Episode 373: How Sex Changes At Midlife
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You're listening to the Sex and Psychology Podcast, the sex ed you never got in school and won't get anywhere else. I am your host, Dr. Justin Lehmiller. I am a social psychologist and research fellow at the Kinsey Institute and author of the book, Tell Me What You Want, The Science of Sexual Desire and How It Can Help You Improve Your Sex Life. It's an inescapable fact that sex changes as we age.

While these changes are often small and gradual, once we hit midlife, a period of time spanning your 40s and 50s, it's not uncommon for people to start noticing much bigger changes that sometimes set the stage for sexual and relationship problems. Of course, everybody has their own unique trajectory of change, but it's usually somewhere in that midlife period when the changes begin to escalate for reasons that we'll be exploring in today's show.

This episode is going to be all about sex at midlife and some of the most common sexual issues and challenges that come up during this time for women. Some of the topics we'll explore include what you need to know about perimenopause, which is a period of several years during which sex hormone production begins to decline. We'll talk about how perimenopause can affect your sex life and strategies for dealing with common symptoms and problems, including the helpful roles of both hormones and self-pleasure.

We're also going to explore the taboos around talking about midlife sexual distress and how we can overcome these barriers and open up more conversations around sex in midlife. My guest today is Dr. Samina Rahman, a board-certified OB-GYN, sex med gynecologist, and menopause specialist with an academic affiliation at Northwestern University's Feinberg School of Medicine.

She's the founder of the Center for Gynecology and Cosmetics and host of the podcast, Gyno Girl Presents, Sex, Drugs, and Hormones. This is going to be another fascinating episode full of lots of practical information. Stick around and we're going to jump in right after the break. Do you want to learn more from me in the form of an online or in-person course? Become sexceptional by getting certified with Sexual Health Alliance, where you can learn from yours truly and a number of top sexuality scholars.

Each year with Sexual Health Alliance, I teach courses like fantasies around the world, as well as immersive study abroad classes in several exciting countries. Join these programs and become a certified sexuality professional at the same time.

From sex therapists to sex educators, sex coaches to sexologists, Sexual Health Alliance streamlines your path to certification while allowing you to learn from leading experts in the field. Most importantly, you'll gain the knowledge, skills, and credentials that you need to excel. Become sex-ceptional and connect with world-class experts and an engaged community of sexuality professionals from all across the globe. Start your path to certification today at sexualhealthalliance.com.

Hi, Samina, and welcome to the show. Thanks so much, Justin. Thanks for having me. I appreciate it. Well, thanks for joining me. So in today's show, we're going to be talking all about sex at midlife. This is a period of time when many people start to notice changes in their sexual health and function, which can lead to decreases in sexual frequency and satisfaction. So as a physician, what are some of the most common sexual issues and challenges you see for your midlife patients?

Yeah. And it's so vast, the number of different symptoms that patients feel, but the majority of what we're dealing with for most patients is really the genitourinary syndrome and menopause where you get this, you know, your ovaries go into retirement, they quit making estrogen. The amount of androgens you make is cut out by 50%. I think it's by year eight, meaning eight years post-menopause, up to 80% of women will have genitourinary syndrome menopause, which includes any issue you can imagine. I mean,

the labia resorbs. So this is what we talk about, the disappearing labia, which people are always like, what, what happens to my labia? No, they actually can disappear. The clitoris can shrink down the vagina also because of the lack of

estrogen, you know, you get a change in your vaginal pH, it becomes more basic. And so you get less of that normal vaginal microbiome, that lactobacillus. And as a result, you get less moisture there and you have less collagen that's being produced in the vagina. So it becomes thinner and it becomes more narrow. And so you get a lot of vaginal dryness.

And general urinary syndrome menopause used to be referred to as vaginal atrophy before 2014. So it's really this loss of elasticity. It's a loss of function. People feel like there's this notion of sandpaper sex. I think my friend, Dr. Lauren Stryker, coined it. But it's like that as well as some...

razor blades down there. So it's painful sex, it's urinary frequency, it's recurrent UTIs, pelvic floor dysfunction, all of the things that a lot of women experience. And what comes with that as well, like I said, you know, you lose about 50% of your androgens in menopause. And so a lot of patients then without that, you know, testosterone, they're

And with sexual pain, start to lose their libido. Right. So that's probably the most common complaint in midlife, you know, up to 40 plus percent by their midlife feel that they have a loss of libido. And for a lot of them, it becomes very bothersome because the libido mismatch, their husbands are out getting Viagra. All of a sudden they're ready to go and, you know, they don't have the desire to drive and they also have the pain.

So definitely the low desire is probably the most common. The sexual pain is in there as well and discomfort around the genitourinary syndrome and menopause. And then, of course, you know, with the clitoris shrinking and the labia shrinking for so many patients, people do also have, you know, a difference in their arousal. They don't feel as aroused. And then the magnitude of their orgasms might fall off or they might not even be able to orgasm at all. So but most of the time it's muted. You

And the nerves, there's, you know, 10,000 nerve endings or more in the clitoris, but, you know, there's the smaller nerve endings tend to feel that deprivation of the blood going into that area. And so you might not get as much of a sensation.

Yeah, so there's a lot of things that can change and happen in the body as we start to reach midlife that can have a big impact on our sexual health and sexual function. And when people start to experience sexual problems or become distressed about their sex life, unfortunately, many of them don't seek help and they suffer in silence instead.

Sexual problems are a taboo topic. Many people are too embarrassed to talk to their doctor or healthcare provider about them, and many feel too ashamed to bring it up to their partner. They might find it easier to avoid having sex than to talk about their sexual problems. So why is this such a taboo thing, and how can we make it easier to talk about? Yeah, I mean, I think sex in general has been taboo for so many people, but for midlife women, I think that...

I know one of the biggest issues is this whole notion that at least in the developing world, when people are aging, they're just dismissed more, right? Like we see in different countries that, you know, the elderly population are really admired. They're looked for for guidance and advice. But there's a lot of ageism in the Western world.

And so I feel like that also impacts, you know, their lack of a bit like, should I be having sex as a 70 year old? You know, I have 70 and 80 year old women coming to me, like fix my vagina. I'm ready to go. You know, like it's just been so taboo for so long because, you know, it's like this whole idea, like, should they be put out to pasture kind of thing? Right. Like, but I think that now midlife women are changing the narrative because they're

We're realizing that we don't have to suffer in silence. And I think another big problem was it's not only that it's a taboo topic, but the clinicians weren't bringing it up, right? Because you're not getting the training. You might feel embarrassed to talk about it. So there's a barrier on two ends. Like you don't want to talk about it and they don't want to talk about it. So nobody's bringing it up. And so I think that, you know, that's not okay. I think we're also changing. There's more healthcare clinicians that are

really looking to learn more about sexual medicine. They're looking through, you know, our organization, Ishwish. They're looking really to become better clinicians. So I think that knowledge base is, it's getting diversified. But I also think our current healthcare system is not set up to discuss relationships

really expansive issues, right? Like if you are in a typical practice in an OBGYN practice where, and this was me like 15 years ago, I was in academic practice. I had to see 35 to 40 patients a day. 90% of them were OB patients. The 10% that came in for gynecologic issues, if they were midlife patients or issues that had sexual or pelvic pain related complaints,

It takes a while, right? It takes a while to get the answers. My friend, Rachel Rubin, we talk about like how in sexual medicine, we have to be sex detectives, right? We have to actually put on our detective hats, try to figure out what the patient is going through. And because it's such a biopsychosocial issue,

that we give patients, we really have to get to the bottom of it through like learning about what's happening from every perspective of their life, right? And you can't do that in a 10 minute visit. So I think there's so many barriers to seeking care and then finding the right person that has the knowledge to deal with it on top of that. So those issues have been so pervasive for the longest time that women just haven't wanted to talk about it.

And for so long also, we didn't have any real treatments for them, right? Like I have spoken to Dr. Erwin Goldstein so many times about when he, you know, was on the Viagra paper and I guess he was one of the main researchers. And so when Viagra came out and he would have all of the patients coming in to get Viagra, all of the female partners were in there too, wondering like, what about us? Like now we, our partners are getting fixed.

But, you know, our vaginas are still in pain and so no one's helping us. So I think that, you know, we have some barriers because the research wasn't being done and studies weren't being done for women. And so now those of us in this area are trying to change the trajectory. And I feel like now women are feeling more empowered to come forward and talk about these issues.

Yeah, you're so right in everything that you say about this being a very complex issue, right? There are so many barriers to care, like just getting an appointment to see your provider sometimes can be many months of a wait before you can actually get in. And then when you actually get there, they might not have received training and might not know a lot about the particular issue that you're dealing with. And then they might have to refer you out. And then there's a long wait to get to your referral doctor. And so, yeah, it can be a really long process. And then,

You know, I've spoken before with other folks on the show about how in many cases of sexual difficulty and dysfunction for women, sometimes it takes years to get an appropriate diagnosis because they're just bounced around all over in the system. Yeah. A few patients just sent me this meme that came out on the New Yorker. I'll send it to you later, but it's just, so as a doctor pointing to this part of a woman's brain, it says this part of the brain was caused by

by the stress of being dismissed for so long, but don't worry about it. Like, I mean, but that's the reality of so many of my patients is that, you know, just being dismissed from your symptoms because on one hand, some clinicians don't know how to talk about it and don't know how to deal with it. And on another hand, they don't have the time or infrastructure or desire to do it. So I think the appropriate thing, if you're a clinician listening and you don't know how to deal with it is to help guide your patient to the right person, instead of just saying, you know,

What's the typical thing we hear? Like, relax and have a glass of wine. Like, you'll be okay. Like, you know, push through. Those are not, you know, appropriate treatments. Yeah, I've heard that many times before. The, you know, just have a glass of wine and take a bath or something like that. And it's like, you know, I think we can expect a little bit better from our doctors in terms of sex advice.

So for women, midlife is a time when perimenopause typically begins. And that's one of the factors that can affect their sexual health and function and contribute to sexual distress. But because we don't really get any formal sex education around menopause at all, many people don't even know what perimenopause is. They don't know that it's a thing. And some perimenopausal women might be in perimenopause but not even know it.

So can you tell us a little bit about perimenopause and how it can affect your sex life and just what people need to know about it?

Yeah, absolutely. I mean, perimenopause is probably the most distressing time for midlife women. I always say it's like the perfect, excuse me, shitstorm of events happening at once, right? Because number one, your hormones are fluctuating. Average age of menopause, which is really a retrospective diagnosis, means that your final menstrual period hits and it's around 51 and a half in the United States. And so the period of time leading up to that is perimenopause. And it's like

Your ovaries go into retirement when they ovulate the last egg, but they don't go into retirement easily. They're pushing their way through. On some months, you might have really high levels of estrogen and you might super ovulate. In other months, it hits rock bottom. It's like this roller coaster of hormones happening at once.

And as a result, you have to think about what's happening to women in midlife too. Like they might have teenage kids. They might have older parents. They might be at the pinnacle of their career. They might be going through a divorce. They might be dealing with deaths. And so they have a lot of underlying stresses. So patients always say, is this perimenopause or is this my life? And the short answer is it's all of the above. You know, it's like everything happening to you at once. And so symptoms just get worse and exacerbate. And so when you have all these highs and lows,

It's really the Delta happening between the high and low estrogen and your progesterone stays consistently like it's just lower in perimenopause. But again,

You know, patients tell me that they have cognitive distress, right? Like brain fog, why did I come in this room? But then you're also like having anxiety for the first time in your life. I have patients that won't fly anymore because all of a sudden they have this, you know, ruminations about having a plane crash. I have patients that just cry over the slightest thing. And so they're very disturbed by their mental stress. And the majority of women tell me that they just don't feel like themselves.

So if you're in the state, you don't feel like yourselves, your body's changing a little bit too, because you get a little more midsection or visceral fat. Like we said, the vagina might be dry or you might be a little uncomfortable having pelvic floor issues. And then you have all these muscle pains and joint aches and stuff that might be related to the musculoskeletal syndrome menopause. And he's throwing a couple of hot flashes and night sweats. It's like, well, you know, give me a break at this point. Like how am I supposed to deal with my daily life? Much less want to have sex with someone. There's so many factors that are involved.

that contribute to what we call hypoactive sexual desire disorder, which is really that low libido with bother. And it's a lot of my patients are not bothered by their low libido. They're fine. They're like, I don't have time for it. And neither is my partner. But when you have a disconnect, you know, you have this desire mismatch. I think that's what triggers patients to really say, like, I wish I was like my old self, like they feel like a shell of themselves.

So I think all of these issues combined make it really hard to navigate this period of time. And it's like women don't want to take it anymore. They shouldn't. They shouldn't suffer in silence anymore. Yeah. And something we've seen in recent years is that there have been a lot more conversations about menopause in the popular media. So the New York Times, the Washington Post, some other big media outlets have started running these huge pieces on menopause. And I think they're helping to change the conversation a little bit.

increase people's awareness and knowledge. But still, there's a lot that people don't know and don't understand about menopause. And, you know, one of the key things is that we need to recognize that perimenopause is a thing and that it can last anywhere from two years to up to six or eight years in some cases. And so you can have this prolonged transition period before you have that abrupt shut off of or retirement of the ovaries, as you put it.

And a lot can happen during that period of time. And I really appreciate what you bring up about stress and how that can exacerbate a lot of the symptoms that people are experiencing. And at midlife, there's often an increase in stress, right? Because there can be different things going on in your work life. There can be family and home transitions and things going on. You know, oftentimes that's a period where kids might be moving out of the house, going off to

college, other things like that. And so you've got this whole new dynamic to navigate at home and with your partner. And if your partner is taking Viagra and is ready to go, but you have sandpaper vagina, you know, that's not going to be an optimal match.

Absolutely. And I think that's the most distressing thing for most patients. And, you know, most of my patients are very irritated and their mood is really disrupted and they don't like it. They don't like how they feel. I always tell them, you know, we have to give ourselves grace and try to navigate this. It's not an easy navigation and there's not a quick fix to it, but we have to use all of our tools in our toolbox, which may be menopausal hormonal therapy for some, it may be exercise, diet, stress relief, you know, other things, but it has to be a number of things at once. And, and

Some of my patients are, you know, tell me that, you know, I think it's great. You know, you're helping me so much, but my vagina is so high maintenance. And I'm like, yeah, I mean, you know, we do a lot to help improve some of these chronic progressive conditions that happen with estrogen deprivation. But I think the main thing is we have to give ourselves grace too, because it's not, it's not an easy time for most.

Yeah. And, you know, I think we also need to think about treatments here as being biopsychosocial, considering that the factors that are affecting sexual distress in midlife are also biopsychosocial. So lifestyle factors, you know, diet, exercise, getting an appropriate amount of sleep and

other things like that are certainly very important. But in addition to that, hormone therapy might be indicated in some cases. I know that some women are concerned about potential side effects of hormones. And I know that there was the whole thing with the Women's Health Initiative trials in the early 2000s that kind of scared a lot of women away from hormone therapy because it suggested that there was this big elevated risk of breast cancer. But what we've seen in recent research is that a lot of the risks of hormones

seem to be overstated and that there are also different ways of getting hormone replacement. So instead of taking the systemic hormones, you can also take instead the more localized topical hormones. And for some people that has a much better efficacy rate and lower side effect profile. So can you talk a little bit about some of the other tools that might be available to women for dealing with perimenopause?

Yeah. And specifically when we talk about sort of like the sexual pain and issues around that, the gold standard for that is local vaginal estrogen treatment, right? So what's beautiful about vaginal estrogen that it's safe for the majority of the people, we always say it's life-saving because it does reduce the rates of UTIs in midlife and beyond. And so I always say like, just imagine, you know, your aunt Rosie or your grandma that's

in a nursing home that gets a UTI and then all of a sudden she gets delirious because she doesn't remember anything because now her UTI, the bacteria from there has gotten into her bloodstream and now she's septic, right? And so then what sepsis can lead to, you know, ICU stays and that can lead to death. So when we use vaginal estrogen, you know, it's not just vaginal dryness, we're treating the vulvar vestibule, which is a source of so much sexual pain. We're treating the bladder and we're

reducing the rates of UTIs by at least 50% in that treatment. So we're improving the quality of your life, but hopefully your longevity as well. And so I think that's really important. And there's a lot of different forms of vaginal estrogen.

I actually really prefer vaginal DHEA, which converts in the vagina and the vulva into both estrogen and testosterone because we have receptors for both. And so it's really important to get that treatment locally. And it's local, meaning that it's just really getting to the tissue that it's affecting. So we're not getting these big rises in systemic blood, like our blood levels of estrogen are not going up.

So that's the fear that so many people have had in the past. And that's why it's considered safe even for cancer survivors and other patients across the globe is that, you know, this is just really local therapy and there's different variations that we can utilize. And so we got to get in there and do that. You can use vaginal lubricants.

for actually during the time of sex. People can also find some good vaginal moisturizers that have hyaluronic acid, which is a precursor to collagen that will really help to continue to moisturize the vagina. Then of course, we really need to address the muscles of the pelvic floor, right? We don't want to forget them because what happens to patients when

The vaginal tissue kind of shrinks. The muscles aren't getting enough blood flow to them. And you're clenching because you're in pain. You're clenching your jaw. You're clenching your pelvis. The muscles become shorter. They become high tone. They're losing oxygenation and they're gaining lactic acid and that causes more burning. So we ought to get into some pelvic floor physical therapy. You may have to use dilators or, you know, vaginal trainers as we call them.

And so there's a lot that goes, that's why my patients call it high maintenance vagina. They give them a whole list of things that they should use. But I think that like, because like something like the general urinary syndrome menopause is a chronic progressive condition. If you ever stop the use of some of these things, your vagina can go back to being in that state and even worse.

So, you know, that's kind of like the mainstay in terms of treating locally. Then we look at, you know, we talk about the biopsychosocial, right? So we treat the pain and hopefully when you treat the pain, your desire will come back.

come back. But if after treating pain, your desire is still isn't there, then we can approach, you know, this low desire with bother, this hypoactive sexual desire disorder. And in this population of midlife, you know, this is where we can actually get into even replacing testosterone for those patients. And so, like I said, when your ovaries retire, they're 50% of the testosterone is lost too. And so by replacing testosterone in the

the best manner that we can, because there's no government approved testosterone in the U S we can try to get you back to your premenopausal levels and hopefully restore some of your sexual function too, which will include your desire, hopefully your arousal and orgasm as well. So, I mean, I think those are some of the mainstays of the,

biological aspect of treatment that I do. And then of course the psychosocial, right? If someone has significant anxiety and depression, you have complete anhedonia for everything. You're not going to want to have sex. So you got to treat those with, as you know, I mean, I don't have to tell you. So that's something that we can do. And then, and then the social aspects, right? Really getting into, you know, your relationship, how you feel about that person, any cultural baggage you may have related to sex.

Yeah, thanks for sharing all of that. There's a lot that goes into treatment here. So we actually related to this, did a study at the Kinsey Institute last year in collaboration with the sexual health and wellness brand Womanizer. And the main thing we wanted to look at in that research was the role that masturbation could potentially play in relieving symptoms for women who are peri or postmenopausal.

And what we found was that about 10% of women who were in some stage of the menopause transition reported that regular masturbation was one of their main strategies for relieving symptoms. And further, when we asked whether participants had ever noticed an effect of masturbation on specific menopausal symptoms, more than one-third had, with improved sleep and improved mood being the symptoms that were most positively affected.

So I wanted to ask for your take on this and whether you have any other thoughts on ways that self-pleasure might be helpful in dealing with sexual distress at midlife.

Yeah, absolutely. And I think it has to do more with, you know, like staying in touch with what's happening in your genitals, right? Like I think when we do self-stimulate, there is an aspect of, you know, getting that blood flow to the area, getting more of a focus there when we haven't had that focus in a while. So I think it goes along with directing yourself to trying to increase your pleasure. And then if you feel like, oh, this is something that I enjoyed and it was a big stretch,

stress relief, right? Like I think most of us feel relief when we orgasm. So then you may want to continue to do that in a capacity that you can, then you can actually, if you are in a partnered relationship, guide your partner better as well. And so that can improve your relationship with your

partner if that is the case. And if you're unpartnered, you have the ability to pleasure yourself because there's so many great vaginal trainers and toys and, you know, we prescribe them all the time. So I think it's very important to remember that utilizing these, I guess, lack of better term, toys, you

And utilizing vibrators and dilators and trainers, wands, all of the things can not only, and there's, I think there were studies to show it helps your pelvic floor as well. So I think all of these things in combination can help you from a biologic perspective, but also psychologically, like that release, that stress relief. I can totally imagine how that would help so many women.

Yeah, and I think another big way that it can help in terms of addressing sexual problems is in terms of if you masturbate to orgasm, that has been shown in research to help people fall asleep faster and to stay asleep so they get better quality sleep.

We know that impaired sleep is one of the biggest side effects of perimenopause and menopause. And I think it drives a lot of other symptoms that can exacerbate them when you're not getting good sleep. So for example, that can contribute to higher levels of stress and more mood changes. And so to the extent that you can do something that helps you to get better sleep, it can help in terms of like the cascade of some of the other symptoms that often stem from impaired sleep.

Yeah. And we also know how many medical symptoms evolve from lack of sleep, you know, increased risk for obesity, diabetes, heart disease. So if by the transitive property of orgasms help you fall asleep and when you sleep well, you can prevent some diseases and orgasms prevent disease, I guess. Right. Yeah.

Hey, I like that. Another good reason to engage in a little self-pleasure. So I wanted to ask for your take on this idea that we often hear when it comes to sexual health and the genitals, which is that they're kind of a use it or lose it phenomenon. So I found an old study from the 1980s in which they looked at women who were in menopause and what

what they found was that for their combined frequency of sexual intercourse and masturbation, like, so the more they were engaging in self-pleasure and the more often they were having partnered sex, that predicted less vaginal atrophy, you know, what they called it at the time. And so, you know, that was some support for this idea that it's kind of use it or lose it. And we see something similar in men, for example, when

guys have severe erectile dysfunction. For a long period of time, you can actually have some shrinkage of the penis. So can you tell us a little bit more about this idea of sex as being a use it or lose it phenomenon?

I have patients tell me this all the time and I don't, I don't like for them to think of it that way because then they just internalize so much guilt about not, you know, either not having an ability to use it for themselves or, you know, partner wise may not have someone. And so I think that, you know, there's probably some merit in obviously like, you know, bringing some blood flow to the area and doing all that. But when it comes to like, if you actually have sort of like the genital urinary syndrome and menopause and you really have a hormonal deprivation,

You've got to treat the hormone deprivation first. So I don't like to tell patients that, you know, it's because you don't use it or lose it. You know, that's what you've got to do. It is encouraging for patients to know that they can reconnect with themselves that way. I think there's a better way to phrase it. I don't think it's so black and white that, you know, okay, you're increasing flow to that area for that time. But ultimately,

Otherwise, your vagina is not all of a sudden getting estrogen and testosterone out of anywhere. You know, so I think it's important for them to understand that these processes are chronic and progressive. And so the treatment is what we've described. But some of these things can work adjunctively and help them, you know. So I think women tend to internalize so much that I don't like to tell them that, you know, if you don't use it, you're going to lose it. Okay.

And I appreciate that. I like everything that you described there. And I think a lot of these things can go hand in hand. You know, for example, if you're using the topical estrogen and then you're incorporating some masturbation on top of that, well, the topical estrogen can make it more comfortable and pleasurable to masturbate. And then by virtue of masturbating, that can increase blood flow to the area. And so, you know, it can kind of help potentially in augmenting some of the effects there. So yeah, it's not a one or the other kind of thing for sure.

So one other question for you about sex at midlife, which is, you know, for individuals who might be struggling with some sexual distress, but they feel hesitant or embarrassed about seeking help, how can we help them overcome those barriers and improve their sexual health and well-being?

There's something to be said about normalizing what's happening in their life. So when I teach other clinicians how to really even do a sexual history or how to talk to patients about sex, I always tell them, you know, maybe start by normalizing topics.

Like you have diabetes and a lot of patients with diabetes suffer from X, Y, or Z. Or at least 40% of women have this issue about low desire that really bothers them. Patients enter menopause, normalizing statements that are happening to women across the board because most women feel like it's just,

them, that this is just me suffering in silence. So I think that's why the power of social media and the power of so many celebrities speaking forward on perimenopause and menopause has been, has been so great for the movement because all of a sudden people realize, Oh, that's just not me. Like this is actually something that, you know, most women might go through and I don't have to live with this. So I feel like, you know, just having that understanding and just like educate yourself as much as possible on this, you know, what,

One of my taglines is always, I'm here to educate so you can advocate for yourself. But nobody's going to come and save you and try to like do it for you. So at the end of the day, it's your health. It's your sex life. And as Dr. Mel Harris talks about sex span, I just talked to him. He's a prominent urologist in Texas.

you know, it's your life, it's your sex span, and it's your quality of life and it's your longevity. So you should want to invest as much as you can in it. And I do understand how busy midlife patients are. My patients are so busy that it's really hard for them to incorporate everything. But, you know, just taking it piecemeal, just do one thing at a time that you can do until you can come together and feel better about yourself and better about your quality of

life. So I think that, you know, that's very important is understanding how frequent some of these things are and how common they are, but doesn't mean that you have to suffer from them. Yeah. Love everything you said. And especially that idea about how we need to educate people so that they can advocate for themselves, because if you don't know what's happening or going on with your body, it can be hard to seek help.

Absolutely. I would say we do these really shoddy puberty talks for kids, right? Like, I mean, they get very bad sexual education in class, but at least they know like, hey, your body's about to experience this really crazy thing that's going to happen over the next few years. But we don't do enough Perry talks. So when I have like a late 30 year old patient in my office that's just here for like a checkup of some variety, I'm like,

heads up, this may be coming. And sometimes they're like, why are you telling me this? And other times they're like, well, thank you. I just did not know. And, you know, just encouraging people to talk to others, whether or not they talk to friends, whether or not they can talk to their mothers or sisters or, you know, family members. Those are all very important because some of those, you know, genetic factors play into some of the stuff too. Yeah, definitely so. Well, thank you so much for this amazing conversation, Samina. It was a pleasure to have you here. Can you please tell my listeners where they can go to learn more about you and your work?

I have my own private practice in Chicago, so I'm where I just do sex med and menopause management. But if you go to Instagram, I'm gyno girl on Instagram. I also have my own podcast. Gyno girl presents sex, drugs and hormones. I have a YouTube channel that I'm trying to foster called gyno girl TV. You can find me at any of those locations. And I'm always happy to help and try to educate more.

Well, great. And I will be sure to include links to all of that in the show notes. So thank you again so much for your time. I really appreciate having you here. Thanks, Justin. Appreciate you. Thank you for listening. To keep up with new episodes of this podcast, visit my website, sexandpsychology at sexandpsychology.com or subscribe on your favorite platform where I hope you'll take a moment to rate and review the show. If you listen on Apple podcasts, please consider becoming a sex and psychology premium subscriber to enjoy ad-free listening for just $3.99 a month.

You can also follow me on social media for daily sex research updates. I'm on Blue Sky and X at Justin Laymiller and Instagram at Justin J. Laymiller. Also, be sure to check out my book, Tell Me What You Want. Thanks again for listening. Until next time.