What is libido? When people use the word libido, they may mean desire, arousal, sex drive, interest in sex, or the urge for sex. Originally, the word comes from the Latin term libido which means “desire” or “lust.” But with the science of sex advancing rapidly, I’m asking what does “libido” actually mean today, and where does it fit in with everything else we now know about sex?
If you are confused about what “libido” means, you are not alone. Scientists are actively debating this question. A widely used manual of psychologic terms called the Diagnostic and Statistical Manual – V, recently got rid of the word “libido” in its description of sexual function disorders. Instead, disorders of libido are now categorized as “interest” and “arousal” disorders of sexual functioning.
Not only does the current science of sex FAIL to give us an easy definition for libido, but it also hasn’t yet discovered exactly how libido works.
However, current scientific literature does offer information on how a key part of libido, sexual desire, works. Here’s what I think we know about this key part of libido based on my read of the literature:
Sexual desire can be described as spontaneous and responsive (1, 2). The spontaneous side of desire is best described as the drive to become sexually aroused. Someone concerned with spontaneous desire might say that they want to want sex, they want to feel interested or turned on, they want to have sexual thoughts or fantasies, but they don’t. The responsive side of desire has been described as when a person has sexual feelings in response to sexual cues, like a touch (3) from your partner, or even just seeing your partner become aroused (4). Someone lacking responsive desire might say they want their partner’s touch to feel “erotic” or “sexy,” or they want to feel “turned on” when their partner gets turned on, but touch feels like “nothing” or they feel “numb” or even “turned off.”
Where did my libido go?
At the University of Chicago Program in Integrative Sexual Medicine, we have been caring for patients who have sexual function concerns. When we see people with low, decreased, or loss of libido, they say things like:
“I couldn’t care less about [sex]. I just do it for my partner.”
“I feel dead inside.”
“I have lost all interest in having sex. I have none.”
“I no longer feel sexual.”
“I have no sex drive. Even cuddling isn’t a thing for me anymore.”
“I’m numb down there.”
According to a 2018 study of adult women, nearly one in three women report low libido. Half of these women (or 14.5%) reported a low libido problem that bothers them. So if you or your partner have a low libido problem, you are obviously not alone.
It’s important to note that if you feel your libido come and go or ebb and flow, it does not necessarily mean there’s something wrong with your sexual functioning. Your libido can fluctuate for many reasons. It can go up and down with the menstrual cycle. Some menstruating people feel their libido is best around the time they are ovulating, usually 14 days before their next period. Libido can also change with the decrease in estrogen that happens before and during menopause. Most people feel a drop in their libido when they are sick.
There are many reasons why low libido occurs, but only you can determine if changes in your libido are a problem in your life. If your libido is low, but you are not bothered or stressed by it, then it’s not a problem: you do not have sexual dysfunction.
Of course, libido mismatch can be an issue between partners. This situation is a relational problem that can be addressed by talking to your partner about it or with the help of a couples or sex therapist. These therapists will typically see individuals and couples. If you and your partner are not both on board, consider getting help on your own.
What else can contribute to loss of libido?
Certain medicines and common health conditions can cause libido to change. Medicines like antidepressants or chemotherapy agents have been associated with decreased libido. It can be hard to sort out the effect of the medication from the effect of the illness itself, either of which can interfere with hormones (like estrogen or testosterone) or brain neurotransmitters (like dopamine or serotonin) that may be related to libido. Depression and anxiety, which commonly come with symptoms like loss of interest in pleasurable activities, poor sleep, and low energy, can also cause low libido. In a 2017 Australian study (5), nearly three quarters of women with Hypoactive Sexual Desire Disorder (HSDD), meaning low and bothersome sexual desire, also had moderate to severe symptoms of depression. More than half of those women were taking antidepressants. This study does not specifically say that depression or antidepressants cause low libido, but it does suggest a connection between the two.
Pain can also affect libido. The same 2017 study showed that, of women with low libido, 68% also have vaginal dryness and 62% experience pain during or after sexual activity. Many people who visit our clinic say that their libido has suffered ever since they started having painful sex (6), like it “dropped off a cliff.” Our best explanation for this experience is simple: our brain is largely programmed to avoid things that hurt us. We generally don’t desire pain. In our experience, eliminating sexual pain is an important part of regaining libido.
Can I get my libido back?
Here is a list of resources we find helpful when talking to people who experience issues with libido. This list is not an endorsement of any one treatment option—speak to your doctor or other healthcare professional to develop a plan that works for you.
- For low libido when you are also having painful sex:
- Pelvic floor physical therapy: A kind of physical therapy that targets the pelvic floor muscles to treat tightness and pain, improve muscle mobility, strength, and coordination. This approach, which may involve muscle work on your lower abdomen, hips and internally like in your vagina or rectum, can help ease penetration and improve sexual arousal and pleasure.
- Hormone replacement therapy: Not a treatment for libido specifically, but hormone replacement therapy after menopause can help improve vaginal wetness, elasticity (or stretchiness) and sensation in the clitoris. It can also help reduce pain during sex. While estrogen or testosterone-related treatments may directly improve libido in women, the U.S. Food and Drug Administration does not approve use of these hormones specifically to treat low libido problems. Multiple studies (7, 8) suggest that there is no association between estrogen therapy and low libido for cis and trans women, so there is no reason to think that taking hormone replacement therapy should hurt or decrease your libido.
- Lubrication: Lubrication can ease the pain that comes with friction during penetrative sex (like sex with a penis or dildo in the vagina). A wide variety of lubricants can meet your specific needs and eliminate painful penetration. Our bias is that fewer ingredients are better in the lubricant category – try to find products with as few chemicals as possible.
- Medication: Flibanserin (marketed as Addyi in the U.S.) is a prescription medication approved to treat low libido in pre-menopausal women. This medicine needs to be taken daily for benefit (unlike erection medicines which are taken on an as-needed basis) and has some negative side effects. The size of its effect on libido is also small compared to placebo or a sugar pill. Nearly a third of women in the Flibanserin studies who took a placebo pill also experienced some improvement in their libido (a big placebo effect). More information about Flibanserin can be found on the Journal of the American Medical Association Patient Page located here.
- Psychological approaches:
- Sex and couples therapy with a certified therapist offers effective strategies to increase libido.
- Mindfulness: Defined as a state of presence or hyper-awareness of one’s self, mindfulness is used in meditation and during activities like sex to help relieve stress and heighten the senses. In some cases, a mindfulness-based intervention may work to uncover a ‘lost’ libido. Lori Brotto, a Canadian researcher on sex and libido, finds that mindfulness practices can help with a mismatch between a person’s desire for sex and their ability to feel sexually aroused (9). Dr. Brotto calls this situation “arousal nonconcordance.” There are many resources to learn mindfulness, including mindful sex. The following articles introduce the subject:
Does treatment always work?
Low libido is a problem that usually has a solution. Solutions typically come from understanding that libido is a mind and a body function. Only you – not your partner or your doctor – can say if your libido (low or high) is bothering you. If you are bothered by a problem with your libido, see a doctor or other healthcare or mental health professional. It’s not your fault and there is help.
Note: Names of specific products or places to buy products should not be considered endorsements. WomanLab does not have funding or sponsorship from these products or places.
- Rethinking low sexual desire in women. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2002.01002.x
- The Female Sexual Response: A Different Model. https://www.tandfonline.com/doi/pdf/10.1080/009262300278641
- The physiological basis of human sexual arousal: neuroendocrine sexual asymmetry. https://www.ncbi.nlm.nih.gov/pubmed/15811068
- Gender Differences and Similarities in Sexual Desire. https://link.springer.com/article/10.1007%2Fs11930-014-0027-5
- Prevalence and Predictors of Low Sexual Desire, Sexually Related Personal Distress, and Hypoactive Sexual Desire Dysfunction in a Community-Based Sample of Midlife Women. https://www.sciencedirect.com/science/article/pii/S1743609517304186?via%3Dihub
- Psychosocial Correlates of Vaginismus Diagnosis: A Case-Control Study. https://www.ncbi.nlm.nih.gov/pubmed/30044690
- Sexual Desire in Trans Persons: Associations with Sex Reassignment Treatment. https://www.sciencedirect.com/science/article/pii/S174360951530535X
- Hormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons. https://www.sciencedirect.com/science/article/pii/S0193953X16300727?via%3Dihub
- Mindfulness-Based Sex Therapy Improves Genital-Subjective Arousal Concordance in Women With Sexual Desire/Arousal Difficulties. https://www.ncbi.nlm.nih.gov/pubmed/26919839
Edited by Leilani Douglas
Photo by Justin Follis via Unsplash