122. SFMD After Dark Part 3 - Q&A

In this final episode of the SugarFreeMD After Dark series, Dr. Stacy answers the most common—and most honest—questions women ask about sex, desire, and intimacy in midlife.

If you’ve ever wondered:

• Is it normal to love my partner but not want sex anymore?
• Why does sex hurt now when it never used to?
• Why am I never thinking about sex unless someone brings it up?
• Is it normal to need lube every time?
• Why do I feel so self-conscious about my body all of a sudden?

…you are not alone—and nothing is “wrong” with you.

In this candid Q&A, Dr. Stacy breaks down what’s actually happening with hormones, tissue changes, desire shifts, body image, and nervous system stress during perimenopause and menopause. She explains why spontaneous desire often disappears, why responsive desire is normal, and how planning intimacy can actually protect connection—not ruin it.

This episode is educational, empowering, and real. It’s not medical advice, but it will give you the language and confidence to have better conversations with your doctor and your partner.

⚠️ Not G-rated. This episode includes adult topics and anatomical terms.

If you have more questions or want deeper teaching on this topic, email drstacy@sugarfreemd.com and let us know what would be most helpful.

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This episode was produced by The Podcast Teacher: www.ThePodcastTeacher.com.

Transcript

Hey everybody. I want to do one more episode about SugarFreeMD After Dark because I didn’t get to do any of the questions. And I’ve gotten so many good questions, so I wanted to take a minute to answer those. So we’ll just see. It might be a short episode. I’m not sure. Remember, it will likely not be a G-rated episode because we are talking about intimacy and adult sexual satisfaction. So if you’ve got kids, just remember that.

And you know, I am talking about medical stuff, but I am not giving you your medical advice. You need to talk to your doctor about your specific case. I am just trying to educate so that you have some of the terms and feel empowered to go and have those conversations with your doctor. So this is in no way medical advice, but I want you to feel like you have what you need to have a good, deep conversation.

If you’re in Louisiana and you do have virtual visits, I’m happy to see you, and then we can have a doctor-patient relationship. But this is for education, and I want you to just have what you need so that you can feel great no matter what age you are. This is all stuff I did not know when I was 30 or 35 or 40—and I’m going to stop there because you don’t need to know exactly that I’m old.

I wish I had known all of this a little bit earlier because I definitely had a lot of time feeling like there was something wrong with me. Because my desire was so different than when I was in my 20s and 30s, I thought something must be broken. And it was causing frustration in my marriage because it was making me feel bad about myself and unsexy and all the things. And so when I learned all this, I just felt like everyone else should know it too.

It’s kind of like everything I’ve done up until this point. When I learned about coaching, I felt like everyone needed to know it. And the more I learned, the more I want to teach you because I don’t think anyone should ever have to feel bad about themselves for things that are normal that we just didn’t know about. And that is 100% the case with this.

So I have a bunch of questions. I’m going to run through them and give some answers. If you have more questions after this, just send them in. I can always do another episode if we need to.

The beauty and joy of having a podcast is I can do whatever I want. So if you’ve got questions you want me to answer and you think everyone should know the answer, please email them to drstacey@sugarfreemd.com.

First question: Is it normal that I love my husband and just don’t want sex anymore?
Yes. Of course. Super normal. That’s what we’ve been talking about. Love and libido are not the same thing. There are lots of people in very loving relationships that do not have very much sex, and they’ve agreed that that is okay. There are lots of ways to show that we love each other that have nothing to do with libido.

For a lot of women, desire becomes responsive. We don’t have that spontaneous desire anymore. We don’t see someone walking down the street and our body physically changes and is immediately ready for sex. Those days were fun, but that’s just not it anymore—and that’s okay.

If life is stressful, if you’re having pain with sex, if you’re exhausted, desire and arousal are affected by multiple factors. We need to make sure we’re comfortable, not feeling pressured, and stop expecting desire to be spontaneous. Very low or non-existent spontaneous desire is normal. We pivot. We plan.

Question two: Why do I feel dry and irritated? Is that just aging “down there”?
Yes. It’s very common in perimenopause and menopause due to estrogen shifts. Estrogen is a tissue hormone. Vaginal dryness, tissue thinning, and pain with sex are GSM symptoms. You do not have to suffer. There are prescription and FDA-approved options—both hormonal and non-hormonal—that can help.

Over-the-counter vaginal moisturizers and lube can help, but the more permanent fix is treatment that improves tissue quality.

Why does it hurt sometimes when it never used to?
Very common. It can be tissue quality, moisture issues, or pelvic floor tension. Pelvic floor physical therapy can be incredibly helpful. Pain trains your brain not to want sex, so comfort is the first step.

Is it normal to never think about sex until someone brings it up?
Yes. That’s responsive desire. It doesn’t mean you won’t enjoy sex—it just means your brain isn’t offering it up spontaneously anymore. Planning and context matter now.

Does testosterone work, or is it overhyped?
Both. Testosterone can help hypoactive sexual desire disorder and may help arousal slightly. It does not help fatigue, stamina, or lean muscle in women at normal doses. It has a specific role, but it’s not magic.

Can I take hormones if I’m scared of cancer?
It depends on your history and your risk. This is shared decision-making. Local vaginal estrogen does not have the same risk profile as systemic estrogen. This is individualized medicine and should be discussed with your doctor and oncologist if applicable.

Why am I so self-conscious about my body even though I’m “fine”?
Midlife messes with identity. Hormonal shifts cause fat redistribution even if the scale doesn’t change. That can be incredibly disorienting. You’re not imagining it. When we feel good about our bodies, intimacy is easier.

How do I get out of my head during sex?
Slow down. It takes longer now, and that’s okay. You need a longer runway. Talk to your partner. Pressure kills pleasure.

Why does my partner want sex more than I do?
Desire mismatch is incredibly common. It doesn’t mean you don’t love them. It means your desire has changed. Planning connection and removing pressure helps protect intimacy.

Is it normal to feel numb or have a harder time orgasming?
Yes. Tissue changes, blood flow, stress, and pelvic floor tension all play a role. Normalizing this can help you relax and enjoy what is happening.

Is it normal to only want sex if I’ve had a drink?
It’s common, but it’s information. Alcohol may be quieting your brain. If that’s the case, we want to find other ways to calm your nervous system that don’t disrupt sleep or health.

Is it normal to want sex less after kids—even when they’re older?
Yes. Planning intimacy is not unromantic. It’s realistic.

Do I need lube every time now?
Yes. Many women do. It’s smart, protective, and prevents pain—which protects desire.

Why do I feel embarrassed talking about this?
Because we were trained to be. Embarrassment doesn’t mean it’s wrong. It means you’re doing something brave.

That wraps up this Q&A. If you have more questions or want deeper teaching, please email me at drstacy@sugarfreemd.com. I want to make sure you have all the information you need to feel connected, confident, and well for as long as possible.

That wraps up our After Dark series. If you didn’t listen to the other two episodes, go back and catch them. I’ll talk to you next week. Bye.