When a patient says, “I have lost my desire,” there is almost never just one cause. The approach, however, is clear: first, we rule out physical causes; then we address psychological and emotional factors.
Psychotherapy will not eliminate pain caused by endometriosis. A sexologist cannot restore estrogen levels. And hormones will not resolve the effects of birth trauma or chronic stress.
What can cause low libido?
Hormonal changes
Low estrogen levels can cause vaginal dryness, thinning of the vaginal tissues and pain during intimacy. Lower testosterone levels may reduce sexual initiative and sensitivity.
Elevated prolactin levels can suppress sexual desire. Thyroid disorders—both hypothyroidism and hyperthyroidism—can also affect sexual function.
Postpartum changes
After childbirth, estrogen and progesterone levels drop sharply. Breastfeeding-related amenorrhea is associated with naturally lower estrogen levels.
Perineal injuries, scarring, diastasis recti and pelvic floor prolapse can affect comfort during intimacy. Changes in tissue sensitivity, nerve function and blood supply may also contribute to reduced desire.
Inflammation and vaginal microbiome imbalance
Chronic infections, recurrent candidiasis, bacterial vaginosis and sexually transmitted infections can all affect sexual wellbeing.
Even inflammation without obvious symptoms may create an association between intimacy and pain. In response, the brain may begin to suppress arousal.
General health conditions
Diabetes can affect nerve function, blood circulation and vaginal moisture. Autoimmune conditions, such as Sjögren’s syndrome, and neurological disorders may also play a role.
Medication
Some medications can affect libido and vaginal lubrication, including SSRIs, antihistamines, blood pressure medications and hormonal contraceptives.
Do not stop or change prescribed medication without discussing it with your doctor.
Psychological and emotional factors
Chronic stress raises cortisol levels and may affect the production of sex hormones. Anxiety, depression, low self-esteem and fear of pain can all reduce sexual desire.
Internal restrictions, shame around sexual fantasies and negative sexual experiences may also create a persistent inhibition of libido.
Relationship and social context
Conflict, a lack of emotional closeness, household responsibilities and fatigue can all affect desire.
Unrealistic expectations, pressure from social media and myths about the “right” frequency of sex can make the situation more difficult.
What to do
The first step is a consultation with a gynecologist. This may include an examination, ultrasound and, when indicated, assessment of hormonal status.
It is important to rule out infections, pain-related conditions and anatomical changes. Once physical causes have been assessed and treated where necessary, working with a sexologist or psychotherapist can be the next step.
Psychotherapy will not eliminate pain caused by endometriosis. A sexologist cannot restore estrogen levels. And hormones will not resolve the effects of birth trauma or chronic stress.
What can cause low libido?
Hormonal changes
Low estrogen levels can cause vaginal dryness, thinning of the vaginal tissues and pain during intimacy. Lower testosterone levels may reduce sexual initiative and sensitivity.
Elevated prolactin levels can suppress sexual desire. Thyroid disorders—both hypothyroidism and hyperthyroidism—can also affect sexual function.
Postpartum changes
After childbirth, estrogen and progesterone levels drop sharply. Breastfeeding-related amenorrhea is associated with naturally lower estrogen levels.
Perineal injuries, scarring, diastasis recti and pelvic floor prolapse can affect comfort during intimacy. Changes in tissue sensitivity, nerve function and blood supply may also contribute to reduced desire.
Inflammation and vaginal microbiome imbalance
Chronic infections, recurrent candidiasis, bacterial vaginosis and sexually transmitted infections can all affect sexual wellbeing.
Even inflammation without obvious symptoms may create an association between intimacy and pain. In response, the brain may begin to suppress arousal.
General health conditions
Diabetes can affect nerve function, blood circulation and vaginal moisture. Autoimmune conditions, such as Sjögren’s syndrome, and neurological disorders may also play a role.
Medication
Some medications can affect libido and vaginal lubrication, including SSRIs, antihistamines, blood pressure medications and hormonal contraceptives.
Do not stop or change prescribed medication without discussing it with your doctor.
Psychological and emotional factors
Chronic stress raises cortisol levels and may affect the production of sex hormones. Anxiety, depression, low self-esteem and fear of pain can all reduce sexual desire.
Internal restrictions, shame around sexual fantasies and negative sexual experiences may also create a persistent inhibition of libido.
Relationship and social context
Conflict, a lack of emotional closeness, household responsibilities and fatigue can all affect desire.
Unrealistic expectations, pressure from social media and myths about the “right” frequency of sex can make the situation more difficult.
What to do
The first step is a consultation with a gynecologist. This may include an examination, ultrasound and, when indicated, assessment of hormonal status.
It is important to rule out infections, pain-related conditions and anatomical changes. Once physical causes have been assessed and treated where necessary, working with a sexologist or psychotherapist can be the next step.