sexual wellness

Dude, Where’s My Orgasm?!: Unpacking Sexual Wellness In Perimenopause

Today I’m unpacking a topic that doesn’t get the attention it deserves: sexual wellness during perimenopause. While this is a powerful time in our lives, it can come with a lot of changes that make us feel like those orgasms we once had are now a thing of the past. 

What’s worse than searching for our former sensuality is we’re often told by doctors, “That’s common at your age,” and sent on our way without a solution, wishing we hadn’t taken our turn-on for granted. 

But here’s the thing: sexual wellness is not a luxury reserved for our younger selves. It’s an essential part of our health and wellbeing in all stages of womanhood: even perimenopause, menopause, and beyond. Pleasure is our birthright, ladies, and together we’re going to reclaim it!

 

Understanding the Link Between Hormones and Sexual Pleasure 

Perimenopause brings a lot of hormonal fluctuations as our bodies prepare for menopause. But there’s more to it than hot flashes and mood swings: hormones like estrogen, progesterone, and testosterone can have a significant impact on our sexual health and intimacy leaving us with reduced sensation, discomfort, or no desire to “do it” in the first place. 

If you're facing any of these challenges, you’re not alone–over 40% of perimenopausal women report sexual dysfunction. And sexual dysfunction isn’t just lacking the drive to get down–it can mean having trouble at any of the four stages of sexual response: 

  1. Desire: Lasting anywhere from minutes to hours, desire is when the body begins to prepare for sexual activity in response to thoughts or sensations by increasing blood flow to the vaginal area.
  2. Arousal: The Lubrication of the vagina and swelling of the clitoris that began in the Desire stage intensified in the Arousal stage.
  3. Orgasm: During orgasm, or climax, pelvic muscles contract and tension is released.
  4. Resolution: This is when muscles begin to relax, heart rate slows, and the body returns to its unaroused state.

The good news? These issues can often be addressed, bringing you back to a place of sexual satisfaction. Before we talk about how to address them, though, let’s take a look at what’s causing these unwanted changes.

 

Decreased Sensitivity and Sensation 

Estrogen plays a vital role in maintaining vaginal lubrication and blood flow. As estrogen levels begin to drop during menopause, women may experience decreased sensitivity and sensation, particularly in the clitoris. This can lead to orgasms that are less intense, more difficult to achieve, or are even non-existent. So if you’re feeling like someone “turned down the volume” on your orgasms or they’re completely MIA, estrogen may be to blame. 

 

Discomfort

Estrogen is also responsible for overall vaginal tissue health. Decreasing estrogen can lead to vaginal atrophy: thinning and inflammation of the vaginal walls, along with vaginal dryness. All of this can contribute to discomfort, irritation, and pain during sex. 

 

Low Sex Drive 

We can’t place all the blame on estrogen for trouble in the bedroom, though. Progesterone and testosterone can also start to decline during menopause, bringing your mood and–you guessed it–libido right down with them. 

 

A Holistic Approach to Rediscovering Sexual Pleasure In Perimenopause

So, what can we do to relight the fire and restore intimacy? Here’s where to start:

  • Address Hormone Imbalances: Just as I emphasized the significance of hormone balance for skin health, the same applies to your sexual health. Comprehensive hormone testing is key to addressing imbalances. The DUTCH panel can give invaluable insight into your hormone levels and guide a personalized protocol to restore balance.

 

  • Nurture Your Gut: Surprisingly, gut health also impacts sexual health. A healthy gut supports nutrient absorption, including essential vitamins and minerals crucial for hormone production and overall well-being. Prioritize a diverse, nourishing diet and consider probiotics to support your gut microbiome.

 

  • Manage Stress & Boost Adrenals: Chronic stress can negatively impact adrenal and sex hormone levels–and can make-or-break the feeling of being “in the mood”. The stress hormone cortisol can also reduce estrogen, leading to decreased sensitivity in the vagina and clitoris. To support adrenal health and balance cortisol levels, practice stress-reduction techniques like mindfulness, meditation, or gentle exercise. In addition, shoot for 8 hours of sleep each night. If you have ongoing signs of HPA Axis imbalance (constant fatigue, feeling “wired but tired”, trouble falling or staying asleep, or a poor stress response) talk with your Functional Medicine provider about running a DUTCH Adrenal panel to get a customized repair protocol.

 

  • Embrace Self-Care and Connection: We talked about how self-care is essential for healthy skin, but it's equally vital for your sexual well-being. Prioritize time for relaxation, self-exploration, and connection with your partner to enhance intimacy. Share your experiences, concerns, and desires with your partner to build trust and understanding as you navigate perimenopause.

 

  • Explore New Avenues: As our bodies evolve, so can our desires and interests. Embrace this opportunity to explore new ways of intimacy and sensuality, whether through mindfulness practices, tantra, or simply trying something new with your partner. Studies have shown that women in their 40s and 50s tend to become more independent, confident, and decisive, and less self-critical. They also generally feel better in their own skin and more comfortable with who they are, which can lead to new levels of sexual confidence and willingness to explore what they actually find pleasurable. Give it a try! Who knows, you might discover ways of connecting that bring you to new levels of intimacy and satisfaction.

 

  • Address Trauma: If you’ve been affected by trauma, please know that you are not alone. Any experience with trauma–not just sexual trauma–can cause issues with sexual function. Addressing your trauma with a qualified professional is the first step to resolving any sexual challenges you may be facing.

 

Here are some other great treatment options to consider:

  • Topical DHEA: Julva, a topical DHEA cream, can help rejuvenate vaginal tissue and support sexual health. It’s generally safe when used as directed, but always consult your healthcare provider–especially if you’ve had breast cancer. A recent study found that the use of vaginal DHEA in women after breast cancer treatment did result in increased hormone concentrations, though the levels were still within the lower postmenopausal hormone range.
  • Topical Estriol or Estradiol: Topical estriol or estradiol can increase clitoral sensitivity, improve vaginal tissue health, and prevent or treat atrophy. Estriol is a safer alternative to estradiol, and is just as effective. One study found that hormone levels remained unchanged after a 12-week treatment with 0.005% estriol vaginal gel in postmenopausal women with early hormone receptor-positive breast cancer. These results support the safety of 0.005% estriol vaginal gel for the treatment of vulvovaginal atrophy symptoms in women who have had breast cancer. While low-dose, locally applied estrogen can be a safe option, hormone levels should be closely monitored by your healthcare provider while using topical creams through testing like the DUTCH Sex Hormone Panel.
  • Pelvic Floor Physical Therapy : If you haven’t seen a pelvic floor physical therapist, now might be the time! Pelvic floor therapists are trained physical therapists who specialize in treating pelvic floor dysfunction. The pelvic floor refers to the muscles supporting the reproductive, urinary, and bowel organs. If you’ve ever given birth (vaginally or via cesarean), you should be assessed by a pelvic floor physical therapist. This type of therapy isn’t just for women who have given birth, though–it can be highly effective in treating pelvic pain, urinary and bowel problems, pelvic organ prolapse, sexual dysfunction, and more. In fact, research supports the use of pelvic floor physical therapy as a minimally invasive, first-line treatment for pelvic issues–including sexual dysfunction. 
  • Perifit: Ever think you’d get to play video games with your vagina? Perifit is a device similar to a sex toy that uses video game technology to help visualize, measure, and strengthen your pelvic floor muscles. It can help restore sexual function and pleasure and reduce incontinence. Not to mention, it’s fun and addictive!
  • Joylux vFit - Red Light Therapy: Red light therapy isn’t just for anti-aging skin treatments–it can also work wonders for vaginal health! vFit by Joylux is a non-invasive red light therapy device designed to improve vaginal moisture, tissue resilience, sensitivity, sensation, and sexual satisfaction in just three 10-12 minute sessions a week. Painless and hormone-free, vFit is easy to use from the comfort of your home. Some women see results in as little as 3 weeks! For faster and more complete results, Joylux offers a $99 upgrade to the vFit Gold Device that includes a 32% increase in power and 2 additional minutes of treatment time. You can access this upgrade and accelerate your results for free by purchasing through our office! For more information, contact us today. Contact our office for more information if you’re interested in the vFit–we can get you free access to the upgrade!
  • Bonafide Ristela: Ristela is a plant-based, hormone-free supplement formulated to improve orgasm and overall sexual satisfaction by increasing blood-flow to the vaginal area. After just two months of taking Ristela, 75% of women reported an increase in both physical arousal and sexual satisfaction, and 74% reported an increase in orgasm!

 

Other Factors Contributing to Sexual Dysfunction

It’s important to note a few other factors, not necessarily related to perimenopause, that can contribute to sexual dysfunction. Here are some common situations to consider, and how to address them. 

  • Clitoral Atrophy: Clitoral atrophy is when the clitoris shrinks in size and loses sensation due to impaired blood flow to the area, menopause, or having a hysterectomy. In the case of clitoral atrophy, the saying “use it or lose it” may actually come into play! Masturbation and exercises can help redirect blood flow to the clitoris, which can help in certain cases with clitoral atrophy. Don’t be afraid to ask your doctor about hormone therapy–estrogen may also be helpful.

 

  • Pelvic Organ Prolapse: Pelvic organ prolapse is a condition where one of the pelvic organs (most commonly the uterus or bladder) drops down into the vagina. This is common and not life threatening, but can significantly impact quality of life, sometimes causing symptoms like painful intercourse and decreased vaginal sensation. Other symptoms may include a feeling of fullness in the vagina, urinary problems, and feeling or seeing a lump inside or coming out of the vagina. If you think you’re dealing with pelvic organ prolapse, get evaluated by your doctor. Surgery isn’t the only option–he or she may recommend pelvic floor physical therapy, hormone therapy, or a vaginal pessary (a flexible device inserted into the vagina designed to support the areas affected by the prolapse).

 

  • Childbirth: Scarring and weakened pelvic muscles after childbirth can contribute to decreased sensation or discomfort during intercourse. This is extremely common, but can be addressed. Talk with your functional medicine provider, doctor, or pelvic floor physical therapist for recommendations.

 

Empower Your Perimenopausal Sexual Health

Perimenopause doesn't mean your nights between the sheets are over. Sexual wellness and satisfaction are an essential part of your health and happiness today and everyday! 

OPTION 1 My goal is to support you on this journey, helping you rediscover your vitality and sexual pleasure along the way. If you’re ready to embrace this phase of life with confidence, schedule a 15 minute call to learn more about how I can help guide you. 

OPTION 2 If you’re ready to embrace this phase of life without hormonal symptoms dragging you down, come learn more about our new program, The Reverse Age Method. 

This group coaching program is compassionately designed for women in perimenopause who want to stop menopausal weight gain, supercharge their energy, boost brainpower, and support glowing, vibrant skin. Oh yeah…and have great sex! Join us today.


Feet under the sheets of a bed

The Truth About Hormones & Your Sex Drive

Which of these best describes your sex drive?

Want it, need it, gotta have it!

Could take it or leave it...” or

Don’t even think about it!

Whatever you answer, there’s no shame.

Women are pretty reluctant to say our libido (or lack thereof) is one of our top health concerns. But when I dig deep with the women I work one-on-one with in my clinic, I find that almost all of them are struggling with their sex drive.

And personally, when I was struggling with hormone imbalance, my sex drive was non-existent. I thought it was just “normal.” After all, as women we are conditioned to believe we should want sex less than men.

Truth: healthy women have robust sex drives!

Our libido isn’t just dictated by whether our partner brings home flowers or we’ve shaved our legs - it is controlled by a complex group of hormones and neurotransmitters. Too much or too little of one or another can cause our sex drive to dwindle away or get out of hand.

That means that if your libido is lacking, you don’t just need to try lighting candles or new lingerie (although if your sex drive is healthy, that would sound fun instead of like a chore!). Balancing your hormones can restore a healthy libido.

Today, I want to explain how your hormones impact your sex drive. I hope this information empowers you - and if you have more questions or need more support, please reach out to me!

 

What This Article Can’t Do

Before I dig in to all the juicy hormone info, there are a couple other things I want to get out in the open.

First, most of the research on hormones has been done based on cisgender, heterosexual people and in heterosexual relationships. More research on hormones in other populations is long overdue. If you’re outside this group, some of this information will apply to you and some of it won’t - but I’d love to support you in overcoming hormone issues one-on-one until more inclusive research is available.

Secondly - as you're reading this I know symptoms of too much or too little of various hormones are going to jump out at you. But know this: the only way to diagnose hormone imbalances is with proper testing! That means blood, saliva, and/or urine testing.

Treatment for hormone imbalance is highly individualized, and I always recommend anyone who suspects hormone imbalance work one-on-one with a trained practitioner like myself for accurate testing and treatment! At the end of the article, I’ll share about my favorite hormone tests.

OK - disclaimers done - let’s get to the good stuff!

 

Estrogen - “The Feminine Hormone”

Estrogen is the hormone we associate with women. It makes women softer - both emotionally and physically. Estrogen is responsible for women’s curves: breasts, hips, and more fat on the butt! In studies of heterosexual men, women with higher estrogen levels were rated as more attractive.

It also increases a woman’s receptive sex drive—the part that makes her interested and open to penetration. Estrogen says “Take me now!”  Women with higher estrogen levels may have more of a seductive sex drive - they are more likely to be receptive to sex, more likely to flirt and give “I’m available” signals,  than they are likely to initiate it.

 

Testosterone  - “The Masculine Hormone”

What hormone causes horniness? Testosterone is the hormone associated with men - but healthy women have testosterone, too. It helps us build muscle and causes us to feel more competitive and aggressive. In the bedroom, testosterone makes us want to initiate sex and governs the drive for genital sex and orgasms. Women with higher testosterone levels tend to have more of an aggressive sex drive and are more likely to initiate sex than wait for a partner to start things up.  Interestingly, some post menopausal women have relatively higher testosterone levels (as compared to other hormones like estrogen) and may notice more of an interest in initiating at this phase in their lives.

Testosterone makes us less interested in relationships and commitment and more likely to want time alone (that’s what the Man Cave is for!). Women with higher testosterone levels tend to masturbate more, too. Too much testosterone can make us feel irritable - but too little can make us feel depressed.

 

Dopamine  - “The Pleasure Chemical”

Dopamine isn’t exactly a hormone - it’s actually a neurotransmitter. Dopamine helps us anticipate pleasure - therefore having the drive and motivation to take action. It’s dopamine that makes us anticipate that sex = pleasure.

People who are low in dopamine tend to seem “flat” - they lack interest, enthusiasm, and get-up-and-go.

Testosterone increases the activity of dopamine in our brains, so supplementing with testosterone is often prescribed for women with low libido. But in my experience, this rarely works - or at least not without other support - probably because the issue isn’t just low testosterone, but also low dopamine. (Just another reason why you have to test!)

 

DHEA  - “The Master Hormone”

DHEA is our most abundant circulating hormone. It’s produced both in the Adrenal glands and in the brain, and most of our other hormones are derived from it. DHEA levels peak in our 20s and start to decline from there - faster for some than others based on factors like your genetics and stress. Oral contraceptives are also know to lower DHEA levels.

Ideally, I like to see DHEA levels on the higher end of the normal range because DHEA can:

  • Lower risk of depression
  • Provide better function in old age
  • Protect against immune suppression when cortisol levels are high (from stress)
  • Prevent osteoporosis
  • Maintain muscle mass

And of course, DHEA plays a major role in sex drive, orgasms, and sex appeal. Higher levels of DHEA in women correlated with higher rates of sexual desirability in studies. Most of our pheromones are derived from DHEA - scents that in the animal world dictate attraction and mating. Pheromones are often what make us feel an “instant connection” or drawn to someone. When a woman complains of low libido, I always test her DHEA levels first!

In times of stress, DHEA levels decrease significantly -and this can cause a cascade of low hormones throughout your body, since most other hormones are derived from DHEA.

 

Oxytocin  - “The Love Molecule”

Oxytocin is a molecule that is triggered by physical touch. Oxytocin levels increase if you hug, hold hands, have sex, hold a baby - and even if you look at a dog! Levels of oxytocin also spike when you’re aroused and when you orgasm - it’s also what causes the uterus to contract during orgasm. If you’re in love, just thinking about the person can make your oxytocin levels go up.

Oxytocin helps you bond and feel love. It’s especially important for maternal bonding, and oxytocin levels rise during breastfeeding. Higher levels of oxytocin both reduce stress and rational thought - making it easier to “fall in love.”

 

Progesterone  - “The Cock Blocker”

Does progesterone increase libido? In my practice I call progesterone the cock-blocking, (or clam-jamming) hormone. Basically, progesterone stops your sex drive. The effect of progesterone on your sex drive is so powerful, monks used to take the herb Vitex (aka Chaste Tree Berry!) to promote progesterone production and block their sex drive. Progesterone actually numbs the erogenous zones, meaning you’re likely to have dull orgasm with more stimulation - or no orgasm at all.

Many women have high levels of progesterone because they take hormonal contraceptives. The birth control pill contains a synthetic form of progesterone called progestin. Great birth control, right? Just kill your sex drive completely!

Progesterone isn’t all bad though - it promotes maternal behavior and has a mild sedative effect. It can make you feel calm, happy, and that everything is a-okay.

Does ovulation make you horny? In the second half of the menstrual cycle (after ovulation), progesterone is naturally higher. That makes sense biologically - once you’ve ovulated, your body won’t drive you to sex for reproductive reasons. When natural progesterone is balanced with estrogen, the dip in sex drive isn’t as strong and some women don’t notice it at all. Others might just be more interested in cuddling rather than going for an orgasm.

 

Prolactin  - “The Nursing Hormone”

Prolactin is mostly associated with lactating women - it is the hormone that triggers your milk to let down after birth. Prolactin also tends to lower your sex drive - that’s why, in general, women have less sex when they are breastfeeding. Depending on your estrogen levels, you might retain some “receptive” sex drive even when prolactin is higher.

Promoting dopamine opposes prolactin. So if your prolactin levels are high and you’re NOT breastfeeding, using dopamine-promoting herbs can help lower prolactin and improve your sex drive. The only way to accurately gauge your prolactin levels is with testing!

 

Serotonin - “The Happy Chemical”

Serotonin is dopamine’s partner - together they are the two main neurotransmitters in the brain. Serotonin can impact your sex drive whether it’s too high or too low. Certain medications (like SSRIs) can cause high levels of serotonin. Dieting and chronically low calories can cause low serotonin, too.

Very high levels of serotonin dull your sex drive. That's why SSRI antidepressants have lowered sex drive and delayed/weaker orgasms as a side effect.

Conversely, low levels of serotonin can magnify your sex drive. In people with depression, low serotonin levels can even lead to sex addiction. In women with low serotonin, orgasms happen faster and easier. Men with low serotonin ejaculate right away.

 

Your Menstrual Cycle - “The Conductor”

Your menstrual cycle is like the conductor of all these hormones and chemicals. As the cycle progresses, hormone levels naturally rise and fall, leading to a shift in your sex drive.

At the beginning of your cycle, all hormone levels are low. Mid-cycle, estrogen and testosterone both spike - leading to an increase in sex drive (you’ll be both more aggressive and receptive to sex).

Many women also notice their libido peaks right before they start their period, as progesterone is naturally falling relative to testosterone. Your genitals will be more sensitive and it’s easier to orgasm during progesterone withdrawal.

During menses, some women have an increased sex drive - again because progesterone is lower relative to testosterone. But because serotonin levels can also drop during this time you might be grouchy too. Grumpy and horny!

The natural shift in hormones throughout the month can explain why sometimes you want sex more for the cuddling, emotional bonding, and skin-to-skin contact,  - and why other times you just want an orgasm without all the bells and whistles.

 

Your Hormones & Your Libido

Our sex drive is completely dependent on our hormones. And as you’ve learned in this article, it’s not as simple as “more testosterone makes you horny!” Balanced hormones are the key to a healthy sex drive.

If your sex drive isn’t how you’d like it to be - either too much or too little - looking at your hormone balance is a great place to start. I know you’re sick of hearing me say this by now, but the ONLY way to accurately diagnose hormone imbalance is with advanced testing. You never want to “guess and check” by starting treatments or supplements for what you “think” is the problem. This can cause even greater imbalances that take more time and work to resolve.

Over the years I’ve used blood and saliva hormone tests - but now I almost exclusively use the DUTCH hormone test. This test is a kit your practitioner orders and you complete at home. It uses dried urine (that’s what the D and U stand for in DUTCH) to accurately test various hormone levels. It’s more accurate than saliva testing, and much simpler than blood testing. You just pee on a stick, let it dry, and mail it back to the lab.

Once I know a patient’s hormone levels, we can work together to come up with a plan to balance them. I never share exact protocols publicly because I’ve never had 2 patients who needed the exact same treatment! Hormones really are that unique.

If this article has resonated with you and you think hormone imbalances could be at the root of your sex drive struggles, I hope you’ll book a free 20-minute exploration call with my team. There’s zero obligation, but we’ll dive deep into your issues and then share what we can do to help.

Having come out the other side of hormone imbalance, I can tell you - having my sex drive back is great! (And my husband loves it too.) I want the health and radiance that comes from balanced hormones for all women. Book a 20-minute call for free here!