Health & Longevity Series · Medical education

The neurobiology of sexual desire

3 min read

01Overview

How desire arises

Key takeaway for patientsLow desire is common and rarely has a single cause. Hormones, mood, medicines, sleep and the relationship all contribute, and a physician can help to sort out which matter.

Sexual desire begins in the brain. It reflects a balance between excitatory signals, in which dopamine and the sex hormones play a part, and inhibitory ones, in which serotonin, stress and fatigue weigh in. The hypothalamus and the brain’s reward circuits bring them together.

Testosterone contributes to desire in men and in women, and estrogen to comfort and arousal. Desire also depends on context: mood, the relationship, health and sleep.

02Key steps

Key steps in the regulation of desire

Cues: Internal or external stimuli are appraised by the brain.
Excitation: Dopamine pathways raise interest and motivation.
Inhibition: Stress, fatigue and serotonin signaling hold it back.
Hormonal modulation: Sex hormones set the background sensitivity.

03Factors in decline

Factors that lower desire

Several of the common causes can be identified and addressed:

Hormonal change: Low testosterone, the menopause, the months after childbirth, thyroid disease.
Medicines: Some antidepressants, among others.
Stress, low mood and poor sleep: Strengthen the inhibitory side of the balance.
Chronic illness and pain: Reduce energy and comfort.

04Clinical management

Clinical management and physician guidance

Assessment looks at the physical, psychological and relational contributors together.

Clinical and hormonal assessment: History, mood, medicines and hormone levels where indicated.
Physician-guided care: Addressing the contributors found, with referral for counseling where appropriate.
Monitoring and follow-up: Symptoms and markers are reviewed over time, and the plan is adjusted to them.

05Research focus

Research focus in the neurobiology of desire

Core focus area	Biological target	Clinical relevance
Reward circuits	Dopamine pathways	Motivation and interest
Inhibition	Serotonin signaling	Suppression of desire
Hormonal modulation	Androgen and estrogen receptors in the brain	Background sensitivity to cues
Integration	The hypothalamus	Linking hormones, mood and behavior

06Questions

Frequently asked questions

Is low desire a medical problem?: It can be. Hormones, medicines, mood and illness all contribute, and a physician can help to sort out which matter.
Do hormones decide desire?: They set the background, but mood, stress, sleep and the relationship weigh as much.
Can medicines lower desire?: Some can. Never stop a prescribed medicine without speaking to your physician first.

07References

Academic references and literature

Pfaus JG (2009). Pathways of sexual desire. J Sex Med, 6(6), 1506-1533. PMID 19453889.
Bancroft J et al. (2009). The dual control model: current status and future directions. J Sex Res, 46(2-3), 121-42. PMID 19308839.
Georgiadis JR, Kringelbach ML (2012). The human sexual response cycle: brain imaging evidence linking sex to other pleasures. Prog Neurobiol, 98(1), 49-81. PMID 22609047.

This guide belongs to the Sexual Health program