Too Tired for Sex? The Real Reasons Women Lose Desire

Hey y'all, it's me, Dr. Smeena Rahman, Gyno Girl. Welcome back to another episode of Gyno Girl Presents, Sex, Drugs, and Hormones. I'm Dr. Smeena Rahman. I'm a board certified gynecologist and a sex med specialist in downtown Chicago, treating in a few other areas around the country virtually as well.

I am very excited to continue to this podcast with you guys and I hope that you guys can follow me over on Instagram and also check out my YouTube channel, GynoGirlTV. stay tuned for more fun stuff. I'm working on a book that is gonna come out soon. Well, not soon, but maybe in the next six to eight months. So guess that's soon enough.

You know, today I wanted to talk to you guys just one on one a little bit because I wanted, I recently, you know, had gone to the International Study for the Study of Women's Sexual Health Conference that I'm an active member of the board and I'm a part of, as you guys know, is the Sexual Medicine Society in, when it comes to female sexual dysfunction. And I just, I wanted just to briefly talk about one concept that was brought up by my dear friend, Lori Mitz.

If you don't know who she is, I did a podcast with her earlier in the year. And she is an amazing sex therapist in Florida. She teaches clinicians, she teaches providers. She wrote, Becoming Cliterate, Why Orgasm and Equality Matters. And that's what we discussed when I had her on my podcast. And I need to have her on my podcast again, because she's doing so much other stuff as well.

But she's an amazing sex therapist. And so, you know, she actually did a little course with us at ISHWISH, the International Society for the Study of Women's Sexual Health, our annual meeting. And it like blew everyone away. Like everyone was super amazed by, you know, the information that she brought. It was very thoughtful. It was very funny. She's hilarious. And it was very much like, you know, actionable things that we can do when it comes to

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you know, helping to treat our patients that have sexual dysfunction. And so I loved, you know, everything that she brought to the equation. And, you know, one of the most interesting things we talked about was really around the concept of, you know, low desire. And so I've done podcasts about low desire, hypoactive sexual desire disorder.

and what it means and how to treat it from a biologic perspective, right? Because in sexual medicine, we use a bio-cycle social approach to treating these conditions. And so it's really important that we approach the biology of it, right? Remember, your brain is your bigger sexual organ. are neurotransmitters and hormones that modulate our

Central function that actually can put us into an excitatory mode or put us into a like negative mode, right? So you got like your testosterone you got your oxytocin these amazing hormones that we have that work on your brain you have things like Norepinephrine and dopamine things that work on our brain and things that rich that that actually And any of the things that like really? diminish our desire right that

inhibit our sexual function. That's your serotonin, that's your prolactin, that's your opioids and other things. So, you know, we have these things that work on our brain from a biologic perspective. Then you have all these psychosocial factors, right? I mean, we always joke that, you know, we give hormone replacement therapy, not husband replacement therapy. think Dr. Stryker told me that was, well, you know, we joke about it, but it's true. Like if you have a bad

situation with your partner then you know no amount of like medication or therapy will probably I mean no amount of medication I'm sorry will you know transcend the biology because there's so much more going on with the relationship right so we know that that has to be addressed people have libido Discoordinates and you know when one person has low desire the other person doesn't so you know we talk about that a lot

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But she brought up some interesting points from a sex therapist perspective, which I am now using in my practice and it actually made total sense. We talked about how some of the patients, when they talk to us, or even ourselves, think about yourself for a minute. Are you somebody that kind of feels a little bit like part of you feels dead or you can't really remember what it used to feel like?

some people just don't feel horny anymore. Like they don't care if they have sex again, but they know they should because their husband wants it. Or maybe there's not in the mood. I mean, there, I think there was a survey she talked about that, you know, the majority of women when they say why they want to have sex with their partner has very little to do with the fact that they have a desire for it. Maybe they're trying to appease them, maybe they're hoping to make them feel good so that they can

really interesting study from: 2021

like really contribute to low desire. And I think this is something we all know, but it was so nice to see in a study because I think it resonated with a lot of us in the audience as people in potentially heterosexual couples, but also like, yeah, there are patients who tell us this all the time, right? And this is specifically, I think true for people that have been in the same relationship for a very long time. And maybe, you know, we see that they've been married for a while. They're in their...

or they've just been together for a while, and you get into these roles that come up. But what they found was that gender inequities actually contribute to low desire. So if there's an inequitable division of labor in the household, if the woman is doing more overall hours, they are.

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doing more of the low versus high control household chores, right? So that's like, they're doing all the cleanup at the end of the night, doing the kitchen, they're doing the dishes, they're doing all the things that, you know, that maybe, you know, the husband will go out and mow the lawn or do something really like a big chore. But this little daily grind that gets to women over time, right? When you have more chores than recreational tasks,

in childcare, right? Like you're the one doing all the parenting and you're the one disciplining and you're the one Ubering them around everywhere. Obviously like inequities and recreational time and hours, right? Like, how he goes out golfing or, you know, they're out, you know, with their friends having a guy's night out, but you're stuck doing the same things over and over again, not giving yourself time.

for this quote unquote self care, not even getting to the doctor when you need to, right? Like we know that women in midlife are really balancing everything on their shoulder, right? We always talk about that. talked to so many times, you you might have aging parents, you might have aging in-laws, you might have young kids that need you, you might be at the pinnacle of your career, you might be shifting your career, you might be going through a divorce, you might be dealing with death. You know, there's so much.

that is this like really stressful time for so many women, but also such an amazing time, right? Cause you might be pivoting your career. And so there's a lot that's happening all at once. And I feel this every time I talk to my patients and I feel it myself, quite frankly, that the world is sitting on my shoulders and I have an endless, endless to-do list. And it sometimes drives me crazy and it makes me like really, you know, it does, it gets to me.

But I feel like, and I see this in my own patients, they come in crying, yeah, he never does this for me, he doesn't do that. And really it's like when you are the household executive that it contributes to low desire, right? Inequitable division of household labor. The other interesting thing that we talked about was how you blurring, there's a blurring of the line of what a partner is versus what a mother is,

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If you are actually taking care of your husband like he's a child, then you don't feel that sexual relationship, that feeling for them sometimes, right? There are issues around objectification of women and then like gender norms around sexual initiation. These all contribute to low desire. And so really the social neural thinking of this is that you have this chronic stress, right? You're always high stress, high cortisol.

cortisol levels you have you know maybe hypoactive adrenal glands are not responding to you're no longer responding to positive short-term stress or even sexual cues right because sex can be a stress reliever and you're not responding to that anymore you see your partner as someone who has to take care of this kind of activates more of a nurturing system and there goes your oxytocin and there goes your testosterone right there's

inhibition out the wazoo. And so there was actually a lovely figure in this in this article that she kind of highlighted in the talk that she gave us that you know, you're the one that's feeling that that partner is dependent on you. You're the one is feeling this perceived unfairness. Like this is like, I don't I have all the labor in the house. I don't want to have sex with that dude, you know.

maybe you feel like that person is so codependent on you, you know, have to give him his medication, you have to take him to appointments, you you're the one telling him you need to go see the doctor, you have erectile dysfunction, I'm going to get you to the doctor because you're not doing it right. So again, even in this arena where you're dealing with the fact we talked recently with

We just talked recently with my friend Jessica, who's a urologist, about all the issues that come up with male sexual dysfunction. sometimes she even said, sometimes the partner is the one bringing that person in. So that's so much responsibility for you that no wonder you don't want to have sex with them. There you go. That's the number one. And so it's interesting because

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Dr. Laurie mince in her discussion and she's told me this before that sometimes she actually just sits down and does like household duties and breaks them up for people. Right. And that's one way that she helps them overcome this because it's now by her. Like this is a doctor's orders like you got to you got to vacuum more. You got to do your dishes. You know all the things. And so I think that's really it was an important insightful thing that there's actually studies showing that this

this dysfunction of gender roles actually can create this distress and make you not wanna have sex with your partner. It makes total sense. I'm glad they studied it. So what do you do about it? Again, having an open communication with the partner is very key. You gotta talk to them. This is what's pissing me off. Maybe you see a therapist, sex therapy is such an important part of sexual dysfunction treatment that it is really important that you find one.

And so, you know, we can link some ways to find a great sex therapist here. But, you know, you also have to...

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really start being more mindful, right? That's one thing she was talking about and Dr. Lori Barada talks about this better sex through mindfulness. But you know, I think it's really important to be mindful in the moment, right? Like that's why this whole idea of sensei focus that's done by so many sex therapists is so pivotal. Because hold on a second.

because it's really teaching that person to be more mindful, to really think about every sensation that they're doing. Like she talks about like being, like when you're brushing your teeth, think about the sounds you're hearing. Think about the motion of you brushing your teeth. If you have a battery operated toothbrush, listen for that. Think about what it feels like to get the water all over your face. Like be in touch with your senses.

Right, because then you're more mindful, then you're not running a list in your head, trying to get through sex with your partner that you're actually like, being mindful, you're thinking of the moment you're thinking of every touch, you're thinking of every kiss, whatever the case may be. And so that is a really important part of that treatment process when it comes to low desire. You know, scheduling, she was funny, she was talking about scheduling a trust, right? Like, where, where, you know, you schedule an appointment.

with your partner and you're appointed at a meeting place and you schedule a tryst. you can, you I mean, I know it's scheduled sex sometimes is not considered fun for anyone, but you're trying to have sex to get horny, not waiting to get horny to have sex, right? Like that's the whole thing. And so that was something really cool that she like really went through was like this whole idea of scheduling a tryst.

and had a very funny flight of the Concords video that she shared with us. It was fun. But you really want to take that time. You want to be mindful. And you want to be able to receive pleasure. And so that, think, is really important. It's easier said than done. But you've got to get out of your head in the respect of all the things that were running in our head all the time, all the to-do lists, all the things.

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I really like that she had that as part of a treatment plan, that being mindful to give yourself permission, to give yourself permission to fantasize, to think about sex even when you're not having it. Remember back in the day when your mind would think about sex when you're not having it? guess that's something that you should try to actively do.

And then, you know, sometimes it's about like trying some novel activities like go ballroom dancing, you know, where you're not actually like scheduling yourself to have sex or going out to eat, but you're there. She talked about how ballroom dancing or novel activities were so important that some studies have shown that 36 times more likely to have sex that day if you're doing a novel activity together.

Is it yoga? it a ballroom dancing? it salsa dancing? Is it going out together to try something new? it, you know, remember the, the, from, God, that movie with Patrick Swayze. Yeah. Brain fog. But remember the pottery, scene with Demi Moore and Patrick Swayze and, was it ghosts? Yeah. Anyway, so, so I think, you know, all of that is part of these novel activities you can do with your partner.

to increase your likelihood for having that relationship that you want. And then of course, you also have to make sure that you're doing your own self care, your own exercise. And so I think that's really, these are some really important factors. You know, we always talk about vibrators being such an important factor, knowing what makes you have an orgasm so that you can teach that and communicate that. Again, communication, right? You communicate that to your partner.

using the correct lubrication, using visual or audio or radica, all of these things are really important guys. And so I think we have to kind of like think outside of the box sometimes when it comes to, especially for the people like some of my patients who don't wanna go straight to medication or whatever. Some people just want the medication, they want a quick fix, but you can't actually like do that in a vacuum because sometimes it's not just the biology, it's the whole thing.

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And so, you know, I think it's really important to think about that touching, think about the special time, you know, talking about it. You know, it's really important to do all of that, to schedule those trips. You know, the Rosie app by my friend, Lindsay Harper is really good as well. So actually, I should get Lindsay on this podcast. And then, you know, just the erotica and all the things.

So I feel like that was worth it just talking about because I found it was so interesting that she really brought that into light. Especially the things in a relationship that cause low desire that's outside of the biology. That's more about the psychosocial component that can really be addressed. And remember, if you have anxiety, if you have depression, if you have OCD, all of these things have to independently be addressed as well. And so remember, if you have total anhedonia, you have no desire to do anything.

you are less likely to have desire to have sex too. But remember, try to mix it up and get your household duties separated more. Maybe if you tell him there's that meme that goes around where there's a guy who's in an apron and he's doing dishes and he's cooking and then he's taking care of the kids and this is real porn for women. There you go. I I think that's enough said, right? Get your spouse or your significant other to get more involved.

so you don't feel that pressure and stress and that you don't feel like you're just taking care of someone else. And I will try to do the same. Anyway, I thought that was worth talking about. It was actually very eye-opening and a great discussion. Please go over to Laurie Mitz's Instagram. I'll try to get her on my podcast again. She's amazing. She's funny. She is a wonderful soul and she has written two good books, which I talked about. The one was,

being clitorate and the other one is a tired woman's guide to...

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The other one was,

Sorry, it was A Tired Woman's Guide to Passionate Sex. Just fix that up, let me carry. Yeah, so she has those two books, so I think worth checking out. And hopefully this little quick podcast I just did will give you some insight into stuff that we recently learned that we're trying to implement, and maybe you can do it if you're a clinician or do it with your partner too. All right guys, that's it. Remember, I'm Dr. Smita Rahman, I'm here to educate so you can advocate.

just wanted to do a quick little turnaround here to talk about this because it's been on my brain for a very long time. I think it's very important to do and discuss. please follow me on Instagram and on my socials and stay tuned for more information. I'm here to educate so you can advocate for yourself. Please join me for another episode next week. Thanks so much.