By Dr. Sarah Maddison
In this recurring Midtown Magazine column dedicated to the complexities of the female body, we are partnering with local expert Dr. Sarah Maddison to bring readers clear, evidence-based, and personable insight into health topics that too often get brushed aside.
Low libido is one of the most common concerns women experience, yet it’s also one of the least discussed. While busy schedules, stress, and exhaustion can certainly affect sexual desire, persistent changes in libido may signal something more than simply having too much on your plate. Hormonal shifts, menopause, medications, chronic health conditions, and even pain during intimacy can all play a role. The good news? Many of these issues are treatable, and women don’t have to accept them as a normal part of aging.
Dr. Maddison explains what can cause low libido, when it’s time to talk with a healthcare provider, and the treatment options that may help women regain both comfort and confidence.
How do we differentiate between a “busy life” causing low libido and an actual hormonal or physiological issue?
Low libido is rarely caused by just one thing. Stress, exhaustion, relationship dynamics, parenting, work demands, and poor sleep can absolutely lower sexual desire—sometimes significantly. In many cases, the body simply shifts into “survival mode,” where intimacy becomes less of a priority.
However, when low libido becomes persistent, distressing, or noticeably different from a woman’s baseline, it may point to an underlying hormonal or physiological issue. Hormonal shifts during perimenopause and menopause, thyroid disorders, certain medications (especially antidepressants), chronic pain, vaginal dryness/painful intercourse, sleep disorders, and mental health concerns can all contribute.
One of the biggest clues is whether desire returns with rest, reduced stress, or improved connection. If it does not—or if physical symptoms like pain, dryness, fatigue, or mood changes are also present—it’s worth exploring the issue more deeply with a health care provider.
Are there specific vitamins or over-the-counter supplements that actually work, or is prescription intervention usually necessary?
There is no universal “magic supplement” for libido, despite what the internet may promise at 2 a.m. Some vitamins and supplements may help women who are deficient or experiencing specific contributing factors. For example, vitamin D, iron, magnesium, and B vitamins can support energy, mood, and overall well-being when levels are low.
Certain over-the-counter supplements marketed for sexual health—such as maca root or saffron—have shown modest benefits in small studies, but the evidence remains limited and inconsistent. Supplements can also interact with medications, so they should still be discussed with a clinician.
For some women, making lifestyle changes and addressing underlying contributors are enough. Others may benefit from prescription therapies, particularly if hormonal changes, pain, anxiety, or significant distress are involved. The most effective treatment depends on identifying the root cause rather than simply trying random products off a shelf.
Currently, there are two FDA-approved prescription options for treating low libido: Addyi, a daily oral medication that alters serotonin levels, and Vyleesi, an injectable medication that stimulates the hypothalamus and is designed to be used on demand. Response to these medications varies, as the causes of low libido are often complex.
One promising non-medication option, Morpheus8, uses microneedling and radiofrequency ablation to stimulate new collagen deposition in vulvar tissue. This treatment also improves the blood flow needed for arousal. Whether paired with vaginal estrogen or used alone in women seeking nonhormonal options, Morpheus8 helps reduce pain caused by the genitourinary syndrome of menopause and enhances sexual function and pleasure. One of the best cures for low libido is restoring a woman’s ability to have a positive and rewarding sexual encounter.
How do hormones like testosterone play a role in women’s sexual health and desire?
While testosterone is often thought of as a “male hormone,” women produce it as well, and it plays an important role in sexual desire, arousal, energy, and overall well-being. Levels naturally decline with age, particularly during and after menopause.
For some women, low testosterone can contribute to decreased sexual thoughts, reduced responsiveness, lower energy, and diminished motivation for intimacy. However, libido is complex and influenced by far more than hormone levels alone. Emotional connection, stress, body image, sleep, medications, and physical comfort all play major roles.
In select cases, carefully monitored testosterone therapy may help women experiencing hypoactive sexual desire disorder (HSDD), particularly after menopause. However, treatment should always be individualized and medically supervised to avoid side effects or inappropriate dosing.
What are the most common physical barriers to intimacy that women are often too shy to bring up in a quick exam?
Many women quietly experience physical symptoms that significantly affect intimacy, but feel embarrassed bringing them up—especially during a short appointment. Vaginal dryness, painful intercourse, bladder leakage during sex, pelvic floor tension, reduced sensation, difficulty reaching orgasm, and discomfort from prolapse are all extremely common concerns.
Unfortunately, many women assume these issues are “just part of aging” or something they should tolerate. In reality, most of these are treatable. Hormonal changes, childbirth, pelvic floor dysfunction, medications, and chronic stress can all contribute to physical discomfort that directly affects desire and intimacy.
Often, once women feel comfortable discussing these symptoms openly, they realize they are far from alone—and that effective treatment options exist.
What is the first step a woman should take to start this conversation with her doctor?
The first step is simply bringing it up directly and honestly. Many women wait years before mentioning concerns about libido because they feel embarrassed or assume nothing can be done. In reality, sexual health is an important part of overall health and quality of life.
It can help to be specific about what has changed. For example: “My desire has significantly decreased over the past year,” or “Sex has become uncomfortable, and it’s affecting my relationship.” Mentioning related symptoms—such as fatigue, sleep issues, pain, dryness, mood changes, or medication changes—can also help guide the conversation.
Most importantly, women should know they do not need to have a “serious enough” problem to ask questions. Open conversations are often the first step toward identifying solutions that can improve both physical and emotional well-being.
