Ep 42 Navigating Sexual Health in Midlife w. Emma Perks Physiotherapist

so Emma Perks, welcome back to the podcast. So happy you’re here. Tell us a bit about yourself, your business, your services, how you help people.

[00:01:04] Emma Perks: Thank you for having me back, Megan. Um, so, uh, I am a pelvic health physiotherapist. Um, so, for people who don’t know what that is, it is like a generic physiotherapist and we treat people through all parts of their body, but we have a particular interest in pelvic health.

So, things that happen within the pelvis usually, so that, you know, um, In relation to women’s health in particular, that is, uh, things like continence issues, so bladder and bowel issues, uh, any problems with periods or period pain, uh, perimenopausal pregnancy, babies, uh, and pain. So all of the above. Uh, and we treat people, um, From the ages of sort of naught onwards.

So we, as I say, we see women through their ages and stages of life and through their major transitions. So that’s usually pre puberty, puberty, pregnancy, postpartum, perimenopause, and post menopause. And that’s kind of really the idea of why we called it full circle physiotherapy, or what I called it full circle.

Um, it’s just this idea that, Women are cyclical beings. We go through these big transitions and every transition is an opportunity for an upgrade or an opportunity for a change. Um, again, that idea of a cycle, it kind of starts and the duration and then it finishes. So you have opportunity to start again as it were, um.

Yeah, so there’s actually now, um, a team of us. So there are four physiotherapists that work together and we work around the mountain. So we are based in new Plymouth at Tahi. Uh, we’re also based in Hāwera , and then we’re also now placed in Okato . So there’s three different locations we are at.

[00:02:54] Meegan Care: Beautiful. So wherever you live around the mounga We can access, full circle physios services.

Fantastic. Yeah, so good. And so the part of the, um, cycle. That I’m interested in and that I work with women around is, um, midlife, but perimenopause, postmenopause. And so that’s why I’m super excited that you’ve jumped on the podcast today to have a chat with me. Because I, I wanted to speak to you about, pelvic health issues that come up for women, peri and postmenopause.

So I’m just going to say midlife, right? Because that’s that broader range. But also how that. Relates to sex because that that’s such a big issue through perimenopause and post and I really wanted to Dive into a bit of conversation with you about it because whenever I’ve talked to you about That subject around sex and around midlife it’s been so incredibly helpful for me as a woman in midlife and it’s opened up my awareness about I guess they’re simple things, but understanding around how my brain and body works and the, the hormonal shifts that happen and how that impacts my interest or lack of interest in sex and all of that kind of stuff.

So I guess let’s begin with the, the physical. Wherever you want to start around it.

[00:04:22] Emma Perks: Cool. Yeah. So I guess it’s useful to start almost, if I cover a little bit of what is quote unquote normal in a normal cycle of a woman who is maybe having regular periods almost maybe before, just before perimenopause because it sets the picture of what is, as I said, to be expected and how you make those changes.

So, it’s, And I say this a lot of times to, to clients is that again, there’s a normalcy around, there are going to be different points in your cycle when you are going to be more interested in sex than others. Okay, so even if we take out perimenopausal and hormonal shifts just within a natural kind of menstrual cycle for women, right, is that there is going to be this, uh, shift in hormonal changes, obviously one, but then there’s also physical changes.

So we know our cervix height will change as well at different points in the month. That will impact on things like sexual positioning, for example. So, for example, if I’m talking, uh, kind of. I talk about penis and vagina sex, penetrative sex, um, then you’re going to find, you might find that having, you know, being intimate with someone, um, and using a particular position on this week, you do the same position in a couple of weeks and it feels completely different and you’re like, Oh, that’s not.

That’s not what I like and not what I want right now. So there is already a natural trend that happens along a normal menstrual cycle. So that’s just useful to put out there because I think, again, there’s this consensus that Uh, we should be ready for sex at any, any given time, any given day, on any given month.

And when you don’t feel like it, as women, we always assume there’s something wrong with us, you know, like, Oh, there’s something wrong with me. Um, and so that’s useful to kind of put out there and project out there that if you are not feeling particularly, uh, you know sensual and sexual on this week, for example, the week of your period or leading up to your period, one we would recognize as a season or change that kind of being your autumn winter, you’re more likely to want to have sex when you’re coming into your spring and summer, right?

Like it makes biological sense because that’s when your body is prepping for the egg to be released, the ovulation to occur. If sperm was going to happen, they’re going to make that kind of environment super, as we just used the word juicy, but it’s going to make that environment super attractive to bring sperm in to make a baby.

And then once the egg has not been fertilized, then It recognizes, okay, not this, not this month, and it goes away again. So, um, this also, that doesn’t follow a very strict rule. So, for example, um, some people will find that, you know, they might feel more, um, you know, kind of more sensual and more sexual, kind of, when they’re closer to their period.

There’s a, there’s, it’s not kind of one size fits all kind of rule. But, The best thing I do with people is just to get them just to take note of where their natural feelings of arousal seem to be, or, um, you know, when they’re feeling more feeling like sex or intimacy at what point in their cycle. So that’s kind of the start, if that makes sense.

So when you’re entering into a perimenopausal cycle, because of that, there isn’t obviously that same routine, predictable, hormonal. Shift through things and we like in perimenopause very much like the teenage years. Okay. So if you look at the chart of how a menstrual cycle in a teenager, or when you first start having your period for the first 2 or 3 years, it looks.

very much like a perimenopausal picture. And what that is, is that you could be having a blade, but you might not necessarily be ovulating. So you’re not necessarily getting, um, um, that kind of peak in progesterone. And that’s often why perimenopausal as well as. Uh, you know, puberty periods can look really similar.

They can look quite floody and quite heavy and quite clotty. And that’s commonly associated with a lower progesterone in balance of your estrogen. Okay, it’s just your body, as I say, I like it very much at puberty, like, um, oil going through your engine for the first time, right? Uh, it’s that same thing.

Your body’s just trying to figure it out. On the other end of things, perimenopause, it’s the same thing, but on the other end, it’s like the oil is coming through the system and coming through the engine, because it’s been doing it for a while, but it’s kind of coming to the end. So it’s, it’s still that kind of, um, erratic irregularity, right?

So you aren’t going to have the same swoop of hormonal. predictability as you would do when you were having regular periods, for example. So that’s the first thing to kind of know that there is also going to be a shift in how you feel around sex and intimacy, depending on where your cycles are. The other thing that is also going to happen.

So the impact on that is that there’s the more, as I say, the physical changes, the more biological changes that you have in that, in that season of time as well. So this is when we talk about, we label it as the thing called GSM, which is genitourinary syndrome or symptoms of menopause. So, that might be when people are noticing a bit more physical symptoms such as, um, Vaginal dryness or irritation, and that most commonly is apparent in intimacy.

So it doesn’t necessarily mean penis and vagina sex. That might just be with like their own arousal that they either find that they needing a little bit more lubricant or they’ve never used lubricant before and all of a sudden they feel that things are needing a bit more lubricant. Um, or, uh, the other thing is that on another context of GSM can be that they’re noticing a bit of leakage, like urinary leakage.

So that is another symptom that tends to come along around this time. And again, it’s due to those kind of fluctuating levels progesterone while they’re trying to figure themselves out. Um, and it’s actually the estrogen that Creates a bit more stiffness and a bit more again, juiciness and plumpness around the vulva region, particularly around that urethral sphincter.

So I liken it to a lot of clients like, uh, yes, pelvic floor is important in terms of keeping your incontinence at bay and making sure you’re getting a good closing pressure. But if you imagine the hormonal impact on that is like the washer on a tap. So when you turn the tap off, you can turn the tap off.

kind of manually as if that’s your pelvic floor muscles, but if you haven’t got the washer, you don’t get a tight seal. Okay. And it’s the hormonal influences what gives you your tight seal. And maybe that is what clients or patients are experiencing. Like nothing really has changed in my pelvic floor strength.

I feel like I’ve been doing the same kind of activity, um, but I’m getting a bit more urgency and frequency and I’m also getting a bit more leakage. And it’s the hormonal impact on those physical structures, which makes the biggest differences. So they’re probably the most common, I say, two common things physically in a pelvic health arena, which is, I should say, vaginal dryness.

We used to call it vaginal atrophy. It’s a horrible word. How rude. He’s the worst. So we, I said, like, we would refer to it as GSM, which is just Genitourinary Symptoms of Menopause, which is stating a fact of what it is. Um, and, um, yeah, so it’s the vaginal dryness, um, or irritation or painful sex. So it depends if you have to unpack that a little bit of what that means to that person, um, and urinary incontinence and the difference being.

Or the main thing to note about the physical symptoms of this is that they don’t always change over time. So, whereas, for example, in terms of the hormonal shift, as you’re kind of in that season of irregularity heading towards menopause and then postmenopause. You can assume, to some degree, some of those symptoms you may be having, such as, like, hot flashes, or, uh, brain fog, or anxiety, all the other stuff, okay, and not necessarily super physical.

You would assume, to some degree, once those hormones have sorted their shit out, and you’ve decided, okay, yeah, we’re done, we’re at the end of that season, then usually those symptoms go away. Yeah, so you kind of or they have less impact Sometimes with GSM they can continue. So again, it’s because you’re Those hormones are affecting an actual physical structure So for some people they will need to kind of manage those GSM symptoms right the way through perimenopause and postmenopause Yeah, yeah, absolutely

[00:13:33] Meegan Care: how So I know a lot of women suffer and don’t talk about those experiences, you know, and how treatable or how complicated is it to treat it?

Is it like incredibly worthwhile them coming to say see someone like you, pelvic health physio, is there a lot that can be done with

[00:13:59] Emma Perks: those issues? Yeah, absolutely. Because sometimes, I say, sometimes the simplest solutions are the simplest, really. So, for example, if you are, and I say like catching this, half of the point is what you’re trying to generate is awareness, right?

So, A, the normalcy of these symptoms, and it’s not something that you have to put up with. And it’s something that actually that can be quite a quick, easy solution to this problem. If you address it and bring it to light, and it can be quite confronting going or coming to, say, someone like ourselves, you know, it’s putting yourself in a place of vulnerability, you may not have talked to anybody about sex before, you may not, it depends on your communications and your culture around what sexual health means to you.

Um, so it is quite a. brave thing to do. But sometimes, so for example, with the GSM, um, what I’ll usually say, uh, to people, and one of the ways that we can get more information, obviously, is, is an internal exam or a pelvic exam. So I can look at the tissues and see what it looks like. And you usually get a good idea just from observing what the tissues around the vulva look like, right?

So, Um, we’re looking for, um, like a texture. Does it look dry? Does it look fragile? Does it look raw? Does it look red? Does it look pale? Does it look like it’s got a good blood supply? Does it look like, I often choose and say, you know, does it look like it just needs a bit of love? It’s kind of thing. Um, so all of those physical symptoms, we can kind of pick up observationally wise, but also checking out that there’s nothing sinister because obviously not kind of discounted.

Sometimes, you know, involvement changes are really important for us as women to take note of. So we know what’s normal for us and what’s not normal for us. So something like that, it may be something as simple as just using a vaginal moisturizer. So a vaginal moisturizer is basically. Just like moisturizer or any other part of your body, but it just goes on the vulva and around, we call it the vestibule, which is like the opening to the vagina and around the urethra.

Um, and what I, again, how I explain it to people is in the same way that you’d use moisturizer as a preventative for your skin drying out, right? So if your skin gets dry on your face, for example. And you can notice those dry changes, like, oh my skin feels quite dry, you might, you know, slather yourself in moisturizer to kind of address the problem at the time, but if you moisturize your skin every day, you’re building up your body’s actually kind of like, Like mucosal skin layer of hydration, which means it’s more resilient to external environments on it, right?

So, um, vaginal moisturizer is a bit like that in the vulva. So if you are acknowledging that there is a change in the skin tissue, Elasticity, uh, I think plumpiness, juiciness around that area, and you’re like, okay, what often people find is that they need a lot of lube during intimacy, and it’s almost like there’s not enough lube, so they almost go through half a tube in, in one kind of like session.

Um, but if that skin was more nourished on a, a more consistent, for example, like daily occurrence, you’ll need far less lubricant when you’re actually being intimate together. So quite often there’s this kind of confusion between what is lubricant, what is vaginal moisturizer, and then what is a vestin. A vestin is a really low level of, but it is hormonal.

and oxygen cream that you apply. Right. So you’ve got these three different things going on. And I was like, I don’t know where to start. The simplest place to start is vaginal moisture either. And we, for example, we sell it here at Tahee. There’s really lovely products. There’s oil based ones. There’s kind of more like a gel, like a water based one.

They’re all organic. They’re, there’s nothing nasty in them. There’s no parabens, there’s no PHAs or BPAs or anything like that. Um, and it basically, it’s, it’s only job is to nourish and moisturize the vulva. So if you were using that, for example, after you have a shower or a bath or whatever, and you just moisturize moisturize your knees or, or your face, takes five.

10 minutes tops, not even, um, and it will soak in because it’s a really lovely product. That might be all you need to eradicate some of these GSM problems. If, and I might as well, on top of that, if they’ve mentioned, oh, well, I’m also getting some discomfort with sex. So with particularly penis and vagina sex, with penetrative sex.

I might say, okay, maybe using a vaginal moisturizer on a daily, that’s just for you. And then during intimacy, using a specific lubricant that’s going to be specific to that person. So quite often what we recommend in the perimenopausal population is a silicone based lubricant because it’s got, um, a really nice, um, like kind of friction free, silky feel to it.

It’s not globby, that’s the word, and it’s really thin. It Um, and it also, it provides a nice kind of almost protective layer against the skin. So it reduces friction, obviously, um, but it produces this really nice glide, which patients find really much more comfortable and a little goes a long way. So there’s lots of different, um, types of lubricant you can use, but particularly in the perimenopausal population, I would recommend an oil based lubricant or a silicon based lubricant.

Usually. Water based, um, is a lot, uh, sorry, again, it’s if you’ve got water based, water based lubricant in an environment that’s quite dry, your body will suck it up. Uh, absorb it, yeah. We need more lube, so you put some more in, and it just kind of sucks it in. So, by moisturizing the area, you kind of prevent that from happening, but also by having an oil based or a silicon based lubricant, you kind of, you reduce the need for more lube.

So, for some people, that might be all they need, okay? Um, if there’s an escalation on that, so, for example, if they are also… Coincided with discomfort with six vaginal irritation and that they are actually noticing bladder symptoms. So they’re getting a bit more urgency Again, I need to pee and I need to pee now and I can’t wait and a bit more frequency Like I feel like I’m peeing all the time and there’s really specific bladder issues that might be when I uh, recommend they go and have either a conversation with their GP or gynecologist or whoever it is that’s kind of managing them and talk about the option of maybe introducing a vest into them if the patient’s happy and if it’s suitable for that person.

Because that is usually when you need a bit more than just moisturizer, you might need a bit of topical estrogen in that region to create a bit more. Plumpness. Um, yeah. And again, stigmatism attached to h i t, it’s not h i t in the, in the most common sense of the word. It’s in the scale. Um, but it’s so, so minimal and kind of, yeah.

Guidelines, certainly from the uk like nice guidelines. Um, for G S M is the first thing is Avastin and pelvic health physiotherapy. They’re the two things together that often give people. Most benefit. So unless there’s a very specific reason why you can’t use a vest in or you have a again, a personal negative connotation with it.

Um, it is usually really well tolerated by a lot of people and that’s all it is.

[00:21:37] Meegan Care: Beautiful. Well, I know what we’re putting on our shopping list.

[00:21:40] Emma Perks: Do not buy lube from the supermarket, that’s usually my motto, but please don’t. Please don’t buy lubricant or don’t leave it to your partner to be their job because again, I always say, if there’s something going in your vagina, you have to be happy to put it in your mouth, whatever that is, okay?

So, it’s not,

[00:21:59] Meegan Care: it wouldn’t be a good guidelines for life. Good

[00:22:03] Emma Perks: guideline for life, because it’s a similar mucosal layer, right? It’s the same kind of absorption in your mouth as it is in your vagina. So, if you ask me to kind of squirt, um, you know, a teaspoonful of Durex onto a teaspoon and eat it, I, I, that would be a hard no for me.

Um, and so consequently, it’s a hard no for my vagina. Not happening. It’s not happening. Just don’t go near it. So good.

[00:22:28] Meegan Care: That’s so great. Let’s move on to, let’s move on to sex, sexual desire. We talked about it and you know, we were going to talk about it in terms of, um, our psychology, I think, but I mean, just in terms of how we experienced that as women in midlife is, you know, I know for many women and myself included, it’s like, Your sexual desire has that cyclical nature, you know, at certain times of the month it’s there, and other times it’s not so much there, and then you come into perimenopause, and then it’s like, Get away from me.

Don’t even touch me. I don’t even want to see, I went through a stage where I didn’t even want to see people having sex on television because I was like, what are they even doing? It can be that full on.

[00:23:10] Emma Perks: Yeah, absolutely. And it’s, it’s in the context of things as well, right?

Like I, um, it’s, it’s something that it’s on a different scale. So what I mean by that is, for example, for guys, a lot of the time, uh, from their pelvic health, okay, it can sometimes be harder for them to maintain an erection. So they almost, you have this kind of like crossroads where. Potentially for women, either it takes a lot longer for them to become aroused, if they’re even interested in it.

It takes a lot longer for them to, um, reach orgasm or kind of feel aroused enough to have penetrative sex and it not hurt. But for guys, it’s almost like this shortened window where they can only maintain an erection for so long. So it’s almost like this kind of, you’re trying to kind of cross these lines together in this perfect.

Perfect window where A, you feel like it, you’ve got enough time to get aroused, he can maintain an erection, and it’s almost like that those opportunities become less at times, so it can be a particularly tricky time. Um, I think as well, like you say, Around that time of perimenopause as a generic population of people.

Right. Uh, it’s when people are still in their careers. They may have teenager kids, um, or kids who are a bit older. You know, you’re not kind of wiping bums and nappies and that kind of season. Usually, yes. It’s usually you’re kind of like the tweens or the teens and, um, you’ve got them going through this.

big hormonal shift yourself. It’s like, essentially, especially if you’ve got, you know, more girls and boys, right? Um, and it’s kind of the teenagers, their brain is going to these big shifts and these big recalibrations, but you’re also going through those big shifts of recalibrations yourself. So it’s like the perfect storm for a clusterfuck, basically, because nobody wants to come into our house.

You have this kind of the two kind of things that are happening at the same time and it always crosses over and so it’s quite stressful for everybody involved. And, and I think, you know, you might on top of that, you might be having aging parents. So you might be also, you know, your dependents. Of ships.

Um, so when you had younger kids, you might just have to look at the littlies, but now you have to look after these tweens and teens and potentially aging parents as well. You might kind of be into your career and things that just, that’s just you, you spread really thinly. Um, and I think again, it’s just that kind of portion to have a kind of almost what I say to people is we need to zoom out a bit because.

I think when you look at things, and obviously I’ve just talked about the like super physical, super biological sense of things. I’m like, yes, that’s, that’s all well and good. And we can treat the physical components, but actually you need to look at that in a bigger picture, right? So if you’ve got a really lovely moisturized vulva and, you know, you’ve got your lube, which isn’t from Countdown, that’s, you know, you’ve Quality lube, and you may or may not have some on board.

That might be amazing. But if you, as you say, you’re feeling like, well, actually, the last thing I want to do is get intimate with someone. That’s kind of pointless. Like, you know, it’s great when you, when you do, but it does happen. You haven’t got any physical barriers, but it’s all the other barriers, which is, um, Often what happens.

And so when we were talking about it on the, uh, Tahi talks, which I talked very much around this idea of kind of, as I say, the psychology behind arousal. And I think it’s again, going right back to the start of our talk of that, you know, there’s this preconceived idea that, um, women are. You know, as we should be kind of good to go at any time, you know, irrelevant of our hormonal status that, you know, intimacy and sex looks like it is in the films, you know, like he comes, she comes at the same time.

It’s like fireworks. It was amazing. And the reality of sex is so far removed from that. That it sets us up to almost expectations is, is, is false. It’s not fair. So as soon as you don’t meet that expectation, you think there’s something wrong with you. Um, and that in turn creates this maybe internal dialogue of like, Oh God, it’s me.

I, I don’t want sex. I don’t, you know, and, and, and I’d say the biggest thing in, in couples or, you know, in relationships really is the assumption is. Again, the mother of all fuck ups, basically, because quite often you have this internal dialogue of that you might be thinking something like, okay, We haven’t had sex for a while, or we haven’t been intimate for ages.

He’s probably thinking, oh God, when’s it going to happen, and da da. Um, and you might be running through your mental list of things of stuff you need to do for the week. I really want to get to sleep. I’ve got this due, da da da da da da. But he might also be feeling like, I don’t wanna feel pressuring her.

I don’t wanna feel like I’m pressurizing someone. Yeah. But equally, if I don’t instigate it, does she think that I don’t find her attractive anymore? And I know she’s going through some mental stuff and I wanna be there for her, but I dunno quite how to be there for her. So then it’s this whole internal dialogue that never gets verbalized.

So the, the biggest thing I think in, in kind of a, a sex topic, perimenopause. It doesn’t matter about physical stuff. It’s really communication. It’s really explaining, and I’m trying to keep some level of communication channels open in a non pressurized situation. And so, um, that’s probably like my, my biggest go to.

The second. Yeah, it’s huge, right? Because. Like I said, sometimes it’s not always the story you tell yourself in your head. Okay, there’s the other kind of connotation of men and women have different arousal rates and that is like a, you know, kind of. They have lots of evidence around sex studies and sex surveys and thousands of people from the UK.

And so what they found this thing of, it’s called this thing called concordance. So they had this one study where what they looked at was physical arousal rates. So they used temperature gauges and lubrication levels and obviously engorgement. So females have erections just like males. And so for the male, it’s obviously a penis enlargement engorgement.

Blood fills the penis, but for women, it will be the clitoral area so that the clitoris expands four times its size when it’s aroused, right, so it’s own female little erection. So we’re looking at the physical elements of arousal and we’re just obviously, um, showing the. Participants, different images and stuff.

But what they actually found is that there was a, with the men, the feeling of arousal and actually them feeling turned on was so much quicker and so much more correlated to their. physical arousal than the women. So for example, what I mean by that is that they got physical arousal men, they got physical arousal symptoms and they felt turned on more.

Okay. So there was like a positive correlation or a more positive concordance between their head and their genitals. Females. Have the same physical arousal symptoms in their genitalia, but they didn’t have the same uptake in their kind of mentality, in their nervous system. So it just showed that women had this lesser or uh, um, uh, yeah, lesser concordance, if that’s the right word.

Um, so what does that tell us? What it tells us is that a. Potentially, as females, we are not taught about, um, uh, our own kind of sexuality, our own pelvic health, our own bodies, our own biology, but also kind of arousal senses of things. We’re almost like, learn to shut it down, or, um, it’s just not encouraged.

So again, if you look at that in a bigger social construct, right, that’s kind of this idea of, uh, this double standard of. If a guy has a one night stand, he’s like an absolute stud. If a woman has a one night’s dad, she’s a slut. Like there is lots of social constructs that you can Exactly.

You know, in terms of sex ed, right? When you think about younger women, um, tick being taught around their bodies, it’s all around period management. Oh, you get a period, this is some tampons pads. You stick it in you and don’t have sex, you’ll get pregnant. That’s pretty much it. Guys, it’s a lot more like, oh, these are condoms.

This is how you apply your condom to a normal erect penis. This is normal. It’s kind of expected that you will probably want to masturbate reasonably frequently in your teenage years. Females don’t get any of that information. And so from an arousal perspective in a later generation, you’ll, hopefully the tide is turning here.

Um, but you know, for, for sexual intimacy, there has to be. It has to be a reward. Anything we do is risk versus reward. So. So can I,

[00:32:07] Meegan Care: that’s, that’s so key, isn’t it? Because I think prior to perimenopause, we can sort of glide on through with that biological imperative, that sort of. Hormonally, a right, you know, brings that level up beyond that initial attraction, right?

But when we’re in perimenopause, postmenopause, it’s like, well, you know, I’ve got all these hundreds of things to do, and for many women, sex just feels like another thing on their to do list. Like, how do we get back to this can actually be rewarding?

[00:32:41] Emma Perks: Yeah, so I think the first thing with that is that you’ve got to, as I say, you’ve got to look at the risk versus reward.

And I say risk, I just mean, is it rewarding? So, would I rather be doing something else? So, when you first look at that, even just the word sex, right, can mean, majority of people would imagine what that means is penis and vagina sex, but that isn’t sexual equality. 80 percent or 85 percent of women won’t be able to reach orgasm with penetration alone, right?

So if you just keep sex to PIV, penis and vagina sex, 85 percent of women won’t get anything out of it. They may get something out of it obviously for their partner, but they’re not necessarily getting anything out of it reward wise in terms of orgasm, alright? So 25 percent of people will probably do that, which is great, um, but You know, in terms of the other half.

Majority don’t. So, sexual equality, when we look at that in terms of reward, it really is he comes, she comes. That is sexual equality. And that should really be across the board. So, from young people who are becoming sexually active. Right. The way through to kind of like the other end of stages, right? So that’s the first thing is understanding if you aren’t getting or if you aren’t being able to reach orgasm with penetration alone You’re pretty normal.

You’re in within the majority of people So it’s normal to need clitoral stimulation other than just penis and vagina sex. So if your your own relationship is Just that so whenever you’re being intimate together, it is literally the penis in the vagina in and out And that is it. You’re probably not going to see that as a reward like Because if you’re not in the majority, yeah, you’re not gonna get an orgasm from that.

So you might feel like it’s You might be doing it for your partner and that will give you some kind of intrinsic reward, but there’s not really anything physical. There’s not, you’re not going to seek it. And I think this is the thing as well, when you talk about drive, um, you know, sexual drive isn’t really a thing like food and water and shelter.

Um, so we don’t, especially in perimenopausal years, as you said, you haven’t got that. Um, drive that to produce, you know, you’re coming to the end. So if you’re relying on your sexual drive in perimenopause, it’s not, it’s, it’s going to taper off for natural reasons, reproduce anymore. Ironically for guys, they can keep reproducing right away into the eighties.

Right? So again, this is where you have the differences between men and women. Um, So, the other thing with that is that, with regards to, again, going back to this reward thing. So, the first thing is, you need to make it rewarding for you. So, um, I would say, first and foremost, communication. Second thing, you need to have something in that intimacy session that is rewarding for you.

AKA, you need to have an orgasm in order for that to happen. So, again, There’s a physical things for that with some people that they might well need to introduce a bit of just difference, right? So that might be use the use of vibrators. It might be the use of like clitoral vibrators and Associated with penetrative sex it might be that you are needing something to even kind of get you to that arousal point So, um again low testosterone in perimenopausal women is really common as well.

And that is a big Indicator so if you are saying as you’re saying like, you know I’m absolutely not interested at all. In fact, I find the idea completely abhorrent to have anyone near me. Looking at that lower testosterone is a useful component because that might well be something that is helpful to that woman.

There you go. I’ve got my

[00:36:15] Meegan Care: hand up for that. Once I, once I started on the, um, the, Body Identical HRT and a tiny bit of testosterone it really changed things .

[00:36:26] Emma Perks: Yeah, it makes it makes sense, right? Because it’s a sex hormone. It’s something that actually stimulates libido. So, um, making sure that, and again, this is where communication comes into key, right? It might well be, you’ve always had PIV the whole time you’ve been together. And then all of a sudden it’s like, Oh, I want to do something a bit different. It’s where you need to kind of, Again, like, have that communication channel of, like, this isn’t because I don’t find you attractive anymore.

Um, and again, there’s a big stigmatism around using things like sexual aids or toys or lube, even. Um, almost like it’s, oh God, we’re at this point in our relationship where we need lube. We need a vibrator. It’s like, well, actually. Our brains are very much geared towards anticipation of acts. So again, I liken intimacy a bit like if you’re doing your food shopping.

All right. So if you go to the same supermarket every week and you know where your bread is, and you know where your eggs are, and you know where your milk is, you could probably go around and do your supermarket shopping with your eyes closed. Intimacy is not much different if you know which way, which order it’s going to come.

He’s going to do this, I’m going to do that. Then he’s going to do this, then I’m going to do that. Your brain gets a bit bored. So, it’s useful to have that injection of different things. Um, the other thing I talk about, Pinkle, is, um, you know, again, the normalcy for, um, things like porn or erotic fiction, like when Grey’s, um, Fifty Shades of Grey came out, you know, it was like a sexual liberation for women.

Um, we’ve, it’s probably always been there in things like, you know, Jilly Cooper novels and, but, you know, it’s like three pages in amongst 900. So you kind of like, Three well worn pages. Yeah, like, some marked the pages. Um, So there’s lots of things. There’s also this app called Dipsy, which I recommend to a lot of clients.

And that’s like D I P in the C, S E A, um, and they’re just audio short stories. They’re like 10 minute stories, erotic fiction, but it being read to you. So it’s obviously for, for. You know, for everybody there. Um, and it’s great. It’s just being able to, and this is where the psychology of sex comes in, that, um, women have this ability to have lots of tabs open, uh, in your brain.

And if you have distraction, so you can have. arousal, and that you can have that kind of reward, like, okay, I’m going to do this action. I feel like I want to do it. I am a willing participant. Like, yep, let’s go for it. But if there’s distraction in there, then that will kind of cut you off. It won’t allow you to kind of focus in on what you’re trying to do.

So this is where, arousal can be really helpful. It might not always be the same way that you’ve done things before, because your brain is literally going through this. big upgrade recalibration. So it’s another opportunity for you to mix it up. Just try to create

[00:39:22] Meegan Care: some change and

[00:39:23] Emma Perks: novelty. Yeah, exactly. And your brain loves change.

Um, and so as in to create new, uh, With like neural mapping or schemas, it actually, you know, and then more often you mix it up, the more it keeps its attention, right? So in that sense of things, it’s helpful. And then the last part to that, I think for people is, um, they talk about, um, there’s It’s something called sexual currency.

Um, so there’s a lady called Karen Gooney. She’s got a really good, uh, resource. And she’s under the sex doctor on Instagram. And she’s got a really good book called Mind the Gap. And another book she has is How Not to Let Your Kids Ruin Your Sex Life. Basically. She has courses on that. It’s amazing. It’s like absolutely 100 percent like kids kill your sex life.

Um, so from the sexual currency things, what she talks about is this idea of, um, exchange, right? It’s give and take, which is what a partnership is, right? Um, but sexual currency is all the things you might do for your partner that are non sexual, but contribute to it. An attraction to that person. So if, again, you have very little exchange, uh, and there’s not much you do for each other in terms of a partnership, and then you expect sex to happen, it’s probably not going to be.

Fireworks and, you know, the most amazing experience ever because you’re not investing in that exchange. You’re expecting something to happen that you haven’t invested in, um, versus, for example, um, and I was saying at this time, at the talk, you know, my partner, for example, he empties, he cleans out the shower, which is disgusting.

I, you know, I’ve got two girls, it’s almost full of hair and gross. It actually makes me want to gag. Um, and he cleans the shower and I really appreciate that in our partnership. It’s the way that he interacts with my kids, the way that he makes time for me, the way that we can have physical displays of affection, but it doesn’t necessarily come with an obligation for it to go any further.

It can be. Words of affirmation, you know, again, going back to the love language, the love languages, sorry. Some people are all about verbal, some people are about action, some people are about gifts. So that’s, that’s sexual currency. And again, it’s this idea of exchange. So you can invest, you know, kind of make a deposit or make a withdrawal.

And if you keep that exchange, you’re going to find that intimacy you create together is so much more fruitful and it depends on, um, what sex means to your relationship. You know, some people it’s really important. Some people it’s less important. But I think, again, coming back to our communication, you guys need to know.

What it means to you is that your partner is connecting with you, and that’s really a really important thing to them, to them, and to you, then it’s worth investing in. And in that respect, it’s worth investing in, as I say, things like time and effort, um, because The hardest relationship to maintain is a heterosexual monogamous relationship, which is, I’d say, the majority of people out there.

Um, and they also find the sexual satisfaction relationship satisfaction is very much correlated together, but it’s better in the same sex relationships. That is in heterosexual relationships. So there you go,

[00:42:50] Meegan Care: makes a lot of sense that that correlates with what I hear.

[00:42:55] Emma Perks: It makes a lot of sense, right? So I think, yeah,

[00:43:00] Meegan Care: I think that that’s been so amazing, Emma.

So, so helpful. I think what, you know, is really striking me through this conversation, you know, communication is so key and, and so many women I speak to, and I’ve been there myself as well in mid life where it’s like, The desire for sex is sort of waned and waned and waned. The thing is it’s not going to change unless we do something different, unless we open up communication, even if it’s with ourselves first, however, we want to do that.

We, we can’t just expect the months and months to go by. We’re not doing anything to change anything and, and then for it to get better because it generally doesn’t.

[00:43:44] Emma Perks: And that is, that is. It’s very true in this component of like the less you have, the less you want it. So when people have had this kind of, I talk about like, you know, like a drought when you’re like, Oh God, it’s been a while.

The less you have, the less you want it. As I said, it’s not a, it’s not a drive. Like we seek out food and shelter and water, right? If you don’t have sex or intimacy, there’s nothing about it that probably makes you want to have it again. Do you know what I mean? Cause you’ve almost forgotten it.

How it feels or what have you. So as you say, it really is your, the, how important it is to you and your relationship, but also how it is important to yourself as well. Like I say, it’s, um, for some people, the, you know, the PRV, the penis and vagina sex is fine, but they find it really hard to orgasm themselves.

And it’s like, well, okay, well, what is your relationship like with Um, and so sometimes it’s very much starting there. So, um, it’s It’s almost like, okay, well together you almost, it’s fine, you know, for people, but actually you might need to spend a bit more mindfulness of connecting with yourself, finding out what it is that you like, what you don’t like.

And that’s, I think people find it really hard then to communicate that across. They find it really hard in an intimacy session. I want you to do this is really hard to say. Uh, particularly for women because of all the social constructs that we, all of us. Yeah. Yeah. It’s almost like not been allowed. It’s like, you know, again, like female masturbation is dirty and it’s shameful.

You know, young boys will pull on their penis and make an erection and it’s like, oh, isn’t that sweet or funny? But for girls to do it, it’s dirty or don’t do that. It’s not ladylike. That’s our conditioning, isn’t it? Yeah,

[00:45:34] Meegan Care: it’s just a big shutdown. Yeah. Yeah. Um, I think that’s such a great place to complete.

I know we could keep going for another hour, but this piece around In midlife, our brain is going through an upgrade and so wherever we find ourselves there is an opportunity to learn about ourselves and to receive more pleasure and more connection in our life, right? No matter what’s going on right now, there’s always another door that we can walk through.

[00:46:08] Emma Perks: Absolutely. Opportunity to change. I think just keeping things as they’ve always been doesn’t have to stay the same, right? Like you can, as you say, opportunity to change, and that might be your sexual liberation in perimenopause or menopause, which is amazing. Yeah. Yeah.

[00:46:26] Meegan Care: Oh, so good. This has been so helpful, Emma.

Thank you so much. I really wanted to share The wisdom that you’ve imparted to me when I’ve been at that Tahi talk when we’ve just had those odd conversations. I wanted, um, the podcast listeners to get a chance to, um, enjoy that and soak that in as well. So, thank you so, so much. How can people get in touch with you if they want to talk to you some more or see you professionally?

[00:46:53] Emma Perks: Yep, absolutely. So we’re on all kind of social media platforms. Um, so we’re on Facebook and on Instagram under Full Circle Physiotherapy. So there’s lots of free resources and we put videos up there and links and things like that. And then if you’re wanting to book an individual appointment, then the best way to do it through our website, which is www.

fcphysio. co. nz And you can just submit an inquiry, um, and where you are located, uh, around the mountain. Um, Yeah, or you can reach out through Instagram messages, but, um, emails or website is probably the best way to find us.

[00:47:28] Meegan Care: Beautiful. And I’ll put links in the show notes as well. Yes. Emma, thank you so much for, uh, sexual revolution on the podcast today.

It has been such a pleasure.

[00:47:39] Emma Perks: You’re welcome. I hope people found it helpful.

[00:47:42] Meegan Care: I’m sure they will. I’m sure they will. Thank you.