What should you know about really low sex drive?

There is no single level of desire that is normal for everyone. A change matters when it is persistent, distressing, affects a relationship, or feels different from your usual pattern. Desire can also change with life stage, sleep, stress and physical comfort.

Possible contributors include vaginal dryness or pain, fatigue, anxiety, depression, changes in body image, difficult experiences, relationship tension and demanding caregiving or work. Some medicines, including certain antidepressants and hormonal medicines, can affect desire. Medical conditions that alter energy, hormones or comfort may also play a part.

During the transition around menopause, changing oestrogen levels may contribute to dryness, irritation or pain, which can make sexual activity less appealing. Learn more about [Perimenopause](/conditions/perimenopause/), [Menopause](/conditions/menopause/) and [Genitourinary Syndrome of Menopause](/conditions/genitourinary-syndrome-of-menopause/). Low desire itself is not a diagnosis, and a clinician may need to consider several contributors together.

Notice when the change began and whether it followed a new medicine, illness, pregnancy, childbirth, menopause symptoms, pain or a period of stress. Record sleep, mood, menstrual or menopausal changes, discomfort and any medicines or supplements. This gives your clinician useful context.

If sex is painful, pause activities that hurt and discuss the pain rather than trying to push through it. Treatment may focus on dryness, an underlying condition, mood, medication effects or relationship concerns. Do not start hormones or supplements for libido without medical advice. In selected situations, a clinician may discuss [Testosterone Therapy for Women](/treatments/menopause-and-hormone-therapy/testosterone-therapy-for-women/).

Arrange a medical appointment if low desire is persistent, upsetting, follows a medicine change, or occurs with pain, vaginal dryness, bleeding after sex, unusual discharge, pelvic symptoms, marked tiredness or mood changes. A clinician can review your health, medicines and symptoms and decide whether an examination or tests are appropriate.

Seek prompt support for sudden severe pelvic pain, heavy unexpected bleeding, or thoughts of harming yourself. If sex is unwanted, pressured or unsafe, confidential support from a healthcare professional or local support service is appropriate regardless of your level of desire.

You could ask: Could a medicine or health condition be affecting my desire? Could dryness or pain be contributing? Which symptoms should I track? What treatment options fit my health history? Should we review my mood, sleep or hormone-related symptoms?