Sexual Health Pt III: Libido

Libido—also called sex drive or sexual desire—varies widely between individuals and even within the same person over the course of life. What’s “normal” for one person may feel abnormal for another, and fluctuations are natural.

In medical literature, sexual desire is primarily discussed as a psychological phenomenon rather than purely a physiological one.. Broadly, sexual function can be broken down into three overlapping components:

• Desire – interest or motivation for sexual activity

• Arousal – physiological readiness (e.g., erections in men, vulvovaginal lubrication in women)

• Orgasm – the climax of sexual activity

  
  

It only becomes a “problem” when changes in any of these areas cause distress. Interestingly, while low sexual desire becomes more common with age, distress about it tends to decrease over time.

Multiple factors influence libido, including hormonal health, mental health, relationship quality, physical health, and medication use.

1. Hormonal Health

Hormones play a central role in regulating sexual desire:

• Estrogen: Falling estrogen levels—especially during menopause—can cause vaginal dryness and atrophy, leading to painful intercourse and reduced desire.
  

• Testosterone: In both men and women, low testosterone levels can decrease libido. Supplementation can sometimes improve sexual desire when levels are deficient.
  

• Prolactin: Elevated prolactin suppresses libido. This often occurs naturally during breastfeeding but can also result from pituitary adenomas, certain medications, or B-vitamin deficiencies.
  

• Cortisol: Chronic stress raises cortisol, which can reduce testosterone production and affect brain pathways involved in sexual desire.
  

• Thyroid Disorders: Both hypothyroidism and hyperthyroidism can affect libido and should be evaluated as part of a workup.

2. Mental Health & Substance Use

Your emotional state, habits around alcohol, and/or substances strongly influence libido:

• Mood disorders such as depression and anxiety often reduce sexual interest.
  

• Substance use, including heavy alcohol intake, opioids, and certain sedatives, can further suppress desire.
  

• In some cases, treating the underlying mood disorder or adjusting substance use can restore sexual function.

3. Relationship Quality

For many, libido isn’t just about biology—it’s deeply tied to emotional connection:

• High-quality relationships characterized by trust, communication, and emotional intimacy are consistently linked to higher sexual satisfaction.
  

• Research shows that partner appreciation and overall relationship quality predict sexual function in women even more than body image does.
  

• Conversely, unresolved conflict, resentment, or lack of communication often erode desire.

4. Medications & Medical Causes

Prescription drug use has steadily increased over the past two decades, with nearly 60% of Americans taking medications as of 2012 (Kantor et al., JAMA). Many of these can affect libido:

• Antidepressants (especially SSRIs)

• Blood pressure medications

• Hormonal therapies and certain antihistamines
  

If medication side effects are suspected, discuss alternatives or dose adjustments with your healthcare provider.

There are a multitude of medical procedures that can impact sexual function and subsequently libido. Some treatments (prostatectomy and mastectomy) can directly impact sexual function. Most academic medical centers have care teams that consider secondary effects from interventions. If you have an intervention and have sexual side effects bring it up with your health care provider.

5. Treatment Approaches

Because low libido can have multiple causes, effective treatment often requires a personalized approach:

Medical & Hormonal Treatments

• Workup may include hormone panels, thyroid testing, medication review, and nutritional assessment.

• In some cases, short- or long-term medications can improve symptoms or treat underlying issues.
  

Psychological & Relationship Support

• Open communication with your partner can reduce performance anxiety and improve intimacy.

• Therapy—either individual or couples—can be beneficial, especially when emotional disconnect or unresolved trauma are factors.
  

Physical Interventions

• For women: vaginal moisturizers, lubricants, or localized estrogen therapy can reduce discomfort.

• For men: addressing erectile dysfunction or Peyronie’s disease can remove psychological barriers to desire.

The primary thing to remember is that things that support general health tend to support libido. Effective communication with your partner. A supportive relationship. Maintaining physical fitness. Good sleep quality. Having fun with your partner. Go on dates. Play and work on not taking yourself too seriously. If sex is important to you and your partner and things aren't functioning like they used to, bring it up at appointments. It's common for patients to get shy talking about these topics and it can be challenging bringing this up with your healthcare provider, but they hopefully have resources that can help with this if it becomes an issue.

Key Takeaways

• Libido is complex and multi-factorial—it’s shaped by hormones, mental health, relationships, and lifestyle.

• Stress, mood disorders, and certain medications commonly suppress sexual desire.

• Open communication with both your partner and healthcare provider is critical for understanding causes and exploring solutions.

References

Kantor, E. D., PhD, MPH, et al. (2015). Trends in Prescription Drug Use Among Adults in the United States From 1999–2012. JAMA, November 2, 2015.