What To Do. . . When You Just Don’t Want To.

My partner wants to, but I just . . . Don't. 

I think there's something wrong with my hormones.

Isn't there a female Viagra?

These are all pretty common concerns of female patients on almost a daily basis. Lack of a “sex drive” or “motivation” to spontaneously have sex can affect relationships, marriages, dating, and mental health. So let’s talk about it. 

"Libido" and "sex drive" are terms we throw around loosely without much thought behind their actual meaning. Many women and men suppose they are abnormal with their lack of desire, and struggle to bring this concern to their healthcare provider. We still often view "sex drive" as something you innately have, can flip like a switch, and something possibly shameful too. One note before you read further, I highly recommend you read "Come As You Are," by Emily Nogaski. It's incredibly helpful at breaking down anatomy, physiology, and common misconceptions/myths.

If you bring this concern to your provider, what might they say?

- They may tell you testing hormones isn't helpful if we are not testing for menopause or infertility. Which is true, since there is not a special hormone to measure sex drive exactly. Hormonal testing can be done, but we should know WHY we are doing it first.

- They may discuss your birth control method, as some have been found to cause mood changes and vaginal dryness. Many other medications can decrease libido, so it is important to discuss EVERYTHING you are taking with your healthcare provider.

- They may suggest a few labs depending on your medical history and most recent blood work. They may investigate thyroid levels, lipid panels, or other hormones you haven’t heard much about in the past.

- But if everything is perfect. . . Then what?

Stress.  Work, life, family, all of it. Stress will bring your libido to negative zero. From an evolutionary standpoint, if you are solely focused on survival to get through the day, it is difficult to also focus on procreation. Men in the military often report how they almost NEVER get an erection while conducting field operations. Because of stress, lack of sleep, etc. When women are under intense stress we can completely miss a menstrual cycle. So if stress is interfering with your sex life, it might just be a season, but it probably also requires attention. 

Relationship. How is your relationship? I will never forget in grad school, another student was doing a workup on a woman for decreased libido. They went through detailed medical history, exams, testing, and everything was normal. They finally asked, "Do you like your husband?” She point blank said, "No." It's difficult to be sexual and vulnerable with someone you are struggling to see as a decent partner/human. That doesn’t mean you should end your relationship, but it means it might need some work, and a professional might need to be involved.

Your relationship with yourself. We go through a LOT of changes in life and our bodies change too. Women will often tell me that they just can’t relax, try to keep some clothes on during sex, or have to make sure that all the lights are off, but why? Likely your partner is just excited to touch you, and they do not care about an extra curve here or there. But if you are struggling to see yourself as someone who can be sexual, or someone who is worthy of loving sexual touch, then it may be time to talk to someone. 

If everything is normal on exam, labs, and your relationship has its normal ups and downs, then let's talk about reality.

It is not sexy. It is not cute. But when you get out of the swing of things, and have no idea how to get back to "normal," it's time to do some un-sexy stuff. That means putting sex on the schedule. Yup. Put it on your phone, on paper, or anywhere else. But this is on the schedule as an agreed upon event that cannot be rescheduled unless there is an emergency. (Binging Netflix, cleaning your house, or folding laundry is not an Emergency).

Next, find a compromise on the frequency. If your partner could have sex a few times a week, but you could go months in between, maybe you settle on once per week. I encourage patients to schedule this on a day that has the opportunity for your partner to show up in other ways that make you appreciate them: trash day, a day they could take over drop off or pick up of kids, or they could cook a meal, literally anything that makes you remember that "hey, I really do like this person".

This also gives you ALL DAY to get mentally and physically prepared. It gives you time to think about all of the good things that made you fall in love in the first place. It gives you time to get excited, or nervous and calm yourself down again.   You need time and you need context.

You may be pleasantly surprised with your progress over time, or just come to a place that you are content and so is your partner. But if you find yourself constantly canceling, ending the evening upset or frustrated, then it may be time to consider talking to a professional, revisiting your healthcare provider, or going to couples therapy. I hope this has been helpful to someone, and please reach out if you have questions, or would like me to do a deep dive on a similar or different subject.  There are many aspects of your sexual life that I do promise to cover soon, so stay tuned.