Sex With Emily - Love, Lust & Lexapro

Episode Date: November 18, 2022

Mental health and sexual desire - do you really have to choose between one or the other? While antidepressants like Lexapro can be lifesaving — all too often, they can deflate our sex drive. But conversely - it’s hard to get aroused if your depression goes untreated. Is there any way out of this predicament? On today’s show, I’ll discuss how to overcome this struggle that is more common than you think - as you’ll hear from some of our listeners. From alternative treatments to hacks around timing and dosage, I’ll help you keep pleasure in your life without compromising your mental health.Show Notes:Sexiest Gift Guide Ever: Emily’s Picks for 2022 HolidaysArticle: These Are The 5 Arousal Styles. Which One Are You?Episode: What’s Your Arousal Type?The Experimental Generation of Interpersonal Closeness (36 Questions)Article: How Do I Have Good Sex During Menopause?Hormone Intelligence by Aviva Romm, MD Article: How Do I Deal with Anxiety During Sex?Article: Ask Emily: How Do I Make Scheduling Sex Sexy? Hosted on Acast. See acast.com/privacy for more information.

There's a lot we don't feel like doing but can you hear me out? That once we started doing it we're glad we did. Like I don't think anyone's ever been like fuck whatever that orgasm was like. Why do I have sex last night? So if you have to do little things to push yourself and to keep going like with masturbation or toys, start getting you in the mood and get you going, I think you're going to find that your orgasm is going to come back, maybe even come back stronger. You're listening to Sex with Emily.

I'm Dr. Emily and I'm here to help you prioritize your pleasure and liberate the conversation around sex. Let's talk mental health and sexual desire. Do you really have to choose between one or the other? While anti-depressants like lexipro can be life-saving, all too often they deflate our sex drive. But conversely, it's hard to get aroused if your depression goes untreated.

So, is there any way out of this predicament? Like, you have to be really depressed in that one sex or you take a pill and you feel better but then you have a side effect. What to do? Well on today's show I'll answer how to overcome this struggle that is way more common than you think. You'll hear from some of our listeners and I'll also share alternative treatments to

hacks around timing and dosage. I'll help you keep pleasure in your life without compromising your mental health. We can have really strong mental health and a lot of pleasure. Promise. All right, intentions with Emily. I want to start off by setting an intention for the show and I encourage you to do the same. Well, buying attention is to alleviate any sense of hopelessness you may have around mental health and your sex life. Whether you or a partner supporting your mental health doesn't mean saying goodbye to your sex life.

Please rate and review Sex with Emily wherever you listen to this show. It really helps us. I appreciate you all. My new sexy, skiff guide ever, Emily's picks for 2022 holidays is up at sexwithemily.com. Check out my YouTube channel, social media, and TikTok. It's all at sexwithemily for more sex tips and advice. If you want to ask me questions,

leave me your questions or message me at sexwithemily.com. slash askemily or call my hotline 559 talk sex or 559 825 5739., 2, 5, 5, 7, 3, 9. Just include your name, your age, where you live and how you listen to the show. And you can totally change your name or choose to remain anonymous. Alright, everyone, enjoy the show. Alright, I'm going to do things a little differently and I'm going to start off with an email because it really illustrates the main issue we've heard a lot from you when it comes to your mental

health and treatments. Okay, this is from Sarah, 22 in Georgia. Hey, Dr. Emily, I may long time listener of the show and I was reaching out because recently I've had some sexual troubles. I'm on edit depressions for my anxiety and it's helping out in so many ways except sexually. I know it's a side effect of my medication, but my sex drive is so low. I no longer crave sex most of time and I've stopped masturbating as a result. Reaching orgasm was normally easy for me, but it's now difficult to almost

impossible. My boyfriend I've been dating for three years and we usually rip each other's clothes off. Well, I don't want to stop taking my medication, but also don't want to give up my sex life. Any suggestions? Sarah, you just painted this very common conundrum. Do we have to choose? Can you be on a medication that's helping your symptoms and still want to have sex? Well let me clarify one thing here. You have been with your partner now for a few years.

And so I want to normalize that after a few years, the honeymoon phase starts to wane, we're just not going to want to rip our partners clothes off with the same verb and intensity that we did before the honeymoon phase. Or when we were still in the honeymoon phase, okay? So just normalize that it gets, we have to put a little bit more effort in. And I'll share more of this in a few minutes, but sex drive is lower. That is a side effect of taking an antidepressant, especially an SSRI. So just know that once you do get going sexually,

many you can get over this lack of just spontaneous desire of just instantly wanting your partner, the second they walk in the room, and ripping the clothes off. Like that's not going to happen. It's not going to happen in longer term relationships and it's definitely doesn't help to be an antipresent. I get it's not going to happen spontaneously but understand what you need to get it in the mood for sex. Once you can get yourself going in the mood, you're going to want to keep going. I often like you, it's like going to

the gym. You know, sometimes you just don't want to go to work out and the hardest part is getting on your shoes and getting out the door. But once you get out the door and you got your workout clothes on, it's a lot easier. So think of your sex life this way. Like okay so maybe you're not having that really strong desire, but you need to do things that are going to get you there. Maybe it's sending your partner a sexy text and saying, I can't wait to see you tonight. And I look forward to doing these different things with you. Maybe you guys make out in the morning

and you start sending each other sexy texts throughout the day, building the anticipation for when you see each other later. So it's sort of hacking this typical arousal that you used to feel and desire. And remember, desire and arousal are often used interchangeably. But technically they mean something different, but it's also okay if you could flate them. Desire is the mental.

It's the wanting. It's the desire for sex. It's that thinking about sex, it's that knowing I want to have sex right now, and what I'm asking you to just think about other ways you can get yourself in the mood so that desire will come. It's not as spontaneous as it might have been in the past, it might be more responsive. A rousal is actually the physical symptoms.

The rousal is when your body is showing signs of a rousal, maybe you're getting wetter, there's an erection, your breath is quickening, your face is flushing, that's the arousal symptoms. But either way, we tend to use them interchangeably. So all I'm saying is here, we've got to figure out your desire arousal and what's going to get you in the mood because once we get going with sex,

once we start to say like, I'm going to start making out or doing four plays, you'll find that you will get into the mood with your partner and you will want to have the sex and finishes the sex and you'll be so grateful that you did much like going to the gym where we don will want to have the sex and vengeance the sex and you'll be so grateful that you did much like going to the gym where we don't want to and then once we get out the door and get the gym we're always glad we did and I'm here to say

I think we're always glad at what we get to the sex as well. In fact, I don't think anyone's ever like, oh, why did I have sex last night? Why did I have that orgasm as like? That was terrible. No, we want to do it. What these medication is making us do, it's making us work a little bit harder, I have sex last night. Why do I have that orgasm? That was terrible. No, we want to do it. What these medication is making us do, it's making us work a little bit harder, a little

bit smarter, and sort of hacking our system so we can get to that point of being ready for sex. Okay? So Sarah, you are so not alone. And we're going to get into how you balance taking an antidepressants with a healthy sex life. Why is this a common challenge right now? Well, for starters, let me just lay down the facts for you.

More people are feeling anxious and depressed than ever before. In fact, the prevalence of anxiety and depression have increased by 25% worldwide in the first year of the COVID pandemic. How crazy is that? So think about it this way. Pre-pandemic among adults, about 8 to 9% of adults were saying they were feeling depressed.

During the pandemic, that number climbed to 32%. That is a massive jump, which means that one in three, one in every three of Americans are experiencing some depression. And as far as anxiety, more than four in 10 Americans say they were more anxious than the year prior in Bay 2021. Also, more people are suffering from social anxiety after you're emerging from the social isolation, so we all experience during the pandemic, which makes sense. We were not around as many people. We got very comfortable at home and it got a lot harder to get out there and to start talking to people again.

So we have to all go easy on ourselves. And remember this, your sexual well-being is directly impacted by your mental health. If you're not feeling mentally well, well, you're not going to feel as sexually tuned in and turned on. As study in 2022 found there's a decrease in sexual activity in higher rates of sexual dysfunction during the pandemic, largely due to higher rates of anxiety, depression, and fear and an uptick at antidepressant and anti-anxiety bed usage. So there's less sex happening, more dysfunction, and there are too many get to people on 90 depressants.

But listen, it wasn't just the pandemic. We also saw before the pandemic that sexual dysfunction was prevalent in 62% of depressed men. And then we look at women. And this data has been around for a long time that 21% of our owners will experience depression at some point. My belief is that penis owners or men experience depression just as frequently as vulva owners, but maybe they're not as in touch with what it means to be depressed. So I want to normalize that as well. We all know that men are not socialized to talk about their emotions as much, at least they weren't 20, 30 years ago. Hopefully men of today were raised at homes more open and a lot more support around expressing emotions.

But again, this study's been around forever that twice as many women are depressed. The men and again, I think that it's equal opportunity. We all get depressed. We are in a conundrum because now that we're treating our depression with donated depressants, we are having the side effects. So why?

Why are donated presence causing a low sex drive? Well, the most common is that we're taking these antidepressants, which are SSRIs and SNRIs, but the SSRIs are the ones that are most common that initially they're saying they increase the levels of serotonin in the brain because low serotonin, which is a hormone, is what's influencing happiness, learning,

and memory. And so we have to maintain serotonin levels, which is why SSRIs can be powerful. And when I say SSRIs, it's like all the common ones that you hear of. It's like Symbolta and Prozec and Zoloft and Lexipro. Those are the big culprit. Those are the ones that are the most commonly prescribed and the most common ones that are going to cause sexual side effects. And there's also SNRIs, a serotonin and non-net preference, reuptake inhibitor.

So these also work on levels of like non-net preference of the brain just to break this down. That's like a fixor, that's subulta, basically the same. Basically, if you're at SNRI or an SSRI, the ones that you are most, count me prescribed, you're going to have a sexual side effect. Now listen, the reasons are that totally understood since depression itself can cause sexual side effects.

So how do you know? Is it the medication or is it just that I'm feeling depressed? What we do know is that these medications are in place to release serotonin to help with users that are feeling depressed and anxious. And some studies have shown that too much serotonin in have its person sex drive, which is why you're making a harder experience pleasure. So what we're saying is you've low serotonin, so you've got to take a pill, it's going to increase serotonin,

but when we increase serotonin, you're going to feel happier, but it's going to impact your sex drive. Another theory is that as your serotonin is increasing, as if these medications, then your levels of dopamine are increasing, and then since dopamine is the chemical, we need to feel stimulated sexually,

our sex drive is going to decrease. So there's all this stuff happening with your hormones. We want to get this happy hormone in place. It's going to decrease the sex hormone, which I got to be honest. Seems like this really cruel trick in a way. It's like I am so depressed, can't get out of bed. The last thing on my mind is sex. Taking that into person makes you feel alive and happy and social and like you want to have sex but now you can't because of the side effects. Which to me,

it's just a huge freaking bummer. It's a huge bar that like we need dopamine to feel stimulated and then it's going to be decreased a few months ago. There was a groundbreaking study that came out because what we've been told for many many years. So 30 years, since the 90s, since Prozac and all these other antipresidents came out, we were told that somebody who's depressed is having a chemical imbalance. And this chemical imbalance needs to be treated by an antidepressant.

Well, these studies that have came out showed that it's actually not true. There isn't a chemical balance. That depression is not caused by low serotonin. But the truth is that we have to remember this, is that they're not really sure why and I actually did a big deep dive on this study. They're showing that well that might be true. What's also true is that antidepressants do help treat depression and symptoms of depression,

anxiety, OCD, eating disorders, and they can be life-saving. So I am in no way, say, go off your antidepressants. And I don't think the studies say that either. It's just saying, you know what? The culprit might not be this elusive chemical embellish. The culprit might be The culprit might not be this elusive chemical embellish. The culprit might be life of trauma, someone from PTSD, someone who had a really unstable childhood with more trauma than usual, because side note, we all have a little messed up things that happened in our childhood. So it could just be your own experience isn't life, which is why there's also been so much talk lately about trauma and treating trauma through a lot

of your nervous system treatments, which is like heat therapy, cold therapy, acupuncture, exercise, nutrition, therapies like EMDR, eye movement, desensitization, reprocessing. There's a lot of great trauma therapies out there and different kinds of traumataries that work in the body to release trauma and to release stuff that stored in the body in addition to in conjunction with adding depressants. So you're on an antidepressant. So what are these side effects everyone talks about? Let me break it down for you. Love owners, 72% had problems with sexual desire, which we already talked about about is the psychological part of whiting have sex.

That's the part of it that says, I'm so horny, I'm so turned on, I can't wait to just rip my partner's clothes off. 72% had increased problems with that. 83% of all of others had problems with arousal. That's physical. That means they were getting as lubricated as normal. Their breath wasn't quickening. They weren't having as many physical symptoms of arousal.

And for evolve owners on SSRI's 42% had problems with having an orgasm. But let's go to penis owners. Penis owners, their most common sexual side effects for using an SSRI is they also reported higher rates of problems with sexual desire and having an orgasm. But lower rates of problems with sexual rousal, which means that men were getting erections, but they weren't necessarily desiring sex or having orgasms. So they were walking around erect, but not ejaculating. It's what I'm hearing from this.

But also because the rouse will for men, I think it'd be more mental, like you can get an erection, right? But the desire wasn't there, but what you got in your desire going, you got a rouse, but the orgasm wasn't happening. And I've heard this from many, they're like, I'm doing all the things,

I'm having sexual hyperaritor and I'm not coming, okay? So the antidepressants that are most causing these sexual side effects are the SSRIs, which is like prozac, zoloft, effects, or subulta, paxil, and a Vex or XR. So okay, I've laid the land out for you now. You're realizing that you are not alone, but this is the mean that your sex life is over. Does it mean you have to go off of the antidepressants? No, I'm not saying that. Here's some things that you can do.

Okay. First off, well, listen, even if you are suffering from depression or anxiety, I think this goes for everybody, that the more you can do more holistic healing practices like acupuncture, breathing, moving your body through exercise, working on healthy nutrition, taking supplements, meditation, yoga, all of these practices, absolutely help calm the nervous system. They help you're helping moving your body and they can be a great supplement to any other thing that you're doing to treat your depression and anxiety. You definitely have to consult with your doctor about all this stuff because

SSRIs are notorious for killing sex drive. You have to remember that only 20% of doctors who prescribe them are even going to tell you about it, which is why a lot of you are not clear. You're like, what happened? I was wanting to have sex all the time and now I don't. So I just want you to understand that your doctor might not be telling you this, so in conjunction to taking a med, try to make sure that you are practicing a healthy lifestyle overall. Here are some things that you can do. Always gins out with your doctor. You can try switching medications. There's a handful of non-SSRIs out there that have fewer sexual side effects like

well butrin or remoron. Those are really common. Those are common alternatives to SSRIs to treat depression and anxiety. They don't work for everybody, but you can definitely talk to your doctor about trying another one of these medications. There's also some supplements that have been reported to help with sexual dysfunction, saffron. That's been one that's derived from a flower and that can help with Afro-DZAC effects and animals and humans. And some evidence that inhibits serotonin reuptake and can sort of help with achieving erection and orgasm in others. Another one is 5HTP. This has been around for a long time. That's another supplement that can be as effective some say as SSRIs. Now again, try it out. You got to talk to your doctor about this. I think you have

to be really regular with these doses and also try some of the other holistic approaches I talked about for these supplements to work. Okay, but here's some other hacks. If you're staying on the antidepressants and you're like, but what else can I do? I don't want to go off the beds, which I totally understand. Here's a few hacks, timing. So a lot of patients have noticed

that there's stronger side effects right after they take it there antidepressant. So if you know you're gonna be having sex, take your SSRI first thing in the morning. So when you're having sex later that night, the side effects might be decreased. Another one is reducing alcohol. Many, many, many people are quick to blame their SSRI for a lower sex drive, when alcohol might actually be the culprit. There was a study that found that 34% of women experienced symptoms of sexual dysfunction, especially lack of desire and difficulty with orgasm when they were on an

added depression and also having a high level of alcohol consumption. They clearly warn you on these added depression, it's not a strict alcohol and I'll be honest, very few people read that or adhere to that, but it might not be your antidepressant. It might be your alcohol intake. So as always, just pay attention to that and reduce your alcohol consumption. Marijuana. Lot of studies lately about marijuana, cannabis, and sex drive, but it is limited. A lot of these studies, but it seems that at low doses, seems to help a sex drive, but it is limited a lot of these studies, but it seems that at low doses seems to help a sex drive, which I've heard from many's, anecdotally, and in research,

that a low dose of marijuana, whether it's like an edible or, you know, another form can sort of help a sex drive, you're kind of decreasing it in ambitions, and it can help you get more in the mood. It's already shown that more than 200 women and men who use cannabis found that nearly 60% said that cannabis increased their desire for sex, which is a great thing. Again, I think it decreases your inhibitions and it allows you to be more in your body, maybe your less in your head. The flip side of that is that cannabis can lead some to be more anxious and paranoid, which is not a news flash here, but if you're feeling a lot more anxious and paranoid from cannabis, you're definitely not

going to be as much in the mood, and also, he will experience problems with less motivation for sex or rectal dysfunction, trouble reaching orgasms, or premature ejaculation. Well, looks like vulva owners seem to benefit the most with cannabis because in the study, they show that there was a definitive link between cannabis and improved orgasms for vulva owners. So perhaps just using your cannabis in the bedroom when you know you're going to have sex might be the sweet spot for many. But again, check out the side effects, talk to a doctor, try it out, maybe it's small doses and see

how it goes. I'm also excited to share with you some alternative treatments for depression and anxiety that I've been really fascinated with and I've had some friends and colleagues who have tried it out. And one is called TMS therapy or Trains cranial magnetic stimulation. What I love is that it's FDA approved as a safe and effective treatment for a major depressive order. Maybe people who weren't responding to the antidepressants have just been depressed for

a long time. And essentially what it does is you go to see a doctor, I think some of these clinics you go once a day for 40 days, you go and they deliver these electromagnetic micro pulses to your scalp. So essentially you're wearing like you lay down on a machine and you're essentially wearing like a a scalp mask, a scalp helmet with a lot of different pulses on it. And what it's doing is it's activating reaches of your brain affected by depression. So it's a non-invasive form of brain stimulation. And what the cool thing is it operates completely outside of the body and it's affecting the central nervous system activity

by again, just applying these powerful magnetic fields to specific areas of the brain. It is shown that this can be more effective for many individuals and any depressants and it does not lead to sexual dysfunction. It's painless, it's non-invasive, does it require anesthesia, it just requires a lot of time. Another thing people are asked about with this, like, oh, is that like shock therapy, which has been used for many, many years. Shock therapy is still being used, ECT, or electro-convulsive therapy. TMS offers low, low intensity bentonic pulses. ECT is like shock therapy. You probably heard about this, like, in the 50s, too. Like,

it is literally shocking your brain because nothing else has worked. Your brain is actually seizing, but with this seizing, it's resetting your brain. It can help patients with severe major depression. I don't know many people use it, but it can be used with very, very severe cases of depression. Another thing, hallucinogens, aka psychedelics. Now, there's been a lot of great research of recent years that's super, super promising for the treatment of anxiety, depression, and PTSD with hallucinogens psychedelics. So, what is ketamine?

Ketamine is a dissociative anesthetic and that has been used in small doses, according to a 2022 study in the Journal of Clinical Psychiatry, 72% of patients on proven in their mood, 38% were depression, symptom-free, after 10 infusions, 85% on decreased suicidal ideations after only 15 infusions of ketamine. And they didn't have to go back on any depressions or maybe antipressants weren't even working. So I think this stuff was really, really promising. MDMA also, aka mylier ecstasy. There was a study that showed that 67 percent of patients no longer met the diagnostic criteria for PTSD 18 weeks after starting treatment. And then there's psilocybin, which is magic mushrooms.

Studies have shown that again, 71% of people who took psilocybin from major depressive disorder showed a 50% reduction in symptoms after only four weeks. I think this stuff is really probably promising, but let me just tell you this, there is a disclaimer and there's definitely downsides like everything. First, if you find a clinician, please only consult clinicians who are

credited by maps, which is a multi-disciplinary association for psychedelic studies. This is one of the only places that I think that are the most reputable. If you want to find someone who's worked with maps, things to know, insurance doesn't cover these type of treatments yet. Hopefully they will. And in fact, maybe in some states they do, but many of them don't. Access is limited. You have to go to a clinic and roll in a study or do it from home. And again, you guys, I've had friends who had some bad experiences. I'm going to be honest. They found an academic clinic like in their area and it was just not what they wanted to be. So I just can't emphasize enough that you want to be with a

practitioner and maybe you could talk to some of their clients, do some research on that. Make sure you are working with somebody who is accredited. And again, the risk is that in some instances, hallucinogens can evoke a long-lasting psychotic reaction, especially if you have a family history of psychosis. Okay? So really, I just wanted to lay out for you everything that's happening in the space of mental health and wellness and treatments for it. So hopefully that explanation and why under presence can affect your sex drive.

And then some solutions to address this side effect were helpful for you. And please just let me know any questions. You have any clarifications. And if you'd like me to do more episodes on this topic, I would love to. Okay, so you let me know what you need here. All right, after the break, I'll be answering your questions all about antichristins, sex drive, and arousal.

So don't go anywhere. This is from L, 40 in Chees and Los Angeles. Hey, Dr. Emily, I know the difficulty of achieving orgasm is a common side effect of antidepressants, especially SNRIs and SSRIs. I've experimented with different antidepressant beds and the only ones that help my depression are SNRIs. And they make it much more difficult for me to achieve orgasm. Never had a problem with orgasm being prior to meds.

And when I switched off the SNRIs to well-buterin, I had no issues achieving orgasm, but well-buterin didn't help my depression. Side note, I've heard this is very, very common. A lot of you will get switched to well-buterin, I would say, for half people, it really works, but for half people, it doesn't work. Is there anything I can do to help counteract

this horrible side effect of my SSRIs and regain my normal ability to orgasm? I appreciate any vice you can give. All right, so yes, I want to help you here, and I want to say a few things. First, the side effects of SSRIs tend to subside over time. They're really intense in the beginning, but for many people after a few months,

they can subside. And a lot of it is mental too. We were like, oh, I'm gonna be able to orgasm, I get turned on the last few months. I haven't been turned on in a rouse, and we continue to perpetuate this belief. So I think just knowing that you can figure out a way to break through it is going to help you.

You could also try some of the hacks I mentioned above switching up your dose, making sure that you are healthy, that you're exercising, that you're moving your body, that you're eating healthy foods. You know, maybe trying as a little bit of marijuana has been helpful for some. The timing of the dosage, like I said, trying different timing of your dosage could be helpful. Mastervation, you guys, listen, you might not be hit over your head with this desire. You might not want to masturbate. You might be feeling like I don't want to sex, but sex beget sex. The more you start like trying to work on your desire or to hack your desire, so maybe you start to masturbate. So you remember

what it feels like to orgasm, even if you don't feel like it, okay? Just like you don't feel like going to the gym. You don't feel like taking your medisins or there's a lot we don't feel like doing. But can you hear me out? That once we started doing it, we're glad we did. Like I don't think anyone's ever been like, fuck, what if that orgasm last night? Why do I have sex last night? So if you do little things to push yourself and to keep going like with masturbation or toys, start getting you in the mood and get you going, I think you're gonna find that your orgasm is going to come back, maybe it'll even come back stronger.

So be willing to do some work around and some supplemental activities that will help you reach orgasm and more pleasure. Okay, thank you for your question. I really appreciate you. This is from Gemma, she's 28 in London. Hey Dr. Emily, I need appreciate you. This is from Gemma. She's 28 in London. Hey, Dr. Emily, I need your help. I'd be with my partner for a couple of years or both on SSRIs and data presents.

Minds for anxiety is for OCD. This is taking a huge challenge. Our sex life is neither of us had a sex drive since taking them, but they make our mental health so much better. There are so many societal norms at all. Often we should be having sex, but it's not average happening once a month. That feels that we're doing it just because we should. We love each other dearly, but if this carries on, I worry we'll only become friends. Is there someone out there that will make me want to have sex? Or is this how it's supposed to be? All right, well, thank you for your question here. And, Gemma, I get it. It is not easy when you're noticing this sudden plummet and change in your sex drive.

But the good news here is that your partner's coming right along with you. He's also not feeling it. So how can you guys work together to say, you know what, once a month doesn't quite we feel right for both of us. And I kind of agree with you that if you're only having sex once a month with a long-term partner,

I feel like we probably need to be doing a little bit more than that. Unless you're both totally fine with it, but I'm not hearing that. What I'm hearing is that this is a great opportunity for you guys to taglet together, work together as a couple. I don't think that you're gonna find a brighter, shy, and your person out there

that's gonna help you want to have sex again in a way that you want to be having sex because you still love your partner, right? What might be interesting is to find your desire style. What do you need to feel aroused in the mood? We have an article five arousal styles and we'll put that in the show notes. We also have a podcast that explains what your arousal type and some things in this article thinking again, you guys, like I said earlier, desire in arousal or very closely linked.

I don't think we have to get caught up in it. But knowing where your arousal slash desire, it's thinking about, if desire is like your motivation to have sex, like we're mentally, like, am I in the mood for sex? And how am I gonna get arous to it? Like what actually happened? So arousal could happen. And how am I going to get a rouse? Who like, what actually happens? So a rouse look at happened.

Like, how do you get to the point of your desire and a rouse look? It's through, maybe you could find out, I need conversation. Maybe you know, you know this, that when you have long conversations with your partner, by your hopes and your dreams, and you know, maybe you're more of a satiosexual, meaning that you need more of an intellectual conversation to turn you on, that's when you get a rouse.

Well, maybe you need to build in more of those conversations. Or maybe you find that you get a rouse more through touch than what your partner raises your thigh, gives you a central massage. That's what you need to be moving for sex. Or maybe you need visuals. Maybe you need your partner to send you sexy nudes or you want to watch porn together. And maybe you want to share some fantasies. Or maybe you need to play, you know, maybe like talking about and planning your future.

Like I can't wait to dock dirty with you to get dressed up or to do some kinky your things with you is really going to be the thing that'll get you guys in the same page. Or maybe you need physical adventure. Maybe the two of you when you work out together, you go hiking, or you're like, you know, you get the adrenaline going together. Well, couples who get the adrenaline and their heart pounding, find that they're releasing feel-good chemicals in the body, which is prompting them to feel sexual. So you sort of leverage this physical arousal and then enhance the intimacy between both of you. So really, this is about truly just understanding and sort of it's a hack for both of you. Like knowing that you're brought that in the mood, look at this arousal style inventory.

We'll put it in the show notes and just figure out what do we both need to get there and then start to work around it so you can both find the pleasure and the desire and the sex that you both need in their relationship. The other thing that you can do and this is a really interesting study is that you can prioritize emotional intimacy. Again, emotional intimacy is a prerequisite for physical intimacy, for many, many couples. And there's more couple counselors that are utilizing the 36 questions. There's a study that I find fascinating that's proven to increase closest in couples.

So each partner goes back and forth answering questions and you can do them over a single session or stretch them out over time. And the studies have found that when couples do these 36 questions, they've bound to enhance intimacy and arousal and their frequency of sex. So some example of these questions are, for what in your life do you feel most grateful?

Take four minutes to tell your partner your life story as much detail as possible. Another question is, is there something that you've dreamed of doing for a long time and why haven't you done it? Another question is, what roles do love and affection play in your sex life? So they found that when couples sit and ground in these 36 questions that it increases their closeness, it melts away resentments, and couples have found more connected, more intimate, and more ready for sexual intimacy as well. Because again, any depressants might be wreaking havoc on your body in ways that are negatively impacting your sex drive and your sex life. But all these tools here will might help you override the side effects so you could really work towards closeness and intimacy. Last question is from Courtney, she's 48. Amish again.

Hey, Dr. Emily, I'm 48 years old and I recently started taking well-butch and Alexa Pro for symptoms of depression, anxiety, fatigue, lack of arousal, energy, brain fog. From 2010 to 2017, I took Zoloft. When I went off Zoloft in 2017, my sex drive life was reignited. Everything awoke from a slumber. I didn't even realize it was in. It was amazing. This experience made me very reluctant to go back at any meds.

But my symptoms were worsening rapidly despite the use of alternative treatments. As feared, the meds have affected every aspect of my sex life and it's so frustrating that they have to chew the tooth mental health and have an enjoyable sex life. Any thoughts, suggestions, or help will be appreciated. Thanks for the work you do. Alright Courtney, I hear you. This is a bummer. So it sounds like you went off of all of your meds and initially you felt really aroused turned on like you were rediscovering your sex life. But those pesky symptoms were coming back

which sucks. Sounds like you started feeling anxiety, you started feeling anxious and depressed again and you went back on the meds. So what to do? Well first I just want to say that you're 48 years old now that there could be other things going on. And I would definitely find a doctor who specializes in hormone treatment therapy, especially for women's sexual health and see if there's something going on with your hormones. Because at age 48, I would guess that you're a parimenopause. Parimenopause can last a woman anywhere between like eight and 10 years where your body's making a transition to menopause, which is menopause is simply like a day. Like menopause is when it's a year without a menstrual period.

Pairing menopause is a treatment that lasts forever, it seems like it's forever. And women, eight, ten years, and in that period, you're all your sex hormones are decreasing. And unfortunately, when you've got estrogen, that's taking you to crease and testosterone, and you've got to play with your progesterone. What happens is you're starting to have symptoms that are related to anxiety and depression, but it's not in the same way you were having before. So in conjunction to going back on your meds, you might also want to get in some hormone replacement therapy.

But again, only if you find somebody in your area that specializes in it, because there's a lot of people who think they do or there's a lot of different opinions about it. A lot of times our Western doctors like Daticologists are not necessarily up on the latest treatments. I'm a fan of bio-identical hormone replacement therapy, so I would look to that as well. And another thing I haven't mentioned is nutrition. I don't think as much, but there's a lot of great information lately. A Viva ROM, ROMM, wrote a great book on hormones, and that kind of talks about like it's a multi-disciplinary approach. We have to like, there's certain foods we should be avoiding, different supplements we could be taking. There's just a lot to understand about hormones as it relates to your sexual health and your sex drive And so just becoming an expert in your own

Sex life and your own Challenges right now is really important to mean sometimes we have to become our own very best advocates because I'm telling you in my journey I've probably gone to five or six different doctors that have gotten all this different advice And I really have to pick and pull what worked for me and I can do another show where I talk about that. But you know, menopause can start to women age, age 40 to 44 and you're 48 years old. So I'm sorry to say this Courtney because it seems like you've been through a lot in all these years, but I would also just add getting successful hormone panels done with a doctor that you trust and working

in nutrition and maybe some hormone replacement therapy as well. And so maybe you'll find that you won't need as much of the antidepressants as you need to supplement some other treatments. All right. Thank you so much. Everybody, thank you for your questions, your emails, and we'll talk soon. That's it for today's episode. See you on Tuesday. Thanks for listening to Sex with Emily. Be sure to like, subscribe, and give us a review

wherever you listen to the podcast and share this with a friend or partner. You can find me on YouTube, Instagram, Facebook, and Twitter at Sex with Emily. Oh, I've been told I give really good email. So sign up at sexwithemley.com. And while you're there, check out my free guides and articles for more ways to prioritize your pleasure. If you'd like to ask me about your sex life,

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