Low Libido in Women: How Hormones, the Brain, and Modern Life Shape Desire

February 8, 2026 

For generations, women were never taught how their bodies actually work sexually.

I never learned about sex from my mother because she was not comfortable talking about it. Many of us grew up believing that difficulty with arousal, lubrication, or orgasm meant something was “wrong” with us. In reality, female sexual response is complex, hormonally driven, and deeply connected to brain health.

When desire fades, it is rarely a personal failure. It is information.

Sexual Desire Is a Marker of overall Health

Low libido is one of the most common—and least discussed—concerns women experience across midlife and beyond. Libido is a marker of overall vitality and is often one of the first signs that something in the body is out of balance—whether hormones, brain neurotransmitters, sleep, stress, metabolic and nutrition, or emotional relationship safety. When libido changes, the body is communicating, not malfunctioning. Understanding desire through this lens allows women to move away from self-blame and toward informed, compassionate care.

The Female Brain: The Hormone–Neurotransmitter Dance

Psychiatrist Luanne Brizendine, author of The Female Brain and neuroscientist Lisa Mosconi have shown that women’s brains are extremely sensitive to hormonal change across their lifespan. Estrogen fuels the female brain. Progesterone promotes calm and emotional safety. Testosterone supports motivation and desire. Neurotransmitters such as dopamine and oxytocin shape anticipation, bonding, and pleasure.

It’s also important to zoom out for a moment. Across age groups — especially among younger adults — people are having less sex than previous generations. Large population studies show declines in sexual frequency, fewer in-person relationships, and more social isolation, driven by digital communication, dating apps, and fewer real-world connection opportunities. Mostly this is occurring in the Millennial and Gen Z groups but is also happening to many others— it’s not anecdotal—it’s been shown in large national surveys.

So when people say, ‘Is something wrong with me?’ — often the answer is no. The environment has changed.

Oxytocin: The Hormone of Connection, Trust, and Touch

Libido is not driven by only hormones and neurotransmitters related to desire — it is also deeply influenced by connection, safety, and touch. This is where oxytocin plays a critical role.

Often called the bonding hormone, oxytocin helps shift the nervous system out of stress mode and into calm, receptivity, and connection. It is released through affectionate touch, emotional intimacy, trust, orgasm, and close physical connection. Without this nervous-system shift, desire may struggle to emerge — even when other hormones appear adequate.

Low oxytocin signaling — commonly driven by chronic stress, emotional disconnection, trauma, sleep deprivation, or life-stage hormonal shifts — can make intimacy feel like a “to do” list item or emotionally distant rather than pleasurable.

Oxytocin works alongside estrogen, testosterone, and dopamine, creating the internal environment needed for desire. You can support it naturally through connection, touch, rest, and stress regulation — all foundational to sexual health.

When hormones change, the brain changes—and libido often follows.

Hormones That Matter for Libido

Hormones don’t act alone. They dance with neurotransmitters. If progesterone drops, GABA drops. If estrogen drops, brain fuel changes. That’s why women say ‘I don’t feel like myself anymore’.

Estrogen

Estrogen supports vaginal tissue integrity, elasticity, lubrication, and blood flow, while also serving as a primary fuel source for the female brain. As estrogen declines during perimenopause and menopause, women may experience vaginal dryness, discomfort with intercourse, decreased arousal, brain fog, and memory changes. These are physiological changes, not psychological ones.

Progesterone

Progesterone is a neuroprotective hormone closely paired with the calming neurotransmitter GABA. It supports sleep, emotional regulation, and a sense of safety—conditions that are essential for desire. Progesterone levels begin declining in the mid-30s and may contribute to anxiety, irritability, poor sleep, and reduced libido long before menopause.

Testosterone (Yes, in Women)

Testosterone plays a critical role in sexual desire, motivation, orgasmic intensity, muscle tone, and vitality in women. Levels decline with age and can be further suppressed by chronic stress and certain medications. When used thoughtfully and at physiological doses, testosterone can be an important component of restoring libido in women who have tested their levels appropriately.

DHEA

DHEA is a precursor hormone produced by the adrenal glands and is involved in stress response, immunity, bone health, mood, energy, and sexual receptivity. Levels naturally decline with age, and low DHEA may contribute to reduced vitality and desire. An important study showed that DHEA used vaginally increased response, orgasm, and relieved vaginal dryness.

Cortisol

Cortisol is the body’s primary stress hormone. Chronic elevation competes with sex hormones and suppresses libido. Ongoing stress, under-eating, poor sleep, and burnout often keep cortisol elevated, shutting down desire even when sex hormone levels appear “normal” on testing. We covered testing in my last WTF podcast and associated blog.

Libido is best understood as a hormone–neurotransmitter symphony. When one instrument is out of tune, the music changes.

• Estrogen ↔ brain glucose metabolism
• Progesterone ↔ GABA, calm, sleep, safety
• Testosterone ↔ desire, stamina, orgasm
• DHEA ↔ mood, receptivity, vitality
• Cortisol ↔ insulin resistance, brain fog, weight gain
• Oxytocin ↔ bonding, orgasm, stress buffering

When we talk about hormones and desire, we also have to talk about insulin — a hormone that quietly shapes sexual health through its effects on blood sugar, circulation, and inflammation. Even subtle insulin resistance can impair blood flow to sexual tissues, alter hormone signaling, and reduce responsiveness to stimulation. This makes diet a foundational part of the libido conversation.

Sugar & Simple Carbs: The Libido Blocker

High insulin quietly damages the microvasulature to the genitals and starves the genitals of blood flow by reducing nitric oxide. And without blood flow, arousal and orgasm become harder—no matter how good your hormones look on paper.

This affects men and women equally

Insulin Resistance & Clitoral Blood Flow:

Like all erectile tissues, the clitoris relies on microvascular health to engorge and respond.

Insulin resistance and metabolic syndrome impair small blood vessel function — affecting clitoral engorgement and sexual arousal, similar to how they affect penile erectile function. That’s an overlooked link between metabolic health, libido, and sexual satisfaction.

Eating for Hormone Balance & Blood Flow

“Once insulin is under control, food becomes medicine for libido.”

Food supports:

• Estrogen & testosterone balance
• Mood & energy
• Nitric oxide production
• Prostaglandins (critical for arousal & orgasm)

Once diet improves insulin sensitivity and circulation, the body can actually respond to stimulation. That’s when hormones work better, and that’s when clitoral health and self-pleasure tools become effective instead of frustrating.

Diet plays a foundational role in libido by influencing insulin, circulation, nitric oxide production, and hormone balance. For readers who want specific foods that support sexual health, an expanded food list is included below in the Addendum.

Bottom line for sexual health foundation:

• Low or no simple carbs
• No added sugar

Muscle Health: The Missing Link in Libido Conversations

Libido is often discussed in terms of hormones, stress, or relationships, but there is another critical piece that deserves attention: muscle health.

As taught by Gabrielle Lyon, D.O., through her Muscle-Centric Medicine® framework, skeletal muscle is not just for strength or appearance. It functions as an active metabolic and signaling organ that helps regulate blood sugar, inflammation, circulation, and hormonal balance.

Why does this matter for libido?

Sexual desire and arousal depend on energy availability and blood flow. When muscle mass and strength decline — something that accelerates with aging, inactivity, insulin resistance, and inadequate protein intake — the body becomes less efficient at controlling blood sugar and supporting healthy circulation. Over time, this can impair blood flow to sensitive tissues, including the genitals, making arousal slower and orgasm more difficult.

Healthy muscle supports:

• Improved insulin sensitivity
• Better nitric oxide signaling and vascular function
• Reduced inflammation
• More stable hormone signaling

This helps explain why preserving muscle through appropriate nutrition, resistance training, and metabolic support is increasingly recognized as foundational not only for longevity — but also for sexual vitality and responsiveness, particularly in midlife and beyond.

And when muscle, hormones, and circulation are working together, the body is far better equipped to respond to sexual stimulation and desire.

Why Muscle Matters During Rapid Weight Loss

An important clinical consideration in this muscle conversation is the growing use of GLP-1 medications for weight loss. While these medications can improve insulin sensitivity and support metabolic health, rapid weight loss without adequate protein intake and resistance training can accelerate muscle loss, a condition known as sarcopenia.

As Dr. Gabrielle Lyon and others have emphasized, muscle is where excess glucose is meant to go. When muscle mass is lost too quickly, the body’s ability to clear glucose from the bloodstream is reduced, insulin resistance can worsen, and circulation may suffer — including circulation to sexual tissues. Over time, this can undermine energy, strength, libido, and sexual responsiveness, even as the number on the scale goes down.

GLP-1 medications must be paired thoughtfully with muscle-preserving strategies, including adequate protein intake, resistance-based movement, and metabolic monitoring. Preserving muscle is not just about being strong or living longer — it is essential for vascular health, hormonal signaling, and sexual function.

This discussion focuses on the physiological effects of rapid weight loss on muscle, insulin sensitivity, and circulation. GLP-1 medications effects on libido, brain chemistry, and lived experience is addressed later in the medications section.

The Role of Female Sexual Anatomy: Why the Clitoris Matters

“For decades, medical textbooks described the clitoris as a small external structure. In the late 1990s, Australian urologist Helen O’Connell published landmark anatomical and MRI imaging revealing that the clitoris is far more extensive than previously understood. Her work showed that nearly two-thirds of clitoral tissue is internal, forming a wishbone-like structure extensive erectile tissue surrounding the vaginal canal — helping explain why adequate arousal, blood flow, and time are essential for comfort and orgasm. This discovery helped explain why so many women struggle with pain, dryness, or dissatisfaction when arousal is rushed or misunderstood.

What followed over the next decade was slow uptake into medical education, clinical practice, and public awareness.

The clitoris is far more than a small external nub. Modern research shows:

• The clitoris is a wishbone-shaped organ, with internal crura and bulbs that wrap around the vaginal opening. Most of it is internal — only the tip or “glans” is visible.
• It’s the homologue of the penis — same embryonic origin, with erectile tissue that engorges with blood during arousal.
• Estimates suggest the clitoris contains ≈10,000+ nerve fibers, making it one of the most sensitive organs in the body.
• The common term “clitoral bulbs” is anatomically a misnomer; “vestibular bulbs” is more accurate.

What the Clitoris Actually Is

The clitoris is a complex erectile organ, and the glans is just the visible tip of it.

• Clitoral glans → the small, external, visible part (what most people think is the clitoris)
• Clitoral body (shaft) → internal erectile tissue extending back from the glans
• Crura (legs) → two internal “arms” that extend along the pubic bone, often described as a wishbone shape

Together, these structures make up the clitoris.

What is often referred to as the “clitoral bulbs” is anatomically imprecise. These structures are more accurately called the vestibular bulbs — paired erectile tissues that sit alongside the vaginal opening and swell with arousal. While they are closely associated with clitoral function and contribute to female sexual response, they are anatomically distinct from the clitoris itself. This distinction comes directly from the work of Helen O’Connell and modern anatomical mapping.

Clitoral vs Vaginal Orgasm:

Research consistently shows that most women need clitoral stimulation to orgasm:

• Only about 18% of women report that intercourse alone (without clitoral focus) reliably leads to orgasm.
• In contrast, 35–40% report that clitoral stimulation — alone or with intercourse — is their most reliable pathway to orgasm.
• When intercourse is coupled with intentional clitoral focus, orgasm likelihood increases significantly.

From LIBIDO to Self-Pleasure: Why Stimulation Matters

Even when hormonal and emotional conditions improve, sexual pathways still require stimulation. Without regular blood flow and nerve activation to the clitoris, responsiveness can diminish—especially after menopause. This is where self-pleasure becomes an essential part of sexual health, not an indulgence.

Vibrators as Sexual-Wellness Tools

Vibrators are not novelty items. They are therapeutic tools that support blood flow, nerve signaling, and orgasmic capacity. Devices such as air-pulse clitoral stimulators like The Celebrator and pelvic-floor–focused tools such as the Luna Wellness Device, designed by a urogynecologist, address real physiology. Pelvic health is sexual health, and nearly half of women experience some degree of pelvic floor dysfunction.

Self-pleasure is not a replacement for intimacy. It is the foundation for it.

I used to have a sexual health boutique called Your Goddess Room, both in the Apothecary and online but there were those who thought it represented porn so I had to take it down. But I still remember today the woman on her second honeymoon and her elation at having an orgasm with the help of one of our favorite vibrators I chose for her!

Where Medications Fit In—Including GLP-1s and SSRIs

Modern medications can influence this delicate balance. GLP-1 medications such as Ozempic and related agents reduce dopamine-driven reward signaling in the brain. While this can quiet food cravings, dopamine also drives motivation, anticipation, and sexual desire. Similarly, commonly prescribed antidepressants—particularly SSRIs—are well known to blunt libido by altering serotonin-dopamine balance and reducing arousal and orgasmic response.

This does not mean these medications are “bad,” but it does mean that changes in desire should be viewed as meaningful feedback. Evaluating both hormones and neurotransmitters together provides critical insight into dopamine, serotonin, GABA, and other brain chemicals that directly influence desire and pleasure.

I want to be very clear — sexual health matters for men too, and many of the same metabolic and vascular principles apply.

The LIBIDO Framework: Restoring the Conditions for Desire

Libido does not return because we force it or schedule it. Desire emerges when the body, brain, and nervous system feel supported and safe. Over the years, I’ve found it helpful to think about libido as a system rather than a switch. The acronym LIBIDO as coined by Dr. Anna Cabeca, OBGYN captures the key elements that work together to support sexual health.

L – Lubrication

Adequate lubrication is foundational to comfort and pleasure. Hormonal changes—especially declining estrogen—reduce natural vaginal secretions and tissue elasticity, often leading to dryness or pain. Addressing lubrication with safe, microbiome-friendly products is not cosmetic; it is necessary to restore pleasurable arousal and prevent the nervous system from associating intimacy with discomfort.

I – Intimacy

Intimacy is not synonymous with intercourse. It includes affection, emotional connection, communication, and presence without pressure. Desire thrives when women feel emotionally safe, unrushed, and connected.

B – Bedroom Environment

The nervous system needs cues that it is safe to relax. A cluttered, noisy, or stress-filled environment keeps the brain in alert mode rather than receptive mode. Creating a calm, inviting space supports arousal and orgasm.

I – Internal Dialogue

Libido is strongly influenced by how women speak to themselves. Negative body image, self-criticism, or beliefs such as “I’m too tired” or “something is wrong with me” can suppress desire just as effectively as hormone imbalance.

D – Diet

Sexual desire is energy-dependent. Blood sugar instability, chronic under-eating, excess sugar, and highly processed foods impair circulation and hormone signaling. Adequate protein, healthy fats, minerals, and micronutrients support both energy and sexual responsiveness.

O – Oxytocin

Oxytocin supports bonding, trust, and orgasm. It counterbalances cortisol and allows the body to shift from stress to connection. Touch, affection, laughter, gratitude, and pleasurable experiences all increase oxytocin.

Together, LIBIDO reminds us that desire is not a character flaw or a performance issue—it reflects how well the body, brain, hormones, and emotional world are being supported.

The LIBIDO Checklist

☐ Am I using a vaginal microbiome-safe lubricant?

• ☐Do I allow enough warm-up time?
• ☐Do I trust my partner?

☐ Is my bedroom inviting intimacy?

☐ How do I speak to myself about my body?

☐ Am I avoiding sugar/simple carbs that impair circulation?

• ☐Do I create moments of connection and pleasure daily?

Hormone and Neurotransmitter Testing: Don’t Guess

When libido changes, guessing is not the answer. Evaluating estradiol, progesterone, testosterone, DHEA-S, cortisol, thyroid markers, and key neurotransmitters allows care to be guided by data rather than assumptions.

The Bottom Line

Low libido is not a personal failing or an inevitable consequence of aging. It is a signal—one that deserves curiosity, education, and thoughtful support.

Libido is not driven by a single hormone, food, or supplement. It reflects how the brain, hormones, metabolism, circulation, muscle, and anatomy work together — which is why understanding the whole system matters.

When desire fades, it’s not a failure — it’s your body’s way of telling you to listen and take steps to restore balance.

Addendum:

Foods That Actively Support Libido

Healthy Fats (Hormone Builders)

• Avocados – folate + B6 → hormone stability, sex drive
• Walnuts & almonds – improve circulation, relax blood vessels
• Omega-3 rich foods – building blocks of prostaglandins, which directly affect sexual response

“If you’re afraid of fat, you’re afraid of hormones—and hormones drive libido.”

Shellfish (Nature’s Nitric Oxide Boosters)

• Oysters, lobster, crab
• High in arginine
• Arginine → nitric oxide → blood vessel relaxation
• Same pathway targeted by Viagra

“Shellfish support sexual blood flow the same way erectile-dysfunction drugs do—just naturally.”

Pumpkin Seeds

• Magnesium + zinc + healthy fats
• Support:
• testosterone balance
• prostate health
• heart health (circulation matters!)

Asparagus

• Folate, fiber, vitamins A, C, K
• Improves digestion
• Lowers blood pressure
• Supports nitric oxide pathways

Strawberries & Raspberries

• Rich in zinc
• Zinc:
• supports testosterone
• improves sperm quality
• supports libido in both sexes

Watermelon

• High in citrulline
• Converts to arginine in the body
• Improves erections, libido, and vascular health

Eggs

• Rich in L-arginine
• Supports nitric oxide production
• Can improve erectile function and arousal

Peaches

• Vitamin C → sperm count & quality
• Supports fertility
• Antioxidant benefits

Maca: Evidence-Backed Libido Herb

“Maca is one of the best-studied herbs for libido.”

Key points:

• Research supports:
• improved sexual desire
• improved fertility

• Works in men and women
• Adaptogenic — supports energy & mood

This isn’t a ‘take it once’ supplement. Maca works best as part of a daily lifestyle.

Dark Chocolate: Why It Actually Works

Why dark chocolate is a true aphrodisiac:

• Theobromine – mood elevator, anti-inflammatory, energy
• Tryptophan – serotonin production → arousal response
• Phenyl-ethylamine (PEA) – endorphin, excitement
• Anandamide – binds dopamine receptors → euphoria
• L-arginine – increases blood flow → sensation & satisfaction

Dark chocolate doesn’t just taste good—it activates dopamine, serotonin, nitric oxide, and endorphins all at once.

Choose high-cacao, low-sugar dark chocolate.

Susan Merenstein, RPh

Holistic Consultant Pharmacist | The Vital Health Pharmacist™

Listen to the companion podcast on Women Talking Frankly on Spotify:

https://open.spotify.com/episode/23LfUIbqkpHS801rXRina4

Listen to the companion podcast on Women Talking Frankly on Apple:

https://podcasts.apple.com/us/podcast/women-talking-frankly/id1488184357?i=1000749342571

Educational Disclaimer

This article is for educational purposes only and is not intended to replace individualized medical care or consultation with a qualified healthcare professional.

Key References

Brizendine, L. (2006). The Female Brain. Broadway Books.

Brizendine, L. (2010). The Male Brain. Broadway Books.

O’Connell et al., 1998 — Journal of Urology O’Connell HE, Sanjeevan KV, Hutson JM. Anatomy of the clitoris.

Journal of Urology. 1998;159(6):1892–1897.

O’Connell & DeLancey, 2005 — Clinical Anatomy O’Connell HE, DeLancey JOL. The anatomy of the clitoris and the female sexual response.

Clinical Anatomy. 2005;18(1):3–13.

• Expanded the anatomical findings into functional sexual response
• Linked structure → blood flow → nerve pathways → orgasm
• Integrated anatomy with clinical sexual function

This paper builds on the 1998 work and explains why the anatomy matters for arousal and orgasm.

North American Menopause Society (NAMS). Position Statements.

Cabeca, A. (2019). The Hormone Fix.

Lisa Mosconi, PhD Research

Mosconi et al. (2021)

Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition — showing significant neurobiological changes across menopause stages in women’s brains (distinct from aging in men).

Mosconi L, Berti V, Dyke J, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11:10867. doi:10.1038/s41598-021-90084-y.

Mosconi et al. (2024)

In vivo brain estrogen receptor density by neuroendocrine aging and relationships with cognition and symptomatology — demonstrating changes in estrogen receptor density in the female brain across the menopause transition.

Mosconi L, Nerattini M, Matthews DC, et al. In vivo brain estrogen receptor density by neuroendocrine aging and relationships with cognition and symptomatology. Sci Rep. 2024;14:12680. doi:10.1038/s41598-024-62820-7.

3. Perimenopause Brain Energy & Alzheimer’s Risk

Mosconi’s work with PLOS Perimenopause and emergence of an Alzheimer’s bioenergetic phenotype shows how menopause-related changes in brain energy metabolism emerge alongside biomarkers linked to Alzheimer’s risk.

Mosconi L, Berti V, Guyara-Quinn C, et al. Perimenopause and emergence of an Alzheimer’s bioenergetic phenotype in brain and periphery. PLOS ONE. 2017;12(10):e0185926.

These studies collectively support the idea that estradiol and other ovarian hormones have measurable effects on brain metabolism, structure, connectivity, and receptor expression — all tied to cognition, mood, and potentially libido across the female lifespan.

Women’s Orgasm Pathways — PubMed Data

1. Herbenick et al. (2018) — US Probability Sample

In a large U.S. survey of sexually active women, only ~18.4% reported that intercourse alone was sufficient for orgasm, while ~36.6% required clitoral stimulation, and an additional ~36% said orgasms were better with clitoral stimulation.

Herbenick D, et al. Results From a U.S. Probability Sample of Women Ages 18-94 on Orgasm and Stimulation Preferences. PubMed PMID: 28678639.

2. Pfaus et al. (2016) — Clitoral vs Vaginal Experience

This analysis describes how women subjectively experience clitoral versus vaginal orgasms, supporting the view that different stimulation pathways yield unique sensations and that most orgasms involve clitoral sensory input.

Pfaus JG. The whole versus the sum of some of the parts: subjective experiences of female orgasms. PubMed Central. 2016.

3. JSM Sexual Medicine (Wetzel & Sanchez 2021)

Large descriptive study confirming that clitoral stimulation remains the most reliable route to orgasm for women, with vaginal penetration alone rarely sufficient.

Wetzel GM, Sanchez DT. Heterosexual women’s most reliable route to orgasm during partnered sex versus masturbation. JSM Sexual Med. 2021;5(2):1069.

4. Prause et al. (2016)

Shows that clitoral and vaginal stimulation contribute to orgasm, clarifying that multiple stimulation routes can co-occur, but clitoral involvement is consistently key.

Prause N, et al. Clitorally stimulated orgasms are associated with better control of sexual desire and are not associated with depression or anxiety. PubMed PMID: 27667356.

5. Sansone et al. (2024) — Orgasmometer Scale

Large quantitative study finding ~40.7% of women reported primarily clitorally activated orgasms, ~18% vaginally activated orgasms, and ~41.2% both types.

Sansone A, et al. A psychometric analysis using the Orgasmometer scale. PubMed PMID: 39567673.

Additional References-Muscle and Sexual function

Lyon G. Forever Strong. Atria Books; 2023

Duan M, et al. Association between skeletal muscle mass and sexual dysfunction: a systematic review. Sexual Medicine Reviews

Park HH, et al. Sarcopenia is associated with severe erectile dysfunction. World Journal of Urology

Houston DK, et al. Skeletal muscle, aging, and metabolic health. Journals of Gerontology Series A.

Selected Population Research on Sexual Frequency & Intimacy Trends

Jean Twenge, PhD — analyses of U.S. General Social Survey (GSS) data

Findings: declines in sexual frequency among Millennials and Gen Z compared to prior generations

U.S. General Social Survey (GSS)

UK Natsal (National Survey of Sexual Attitudes and Lifestyles)