Latest / What The Peri? - With Kirsten Cooke / Not in the Mood? Perimenopause, Desire and Your Sex Drive — Part 2 (Ep 15)

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Not in the Mood? Perimenopause, Desire and Your Sex Drive — Part 2 (Ep 15) · What The Peri? - With Kirsten Cooke

0:07
SPEAKER_00: Welcome to What the Perry.
0:09
SPEAKER_00: I'm your host Kirsten Cook, personal trainer, menopause coach, and a woman living it right alongside you.
0:16
SPEAKER_00: This is the podcast for women navigating perimenopause and menopause.
0:20
SPEAKER_00: The change you didn't ask for, but the conversations you need.
0:24
SPEAKER_00: Let's get into it.
0:34
SPEAKER_00: Last week I asked you to picture a woman lying awake in the dark, Googling her symptoms with the brightness turned right down.
0:41
SPEAKER_00: I want to go back to her today because her story isn't finished.
0:45
SPEAKER_00: It's a few months later now.
0:46
SPEAKER_00: She finally booked that appointment, said the words out loud to her GP, and walked out with a script for vaginal estrogen.
0:54
SPEAKER_00: There's a moisturizer and a good lube in the bathroom cupboard.
0:57
SPEAKER_00: The perfumed body wash is gone, and she's seen a pelvic health physio about the bracing.
1:03
SPEAKER_00: And it's working.
1:04
SPEAKER_00: The itch has settled, and she can wear her jeans again without shifting in her chair all afternoon.
1:09
SPEAKER_00: Wing doesn't sting anymore, and she can't remember the last time she bought a thrush cream.
1:14
SPEAKER_00: Her body feels like her own again, well, at least down there.
1:18
SPEAKER_00: She's a little amazed at something so simple made such a big difference, and a little sad that she put up with it for as long as she did.
1:26
SPEAKER_00: Then one night, after the kids are finally in bed and the kitchen's cleaned up, her partner slides in close and reaches for her.
1:33
SPEAKER_00: And this time, there's no sandpaper to dread and no bleeding afterwards to worry about.
1:38
SPEAKER_00: The pain is gone.
1:40
SPEAKER_00: The reason she gave herself all those months is gone, and she lies there and realizes she still doesn't want to.
1:47
SPEAKER_00: She doesn't feel sore and she isn't frightened of it hurting anymore.
1:51
SPEAKER_00: She just doesn't want sex.
1:53
SPEAKER_00: She'd rather read her book or scroll on her phone or simply go to sleep.
1:58
SPEAKER_00: So she makes the same excuse she's been making for months, rolls over to her side at the bed, and lies awake with a different kind of worry.
2:05
SPEAKER_00: If it isn't the pain, then what is it?
2:08
SPEAKER_00: Is something wrong with her?
2:10
SPEAKER_00: Does it mean she doesn't love her partner anymore?
2:12
SPEAKER_00: Or is it just who she is now?
2:14
SPEAKER_00: And underneath all of it, there's guilt.
2:17
SPEAKER_00: She knows her partner is hurt, even if nothing gets said.
2:21
SPEAKER_00: She can feel the distance growing between them and she hates that it's there.
2:25
SPEAKER_00: Part of her wonders whether she should just go along with it to keep the peace and to stop feeling like the problem.
2:31
SPEAKER_00: Another part of her quietly wonders why she should have to.
2:35
SPEAKER_00: Maybe she's hinted at it to a close girlfriend over coffee, or maybe she's kept it all to herself, because she doesn't even know where to start.
2:44
SPEAKER_00: If any part of that sounds like you, I want you to know straight away that you're in very good company, and there's a lot more going on here than you might think.
2:52
SPEAKER_00: So today I want to talk about desire, plainly and without any judgment.
2:58
SPEAKER_00: Last week was all about the body, and today is about what happens in your head, your heart, your relationship, and your life when it comes to sex.
3:06
SPEAKER_00: And by the end of this episode, I hope you'll feel way less alone in all of it.
3:12
SPEAKER_00: Welcome back to What the Perry, I'm Kirsten Cook.
3:15
SPEAKER_00: This is part two of my two episodes on sexual health.
3:18
SPEAKER_00: Last week was part one, all about your body, and if you haven't heard it yet, I'd start there because today picks up right where it left off.
3:26
SPEAKER_00: I finished last week with something Dr.
3:28
SPEAKER_00: Kelly Kasperson says.
3:30
SPEAKER_00: She's the U.S.
3:31
SPEAKER_00: urologist I've mentioned a few times now, and her line was we have to address the pain before we can address the desire.
3:38
SPEAKER_00: Last week was about the pain, and today is about the desire.
3:43
SPEAKER_00: There was another line from last week I want to bring back because it's going to run through a lot of today.
3:48
SPEAKER_00: Dr.
3:48
SPEAKER_00: Rachel Rubin, the U.S.
3:50
SPEAKER_00: urologist who works in sexual medicine, says the clitoris is how most women orgasm, and penetration is not how most women orgasm.
3:58
SPEAKER_00: And the research backs her up.
4:00
SPEAKER_00: In one large study of women of all adult ages, fewer than one in five said penetration on its own was enough for them to orgasm.
4:09
SPEAKER_00: So if that's you, you're very much in the majority.
4:12
SPEAKER_00: And I'll come back to what that means for your sex life a little later.
4:16
SPEAKER_00: So here's how I've laid today out for you.
4:18
SPEAKER_00: First, I'll talk about what this feels like to live with, whether that's not being in the mood or feeling out of step with your partner.
4:25
SPEAKER_00: Then I'll explain why desire changes at this stage of life and why hormones are only part of the story.
4:32
SPEAKER_00: I'll talk about the two different ways that desire can show up, and then I'll walk you through what the numbers say about how many women feel this way.
4:41
SPEAKER_00: After that, I'll share my own view on all of this.
4:44
SPEAKER_00: Then I'll talk about pleasure, testosterone, talking to your partner, and where to get help.
4:49
SPEAKER_00: And I'll finish with three things you can do this week.
4:52
SPEAKER_00: And the same heads up as last week.
4:54
SPEAKER_00: This is a frank conversation, and I'll be using the proper words for every part of the body.
4:58
SPEAKER_00: So if the kids are in the backseat, you might want to save this one for later.
5:02
SPEAKER_00: I want to begin with what this is like to live with because I don't think women talk about it nearly enough, even with their closest friends.
5:10
SPEAKER_00: For a lot of women, it starts with simply not being in the mood.
5:14
SPEAKER_00: Not tonight, not this week, and if you're honest, maybe not for a while now.
5:19
SPEAKER_00: Sex used to be something you looked forward to or at least something you were happy to go along with.
5:23
SPEAKER_00: And now it feels like one more thing on the list.
5:26
SPEAKER_00: And it can creep up so slowly that you don't notice how long it's been until you stop and count back.
5:32
SPEAKER_00: Then there's the gap between you and your partner.
5:35
SPEAKER_00: Maybe they want sex more often than you do, and you can feel them waiting or keeping count or going quiet when you say no again.
5:43
SPEAKER_00: For some women, a partner who goes quiet is almost a relief, and plenty of partners are patient and kind about it and want to understand what's going on.
5:52
SPEAKER_00: But some partners aren't quiet at all.
5:54
SPEAKER_00: They whinge, complain, get angry, or criticize and belittle you about the lack of sex with very little thought for everything you're going through physically and emotionally.
6:05
SPEAKER_00: And when there's so little interest in understanding or supporting you, it only makes things worse, and so the cycle continues.
6:12
SPEAKER_00: So you start to dread bedtime a little.
6:15
SPEAKER_00: You go to bed early or stay up late or start a conversation about tomorrow's school run the minute you get under the covers.
6:22
SPEAKER_00: Last week I talked about women avoiding sex because it hurt.
6:25
SPEAKER_00: Even once the pain is gone, a lot of those same habits can stay because the wanting hasn't come back.
6:32
SPEAKER_00: And then there's the guilt, which can be the heaviest part of all.
6:36
SPEAKER_00: You might feel like you're letting your partner down, or that you're a bad partner, or that something in you is faulty.
6:42
SPEAKER_00: You might worry that they'll look elsewhere or that the relationship won't survive.
6:46
SPEAKER_00: Some women feel resentful too, and then feel guilty for feeling resentful.
6:51
SPEAKER_00: And it all gets tangled up together.
6:53
SPEAKER_00: And because it's so private, many women carry all of that on their own without ever saying a word of it out loud.
7:00
SPEAKER_00: Some women find themselves going along with sex they don't really want just to keep the peace.
7:05
SPEAKER_00: Last week I talked about pushing through painful sex because you don't want to disappoint your partner.
7:11
SPEAKER_00: This is the other side of that same coin.
7:14
SPEAKER_00: Even without any pain, you might be saying yes because it's easier than saying no, or because you think you should, or because you can't face the hurt or angry look on their faces again.
7:24
SPEAKER_00: I'll come back to that later because I think it deserves a proper conversation of its own.
7:29
SPEAKER_00: Now, I want to say clearly that this isn't everyone's story.
7:33
SPEAKER_00: Some women find at this stage of life their desire goes up, not down.
7:37
SPEAKER_00: Maybe the kids are older, maybe there's a new relationship, or maybe something has simply shifted, and they feel more like themselves than they have in years.
7:46
SPEAKER_00: And in my experience, for a small number of women, once they get their HRT right, their desire goes up so much, they joke that they feel like a teenage boy again.
7:56
SPEAKER_00: And if that's you, the mismatch can run the other way with a partner who isn't as interested as you are, and that can hurt just as much.
8:04
SPEAKER_00: I'll talk about how common that is a little later.
8:07
SPEAKER_00: And if you're single, separated, widowed, or simply not interested in sex right now, I want you to know this episode is for you too.
8:15
SPEAKER_00: Because desire isn't only about a partner, it's also about how you feel in your own body.
8:21
SPEAKER_00: Whether you feel any spark at all and whether that matters to you.
8:25
SPEAKER_00: For some women, losing that spark is a real grief.
8:29
SPEAKER_00: For others, it's a relief.
8:31
SPEAKER_00: And honestly, both of these are completely okay.
8:34
SPEAKER_00: So if any of this sounds like you, please hear this.
8:38
SPEAKER_00: What you're feeling is very common.
8:40
SPEAKER_00: There are real reasons behind it, and none of them mean there's something wrong with you.
8:45
SPEAKER_00: Once you understand where it's coming from, it gets a lot easier to work out what, if anything, you want to do about it.
8:52
SPEAKER_00: So let me explain what's going on.
8:54
SPEAKER_00: So why does desire change at this stage of life?
8:57
SPEAKER_00: I want to start with hormones because they're real and they do play a part.
9:01
SPEAKER_00: A big American study followed women who were 42 to 52 when they joined, right in the age range most of you are listening.
9:09
SPEAKER_00: It found that sexual function started to drop about 20 months before the woman's final period and kept dropping for several years later.
9:17
SPEAKER_00: So if you've noticed a change in perimenopause, that timing fits with what the research shows.
9:23
SPEAKER_00: And there's an Australian study that backs this up.
9:25
SPEAKER_00: It's one of the biggest of its kind, and it looked at Australian women aged 40 to 69.
9:31
SPEAKER_00: Women in early perimenopause had about twice as many problems with desire and arousal as women who hadn't reached perimenopause yet.
9:39
SPEAKER_00: The researchers called early perimenopause a vulnerable time for this.
9:44
SPEAKER_00: So if you're in that early stage and you feel like your sex drive has quietly packed its bags, you're far from alone and it isn't in your head.
9:52
SPEAKER_00: But hormones are only part of the picture.
9:54
SPEAKER_00: That same Australian study found the thing most strongly linked to women feeling distressed about their sex life was how they felt about themselves as a sexual person.
10:04
SPEAKER_00: In other words, body image and self-image.
10:07
SPEAKER_00: Mood, vaginal dryness, and some medications, including antidepressants, can play a part too.
10:13
SPEAKER_00: So it isn't one switch that's flicked off.
10:16
SPEAKER_00: It's a lot of things all pulling in the same direction.
10:19
SPEAKER_00: Now let me start with pain because it ties straight back to last week.
10:23
SPEAKER_00: If sex has hurt, your body learns to brace for it, and I talked about that guarding cycle last week.
10:29
SPEAKER_00: But your mind learns it too.
10:32
SPEAKER_00: Dr.
10:32
SPEAKER_00: Kasperson says you're never going to desire something you could take or leave.
10:36
SPEAKER_00: And I'd add that it's even harder to desire something that's hurt you.
10:40
SPEAKER_00: So even once the pain has been treated, it can take time for your mind to catch up and trust that sex can feel good again.
10:48
SPEAKER_00: That's why the pain has to come first and why desire doesn't always switch back on straight away.
10:53
SPEAKER_00: Then there's how you feel in your own skin.
10:56
SPEAKER_00: So many women at this stage feel like a stranger in their own body.
11:00
SPEAKER_00: The weight has shifted, the skin has changed, you're hot and sweaty half the night, and you might not recognize yourself in the mirror some days.
11:08
SPEAKER_00: It's very hard to feel sexy when you feel like your body is letting you down.
11:12
SPEAKER_00: And when that's how you feel, being touched can feel more like being looked at than being wanted.
11:18
SPEAKER_00: And then there's exhaustion and the mental load.
11:21
SPEAKER_00: If you're sleeping badly, waking at three in the morning, working, raising kids, maybe looking after aging parents, and running the whole household in your head, then by the time you get into bed, there's often nothing left.
11:34
SPEAKER_00: Sex can start to feel like one more person needing something from you at the end of a very long day.
11:40
SPEAKER_00: I think that's one of the most common reasons desire disappears and one of the least talked about.
11:45
SPEAKER_00: There's an interesting piece of research on this.
11:48
SPEAKER_00: It looked at women living with a male partner and at least one child under 12.
11:53
SPEAKER_00: The women who did more of the housework and the mental load had lower desire for their partner.
11:58
SPEAKER_00: And the reason wasn't only that it felt unfair, it was that they'd started to see their partner as someone who depended on them, a bit like another child to look after.
12:08
SPEAKER_00: As the researchers explained, feeling like your partner's mother isn't great for desire.
12:13
SPEAKER_00: Now that study didn't look at perimenopause, but I think a lot of you will recognize yourself in it.
12:18
SPEAKER_00: So when your desire drops, I don't want you to think that it's just your hormones and there's nothing else you can do.
12:24
SPEAKER_00: Your hormones are a part of it.
12:27
SPEAKER_00: So is pain, how you feel about your body, how much sleep you're getting, how much you're carrying, and how things are between you and your partner.
12:35
SPEAKER_00: And the good news is that every one of those is something you can do something about.
12:40
SPEAKER_00: Now, there's something I wish every woman knew because I think it would take so much guilt out of the bedroom.
12:46
SPEAKER_00: There are two different ways desire can show up.
12:49
SPEAKER_00: The first is called spontaneous desire.
12:51
SPEAKER_00: That's the kind you see in movies where you're thinking about sex and out of the blue, and you want it before anything has even started.
12:59
SPEAKER_00: It's the kind a lot of us felt early in a relationship and the kind we often think we're supposed to feel forever.
13:05
SPEAKER_00: The second is called responsive desire.
13:08
SPEAKER_00: That's when the wanting doesn't come first.
13:11
SPEAKER_00: It turns up once things get started, once you're being touched or kissed or held in a way that you like, and your body and your mind start to warm up.
13:20
SPEAKER_00: Dr.
13:20
SPEAKER_00: Rubin compares it to exercise.
13:23
SPEAKER_00: You might not feel like going for a walk, but once you're out there and you're moving, you're glad you went.
13:28
SPEAKER_00: Many women find this is how desire works for them, especially in a long relationship.
13:33
SPEAKER_00: And sex researchers see it as a normal way desire works, not as a fault.
13:38
SPEAKER_00: And Dr.
13:39
SPEAKER_00: Kasperson says something here that I think a lot of women need to hear.
13:43
SPEAKER_00: It's not normal to have spontaneous desire in a long-term relationship.
13:47
SPEAKER_00: So if you've been waiting for that out-of-the-blue feeling to come back before you're interested in sex and wondering what's wrong with you because it hasn't, there may be nothing wrong with you at all.
13:58
SPEAKER_00: You may simply be a woman whose desire responds rather than arrives on its own.
14:03
SPEAKER_00: But I want to be careful here because there's a catch.
14:06
SPEAKER_00: Responsive desire only works if what happens next is something you actually enjoy.
14:12
SPEAKER_00: If the touching is rushed or it's always the same thing, or it's all about getting to penetration as quickly as possible, then there's nothing for your desire to respond to.
14:21
SPEAKER_00: And that's where pleasure comes in, which I'll talk about properly a little later.
14:26
SPEAKER_00: For now, I just want you to know that not feeling like it before you start doesn't mean anything is wrong with you.
14:32
SPEAKER_00: So how many women feel this way?
14:35
SPEAKER_00: I want to give you a few numbers because I think they'll help you see just how normal this is.
14:40
SPEAKER_00: That big Australian study of women aged 40 to 69 found that almost half of them felt distressed about their sex life in some way.
14:48
SPEAKER_00: But that doesn't mean they all had a sexual problem.
14:51
SPEAKER_00: About one in four had a problem like low desire or pain that was upsetting them.
14:56
SPEAKER_00: Another one in four were upset about their sex life even though they didn't have a problem like that.
15:02
SPEAKER_00: They might have been worried about it or unhappy with how things were, without low desire or pain being the cause.
15:09
SPEAKER_00: And here's something worth knowing.
15:11
SPEAKER_00: As the woman got older, the sexual difficulties went up, but how much they were bothered by it went down.
15:17
SPEAKER_00: So more women had lower desire or less interest or less going on in the bedroom, and fewer of them cared.
15:24
SPEAKER_00: I think that tells you something important.
15:27
SPEAKER_00: Having lower desire isn't automatically a problem.
15:30
SPEAKER_00: It's only a problem if it's a problem for you.
15:33
SPEAKER_00: There's an earlier Australian study that adds to this.
15:36
SPEAKER_00: It looked at Australian women aged 40 to 65.
15:39
SPEAKER_00: Most of the women in it scored low on desire, but only around a third had low desire that was actually distressing them.
15:46
SPEAKER_00: And here's what stood out to me.
15:48
SPEAKER_00: The women who had a partner were twice as likely to be distressed about their sex life as the women who didn't.
15:55
SPEAKER_00: So for a lot of women, the distress isn't about their own wanting at all.
15:59
SPEAKER_00: It's about the pressure, the expectations, and the worry about letting someone else down.
16:05
SPEAKER_00: Now, what about women whose desire goes up?
16:07
SPEAKER_00: I went looking for a recent figure on how many women our age have a high sex drive, and I couldn't find one.
16:13
SPEAKER_00: If it's out there, I haven't found it, and I'd like to.
16:16
SPEAKER_00: What I can tell you is that in hundreds and hundreds of conversations I've had with women myself, it's a small number.
16:23
SPEAKER_00: Some women do find their desire goes up at this stage, and if that's you, that's wonderful.
16:28
SPEAKER_00: But most of the women I talk to don't.
16:30
SPEAKER_00: And Dr.
16:31
SPEAKER_00: Casperson says low libido is one of the two main things that women come to see her about.
16:36
SPEAKER_00: And whichever way it goes, one thing comes up again and again, and that's a mismatch with your partner.
16:43
SPEAKER_00: Dr.
16:43
SPEAKER_00: Casperson says desire mismatch is completely normal because in any relationship, one person is always going to want to have sex more than the other.
16:52
SPEAKER_00: And she says something I think every couple should hear.
16:55
SPEAKER_00: It's not the lower desire person's job to come up to the higher desire person's level.
17:00
SPEAKER_00: It's about working out together what your relationship needs so it works for both of you.
17:06
SPEAKER_00: So if you're the one with lower desire, please hear that it isn't your job to fix yourself so you match someone else.
17:12
SPEAKER_00: And if you're the one who wants more, it isn't your partner's job to give you sex they don't want.
17:18
SPEAKER_00: That's a conversation, not a problem to solve on your own, and I'll come back to how to have it.
17:23
SPEAKER_00: I want to share my own view on all of this because I think it matters, and I think a lot of women are thinking it without saying it.
17:30
SPEAKER_00: From hundreds and hundreds of conversations I've had with women over the years, and from what I hear from the doctors working in this field, I believe many women may never have had wonderful sex.
17:41
SPEAKER_00: Maybe they've gone along with it, put up with it, made the right noises and kept everyone happy, but it was never really about their pleasure.
17:49
SPEAKER_00: And Dr.
17:49
SPEAKER_00: Kasperson agrees.
17:51
SPEAKER_00: When women tell her they love their partner but just don't want sex, one of the first things she wonders is whether there's something else going on.
17:59
SPEAKER_00: And she says, or they've just been having crappy sex their whole life.
18:03
SPEAKER_00: Then perimenopause and menopause come along and something shifts.
18:08
SPEAKER_00: A lot of women find they just can't mask the way they used to.
18:12
SPEAKER_00: The people pleasing, putting everyone else first, going along with things just to keep the peace, and the putting up with a sex that's subpar, they all get harder to keep doing.
18:23
SPEAKER_00: Your patience is shorter, your energy is lower, and your tolerance for things that don't serve you drops.
18:29
SPEAKER_00: And I think that can be a very healthy thing.
18:31
SPEAKER_00: On top of that, so many women already feel like strangers in their own bodies at this stage.
18:37
SPEAKER_00: They feel disconnected, as if their body is failing them, and their brain isn't working the way it used to.
18:43
SPEAKER_00: So when sex was never really that great to begin with and you already feel like a foreigner in your own skin, it's no wonder that many women couldn't care less if they never had sex again.
18:54
SPEAKER_00: Not every woman, of course, but many, and I think that's very understandable.
18:59
SPEAKER_00: And that brings me to the hard question, the one I really want to ask out loud.
19:03
SPEAKER_00: Why should a woman give her body to sex she doesn't want?
19:07
SPEAKER_00: I'm not talking about sex that starts slowly and becomes something you enjoy, which is the responsive desire I talked about earlier.
19:15
SPEAKER_00: I'm talking about sex you don't want from start to finish, that you go along with anyway.
19:21
SPEAKER_00: Researchers have a name for it, which is Judy Sex, and one study found the women having more sexual pain and less satisfaction were the ones having more of it.
19:30
SPEAKER_00: That study was mostly women in their 30s, but I don't think it gets any easier with age.
19:35
SPEAKER_00: Dr.
19:36
SPEAKER_00: Kasperson talks about women having sex just so their partner won't get grumpy or upset, rather than for connection and pleasure.
19:44
SPEAKER_00: And then those same women walk into her office thinking they're the problem for having a low libido.
19:50
SPEAKER_00: So I want to say this as clearly as I can.
19:52
SPEAKER_00: You don't owe anyone your body, not your partner, not your relationship, and not some idea of what a good wife or a good partner is supposed to do.
20:02
SPEAKER_00: Last week I said that stopping painful sex isn't giving up and it isn't failing anyone.
20:07
SPEAKER_00: The same is true of sex you don't want.
20:10
SPEAKER_00: Saying no or not right now or not like this is not a failure.
20:15
SPEAKER_00: It's information and it's the start of an honest conversation.
20:19
SPEAKER_00: And I want to be fair to partners here because they're often not the bad guy in this.
20:23
SPEAKER_00: Dr.
20:24
SPEAKER_00: Rubin says when one person wants sex more than the other, there's no evil bad guy, but there still is conflict.
20:31
SPEAKER_00: Your partner might be hurt or confused or feeling rejected, and that's real too.
20:36
SPEAKER_00: But the answer isn't for you to keep giving your body to sex you don't want.
20:41
SPEAKER_00: The answer is to work it out together what would make sex something you'd actually want again.
20:46
SPEAKER_00: Last week I promised you I'd talk much more about pleasure, and this is where I keep that promise.
20:52
SPEAKER_00: Because if one of the reasons so many women don't want sex is that it was never that good for them, then pleasure isn't an optional extra.
21:00
SPEAKER_00: It's at the heart of it.
21:01
SPEAKER_00: And I think a lot of us were never taught much about our own pleasure at all.
21:05
SPEAKER_00: Remember Dr.
21:06
SPEAKER_00: Rubin's line from earlier?
21:08
SPEAKER_00: The clitoris is how most women orgasm, and penetration is not how most women orgasm.
21:14
SPEAKER_00: Yet, so much of the sex so many of us have has been built around penetration.
21:19
SPEAKER_00: Dr.
21:20
SPEAKER_00: Rubin says many women think orgasm is supposed to come from penetration, and when it doesn't, they think something is wrong with them.
21:27
SPEAKER_00: Yet those same women often find they can orgasm easily with touch from a hand when the focus is on the clitoris.
21:34
SPEAKER_00: There's nothing wrong with them at all.
21:36
SPEAKER_00: They've just been having sex that isn't designed for their body.
21:39
SPEAKER_00: Dr.
21:40
SPEAKER_00: Rubin puts it brilliantly.
21:42
SPEAKER_00: Making penetration the main event is where the challenge lies.
21:45
SPEAKER_00: And Dr.
21:46
SPEAKER_00: Kasperson says much the same thing that male orgasm is what we've prioritized, and we need to undo years of being taught that women's pleasure doesn't matter as much.
21:56
SPEAKER_00: So if sex in your house has always followed the same pattern, With a bit of foreplay, then penetration, then it's over when your partner finishes.
22:04
SPEAKER_00: I gently ask whether that sex was ever really designed with you in mind.
22:09
SPEAKER_00: And I don't think most of us were ever taught any of this.
22:12
SPEAKER_00: Growing up and even into adulthood, there are very few conversations where men learn that women's arousal often works differently to theirs, and that we can need quite different things to feel pleasure and closeness.
22:25
SPEAKER_00: For a lot of women, feeling emotionally connected comes first and the physical follows.
22:31
SPEAKER_00: And when the physical does happen, some men, not all, are focused on their own pleasure without really understanding how a woman's body works.
22:40
SPEAKER_00: Yet about three in four women either need their clitoris touched to orgasm or find it makes orgasm better.
22:47
SPEAKER_00: And as I said last week, in the US, the clitoris is in even on the checklist of what a gynecologist has to learn.
22:53
SPEAKER_00: So if the professionals aren't taught, it's no wonder so many partners haven't learned it either.
22:59
SPEAKER_00: Last week I also talked about your clitoris changing with falling estrogen.
23:03
SPEAKER_00: It can get a little smaller, and in some women, the hood can get stuck to it, which Dr.
23:07
SPEAKER_00: Rubin calls a clitoral adhesion.
23:09
SPEAKER_00: And there's one more reason to look after it.
23:12
SPEAKER_00: If you've noticed that you're less sensitive than you used to be, or that orgasms are harder to reach, that's worth raising with your doctor.
23:19
SPEAKER_00: And the vaginal estrogen I talked about last week can help the tissue there too.
23:24
SPEAKER_00: So what does putting pleasure first look like?
23:27
SPEAKER_00: It might mean more time and less rushing.
23:30
SPEAKER_00: It might mean more touching, kissing, and closeness that isn't on its way to anything else.
23:36
SPEAKER_00: It might mean showing your partner what you like and how you like to be touched.
23:41
SPEAKER_00: And it can mean that sex doesn't have to include penetration at all if penetration isn't what you want.
23:47
SPEAKER_00: Sex can be a lot of things and you get to decide what it looks like.
23:51
SPEAKER_00: And if you've been faking orgasms maybe for years, please don't be hard on yourself about it.
23:56
SPEAKER_00: Dr.
23:57
SPEAKER_00: Rubin says a lot of women have, and I think it usually comes from wanting to make someone else feel good or wanting it to be over.
24:04
SPEAKER_00: But it also means your partner has been learning the wrong lessons about what works for you.
24:09
SPEAKER_00: So part of putting pleasure first is being honest about that, gently and without blame, so you can start again on better information.
24:18
SPEAKER_00: Now I want to talk briefly about testosterone because I know a lot of you will be wondering about it.
24:23
SPEAKER_00: I covered testosterone in detail back in episode two, so if you'd like the full picture, I'd go back to that one.
24:29
SPEAKER_00: Women make testosterone too, and it plays a part in libido as well as energy, vitality, and muscle.
24:36
SPEAKER_00: And in Australia, there's a testosterone cream made for women called Androphem, which is the only one approved here for women.
24:44
SPEAKER_00: So has anything changed since then?
24:46
SPEAKER_00: Not much.
24:46
SPEAKER_00: It's still approved here for low sexual desire that's causing distress in women after menopause.
24:52
SPEAKER_00: Many doctors also prescribe it for other things like energy, vitality, and muscle mass, and many women tell their doctors they notice a difference there too.
25:01
SPEAKER_00: The trials so far haven't been big enough or long enough to prove those other benefits yet, but that's what the doctors are seeing and what women are reporting.
25:09
SPEAKER_00: But I want you to know what to expect.
25:11
SPEAKER_00: Testosterone isn't a magic switch for desire, and not every woman notices a difference.
25:16
SPEAKER_00: In the trials, somewhere between about a third and a half of women didn't notice a real change.
25:23
SPEAKER_00: My own hormone doctor says the same thing that many women don't notice much at all, and clinically she puts her numbers higher than 50%.
25:31
SPEAKER_00: And for the women, it does help, it can take two to three months before they feel anything, so it's worth giving it time.
25:38
SPEAKER_00: And here's where it links straight back to last week.
25:40
SPEAKER_00: Dr.
25:41
SPEAKER_00: Casperson tells the story of a woman who came to see her with a vulva and vagina so painful from menopause that even touching herself hurt.
25:49
SPEAKER_00: And someone had put her on testosterone for her low desire.
25:53
SPEAKER_00: As Dr.
25:54
SPEAKER_00: Casperson said, you're completely missing the boat if you give testosterone to someone who has a painful vulva, because she's never going to want to be touched in the first place.
26:04
SPEAKER_00: That's exactly why she says pain has to come first.
26:07
SPEAKER_00: So if sex hurts, start with last week's episode and then look at desire.
26:13
SPEAKER_00: So how do you talk to your partner about all of this?
26:15
SPEAKER_00: I know it can feel like the hardest conversation in the world, especially if you've never really talked about sex before.
26:22
SPEAKER_00: Dr.
26:22
SPEAKER_00: Kasperson says that's very common.
26:24
SPEAKER_00: Couples who never talked about sex when it was good often have no idea to talk about it when something changes.
26:30
SPEAKER_00: And Dr.
26:31
SPEAKER_00: Rubin says expecting your partner to have all the words and know everything is the wrong answer.
26:37
SPEAKER_00: Neither of you has to be an expert.
26:39
SPEAKER_00: You just have to start.
26:41
SPEAKER_00: So pick your moment and I'd suggest it isn't in bed and it isn't straight after you've said no.
26:46
SPEAKER_00: Try a walk or a drive or a cup of coffee when neither of you is hurt or tired.
26:52
SPEAKER_00: Then explain what's going on for you.
26:55
SPEAKER_00: You could tell them some of what you've heard today, that desire changes at this stage of life for lots of reasons, that it isn't about them and that you'd like to work it out together.
27:05
SPEAKER_00: Last week I suggested Dr.
27:06
SPEAKER_00: Rubin's sunburn picture for explaining painful sex.
27:10
SPEAKER_00: Today you might simply say, I want to want this again and I need your help to get there.
27:15
SPEAKER_00: And if your partner is the one pushing, this might help them too.
27:19
SPEAKER_00: Dr.
27:19
SPEAKER_00: Kasperson says, you need to have sex with me more is the least sexy thing you can say to somebody.
27:26
SPEAKER_00: Pressure and guilt never make anyone want sex more.
27:29
SPEAKER_00: If anything, they push it further away.
27:32
SPEAKER_00: So the conversation needs to be about what would make sex feel good for both of you, not about how often it's happening or who wants it more.
27:40
SPEAKER_00: And you don't have to work it out on your own.
27:42
SPEAKER_00: Back in episode 12, I shared Dr.
27:44
SPEAKER_00: Kasperson's three-legged stool, and this is where it all comes together across both of these episodes.
27:49
SPEAKER_00: The first leg is a doctor who understands hormones for things like vaginal estrogen and testosterone.
27:56
SPEAKER_00: The second leg is a pelvic health physio for the muscles like the guarding cycle I talked about last week.
28:02
SPEAKER_00: And the third leg is a therapist or a counselor for everything going on in your head and in your relationship.
28:08
SPEAKER_00: Dr.
28:09
SPEAKER_00: Kasperson says if you're missing any one leg, the stool falls down.
28:14
SPEAKER_00: The therapist's leg is one a lot of women have never thought about, and it can make such a difference whether you go on your own or with your partner.
28:21
SPEAKER_00: Your GP can point you to one, and if you're struggling with anxiety or low mood as well, they may be able to set you up with a mental health plan to help with the cost.
28:30
SPEAKER_00: So if you've treated the pain and you're still stuck, or if talking to your partner keeps going round in circles, that's the leg I'd look at next.
28:38
SPEAKER_00: So let me bring all of that together into three things you can do this week.
28:43
SPEAKER_00: They're simple, they're kind, and each one is a step towards a sex life that works for you, whatever that looks like.
28:49
SPEAKER_00: You only need to start with one of them, and the others will feel easier once you've begun.
28:54
SPEAKER_00: Step one is to check in with yourself, honestly.
28:58
SPEAKER_00: Ask yourself what's really going on with your desire.
29:01
SPEAKER_00: Is it pain?
29:02
SPEAKER_00: Is it exhaustion or the mental load?
29:04
SPEAKER_00: Is it how you feel about your body?
29:06
SPEAKER_00: Or is it that the sex you've been having has never really been that good for you?
29:11
SPEAKER_00: There's no wrong answer and you don't have to fix anything yet.
29:14
SPEAKER_00: Just knowing what's underneath it will tell you where to start and it might take a lot of the guilt away.
29:20
SPEAKER_00: Step two is to have one honest conversation with your partner.
29:24
SPEAKER_00: Pick a quiet moment outside the bedroom and tell them a little of what you've heard today.
29:29
SPEAKER_00: Tell them it isn't about them and that you'd like to find a way forward together.
29:33
SPEAKER_00: And if there's something you'd like more or less of, or something you've never told them, this is a good time to start.
29:40
SPEAKER_00: One conversation won't fix everything, but it can take a lot of pressure out of the room.
29:45
SPEAKER_00: Step three is to find the leg of the stool you're missing.
29:48
SPEAKER_00: So if sex still hurts, start with your GP about vaginal estrogen or a pelvic health physio.
29:54
SPEAKER_00: If the pain is sorted and you'd like to talk about your hormones, including testosterone, book in with a doctor who understands menopause.
30:02
SPEAKER_00: And if it's more about your head, your heart, or your relationship, ask your GP to point you to a therapist or counselor you can talk to, on your own or with your partner.
30:12
SPEAKER_00: You don't have to do this alone.
30:14
SPEAKER_00: If you'd like to read more, I've put the research behind both of these episodes in the show notes.
30:18
SPEAKER_00: So if you want something to take along to your appointment or you'd simply like to read it in your own time, that's where you'll find it.
30:25
SPEAKER_00: Here's where I want to leave you today.
30:27
SPEAKER_00: I want you to think back to the woman at the start of this episode, the one lying awake wondering what's wrong with her because her pain is gone and the wanting hasn't come back.
30:36
SPEAKER_00: Now picture her a few months from now.
30:38
SPEAKER_00: She's worked out that it was never just her hormones.
30:41
SPEAKER_00: She's had an honest conversation with her partner, out on a walk, and it went better than expected.
30:46
SPEAKER_00: Maybe she's seen a counselor, or maybe they're simply taking things slower and putting her pleasure first.
30:52
SPEAKER_00: And she isn't lying awake feeling guilty anymore.
30:55
SPEAKER_00: Across these two episodes, I've talked about your body and your desire, and I hope you can see now how they fit together.
31:03
SPEAKER_00: Last week was about looking after the tissue, the comfort and the pain, because as Dr.
31:08
SPEAKER_00: Kasperson says, the pain has to come first.
31:11
SPEAKER_00: And today has been about everything else: your hormones, your body image, your exhaustion, your relationship, and your pleasure.
31:19
SPEAKER_00: Both of them matter and you deserve care for both.
31:22
SPEAKER_00: So here are your three steps again.
31:24
SPEAKER_00: Check in with yourself honestly about what's really going on with your desire.
31:28
SPEAKER_00: Have one honest conversation with your partner outside the bedroom.
31:32
SPEAKER_00: And find the leg of the stool you're missing, whether that's a doctor, a pelvic health physio, or a counselor.
31:38
SPEAKER_00: And whatever sex looks like in your life from here, if you have a partner, I hope it's something you can work out together as a team in a way that feels right for both of you.
31:48
SPEAKER_00: But before then, if these two episodes have helped you, I'd really appreciate if you share them with a friend.
31:54
SPEAKER_00: Maybe it's the friend who joked over coffee that her sex life has gone into hibernation, or the one who's quietly told you she doesn't feel like herself anymore.
32:02
SPEAKER_00: These two episodes might be exactly what she needs to hear, and she might never ask for them herself.
32:08
SPEAKER_00: And if you haven't already, follow the show and leave a rating or a review because it helps other women find these conversations.
32:15
SPEAKER_00: I'm so glad you're here.
32:17
SPEAKER_00: Look after yourself, and I'll see you next week.
32:23
SPEAKER_00: Everything I've mentioned today is referenced in the show notes, along with all the links.
32:28
SPEAKER_00: And you can find me at Kirstencookcoaching.com.
32:31
SPEAKER_00: Just a reminder, though, this is education, not medical advice.
32:36
SPEAKER_00: So take these conversations to a practitioner who will actually listen to you.
32:41
SPEAKER_00: Thank you so much for being here and for listening to the What the Perry podcast.
32:45
SPEAKER_00: The change you didn't ask for, the conversations you need to do.