Much about libido remains a mystery. But available evidence paints an interesting picture of the diverse factors that drive our interest in and capacity for sexuality. When it comes to libido, men and women differ in many ways, but certain lifestyle choices and conditions have similar effects on both sexes.

Weight, diet, and sex drive

Up to 22% of obese women and up to 21% of obese men report sexual dysfunctions that include decreased desire and arousal problems. Studies have highlighted links between obesity, sexual dysfunction, and the development of non-communicable diseases—with cardiovascular disease as the most prominent.

For men, those with higher-than-average body weight and waist circumference are at a higher risk of developing erectile dysfunction. Most evidence suggests that this link is due to decreased endothelial function and reduced blood flow. While this may not affect libido directly, experts at the Mayo Clinic point out that obesity can also lead to low energy and self-esteem issues, which may result in a significant loss of sex drive.

The authors of the Reproductive Biology and Endocrinology review suggest that the association between obesity and impairment of sexual quality of life affects women “to a greater extent than that of obese men.” The authors cite studies that found a high BMI is associated with reduced sexual desire, adding that the mechanism behind this may be psychosocial. Obese women, in particular, are often the targets of social stigma and weight-related discrimination, which can lead to depression and mood disorders—and, ultimately, decreased libido. 

On the flip side, weight loss is associated with improvements in many biological, psychological, and sexual factors. According to the review, losing weight significantly benefits testosterone levels and sexual desire in obese men. Studies point to a Mediterranean-style diet (involving a base of legumes, vegetables, and fruits, and limited consumption of red meat and dairy products) as improving sexual function in men and women. For men, evidence suggests a Mediterranean diet can reduce erectile dysfunction. For women, it helps lower BMI and improves sexual function.

Mental health, stress, and sex drive

Research suggests that sex drive is affected not just by habits, such as diet and exercise, but by common stressors, too—things like deadlines, financial concerns, or even traffic can change the way you think and feel about sex. According to the aforementioned review, chronic stressors lead to higher levels of the hormone cortisol, which can lead to reduced activity of gonadic steroids and adrenal androgens. This, in turn, can result in lower sexual desire and genital arousal for men and women. 

The authors also point out that stress can affect emotional and cognitive states, which distract people from focusing on sexual stimuli. This can become a circular issue, in which chronic stress leads to a low sex drive, which leads to anxiety and more stress, and so on.

In fact, the review cites a number of studies in which stress-management techniques were found to be more effective than pharmaceutical interventions for sexual dysfunction. An article published in the American Journal of Lifestyle Medicine in 2018, which focused on the sexual well-being of women, notes that practising mindfulness or yoga can lead to improved sexual health. Its authors point out that mindfulness and yoga improve attentional capacities and reduce clinical symptoms of anxiety and depression, all of which can help boost sexual desire and function.

Relationship problems and sex drive

The 2018 American Journal of Lifestyle Medicine article points to another non-physiological cause of sexual desire disorder in women: low relationship satisfaction, often driven by interpersonal conflicts or a partner’s sexual dysfunction. According to experts at the Mayo Clinic, lack of emotional intimacy, trust issues, and poor communication of sexual needs and preferences can all lead to a decrease in sex drive.

This is also true for men. Loss of intimacy can lead to lower sex drive in men. Likewise, an article from the Cleveland Clinic points to low testosterone in men as a potential contributor to low sex drive, along with mental health issues such as depression or anxiety, or relationship difficulties. 

Getting the sex drive back

As noted by the authors of the Reproductive Biology and Endocrinology 2020 review, clinicians treating patients with self-reported low libido should proceed with a “systems perspective,” meaning that the patient’s sex drive is likely affected by a range of physical and psychosocial factors. The authors of the 2018 American Journal of Lifestyle Medicine article draw a similar conclusion, positing that the causes of low libido may be physical, cultural, emotional, medical, psychological, or due to relationship dynamics—or a combination of all of these factors.

When trying to understand sex drive, start with this holistic systems approach. Make sure your patient is eating healthy, getting regular exercise, take a closer look at their medication, and help your patient understand that it is important to nurture their relationship with their partner.

This article was originally published on 15 Aug 2021

This story is contributed by Alistair Gardiner and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.