Illustration by Matthew Billington
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
If your sexual desire has changed or disappeared, you’re not alone. Research suggests that low sexual desire affects 40 per cent of Canadian women and 30 per cent of men. Sexual health is an important part of overall health, yet it’s often poorly understood and frequently overlooked in discussions between doctors and patients.
I know it can feel vulnerable to talk about libido with your clinician, so here are some points I share with my patients, which may help start the conversation.
1.Libido is not fixed
Our desire changes with our overall health, stress and life circumstances. Low libido rarely has a single cause but common contributors include:
- Physical changes: hormonal fluctuations, illness, pain, poor sleep
- Medications: including antidepressants (selective serotonin reuptake inhibitors) and some hormonal contraceptives
- Psychological factors: stress, anxiety, depression, body image
- Relational concerns: communication challenges, mismatch in desire
- Contextual challenges: parenting, caregiving, work demands
I often say that libido is, in part, a bandwidth issue. When your day is filled with work, caregiving and constant demands, sexual desire often becomes the last thing on your mind. That doesn’t mean something is wrong. It means your brain and body are prioritizing what feels most urgent.
2. There are different types of desire
Desire is often expected to be spontaneous, a sudden interest in sex that appears without effort. But there is a different type known as responsive desire, which develops after connection, touch or intentional time together, something that is common in long-term relationships and during busy life stages. This distinction matters. What is often interpreted as low libido may reflect a shift in how desire shows up, not a loss of it.
Sex educator and author Emily Nagoski describes desire as having both accelerators and brakes. Factors such as feeling rested, connected or relaxed can support desire, while stress, fatigue, pain or distraction can suppress it. For many people, it’s not that desire is gone, it’s that the brakes are fully on.
To help guide support options, it’s also helpful to distinguish between desire (mental interest) and arousal (the body’s physical response), which don’t always move together.
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3. Treatment is not a one-size-fits-all solution
Not every change in libido requires treatment. But if you are concerned and feel it is affecting your life personally or your relationships, it’s important to seek support. In primary care, the first step in treating low libido is to address underlying factors.
A medication review is particularly important, as some commonly prescribed treatments, including antidepressants and certain forms of birth control, can affect sexual desire. If that’s the case, your care provider may be able to suggest alternative medications that have less of an impact on libido.
Sleep health is also important to consider. Poor or fragmented sleep affects energy, mood and hormone regulation, all of which play a role in sexual desire.
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Some physical causes of low libido are common, under recognized and very treatable. For example, pain with sex (which is not normal and should not be normalized), particularly in midlife and beyond, is often related to genitourinary syndrome of menopause (GSM). This can lead to dryness, irritation and discomfort, all of which can significantly affect desire. Local vaginal estrogen is a safe and effective treatment for many patients and can make a meaningful difference. Some neurologic and dermatologic (skin) changes can also contribute to discomfort with sex. If you are having pain with sex, a physical exam can help determine the underlying cause.
Additional supports for low libido can include sex therapy to address communication, expectations and connection between partners, and pelvic floor physiotherapy, particularly when pain or muscle tension is present.
Psychological approaches are also effective. A research review led by Dr. Lori Brotto, a professor at the University of British Columbia who holds the Canada Research Chair in Women’s Health, found that cognitive behavioural therapy and mindfulness helped improve sexual desire.
4. Testosterone therapy requires careful, individualized assessment
Testosterone therapy is sometimes used to treat low libido in women. There is evidence supporting its use in postmenopausal women with persistent low sexual desire (hypoactive sexual desire disorder). However, it’s important to know that in Canada there are no testosterone products specifically approved for use in women, so treatment is prescribed off-label using male formulations at lower doses.
Evidence suggests modest improvements in sexual desire and satisfaction for some patients, but it is not a quick or universal fix. Testosterone therapy requires a clear diagnosis, discussion of expectations, careful dosing, and monitoring of hormone levels to ensure safety and effectiveness. Other medications for low sexual desire exist, but their benefits are also modest and they are not widely used in Canada.
The goal isn’t to “fix” libido in isolation, but to understand what’s affecting it and address those factors in a way that supports overall health and personal goals.
5. Be cautious of quick fixes and oversimplified solutions
There is no shortage of products promising to “boost libido,” from supplements to hormone creams or online programs from social media wellness influencers. Most are not supported by strong evidence. And many of these products focus on a single solution, when libido is usually influenced by multiple factors.
In addition, some supplements and over-the-counter products can potentially cause harm as they are not regulated in the same way as prescription medications. If a solution sounds simple or universal, it’s worth approaching with caution and discussing it with a trusted health care provider.
6. Don’t be afraid to advocate for yourself
If you’re experiencing low libido, I encourage you to speak to your primary care clinician. Be sure to describe what’s changed and when; mention any pain, sleep issues or medication changes; and share what’s affecting you most physically, emotionally or in your relationship.
Many of the factors that affect sexual desire are common and treatable – but they are not always asked about. Raising the concern is often the first step toward getting the support you deserve.
Dr. Sheila Wijayasinghe is a menopause-certified family physician practising at St. Michael’s Hospital in Toronto and the medical director of primary care outreach at Women’s College Hospital. She is also the resident health expert on CTV’s The Social and co-host of The Doc Talk Podcast.