Two people are holding hands.
Women: Take control of your libido by asking the right questions of yourself, your partner and your physician. (For Spectrum Health Beat)

Imagine curling up in front of a cozy fire with your husband while the temperatures drop below freezing outside.

Does that thought make you happy, or does it make you worry he might want to have sex?

If the thought of having sex with your partner makes you feel uncomfortable or it just doesn’t sound exciting at all, you’re not alone. When your libido is gone, the idea of sex can create more friction than warm feelings.

Approximately 80 percent of women have concerns about sex, but only about 10 percent bring up the topic with their doctor. Whether it’s fear of the unknown or embarrassment about the sensitive topic of sex, it’s important to talk to your doctor if you are having these issues in your relationship.

There are often solutions for low sex drive that can bring you even closer to your partner. Sex drive may be an uncomfortable topic, but the solutions are often easier than you might think.

A patient I’ll call Jenny came to me with several concerns about her health. She had developed sleep problems (waking up with night sweats) and had belly fat weight gain and fatigue. Her periods were irregular and heavy at times and she just wasn’t feeling like herself.

After she described her symptoms, I asked her about her sex drive. She had tears in her eyes when she said, “My sex drive is gone—I just do not want to do it! I really love my husband, but I’m so tired at the end of a busy day, I just want to snuggle up and go to sleep. But I can’t even snuggle because then he will think I am OK with sex. What do I do?”

I sympathized with Jenny and felt grateful she opened up about her situation. I could help her find a solution to her problem, but she first needed to understand what could be happening to her body.

We began by talking about the fact that a woman’s sex drive has many components. Many women think once they no longer feel the urge, their sex drive is gone and will never come back. Sex drive can change over time, and for some women, the switch does flip in their brain to where they just do not have the drive at all.

To understand what is really happening, we have to talk about the various causes of low sex drive.

Mind, body, soul

There are three possible causes of low sex drive: physical, psychological and interpersonal.

When we talk about physical factors, we are talking about the following possible issues:

  • Pain during sex from overly tight pelvic muscles
  • Vaginal dryness from low estrogen (during menopause or while breastfeeding)
  • Performance anxiety or difficulty having an orgasm
  • Skin conditions such as lichen sclerosis
  • Low testosterone
  • Depression or anxiety
  • Physical inactivity
  • Difficulty focusing because of stress
  • Fatigue
  • Excessive alcohol consumption
  • Smoking cigarettes
  • Certain medications, including low-dose birth control pills and antidepressants
  • Medical problems such as Rheumatoid arthritis, obesity, diabetes or cancer

Psychological issues can also cause low sex drive in women. These can include:

  • Job stress
  • Poor self-image, possibly from weight gain or embarrassing surgery scars
  • Fear of pain with sex
  • History of sexual, emotional or physical abuse (even if not from current partner)

The third possible cause of low sex drive is categorized as interpersonal factors. These can include any of the following:

  • Intimacy with your partner
  • Connection with your partner
  • Respect from your partner
  • Being listened to
  • Lack of fun in your relationship
  • Lack of support in your relationship
  • Similar sexual needs (how often to have sex, for example)
  • Trust between each other
  • Mutual physical attraction
  • Strong communication
  • Ability to resolve differences
  • Resentment between each other

Clearly, the possible causes of low sex drive in women make for quite a list. When I shared this list with Jenny, she may have felt overwhelmed but perhaps also relieved she wasn’t alone in experiencing some of these issues.

But here’s the secret to helping Jenny and women like her: We must identify the factors that cause a lack of interest in sex.

Avoidable trouble

When we consider the physical part of sex and midlife, the “change” can be quite dramatic. This is because when a woman ovulates, she releases an egg from her ovary and the brain sends out messages that it’s time to have sex in order to get pregnant.

When women are on the pill, ovulation doesn’t occur. Therefore, the mid-cycle sex drive is suppressed.

In perimenopause, women ovulate some months but not others. In menopause, there is no ovulation. This doesn’t mean the sex drive is gone, but the big change can make women think it is gone.

Men, on the other hand, “ovulate” about every 90 seconds. I’m not even sure how they get anything done.

For women experiencing frequent ovulation, weight gain and fatigue from lack of sleep—not to mention the added stress from relationship issues, such as having sexual needs that conflict with their partner’s—midlife can be a rough time.

Many couples say that if they had known all of these changes were normal—and hopefully temporary—they may have been able to handle the issues better.

Unfortunately, some couples will choose divorce because of the woman’s drastic decrease in sex drive.

It’s sad, especially because it is often avoidable.

Many of my patients say to me, “He thinks I am with someone else, but I don’t even have the energy to do anything with him. How could I be with someone else? How could he even think that?”

A great solution for couples experiencing this issue: Talk openly and figure out which components are at play—physical, psychological, interpersonal or some combination.

Then, visit a specialist. Talking about sex drive doesn’t have to be a scary taboo subject. Many couples have sex late into their 80s and beyond. The recipe for success is to stay healthy, communicate and maintain a sense of humor.

Couples must give each other the benefit of the doubt and try to understand each other’s point of view. The problem is that sex is so personal and private—and so intimately tied to feeling loved—that feelings easily get hurt.

If each partner takes a step back and looks at the other without blame, as a pair they can identify solutions that benefit them both—and bring them closer together.

Glorious mornings

Jenny had many components wreaking havoc on her sex drive, including physical and psychological issues.

She had low self-image from recent weight gain and it didn’t matter that her husband didn’t care about her weight—she cared about it. She also battled fatigue from lack of sleep and she wished her husband would help more with evening chores after the kids went to bed.

Jenny felt this would give her some time to relax and spend quality time with him.

In addition, she wished she and her husband could snuggle sometimes without having sex. She also knew if she got more sleep, she would have more energy.

Her monthly period added to her lack of energy. Her flow had become very heavy and zapped the last bit of energy she had. It’s no wonder she had grown stressed about her situation.

After several months, we helped stop Jenny’s periods with a Mirena IUD. She also went back to her healthy habits by cutting out sugar and exercising at least three times a week. And we added an estrogen patch during the week of the month when she experienced night sweats, which worked well for her.

All of these changes helped Jenny find her sex drive again.

She started initiating sex early in the morning when she felt rested, and then at night she could be cozy with her husband without leading to sex. It led to a happier relationship for both.