I also talk about how hormonal changes that occur during perimenopause can influence sexual desire, and why understanding our sexual functioning and desire is important when talking about body image.

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Summer:
If we feel body shame that’s going to influence our level of sexual desire and satisfaction. And conversely, if we are experiencing issues with our sexual functioning like pain during sex, then that’s going to influence how we feel about our body. So these two things are interrelated.

This is eat the rules, a podcast about body image, self worth, anti dieting, and intersectional feminism. I am your host summer Innanen, a professionally trained coach specializing in body image self worth and confidence and the best selling author of body image remix. If you’re ready to break free of societal standards and stop living behind the number on your scale then you have come to the right place. Welcome to the show.

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This is episode 295. And I am looking at aging body image and sexuality. Specifically I’m looking at perimenopause and how that transitional time period can influence our sexual functioning and desire and how that intersects with body image. You can find all the links mentioned at summer innanen.com forward slash 295. I want to give a shout out to Eaton hope who left this review. Thanks for this amazing podcast. I love listening and learning. Thank you so much all the way from Australia. I appreciate you listening as well. And you can leave a review just a short one like that and it means the world to me. You can go to Apple podcasts search for eat the rules, then click ratings and reviews and click to leave a review. You can also subscribe to this show to let me know that you like it and want to keep it on the air. And if you haven’t already done so grab the free 10 Day body confidence makeover at summer innanen.com forward slash freebies with 10 steps to take right now to feel better in your body. And if you’re a professional who works with people who may also have body image struggles, get the free body image coaching roadmap at summer innanen.com forward slash roadmap. Okay, so last episode, Episode 294 We talked about perimenopause and body image. And for those of you that don’t remember didn’t listen to that episode. I’m currently doing my masters of counseling and I’m centering most of my research around the perimenopause demographic and mental health and eating disorders and things like that. And so in my last semester, I had a sexuality class which was really cool. And my project my research paper was around perimenopause and sexual functioning and desire. And I spent so much time doing all of that research that I thought why not share it with all of you make it you know, kill two birds with one stone. So here we are. So the first part was last episode where I talked about body image and ageism and perimenopause. And this time, I’m going to be talking about sexual functioning and desire and how that relates to body image and aging and specifically how that might influence you during the pre menopausal period. And spoiler alert, it’s not just about hormonal changes, it’s actually just aging changes. So no matter where you are, in your lifespan, I think you’ll probably take something useful away from this episode.

And let’s get started with it. And if you haven’t listened to the last one, definitely go check it out. Thank you so much for anyone that sent a message just saying how much you enjoyed it or if it was helpful for you, I really, really appreciate that. It means a lot to me. Otherwise I just feel like I’m talking to a wall so it’s nice when people say hey, this was helpful or this was useful or could you talk about this because it just you know, then I know I’m not just talking to myself, although I do find myself Interesting.

Okay, so let’s get into this let’s talk about aging and body image and sexuality. So when I use the word sexuality here, I’m really going to be referring mostly to sexual desire as well as sexual functioning. So things like sexual satisfaction, frequency of activity, desire, arousal, pain during intercourse. ers those are the central things are going to be talking about. And I was just gonna say in this paper, that is not what I am doing in this podcast. So we’re going to talk about how these things change as we age as a result of hormonal changes that we might be going through as well as aging in general.

I’m going to talk about the concept of the brakes versus Excelerator framework as it relates to sexual desire, which is something that Emily Nagurski talks about in depth in her book, come as you are, so I highly recommend getting that book if you want to know more about that. But I’m gonna review that framework loosely, just to give us context for the rest of this episode, when we talk about what can influence sexual functioning and desire. Then we’ll take a look at how hormonal changes that occur. During the perimenopause time period, the menopause transition can influence sexual functioning and desire. I’ll highlight some of the results from the studies that have been done on this topic and what they said and the aspects of sexual functioning. They’re most influenced during perimenopause that might surprise you. Then we’ll look at the role of psychosocial variables including body image, as well as how gender roles influence sexual desire. super interesting. But before I dig in, I just want to highlight that I’m just scratching the surface here. Sexuality is not my area of expertise. So please do not think I’m an expert here.

I just want to share what I learned from my paper, and some of the research that I took away on this topic. So by no means am I an expert on sexuality, body image, yes, I would say I’m definitely an expert on that. I would not say that I’m necessarily an expert on her menopause or menopause. Although I’m just an avid learner, because I think it’s super, super important. And as I continue to do more research in that area, I know I will continue to learn more as well. That said, I think there’s still some really helpful takeaways. And if you want to learn more than like I said, Get Emily Nagasaki’s book COMM As you are because I think that you’ll find that to be really, really helpful for learning more about sexuality and, and how we can have a better sex life and relationship with our body. Now, and as we age, the reason why I’m talking about this is because whenever I’m having conversations with people around body image, the topic of intimacy, and sexual desire often comes up because body image can influence that, if we are feeling really ashamed of our body, we might not have a lot of a desire to have sex, or we might be afraid of being intimate with our partner. And so that’s why I think that this topic is really important. And then conversely, if we are experiencing some sort of issues with sexual functioning, like pain during sex, or feeling like we don’t have much desire and thinking, that means there’s something wrong with us, we can sometimes internalize those beliefs like that there’s something wrong with me, there’s something wrong with my body, and then that can influence our body image as well. So these two things can influence each other. And so in other words, our body image can influence our sexual functioning and desire. And conversely, sexual functioning and desire can influence our body image. And so that’s why I thought it was relevant for this podcast. I just think that these two things are important to understand when we talk about our relationship with our body and understanding our body and being more connected with our body. And so that’s why I wanted to share this with you.

The first thing that I want to talk about is this concept of brakes versus accelerators. So this is a framework that Emily Nagurski uses that I believe she adopted from other researchers, but do not quote me on that just go and read the book. But in any event, just like in our car, our sexual desire can be increased or decreased by certain things. So there’s going to be certain things that put on the brakes, meaning they’re going to lower art, it’s going to lower our sexual desire, it’s going to make us uninterested in having sex with ourselves or other people. And there’s going to be things that accelerated that stimulate it that cause us to have more desire to want to be more sexual with ourselves or somebody else. And this analogy is really useful, because as I start to talk about the various factors that influence sexual functioning, you can start to think about how they fit into either something that puts on the brakes or something that increases the accelerator. And most of the things we’re going to talk about are kind of like they put on the brakes. So the brakes are these are kind of like turn offs or not even necessarily in like a direct way. But these are things that lower our sexual desire. And they may even make you not want to have sex with somebody because you’re exhausted or you’re super stressed or you have a history of trauma or your body image is terrible, and you’re afraid of what someone’s going to think of your body. So those are the things that are considered brakes. And some people have more sensitive brakes. So some people, if you are going through a lot of stress, like you can’t turn your mind off, it’s really, really hard for you to feel any sort of sexual desire, whereas other people are going to have less sensitive breaks. A good question you can ask yourself is like, what do you think influences your sexual desire? What do you think your breaks are some of the things that Emily mentioned our body image trauma, history, sleep deprivation, relationship, conflict, unwanted pregnancy, or STIs, or fear of those things, depression, anxiety, stress, performance, anxiety, feeling obligated or expectations on how you think it should be, that don’t match up with how it really is. So those are all things that decrease our sexual desire, they’re going to make us not want to have sex with ourselves or other people. And a lot of times these things are happening and we don’t connect it to our sexual desire. We just think we have low sexual desire and that perhaps there’s something wrong with us when the reality is that maybe these things are going on that’s that are contributing to that as well. I talked a lot about how our body image and mood are influenced by perimenopause and aging in the last episode, and one of the things I mentioned was that this period of time perimenopause is really a perfect storm for body image struggles because of the additional life stressors because of the hormonal changes, because of ageism, because of appearance changes, because of often experiencing a worsened body image. And therefore our body image becomes a lot more vulnerable during that time. So it makes sense that during perimenopause, we might have more breaks that are going to cause us to have lower sexual desire. And I’m gonna break that down a little bit further, but it’s just something for you to to mull over.

And then conversely, there’s accelerators. So these are the things that stimulate your sexual desire. And again, some people are going to be more sensitive to these things. But that could be things like your partner’s smell, or the parents or the environment that you’re in, or pleasant sensations, or visual or auditory cues, could be like the level of intimacy. So just someone making you feel really special, or you making yourself feel special, trusting your partner novelty, or if it’s like a new relationship, or a new vibrator, you know, those types of things. And so they’re not universal. These are all individual. And I’ve listed the ones that Emily listen or book. And I’ve also added a couple of my own here and there. But something I learned in my sexuality class is that we want to focus on reducing breaks versus adding accelerators. So if you think about these two things, like I think a lot of times, when we read advice on the internet, or we look at advice in like the magazines, like back in the day, when if we used to read like Cosmopolitan magazine, like I did in my 20s, then a lot of it focused more on kind of like the accelerators. And whereas if we want to increase our sexual desire, really, it’s more important to focus on lowering the brakes. And looking at those things. And when we talk about aging and body image, I think that that makes a lot of sense. Because we’ve got increased stress, we’ve got these hormonal changes, we’ve got mood changes, and all that stuff is going to increase the brakes. And so the reason why I wanted to start out with that framework is so that it will hopefully give you a better perspective for the rest of this episode on how aging and perimenopause influenced sexual desire.

So let’s talk about perimenopause and sexual functioning. I talked about perimenopause last time. And just as a reminder, it’s that period of time before you reach menopause and menopause is the cessation of your period when you haven’t had your period for a year. That is that blip, that blip in time is considered menopause. So the years leading up to that when your hormones are changing are considered perimenopause. And for a lot of people they can last a decade, the average age of menopause is about 51. So most people who are in their 40s are most likely going through perimenopause. But it can even start for people in their late 30s. And some of the perimenopause symptoms that can create changes in sexual functioning are things like hot flashes, mood changes, heart palpitations, depression, anxiety, rage, sleep disturbances. So if you think about the symptoms that happen as a result of these hormonal changes, yeah, they’re probably going to put the brakes on. And another thing I just want to call out here is that black women tend to have a longer duration of menopausal transition than white women as well, longer and more intense hot flashes. So there’s that difference taking place to that they’ve seen across races. Women in perimenopause also experience a reduction in the concentration of sex hormones in the blood, and that can increase pelvic pain and so So what that means is that it might hurt when you’re having sex as well, it can decrease sexual desire that change in hormones. But let’s talk about pelvic pain for a second. Because I think that again, this is going to put on the brakes. So in my research, I found that I think the number was 40% of people in one study, actually, it’s kind of like this signature study. It’s called the swan study the study of women’s health across the nation. And they found that 40% or more women in the study, were more likely to report having frequent pain during intercourse. And so if we think about that, okay, we’ve got a lot of people that are going to be potentially experiencing pain. And some of that is because of the change in sex hormones. And that can result in vaginal dryness. But other changes that can happen are vaginal narrowing and shortening, uterine prolapse and urinary incontinence. And so these factors, these hormonal changes, and other factors can affect the tissue of the pelvic floor. And if you don’t know what the pelvic floor is, it’s like, and by the way, I am not a physiotherapist here at all.

So I’m probably going to butcher this but like, it’s essentially like the series of muscles that are holding up your there’s a better way to say it, but that’s kind of my understanding, like holds up your reproductive organs and like your bladder and stuff like that. Gosh, that’s like a really butchered way of saying it. I don’t know, Google it. But anyways, the point being is that your pelvic floor is really important. So if you like pee when you sneeze, then that’s a pelvic floor thing. And definitely go see a pelvic floor physiotherapist because they can help you with that. But the point is, is that these pelvic floor changes can happen during perimenopause, and it can result in worsened sexual functioning and pain during sex. And so it’s a really good idea to meet with a pelvic floor physiotherapist for an annual check. And that’s something that I do, especially since having given birth over five years ago, as well as having had a hysterectomy, I don’t have as much, there’s not as many organs there keeping my bladder in place. So I have to be really, really careful and make sure I’m doing my pelvic floor exercises. But if you’re experiencing pain, that could be potentially why and it also could be because of vaginal dryness. And so there’s estrogen creams that you can use for dryness, which are super safe. So all these physiological symptoms can affect the overall quality of life and in turn, sexual functioning and desire. And these things are going to activate the brakes, right? Like, if you’re in pain, when you’re having sex, like, that’s not going to make you really want to have more of it. And I think often we try to push through these symptoms, or internalize that our body is broken. And the reality is, is that what we’re experiencing is totally normal. Not enough people talk about it. And there’s things that we can do to help so your body is not broken, it’s normal to go through those things, doesn’t mean that you have to always pay yourself when you sneeze, there’s things that you can do about that there’s things that you can do, it doesn’t mean you’re always just going to be in pain, when you have sex, you don’t have to push through that. So definitely, you know, go see a doctor, go see a hormone specialist, but go see a pelvic floor physio. But if you’re experiencing any of these things, just know that that’s super normal, and it will impact your sexual desire. And it’s probably going to impact your body image too. You know, it might make you feel like your body is broken, or something’s wrong with you. And that’s gonna make you feel more self conscious about your own body or want to kind of disconnect from your body and be less embodied. And so these things like I said, go hand in hand.

I want to talk about the studies that looked at what happens to our sexual functioning during perimenopause. So there’s a few different studies that looked at this specific lifespan that that period of life perimenopause and looked at the various aspects of sexual functioning and looked at okay, what happens during that timeframe? What are sort of the predominant changes in sexual functioning? And so one study that called the Massachusetts women’s health study showed that perimenopausal women had less frequency of sexual desire, but that was pretty much it. That was the main outcome that changed was just less frequency of sexual desire, although I would say that’s a big outcome. So I don’t want to like downplay it and call it minimal, but it was just a reduction in sexual desire. The other study which is called Swan, which is the study of women’s health across the nation, that’s kind of like this, like landmark study that gets referenced all the time when we talk about perimenopause and menopause, is it found that permanent puzzle women were about 40% more likely to have frequent pain during intercourse, which I mentioned earlier, and they also found a decrease in sexual desire, but they didn’t find any difference in terms of frequency of intercourse, arousal or physical or emotional satisfaction. More specifically, they found that vaginal dryness was associated with pain and lower arousal, emotional satisfaction and physical pleasure. So pain sort of being like that element that can intersect here and really cause a decrease in arousal and satisfaction. The thing that kind of stands out to me which this is just my own like this is my own summarization. So they didn’t say this. But this is just me sort of reading this and thinking about it is that if there isn’t a difference in terms of frequency of sexual intercourse, but there’s this increase in pain, like how many people are just pushing through, right, like how many people are just pushing through this pain to potentially satisfy their partner, or because they feel like they should, or because they can just muscle through it. And so anyways, I don’t know. I don’t know if that’s necessarily true. But that’s one of the little conclusions that I come to here and it is a little bit concerning to me.

Another study called the Melbourne women’s midlife health project showed that sexual responsivity declined during perimenopause, feelings for partners declined and partner problems increased. So they found that issues between partnered individuals increased as well, sexual responsibility decline, which to me, that makes sense that those things would go hand in hand. And I think when we talk about gender roles, and we look at stress, then some of those changes that we see between feelings for partners will probably make more sense to the interesting thing about that particular study was that they were able to control for aging. And they found that these areas, so sexual responsivity, and feelings for partner declining and partner problems, they happened equally, it didn’t matter if the person was in a hormonal transition or not. So it was just an aging effect versus a hormonal effect. And I think that’s really important, because that was something we pulled out last time that we talked about in the last episode, Episode 249, when we talked about perimenopause and body image, that it was less about the hormonal transition and more about the psychosocial factors that affect anyone who’s aging. So it’s not necessarily about this hormonal transition. And I think that that’s really, really important. Although these physical symptoms that happen as a result of the hormonal transition are absolutely going to contribute to a decrease in sexual desire.

There’s also these other psychosocial variables that are super, super important. And that’s why it’s really important to look at those psychosocial variables and other aging factors. It’s not just the hormonal shifts, and those other psychosocial factors. We talked about them last time, ageism, body image, mood changes, gender roles, we’re in talked about this time, increased stress during that period of time of life. And so across the board, these findings suggest that pain and diminished sexual interest are the primary symptoms most experienced by Peri menopausal women. That’s kind of the summary. Even though they looked at all these other aspects of sexual functioning across all these studies, it was mostly pain and diminished sexual interest. And so that’s why I think looking at sexual desire and looking at it as it relates to the brakes and the accelerator are really important when we talk about why things might be changing as we age. The other thing I just want to call out is that all of these studies seem to focus on sis hetero, women’s experiences. Therefore, more research would be needed on how these translate to LGBTQ i A plus plus individuals. And some of these studies are from the early 2000s. Therefore, things have changed in the past couple of decades. So it would be interesting to see how those changes have affected that results. So those are just two things to keep in mind. Let’s talk about these psychosocial variables. So psychosocial variables are really looking at the social environment and the psychological state of the person. And as I mentioned, they play a really important role in our body image, they play an important role in sexual functioning outside of hormonal changes. And one study looked at the role of body image, depression and sexual communication on premenopausal women and their sexual functioning. And this particular study found that these psychosocial variables body image depression and sexual communication, there was an association between those variables and sexual functioning in premenopausal women.

So in other words, body image depression and sexual communication, influence sexual functioning and premenopausal women. I feel like I use way too many words to just where I could have just said that sentence from the get go. But there you have it, they found that the changes were again, not so much related to perimenopause symptoms or the hormonal changes, but rather, they were related more to this, these psychosocial variables. That particular study I’m referencing just for full disclosure, it was not randomized, and it looked at people in South Korea, so more research would be needed to see how that translates to other cultures and broader populations. But I think there’s a common thread throughout all of this, that it’s more about just the aging process, unless about the hormonal changes that are happening. But overall, this suggests that interventions geared towards improving body image and reducing depression improving mood reducing stress enhancing communication between partners would be beneficial to improve sexual functioning. And that makes a lot of sense. Okay?

The last little tidbit that I found was another study that looked at sexual satisfaction and found that it was decreased during perimenopause. But this particular study also looked at body image and found it was, it was only weakly correlated with body image. So what that means is that, even if you have a bad body image, you can still have sexual satisfaction. So don’t feel like just because you feel bad about your body, that you might not be sexually satisfied, these two things may not necessarily be co occurring for an individual, it’s always an individual thing to I think, with any of this information, it doesn’t mean that you’re going to fit into any of these boxes, I think it’s just like, hopefully, it just helps you make sense of some things and make you makes you feel like there’s not anything wrong with you or your body. And that what you’re experiencing is, is normal, and a lot of it is culturally driven. It’s driven, because of ageism, and anti fat bias, which causes us to have a poor body image and other factors. And one of those other factors is gender roles. So let’s talk about that. So there’s this really interesting paper called The heteronormativity theory of low sexual desire and women partnered with men. It looks at how gender norms explain low sexual desire. And so while this paper doesn’t focus on premenopausal people, specifically, I think it’s still super relevant doesn’t matter your age, they speak to how heteronormative gender roles influence our sexual desires. So what are heteronormative gender roles, they look at four different ones in this particular paper. So one of them is inequitable divisions of labor. So if you think about the physical and mental emotional labor, in a heterosexual couple, and oftentimes the women hold a lot more of the mental labor and emotional labor and physical labor. So thinking and planning about what groceries we’re going to buy for this week, okay, I have to sign my kid up for this summer camp, I have to pay this tuition payment, I have to do this other thing, I have to buy the president for the birthday party, I have to send that thank you card, like all of that stuff, right? It’s a lot of stress, it’s a lot of extra work. So that’s one area. Second is the caregiver mother role to men. So taking on the role of like, feeling like you got to look after your partner in the relationship, and potentially doing more labor in order to do that. Third one is a prescriptive focus on parents. So feeling like you have to, you know, tend to your parents and look a certain way. And the last one is norms about sexual initiation. So kind of expectations around how you should be as it relates to sexual initiation. And so those four categories, those four areas can all influence sexual desire. And so when we think about the breaks that we talked about earlier, and what influences sexual desire, it’s important to take into consideration the stress and expectations of gender roles, especially for permanent puzzle aged women. Last time, we talked about how you might be, you know, looking after parents or having family members or friends that are either ill or have died, caring for children potentially having a really demanding job, and all of these things to be happening in that sort of like midlife phase of your life. And that can be amplified even more by gender roles, as we tend to take on the brunt of these things and more of those caregiving roles.

So overall, what I want you to take away from this is that you’re not defective. If your sexual functioning and desire has changed, so much of this is cultural, and it’s less about hormonal change, and more about the increased influence of psychosocial variables. Of course, the hormonal changes play a role, like if you’re having a hot flash, maybe you don’t want to have intercourse, right. This is affects anyone regardless of whether or not they go through the menopause transition. So ageism, appearance changes worsened body image, mood changes, increased stress, all of these things are also going to influence your sexual desire and overall, potentially how you feel about yourself and your well being.

So to summarize this episode, and just give you some things to take away from it, the first one is just to think about what your breaks are, and perhaps look for ways that you can reduce those, or at least bring awareness to why you might be experiencing what you’re experiencing. I think there’s also this idea that like, there’s a way that people are supposed to have the same level of sexual desire and that’s not true either. So I don’t want you thinking that like, you have to have more sexual desire. If you don’t want to, that’s totally fine. It’s really whatever you want. But if you feel like it’s decreased or you feel like you’re like, Oh, hey, like I’m not in the mood as much as I used to be. Then think about your breaks and look at it, whether or not there’s ways to get some support to reduce those things. Second is to know that working on body image might help with increasing sexual desire. And working on other areas that might influence sexual desire, like reducing stress might help your body image improve to, because when we’re stressed and other areas of our life that causes us to experience body shame. And in addition to that, when we improve sexual desire, we experience more pleasure in our body. And that helps us to feel better overall in our body.

So it’s a piece of the puzzle that I probably don’t talk about as much on this podcast specifically, I do oftentimes when it comes up when I’m working individually with clients, but pleasure is really important, and connecting with our body and being embodied and knowing what gives us pleasure and being able and knowing our body. You know, because a lot of us grew up in a time where sex education was just like, the teacher putting a condom on a banana. And we didn’t learn about pleasure, and we didn’t learn about consent, and we didn’t learn about what a clitoris is, or any of those things. And so, becoming more connected and knowing your own body can actually help you to just feel better overall in your body and be more connected to it. Next thing I want you to take away is that if you experience physical changes, like pain during intercourse or incontinence, look into pelvic floor therapy, I can vouch for that I do not pee when I sneeze anymore, and talk to your doctor or look for a NAMS hormone specialist. So NAMS is the North American menopause society and they do trainings for doctors and like nurse practitioners and things like that to give them a lot more training on menopause transition because doctors don’t really learn much about that in school. And you can also just see your doctor about getting like a vaginal estrogen cream as well if you have vaginal dryness. And then the last point is just talking about something that came up in the previous episode, which was how the research suggests that having greater resiliency can impact overall wellbeing for pre menopausal people. And so again, just remembering that focusing on things like emotional stability, emotional regulation, self compassion, and self worth, are going to help you overall, to have greater psychological well being, which is also going to help reduce some of those breaks and help with your sexual desire. All right, that’s a wrap on this episode, you can find the links mentioned at summer innanen.com, forward slash 295. I will include the studies that I mentioned in this episode as part of the show notes, so you can check that out there if you’re curious to read those in more detail. And yeah, let me know what you thought of this episode. If you enjoyed it. That’s awesome. I’m so glad let me know what you took away from it. And I will be back again in a couple of weeks with a new episode. Thank you so much for listening rock on.

I’m Summer Innanen. And I want to thank you for listening today. You can follow me on Instagram and Facebook at summer Innanen. And if you haven’t yet, go to Apple podcasts search eat the rules and subscribe rate and review this show. I would be so grateful. Until next time, rock on.