6 Reasons Your Sex Life Might Be Suffering—And What to Do About It

Sexual health is health

Jun 17, 2025

ICYMI 👉

🙋🏻‍♀️ Today at 5 pm ET, I’ll be talking live with Dr. Rachel Rubin, board-certified urologist and sexual medicine specialist. Join here!

We will explore the topics of sexual health, menopause, and genitourinary health (for men and for women) in greater depth and will discuss specific treatment approaches for menopause and common sexual health concerns. Bring your questions!

I recently saw a happily married middle-aged woman who reported a near-zero interest in sex. I jokingly told her I could fill an auditorium with women telling me the same thing. When I asked her to elaborate, she said intercourse had become uncomfortable and unsatisfying—but quickly added, "I know that's normal at my age." Her partner had started taking it personally, creating tension in their 20-year marriage.

It turns out that her symptoms—vaginal dryness, decreased arousal, occasional UTIs, and some urinary frequency—were imminently treatable. But, like many women, she assumed declining sexual function was an inevitable part of aging that she should simply accept.

Sound familiar?

The assumption that sexual problems are normal, inevitable, or untreatable keeps millions of people suffering unnecessarily. Whether you're dealing with pain, decreased desire, performance issues, or relationship strain around intimacy, these problems often have identifiable causes and effective treatments.

"Doctors are not trained to give a crap about your sexual health, and that's a problem," Dr. Rachel Rubin explains. This medical neglect leaves people struggling with issues that could often be effectively addressed with proper evaluation and treatment.

Be sure to bring your questions to my conversation with Dr. Rubin later today. (Join here!) In the meantime, here are six common reasons your sex life might be suffering—and what you can actually do about them.

yellow papaya and two lemons — Photo by Ed O'Neil on Unsplash

1. Hormonal Changes

For many people, sexual problems stem from hormonal shifts that profoundly affect sexual function. These changes aren't just about menopause—they can occur at any age due to various factors.

For women, perimenopause and menopause bring dramatic drops in estrogen and testosterone that affect every aspect of sexual function. As Dr. Rubin explains, "Your genitals are hormone sensitive. When there are hormones, they thrive, they are thick, they lubricate, they are healthy, they are acidic." When hormone levels decline, the tissues become thin, dry, and more prone to irritation and infection.

This leads to genitourinary syndrome of menopause (GSM), a condition affecting up to 84% of postmenopausal women. GSM encompasses vaginal dryness, painful intercourse, decreased arousal, urinary frequency, and recurrent UTIs. "When your hormone levels start to drop, you start getting urinary frequency or urgency, you start to get itching, burning, and dryness, and you may start to have pain with sex. Your orgasm may be muted, and no one is explaining anything to you."

But hormonal changes aren't limited to natural menopause. Birth control pills can suppress testosterone production, affecting libido and arousal in younger women. Breastfeeding creates a low-estrogen state that can cause vaginal dryness and decreased interest in sex. Antidepressants can alter sexual function.

For men, gradual testosterone decline with age can affect libido, energy, and sexual performance. Medical conditions like diabetes or treatments like cancer therapy can also disrupt hormonal balance.

What you can do: Hormonal sexual dysfunction is often highly treatable. For women with GSM, vaginal estrogen or DHEA therapy can restore tissue health and sexual function. Dr. Rubin advocates that any woman with symptoms should consider vaginal hormones, whether in the form of vaginal estrogen or vaginal DHEA because they're extremely safe and effective. For systemic hormone deficiencies, hormone replacement therapy may be appropriate, especially for women within the 10-year window after their last menstrual period. The key is getting proper evaluation to identify hormonal causes rather than accepting dysfunction as inevitable.

2. Low libido

Loss of sexual desire is one of the most common sexual complaints, affecting people of all ages and genders. Unlike arousal or orgasm problems, low libido involves a fundamental lack of interest in sexual activity that can persist even when physical function is normal.

For women, hypoactive sexual desire disorder (HSDD) can develop due to hormonal changes, medications, stress, relationship issues, or medical conditions. It's particularly common during perimenopause and menopause when testosterone levels decline alongside estrogen.

For men, low libido is often related to declining testosterone levels, though psychological factors, medications, and chronic health conditions can also play a role.

The challenge with low libido is that it can become self-perpetuating. When you're not interested in sex, you have it less frequently, which can lead to further disconnection from your sexual self and partner.

What you can do: Several treatment options exist for low libido, though they require careful evaluation to identify underlying causes. According to the North American Menopause Society (NAMS), approximately 10% to 12% of women meet the criteria for hypoactive sexual desire disorder, with the highest prevalence in midlife women, ranging from 14.5% to 33%. Their clinical pearls on the Clinical Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women are here.

For women with HSDD, two FDA-approved medications are available. Addyi (flibanserin) is a daily pill that works on brain neurotransmitters involved in sexual desire. Vyleesi (bremelanotide) is an injection used before sexual activity that affects pathways in the brain related to arousal and desire. Both require prescription and careful monitoring, as they can have side effects and interactions with other medications.

Testosterone therapy can be helpful for both men and women with low libido related to hormone deficiency. For women, this is considered off-label use and requires careful consideration of risks and benefits, plus close monitoring of blood levels. For men with documented low testosterone, replacement therapy can significantly improve libido along with other symptoms.

Addressing underlying causes is equally important. This might involve switching medications that suppress libido, treating depression or anxiety, addressing relationship issues, or managing chronic health conditions that affect sexual desire.

The key is comprehensive evaluation rather than assuming low libido is just a psychological issue or inevitable consequence of aging.

3. Vascular Problems Affecting Blood Flow

Sexual function depends heavily on adequate blood flow to genital tissues. Vascular problems that affect circulation throughout the body also impact sexual organs, often before causing symptoms elsewhere.

For men, erectile dysfunction is frequently the first sign of cardiovascular disease. The blood vessels in the penis are smaller than those supplying the heart, so circulation problems often show up there first. Conditions like diabetes, high blood pressure, high cholesterol, and smoking all damage blood vessels and can cause erectile dysfunction years before causing heart problems.

For women, reduced blood flow affects arousal, lubrication, and orgasm intensity. The same cardiovascular risk factors that cause erectile dysfunction in men can impair sexual function in women, though this connection is less widely recognized.

What you can do: Treating underlying cardiovascular conditions often improves sexual function. This might involve managing diabetes, controlling blood pressure, lowering cholesterol, or quitting smoking. Exercise, particularly cardiovascular exercise, can improve blood flow throughout the body, including to sexual organs. For men, medications like sildenafil (Viagra) can directly address blood flow problems. Similar medications are being studied for women with vascular-related sexual dysfunction.

4. Pelvic Floor Dysfunction

The pelvic floor muscles support your pelvic organs and play a crucial role in sexual function. When these muscles are too tight, too weak, or poorly coordinated, they can cause significant sexual problems.

Tight pelvic floor muscles can cause painful intercourse, difficulty with penetration, and reduced sexual sensation. This often develops in response to pain, stress, or trauma, creating a cycle where muscle tension causes more pain, leading to more tension.

Weak pelvic floor muscles can contribute to reduced sensation during sex, difficulty reaching orgasm, and problems with urinary incontinence that interfere with sexual confidence.

Many people develop pelvic floor dysfunction after childbirth, pelvic surgeries, or in response to chronic stress or trauma. Others may have underlying conditions that affect muscle function.

What you can do: Pelvic floor physical therapy can be transformative for sexual function. Specialized physical therapists can assess muscle function and provide targeted exercises and treatments to address both tension and weakness. This might involve relaxation techniques, strengthening exercises, manual therapy, or biofeedback training. Don't assume pelvic floor problems will resolve on their own—they typically require specific intervention.

5. Medication side effects

Many common medications can significantly impact sexual desire, arousal, and orgasm, yet patients are rarely warned about these effects or offered alternatives.

Antidepressants, particularly SSRIs, are notorious for causing sexual side effects including decreased libido, delayed orgasm, and reduced sexual satisfaction. These effects can persist even after stopping the medication in some cases.

Blood pressure medications, antihistamines, birth control pills, and many other drugs can also interfere with sexual function through various mechanisms—affecting hormone levels, blood flow, or nervous system function.

The problem is compounded when patients don't realize their medications might be causing sexual problems, or when healthcare providers dismiss these concerns as less important than treating the primary condition.

What you can do: Never stop medications without medical supervision, but do discuss sexual side effects with your healthcare provider. Often, alternative medications with fewer sexual side effects are available. Sometimes adjusting dosages or timing can help. In some cases, adding medications to counteract sexual side effects might be appropriate. The key is having an honest conversation about how medications are affecting your quality of life, including your sexual function.

6. Psychological and Relationship Factors

Sexual function is profoundly influenced by mental health, stress levels, relationship dynamics, and life circumstances. Even when physical factors are addressed, psychological barriers can maintain sexual problems.

Stress and anxiety trigger the body's fight-or-flight response, which diverts blood flow away from sexual organs and makes arousal difficult. Chronic stress can suppress hormone production and make it nearly impossible to relax enough for satisfying sexual experiences.

Depression can eliminate sexual desire and make physical pleasure difficult to experience. The relationship between depression and sexual dysfunction is bidirectional—sexual problems can contribute to depression, while depression worsens sexual function.

Relationship issues—poor communication, unresolved conflicts, differing sexual needs, or lack of emotional intimacy—can create barriers to satisfying sexual experiences even when physical function is normal.

Performance anxiety can develop after experiencing sexual problems, creating a cycle where worry about sexual performance makes sexual problems worse.

What you can do: Addressing psychological factors often requires a multi-pronged approach. Stress management techniques, regular exercise, adequate sleep, and mindfulness practices can all improve sexual function. Relationship counseling or sex therapy can help couples address communication issues and develop strategies for rebuilding intimacy. Individual therapy might be needed to address depression, anxiety, or trauma that's affecting sexual function. The key is recognizing that sexual problems often have psychological components that deserve attention alongside physical causes.

What You Can Do Starting Today

If you're experiencing sexual problems, start by recognizing that they're not character flaws or inevitable consequences of aging—they're often medical issues with identifiable causes and effective treatments.

Seek appropriate medical care. This might mean talking to your primary care provider, but don't hesitate to seek specialized care from urologists, gynecologists, or sexual medicine specialists who are comfortable addressing these issues comprehensively.

Be honest about all your symptoms. Sexual problems often connect to other health issues—like the UTIs and urinary frequency that my patient mentioned alongside her sexual concerns. Giving your healthcare provider the complete picture helps identify underlying causes.

Don't accept dismissive responses. If a healthcare provider tells you sexual problems are "normal for your age" or suggests you just "use more lubricant," consider seeking a second opinion. Effective treatments exist for most sexual health problems.

Address relationship factors. Even when medical treatments are helpful, open conversations with a sexual partner can be a great place to start. Relationship counseling or sex therapy might be needed to rebuild intimacy and communication around sexual needs.

Remember that sexual health is health. Prioritizing sexual function isn't vanity—it's an important component of overall wellbeing that affects relationship satisfaction, mental health, and quality of life.

The Upshot

Sexual problems are common but not inevitable. With proper evaluation and treatment, most people can experience significant improvement in sexual function and satisfaction. The first step is breaking the silence and seeking the care you deserve.