How to Talk to Your Doctor About Low Libido

The hardest part is usually the first sentence. Once it's said, most clinicians treat a change in sex drive like any other symptom: they ask how long it's been going on, what else changed around the same time, and what you've already tried. A little preparation makes that conversation shorter, clearer and far more useful.

Why is it so hard to bring up low libido?

Silence on both sides of the exam table is the norm. In the Global Study of Sexual Attitudes and Behaviors, which surveyed adults aged 40 to 80 in 29 countries, almost half of sexually active people had at least one sexual problem, yet fewer than 19% of women with a problem had tried to get medical help. The most common step was talking to a partner. Only 9% said a doctor had asked about their sexual health during a routine visit in the previous three years (Moreira et al., 2005).

By the numbers

The silence around sexual health

<19%of women with a sexual problem had tried to get medical helpSource: Moreira 2005

9%said a doctor had asked about their sexual health in three yearsSource: Moreira 2005

So if you've been waiting for your doctor to ask, you may be waiting a long time. Common reasons women hold back include:

• Embarrassment or a sense that sex isn't a "real" health issue.
• Fear of being dismissed with "it's just stress" or "that's normal at your age."
• Short appointments that already feel full.
• Uncertainty about whether anything can be done.

How to prepare for the appointment

Track what's happening for a few weeks

A short log beats memory. Note your interest in sex, any sexual activity and how it felt, pain or dryness, sleep, mood and stress, and where you are in your cycle if you still have one. Two to four weeks is enough to show a pattern. Our guide on how to track your libido includes a simple template.

List every medication and supplement

Include antidepressants, blood pressure medicines, hormonal birth control, hormone therapy, sleep aids and over-the-counter products, with doses and start dates. Medication side effects are one of the most common and most fixable causes of low desire, and the timing often tells the story.

Decide what matters most to you

Write down your top two or three concerns. Is it lack of interest, trouble getting aroused, difficulty with orgasm, pain, or the strain on your relationship? Also note what you'd like from the visit: an explanation, a check for medical causes, a referral, or a discussion of treatment.

Book the right visit

If you can, say "sexual health concern" when you book so enough time is set aside. A primary care clinician or gynecologist can start the evaluation. Telehealth works well for this kind of conversation; see telehealth vs. in-person care for sexual health.

What to say: conversation starters that work

Raise it at the start of the visit, not with your hand on the door. Plain, specific language helps your clinician help you:

• "I've noticed a real drop in my interest in sex over the past [time], and it's bothering me. I'd like to understand why."
• "Since I started [medication], I've had trouble getting aroused. Could that be related?"
• "Sex has started to hurt since my periods became irregular. What could be causing that?"
• "This is affecting my relationship and how I feel about myself, so I'd like to look into it."

What a good evaluation looks like

Expert guidance from the International Society for the Study of Women's Sexual Health describes a stepwise approach: ask about sexual concerns, take a careful history, look for contributing factors, educate, and then discuss treatment or refer when needed (Clayton et al., 2018). The American College of Obstetricians and Gynecologists likewise recommends that clinicians assess sexual concerns and consider physical, psychological and relationship contributors (ACOG, 2019).

In practice, expect questions about:

• When the change started and whether it's with all partners or situations
• Desire, arousal, orgasm and pain, which are often linked
• Medications, alcohol and other substances
• Mood, stress, sleep and fatigue
• Menstrual changes, perimenopause or menopause symptoms
• Relationship satisfaction and any history that affects how sex feels

A pelvic exam may be recommended if you have pain, bleeding or other physical symptoms. Lab tests depend on your history; there is no single blood test that measures libido.

Questions to ask your doctor about low libido

1. What do you think is contributing to this, and what else should we rule out?
2. Could any of my medications be playing a role, and are there alternatives?
3. Are my symptoms related to perimenopause or menopause?
4. Would counseling, sex therapy or pelvic floor therapy help in my case?
5. What treatment options exist, including FDA-approved medications, and what are their risks?
6. When should we follow up, and what should I watch for?

What treatment options might come up?

Treatment depends on what's driving the problem. A clinician might suggest changing a medication, treating pain or dryness, addressing sleep or mood, or referring you to a sex therapist. For women diagnosed with hypoactive sexual desire disorder (HSDD), two FDA-approved drugs exist: Addyi (flibanserin), a daily pill approved for women under 65, and Vyleesi (bremelanotide), an injection used before sexual activity and approved before menopause. In phase 3 trials, bremelanotide modestly improved desire and reduced distress compared with placebo (Kingsberg et al., 2019). See PT-141 vs. Addyi for how they compare.

Some clinicians also prescribe compounded options. Amie's Blys is a compounded rapid-dissolve tablet with PT-141 (bremelanotide), oxytocin and tadalafil, taken 30 to 60 minutes before intimacy and made with women on antidepressants in mind. It is not FDA-approved, and it must not be used with nitrate medications. A licensed clinician reviews your history to decide whether it's appropriate, so bring the same medication list you'd bring to any appointment.

Red flags and green flags in your doctor's response

If you get a red-flag response, it's reasonable to ask directly ("I'd like this evaluated. Can we look into it or can you refer me?") or to seek a second opinion from a clinician with a women's health or sexual medicine focus.

Making follow-up visits count

Keep tracking after the first visit, especially after any change in medication or treatment, so you can tell your clinician what actually changed. Report side effects promptly. If a plan isn't helping, say so rather than quietly stopping; there are usually other options to try. For a broader overview of causes, see female sexual dysfunction.