Can Breastfeeding Decrease a Woman's Libido?
Yes, breastfeeding is strongly associated with decreased libido in women, primarily due to hormonal suppression of estrogen and progesterone during lactation, combined with elevated prolactin levels that directly reduce sexual desire.
Hormonal Mechanisms
The physiological basis for decreased libido during breastfeeding is well-established:
Breastfeeding suppresses estradiol and progesterone levels during lactation amenorrhea, while prolactin remains elevated and increases acutely with each breastfeeding bout 1. This hormonal profile creates a hypoestrogenic state that directly impacts sexual function.
Women who breastfeed have significantly lower testosterone and androstenedione levels, and those reporting severe reduction in sexual interest show even more pronounced decreases in these androgens 2. These hormones are critical for maintaining libido.
The low estrogen state during breastfeeding causes vaginal dryness and dyspareunia (painful intercourse), which further compounds the reduction in sexual desire and activity 3.
Clinical Evidence of Impact
The magnitude of sexual dysfunction during breastfeeding is substantial:
Almost all lactating women suffer from sexual dysfunction, with the lowest scores specifically in libido and sexual arousal domains 4. This represents a near-universal phenomenon rather than an isolated occurrence.
The number of women with sexual dysfunction increases fivefold after giving birth, reaching approximately 40% of young mothers, with pregnancy and childbirth significantly reducing Female Sexual Function Index (FSFI) scores 5.
Sexual activity decreases toward the end of pregnancy, and the majority of mothers experience only a slow return to pre-pregnancy levels throughout the first postnatal year 3. Breastfeeding appears to prolong this recovery period.
Breastfeeding has an adverse effect on sexuality in the first postnatal year, with painful intercourse reported by breastfeeding mothers likely related to low estrogen levels 3.
Important Clinical Considerations
The relationship between prolactin elevation and sexual dysfunction is complex—changes in sexuality are not directly correlated with absolute prolactin levels, but rather with the overall hormonal milieu that breastfeeding creates 2. This means measuring prolactin alone won't predict sexual dysfunction severity.
Women who breastfeed for less than 2 months have significantly increased likelihood of excess body weight retention (2.9× higher odds), which can further impact body image and sexual function 1. This creates a clinical dilemma where early cessation of breastfeeding may improve sexual function but worsen metabolic outcomes.
Management Approach
Based on the evidence, address decreased libido in breastfeeding women through:
First-line treatment with non-hormonal water-based lubricants and moisturizers for vaginal dryness and dyspareunia, as silicone-based products may last longer than water-based or glycerin-based options 6.
Psychoeducational support, sexual counseling, or marital counseling achieves successful outcomes in 50-80% of patients and should be offered to all patients with sexual complaints 6.
Open, directed inquiry in clinic provides opportunity for patients to disclose dysfunction that they may not volunteer, as libido decline should not be dismissed as "normal" postpartum changes 6.
Do not prescribe hormonal contraception to address symptoms, as this can interfere with breastfeeding and is contraindicated in certain populations 6.
Critical Pitfalls
Do not overlook the partner's role—partner sexual dissatisfaction negatively affects the woman's sexual recovery, and many couples require support to recover sexual intimacy 6. Sexual problems during breastfeeding cause problems in the spousal relationship and require dyadic intervention 7.
Do not ignore medication-induced dysfunction from antidepressants (common in postpartum depression), spironolactone, or beta-blockers, which profoundly impact desire and arousal 6. These compound the hormonal effects of breastfeeding.
Fatigue, depression, anxiety, chronic stress, body image concerns, and relationship conflicts are major contributors to decreased libido that coexist with the hormonal effects of breastfeeding 6. Address these psychosocial factors concurrently with physical symptoms.