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Amanda: Welcome to the podcast everyone.  I recently got a question in my membership, and I thought it would make a great podcast episode.  I invited my friend Cami Hurst to come on the podcast and talk about it today.  

Welcome to the podcast Cami! 

Cami: Thanks, Amanda. I’m just honored to be here.

Amanda: So can you please introduce yourself to my audience? 

Cami: Of course. So my name is Cami Hurst. I have a master’s degree in marriage and family therapy. I have a post-graduate degree in sex therapy and I’m currently a PhD student in clinical sexology. I have a private practice in Meridian, Idaho, where I work with couples and individuals around things like relationships and sexual health and throw in a little bit of faith crisis in there or mixed faith marriage. In addition to my private practice, I also host a weekly podcast around sexual health. It’s my attempt to get some education out there as a passion project because a lot of the issues we see in the therapy room can benefit from just some psychoeducation. 

Amanda: And I am a big fan of your podcast. I get a lot of education from your podcast, so thank you so much for that. So here’s the question that was posed in my membership. And I’m just going to read it as she wrote it, and then we can talk about it afterwards. Okay. She said, “I keep hearing from friends and family about how everything changes physically and sexually when women go through menopause. I’m not at that point yet, but I would love to know what I can do now to prepare physically and mentally. So this can be a time when my husband and I are still connected intimately. So many people I talk to say their sex lives went downhill when they got to that point. Do you have any suggestions? I’m not even sure what to expect because I can’t find anyone willing to talk about it.” 

So I thought this was the perfect question to bring to you because I don’t know a ton about sex during menopause. I haven’t been through menopause yet myself and so I wanted to come to an expert. So take it away.

Cami: I think a lot of things do change and it might be nice, but it’s not all on the female, right? So we’re going to spend all day talking about the female changes later in life that affect relationships and sexuality, but we could do a whole other podcast on the male experience and how it impacts the relationship because our statistics are showing a lot of the men are shutting down the sexual relationship because of their insecurity as well.

So I’m just going to balance that, that we don’t need to own all the weight here as women for that basis later in life. Let’s share the responsibility, but today we’re going to talk about the female experience. And so we talk about menopause so we want to have a good working definition.

The definition of menopause is when a female bodied individual has gone 12 consecutive months without a period. That is what menopause is. Pre or peri-menopause happens usually about 10 years leading up to that point where our periods are changing, they can get more infrequent. They can get frequent. They just look really unpredictable because our body is changing and shutting down a little bit. It’s changing its expectations for reproduction. 

Amanda: And I have to say I’m experiencing that at this point, right? Like sometimes I’ve always been like super, super regular, and now I’m having some cycles that are like, instead of like 26, 27 days, which is normal for me, 45 days, which then you start to freak out going, am I pregnant? But that would be crazy. This point in life taking stupid tests. So let’s just say it like, it’s totally scary, but okay. 

Cami: So if you were to look at a bell curve, the average age, where a woman begins those 12 consecutive months is about 50. So women about 40 to 50 on the bell curve are experiencing peri-menopause and it can go up and down. Right. Everyone’s going to be like, well, let’s start it for me at 30. Well sure it did, but we’re looking at like the bell curve, the average. And then post-menopause is the two to three years after we haven’t had a period for a year. Where our body settles into some kind of normal and then the symptoms lift. And so some women believe once they enter this menopause of 12 consecutive months, then these symptoms continue for the rest of their life. And that’s just not true. It’s a transition period. And those symptoms lift about two to three years after we’ve ceased having menstruation.

Amanda: Okay. That’s good to know.

Cami: So that’s our definition for menopause. A lot of women who are in peri-menopause are like, I’m starting para I’m starting menopause. Well, not really, but that’s just a little bit of education. So definitions while we’re talking. So whenever we’re talking about sexual health, and remember I’m not a doctor, but I have clinical training. We’re going to look at three areas that affect our sexual health, no matter what phase we’re in. There’s the biological lens of what’s happening biologically, then there’s the psychological lens, which is what’s happening psychologically. And then there’s the social lens of what’s happening socially. And that’s like in the relationships and our beliefs and things like that. So if we look at menopause from a bio psycho social lens, I want to pull those three apart today and talk about the symptoms and things we can do in each area. So biologically what’s happening in menopause is our body stops producing eggs. We’re going to shut down reproduction basically. Then our estrogen and our progesterone start to decrease. Now, the important thing about estrogen and progesterone to know is that we feel best when they are at the right proportion to each other. So people often ask me what numbers should my estrogen be at so I can feel good. Well, that isn’t a thing. It isn’t, this is the best level. It’s the proportion it is to your progesterone. 

Amanda: That makes sense. 

Cami: They can be high together. They can be low together, but you want the right ratio together. So as the estrogen decreases one of the most common symptoms is what happens to the vaginal tissue. Everyone wants to talk about estrogen affecting the drive and it can, but I think a lot more things are affecting the drive. As far as do I want to have sex? So first I’m going to talk about what is biologically happening, not what you might want to do or not do. Biologically, when the estrogen drops, our vaginal lining, all our tissues, they get dry, but they also thin. And so a lot of people will say, well, you’re dry, you just need a really good loop. That is some of it. But if you go and listen to one of my podcasts about lubes, you want to be a little careful about just any lube, because many lubes take your body’s moisture and pull it to the surface to keep the lubrication going, but actually leave you dried out overall after the sexual encounter. 

Amanda: And I’ve done an episode on lube as well. We know here how important lube is! 

Cami: You don’t want to contribute to the drying out of the vaginal tissue. Now young, healthy vaginal tissue, when it is engorged with blood because it’s aroused, it plumps up and it lengthens. And so your vaginal canal when you’re aroused is actually like half an inch longer, and a lot of really nice padding in there, which can make penetration possible, but also more pleasurable. When our estrogen drops that isn’t happening. The tissues are not plumping. The canal is not lengthening. It gets very thin. And if you think like almost tissue paper, it’s really easy to tear. And so women are experiencing some micro tears. But they’re also not lengthening. So with a deep thrust, they might be tapping up on the cervix in a way that hasn’t happened before. And so then we’re having painful sex. A lot of this can be shifted with an estrogen cream that will do more for the tissue than a lube, depending on the severity of your thinning tissues. So the estrogen cream is going to keep the elasticity of that tissue healthy, because it tends to become less elastic, more prone to micro tears.

Amanda: And so we would go to our doctor to get that.

Cami: Yes, you can go to your doctor. So that is biologically something that’s happening that can influence our experience of sex. And when we start to track discomfort with sex, of course, we’re going to start to want less. I mean, some people are like, I don’t want sex because it hurts. Okay. Well that makes a ton of sense. And so there are ways that we can keep penetration more comfortable, and in fact, keeping the frequency of penetration up also helps with the elasticity. So if you were to say, we’re going to take a moratorium on penetration, which you can totally do, I’m not against that, but you just want to know that the less you make those elastic tissues stretch and bend, the less they’re going to stretch and bend. And so that is one of the biological effects. We’re thinning and the decreased lubrication. Another biological thing that’s happening is some irritability that comes from the other things that our hormones do like regulate our temperature. So our hormones regulate our temperature. That’s why we have hot flashes and night sweats, because our body is changing the purpose from procreation to a non-procreating body. There’s some things we can do to help that. But everyone wants to say, I’m going through menopause, so I don’t want sex, when if we pull it apart a little bit and we treat some of the symptoms, most people who are really irritable or angry or uncomfortable don’t want to have sex. So let’s try and figure out how we can get you comfortable, how we could address the irritability instead of just labeling it as a desire issue. It might be a comfort issue. It might be a pain issue. It might be a fatigue issue.

Amanda: All coming from those hormones changing. 

Cami: And when we can address that, then our likelihood of wanting to engage sexually increases. So that’s biologically what’s happening and what we can do about it.

Psychologically what’s happening as we enter into our 50 plus years of age is our adult development continues and that stage of development is often centered around making peace with our life. Evaluating where our effort has been. We start to have a bit of an existential crisis realizing that aging is upon us, that we’re coming down the hill instead of going up the hill and that stage of development depending on how you’re making peace with your life can create anxiety and depression during these menopause years that might not be really linked to the hormones shifting, but are linked more to the psychological meaning-making that we’re going through in that process. Women who their identity was really wrapped up in their children and now their children are leaving and their parents are aging and the sandwich generation where they’re in the gap, they’re still caretaking, but it’s a lot less fulfilling. It’s pretty demanding. And the anxiety and depression can come from the meaning we’re making as we’re going through this later stage of life. Who am I? What am I contributing? Is what I contributed enough for me to feel fulfilled? These kinds of things. So that’s really common to go through. Simultaneously with the biological changes. Those things can be addressed with some therapy, with some anxiety medication perhaps, but we want to make clear that that will impact whether you want to engage sexually. How you feel about yourself, whether you’re depressed, whether you’re anxious and that is separate from menopause. It’s the stage of life that you’re psychologically going through.

Amanda: I get a lot of clients about that age group, because they’ve realized, okay, kids are out of the house. I’ve still got half my life with this person. We haven’t made sex a priority. I don’t know my identity as a wife, more than a mother. And so trying to figure themselves out at that stage, I get a lot of clients in that stage of life.

Cami: I think that’s true for a lot of individuals who come from a conservative religious background where the identity was wrapped up in that role. And so the process of claiming internal authority is pushed back to the stage where outside of that culture, it happens around 30, but it gets pushed back into this fifties of reclaiming authority. So you hear a lot of women who are like, I’m not gonna have duty sex. I don’t like this. I’ve been being nice for 50 years. I’m not going to be nice. And it’s not a hormonal thing. Everybody wants to say, Oh, this is just menopause because your hormones are shifting. This is actually a life development stage. Where we’re figuring out how much of my life is coming from my own authority instead of an external authority. So I really want to name things what they are, When I work with people I’m like, let’s name it what it really is. And then of course, if we’re going to be doing any pharmacological interventions for anxiety and depression, it will impact our experience of sexual arousal and/or orgasm and/or desire. Because those medications are trying to keep us really stable and sexual arousal and orgasm look a little bit like a panic attack. Because it is like physiologically, our heart is racing all the adrenaline. And so it’s like, wait, wait, I want to tamp this down. People don’t really realize why we do have sexual side effects with them, depression and anxiety medication, and that’s why. It’s doing its job. 

Amanda: It’s just tampering other things that we don’t want it to tamper with.

Cami: It’s really trying to keep you level and you pay a little bit of a price with that, which isn’t, you know, unaddressable, right? 

Amanda: There are some drugs that are better than others when it comes to sexual side effects.

Cami: There are, and I’m not going to prescribe, but I might send you back to your doctor and say, this has having some sexual side effects. Because that’s a lot of things women don’t want to say to their doctor, but they’ll say to their therapist.

Amanda: And they say it to me as well. And I send them back to their doctor and say, This isn’t working for me. I need to find something else that works. So I am in agreement with that, for sure.

Cami: And then the social lens. Because these all three work together. The biological, the psychological, now the social. Those are what’s the quality of the relationship. Did you enjoy sex before? Did you believe it was for your husband? And now you’re claiming internal authority and being like socially, you feel like you can say that you’re not doing this anymore. Because you didn’t ever develop your sexual potential within the relationship. What are your beliefs about aging and sex? I had a client who was presenting with a lot of very compulsive thoughts about hair loss, muscle loss, tissue relaxing, all our tissues start to relax as we age. Really compulsive thoughts, checking all the time for the aging that was happening. And as we got into more, there was this, they had a really enjoyable sex life, and they had a belief that that just stopped around 50 and they were mourning in their forties. It was all grief and lost aging leads to a death of sexuality. And so when we look at the social lens, it’s what are your beliefs about aging and sexuality? Do you think it’s gross? The people in their seventies and eighties still enjoy sexual touch and sexual pleasure together. Well, that’s going to get in your way around menopause because these beliefs about what happens to couples sexually will influence your drive. And what you think is supposed to happen. A lot of women are like, Oh, I’m so excited for my husband to start experiencing erectile dysfunction because then I won’t have to have sex anymore. 

Amanda: I’ve heard that before.

Cami: These ideas we have about sex and aging is an issue. And we look at that. What are your beliefs around pleasure for pleasure’s sake if procreation is impossible. A lot of women are like, Ooh, phew. I can’t have babies anyway, so you don’t need to touch me. And it really highlights socially the lack of support for lifelong intimacy and pleasure with a partner. And that’s a social issue that we have in America, but also in conservative cultures or conservative religions that impact social belief that would get in the way, the body image that I’m changing. Sexy is firm and perky and young. And if that’s a belief that’s going to get in the way. Also how you feel about fantasy. That’s a lot of what we use in our older age. Remember our trip when we were 35 to the California coast and if people are really uncomfortable going to a fantasy place together to the past. That’s something I’ll really use with older couples. It’s very powerful to keep the relationship exciting with the realities of our changing bodies. So, that is the social lens of, What do we believe about aging? Who is sex for? What do we believe about pleasure for pleasure’s sake? What do we believe about body image and sexuality? What do we believe about fantasy? All these beliefs come to a head. And so those are the three lenses that I’m looking at. And far too often, we simplify menopause and blame the hormones. There’s a lot of other places to look for solutions. 

Amanda: Absolutely. And I love that you’ve brought out that there are really three distinct areas that we need to look at and not just blame everything on hormones.

Cami: And now as we’re having this conversation, we’re kind of having the assumption that we’re talking about a married female. 

Amanda: Yeah, which is, primarily my audience.

Cami: So I would be having an additional conversation if we’re talking about single women or women who are dating again in their fifties.

Amanda: Okay. Well, let’s have that conversation because who knows? They’re probably out here too. 

Cami: So I’d be looking at women who are dating again, or are single. I’d want to point out is that the decrease in estrogen leaves vaginal tissue at a higher risk for infection. And so when we look at STI rates, we really want to believe that it’s a college campus issue. But actually, the highest percentages of STI’s are people 50 and above. Because they believe that the condom is to stop a baby. And so if I am not really able to have a baby, we can do whatever we want, which is just a failure of our education system. And so we’re going to be talking about continuing safe sex practices. Also, what is your belief about solo pleasure and these increased ages. Frequent emissions is a protective factor against prostate cancer. And so when you’re starting to think about prostate health in your fifties and sixties, and you don’t have a partner, but we know that frequent emissions is protective of cancer, we’re going to be really working through the social beliefs. And what do we do with them? It’s also very protective against depression and anxiety that is produced from stress. So if you are solo, but we know that you’re in a very stressful sandwiched place in life, taking care of parents, taking care of adult children, taking care of grandchildren. Stress is a huge proponent of depression and anxiety. And an orgasm is an incredibly natural way to combat stress, to decrease the likelihood of stress induced anxiety and depression. So it’s a lot of conversations that we’re trying to have, and then it gets really complex because I just said things that were biologically effective, but guess what? Our psychological and our social selves are going to come in and make that conversation not so simple. Some things that can help through this transition are decreasing caffeine. It’s going to help with the irritability. It’s going to help with the night sweats and the sleep disturbances. We’re going to want to decrease our caffeine. We’re going to want to increase our calcium and our vitamin D. Those are protective for our hormone production, but also protective for mood stabilization. With vitamin D exercise is going to be really helpful. What we found most helpful with hot flashes is mindfulness and breathing exercises. That’s where the literature’s going. Right now. isn’t that so funny? So it’s not a pill for hot flashes, but much, much more effective to start practicing mindfulness and deep breathing through the hot flash. Staying sexually active will, or at least maintain some elasticity, if that’s important to you. And then water-based lube is going to be the safest because it doesn’t do the absorption of moisture from the tissue to create the lubrication, even though for other purposes water-based, isn’t my highest recommendation, it is if it’s an estrogen issue. Something else that I’ll talk to couples quite a bit during this period, whether it’s the male experience or the female experience that is complicating sexuality in a new way for the couple is restructuring what we believe or defined as sexual engagement. Too many couples are either holding hands or having intercourse. And there’s not a lot of middle ground. And if intercourse becomes difficult, either because we have some prostate issues or some erection issues, or because we have vaginal tearing and pain there are a lot of ways that we can maintain pleasure and connection with a partner that doesn’t have to depend on penetration. That’s a new idea for a lot of people who are in their fifties and above. 

Amanda: Absolutely. That’s a big thing that I talked to about on this podcast and with my clients is expanding your definition of sex and there’s a lot more in there between, like you said, holding hands and intercourse. There’s so much in there that we can use to increase pleasure and our connection with each other.

Cami: Yeah, the female orgasm does not depend on any type of penetration. And actually the male orgasm does not depend on an erection. And so there’s a lot that we can do to still maintain pleasure and connection. And I actually see couples have a lot of growth in this 10 to 20 year period if they’ll address their limiting beliefs. If they’ll address the biological factors that they can have a degree of control over. And if they’re willing relationally to go somewhere new together. That this can be an incredible time of life for people. 

Amanda: Absolutely! I mean, when you can get through that individuality of understanding who you are and quit looking to external sources and really come into yourself, that opens up a whole new thing for sexuality. The best sex can happen in your fifties and beyond just because you’re not worried about getting pregnant. You’re not worried about the kids walking in. You have more time possibly during the day, depending on what’s going on. Plus you’re coming into your own more as an individual. I just think it can really be a great time. If you can get through some of these belief systems and physical things going on.

Cami: Yeah. In relation to that question, when she said, I heard everything changes, a lot does change. I don’t think that’s something we need to really be scared about that we can actually empower women to say, here are the three areas in which things change and here’s the power control that you have in each of those areas to address them. Instead of throwing up our hands and saying hormones, hormones, hormones, and feeling completely overpowered and out of control. When we get powerless it can really be a concerning place to be. 

Amanda: Well, thank you so much, Cami. This was fantastic. Can you let my audience know where they can find you and possibly work with you if they’re in the Meridian, Idaho area? 

Cami: First I wanted to give just two recommendations. The first recommendation that I would give people who are wanting to change how they think about sex from either a performance model or a penetration model or a young and sexy model would be the book by Marty Klein called Sexual Intelligence. This is going to shift our mind into pleasure and connection. And then the second book I’d recommend is by Laura Briden. It’s called The Period Repair Manual. You want the second edition. That one addresses perimenopause and menopause specifically. The first edition didn’t. So those are my recommendations for what we talked about if people want to do some more study. For people who want to find me, my website is camihurst.com. I do therapy in Idaho. I do coaching online for out-of-state clients. It’s a little bit of a different process. And then I provide free weekly sexual health podcasts called Sex Therapy 101. Feel free to find me in those places. I’m on Facebook and Instagram, but I’m not super active there, I’m in my office a lot with people instead of online.

Amanda: You’re focusing on what you do best, yes!

Cami: The podcast has been a big passion project of mine because I believe so much in the power of psycho-education. And so that is not a money maker. It is me trying to improve the world and move the needle. 

Amanda: It’s fantastic. Well, thank you so much for being here, Cami.

Cami: Thank you for what you do. So nice to have you as a friend and colleague.

Amanda: Thanks so much to Cami for coming on the podcast today. I have linked all of her information in the show notes, so you can reach out to her if you would like to. Thanks for being here and have a great weekend. We’ll see you next time.