In our sex-obsessed culture, fewer subjects feel more taboo than having a low sex drive—but it’s a common complaint for women of all ages. There are plenty of factors that can contribute to a decrease in libido, so before you reach for the female Viagra, let’s look at the full range of what might be up, from stress and fatigue to hormone levels and body self-consciousness.
The technical term for a low sex drive is Hypoactive Sexual Desire Disorder (HSDD), which the DSM defines as “persistent deficient sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty.” A 2016 study found that 8.9 percent of women ages 18 to 44, 12.3 percent of women ages 45 to 64, and 7.4 percent of women over 65 suffer from HSDD. Dr. Tiffany Lester, medical director at Parsley Health San Francisco, believes the number is higher than reported, as many people feel embarrassed talking about it.
If you’re asexual or fall under the ace umbrella, that’s completely OK. These steps are only for ramping up your libido if that’s something that you value and you feel like you’re struggling with. If that applies to you, here’s how to get to the root of the problem and get your sex drive back in working order.
Get your levels checked
“Seventy percent of low libido is hormonal,” says Dr. Sara Gottfried, author of The Hormone Cure and The Hormone Reset Diet.There are four main hormonal culprits. First on the docket: cortisol. This stress-managing hormone can be too high or too low—or both over the course of the day. “If it’s too high, you’ll feel tired but wired, and when low, you’ll feel exhausted and drained,” Gottfried says.
Others include low testosterone, low estrogen, and thyroid issues. Testosterone, the primary hormone of vitality and sex drive, can tank from prolonged stress in our 20s and 30s and pre-menopause in our 40s. Low estrogen can cause thinner vaginal tissue, leading to uncomfortable or even painful sex. And then there’s the thyroid, the butterfly-shaped neck gland that regulates metabolism. If the gland doesn’t make enough thyroid hormone, you can experience fatigue, weight gain, and constipation. This is a super prevalent one, as nearly 5 percent of the adult population suffers from an underactive thyroid. “The problem I see commonly is that women have no energy for sex. They feel depleted,” says Gottfried.
Your doctor can conduct simple blood tests to check your hormone levels; if they don’t take your complaints seriously, you might run the tests yourself by using a service like Wellness FX. If you do have levels that are outside the suggested range, medications and synthetic hormones can help.
Watch out for side effects
It’s also worth talking to your doctor about the side effects of any other medications you might be on, like antidepressants and oral contraceptives. While there are conflicting studies on the sexual impacts of various medications, there’s plenty of anecdotal evidence to suggest they’re not all a sexy walk in the park. Your doctor can help you sort whether it’s worth trading your medication out for another with fewer side effects.
Adjust your diet to restore the flow of your qi
Chinese medicine identifies qi (pronounced “chee”) is the life force, or energy, that moves throughout the human body. “Nothing stops the flow of qi faster than stress,” says licensed acupuncturist and YinOva center founder Jill Blakeway. And qi stagnation is said to have have a major impact on your sex life.
A regular diet of heart-healthy and plant-based foods can increase circulation and libido. Qi moves best when you cut refined carbs (i.e., too much pasta and bread) and add leafy greens, lean protein, and a small amount of whole grains.
Cut down on the caffeine
No surprises here, but try to moderate your caffeine intake. The energy boost can impair estrogen metabolism and raise estrogen levels in the body enough to overpower, rather than collaborate with, your progesterone.
Incorporate acupuncture and adaptogenic herbs
You might also consider ancient practices like acupuncture to balance hormones. Acupuncture “promotes circulation and boosts energy, making it helpful for anyone whose libido is lagging,” says Blakeway. For women over 40, adaptogenic herbs like Maca have been shown to improve libido and lower anxiety and depression, which are both classic symptoms of low estrogen. Adaptogenic herbs have “been shown to help with the sexual side effects of a type of antidepressant called selective serotonin reuptake inhibitor (SSRI),” echoes Dr. Gottfried, who says the common dose of 2,000 mg/day can be blended into breakfast smoothies. The magic herb also aids with insomnia, depression, memory and vaginal dryness.
Supplements like B complex can also offset the effects of body stress, as can a qi-boosting herbal supplement. (Blakeway recommends the widely-available Chinese formula Si Jun Zi Tang.)
Change your timing
Next up, check out your internal clock. According to licensed massage therapist and herbalist Katinka Locascio, it helps to make time for regular sex when you’re most energetic—which is frequently not at bedtime. Locascio also recommends tonic herbs and teas like Jessa Blades Mountain Woman Tea; “the nettles and oats and lemon balm relax and strengthen and damiana, an herb used both for its nervous system properties and its ability to enhance sexual function,” she says.
Try to get comfortable with your body
“My patients of all ages give me long lists of things that are ‘wrong’ with their bodies,” says Blakeway. “Too wrinkly. Too fat. Too thin. Breasts too large. Too-small breasts. Lack of muscle. Cellulite. Flabby stomach. That jiggle bit under my arm.” Embracing body positivity can be challenging, given all of the damaging messages society feeds to women. But working to see our bodies in a positive light can improve our sexual experiences.
Turn the porn off
Blakeway also suggests eliminating porn, which can interfere with your ability to focus on connection with your partner. “It draws energy out—but none comes back in. None of us have sex like porn stars in real life, so comparisons are not helpful,” she says.
Are you too tired to even think about sex? Dr. Lester suggests regular massages, warm baths, and prioritizing your z’s, ideally to seven or eight hours. “If you’re not sleeping well, increasing your libido is nearly impossible.” Additionally, exercise can help the balance of progesterone to estrogen and increasing workouts becomes important if testosterone is low.
Make time for foreplay
Foreplay is key, as is taking time to get familiar with your own arousal pathways. “If someone asked you to draw the clitoris, could you? The truth is that many of us don’t have as much clitoracy as we could,” says Locascio, who points to Sheri Winston’s Anatomy of Arousal as good reading, “whether or not your libido could use a boost.”
If this all seems overwhelming and feels like homework, or you don’t know where to begin, simply start with the ABC’s. If you make an extra effort to eat healthy, exercise often, and get enough sleep, you might find yourself feeling frisky soon enough.