Language of Love with Dr. Laura Berman - Breaking Down Barriers to Sexual Pleasure

Episode Date: April 21, 2021

On today's episode of "The Language of Love," Dr. Berman helps people who are facing physical roadblocks on their journey to sexual pleasure, in particular women who are suffering the loss of desire and arousal due to menopause.   Dr. Berman first helps a woman going through menopause who is dealing with unpleasant symptoms like rashes after intimacy and difficulty reaching orgasm. She says she feels as though her clitoris is difficult to find and that things are dry and uncomfortable down there. Is diminishing estrogen causing her rashes and dryness? How can older women protect their sexual health when faced with these unique challenges? And how can you talk to your doctor about these sexual symptoms in a proactive way without feeling embarrassed?   Next, Dr. Berman helps a woman with lichen sclerosis who has extreme pain and discomfort during sex. Around 1 in 80 women suffer from lichen sclerosis, but it is most common among middle-aged and elderly women. This inflammatory condition can be very painful and it often takes a toll on a woman’s sex life. Is there any way to preserve sexual pleasure when pain makes you afraid to be touched? And how can she help her partner feel loved and desired even when sexual intimacy sometimes has to take a back seat due to her condition?   Even when sexual challenges can complicate your ability to reach orgasm or achieve pleasure, on this episode, Dr. Berman shows that is still possible to find treatments and options that can help to support your journey back to sexual wellness. Often this will require treatment, sex therapy, or talking to your doctor, but as Dr. Berman reveals, with small mindful changes, you can continue having passionate sex even as you age or face medical conditions. Most importantly, however, you have to continue communicating with your partner, and seek ways to keep that physical connection and romance alive, even when sexual intimacy isn’t always possible. There is no such thing as a ‘sexpiration’ date, as long as couples are willing to keep prioritizing sexual pleasure and working together to create great sex.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, I'm Dr. Laura Berman, a sex and relationship therapist. And for the past three decades, I've been helping people learn how to love and be loved better. That's just what I'm doing here on The Language of Love, where I get to answer your calls and emails and your most important questions. Because my goal here is to help you discover more meaningful emotional and physical intimacy and to also help you build more awareness of how precious and sacred your sexual life really is.

So be sure to email or reach out with your very own love, sex, and relationship questions. And I might just answer them live on the air. Whether you're single, married, gay, straight, cis, transgender, I am here for you. And this is a safe space to ask all the questions you've always wanted to ask your doctor or your friends, but maybe have just been too embarrassed to bring up.

It's time we all become fluent in the language of love. Welcome to the show. This is a topic that, boy, I think I've been talking about in one way or another for decades. And that is the physical roadblocks to sexual pleasure. What are they? How do we tackle them? I've gotten a lot of questions I've pulled together via email and on voicemail To get into this on this week's podcast, let me just start by saying that I am a PhD, as my kids would say, a talking doctor, not an MD.

I don't prescribe medication. I'm not a physician, but I also have worked in depth with all sorts of physicians through the years and shepherded numerous people through the medical process of addressing sexual concerns. and I actually started and ran the first multidisciplinary sexual health center for women in Boston, in California, in Chicago. I launched them in all three places where we did this mind-body approach to sexual health in women and in men. And so I intimately understand the physiology, but I am by no means a physician. So I want to start by that caveat before we dive into this, but let's start with an email. It doesn't say her name, but EJ Levin wrote an email and

says, Dr. Berman, it seems like I tend to get a rashy type thing on my undercarriage after sex. I like how she says that, undercarriage. I assume she means her genitals. Is it possible that the pH of his semen is different, more acidic than my lady parts and causing the rash? Also, I used to be able to orgasm maybe 50% more of the time. It seems like the last several months I've not been able to finish the job. I'm finding that I can't even find my clitoris. It seems to have dried up and disappeared. Oh no. She says I've struggled with menopause issues for many years, five plus years. So I'm wondering if that's the problem, but is my clitoris never going to come back? I really want to be able to orgasm. My man tries so hard to keep me satisfied, disappointed in

himself. I feel like I might need to fake it so I don't disappoint him. I'll tell you that I take bioidentical hormones that are applied to the labia and inner thighs. I don't, if I don't take them. I have horrible hot flashes all day and all night, which interrupts my sleep patterns, making me a raging maniac. I don't want to stop taking HRT because I feel like it would be counterproductive to my general overall health, but I need my sex life back. Yeah. I mean, first of all, HRT hormone replacement therapy or hormonal therapy, you know, should not be destroying your sex life. Let's just put that on the back burner for a second and talk about the symptoms you're having. If this is a new partner and you're experiencing the rash specifically with him

and not with other partners, then yeah, I mean, there are rare cases where there's an allergy to that person's semen or it's more acidic. But I find, and I see this happening, it's rarely talked about, which is so weird because I talk to women about this all the time. But what I find is when women start to have diminishing estrogen levels in particular, it is extremely common to get really bad rashes and urinary tract infections after sex. And that's not necessarily because something is not agreeing with you and your partner's semen. It has more to do with how estrogenized the genital tissue is. But I would definitely talk to your doctor who's prescribing you the hormone therapy, which we'll get to in a minute. So put a pin in that. Now, in terms of

your orgasms of course you're not you know if you were someone who had clitoral orgasms orgasms through clitoral stimulation and now your clitoris feels like it's shrinking which happens in menopause I'll tell you why in a second then you know there's less nerves there exposed there's less tissue there there's less blood flow there and yeah it's going to be harder to reach orgasm and by the way you know I tell this to couples all the time if you are a woman who is over the age of 40 make friends with the vibrator there are so many great small teeny little vibrators that can fit in between the two of you or even wireless remote ones that he hands-free ones that he can wear around the base of his penis that provides that added clitoral stimulation because even with your

clitoris still being the same size just with the changes in blood flow and hormones as we age before we're menopausal, you know, as we start to hit our forties, we need a lot more stimulation down there than most humans can give alone. It doesn't mean that he's not enough or he's not doing it right. It just means embrace the tools that are available to you. Because think about this, our bodies still haven't, you know, evolution hasn't caught up with modern medical science. Our bodies are, you know, we're now living to a hundred, but our bodies haven't changed that much since 100 years ago, 200 years ago, when we didn't live well past our reproductive years.

Our bodies aren't really designed to thrive in the way medical science can help us thrive until we're 100. Biology doesn't necessarily go along with that without some assistance. That assistance can certainly come in the form of hormone therapy, if you're a candidate for that,

but it can also come in the form of lubricants and in the form of toys so embrace those now don't fake it okay because that creates a cascade that you don't want to get stuck in where you start to resent him and then if you ever want to change things and you tell him what happened and that you've been faking it then he feels like a total idiot and like he's been totally bamboozled and wondered what else you lie about and is freaked out by how good you faked it and it's just not worth it okay so I would not say to fake it the reason that guys become so focused on this it's not that we don't want him to want you to be satisfied of course we do but I find that the reason men like get so stuck on you having an

orgasm is because for them orgasm is the punctuation mark in a sexual encounter you know it's like sex ends or it's finished quote unquote when he finishes they can't imagine having sex and satisfying sex without an orgasm. But what women will tell you is that they don't orgasm every time and they love orgasming, but that's not necessarily the predictor of what the most sexually satisfied women have in common. I did a huge national study looking at what the most sexually satisfied women have in common, and it was not the number of orgasms they have or how orgasmic they were. It was the emotional connection they felt to the person they were having sex with that most predicted for their sexual satisfaction. And that's important for men to understand because

they're looking at orgasm through their lens and not understanding that women, you know, 99% of us don't reach orgasm every time based on where we are in our cycle, where we are in menopause, where we are with the weather, with stress, with distractions, whatever, with our body image, all of those things play a role. So don't get caught up in the faking the orgasm thing. Now, with regard to the bioidentical hormones, my guess is that your hormones that you're taking are probably estrogen, maybe progesterone, but not testosterone. The problem is that if you're taking estrogen only without testosterone, then what you're accidentally doing is you're attending to the estrogen related issues like lubrication

or hot flashes like you describe, but you aren't attending to sensation and to arousal. which testosterone plays a huge role in. Furthermore, and this is true, by the way, of hormonal contraception as well, that as you take estrogen, either in hormonal contraceptives or in hormone replacement therapy, as you take estrogen without testosterone, then what happens is that the more estrogen we get, a protein in our blood increases, which is the acronym is SHBG, sex hormone binding globulin, or steroid hormone binding globulin.

It binds testosterone to the cells and makes it unavailable for the body to use for arousal, sensation, orgasm, all of that. So my guess is what's happening with you is that you're taking estrogen without testosterone and the little bit, and that's helping with the hot flashes and maybe with lubrication,

but the little bit of testosterone you already have in your body is now being bound up by the SHBG secondary to the estrogen you're taking. You see what I'm saying? So you need to see a hormone therapy specialist. You don't want to just take some cream from your GYN who doesn't specialize in this. And you want to make sure that you are looking at estrogen, testosterone, and progesterone,

and that you are attending to all of those, okay? And I like the fact that you're taking bioidentical hormones because those can really be customized. They're made from natural sources, and they can be more managed so that they can slowly titrate you up without giving you too much and stop at the point where your symptoms get better. So it does require working with a specialist and being patient because it can take a while to get to the right dose to manage the symptoms, but it is certainly possible. So I would say to you, revisit the HRT with your doctor, with a specialist, and embrace the sex toy, and that will get you started. Here's an email from Chris who says, Dr. Berman, I hope you can help me find

a way through the health issue I've been living with to fulfill my and my husband's desires. I have lichen sclerosis in my genital area diagnosed about 18 months ago. As you know, it leads to eruptions of lesions causing intense itching and rawness. I do use clobesterol cream, which is considered to be the most effective treatment right now upon breakout, but it's ruined my sex life. As if menopause didn't cause such a hit to my body and sexual desires, I now have this physical ailment. I don't want to be touched in fear of any pain that comes from the lichen sclerosis. I've tried to push through that feeling and even some of the pain, but it's not enough. My husband has also started having some erectile dysfunction issues, but he's healthy,

and I think it's more in response to my wincing or moving away from him touching me in that area. I miss the sex we had, which was playful, pleasurable, and mind-blowing. We are 68 and 69 college sweethearts that separated, stayed best friends, and found our love again at almost 27 years ago. And soulmates, both of us felt we'd finally come home when we got back together. Aw. She said, we do take care of his sexual needs through other means, but I want more. Is it too much to expect my body to give more?

I feel like I've been handcuffed and can only recall those memories of a great sex life. With great expectation, I look forward to your response. Okay. So, boy, I'm so sorry that you're going through this, Chris. And it sounds to me, I'm not an expert. I certainly have worked with many people who have the diagnosis of lichen sclerosis and it really can certainly, I mean, it's so painful. Of course, it's going to wreak havoc on your sexual arousal and on your comfort with sex. And of course, your husband who loves you and can't, you know, this is supposed to be pleasurable, can't, you know, handle giving you pain. And so, of course, it's going to hurt his arousal as well. I love the fact that you are still being sexual with him, you know, taking care of, quote unquote, his needs.

I think the more intimate, and I'll give you other advice too, but just with regard to that, the more intimate you can keep taking care of his sexual needs. So it's not just you servicing him, but with a lot of kissing and tenderness and breast touching and buttocks touching and massaging, you know, make it a mutual act, even if it doesn't address or focus or touch on your genitals in those situations where you're quote unquote taking care of his sexual needs, because then it starts to feel more like a mutual sensual act. I know it doesn't solve the problem of wanting to have intercourse and orgasms with your

husband. You know, I get that. So let's talk about that piece as well. Now, you have found something that helps with the breakouts. And as I'm sure you have educated yourself, lichen sclerosis, you know, is not most of the time it's treated, the symptoms are treated rather than the underlying cause. The underlying cause of lichen sclerosis is it's a chronic inflammatory skin disease. it is related to inflammation. Now, remembering that I'm not an MD, I'm a PhD, but Lord knows I've worked with a lot of people with inflammatory diseases that are affecting their life and their

sex life, including lichen sclerosis. And when we're talking about inflammation, we want to look at not only how to manage the symptoms of that inflammation, like that cream you're taking, but also how to, you know, think of inflammation like a fire. You know, that's inflammation, right? So we need something to put that fire out. We have to figure out what's causing that fire and we have to pour water on that fire, right? We don't just want to put cream on the burns from the fire.

We want to find the source of the fire and put out the fire and try to keep it out. And what I have found with all of these inflammatory diseases is, is that that can be really hard to figure out, right? Because there's so many things that could be causing it. And we also know that emotional stress, anxiety, depression, those things play a huge role in inflammation in the cells as well. But as or more importantly, because I think way too many people with lichen sclerosis and other inflammatory diseases are told it's in their head or it's all emotional or whatever. You know, I don't mean to say that to you by any means.

I also believe and have found it to be true that a lot of it has to do with diet. And what I would encourage you to look up is Anthony Williams' work. So with inflammation, usually if it's internal inflammation, often, usually it is related to the liver. And what happens is that as the liver gets stressed, which can be due to emotional reasons, due to dietary reasons, due to all sorts of reasons, the liver releases bile, which is what the liver does. That's its work.

But the more bile it has to produce to, let's say, break down dairy or other things, the more inflammation occurs. So my guess is there are a lot of things you could be doing on a dietary level that would drastically help to make that fire of inflammation smaller, the breakout smaller, and the symptoms less. Anthony Williams is one of the best I have found in creating a protocol for people to address inflammation and inflammatory disease. I want you to read his books, in particular, the Liver Rescue book. I believe it's called Liver Rescue by Anthony Williams. You can follow him online. Check him out.

I have seen him work miracles with people, just changing their diet, the foods they eat, the kind of foods they eat, and the way and the order in which they eat them. And I have done some of his cleanses and cures. And I am not someone who does cleanses. I hate cleanses. I hate starving myself. I'm not good at it. But I love his cleanses because you're not starving.

You're eating real food. And my body like sings. It likes the food so much. So I really want you to try that and see if that helps. And I also want you to find a specialist in inflammatory diseases. Even better if they're a specialist in lichen sclerosis because they will know a lot about other things and be able to look at other things medical condition-wise, medical history-wise that may be playing a role in the inflammation. I hope that gives you a place to start. Okay,

I'm cheering you on. Let me know how it goes and if we can help more. We have a voicemail from Sherry. My husband and I have been together for 42 years, have been married almost 31 years, have had a great sex life. And I've had the wonderful experience of having fantastic orgasms. But lately, like in this last year, it's very hard for me to orgasm. Any advice? Yeah, Sherry, we absolutely can talk about that. I think what you're describing is not at all uncommon, right? So if you've been married 42 years, you're now at least in your 50s and you are probably going through menopause and have been going through perimenopause. And as women go through menopause, all of our hormones are diminishing or declining. So testosterone in

particular, which plays a huge role in orgasm, so does estrogen. Testosterone plays a role in sensation and arousal in orgasm. And a woman in her 20s has double the testosterone that a woman in her 60s has, for instance, but it's slowly declining throughout our entire lives. So often by the time we're reaching our mid to late 40s, but certainly into our 50s, it's declining enough that you're starting to see the symptoms. And difficulty reaching orgasm is a really common symptom because one of the key things that you'll notice is a loss of sensation and sometimes even that shrinkage of the clitoris that we talked about earlier. So you are, like one of our email questions this time, are experiencing the same kind of thing. My guess is that you may also be

experiencing some dryness. So estrogen plays a role in dryness and in what we call engorgement of the genital tissue, kind of that swelling and reddening that pushes the nerve closer to the surface of the skin and the health of the tissue and lubrication. And testosterone plays a role in desire, sensation, arousal, orgasm. So my guess is that you need to speak to someone about the potential of hormone therapy. And like I was saying earlier, embrace the sex toy. So I talked about all the reasons to embrace the sex toy earlier, but what I'll add to it is a couple of suggestions so first of all you want to tell your partner you know that this is just natural that it has nothing to do with you that it with him excuse me that it doesn't replace a partner

but that added stimulation is needed once we sort of hit our 40s and until you get your testosterone levels regulated and there are small ones I have one in my line that I recommend a lot in my line of sex toys called the Athena. They're all named after goddesses, which is a small little cylindrical vibrator that can easily fit between the two of you. And so while you're having intercourse, you could actually use the vibrator. It doesn't have to be the Athena. It could be any small vibrator that use it on your clitoris. And then you're getting vaginal penetration with clitoral stimulation, and it will be much easier for you to have an orgasm. At the same time, like I said, you want to talk to someone about ideally bioidentical hormones. You want to find

someone who specializes in bioidentical hormones different than the ones that are pharmaceutically made because, you know, the pharmaceutical brands are kind of in two or three doses and they're standardized and they're not customized. And the reason I like the bioidentical hormones is because they can be customized and you're getting the smallest amount that you need and you're getting what you need. And you have to be patient because it can take three to six months to slowly titrate up, look at any side effects, look at the symptoms, make sure, you know, that it's all working the way it should. So it's a process, but that's why you want to find a good doctor who can work with you through that process. The good news is that you used to have amazing orgasms and that's one of

biggest predictors of women being able to regain their orgasmic potential is whether or not they ever had orgasms. And it sounds like you're happily married. So there should be no reason if we can get your physiology on board that this roadblock can't be removed. All right. If you need any recommendations or suggestions about removing the roadblocks in your life to the sexual pleasure you want, or you have any questions about love, relationships, dating, finding love, keeping love, I am always here for you. Just go to drlauraberman.com. You can find all the links to ask me questions via voicemail or email.

You can also follow me on all platforms at drlauraberman. I'll see you next time on the Language of Love. and here the mona lisa gaze into mona's eyes in perfect health with no undiagnosed problems and her optic nerve in excellent condition anyone here got eyes like mona minor brownish not enough people know about their eye health that's why oct scans are included in every standard eye exam at Specsavers locations. Should have gone to Specsavers. Book an eye exam today. Eye exams provided by independent optometrists. Contact your local Specsavers for details.