Subscribe to Our Newsletter!
By clicking Subscribe, I agree to the Pelvic Health Support Privacy Policy and understand that I may opt out of Pelvic Health Support subscriptions at any time.
The Libido Clarity Map: Unlocking Low Desire
By Dr. Sasha Mastroianni, ND
As a naturopathic doctor focusing on women’s health, I often speak with women who come in hoping there’s a simple explanation or fix for their low libido — hormones, medication side effects, or a treatment they haven’t tried yet.
And sometimes, we do make simple changes and see a big difference — topical testosterone, switching antidepressants, or a trial of Addyi.
But what about the times when we’ve tested the hormones, addressed the pain, and adjusted medications, but desire still hasn’t returned?
That’s the moment I used to feel stuck.
Like many clinicians, I’d recommend books like Come As You Are by Emily Nagoski, PhD, or suggest working with a sex therapist trained through AASECT. These are excellent resources. But I also know that reading a whole book while feeling overwhelmed can be… well, overwhelming. And therapy, while powerful, is a big step, especially when it’s hard to find the right fit.
I wanted something simpler. I’ve always loved algorithms as a tool to give a framework for where to start, so I decided to explore the information I had and see how I could craft it into something a little more cohesive.
While I primarily work with women, this framework may resonate with anyone navigating low or shifting desire, regardless of gender or identity.
Making Sense of Libido: A Visual Framework
Over the years, through both clinical experience and my own healing journey, I’ve immersed myself in tactics for approaching low libido. I’ve listened to the words of thought leaders like Nagoski and Esther Perel, MA, LMFT. I’ve studied the biopsychosocial model of libido, responsive vs. spontaneous desire, arousal pathways, and the role of relational dynamics.
There were so many excellent insights, but I struggled with how to share that information in a digestible format with my patients.
So I created the Libido Clarity Map (which you can see here), a reflection tool to help patients (and clinicians) gently explore what might be influencing low desire, and where to begin. It’s not diagnostic, but instead it’s a map to guide curiosity — and, hopefully, some clarity.
Here are a few of the core questions it explores:
Does imagining never needing to want sex bring relief?
This is a question many people haven’t considered, and it often requires a pause. The first reaction might be, “No way. Or I wouldn’t be here.” But with a bit of reflection, it’s not uncommon to uncover a deeper layer.
For some, the idea of not needing to want sex brings a surprising sense of relief. It can feel like finally letting go of the belief that you’re broken, or the fear that unless you “fix” your libido, your relationship will fall apart. Those are heavy pressures to carry.
If relief is your honest answer, we explore whether the pressure to want sex, not the lack of desire itself, might be the real issue. That might open the door to conversations about asexuality, or simply choosing not to prioritize sex during certain seasons of life.
If your answer is no, it often points to a deeper sense of longing — the sense that something once meaningful is missing. But that longing may be tangled up in unspoken beliefs, past trauma, or fear of disconnection.
And sometimes it’s both: part of you feels relief, while another part fears the cost to your relationship. Desire discrepancy is one of the most common reasons couples seek sex therapy.
It’s why I appreciate hearing Martha Kauppi, MS, LMFT, speak on how pressure can shut down desire, because it’s something that’s often missed. Desire can’t be forced. If the pressure is coming from within yourself, ask: Where can I soften the expectations I’ve placed on myself? What kind of connection or pleasure might actually feel good?
If the pressure is from a partner, working with a couples therapist who understands these dynamics can make a big difference. (AASECT’s directory or Kauppi’s provider list is a good place to start).
Do I only feel desire once something’s already happening?
We’ve learned to expect spontaneous desire, the kind that just shows up out of nowhere. But many people actually experience something called responsive desire — the kind that arises after arousal has already begun, in response to things like touch, emotional connection, or flirty conversation.
While some people experience mostly spontaneous or mostly responsive desire, most fall somewhere in between. These people have contextual desire, meaning it’s shaped by environment, stress levels, relational dynamics, and more.
At the start of a relationship, you might experience spontaneous desire, but now have primarily responsive desire — and that’s normal. It doesn’t mean you’re not attracted to your partner, or you’re broken. You just might need to explore what contexts your body responds to, and how to invite more of that in.
Is the sex I’m having worth wanting?
Desire doesn’t exist in a vacuum. If sex feels rushed, disconnected, painful, or performative — it makes sense that your body says, “No thanks.”
There’s no one-size-fits-all for pleasure. Maybe you want slower touch, more emotional connection, more teasing or novelty, or just to not feel “on” at the end of a long day. Your preferences matter, and they’re allowed to change.
Has my body changed?
If you’re experiencing pain, vaginal dryness, fatigue, or other physical symptoms, your body may be asking for care before it can even think about desire. Ideally you have a clinician who knows how to comprehensively assess your health.
Regarding pelvic pain, it’s important to remember: sex shouldn’t hurt — and many cases of pain can be effectively treated. Specialists like gynecologists can be experts at diagnosis and medication and surgical management. Unfortunately, many providers still receive limited training in pelvic pain and sexual function. It’s worth asking directly: How comfortable are you with evaluating and treating pelvic pain?
If you’re having pain with sex, I also highly recommend having a pelvic floor physical therapist as part of your team. Just like in the rest of our body, pelvic floor muscles need to both activate and relax. If they can’t, that can contribute to pain.
What are my beliefs about sex — and do I prioritize pleasure?
Many of us grew up absorbing unspoken (or very spoken) beliefs that sex is a duty, that desire should be spontaneous, that sex happens in a very specific order of events, that talking about sex is shameful, or that our bodies must look a certain way to be desirable.
If you believe you “should” enjoy sex — but don’t — it’s worth asking: Where did I learn that sex should look or feel a certain way? Have I ever been taught to explore what I actually like?
Practices that help us reconnect to our bodies — like working with a skilled somatic therapist — can support us in rediscovering what feels good, and what doesn’t. For example, if you learned to associate sex with obligation, or never felt comfortable exploring your own touch, you may discover that your body braces or shuts down — even with a partner you love.
Relearning pleasure often starts with very small moments of feeling good in your body, with no agenda.
Pleasure doesn’t mean just sexual pleasure. When we’re able to pay attention to what feels good in our bodies in every aspect of our lives — whether that’s a warm bath, dancing in the living room, or feeling the sun on your face, it gets easier to access pleasure during sex too.
A Final Thought
Low libido is not a flaw to fix. It’s a signal that something in your body, mind or context, is asking for attention. And attention can lead to clarity, even if desire takes time to return.
You don’t need to do it all at once. You just need to know where to begin.
Learn more here about my clinical and educational offerings, including my group program Desire Unlocked.
Dr. Sasha Mastroianni, ND is a naturopathic doctor who supports women navigating low libido, hormonal shifts, pelvic health concerns, and mental wellbeing. Her approach blends evidence-based care with deep compassion. She sees patients one-on-one both in-person and virtually in Washington state, and has an online program called Desire Unlocked for women navigating low libido.
