Desire differences between partners

The most common sexual complaint

Desire discrepancy — one partner wanting sex more often than the other — is the single most frequently reported issue in couples therapy, more common than any dysfunction. It is a difference between two people, not a fault in one.

The framing matters. Calling one partner's level "low" and the other's "normal" imports a standard that does not exist. There is no correct frequency, and population data show enormous spread: the British National Survey of Sexual Attitudes and Lifestyles (Natsal-3, 2013, n = 15,162) found a median of three occasions of sex in the past four weeks among sexually active adults, with a wide distribution and a long-run decline in frequency across successive surveys.

Spontaneous and responsive desire

Basson's model (2000) describes desire that emerges after arousal begins, rather than preceding it. Responsive desire is common, is more common in women and in longer relationships, and is entirely normal.

The practical consequence is large. A responsive-desire person waiting until they feel like it will rarely feel like it, because the feeling is downstream of the activity. Agreeing to begin — in unhurried conditions, with no obligation to continue and an explicit right to stop at any point — is what allows desire to appear. This is not the same as having sex you do not want; the difference is the freedom to stop, and it collapses without it.

Causes worth ruling out

Medical. Thyroid dysfunction, anaemia, diabetes, low testosterone with symptoms, prolactin excess, chronic pain, sleep apnoea, depression and anxiety.

Medication. SSRIs and SNRIs are the most common culprit — Montejo et al. found sexual side effects in an estimated 40–65 percent of users, frequently unmentioned at prescription. Also: some hormonal contraception, finasteride, beta blockers, antipsychotics, opioids, and anti-androgens. Alternatives usually exist; do not stop a psychiatric medication without advice, but do raise it.

Hormonal. Menopause, postpartum, breastfeeding, gender-affirming hormones, and hormonal contraception in a subset of users.

Situational and relational. Exhaustion, caregiving load, unequal domestic labour (repeatedly associated with lower desire in the partner carrying more), unresolved resentment, criticism, and lack of privacy.

Historical. Trauma, shame from religious or family upbringing, and past painful sex establishing anticipatory avoidance.

What does not work

• Keeping score. Frequency counts turn sex into an obligation ledger and reliably reduce desire further.
• Pressure, sulking or guilt. These are coercive whether or not they are intended that way, and they associate sex with unpleasantness, which lowers desire further next time.
• Assuming it means loss of attraction. It usually does not.
• Waiting for it to resolve on its own. Discrepancy that goes unaddressed for years is much harder to shift than discrepancy addressed at one year.
• Aiming at a frequency number. Satisfaction, not frequency, is what correlates with relationship quality — and Muise et al. (2016, Social Psychological and Personality Science), analysing three studies including over 30,000 people, found the association between frequency and wellbeing levelled off above about once a week.

What has evidence

• Separate desire from sex. Affection, touch and closeness without an expectation of escalation removes the association between contact and pressure, which is itself a common cause of touch avoidance.
• Broaden the definition. Manual, oral, mutual masturbation, sensual touch. A rigid definition of what counts creates all-or-nothing decisions.
• Scheduling. Counterintuitive but well supported in clinical practice: planned intimacy allows anticipation to build, protects it from the day's exhaustion, and removes the constant low-level negotiation of initiation and refusal.
• Sensate focus. Developed by Masters and Johnson, still the core behavioural intervention in sex therapy: staged, non-demand touching with intercourse explicitly off the table, removing performance pressure while rebuilding physical connection.
• Address the load. Practical redistribution of domestic and caregiving work has a measurable effect where imbalance exists.
• Treat the brakes. Under the dual control model, reducing inhibition usually achieves more than increasing stimulation.
• Sex therapy. Effective, brief in many cases, and specifically trained for this. Directories: COSRT in the UK, AASECT in the US.

Medication for low desire

Flibanserin and bremelanotide are licensed in the US for acquired, generalised hypoactive sexual desire disorder in premenopausal women. Meta-analyses (Jaspers et al., 2016, JAMA Internal Medicine) found statistically significant but small effects — roughly half an additional satisfying sexual event per month over placebo — alongside meaningful side effects including hypotension and somnolence with flibanserin, which also interacts with alcohol. Transdermal testosterone for postmenopausal women has better evidence (Islam et al., 2019, Lancet Diabetes & Endocrinology) for a modest improvement in desire and satisfying events. None of these are transformative, and all work better alongside the behavioural approaches above than instead of them.

Sources

• Mercer CH et al. "Changes in sexual attitudes and lifestyles in Britain through the life course (Natsal-3)." Lancet, 2013.
• Basson R. "The female sexual response: a different model." Journal of Sex & Marital Therapy, 2000.
• Muise A, Schimmack U, Impett EA. "Sexual frequency predicts greater well-being, but more is not always better." Social Psychological and Personality Science, 2016.
• Montejo AL et al. "Incidence of sexual dysfunction associated with antidepressant agents." Journal of Clinical Psychiatry, 2001.
• Jaspers L et al. "Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis." JAMA Internal Medicine, 2016.
• Islam RM et al. "Safety and efficacy of testosterone for women." Lancet Diabetes & Endocrinology, 2019.
• Masters WH, Johnson VE. Human Sexual Inadequacy, 1970 (sensate focus); Weiner L, Avery-Clark C. Sensate Focus in Sex Therapy, 2017.

Last reviewed: August 2026.