What can cause a low sex drive in my wife?

Sexual desire naturally changes across life and relationships. It may fall when sex is uncomfortable, when vaginal dryness or irritation develops, or when fatigue, anxiety, depression, conflict, grief, or caregiving demands leave little energy for intimacy. Some medicines and health conditions can also affect desire. The key question is whether the change is unwanted or distressing to her, rather than whether it matches someone else’s expectation.

Perimenopause and menopause can bring hormone changes, sleep disruption, and genital symptoms. Genitourinary syndrome of menopause may cause dryness, burning, urinary symptoms, or pain with sex, all of which can reduce interest. Low desire does not by itself prove a relationship problem or a hormone deficiency.

Raise the subject gently outside an intimate moment. Use language such as, ‘How are you feeling about intimacy?’ and listen without pressure, blame, or demands. Ask what would make affection feel comfortable, and respect a no. Closeness can include conversation, touch, or shared time without an expectation of sex.

If she wants help, encourage an appointment with a clinician to discuss pain, dryness, mood, sleep, medicines, contraception, and menopause symptoms. A clinician can consider local treatments or other options when appropriate. Testosterone therapy for women is a specialist discussion and is not suitable for everyone.

Arrange medical care for persistent pain with sex, bleeding after sex, sores, unusual discharge, urinary symptoms, or sudden distressing change in desire. Seek urgent help for severe pelvic pain, fever, or suspected injury. If low desire is accompanied by hopelessness, severe anxiety, or thoughts of self-harm, seek immediate mental-health support.

Could dryness, pain, medicines, mood, sleep, or menopause explain this change? What can make intimacy more comfortable? Which treatments fit my symptoms and health history?