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The 'Pause
The menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn’t see coming, and the hilarious moments midlife can bring. You've got questions and we've got the experts to answer them.
The 'Pause
The Midlife Bedroom: Sex During Perimenopause
Sex during perimenopause changes for everyone. We dive into the often-silent topic of midlife intimacy with sex therapist Nisha McKenzie, who helps us understand why our desire shifts and what we can do about it.
• Changes in libido are normal and common during perimenopause
• Estrogen decline affects vaginal tissue, causing dryness, pain, and thinning
• Vaginal estrogen treatment can help with physical symptoms without systemic effects
• Communication is more important than hormones for maintaining intimacy
• Non-demand touch helps maintain connection without pressure for sex
• Building a "third relationship island" instead of one partner always accommodating the other
• Testosterone therapy can help with libido for some women, but won't fix relationship issues
• Our society fails to teach healthy sexual communication, especially for women
• Pain during sex is not normal and should be addressed, not tolerated
• Sexual desire doesn't end after menopause - many women experience increased freedom
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Welcome to the Pause, the menopause podcast, with unfiltered conversations about the symptoms you hate, the changes you didn't see coming and the hilarious moments midlife can bring. I'm your host, val Leggo, and I've been a dedicated health reporter for 25 years and I wanted to normalize something that every woman goes through menopause. Hey friends, welcome back to the Pause, the podcast, where we talk about all the things no one told you about perimenopause, but probably, definitely, maybe, you should have. I'm your host, val Lago, longtime health journalist and passionate advocate for helping women navigate this wild and sometimes WTF stage of life. I know you're feeling it.
Speaker 1:Today we're talking about one of the biggest topics in midlife that's often met with silence. Nobody wants to talk about it. Shame, confusion, do you try to muddle your way through it, and that does not work. We are talking about sex during perimenopause. Yeah, we are going to go there and we're going to talk about it candidly and openly. We're, of course, going to laugh and have a lot of fun with it as well, because, let's face it, sex changes during perimenopause, whether it's your libido that's too low and you just don't feel like it because you'd rather watch your favorite Netflix show, discomfort. Maybe you've lost connection with your partner, or just figuring out why. You need just some me time, right? So many women are left wondering is this normal, and why didn't anybody warn me about this? Lucky for us, though, we are not having this conversation alone, because joining me is my amazing co-host, nisha McKenzie, who is not only a nationally certified menopause provider, but she's also a sex therapist, and this is her favorite topic. So this podcast may go on and on, and on, and on and on.
Speaker 1:Anyways, it's time to get ready for real raw and honest chat about midlife intimacy, the hormone rollercoaster and how to reconnect with your body and your desires. You are so excited that we are finally talking about this on a podcast. You've been holding me back, pal. Been holding me back, pal. Wait a minute to talk about the s word, the s word. And so it starts happening in perimenopause, and it's different for every woman, and I think that's the biggest thing we have to remember. We keep preaching that and preaching that for all of the things, but also especially for this. You can go from being like yeah, yeah, like I was really like Jones, and like constantly all the time, and now you're like nah take it or leave it.
Speaker 2:Yeah, I mean, there's so many reasons for this right that are that are marching through life as just benign practices, but they're, they're masked, all these little things that that make it so that female desire is not prioritized.
Speaker 1:Right.
Speaker 2:Right. So but yeah, I mean, does it make sense that by the time we hit our 40s, maybe if this person is in a heterosexual relationship and they've had babies, maybe their reason, like one of the driving forces for having sex, is waning or is gone? Maybe they're no longer wanting to procreate and they didn't even realize that? Like, yeah, side benefit of having sex is sometimes it feels good, but I want to do this because I'm, you know, I want to have a baby right Now we're past that phase of life. There's one big reason. Another big reason is those big fluctuating hormones. Another big reason is we forget to keep the intention of communicating with our partners. Yeah, this is in same-sex relationships, opposite-sex relationships.
Speaker 1:Any kind of relationship where you're having sex there you go, that is a great umbrella.
Speaker 2:I'm going to get it printed on an umbrella. Yeah, any relationship where you're having sex, we just don't going to get it printed on an umbrella. Yeah, any relationship where you're having sex, we just don't. It's like we all know our biggest sexual organ, our most powerful sexual organ, is our brain. We have sex with our bodies, often with our genitals, but our brains are the powerful thing and our brain is a muscle.
Speaker 2:Do we ever think, like you know what? I really could use? Some biceps. I'm going to go to the gym, I'm going to start getting me some biceps, and then we get those biceps and then do we just stop going to the gym because we got the biceps? Sometimes, yeah, right. But then when we lose the biceps because we stopped going to the gym, we're like, yeah, it's because I'm not going to the gym, right, right. But when we lose the connection with our partner because we stopped working out our brain in a sexual way, that doesn't mean you have to have sex, but the conversation around sex, right, the sex, the idea of sexuality or sensuality, when we stop being intentional about that part of our brain, about working that part out, it's going to the word is atrophy, right?
Speaker 1:It's going to like that sounds terrible, yeah, when you think about all the other parts of your body that are atrophy. Right, it's going to like. That sounds terrible, yeah, when you think about all the other parts of your body that are atrophy as well. But I have to say I, in the last probably two to three years, have been very intentional about this with my husband. He is a very visual guy when it comes to sex and loves it like every man does, and so I have learned with him that it's okay to be, you know, to naughty, flirt with him, like and to like, send text messages and so forth, and he doesn't necessarily have this like well, because you sent that text, that means tonight I'm expecting you to, you know, have some sex with me like he's it's really just kind of it's his love language. I've learned to not only talk it but embrace it and understand. Because I love him so much. I know how important that is to him, that it has really like we've grown on a deeper level.
Speaker 2:Can I ask a question though? Did you have a conversation with him ever to say, hey, just because I'm sending you these texts doesn't mean I want to come home and be penetrated.
Speaker 1:I. I said let's see how did that I? I did not start that conversation. He said to me I really do like it when you know you, you tease me a little bit, or whatever. But one. I said well, here's the thing, like because every other relationship I ever had had that expectation. So it's just like I can't make. I don't know what the end of my day is going to be like. I might come home, be wanting to just jump all over you, or maybe my day just turned upside down and is a bunch of crap and I'm like I I just don't, like, I don't want to be touched, I just want to sit down and like, have a glass of wine, maybe cry, maybe not, I don't know.
Speaker 2:Um, and he said I don't care yeah, I don't care, so you may not have initiated it, but you had the conversation yes, we had the conversation, like because he's an amazing communicator.
Speaker 1:Yeah, so when he was like I'm not, you know he's the bees knees he really is everybody needs one of him so, but we did have that conversation
Speaker 2:and and that's so. That's one of the things that can hold women back. Often, right Is is feeling like, yeah, but if I reach out and touch his leg right now, just because we're sitting on the couch next to each other, he's going to think you know, it's like if you give a mouse a cookie, right, if I do this, then it's going to lead to that and that and that and that. So I'm just not going to do anything. And I had a couple I worked with years ago that the only touch they had in a 24-hour period was a fist bump before they split the hall and went to bed in opposite sides of the hall, in opposite rooms. I'm just going to say, went to bed in opposite sides of the hall, in opposite rooms.
Speaker 1:I'm just going to say I don't mind the sleep divorce. You know it's kind of nice with you being able to sleep in your own bed, so I don't judge anybody for doing that. No, no, no.
Speaker 2:But their whole day in a 24-hour period. That was the only touch and they had. There's reasons for having different rooms. Their reason was because if the lower desired partner accidentally touched, their foot to the leg of the higher desired partner in the night and the higher desired partner felt that then maybe they'd think this way, so it was so intense in them.
Speaker 1:That's a big wedge.
Speaker 2:It's a big wedge Like that wedge grows and grows and grows over years, and that had been like 20 years that they had gotten to that point. And so we can start by doing some exercises to say let's work on some non-demand touch. But you have to have that awkward conversation first to say I'm going to sit next to you, I'm going to put my hand on your leg, we're just going to sit here, are you OK? If that means we are not having sex, like clear boundaries, we're not going to have sex. At the end of this, I want to know what touch can mean for touch's sake, versus what my brain attaches that kind of touch to, and touch is very contextual.
Speaker 1:Yeah. So I definitely had to like relearn, you know, like my entire life, after we had that conversation. You know, like, okay, I can think about this completely differently, like sometimes, you know, he usually gets up before me on a Saturday and sometimes I'll just walk out into the living room naked and be like, so I was wondering what you felt like. You know, did you want toast, did you want eggs? And he'll just be like, oh, and he'll love it, and then I'll go back in the bedroom and put clothes on and we'll have breakfast, and but that kind of like starts the day. That's his like, he's fine with all of that kind of stuff. You know, knowing that maybe not today, but tomorrow, you know, at some point in time. I know you can't go on for months like that, but it's just that you have to know the love language and the timing of it and how that all wraps up, and that is owning your sexual prowess.
Speaker 2:That I mean. There's a few words I really don't like. Should is one of them. Right? I don't like the word should. I don't like the word foreplay. But if you're going to use the word foreplay, it needs to start at the end of a sexual encounter and carry all the way until the next sexual encounter. I don't care if it's a day later, a week later, a month, a year. It starts at the end. That's your foreplay, that's your. Hey, babe, I see you, I know that we're in this together, right? We're not going to have sex right now, me walking around here in my nudie booty, right? This does not necessarily mean that I want to be penetrated at this moment, so let's not jump to that conclusion. This means I'm owning my sexual power and we're going to just tease and tantalize each other a little bit.
Speaker 1:So there's that part of the perimenopause that you might have to put a little bit of brainpower effort into, which I know you're already tired and you're already not sleeping and you're already angsty, so it's a little hard sometimes to power through that, which might be one of the reasons why there's so many divorces in perimenopause. I don't know that they haven't. They talk about it a lot. I don't know if they've actually done studies on it, but but there's some other things too Like for some women it can just be really uncomfortable.
Speaker 2:Yeah, there's the biological part. We always take a biopsychosocial approach. The bio is the physical part. When estrogen goes down, estrogen receptors we always say they're everywhere in our body. They're also in the vagina and at the vestibule, which is the opening to the vagina. Is it really called the vestibule?
Speaker 1:Is that a doorbell?
Speaker 2:Like the opening of your house. Right there's the vestibule for your foyer. It's the foyer to your vagina. So there's the vagina, the vestibule, the vulva. There's estrogen receptors everywhere.
Speaker 2:When those go down, estrogen keeps the vaginal tissue elastic, oxygenated and lubricated. So without that we don't have the ability for the tissue to expand and contract as well. The tissue gets thinner, it can tear. We don't have protection over the urethra. I always say there's like folds or kind of wrinkles right in the vaginal tissue that helps protect the urethra. In a way. I liken those to the like eyebrows and eyelashes for your eyeballs. Right, they're not a complete protection but they help a little bit Without that. So without the estrogen for the urethra, the urethra is like just exposed right and then you get more UTI, urinary tract infections, bladder infections, frequency, urgency, leaking Bladders can kind of start to migrate downward right, a prolapse. There's so many things that can happen that are not healthy for the vaginal canal with lack of estrogen, and putting estrogen in a vagina is about the easiest and most benign thing that we can do and in other words, like most safe thing that we can do.
Speaker 1:Right. So women who are afraid of like going on hormone replacement therapy which is completely fine, everybody's on their own journey. You need to discover and do the research and talk with your doctor about it on your own. But the vaginal estrogen is completely absorbed, completely differently than the one that you would patch. You'd stick on yourself, exactly.
Speaker 2:You've heard me say this before too. I always say vagina's super selfish. She keeps it. She's been ignored her whole life. About the time you give her something, she's going to hold on to it. She's not sharing it with anybody. So if you're having hot flashes and you put estrogen in your vagina, you're going to still have hot flashes.
Speaker 1:It's not going to help those, but it is going to feel really great when you have sex.
Speaker 2:Yes, right, You're still going to be hot and sweaty if you didn't treat the other hot flashes the hot flashes. But yeah, you can really really easily supplement the estrogen or a DHEA testosterone any types of these hormones you can supplement in the vaginal tract and that can help with dryness, pain. Um, some people with tearing. Some people say it feels like razor blades, sandpaper. If had people who've had a hysterectomy and had no estrogen 20 years and they'll come in and and the vagina is shortened and narrowed so much that it's almost just a dimple left.
Speaker 1:I didn't even know that was possible, that's pretty severe.
Speaker 2:But yeah, I mean the vagina can really negatively react to no estrogen in it.
Speaker 1:Wow.
Speaker 2:And we can address even that.
Speaker 1:Will it get bigger if you?
Speaker 2:put some cream in it. We need to do some pelvic floor physical therapy, some pelvic floor rehab, some estrogen cream. Dilation, vibration, massage, moisturization, all those things.
Speaker 1:But in addition, what you'll find, though, too, is probably you won't have as much, maybe leakage.
Speaker 2:Right If you're using some vaginal hormone, correct. Yes, yeah, it can help protect against all of those things. It's wonderful. You shouldn't have to have pain. And this is the other problem is pain for women is so normalized Just soldier through, don't say anything, don't be a complainer, right, don't be a sissy. So when this happens, when we have pain, so many women come into me and they're like no-transcript, pain might mean death, abort, mission and it's just going to do it for you, just like that. So you're not going to have a libido. If there's any kind of pain and some people will come back and say, yeah, but it's not really pain, it's just like a little uncomfortable. Still like.
Speaker 2:Sex is also not supposed to be just a little uncomfortable. It's not even supposed to be like meh, just neutral. It's supposed to feel good. Folks, if it's a little uncomfortable, what's the dangling carrot? Why would you go back and do more? I promise you, if you have a partner with a penis, if it felt like razor blades every time he had sex with you, he would also not. He'd be thinking twice.
Speaker 1:Yeah, He'd be like what's wrong?
Speaker 2:Right and also there would be a fix by the way Right, there would be.
Speaker 1:And so another part of it, though, too, you know, we talk about like, like the mental aspect of it. We talk about, you know, the vaginal dryness, and sometimes, even with all of that, you're like I just got nothing, I got nothing. And so how do you feel about testosterone therapy, to sort of like jumpstart that?
Speaker 2:I mean, testosterone therapy is wonderful for the right person, For probably more people than are utilizing it at this point. Maybe not for everybody, or certainly not for everybody. But testosterone is a hormone that we are born with and it starts to leave in our 30s and our 40s and it is our main sex hormone, like as far as libido hormone. But testosterone doesn't fix everything. If you get a real dysfunctional relationship and I pump you full of testosterone, you're still not going to want to have sex with him if he's a jerk.
Speaker 1:You might want to have sex.
Speaker 2:I've literally had people come in and go Nisha, I don't want to have sex. My libido, please fix my libido. I don't want to have sex. Well, I do want to have sex with my boyfriend, just not my husband. Like, okay, testosterone is not going to help that and we have Right.
Speaker 1:So I mean it's good to explore those things because if you are truly still in a great relationship, you know all of these things can help bring that back.
Speaker 2:Yeah.
Speaker 1:Nothing helps more, though, than communication.
Speaker 2:Communication is the key for all of it. Get awkward. That's when the hottest sex happens. That's when the best sex happens.
Speaker 1:After a fight. Why do you think that makeup sex is so good?
Speaker 2:right Because it is vulnerable to apologize, right. So anytime you can get awkward, you can get vulnerable. What is more vulnerable than getting naked in front of somebody making the weirdest scrunched up faces? You've got. You know, you get hot and sweaty, you tinkle, you toot right.
Speaker 1:Like you've got these liquids coming out of you. Nisha is talking about sex, by the way, I don't know if you didn't, if you lost that train of thought. She's talking about sex.
Speaker 2:I'm glad you can follow me. When you have sex with someone, there's not anything that's really much more vulnerable.
Speaker 1:I've had some boyfriends in the past, past, past, you know, 20 years ago, where I'd be like I don't know about that face. I got to close my eyes. I can't see, you do? I can't unsee it.
Speaker 2:Vulnerability is the key, communication is the key and and that is one thing that is really hard, let me just say, for stereotypically males in our society, yeah, so, what do you do if you have a partner who doesn't understand what you're going through?
Speaker 2:You find help. You find a sex certified sex counselor or sex therapist or sex educator that can walk you through how to understand that you may be over here on this island, your partner may be over here on this island, and you're just like how do we swim to each other's islands? And that's the problem. You don't swim to each other's islands. You swim to your third island, which is the relationship island. Because if you're constantly trying to swim to your partner's island, you will tire of that and you may start to resent it. It's boring, right? You can't consistently swim to the one partner's island.
Speaker 2:So say that partner's sitting there on that island with an erection going. Swim on over, I'm fine, right, just come on over over, I just hop on. Yeah, I'm erect and ready. Maybe it works for a while, but you will tire of that. Not a single person on the planet is noble enough to continue to do that for their whole lives and go and not say I'm tired, I just got home from a long day and I need to prioritize something for myself. I mean, when's the last time you came home after a long day and sat down in your chair and was just like I'm exhausted, I could really. And then said I could really use some sex Right, like that's not something that women are socialized to feel. Like women are socialized to know that they are the object of sexual desire. But how can they own their own sexual desire? Everybody has one. Some are.
Speaker 1:And to that point it doesn't die, like people think that at some point you get postmenopausal or you turn 75 or what have you? There's no sex drive, and that's not the case. That's why having this conversation now, like reigniting with your partner or having have you, there's no sex drive, and that's not the case. That's why having this conversation now, like reigniting with your partner, or having that communication, or getting the vaginal estrogen or the testosterone or doing all of it, you know if you're truly in it with this person for the rest of your life, because you're like man. I found the one like you can have sex for the rest of your life.
Speaker 2:Some people this isn't the most common, but some people their sex drive goes up with menopause because, oh my gosh, no unintended pregnancy risk. Hallelujah, right, kids are out. Maybe I'm an empty nester. I can have a nooner on the kitchen counter, right, Like there's a new freedom to it for some people, but that's not the most common, certainly.
Speaker 2:I mean, everybody's journey is different, right, if we can learn, nobody's teaching us how to have that conversation, how to have the reciprocity, how to like where do we learn about sex? Hollywood and porn? Well, at that point everybody's got that little sex switch somewhere. You know, behind the scenes, that someone's like let's flip them on at the same exact time. And now they're both throwing their heads back in ecstasy at the same exact time and and also they're standing up and they're, you know, this one's holding that one against the wall and like somehow the clitoris is also getting stimulated.
Speaker 2:And yeah, it's like whoa, why? Why don't I work that way? Well, crap, I must be broken, right? No, that's not what's happening. That's just Hollywood and porn, right, but that's the only place we see it. Yeah, I mean finding someone that can help you walk through it and understand that you and partner are just A-plus students in a craptastic educational system which is our society. I don't honestly know how every human on the planet is not in a same-sex relationship based on how we set up heterosexual relationships for failure. We do not set heterosexual relationships up to say here's how you have success right, here's how you have long-term sensual erotic power together. No, we don't do any of that To wrap this up.
Speaker 1:If you were going to like, wait, you're gonna make me wrap up this time, I'm sure we'll be back to talk, all right, but if, as we wrap this up, what? What are your thoughts for, like women who are on the struggle bus right now, like what would be the main things you'd want them to to do to?
Speaker 2:discover to You're not alone, you're not broke, it doesn't need to be fixed, it needs to be talked about, see if you can find someone that will talk to you about it.
Speaker 1:And there are things that you can do that work, that make it so it's not painful, so make it. So maybe you have a little bit more desire.
Speaker 2:The hard part is, a lot of these women go, I feel like it's important, but I don't even want to want it. I just I know I should. There's that should again. Right, we can't start with sex. We can't start with saying, well, you know, go have a glass of wine. Please don't just do that, right? Like don't just numb out and make yourself a fleshy receptacle, like that's not, that's not how you're going to own your power.
Speaker 2:We would start with do you even take yourself up for a cup of coffee? What do you do for yourself? What do you do to just enjoy something that's pleasing for you? How can you find something pleasing for you? And then we start to take baby steps and we build the bridge. Otherwise, she's consistently trying to jump that chasm to his island and she'll fall short every time, maybe clamber up, do the thing, and then she does sex. But she probably wants to experience sex, right? So if we can just build the bridge, one brick at a time, so she can solidly walk to wherever toward that third relationship island, right, and he's going to have, he or whoever's on the other side is going to also have to build a bridge to that relationship island where they can go and have all the hot, transcended, erotic, wonderful, beautiful sex that they. And then they go back to their own individuals. Like you're still yourself, you want to maintain that individuality in a relationship as well. That's sexy, that is sexy.
Speaker 1:So all of that, plus the fact that there are things that can help to make it less painful, that can give you more desire, that can walk you through this perimenopause journey with a great orgasm, so that's what I want you to have the takeaway on there you go.
Speaker 2:Aren't you proud of me. Sometimes it's hormones, sometimes it's not hormones, right? A lot of times it's just talking.
Speaker 1:All right. Well, thanks so much for joining us on this pause. I hope that you enjoyed today's topic. If it did resonate with you, do not keep it to yourself. Share it with a friend who might be going through the same thing. And if you haven't done it already, why don't you join us in the Paws Diaries Facebook group? It is a private space where we keep the conversation going. We swap stories. The women in there there's almost 700 of them and they really love the new members and just helping them along on their journey, so it's a great place to be. Until next time, I'm Val Leggo. Take a deep breath, give yourself some grace and remember menopause is not the end of anything. It is the beginning of the rest of your life and we are going to talk about it.
