Who is this for?
This information is for women who feel their interest in sexual activity has declined to the point that it causes distress. Some people call this hypoactive sexual desire disorder (HSDD). HSDD is defined as a deficiency of sexual thoughts or receptiveness to sexual stimulation that lasts at least six months, causes personal distress and cannot be explained by another medical condition. Many different factors – stress, mood, relationship dynamics, medical conditions, medications and hormones – can influence desire.
Two helpful models for understanding desire:
Dual Control Model – accelerators and brakes
The dual control model explains that sexual desire results from a balance between excitatory signals (accelerators) and inhibitory signals (brakes). Desire increases when accelerators outweigh brakes, and HSDD may occur when brakes are strong or accelerators are weak.
Examples include:
Accelerators: Feeling loved and connected, affectionate touch, relaxing together, erotic cues
Brakes: Stress, fatigue, pain, worries, conflict, distractions, negative thoughts
Your goal is to gently press the accelerators and ease off the brakes.
Basson’s circular model – desire can follow arousal
Many women do not feel spontaneous desire at the start of sexual activity. According to Basson’s model, a woman at baseline is neither motivated nor avoidant of sex; with appropriate stimulation (comfort, closeness and relaxation), arousal occurs and desire can build afterwards. In other words, it is normal for desire to follow arousal rather than precede it.
Step-by-step plan to support desire
1. Ease off the brakes
- Protect sleep and reduce stress. Set aside time for rest before intimacy. Slow breathing for several minutes, a short walk or a warm shower can calm the mind. Try planning intimacy earlier in the day when you feel less tired.
- Manage pain or dryness. Use a generous amount of fragrance-free lubricant every time you have sexual contact. A vaginal moisturizer several times a week can improve comfort. dryness) can be treated. If pain persists, talk with your clinician – many causes (for example, menopause – related dryness) can be treated.
- Review medications and health conditions. Some medicines (like certain antidepressants) and conditions (such as thyroid disease or diabetes) can lower desire. Ask your doctor about alternatives.
2. Press the accelerators
- Build daily connection. Spend 10–20 minutes each day without screens simply talking, cuddling or giving a brief massage. Focus on warmth and closeness rather than sexual performance.
- Plan low-pressure intimacy. Schedule one or two times per week to be intimate with no pressure for orgasm. Agree that either partner can pause at any point.
- Create a soothing environment. A warm room, soft lighting and your favorite music can help you relax.
3. Communicate kindly
- Use short “I” statements, such as “I like it when…,” “Softer,” “More,” or “Here.”
- Have a weekly 10-minute check-in with your partner. Share one thing that felt good and one small change for next time. Focus on collaboration rather than blame.
What to expect
It is normal for desire to ebb and flow. Many women find that starting with comfort and connection rather than waiting for desire to appear leads to improvement. Progress is usually gradual over weeks. Celebrate small wins and adjust together. Expect setbacks; they are part of the process.
When to seek extra help
- Persistent distress about low desire, pain with sex, fear of intercourse or difficulty relaxing pelvic muscles.
- Sudden changes in desire after starting a new medication or after a health event.
- History of trauma or significant relationship problems.
Brief counseling with a trained therapist (cognitive behavioral or mindfulness-based) can be very helpful.
Medicines that may be discussed
Two prescription medications that may be discussed – flibanserin (a daily tablet) and bremelanotide (an on-demand injection) – are approved for premenopausal women with acquired, generalized HSDD. They offer modest benefits and may have side effects. Testosterone therapy may be considered off-label for postmenopausal women after weighing risks and benefits. These medicines are usually considered after education and behavioral steps and after addressing any pain or medical contributors.
Key takeaways
- Sexual desire is influenced by both accelerators and brakes. Easing the brakes (stress, fatigue, pain) and pressing the accelerators (connection, positive touch) helps rebalance desire.
- Desire does not always come first; it often grows after feeling safe, close and aroused. Try starting with comfort and let desire build.
- Simple steps like mindfulness, open communication and treating pain or dryness are effective first approaches. Progress may be gradual, so be patient and kind to yourself.
