I was listening to one of my favorite podcasts yesterday called ‘We Can Do Hard Things’. The hosts, Glennon, Abby and sister, were interviewing sex therapist, Vanessa Marin, about sex. Specifically, sexual desire and why many of us don’t feel like having sex.
There are many, many reasons why sex drive declines. According to this podcast sexual satisfaction is a big reason. And few of us make the connection between the enjoyment of sex and sexual desire.
As Vanessa stated on the podcast: ‘if you’re not enjoying the sex that you’re having, why would you crave that sex? It doesn’t make any sense. I never crave eating a bowl of overly steamed mushy broccoli. Do I judge myself? Feel like something is wrong with me? Like something is broken? No. Never.’
But when it comes to sex, many of us are stuck in sexual routines that have become an obligation instead of about our own pleasure. Worse, many of us are beating ourselves up about our lack of sexual desire instead of addressing the cause.
Why Are We Eating Mushy Broccoli?
While it can sometimes be about the sexual activity itself and/or who we are being sexually active with, in most cases it’s one, or many, of the following that affect desire. Especially for menopausal and postmenopausal women.
1. Pain
About one third of women experienced pain in their last sexual interaction as per one of the largest national sex surveys ever conducted in the US. Stands to reason that if it hurts, your sexual interest is going to wane. Unfortunately it seems that many of us don’t actually address the fact that we are experiencing pain and continue to have sex. Mushy broccoli indeed.
While pain with sex is common, it should never be considered the status quo. Get help from a qualified medical professional.
Ten Common Causes
According to The Vagina bible, there are ten common causes of pain with sex. These can range from not enough foreplay to endometriosis. Treatment options can range from better communication with your partner or products that provide vaginal lubrication, to surgery. Having an open conversation with your partner and/or finding the right medical provider who can properly diagnose what is going on is key.
Let’s look at some common causes of sexual pain for woman in perimenopause that aren’t well known.
Genitourinary Syndrome of Menopause
Genitourinary Syndrome of Menopause (GSM) is a medical condition associated with menopause, both pre and post. Formerly known as vaginal atrophy, GSM is a collection of symptoms caused by declining estrogen levels in the vulva, vagina, urethra, and bladder. Symptoms can include vulvar and/or vaginal dryness, itching, burning, and not surprisingly pain with sex.
Hormone replacement therapy, specifically vaginal estrogen, is the most effective treatment for GSM if your symptoms are beyond vulvar and vaginal moisturizers.
Autoimmune Skin Conditions
Autoimmune skin conditions of the vulva and/or vagina are most likely to develop between the ages of 40 and 60. These types of skin conditions can also cause itching, burning, and painful sex. Lichen sclerosis and lichen planus are the most common. In addition to their impact on sexual function, they can also cause permanent physical changes. Left untreated these changes can be dramatic.
The symptoms of these autoimmune skin conditions are similar to those of GSM. So finding a knowledgeable practitioner is important. A good place to start is the North American Menopause Society (NAMS). They have a tool to find NAMS certified practitioners.
2. Other Menopausal Symptoms
There are 30+ recognized symptoms of perimenopause. And many of them will have a direct impact on your sex drive. In addition to symptoms like vulvar and vaginal dryness, itching, and burning, you might also be dealing with recurring urinary tract infections, vaginal infections, or a leaky bladder. Hard to feel sexy when your vulva is on fire, and you’re worried about your bladder leaking.
Here are some other common symptoms that might be negatively impacting your sexual desire and sexual response:
Lack of Sleep
Sleep. Ugh. Nothing works well when you are under slept. And most of us struggle with sleep in perimenopause due to fluctuating hormones. Maybe you are dealing with night sweats. Maybe you can’t get to sleep. Or maybe you are waking up in the middle of the night and can’t get back to sleep. All of this is likely going to wreak havoc on your sex life.
It has been studied, and sleep is actually a predictor of frequency and quality of sex according to Emily Nagoski, author of ‘Come As You Are’. If you’re not sleeping well, speak to your doctor.
Mental Health
The toll perimenopause can have on our mental health can be significant. If you are dealing with anxiety, rage, feeling blue, depression, irritability, mood swings, panic attacks, or tearfulness, your sex drive is going to be impacted. It will likely also impact your partner’s sex drive. Especially when the rage you are feeling has to do with the fact that they are breathing.
If your mental health is suffering, seek help from your medical practitioner, a therapist, your partner, your family, and/or your friends. I don’t know what I would do without my friends. And my doctor, and my therapist,….
If you’re in emotional distress or suicidal crisis, find help in your area with Find a helpline.
Period Changes
Your menstrual cycle can become erratic in perimenopause. This can mean fewer, lighter periods or more frequent, heavy ones. Some people have no issue having sex while menstruating, and others would rather not. Even if you do have no issue, bleeding heavily can deplete your body’s iron stores and cause iron deficiency anemia. The symptoms can include fatigue, headaches, mood swings, and a lot of other non-sexy things.
There are solutions for heavy and frequent bleeding. Speak to your doctor about what medical treatments might help reduce, or even stop the flow.
Body Image
The physical changes that can happen to a woman’s body in perimenopause and beyond can also cause low sexual desire. Even if your partner thinks you’re hot (thanks, baby;), you may struggle with wanting to express your sexuality in a body you no longer recognize.
Adjusting to weight and/or shape changes is tough. Especially with the constant pressure to look like your Instagram feed. Add in some good old ‘past your prime’ societal messaging where a woman’s worth is tied to her reproductive capability. And voila! Libido. Dead.
Talk to your partner. Speak to a therapist. Maybe take a break from Instagram. Know that you are enough. You are beautiful. And you deserve to experience pleasure.
3. Medication
If you aren’t sleeping or are struggling with your mental health, medication may be the right choice for you. Important to note that certain medication like antidepressants or sleep aids can impact your sex drive. Talk to your doctor or pharmacist if you suspect medication may be impacting your sexual motivation.
4. Decreased Response
As we age our ability to orgasm may be impacted. Once again, the why is not understood. Sigh. It may be due to declining estrogen and changes related to aging. Regardless of the cause, it is common for perimenopausal and postmenopausal women to need more time to orgasm, have less intense orgasms, and/or they can also be less frequent.
Everyone Should Own A Vibrator
According to The Menopause Manifesto, it’s not uncommon for women to need a vibrator to achieve orgasm later in life. It’s also common to need a vibrator that is more powerful.
Not sure where to start? Here’s an excerpt from ‘The 4 best Vibrators of 2023’ published in the New York Times:
“After putting in 140 cumulative hours of research and testing – interviewing sex researchers, crowdsourcing opinions from enthusiasts, and analyzing data from 10 volunteers who have tried more than 20 different models since 2014 – we’ve concluded that the cordless Magic Wand Rechargeable is the best vibrator for clitoral stimulation. The intense deep stimulation it provides can be helpful for people experiencing diminished libido or sensitivity.”
5. Spontaneous vs Responsive Desire
Spontaneous desire is said to emerge out of the blue. It’s typical in a new relationship. In the spirited words of Miranda Hobbs in the first Sex and The City movie: “Yeah, it’s all so hot three days in!”
Responsive desire emerges in response to experiencing pleasure. This is typical of a long-term relationship. Let me explain.
You and your partner are busy. You’re tired. You have a big work trip in 3 days. You can’t seem to find your passport. Your partner’s dad is ill. The likelihood of spontaneous desire: 0.
Cultivate Desire
The problem is most of us assume we should feel spontaneous desire. Which is ridiculous when some version of the above description is, well, life. Instead of waiting for that ‘three days in’ sexual desire, cultivate it. Work at it.
You find your passport. Celebrate this win. Suggest to your partner that you snuggle on the couch and watch something erotic. See if responsive desire kicks in. Or suggest that since you are leaving on a business trip, maybe you could get under the covers and kiss for a little while. Maybe buy something sexy while you’re away and surprise your partner when you get back.
Feel like you might need more than an erotic movie or sexy lingerie? Read on.
6. Poor Communication
If we can’t tell our partner what we like, don’t like, or need when it comes to sex, we are leaving a lot of pleasure on the table. According to Dr. Emily Morse, host of the podcast ‘Sex With Emily’, “the number one thing that keeps people from thriving in their sexual relationship is communication. And it’s always uncomfortable to talk about sex.” Agreed. So now what?
You’re going to have to talk about it. But you don’t have to go it alone. Here are three suggestions:
- Sex therapist, Vanessa Marin, and her husband Xander have written a book called ‘Sex Talks: The Five Conversations That Will Transform Your Love Life’.
- For a deeper dive into what shapes our desire, and how to balance love and eroticism in a committed relationship, check out Esther Perel’s ‘Mating In Captivity’.
- Try couples therapy. Psychology Today has a search tool where you can search for a therapist by geography. You can then use several filters to narrow your search. Use the ‘issues’ filter to select sex therapy.
7. Desire and Shame
Many of us had very little sex education, if any. And what education we did have was probably more harmful than helpful. Most of us got the message that abstinence is best. Sex is something you should do only once you’re married. Touching yourself is inappropriate. Oh, and if you’re female and you have lot’s of sex, ‘you’re a slut’.
Don’t Touch That
Some of these messages were direct, but many we likely didn’t even notice. Or we were too young to remember. On ‘The Knowledge Project’ podcast episode #66, Dr. Emily Nagoski talks about moral dumbfounding. This is when you can’t describe the ways or why something is wrong, but you just know it is. Like talking about sex or our genitals, particularly female genitals.
Dr. Nagoski shares a story of someone watching their adult brother changing his daughter’s diaper. As he is about to put on the clean diaper, the baby grabs her genitals and dad says “ah, ah. don’t touch that.” The daughter will not remember this moment. But these moments accumulate over time. Eventually the thinking, or feeling, that our genitals are bad becomes embedded. Moral dumbfounding ensues.
But Be A Sex Goddess
Layering in more complexity, the media pushes the exact opposite messages. We should be great at sex. Sex should be something we want all the time. Orgasm should be easy to achieve and frequent. Multiple even. And happen in sink with our partners.
So not only are many of us left feeling inadequate, we can never quite reconcile these mixed messages. As Dr. Nagoski explains, discomfort with talking about sex “comes from spending your entire life being raised with these weirdly mixed messages that it’s a disgusting act that should be hidden. But if you are not really good at it no one will love you.” Sadly, what often happens is women learn to perform instead of experience sex.
Could mixed messages and your upbringing be impacting your sex drive? Put ‘Mating In Captivity’ and Dr. Emily Nagoski’s book, ‘Come As You Are’ on your reading list. It’s time to stop performing and learn to fully experience sexual pleasure.
8. Mindfulness
According to Dr. Lori Brotto, there are hundreds of studies that show that many of the women that are reporting decreased sexual arousal are in fact experiencing arousal. It’s just that our minds are so disconnected from our bodies, we don’t even notice or realize that we are in fact sexually aroused.
When you are having sex are you fully present? Or are you making mental lists of things you need to do or groceries that need to be purchased? Or maybe you are spectatoring, where you are judging your, and perhaps your partner’s, sexual performance. Regardless of the reason, many of us have come to think of sex as something that is automatic and doesn’t need our full attention. Dr. Brotto disagrees.
The Raisin
In her book, ‘Better Sex Through Mindfulness’, Dr. Brotto shares the science behind our sexual problems and how practicing mindfulness can expand our sexual well-being. Short on time? Read ‘The Raisin’ exercise on page 74. It could be that paying attention is the key to finding your lost sexual desire.
The Hero Bit
We all deserve to experience pleasure. And yet many of us are settling for mushy broccoli. Untangling your particular web of sexual dysfunction may be complicated. Most of us struggle with several of the causes listed above. Pick one and just start. For example, if you don’t own a vibrator make that step one.
Whatever your path, be sure to take the time at some point to learn to be fully present. Not just when having sex, but everyday. That’s when we become fully alive.
