"Help, I don't want to have sex anymore: I'm too tired, stressed, I don't feel sexy, what is wrong with me?"

Here's how Prof. Graziottin answers this question from her patients:

Here is a list of questions you could ask your patients in order to provide them with the best possible answer:

• First, how old are you? The hormonal status has a major role in modulating the biological basis of sex drive. The hypothalamic amenorrhea, say when you don't have period because of stress, you don't have period because you're lactating, or menopause, are three conditions with low sexual hormone levels that have a major role in killing your sex drive.  And also check your thyroid hormones as well.
• Second, are you really feeling stressed? Stress is another major enemy of sex drive. Because we have a peak of cortisol due to stress to face enemies or difficult situations, also emotional, and this will cause a systemic, say all your body will be inflamed with neuroinflammation, say in your brain, and this causes depression, a major enemy of sex drive. But also irritability, mood changes, and a frank depression that will cause a loss of sex drive. But also stress is the major etiology of gut dysbiosis. Besides, and this is true, and you know that, stress is the major killer of our vital energy. Say we have no energy; we have no possibility to enjoy sex drive and have thrilling sex.
• Third, how’s the quality of your sleep? Because sleep is a major protector of your vital energy and also of your sex drive. When sleep is inadequate in quantity or quality, another major enemy of sex drive is dramatically in play.
• Another question: how’s the tonus, the contraction, of your pelvic floor muscles? Do you complain of vaginal dryness or sexual pain at the entrance of the vagina? This is clear. If you have a tight pelvic floor and you have pain at the beginning of the intercourse, this will kill your sex drive because to have no more sex drive is a self-protective measure to prevent other painful intercourse. So your physician should check the pelvic floor and recommend physiotherapy. 
• And then, very important for every patient and with doctors as well: What are your lifestyles? How’s your diet? Do you do any physical activity, at least brisk walking in the morning, to steam off your stress, your irritability? Are you overweight or obese? Do you drink, smoke or use drugs? Do you have any bowel symptoms, diarrhea, constipation? Why that? Because chronic stress may affect your gut microbiome and cause gut dysbiosis with a lot of consequences on the energy level, your sense of well-being, the smile to life and to sex or not.

Check the hormones and recommend, if feasible, more time to sleep and recharge the vital energy. Recommend daily brisk walking outdoors in the morning, also to go to work or to accompany children to school. 30 minutes is 1/48 of the daytime! And this is an effective money and time-saving good start to reduce physical and emotional stress, from scratch, so to speak.

Recommend a better diet and no alcohol: apparently it relaxes, but it is a powerful killer of sex drive, also through the gut dysbiosis it provokes, in parallel to the damage to the central nervous system. And also recommend a committed program to exercise and lose weight, to improve self-image and self-perception.

In parallel, ask about the quality of the relationship? If the couple has a major crisis, sex drive loss is the first symptom the woman complains of.

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