What is hypoactive sexual desire disorder

Hypoactive sexual desire disorder is defined in Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) as persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts, and/or desire for or receptivity to sexual activity, which causes personal distress. As a largely subjective experience, sexual desire may or may not be accompanied by externally observable changes in sexual behavior ¹⁾.

Hypoactive sexual desire disorder – DSM 5 Diagnostic Criteria ²⁾:

• A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life.
• B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.
• C. The symptoms in Criterion A cause clinically significant distress in the individual.
• D . The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
• Specify whether:
  • Lifelong: The disturbance has been present since the individual became sexually active.
  • Acquired: The disturbance began after a period of relatively normal sexual function.
• Specify whether:
  • Generalized: Not limited to certain types of stimulation, situations, or partners.
  • Situational: Only occurs with certain types of stimulation, situations, or partners.
• Specify current severity
  • Mild: Evidence of mild distress over the symptoms in Criterion A.
  • Moderate: Evidence of moderate distress over the symptoms in Criterion A.
  • Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.

Loss of sex drive (libido) is a common problem that affects many men and women at some point in their life. Low sex drive often linked to relationship issues, stress or tiredness, but can be a sign of an underlying medical problem, such as reduced hormone levels.

Everyone’s sex drive is different – there’s no such thing as a “normal” sex drive (libido). But if you find your lack of desire for sex distressing or it’s affecting your relationship, it’s a good idea to get help.

A woman’s sexual desire naturally fluctuates over the years. Highs and lows commonly coincide with the beginning or end of a relationship or with major life changes, such as pregnancy, menopause or illness. Some antidepressants and anti-seizure medications also can cause low sex drive in women.

If you have a persistent or recurrent lack of interest in sex that causes you personal distress, you may have hypoactive sexual desire disorder — also referred to as female sexual interest/arousal disorder.

But you don’t have to meet this medical definition to seek help. If you are bothered by a low sex drive or decreased sexual desire, there are lifestyle changes and sex techniques that may put you in the mood more often. Some medications may offer promise as well.

Male hypoactive sexual desire disorder

About 5% of men have decreased libido, a condition that increases with age. Libido is the desire to engage in sexual activity.

What causes male hypoactive sexual desire disorder?

Decreased libido often accompanies other sexual disorders. Although most men with erectile dysfunction do not complain of decreased libido, after time, persistent failure with erections and sexual performance can lead to reduced sex drive in some men. Men who have other causes of decreased libido also often have trouble getting erections.

Common causes of low libido in men include:

• Medications (SSRI antidepressants; medications that reduce testosterone levels, such as those taken for prostate cancer)
• Excessive alcohol use or recreational drug use
• Excessive fatigue
• Systemic illness (such as chronic lung, heart, kidney and liver failure, cancer)
• Low testosterone (male hypogonadism)
• Depression
• Relationship problems

What is the treatment for male hypoactive sexual desire disorder?

As is the case with erectile dysfunction, treatment of decreased libido depends on the cause of the condition. For some men, adopting a healthier lifestyle, such as exercising regularly, eating a healthy diet, getting enough sleep, reducing stress, and/or limiting alcohol, can help resolve the problem.

Other treatment options may include switching medications, treating an underlying condition, testosterone replacement hormone therapy if the man has hypogonadism, or relationship counseling.

What causes low sex drive in women

A woman’s desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you’re experiencing a problem in any of these areas, it can affect your sexual desire.

Physical causes

A wide range of illnesses, physical changes and medications can cause a low sex drive, including:

• Sexual problems. If you experience pain during sex or an inability to orgasm, it can hamper your desire for sex.
• Medical diseases. Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
• Medications. Many prescription medications — including some antidepressants and anti-seizure medications — are notorious libido killers.
• Lifestyle habits. A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs. And smoking decreases blood flow, which may dampen arousal.
• Surgery. Any surgery, especially one related to your breasts or your genital tract, can affect your body image, sexual function and desire for sex.
• Fatigue. Exhaustion from caring for young children or aging parents can contribute to low sex drive. Fatigue from illness or surgery also can play a role in a low sex drive.

Sexual problems

Another thing to consider is whether the problem is a physical issue that makes sex difficult or unfulfilling.

For example, a low sex drive can be the result of:

• ejaculation problems
• erectile dysfunction
• vaginal dryness
• painful sex
• inability to orgasm
• involuntary tightening of the vagina (vaginismus).

Underlying health problems

Any long-term medical condition can affect your sex drive. This may be a result of the physical and emotional strain these conditions can cause, or it may be a side effect of treatment.

For example, a low libido can be associated with:

• heart disease
• diabetes
• an underactive thyroid (hypothyroidism) – where the thyroid gland doesn’t produce enough hormones
• cancer
• major surgery – for example, surgery to remove the ovaries and womb in women

Speak to your doctor or specialist if you think your low libido may be the result of an underlying medical condition or treatment.

Medication and contraception

Certain medicines can sometimes reduce libido, including:

• medication for high blood pressure
• many types of antidepressant medication
• medications for fits (seizures), such as topiramate
• medications called antipsychotics, such as haloperidol
• medication for an enlarged prostate, such as finasteride
• medication for prostate cancer, such as cyproterone
• hormonal contraception, such as the combined hormonal contraception (pill, patch or ring), the progestogen-only pill, the contraceptive implant and the contraceptive injection

Check the leaflet that comes with your medicine to see if low libido is listed as a possible side effect.

See your doctor if you think a medicine is affecting your sex drive. They may be able to switch you to something else.

Alcohol and drugs

Drinking excessive amounts of alcohol over a long period can reduce your sex drive, so it’s a good idea not to drink too much.

Men and women are advised not to drink more than 14 alcohol units a week on a regular basis.

Hormone changes

Changes in your hormone levels may alter your desire for sex. This can occur during:

• Menopause. Estrogen levels drop during the transition to menopause. This can cause decreased interest in sex and dryer vaginal tissues, resulting in painful or uncomfortable sex. Although many women continue to have satisfying sex during menopause and beyond, some women experience a lagging libido during this hormonal change.
• Pregnancy and breast-feeding. Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sexual desire. Of course, hormones aren’t the only factor affecting intimacy during these times. Fatigue, changes in body image, and the pressures of pregnancy or caring for a new baby can all contribute to changes in your sexual desire.

Getting older and the menopause

A reduced sex drive isn’t an inevitable part of ageing, but it’s something many men and women experience as they get older.

There can be many reasons for this, including:

• falling levels of sex hormones (estrogen and testosterone) just before, during and after the menopause in women
• falling levels of sex hormones (testosterone) in men
• age-related health problems, including mobility problems
• side effects of medication

Speak to your doctor if you’re concerned about this. They may ask about any other symptoms you have, and sometimes they may do a blood test to check your hormone levels.

There are treatments to increase hormone levels if low levels are causing problems, such as hormone replacement therapy (hormone therapy) with or without testosterone treatment for women going through the menopause.

Pregnancy, giving birth and breastfeeding

Loss of interest in sex is common during pregnancy, after giving birth and while breastfeeding.

This can be because of:

• changes in hormone levels
• changes to your body and issues with your body image
• exhaustion
• painful sex caused by an injury, such as a cut or tear, during childbirth
• changed priorities, such as focusing on looking after your baby

These issues may improve over time. Speak to your doctor if your sex drive doesn’t return and it’s a problem for you.

Sex during pregnancy

It’s perfectly safe to have sex during pregnancy unless your doctor or midwife has told you not to.

Having sex will not hurt your baby. Your partner’s penis can’t penetrate beyond your vagina, and the baby cannot tell what’s going on.

However, it’s normal for your sex drive to change during pregnancy. This isn’t something to worry about, but it’s helpful to talk about it with your partner.

Some couples find having sex very enjoyable during pregnancy, while others simply feel they don’t want to. You can find other ways of being loving or making love. The most important thing is to talk about your feelings with each other.

If your pregnancy is normal and you have no complications, having sex and orgasms won’t increase your risk of going into labor early or cause a miscarriage.

While sex is safe for most couples in pregnancy, it may not be all that easy. You will probably need to find different positions. This can be a time to explore and experiment together.

Sex with your partner on top can become uncomfortable quite early in pregnancy, not just because of the bump, but because your breasts might be tender. It can also be uncomfortable if your partner penetrates you too deeply.

It may be better to lie on your sides, either facing each other or with your partner behind.

Later in pregnancy, an orgasm or even sex itself can set off mild contractions. If this happens, you’ll feel the muscles of your womb go hard. These are known as Braxton Hicks contractions and can be uncomfortable, but they’re perfectly normal and there’s no need for alarm. You might want to try some relaxation techniques or just lie down until the contractions pass.

Sex after birth

There are no rules about when to start having sex again after you’ve given birth.

You’ll probably feel sore as well as tired after your baby is born, so don’t rush into it. If sex hurts, it won’t be pleasurable.

You may want to use a personal lubricant, available from pharmacies, to begin with. Hormonal changes after birth can make your vagina feel drier than usual.

You may be worried about changes to your body or getting pregnant again. Men may worry about hurting their partner.

It might be some time before you want to have sex. Until then, both of you can carry on being loving and close in other ways.

If you or your partner have any worries, talk about them together. You can talk with your health visitor or doctor if you need some more help.

Tips for starting sex again after birth:

• If penetration hurts, say so. If you pretend that everything’s alright when it isn’t, you may start to see sex as a nuisance or unpleasant, rather than a pleasure. You can still give each other pleasure without penetration – for example, by mutual masturbation.
• Take it gently. Perhaps explore with your own fingers first to reassure yourself that sex won’t hurt. You may want to use some personal lubricant. Hormonal changes after childbirth may mean you aren’t as lubricated as usual.
• Make time to relax together. You’re more likely to make love when your minds are on each other rather than other things.
• Get help if you need it. If you’re still experiencing pain when you have your postnatal check, talk to your doctor.

Psychological causes

Your problems don’t have to be physical or biological to be real. There are many psychological causes of low sex drive, including:

• Mental health problems, such as anxiety or depression
• Stress, such as financial stress or work stress
• Poor body image
• Low self-esteem
• History of physical or sexual abuse
• Previous negative sexual experiences

Stress, anxiety and exhaustion

Stress, anxiety and exhaustion can be all-consuming and have a major impact on your happiness, including your sex drive.

If you feel you’re constantly tired, stressed or anxious, you may need to make some lifestyle changes or speak to your doctor for advice.

Depression

Depression is very different from simply feeling unhappy, miserable or fed up for a short while. It’s a serious illness that interferes with all aspects of your life, including your sex life.

In addition to low libido, signs of depression can include:

• feelings of extreme sadness that don’t go away
• feeling low or hopeless
• losing interest or pleasure in doing things you used to enjoy

It’s important to see your doctor if you think you might be depressed. They can advise you about the main treatments for depression, such as talking therapies or antidepressants.

A low sex drive can also be a side effect of antidepressants. Speak to your doctor if you think this may be causing your problems.

Relationship problems

One of the first things to consider is whether you’re happy in your relationship.

Do you have any doubts or worries that could be behind your loss of sexual desire?

For many women, emotional closeness is an essential prelude to sexual intimacy. So problems in your relationship can be a major factor in low sex drive.

Decreased interest in sex is often a result of ongoing issues, such as:

• Loss of sexual attraction
• Lack of connection with your partner
• Unresolved conflicts or fights and frequent arguments
• Poor communication of sexual needs and preferences
• Infidelity or breach of trust
• Difficulty trusting each other
• Being in a long-term relationship and becoming overfamiliar with your partner
• Unresolved conflict
• Physical sexual problems

You may find it helpful to read advice about keeping the passion alive in your relationship and talking about sex with your partner.

Your doctor may be able to refer you and your partner for relationship counseling if you’re having persistent problems, or you may wish to contact a sex therapist for support and advice.

What does a sex therapist do?

A sex therapist helps people with sexual problems.

Sex therapists are qualified counselors, doctors or healthcare professionals who have done extra training in helping people with difficulties relating to sex.

A sex therapist can help people with various sexual problems, including:

In men:

• lack of desire
• difficulty getting or keeping an erection (erectile dysfunction)
• premature ejaculation or other ejaculation problems

In women:

• lack of desire
• difficulty having an orgasm
• pain during sex or inability to have penetrative sex

What happens in a sex therapy session?

A sex therapist will listen to you describe your problems and assess whether the cause is likely to be psychological, physical or a combination of the two.

Talking about and exploring your experiences will help you get a better understanding of what is happening and the reasons. The therapist may also give you exercises and tasks to do with your partner in your own time.

Each therapy session is completely confidential. You can see a sex therapist by yourself, but if your problem affects your partner as well, it may be better for you both to attend.

Sessions usually last for 30-50 minutes. The therapist may advise you to have weekly sessions or to see them less frequently, such as once a month.

How can I find a sex therapist?

If you have a sexual problem, it’s a good idea to see your doctor first as they can check for any physical causes. Your doctor can refer you to a sex therapist if they think it will help you.

You can also find a sex therapist privately, which you’ll need to pay for. It’s important to see a qualified registered therapist.

Hypoactive sexual desire disorder symptoms

If you want to have sex less often than your partner does, neither one of you is necessarily outside the norm for people at your stage in life — although your differences, also known as desire discrepancy, may cause distress.

Similarly, even if your sex drive is weaker than it once was, your relationship may be stronger than ever. Bottom line: There is no magic number to define low sex drive. It varies from woman to woman.

Some signs and symptoms that may indicate a low sex drive include a woman who:

• Has no interest in any type of sexual activity, including self-stimulation
• Doesn’t have sexual fantasies or thoughts, or only seldom has them
• Is bothered by her lack of sexual activity or fantasies.

Hypoactive sexual desire disorder diagnosis

By definition, you may be diagnosed with hypoactive sexual desire disorder — also called female sexual interest/arousal disorder — if you frequently lack sexual thoughts or desire, and the absence of these feelings causes you personal distress. Whether you fit this medical diagnosis or not, your doctor can look for reasons that your sexual desire isn’t as high as you’d like and find ways to help.

In addition to asking you questions about your medical history, your doctor may also:

• Perform a pelvic exam. During a pelvic exam, your doctor can check for signs of physical changes contributing to low sexual desire, such as thinning of your genital tissues, vaginal dryness or pain-triggering spots.
• Recommend testing. Your doctor may order blood tests to check hormone levels and look for evidence of thyroid problems, diabetes, high cholesterol and liver disorders.
• Refer you to a specialist. A specialized counselor or sex therapist may be able to better evaluate emotional and relationship factors that can cause low sexual desire.

Hypoactive sexual desire disorder treatment

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling and sometimes medication.

Counseling

Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sexual desire. Therapy often includes education about sexual response and techniques and recommendations for reading materials or couples’ exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire.

Medication review

Your doctor will want to evaluate the medications you’re already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil, Pexeva) and fluoxetine (Prozac, Sarafem) may lower sex drive. Adding or switching to bupropion (Aplenzin, Wellbutrin) — a different type of antidepressant — usually improves sex drive.

Hormone therapy

Estrogen delivered throughout your whole body (systemic) by pill, patch, spray or gel can have a positive effect on brain function and mood factors that affect sexual response. But systemic estrogen therapy may have risks for certain women.

Smaller doses of estrogen — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire without the risks associated with systemic estrogen. In some cases, your doctor may prescribe a combination of estrogen and progesterone.

Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in women. However, replacing testosterone in women is controversial and it’s not approved by the Food and Drug Administration for sexual dysfunction in women. Plus it can cause acne, excess body hair, and mood or personality changes.

Flibanserin (Addyi)

Originally developed as an antidepressant, Flibanserin (Addyi) is a prescription medication approved by the Food and Drug Administration as a treatment for low sexual desire in premenopausal women.

A daily pill, Addyi may boost sex drive in women who experience low sexual desire and who find the experience distressing. Potentially serious side effects include low blood pressure, dizziness and fainting, particularly if the drug is mixed with alcohol. Experts recommend that you stop taking the drug if you don’t notice an improvement in your sex drive after eight weeks.

Good Sex Tips

If you want to make the most of your sex life, these sex tips are a good way to start.

Talking and listening to each other about your feelings, preferences and desires can bring you closer together and make sex more enjoyable.

But even the most contented lovers can have fun trying new things. Here are a few ideas.

1. Talk about sex

If your sex life isn’t fulfilling, there are steps you can take to make it better. A good start is talking to your partner about how you feel about sex.

Why talking about sex is good

Communication is important in any healthy relationship because it lets you share your feelings and tackle problems together. This is also true of your sex life, especially if something is worrying you.

• If you can talk about things that are going on in your sex life, then you don’t have to bury your problems.
• It’s often when a problem goes underground that people start to worry about what might be wrong. That’s when a distance arises in the day-to-day relationship.

For example, if you want sex less often than your partner but you don’t talk about it, your partner may worry that you don’t love them any more or are having an affair.

If you talk about it – perhaps you’re feeling stressed about work, or you’re coming to terms with changes to your body as you get older – then your partner will know the truth and both of you can work on managing the problem.

How and when to say something about sex

Many people find it hard to talk openly about sex, especially if they’ve never spoken about it with their partner.

• You have to pick the right moment,. If you’re concerned about your sex life, don’t discuss it when you’ve just tried to make love and it hasn’t worked.
• Sex is an emotive subject, and you’re in an emotional situation at that time.
• Be reassuring and say, ‘OK, but I think we need to talk about this another time’. Don’t tell them that everything is fine, because it isn’t.

Choose a time when you can be alone together and won’t be interrupted by phones ringing or children returning from school.

Think about the words you’ll use.

• Many couples don’t say anything for fear of hurting their partner’s feelings. But if you’re not happy with your sex life, it’s OK to be honest about how it’s affecting you.

In a loving partnership, the two of you can work together to find a solution that works for you both.

Be sensitive about your partner’s feelings

You can bring up suggestions or concerns without hurting your partner’s feelings. Be sensitive and reassuring, and ask your partner to share their thoughts with you.

You can say something like:

• ‘I’ve noticed we’re not making love as often as we used to, and that kind of bothers me. What do you think about it?’

If your partner asks why you haven’t brought it up before, be honest – perhaps it’s because you weren’t sure how to say it, or you were hoping that things might improve.

Once you’ve raised the subject, you’ll need to give your partner some time. It can be a shock for your partner. Once the subject is out in the open, you both might need to go away and think about how you’re feeling, and what you could do differently. But do come back to it. There’s no point raising the subject, then not following it through with another action, even if that action is to have another discussion.

Together you can work out how to manage the situation. If you’re both honest about your feelings, you’ve got a better chance of finding a solution that works for both of you. If you don’t feel you can work it out together, then sexual therapy might help.

A sexual therapist can help you address issues that you might find difficult to tackle. They can also suggest ways to improve your intimacy and sex life to suit both of you.

Dealing with infidelity

If one partner in the relationship has had an affair, trust is broken. You may feel you no longer trust them at all.

A couple can recover from an affair if they both want to, but they need to recognize that their relationship will never be the same again. You and your partner have to let go of the old relationship and renegotiate a new one.

If a partner has cheated on you in the past, it can be hard to trust anyone new. You need to recognize that this new person is not the person who cheated on you.

Recognize the effect that the cheating had on you, and tell your new partner. If they want to be in a relationship with you, they’ll help you.

2. Build anticipation

Agree on a period of time – say one week, or whatever works for you – when you won’t have orgasms or penetrative sex. At first, allow only kissing and holding each other. Gradually move on to touching and stroking each other, masturbation, oral sex, or whatever feels right for you. Avoid orgasm.

At the end of the agreed waiting period, allow yourselves the pleasure of orgasm through any kind of sex you like. This week may help heighten your senses to all the other wonderful feelings you can share when you’re making love.

3. Massage

Massage can help you have very sensual sex. As part of foreplay, it’s a great way to start things off slowly and relax into the feel of each other’s skin as your arousal intensifies.

But a simple massage that doesn’t lead to sex can also work wonders for your sex life. A non-sexual massage will familiarise (or refamiliarise) you with your partner’s body, reduce stress, and reaffirm the intimacy between you.

If you don’t want a massage to lead to sex, discuss this with your partner so you can avoid any misunderstanding.

4. The senses

Good sex can embrace all the senses, not just touch. Scented oil for a massage, music and candles for soft lighting can all be erotic, as well as listening to your partner’s breathing and the sounds they make. But remember not to get oil on a latex condom, as this can damage it.

Taste each other as you kiss. If you both want to, you could mix food and sex – feed each other something delicious and juicy, such as strawberries.

5. Whisper

Whether it’s sweet nothings or your sexy intentions, whispering things to each other can add an extra thrill. It doesn’t have to be during foreplay or sex. Foreplay can start during the day with a sexy phone call or text – this could leave both of you looking forward to the event for hours or days.

This works with texts and emails, too – but make sure you send them to the right person, and remember that your employer has the right to access your work email.

6. Masturbation

Masturbation, by yourself or with your partner, can be a bonus for your sex life. Exploring your own body and sexual responses means you can share this knowledge with your partner.

Masturbating your partner can help you learn more about what turns them on. It can also be an option if one of you doesn’t feel like full sex. Talk about this with your partner.

7. Sex toys

If you and your partner both feel comfortable, using sex toys can be an arousing thing to do together. Some people use vibrators (and more) as an enjoyable part of their sex life. If you’ve never thought about using sex toys before, how do you feel about trying them?

You can buy them online or in sex shops. You don’t have to spend a fortune on toys – you can get creative. Soft hair brushes can feel great against the skin, and making your own games up can be fun.

If you use sex toys use them responsibly and keep them clean – otherwise, sex toys can pass on sexually transmitted infections (STIs) and infections passed on through the blood (blood-borne infections).

Avoiding sexually transmitted infections (STIs)

If you use sex toys, you can avoid STIs by:

• keeping sex toys clean – wash them after each use
• covering penetrative sex toys, such as vibrators, with a new condom each time they’re used
• not sharing sex toys
• having a different set of sex toys for each partner

Sex toys can pass on:

• Chlamydia
• Syphilis
• Herpes
• Bacterial vaginosis

There is an increased risk of bacterial vaginosis in women who have sex with women who have a history of sharing sex toys, or whose partners have bacterial vaginosis.

Avoiding blood-borne infections

Don’t share any sex toy that may draw blood from the skin, as this type of sex toy can pass on blood-borne infections.

Take care when using penetrative sex toys, particularly if there are any cuts or sores around the vagina, anus or penis and blood is present, as there’s an increased risk of passing on infections such as:

• Hepatitis B
• Hepatitis C
• HIV

Cleaning sex toys

How you clean a sex toy depends on:

• what the sex toy is made of
• if the sex toy uses batteries and has parts that cannot be washed

Sex toys bought from a trusted source should come with advice about how to clean and store them. Follow the manufacturer’s instructions carefully.

For sex toys that can be washed, make sure you wash them thoroughly with warm water and soap after each use.

You should also wash them between:

• using them on different parts of the body, such as the mouth, vagina and anus
• one person and another

Check sex toys regularly for any scratches or breaks in the surface material where germs could be present and spread, as this can increase the risk of infection.

If you’re allergic to latex, do not use sex toys that are made of, or contain, latex.

8. Read a book

There are many books that have exercises and ideas to help you achieve a fulfilling sex life, whatever your age, gender, sexual orientation or taste.

If you’ve never thought about buying a book about sex, why not do it now? You might wish you’d done it years ago.

9. Share fantasies and desires

Everyone has unique fantasies, tastes and preferences when it comes to sex. From earlobes to ankles, hairline to hips, pirates to picnics, don’t be afraid to talk about them.

If you and your partner know about each other’s turn-ons, you can make the most of them.

10. Keep it clean

We’re talking about your general hygiene. You don’t have to keep yourself super-scrubbed: a certain amount of sweat is fine, as long as it isn’t overwhelming.

But be respectful towards your partner, and wash every day to prevent nasty smells and tastes. For specifics, read more about keeping your vagina clean and how to wash your penis.

11. Relax

Sex with a loving partner can be one of the most beautiful and intense experiences in life.

Sometimes the best sex happens when you’re not worrying about making it exciting or orgasmic. Relax with your partner and great sex may find you.

Breathing exercise for stress

This calming breathing technique for stress, anxiety and panic takes just a few minutes and can be done anywhere.

You will get the most benefit if you do it regularly, as part of your daily routine.

You can do it standing up, sitting in a chair that supports your back, or lying on a bed or yoga mat on the floor.

Make yourself as comfortable as you can. If you can, loosen any clothes that restrict your breathing.

If you’re lying down, place your arms a little bit away from your sides, with the palms up. Let your legs be straight, or bend your knees so your feet are flat on the floor.

If you’re sitting, place your arms on the chair arms.

If you’re sitting or standing, place both feet flat on the ground. Whatever position you’re in, place your feet roughly hip-width apart.

• Let your breath flow as deep down into your belly as is comfortable, without forcing it.
• Try breathing in through your nose and out through your mouth.
• Breathe in gently and regularly. Some people find it helpful to count steadily from one to five. You may not be able to reach five at first.
• Then, without pausing or holding your breath, let it flow out gently, counting from one to five again, if you find this helpful.
• Keep doing this for three to five minutes.

How to tackle stress

You can’t always prevent stress, but there are lots of things you can do to manage stress better.

You could:

• try the 10 simple stress busters (see below)
• use these easy time-management techniques
• try mindfulness – studies have found mindfulness can help reduce stress and improve your mood
• use calming breathing exercises
• download some relaxation and mindfulness apps on to your phone
• listen to an anxiety control audio guide

Other things that may help:

• share your problems with family or friends
• make more time for your interests and hobbies
• take a break or holiday
• take some regular exercise and make sure you’re eating healthily
• make sure you’re getting enough sleep (see tips on better sleep)

10 simple stress busters

If you’re stressed, whether by your job or by something more personal, the first step to feeling better is to identify the cause.

The most unhelpful thing you can do is turn to something unhealthy to help you cope, such as smoking or drinking.

In life, there’s always a solution to a problem. Not taking control of the situation and doing nothing will only make your problems worse.

The keys to good stress management are building emotional strength, being in control of your situation, having a good social network and adopting a positive outlook.

1. Be active

Exercise won’t make your stress disappear, but it will reduce some of the emotional intensity that you’re feeling, clearing your thoughts and letting you to deal with your problems more calmly.

2. Take control

There’s a solution to any problem. If you remain passive and negative, thinking, ‘I can’t do anything about my problem’, your stress will get worse. That feeling of loss of control is one of the main causes of stress and lack of wellbeing.

The act of taking control is in itself empowering, and it’s a crucial part of finding a solution that satisfies you and not someone else.

3. Connect with people

A good support network of colleagues, friends and family can ease your work troubles and help you see things in a different way.

If you don’t connect with people, you won’t have support to turn to when you need help.

The activities you do with friends help you relax. You often have a good laugh with them, which is an excellent stress reliever.

Talking things through with a friend will also help you find solutions to your problems.

4. Have some ‘Me Time’

Here in the US, people work the long hours, meaning they often don’t spend enough time doing things they really enjoy.

You need to take some time for socializing, relaxation or exercise.

Setting aside a couple of nights a week for some quality “me time” away from work. By earmarking those two days, it means you won’t be tempted to work overtime.

5. Challenge yourself

Setting yourself goals and challenges, whether at work or outside, such as learning a new language or a new sport, helps to build confidence. This will help you deal with stress.

By continuing to learn, you become more emotionally resilient as a person. It arms you with knowledge and makes you want to do things rather than be passive, such as watching TV all the time.

6. Avoid unhealthy habits

Don’t rely on alcohol, smoking and caffeine as your ways of coping. Men more than women are likely to do this. Scientists call this avoidance behavior. Women are better at seeking support from their social circle.

Over the long term, these bad habits won’t solve your problems. They’ll just create new ones. It’s like putting your head in the sand. It might provide temporary relief, but it won’t make the problems disappear. You need to tackle the cause of your stress.

7. Help other people

Evidence shows that people who help others, through activities such as volunteering or community work, become more resilient.

Helping people who are often in situations worse than yours will help you put your problems into perspective. The more you give, the more resilient and happy you feel.

If you don’t have time to volunteer, try to do someone a favor every day. It can be something as small as helping someone to cross the road or going on a coffee run for colleagues.

8. Work smarter, not harder

Working smarter means prioritizing your work, concentrating on the tasks that will make a real difference.

Leave the least important tasks to last. Accept that your in-tray will always be full. Don’t expect it to be empty at the end of the day.

9. Try to be positive

Look for the positives in life, and things for which you’re grateful. People don’t always appreciate what they have. Try to be glass half full instead of glass half empty.

Try writing down three things that went well, or for which you’re grateful, at the end of every day.

10. Accept the things you can’t change

Changing a difficult situation isn’t always possible. Try to concentrate on the things you do have control over.

If your company is going under and is making redundancies, for example, there’s nothing you can do about it.

In a situation like that, you need to focus on the things that you can control, such as looking for a new job.

Lifestyle and home remedies

Healthy lifestyle changes can make a big difference in your desire for sex:

• Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and boost your libido.
• Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive.
• Communicate with your partner. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy.
• Set aside time for intimacy. Scheduling sex into your calendar may seem contrived and boring. But making intimacy a priority can help put your sex drive back on track.
• Add a little spice to your sex life. Try a different sexual position, a different time of day or a different location for sex. Ask your partner to spend more time on foreplay. If you and your partner are open to experimentation, sex toys and fantasy can help rekindle your sexual sizzle.
• Ditch bad habits. Smoking, illegal drugs and excess alcohol can all dampen sexual desire. Ditching these bad habits may help rev up your sexual desire as well as improve your overall health.

Alternative medicine

Disclosing low sexual desire to your doctor may be difficult for some women, and some people may turn to over-the-counter herbal supplements instead. But, herbal supplements aren’t regulated by the Food and Drug Administration, and in many cases, haven’t been well-studied. Because these products can have side effects or interact with other medications you may be taking, it’s important to talk with your doctor before using these products.

One product that’s a blend of herbal supplements is called Avlimil. This product has estrogen-like effects on the body. And while those effects may help with some sexual difficulties, those same effects may also promote the growth of certain types of breast cancer.

Another product — a botanical massage oil called Zestra — is applied to the clitoris, labia and vagina. One small study found that Zestra increased arousal and pleasure when compared with a placebo oil. The only side effect was mild burning in the genital region. Zestra is not a good option for women with vaginal dryness or sensitive vaginal tissues.

Coping and support

Low sexual desire can be very difficult for you and your partner. It’s natural to feel frustrated or sad if you aren’t able to be as sexy and romantic as you want — or you used to be.

At the same time, low sexual desire can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex.

It may help to remember that fluctuations in your sexual desire are a normal part of every relationship and every stage of life. Try not to focus all of your attention on sex. Instead, spend some time nurturing yourself and your relationship.

Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant. Feeling good about yourself and your partner can actually be the best foreplay.