Episode 61: Why Libido Changes During Menopause

Sex and desire can change in midlife in ways that feel sudden, personal, and isolating. We wanted to pull this topic out of the shadows and put real language around what is actually happening in your body, your brain, and your life. Our guest, Dr. Sarah Berg, is a board-certified OBGYN and certified menopause practitioner known for a direct, honest approach, and she helps us replace shame with clarity. 

We dig into why menopause libido changes are rarely “just hormones.” Dr. Berg breaks down the biology that can make sex uncomfortable including vaginal dryness, tissue changes, pH shifts, and urinary symptoms that raise UTI risk or create fear of leakage. We define genitourinary syndrome of menopause (GSM) in plain terms, explain why it affects the vulva, vagina, urethra, and bladder, and talk through how painful sex can create a lasting pain-tension cycle that takes time to unwind. You will also hear why pelvic floor physical therapy can be a game changer for both function and pleasure, and what to expect if you book an evaluation. 

We also get practical about treatment options and expectations. Dr. Berg explains where vaginal estrogen fits, why it is different from systemic hormone therapy, and why it matters for comfort and UTI prevention. We cover testosterone as a possible tool for carefully selected cases, plus the real first step many women skip: bringing it up with your clinician and asking for time to address sexual health properly. If you are carrying the mental load, running on no sleep, or caring for everyone but yourself, we talk about that too because desire does not thrive in survival mode. 

Dr. Sarah Berg is a board-certified OB-GYN and Certified Menopause Practitioner who spent over a decade caring for women across all life stages. After seeing too many women feel dismissed or confused in midlife, she made it her mission to change that through education.

She is the founder of Selfority, a science-based women’s health education platform designed to make menopause information accessible, engaging, and empowering. Dr. Berg writes for Katie Couric Media, Parents.com, and Unbiased Science, and is a national speaker known for her honest, direct, and slightly “spicy” approach to women’s health.

Her work helps women better understand their bodies, advocate for their care, and feel confident navigating the menopause transition.

Website: https://www.selfority.com/

Let’s Talk Menopause Menoposium/ Boston: https://www.eventbrite.com/e/lets-talk-menopause-live-boston-ma-tickets

www.letstalkmenopause.org

MiDOViA LINKS:

Website: https://www.midovia.com/
Instagram: https://www.instagram.com/mymidovia
LinkedIn: http://www.linkedin.com/midovia
Email Us: info@midovia.com

MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness & supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.

The information, including but not limited to, text, graphics, images & other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. 

Transcript

Welcome And Topic Setup

Speaker 1 0:00

Welcome to the MiDOViA Menopause Podcast, your trusted source for information about menopause and midlife. Join us each episode as we have great conversations with great people. Tune in and enjoy the show. Welcome back to the MiDOViA Menopause Podcast, where we talk about the real experiences of midlife and what they mean for women's health, work, and longevity. Today we're talking about sexual health and desire during menopause. It's often reduced to a hormone conversation, but the reality is much more complex. Tissue issues, pelvic and urinary symptoms, sleep disruption, stress, and mental bandwidth all play a role. When we only focus on hormones, many women end up feeling confused and blaming themselves for changes that are actually biologically predictable. Our guest today is Dr. Sarah Berg, a board-certified OBGYN and certified menopause practitioner who spent more than a decade caring for women from adolescent through postmenopause. Over the years, she saw too many women in midlife feeling dismissed or isolated, which shaped her belief that education itself is preventative care. She's the founder of Self Fority, a science-based women's health education platform created to close the gap between medical evidence and cultural messaging around menopause. Dr. Berg also writes for Katie Couric Media, Parents.com, and Unbiased Science, translating complex medical research into language women and leaders can actually use. Known for her direct, honest, and slightly spicy approach, we hope you bring that today. She believes menopause education is about more than symptom relief. It's about restoring confidence and changing how we support women in midlife. Dr. Berg, welcome to the podcast. We're so glad you're here today.

Speaker 2 1:56

I am honored to be here. And oh my gosh, you have the best podcast production voice. I am loving it.

Speaker 1 2:03

Thank you.

Speaker 2 2:05

Thank you. Yay, April. Yay, yeah. I mean, you have a face for video, but you have a voice for radio. You've got it all.

Speaker 1 2:12

Oh, well, thank you. Maybe that's what I should have done, right? But here I am talking about menopause, and it's so much fun here too. I know I always put it.

Speaker 2 2:20

Wow, exactly. So, well, thank you again. Thank you so much for having me. I'm really excited to dive into this topic with everyone.

Why Libido Feels Hard To Discuss

Speaker 1 2:27

We are too. This is a topic that women are very curious about, and podcasts offer a safe space uh for them to learn, right? Um, so let's dive in. It's speaking of which, sexual health during menopause is it's rarely discussed openly. You know, we feel like once we start the conversation, you know, the doors and the hinges are kicked off and women want to talk about it. But why do you think that libido changes in midlife? What's so misunderstood about it?

Speaker 2 3:03

I think the biggest concern is that, or the biggest question is that it gets crowded into a corner and people are scared to talk about it. So the issue gets worse and worse without having great ideas of what to do about it. And like you said, when people start talking about it, all of a sudden the floodgates open. And I mean, people are bringing in information, never as a gynecologist, there's never too much, but they'll they'll tell you all the things. Um, but it's just opening that door and helping someone feel comfortable having that conversation because often they don't know where to have it. They're not necessarily sure if they want to talk about it with their friends.

Speaker 3 3:45

Yeah.

Speaker 2 3:45

They may not feel comfortable talking about with their mom or their grandmother, and then they go to a clinician and they may feel a little bit like the clinician's going, okay, okay, okay, okay, okay. So they don't feel like they have the space and time to have the conversation there. So it's kind of the in-the-closet feel a lot of women get about it. And the idea that we live in a world where people feel like they can't talk about sex, period. And especially when they reach a certain age, they feel like they're told that, you know, you're past your prime. So we aren't even going to discuss it. We're not going to showcase you on the on TV having sex. We're not going to showcase you in a movie having sex. Your 50-year-old uh co-star could be having sex, but the 50-year-old woman is the mother, the grandmother, the other factor. So you're not seeing it on the media to make you feel like there's a relatable person out there still sexually active and vibing that you can relate with.

Speaker 1 4:41

Yeah. Yeah. Do you think too um women uh women are afraid to talk about sexual health in general because we're told that we shouldn't enjoy sex. It's it's shameful. You're supposed to act a certain way. And then we hit midlife, and we have challenges now down there. And it's even it's even harder to talk about.

Speaker 2 5:06

Oh, yes. I think, period, for women, sex is hard to talk about because we get a lot of messaging saying we're supposed to not think about it, but when you go to the bedroom, you're supposed to be really, really good at it. And and you're just supposed to naturally know how to do everything. And I get questions from 20 on up. I have 80-year-olds that will ask me questions. I'm like, I wish you would have felt comfortable asking this when you were first having sex. Just like the anatomy of it, knowing what there, you know, a lot of women don't even want to look at their vagina. They don't know what it looks like, so they don't know what parts aren't working for them. They just are like that area. And I'm like, there's a lot going on down there. So we down there, yeah. Yeah. They're like, something here doesn't feel right. And then you're like, yeah, is it, you know, is it your clitoris? Is it your vagina? And even those words make people feel like cringe. But it's anatomy. It's just places where blood flows, it's just tissue that things go to. So it's that universal discomfort with talking about sex. But yes, even more so when we get to a stage where things aren't acting the way we feel like they should. And we are only told one way sex should feel or go through the process or our body should go through. And so when we hit the stage, we think something's wrong with us personally and us alone. And so then you start feeling bad about yourself, and then you kind of go into the box a little further. And I have all sorts of things to say about that.

Biology Behind Desire Changes

Speaker 6:38

Right, sure. Yeah. Well, and women talk about uh at this point in their life that they feel like their desire has changed. And, you know, what are the real biological drivers at this point that are causing that to happen? Because, you know, they could have loved to have it in their 20s and 30s, and all of a sudden they get to this point, they're like, I could care less. You know, sometimes I've heard heard, you know, and like you, we hear all the stories, you know, it's the dry vagina symptom, or I just don't really want it anymore, or it hurts, right? So what why does desire change at midlife? And what are some real things that are happening to people so that can understand why they feel this way?

Speaker 2 7:22

Well, I love starting with the biologic. So it's definitely not a one system area, but the biology is something that people don't think about a lot, or they think it's just an estrogen or testosterone problem. So, what you're saying, I want to key in on the idea that it sometimes hurts, or not only hurts, or they feel pressure or discomfort in the pelvic area, or they're worried they're gonna pee on their partner because they have incontinence issues, um, all the biologic issue from decreased estrogen because the estrogen receptors aren't getting fed with that estrogen supply are going to make a difference. And so walking through it, we know that the tissue changes. The tissue becomes less elastic, it becomes less lubricated. Um, and oftentimes, because of those changes, there's also a pH change. So your increased risk for infections. So urinary tract infections, but also bacterial overgrowth infections, which can bring smells and odors, which make people feel really uncomfortable. Um, and then you've got estrogen receptors on your bladder and your urethra, so where the urine is held and the tubing that comes out of. And so when those receptors aren't fed as well, you may notice some urge incontinence. So that I I love the commercial from the 90s where it's I gotta go, gotta go, gotta go right now. That feeling. So you all of a sudden have to go to the bathroom and you don't know when it's gonna hit. So that doesn't feel sexy, and even more so when you're thinking about when you're being penetrated, oh my gosh, is this gonna cause a trigger reaction? And then because of the increasing urinary tract infections, and you're thinking about the whole time, okay, when we get done, I have to go pee, and then I have to take my antibiotic that comes with it. So your brain is going somewhere else, which is a whole nother part of the decreased desire process because your brain half the time isn't even in the game. You're thinking about your laundry list or you're like what time you need to pick up the kids for school, and you're pretending like you're into it, but you're really somewhere completely different.

Speaker 3 9:32

Yeah.

Speaker 2 9:33

That's all again, that's we're getting into the brain side of it and all the brain reactions that are changing.

Speaker 9:38

Brain's important in this. I mean, you know, right?

Speaker 2 9:40

I would say the brain is our sex organ. Um, and we don't think about it, but a lot of what's going on is starting in the brain. And when we think about the psychosocial side of it, we've got the idea that you're now at the point in your life where you've got probably parents and family members you're taking care of. And we know there's the caregiver issue. You may have kids still in the house or kids in college that are still needing you. You've got a husband or significant other that may be needing you. Um, and at the same time, your brain isn't working the way it was because we know that there's brain fog and memory issues. And uh for people like me, rage around when your hormones aren't doing what they're supposed to do, when they're supposed to do it. Um, so there's a lot of brain issues going on that are going to play into your desire as well. But I was I'm I was trying to say in biology, but then I always go to the psychosocial. It's just so important.

Speaker 1 10:38

Hey friends, for those of you that are in the Boston area, we wanted to make you aware of a fabulous event that's coming up on May 1st. Let's Talk Menopause, one of our trusted partners, is hosting a half day in-person event in Boston. It's hosted by award-winning journalist, author, menopause advocate, and Let's Talk Menopause board member and ambassador, Tamson Fidel. You'll learn from leading women's health experts about how perimenopause, menopause, and postmenopause can impact your mood, memory, sleep, energy, weight, sex life, and just your general overall well-being. And what you can do about it. Tickets are still on sale, and we will put the link in our show notes for you in case you'd like to attend. Now back to the show.

Speaker 11:31

My first question after all that, Dr. Berg, is okay, what the hell am I supposed to do then?

Speaker 2 11:37

Yes. I think the question is ask. The question is take the time to make your sexual health and your sexual issues an important part of yourself again. Um, and do the things that are gonna make you feel as much like yourself as possible so that you can even care about sex anymore. So I always tell people if you haven't slept in weeks and you are feeling on the edge emotionally, and you've got all these other factors lining up, sex is gonna go to the very bottom of the list. So it's almost like you've got to hit those survival things first. And this is goes back to the like putting yourself on your list. I think so many women, we know we're not at our best, we know we're not doing well, but we put our needs and what we need to do for ourselves so low on the list, or not even on the list at all, that we're not taking care of our survival needs. And so without taking care of the survival needs, it's gonna be hard to get your libido back. And it's just gonna stay on the bottom of that list.

unknown 12:44

Yeah.

Speaker 12:44

It comes back to radical self-care.

Speaker 2 12:46

Yes, yes. We need to stop thinking of ourselves as extra. We're important. I'm important.

Speaker 1 12:55

We always say not necessarily a spa weekend, although those are really great if we can do that, but um, day to day.

Speaker 2 13:01

Yes. I mean, it's just like saying, hey, I feel better when I exercise. So even though it's not convenient to my family, I'm gonna take 30 minutes of my life and I'm gonna exercise. And I'm not gonna let anyone make me feel guilty about it. Right. I did that yesterday.

What GSM Means In Real Life

Speaker 13:17

I was on it. I first started saying, Hey, are you okay if? And then I'm like, I'm going to the gym. I'll be back.

Speaker 2 13:25

Right?

Speaker 1 13:25

Yeah, don't have to ask permission, right?

Speaker 2 13:28

We we all do it. Even if like I say it like I'm like, oh, hear me more. And then I'm like, um, is it okay if I take a minute to myself? Like, we all do it.

Speaker 1 13:37

Just take it. Yeah. I I want to come back to um the the pelvic floor. I want to come back to the genital tissue issues and and just unpack it a little bit more for our audience because I think sometimes we forget that we're in a bubble, right? We we we talk the talk, we hear about it, um, it's common. But our audience members might not fully understand what GSM is. Um, so if you if we can reverse and go back to just generally speaking, what is GSM? It's a mouthful. Um and and how does that affect our our overall physical health? What can happen in this stage of life? Just so that we prepare our audience members, and then I promise we won't leave you in that fearful place. We'll give you tools and solutions at the back end. But what am I looking at as I enter? What can I be looking at as I enter this perimenopause stage?

Speaker 2 14:43

I think that's a great question. And we do, we hear GSM, which is genito-urinary syndrome of menopause, floating in the space. And I think it's great to kind of step back and define it. Um, previously it was called vulvar vaginal atrophy, which was really not a good name for it because it wasn't just about your vagina, it was also about your bladder. So all the organs in that area have estrogen receptors, and so when the estrogen starts changing, then they're not getting that source that they've been using for the last 30 years that helps keep the tissue on point. And that includes your vagina, your vulva, your urethra, your bladder. So all those organs are are getting estrogen on the regular until you get to this point. Now, when you get to this point, it's not a grab and it all goes away. It goes up, it goes down, it goes all over the place. So your system also feels that. So it goes through the shift and adjustment. But as the estrogen starts to peter out, that area isn't getting the nutrients or the sourcing it used to, which can lead to the dry tissue. So we we um it's not lovely, but I said it a lot in the clinic, and people always nodded their heads. It can start to feel like if you're feeling the cat scooching across the carpet because it's trying to like help the irritability. That's how many women feel. So they even start changing what they wear and what kind of underwear they use because it your vaginal area gets very sensitive. So, of course, if it's sensitive to clothing and touch, it's going to be very different during sexual activity. And then also to the bladder and the urethra, the change and the decrease of estrogen makes the the bladder and urethra more um what's the word for it? It like is it's more nitpicky. Um, it really is on an edge. And so it will lead to more infections because the estrogen was kind of making a coating around the urethra and the vagina, keeping it for like a almost like a bacterial protection. And now that tissue is thinner, so the bacteria can get in so much easier. And also, we were talking about pelvic flora, it also can make that tissue that supports the bladder, supports the uterus, it can make it more loose and it doesn't do its job as well of holding everything where it used to be. And there are also other things that cause this. I mean, with time, just standing up can cause it. I mean, there's just resistance, it's gravity doing its job. If you've had multiple pregnancies, it can do that. If you've gained some weight and lost some weight or had more weight on the pelvic area, it can cause that pelvic tissue to be a little bit stretchier. But then when those things all start falling down, that doesn't feel good either. It's almost like everything feels like and can actually look like it's falling out. And you we will have patients that maybe don't even, if they haven't been seen in 10 or 15 years, come in and we literally see the cervix on the outside. That's how extreme it can be. And how little people take care. They feel like the again, themselves on the list when it gets that long, it didn't happen overnight. So if the pelvic tissue isn't holding everything out, that doesn't feel good. It feels odd, and you've already in this time frame, our bodies are doing a lot of things that don't feel normal or right. We know the estrogen decreasing and changing can cause that we love I call it the muffin top, that middle section because of a different kind of estrogen. So you feel not perfect about your body, you feel like you're out of control of how your body feels. And these are all factors that obviously don't make you feel the sexiest you've ever felt. Right.

Speaker 1 18:43

Absolutely. So painful sex, dryness, uh, bladder infections, UTIs. Um, you mentioned the pelvic floor as well. Can you uh talk to us about how the pelvic floor or pelvic floor health plays a role in sexual function and pleasure? Because I don't know that we always tie pelvic health to sexual pleasure. We think vagina, but we don't think pelvic floor. So can you help tie those two together for me?

Speaker 2 19:14

Absolutely. And truthfully this is not because I make anything off pelvic floor therapy recommendations, but I feel like every woman should at least get an evaluation with a pelvic physical therapist. And that is a physical therapist that literally went to an extra fellowship to be able to help with just the pelvic region. And this is men or women, but 90% of who they see are women. And so usually they are actually female. I think a majority of the pelvic floor therapists out there are female, which is again like how gynecology now is a little bit more tilted towards female. Yeah. It's the idea of you feel comfortable seeing someone, especially if you're going to if you've been to a physical therapy session, you know they're they're moving and doing and whatnot. They're doing the same thing in the pelvic area. So you have to come in knowing it's like a female exam that's just gonna go on for a little bit longer.

Speaker 3 20:07

Yeah.

Speaker 2 20:07

Um, so just putting my PSA out there that pelvic floor therapy is a thing. There are a lot of them out there, they are fabulous, and just knowing what's going on with your pelvic floor, especially in midlife, is a good starting point because when we have that loosening or changing of the pelvic floor, and there's usually two ways that this kind of plays out either the muscles start spasming, so actually it can be painful because there's two tints. Your body's tinting up because it's not feeling it's doing what it's supposed to, so it it's called hypertrophic, so it's tightening up, or a lot of times in this stage, hypotonic. So there's less tone and things are falling down, which makes the space that things are supposed to happen in feel unavailable. And so these are both things that are not like, oh, it's happened, this is who I am now, nothing can be done. We have the literally a physical therapist that can help with this, and they can help us decide if we even need to do surgery to help improve that for just feelings of well-being.

Speaker 3 21:12

Wow.

Speaker 2 21:13

So having the ability to put things back where they felt like they belonged is available, and something women can do to help themselves feel more like themselves in the vaginal area.

Speaker 1 21:27

It's so good that there's help available. We don't have to suffer, we don't have to suffer. We don't have to suffer, right?

Speaker 21:32

Yes, yeah. Pelvic floor physical therapy is actually kind of fascinating. I had no idea what I was walking into, and I learned a whole bunch about my body and that I didn't really understand and the relationship to my hips and all, you know, my C section scar and how that was pulling on my back. Like I learned a 10. So it was, I I appreciate that you say that because it was really interesting and helpful to be able to look at that. Um but you talked about pain and let's talk about that a little bit. You know, we have friends who are like, it hurts, I've tried everything. And so when sex becomes uncomfortable or painful, it sort of creates a cycle around that, a muscle memory, like this hurts, and I don't want to do this. What are you know, what are you hearing from your patients? What are you saying to them at that time? What kind of is happening uh physiologically and psychologically that you know women can become aware of to be able to maybe start addressing? Like what's your what's your um guidance on that?

Speaker 2 22:41

So it is a very common problem, and exactly what you said plays a major role in it. So you start having pain, likely because you may have started with either the two tight muscles in the pelvis, or usually more likely in the stage of life, it's because the dryness and the discomfort hasn't been treated and it's gotten so far down the line that it's now markedly painful every time you have uh intercourse. And once you get down that road, there's not a quick fix to get back. It takes time to undo. I would say it's usually a couple years of damage done that we can't undo in a month or two. It's gonna take a couple of months to undo, but now you've got that trigger in your brain, just like you were saying. The trigger in your brain saying, okay, every time I have sex, it's gonna hurt. So not only is there the discomfort, but then they feel like, okay, things didn't fix with the maybe the vaginal estrogen or the lubricant or the DEA um supplement they were given. And so they think if it didn't instantaneously get better, that it didn't work at all because we're used to kind of the antibiotic effect. We get a medicine and a day or two things are better. But these are the slow role. We're giving you just enough to kind of undo the damage, but it's a very slow role of getting things better. So, first of all, it's giving it time. So a lot of people, when they say it hurts and nothing I've done gotten better, there may be the part that they've given up quickly, and just because no one told them it's gonna take a long time to undo that. And once you kind of know in your brain, okay, not overnight, maybe three to six months, I'm gonna follow up with her. And really, if nothing's happening, we have another game plan, another medicine, another way we can do this. That usually mentally also unlocks there. But then the psychological side is that we are needing to undo that replay in the brain that's gonna cause every single time someone comes near you, you just have the full body tension mode. You know? Yeah, tightening up. Yes, it's like because that also doesn't help. And so again, this is another time I usually get pelvic floor therapy involved because even if it isn't a long-term tone issue, there's actually medicines that can be used in the vaginal area to relax. Like they actually have like vaginal volume you can use.

Speaker 1 25:05

Oh wow, I had no idea.

Speaker 2 25:06

Yeah, like to give it a moment, like it's also helping it down there. It absorbs very well, it doesn't go systemically. You're not gonna be like on cloud nine, but the vagina will. It's great. Yeah. But so that can kind of bridge that gap. So as the tissue's getting healthier and getting back to what it was before, you're also getting that musculature from doing the like seize up moment it was having. So that's that makes sense.

Testosterone And Other Treatment Tools

Speaker 1 25:33

That makes sense. You know, I I want to ask you this question because we're on the conversation um on pain in the vagina. Um, I've had a lot of women ask, can I just take testosterone? Does that really help with libido? Can you address that?

Speaker 2 25:49

That is a great question. And it can be a tool, I call it a tool in the toolbox. Um, so testosterone is uh we know helpful for women with hyposexual desire disorder. So that means you've run through the whole gantlet of things that are going on. So it's not pain that's causing the problem, it's not disconnect from your partner and uh psychosocial issues that are causing the problem, it's not a medication that you're on that has a side effect problem. So you really have to do a lot of work to say there's nothing else going on, there's no other issue. And then testosterone is a good idea, it could be a good bolster. Um, and it does work, and it's definitely a medication that we can try and use, but there's, I wouldn't call it a magic bullet. And and I always say this with um anything, if ever someone tells you it works for everyone, it's gonna fix everything. We are not one size fits all. We are so cool. We're the onions, we are multidimensional, we have layers, like there are things going on, so there's not one thing everyone's gonna do that's gonna fix a problem, but it's a tool and it definitely has a place, but it's not like this is a thing that's a hard for people to really get their head around, is that there's not a level that we need to like start treating at, like, oh, my level of testosterone is is 0.1, so I need it because I need it to be a certain level. We only treat if you're having this the problem, we can't figure out another reason, and then we only check labs after just to make sure you don't get out of a normal female range because then you can have a lot of side effects that you probably won't want to have. Yeah, yeah. And so that's why I say it's like you'll hear people saying, But my lab said this. And I was like, But what did you come in for? What was the original problem? Did you kind of get talked into it? Because that can happen too.

How To Talk To Your Doctor

Speaker 27:49

I really love how you're like, some of this takes time. You got to experiment a little bit to see what really works for you and what might work for me might not work for you. And so figuring out what this proper mix is to help you feel really good is something you shouldn't give up on, right? Just because it takes some time. Let's look at some like practical guidance. What are the first signs someone should pay attention to when it comes to their sexual health at midlife?

Speaker 2 28:18

If it's causing them a problem. Because, you know, uh again, sex is wonderful, it's amazing, it's awesome. But having sex isn't a requirement of life. So if you are truly someone that has never had a sex drive and doesn't really want to have sex, that's not a problem unless it's affecting you. Um, even if your partner has issues with that, that's his problem or her problem. That's not your problem. Um, but if you do want to have a sexual relationship and you notice that decrease and that kind of top off, then the first thing is like bring it up with a physician. Even if they're not asking about it, bring it up, and one of two things will happen. One, hopefully they're able to at least give some guidance, even if it's in your well-woman exam or your yearly check-in, and be like, hey, but hopefully you get a follow-up visit that's all about that. So you have time committed to talking about that part of your health because it shouldn't be able to be something that you can talk about in two to three minutes, which may be all they have in your annual exam to give something like that. Yeah. And then I always think it's important for I say everyone needs therapy. It doesn't matter if you're happy, sad, whatnot. And then if it's with somebody else, like if you want to do couple therapy, that's also great. But I think it's great to look for sources of people that can get into the brain and think about what else is going on. So again, it's not just physical, there's a mental component, and we need to we need to catch them all. And we need to answer all the questions.

Speaker 29:55

Yeah, and you know, you said tell your doctor, like first off, tell your doctor. And it's funny, I was listening to a podcast yesterday where an attorney said, only you should feel safe giving the truth to your attorney and your doctor because they swear an oath of confidentiality. So talk to your doctor and don't be afraid. Because I'm like, I'm fine, fine, I'm fine, you know. But you're you have that person on your team to help you figure out how to be really fine, not just fine, fine.

Speaker 1 30:22

I like to unpack that a little bit more because you know me, Kim. I just want to go a little bit deeper and get a go more to the audience. Okay, so I have someone who isn't comfortable talking about sex, sexual health. I hit midlife. Now I really need to talk about it because I do want to have sex, it's painful. I'm I'm having challenges. I go see my physician. What do I even say? I mean, what are the words that come out of my mouth, right? I mean, I think that that is an obstacle for a lot of women. It's easy to say, go talk to your doctor, but I don't know, I don't even know how to bring it up.

unknown 31:01

Yeah.

Speaker 1 31:01

What do I say?

Speaker 2 31:03

The easiest thing is to say, I want to talk about my sexual health. It doesn't feel the same as it did a year or two before.

Speaker 1 31:10

There you go.

Speaker 2 31:11

And then that's just a leap-off point. And there should be a lot of follow-up questions. There should be a lot that they can offer. And, you know, I actually just wrote an article about this. Like, there's a lot of statistics about doctors not bringing it up. And I get it from the doctor's side because we have like a laundry list of things we have to get through. So I get where it might not be the top thing they're asking, but I hope the more we talk about it, the more your doctor may be able to bridge that because we know it's uncomfortable to talk about with us. But we also know that we have answered the craziest questions you'll ever think of, and they stay right here because we have HIPAA and we think it's really important. And so there's nothing you're gonna ask us that we are like, no one's ever asked that before. And I can't believe, or I can't believe you didn't know that about your body. Like, we just want, we don't, we like we said, we're an ecosystem, we talk about this all day, and your doctor's an ecosystem, they talk about this stuff all day. So whatever you're bringing to them, it's not gonna feel weird or out of the box. They're just they're literally gonna come back at you and talk just like I'm talking right now. It's like, oh, okay, yeah, your vagina feels weird. Let's go take a look at it.

Speaker 32:21

And if they don't, then you go find another doctor. Yes. Absolutely. Yeah.

Speaker 1 32:26

Yes. But but I think it's important too to remind everyone that this is very common that you aren't the only one. Yeah. You are not the only one. Um, and this is not the first time that your doctor has heard this. That there are what's the percentage? Do you know how many, what percentage of women suffer from GSM? Just just GSM?

Speaker 2 32:46

Over 80%. Yeah.

Speaker 1 32:48

So it's a lot of us.

Speaker 2 32:50

70. And this is just the people that are saying it in a survey. So this isn't actually, I think these numbers are way higher. 745% of them say they have sexual issues because of GSM, which means they have some sort of pain issue because of the dryness and the irritability. Yeah. That's huge. It is huge.

Speaker 33:09

A lot. Yeah. I also like Dr. Berg that you were saying, like, you, you know, maybe you don't want to have sex. So if you don't, that's okay too. But if you do, then let's figure out how to make it great.

Speaker 2 33:19

Yes.

Speaker 1 33:21

Yes. And vaginal estrogen can help with the dryness. I'm not sure if we mentioned that or not.

Speaker 2 33:26

Well, if we didn't, I'm sorry.

Speaker 1 33:28

No, I don't I can't remember. Wait, we it's a good conversation. So if we haven't, it does help, right?

Speaker 2 33:33

Oh my gosh. And so people think of vaginal estrogen the same way they think of estrogen that goes throughout the body, and it's night and day. Like we can actually give you extra vaginal estrogen even if you're already on systemic or all over estrogen. That's how localized it is. So most people, even when they've had breast cancer, can have vaginal estrogen. If you've had blood clots, can have vaginal estrogen. Liver issues, you can have vaginal estrogen. Of course, you have to talk to your doctor and it's individualized case because, again, we're not one size fits all. But most people can be on it even if you don't feel comfortable being on systemically or all over your body. And so I think that I'm thank you for bringing up because that is something I don't feel like we talk about enough. Yeah. I have uh Rachel Rubin has a story that I want to bring up, and it's her story, but I think it's so important. And she says it a lot, so I know it's important to her. When her mom was in the ICU, very sick, obviously not moving around. So she had a clotting risk, so they had her on medicines to help prevent clots. She was upset, appropriately so, because they stopped giving her vaginal estrogen. And the nurses and the doctors were like, no, we wouldn't give her something that can increase clots because she's, you know, in this high clot state because she's not moving around. And she's like, heck no, you're more likely going to give her a UTI if we take away her vaginal estrogen, which we know in this situation can lead to sepsis and death. So she's like, do not kill my mother by not giving her vaginal estrogen. And that's how intense it could be. Like, that's a good medicine that you really don't, there's not a lot of reasons not to give it. Right. If you're scared of estrogen, I hear you, I get you. But please don't be scared of vaginal estrogen because it's a whole different playground.

Speaker 1 35:25

Yeah, I love that. I love that you clarified that and that it helps with UTIs. So uh it helps, it just helps. I tell my daughter, you know, you don't have to wait until you're suffering. You don't have to wait two years down the line for your, you know, vaginal health to be suffering before you get your vaginal estrogen when you're our age. Ask for it when you hit perimenopause. Use it as preventative medicine. You don't have to get to that point to suffer. So I love it. It's on our list. Like, I have a list for you, honey. Like if I die tomorrow, this is on your list.

Speaker 2 35:59

Like And this is what I love about what we're doing here is that we are doing it in the thought process of I'm I want my daughter to have a better version of this than I did. Absolutely. My daughter knows way more about menopause than most women do. And she jokes, she's like, oh, not another conversation about menopause. But I think it's important. We talk about puberty with her. I wanted to know the other side, and I wanted to know maybe why I'm grouchy that day, just like I want her to tell me why she feels that grouchy that day.

Speaker 36:30

Yeah, that's right. And I think it's safe to say that the three of us do the work that we do so that our daughters don't have to suffer.

Speaker 2 36:36

Yes.

Speaker 36:36

Yeah, we wake up in the morning because we want our daughters to have a different experience than what we had.

Speaker 2 36:42

And I'm always telling my son too, because I want him to be a guy that isn't afraid to hear all this stuff. Yeah, yes. Because I always say this is all about the women that deal with it and the people that love them. So that's it should be everybody.

Speaker 36:55

It should be, yes, I think yes, I agree. We agree with you on that.

Speaker 1 37:00

Well, and and you know, here's the thing when we talk to our sons um about this, if and when they end up in a marriage with partners who are experiencing what we're talking about here, they're going to be a lot more compassionate and understanding, and they're going to know how to help. So, you know, again, we're trying to avoid the situation that we're in right now, the lot of relationships and sexual health that isn't what we want it to be, right? And not having conversations with their spouse and being afraid and fill in the blank. So hats off to you.

Partners, Relationships, And Support

Speaker 2 37:34

And I think going back to sexual health with this idea, a lot of the patients would come in because their husband was unsatisfied or their significant other was unsatisfied. And I, we had to have that, you know, come to, you know, come to moment where I was like, but how do you feel? Yeah. What is your purpose? What do you feel like you like him enough right now with him telling you these things about you to want to have a sexual relationship? Because sex is about bonding together, it's about having a good time together. And if you really don't like your significant other because they're telling you all this stuff that's bad about you, why would you ever want to have intercourse with them? Like, come on. So, but I heard that often and I was like, this is a relationship issue that may or may not work. And then maybe if it doesn't work, because sometimes I heard things and I was like, I don't like that man. Um, but I didn't say it out loud. I kept it in my hippo. I kept it in my bubble, in my hippet bubble, and I would say, and then when they were out of that relationship and I see them with a new person, I was like, see, there's you now you want to make this work.

Speaker 1 38:43

Yeah.

Speaker 2 38:44

And again, there are for lots of reasons, there's a lot of divorces around this time. And we are not blaming menopause on divorces, but I think it's important to know that this might be the first time you have things that aren't that you're needing people to assist you with. And if those people aren't there to support you, then that might be a sign and you deserve to be supported. Again, putting yourself on that list.

Speaker 39:09

That's a great point. Yeah, a really good point. Okay, we could talk forever, and we probably will talk again. But if there's one message you wish every midlife woman understood about libido and sexual health, what would that be?

Speaker 2 39:22

Oh, one message. Um, you don't need to take it on as one.

Speaker 39:26

I mean, you know what I mean though.

Speaker 2 39:27

You are not alone. This is very common and it gets asked all the time in the privacy of the office, even if your girlfriends aren't talking about it or your family isn't talking about it. This is very common and it is very appropriate to bring to your primary care, your gynecologist, your therapist, whoever.

Speaker 1 39:46

Thank you.

Speaker 2 39:46

I love that.

Speaker 1 39:47

Yeah, that's a great reminder. I'm gonna ask you actually one more question because we ask everyone this last question. What's the best piece of advice that you've ever received?

Speaker 2 39:57

You do you boo. You do you boo.

Speaker 40:02

That's so good.

Speaker 2 40:03

From my daughter.

Speaker 40:05

That is really good.

Speaker 2 40:08

She is a champ. Yeah, oh yeah. She's got all the personality. I don't know where she gets it from. No, right.

Speaker 40:14

Well, Dr. Berg, where can people find you?

Speaker 2 40:17

So I am I have a uh educational platform called Self 40, and I made a masterclass on education around menopause. And I actually have a whole, like I made a whole section around sex education because I thought it was that important. It's not just like slipped in other areas, but it's standalone, it's got its own music, it's rocking. Um, but it's all about helping people learn about themselves in the way that feels comfortable. And we love watching videos. So it's videos not only of me talking, but there's other stuff coming in and out because no one wants to watch me talk for like six hours. But it's little segments, it's broken up so it's easy to kind of follow through. And then I'm love being on social media just so that I can help answer the questions people are asking me. So I'm at self-fority on Instagram and Facebook and LinkedIn, and then I write a ton because it's so much fun. So I have a subsect that you could follow as well.

Final Advice And Where To Find Her

Speaker 1 41:11

Amazing. Fantastic. And we will put all of the links in our show notes as well, everyone, so that you can find those easily and you can find Dr. Berg. And this has been a fantastic conversation. Have no doubt that we are going to help audience members find good sexual health. Healthy sexual health. Is that a thing? And I guess it's like that. Healthy sexual health, yeah. Yeah. So thank you for being here and spending the time with us today. And audience members, until we meet again, go find joy in the journey. Thanks. Take care, everyone. Thank you for listening to the Medovia Menopause podcast. If you enjoyed today's show, please give it a thumbs up, subscribe for future episodes, leave a review, and share this episode with a friend. Medovia is out to change the narrative. Learn more at Medovia.com. That's M I D O V I A.com.