120. SFMD After Dark Part 1 - Desire, Arousal & Why You’re Totally Normal

What if nothing is “wrong” with you… your body is just changing?

In this first episode of a three-part series, Dr. Stacy dives into a topic most women were never taught about: how desire and arousal actually work as we age — and why so many women feel confused, broken, or disconnected when things change.

This conversation was inspired by a recent live event for Sugar Free MD After Dark, where women asked honest, powerful questions about sex, intimacy, and what’s normal in midlife. Spoiler: a lot of what you’re experiencing is completely normal — and fixable.

In Part 1, Dr. Stacy breaks down:

• The difference between spontaneous vs. reactive desire (and why spontaneous desire naturally fades)
• Why arousal doesn’t always start in your head anymore — and why that’s okay
• The 5 domains that influence sexual desire (physical, mental, relational, cultural, and environmental)
• How stress, mental load, sleep, medications, and body changes impact libido
• Why pressure kills desire — and how desire mismatch affects relationships
• How emotional discomfort can drive overeating and impact weight loss
• Why planning intimacy doesn’t make it “fake” — it makes it possible

If you’ve ever thought:

• “I love my partner, but I don’t feel like I used to”
• “Something must be wrong with my hormones”
• “Why do I never want sex anymore?”

This episode will help you understand what’s really going on — without shame, hype, or oversimplified answers.

🧠 Important reminder: This episode is educational, not medical advice. Take what you learn here into informed conversations with your doctor.

👉 Coming next week in Part 2:
We’ll talk anatomy, hormones, vaginal health, and answer real questions from the live event — including what actually helps and what doesn’t.

📩 Questions or thoughts after listening?
Email: drstacy@sugarfreemd.com or admin@sugarfreemd.com

Free 2-Pound Plan Call!
Want to jump start your weight loss? Schedule a free call where Dr. Stacy Heimburger will work with you to create a personalized plan to lose 2 pounds in one week, factoring in your unique circumstances, challenges, and aspirations. Schedule now! www.sugarfreemd.com/2pound

This episode was produced by The Podcast Teacher: www.ThePodcastTeacher.com.

Transcript

Hey everybody, welcome back to the podcast. I have decided that I'm going to do a two-part series for you. I did an in-person event last night for a new course I'm launching called Sugar Free MD After Dark, and it is about women and desire and arousal and sexual health. Now that I'm menopause certified, I just think this is a huge area where we didn't learn anything, right? So it's a bunch of stuff I wish someone had told me at 30 and 35 that I want to share with you.

And for those of you who listen to the podcast strictly for weight loss, you're probably saying, “Stacy, how does this fit into weight loss?” And it does, because when we are feeling like there's something wrong with us, or we're not feeling sexy, or there's stress in our marriage because of a desire mismatch or one of the dozens of other things that surround our sexual health and our arousal and desire and all the things as we get a little bit older and things change a little bit, it can absolutely increase bad feelings that are uncomfortable, that we don't like, and lead to overeating.

So instead of turning to food, we're going to get real answers. You know me, I'm going to keep it as simple as I can, real speak, and hopefully you're going to leave this two-part series just feeling a lot more empowered, a lot better, maybe armed to ask some better questions of yourself, your spouse, your doctor, whatever that is.

Quick reminder, I'm not your doctor. This is just educational, but it is education that you can take to your doctor to make an informed decision about where you go from here, if hormones are right for you, lots of things.

So in part one today, I want to talk about just desire and arousal and how those things change and why they change and just sort of normalize everything. And then next week's episode, I want to talk specifically more about our anatomy, why we need what we need, and all the hormones, and sort of a Q&A after that.

So I ran this event live. I've got some amazing questions, and I'm going to go through sort of a Q&A at the end of part two. So you hopefully will get everything you need. As always, if you need more information or feel like there's questions I'm not answering, you can always email me, drstacy@sugarfreeMD.com or admin@sugarfreeMD.com, and those messages will get to me as well. You can tag me on Instagram, sugarfreeMD. It's actually sugar underscore free MD. That's the Instagram handle, and I'll answer whatever you want there as well.

So let's get into it a little bit. First of all, what I want to talk about is how there are two types of desire, okay, or two types of arousal. There is spontaneous and there is reactive. And so what's the difference?

Spontaneous is like in our twenties, right, where we see something and we're like, “I could do something with that,” right? And we have sexual feelings and we sort of get turned on pretty easily, and then we are ready to go.

I guess I should backtrack. We are going to use some explicit words. I'm not going to curse. I'm going to use anatomically correct terms, but it is a spicier episode. So if you've got kids listening, you might just want to take that into account.

So again, spontaneous desire. That's like when we were in our 20s, like somebody looked hot and we were like, “Let's go,” right? And we could kind of feel those feelings of arousal, some increased blood flow to areas, feeling good to go, and it really didn't take a lot to get in the mood. That is spontaneous desire.

That disappears really as we get older, right? No one told us that. So spontaneous desire dwindles quickly, and it's for a multitude of reasons. Our hormones are one of them.

Reactive desire or reactive arousal is where we start getting into it a little bit, right? We get a little touchy-feely with our partner. We start a little skin contact. We start making out a little bit, and then we're like, “This isn't so bad, right? I could do this.” That is reactive, okay?

And so with reactive desire and arousal, there's some things that we need to talk about before we get to that part. But if you are still able, while you get started, to be in the mood, that is reactive.

Right? So you start going, you're like, “Why was I avoiding this? This feels good,” right? And we don't have any problem having an orgasm, right? If we're having problems downstream of that, that's a different conversation. But for our conversation today, we used to quickly get aroused, very easily. We'd see a hot person on the street and be like, “Yep, let's go,” right? And now it is more like we need to get started a little bit. We need some intimacy. We need some connection. And once things kind of get going, we're like, “Yes, this is great,” and we can have completion and an orgasm and no problems.

Okay, so those are the two differences. I want to talk about just the influences and sort of the multifactorial situation that goes into our sexual function as females, because it is not just that pathway, right? There's all kinds of stuff going on.

So there's five domains, and I'll give you some examples from each one. One is physiology, that's like our physical body. Two, psychology, that's our mental space, right? Three is our social or sociocultural influences, right, so what society is telling us, what culture has told us. Four is our interpersonal relationship with our partner or a new partner or whatever that may be. And then five would be context and environment.

Okay, so am I feeling safe? Are our kids going to walk in? That kind of thing.

So let's do context and environment because I think that's the simplest one and that makes the most sense. If I don't have time to be intimate, it is hard to be intimate, right? So most of the women that are listening to my podcast, we are overscheduled. We are very busy. We have a tendency to take on a lot. We've got multiple kids or just multiple business pressures, whatever it is that are taking a lot of our time. So we need to make sure we have time for intimacy.

Okay, so if we have no time, that is a barrier, right? That is something that is going to sort of block this whole stream of arousal and intimacy.

The other thing would be privacy, right? If our kids are in our bed, if they're walking in, whatever, right? If we're just worried about privacy, it can really dampen the mood, right?

Physical comfort, right? So gone are the days where you're like, “I'll have sex on the beach,” right? Now you're like, “Sand,” right? So physical comfort. Am I feeling comfortable? And some of that is our comfort in our body as well, which is something we can coach about and get better on that section. But just having time, privacy, all that, okay? That's sort of like our environmental setup for either success or not success.

Sociocultural influences. This might be like education gaps, right? So part of it is myths about menopause, or like after kids, I'm not supposed to want to have sex, or good girls don't talk about sex, right? So some of you might just be like, “I can't listen to you today, Stacy, you're talking about sex?” That's fine. But understand that that's influencing this whole circle as well.

And then we have cultural messaging and our social media influencing, right? So everyone just saying like, “Take a testosterone shot, you'll be fine,” right? TikTok says I should, so that must be the answer, right? So those influences are back there as well.

In our personal relationship, this can have lots of little things under here, right? So maybe it is a new partner, right? A new partner or lack of a partner or multiple partners, whatever that is. It could be a desire mismatch. And I want to come back to that because I think that is sort of one of the areas of our highest opportunity in moving forward after this talk.

But it could be our partner performance, right? Lots of medications as men get older might affect their ability to perform, right? So some erectile dysfunction, maybe just pressure or obligation, right? So if you are feeling pressured to have sex by your partner, there is nothing that will turn off your desire more quickly than feeling obligated or pressured to have sex. It just won't.

And it could just be life stage factors, right? There could be just a lot of stress, right? Caring for an elderly parent, still caring for kids, like everybody needs your attention, and that can be stressful.

Let's talk for one second about this desire mismatch. I think this is our biggest opportunity. And women were not used to usually initiating this conversation. But an honest, open conversation with your partner about like, “Hey, Dr. Stacy tells me I'm totally normal not to spontaneously want sex every 35 seconds, so let's talk about it. My relationship and our sexual relationship and our connection is important to me. So can we talk about what, how, how much sex is going to work for us?”

And one of the questions that came up last night is sort of what's normal. The entire gamut is normal, everybody. It's whatever works for you and your partner.

So there are couples that are perfectly happy having sex one or two times a year or not at all, right? Some people have those relationships and they feel fulfilled in their relationship having little to no sex. Some people together have decided twice a day is what makes them happy, both partners are in agreement.

So the point of this conversation is to find out where is your partner? What would make them feel connected and satisfied? Where are you connected and satisfied? And if you're really like, “None, I feel connected and satisfied with none,” then the question really for you becomes how much are you willing to do for your partner to feel connected and satisfied, right?

So if you're like, “I want zero and he wants every day,” or maybe we settle on three times a week or something or every other day or something, right? It just needs to be a mutual agreement of what works for you as a couple.

So it's going to take an open and honest conversation, and you're going to feel better prepared for that conversation because you're listening to this podcast with me. Feel free to play it for your partner. Be like, “You should listen to this one.” And then you guys can just have an open dialogue.

What would make you feel connected enough, satisfied enough? What does that look like for you? And then we agree as a couple. That's it. And then we try it and then we reassess, right? So especially if there's a mismatch, we try meeting in the middle and then we have to reassess. Was that too much? Not enough? Where are we?

Okay, so dialogue is very important here. So that's why I think it's our biggest opportunity for just everyone feeling more satisfied in the relationship, at least from a sexual standpoint, is like, let's talk about it.

So that's interpersonal relationship. We're going to go back to physiology and psychology.

Physiology would be like, I'm menopausal and things are not feeling right and moisture is an issue, like everything is dry and sex hurts, right? So things we can address on that end.

Maybe it's substances or medications, right? So medications prescribed and self-medicating with substances that are not prescribed. All of those can affect our sexual function. Antidepressants are notorious for this. Drinking, THC use, right? All of those things can affect performance.

Poor sleep can fit in both of these categories, right? So if we're not sleeping because of menopause or medications or anything else, we need to address that and sort of get that under control.

So if we move over to the brain part, the psychological part, it would be things like I'm really anxious. I'm too anxious. I have too much mental load. I'm super stressed. I'm laying there in bed, you're trying to be intimate, and I'm running the to-do list for tomorrow. It's a mismatch mentally of what's going on.

So we might need to ask, can we split this mental load? Like I'll be ready to be intimate, but can you help me do these things first so that I'm not thinking about those things?

Body image and self-esteem can go here too. Alcohol and drug use can go here too. Sleep deprivation can go here too, right? Because it all messes with our brain.

The other thing, which I think especially when your kids might be younger, is this idea of touch aversion, right? Like everybody has been on me all day. I don't want to be touched right now.

And so that can feel very rejecting for your partner, right? And now we've got all these mental things that are messing up our desire and arousal. So we might just need to say, “Hey, I want to be connected, but I need no touching for the next 10 minutes,” or “I need to go for a walk and just have nobody be on me for a minute.” And that's very fair.

But if we've never heard of that, we don't know what's coming on, right? Until I heard that term, I didn't really understand that's what I was feeling.

And then the other thing is once we're being intimate, there's this thing that happens sometimes where we kind of have this out-of-body experience, especially for women, and we call it spectatoring. And so we're watching ourselves, and the most common thought that is pulling women out of the immediate interaction is this idea that I'm taking too long.

So just be mindful. If you're spectatoring, go back in and just try and do some of the mindfulness stuff that I've taught you before. Be really in the moment and just don't worry about it. Take as long as you need. You're going to take longer now than you did when you were 20, right? That's part of our anatomy changing and our arousal and desire changing. Blood flow is not happening as quickly as it used to.

So we're going to need a little more touching, a little more foreplay, a little bit more to get going. And so it is going to take longer, and that's okay, and you don't have to apologize for it.

So if you find yourself spectatoring, thinking “I'm taking too long,” take as long as you need, girl. It's fine.

All right, so I think that you can see there are so many factors influencing whether or not we feel like being in the mood or feel like being intimate.

Again, I think our biggest opportunity is just knowing that everything is fine and we are normal and this is okay, and that maybe there are some conversations with our partner.

So the desire loop, right? This is again going back to this idea that we have spontaneous desire or reactive desire. So what basically happens is instead of this immediate intense desire out of nowhere, we have to have some incentives for wanting to be intimate. And so that's usually connection.

We want to have this meaningful relationship and feel connected to our partner. And we know that they might want to be intimate more than we do. So all these reasons that we're like, “Yeah, we should, we will, we're okay,” right? It might not be like I'm hot for it, but we want the connection.

So the next thing we have to do is deliberately pay attention to the stimuli. If you are getting petted or you're making out, whatever, don't be spectatoring, don't be in your mental to-do list. Pay attention. Understand that I need all this to get going, so I need to be paying attention to what's going on.

Then we have all these biological factors that sort of get in the way. Have I slept? Am I on medicine? All that. But then we get going. We have this appraisal of the stimuli, like, “This feels good.” So we try and get back in the moment.

Then we start to have some physical response. Things start, we get more blood flow to all of our important areas, things start feeling good, and then we can continue on with our intimacy, usually reach orgasm, and then we feel satisfied.

Then we have these other benefits and rewards. We get that connection, and we just feel really close to our partner. Plus, it feels good to have an orgasm, or nobody would, right?

Desire does not always come first, and that is okay. For many women, arousal comes first. So we might not want to do it, but once we start, we're like, “This feels good.” So arousal comes first and then desire follows.

You can love your partner and still not feel spontaneous desire, and that is totally normal. If you hear nothing else from the podcast today, that is what I want you to take away. It is totally normal not to feel spontaneous desire. That does not mean you don't love your partner.

Comfort matters. If you are having pain with intercourse for menopausal reasons, we are going to go over hormones next week. There are things we can do. If it hurts, our brain is not going to be like, “Yeah, let's keep doing that.” So if you are having painful intercourse, there are hormonal and non-hormonal treatments that can help.

Pressure kills desire. Planning intimacy does not make it fake. In fact, planning is one of the most successful ways to handle this change in desire.

All right, I hope this was informative. I hope it wasn't too shocking. These are all the things no one told us when we were 35. I did not learn any of this in med school. Your doctors did not learn this in med school.

If you're not in Louisiana, take this information to your doctor. We will talk more specifically about medications and hormones next week. Until then, bye.