My Rusty Valentine

Not tonight, honey, I have perimenopause

Is this you? You’re tired of feeling awful. You don’t have time or energy to figure out perimenopause. Your brain is swirling with information you can’t make sense of. You wish you had someone you could talk to. If you’re at this point, I can help sort it all out with you based on your individual experience.

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With Valentine’s Day creeping up in just a few hours, I thought it’d be the perfect time to tackle a hot topic: libido during perimenopause. Nothing says romance than arriving to the bedroom already hot and sweaty.

There’s a popular myth floating around the internet that libido is driven solely by testosterone. Well, let’s clear that up before Cupid's arrow strikes! For women, it’s much more complicated than this, which I’ll discuss in this week’s article.

Before we proceed, I want to acknowledge that discussing sex can be uncomfortable or challenging for some women. It's completely acceptable to move at your own pace and comfort level even if it means skipping this article.

However, if you're concerned about your libido and want to do something about it, it’s important to remember the saying, “In order to clean, you have to see the dirt,” which means learning about it and self-reflection. I found out through this process that I could talk to anyone else about sex, but having honest and meaningful conversations with myself about it made me uncomfortable. It was something I had to work on.

This article also assumes that you don’t have a history with sexual abuse, harassment, or any other situation that may complicate things further.

What is Libido?

Libido is a desire for sex. Everyone has a different range of what’s normal for them when it comes to libido. What you would consider low libido could be high for someone else. It’s all individualized.

When it comes to desire, Vanessa Marin, LMFT author of the book Sex Talks: The Five Conversations That Will Transform Your Love Life and licensed psychotherapist specializing in sex therapy, has the best quote about desire “It’s a fucking fairytale.”

What you see in movies where two people are instantly attracted to each other and rip off each other's clothes is not real life, especially in long-term relationships. In reality, desire encompasses both mental and physical aspects.

According to the experts, there are two types of desire: "spontaneous” and “responsive.” In each couple, a blend of both types exists, and this can shift over time, causing a spontaneous individual to become more responsive and vice versa.

The different combinations in a partnership are:

• Spontaneous person with a spontaneous partner

• Responsive person with a responsive partner

• Spontaneous person with a responsive partner.

People with spontaneous desire are turned on mentally first (meaning they think about sex), and then their body’s arousal signals follow. People with responsive desire need to be turned on physically first and then are turned on mentally.

A spontaneous person may be more likely to initiate sex in a relationship than a responsive person. This can cause conflict within couples, where one feels that they are always the initiator or because the other one is always initiating.

So you have this underlying difference at the heart of it, a possible disconnect between desire types.

Enter, Perimenopause….

Like everything else, perimenopause adds another layer of complexity to the situation. As I mentioned above, testosterone levels are just one factor in determining libido in women, and the more research I read, the clearer it becomes that it’s a minor factor in perimenopause.

During perimenopause, testosterone levels are typically normal or even high. Testosterone generally does not decline until after menopause and is considered part of the aging process rather than the menopause process itself.

It's possible to have high testosterone levels but still experience low libido or have low testosterone levels while experiencing high libido. There’s not a direct, one-to-one relationship between testosterone levels and libido in women.

Women are far more complex than men when it comes to sexual dynamics. For many women, the factors contributing to sexual excitement can vary widely and are not solely based on physical stimulation. Emotional intimacy and connection play a crucial role and are delicate things that can be disturbed easily.

Let’s look at some examples of physical and emotional challenges that influence a woman’s sexual interest.

Physical Challenges

Women can experience physical changes during perimenopause that can cause discomfort anywhere in the body, including issues related to the vagina and bladder. We become more susceptible to urinary and vaginal infections and may notice visible changes to the entire genital area, which can affect our interest in sex.

Pain in any part of the body can dampen your interest. I once joked that perimenopause should be called “SHED Syndrome,” which stands for Something Hurts Every Day.

If you’re dealing with discomfort during intercourse or general vaginal discomfort outside of the bedroom, know that there are solutions. To learn more about this, read my article, Papaya Dryness.

I started evaluating my libido by looking at the physical barriers that were holding me back. This was the easiest area for me to investigate as a starting point. I worked with a urologist who got me back on track, so I didn’t have to worry so much about ending up with a UTI or dealing with dryness irritation.

I solved one problem, and it brought me a great sense of relief to have a plan in place - one less thing to worry about. At this point, I felt a bit invincible, so I took the opportunity to step out of my comfort zone by reading books about sex and relationships to gain a better understanding of what information was out there that I’d find helpful. This process was driven by curiosity, but it was also, at times, painful, as I had to confront and discard many assumptions I had been making.

Here are some other physical considerations that may impact your interest:

• Cycles where we don’t ovulate. It’s very common in perimenopause to have what’s called an “anovulatory” cycle, which means that we don’t release an egg, which means we don’t ovulate, which means we don’t release the chemicals that get us in the mood around ovulation. The body spikes our sexual interest during this time to help us procreate.

• Fatigue

• Hormonal fluctuations can make us feel not like ourselves or to not like ourselves

• Being generally physically uncomfortable

• Dopamine, serotonin, and oxytocin are all affected by hormonal fluctuations

• Feeling “touched out” and activated in our nervous system and how we respond

• Things feeling different during intercourse or it has become painful

• Chronic diseases

• Weight gain

• Mood changes

• Feeling burnt-out

Emotional Challenges

For women, there is a great emotional component that also affects our interest in sex and intimacy. Factors such as the quality of the relationship, feelings of safety and trust, and overall emotional connection can greatly influence your feelings of attraction and desire.

It’s important to also think about the emotional aspects that could be involved. Here are some examples:

• Not feeling attractive

• Feeling relationship or sexual resentment

• Body image issues

• Emotional considerations of a long-term relationship (the “new” feeling and excitement are gone)

• Feeling like this is just another area for perfectionism or not feeling good enough

But my absolute favorite reason came from a sex therapist that I had breakfast with during The Menopause Society annual meeting last year. (There’s nothing like pondering the mysteries of intimacy over breakfast. No need for coffee; that will wake you up!)

She said to me, “I ask my clients, ‘If I had a magic pill to fix your low libido instantly, would you be happy with what was being offered in the bedroom.’”

Alexandra Stockwell, a physician, intimacy coach & marriage expert, believes that this is the critical factor in relationships, that if you put physical problems aside, this is the #1 reason why women aren’t interested in sex – we don’t like what we’re being offered. And, that can mean different things to different women.

So, if you’re not getting what you want, it’s time to evaluate what you do want and to speak up! I recommend the book I mentioned above (which is inclusive of different types of couples). If you’re looking for something specifically for man/woman relationships, I really enjoy the work of Shanti Feldhahn, who wrote several helpful books, including her latest Secrets of Sex & Marriage (cheesy title, but I found this book so fascinating).

When it comes to the emotional side of our libido, I’m going to end this article with a song that makes this point on how important it is, “It Matters to Her” by Scott McCreery:

“It matters to her, it stays on her mind
When you put her first every single time
When you think she don't see, when you think she don't care
When you think she don't notice what you're doin' there
Every little look, every single word
Oh, it matters to her”

Be well, stay cool…

Shelby Tutty, MHA
Certified Perimenopause Educator
Founder of The Periprofessional, LLC

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