Pleasure in the Pause: Midlife Conversations About Menopause, Sex & Pleasure
Menopause doesn't mean the end of pleasure — it’s a new beginning! Pleasure in the Pause is the podcast redefining midlife for women ready to reconnect with their bodies, pleasure, and power — at every stage of the menopause journey and beyond. Hosted by Gabriella Espinosa, certified menopause coach and sexual health advocate, each episode features informative and thought-provoking conversations with doctors, thought leaders, and wellness experts on hormones, sexual health, desire, and healthy aging.
Expect actionable strategies and empowering insights to help you feel more confident, energized, and connected to your body — no matter your age. Together, we’ll reframe the conversation around pleasure, sex, and midlife so you can be the best advocate for your body — in and out of the bedroom. Because PLEASURE HAS NO EXPIRATION DATE! Say YES! to Pleasure at www.pleasureinthepause.com
Pleasure in the Pause: Midlife Conversations About Menopause, Sex & Pleasure
115 | Love in Midlife: Navigating Intimacy and Change with Dr. Tina Sogocio
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Two women. Both champions in the midlife women's health space. Both celebrating their 25th wedding anniversaries in the same summer. And both deeply committed to changing the conversation around intimacy, pleasure, and connection in midlife.
In this episode Gabriella sits in the interviewee seat again, joining Dr. Tina Sogocio, physician and menopause educator, for an Instagram Live conversation about what it actually takes to keep love alive through one of the most destabilizing transitions a woman can go through. This is a conversation between two midlife women comparing notes — on long marriages, on the changes menopause brings to intimacy and identity, on what couples who come out stronger actually do differently, and on why this generation of women has an opportunity their mothers never did.
Warm, honest, and full of practical wisdom from both sides of the exam room, this episode will leave you feeling seen, informed, and a little more hopeful about what is possible in love and intimacy in this season of life.
Are you ready to awaken your sensuality and feel more empowered in your body? Access the FREE Pleasure Upgrade Bundle at https://www.pleasureinthepause.com/gift.
Dr. Tina Sogocio is a physician, menopause educator, and advocate focused on helping women better understand and navigate the hormonal transitions of midlife. Through both her clinical care and public education work, she supports women during perimenopause, menopause, and the years that follow. In addition to caring for patients, Dr. Sogocio speaks and leads community conversations that bring clear, compassionate insight to women’s health and midlife well-being.
Highlights from our discussion include:
- Why menopause pulls the Band-Aid off and makes couples vulnerable in ways they were not prepared for
- How couples who come out stronger approach change with curiosity rather than going quiet
- Why feeling seen and heard by a partner is the foundation of intimacy and the best foreplay there is
- The difference between therapy and coaching and why both play a vital role in midlife healing
- How the nervous system river metaphor explains why so many women cannot find their way back to pleasure, joy, and connection
- Why doctors have to do better at asking directly about intimate health and what women can do when they do not
- Why this generation of women is redefining what love, intimacy, and pleasure look like in the second half of life
Dr. Tina said something near the end of our conversation that I keep coming back to. It is not a one and done. We are constantly evolving. And the post-menopausal years are not a winding down. They are an invitation to live into. Our generation of women has an opportunity our mothers never had — to redefine who we are becoming and how we want to live, love, and feel in this season of life. That is not a small thing. That is everything.
If this episode resonated, subscribe to Pleasure in the Pause and share it with a woman or a couple in your life who needs this conversation. And if you want to go deeper into this work, you will find all of Gabriela's coaching resources at pleasureinthepause.com.
If you're seeking to reclaim your pleasure and vitality, join Gabriella atwww.pleasureinthepause.com for this enlightening journey into the heart of female pleasure and empowerment.
CONNECT WITH DR. TINA SOGOCIO:
https://www.instagram.com/the.drtina
https://www.youtube.com/@the.drtina
https://www.facebook.com/mociwellness
CONNECT WITH GABRIELLA ESPINOSA:
Episode 114 — Intimate Wellness with Sally Mueller and Womaness
Episode 110 — How Co-Regulation Deepens Intimacy
Full episodes on YouTube.
The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.
Introduction and Gabriella's 25th wedding anniversary
Gabriella EspinosaWelcome to Pleasure in the Pause, a podcast dedicated to empowering midlife women to connect with their bodies, pleasure, and power in Perimenopause, Menopause, and beyond. I am your host, Gabriela Espinoza. Each week I sit down with leading medical experts, thought leaders, and trailblazers for bold, thought-provoking conversations that educate, inspire, and challenge the myths we've been taught about our bodies, aging, and sexuality. I also share solo episodes with evidence-based insights and real talk to help you feel informed, supported, and in charge of your health and pleasure in this season of life. Because your pleasure matters in and out of the bedroom. So take a deep breath, settle into your body, and let's begin. Hello, beautiful listeners. Welcome back to Pleasure in the Pause. I recently celebrated my 25th wedding anniversary. Twenty five years. Wow. I'm sitting with so much gratitude for this love, for this connection, for this life my husband and I have built together. Because here's the thing, I didn't grow up with a lot of examples of long-lasting love. I've shared here on the podcast before how my parents divorced when I was a young girl, and there was a lot of conflict in our house. Enough that for a long time I thought that's what relationships actually involved. Conflict. But then I met Ted and he felt like the family I always wanted. We were friends for almost a year before we ever decided to be together. We just got to know each other by being exactly who we were. No performing or trying to impress. And then one day we both had this unmistakable knowing that this is my person. Before long, we found ourselves dreaming about the life we wanted to build together. And here we find ourselves 25 years later, we've raised three incredible children and navigated every season of life together. I never knew this kind of love was possible. But when love is rooted in trust, respect and generosity, it becomes a place where every version of you is welcomed. And that's really what today's conversation is about. What it actually takes to keep growing alongside someone, especially through a season like menopause, when so much about you is changing at once. My guest today is Dr. Tina Sagochio. She's a physician and menopause educator, someone who spends her days helping women actually understand what's happening in their bodies during this transition, both in her clinical work and in the broader conversation she leads publicly around midlife health. Dr. Tina also just celebrated her own 25th wedding anniversary. And she invited me to join her for an Instagram live to talk about love and intimacy in midlife. Two women, same milestone, same season of life, comparing notes. I really loved this conversation with Dr. Tina. Our values and our sentiments felt so aligned throughout. From how menopause reshapes intimacy to why communication matters more than ever, to what it actually takes to stay connected through change. So this week I'm sitting in the interviewee seat again. Something I always enjoy, sharing my story and my experience as a menopause and sexual wellness coach, while Dr. Tina brings her perspective as a physician who sees this every day in her patients. I hope you enjoy this conversation as much as I did. And if you want to know more about Dr. Tina's work, check out her bio and Instagram handle in the show notes. Let's dive in.
Two women, same milestone, comparing notes
SPEAKER_00I'm so excited to have this conversation with you because I'm sure you hear about as much as I do as a gynecologist and a menopause provider, but I'm sure you hear it from a very different perspective often that we don't get as providers. And so I'm just really looking forward to having this kind of conversation with you. But I also know that we share something in common. We both, I think, celebrated our 25th wedding anniversaries, not too long ago.
Gabriella EspinosaThat's right. Yeah. Happy anniversary. I celebrated on July 7th. 25 years. Can you believe it?
SPEAKER_00Absolutely. We just celebrated July 28th. So we're very fresh just a couple days. But I love this connection to start our conversation off because I think you and I would both agree that some couples just don't make it. We hear that side of things too when we speak with women. So I would say that I think we are proud to successfully have gotten it through 25 years.
Gabriella EspinosaIt's not easy. You really have to be committed for the long game and deal with the roller coasters of so many things, building a life together. If you decide to have kids, jobs. Yes. But it's really a huge commitment and it takes work and effort. And I think really what happens sadly during the perimenopause, menopausal upheaval is that we forget to prioritize our relationships. And it's a huge identity shift. We ask ourselves, who am I? And then we lose ourselves in the building of a life together, absolutely partner in the balancing family, life, work,
How menopause pulls the Band-Aid off in relationships
Gabriella Espinosaparents. We lose part of ourselves. There's so much going on. And the relationship goes to the bottom of the list. And I think that's what it takes to keep a long-lasting relationship. Yeah. Just to really always prioritize it and keep it at the top of the list. It's so easy to go down to the bottom of the list.
SPEAKER_00I couldn't agree with you more. And I think it's almost fascinating in a way to take a step back and look at how relationships or marriages evolved, especially over 25 years. You start off as this couple with two real strong individuals who are looking to find their place in their professions or where they are in a new marriage. And then all of a sudden we're all thrown into our jobs and family and starting a family. And then fast forward, and you get to our point in the marriage after 25 years, and you're like, where did that all go? And how did we manage to get through all of those different changes? It's such a fascinating thing to look back on and kind of give ourselves a little pat on the back for making it work. Recognizing that, especially in midlife, as we enter this stage, how drastically things can change and how our identities get thrown into this mix. And it almost feels like menopause pulls the band-aid off and makes us very vulnerable.
Gabriella EspinosaOh my gosh, you are so right. Yes, absolutely. And we have to be prepared, just like we ride all the other challenges that do in a relationship. I think that's one that will hopefully the generation coming after us, you know, we're Gen Xers. I don't think Gen Xers were prepared for that. When I entered perimenopause, I was completely caught off guard. I felt so much silence and shame around the very noticeable changes to my mood. Of course, I always talk about the noticeable changes that were happening to my sexual health, libido,
Gabriella's perimenopause journey and what caught her off guard
Gabriella Espinosavaginal dryness, loss of sensation, and just a growing disconnection from pleasure and intimacy because things didn't feel like when we first got married or when we were, you know, courting and everything was hot and heavy, and we were just going to take our hands off of each other. And what shocked me was I didn't have the language or understanding to make sense of what was happening. And I remember thinking, is this what getting old feels like? Is this how it's going to be now? Is this part of our lives over now? And what I realized, I think it was in my 40s then, in my early 40s, I knew so little about my own sexual anatomy. I knew so little about my own sexual health. I knew so much about so many things, about periods, pregnancy, parenting. I thought, okay, I aced all those things. But nobody prepared me for this. No books, no podcasts, no Instagram ride like we're having right now. And to be quite honest, Dr. Tina, I didn't really have a very good blueprint role models in my life in terms of the relationship aspect. Yeah. I knew what my model was when things get bad, or when you ride those big bumps in the roller coasters, you just jump off or you blow things up. That was what I saw modeled in my family. Yeah. I come from a Latin American family, though we're very fiery and temperamental. And I saw a lot of that. And I knew that I wanted this to be very different. So what I think what it did for me was like, okay, I don't want to blow things up. Although there was rage, there was anger. I'm not gonna say I stayed silent about a lot of things, but about the changes to my sexual health, the changes that menopause the changes in identity that it was the questionings, all the questions creating a lot of silence and shame inside of me.
SPEAKER_00Yeah, I think you bring up a really interesting point because I also come from a very strong cultural background, a Filipino background, and also a very staunchly Catholic background. It's an interesting aspect for both of us because there was a very strong cultural effect for me growing up, too, because I had a mother who worked really hard to carry the household, who held two or three jobs, but made sure there was dinner on the table, and I had a great role model. But at the same time, it was always very hush-hush about relationships, about demonstration of love in front of other people, or how do you handle conflict with your spouse? It was just very interesting to grow up with that as my background. And then also in a in a culture in that you and I got brought into where we learned how to speak our minds, become professional women, and especially in our professions specifically, where we really learned how to find our voices very differently than I think our mothers and our grandmothers did.
Gabriella EspinosaYou hit the nail on the head, yes, for sure. Well, I did experience that silence and shame. I did realize it was the cultural conditioning. Then when I realized that nobody was talking about it, I set out on a mission to learn everything I could. The more I learned, the more I realized women were quietly having the same experience. And it became the why for the work I do today. I always say no more silence, Gabriella. And so I began talking about it. That's why I started my podcast. I started the kind of coaching practice now with women to have those open conversations to break down the shame and silence about this very beautiful fundamental aspect of our lives, which is sexuality, sexual health, connection. It's really connection and intimacy.
Why the silence around intimate health is a cultural issue
SPEAKER_00Absolutely. It's interesting because as a gynecologist and OBGYN, with the training that I have, I've always had a very almost organized, controlled approach to these things with women. And we were not trained to talk about these things. It was just about pregnancy, how we have safe deliveries, how you take care of the mother on those six weeks postpartum. And then if it was gynecology, all the routine gynecology things, but we never really were trained or encouraged to have those deeper conversations about connection, about intimacy. And we barely touched the surface on sexual health with relation to the signs and symptoms of genital urinary syndrome of menopause and all the things that came along with that. So it's interesting because I've had to relearn and find new conversations and get more curious with my patients. So I find that it's just something we were not as providers trained to talk about, but I'm so excited that we're really pushing the envelope and opening.
Gabriella EspinosaI love that. Yeah. Thank you so much for doing the work that you're doing and for approaching your work with that, with that compassion and with that empathy. You're a midlife woman, so you know where these women are coming from.
SPEAKER_00Absolutely. No, I couldn't agree with you more. I think I got to a certain point in my career where it was like, oh, wait, I'm that person. It made the conversation certainly easier to have because I could relate. But I realized how poorly of a job we did, or at least in the early years of my career and my practice. I look back and I'm like, wow, we just didn't do it well enough. And so I love the opportunity that I have as a provider to really change the course of how we take care of our women. But I will tell you, it's women like you who also round out the support. Our coaches, our health and wellness coaches are fantastic because they fill in so much more of a gap. And so I wonder if you'll share with us a little bit about your journey and becoming a coach
Girlfriend medicine and the power of community
SPEAKER_00for women.
Gabriella EspinosaYeah, I'd love to. Thank you so much. I always believed it takes a village to move through this perimenopause and menopause journey. And that is having a team of practitioners around you. As a coach, I always refer out to public floor, physical office. I have a whole network of OBGYNs in my area, especially those that are menopause certified. Becoming a coach was part of this unsilencing the shame that I had around female pleasure, around sexuality, around sexual health. I was like, why didn't anyone tell me about this? This is such an underserved part of our health. I felt I was a pretty educated person and I felt like I don't know enough about it. There must be so many other women who don't know about it. That just became my mission, my why for waking up every morning and saying, I have to change this. I have to play my small role in changing. Exactly.
SPEAKER_00I have a term that I use with my own girlfriends. I call it girlfriend medicine. There is such power in how we take care of each other as women. And it's like almost like a secret society as you get older, where the conversations that we have are certainly now about how we've changed through midlife and how we're helping and supporting each other. And so I couldn't agree with you more. It takes a village for us to support one another through these transitions, but how we can also break the barriers among ourselves about intimacy and pleasure and sexual health. Because if we can't be comfortable around the people who we feel most comfortable around to talk about those things, I can't even imagine how it is for any woman to feel comfortable talking with a provider like myself or a coach. So it's really about just breaking those barriers, even in the smaller capacity of our girlfriend groups.
What is normal after menopause and what to do about it
Gabriella EspinosaAnd what you're doing in those girlfriend groups are normalizing the conversation. And there's just a whole list of things that are normal, if you want to call them normal after menopause, that nobody tells us about. And it's so important to understand that you are not broken. There are solutions, and talking about them is the first thing. That lost uh sensation during intimacy, that it can take longer to get aroused, that you need more lubrication than you used to. Normal. Some positions stop working, and maybe other feel better. Normal. That your mind, your mind has to be on board, or your body can follow, which is a huge one. Some days you're not in the mood. And that doesn't mean that something's wrong. And so there are other things that become as important or more important, I think. This is what I invite a lot of the women that I coach to step into is the feeling of presence, the feeling of being connected to themselves, the feeling of really being body aware what their yeses are, what their no's are, so their boundaries. How to communicate from that place deep knowing. So the work starts with yourself. So yes, the changes that happen as we move through menopause are normal, but there are solutions. I like to first start with the psycho-emotional aspects of really getting to know yourself better. And menopause is a beautiful invitation for that. Yes. We can blame menopause for a lot of things, but wow, what a gift to be able to get know ourselves better and to take this opportunity to really take time to pause and to ask ourselves: what is it that I want? What is it that I desire? Future engineer your life because you realize how much runway you have ahead of you. And how do I want to live and love and make love? And all those things are up for discussion.
SPEAKER_00I love that because I think this time of life is all about the question of now what? What about me? And all of a sudden we have an opportunity to just focus on ourselves. The kids are grown up, maybe they're out of the house, maybe we're in different stages of our careers where we can maybe back off, or we're just finding ourselves that we have a lot more opportunities to focus on us. It's just us now. And I couldn't agree with you more that menopause can be such an opportunity. And I think that I see that more for myself in my own journey through how I went through things. And I feel like I know myself so much better now than I did even five, six years ago, or even 10 years ago. And I think it's so exciting. I know I'm excited for the first time in a really long time. I feel excited about the future. I love that we can look at menopause as also an opportunity, and with that, we can explore all the things that make us who we are, bring us pleasure, those deeper things about confidence communication.
Gabriella EspinosaWe're constantly evolving, bringing sense of curiosity of, oh wow, I'm noticing this. I'm noticing that I have less tolerance for drama for people who are not willing to engage in deeper, more intimate conversations like you and I are having. Just noticing that. And then also having that same curiosity now that since we're on the topic of also relationships and marriage, inviting that same curiosity in your relationship and in the person that you're partnered or married to. They're changing too alongside. You're evolving together. So being curious about how they're changing. I think it's so easy to, in long-term relationships, to look at people's flaws and faults. They're moving through midlife as well, along with you. And so, how do you do that together as a team instead of getting angry or upset or annoyed at those changes? And yeah, having conversations about it. Couples who come out stronger are curious. Instead of going quiet, you need to get more curious. And so if it's talking about how your body's changing, how intimacy might look different, that's okay. Have the messy, awkward conversations.
Curiosity as the foundation of lasting connection
SPEAKER_00I think that it also has a lot to do with that safe space, that sense of safety in the relationship. I think there's definitely the aspect of being curious for ourselves and about our partners. But I also think it stems from a place of safety, of where we find ourselves. How safe are we feeling in this relationship to even want to be curious or feel confident to be curious?
Gabriella EspinosaWe hear a lot of talk about wanting to feel desired. Yeah, that's important. That's very sexy, but feeling seen and heard by your partner, I think, is the sexiest thing ever. Yeah. So I say starting there, and that's what creates that safety. You're someone who is able to welcome all the parts of you. The messy, the good, the weird, the awkward, the quirky and welcomes and respects all the parts of you and takes time to see and hear you as you are evolving, the person you are becoming. Absolutely.
SPEAKER_00I think you also bring up a very good topic about how we are redefining. I think for a long time we've just thought of intimacy as just sex. And it's really so much more than that. And so I'm curious how you counsel and coach your women when we start talking about levels of intimacy.
Gabriella EspinosaYeah, a lot of women feel like, oh, there's something's wrong with me because there's this sex discrepancy. My husband wants it more than I do. And then we start talking about very simple, going back to these questions that most women are never given permission to ask themselves. What does pleasure mean to me now in midlife? What is it that I desire? What is it that I want? It can sound very simple, but it takes time to really explore that. And that can take a couple of sessions with someone to figure that out and how they're going to step into embracing and vocalizing, owning their own needs and their own desires. Because before you did it
Redefining intimacy beyond the bedroom
Gabriella Espinosafor the collective, maybe you made dinner, chicken, nuggets, and fries because that's what the family wanted, but that's the last thing you ever wanted, right? Or you prioritize pleasing your partner. So keep the peace, but you don't have to do that anymore. It's really all about you. It doesn't mean that you're going to be selfish, and being selfish isn't a negative thing either. No. Yeah. Yeah. Being selfish is a good thing. And then again, establishing a very clear idea of what your needs, wants, and desires are. What does pleasure mean? And having those very tender, vulnerable, but very courageous conversations with them.
SPEAKER_00Absolutely. Yes. But it's interesting because I had said earlier that menopause it just makes us very vulnerable at one point. And I think things like this come to the surface. And I find that it's difficult for women to really truly vocalize what they want for themselves, even as simple when they come into the office. And we talk about things like painful intercourse or dryness or bladder issues. And then it kind of segues into other things. And I'll hit up about how does it affect levels of intimacy or sexual health. And it's interesting how women sometimes automatically default to the other rather than themselves. And I always try to encourage them to turn it around and no, you tell me what you need or what you want or what hurts you. It takes time. And I think for someone like myself and someone like yourself as a coach, it takes time to coach women to look and talk and vocalize differently. Because for all the years that before, it was always about them before us.
Gabriella EspinosaYes. And I just recently had a conversation with Sally Mueller on my podcast where we talked about the power of comfort. Using that to redefine how we view our sexual wellness in love. Because we've been conditioned to prioritize the comfort of others. It really is time that we prioritize our comfort. You know women, and you must know women too, who don't tell their partners that they're using some painful sex. They just do it to get it over with and take one for the team. One for the teams and don't seek the support they need. I've heard you talk about, and I talk about this a lot, that loss of libido or low libido information that we have to look at. Is it physical or biological? Do you need support in terms of vaginal estrogen or other hormones that support that? Is it that you need to really break down these internalized narratives about what it means to want and to desire with life? What are those narratives, the psychology of it? Or is it a relationship issue? Or is it something that you need to bring up with your partner that you want to try things differently? You want to take more time, you want more sensuality, you want to dim the lights, put on candles, music. You want things to be different. So how do you bring that up in a relationship? And so there are so many factors when we talk about desire and libidity. Yeah. I think it's so much good information. I don't feel as an end of light diagnosis.
SPEAKER_00Exactly. It's just a transition that we adjust with and adjust to, and we find new ways. And I think, again, if we can look at it as opportunity rather than the end of something. And I think also, too, what's interesting is it's okay to also reassure our women that it's okay for things to change. The things that we might have benefited from or desired back in the past or made us happy might not be the same things now. And that's okay. And to also embrace some of those things.
Gabriella EspinosaAbsolutely. And you mentioned safety earlier. And I wanted to bring that back
Everything outside the bedroom is an investment in what happens inside it
Gabriella Espinosahere in the conversation. Because I talk a lot about on the podcast that the best intimacy, the best sex doesn't start in the bedroom. It starts way earlier than that. And then again, it takes having that conversation with your partner about what is it that you need to cultivate that more responsive desire? Is it spending just a little bit of time in the morning before you go off to work, having a conversation or a coffee together, taking walks before or after dinner, and spending time connecting and just the idea, I think women want to feel seen, not just wanted. That's the foreplay. And that's the sound that really builds lasting connection. We want to feel emotionally safe before we can fully open up. We need to get out of our heads and into our bodies. And honestly, nothing does that, like just being together with no pressure attached. Yes.
SPEAKER_00Everything you do outside of the bedroom is an investment in what happens. Happens in events. Yeah. Exactly. And I love having these conversations with patients. I've changed the way I practice, certainly, as a gynecologist. And I try to really spend a lot of time with my patients exploring these other topics because I know they don't often have these opportunities to explore it with other providers or their other physicians. And I do think that it is part of our overall health, right? We know the power of connection in terms of even what the studies show us about loneliness, right? There are statistics that show as there's a difference about between being alone and loneliness and just the power of connection, whether you're involved with someone sexually or not. But it's really learning that power of connection. And touch is one of those great manifestations of just putting your hand on someone's shoulder, a hug. But even more so when you're connected as a couple, those things go so much further. Absolutely. I love massages.
Gabriella EspinosaBut massages, hand massages, scalp massages. Let's start there. Yeah. Yeah. And then you can make it a mutual massage, but touch goes such a long way in hand to heart, each other's hearts, just starting there, holding hands, going for a walk. All of that matters.
SPEAKER_00So if I may, how do you approach those that may come to you with a history of trauma? Whether it's emotional, physical, sexual, you know, because that plays a big part in how women really feel safe, obviously. But this whole transition through midlife can really expose quite a bit for these women.
How trauma surfaces during menopause and why therapy matters
Gabriella EspinosaAs our hormones start to decline, estrogen in particular played a big role in making us feel like we had control over our lives. Yeah. We got stuff done. And then as that starts to wane, I think everything that we suppressed or didn't deal with in the past all starts to bubble up to the surface. And for women in particular, a lot of that can be past traumas, big T traumas, almost like sexual abuse, smaller T traumas, or adverse childhood experiences, like divorce or death of a loved one. Maybe you didn't have time to process it earlier on. And I think therapy is the best tool any woman, any couple can undertake, whether together or sorry. Because we also come into relationships with our past imprints of how we're loved or not loved. Sometimes that comes up to the surface. Resentments. And you hold on to those resentments. And then again, when the estrogen veil lifts, all of that comes up to the circles. I always refer out to therapists. So important to do that inner work, especially for your own mental and emotional well-being, also for the benefit of a relationship.
SPEAKER_00Absolutely. I really like to make sure that I have resources for women with a list of therapists that I provide for my patients. Because I think you're right. It's such an important asset to how women go through midlife because so much is becomes very vulnerable. And especially when there's a history of trauma, it can really disable some women at this point. So I like that you also work with therapists because I think it's just so important to give that outlet to women as well. I'm not equipped to do everything for my patients, and I certainly will never venture to become the therapist or the psychologist or the psychiatrist.
Gabriella EspinosaAnd what I often tell my clients, I often distinguish between coaching and therapy. Therapy helps you look at these past wounds or traumas.
The difference between coaching and therapy
Gabriella EspinosaThey make you get a sense of them, understand them, and how you can move forward with your life with that greater understanding and help shift the patterns that maybe didn't serve you that you adapted to because of those past traumatic experiences. But a coach is really about behavior change. If someone comes to me and says, I want things to change in the bedroom, right? I want to feel more seen, more connected. So what can we do? What small steps can we take to have you look at what you want to change, how you want to change them. And a lot of it starts with mindset, those inherited narratives that we have about maybe I'm not deserving of pleasure. A lot of women think that they're not allowed to want more or to ask for what they want. And then a lot of it is the body connection. Because our hormones are shifting, because we experience this changes to our bodies, physical change that we may not like. How can we stay connected to these incredible vessels of life that have done so much for us, that have carried us so far? I guide women to develop practices to connect to their body on a daily basis. Either through self-touch, movement, through breath work, all of that goes towards building this sense of reverence, awe, and respect for your body.
SPEAKER_00I really love that because it goes back to what we had mentioned before. It's just having that self-confidence and being able to become curious about yourself and realizing that there's so much opportunity that we can take advantage of. But it does take a village. It takes acknowledging maybe past traumas, it's dealing with the here and now of possible GSM symptoms, it's behaviors like you had mentioned and bringing it all together because it is a journey, right? It's not a one and done. We are constantly evolving. And I often remind patients too that we have to think of this as the long game. We might go through our years of carry menopause, menopause, but we've got that whole postmenopausal time frame to really live into. And I think our generation of women is redefining that. Absolutely.
Gabriella EspinosaWe can redefine that. And so that's what's so exciting. And we can redefine who we're becoming. We can redefine how we want to live and feel in this season of our lives. And I think that's something that our mothers didn't have the opportunity to. Yeah.
SPEAKER_00I like a little bit of comments about how you're exploring more about the nervous system, those somatic pathways. That's something that's starting to be talked about a little bit more in how we connect with ourselves and how we connect with others. That's the foundation of a lot of the work that I do.
Gabriella EspinosaI think most of us, all you have to do is
The nervous system river metaphor explained
Gabriella Espinosaopen up the New York Times. You notice what's happening in your body. You feel that sense of stress, doom, overwhelm, that sense of dread. And then you add on to that the responsibilities. We have so much on our plate. Teenagers leaving the house or they're in college, and you still have to guide them, caregiving for elderly parents, or thinking about your future, your financial future. All of those things can create a lot of stress in our system. So a lot of the work that I do is about learning to regulate your nervous systems. First of all, understanding your window of regulation. I use the metaphor of a river. So when you're in the river, you're in that flow state. You can handle, your system can handle life's ups and downs because they're going to be thrown at you no matter what. But how is it that you handle life's ups and downs? The good news, the bad news, the load of response. How can you stay connected to pleasure, jewel intimacy? So that's being in that flow state. But when you go above the river, so you're thrown out of the river off. That's when you go into this hyper-aroused state, that sense of overwhelm, stress, chronic anxiety, insomnia. A lot of women reside in that state. And then on the other end, the river dries up and you move into this hypo-arousal. So that feeling lethargic, that loss of motivation, that anhedonia, that loss of numbed out. A lot of women float between these two extremes. They can't find their way back into that flow stream, into the winning of regulation. And so a lot of my work is about letting a woman realize that there's nothing wrong with the work we're humans. Yeah. We kind of move into hyper-aroused states and maybe into those hypo-aroused states. But being able to recognize that doesn't mean your system is broken. Your system is working with you to protect you. So being able to recognize that's information. And how do you engage in practices that can bring you back into your window of relationship? Kind of floating between those different states.
SPEAKER_00I love that analogy. It's really about flow. I love that. We get to this point in life where we've mastered everything else that got us here. And yet now we're kind of thrown into a different kind of chaos, but it can be so differently organized in how we approach it and how we go through it. And I love the idea of the river flowing through that.
Gabriella EspinosaI think that's beautiful. I often hear perimenopause or the menopause transition described as that zone of chaos. And yes, okay. First of all, is noticing that you're in that zone. Okay. You're in that zone. And you're in that zone for a reason. Doesn't mean you're broken. But the first and important thing is recognizing that, having that awareness. The way that you bring awareness to those different states, whether it's chaos or being numbed out, is that self-connection piece of noticing that interoceptive state, your internal state of sensations, emotions, whether they're physical sensations or emotions. Some women can't go there. Sometimes it's too difficult to go there. So we build our extrasceptive ability of this is where it can sound so simple, but sitting outside and observing the natural world, sitting outside in your car, or going sitting on a park bench and watching children play or having a conversation with a friend. So the world around you and noticing how that can bring you more into a more regulated state. I then gently guide women into noticing their more internal states. And building a language means that you can express what doesn't feel good. What's a yes, what's a no. So all of that is forms the foundation of the work that I do. And it's all based on nervous system science, which is all based on the science of connection, connection to ourselves and connection to others.
SPEAKER_00It's fascinating. I think we are so fortunate to be having these conversations so much more frequently and so much more openly. And I think for many of us in the midlife women's health space, menopause space, we are becoming that village for one another. I love that that analogy that you use this earlier was just it takes a village to get us all through. And it is reconnecting, it's finding new vocabulary, it's learning how to vocalize, maybe for the first time. I always say to my patients, it's always easier to work from a place of comfort than from a place of discomfort. And my role as a physician is to certainly help recognize symptoms and how we can make things better. But I certainly believe that once the building blocks start getting placed, the next layer is the emotional component. And I think that's where the real work comes in for a lot of us. So grateful for physicians like you.
Gabriella EspinosaAnd that comfort comes with the solutions that you have in your toolbox as a doctor, right? Whether it's vaginal estrogen or hormones or any other pollutions that you have, we don't have to suffer in silence. And I used to be one of those people that believed that natural was bad. And so I hit a wall with the suffering. I was like, I can't do this anymore. But now that I turn to hormones or vaginal estrogen, I can turn to the goodness of the natural world to feed me and nourish me in other ways. I'm not looking for those natural solutions to provide everything. Now I can, I feel like they can sustain me in a way that they never could before. I did want to ask
How doctors need to do better at asking directly
Gabriella Espinosayou a question. So, how do you bring up the conversation around sexual pain, vaginal dryness, all these symptoms of genito urinary syndrome of metaphors? Because I know a lot of women tell me my doctor didn't say anything about it, so I didn't bring it up with that.
SPEAKER_00I have learned to ask directly because part of the problem was not asking at all or asking around it and not listening. Worse, not doing anything about it. And that I think has been the unfortunate part of the traditional medical approach is we don't really listen, we pretend to listen, and or we don't do anything about it. For me, in the last several years, it's asking, listening, and then coming up with a treatment or a plan that's gonna work for her to get her to a better place of comfort. And then I think as that builds, then we start exploring if the trust is there, then how has the experience of more comfortable, penetrative sex made you feel? Are you able to get to that orgasm? I can build if I myself am direct and respectful, but I also offer something for it. We just can't leave them empty-handed. So I've really learned how to change how I approach these topics with my patients because I just refuse to not see them holistically. We are everything.
Gabriella EspinosaAnd I imagine that makes it easier for them when once they have that sense of comfort in their bodies and comfort and having that conversation with you in the exam room, then that translates into the bedroom for them. Maybe
Breaking the silence in the exam room opens it up in the bedroom
Gabriella Espinosathat's a good starting point for them to have a conversation with their partner. I spoke to my doctor today, and the doctor said X, Y, and Z. And my doctor said, try this, and I'm gonna try this, and I'm on this plan. And that means that we can do X, Y, and Z in the future. Whatever happens, once you break down that silence in the exact room, you open it up in the bedroom.
SPEAKER_00We as providers, we as physicians have to do better. We have to be better, and we have to not be afraid. It's one thing if you honestly don't want to know about someone's history or issues with sexual health or intimacy or whatnot. And if that's obvious from the get-go, then the patient hopefully will just realize that's not going to happen in that conversation and maybe find a different provider. But I think that we can also coach and encourage and empower our patients to say, no, you go into your visit and you ask also. Hopefully, you'll get some response, but also to encourage them to try to find the confidence to talk about it as well. So I think it comes from both sides, but myself as a physician, I've known for 20 years as a gynecologist, we never did it good enough. But now we have an opportunity, we've had this opportunity in the last several years to really get better at this. And now we're really pushing forward with we have to normalize all of it. It can't just be the one thing, it has to be everything.
Gabriella EspinosaNow that that translates into that sense of confidence that we feel when we have that support from a practitioner matters so, so much. Thank you for asking.
SPEAKER_00Gabrielle, I couldn't thank you more for your time. I just love this conversation and I hope we have a part two at some point. Congratulations again to you and your husband for your 25th wedding anniversary. It's a great thing for us to share.
Gabriella EspinosaYeah, so you happy anniversary and enjoy the next 25 years. Yeah. Thank you. It's been a pleasure. Thank you for joining me for this episode of Pleasure in the Pause. Want to help me spread more pleasure in the world? Please hit subscribe to the podcast and share this episode with a friend, a sister, or any woman you care about. Because when we share these conversations, we remind each other we are not alone. Together, we create ripples of empowerment and support that reach far beyond ourselves. Your support means the world to me. Thank you. Remember, your pleasure matters. The information shared on this podcast is for educational and informational purposes only, and it's not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or pleasure in the pause.