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If your sex drive has disappeared lately, you’re not alone. And you’re certainly not broken.

Between GLP-1 medications, perimenopause or menopause, postpartum changes, and the sheer mental load of modern life, many women notice their libido shift or fade. Unfortunately, we often end up blaming ourselves for changes that are actually incredibly common.

In a recent conversation with Dr. Kristen Wolfe, OB-GYN and women’s sexual health specialist, we unpacked why desire changes for so many women and what actually helps. In this post, we’ll explore what’s really behind low libido, and the practical ways women can support their sexual health at every stage of life.

Why libido changes (and why it’s normal)

If your sex drive has shifted, the most important thing to know is this: libido rarely changes for just one reason.

As Dr. Kristen Wolfe explains, women’s sexual desire is shaped by a bio-psycho-social mix, meaning physical, emotional, and life factors all interact.

Common contributors include:

• Biological factors: hormone shifts in perimenopause and menopause, postpartum recovery, sleep deprivation, pain with sex, vaginal dryness, medications like SSRIs, or changes after starting GLP-1 medications.
  
• Social factors: work demands, parenting, caring for aging parents, lack of privacy, relationship stress, and the constant mental load many women carry.
  
• Psychological factors: anxiety, depression, body image concerns, sexual trauma, or the belief that something is wrong with you.
  

Desire doesn’t usually disappear overnight. It gets crowded out.

And when libido changes, many women internalize it, worrying their partner will lose interest or assuming they’re failing somehow. In reality, these changes are incredibly common and often predictable.

Your brain is your most important sexual organ

One of Dr. Wolfe’s biggest messages is that the brain is the most important sexual organ.

If your mind is stuck in to-do lists, stress, or self-criticism, your body struggles to respond sexually.

Many women describe lying in bed mentally planning tomorrow while sex is happening, or worrying about how their body looks instead of feeling pleasure. When brain and body are disconnected, arousal becomes harder to access.

This is why mindfulness and mental load reduction matter so much. Libido isn’t just physical — it’s mental presence.

The myth of spontaneous desire

Movies teach us that desire should appear instantly and passionately. But research tells a different story.

About 85% of women experience responsive desire, not spontaneous desire.

That means many women don’t feel desire first. Instead, desire develops after intimacy, touch, or emotional closeness begins.

So if you’re not randomly craving sex the way you did in your twenties, that doesn’t mean anything is wrong. It often means your desire pattern has simply evolved.

The real libido killer (aka the “brakes”)

Dr. Wolfe uses a helpful analogy: libido works like a car with an accelerator and brakes.

Most women don’t lack desire, they just have the brakes pressed down.

Common libido “brakes” include:

• Chronic stress and exhaustion
  
• Feeling touched out after parenting all day
  
• No privacy or constant interruptions
  
• Body image worries
  
• Pain or dryness during sex
  Relationship tension or resentment
  
• Negative thoughts during intimacy

Adding medication may help a little, but if stress, fatigue, or discomfort remain, progress feels limited. Often, improvement comes from reducing these brakes first.

Small changes that actually help

Solutions don’t require becoming a different person or suddenly having more time. They involve creating conditions where desire has space to return.

Dr. Wolfe often recommends:

• Planning intimacy instead of waiting for spontaneity
  It may sound unromantic, but planning intimacy reduces anxiety and mental load. When you know connection is coming, your brain can shift gears instead of being caught off guard at the end of a long day.
• Practicing mindfulness
  Mindfulness reconnects brain and body, helping women stay present enough to actually feel pleasure rather than mentally multitasking.
• Using arousal supports
  Arousal creams, lubricants, and vibrators are simply tools that help blood flow and sensation. Bodies change with age and hormones, and using supports is normal, not a failure.
• Reducing pressure around sex
  Expanding what intimacy looks like (touch, closeness, connection) removes performance stress and makes desire easier to access.

When medical options help

Sometimes lifestyle changes aren’t enough, and medical treatment plays a role.

Dr. Wolfe discusses several options:

Hormone therapy
Estrogen therapy during perimenopause or menopause can improve vaginal dryness, discomfort, sleep, and mood, all of which affect desire.

Testosterone therapy
Though not FDA-approved specifically for women in the U.S., testosterone is often prescribed off-label for low desire. Some women experience improvement, while others see little change or stop due to side effects like acne or hair changes. It’s not a universal solution, but it helps some women when monitored carefully.

FDA-approved libido medications
Two medications exist for hypoactive sexual desire disorder in premenopausal women:

• A daily pill (flibanserin/Addyi)
  
• An injectable medication used as needed (bremelanotide/Vyleesi)

Both can help some women, though results vary and side effects may limit use. They work best when combined with lifestyle and relationship support rather than used alone.

Treating pain or dryness

Local estrogen therapy or other treatments for vaginal discomfort often improve libido simply by making sex comfortable again.

The key message: medication can help, but it works best alongside lifestyle and psychological support.

Helpful resources Dr. Wolfe recommends

For women wanting to explore further, Dr. Wolfe often recommends:

Books

• Come As You Are — Emily Nagoski
  
• You Are Not Broken — Kelly Casperson
  
• A Tired Woman’s Guide to Passionate Sex — Laurie Mintz
  
• Better Sex Through Mindfulness — Lori Brotto
  
• Becoming Cliterate — Laurie Mintz
  

Online resources

• Dipsea, an app offering erotic audio stories designed for women, helping cultivate desire in a way many women find more appealing than traditional pornography.
  
• OMGYes, an educational platform where women share techniques and insights about pleasure and orgasm in a practical, research-based way.
  

Low libido isn’t a personal failure, a broken relationship, or proof something is wrong with you.

It’s often the predictable result of hormonal shifts, stress, medication changes, and the intense demands placed on women’s lives.

It’s important to keep in mind that the goal here isn’t to return to who you were at 25. It’s to build a sex life that works for the woman you are now, with the tools, support, and understanding your body actually needs.

If low libido has been on your mind lately, listen to the full conversation with Dr. Kristen Wolfe. We dive deeper into why libido changes, how hormones, stress, medications, and mental load all interact, and the practical tools and medical options available to help you reconnect with desire in a way that actually fits your life right now.

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.   

 welcome back to another episode of the podcast. Today, I have a topic that at first glance, some of you are gonna be a little bit queasy, like, ooh, are we gonna talk about this? But I need to tell you, being a physician clinically all day long, seeing patients, this is something that majority of women are struggling with and we're not talking about it enough.

So I brought on today, Dr. Kristen Kristen Wolf, she's an OB GYN physician. Her clinic is evermore women's health. It's located in Longmont, Colorado. I hope I said that right? You did. Yes. Is it okay if I call you Kristen during this interview? Yes, of course. Okay. So, so I met you, a few years back here at this point at a conference that we were both attending.

And then after that I started to follow you on social and the way in which you talked about women's sexual health. It is so compassionate. It is so nice. It is so informative. And what I have really seen with my patients is that some women are really affected with GLP one and their, their sex drive going down, their libido.

And so I was talking to you about all these different aspects of it, and then a lot of the women that are finding me are in perimenopause or menopause. And so it's this moment where all of it comes together. And so I just wanna go from A to Z over all of this with you, and I think our listeners are gonna learn so much.

But can we start out with you introducing yourself, and then we're gonna get into all of this. Yeah, of course. I'm Dr. Kristen Wolf, o ob, GYN, physician. I'm a menopause society certified provider and then I'm also a member of the organization called ishish, the International Society for the Study of Women's Sexual Health.

And I do just wanna call them out because they're a great place to find providers who provide this type of care that I'm gonna be talking about today. And they actually are few and far between, and that's really what got me into this. I have a practice where I specialize in perimenopause and menopause and just saw that.

There's a lot of people out there who are doing that type of care, but sexual health kind of remains this big gap. And as you'll find out today, there is no Viagra for women. Women can take Viagra, we can talk about that at some point if you want to, but it just is not the same as it is for men.

It's so much more complex. You need to put a lot more, thought into it. And every woman is so different. And so I've really cultivated this practice and, really tried to learn as much as I can to make sure that I can offer everything that's out there to women. And as you said, this is not something that people necessarily just spontaneously bring up with their doctor.

They don't know if it's a safe space. They don't know if they're, they may have asked before and not gotten any help. You hear stories of women saying oh, I was told like, just relax and have a glass of wine, or any number of things. And I still today hear that from patients. And we actually know women wanna talk about this and they want their doctor to bring it up.

So that's why I try to shout from the rooftops, Hey, I'm a sexual health doctor, come and talk to me and I can help you. And if there's somewhere where I can't help you, I can get you to the right person. So that's also, if we do have any healthcare providers listening today is, that's also really important to be able to say, you know what, this is a little bit outside my scope, but I'm gonna send you to an expert because this is really important to me that you get this care.

So that was more than just an introduction, but you can see I'm very passionate about this topic. No, I love this. Honestly, I don't know that a lot of doctors know what you were saying, these societies and this specialization that exists. So I feel like honestly, some people here are gonna say, oh, I didn't realize that I could send to a physician that does that.

Yeah, absolutely. Because I think people absolutely. You know, like they might be thinking about like a sex therapist or other things, but they're not thinking along these lines. Can you just give us a little bit of why we should care about this? This topic in general. Yeah, I think there's so many reasons to, to care about it.

Obviously sex is a very integral part of just the human experience. And things change. You know, uh, women know, like you said, you see women in perimenopause and menopause. You see people who maybe are postpartum, maybe have had different pregnancy experiences, have had different other things affecting their life.

Surgeries, you know, maybe they've developed diabetes, you know, other medical issues. Things are just very different in your forties and fifties than they are in your twenties and thirties. And women really internalize often, and this is what I see is something's wrong with me, something's broken.

And they feel a lot of shame and they feel a lot of negative thoughts about, oh, this is, my partner is gonna leave me. I'm not an adequate, partner for my spouse anymore. And it really becomes something that really affects women in a negative way. From a just holistic standpoint of help, it's really important to say, Hey, no, this is number one.

What you're experiencing is normal. There's nothing wrong with your body. These are expected changes. Just because they are expected changes doesn't mean we don't have lots of great treatments and therapies and ways to get you back to be having the sex life that you want, that works for you, that works for your partnership.

And that's actually something that we should talk about just at the beginning, is that there is a lot of foundational neuroscience in women's sexual health. And we're gonna talk a lot about different studies and different books, but the majority of this is actually mostly in male, female, cisgendered, heterosexual couples.

Much of it is done in, white people, Caucasian people. And so that is a, just a big important limitation of what we're gonna talk about today. It doesn't mean that we can't apply some of this thing to other groups of people, but I do just like to mention that, in general these studies were done on heterosexual, typically married couples for the most part.

Yeah. Thanks for setting the groundwork on that. 'cause I know there's always lots of, changes and nuances and hopefully we get there more. How often actually are, are couples having sex? That's a great question and there is no right amount. And so really what we find is that what's important in, marriages or partnerships is that you and your partner are on the same page.

And if the same page is once a week, great, and if the same page is once a month, that's also great. There's nothing that you need to be doing. In general, we know the majority of people, 70 plus percent, again, this is married heterosexual couples who are between the ages of 30 and 60. The majority, 70 plus percent of people are having sex somewhere between one to four times a month.

Somewhere between a couple times a month to once a week. There are about 10% of people that generally are having very little sex, maybe never, or maybe once a year or somewhere on the scale of. Quite infrequently. And then there's about 20% that are having sex more frequently than once a week.

So typically in the two plus times per week. So again, nothing you can see the spectrum is, is pretty large. And what's most important, what we actually see when we look at even studies on divorce for instance, is that the amount of sex does not matter as much making sure that you're concordant with what you and your partner both want.

So it's that discordance where one person is wanting more and the other person is wanting less, that tends to create more strife. Yeah, I, so how I usually hear it come up, like what would make me, I actually send patients to you. So by the way we said Colorado, but you also see it several other states virtually.

I do a virtual practice and I am licensed in many other states. So yes, I will see patients in other states as well. So a lot of what comes up is that women, they want to have sex, right? Yep. But things have changed once they get on a GLP one, whether their body changes, the desire changes, a lot of them will often say, do you think I need testosterone?

Can you just Yes. Walk us through. That's a lot. What are things that, 'cause I, there's just a lot going on with women with this, so can you walk us through a big framework of kind of everything that can be affecting it? Yeah, absolutely. And so you're very right. People come to me because I think what they see on social media and what they see out there in the world is testosterone.

Yeah. And I always tell people, I see people frequently, I'm here for a testosterone. And I say, great. I say, if you want testosterone, you will leave this appointment with a testosterone prescription. I wanna set that, out there first. I love testosterone, happy to offer it. But let's back up because there's so much more.

If I just send you out the door with a testosterone prescription, you're gonna, it's gonna be a really lackluster response. And again, then what's really important to me is that. What's gonna happen is you're gonna think, oh, I am broken. I knew it all along. She gave me the medication that's supposed to increase libido and it did nothing for me.

CI knew I was broken. And so that's why I say we need to back way up and talk about more foundational things before we can even get to medications. 'cause if we don't put some of this foundation in place. The medications are one piece of the puzzle, but they really are just that one small puzzle piece that kind of needs to fit into a bigger picture. So really, if you're talking to anybody about women's sex drive, women libido, you're gonna talk about the bio-psychosocial model, and we can go into that and obviously it's gonna be different for different people, but, basically we're looking at, okay, what are biological changes that have happened in your body?

Again, for a lot of your patients, that may be that they're on A GLP medication. It may be that they've had changes in their diet, changes in their exercise, any number of changes. Also with aging, certainly we're gonna have decrease in estrogen, decrease in testosterone. A really big factor, that a lot of women do not know.

I do not think this is disclosed when SSRI medications are prescribed, which I'm very pro SSRI, if you need that and it's a appropriate medication for you, I'm, you definitely should take it. But many of them do have sexual side effects that I don't feel are typically disclosed to patients. A lot of women get put on SSRIs postpartum, again, very appropriately for postpartum depression, but then are maybe not told about these, more long-term sexual side effects.

So that's really important also. Certainly if you're having pain, a lot of women, again, after childbirth with aging, can have changes in the pelvic floor muscles, changes in, lubrication from, lack of estrogen. So there's all kinds of biological factors that can be playing into why you're having a different experience than what you're used to.

And then I like to talk about social next and then the psychological. So social is. All the things out in the world that affect you. And for women, that's a lot of things. So often they, have a lot of, expectations around their household. They may have very demanding jobs. There's a lot of things that go into raising children, whether some women don't have children, some women do.

But regardless, we tend to have very busy lives, very high demands of what is expected for us. A lot of us have aging parents that we're expected to take care of and things may just be very stressful and very busy. And then there may be issues with this is not actually the case for most people.

I see. You may also have issues with a partner, maybe there has been infidelity or maybe you have a poor relationship, poor communication. Typically I don't see that. And I actually really, dislike, a lot of women get shoved aside of you probably just need a better partner if you're not having sex.

And usually people say, no, I love my husband, he's a great guy. This is not that. But I do like to mention that because it is important. And then there's the psychological component as well. So generally what I describe is it's what you are now making all of these biological and social things mean.

And so certainly it can be underlying mental health, disease. And then I do wanna mention that, certainly if you've had a history of sexual trauma, which unfortunately is incredibly. Common in women. That is a whole overlay over this whole bio-psychosocial model that needs a much more nuanced approach.

There'll probably a little bit more than we can get into today. But I do just wanna mention that's a really important factor that usually you need a very multidisciplinary, team and management plan for that. But in general, for psychological, often that can be anxiety, depression, but then it's also your thoughts.

So kind of those thoughts that we talked about, something's broken with my body, this will never be normal. I'll never be interested in sex again. What is my husband going to leave me? Et cetera, et cetera, et cetera. So it's what all of the, how you are making all of these things be very negative in your brain, which then, as you can imagine, just compounds the entire issue.

Well, I feel I'm so glad that you mentioned all of this because again, it's so complex, right? Like it's not just like you said, not just take this testosterone and Right. I think that women, I know I've heard this before, but can you kind of like, uh. Kind of expand on this, that there's this difference between, I think everyone thinks about, these things being spontaneous because we see a lot of the male perspective on this, and there's a difference between spontaneous versus receptive desire.

Can you explain that a little bit? What's happening there? Yeah, so a lot of women, maybe when they were younger, they did have a little bit more spontaneous desire, and that's what we define as like maybe for, it's often a visual cue. So you may just see your partner and just suddenly be interested in, having sex or being intimate with them.

And often that can be the case for men, they just see their partner getting dressed or stepping out of the shower and, with no other real context or anything else going on. They're just, immediately interested in having sex. And again, I think because of all of those bio-psychosocial interplays over time, women, we find, and there's actually lots of really lovely research, Rosemary Basan has really great research on this, has defined this more responsive desire and kind of this non-linear, more circular, approach to desire in women where women are actually, it's much more normal.

85% of women have what's called responsive desire. And so generally that's gonna be where. You initially are more neutral towards sex. It's not you can't be in a place where you don't wanna have sex, and we'll talk about what that could look like because of pain or discomfort or bad relationship, or et cetera, et cetera.

But you're more neutral and you're not necessarily strongly desiring it, but because of all these other things, the appropriate context, good relationship with your partner maybe intimate touch and wanting to be able to please your partner. Maybe knowing I'm gonna enjoy it once I do it, and we can talk what more what that looks like.

Women will engage in sex and then become aroused. So we think about it often of just like this spontaneous arousal where you're just suddenly, have this urge to jump on your partner type of thing. And again, for women, that tends to, it's not that can't happen again, it, it is fine if that happens.

That's what happens in the movies, of course, for, that's what we see. But for women, it tends to go the other direction where you decide you want to have sex more from. Perspective of your thoughts and your brain, and then you get the physical arousal and that, once women hear that, they often say, oh, okay, yeah, no, that, that is normal.

And what I tell people is if that's acceptable to you, which it is for a lot of women, then great, we can, there's still a lot of things we can work on. But if you want to have that more spontaneous desire where you hear your husband's car come into the garage and you're like, oh, type of thing, we can get you to that point.

We talk about the more sex that you have, the more orgasms that you have. It becomes more just, it's like a pathway in your brain that you are strengthening over time. And so if you want to get to that point of more spontaneous desire, you absolutely can. But we have to start with kind of, we'll talk more about what the framework can look like, but start with being more open to the responsive or the receptive desire, which is much more common for women.

So you're describing here, again, it's a lot of what I'm hearing with my patients. They're so busy. I've heard you describe it as what is like a break being down?

Is that, can you like what, what's happening with that? Yeah, absolutely. So once we have this context of the bio-psychosocial model, you can start to look at, oh, what is affecting me positively and what's affecting me negatively? And in the research for women's sexual health, they often talk about the accelerator and the brake. And so I tell people, I can give you, for instance, testosterone that may be a little bit of an accelerator, pushing the gas pedal down. But you can imagine if you're, if the brake is pushed all the way down in this analogy that we're using, we're not gonna get that much traction by nudging the accelerator a little bit.

And for a lot of women in particular. The accelerator is not so much the issue. It's actually the brake pedal. And the brake pedal is that chronic stress, that chronic fatigue, all of the changes with, after childbirth, if you've had, pregnancy or after other medical issues, for a lot of women they describe like just being touched out.

Your kids are like, mom, mom, mom. They're touching you, they're hugging you. They're, my daughter always wants to sit in my lap. And like by the end of the day you're just like, okay, I'm done. Let me be, type of thing. And so it's not so much this lack of interest in sex or, lack of ability to have, arousal or desire, but more of this, sense of.

All of the expectations that you have, all of the negative thoughts that you have about yourself, all of the other things that go into, how you feel about your body, et cetera, where those are the things where you're really gonna get much more traction if we can start to ease off on that brake pedal a little bit, which often you can do with even just your thoughts.

I obviously can't help you change your job necessarily, or I can't, I cannot take away the fact that you have three kids under the age of five. But just recognizing how some of those things play into it. Oh, another big thing is like kids coming into your room, not having privacy. All of these things, just as you can imagine, really kill the vibe.

Yeah. And so it's. And then, again, it could be things like SSRIs. Certainly we can talk about GLP ones. I've actually heard it's really interesting about half of people tell me, oh, I actually have a better sex life after starting the GLP one. I have more interest in sex. And then half of people tell me, oh gosh, I just suddenly have no interest at all.

And there's a lot of theories as to why that could be. But I think it's also really important to say it is not one size fits all. And so it's important to look at your life, your experience, think back to prior experience and see what is affecting the brake pedal here. And that's where you really wanna start.

'cause again, the accelerator we can play around with, but it's really gotta be you that makes those adjustments to the brake pedal. And women do intuitively understand that. And again, I think it helps to understand why do I feel so different than how I felt in my twenties? So I love how you're saying how it's actually a problem with the break and not really the accelerant.

Hopefully I'm saying that yes. By the way, when you're saying all these things, I'm thinking how do any of us make it through any of this? There's so much going on. You describe that, so ama so good with the kid being on you and, all this stuff happening. Totally.

Yeah. So how do you take that, the off the break a little bit because like you said, we, and I always say this to people too, we're not, I'm not asking you to quit your job, but how do we help that a little? Yes, absolutely. So there's a lot of things we can do. And again, we certainly talked about like we need to make sure there's not pain and we need to make sure there's not some other biologic.

Again, could we maybe make a tweak to an SSRI or is there something that we can do that is an outside factor? So we'll talk more about those things. But one of the absolute best things that you can do, and there's a lot of research and I'll share some, literature recommendations and some book recommendations.

But one of the most important things we can do is practicing mindfulness. And again, there is actually quite a bit of research about this and, mindfulness, it's a little bit of a murky concept, but the way I like to describe it is basically when your brain and your body are matching up. 'cause again, women were busy.

You can imagine for years and years, you have just pushed aside what you're feeling in your body and you've just focused on, okay, I gotta get dinner ready, I gotta clean up, I gotta get my kids to bed, I gotta do this. I have this project at work, I gotta do this. And you have. Pain in your back.

You have a cramp, you have a headache, and you're like, I'm just gonna ignore it. Take a Tylenol, move on. Go, go, go. And we get really detached from our bodies where basically we don't pay attention to any of the sensation in our body. We don't pay attention to what we're feeling. And it's something that you really, really need to back up and be able to start practicing that, because as we'll talk about, it's really, really important to be practicing mindfulness actually during sex.

But before you can do that, you need to practice it just during your day-to-day life. So I usually tell people, imagine a scenario where. One thing that I will often think of is like sitting and watching a sunset where you often are just enjoying the sunset. You're not having that constant running to-do list.

You're not like thinking about, okay, I have all these million things when I get back in the house. It's this moment of just kind of peace. And that's what I describe as mindfulness. And so another way you can practice it is, a lot of people drink like coffee or tea in the morning. And so I tell people, when you're drinking your coffee or tea, rather than doing the wordle or scrolling on, Instagram, which is what I do when I'm drinking my coffee or tea, is you can just take a moment, try to and this is a little, it's similar to meditation, but it's a little bit different.

You can take a moment and just focus on. What am I feeling right now? So you can feel like the weight of the coffee cup, you take a sip of it. What does it feel like in your mouth? What does it feel like after you swallow it? Do you feel the heat? What is the sensation that you're having in your body?

And even if you just take two or three minutes and start to practice, being able to connect up your brain and your body. That is really like the most, and I'll talk about like hacks where I go through all this and I say, okay, and then here's the hack. If you don't have time to do all of this, I'll teach you the easy way.

But that is the easy way. We wanna know. Yeah, we'll get there. We'll get there. I promise. I have the easy ways to do this, but it's important to understand because what I often will have women tell me as well is they can't turn off their brain during sex. Yeah. So during sex, they're not thinking about how pleasurable it feels.

They're not thinking, loving thoughts towards their partner. They're thinking it could be one of two things. They're either thinking like. Did you remember to take the trash out? What am I gonna do in the morning? And they're like, actually can't stop their brain. And they're not connected with their body at all.

Or they're thinking negative thoughts. They're thinking things like, oh, is my partner thinking that my thighs look flabby right now? Do I have a weird smell? Oh, maybe I should have showered. Why didn't I shave? Oh, what if I don't orgasm? And as again, as you can imagine, none of those things are leading towards, a pleasurable sexual experience for you or your partner.

So that's why I always tell people like the brain is the most important sexual organ. Like we absolutely need to be. We need to practice this mindfulness because, and you can't just practice it during sex. You have to take time during the day to practice it again, just a few minutes a day here or there.

Because otherwise you're not gonna be able to do it when you actually need to. And that is gonna dramatically change sexual experiences for you. You know what I'm struck by as you're talking, 'cause I wrote this note down, I love this with mindfulness connecting the brain and the body that they're matching up, right?

Yeah. And then you're saying, and I always describe it as like you have this little weeble wobble head up here and the body's disconnected, right? Totally. Yeah. When you're talking about sensations and stuff in this land, what's so interesting is this is a hundred percent the same with hunger cues and all the other things.

Yes, absolutely. Yeah. All roads lead to Rome, right? So I think often. I think people think oh, I don't wanna have to think about this. I don't wanna have to delve into this area of my life. But the reality is, it's all connected. So it's okay, do you wanna work on hunger? Do you wanna work on sensations with this area?

But it's at some point it's always the same work. Yeah. I get shocked by that, that it's No, yeah. When you say that you're right it's act. It's completely the same. And again, normal, like I tell people all of these other things in your, it makes sense why this is happening, but it's normal. But we can, I don't wanna say fix because it's not broken, but we can develop strategies to reverse some of these things that have ex happened, as we would expect them to happen with the busy ca you know, crazy chaotic lives that we lead.

I have a question. Do you recommend that your patients schedule time with their partners? Is that a strategy that you use? Yes. And so this is actually one of the very first things I talk to my patients about. We kind talk about like, how much sex do you wanna be having? How much sex does your partner wanna be having?

And we talk about, okay, we've built this foundation of the bio-psychosocial model, having, more responsive desire versus spontaneous desire. We've talked about the accelerator and the break. We've talked about mindfulness. Okay, what does that actually look like? Okay, I have this information, I understand maybe why I'm at this point, but what do I do to change it?

And so I tell people it's really important to plan out when you're having sex. And I try not to use the word schedule 'cause that really doesn't sound sexy. Plan sounds a little bit better. And you know what, I'm always like, you know what, is your partner really gonna be upset if you're like, Hey, Wednesday, wink, wink.

They don't care. You know what, it's the fact that society is like, it should just be happening. And you're sold that bill of goods. I think so, I think that's why there's some judgment involved. And I tell people like it's just, again, when you think about the things you think about all day long, why do you think suddenly at 9:00 PM your brain's gonna flip over to being like it?

It just doesn't work that way unless you're practicing and planning and you need to cultivate. A situation. And I joke with my patients, and everybody laughs when I say this, but I'm like you need to make sure you've showered, you need to make sure you've shaved, you put on your cute underwear, what are you gonna not, you're not gonna have chili for dinner that night, or Mexican food.

Because you know that you wanna have sex with your partner that night. And so you're gonna be doing all these little things. And again, we'll talk about some of the mindfulness tricks because all it all once it's planned, then all of the other puzzle pieces fall into place.

You can, focus on doing mindfulness that day. We're gonna talk about also ways to cultivate arousal. But then also you can make sure, okay, we don't have to get up early and go to the airport in the morning. The kids, maybe they, we know we're gonna give 'em the iPad and let them do whatever type of, like, whatever works for you and your family, you are gonna make sure that all of those puzzle pieces fall into place so that you can.

Basically it's just a way of easing up off the break, for lack of a better way of saying it, is you're taking out some of those things where you're thinking, well, what if they don't want to? Or what if they're surprised if I ask? Or what if this, or what if that, you just have by able being able to say, Hey, it's gonna be Wednesday.

You've basically just taken half of the brake pedal. The pressure's taken off at that point. Yeah.

So I wonder, I just have to ask, are there medicines, we talked about testosterone, right? Yeah. But can you talk about, are there medications that women can take for this? Yes. So do you mind if I back up a little bit? Yeah. Back to my planned sex. Okay. Yeah. And then we'll talk because there are medications, but there's other, before we get to like prescription medications of which I'm happy to prescribe for my patients.

And there can be benefit. There's other tools that we can use as well that. And actually it's very interesting. I see people are really excited when I talk to them about these things. And I think people just don't know, nobody just wants to start Googling vibrators on, what are you gonna do, buy one on Amazon?

And it comes to the health yes, of course people do that, people don't know where to start. I like to start there. And so I talk to patients about, I really like arousal creams, and I'll explain why it is, and that's the hack that I was talking about earlier.

So when you use an arousal cream, you're supposed to, apply it, rub it into, and we, we can talk, we may not have time today to talk all about the anatomy and physiology and all of that. I certainly go into that with my patients. But in general, with an arousal cream, you're going to 20 to 30 minutes before your planned sex, you're going to rub it into your clitoris and labia.

And obviously that already is getting the ball rolling on things. So even if you had no time during the day to, to do any of that mindfulness type work, you're saying. Okay. And again, you can imagine your partner would be pretty excited if you're like, Hey, we're having sex in 30 minutes. I'm applying my arousal cream right now.

It's something novel, it's something fun. Yeah, there's tons of different brands out there. I usually help, my patients. I personally am someone, I'm like allergic to every like cosmetic product. So I really look for brands that have really, minimal ingredients in them. But regardless, I work with my patients to find something that's gonna work for them, or I tell them, you can also just use a lubricant.

It doesn't have to be something that has, a lot of the brands have CB, D or Sildenafil, which is the active ingredient in Viagra or arginine, which helps with blood flow. But really it's the act of. Getting ready for sex, you know? And then I tell people during that 20 or 30 minutes, that's when you can practice your mindfulness.

So that's when you can be Ooh, what am I feeling in my body? Am I feeling a little bit more aroused? Am I feeling some tingling? You can use a vibrator during that time, there's actually research that. The nerve endings around the clitoris. There's two different types. And the ones that respond to vibration generally are the healthier nerve endings that function better with age.

And the ones that respond more to light touch, they are not gonna be, they don't have as strong of a myelin sheath around them, and they're not generally as responsive with aging. So I tell people it's really normal to, to need to introduce a vibrator at some point. And again, that doesn't mean something's wrong with you, it just means you're aging.

Things are changing with your body. So again, even if you do none of the things we talked about, I say plan sex, use arousal cream, use a vibrator. You also can listen to a sexy story. We can talk about that. So even if all you do is this 20 to 30 minutes before your planned sex, that is gonna make a huge difference in your experience.

Okay, women are gonna wanna know, because you were mentioning, with being allergic to a lot of things, I know you're maybe not sponsored or anything by any of these companies, but can you, is there a, would you be willing to say a name of, an arrival cream that you recommend and also the lubricants?

I wanna hear more about this because I think yes, there's such, I don't know. When I'm reading stuff online, it's all what about coconut oil? And there's just so much there. Yeah. I'm like, so can you just help the women to understand this? Absolutely. So arousal creams, there's tons of them on the market.

They, most of them have compounded medications, which I'm not opposed to compounded medications, at all. But you do wanna be a little bit cautious about what you're getting, making sure, you've done some research, looked at the ingredients. I personally really there's one by Vela Biosciences and actually to see, it's like their, I think it's called their Pleasure Serum.

And it's a CBD based product. And it, I believe it can be shipped to all 50 states. I don't think there's any CBD regulations. It doesn't have any THC, you're not getting high, but it helps enhance blood flow. And they have, they actually have it designed in a way that it can get absorbed a little deeper into the tissues.

And I really like that one. I think none of them. Are necessarily gonna be, again, there is no Viagra for women necessarily. But it's all just these little things that you can do. I'm really excited about this new product coming out by DRE Pharmaceuticals, which actually is a sildenafil based cream that they've designed in a way that can actually get deeper into the tissues for women.

'cause women can actually take Viagra and it does actually help with arousal and orgasm. But the problem is to take the right dose. Women get tons of side effects on it if they take it systemically. Okay, and then many, yeah, many of the creams on the market don't penetrate deep enough to really do all that much.

So I'm super excited and I'll, you'll be the first to know when this new product is available. It's supposed to be coming out pretty soon, but in the meantime, I usually recommend, the Bella, the Vela, excuse me, VELA, uh, V-E-L-L-A, uh, because I know it has ingredients that are safe. And the other thing is, again, these are like nitty gritty type of things, is, some of the products that use Sildenafil and other things, they say not safe for oral sex.

And it's oh, and they say wipe them off. I'm like, that's not really gonna work. So I like that. That's gonna be awkward. Oh my God. So that's why I like the velo one. 'cause it's safe for oral sex, so you just don't have to worry about that type of thing, does it affect, if a woman has something on, does it affect the partner? Can it get transferred 30 minutes later? There's just not, there's not a lot of good data. So that's why I like the, again, the CCB D based one because I know that's gonna be safe for everybody.

Okay. And there are some, that's why with again, the sildenafil arginine, the companies are really cautious because they actually say what if your partner has heart issues? Or what if that's what I'm thinking. That's what I'm, in my mind, I'm just thinking Wow. Totally. All the times I've been writing for SIL and a a, a tablet of a cream, it's not been for this.

Yes. Yes. So that's why, again, I like the CCB D based one, but Dari Pharmaceuticals, again, they're coming out with a new Syl one, they've tested it and proven it's safe for partners. So I'm really excited once that one comes out. And then, in terms of lubricants, you do need to be cautious. There's a couple different considerations.

You wanna make sure that you're getting something that has the right osmolality, that's. pH balance that isn't gonna cause, infection or irritation. The brands that I typically recommend, and this is what I see universally recommended, really popular one, is Uber Lube. The reason people really like it is because it's silicone based, so it's gonna be a lot more slippery.

It's not gonna get like tacky and dried out and sticky. The only co it's also really pretty, it comes in like a glass bottle and it's really nice, really reasonably priced too. Like for how fancy it looks, you would think it would be a lot more expensive and it's actually 20 or $30 is really reasonably priced.

The only downside of that one that you need to be a little cautious. Silicone-based lubricants tend to be best for perimenopausal, postmenopausal women, but they're not compatible with silicone-based toys. They can actually erode the toys. And so that is just something you wanna be a little bit cautious with.

So you could use more like a water-based lubricant if you're gonna use a vibrator, either with masturbation or before sex. And then during sex you could use the silicone based. But again, it's a lot to consider. So otherwise I recommend typically good, clean love. They have a couple different products, and they have really good water based ones that are gonna be compatible.

Again, they have the right pH, the right osmolality, and they're gonna be compatible if you're using vibrators. So just something to be, to consider there. So what about, okay, so can we talk now about the medications? Because I think people are gonna be interested in that. Yes. So I do like to tell people, and literally I have yet to hear a patient who's aware of this.

There are actually two FDA approved products on the market for female hypoactive sexual desire disorder, which you can talk about what you to, what you need to have to meet that diagnosis. Yeah. That are FDA approved for, specifically for premenopausal women, although there is, you can use them off-label postmenopausal as well.

But to meet the definition for hypoactive sexual desire disorder. And what that means basically is not that you can't use it if you don't meet this definition, it's just that's how it was studied. So this is, generally women who are in, longer term, relationships who have had a change in their sexual function that's lasted at least six months, that is bothersome to them.

So that's the definition. And those, that's the groups of women that were studied for these medications. And so there's one medication, it's called Adi, A-D-D-Y-I, or the generic is Flibanserin. Both of these, they're brand branded medications. We can, there, there is no generic version of them.

It's a daily medication, so it is a pill that you have to take every single day. And it, I always like to tell people, like, how do these medications come about? Because they were not actually designed or studied for this. It was more of a, oh, hey, look what this does, type of thing. So it was, it works on the dopaminergic and serotonergic, neurons in the brain, or neurotransmitters in the brain, I should say.

And it was actually designed to be an antidepressant and they found that it wasn't a very effective antidepressant, but. Randomly women reported increased, interest in desire in sex. And so then they restudied it, rebranded, it, got the FDA approval for hypoactive sexual desire disorder when it very first came out, which honestly was like 10 years ago.

It was a while ago. Really? Yes. Okay. Yes. Actually there's a new, documentary out about it. Really fascinating, but I've actually added him to watch it yet. But I've heard that it's great. We can post it in the show notes. It's called like the Little Pink Pill or something. But regardless, and it's not just about the medication, but just about how there's so few options for women in this area in general for women's sexual health.

But the big, big issue, and this is why I think it never got traction, is when it first came out, they said you can't drink any alcohol if you take this medication. Oh, yeah. And so obviously that, again, which is hilarious because for years we've been telling women just have a glass of wine. And so it just, because basically they thought it could lower your blood pressure, they thought you could basically pass out. It was just a whole thing. And so they've restudied it and looked at it and basically said, no, you can drink alcohol, but if you have more than two drinks in a night, skip your pill that night.

So it's much less strict than it used to be. But a lot of doctors that I talk to don't realize that the guidelines changed and they still just tell women, you can't have any alcohol. You don't want this one type of thing. How effective is it? What percentage respond to it? Maybe that's what I'm asking.

Yeah, that's a great question and I don't wanna give you a number because I don't wanna not remember it correctly off the top of my head, but I would say it's modestly effective. Okay. It's one of those things, and this is gonna be true for all the medications we talk about. They do work for some women and they don't work for other women.

Part of it is that kind of what I think we talked about. If I just give you Addie and you do nothing else, it's not gonna be a blockbuster medication for you. It really needs to be in conjunction with all these other things that we talked about. And so that is one reason why I think it is a little bit tricky to look at effectiveness.

And it's interesting too, we can talk about this with testosterone. None of these medications lead to people having a lot more sex, but they do lead to people having more of that kind of spontaneous desire and interest. And that's actually, people are really happy with that response. Yeah. Because that's really what's bothering people generally.

It's not so much how often they're having, they could go have sex if that was the issue. The issue is that they want, so again, that's a little bit trickier to measure. Yeah. But again, it's one of those things I would generally offer it to a patient. If we decided it was a good fit, try it for six months.

Again, in conjunction with all the other things that we're talking about. But I would say modest benefit for some patients. And that's gonna be true for everything we talk about. And I was gonna ask you like, what length of time do you give it before you say, Hey, this isn't it? And so it sounds half a year.

'cause I'm assuming you're bringing all the other things in as well. Exactly. Yeah. Okay. Yeah. And again, generally I'm somebody who likes to do one thing at a time, because otherwise it's really hard to know what's what. But I know that with, again, because we talked about that bio-psychosocial matter, one thing at a time isn't gonna move the needle for this.

And so I, I do approach women's libido and sexual health differently than how I approach other things in my medical practice because I know it's a lot of little changes. So that does make it a little bit trickier to know sometimes is the medication a placebo effect? Are there other things that's helping?

But unfortunately it's just the way that it works in this particular situation. And then how does, you had mentioned a second med that's been around. Yeah. So the second medication is called vii. I actually have a little fake VII here. It's actually an injectable medication, which it came out before GLP ones became very popular.

And I always joke people were like, an injection what? And then now they're like, oh, an injection. Sure, no problem. Everyone's used to it now. Yeah, it's totally normalized it, subcutaneous injection. So this medication, it's, IDE is the generic. It was actually designed, this is really interesting, fascinating actually to be a self tanner.

It works on the melanocytes in the brain. I know. And it turned out, again, it wasn't a very good self tanner, but people said, wow, I'm really horny when after I inject this medication. And so again, so funny, and I always like to put this out 'cause I'm like, there's not really companies that are out there designing products necessarily.

Hopefully more so in the future. So all of these are like, how do they work? We don't know. Like why does it work for some women and not others? We don't know. Like it, so because it wasn't really designed with this thought or this intent in mind, again, it doesn't mean it's a bad product.

It doesn't mean anything negative about it. I just like to put that out there just when we're talking about like, why does it work for some people? Why doesn't it work for other people? Okay. We really truly don't know. But it's an injectable medication that, generally starts working within about 45 minutes.

You can use it up to eight times a month. Just for context, in terms of. How often you can use it. It does last for a while. People tell me that it actually lasts for 12 hours. That's just something to be aware of in terms of the side effects. One issue is that for some people it causes severe nausea.

So I usually give like a Zofran prescription with it. You can tell this is getting less and less sexy as we talk about it. I'm like, I don't know man,

but I can imagine all the women that are getting this are in a lot of distress. Yeah. And so it's they're willing to Yeah. And then I tell people this one, you have to have a lot of communication with your partner. I do like it 'cause it forces the scheduled sex. But I tell people the first time you use it, tell your partner, whoa, hold your horses.

Because if I'm vomiting into the toilet all night, this is not a thing that's happening. Oh my God, these conversations must be so colorful. They're, it's, it really, it truly is. And then, one of the issues with these medications too is it's a little bit tricky to get insurance coverage, but there are ways, there's like specialty pharmacies.

But again, you need a doctor who's used to prescribing them, who knows the tricks to getting them. Again, you may have a very well-intentioned OB GYN who says, yeah, I'll prescribe it. And they send it off to your CVS. It's not gonna work. And then you're gonna just feel worse

yeah. You're like, gosh, there's this thing that might help me, but I can't get it. Just know there are ways to get these medications. There's like specialty, mail order pharmacies that are able to apply all these coupons and most people can get them at least for a trial to see if they work for them.

Yeah. Awesome. I think you answered everything I would think of with that. Had, you said with testosterone, maybe I met, you probably said in the beginning, but is that effective for women? If it works, yes. Does it last like, 'cause sometimes Yeah, it does. Yeah, it does last as long as you keep using it.

As for most medications, because you can imagine. We do actually have many good high quality studies on testosterone for hypoactive sexual desire disorder for women. The majority of the studies are in postmenopausal women doesn't mean we can't give testosterone to per menopausal or premenopausal women, but again, the majority of the studies are postmenopausal women.

Unfortunately despite a very lovely three year study with really great safety data that was statistically significant. Again, it didn't lead to a lot more sex, but people were really happy. They reported increased interest in sex. Despite that study that came out in the early two thousands, it was not too long after that women's health initiative study and the FDA just did not have much of an appetite for that.

And they said, I can't remember exactly, but they said like we would need 10 year safety data or something ridiculous. And so obviously that was gonna be way too expensive to do that study. And so we don't have any FDA approved products in the United States. There are FDA approved products in Australia, New Zealand, South Africa, and I think there's a new one in the UK now.

I might be wrong, but if not, there's one that's coming. So it's not that it's not FDA approved because there wasn't efficacy or safety data. It was just. Again, at the time and the moment that the company that was, that had that product, it was a patch that had that product, they decided not to pursue it in the United States just because from a regulatory standpoint and a financial standpoint, it wasn't gonna be viable for them.

So that doesn't mean we can't give testosterone off-label. We give obviously a lot of medications off-label, and we do, it is an evidence-based use, even if it's not an on-label use. And I tell people there's two options. And they both have pros and cons. One option is I can prescribe you an FDA approved testosterone product for men, and typically we'll use, the common one is like a 1% testim, gel product.

And you get a tube that a man would use the entire tube in one day and a woman is gonna use one 10th of the tube. And we can talk about strategies for how to safely use that and how to store it and how to make sure that works for you. And you do have to pay out of pocket for it, because again, there's not gonna be any insurance coverage, but.

Usually with a GoodRx coupon, you can get, again, what should be a 30 day supply for a man is gonna be a 300 day supply for a woman and that it's generally about $200. So it's not outrageously expensive. There's some hoops to jump through the pharmacy, et cetera, et cetera, but you can get it. Again, what's nice about it is an FDA approved product.

Now, obviously we can't adjust the dose. Some women absorb it really well. Some people don't absorb it, so we're really limited. If we need to make dose adjustments, it's harder to go much lower than a 10th of a tube. It's already like a pea-sized amount. It's one one half ml. So you know it. It's a little bit tricky.

The other option is we can order it to a compounding pharmacy in a dose that's more appropriate for women. Again, I do work with a local compounding pharmacy that I've worked with for years that I trust, I've had good experiences with. So again, this is not something where even, again, if you have a really well meaning, primary care or OB GYN, who's trying to order it for you, the problem is just because there's no streamlined, easy way to do this, you either need to really know the nuances of using a male product for a woman, which we can talk about.

That can go wrong. Obviously, if you use too much. Or you need to know that you have a trusted compounding pharmacy. And there's a lot of nuances. I'm sure, with the GLP one medications, you order things completely different. No one is trained in how to order compounded medications. It's really a skill you have to yeah.

Learn. And so until you have that skill, you can't necessarily just be doing, going out and doing that. I offer both, I'd say 90% of my patients choose the compounded option, which I'm always a little surprised by. It's actually more money. But people just, they want something that's meant for them, not something that's meant for a man.

Yeah, that's some, sometimes it's the same in my world where, of course it's a luxury to be able to spend a little bit more, but if it's easier, if there's less chance of error, I think people are, yeah, they're more invested in that than just what the price is. Yeah, agreed. And it's still not dramatically different.

It might be closer to $400 a year rather than 200. And then again, we can make dose adjustments really easily. So it is important to know, unlike, you probably hear with like perimenopause, menopause, we don't generally routinely check like estrogen or progesterone levels.

We can if we need to, if we have a clinical reason to. But testosterone, we do check levels. We check a baseline level and we usually are looking at again, you need to know how to order it. You need to order the female version of the test, not the male order. 'cause as you can imagine, all these assays were made for men and they're not reliable.

And women, the only reason we even have reliable assays is they made them for men with hypogonadism. So luckily we can use those ones for women. That's, so I wouldn't even think of that. Yeah, exa, that's, you have to know you're ordering the correct test, know how to interpret it. And then typically once we start testosterone, we will check a level on a fairly routine basis every four to six weeks until we have a stable level.

We wanna make sure that we're staying in a physiologic range for women not going into a super physiologic range. And then we check every six months at a minimum from there. And so there's a lot of things to consider. And then with testosterone, I usually tell my patients.

After I do my whole spiel, usually about half of my patients wanna go on testosterone. There's other anecdotal reasons, people to go on testosterone. We don't have any evidence to prove that there's like improvement in energy, muscle, mass, mood. But sometimes people say, well, my neighbor, my friend, and I say, great, if you wanna try it, you can.

As long as you're aware, this is anecdotal, maybe it'll help you, maybe it won't type of thing. But about half my patients, after I do the whole spiel, wanna go on testosterone. The other half don't. And then the half that go on it, about half continue it and half stop it. Hmm. And there's two reasons for stopping it.

Half my patients stop it because it's doing nothing. We try for six months and they're just not noticing a benefit despite inappropriate level and doing everything. They're just not noticing anything. The other half stopped due to side effects. Even at low levels, some women just get really bothersome, oily skin acne.

I tell people you grow hair where you don't want it and you lose hair where you do want it. Some people get mood changes, some people get like, I, I laugh at this one 'cause it's just really funny. But some people tell me they feel like murderous rage. And then I'm like, well that's not if you wanna murder your husband, that's not the goal of what we were trying do the opposite and again.

Yeah, exactly. So it's like you can only just laugh at these. But that's why it's just not a one size fits all. I really do have very nuanced, long discussions. I check in with my patients frequently and I really try to temper expectations like, Hey, this may really work for you, but we just need to be aware.

It really may not work for you. And that's okay. We have other options as well. Something that you told me when we were talking before we were recording here is that in your clinic you use some validated, tests or screens to track people long-term, which I, yes.

I didn't even, again, I'm just not in this area, so I didn't know it existed. How does that work? What types of things are on there? Yeah, so there's a number of validated questionnaires and of course nobody likes filling out questionnaires. It takes a lot of time. And so I have, the luxury in my clinic because I'm seeing people virtually and I can send these things in advance and I can spend a little bit more time with patients.

Again, I do understand like in a regular clinic where you've got 15 minutes and you're seeing, 20 to 30 patients in a day, it's a lot harder to do these things. But I typically do to have some sort of scientific way of, I joke like, who can remember what you felt like six months ago?

You can't even remember what you ate for lunch yesterday, type of thing. There's different questionnaires that have been validated that are again recommended by that issue, society where we can look at, current sexual distress, sexual function also I like to look at a menopause rating scale.

I have patients fill out these validated screening questions and then we can track them throughout their journey. To really, take a look at what's improved, what hasn't improved. I do really a stepwise approach with patients where, generally I'll see them start them, traditionally on estrogen and progesterone, or just estrogen depending on what they need.

I do a sequential start and then I give it, six to eight weeks and then we check in and then we say, okay, what's the outlier symptom? Is it libido? Is it sleep? Is it mood? And then we make a plan for that. I never start all three at once. Estrogen, testosterone, progesterone because it's too messy and you don't know what's helping what or what side effect is causing what.

I like to be very scientific and very methodical with how I introduce things for people. Because again, there can be side effects. I hate to have somebody spending money on something that's not doing anything for them. I do try to really track the benefits for patients. This is unrelated, but it's related 'cause it's testosterone and a hormone, you're saying you don't start all three at the same time.

Let's say someone is eventually gonna be on all three How long? Yep. Typically. And I know there's a range, but how long does it typically take someone to get it all adjusted and be. Feeling better. And I'm saying that in quote marks because that's so subjective. Yeah. How long is that process typically?

So testosterone specifically is a little bit slower. Like estrogen, again, it depends on the person and what symptoms they're having. But with estrogen, I'm often like, you're gonna feel better in 72 hours. We'll know soon whether or not this is working for you. Testosterone, I typically say eight to 12 weeks.

Basically two to three months before we're seeing it. But the studies show the full benefit at six months, so that's why I do the six month trial. If you're seeing nothing at three months, we can adjust the dose, we can make other changes, but we're wondering, okay, maybe this isn't gonna be working, but by the six month mark, if we're not seeing any benefit, then usually I'll have patients stop at that point.

Because I, again while I'm not primarily seeing women for this, we're talking about it in, in my visits. Yeah. And I think I can give up too quickly. So it's like one, two months and I'm like, but you, how could you have adjusted anything in that period? Again, I think it goes back to the brain because they never believed it was gonna work because they think something's wrong with them.

Yeah. Oh, that's really, yeah. It's like sad when you say that, but it's also empowering. Yeah. Because if they can hear that, then, I just think you can take this a little bit more slowly instead of thinking about Be solved overnight. Yeah. Yeah. Do you have any, books or resources, websites that you commonly tell patients go look at them?

Yes. Yeah. Yes, for sure. So I'll give, there's a whole list of books I have. All my books right now, I love this one 'cause it's called A Tired Woman's Guide to Passionate Sex, which I'm just like, the name says read. I always have my books next to me. Better sex through mindfulness. I'm a big mindfulness person this one's a little bit more academic.

But I still really like it and it's really good to introduce the mindfulness topic. Becoming clit. It's another great one. Have to call out Kelly Casperson. You are Not broken. Yeah. These titles are just like on it, this one like foundational literature Come as You Are by Emily Naski, where it basically just normalizes everything.

It's this whole book is you are normal. Yeah. Again, I literally keep them because I show them every single day to be, and I try to show people, look, there this is not you. Like people just feel like I'm the only one this is happening to. It, this is just not true. But those are the books.

I did wanna make a call out 'cause we haven't mentioned it yet for Dipsey, D-I-P-S-E-A. It's an audio app that has sexy stories for women a lot of women, are not necessarily interested in traditional pornography. If you are, that's certainly fine, but I think again, it's that like, where would I even look to start type of thing.

And a lot of things are just as we know, designed for men. And so for women there's a lot, there's more thing again, dipsy, iss a a great company where. You can choose and what are you interested in? And that's another good thing you can do while you're letting your, arousal cream set in, is listen to a sexy story.

Or again, if okay, it's Wednesday we're having sex, maybe during lunch you pop your earbuds in and listen to a sexy, like you wanna get to the point where when it's like you put the kids down for bed, you're like, okay, I've been waiting for this type of thing. And again, you have to retrain your brain.

And then you can work on that mindfulness, mind, body connection, et cetera. So I really like dipsy. And then OMGS is another great website. I think it's like a modest subscription that you pay. And it basically just, it goes into a lot of, women talking about what works for them, how are they able to have orgasms, all these, it's a quite a good website.

It's very informational, very empowering. It can give you a lot of ideas of if whatever I'm interested in doing hasn't really been working for me, what are other things out there that I haven't been exposed to? But not in a or not pornographic type of way. Do you think there's anything that we didn't address or need to address? Anything that we missed? No, I don't think so. I think again, the most important thing is just knowing the brain is the most important sexual health organ.

Good communication with your partner, knowing that you are healthy, you are normal. And again, all of these things that they require a lot of effort, a lot of time, a lot of checking in with a provider. It's not just again, a Oh, I'm gonna do this one thing, and then it's gonna be back to the way it is.

And also, there is no right way to do it. Everybody's different. Every relationship is different. And what we need to find is just what works for you and not what you think. I can't remember who said this, but there's a, I think it's Kelly Casper actually. She said, stop should all over your sex life.

Yeah. There's no should, there's absolutely no should, you should not feel a certain way, you should not have this particular thing happen. You should not want X, Y, z. It's really a very personal experience between you and your partner. Or even if you don't have a partner, that's fine as well I think that's the main thing to hear.

And again, I think it's, very similar to the journey that you're on with a lot of patients where it's not one size fits all. It's not a set it and forget it. It's not like a, oh, this works for everybody. Just do this one thing. You'll be fine. It's a very personalized experience that you have to be as mentally engaged as you do physically engaged for it to be successful. Yeah. Thank you for all the things you shared. Anyone who's listening, we're gonna make sure in the the show notes to have all of the, everything linked that you've been talking about.

'cause I know people are gonna want to go back and look at that. Can you tell everybody where they can find you? 'cause I know that yes, there's gonna be tons of women that want to talk to you. Yeah, because Can I just say this before anyone, before you say that? I send so many people to you because I just love the way in which you talk to people.

All my patients that see you come back and they say, I'm so glad that I saw went great. They like message me right after. Actually, I don't think you know this. They send me an email right after. I'm so glad. We just, I believe it. Yeah. Well, on the flip side, I'm like, oh, Mateo has you optimized on everything.

I just get to do my one little part, which is great. It's like I barely even have to look. I'm like, oh, lipids, blood pressure, blood sugar. She's got, you're good. I love that. Give us your website or the best way that people can reach you and find out more. Yeah.

And evermore women's health dot com is my website. And I'm gonna be accepting patients, for, membership based practice starting in early 2026. And so that may already be once this has aired, but either you can sign up to see me as a patient or sign up for the wait list, depending on when you, see the website.

But evermore E-V-E-R-M-O-R-E women's health.com. I would say if anyone's listening, you jump on this right now because I know that you're already so busy. You're gonna be waitlist in two seconds with that, and I'm just like, I need my people to see you. And this is really what I love doing. It's so rewarding, and I can just see what I really love is, as I go through this, I spend an hour with patients talking about this, and you can imagine, you can tell I could go on forever, but I can just see their faces change. I can see their shoulders drop, I can see a lightning when I'm talking to them, where patients just are like, oh my gosh, I finally found that person who's gonna help me?

That is just what is so rewarding to me. I really love this work and, I'm excited to see any patients who come my way. Again, just thank you so much for coming on.