Low libido

When you first met your partner, there was electricity, there was passion, and there was sex—lots of it! Now, it’s a challenge to remember the last time you were naked together. “Virtually all relationships go through some sort of tapering-off period, typically after 6 months to a year,” says San Francisco-based licensed marriage and family therapist Vanessa Marin. In a National Institutes of Health study that followed couples over 30 years, a whopping 75% reported a decline in bedroom activity over time.

While there are dozens of reasons for lack of lust—from illness to stress to scheduling—the truth is that sex is healthy for body and mind and builds closeness, intimacy and a sense of partnership in your relationship. A 2013 study in the journal Sex and Marital Therapy found that women who are sexually satisfied report higher levels of overall wellbeing than women who aren’t getting the same satisfaction. We invite you to recognize the real-life obstacles to your healthiest, most fulfilling sex life, so you can find ways to overcome them.

 You’re too busy playing Candy Crush

Smartphones keep us connected to everyone except the one person we’re sleeping with. “We’re on our phones and computers when we spend time together, before we go to sleep and all too often first thing when we wake up,” says Amy Levine, sex coach and founder of IgniteYourPleasure.com. In a 2015 study of nearly 150 married women, 70% said that technology interferes with their sex lives.

 Sex Rx: Turn off to get turned on. You could agree to quiet notifications during QT with your partner, but if that’s unrealistic, try putting sex on the schedule. “The idea of spontaneity is exciting, but if you want it and it's not happening, you have to plan for it,” Levine says. There’s still plenty of room for spontaneity, she adds, as all you're planning is the time slot—not how the deed will unfold.

 You’re busy with stuff

When it comes to day-to-day priorities, sex often falls low on the totem pole. “We prioritize the things that stress us out the most, even if it’s emptying the dishwasher,” says Anita Clayton, MD, University of Virginia psychiatry professor and author of Satisfaction: Women, Sex, and the Quest for Intimacy. “When our partner approaches us, we think, ‘I have to get this done and you’re talking about that?’”

 Sex Rx: Accept the fact that the dishes and laundry will still be there later, and a roll in the hay will likely not decimate your world order. Take 20 minutes out of the multitasking marathon of life for some private time with your partner, which is likely to be heaps more rewarding than an empty dishwasher or a neat pile of shirts.

 You’re letting stress win

Stress is par for the course, especially for women. The American Psychological Association’s 2014 Stress In America survey confirms that women report higher stress levels than men, and are more likely to feel stressed in the first place. What's important is how we manage it. “Some people can handle pressure and crises in their life and stay calm and loving,” says Stanley Ducharme, PhD, clinical psychologist and sex therapist at Boston Medical Center. “Other people sort of fall apart—they get frustrated and upset and need to blame someone.”

 Sex Rx: Find healthy outlets for stress, whether it’s yoga, running, a painting class or…sex! Unless your partner is directly responsible for your stress (more on that later), connecting in a physical, soulful way will bring on the happy hormones and send stress packing.

 You haven’t laced up your sneakers in weeks

 Besides easing stress and boosting mood, exercise increases blood flow to your lady parts and stimulates feel-good hormones, allowing you to get turned on more quickly and easily and heightening sensation. In a study from the University of Texas at Austin, women who rode stationary bicycles for 20 minutes got more physically aroused by a racy film clip than women who had filled out paperwork beforehand. Other research suggests men benefit too, so if you’re not moving, you’re missing out on this biochemical foreplay. “The brain is very plastic, so the more you reinforce those circuits, the better they work,” Clayton says. “And if you don’t use it, there’s this atrophy.”

 Sex Rx: Move your body for at least 30 minutes a day—bonus if it’s just before sex. And if you can work out together with your partner, even better!

 You’re obsessed with your weight

 Worrying about a muffin top, saddlebags, a spare tire, cellulite, or other perceived body flaws can leave you hiding under the covers—especially if your body has changed after pregnancy or packing on some pounds. “Whether you realize it or not, your body image has a huge effect on how you feel and act sexually,” says relationship expert Terri Orbuch, PhD, author of 5 Simple Steps to Take Your Marriage from Good to Great. Your self-consciousness can lead to avoiding sex, but it can plant seeds of doubt in your partner’s mind. He (or she) might think: Does she not love me? Is there someone else? Am I doing something wrong?

 Sex Rx: Stay present during sex. “So often we’re not in the moment—we’re above it or outside of it looking in and thinking, ‘Oh God, I look so unattractive,’” Clayton says. “It changes that emotional intimacy that’s part of experiencing pleasure with a partner.” To help yourself stay in the moment, try replacing doubting thoughts with a narration of the action: “My partner is caressing me and it feels good.”

 Everything you know about sex you learned from Hollywood

 First they kiss; then their hands wander; and soon they’re intertwined, feverishly thrusting until the man orgasms. That may work for the big screen, but it may not work for you. Believing that sex happens only in a set way can be intimidating and dampen the impulse to try. “Instead of being goal-oriented, women tend to be more pleasure-oriented, like a circle, with each sensation on the perimeter of the circle and an end unto itself, not necessarily culminating in a climax,” says Rutgers University sex researcher Beverly Whipple, PhD.

“Women can feel good about whatever brings them pleasure—they don’t have to fit into a mold.” Whipple’s study in the Journal of Sex Research confirms that women’s sexual responses don’t fall neatly into one pattern, but come from a variety of stimuli and can light up the same parts of the brain as men’s do when they reach orgasm.

 Sex Rx: Give yourself permission to feel sensual and sexual pleasure in non-textbook ways. Pursue what truly feels good without pressure to perform.

 The sex plays out like reruns on Hulu

 The same-old, same-old can leave you tired and uninspired. “Couples tend to fall into what's quick and easy rather than what's fulfilling and adventurous,” Levine says. “On one hand, it’s nice to feel known and understood by your partner sexually, but on the other hand, familiar routines easily get stale.”

 Sex Rx: A 2014 study shows that if you’re motivated to satisfy your partner’s sexual needs (within reason), your partner will detect this responsiveness and in turn, feel more satisfied and committed to the relationship. To show your can-do spirit, Levine recommends that you and your partner list 20 new sexual experiences to do or try—think scented candles, a sexy playlist, dirty talk, or trying out toys. Rate the ideas on a scale of 1 to 5—1 being “don't like and don't want to try” and 5 being “love and/or want to try,” and plan a time to give your top picks a whirl.

 You’re too comfortable

 Security, predictability, and stability are part of the beauty of marriage—hello, sweatpants and Netflix! But they can also be its undoing in the bedroom. That’s because we also crave novelty, adventure, and discovery—and we’re in a position, paradoxically, to have to get both of these needs met by the same person.

 Sex Rx: The key to desire is wanting, not having, according to couples therapist Esther Perel, author of Mating in Captivity ($13; amazon.com). Wanting each other is the electric current that first brought you together, and the thing you want to recapture to spark up your sex life. Go for the big tease: send a tantalizing text or suggestive selfie; create a calendar invite for a VIP meeting under the sheets; or give him a sneak peek of lace underthings while you're at a party or restaurant (or whisper that you're wearing no underthings at all). These bold moves are themselves a kind of foreplay—you’ll both come home with only one thing on your mind.

 You’re seriously just not interested

The majority of visits to sex therapists and sex medicine doctors are because of low libido, says Ducharme. Although “low libido” can have dozens of causes, in women,  hypoactive sexual desire disorder often has to do with pain with sex, difficulty with lubrication, and difficulty reaching orgasm. “If a woman has low libido, most often there are other difficulties that go along with that,” he says.

 Sex Rx: In 2015, the FDA approved Addyi, or Flibanserin, the first medication to treat hypoactive sexual desire disorder in pre-menopausal women. Unlike Viagra, which brings blood flow to the genitals, the controversial drug works in the brain, boosting the release of the pleasure hormones dopamine and norepinephrine and tamping down serotonin, which can decrease sexual interest and pleasure if released in the wrong place at the wrong time. Talk to your doctor about whether you’re a candidate for Addyi, or whether there are other remedies that might help—such as vaginal estrogen, lubricants, clitoral pumps, or pelvic floor therapy.

You're having technical difficulties

 As we age, it’s not unusual for men to have trouble getting it up or keeping it up, thanks to medications or health issues like hypertension, high cholesterol, and diabetes. “Anything that affects blood flow affects a man’s ability to achieve and maintain an erection,” Ducharme says. “Erections just aren’t as reliable, they’re not as firm, and they’re not as predictable.” This can become a source of anxiety and make sex feel more obligatory than fun. You may start to feel embarrassed, humiliated, and inadequate in the sack, which only makes them want to avoid it more.

 Sex Rx: Get checked out by a doctor, especially since problems in bed could point to bigger health issues. “These kinds of sexual dysfunction are treated very effectively these days,” Ducharme says. And in the meantime, roll with the punches. If you get an erection, great, let’s have fun, Ducharme says. “If not, let’s just enjoy being naked together and touching and kissing and enjoying what we can do.”

 You’re not feeling super connected right now

 In this age of tag-team parenting and 80-hour workweeks, staying connected can feel impossible. And yet for many people, intimacy is a prerequisite for sex. “Most women need to feel connected to their partner before they’ll engage in touching, hugging, kissing, which then, and only then, leads to actual sex,” Orbuch says. “But for men, it’s the reverse. It’s the act of having sex that makes them feel connected, which can then lead to touching, hugging, and other acts of affection.” And yet, feeling bonded is obviously important for both partners, as is clear from the results of a study in the Journal of Sex showing that married couples have more sex during periods of greater intimacy.

 Sex Rx: Inject some flirtation into life outside the bedroom. Leave a heartfelt sticky note on your partner's laptop, sneak a kiss, or even pay an unexpected compliment. Lighting the sexual pilot light, as it were, will make it easier to get a roaring fire going.

 You’re pissed off

 Tensions in the relationship take a heavy toll in the bedroom. “If you’re annoyed with your partner, you’re probably not going to want to have sex with that person,” Dr. Clayton says.

 Sex Rx: Any strong emotions that you don’t acknowledge will only erode your intimacy and trust over time, Dr. Clayton says. Hashing out issues—outside of the moment (that’s key)—will help resolve minor quibbles before they snowball into major problems. A 2015 study of women suffering from sexual dysfunction showed just how important communication can be. While one group of women got a nasal spritz of the bonding hormone oxytocin before sex and the other group got only a spritz of a placebo, both groups enjoyed similar improvements in sex, according to the diaries they kept. The study author credits the fact that in keeping diaries, the women thought more about their sexuality and communicated more with their partners about sex during the course of the study, potentially clearing up any misunderstandings that were preventing them from fully expressing and enjoying their sexuality.

 You’re feeling blue

 If you feel tired, forgetful, and indecisive, your sex life may not be the only thing that’s off. About 19 million Americans suffer from depression, according to the National Institute of Mental Health, affecting 10 to 25% of women at some point in their lives. Unfortunately, depression goes hand in hand with low sexual desire. “If you’re depressed, you’re much more likely to have low sexual desire, and if you have low sexual desire, you’re more likely to have depression,” Dr. Clayton says. They feed off one another in a vicious circle.

 Sex Rx: The dynamic duo of exercise and meditation just twice a week can ease depression, according to 2016 findings from Rutgers University. If you prefer to pop a pill, talk to your doctor about an anti-depressant that is not a selective serotonin reuptake inhibitor (SSRI), which have been known to affect sexual function. Medications such as Brintellix, Vybrid, Wellbutrin, Remeron, and Mirtazapine help lift the blues without zapping your sex drive, Dr. Clayton says. Wellbutrin may actually boost your sex drive.

 Your bedroom isn’t exactly a love nest

 Scenery makes a difference. Having work papers on the night table, family photos on the dresser, cell phones pinging and dinging, and a TV blaring horrible news is unlikely to set the stage for romance. Ditto the bright overhead lighting and flannel bedding that beckons sleep before sex.

 Sex Rx: Levine encourages a sex-friendly bedroom makeover: Clear out anything that reminds you of work, stress, or your parents (or in-laws), and banish the big screen, which may discourage the kind of pillow talk that leads to sex. Then add romantic touches like bedside candles for ambient light, throw pillows for adventurous positioning, a plush rug as an alternate spot for lovemaking, and even a stash of “pleasure props” in the nightstand. (Or at least a good tube of lube.) Make sure there’s a lock on the door for privacy—then you’ll know you’re alone, at least until you hear little knocks.

 One word: Kids

 It’s natural to lose interest in sex temporarily after having a baby. “That can be biologic because of hormonal shifts, or because we tend to gain weight and because our roles change,” Dr. Clayton says. “We go from being a sexy hottie to a nurturing mother.” And a dip in sex drive isn't limited to biological moms; dads and adoptive parents have to deal with dirty diapers, burping, and soothing, too, leaving you with radically less time to just be a couple and do the fun, romantic things that brought you together in the first place. Even when the kids get older, they’re still around, making privacy elusive.

 Sex Rx: You’ve heard the advice to plan for date night, and that’s a great first step. “But honestly,” Dr. Clayton says, “having some time to just be together without the distraction of the children can help restore a spark there.” Try to schedule an adults-only getaway about every two months, even it’s just to a hotel a mile down the road.

 You’re not a pro at orgasms

 f the big “O” is more like the big “eh,” you might feel less compelled to get busy. “It’s not unusual for women to have elusive orgasms, especially when they’re focused on the outcome, when it's really about the journey,” Levine says. And many of us haven’t gotten to know our bodies as well as we could. “You can't expect someone else to get you off if you don't know how you like to be touched.”

 Sex Rx: Take responsibility for your own desire by exploring what turns you on in solo sessions or with your partner, Levine says. As a bonus, having more orgasms will fortify your bond, according to a 2014 study from the University of Connecticut, which could lead to yet more orgasms. When the hormone oxytocin floods your brain immediately after climax, the researchers found, you’re more likely to share important, usually positive, information with your partner. According to the lead study author, post-coital communication is key to sexual and relationship satisfaction.

 Medication is getting in the way

The answer to your low libido could be sitting in the medicine cabinet. Antidepressants (including SSRIs such as Prozac and Zoloft and tricyclic antidepressants such as Elavil), anti-anxiety drugs, beta-blockers, blood pressure medications, steroids, pain medications, birth control pills, and even antibiotics, antihistamines, and diuretics may dampen desire. “They change your body chemistry and can cause sexual side effects,” Orbuch says. Antihistamines, for example, dry out your body’s mucous membranes, robbing you of natural lubrication. Antidepressants inhibit the key neurotransmitters dopamine and noepinephrine, keeping orgasms out of reach. Birth control pills dampen your libido by boosting production of a protein that makes testosterone unavailable.

Sex Rx: You’re not stuck choosing between good sex and good health. Talk to your doctor about switching medications, trying alternative remedies or just changing up the dosage or timing of your existing Rx to minimize its effect on your mojo.

 You’re sick

 Not feeling well can put the kibosh on sex. There’s a laundry list of conditions that can dampen your drive—from sleep apnea and stress incontinence to diabetes and thyroid disorders. “Any illness that damages nerves or blood vessels or hormones can cause problems with sexual functioning,” Dr. Clayton says.

Sex Rx: If you suspect your system is out of whack in some way—you’re not sleeping well, you feel especially sluggish, or your menstrual cycle has gone screwy—talk to your doctor to see if you can pinpoint the cause and get any conditions under control.

 You need more life outside the bedroom

 Your nights and weekends all blend together in a haze of cooking, cleaning, parenting, TV, and Facebook. But when life is boring, sex is boring. “One of the reasons sex is so wonderful at the beginning of a relationship is because everything is new and exciting,” says Orbuch.

 Sex Rx: Recapture the newness of your dating days by doing something different together—ideally an activity that gets your adrenaline pumping. “Your brain will naturally transfer the feeling of novelty onto your relationship,” Orbuch says. “You feel physical arousal in your body and pin the cause of it on your partner—and one kind of arousal can stimulate another.” Take a surfing or snowboarding lesson, train for a marathon, or take in a box-office thriller that gets you gripping each other in fright.