Women Say What’s Up With My Libido
Women Say, “What’s Up With My Libido?”
If this is your first time hearing this, you’re not alone—and you’re not broken.
At My V Clinic, one of the most common questions we hear from women in their 30s, 40s, 50s, and beyond is some version of this:
“Why don’t I want sex anymore?”
“Is something wrong with me?”
“Is my libido gone for good?”
The short, honest answer: libido changes are common, complex, and very real—especially during perimenopause and menopause. The longer answer is more nuanced, more hopeful, and far more empowering.
This conversation has been gaining long-overdue traction thanks to clinicians and educators like Dr. Kelly Casperson, a urologist and nationally recognized voice in women’s sexual health. Her work helps clarify what many women intuitively feel but were never taught: libido is not just about sex—it’s about brain chemistry, hormones, health, stress, sleep, relationships, pain, and permission.
This article is inspired by that growing body of education and is intended to help you understand what may be happening in your body, what is normal, and what support options are commonly discussed in modern women’s health care.
Libido Is a Brain Process—Not a Moral Failing
One of the most misunderstood aspects of libido is where it actually lives.
Libido is not a switch.
It is not a personality trait.
It is not a measure of love or commitment.
Libido is best understood as a brain-based mood state, influenced by neurotransmitters like dopamine, serotonin, and norepinephrine. Hormones—especially estrogen and testosterone—play a major role in modulating these pathways.
When hormone levels shift, particularly during perimenopause and menopause, those signaling systems can change too. Desire may feel quieter, slower, or harder to access.
That doesn’t mean it’s gone.
It means the system has changed.
Hormones Matter—But They’re Not the Whole Story
Estrogen and testosterone both contribute to sexual interest, arousal, and comfort. When these hormones decline:
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Dopamine signaling related to desire may decrease
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Blood flow to genital tissues can change
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Vaginal and vulvar tissues may become thinner or drier
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Arousal may take longer
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Pleasure may feel muted or inconsistent
But hormones are only one piece of a biopsychosocial picture.
Libido is also shaped by:
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Chronic stress
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Poor sleep
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Pain with sex
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Relationship dynamics
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Body image
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Cultural messaging about sex
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Past sexual education (or lack of it)
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Mental load and burnout
This is why some women start hormone therapy and still feel frustrated. Hormones can support libido—but they don’t override exhaustion, resentment, pain, or shame.
Personalized hormone support, weight loss, and aesthetic care for people ready to feel like themselves again.
The Myth of “Spontaneous Desire”
One of the most damaging myths women are taught is this:
“If you don’t feel spontaneous desire, something is wrong.”
In reality, many women—especially in midlife—experience responsive desire, not spontaneous desire.
That means:
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Desire often follows arousal
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Interest can build after intimacy begins
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Wanting sex doesn’t always come first
This isn’t a dysfunction. It’s a normal pattern that has been misunderstood for decades.
Women with satisfying long-term sex lives often:
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Prioritize time for intimacy
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Communicate openly
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Experiment without pressure
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Focus on pleasure—not performance
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Accept that desire doesn’t have to “strike out of nowhere”
Pain Changes Everything—and It Deserves Attention
If sex hurts, your brain learns quickly.
Pain activates protective pathways. Over time, your body may associate intimacy with discomfort, tension, or anxiety. That alone can suppress libido—regardless of hormones.
Many women experience genital or urinary symptoms related to hormonal changes, sometimes grouped under Genitourinary Syndrome of Menopause (GSM). These may include:
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Vaginal dryness or burning
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Pain with penetration
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Recurrent urinary tract infections
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Urgency or leakage
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Decreased elasticity or sensitivity
These symptoms are common—and they are not something you should “just live with.”
Local vs. Systemic Support: What’s Often Discussed
In modern women’s health conversations, clinicians may discuss different categories of support depending on symptoms and individual history.
These discussions may include:
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Local vaginal estrogen or DHEA for tissue health
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Systemic hormone therapy for broader symptoms
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Pelvic floor physical therapy
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Sexual health counseling or sex therapy
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Lifestyle factors like sleep, movement, and stress reduction
Local therapies are often described as acting primarily on the tissues where applied, rather than throughout the entire body—but individual recommendations always depend on personal medical context.
Why Libido Can Feel So Confusing
Libido doesn’t decline in a vacuum.
It shifts alongside:
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Caregiving responsibilities
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Career stress
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Aging parents
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Children leaving home
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Body changes
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Sleep disruption
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Emotional labor
When you add cultural silence around women’s pleasure, it’s no surprise so many women feel isolated or embarrassed asking for help.
The truth is simpler—and kinder:
Libido changes because your life and biology change.
10 FAQs Women Ask About Libido
1. Is it normal for libido to change in perimenopause or menopause?
Yes. Hormonal shifts, sleep disruption, and stress commonly affect desire during this stage.
2. Does low libido mean something is wrong with my relationship?
Not necessarily. Libido is influenced by biology, mood, energy, and comfort—not just emotional connection.
3. Is libido only about hormones?
No. Hormones matter, but mindset, pain, stress, and mental load are equally important.
4. If I don’t feel spontaneous desire, is that a problem?
No. Many women experience responsive desire, especially in long-term relationships.
5. Can pain during sex reduce libido?
Absolutely. Pain can train the brain to avoid intimacy. Addressing pain is often a key step.
6. Are there non-medication ways to support libido?
Yes. Communication, prioritizing pleasure, addressing stress, sleep quality, and body comfort all matter.
7. Is it “too late” to address libido changes?
No. Women seek support at all ages and stages.
8. Should I talk to my partner about this?
Often, yes. Libido is a relationship experience—not a personal failure.
9. Do all women want sex less as they age?
No. Many women report satisfying sex lives well into later decades.
10. Who should I talk to about libido concerns?
Depending on symptoms, conversations may include medical providers, pelvic floor therapists, or sexual health specialists.
Giving Credit Where It’s Due
Much of the modern, science-based conversation around women’s libido has been shaped by clinicians willing to speak openly about what women experience—and what medicine has historically overlooked.
Educational voices like Dr. Kelly Casperson have helped reframe libido as a legitimate health topic rather than a personal shortcoming.
You can learn more about her work and educational resources at: https://kellycaspersonmd.com/
Related Reading
This content is for educational purposes only and does not constitute medical advice. It does not diagnose, treat, cure, or prevent any condition. Always consult a qualified healthcare professional regarding symptoms, medications, or treatment decisions.