What causes a low sex drive?

With COVID-19, my sex therapy practice is busy: Sex has undoubtedly taken a hit for most relationships. And if sex was stressful before COVID-19, it likely is only getting more stressful and not less. With the pandemic being more of a long-term problem rather than a short-term crisis, you may be wondering how to get back to enjoying sex again. Perhaps more than ever we are entitled to pleasure— pleasure can bring hope, and with hope, comes survival!

When I am working with clients in sex therapy who are distressed by their low sexual desire, these are some of the questions we explore in sex counselling to better understand what is underlying their historical or current low libido.

Here are some question I ask folks in individual sex counselling or during couples therapy and relationship therapy:

(TW: There are a lot of rapid fire questions below… consider answering each section once a day or once a week or even once a month! Go at your own pace and feel free to skip any sections you don’t want to explore until you are ready)

1. Have you ever wanted to have sex or had a significant interest in sex? Perhaps your asexual, demisexual, grey sexual— it is completely healthy and normal to be someone who does not want to have sex at all or very often or needs really specific conditions to feel sexual desire. It does not mean you were sexually traumatized or hormonally off-balance. It may just be fundamentally how you are and that’s okay!

2. Do I live with a hormonal condition, have had reproductive organs removed, or are on hormone therapy? Anyone who has ever taken anti-depressants, hormonal birth control pills, started to take testosterone or estrogen, had one or both testicles/ovaries removed, or felt their estrogen dip during menopause can tell you that hormones make a difference, absolutely. There may be hormonal options to remedy this biologically (estrogen creams, taking testosterone, or trying a different anti-depressant).

It may also mean that you now experience arousal differently— you’re not wrong or unhealthy, broken, or bad! Maybe you experienced more spontaneous, “out of the blue” physiological arousal and now your sexual desire is more of a slow burn over a longer period of effortful time. That’s okay! Sex isn’t over, it just has new rules for you and that is workable if you want to work it.

3. When I do have sex is it fun? Our culture has some really ridiculous ideas about what makes good sex, or what even counts as sex, or who gets to have sex, or how we should have sex! So, really ask yourself… when you do have sex, do you like it? Is it fun? Does it get you excited or is it exhausting? If you don’t like the sex your having when you do have it, why would you fantasize or think about having it more? It is totally fair to have no interest in boring, annoying, tiring, or sub-par sex. 100% fair.

4. Is sex painful or uncomfortable? I mean in any way: emotionally, psychologically, or physically? What kinds of sex hurt? How does it hurt? Are there certain types of penetrative positions or ways of having digital or oral sex that are physically uncomfortable that tend to happen a lot during sex? Are you having flashbacks to past trauma?

Or do you have an on-going critic in your head making you feel self-conscious and pointing out all the things that are going wrong during sex? Pain does not make for a fun time unless you’re specifically into kink-play that involves the delicious playfulness of pain. And in that case, you’re probably not reading this article if all is going well…

5. Do you feel pressured to sex? There are lots of ways our culture and our partners can makes us feel pressured to have sex without being intentionally sexually coercive. That said, if you are uncertain of whether or not you are in an abusive relationship or situation, here is a power and control wheel you can reference regarding abuse. Here is a number of relationship resources from LoveIsRespect.org, and here is an Ontario-based organisation called the Assaulted Women’s Helpline dedicated to assisting women out of abusive situations, or the national peer-support Trans Lifeline if you need to talk: 877-330-6366.

If you are certain you are not in an abusive relationship or aren’t in a relationship at all but still feeling sexually pressured, investigate what might be causing that. Is it the idea that healthy relationships should have lots of sex in them (which is not necessarily true at all)? Is it the idea that you’re a prude if you don’t masturbate? Do you worry your sexual identity is called into question if you are not having a certain kind of sex? Is your partner asking you if you want to have sex and you feel guilty for always turning them down?

Pressure is the fastest route to low sexual desire. Try taking the lead on initiating sex when you want to have sex and ask your partner to wait for you to come to them for the next month (experiment! see what happens). Challenge assumptions about what makes healthy relationships and consider other ways of affirming your sexual identity or changing it if your fluidity is on the move! This is not an exhaustive list of ideas, just some things to consider/try.

6. How do your partners try to entice you? Does your partner make eyes at you and jump into the deep end? Sometimes partners are a little quick to get things going. Some folks just need more sexual warm-up and that may mean taking 15-20min to make-out on the couch for a while or flirting in the morning to get the fantasies going before getting down to the sex at night.

7. How do you entice yourself? If you’re not thinking about sex, reading about, watching it, or have given yourself permission to fantasize about whatever or whomever you want… it makes sense you don’t want to have sex! Consider times when you have been really turned on. Where were you? What were you thinking about? How did you feel in your body? …Are you turned on yet?

8. What makes your low interest in sex a “problem”? Do you mind? Does your partner mind? Do you both mind? Again, there are all kinds of messaging that may lead us to believe we should care about something we ultimately don’t care about. It may be that something else in your life is a priority or it may be that you are asexual. Whatever the reason, it is okay to not care about not wanting to have more sex! If it’s causing tension in your relationship you can talk about that but you don’t need to pretend you’re interested, either.

9. How much sleep and restoration do you get? Not getting enough sleep or rest will not only leave you feeling exhausted and physically too wiped to get into some hot sex but it can also impact your hormones (as discussed above). No one knows this better than postpartum relationships who are going through round the clock feedings and getting less than 2 hours (if that) of nap time in-between. Or folks who manage chronic pain regularly and are wiped from having to navigate their own needs, relationship needs, money needs, body needs, and the like. In order to even want to want sex again, you may need to find ways to restore your batteries first… literally or figuratively. Or lower expectations for how grand of a show sex needs to be.

10. Are you feeling weird in your body? There is no question that women, femme, and trans folks experience an incredible degree of body policing by our body-negative culture. It’s a tale as old as time… or capitalism— it’s profitable to create unobtainable beauty standards. It’s powerful to create elite in-groups that can only be obtained through special patriarchal membership approval based on what men decide is sexy. It is an on-going and exhausting process to push back against this very real and very violent body-controlling. Seeking out or creating body images that nourish your soul can be life saving, body-saving, and sexy as hell. Recognizing when you’re having a day you’re just not going to win is also very okay. Remember: you did not put that bullshit there. It is not your fault if you struggle to love your body. Any amount of love and attention you can give it counts and is impactful!

Trauma can also continue to live in the body so having an embodied sexual experience may actually be understandably very frightening. Becoming reacquainted with the body may take some gentle, slow, rituals. Whats one part of your body you feel okay about being aware of? How can you nurture this part of your body? For example, if you like feeling your hands can you lather them in moisturizer and really mindfully attend to the feeling of your hand on your own hand? Slowing exploring different parts of your body in this very gentle, curious, and at-your-own-pace way is one way to re-connection and self-love. Somatic sex therapy is another fantastic way! Whenever YOU are ready.

These are just some of the ideas and questions to explore. And remember: there are no wrong answers! Whatever your reason for not wanting to have sex right now is 100% valid, reasonable, and understandable. You do not owe ANYONE sex (including your partner). Sex with you is a privilege! And you have every right to have sex on your terms with yourself and with consenting others.