PCOS and sex drive: Is PCOS affecting your sex life?

If you’re living with PCOS and noticing changes in your sex drive, you aren’t too far off in thinking the two are connected–sexuality, desire and hormonal health are all intrinsically linked.                                          

At Allara, our clinicians frequently hear from our patients dealing with this issue. Women come to us feeling confused, frustrated, or quietly ashamed because their desire doesn’t look the way they think it should. “Low libido is a common concern for our patients,” says Gouri Pimputkar DO FACOOG, DipABLM. “Unfortunately, it’s rarely addressed in traditional care, but it should be, sexual health is a key part of overall health and wellness,” Dr. Pimputkar continues.

If you’re wondering why intimacy feels harder, you’re having issues with arousal, or why your body isn’t cooperating with intimacy, you’re in the right place. We’re covering the hormonal connection, ending the shame and stigma, and getting the care and treatment you deserve.

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There’s nothing wrong with you

Firstly, we need to be clear: there’s nothing “wrong” with you. Instead of thinking of this as a problem, think of it as your body trying to communicate with you. There’s a fundamental misunderstanding of what libido is.

Libido isn’t just attraction or mindset. It’s the drive to engage in sexual activity influenced by several factors, including stress and energy levels, physical and mental health, safety and, yes, hormones. When one or more of those systems is out of balance, desire often follows.

That’s why low libido in PCOS isn’t a personal failure. It’s an indicator of health, and one that’s often overlooked in traditional care.

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Does PCOS affect sex drive? 

The short answer is yes, it does, and women with PCOS consistently report lower sexual function. 

PCOS is a whole-body condition that can cause a range of symptoms. Those symptoms are related to reproductive hormones, metabolic health, the nervous system, and mental health. Dr. Pimputkar explains, “PCOS is often treated solely as a reproductive condition, but its effects are systemic.”

PCOS can affect mood, energy, emotions, and mental health. Libido lives at the intersection of all these systems.

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Why is sex sometimes painful?

Dyspareunia, the medical term for painful sex, can have a few underlying causes. Possible causes for dyspareunia in those with PCOS are ovarian cysts, emotional factors, use of certain medications, and more. If painful sex is an isolated incident, there may be no need to worry. But if it’s a regular occurrence, then definitely schedule an appointment with your medical professional to suss out a solution.

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Hormones, PCOS, and libido

As you may already be aware, women with PCOS produce an excess of male hormones, called androgens. 

There are many misconceptions around hormones and their effect on pleasure, namely, androgens like testosterone. Androgens are male sex hormones, but both men and women have them. 

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High androgens don’t always increase desire

Elevated testosterone levels can increase sexual desire–IN MEN. For women, elevated androgens don’t always mean elevated desire, says Dr. Pimputkar, “Testosterone plays a role in libido, but it’s a nuanced relationship; in fact, in PCOS, it can contribute to discomfort or disconnection rather than increased desire.”

In one study, researchers found that even when women with PCOS had a similar sex drive as those without, they were lacking in the climax zone. This means that PCOS may lower the ability to achieve orgasm.

But shouldn’t testosterone affect men and women equally? Meaning, shouldn’t they both feel heightened sexual desire? Desire is a much more complicated matter than hormones alone. However, there is some evidence that higher levels of testosterone do have a moderate association with increased sexual function in women.

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Low SHBG and arousal changes

Low sex hormone–binding globulin (SHBG), commonly seen with insulin resistance, changes how hormones circulate and act on tissues involved in arousal. It’s also regularly associated with a range of conditions, including PCOS. 

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The role of irregular menstrual cycles

When you ovulate, your desire naturally increases. Irregular cycles and even skipping ovulation are key PCOS symptoms, so it makes sense that it can stunt your libido. Dr. Pimputkar explains, “With inconsistent ovulation, you may notice that you don’t get that libido ‘boost’ during the month, which could mess with your sex drive.”

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The non-hormonal reasons PCOS low libido is so common

Hormones matter—but they’re not the whole story. What’s happening physically, mentally, and emotionally is just as important:

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Physical reasons

Negative body image can also play a role. PCOS symptoms like weight changes, acne, or excess hair can lead to a negative body image, effectively altering how one feels about slipping between the sheets. “Feeling self-conscious during sex isn’t superficial,” says Dr. Pimputkar, “if someone doesn’t feel good in their body, that can take a toll on desire.”

Additionally, some research suggests that women with PCOS have higher incidences of Pelvic floor dysfunction (PFD), which could result in uncomfortable or even painful sex.

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Mental and emotional health

PCOS is closely linked with anxiety and depression, both of which are strongly associated with low libido. There’s also fatigue, elevated cortisol levels, and the stress of navigating the healthcare system.

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What actually helps PCOS sex drive

There’s no quick and easy fix to dealing with low libido, even if you don’t have PCOS. Meaningful improvement usually means addressing the whole picture. “Patients can see an improvement when they look at the full picture,” counsels Dr. Pimputkar. 

That may include hormone and metabolic support, blood sugar stabilization, treatment for pain or dryness, and mental health care.

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Tell your partner you have PCOS

Sharing your diagnosis with your romantic partner is essential, as the condition's symptoms may affect long-term plans, such as having children. Don’t think about it as something shameful, instead consider it’s one step closer to a better sex life and relationship.

Here are some tips to have this critical conversation:

• Be direct, and have some studies and research that explain PCOS, its symptoms, and its challenges, and review them together.
• Give them time to digest the information and share what they know–PCOS awareness has grown in recent years, so you might be surprised that they already have some knowledge about the condition.
• Keep the script simple–explain what PCOS is, how it affects you and then detail what you need from your partner to feel good in your relationship.

Above all, be honest! If you’re struggling, a supportive partner can help ease you through your symptoms. If you’re just trucking along nicely and don’t feel the need for support, having another warrior on your team will only help on those inevitable bad days. Plus, sharing your innermost challenges with your partner is a building block to intimacy and long-term romantic success.

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Take some time to understand responsive desire

Not all desire is spontaneous. Many women with PCOS experience responsive desire, where arousal builds after intimacy begins. “When patients understand that responsive desire is normal, especially under stress or hormonal imbalance, it often reduces a lot of shame and pressure,” emphasizes Dr. Pimputkar.

Stress, pressure, and expectations shut desire down. Safety, patience, and communication support it.

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Get professional support

One of the best things you can do for your sexual health is to find a healthcare professional who can help guide you through this journey:

• A Psychologist: Therapy can be beneficial to help navigate issues with body unpack your relationship to sex, and develop coping mechanisms for any stress, anxiety, or other negative emotions you may be experiencing when it comes to sexual relationships. 
• A Sex Therapist: Sex therapists can be an excellent resource for either an individual or a couple to discuss sexual relationship issues in a neutral, judgment-free space.
• Hormonal Health: Hormones play a critical role in your overall well-being. Work with a hormone-informed provider to help you achieve and maintain hormonal balance.

At Allara, we’re committed to your whole health, including sexual health. Dr. Pimputkar shares, “sexual health concerns are quality-of-life concerns. Patients deserve providers who take them seriously.”

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How to find the right mental health professional for you

Finding the right mental health support for sexual dysfunction with PCOS can feel overwhelming, but it doesn’t have to be perfect to be helpful. What matters most is access, fit, and feeling heard. If in-person therapy isn’t realistic due to cost, location, or time constraints, telehealth can be a great option. 

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What to look for in a therapist or sex therapist

A mental health professional, like a therapist, should be credentialed, which ensures you are getting the most effective treatment possible.

Other qualifications you may consider:

• A postgraduate degree (Master’s or doctorate)
• Active state licensure
• Training in evidence-based therapy like CBT or DBT
• A strong personal fit. If the first session feels judgmental or off, it’s okay to move on
• Sliding-scale pricing or reduced fees, if cost is a concern
  

If you’re experiencing pain during sex, start with a trusted healthcare provider to rule out physical causes and discuss treatment options. Mental health support works best when physical symptoms are addressed as well. 

Finally, consider PCOS-focused support groups. Talking with others who understand what you’re going through can reduce isolation, normalize your experience, and offer practical advice you won’t always get in a clinical setting.

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Reclaiming PCOS libido with the right support 

There’s no single definition of a healthy sex drive. PCOS may change your desire levels, but it doesn’t disqualify you from experiencing pleasure or intimacy. It comes down to how you feel and knowing when things are different.

At Allara, we treat PCOS as the complex, whole-body condition it is—including how it affects libido and sexual health. Become an Allara patient today and get personalized, evidence-based support that meets you where you are without dismissal, pressure, or shame.

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FAQs about PCOS and sex drive

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Does PCOS affect sex drive?

Yes. PCOS can affect sex drive through hormone imbalances, insulin resistance, stress, and mental health changes. Libido shifts are common and medically relevant.

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Is low libido common with PCOS?

Very common. Many women with PCOS experience low or fluctuating libido, especially during hormonal changes or high stress.

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Can PCOS cause high sex drive?

In some cases, yes, as PCOS affects everyone differently. Some women experience higher desire, while others experience low libido or fluctuations.

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What causes PCOS low libido?

A mix of hormones, insulin resistance, fatigue, anxiety or depression, body image concerns, pain during sex, and medication side effects often causes PCOS low libido.

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Does high testosterone increase sex drive in PCOS?

Not always. High androgens can disrupt estrogen balance and arousal, which may lower desire or cause discomfort.

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Can insulin resistance affect libido?

Indirectly, it can. Insulin resistance is linked to fatigue, mood changes, and hormone disruption, all of which can affect sex drive.

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When should I talk to a doctor about PCOS and low libido?

If low libido feels distressing, ongoing, or comes with pain or mood changes, it’s worth seeking medical support.

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Can therapy help with PCOS-related sexual issues?

Yes. Therapy can help address anxiety, body image, relationship stress, and sexual confidence concerns.

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How can I improve my sex drive with PCOS?

Improving PCOS sex drive usually means addressing root causes through personalized hormone care, stress support, medication review, and mental health care.

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