.
• Body image: Feeling uncomfortable or unhappy with your body can make it difficult to feel desirable or to enjoy physical intimacy.
• Relationship dynamics: Unresolved conflict, lack of emotional connection, or mismatched expectations around sex can all erode desire over time.
• History of trauma: Past experiences of sexual trauma or abuse can have a lasting impact on a woman's relationship with intimacy and desire.

Medical assessment

A thorough evaluation begins with a detailed and sensitive conversation about your symptoms, medical history, and the context in which your libido has changed. Blood tests may be arranged to check your hormonal profile, including testosterone, oestrogen, and thyroid function. If pain during sex is a factor, a gentle examination may be recommended to identify any underlying cause such as vaginal atrophy, infection, or pelvic floor dysfunction.

Treatment options

Treatment depends entirely on the underlying cause and is always tailored to the individual. Options may include:

• Testosterone therapy: The evidence for testosterone supplementation in women with low libido is growing, particularly for those who are postmenopausal. When prescribed appropriately, it can significantly improve desire, arousal, and overall sexual satisfaction.
• Vaginal oestrogen: For women experiencing dryness or discomfort, topical oestrogen can restore vaginal health and make intimacy comfortable again, often with a notable return of desire.
• Psychosexual therapy: Working with a trained therapist can be invaluable, particularly when psychological or relational factors are prominent. This can be pursued alongside medical treatments.
• Addressing underlying conditions: Optimising thyroid function, reviewing medications, treating depression, or managing chronic pain can all have a positive knock-on effect on libido.