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Low Libido: An Emotional Rock in the Sock

by Dr. Barb DePree

Libido is a tender blossom. A cold blast of hormonal change. A whiff of illness or the wrong medication. Even routine and long-term sexual ho-hum can cause libido to wither like a sweet pea on a frosty morning.

The whole notion of female sexual desire and what causes it to bloom or to die on the vine isn’t well understood (like a lot of female sexuality, actually). But low libido in women is extremely common, according to the few studies done on it. Low libido conservatively affects between 8 and 12 percent of older women—those of us who are in the midst of or beyond the “change.” Other experts say that all women experience low libido at some point in their lives, and I wouldn’t quibble with that statement.

It even has a not-very-sexy name: hypoactive sexual desire disorder (HSDD).

To be clear, the textbook definition of HSDD goes like this: “a deficiency or absence of sexual fantasies and desire for sexual activity. The disturbance must cause marked distress or interpersonal difficulty.” (My italics.)

In other words, it ain’t a problem until you (or your partner) say it’s a problem. Low libido isn’t a disorder per se unless it’s making you or your partner feel distressed, dissatisfied, guilty, or otherwise unhappy.

Interestingly, while sex drive does tend to diminish as we age, most older women are less distressed about it, “resulting in a relatively constant prevalence for HSDD over time,” according to this report by Dr. Sheryl Kingsberg, a friend of MiddlesexMD.

To some extent, women expect to lose their sexy juice after a certain age because that’s what our American culture tells us to expect, according to Mary Jo Rapini, a therapist and MiddlesexMD advisor. Older women aren’t expected to be sexy. They’re expected to be invisible.

Yet, says Mary Jo, women shouldn’t passively accept this state of affairs just because they’re reaching midlife. “Accepting low sex drive because you’re getting older is the same as accepting drugs to control your diabetes when you could change your diet, exercise, and lifestyle regimen.”

For many women, however, low libido is a problem, causing all kinds of guilt, distress, and relationship disturbance, which may either be intense and unrelenting or intermittent and mildily distressing.

If good sex is correlated with general sense of well-being and higher quality of life and self-esteem, it’s not surprising that ongoing sexual frustration can negatively affect health and well-being. Dr. Sheryl mentions several studies that associate HSDD with health problems. In one such study, for example, “women with HSDD experienced large and statistically significant declines in health status, particularly in mental health, social functioning, vitality, and emotional role fulfillment.”


HSDD can be caused by a whole bunch of physical conditions, ranging from certain medications to certain illnesses to, yes, age-associated hormonal changes. But many women struggle with HSDD because of emotional issues, and that’s the focus of Mary Jo’s article. In her experience, the emotional causes of low libido are often relied to stress, relationship and intimacy issues, or to problems with self-esteem and body image.

“Addressing the emotional causes of low libido should be the first step you take in addressing why you no longer desire sex, your partner, or your intimate life,” she writes.

Mary Jo suggests some honest exploration, perhaps with a therapist, to get at the root of these emotional problems:

Are you stressed or depressed? Are you struggling with self-esteem or poor body image? Do you feel emotionally connected to your partner? Can you talk about sexual issues? Is there a history of abuse or infidelity in your relationship?

As with so many sexual matters, the causes of HSDD are complex, intertwined, and challenging to unearth. The cause could be as straightforward as adjusting a medication or as difficult as changing an unhealthy lifestyle or honestly assessing emotional issues.

If loss of libido is troubling you, tackling the underlying causes may also be a journey toward greater overall emotional and physical health, because just as sexuality is woven into the very fabric of emotional and physical well-being, you can bet that what affects sexuality is also affecting other parts of life as well.


  • I don’t think it’s fair to say that there is necessarily anything wrong, as you suggest in the final paragraphs above, with a woman who is not interested in sex in later life. As you’ve written elsewhere, as long as you don’t consider it a problem for yourself, it isn’t a problem unless your partner thinks it is.

    Gary on

  • I wish there had been better and more conveniently available, or perhaps even recommended education pushed on us as a newly married couple, to learn the likely difficulties in a long-term marriage, including the sexual aspects discussed here. When we were newly married, I thought that our sex drives were going to be as strong and durable as our ability to see, hear, walk, and breathe. And so when my wife’s drive diminished after multiple child births and menopause, I took it personally. I had I know what is written here, we might have take a very different approach during that difficult time.

    So I would recommend pushing this awareness on to young couples who can’t even imagine that losing one’s sex drive would even be possible, and that it might happen to just one partner in the marriage, and that it doesn’t necessarily have anything to do with the quality of the relationship.

    Gary on

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