You should want to get hot and heavy with your partner every chance you get. But for some women, sex isn’t all that.

There are many reasons you might not be into it, says women’s health specialist Pelin Batur, MD. Intercourse might hurt. You might have trouble reaching a climax. Or your libido might be taking an extended slumber.

Whatever the reason, you don’t have to grin and bear it. “Your sexual health is important, and you should know you have options,” Dr. Batur says.

Up-and-down sex drives
Sex drives exist on a spectrum from “More, please,” to “Meh.” And your own sex drive is likely to cycle up and down, depending on factors like hormones, stress, relationship issues, and whether you’re dating someone new or climbing into bed with your partner of 20 years.
If you’re happy with the quality and quantity of your sex life, stop right there. You don’t need to get more action unless you want to. But if you want to? Here are some common problems that might be holding you back.

1. Stress
   Stress can do a number on your libido, Dr. Batur says. If you’re being pulled in a million directions — or if a global pandemic has cranked your stress level to 10 — it’s no wonder a roll in the sheets isn’t at the top of your to-do list.

“Ask yourself how vacation sex would be,” she says. “If your sex life is great on vacation, then it’s probably stress, rather than a medical problem.” Finding ways to de-stress can help your sex life bounce back.

2. Pain
   “Pain during sex is like a flashing neon sign telling you something’s wrong,” Dr. Batur says. Common causes of painful sex include:

Pelvic floor dysfunction: This common condition occurs when muscles in the base of the pelvis don’t relax normally. Women with pelvic dysfunction often have painful intercourse. Physical therapy and biofeedback treatment can help correct the problem.
Hormonal changes: Changing levels of estrogen and testosterone can lead to painful sex. Women who are breastfeeding or entering menopause may have hormonal changes that cause vaginal dryness and a burning sensation with intercourse. In some cases, hormonal treatments can correct the problem. A good lube can also come in handy.
Other medical causes: There are other possible causes of vaginal pain, including infections and endometriosis. “Depending on the problem, you might want to see a certified menopause specialist or a specialist in sexual health to get to the bottom of it,” Dr. Batur says.

3. Psychological causes
   “Underlying anxiety or depression can get in the way of your sex drive,” Dr. Batur notes. Issues such as relationship troubles or a history of sexual trauma can also affect your interest in physical intimacy.

In such cases, a mental health professional can help you work through the underlying difficulties.

4. Low libido
   Sometimes, a sluggish sex drive is a matter of mindset. “A lot of women have what’s known as responsive desire — you might not be that interested in initiating sex, but once you get into it, you realize, ‘Hey, this is fun,’” Dr. Batur says. “Sometimes, you just need to go with the flow and let your brain catch up.”

But sometimes, it’s not enough to fake it till you make it. Some women have a low sex drive in the absence of any other underlying problem. This is called hypoactive sexual desire disorder (HSDD). Another term that’s used is female sexual interest/arousal disorder. Your doctor can prescribe medications that can help put you in the mood.

5. Trouble with arousal and orgasm
   If sex just doesn’t feel great, start with a refresher course in sex ed, Dr. Batur explains. “Lots of women think they should be able to climax with intercourse, but many — maybe even most — women need external stimulation to reach orgasm.”

Try shaking things up or adding some toys to your routine. Dr. Batur explains, “Lots of women bring vibrators into the bedroom. There’s no shame in that game.”

If that doesn’t work, there are treatments to help increase arousal, including prescription medications, hormones, and topical oils and creams.

Sexual health: Talk to your doctor
Low libido, arousal problems and painful sex are all-too-common problems. It might feel awkward to bring it up with your doctor, but she won’t even flinch, Dr. Batur says. “It may be a sensitive subject for you, but your Ob/Gyn or women’s health specialist has probably talked to four other women about it just this morning,” she adds.

Don’t expect to solve the problem in a few minutes during your annual exam, though. You might need to schedule a dedicated appointment to discuss your sexual health history and figure out the problem. Depending on the issue, your doctor may refer you to a specialist. But any initial awkwardness will be worth the effort, Dr. Batur says. “Sex is an important part of your life, and you deserve good sexual health.”