Why Has My Libido Changed?
Updated: Oct 14
Understanding the Causes of Low Sex Drive - Libido
Sexual wellbeing is part of overall health, and it's worth talking about.
Too tired, too stressed, or simply not interested in sex like you used to be?
It's something many people experience but don't always feel comfortable talking about. Perhaps you've noticed that intimacy has become less of a priority, your desire has changed, or sex isn't as enjoyable as it once was. You might put it down to getting older, hormonal changes or simply having too much on your plate. But libido, or sex drive, is more complex than that.
Our sexual desire is influenced by hormones, physical health, sleep, stress, medications, relationships and emotional wellbeing. There is no single level of libido that's considered normal for everyone, and desire can naturally fluctuate throughout life. When changes are persistent or causing concern, it's worth exploring what might be contributing.
Exhaustion and Fatigue: When There's Nothing Left in the Tank
Think about your typical day. Work, family responsibilities, household demands and everything else competing for your attention.
By the time evening arrives, you might barely have enough energy to stay awake, let alone feel interested in intimacy.
Poor sleep, persistent fatigue and conditions such as sleep apnoea can affect mood, energy and sexual function.
Sometimes improving sleep quality and addressing the reasons behind ongoing exhaustion can make a meaningful difference to overall wellbeing.
Stress, Cortisol and Sexual Desire
Ever noticed that when life becomes particularly stressful, your interest in sex seems to disappear?
Stress activates the body's fight-or-flight response, involving the nervous system and hormones such as cortisol.
While cortisol is essential for normal physiological function, prolonged stress can influence sleep, mood, energy and sexual interest.
It's important to understand that low libido doesn't automatically mean cortisol is too high. The relationship between stress hormones and sexual desire is complex.
Sometimes it's less about hormone levels and more about having the mental and emotional space to relax and connect with someone.
Vaginal Dryness and Painful Intercourse: It's Not Just Menopause
Vaginal dryness is one of those health concerns that many people experience but may feel uncomfortable discussing, even with their healthcare professional.
While it's commonly associated with perimenopause and menopause, vaginal dryness can occur at any age, including during the reproductive years.
Oestrogen plays an important role in maintaining the thickness, elasticity and natural lubrication of vaginal tissues. When oestrogen levels decline, these tissues can become thinner, more fragile and less well lubricated.
During menopause, these changes may form part of a condition known as genitourinary syndrome of menopause (GSM), which can affect both vaginal and urinary health.
What Else Can Cause Vaginal Dryness?
Apart from menopause, several factors may contribute:
Hormonal changes: Pregnancy, breastfeeding, surgical removal of the ovaries and certain hormonal contraceptives.
Cancer treatments: Chemotherapy, pelvic radiation and anti-oestrogen medications such as tamoxifen.
Medications: Certain antidepressants and antihistamines used for allergies or colds.
Medical conditions: Autoimmune conditions such as Sjögren's syndrome, along with diabetes and some other chronic health conditions.
Lifestyle and irritants: Smoking, vaginal douching, scented soaps and irritating personal hygiene products.
Sexual arousal: Insufficient arousal or stimulation may reduce lubrication during intimacy.
What Are the Symptoms?
Vaginal dryness isn't always just a feeling of dryness. Symptoms may include:
Reduced natural lubrication, including during arousal
Pain, discomfort or occasional bleeding during intercourse
Vaginal or vulval itching, burning and irritation
Urinary urgency or increased frequency
Recurrent urinary tract infections, particularly after menopause
And something worth remembering: you don't need to be sexually active to experience vaginal dryness or discomfort.
For some people, painful intercourse can lead to reduced sexual desire. What initially appears to be low libido may actually be a response to discomfort or concern about intimacy.
Vaginal dryness can also have several causes, so it's important not to assume every symptom is related to low oestrogen.
The good news is that help is available. These symptoms are common, but that doesn't mean you simply have to live with them.
If you're experiencing persistent dryness, discomfort, urinary symptoms or painful intercourse, speak with your naturopath and doctor for assessment and advice. Bleeding after menopause, unexplained bleeding after intercourse or suspected urinary infections should always be medically assessed.
Testosterone, Ageing and Men's Sexual Health
Testosterone plays an important role in sexual desire, muscle maintenance, mood and reproductive function.
Although testosterone levels generally decline gradually with age in men, this doesn't automatically mean libido will decrease or that testosterone replacement is needed.
Clinically low testosterone may contribute to:
Reduced sexual desire
Fewer spontaneous or morning erections
Fatigue and reduced energy
Changes in mood or motivation
Reduced muscle mass and strength
However, these symptoms aren't exclusive to testosterone deficiency. Poor sleep, obesity, chronic stress, medications, depression and other health conditions may produce similar symptoms.
Low testosterone shouldn't be assumed from symptoms alone. Diagnosis requires a clinical assessment and appropriately performed blood tests, usually including repeat morning testosterone measurements.
Testosterone also contributes to sexual function in women, although blood testosterone levels alone cannot diagnose low sexual desire.
The important thing is to look at the whole picture rather than focusing on one hormone result.
Erectile Difficulties: It's Not Always About Testosterone
Erectile dysfunction (ED) refers to persistent difficulty achieving or maintaining an erection sufficient for sexual activity.
It's a common concern, particularly with increasing age, but it's not something that should automatically be dismissed as a normal part of getting older.
An erection depends on healthy blood flow, nerve signalling, hormonal function and psychological wellbeing.
Factors that may contribute include:
Cardiovascular health: High blood pressure, elevated cholesterol and vascular disease can affect circulation.
Diabetes: Changes to blood vessels and nerves may interfere with erectile function.
Medications: Certain blood pressure medications, antidepressants and other prescribed medicines may contribute.
Stress and performance anxiety: Worrying about sexual performance can create a cycle of anxiety and erectile difficulties.
Lifestyle factors: Smoking, excessive alcohol consumption, physical inactivity and inadequate sleep can affect sexual health.
An important point is that erectile dysfunction and low libido are not the same thing. Someone may have a healthy sex drive but experience difficulty achieving or maintaining an erection.
Erectile dysfunction can sometimes be an early indicator of cardiovascular disease, making appropriate medical assessment particularly important.
If erectile difficulties are persistent or recurring, speak with your doctor and naturopath to explore possible underlying causes.
Medications: Could They Be Affecting Your Sex Drive?
Certain medications, including antidepressants, hormonal contraceptives, opioid pain medicines and some blood pressure medications, can affect libido, arousal and sexual function.
For men, some blood pressure medications, particularly certain beta-blockers and diuretics, may contribute to erectile difficulties. However, high blood pressure itself can also affect blood flow and erectile function. In women, certain antidepressants and hormonal contraceptives may reduce sexual desire or vaginal lubrication.
If you've noticed changes in your libido or sexual function since starting a medication, it's worth discussing this with your doctor or prescribing healthcare professional. Not everyone experiences these side effects, and there may be alternative options available.
Importantly, never stop taking prescribed medication because you suspect it's affecting your libido or sexual function. Always speak with your doctor or prescribing healthcare professional. There may be alternative medications or other appropriate options worth discussing and collaborating with a naturopath.
Alcohol: Relaxing at First, But What Happens Later?
Alcohol may initially reduce inhibitions and make someone feel more relaxed.
However, higher alcohol consumption can interfere with arousal, erections, vaginal lubrication and orgasm.
Regular heavy drinking may also disrupt sleep, contribute to fatigue and affect reproductive hormones.
If alcohol has become part of your nightly routine, it's worth considering whether it may be influencing your sleep and sexual wellbeing.
Nutritional Factors
Iron deficiency and anaemia may contribute to fatigue, while inadequate nutrition or restrictive dieting can affect energy availability.
Rather than assuming a particular supplement or hormone is the answer, it's important to understand whether an underlying health condition or nutritional deficiency is contributing.
Relationships, Emotional Connection and Body Confidence
Not every change in libido has a physical explanation.
Relationship satisfaction, communication, emotional intimacy, body image and previous sexual experiences can all influence desire.
It's also worth remembering that sexual desire doesn't always happen spontaneously.
For some people, particularly in long-term relationships, desire develops through affection, closeness and intimacy. This is sometimes called responsive desire, and it's a normal variation in how sexual interest develops.
What Can You Do to Support Your Sexual Wellbeing?
There isn't one solution that works for everyone, but some practical starting points include:
Prioritising restorative sleep and addressing persistent fatigue
Finding manageable ways to reduce ongoing stress
Including regular exercise and adequate nutrition
Reviewing alcohol consumption
Discussing possible medication side effects with your healthcare professional
Seeking professional assessment for vaginal dryness, painful intercourse or erectile difficulties
Making time for communication, connection and intimacy
Disclaimer: This article provides general educational information and does not replace individual medical advice, diagnosis or treatment. Persistent or distressing changes in sexual desire, painful intercourse, urinary symptoms or erectile difficulties should be discussed with an appropriately qualified healthcare professional. Do not stop or change prescribed medications without medical advice.
About the Author
Margaret Leedham is an experienced naturopath, herbalist and nutritionist with over 27 years in the natural medicine industry. She is an Accredited Member and Fellow of the Australian Traditional Medicine Society (ATMS). Margaret has a special interest in perimenopause, menopause, sleep, healthy ageing and personalised, evidence-informed naturopathic care.
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