If you have ever wondered why you do not want your husband to walk through the door and rip your clothes off anymore, this episode is for you.

And if you have ever quietly believed something was wrong with you because you do not orgasm easily, or at all, this episode is for you too.

In this episode, I sit down with Dr. Sally Greenwald, a board-certified OB/GYN with specialized training in menopause medicine, for one of the most validating conversations I have had about women’s sexual health, desire, arousal, orgasm, and what changes in perimenopause and menopause.

 

What she shared genuinely stopped me in my tracks.

We were taught to protect ourselves from pregnancy and disease. But most of us were never taught how our bodies actually work.

No one explained the difference between the desire that hits you out of nowhere and the desire that shows up once you are already in the moment.

No one drew us a real map of our own anatomy.

No one told us what happens to desire, arousal, orgasm, lubrication, vaginal tissue, and pleasure once perimenopause and menopause enter the picture.

Dr. Greenwald walks us through the real data on female desire, arousal, and orgasm. We talk about why only a small percentage of women maintain the “spontaneous” desire we see on TV, and why that has absolutely nothing to do with being broken.

We also talk about what happens hormonally and physically during midlife, and why so many women quietly suffer through pain, dryness, low libido, or a total loss of interest without knowing there is a name for it and a way through it.

We get into the anatomy no one taught us in school, the science behind why vibrators are not just for fun anymore, and why scheduling sex might be one of the most underrated tools in a long-term relationship.

This conversation will change how you think about your own body.

It might also make you a little angry about what you were never told.

Both are fair.

Watch the full episode:

In This Episode, We Cover:

• The real difference between spontaneous desire and responsive desire
• Why so many women think something is wrong with them when they do not want sex the way they used to
• What happens to libido, arousal, orgasm, vaginal tissue, and lubrication in perimenopause and menopause
• How to start figuring out whether low desire is physical, psychological, relational, hormonal, or a combination
• The belief about sex drive that may be creating more shame and pressure than anything else
• The anatomy lesson women should have received in school, but never did
• Why vibrators may support pleasure, arousal, blood flow, and sexual function
• The orgasm myth almost every woman believes, and what the data actually shows
• How scheduling sex can reduce pressure and help bring back intimacy
• Why sex, pleasure, and intimacy may support health more than women realize

Why Low Libido in Menopause Does Not Mean You Are Broken

One of the most harmful myths women carry is that sexual desire should always be spontaneous.

You should just want sex out of nowhere. You should feel turned on before anything starts. You should be ready the second your partner is ready.

But for many women, especially in long-term relationships and especially in midlife, desire is often responsive, not spontaneous.

That means desire may show up after affection, touch, connection, relaxation, safety, arousal, or emotional closeness begins.

This is not dysfunction.

This is normal female sexuality for many women.

The problem is that most women were never taught this. So when they stop feeling spontaneous desire, they assume something is wrong with them, their marriage, their hormones, or their attraction to their partner.

Sometimes hormones are involved. Sometimes stress is involved. Sometimes relationship dynamics are involved. Sometimes pain, dryness, or poor sleep are involved.

But the first step is removing the shame.

What Perimenopause and Menopause Do to Sexual Health

Perimenopause and menopause can change the sexual experience in very real ways.

As estrogen, progesterone, and testosterone shift or decline, women may notice changes in:

• Desire
• Arousal
• Orgasm intensity
• Lubrication
• Vaginal elasticity
• Clitoral sensitivity
• Pelvic blood flow
• Pain with sex
• Urinary symptoms
• Mood and body confidence
• Energy and stress tolerance

Many women are told this is just part of aging, but that is not good enough.

There are names for these changes. There are treatment options. And there are ways to support the body, the relationship, and the nervous system so sex does not become another place where women feel like they are failing.

Painful Sex, Vaginal Dryness and Genitourinary Syndrome of Menopause

Painful sex in menopause is common, but it should never be dismissed as normal.

Low estrogen can affect the vaginal and vulvar tissues, leading to dryness, burning, irritation, tearing, urinary urgency, recurrent UTIs, and pain with intimacy. This is often part of genitourinary syndrome of menopause, also known as GSM.

Many women suffer in silence because they are embarrassed, or because no one ever asked.

But vaginal and sexual symptoms deserve treatment just as much as hot flashes, sleep problems, or mood changes.

This is where options like vaginal estrogen, moisturizers, lubricants, pelvic floor therapy, hormone support, and better sexual education can make a major difference.

Why Orgasm Is Not as Simple as Women Were Led to Believe

A lot of women quietly believe they are broken because they do not orgasm easily from intercourse alone.

But the data on female orgasm tells a very different story.

Many women need direct or indirect clitoral stimulation to orgasm. This is normal. It is not a failure, and it is not something to be embarrassed about.

The problem is that movies, pornography, and bad sex education have created unrealistic expectations about how women are “supposed” to experience pleasure.

Dr. Greenwald explains why understanding your anatomy, using tools like vibrators, and learning what your body actually responds to can be empowering, not shameful.

Why Vibrators Are Not Just for Fun

Vibrators are often treated like a novelty or something women should feel embarrassed about.

But in midlife, they can also be a practical sexual health tool.

They may help support arousal, blood flow, sensation, pleasure, and orgasm. For some women, they can also help rebuild confidence and reconnect them to a body that has changed.

The goal is not performance.

The goal is connection, pleasure, blood flow, and learning your body without shame.

Why Scheduling Sex Can Help Long-Term Relationships

Scheduling sex does not sound sexy at first. I get it.

But for many couples, especially in midlife, it can actually reduce pressure.

When life is busy, hormones are changing, sleep is broken, and stress is high, waiting for spontaneous desire may mean intimacy slowly disappears.

Scheduling sex or intimacy can create anticipation, reduce resentment, and give women time to transition mentally and physically into connection.

It does not have to mean rigid or boring.

It can mean intentional.

And sometimes that is exactly what long-term intimacy needs.

This Episode Is For You If:

• You love your partner but do not understand why you do not want sex anymore
• You rarely feel spontaneous desire and wonder if something is wrong with you
• You have never had an easy time reaching orgasm
• You feel shame about your libido, body, pleasure, or sexual response
• You are in perimenopause or menopause and noticing changes in arousal, lubrication, pain, or orgasm
• You have painful sex, vaginal dryness, urinary symptoms, or discomfort with intimacy
• You want a better understanding of female anatomy and sexual response
• You are tired of comparing your real life to what you see in movies or on a screen
• You want a more honest, compassionate conversation about midlife sex and women’s health

FAQ Section

Why do women lose interest in sex during perimenopause and menopause?

Women may lose interest in sex during perimenopause and menopause because of hormonal changes, low estrogen, low testosterone, poor sleep, stress, vaginal dryness, pain with sex, relationship dynamics, body image changes, and nervous system overload. Low libido is often multifactorial and does not mean a woman is broken.

What is the difference between spontaneous desire and responsive desire?

Spontaneous desire is desire that appears suddenly, before sexual activity begins. Responsive desire shows up after connection, touch, affection, relaxation, or arousal begins. Many women experience responsive desire, especially in long-term relationships and midlife.

Is it normal not to want sex in menopause?

It is common for sexual desire to change in menopause, but that does not mean women have to ignore it or suffer silently. Changes in libido, arousal, orgasm, lubrication, and comfort can often be supported with the right education, hormone care, pelvic health support, and relationship communication.

Why does sex become painful after menopause?

Sex may become painful after menopause because declining estrogen can thin and dry the vaginal and vulvar tissues. This can lead to dryness, burning, irritation, tearing, urinary symptoms, and pain with penetration. This is often part of genitourinary syndrome of menopause, or GSM.

Can vaginal estrogen help with painful sex and dryness?

Vaginal estrogen may help many women with vaginal dryness, painful sex, urinary symptoms, irritation, and tissue changes related to menopause. It works locally on the vaginal and vulvar tissues and should be discussed with a qualified healthcare provider.

Why is orgasm harder in perimenopause and menopause?

Orgasm may become harder in perimenopause and menopause because of changes in hormones, blood flow, clitoral sensitivity, arousal, stress, sleep, medication use, pain, and nervous system regulation. Many women also need direct clitoral stimulation to orgasm, which is completely normal.

Do most women orgasm from intercourse alone?

No. Many women do not orgasm from intercourse alone and need direct or indirect clitoral stimulation. This is normal female anatomy and not a sign that anything is wrong.

Can vibrators help with menopause sexual health?

Vibrators may help support arousal, blood flow, sensation, pleasure, and orgasm. For some women in midlife, they can be useful tools for reconnecting with their bodies and supporting sexual function without shame.

Does scheduling sex ruin intimacy?

Scheduling sex does not have to ruin intimacy. For many couples, it can reduce pressure, create anticipation, and make space for connection in busy seasons of life. In long-term relationships, intentional intimacy can be more realistic than waiting for spontaneous desire.