There is no “normal” when it comes to sexual desire. Libido differs from person to person and can fluctuate depending on a slew of factors—from the medications you take to the status of your relationship.

But what it really comes down to is how each individual woman feels about her personal situation. “If a woman perceives her sex drive as decreased and it distresses her, this can have a huge impact on her self-image and relationship with her partner,” says obstetrician and gynaecologist Dr Lisa Valle.

On the flip side, if you’re happy and totally unconcerned about your libido, “it is not known to be detrimental to health or quality of life,” says gynaecologist Dr Raquel Dardik.

Still, if your low libido is persistent, it could be an indication of a health or psychological issue. While there’s no medical definition of a “healthy” sex drive, there’s little doubt that some people experience a stronger desire than others, and that certain lifestyle or health factors can play a significant role in that. Here, the most common causes of low libido in women—and when to see your doctor about it.

1. Your medication could be to blame.

Certain prescription medications—from blood pressure drugs to athlete’s foot treatments—can interfere with your sex drive by lowering your levels of testosterone, according to the International Society for Sexual Medicine. Research has overwhelmingly linked “low T” to a reduced libido in both men and women.

Mood-altering drugs, including antidepressants and antipsychotics, may also cause low libido as a side effect, says Susan Davis PhD, a professor of women’s health at Melbourne’s Monash University.

2. An underlying health condition is causing trouble.

If your sex drive used to be higher and something feels off, it’s worth checking in with your doctor about it. There are a wide variety of physical and mental conditions that can lead to lowered libido, including thyroid disorders, uterine fibroids, endometriosis, heart disease, diabetes, sleep disorders, fatigue, and more. This could be due to vascular problems that obstruct blood flow (yes, even down there), painful symptoms, endocrine problems that tank your hormone levels, or neurological issues that limit sensations.

Mental health conditions like anxiety and depression can also play a role, as they can wipe out your energy, alter brain chemicals that inhibit sex, and flood your system with stress hormones, like adrenaline and cortisol.

If you suspect an underlying health problem could be to blame, see your doctor to ensure a proper diagnosis and treatment plan. “Often it stems from a combination of issues and each needs to be addressed,” says Dr Dardik.

3. You’re not prioritising exercise.

In addition to reducing your disease risk and helping you maintain a healthy weight, getting regular exercise also proves to be helpful in the bedroom, research suggests. That’s because it has amazing effects on your cardiovascular health, blood flow, and overall mood—all key factors in a healthy sex drive.

Plus, making time for workouts can make you feel good about everything your body can do, which boosts your confidence, says obstetrician and gynecologist, Dr Shahnoz Rustamova.

4. Stress is a constant in your life.

“For a woman to be interested in sex, she’s got to have her brain in the game,” says obstetrician and gynaecologist Dr Hilda Hutcherson. Unlike men whose libidos are almost completely hormonally driven, women often require some emotional investment in sex (well, good sex).

“For a woman to be interested in sex, she’s got to have her brain in the game.”

“When you’re stressed, your focus is elsewhere and there simply isn’t room in your brain for arousal,” says Dr Hutcherson. Plus, your brain pumps out the hormone cortisol when you constantly feel like you’re under pressure, and that can actually impede sex hormones.

“As a doctor, I’ll talk with a patient to try to uncover a source of stress, as well as discuss potential solutions to the problem,” says Dr Rustamova. If work is weighing on you, think about what might make your life easier. Is it time to start looking for a new gig? A conversation with your manager to discuss your current workload? Whatever it is, know that the solution will lead to easier days—and better nights.

5. You’re genuinely exhausted.

Late nights don’t necessarily mean fun nights. “Sleep is essential for your sex drive,” explains Dr Rustamova. “Depleted energy means you’re less likely to be in the mood.”

In fact, one 2015 study found that sleeping just one more hour at night could result in a 14% increased chance of having sex with a partner the next day. In general, women who slept longer on average also reported “better genital arousal” than women who slept for fewer hours. The verdict: Make and keep a date with your pillow and you’ll soon want to make a date with your partner.

6. Your hormones are out of whack.

A change in libido can be influenced by your hormones, and there may be a good reason behind this that your doctor can help you pinpoint. If you’ve had a baby recently, for example, your hormones are going haywire (possibly even more so if you’re breastfeeding or have just stopped breastfeeding).

And if you recently went off of birth control pills, you may find yourself not as attracted to your partner as you once were, according to a study from the University of Stirling. In fact, any contraceptive change can cause a dip in libido, explains Dr Rustamova. So if you’ve noticed a shift, make sure you let your gynaecologist know so that you can find a new type of birth control that works for you on both counts.

Dr Valle notes also that perimenopausal and menopausal hormonal changes can lead to low libido.

7. Sex is painful.

If sex feels painful, it’s not surprising that you’ll want it less. About 30% of women report feeling pain during vaginal intercourse, according to a study published in The Journal of Sexual Medicine, and this can come down to a number of factors, from vaginal dryness to skin disorders to skipping foreplay.

However, painful sex (aka dyspareunia) can also be a sign that there’s a deeper medical condition at play, says obstetrician and gynaecologist Dr Thais Aliabadi. “Endometriosis can cause dyspareunia,” she says. Fibroids, certain infections, and a rare condition known as vaginismus are other potential culprits, so it’s worth getting checked out.

8. Your relationship is on the rocks.

Davis says two of the “most critical” contributors to a strong libido are either a good relationship or a new relationship. If you’re unhappy with your partner or the state of your relationship, mending that first will be crucial in truly firing your desire back up for one another.

9. You’re simply putting too much pressure on yourself.

“So often, patients won’t get close to their partners at all in the evening—no hand-holding or touching—because they’re worried their partner will assume sex is on the table and for whatever reason, they don’t feel like it,” says Dr Rustamova.

Instead, she suggests placing a priority on kissing and cuddling, and then taking the next step from there—only if you both feel like it. “Taking the pressure off yourself to have sex can make it easier to feel aroused, naturally,” she says.

Bottom line: If you are not happy with your sex life, you should feel empowered to do something about it.

“I am a big proponent for women becoming proactive in seeking a satisfying sex life,” says Dr Valle. “Each person’s view on what is a satisfying sex life varies.”

Any time you feel bothered or distressed about your perceived decreased libido, seek a doctor with experience in women’s sexual health. Medical issues can be fully assessed and treated appropriately with a subsequent referral to a sex therapist, which is also highly encouraged.

Additional writing and reporting by Markham Heid and Cari Wira Dineen

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