Decreased sexual desire, known as loss of libido, is a common problem — according to the NHS (National Health Service, the United Kingdom’s public health system), the problem affects up to 1 in 5 men and an even greater number greatest number of women at some point in their lives.
The condition is multifactorial and does not always mean something serious — it can be related to factors such as professional or personal stress, as well as specific phases of life, such as pregnancy, childbirth or breastfeeding.
However, when an unexpected and persistent loss of libido occurs, it is worth investigating the reasons that may be behind it.
“The first step is to differentiate what loss of libido really is”, explains psychiatrist Catarina de Moraes, coordinator of the sexuality outpatient clinic at Hospital das Clínicas in Recife and secretary of the Brazilian Association of Sexual Medicine.
“Sometimes, lack of libido is confused with difficulty with erection, sexual performance or satisfaction — but it is exclusively the absence of sexual desire.”
According to endocrinologist Diego Fonseca, the diagnostic criteria describe that the symptom must persist for at least six months to be considered clinically relevant.
“However, in clinical practice, the assessment may be less rigorous, and it is important to consider the individual situation of each patient,” says he, who currently works at the Mariska Ribeiro Women’s Hospital.
With the help of experts, we have listed below some factors that may be behind changes in sexual desire.
Changes in routine and phases of life
A reduction in libido can happen for simple reasons that everyone experiences at some point, such as stress, tiredness, changes in routine and periods in which other activities take up the time that would normally be dedicated to sexual activity – such as caring for children, for example.
“This does not necessarily mean a disorder. It is also common that over time in monogamous relationships there is a reduction in spontaneous desire (regardless of sexual contact), although responsive desire (excitement that arises with stimuli) is still present. As long as there is satisfaction sexual, this reduction is not necessarily pathological”, says Catarina de Moraes.
Psychiatric disorders such as depression and anxiety can significantly affect sexual desire.
“Patients with depression may experience a decrease in desire due to chemical imbalances in the brain, including changes in the hormones serotonin and dopamine, linked to mood and feelings of reward and pleasure. In these cases, treating the condition can improve desire, and consequently, sexual function”, explains the psychiatrist.
On the other hand, some classes of medications used to treat depression and anxiety have the side effect of reducing libido.
However, there are treatment options and strategies — which should always be recommended by a healthcare professional — to minimize these effects, such as changing the medication, reducing the dose, or focusing on behavioral exercises.
The expert warns that patients should not abandon depression treatment if they notice the symptom, as untreated depression can also impair sexual function — and withdrawing psychiatric medications abruptly carries important risks.
“It is critical that patients openly communicate any concerns related to their sexual function to their doctors.”
If the patient does not present psychiatric disorders or routine changes that justify the drop in libido, the next step is to investigate hormonal changes.
Estrogen in women and testosterone in men are the main regulators of libido and sexual activity, explains Caroline Castro, endocrinologist at Hospital São Camilo.
Estrogen is associated with the health of genital tissues, vaginal lubrication, and emotional well-being. Testosterone is linked to sperm production, the health of genital tissues and sexual desire. It affects mental disposition, increasing interest and motivation for sex.
Diagnosis in these cases can be challenging, says Diego Fonseca.
“In men, for example, we not only assess whether the testosterone level is low, but also examine the clinical history to check whether other underlying conditions may be behind the hormonal change.”
Doctors also point to conditions such as pregnancy, postpartum, breastfeeding and obesity — as well as others that also change hormone levels, as possible causes.
“For these patients, the approach may or may not be with medication and include advice and guidance on natural changes in the body. The assessment must be careful and individualized, considering the context of the person’s life and health”, says endocrinologist Caroline Castro .
The third most common factor cited by doctors is the presence of comorbidities that — directly or indirectly — affect libido. Some examples are:
- Neurological conditions such as multiple sclerosis, Parkinson’s disease, spinal cord injuries, or peripheral neuropathy can also impair the function of the nerves that control sexual response, resulting in difficulties achieving or maintaining an erection, achieving orgasm, or experiencing sexual arousal.
- Diabetes, by causing hormonal changes, can also result in decreased desire. In addition, the condition causes fatigue and neuropathy, a condition in which nerves are damaged. This can lead to loss of sensitivity and compromised sexual function, indirectly affecting libido.
- People with heart problems, such as heart failure, may experience chronic fatigue due to the heart’s reduced ability to pump blood effectively. This constant fatigue can decrease sexual desire. Additionally, some medications used to treat heart disease may have side effects that affect sexual interest.
Treatment and communication
The doctors interviewed for the report emphasize that there is no single or magical solution to a drop in libido. As each case is unique and treatment depends on a personalized approach, considering the underlying causes and individual needs of the patient.
A common piece of advice given by experts is, in the case of couples, to talk to the partner regardless of the cause of the drop in libido.
“It is essential to have an open and sincere dialogue about this issue, despite it being a subject that can cause discomfort. Talking about decreased libido helps to avoid misunderstandings and allows both partners to understand the situation and seek solutions together”, says Diego Fonseca.