Low Libido, Painful Sex, and the Orgasm Gap: What No One's Talking About

If you’ve ever quietly wondered whether your sex life is “normal,” you’re not alone. And if you’ve ever scrolled through social media or stumbled across pornography and felt like everyone else is having effortless, earth-shattering sex, I want to gently push back on that.

What we see online is not real life. It’s curated, performative, and designed to get clicks, not to reflect what sex actually looks like for most people. Research shows that frequent pornography consumption is associated with unrealistic sexual expectations, decreased emotional intimacy, and increased dissatisfaction with partnered sex. For women in particular, exposure to these portrayals can fuel insecurity about how their body looks, how they respond sexually, and what they “should” be able to do in bed. Social media adds another layer, with curated images and conversations that make it feel like everyone else has it figured out.

They don’t. I promise.

The reality is far more nuanced, far more varied, and far more human than anything you’ll find on a screen. So let’s have an honest conversation.

Low Libido Is Incredibly Common

Low sexual desire is the most commonly reported sexual concern among women of all ages. Studies show that around 27% of premenopausal women report low desire, and when all age groups are considered, the numbers are even higher. An Australian study of over 2,000 women found that almost 70% reported low desire at some point.

Those numbers aren’t a sign that something is broken. They’re a sign that desire is complex, changeable, and deeply personal.

It’s also important to know that low desire only becomes a clinical “disorder” when it causes you significant personal distress. Not every woman who has low desire is troubled by it, and that is perfectly fine.

If it’s not distressing you, there’s nothing to fix.

Understanding How Desire Actually Works

For a long time, people assumed that sexual desire always comes first, like an urge that appears out of nowhere and drives you to want sex. This is called spontaneous desire, and it’s the type of desire most commonly shown in movies, on social media, and in pornography.

Here’s what they don’t show you: research by Dr Rosemary Basson has demonstrated that many women experience responsive desire instead. This means desire doesn’t appear on its own. Rather, it emerges in response to being in an intimate situation, experiencing touch, closeness, or other stimulation. Roughly 55–60% of women report that their desire is primarily responsive or contextual.

This is a completely normal and healthy pattern of desire, not a sign that something is wrong.

In practical terms, this means that even if you rarely think about sex during your day, you may find that once you begin an intimate experience with your partner, feelings of desire and enjoyment can emerge. It doesn’t have to start with a strong urge. If what you see in pornography makes you feel like you should be instantly, passionately ready to go at the drop of a hat, know that this is a performance, not reality, for the vast majority of women.

Why Sexual Desire Is Complex

Female sexual desire is influenced by many factors working together, including:

• Psychological factors: Stress, tiredness, mood, body image, past experiences, and how you feel about yourself and your relationship
• Physical factors: Pain during sex, hormonal changes, medical conditions, and medications
• Relationship factors: Communication, emotional closeness, trust, and how safe you feel with your partner
• Cultural and social factors: Expectations from society, media, friends, or family about what a “normal” sex life looks like

This is why there is no single “fix” for low desire. It’s almost always a combination of factors, and what works for one person may not work for another.

Endometriosis and Sex

Endometriosis affects roughly 1 in 7 women, and it’s one of the most significant yet under-discussed contributors to sexual difficulties. Dyspareunia (pain during or after sex) affects an estimated 32–70% of women with endometriosis, and in large studies, eight out of ten women with endometriosis reported that their symptoms negatively impacted their sex lives.

The pain is real. Deep dyspareunia from endometriosis is driven by chronic inflammation and nerve sensitisation in the pelvis. Over time, the fear and anticipation of pain can reduce desire and arousal before anything has even happened, creating a cycle that’s hard to break. Deep infiltrating endometriosis involving the uterosacral ligaments is associated with the most severe impairment of sexual function.

If you live with endometriosis and sex is painful, please know: it’s not in your head, and you shouldn’t feel pressured to push through it. This is a well-recognised consequence of the disease, and there are things we can do to help.

Pain With Sex: You Don’t Have to Just Put Up With It

Dyspareunia is far more common than most people realise. Research suggests it affects somewhere between 8% and 21% of women globally, and in primary care settings, up to 46% of women presenting with sexual concerns report it.

It can be superficial (at the vaginal entrance) or deep (within the pelvis), and causes range from hormonal changes and vaginal dryness to pelvic floor muscle tension, endometriosis, and psychological factors including anxiety and past trauma.

No one should endure pain during intimacy. If sex hurts, it’s always worth raising with your doctor. I know it can feel awkward to bring up, but this is literally what I’m here for. There are effective treatments, and the first step is having the conversation.

Let’s Talk About Orgasm

There’s a widespread and harmful myth, reinforced by pornography and social media, that all women should orgasm easily, loudly, and from penetrative sex alone.

The evidence tells a very different story.

A large study of over 1,000 women found that only 18.4% could orgasm from intercourse alone. Around 37% needed clitoral stimulation to orgasm during intercourse, and another 36% said that while it wasn’t strictly necessary, their orgasms were better with it.

Let me put that plainly: the majority of women do not orgasm from penetration alone, and this is completely normal.

Many women also find it difficult or impossible to achieve orgasm with a partner, even when they can on their own. Research confirms that heterosexual women achieve orgasm during partnered sex significantly less often than during self-stimulation. Factors such as distraction, anxiety, and difficulty communicating preferences all play a role.

Being able to reach orgasm on your own but not with a partner doesn’t mean there is anything wrong with you. It’s a very common experience.

And between 5–10% of women have never experienced an orgasm at all. If that’s your experience, your body is not broken. There is enormous variation in how women experience pleasure, and what you see in pornography is a performance, not a reflection of reality.

Pain With or After Orgasm

Some women experience cramping or pain during or after orgasm, a condition called dysorgasmia. It’s different from pain with intercourse, and it’s more common than most people think.

Physical causes can include pelvic floor muscle spasm, endometriosis, ovarian cysts, fibroids, and adenomyosis. Psychological factors like anxiety, depression, and past trauma can also play a role. In one study, nearly 95% of women with dysorgasmia had pelvic floor muscle spasm on examination, and endometriosis was found at an unusually high rate in this group.

If this is something you experience, it deserves attention, not dismissal. It doesn’t mean something is fundamentally wrong with you as a person. It means your body is telling you something, and treatments including pelvic floor physiotherapy, management of underlying conditions, and psychological support can all help.

What Can Actually Help

There’s no single “cure” for low desire or sexual difficulty, but there are steps that can make a real difference.

Communication With Your Partner

Research consistently shows that couples who communicate openly about their sexual needs and preferences experience better sexual satisfaction. This includes being honest about what you enjoy, what you don’t enjoy, and what your expectations are. It can feel awkward at first, but it’s one of the most effective things you can do. Consider going on a “learning journey” together, and if what you’ve both learned about sex has come from pornography, acknowledge that as a starting point, not a standard.

Pelvic Floor Physiotherapy

This is one of the most underutilised and underappreciated tools in gynaecology. Pelvic floor physiotherapy can improve sexual function by increasing muscle awareness, improving blood flow, reducing pain, and enhancing sensation. It’s especially relevant if you’ve had endometriosis, pelvic surgery, or pain with sex.

A systematic review of 19 studies found that physiotherapy techniques, including pelvic floor muscle training, manual therapy, trigger point release, and TENS, are effective in improving pain and quality of life in women with dyspareunia. Pelvic floor training has also been shown to improve arousal, orgasm, satisfaction, and pain scores. Manual therapy, including soft tissue mobilisation and myofascial release, has been shown to reduce pain specifically associated with sexual intercourse.

Here in Aotearoa we have some excellent pelvic floor physiotherapists, and I work closely with several of them. If you’re experiencing pain with sex, asking for a referral is one of the most practical and worthwhile steps you can take.

Psychology or Sex Therapy

Cognitive behavioural therapy (CBT) and mindfulness-based therapy are considered the gold-standard psychological treatments for low desire in women. CBT can help by addressing unhelpful thoughts and beliefs about sex, reducing anxiety, and building new patterns of thinking. Mindfulness-based approaches can help you be more present during intimate moments, rather than distracted by worries or self-judgement.

A psychologist or sex therapist can also help you explore any feelings of guilt, pressure, or frustration you may be experiencing. These feelings are very valid, and addressing them can make a meaningful difference, especially if unrealistic expectations from social media or pornography are part of the picture.

Self-Exploration and Education

Learning more about your own body and what feels pleasurable is an important part of improving your sexual experience. Understanding the difference between spontaneous and responsive desire can itself be liberating, as it removes the pressure to feel a sudden urge before being intimate.

There’s no right way to experience pleasure, and there’s no deadline.

You Deserve Better Than Silence

Your sexual health matters. Your experience is valid, whatever it looks like. Whether you’re navigating low desire, pain with sex, difficulty reaching orgasm, or pain with orgasm, none of these things make you inadequate or abnormal.

These are among the most common health concerns women face, yet they’re still some of the least talked about. The stigma, the awkwardness, the worry that you’re the only one, it keeps people suffering in private. And the unrealistic portrayals we see online only make it worse.

You deserve care that doesn’t shy away from the whole picture. If any of this resonates with you and it’s causing you distress, please reach out. This is exactly the kind of conversation I’m here for, and it’s a judgement-free zone.