Low Libido in Midlife: You’re Not Broken. Your Body Is Keeping Score.

Podcast Introduction and Mission 0:00

Welcome to Hotness, the podcast that brings you practical tools to balance your hormones and rekindle connection, confidence, and desire in midlife and beyond. I'm your host, Dr. Liz Lister. Hotiness is a safe space for honest conversations about menopause, sex, identity, love, loss, reinvention,and desire, because you can embrace your hotness at every age. Welcome to Hotness, the podcast where hormones, confidence, and desire come back online. This is our first spicy science episode. And we are going to talk about that topic that everybody talks about over cocktails, but not necessarily at the doctor's office.

That is not having any libido, especially in midlife. Now I will tell you some things I've heard my patients say. One thing they say is, Dr. Liz, honestly, I would be fine if I never had sex again.

Why Libido Drops in Midlife 1:12

Sometimes they said, my partner is so understanding. What I don't say out loud when someone tells me that is I think to myself, Yeah, they're understanding for now. But libido is not only about sex, and even sex is also not about only sex. It's about intimacy and connection in a partnership. And also intimacy in connection with ourselves as individuals. Now, first, let me just be clear about something. If sex is uncomfortable, if you have vaginal dryness, If it's painful, there's pain at the entrance or pain deep inside, like pelvic pain, and your body's not responding the way it used to, or it not respond well, it is normal not to want to do something that hurts.

I often say that to women and they go, oh yeah. Okay, so I'm reminding you and I am telling you that it is normal to not want to do something that hurts. That means your brain and your libido are perfectly appropriate. So what's going on in midlife with the physiology? We're wired to avoid pain and to move toward pleasure. However, in midlife, a lot of hormonal changes include a drop in really all of our hormones eventually. Once we go completely into menopause, we have most hormones at very low levels.

All kinds of hormones influence libido and sexual function. Progesterone influences sleep and influences mood. And without enough progesteron, we can feel anxious. We can have sleep disruption. That's not necessarily a woman who is in the mood for sex. Estrogen directly affects the tissues of the vulva, the vagina, even the bladder.

Pain, Dryness, and Physical Causes 3:25

So sometimes women midlife are having issues around those tissues. And it's not just a dry surface. It's a loss of elasticity underneath the surface, okay? Sometimes I talk about the example of I'm trying to organize a drawer and I pull the drawer all the way out and look behind it and something fell down like a pair of leggings and try to see if I can wear them and stretch the elastic waistband and it makes a sound of crackling and sometimes the dust actually comes off in my hands. That is a loss of elasticity.

So once that happens, it could be painful to help fix it. Right? So maybe At one point, sex may have felt good, hopefully. It may've helped feel connection, maybe even fun. And it starts to feel like an effort, right? Or worse, something to avoid. In my experience, at least with heterosexual couples, the man feels terrible and does not want to do something that will hurt his partner. So also to add to that loss of elasticity, loss blood flow, very important. And again, anticipating a painful experience is going to lower your desire.

That makes sense. Then there's an emotional layer, right? That's the physical. Now the emotional. A woman might start to say to herself, maybe I don't need sex anymore. Maybe I'm not a sexual person anymore, Maybe that part of my life is over. And I would like to gently challenge any thoughts. If you're having any thought like that, I'd like gently to challenge that. Because in many cases, it's not that the desire is gone, It's just the conditions to support desire have changed. Okay. Another thing I always say is that libido is not only about sex.

It's about life energy. it is about desire and motivation. All right? It includes getting up off the couch to go do things you enjoy. Might be go to the gym, might be, go for a walk. Alright? So it's not, only, about, sex, so that's why it so important that I'm really passionate about this topic.

Desire, Safety, and the Responsive Desire Model 6:00

So we have this software that goes out of date and we don't have the update for the system. Why do we want to reboot? What happens when we great libido? Sex can become pleasurable again. The body can be supported harmonically. You can feel comfortable and connected in your body and you can still confident. Self confidence is a huge ingredient in that type of sexual and sensual interactions. And not just with other people, but with yourself. Reestablishing faith in yourself, confidence in your self, love for your body.

When all this happens, desire can come back online. One more thing I wanna say about libido for right now. is that the model of you have to think about sex first, then pursue it, and then have it and recover from it. That is an old model. Masters and Johnsons came up with that decades ago. And it was revolutionary at the time. Nobody had even thought about putting these types of important human phenomena into words. So it groundbreaking at that time, but what we now know is that's a very male or masculine linear model.

And what have now is a model from Dr. Shirley Bassin, which is A Circle. And into the circle are all the different factors that affect how women feel. Feeling safety, feeling psychological safety. feeling emotional and physical safety feeling that you have a relationship with someone that You can trust that. You have good communication that, you work together on household chores and caring for others that might be on your plate. All of that becomes this circle and we distinguish between spontaneous desire, which is that linear model, or responsive desire.

One of the questions I always ask women is, all right, I understand that you're really not having sex very often at all, but when you do have sex, of course, first I ask, does it hurt? And we talk about that and how to improve that, and completely resolve that because sex should not hurt. But also when you do have sex, for example, sometimes a couple does not have as much sexual interaction because of kids around the house or parents that they are caregiving. And so then I ask, well, when your away from your own home environment and you don't have all the tasks and don' have the distractions, do you have more desire for sex with each other?

The answer is often yes. So that's one piece. And the other piece is, when you do have sex, does your body respond? Do you lubricate enough to make sex comfortable?

Hormones, Treatment Options, and Closing Takeaways 9:20

If you don't, that is what we call good responsive desire. That's just as valid. It's become, it's a little bit of a masculine point of view to value only the spontaneous desire. The responsive desire is just as valuable. I see this all the time in my practice, women who thought maybe that part of their life is over. I created a midlife guide that I'll link to in the show notes, and it walks you through all of these types of changes and what you can do about them. In other episodes, we will talk and I have done a great deal of material and videos on the safety of the right kinds of hormones.

And that's really important. Even women who aren't ready to use any kind of systemic hormones can use local treatment of the vulva, the vagina, which also helps the base of a bladder. All of those tissues are very important. and you can use tiny microgram doses of estrogen. Sometimes you could use very low doses, of a compounded cream or product made by a company pharmacy that can also contain a little bit of testosterone. Talk about that in a separate segment. But I will say very quickly that testosterone for women is an ingredient in libido.

It's not the main issue for most women. It often helps, but it is often not the only thing. If there isn't a feeling of safety, if there Isn't good communication, If There isn t a good environment for a woman to be able to feel sexual desire, testosterone is probably not going to make the difference to help. And in some cases, it could even cause a problem. If a partner is having medical issues and they cannot have as much sex, I don't want to do anything that's going to cause what we call a libido mismatch.

But for this discussion today about low libid, there is so much that can be done about it and I really encourage you It's normal to not want to do something that doesn't feel good, but being able to help your body, support it hormonally, and be able be intimate in whatever way works for you, especially in the context of a partner relationship, is really valuable. Valuable in a partnership, Valuable for just you. Libido is not only sexual desire, it is desire for life. It is vitality. it Is life energy.

And if you are not feeling like your libido Is where you would like it to be, there's so much that can be done. and I want you to know that you can pursue it and you Can feel better and You can have that aspect of your life again. Thanks for listening to Hotness. Help more women find these practical tools by liking, sharing, and following the show, as well as leaving a review. As a gift for listing, go to drlizmd.com forward slash hotness for your free midlife guide filled with powerful support for you mind, body, soul, because you can embrace your hotnes at every age.