Low Libido / Sexual Difficulties

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• Low Libido / Sexual Difficulties

Medically Reviewed November 2023, by Dr. Susan Mayou (GMC: 2405092) - founder of the Cadogan Clinic and one of the world's leading dermatologists

What causes a low libido?

There are a number of things that may be causing a low libido:

• Anxiety and stress: Stress and anxiety can be exhausting, all-consuming and can have an overwhelmingly negative impact on most areas of your life, including your sex drive.
• Depression: Depression is very different to just feeling sad or unhappy. It’s a serious mental health condition that can leave you feeling down and hopeless and it can last for a long time. Depression can impact on all areas of your life, including your sex life.
• Medication: While depression is a well-known cause of low libido, this also comes as a side effect of many antidepressants, including SSRI antidepressants.  Other medication which may be responsible for low libido include medication taken for high blood pressure (including diuretics), medication taken for psychosis (such as haloperidol), medications that block the effects of testosterone or reduce testosterone production (including cimetidine, finasteride and cyproterone) and medication that treats seizures (for example, anti-epileptic drugs). It is important that you don’t stop taking any medication without speaking to a doctor first.
• Contraception: Hormonal contraception has been shown to reduce libido in some women. Types of hormonal contraception include combined contraceptive pill, progesterone only pill, contraceptive implant, contraceptive injection (the Depo-Provera injection), vaginal ring and contraceptive patch. However this side effect is usually only temporary and improves within a few months.
• Age and menopause: Growing older leads to a drop in hormone levels, along with more age-related health conditions, which may require medication. One or a combination of these can lead to a low libido.  Older men can develop low testosterone levels, which can cause depression, fatigue and a reduced libido, while women experience a drop in oestrogen levels as they approach menopause. This can also cause a low libido. Women may also suffer from low testosterone levels, particularly if they have undergone a hysterectomy (surgery to remove the uterus).
• Health conditions: A number of chronic health conditions can cause a loss of libido. These conditions include diabetes, cardiovascular disease and obesity.
• Hormonal problems: In a similar way to menopause and hormonal contraception, other hormonal problems can cause a low sex drive. This can include an underactive thyroid when the thyroid gland in the neck doesn’t produce enough hormones, leading to a loss of libido and other problems, such as depression, tiredness and weight gain. A hormonal problem called hyperprolactinemia, which causes a rise in prolactin levels, can also impact libido.
• Alcohol and drug use: Using illegal drugs and drinking excessive amounts of alcohol can have a negative impact on libido. In the interest of good health, you should moderate your intake to the recommended three to four units a day if you're a man, and no more than two to three units a day if you're a woman.
• Relationship issues: Perhaps one of the first things to consider if you are experiencing a loss of libido is whether there are any issues in your relationship which may be the root cause of your low libido. And conditions that make sexual intercourse difficult or unfulfilling, such as premature ejaculation or vagismus, can in turn cause libido issues. If there is a sexual condition that is getting in the way of you enjoying a fulfilling sex life, than you or your partner should seek treatment.

Are the causes of low libido different between men and women?

Some of the causes of low libido affect both men and women, for example drinking excessive amounts of alcohol, suffering from depression, anxiety or stress, and obesity.

However women can also be affected by hormonal contraception, such as the combined pill, implant or contraceptive injections.

The menopause often causes a drop in libido as oestrogen  levels fall, and this can be compounded if there is also a simultaneous drop in testosterone levels. Vaginal dryness is a common symptom of menopause and this can make penatrative sex painful, which in turn can make a woman reluctant to have sex and impact on libido.

Hormone levels also change during pregnancy and breastfeeding, which can often result in a low sex drive. And of course tiredness, changes in body image, the pressures of pregnancy and caring for a new baby and injuries sustained during childbirth can lead to an understandable reluctance to have sex. A woman who has given birth should only return to sexual activity when she feels ready.