What I’ve Learned about Low Desire as a Sexual Health Therapist
Desire doesn’t always disappear overnight. Often, it fades gradually…quietly…leaving confusion, shame, or distance in its place.
Hypoactive Sexual Desire Disorder (HSDD) is a common sexual health concern I see in my practice, particularly among women navigating perimenopause, chronic illness, or the aftershocks of unresolved trauma.
What I’ve learned as a sexual health therapist is this: low desire is not a flaw. It’s a signal. And when approached with curiosity and compassion, it can become a powerful entry point for healing.
In this article, I want to share what HSDD looks like, how we diagnose and treat it, and the kinds of support that truly make a difference.
What Is Hypoactive Sexual Desire Disorder?
HSDD is characterized by a persistent or recurrent lack of sexual interest or desire that causes distress.
It’s not about having a naturally low libido…it’s about feeling emotionally impacted by the loss of desire and often not knowing how to express it, especially in a relationship.
In clinical terms, HSDD falls under Female Sexual Interest/Arousal Disorder (FSIAD) in the DSM-5 for women, and as Male Hypoactive Sexual Desire Disorder for men.
But behind the diagnosis is a very real human experience: feeling disconnected from a part of yourself.
What Causes It?
The causes of HSDD are rarely one-dimensional. I’ve worked with clients whose low desire stemmed from:
Hormonal changes (such as menopause or postpartum)
Side effects of medication, including antidepressants
Chronic conditions, like Crohn’s disease or autoimmune issues
Emotional strain, including anxiety, depression, or past trauma
Relationship dynamics, including lack of trust or emotional intimacy
Cultural and religious shame around sexuality
Every case is different, which is why therapy begins with a thorough understanding of the whole person…not just the symptom.
How We Talk About Desire in Therapy
Many clients come to me saying, “I just don’t feel like myself anymore.”
Some are grieving the loss of a part of their identity.
Others are feeling pressure from partners or internal guilt for not “showing up” sexually.
In our work together, we unpack that pressure. We slow down. We ask, “What does your body need right now?” and “What feels safe to explore?”
Using a mix of somatic tools, guided imagery, and narrative work, we reconnect with the body and give desire permission to return…not forced, but welcomed.
The Power of Trauma-Informed Support
One of the most important lessons I’ve learned is that you can’t rush desire…especially when trauma is present. The nervous system must feel safe before it can feel aroused.
That’s why I approach HSDD through a trauma-informed lens, helping clients regulate their nervous systems, process past experiences, and explore sensuality and pleasure at their own pace.
This might involve breathwork, body mapping, boundary exploration, or simply practicing being in the moment…without expectation.
How to Talk to Your Partner About Low Desire
Many of my clients feel unsure how to talk about their experience with their partner. Here’s what I encourage:
Pick a neutral time, not right after sex or in the heat of frustration
Speak from your own perspective using “I” statements: “I’ve been feeling distant from my desire and I want to understand it better.”
Emphasize emotional connection and shared support
Consider inviting your partner into therapy so you can explore it together with guidance
Healing often starts with one honest, vulnerable conversation.
Treatment Options That Help
In addition to therapy, some clients benefit from:
Hormonal support, like estrogen or testosterone during menopause
FDA-approved medications, like Addyi or Vyleesi for premenopausal women
Lifestyle shifts, including more rest, body movement, and stress reduction
Education around fantasy, touch, and different types of arousal
But most of all? Clients benefit from not being judged. From having space to be messy, confused, and curious.
Reclaiming Desire on Your Own Terms
Desire doesn’t have to be what it once was. It can evolve. It can return slowly. And it can look entirely different from what we see portrayed in media.
What matters most is that it feels authentic to you.
Whether you’re dealing with HSDD personally or supporting someone who is, know this: desire can be rediscovered. Not through pressure or performance…but through presence, permission, and patient care.
You’re not broken. You’re human.
And your desire, in whatever form it takes, deserves to be met with curiosity and compassion.
Want to explore this further?
I offer trauma-informed sex therapy for individuals and couples navigating low desire, intimacy struggles, and relationship healing.
