Sally looked down and a bit anxious. “I don’t know what is wrong with me. I’m just not that interested in sex with my husband these days. I feel exhausted with three small kids, I’m working part-time and have been on an antidepressant. Any thoughts?”

One of the top sexual concerns for women has to with desire and interest. We wonder, are we normal? Why don’t we feel and act like the women in the movies and on television? For starters, media is heavily sexual laden to peak your interest and get you to watch. It rarely depicts reality–those are called documentaries!!!

First, there are a number of physical causes to low sexual desire. Everything from diabetes to heart disease impacts desire. Smoking and substance use (alcohol) can affect desire as well. So the first step is to have a physical and make sure there is no medical cause at the root. That said, the biological and psychological are intertwined when we are talking about female sexuality.

Along with medical conditions, consider the medications you may be taking. Many have side effects of low desire. Certain antidepressants and benzodiazepines (anxiety) are associated with sexual dysfunction, so check with your doctor. Sally is on an antidepressant and when it was checked, it was one that does negatively affect sexual desire.

Second, is there a psychiatric link to low desire–are you depressed, have concerns about sexual performance, struggling with guilt, dealing with the effects of past trauma or have attitudes towards sex that might affect desire? This is an important list because about one-third of women who present for sexual dysfunction are clinically depressed and anxious. And past traumas that are untreated also make up a bulk of women who struggle. This means you may need to treat the psychiatric cause for things to get better.

Third, examine your relationship. The relationship itself is a determiner of satisfaction  and desire. So how are you doing as a couple? Emotional well-being is important for you to feel desire. If you are angry, upset, worried, etc. in this relationship, it will translate to the bedroom. Work out your couple issues and sex usually improves.

Finally, other life issues like negative self-image, chronic stress and distractions, heavy work load, having a baby, etc, play a role in how much desire you have on any given day. Certainly fatigue and stress are the top 2 on my list.

So as you think about what might be the cause of low desire, look through this list and decide if working with a doctor or therapist might help. Making a few lifestyle changes like getting rest, limiting your workload, taking time to relax, improving your relationship also help to boost desire.