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Dr. Gaudet: Overcoming Low Libido

Body+Soul, June 2006


Sexuality and sensuality are as fundamental to our health as good nutrition and exercise. So I make it a point to ask all my patients, whether they're single or in a relationship, 20 years old or 60, about their libido. More often than not, patients say theirs is low, sometimes asking jokingly, "What libido?" And they're in good company; in a landmark study of more than 1,000 American women, more than a third reported a lack of interest in sex. Most women who have low libido wonder whether there's a hormonal problem -- and hopefully a hormonal cure. But libido is more complex than that.

Strictly speaking, libido refers to sexual desire, thoughts, and fantasies. But as I tell my patients, there's no such thing as a "normal" libido. It's not that you should be thinking about sex 17.5 times a day, or having it daily. Libido is inherently dynamic, and there's a wide range of normal. But when we're in an optimally healthy state, we're aware of our bodies, and we feel drawn to connect with other bodies. If you've lost these feelings, it's worth exploring the reasons.

Most women know what a healthy libido feels like. When a patient reports low libido, I ask her to think back to a time when she loved the feeling of being in her body, a time when she felt connected to her very essence and, perhaps, shared this essence with another person. I ask her to remember the sense of vitality that coursed through her.

When a patient of mine named Libby recalled such a time, her whole face brightened. She came alive as she remembered a palpable feeling of connection -- with her own body and soul, and with her partner's. Now a mother of two, Libby had come to my office for her annual exam, and when I asked her what she and her husband were using for birth control, she laughed and said it hardly mattered. "By the time I get home from work, make the kids dinner, make sure they do their homework, and get them in bed, I'm exhausted," she said. "My husband wishes we had sex more often. But I'd much rather sleep -- honestly."

What woman can't sympathize with that situation? In reality, there are quite a few external challenges to libido, and recognizing them is crucial. The first year or two after the birth of a baby, for instance, when both parents are often overwhelmed and sleepdeprived, is a notorious libido killer. Career-focused years can leave women depleted and stressed, with all of their passion going into their jobs. Then in midlife, there are other issues. Ann, a 54-year-old patient in menopause, has slowly gained 20 pounds over the last 10 years. "I'm afraid I'm never going to feel attractive again," she says. "My body is changing, and I don't think about sex anymore."

Hormones can certainly play a role in libido. Postpartum and menopause (along with the removal of ovaries, chemotherapy, and the use of the pill) can cause a woman's testosterone levels to drop. When levels drop suddenly, libido tends to follow suit. Estrogen levels, which wax and wane throughout the month and fall during menopause, aren't believed to influence sexual desire directly. But since estrogen plays a role in arousal, it can affect libido; if you're having difficulty getting aroused, your desire for sex may understandably lessen.

Still, women are often surprised to hear that hormonal shifts are rarely the root cause of low libido. Most often, there's an underlying problem -- sudden or prolonged stress, for example, can cause desire to plummet, as can depression or certain medications. Shifting hormones can play a role in unmasking any of these issues.

Though less quantifiable, the most common problem I see involves intimacy. Specifically, a lack thereof. As women, our body's desires are most often an expression of our deeper selves. Most likely, when your soul is feeling seen, attended to, and valued, your body desires connection -- and when your soul is not feeling those things, your body withdraws.

Whether you're in a relationship or single, intimacy starts with yourself. Women often have a strong libido when they're feeling especially connected to their bodies (maybe because they're eating well and moving a lot) or to their souls (for instance, when work is fulfilling, or their family life brings them joy). When you're intimate with yourself, you're in touch with your inner strength and beauty. When you're not intimate with yourself, you may feel lackluster, because beneath the surface, there's no connection.

Part of becoming "consciously female" is understanding and honoring what moves beneath your surface. This is especially true for libido. Every part of yourself -- emotional, intellectual, physical, spiritual -- is capable of intimately connecting with another. Women are typically at their most sensual and most sexual when there are multiple levels of connection. Seen from this view, our culture's dominant concept of sex, the act being an end in itself, is quite limited. For women, sexuality and desire are bigger, broader, and -- dare I say -- more evolved.

Making time to increase intimacy, with yourself and your partner, is a critical part of libido recovery. One of the challenges faced by heterosexual women, obviously, is that most men are programmed differently. Many men experience sex as intimacy, or feel that emotional intimacy is a result of sex. This dynamic can result in sex that's fulfilling for the man but not for the woman. In a common scenario, a woman has intercourse before her body is aroused, because her partner wants to. The resulting sex is not pleasurable for her; sometimes it's even painful. Thereafter, mentally the woman may want to have sex, but her body remembers the discomfort and is hesitant. Understanding this dynamic, and giving the body time and space to relax and be sensual with no expectation of sex, can help break the cycle. (See Dr. Gaudet's Libido Recovery.)

Even though men may be wired differently, many are every bit as hungry for intimate, multidimensional connection as women. If they can open up and not feel threatened, they will love the effect it has on their relationships. The "honeymoon" period, those first few charged months, doesn't last forever, but at the same time libido and length of years with a partner need not be an inverse relationship. Many couples who expand their intimacy find that their sexual relationship improves. They learn that one partner doesn't have to submit to the other's sex drive. The compromise that comes instead becomes a kind of dance.

Part of the work of reawakening libido is purely sensual: noticing the way the spring air or a silk scarf feels against your skin, reveling in the smell of a partner's skin or hair. The process also involves discovering your body's natural rhythms. You may feel more sexual mid-month, or you may have weeks-long cycles. But the work is also the reward. When you recognize and respect your deepest rhythms, when you feed your body what it loves and don't force it to act "on command," your body will feel acknowledged and respond accordingly. Your libido will take care of itself.

Text by Dr. Tracy Gaudet

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