It's no surprise to any adult that sex can be spotted everywhere. It's used in everyday ads and as major plot points. It's in casual conversations and front-page headlines. Sex can seem so ubiquitous, so basic, that when a problem in this arena arises—like a loss of libido—it can feel isolating.
"Forty percent of women never share this information with their health care provider," Sherry A. Ross, MD, women's health expert, and author of She-ology: The Definitive Guide to Women's Intimate Health says. "The medical community and female patients have a difficult time bringing up problems related to sex and what common concerns they are experiencing."
Given that millions of women have experienced a loss of libido, which Ross simply defines as a lack of desire, feeling this way is common even if it's rarely discussed. In order to feel less alone in navigating through it, we asked Ross to describe the potential causes of it, and what to do if you find yourself in this physical, emotional, and mental space.
"Let's face it: A woman's sex drive is complicated and often challenging to understand," she says. "Women's sexual desire and appetite begins in that great organ above the shoulders, the brain, rather than the one below the waist. The daily stresses of work, money, children, relationships, and diminished energy are common issues contributing to low libido in women."
Aside from those emotional stressors, physical changes can be a determinant, too. These five reasons may contribute to a loss of libido, Ross says.
First things first, sex is completely safe during low-risk pregnancies, and a man cannot "hurt" a baby during it. Sex also doesn't cause miscarriages. Ross wants you to know these things up front, in case those misconceptions are contributing to a lack of desire.
It's also a misconception to think that all pregnant women want to have more sex, she says. "In reality, this doesn't seem to be true. Women often lack an interest in sex and prefer to be held, cuddled, and kissed during pregnancy," she says. The steady weight gain and constant hormones can also make women feel self-conscious and uncomfortable. But Ross says that the best way to handle the changes is to communicate your concerns with your partner. "Each trimester brings a whole new set of circumstances that set the stage for sex and intimacy," she notes.
"The least talked-about time during the pregnancy cycle is the postpartum period, which is from the moment the baby is delivered until the body completely recovers, and it varies with each woman in the first year," Ross continues.
"At the six-week postpartum visit, women see their health care provider for an exam and are given permission to have sex and get back into the bathtub again," she says. "For the majority of women, the bathtub sounds great, while the thought of having sex again is the last thing on their minds."
Ross contributes this to the trauma of delivery, and the fact that the body is still recovering. Furthermore, breastfeeding can also spur "postpartum menopause," lessening the libido. "It's probably been at least six weeks since she and her partner have had any sexual intercourse, so the vagina, even though it has a great memory, will take some time to get back on track."
"During this time period, a woman's body transitions, hormonally, physically, and emotionally," Ross explains. "Everybody is different, so it's important for a woman to communicate what she is experiencing with her health care provider or gynecologist."
Ross says that signs of perimenopause may be heavy or irregular periods, night sweats, insomnia, or emotional shifts, all of which contribute to not wanting to have sex. This precursor to menopause also slows women's estrogen and testosterone, too. "More than 60% of women report losing their libido during this time, and more than 30% stop having sex altogether," she says. "Communication and hormonal therapy are helpful treatment options as you enter this hormonal storm."
"When women transition into menopause and decide not to be on hormone replacement therapy, their vaginas suffer dramatically," she continues. Menopause and a loss of estrogen can cause vulva-vaginal atrophy, which Ross says, "is detrimental to intimacy, often makes intercourse impossible, and has a harmful effect on emotional and physical health."
Ross recommends taking estrogen and other medications during menopause to help with all physical changes, which will hopefully lessen the emotional burden, too.
Pain During Sex
"Pelvic pain with sex can occur for many reasons," she says, noting again that this is common. "It could be because of dryness, sexually transmitted infections, penis size, or a latex allergy, as well as various sexual positions. But it can also happen because of depression and anxiety."
As with most of her recommendations, Ross advises that those experiencing pain during sex talk to their partners and health care providers.
What to Do Next
Experiencing the above physical aspects that may cause a loss of libido is far from easy, and if you're going through it, Ross repeats the same advice for every struggle: Speak up at the doctor's office and at home.
"Communication with your partner is so important," she adds. "It can be difficult to talk about sensitive sexual issues, but it can interfere with normal intimacy if you don't. The more your partner is informed about why you are experiencing a low libido, the easier it will be for them to be supportive and helpful in finding treatment options leading to a healthy sex life. The most healthy and natural method to improve a woman's sex drive is having a close connection, emotionally, mentally and physically, with a partner. Having good communication with your partner is the best foreplay a woman could ask for."
In your doctor's office, ask for guidance, which Ross says is unfortunately rare. You could also seek out psychotherapy treatments, which can help partners navigate the issue, too. "Women simply want the same attention in sexual health and responsiveness from the medical community as men have had," she says. "With that in mind, the FDA is finally showing support for the challenges faced in female sexual health. Whether you choose a medical alternative, a little self-love in the afternoon, or a romantic weekend without electronics or distractions, the choice should be yours."