Low Sex Drive in a Relationship: Why It Happens and What Can Help

Is low desire in a long-term relationship normal?

It helps to hold two things at once. First, sexual desire in long-term relationships naturally changes over time. The intensity common in the early months of a relationship tends to shift into something different, and this is a documented pattern, not a malfunction. Second, when that change causes distress — to you individually or to the relationship — that distress is real and worth addressing.

The clinical term *hypoactive sexual desire disorder* (HSDD) applies when low desire causes significant personal distress, and a 2023 systematic review and meta-analysis found that HSDD affects roughly 12% of women, while low sexual desire without meeting the full disorder criteria is present in around 29% 1Ref 1Tetik S, Yalçınkaya Alkar Ö (2023).Incidence and Predictors of Low Sexual Desire and Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-Analysis.Prevalence of low sexual desire (29%) and HSDD (12%) in women; doubled prevalence around menopause. You do not need a formal diagnosis to benefit from care — distress is the signal.

Desire discrepancy — one partner wanting sex more or less often than the other — is also extremely common. Research with diverse couples confirms it is a near-universal feature of long-term relationships rather than a red flag, and it is one of the most frequent reasons couples seek therapy 2Ref 2Arenella K, Girard A, Connor J (2024).Desire discrepancy in long-term relationships: A qualitative study with diverse couples.Desire discrepancy as a near-universal feature of long-term relationships; themes of evolving barriers and coping strategies.

What physical causes can suppress libido?

Several medical factors directly affect sexual desire, and many are diagnosable and treatable.

Hormonal shifts. Low testosterone (in any gender), estrogen and progesterone changes around perimenopause and menopause, thyroid dysfunction, and elevated prolactin can all reduce desire. Among women approaching menopause, the prevalence of low sexual desire roughly doubles compared to premenopausal women — and when that low desire is accompanied by personal distress, it meets criteria for HSDD 1Ref 1Tetik S, Yalçınkaya Alkar Ö (2023).Incidence and Predictors of Low Sexual Desire and Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-Analysis.Prevalence of low sexual desire (29%) and HSDD (12%) in women; doubled prevalence around menopause. For testosterone specifically, the evidence supporting routine therapy for women is mixed and treatment should be individualized and time-limited 3Ref 3Abdo CHN (2019).Is testosterone involved in low female sexual desire?.Mixed evidence for testosterone therapy in women with low desire; individualized, time-limited approach recommended.

Medications. Many common medications list reduced libido as a side effect. SSRIs and SNRIs used to treat depression are among the most frequently implicated: rates of sexual dysfunction with SSRIs range from roughly 25% to over 70% in studied populations, with decreased desire and orgasm difficulty among the most common complaints 4Ref 4Ferraz SD, Kuyunga L, Rech P, et al. (2026).Sexual dysfunction associated with selective serotonin reuptake inhibitors in adults with depression: a systematic review and meta-analysis.SSRIs associated with significantly elevated risk of orgasmic dysfunction and reduced sexual satisfaction in adults with depression5Ref 5Higgins A, Nash M, Lynch AM (2010).Antidepressant-associated sexual dysfunction: impact, effects, and treatment.SSRI-induced sexual dysfunction rates 25-73%; paroxetine, citalopram, sertraline among highest; mechanism via serotonin inhibiting dopaminergic pathways. Blood pressure medications, hormonal contraceptives, antihistamines, and others can also play a role.

Chronic illness. Conditions like type 2 diabetes, cardiovascular disease, and chronic pain conditions are associated with significant rates of sexual dysfunction, partly through vascular and neurological mechanisms, and partly through the energy and comfort drain they create.

Sleep and fatigue. Chronic poor sleep is one of the most underappreciated factors. A pilot study found that each additional hour of sleep was associated with a 14% higher likelihood of sexual activity the next day among women, and that sleep duration predicted sexual desire and arousal 6Ref 6Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA (2015).The impact of sleep on female sexual response and behavior: a pilot study.Each additional hour of sleep associated with 14% higher odds of sexual activity; sleep duration predicted sexual desire and genital arousal.

Alcohol. While alcohol is often used socially to reduce inhibitions, regular heavy use tends to lower libido and disrupt sleep architecture over time.

How do depression, anxiety, and stress affect sexual desire?

The mind is deeply involved in sexual desire. Depression and anxiety are strongly associated with reduced libido, and importantly, both the conditions themselves and some of the medications used to treat them can suppress desire.

A systematic review and meta-analysis found that among women with untreated major depressive disorder, the pooled prevalence of sexual desire impairment was 65% 7Ref 7Gonçalves WS, Gherman BR, Abdo CHN, et al. (2023).Prevalence of sexual dysfunction in depressive and persistent depressive disorders: a systematic review and meta-analysis.65% pooled prevalence of sexual desire impairment in women with untreated major depressive disorder. The mechanism runs in both directions: depression suppresses desire, and sexual difficulties can worsen depression — making early attention to both worthwhile.

Stress — from work, finances, parenting, or caretaking responsibilities — consumes the mental and physical energy that desire requires. Body image and self-esteem are also meaningfully linked to sexual wellbeing. Past trauma, including sexual trauma, can create complex responses to intimacy that are often best worked through with a trauma-informed therapist.

How do relationship dynamics shape sexual desire?

Desire does not exist only inside one person — it exists between people. Unresolved conflict, resentment, accumulated small disconnections, or emotional distance within a relationship often surface as reduced sexual interest. The body sometimes expresses what the relationship has not yet been able to say.

Desire discrepancy — mismatched levels of desire between partners — is present in most long-term relationships at any given time and does not mean the relationship is broken 2Ref 2Arenella K, Girard A, Connor J (2024).Desire discrepancy in long-term relationships: A qualitative study with diverse couples.Desire discrepancy as a near-universal feature of long-term relationships; themes of evolving barriers and coping strategies. What matters more is how couples navigate it. Couples therapy and sex therapy offer structured approaches to address these dynamics in ways that individual conversation alone often cannot.

Responsive vs. spontaneous desire. Rosemary Basson's widely cited model of female sexual response identified that many people — particularly women in long-term relationships — have *responsive* desire rather than *spontaneous* desire 8Ref 8Basson R (2002).Women's sexual desire — disordered or misunderstood?.Circular/responsive model of female sexual desire; desire often follows arousal rather than preceding it; basis for reconceptualizing 'normal' desire. Spontaneous desire arises on its own, seemingly out of nowhere. Responsive desire emerges in reply to closeness, touch, or context — not absence of desire, just a different entry point. Mistaking responsive desire for broken desire is a common source of unnecessary worry.

What tends to help?

Care for low desire is rarely one-size-fits-all, and the cause shapes the approach.

- Medical evaluation. A clinician can check relevant hormone levels (testosterone, estradiol, TSH, prolactin, FSH/LH), review current medications for libido-suppressing effects, and look for underlying conditions like thyroid dysfunction or diabetes. This is a reasonable first step when desire has dropped noticeably, particularly with other physical symptoms.

- Medication review. If a prescribed medication appears to be suppressing desire — especially an SSRI or SNRI — a prescribing clinician can sometimes adjust the dose, timing, or switch to an alternative with a more favorable sexual side-effect profile. Never stop or change psychiatric medication without guidance.

- Individual therapy. Particularly useful for depression, anxiety, stress, body image concerns, or past trauma contributing to low desire. Cognitive-behavioral therapy has a strong evidence base for mood disorders that frequently underlie low desire 9Ref 9Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A (2012).The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.Strong evidence base for CBT in treating mood disorders that frequently underlie low sexual desire.

- Couples or sex therapy. A licensed sex therapist or couples therapist can address relational dynamics and communication, and introduce research-supported approaches to rebuilding desire together. This is especially helpful when desire discrepancy or emotional disconnection is part of the picture.

- Lifestyle factors. Sleep, regular physical activity, stress reduction, and moderation of alcohol consistently appear in research as supporting overall sexual wellbeing. Sleep is particularly underrated: improving sleep duration and quality is a low-risk, evidence-grounded starting point.

- Postpartum context. Low desire is near-universal in the months after childbirth. One study found that between 39% and 59% of new mothers reported clinically low sexual desire in the first 12 months postpartum, compared to community couples 10Ref 10Schwenck GC, Dawson SJ, Muise A, Rosen NO (2020).A Comparison of the Sexual Well-Being of New Parents With Community Couples.39-59% of new mothers reported clinically low sexual desire in the first 12 months postpartum; mothers' desire persistently lower than partners' throughout year one. Hormonal changes, sleep deprivation, physical recovery, and identity shifts all contribute. This typically improves with time, support, and open communication between partners.

When should I see a clinician?

You do not need to wait for a crisis to bring this to a clinician or therapist. Low desire that is causing you distress — whether or not it meets any formal definition — is a legitimate reason to seek support. A useful starting point is a primary care provider who can rule out medical causes before considering psychological or relational contributors.

A therapist with training in sexual health or couples therapy is appropriate whenever the relational or psychological dimension feels primary. You can pursue both tracks simultaneously — medical evaluation and therapy — as the causes often overlap.

Things to bring to a first appointment: - A timeline of when the change started and any life events around that time - A full list of current medications, including hormonal contraceptives and supplements - Any patterns you have noticed (specific contexts, times of month, or situations where desire is higher or lower) - Whether your partner is aware, and their openness to couples support