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Module 17 — Low Desire
Find what is lowering desire, without blaming either of you.
One of you used to reach for the other and now rarely does, or never felt much pull in the first place. The other has started to wonder what it means, and each of you may quietly believe that something is wrong with one of you. This module walks through a session about low desire, so you know what we ask and why.
When desire is low
Summary: what usually happens in the session
1 You each say what has changed. In turn, in your own words, out loud or written down first.
2 You talk about whether it is a problem, and for whom. Wanting sex less than your partner is not a disorder on its own.
3 Your therapist asks about your body, health and medications. And may ask you to see a doctor as well, alongside therapy.
4 You talk about sleep, stress and what your days take out of you. Including caring for others, masking and the senses.
5 You talk about how things are between you. Old hurts, resentment, and whether you both feel safe.
6 You look at the pattern that keeps low desire going. Who reaches, who pulls back, and how each of you feels.
7 Your therapist suggests working on both sides at once. Your body and the pattern between you, side by side.
One way this session can go, not a script. Your therapist will shape it to the two of you and to their own way of working.
Step 1. You each say what has changed
Sessions with us are online, with the two of you together at home and your therapist on the screen. Everything is talk. Nothing sexual happens in a session. Your therapist usually starts by asking each of you, in turn, what has changed and when you first noticed it. If it is easier to write your answer down and read it out, that works too.
Both experiences are real. The partner with less desire often feels guilty, broken or watched. The other often feels lonely, unwanted, or afraid to ask again. Sometimes desire has faded for both of you. Your therapist makes room for each of you, and neither of you is the problem.
The opening question. When did you first notice a change? Tell me what it has been like for you, not what you think is wrong with either of you.
Step 2. You talk about whether it is a problem, and for whom
Most couples differ in how often they want sex, and the gap can shift over the years. In clinical definitions, low desire counts as a problem only when it causes distress.1 A large survey of women in the United States found that low desire was common, and that being distressed by it was far less common.2 So your therapist is less interested in how often than in three other questions.
What makes low desire a concern. Is this a change for you, or has it always been this way?
Does it bother you, your partner, or both of you?
Is it straining the relationship?
Each answer points somewhere different. If one of you has always felt little or no sexual attraction, that may be asexuality, which is an identity, not a symptom to treat. Orientation, Identity, and Desire looks at that conversation.
Step 3. Your therapist asks about your body, health and medications
Desire often drops for physical reasons, and most people have more than one. Your therapist asks about hormones and life stage, such as pregnancy, the months after a birth, perimenopause, menopause or hormonal contraception. They also ask about mood, medications, health conditions, pain, and alcohol or other substances.
Your therapist may ask about all three groups. The first is usually checked with a doctor as well, and each of you may recognize different tiles.
A medical check, alongside therapy. If desire has dropped suddenly, if sex hurts, if erections or arousal have changed, or if hormones may be involved, your therapist will usually suggest seeing a doctor as well. Depression, anxiety and some of the medicines that treat them, especially the antidepressants called SSRIs, can lower desire. If a medication may be part of it, that is a conversation with the doctor who prescribed it, rather than a change to make on your own.
Some problems need a specialist, for example a pelvic floor physical therapist, and your therapist will help you decide. Pain During Sex and Perimenopause and Menopause go further into two of these.
The health question. Has anything changed in your body, your medications or your sleep since this started? Nothing is too small to mention.
Step 4. You talk about sleep, stress and what your days take out of you
Your therapist then asks what an ordinary day takes out of each of you: work, broken sleep, the mental load of running a home, young children, a parent who needs care. Desire is often one of the first things that exhaustion switches off.
Neurodivergence can add to the load. Autism is not, in itself, a lack of desire. In studies of autistic adults, many reported wanting sexual contact, alone and with a partner.3 But many neurodivergent people spend the day masking, hiding their differences to fit in, or coping with noise, light and touch. By evening there may be little left, and touch can feel like one more thing for the senses to manage. Energy, Masking, and the Onramp goes into this.
The energy question. By the time you could be close, how much do you each have left? What used most of it up today?
Step 5. You talk about how things are between you
Desire is hard to feel in a relationship that does not feel safe. Your therapist may ask about resentment, arguments that never finished, and hurts that still sting. Past experiences matter too, including trauma and shame about the body. Some of this is easier to say alone, and your therapist may offer a separate conversation for it.
If you do not feel safe. This work is for relationships where both of you can say yes, no, wait or stop without being punished for it. If sex has happened under pressure, or if either of you is afraid of the other, tell your therapist on your own. Work on sex pauses while that is looked at. Your safety comes first.
Step 6. You look at the pattern that keeps low desire going
Whatever starts low desire, a pattern between you can keep it going. Your therapist may invite you both to describe it, step by step. If one of you is sensitive to rejection, each no can land very hard and speed the loop up.
Each move makes sense from the inside. That is why the session looks at the loop, rather than at either of you.
Desire that comes second is not low desire. Many people, especially in long relationships, feel desire only after closeness or arousal has begun, not before.4 That is healthy. When One of You Wants It More looks at it in detail.
Naming the loop. Where does each of you come in on this loop? What does it feel like from your side?
Step 7. Your therapist suggests working on both sides at once
The body and the pattern feed each other, so we usually suggest working on both at the same time. A medical check runs alongside your sessions, not ahead of them. Better communication is unlikely to lift desire if a body or a mood has shut it down. A prescription alone rarely undoes years of a painful loop.
Waiting for one side to be fixed before starting the other usually gives the loop more time to settle in.
Your therapist may help you choose one small step on each side: a doctor’s appointment, perhaps, and one thing that drains desire that you could take away. Many couples find that removing what turns desire off helps more than adding what turns it on. That is the subject of Brakes and Accelerators.
Neither of you is broken. Low desire usually has reasons, and reasons can be worked with.
After the session
If you agreed to see a doctor, try to book the appointment this week, and bring what you learn to your next session. The Brakes & Accelerators worksheet on our site helps each of you list what turns desire off and what turns it on. Fill in your own copy privately, then trade and read in silence. You decide what, if anything, to share.
The workbook below is for after the session, on your own first. It takes about five minutes.
If this is hard to do. If this is too much right now, there is no need to push through. Spend some time with your partner talking about what makes it hard, and share what comes up: guilt about not wanting more, loneliness at being turned down, or worry about what it means for the two of you. That conversation is part of the work.
Is it a problem if one of us wants sex less than the other?
Not on its own. Most couples differ in how often they want sex, and the gap can shift over the years. In clinical definitions, low desire counts as a problem when it causes distress. So your therapist asks whether it is a change, whether it bothers you, your partner or both of you, and whether it is straining the relationship.
Can antidepressants or other medications lower sex drive?
They can. Depression, anxiety and some of the medicines that treat them, especially the antidepressants called SSRIs, can lower desire. If a medication may be part of it, that is a conversation with the doctor who prescribed it, rather than a change to make on your own. A medical check runs alongside therapy, not instead of it.
Does being autistic or ADHD mean having low desire?
In a review of studies, many autistic adults reported wanting sexual contact. But many neurodivergent people spend the day masking, or coping with noise, light and touch, so by evening there may be little energy left, and touch can feel like one more thing for the senses to manage. A session looks at what your days take out of each of you.
Why does low desire keep getting worse between us?
A pattern between you can keep it going. When one partner's desire drops, they may start avoiding touch in case a hug turns into a request for sex. The other feels unwanted and asks less, or with more urgency. The first partner feels pressured and wants sex even less. The loop can start anywhere, so the session looks at the loop, not at either of you.
Your workbook
Your answers save to this device only - we cannot see a word of what you write. Fill this in after a session about low desire, on your own first.
What I noticed
Answer these on your own first. There are no wrong answers. Your answers stay on this device, so if you share it, your partner may be able to see them. Pick the closest option even if none is exact.
Whose desire are we mostly talking about? — Mine, My partner's, Both of ours, Not sure
Is it a change? — A recent change, A slow change over years, It has always been this way, Not sure
How much does it bother me? — Not much, Somewhat, A lot, It is straining us
Which seems most likely to be part of it? — My body or health, Medications, Sleep, stress or load, Masking or the senses, How things are between us, The loop between us, Not sure yet
A medical check: — Booked, Not yet, Already done, Not needed for now
To bring next time
Write a line or two. If something is about your safety, tell your therapist privately instead.
One thing that drains my desire that we could take away
What I would like my partner to understand about this
Where this comes from
Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson.
Research discussion
The steps in this session come from our clinical work with neurodiverse couples and from our guide to sex and desire. They have not been tested in a trial. The list of common causes, and the advice to see a doctor, are standard clinical guidance rather than findings of ours.
The clinical definitions1 come from an international panel of experts, who agreed that a sexual difficulty should not be diagnosed unless it causes distress. That is expert agreement, not a study of patients. The survey of women in the United States2 asked more than 30,000 women about sexual problems and about distress. Low desire was the most common problem, and far fewer women were distressed by their problems than had them. It asked women only, in one country, once, and did not study couples.
The review of autism and sexuality3 brings together 27 studies in which autistic adults reported desire for sexual contact, alone and with partners. Those studies were mostly surveys of people who chose to take part, and none of them studied couples. The idea that desire can follow closeness rather than come first is a clinical model,4 developed with women in mind, not a trial.
Who this research was done with. The studies behind this module, none of them of neurodiverse couples, drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you.
Clinically reviewed by Harry Motro, PsyD, LMFT · California LMFT #53452 · Founder and Clinical Director, Neurodiverse Couples Counseling Center · Clinical supervisor · Updated October 5, 2026
Peer-reviewed research
1. McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Lewis R, Segraves RT (2016) Definitions of sexual dysfunctions in women and men: A consensus statement from the Fourth International Consultation on Sexual Medicine 2015. Journal of Sexual Medicine, 13(2), 135-143. https://doi.org/10.1016/j.jsxm.2015.12.019 An international expert committee's consensus definitions of sexual dysfunctions in women and men, including hypoactive sexual desire. The definitions require that a difficulty has lasted at least three months, occurs in most sexual experiences and leads to individual distress: without distress, a sexual dysfunction should not be diagnosed. Limitation: a consensus of expert opinion, not an empirical study.
2. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB (2008) Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics and Gynecology, 112(5), 970-978. https://doi.org/10.1097/AOG.0b013e3181898cdb The PRESIDE survey of more than 30,000 US women aged 18 and over. Sexual problems were commonly reported, with low desire the most common, but problems accompanied by personal distress were much less frequent. Limitation: a one-time survey of women in one country; it does not study couples, men or neurodivergent people.
3. Pecora LA, Mesibov GB, Stokes MA (2016) Sexuality in high-functioning autism: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 46(11), 3519-3556. https://doi.org/10.1007/s10803-016-2892-4 Systematic review of 27 observational and cross-sectional publications, nine of which were eligible for meta-analysis. Females reported higher levels of sexual understanding yet more adverse sexual experiences than males and than non-autistic comparisons; males reported greater desire for and engagement in solitary and dyadic sexual contact. The authors describe the findings as an initial characterization requiring further research. Limitation: cross-sectional and largely self-selected samples throughout; no couples data.
Clinical sources and public data
4. Basson R (2001) Using a different model for female sexual response to address women's problematic low sexual desire. Journal of Sex and Marital Therapy, 27(5), 395-403. https://doi.org/10.1080/713846827 The paper that set out the responsive-desire model: for many people desire follows arousal and emotional intimacy rather than preceding them, so an absence of spontaneous desire is not evidence of a disorder. Developed with women in mind and applied more broadly since. Limitation: a clinical model paper, not a trial; the on-ramp follows from it by reasoning and has not been tested as an intervention.
Further reading
• Neurodiverse Couples Counseling Center (2026) Neurodiverse Sex Therapy: a guide for neurodiverse couples on sex, desire and intimacy. Practice materials, Neurodiverse Couples Counseling Center. https://www.neurodiversecouplescounseling.com/sex The practice's guide this course is built from: here, the loop between causes and symptoms, the two layers of low desire (drivers and pattern) worked on in parallel, the common drivers, and the point that a difference in desire is not automatically a disorder. Limitation: clinical material developed in use, not a study.
• Neurodiverse Couples Counseling Center (2026) Brakes & Accelerators. Practice materials, Neurodiverse Couples Counseling Center. https://www.neurodiversecouplescounseling.com/worksheets/brakes-accelerators Each partner privately lists what slows desire down or shuts it off and what speeds it up, then trades and reads, and picks one brake to remove and one accelerator to add. Limitation: a clinical tool developed in use, not a validated instrument.
Low desire has reasons, and we can help you find them
The Neurodiverse Couples Counseling Center works with couples where one or both partners are autistic, ADHD or AuDHD, including when desire has faded. We look at the body and the pattern between you side by side, and suggest a medical check where it fits. Therapy for clients in California, coaching worldwide, all by telehealth. A first conversation costs nothing.
Up next
Module 18 — When One of You Wants It More