When a patient says, “I’ve lost my desire for sex,” there is almost always more than one underlying cause. But the approach is clear: first, rule out physical causes; then, address the psychological factors.

Why does the order matter? Psychotherapy cannot relieve pain caused by endometriosis. A sex therapist cannot restore estrogen levels. And hormones cannot resolve the effects of birth trauma or chronic stress.

What can contribute to low libido?

Hormonal changes

Low estrogen levels can cause vaginal dryness, thinning of vaginal tissue, and pain during sex. Low testosterone may reduce sexual interest and sensitivity. Elevated prolactin can suppress sexual desire through its effects on the hypothalamus. Thyroid disorders, including both hypothyroidism and hyperthyroidism, are also directly associated with sexual dysfunction.

The postpartum period brings additional challenges. Estrogen and progesterone levels drop sharply after childbirth. Breastfeeding-related amenorrhea is associated with naturally low estrogen levels. Perineal injuries, scar tissue, diastasis recti, pelvic organ prolapse, and changes in nerve function or blood flow can also affect comfort and desire.

Inflammation and vaginal microbiome imbalances

Chronic infections, recurrent yeast infections, bacterial vaginosis, and sexually transmitted infections can all play a role. Even inflammation without obvious symptoms may cause the brain to associate sex with pain, making arousal more difficult.

Underlying medical conditions

Diabetes can contribute to nerve and blood vessel damage, as well as vaginal dryness. Autoimmune conditions, such as Sjögren’s syndrome, and neurological disorders may also affect sexual function.

Medications

Certain medications can reduce sexual desire and vaginal lubrication, including SSRI antidepressants, antihistamines, blood pressure medications, and hormonal contraceptives.

Emotional and psychological factors

Chronic stress raises cortisol levels, which can suppress the production of sex hormones. Anxiety, depression, low self-esteem, and fear of pain may also reduce desire. Shame about sexual fantasies, internalized beliefs, and negative sexual experiences can further reinforce these patterns.

Relationship and social factors

Relationship conflict, a lack of emotional intimacy, household responsibilities, and exhaustion can all affect libido. Unrealistic expectations, social media pressure, and myths about how often people “should” have sex may add further strain.

What to do next

Start with a gynecologist. An evaluation may include a physical examination, an ultrasound, and hormone testing, along with screening for infections and anatomical changes.

Once physical factors have been assessed and addressed, a sex therapist or psychotherapist can help explore any remaining emotional, psychological, or relationship-related concerns.

2026 © Elena Konovalova