This article is part of the Sex, Desire and Attraction in Marriage series.
Low libido in a long-term marriage is one of those things that manages to be extremely common and yet almost universally experienced as a private failure. The person with lower desire tends to feel broken, guilty, or vaguely defective — as though something is wrong with them specifically, rather than something that’s responding, quite normally, to a set of conditions. Their partner tends to feel rejected, confused, and often quietly convinced that the loss of desire is actually about them. Neither story is usually accurate. But both stories cause a lot of damage before anyone looks at what’s actually going on.
What I want to do here is go through the actual causes — not in a clinical way, but honestly — because the cause matters enormously for what might help. Low libido that’s rooted in hormonal change needs different attention from low libido that’s driven by unresolved emotional disconnection, which needs different attention again from low libido that’s primarily a symptom of depression or anxiety. This is one reason many couples first need to understand why sexual desire changes in long-term relationships before trying to address it directly.
The most commonly overlooked category is physiological, and it’s worth being direct about it because so many people are quietly suffering from something that has a real, addressable cause they’ve never had properly investigated. Hormonal changes are one of the most significant drivers of libido loss in married adults in their thirties, forties, and beyond — and they affect both men and women, though in different ways and on different timelines.
For women, the fluctuation and eventual decline of oestrogen and progesterone that begins in perimenopause — which can start a full decade before menopause itself — has a direct and sometimes dramatic effect on sexual desire, arousal, and physical comfort during sex. Vaginal tissue changes, reducing natural lubrication and sometimes causing discomfort that makes sex something to be avoided rather than sought. The brain’s response to sexual cues shifts. The whole erotic system becomes, for some women, significantly quieter. This isn’t inevitable or permanent, and there are medical interventions that genuinely help — hormone therapy, local oestrogen treatments, and others — but they require a conversation with a doctor that a surprising number of women never have, partly because the symptoms get attributed to stress or relationship problems rather than physiology.
For men, testosterone levels decline gradually and continuously from the early thirties. For most men this is a slow background process with minimal impact on daily life, but for some — particularly under sustained stress, with poor sleep, or in combination with other health factors — the decline is significant enough to meaningfully reduce both desire and physical responsiveness. Low testosterone is diagnosable and treatable, but again requires someone actually looking for it, which tends to require a degree of honesty with a doctor that men particularly are often reluctant to bring.
“So many people are quietly suffering from something that has a real, addressable cause they’ve never had properly investigated. The hormonal dimension of libido loss is real, common, and far too often missed.”
Medication is another physiological factor that rarely gets enough acknowledgment. SSRIs and SNRIs — antidepressants that are among the most widely prescribed medications in the world — are notoriously associated with reduced libido and delayed or absent orgasm. The irony is that the people most likely to be prescribed them are often already struggling with the emotional weight of a difficult relationship or period of life, and then their medication further suppresses the sexual dimension of intimacy, compounding the problem. Other medications — certain blood pressure drugs, hormonal contraceptives, and some antihistamines, among others — also affect desire in ways that often go completely unconnected to the libido issue in the person’s mind. It’s always worth looking at what someone is taking, and whether an alternative might be available, if medication-related libido suppression seems possible.
Psychological causes sit alongside the physiological, and they’re often more entangled than people expect. Depression is the most significant one, and it deserves plain statement: depression reliably suppresses libido. Not universally, not in every case, but consistently enough that persistent, unexplained loss of sexual desire should always prompt the question of whether depression might be present. Depression doesn’t always look like visible despair — it often looks like flatness, low energy, reduced engagement with things that used to matter, difficulty feeling pleasure. Someone can be significantly depressed and still functional, still showing up for their life, without either themselves or their partner recognising what’s happening.
In many cases, this sits within a broader pattern of emotional disconnection, which is explored in more detail in why intimacy fades in long-term relationships.
Anxiety does something similar through a different mechanism. Chronic anxiety keeps the nervous system in a state of low-grade alert that is physiologically incompatible with sexual arousal. The body under threat — even perceived, diffuse, non-specific threat — prioritises survival functions over reproductive ones. Desire goes quiet. Someone living with sustained anxiety, whether or not they identify it as anxiety, will often find their libido significantly reduced without being able to explain why. And the shame that can accumulate around low desire — the guilt toward the partner, the private sense of inadequacy — often compounds the anxiety, making things worse.
Body image is a quieter factor but a real one. People who feel significantly disconnected from their body, or who carry a lot of shame or discomfort about their physical self, often struggle to access desire because the sexual experience requires a kind of embodied presence they find hard to inhabit. This isn’t vanity or superficiality. It’s a genuine barrier that tends to be particularly pronounced for women, but affects men too, especially in midlife as bodies change in visible ways. The solution here isn’t losing weight or looking different — it’s reconnecting with the physical self in a more neutral, accepting way, which tends to be slow work but does move.
Relational causes — the dynamics between the couple rather than within the individual — are often what people assume must be driving low libido when other factors haven’t been considered, and sometimes they’re right. Unresolved conflict, accumulated resentment, emotional disconnection, or a long history of feeling pressured around sex can each suppress desire as effectively as any physiological cause. The body, in this sense, is keeping a record of the emotional experience of the relationship, and when that record is largely negative, it makes a case against closeness. These patterns often develop gradually and are part of what is sometimes referred to as the emotional withdrawal cycle in relationships.
The pressure dynamic deserves its own mention here, because it’s particularly common and particularly self-defeating. This dynamic is closely related to the pursuer–distancer pattern, where one partner moves toward connection while the other pulls back. When one partner’s low desire becomes a source of ongoing tension — tracked, discussed, referenced with frustration — the low-desire partner begins to associate the whole territory of physical intimacy with stress and obligation. Sex stops being something that might feel good and becomes something to manage, or avoid, or perform reluctantly to reduce the pressure. That association, once established, actively suppresses whatever residual desire might have been there. The person doesn’t want sex less because they don’t want their partner. They want it less because they’ve learned to dread the context in which it occurs.
What actually helps depends, as I said at the start, on what’s driving it. For physiological causes — hormones, medication, health — the first step is getting properly assessed. That means being honest with a doctor, asking specific questions rather than vague ones, and being willing to investigate rather than assume nothing can be done. For many people in this category, there are real options that would genuinely improve things, and the barrier is mostly the discomfort of having the conversation.
For psychological causes — depression, anxiety, body image — the path is individual support, ideally with someone who understands how these things intersect with sexual wellbeing. That might be a GP, a therapist, or both. It’s rarely resolved by relationship effort alone, because the source isn’t primarily relational.
For relational causes, the work is more mutual — rebuilding emotional safety, reducing pressure, addressing the specific things that have built up between two people over time. And the particular practical shift that tends to help most is removing sex as the metric of whether things are improving. A couple that genuinely commits to rebuilding physical warmth without the expectation that warmth must lead to sex — consistently, without the agenda becoming visible — often finds that desire returns in its own time, as the association between physical closeness and pressure slowly dissolves.
None of these paths is fast. All of them are real. And the biggest obstacle, in my experience, is usually not knowing which path actually applies — which is why looking honestly at the cause, rather than reaching for the nearest solution, is almost always where it has to start.
Further Reading
If you are looking for more information on rebuilding the intimacy within marriage, these guides may also help:
• Why Sexual Desire Disappears in Long-Term Relationships
• Can Sexual Attraction Come Back in a Marriage?
• Emotional vs Physical Intimacy: What Matters More?
• What Kills Attraction in Relationships(and How to Reverse It)
About C.J. Taylor
C.J. Taylor created Restoring Intimacy in Your Marriage to help people make sense of a specific kind of relationship challenge—where love and commitment are still present, but closeness has become uncertain or inconsistent.
Their work focuses on the patterns that develop quietly over time, often without either partner fully understanding why things feel different.
By combining personal insight with structured study of relationship dynamics, they offer a calm, practical way to understand and rebuild connection.
Start here: If you’re unsure what changed in your relationship, begin with Understanding the Communication Breakdown Loop—a simple framework that explains how intimacy gradually breaks down.