If you’ve ever had a hard time getting in the mood for sex, you know how frustrating it can be. If it’s happened with any frequency, you might’ve even had the passing thought: Could I be asexual? We checked in with Dr. Leah Millheiser, an OB/GYN and expert in menopause and female sexual medicine to learn more about how to tell the difference between the two (spoiler alert: the difference comes down to sexual attraction versus sexual desire).
I Never Feel Like Having Sex: Do I Have a Low Libido or Could I Be Asexual?
Meet the Expert
Leah S. Millheiser, MD, FACOG, NCMP, is an OB/GYN and expert in menopause and female sexual medicine who has dedicated her career to improving women’s health and wellness. She is a Stanford grad who was also the former VP at hims & hers and now serves as the Chief Medical Advisor at Evernow, a company that’s dedicated to helping women live happier and healthier lives and using its group of women scientists and doctors to help normalize the way we view a woman's changing hormones as we age.
1. If You're Not Interested in Sex, What Are Some Ways You Can Distinguish Between Having a Low Libido and Being Asexual?
The difference between having a low libido versus being asexual is in sexual desire versus sexual attraction. According to the Human Rights Campaign, asexuality is “a complete or partial lack of sexual attraction or lack of interest in sexual activity with others. Asexuality exists on a spectrum, and asexual people may experience no, little or conditional sexual attraction.” On the flip side, Dr. Millheiser tells us, “People with chronically low sexual desire (hypoactive sexual desire disorder) experience lack of sexual desire. People with HSDD want to want to have sex.” She points out that another key difference is that women with low sexual desire experience distress associated with their lack of sex drive. Asexual individuals, she continues, don’t typically experience distress associated with their lack of sexual attraction.
Note that while asexual people might not be particularly stressed with their lack of sexual attraction specifically, that doesn’t mean they’re without hurdles. According to HRC’s analysis of the 2021 LGBTQ Community Survey, 82 percent of asexual people said their highest priority health concern is addressing mental health challenges, including depression and anxiety. The HRC’s analysis reads, “Similar to other LGBTQ+ identities, asexual people are often met with disbelief or dismissal. Asexual people are often told that their identity is just a phase or that they ‘just haven’t met the right person yet.’”
2. What Are Some of the Common Causes of Low Libido?
There are lots of reasons you might be experiencing low libido, Dr. Millheiser explains, including:
- Relationship conflict
- Partner sexual dysfunction
- Depression/anxiety, including treatment for depression or anxiety (SSRIs, SNRIs)
- Psychosocial stressors (work stress, life stress, financial stress, etc.)
- Certain medical conditions (prolactinoma, hypothyroidism)
- Medications (antidepressants, beta blockers, certain pain medications—e.g., narcotics, gabapentin)
- Taboos around sexuality/sexual function that are a direct result of how someone was raised (e.g., religious or cultural beliefs)
- Hormonal changes, including lowered estrogen and testosterone during the menopause transition or during breastfeeding
3. If You Are Experiencing Low Libido, What Are Some Ways You Can Address It?
Dr. Millheiser tells us that if you’re dealing with chronically low or absent libido (meaning it’s been happening for more than six months) and experiencing personal distress associated with your libido, you should speak to your healthcare provider, as there may be treatment available to them (she notes that medications like Addyi or Vyleesi can be used for premenopausal women and off-label testosterone therapy for postmenopausal women).
For shorter-term issues, she explains that there are different paths depending on the root cause. If low libido might be due to life stressors, it is important to work on lessening or eliminating those stressors; if it’s relationship issues, then therapy may be effective; if sexual function concerns are the problem, than sex therapy may be helpful. And, as simple as it might sound, Dr. Millheiser stresses that with everything we all have going on in our lives, date nights are as important for a new couple as they are for a couple that has been together for 50 years.
“If low libido is due to pain during intercourse caused by vaginal dryness,” she says, “that should be addressed first ([via] treatment with vaginal estrogen therapy if perimenopausal or postmenopausal), and a personal lubricant to use during sex.” She also notes that women who experience less spontaneous desire on a day-to-day basis are often more likely to experience responsive desire, meaning they don't start out in the mood but can develop desire and arousal in response to a stimulus. If that sounds like you, “I often counsel women to engage in 'beforeplay’ (watching or listening to erotica, self-stimulation, etc. before engaging with a partner) in order to get in the mood before they engage with their partner. That way, it's an even playing field when they finally get into the act.”
The bottom line is that while it can be confusing and alienating to deal with any sort of uncertainty when it comes to sex, it’s crucial to know that there are so many people in your same position, and tons of resources online to help you understand what’s going on.