Language of Love with Dr. Laura Berman - Menopause, Stress, and Sexual Desire

Episode Date: June 26, 2024

It’s time for another Language of Love Session where I get to sit down with one of my listeners and help them with their love life. I love these episodes because each time you ask your questions (and I give the answer), I know we are helping 100s of thousands of other people with the same query!  In this episode I’m helping Mary who, like way too many of us, has been living in a sexless marriage with her husband for some time. Much of her low desire is due to the daily grind and work-related stress, but was compounded by premature menopause in her thirties. If you are struggling in a sexless relationship or with low desire, listen in for important tips and tools for addressing the symptoms from a mind, body and relationship perspective.  In this episode I help Mary unravel: Challenges in sexual relationships due to menopause and work-related stress Effects of stress on men's sexual desire and decline of testosterone with age Importance of understanding hormonal changes and their impact on sexual health Practical suggestions for improving sexual communication and exploring alternative approaches to intimacy Options for improving sexual response and desire, particularly for women Insurance coverage for treatments such as testosterone replacement and locally delivered estrogen Reassurance about the normalcy of reduced sexual activity in long-term relationships The importance of maintaining a strong emotional connection in a relationship Join us on this journey to better understanding and improving our intimate lives. Visit my website to explore courses designed to enhance your relationships. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, I'm sex, love, and relationship therapist, Dr. Laura Berman, and for the last 30 years, I've been helping people learn to love and be loved better. Welcome to the Language of Love Sessions. This is where I get to work with you one-on-one, on air. You, my listeners, my goal in these sessions is to empower you to enjoy better relationships, both with others and with yourself, and to help you embrace how precious and sacred your body, your love life, and your sexuality really is. It's time we all become fluent in the language of love. Mary, welcome to the language of love. How can I help you?

So Dr. Laura, I was just thinking about, you know, how things sort of change in the marriage, you know from a sexual perspective the interactivity level of intercourse and you know just wanted to sort of hear a little bit from you I know that it varies obviously every couple's a little bit different but our sex life has sort of slowed down quite a bit over the past several years but we still have a lot of intimacy between us it's just not in the bedroom and we both seem to be okay with it. Me more so just because, you know, menopause, that whole thing just sort of has destroyed any desire to want to participate in anything like that. And him, because he has such a high pressure lifestyle with owning a really busy business with a lot of moving parts,

a lot of stress. And so, you know, we always come together, but it just, it's never, it's never sort at the forefront, but it also never used to be. We've been together 17 years and that's kind of my favorite thing about him is that it was never this thing in our relationship. It was always present. It was always great, but it didn't define our relationship. Okay. So you've been together 17 years and at your most consistent, how often were you being, because intimacy is, can mean many things to many people. We'll get to that in a second. Cause you say you still have a lot of intimacy, but in terms of the act of sex, when you were doing it the most consistently, how often were you having sex? Probably one to two times a week.

And how long ago was that where that started to wean off? Long, long time. We've been married now for 12 years. And so sometime after that, but again, And, you know, a lot of it is really at that point was on me because I, I entered menopause in my thirties. It was very, oh yeah, man. Yeah. And, and, you know, you don't know that you're there, so you don't realize that that's why these things are happening.

Yeah. And we'll talk about that in a second. I just want to get a little bit more of a picture because there are a lot of moving parts here. So at this point, how often are you having sex? Never ever? Like when was the last? like November. Okay. So at the time of this recording, that would be, I don't know,

almost nine months, maybe something like that. Yeah. And listen, I meet couples all the time who haven't had sex for 10 years. So I get it. You said that sex has never been like a major driving force for him, but it is definitely true for men, women. And we'll talk about this in a second, all kinds of things can affect our sexual desire. But for guys who otherwise have healthy hormones and are physically healthy and don't have some major trauma issue they're dealing with, for your average healthy man, the one thing that really does seem to impact their sexual desire is work or financial related stress. It's like, because in our culture, that's so inherent to a man's sense of virility and power and masculinity, if he's stressing about that,

it does tend to affect his desire where other kinds of stress don't necessarily, although other kinds of stresses will affect a woman's desire. And so in your case with menopause, what happens is even in the perimenopause, the years before it, and you had premature menopause, I'm going to ask you in a second why, if you know, but usually starting menopause happens around age 50, but as early as the mid to late 30s, you're starting to notice some of the symptoms that you don't identify symptoms of menopause or perimenopause like low desire, dryness, difficulty getting aroused, difficulty having orgasm, lack of energy, lack of kind of excitement and general sense of well-being. that's all related to testosterone and estrogen as well the dryness especially in the sexual response is partly estrogen and so that's starting to decline enough i mean it's declining our whole life but it's starting to decline enough in our mid to late 30s that most women start to experience those symptoms and don't realize that it's a hormonal thing so to me since you're saying

that it kind of happened that your big drop-off in desire happened around menopause tell me just really quickly why you went into menopause at age 30 and what your status is. Are you able to explore hormone therapy or replacement, or is that contraindicated due to some medical risk factor? So I actually found out that I was in post-menopausal range when I was in my late 30s, when we were trying to get pregnant. And so I don't really know premature ovarian failure. they really have no idea you know my sibling didn't have an issue mother never did so no no idea so quite devastating to learn that but luckily through the miracle of science I had my daughter and she's six and it's beautiful and it's great and all those things are wonderful but

so yeah I really don't know and so again when you go back you sort of start thinking about oh god like that's what that was but how do you know if I mean you just don't ever know You certainly wouldn't think so in your 30s. Never. So, have you ever considered or explored hormone therapy? I have. I have, but then insurance changed after COVID, the whole industry. And so, things weren't being covered.

And when you're talking hundreds and hundreds of dollars a month, and I'm luckily in a position where I can afford to do that, but it's a hard pill to swallow, no pun intended. and so you know I've talked a lot about it with my physician OBGYN and so we just sort of decided I tried a little bit insurance change and I just kind of let it go to the wayside and now I'm just so far I mean now I'm in my late 40s and so far gone at this point but you're never too far gone but it is true I mean until recently which has been pissing me off for the past 20 years because I was around and doing this work for 30 years but around 20 years ago this Dumbass study that was so poorly designed and so misread the results of went just viral before the social media, even that hormones in particular, estrogen replacement in women causes breast cancer.

Finally, finally, it has been published in the medical journals that that is not the case. But they're also saying that if you've been off estrogen for a long time, you know, if you're estrogen, so you've been off, I don't know, how old are you now? I'm going to be 48 this month. But you've been basically without estrogen for at least 10 years. So really, there are some risk factors after being not estrogenized, suddenly taking estrogen in particular, and not necessarily testosterone, but estrogen, because it promotes so much blood flow that it does seem to, if you've been off, it allows a lot of plaque to build up and other things that all of a sudden, when you get this big influx of blood flow with the

estrogen, it can break loose a clot basically, or cause a heart attack or something. I mean, I'm talking in layman's medical terms because I'm a PhD and not an MD, but unfortunately or fortunately, I know a lot. I've seen a lot of women through this, but okay. So let me ask you this. What do you think the impact of, because you say you still feel intimacy. I'm assuming you still talk and you feel close to each other and you enjoy each other's company. Is there physical affection, non-sexual physical affection, kissing, cuddling, holding hands, that kind of thing? Yep. Yep. That's never changed. Do you want to have more sex or do you just have a story that not having sex is a problem? I just don't care for it. It doesn't mean that when it happens,

it's not enjoyable. It actually got to a place where it became enjoyable again, because like you said, the dryness and all, I mean, that was just awful. So that doesn't play a role anymore. I mean, I think for women, we go through so many things, right? Our bodies change. There's just a lot right there's just a lot for us to feel that we even want to be touched and all those things right so I think those things play a big role too but yeah I mean I'd like I probably would like a little bit more intimacy but at the same time it again I go back to that it's never really been that defining thing for us and it's what I've always loved about him because prior to that you You know, you date, whatever.

You always feel this big pressure, you know? Yeah, I get that. But I guess the thing is, and I like what you're saying, because truthfully, I absolutely think and meet many, many couples who go for decades for the rest of their life. You know, one of them goes through menopause. The other one isn't super sexually driven. And also men, their testosterone starts to decline in their 50s. So they just peacefully live the next 30 years without sex.

and they're both okay with it. And when both of you are okay with it, it's not really a relationship issue. The way that the diagnosticians define or diagnose, quote unquote, sexual dysfunction in a woman, I hate that word dysfunction. I like to call it a sexual function complaint, but the medical field calls it a sexual dysfunction. But in order for it to be categorized as that, one of the main ingredients is that it has to cause the woman personal distress. Now, if she's having pain or she can't have an orgasm or she can't get aroused, that usually does cause her personal distress. But if she's not interested in sex and they aren't having sex, it doesn't cause her personal

distress. The only reason that most women have personal distress as a result of low desire is because of the relationship impact and that their partner is frustrated, right? So what it sounds like to me is that you don't really have a significant amount of distress over this because A, you don't have the desire and B, your partner is okay with it and you still feel close to him and everything is still fine. All of that said, there's tremendous benefit to maintaining a sexual connection. Not only do you have greater emotional intimacy as a result of that, but in addition, sex is so good for your health. It promotes blood flow. It's good for your

heart. It's good for your immune system. It's good for your mood. It's good for your relationship, obviously. And so there are a lot, it takes you to a deeper level. So it doesn't mean you have to have sex once or twice a week. But one of the things you said that I think is really important and really universal, I find in women who have low desire or who are noticing they're not really in the mood anymore is that they will almost always say that, yeah, I'd rather be watching Bridgerton or doing the laundry or getting stuff done. I'm not really in the mood. But once we get started, I really enjoy it. And that's what you're saying, right? Is that you don't necessarily have the impulse or the energy or the desire, the burning horniness to do it. But when you do,

it's really enjoyable and he's still able to function, right? He can get erections and everything's fine. Last you checked. Yeah. And, you know, the biggest thing for us and, you know i don't this is sort of i find unique in my circle of friends but and i used to think there was a gift and i no longer look at it as a gift is that the guy can just go for a long time and i'm like listen this my region is not like yours and it's not and so that actually you know now that like you're sort of making me think about that yeah that makes you not want to get into it because it's not going to be a quickie. Oh, my God. No, I think that if he was a guy that could have a quickie. Oh, my God. I don't even know. I mean, is he able to orgasm? So that so what he

has is delayed ejaculation. That's yes. Yes. Which is rather rare. If he were with a woman with high desire and ready to go for an hour, that would be a nice benefit. Can he get there eventually yeah but I think for him it's a mental thing too so I think he struggles with that and so because he also knows that because I you know we can be very honest with each other and it's really not enjoyable beyond a certain period like it's kind of like okay again in the early years I found it to be yes you manually take care of them at the you know in other words like once it gets uncomfortable or once you've had your orgasm can you want to i just don't want to it's like it's just i just don't want to you know in that you know i don't even know how how candid we can get

here but it's um we're not on any kind of fcc okay so my husband is not circumcised okay and i didn't date many folks that were not circumcised prior to him so the whole helping him out man like it's just not even i don't know it is different for me and so i don't find like his penis very much yeah yeah i mean i do but it's just because it's attached to him i'm afraid it's i'm gonna hurt him. You know what I mean? Because you have this extra component. Okay. So maybe he could teach you, like, have you ever watched him do it? No, no. Would you? I don't think so. I just don't think so. I don't, I don't even know. Yeah. I don't know. I mean, no, I actually would. I mean, I'm kind of myself and I probably would. Cause that could be a solution too. And many couples

do that, right? Is that you watch him, you're kind of kissing him and he probably can do it. I don't know if you talk about this, but most men with delayed ejaculation during intercourse or with another person don't necessarily have delayed ejaculation when they self-stimulate. So like if he's taking care of himself, which he probably is, if he still has a decent libido, then he can probably reach orgasm pretty quickly I mean I'm not saying immediately but I'm sure pretty quickly on his own it may be something to ask him about just like are you able I'm assuming he knows you're coming on here but can you guys talk about this or is it kind of the yeah okay so you can talk to him about this and I would ask him like when you you know I've been thinking

about, so this is what I kind of would propose is that first of all, if you want to, and obviously there's a part that wants to, cause you're here talking to me, right? If you didn't care and you didn't ever want to have sex again, you wouldn't have called in to this show. So obviously there's a part of you that wants this, right? Or wants to at least explore wanting it. So I would go to him and say, look, I have been thinking and I really would like to start making a more concerted effort to be physically intimate with you and have sex with you, like even just to start with once a month and we'll make a date. But I was thinking in particular about at this stage in my life, I can't really go as long as you need. And I'm just wondering if there are some workarounds

that we could create where we fool around, we have sex, I reach orgasm, maybe you do, but at a certain point, if it gets too painful, I think it would really help me get in the mood and be into it if I knew that if it got too painful or uncomfortable, we could stop and then you could self-stimulate with me there, hugging you, kissing you, holding you, whatever, but that you could finish yourself rather than finishing inside me. Are you open to that? Could you have that conversation with him? Not quite like that, but a version of that, a version of that, for sure. Yeah. Because, you know, again, definitely that was a big distractor because I don't have all day,

nor do I want to this is it should be fun exciting like in and out I mean that's uh no pun intended actually but you understand it's I do I do understand that excitement yeah and especially if you're already there and you have the dryness and the thinning of the vaginal walls hey it's Dr. Laura Berman I've been a sex love and relationship therapist for over 30 years. And the main question I always get asked is how the heck do we spice it up in a long-term monogamous relationship? Well, if you want to take your love life, your sex life to the next level, whether you're in a relationship or not, check out my free course on quantum sex. It's going to teach you how to take your sexual response to the next level capable of full body orgasms,

how to use sex magic to manifest your dreams, and how to connect on an even deeper level sexually with your partner. Just go to drlauraberman.com and you'll find it right there on the homepage, the Quantum Sex free course. Check it out and let me know what you think. The only other thing that I would suggest, and it won't be covered, The estrogen probably would be covered by most insurance policies. Testosterone, especially for low desire, the insurance companies could give two shits if we enjoy sex. They just they will step in if you physically can't have sex, then they will cover something.

But if it's just for your enjoyment or your desire, they will not cover it, which is so They will cover it for men, but not for women because there are so few to no FDA approved testosterone replacement options for women. So the testosterone replacement is usually done as an off-label prescription. It's not very expensive. I mean, I know it adds up over time, but if you really want to dive into this, it's not going to address the dryness piece, but it sounds like you've found ways around that. It's not going to necessarily improve the tone of your vagina, the thinning of the vaginal walls, but it will improve desire, sexual response, get you more in the mood, give you more energy, more muscle tone.

And insurance should cover this. I would talk to your doctor about doing a locally delivered estrogen. My favorite, and I have no connections to any of these sources or companies, but my favorite is a prescription product called Vagifem. Now, it is not going to create that risk factor that I talked about with estrogen when you've been off it for a long time because it's locally delivered to the vagina. It basically is like a teeny tiny pellet, estrogenized pellet, like pill almost, it looks like, that you insert into the vagina with like a tampon type thing. And it adheres to the wall of the vagina and dissolves. And you put it in like every couple of weeks and it's not absorbed into the bloodstream. It's even considered safe for

women with a breast cancer history. So it won't cause that rush and risk factors for heart attack or stroke or the other things that, that they talk about, they're talking about with women who have been off the estrogen for a long time and suddenly get on. And if you are having, you know, if you say to the doctor, even if you've gotten past it with lubrication, if you say to the doctor, I'm having a lot of pain and discomfort, then insurance should cover it. So Vagifem is, is you can do the creams, but they're so messy and they go out into your underwear and it's good, but the little Vagifem pellets are good. So you could, if you want to tackle this and really dive in just as an experiment, I feel like there's a party that wants to at least try, or you wouldn't be

here. So you could estrogen, right? You could estrogenize the vagina with your Vagifem. You could get testosterone prescribed off label, either in an ejection or a patch or pill. I would try to do bioidentical testosterone if you can. And that is not that expensive. There's so many different options out there. Don't let them do any like implants or anything until you know where your level are. I've had so many women get the implants and they right out out of the gate. And then they're there for like three months on the wrong level. It's not pretty because it's usually too high of a level so the nice thing is that you start off at a really small low dose and then you slowly titrate up and it doesn't take much and you will find that you have more energy

more general sense of well-being more desire i mean you won't be like growling and jumping his bones but you will you will feel in the mood or open to the mood right if you were to even without that. And certainly with it, if you were to just try for the next three months, once or twice a month and make a date and keep it. And if you can't keep it because something comes up, reschedule it. Like it really is something that you're creating that is sacred and that you're committing to. And then you have lots of foreplay and you just enjoy each other. You have intercourse as long as you want to. And then he finishes himself with your assistance or cheerleading, whatever it is and see what happens yeah yeah no it'd be nice to get some to someplace like that because

you know it's also nice though to hear you and not that I want to be in this position but it's also nice to hear that you have met couples who don't have any intercourse and are like happy and everything because there are I mean I know I think telling somebody who doesn't know us as a couple right. Or even telling somebody who wouldn't know us as a couple and doesn't understand that part of it, you feel a little insecure, you know, you don't want, and you do get in your head about it a little bit, but again, it's, it's so mutual in terms of, you know, what we love each other. We are embracing, we make sure our daughter, you know, is very much aware of how much we love each other because it's, you know, we want her, we don't do it for her, but you understand, you know,

some maybe some people won't be intimate in front of their their child and kiss or whatever hug embrace and we do we don't yeah we do because we just do but yeah it is nice to hear though that other couples do go through this more than i might imagine sexless marriages and many of them go for years and years even decades without it and it isn't talked about because everybody's supposed to be swinging from the chandeliers now if he'd still i don't know if you've actually had the conversation with him where he has said, I'm fine with not having sex. Right. Like I would check that out with him because if he is a guy who tends to be more placid, more mellow, doesn't tend to kind of speak up when he's bothered by something, doesn't like making waves, just wants

to take it easy and be easygoing. It may be that it does bother him, but he just doesn't want to put pressure on you and doesn't want to have sex with you if you don't want to have sex with him. And so he's just accepting it. That I feel would be important to know. You know what I mean? You've talked about it. We have. Yeah. And it's because I'm a big communicator. And so I always just share with him. And I've said to him before, I said, I'm afraid we're going to fall out of love with each other if we don't do this. He's like, why would you ever say that? You know, it's always like, that's crazy. And, and so we do, I always share with him the moments that I feel insecure because again, it's not, it's not like he's, I mean, he did like

last week and I was like, Oh honey, no, just another time. Yeah. But it's, you know, it's never, that's not a consistent thing where I'm turning him down all the time or anything like that. And so I do, I do communicate that to him because we're, you know, he's my best friend too at the same time. And so he always tells me I'm ridiculous and just stop thinking stupid things in your head. But it's interesting that you say that men, that work stress will definitely bring that out in them. And from the day I've met him, he is just so stressed out with work from the day I met him. Yeah, that definitely do a number. And just generally speaking, and I'm not saying this applies to you for the reasons you just said. He's fine with, I mean, he's saying like, that's

crazy. No, I'm good. It's all fine. That doesn't mean he doesn't want it, especially if he has initiated. But the point where it becomes an issue and maybe puts the relationship at risk is when one of you doesn't want it and the other really does and is feeling frustrated. That does not seem to be the case. Does it make you even closer and more solid in your relationship if you have regular sex? One hundred and fifty percent. It does. Does it mean that you aren't solid enough without it? Who knows? You know, that's a relationship by relationship case. And it sounds like what you're saying is and what you're describing is that you guys are pretty solid. It would definitely be even more solid if you were having regular sex, especially because it

seems like even if his desire isn't through the roof, he still kind of wants it because he just recently initiated. So I would follow up with him and have that conversation in your words that I modeled for you and see if you can experiment. And maybe if you're willing, talk to your doctor about testosterone replacement and Vagifim. Yeah, definitely. I will. Thank you for that. You're welcome. Any other questions while you have? No, no, no. That was great. It's nice to finally meet you. I've literally, The first time I ever saw you was on Oprah in the 90s.

And, you know, yeah, I remember that well. And so I've been on Instagram following you for a number of years. And yeah, so this has been fun. Thank you. I'm so glad that you called in and that we could chat and hopefully it helps. Thank you. It did. I appreciate it.

I went to the doctor, said I'm crazy for your love. wrote me a prescription but there is no cure for