Latest / Sex Advice for Seniors Podcast / Why Does Sex Feel Different After Menopause? | Dr. Maria Sophocles

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Why Does Sex Feel Different After Menopause? | Dr. Maria Sophocles · Sex Advice for Seniors Podcast

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SPEAKER_00: At Oh My Bod,
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SPEAKER_00: helping adults of all ages reclaim confidence, curiosity, and connection.
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SPEAKER_00: That's O-H-M-I-B-O-D dot com.
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[music]
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SPEAKER_00: Hey, this is Suzanne and you are listening to Sex Advice for Seniors.
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SPEAKER_00: And today I am so excited because finally we have managed to make this work.
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SPEAKER_00: We were supposed to talk when I was in Vietnam, but it was chaos.
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SPEAKER_00: So we decided to reschedule this whole thing.
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SPEAKER_00: I'm with Dr. Maria Sophocles.
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SPEAKER_00: She's a gynecologist and author.
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SPEAKER_00: She's a nationally recognized advocate for women's health and inspired to close
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SPEAKER_00: the gender health care gap.
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SPEAKER_00: Yep.
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SPEAKER_00: She delivered a viral TED talk and wrote The Bedroom Gap,
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SPEAKER_00: addressing what happens to women's sexuality in midlife and Which,
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SPEAKER_00: of course, is my favorite topic to discuss.
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SPEAKER_00: And she's based in Princeton, New Jersey.
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SPEAKER_00: And she leads a virtual clinic serving women across 11 U.S. states and internationally.
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SPEAKER_00: And is currently working, as we speak, on a documentary about sex and menopause.
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SPEAKER_00: In fact, we had to reschedule this because she was filming.
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SPEAKER_00: She was filming.
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SPEAKER_00: Sorry.
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SPEAKER_00: So welcome, Maria.
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SPEAKER_00: You're an internationally recognized superstar, you know.
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SPEAKER_00: Not sure if that's apt, but I'll take it.
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SPEAKER_00: I'll pretend for today.
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SPEAKER_00: One of your specialist topics is sexual burnout in modern women and how
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SPEAKER_00: that manifests in midlife women.
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SPEAKER_00: What does that mean, actually?
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SPEAKER_00: And why do you think so many women in midlife are experiencing it?
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SPEAKER_01: Yeah, I think it's not really my favorite term,
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SPEAKER_01: but sexual burnout is referring to the fact that a lot of women sort
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SPEAKER_01: of start having sex in their teens or 20s.
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SPEAKER_01: They learn from porn or from their young partners that the goal of sex is orgasm.
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SPEAKER_01: The destination is orgasm.
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SPEAKER_01: The pleasure of It is imbalanced.
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SPEAKER_01: Female pleasure is sort of secondary and it's about, in general, male pleasure.
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SPEAKER_01: And I think some of the messaging is so bad and limiting.
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SPEAKER_01: And they sort of get on a sexual treadmill and they do that and they get married
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SPEAKER_01: and have kids and they do it and do it and do it and do it in some regular fashion.
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SPEAKER_01: And they hit menopause and they start experiencing a change in libido,
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SPEAKER_01: a change in their body,
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SPEAKER_01: a change maybe in their understanding of their relationships.
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SPEAKER_01: And the kids may be grown and left and they sort of look around and go, you know what?
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SPEAKER_01: Sort of been doing it like this for decades.
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SPEAKER_01: And I feel like there's got to be more to it.
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SPEAKER_01: So either they're saying I'd like something more for myself, which I think is wonderful.
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SPEAKER_01: Or they're saying, gee, it's hurting and I don't think I want to put up with this anymore.
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SPEAKER_01: Maybe I'll just stop having sex and who cares?
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SPEAKER_01: I'll just take it out of my life.
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SPEAKER_01: And so I think all these different permutations, I'm sure, have been on this podcast as topics.
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SPEAKER_01: They need addressing.
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SPEAKER_01: You know, women need to understand what's happening to their bodies physiologically.
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SPEAKER_01: When the ovaries stop making estrogen and testosterone, whatever.
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SPEAKER_01: Hopefully you'll put a little QR code to the TED Talk.
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SPEAKER_01: If they go to the TED Talk,
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SPEAKER_01: they'll see a beautiful animation of when we take estrogen away in the vagina,
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SPEAKER_01: what happens.
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SPEAKER_01: The collagen breaks down, the blood vessels leave town, and this means pain and less moisture.
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SPEAKER_01: So it's good to understand those basics so that you don't feel like, is this just me?
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SPEAKER_01: Is this just in my head?
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SPEAKER_01: It's also really good for your partner to know.
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SPEAKER_01: I mean, I can't tell you how many women buy the bedroom gap and then say,
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SPEAKER_01: actually, I made my partner read it.
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SPEAKER_01: And we've been married 20 years or 30 years or we've been dating six months or whatever it is.
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SPEAKER_01: I kind of wish he knew.
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SPEAKER_01: And the men are incredible.
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SPEAKER_01: They're like, why did no one make this mandatory education?
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SPEAKER_01: And I think this comes back even to sex ed.
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SPEAKER_01: Why is sex ed in the UK and in the US,
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SPEAKER_01: why is it so focused on just got to prevent pregnancy and disease?
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SPEAKER_01: I mean, that's important for sure.
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SPEAKER_01: But it's so limited.
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SPEAKER_01: And we just, we don't teach pleasure.
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SPEAKER_01: We don't teach what happens with aging.
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SPEAKER_01: Yeah.
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SPEAKER_01: We don't really even teach consent that well.
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SPEAKER_01: So I think sex ed needs an overhaul.
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SPEAKER_01: And then maybe when we turn even 40 to say, hey, you're 40.
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SPEAKER_01: Here's what's going to happen over your next 40 to 45 years.
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SPEAKER_01: And by the way, this doesn't mean the death of sex.
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SPEAKER_01: You've got to understand that things will change.
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SPEAKER_01: It also means you've got to understand that things can be helped.
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SPEAKER_01: A, you can get out of a bad relationship or talk about it or talk it through.
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SPEAKER_01: You can use vaginal estrogen and regenerate some
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SPEAKER_00: of that tissue.
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SPEAKER_00: Which is a godsend, frankly.
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SPEAKER_00: It's unbelievable.
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SPEAKER_00: Like, literally,
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SPEAKER_00: they should just give it to women when they turn 50 and just go,
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SPEAKER_00: here you go, have this.
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SPEAKER_01: I believe they should.
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SPEAKER_01: And it should just be mailed to us.
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SPEAKER_01: The government should cover it.
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SPEAKER_01: Do you know what money Medicare would save and the NHS would save
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SPEAKER_01: if they just gave women vaginal estrogen every year with their tax forms?
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SPEAKER_01: Here, wrap it up in a rubber band.
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SPEAKER_01: Please use it.
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SPEAKER_01: We demand that you use it.
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SPEAKER_00: No problem.
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SPEAKER_00: It's so true.
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SPEAKER_00: But there's almost a requirement as well, isn't there?
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SPEAKER_00: We've got this thing, I mean, it's a bit off piece, but sort of relates, so stick with me.
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SPEAKER_00: We've got this thing in the UK called The Midlife MOT is something that
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SPEAKER_00: the government has created in the UK to help people understand their finances
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SPEAKER_00: as they get towards retirement.
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SPEAKER_00: Looking at their finances and looking It's a reality check.
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SPEAKER_00: I would do a hormonal MOT.
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SPEAKER_00: I'll tell you why.
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SPEAKER_01: I think men need it too.
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SPEAKER_01: No, I'm not saying just for women.
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SPEAKER_01: Both MOTs, right?
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SPEAKER_01: So men understood, ah, okay, the ovaries aren't making estrogen, progesterone, and testosterone.
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SPEAKER_01: Okay, this is going to affect libido.
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SPEAKER_01: It's going to affect genital health, bladder health, bone health.
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SPEAKER_01: Gee, I think I'd like my partner to stay vibrant.
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SPEAKER_01: Hey, honey, did you get the free vaginal estrogen in the mail?
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SPEAKER_01: You didn't?
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SPEAKER_01: All right, let's call up some, you know, whatever.
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SPEAKER_01: Fantasy, my own fantasy, but I love that idea.
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SPEAKER_00: Yeah,
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SPEAKER_00: I may just have to have a campaign for a midlife MOT for people around their sexual
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SPEAKER_00: and relational health, right?
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SPEAKER_00: Because as you say, this is not just a women-only problem.
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SPEAKER_00: Although,
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SPEAKER_00: of course,
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SPEAKER_00: probably like yourself,
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SPEAKER_00: a lot of what I hear is from men saying,
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SPEAKER_00: you know, my wife doesn't want to have sex with me anymore.
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SPEAKER_00: My partner seems to have got no desire.
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SPEAKER_00: Maybe they're having erectile health things.
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SPEAKER_00: But But generally,
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SPEAKER_00: it's because as you said,
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SPEAKER_00: there's such a lack of information about the changes that go on in our body.
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SPEAKER_00: I just did a radio show,
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SPEAKER_00: literally,
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SPEAKER_00: another podcast, literally just a couple of hours ago with a couple of guys.
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SPEAKER_00: It was very lighthearted.
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SPEAKER_00: It was very funny.
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SPEAKER_00: They were like,
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SPEAKER_00: so tell me,
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SPEAKER_00: Suzanne,
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SPEAKER_00: is this whole thing about getting older and things changing,
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SPEAKER_00: is it just a load of bullshit?
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SPEAKER_00: Do things really change, right?
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SPEAKER_00: These are a couple of guys, like middle-aged guys.
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SPEAKER_00: And I was like, no, no.
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SPEAKER_00: So it's real how you deal with it.
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SPEAKER_00: Of course, that's like what you said.
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SPEAKER_00: Some women just go, I'm over this.
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SPEAKER_00: I'm done.
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SPEAKER_00: I'm not going to do this anymore.
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SPEAKER_00: And other women go, I need to change my approach to this.
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SPEAKER_00: That's how I reacted was I need to change my approach.
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SPEAKER_00: I'm not getting turned on like I used to.
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SPEAKER_00: I need to figure out what I need to get the wheels spinning up there again.
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SPEAKER_00: So my body goes on.
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SPEAKER_01: Yeah.
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SPEAKER_01: And I'd love those guys if they're listening to know,
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SPEAKER_01: can we myth bust for them,
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SPEAKER_01: please, that penis and vagina sex is not the way that 100% of women orgasm?
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SPEAKER_01: If your partner is suddenly not, that's okay.
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SPEAKER_01: That's not because she's old or anything.
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SPEAKER_01: It's because you probably never did and she was faking it or that your partners
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SPEAKER_01: in your 20s were faking the orgasm.
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SPEAKER_01: And I think more women today are like, you know, Maybe I don't want to fake them anymore.
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SPEAKER_01: Maybe I want to communicate with you.
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SPEAKER_01: Maybe you need to be a little more confident as a lover or you just need
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SPEAKER_01: to understand anatomy and that the clitoris is the powerhouse of sexual pleasure.
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SPEAKER_01: And yes, it's large.
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SPEAKER_01: It extends inside.
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SPEAKER_01: So when the penis is in the vagina,
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SPEAKER_01: there is some indirect clitoral stimulation, but not all women respond to that.
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SPEAKER_01: I was on a podcast in Tampa last week, and the director was sort of a surprise guest.
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SPEAKER_01: So it was me and the podcast host and this male 50-year-old director.
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SPEAKER_01: And he said, well, I know all women orgasm only when the penis is in the vagina.
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SPEAKER_01: Oh, my God.
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SPEAKER_01: In a way,
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SPEAKER_01: I was kind of proud of him for having the guts to say it,
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SPEAKER_01: but he didn't realize he was being courageous.
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SPEAKER_01: He thought he was just correcting me or explaining the truth.
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SPEAKER_01: I was like, au contraire, monsieur.
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SPEAKER_01: That's just nuts.
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SPEAKER_01: A 50-year-old guy.
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SPEAKER_01: Yeah, 50-year-old guy,
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SPEAKER_01: but clearly enough women fake orgasms that for him,
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SPEAKER_01: probably every or many of the women...
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SPEAKER_01: that he's had sex with in his life have made him believe
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SPEAKER_01: that that's how orgasm happened for them.
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SPEAKER_01: And so I explore in the book,
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SPEAKER_01: one of the things I explore is the orgasm gap and why do we fake it?
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SPEAKER_01: Why?
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SPEAKER_01: And the answers I came up with were that They don't want
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SPEAKER_01: to hurt their partner's feelings or the sex is kind of meh and they want
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SPEAKER_01: to take control over it.
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SPEAKER_01: They want to just be able to say, OK, I'm going to like you're about to come.
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SPEAKER_01: I'm just going to moan and scream and then we're both going to get
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SPEAKER_01: to stop this silliness, you know, which isn't a very high bar if you think about it.
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SPEAKER_00: Look, there have been times,
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SPEAKER_00: certainly in my younger days,
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SPEAKER_00: where I probably did fake it a little bit, if I'm really honest.
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SPEAKER_00: And I think part of that was about not wanting to hurt the guy's ego.
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SPEAKER_00: And the other part was, I'm not going to Well, why does male
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SPEAKER_01: pleasure get to be the barometer?
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SPEAKER_01: You know,
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SPEAKER_01: isn't that interesting that over the last thousand years,
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SPEAKER_01: really the goal or the destination of the sex has been either ejaculation
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SPEAKER_01: for procreation or...
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SPEAKER_01: Male orgasm.
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SPEAKER_01: And it's like, wait, wait, I think there's two people here.
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SPEAKER_01: Are you sure there's two of us?
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SPEAKER_01: You know, so,
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SPEAKER_01: you know,
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SPEAKER_01: I think that's what inspired the TED Talk is I just wanted people
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SPEAKER_01: to realize there's like a little different standard and it's kind of universal.
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SPEAKER_01: I wish I could say it's just,
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SPEAKER_01: you know, this country or just this socioeconomic class, but it's like ubiquitous.
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SPEAKER_01: And I think that's why the talk went viral is people are like, yes, right.
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SPEAKER_01: So I just want women to value their own pleasure.
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SPEAKER_01: And I think to value your pleasure, you've got to know your body.
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SPEAKER_01: You've got to know what brings you pleasure.
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SPEAKER_01: So if you don't masturbate,
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SPEAKER_01: you need to find a version of it that makes you feel good,
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SPEAKER_01: which can be with toys or yourself or water or whatever.
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SPEAKER_01: And three, you need to communicate with your partner.
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SPEAKER_01: You need to be able to say, you know what I love is this.
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SPEAKER_01: What I don't love so much is that.
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SPEAKER_01: And even to find the courage to say, I wasn't really that satisfied last week.
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SPEAKER_01: You know, it's hard.
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SPEAKER_01: These are hard, hard conversations.
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SPEAKER_00: What I've learned,
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SPEAKER_00: and I think it's much easier when you're starting new relationships,
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SPEAKER_00: and it's something I learned having not spoken about my sexual pleasure
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SPEAKER_00: in my marriage, was when you learn how to articulate what you like and what you do.
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SPEAKER_00: When you're able to do that sort of thing, then
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SPEAKER_00: Your partner is so grateful because they're not a mind reader and they want it.
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SPEAKER_00: They want to know.
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SPEAKER_00: I mean, that's what I get from most of my followers are men.
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SPEAKER_00: Like 75% of my followers are men.
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SPEAKER_00: And the reason why I suspect they follow me is because they want to know.
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SPEAKER_00: They want to understand what's happening with their partner's body and they want
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SPEAKER_00: to hear it from somebody and they're not hearing it from their partner
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SPEAKER_00: or maybe they're afraid to ask.
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SPEAKER_00: And so they want somebody to say, what the fuck is going on here?
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SPEAKER_00: What can I do to try to regain the intimacy that I had with my partner?
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SPEAKER_00: Give me some tips, you know?
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SPEAKER_01: Let's make sure the guys who are listening today leave with some actionable items, okay?
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SPEAKER_01: You can buy the book in the UK on Amazon.
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SPEAKER_01: Hopefully they buy it because they're going to learn so much or they can listen to it.
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SPEAKER_01: But if not, I want them to know...
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SPEAKER_01: That know that women's bodies change just like yours is changing,
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SPEAKER_01: but know that it's improvable.
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SPEAKER_01: Know that orgasm is improvable.
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SPEAKER_01: Know that arousal and development of moisture is improvable.
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SPEAKER_01: That vaginal estrogen is liquid gold and every single woman listening
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SPEAKER_01: and every single woman who's a partner of every single man listening.
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SPEAKER_01: If they're past menopause, they should be using vaginal estrogen as a screen, a tablet, a ring.
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SPEAKER_01: I don't care what company.
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SPEAKER_01: And they should use it forever.
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SPEAKER_01: This isn't an antibiotic.
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SPEAKER_01: This isn't until the ear injection is gone.
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SPEAKER_01: This is like seatbelts.
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SPEAKER_01: You don't outgrow seatbelts like, ah, I've been saved by them for 50 years.
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SPEAKER_01: I'm okay now.
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SPEAKER_01: You want the seatbelt to save your life?
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SPEAKER_01: You got to keep wearing it.
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SPEAKER_01: Same with sunblock and same with vaginal estrogen.
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SPEAKER_01: So buy it and stay on it.
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SPEAKER_01: Give it three months to work.
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SPEAKER_01: And by the way, it's not a lube.
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SPEAKER_01: You don't use it right before sex to feel better.
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SPEAKER_01: You use it every day, but you use it as directed.
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SPEAKER_00: The cream is twice a week.
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SPEAKER_00: Mine's twice a week that I'm using.
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SPEAKER_01: Or there's a ring you put in and it's, you know, lasts for three months.
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SPEAKER_01: But the point is your partner will have
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SPEAKER_01: You know why your partner might not have great interest in sex?
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SPEAKER_01: Because it hurts.
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SPEAKER_01: Who wants to do something that hurts?
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SPEAKER_01: So I think that's a kind of no-brainer, right?
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SPEAKER_01: And the other thing is just understand that some people are not interested
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SPEAKER_01: in sex right now because they're overwhelmed by their life.
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SPEAKER_01: The aging parent,
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SPEAKER_01: the troubled adult child,
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SPEAKER_01: the financial difficulty, the loss of job, the shock of infidelity.
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SPEAKER_01: I mean, these things...
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SPEAKER_01: Don't just, we don't just grieve and then we're okay.
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SPEAKER_01: You know, sometimes they play out in the bedroom and people can't get their mind clear.
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SPEAKER_01: And if that's the case, A, give them space and give them grace.
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SPEAKER_01: But B, say, hey, I want to work with you on this.
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SPEAKER_01: You want to go to a counselor?
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SPEAKER_01: Do you want to talk to your mom or my mom who's moved in with us and work?
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SPEAKER_01: We could find maybe another solution.
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SPEAKER_01: Or do you want to go away every third weekend so that we can have some privacy?
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SPEAKER_01: Because sex is part of being close with you.
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SPEAKER_01: And I want that.
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SPEAKER_01: I mean, man, if someone told me that, that I was pushing away, I would say, oh, I better listen.
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SPEAKER_01: I better really have a good reason because we know that being intimate is It's such
16:35
SPEAKER_01: a good part of self-worth, of relationship developing, right?
16:38
SPEAKER_01: You know this, Suzanne, so well.
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SPEAKER_01: Yeah, yeah.
16:41
SPEAKER_00: The point about stress,
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SPEAKER_00: and it was Dr.
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SPEAKER_00: Lauren Stryker that I was speaking to who talked about the complexity around libido.
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SPEAKER_00: Often we blame it just on hormones, but it's not solely on hormones.
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SPEAKER_00: As you say, part of it could be Sex is painful.
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SPEAKER_00: The other part could be I'm just overwhelmed and I'm stressed out.
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SPEAKER_00: Other part could be I'm not getting any sleep and I'm totally exhausted, right?
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SPEAKER_00: And when it comes to sleep versus sex, I'm choosing sleep over sex.
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SPEAKER_00: You know, it's like for me, I've often said it starts way before I get to the bedroom now.
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SPEAKER_00: It starts by telling me things that potentially are going to happen in the bedroom
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SPEAKER_00: so I can start getting revved They said, basically, here's like $100 worth.
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SPEAKER_00: And I thought, you know what, I'm just going to buy silly, sexy stuff.
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SPEAKER_00: That's all I'm going to buy.
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SPEAKER_00: I'm just going to buy like cheap, sexy, like I bought a satiny gown, transparent underwear.
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SPEAKER_00: I just bought a whole bunch of brilliant stuff.
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SPEAKER_01: So cheap or not, I mean, free stuff is fun.
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SPEAKER_01: But the point is you have to value sexual activity as part of self-care and part
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SPEAKER_01: of relationship care.
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SPEAKER_01: It doesn't just take care of itself.
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SPEAKER_01: It's no different than a garden.
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SPEAKER_01: We weed a garden and when we don't, guess what?
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SPEAKER_01: It doesn't look as good.
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SPEAKER_01: If you neglect it, it doesn't work.
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SPEAKER_01: If you neglect your children, they don't work as well.
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SPEAKER_01: If you neglect the soup on the stove, it burns.
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SPEAKER_01: So if you neglect sex,
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SPEAKER_01: it's not just there for the taking because you had a good night's sleep
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SPEAKER_01: and maybe your partner didn't, but you want it.
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SPEAKER_01: It does need to be worked on intended and often in non-sexual ways.
18:38
SPEAKER_01: Often in, you remember the languages of love and, and, you know, of thoughtful acts or deeds.
18:44
SPEAKER_01: I mean,
18:44
SPEAKER_01: I have patients tell me the biggest turn on for them is when their husband goes
18:48
SPEAKER_01: and does the dishes.
18:49
SPEAKER_01: Like that might sound silly to us.
18:51
SPEAKER_01: It's not really kinky.
18:52
SPEAKER_01: It's not really woo.
18:54
SPEAKER_01: It's not worthy of OnlyFans or whatever, but.
18:57
SPEAKER_01: It's an act of caring.
19:18
SPEAKER_01: There's two kinds of desire, right?
19:20
SPEAKER_01: Spontaneous and receptive.
19:22
SPEAKER_01: And for so many women, it is receptive desire that ultimately gives them sexual pleasure.
19:33
SPEAKER_01: Or getting a massage or watching their partner do the dishes.
19:37
SPEAKER_01: And through that arousal, they develop almost through the backdoor sexual desire.
19:42
SPEAKER_01: So note to self, note to you, you don't have to have baseline sexual desire.
19:48
SPEAKER_01: Yeah, and I think it's very relevant to older people who sometimes feel that
19:51
SPEAKER_01: the desire happens.
20:03
SPEAKER_00: Yeah.
20:18
SPEAKER_00: Yeah, exactly.
20:33
SPEAKER_01: It's actually lovely.
20:34
SPEAKER_01: So we all have different ways, and it's appreciating that.
20:37
SPEAKER_00: Yeah.
20:38
SPEAKER_00: I mean, for me,
20:39
SPEAKER_00: just buying cheap,
20:40
SPEAKER_00: sexy lingerie and putting it on just makes me feel a little bit better,
20:44
SPEAKER_00: even if it is a bit too small, as I realized.
20:47
SPEAKER_01: We talk in the book about five ways to jumpstart in your sex life or inspire desire,
20:52
SPEAKER_01: and I call them the five M's.
20:55
SPEAKER_01: Mindfulness,
20:56
SPEAKER_01: which is really just clearing your head of the to-do lists and the annoyances
21:01
SPEAKER_01: in life.
21:01
SPEAKER_01: It's easier said than done,
21:03
SPEAKER_01: but there are mindfulness practices that are so simple and easy and cheap.
21:08
SPEAKER_01: So mindfulness is one.
21:11
SPEAKER_01: Media, right?
21:12
SPEAKER_01: Observing,
21:13
SPEAKER_01: having sexual imagery,
21:14
SPEAKER_01: erotic imagery come into our brain,
21:17
SPEAKER_01: whether that's a book,
21:18
SPEAKER_01: a magazine, an app, a Netflix special, using media to our advantage.
21:24
SPEAKER_01: Masturbation.
21:25
SPEAKER_01: Either you masturbate or you don't masturbate or you're thinking about it.
21:29
SPEAKER_01: And the book certainly will tell you how to get started if you want to,
21:33
SPEAKER_01: because some people don't.
21:34
SPEAKER_01: They were taught not to write.
21:36
SPEAKER_01: Mindfulness, media, masturbation.
21:38
SPEAKER_01: Okay.
21:39
SPEAKER_01: What's the massage?
21:42
SPEAKER_01: I said it already.
21:44
SPEAKER_00: Oh, the power of touch.
21:46
SPEAKER_01: And massage is an M word for really touch and that the human body responds to And
21:51
SPEAKER_01: the fifth is actually something you need a clinician for.
21:53
SPEAKER_01: It's medication.
21:54
SPEAKER_01: Do you need medication?
21:56
SPEAKER_01: No, not necessarily.
21:56
SPEAKER_01: But there are medications in the U.S. Two of them are FDA approved.
21:59
SPEAKER_01: One is not.
22:14
SPEAKER_01: That can inspire sexual desire in the female brain.
22:19
SPEAKER_00: Speaking of which,
22:20
SPEAKER_00: I have to ask you,
22:22
SPEAKER_00: because I went on testosterone about,
22:24
SPEAKER_00: I guess,
22:24
SPEAKER_00: about a year and a half ago,
22:26
SPEAKER_00: and I have to say, I'm now really finally feeling the impact.
22:30
SPEAKER_00: But before I did that,
22:32
SPEAKER_00: I was posting out to my community like, oh, has anybody been on testosterone?
22:37
SPEAKER_00: And people were talking about screen cream.
22:40
SPEAKER_00: We don't have screen cream.
22:42
SPEAKER_00: I don't know what is screen cream.
22:44
SPEAKER_01: It's compounded a couple of different things that cause vasodilation.
22:49
SPEAKER_01: So it causes the blood flow in the clitoris to increase.
22:53
SPEAKER_01: And in theory, then makes you have an orgasm more easily or better.
22:58
SPEAKER_01: Does it work?
22:59
SPEAKER_01: Sometimes yes, but sometimes no.
23:02
SPEAKER_01: It's truly not a cure-all.
23:05
SPEAKER_01: Don't forget there's a huge placebo response in these things.
23:08
SPEAKER_01: And by being compounded, we don't have it standardized either.
23:12
SPEAKER_01: So screen cream from your pharmacist.
23:14
SPEAKER_01: Oh, right.
23:15
SPEAKER_01: And what is it?
23:17
SPEAKER_01: Is it got progesterone
23:21
SPEAKER_00: in it?
23:22
SPEAKER_00: What's in it?
23:25
SPEAKER_01: No, it's really, it varies.
23:27
SPEAKER_01: Okay.
23:28
SPEAKER_01: But it's got sildenafil, which is... Oh, sildenafil.
23:31
SPEAKER_01: Oh, like Viacra.
23:33
SPEAKER_01: Oh, right.
23:33
SPEAKER_01: Oh, okay.
23:34
SPEAKER_01: But it's not going to give you a clitoral erection or anything.
23:38
SPEAKER_01: It's just the sildenafil doesn't really...
23:40
SPEAKER_01: We do that much when we apply it because of the way it's formulated
23:45
SPEAKER_01: at these compounding pharmacies.
23:46
SPEAKER_01: Now, the good news, I got some hot, off-the-press good news.
23:51
SPEAKER_01: There is a company called Dare Biosciences, D-A-R.
23:57
SPEAKER_01: DARE Biosciences that has figured out how to properly formulate sildenafil,
24:05
SPEAKER_01: which is what Viagra is, for women.
24:08
SPEAKER_01: And they are launching it later this year.
24:11
SPEAKER_01: And it will be a topical sildenafil that women can use.
24:16
SPEAKER_01: So stay tuned for Because it's coming,
24:19
SPEAKER_01: but you want to get the one,
24:21
SPEAKER_01: I don't work for DARE,
24:22
SPEAKER_01: you know,
24:22
SPEAKER_01: but you want to get the one from DARE Biosciences because they've put all the time
24:28
SPEAKER_01: and money and scientific rigor into getting a formulation
24:32
SPEAKER_01: that will be consistently effective, allowing for better production.
24:37
SPEAKER_01: And is this going to be an over-the-counter medicine in the States?
25:00
SPEAKER_01: It will have to be ordered by a clinician right now,
25:04
SPEAKER_01: but I think they're going to have to explore what's going to be available over
25:09
SPEAKER_01: the counter because they're going to,
25:10
SPEAKER_01: you know,
25:10
SPEAKER_01: obviously they want to get their money back,
25:12
SPEAKER_01: so they're going to be looking at sales and stuff like that.
25:14
SPEAKER_00: Wow, that's very cool.
25:16
SPEAKER_00: Hot off the press news, we heard it here first.
25:18
SPEAKER_00: I'm very excited about that.
25:20
SPEAKER_00: I just want to ask one thing because it is something that I think is important
25:24
SPEAKER_00: to address because we're seeing a lot of women now on a Zempec.
25:30
SPEAKER_00: In the States and in the UK,
25:32
SPEAKER_00: I've got loads of friends on a Zempick,
25:35
SPEAKER_00: and I want to know what, if anything, it does to one's libido and sex life.
25:42
SPEAKER_00: I've heard, and this may or may not be true, that it impacts the vulva, making it a bit saggy.
25:49
SPEAKER_00: And I spoke to a doctor who said she's seeing more vulva reconstruction stuff going
25:55
SPEAKER_00: on from women who are on a Zempick.
25:57
SPEAKER_00: So what's going on here?
26:00
SPEAKER_01: Yeah.
26:00
SPEAKER_01: So it's not that it makes the vulva saggy.
26:03
SPEAKER_01: It doesn't.
26:04
SPEAKER_01: There's no little GLP-1 molecule that goes, let's harm the vulva and make it uglier.
26:11
SPEAKER_01: When we lose body fat and we lose muscle,
26:16
SPEAKER_01: unless we're aggressively fighting against that,
26:19
SPEAKER_01: there is a saggy kind ofness to what happens to skin, right?
26:25
SPEAKER_01: We see it.
26:25
SPEAKER_01: That's what people say.
26:26
SPEAKER_01: Oh, Zempic phase.
26:27
SPEAKER_01: It's not OCD.
26:28
SPEAKER_01: The Ozempic didn't make your face look ugly.
26:31
SPEAKER_01: The loss of fat pads that give your face definition did that.
26:36
SPEAKER_01: The vulva has fat pads.
26:38
SPEAKER_01: So if you lose enough fat in your body, you're going to lose some of that.
26:42
SPEAKER_01: And it gets a deflated balloon appearance.
26:46
SPEAKER_01: And I'm sorry for that.
26:47
SPEAKER_01: I don't wish that on anyone.
26:49
SPEAKER_01: You can get fillers injected into that if you really truly want to.
26:52
SPEAKER_01: Yeah, that's what I've heard.
26:53
SPEAKER_01: That's no judgment.
26:54
SPEAKER_01: That's on you.
26:56
SPEAKER_01: But you can't just say,
26:58
SPEAKER_01: I'm going to lose weight and I'm going to keep losing weight and I only want it here
27:03
SPEAKER_01: and in my belly and I don't want anything to happen to the vulva.
27:06
SPEAKER_01: Sadly, we don't have any meds that target direct that.
27:11
SPEAKER_01: So it's not that the Ozempic is like directly going to the vulva and causing it,
27:15
SPEAKER_01: but it's a byproduct of continued weight loss.
27:19
SPEAKER_01: So yes, that's what that is.
27:23
SPEAKER_01: Your second question or your first is really what's the effect on libido?
27:27
SPEAKER_01: So Ozempic can, or let's just not say Ozempic, let's say all GLP ones.
27:32
SPEAKER_01: They can blunt,
27:34
SPEAKER_01: just like they blunt our interest in food,
27:38
SPEAKER_01: they can blunt joy and our interest in other things, much like an antidepressant.
27:43
SPEAKER_01: Don't forget, antidepressants have a libido-lowering effect very clearly.
27:50
SPEAKER_01: Not all of them, but many of them.
27:52
SPEAKER_01: So this can have that as well.
27:55
SPEAKER_01: And just like if you're on an antidepressant and you really need it
27:58
SPEAKER_01: and it's helping your anxiety or depression or OCD,
28:02
SPEAKER_01: man, you have to decide what What you're willing to trade away.
28:06
SPEAKER_01: And many people are willing to trade away a little libido.
28:09
SPEAKER_01: Does that mean you will have loss of libido?
28:12
SPEAKER_01: No, it does not.
28:13
SPEAKER_01: And most of my patients do not.
28:15
SPEAKER_01: I have been prescribing GLP-1s for 12 years.
28:19
SPEAKER_01: So they're in vogue now, but they're not new to me.
28:22
SPEAKER_01: I have seen very, very little loss of libido, which is great.
28:27
SPEAKER_01: The good news is that people are finding the opposite.
28:30
SPEAKER_01: They feel so good in their body with less fat and more muscle
28:35
SPEAKER_01: because I make all my patients rigorously build their skeletal muscle.
28:39
SPEAKER_01: They feel sexier.
28:40
SPEAKER_01: They feel stronger.
28:42
SPEAKER_01: Their self-esteem goes up.
28:44
SPEAKER_01: Their desire to be sexually active goes up.
28:47
SPEAKER_01: So I see mostly the opposite.
28:51
SPEAKER_00: Yeah.
28:51
SPEAKER_00: And I suppose it makes sense because a lot of menopausal women,
28:54
SPEAKER_00: when they see that little tummy across the middle,
28:57
SPEAKER_00: like we've all got,
28:58
SPEAKER_00: and that visceral fat and just generally finding it difficult to remain
29:03
SPEAKER_00: the way we used to be.
29:05
SPEAKER_00: It does affect our self-confidence.
29:07
SPEAKER_00: You know,
29:07
SPEAKER_00: it does affect how sexual or not sexual we feel or just how attractive we feel
29:13
SPEAKER_00: to other people.
29:14
SPEAKER_00: And I'm very aware of that.
29:16
SPEAKER_00: It's good to hear.
29:18
SPEAKER_00: So for women listening who feel disconnected from their sexuality and midlife,
29:23
SPEAKER_00: what are the first three steps they can take to reconnect physically
29:27
SPEAKER_00: and emotionally?
29:29
SPEAKER_00: We said them with the five
29:31
SPEAKER_01: M's, right?
29:31
SPEAKER_01: But here's three.
29:32
SPEAKER_01: Know your body.
29:36
SPEAKER_01: Notice I didn't say go to your doctor.
29:39
SPEAKER_01: That's usually a bit of a disappointment.
29:41
SPEAKER_01: Until we educate clinicians to be better communicators and better listeners,
29:47
SPEAKER_01: most women are not going to get a whole headache.
29:49
SPEAKER_01: They should be telling you about vaginal estrogen,
29:52
SPEAKER_01: perhaps about the CO2 laser Mona Lisa touch, about vaginal testosterone.
29:58
SPEAKER_01: They should be telling you about all this.
30:00
SPEAKER_01: If they're not, time to find a different doctor.
30:11
SPEAKER_00: The number of people who don't seek help from healthcare professionals, as we know, is high.
30:16
SPEAKER_00: And the ones that give poor advice is also sadly high.
30:21
SPEAKER_00: And for me, I had to advocate for vaginal estrogen.
30:25
SPEAKER_00: They just went, yeah, fine.
30:26
SPEAKER_00: They just wrote me.
30:27
SPEAKER_00: I'm going to support you.
30:34
SPEAKER_01: I will be out in the UK.
30:35
SPEAKER_01: I mean, you know, I have UK patients.
30:38
SPEAKER_01: So if anyone's listening, they can find me, Maria Sophocles, MD.com.
30:41
SPEAKER_01: You know, honest to God, think about it.
30:44
SPEAKER_01: You could do sexual health.
30:45
SPEAKER_01: You could really uncover like erectile dysfunction is
30:56
SPEAKER_01: Proxy for cardiovascular disease, loss of levito, a proxy for loneliness and depression.
31:02
SPEAKER_01: Sometimes like you could uncover a lot.
31:04
SPEAKER_01: So it's actually not a crazy idea.
31:06
SPEAKER_01: It's a really cool.
31:07
SPEAKER_01: No, it's not a crazy idea at all.
31:09
SPEAKER_01: I love what you're doing.
31:11
SPEAKER_01: I love this podcast.
31:12
SPEAKER_01: Thank you so much.
31:12
SPEAKER_01: And I know we have more questions.
31:14
SPEAKER_00: We do.
31:15
SPEAKER_00: We got to do another one.
31:16
SPEAKER_01: Because you know what?
31:16
SPEAKER_01: There's so much more we can talk about.
31:18
SPEAKER_01: And the book has so much more.
31:21
SPEAKER_01: And I hope you'll put a little QR code up for people to find the book.
31:24
SPEAKER_01: It's been a pleasure.
31:25
SPEAKER_01: It's been lovely.
31:26
SPEAKER_01: Thanks, Susie.
31:30
SPEAKER_00: Fancy a deep dive after this episode?
31:34
SPEAKER_00: Pop over to sexadviceforseniors.com,
31:38
SPEAKER_00: the spot for stories, advice, and I can guarantee a good lap or two.
31:43
SPEAKER_00: And maybe discover something new about yourself at sexadviceforseniors.com.