Episode 53: Hormones, Identity, and Intimacy: Sexuality Through the Menopause Transition with Dr. Juliana Hauser

Midlife can be a confusing time for many women when it comes to sexual identity, desire, and connection. In this episode, we talk with Dr. Juliana Hauser, PhD—sex therapist and author of A New Position on Sex: A Guide to Greater Sexual Confidence, Pleasure, and Authenticity.

Dr. Hauser shares how to enact and activate agency—not just in your sex life, but in every aspect of your life. We explore her “sexercises,” designed to help women self-reflect, self-audit, and reconnect with their bodies and desires in powerful new ways.

We also talk about cultivating body compassion, shifting your mind away from the endless to-do list to make space for connection, and understanding the physical changes that occur with hormones in midlife. Plus, we cover the benefits of tools like vaginal estrogen and pelvic floor physical therapy to support sexual wellness and comfort.

This conversation is an invitation to reclaim your pleasure, confidence, and connection—both with yourself and with those you love. 

Find Dr. Juliana Hauser:

website: dr-juliana.com

@drjulianahauser

Get her new book on Amazon: A New Position on Sex: A Guide to Greater Sexual Confidence, Pleasure, and Authenticity

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Email us with questions and topics you want us to cover at
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The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Episode 53: Hormones, Identity, and Intimacy: Sexuality Through the Menopause Transition with Dr. Juliana Hauser

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting day. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome back to the starting gate. We're your host, Dr. Kitty Dotson. I'm Dr. Sarah Schuetz. We're still in our menopause series today, but I really think that today's episode will be helpful to anyone and everyone. We are gonna talk about something that we learned very little about in our medical training, and that is sexual health.

Let's talk about sex, baby B. It's particularly important in this time because so many women going through perimenopause and menopause are experiencing changes in their hormones, and that can lead to a lot of things, changes in body image, changes in desire, and changes in intimacy, which can really feel isolating.

 And so we want you to know that these shifts do not mean that this is the end of a fulfilling [00:02:00] sex life. we're gonna really get into some more questions today. . What is sexual agency? We wanna talk about how you can deal with any concerns around body image or self-consciousness that may be coming up during intimacy.

We wanna talk about what someone can do if their libido is down or if they just can't get their mind off their to-do list while having sex. And then we wanna talk about how to navigate the vaginal changes that may occur during menopause and the impact that can have on sexual health. And you are lucky '

cause Kitty and I are not experts on this at all.

So we called in an expert and we have Dr. Juliana Houser, a sex therapist, coach, educator, and expert in helping women reclaim their sexual agency and rediscover pleasure and connection at any stage of life. She is a part of the menopause movement nationally. She's had the pleasure of being at some of the biggest conferences out there and speaking with people like Mary Claire Haver and Kelly Casperson. And so [00:03:00] we are so fortunate to have her on our show today, and she also is a part of the Un Unmuted Conference a couple weeks ago and did an amazing job there. We're just pleased to have her here today and also have her talk about her new book, A New Position on Sex, a Guide to Greater Sexual Confidence, pleasure, and Authenticity.

Thank you so much for coming today. Let's talk about sex. I'm so excited to be here. 

Thank you for bringing up a topic that is often difficult for people to bring up. we learned from you in the conference already, but you talked about something called sexual agency. Can you talk a little bit more about what this actually means to someone? 

I wanna start about how this came to fruition for me, how I started thinking about it. I was teaching at the College of William Mary and I wanted to focus on sexuality. And I started asking just stories, just having the students tell me stories and it, and at first I was like, wow, I can't believe they're telling me like, like. I dunno if I would've but I I [00:04:00] started noticing patterns and , at first the questions were just to those who identified as female, and I'd hear almost the exact same story. And then one woman would say, ah, whatever I'm over it and it's fine. And the other would feel horrible and would really interpret it something different.

 I kept looking I wonder what the difference is. Is it education? Is it background? Is it geography? What would make the difference of how a woman would interpret a very similar sexual encounter? And after lots of follow-up questions and asking all the wrong questions I started hearing that it was really about choice.

And how they interpreted choice and how they approach choice in a sexual encounter. And I started hearing a lot of it just happened to me and not in the context of an assault, but just I wasn't, I didn't put forethought into it. I was, it just before I knew it. I was involved in this and I didn't really know what I wanted until afterwards and.

That self abandonment or the [00:05:00] feeling of where was I? Then I left, the college and started asking all sorts of people these questions. And I remember this one woman. who was in her fifties, and she was actually sobbing and said I could go back to almost every part of my life and saying, where was I?

Where was I in it? And that felt pretty haunting and I could relate to it. And so then I started asking questions about how do you make sexual decisions? And it was, no one knew how to answer that. It wasn't, it was like no different than I make any other decision. Oh, okay, how do you make those decisions?

And it was like I just decide. I see the right or wrong and I knew that wasn't good enough. And I combined that with my work as a therapist and as I am able to really debrief and spend a lot of time with people, I realized we don't have the skill of decision making. And that's a problem in any area of our life, but it's really a problem in our sexuality.

And it's a big problem. Because it's a space where we don't have lots of education. We have lots of rules. We have so many mixed messages about ourselves and about our sexual culture. It is political, it is [00:06:00] religious. It is cultural and we don't know what to do about it. We don't know a lot of places to talk about it, so I started looking at what would be the solution and how do we do it in an, the term agency came across I don't even remember where I saw the word., But it felt right. And for me, what sexual agency is you learning what you want and then you learning how to live. Through what you want and making decisions with purpose and intention based on the truth of who you are.

And I say it's a noun, it's a verb, it's a concept and a skill. So I teach people how to agency in their life inside and outside 

of sexuality. Can you give us an example of what this would even look like? Like how do you put this into action? 

I'll put it in the context of a sexual connection.

One of my favorite exercises is this thing called the Four Quadrant Exercise, and it was one of the things that I ran outta time to talk about at the conference, but it's one of my favorites and it seems really simple. But , there's actually a lot of complexity to it, and I've seen people cry doing it.

I've seen people really get, get upset and have lots of insights. Other people have lots of fun with it. But the basic [00:07:00] is that there are, you take a long list of sex acts, everything from holding hands to something that you don't know what it is, and you have to look up the definition of it.

So you want a whole variety of that. And then you have a piece of paper that has four quadrants on it, and one is. Sex acts that I've done before that I want to do again, sex acts that I've done before that I don't think I wanna do anymore. Sex acts that I haven't tried, that I'm interested in, and sex acts that I haven't tried, that still feels like a no to me.

And then you take each sex acts and you put them into the quadrants and you do this outside of a sexual context. So you do it while you are not tired and you're rested and you have. You're at your best self. You can show up for yourself in that decision making. And you know that it I say it's set in sand.

It's not set in cement. This is just a day. This is a yes and a no for me. And for some people, that's the first time they ever thought, I don't know if I wanna do this. And when you're not pressured or you're not like under, the influence of alcohol or any influenced by somebody else, you can really think to myself, is this a yes for me?

Is this a yum for me or [00:08:00] is this a no? And most of us has never, have never done that outside of a sexual act. It's most decisions are made on the fly or through repetition habit. And so I have everyone do it individually that I work with. And then if you're a partnered, I love when. When partners do it together, and I have partners do it separately, and then I do lots of teaching of how to be a safe person to receive that.

Because all it takes is one person going like, you, what? You want that and you're shut down and I'm not going vulnerable anymore, after this. And all it takes is one person saying, oh wow, I all this time we could have been doing that. I had no idea you're interested, or I had no idea you didn't like it.

I wish I'd known. And and so it's really powerful. Individually or in a partnered and that's an example of sexual agency. That you do it ahead of time. But, there are also places that you can enact your agency on the fly of it felt like a yes and I was happy in doing this.

We're making out, and then all of a sudden it's progressed to this place. It's like I just, tonight's not the night, like I pushed [00:09:00] myself to do it because we haven't had sex in a while. And if, I feel bad and you're interested, but I don't really want to. And it's that moment that you're in that, like in between, that I want people to enact their agency and it's agency is a yes sometimes, and sometimes it's a no, it's stopping time and asking yourself in the most basic sense is.

This what I want to be doing or not, and then learning how to put a voice to that. And if you are in a relationship that it's not easy to say no to which is not, again, not putting this in assault. Sometimes we just don't know how to say no because our partner doesn't know how to receive a no. Then it's saying, this is where we need to put things back and had those conversations of how do we say yes and no to each other?

How do you 

suggest couples. Bring this up to have this discussion so it goes well. And doesn't make things worse. Mm-hmm.

I often say use this as an excuse. I heard this podcast, they said to do this, or Juliana, da da da. Whatever it is, I, if it's not [00:10:00] common to have this discussion is like blame it on somebody else.

But if you are somebody that can just have that conversation, every couple's different. And so some they're best in the morning, some the, the kids have to be asleep at night or it's not gonna happen, whatever it is. Or you have to plan the time out, know what you as a couple need first and make use of that knowledge.

So it's, the details of how you set it up, I think really has a variety to it. But you don't just pick it. Randomly really pick it. 'cause sexuality is a hotbed of emotion. And usually people like will go, will, they will revert back to defense mechanisms. Especially if they even have a hint of criticism or a hint of.

Difference. Because it's like being pregnant. You can't really be half pregnant in this in sexuality there's some things that just there isn't a compromise for. And the no always wins. And so people can feel defensive if they don't feel like their needs are being met because there's not a really a way to compromise on that.

So set yourself up, in that way. And then. You [00:11:00] always want to lead with. We're team, and this is again, only putting this in the concept of a relationship, but it's oh, I really want I'm really excited about our sex life, or I'd really like us to have this discussion about our sex life.

And when would be a good time for us to have that. But you want it to be positive and you want it to be like, we approach team approach in that. And then you say the thing. So it can be like, Hey, we haven't really done like an audit of our sexual life. And I've heard about this exercise.

Let's try it. And see and I have a place on my website where I put the rules out too of like how to help each other. I can't guarantee it. When you just read the rules, if you're gonna follow it and you can't help your face. Sometimes, but just like a reminder of don't make faces when you, if you're surprised or, watch your tone when your partner is risk taking and saying something.

And I like to have that rule of, or I call 'em guardrails, not rules, that if your partner says something that surprises you or you don't like really look at it with curiosity instead of judgment and respond how you would want it. So think about if you were to have revealed [00:12:00] this deep, dark fantasy of yours.

To your person, how would you want them to respond to you and do that. And think of that all proactively because it's usually the information that you didn't expect, that you have the biggest reaction to, which is usually the most vulnerable because that's, you don't know about it because they've been scared to share it.

So lead with that and then. I always end an ex exercise like this, like thinking like I'm so glad that we are prioritizing this. Like it's important. It's important to us, and we'll figure this out. There is a solution here. We'll find something that works for both of us in this. Because a lot of people, especially when they, by the time they come to me, they've lost a lot of hope that they, if they could have figured out the differences, they would've on their own.

And so they're not really sure what's gonna happen, but I think it's important, even if it's not a hard lift to , your differences, that you really thank each other. There's a lot of choices to make in a day where you're gonna spend your time talking, and when you and your partner can prioritize talking about sex in a constructive way I think it's something to be grateful [00:13:00] for 

Are these the conversations people would expect to have if they went to see you for sex therapy? Because I would have to say, if someone asked me, Hey, I wanna see a sex therapist, what are we gonna talk about? What does this look like? I don't know how to respond.

And I think that's probably a question that many people have and may be fearful to even. Be vulnerable and use someone like you as an expert because they're so scared of what conversations might get brought up. 

I know. Because 

sexuality is vulnerable as I've said already, but it's also, I think we're afraid of people knowing parts of our sexuality make most people have something that they don't want someone to know and and Right.

And are they gonna be forced to talk about it? What is someone's agenda? But the topics in which I speak about with people it is a variety. , If someone comes to me talking about anxiety, they may not realize I, I'm eventually gonna bring up sex and sexuality is a part of things or people come to me leading with sexuality issues.

And we're gonna talk about the other parts of life too, because I always look at everything holistically. So even [00:14:00] though, my title may have that disclaimer to it, it's not all that I do, but it's also. Always something that I do so I always at both end. So what are you gonna talk to a sex therapist about?

Or what is, what are the ranges of topics that you could do? The most obvious is people who aren't happy with their sexual life that they aren't having sex, The amount or the kind they both want to be having. And that's a pretty common one. A mismatch of libido is pretty common.

But I have a lot of people that come to me separately and come alone and say, I just, I don't feel the same way that I did. And that is for both genders and I would say most of my, my practice is predominantly female. But I would maybe 30% is male. And then I have a percentage that, work with other couples that are of both genders and sometimes it's I don't love this word, but sexual performance, like how you're functioning sexually is often a topic.

There's pain if things aren't working the same way, if they're having a hard time with an erection that will be it. But most people wait [00:15:00] way too long to come. I've had people give sessions with me as a wedding gift, and I think that's so fabulous because why not get ahead of this?

Because we know everyone's walking into our relationships with not great sex education and so I've even done that. I do sex education just preemptively. I love that we're 

all about prevention here, so that is a great. Thing that I've not crossed my mind. Kitty. Yeah. As a way to be preventative in this specific part of our health.

And I do have couples 

that do that with me that they come and they say, we don't really have any big, huge problem right now, but because we don't have a big, huge problem, we feel like we have enough space to talk about something that we don't talk about very often. And people will say, what? What don't we know?

Or what should we be trying? Or what could we doing differently? Or What products are there? I've had people hire me. I had one couple hire me to. She, they said solely, they wanted me to decide on a topic they had an argument about. And it was is self-pleasure cheating? And and they said, we want you to say your opinion and [00:16:00] answer on this.

And it was, I've never done that before and I haven't done it since. But I really, now I'm curious what it was. I said it it's a longer answer, but I don't think it is. But it's. I think one of the reasons why it feels. Hard for people to consider going to somebody who has an expertise in sexuality is that we don't really understand what sexuality is, and we think it's only about sex acts.

And so when you limit it to that, then you really do think the only thing that you need help with is having sexual connection with yourself or with somebody else. And I think that's a part of it, but it's not all of it. And when you understand that sexuality can be looked at holistically, then you see why.

You would come to someone who's a sex therapist and then you're not gonna just talk about sex. You can talk about everything in all parts of who you are. And that to me is a really exciting thing that has changed in my career. 

And that's something that's a different thought that I feel like I don't hear from a lot of people.

On this topic, can you just explain like what are things that surprised people that they don't connect as part of their sexuality? 

 even just talking about the word [00:17:00] power. that's one of the nine pillars of holistic sexuality that I speak about. And when we talk about power, obviously there's all of the sexual violence aspect of it, but I actually say let's talk about flirting and seduction.

What, where, what does power play and where? Where do you get power in your sexual energy? There's so many different things to talk about how power infiltrates themselves into who we are as sexual beings and how we use power to either enhance or diminish who we are as sexual beings and how we look at how power is used in a sexual connection, whether it is overt or not overt, even like talking about like sexuality in the workplace.

One of one of. Really interesting conversations that I had was with female priests in the Episcopal church and talking about what it was like for them to be pregnant and to be standing up there and realizing everyone was looking at them thinking, oh, you've had sex to have most, you know, not, I mean, some people do their IVF, but you know, like, oh wow, you are a [00:18:00] sexual being.

But if it was a male then they aren't sitting there thinking, oh, their pregnant wife is sitting there and they, he had sex with her, but she looks like a sexual being. Or having parishioners talk about their hair and that again, doesn't necessarily exactly sound like your sex life, but it's a huge part of how that they would show up and they didn't have a lot of space in which to talk about, how am I sexual being without being sexualized?

 I think a lot of people have that version of the conversation in their own life, depending on, what their profession is or how they're showing up in the world too. 

And I think you're right. Like how am I perceived, especially for women, I think is a lot of how women view sexuality is, am I sexually attractive to someone else?

Mm-hmm. Is my performance good to someone else? As opposed to really thinking about what they want out of their sexuality. How do you advise a woman that's never really put themself into the mix? To just get started in thinking about that and thinking about what she actually [00:19:00] wants out of the situation.

Oh I love that so much. And I, the word I use for that is sexual currency, like the first part of what you're talking about, of how sexual desirable am I how sexually desirable do I want to be and where do I prioritize who I am as a sexual being in my life? And a lot of people put it as a luxury, not as a necessity.

And that's again, like where I like to go into the conversation of, I want you to prioritize who you are as a sexual being so much more than you are. And let's start with something that feels more accessible, which is why sensuality is the first pillar that I go to when a woman is learning about who she is as a sexual being.

And I want everything to be individual. , Even if they're partnered, we are not talking about who she's a sexual being compared to anybody else and in relation to anybody else. And then sometimes we're there a long time because a lot of women are taught that their sexuality is for somebody else and determined by somebody else too.

So we have to unlearn a whole lot. I used to run this workshop called Finding Sexy. [00:20:00] And I remember I was like, crickets. Like no one wanted to come to it. And they all thought that they were, have to wear boas and lingerie. And I was like, what? It's like, no, no, no. I, I'm actually saying what is sexy?

What does that mean? And because it was such a hard lift to get people to come , to that workshop I infused it into this work because I thought . It is also an active agency of what do you think is sexy about you? What does even that word mean? What does sexy mean? And why is it such an offensive term to so many people?

They don't feel it applies to them. And so we start with sensuality because maybe everyone doesn't have all senses. Or the same access to all of their senses, but everyone has some of them. And so we have a, more of a common language to begin. And because sensuality doesn't have to be positioned within sexual context, , it's just an easier entry point into looking at it.

And some of the most exciting conversations I've had, especially in this pillar, is a woman who're like, oh, I'm not a sensual person. Not at all. And then by the end of all the journal prompts, 'cause in the book I only give five, 'cause [00:21:00] you're not, the book can't be forever. But I have a course that the book is based off of, that I have really 30 questions almost in every single one of them.

By the time you're done with that, by the time we've worked through that, I love it when a woman is oh. I am this, I'm this is the touch I like. This is what I like to look at. This is the sound that I have. And we do all of it inside of a sexual connection and outside of a sexual connection.

And even if a woman comes to me feeling disconnected with who she is, sometimes she'll still start with it because it is an easy script to draw from, even if it's not authentic. And we'll start there. And then we'll move to make sure it is authentic and oftentimes outside of sexual connection is when we really get the answers and we will go back to it.

So that's the starting point is I think sensuality. 

And for someone, especially in perimenopause and menopause, whose, let's say body has changed, maybe they've had kids, they're feeling like their body just doesn't look like the picture they had of themself, which was a more sensual, sexual being.

Yeah. What advice do you give to women to try [00:22:00] to be able to reframe that and not be so self-critical? 

I I love this question. And it's really common, and I'll say it's for men too. That I would say probably the conversations I have with those who identify as male are, more heart wrenching actually 'cause men have such little space to even talk about their bodies. But in, going back to speaking about women, I have this course that I wanted to change. I don't love the word body image and I couldn't figure out what I wanted to use instead of that.

And so I started looking up this research and I found this one research that said that body compassion. Was actually more effective in changing how body composition or like weight loss or weight change than any other psychology about their body. I thought that was really interesting.

So I started talking about it and asking my clients and working with a concept of body compassion. And it's really interesting how. Potent it is to name what your body has been through and be able to honor [00:23:00] that, to grieve it, to honor it in like a deeper sense. And that can mean like being angry.

A lot of women will say too that they feel like their body's betrayed them and so they don't feel close with their body. Don't. Feel like their body has supported them. And so how do you have compassion for something that you feel betrayed by? And so we work through that complexity as well.

But, in the course and in the process of going through body compassion I have found, I wouldn't say that it can be this miraculous, like you're gonna turn from like hating your body to you're now doing nude photo shoots, for billboards. . But what I really love is when a woman can say I don't like this position that we're having sex in because I don't like how my breasts hang, or I don't like my belly or my knees don't work, anymore to either.

For some women, it's like they just stop caring and they're fine, or others it's , it's okay to not like that. And that's really interesting too, when I say to him you don't have to do that position. If or it's okay to not, like that's how your breasts are hanging.

We can find a different way that you do feel comfortable with, because I think with the body positivity [00:24:00] movement or with body image campaigns, what we are teaching women is you're not doing it right if you don't love your body completely. And I think that's a dangerous message because. I think it's a pretty big haul for some people to get to that place.

And then, so if you're not at that place of loving your body completely, then what are you and what access do you have to that? So I think it, you have to look at it as a journey. And I like looking at it as a relationship with our body instead of a body image. And sometimes our relationships are gonna be great and sometimes they're not.

And if we honor that and normalize it, there's gonna be ups and downs and I think it makes it feel more accessible for change and that you can get to a place that you may. Not like this part at this point in your life, but that may change later, especially if you have compassion for it. , I just know some really powerful stories of people who've gained compassion and that changes a whole lot for them.

That was powerful. It was I've not heard of that phrase. I am, I love it. So thank you for introducing that. I also [00:25:00] think that something that's really hard at this time. Again? Speaking about perimenopause and menopause for women. Is opening up space in their mind for this and making time for it.

Because when you feel like I have a plate that's so full and I have a body again that you feel is retaliating against you, how in the world am I going to clear my mind to be like excited for sex? Like how do, how does that even occur? 

 And that is so real. And I and again, like I, when I work with somebody or with a couple really quickly in, I'm like, tell me about your day-today, life.

What is it like and where is your energy going? And how are you taking care of yourself? Because sexuality , the way that we position it in our culture is that it's. Definitely the last on the list. There's a window where it's fun or cute like when you're a teenager or a young adult because the way people describe it's that your hormones are really promoting that.

But then it. It's not promoted, it's not as cool. It's not as cute. I think also [00:26:00] we have made sex something that it's okay to talk about if you're single. It's not okay to talk about if you're partnered, it's rude or disrespectful or it's, betrayal of your relationship. That's something that's sacred.

So then we stop losing modeling and we stop sharing information when people become partnered, which then we've become more and more isolated in that too. So we talk about that, like how much are you talking about it in your life? How much are you consuming in private? So looking at energy, looking at how you're taking care of yourself.

We're looking at how you are positioning sex in your life as a priority. And do an audit about what, what's getting in the way of that. And then I, after we've done that, I'll say, okay, so what is the purpose of sex? What is the purpose of it? And most people have never been asked that question.

And so they'll pause and there's some variety, normally it's procreation like to have kids, but if you don't wanna have kids, or if you're done with that, then I guess, it's pleasure and that's usually is. Far as we get. Though some people will have a little bit more of information, but I then that's when I step in with education about these are the [00:27:00] physical benefits of sex or pleasure to yourself individually.

And then we talk about relationally, what it can do for a relationship. Not that any of that is groundbreaking, but it's never top of mind. I have yet to have anyone in a workshop, in, in a speak engagement or in clients that can have a long list of what the purpose of sex is. Like, why should we care about it?

We have a bad PR job in the sex world. So educate people on that about why you would position it, like what is the whole point of it? We know why you would work out. What are the physical and psychological benefits of that? We don't know the benefit. Of sex. And so once you know that, it also helps make it more of a priority.

But then we have to go back to it. So now know the purpose. Now let's go back to what we know about what your life is. If you're exhausted, if you are working full time, you've got kids, you've got household stuff, or you've got any kinda stressors. If you don't really see a huge benefit or you're not having great sex then why would you prioritize that over sleep?

Because we know sleep is one of the most important things that you can do. Why would you do that? You have [00:28:00] to be able to understand your why in order to prioritize it when you have a busy life. Or if your body isn't driving you towards that naturally if you don't have a natural interest in it, which some people are like that, they don't have that.

And there are different ways that our arousal gets affected and I would say desire and arousal need to be really understood as well so that you can figure out how to make it be a priority.

I guess I, I've never really thought about the physical or health benefits of sex. I've thought about it in the term of pleasure and in the term of connection in your relationship, but I've never really thought about just the long-term health benefits. Yeah. So you bringing that up as something new to me.

Can you tell me more? 

Yeah. Yes. Yeah. So they and unfortunately we don't have tons of research. I bet. Yeah. Yeah. I can't imagine 

this getting a lot of funding. Yes.

Just, Nope. It doesn't, it should. Yes. And it's, baffling to me, especially if we're gonna [00:29:00] look at women's sexual health too, there's hardly any and the reasoning is that it's.

That they will say it's just too complicated to really understand it as opposed to an erection that is just hard, like where are the parameters? And there's so much more nuance to female arousal. But that aside, what we do know is and of course if you're going all the way to orgasm in our pleasure continuum, then we do have a lot more understanding of like when you're having those hormones released from an orgasm, that the flooding of that has been studied enough to know that even if it's just a small amount for a short amount of time, that it is a really good flooding of hormones for your body.

And that's a really good thing. And if you keep stacking that and you are daily or weekly or whatever, if you are having that, you're that oxytocin. Flooding, then we know that, your body responds well to that. They haven't gone further as to is it rebuilding things?

Is it, is it preventing other problems or diseases? We don't have that information. I can say psychologically, it often does if, when I work with [00:30:00] couples that they both are feeling sexually fulfilled. That's the word I look I like fulfilled more than satisfied.

Then whether their sexual contact ends with orgasm for both or not, it's still extremely bonding for the relationship and it's, the benefits psychologically of connection are huge. In fact, top three of what you can do for your relationships, for longevity and for, connection.

In my eyes it's because you are really feeling those parts of being wanted, being seen and being valued when things are really working together. And it's another reason why I think it's, finances and sex are in the top two of why relationships don't work. It's because the lack of feeling wanted seen and valued in a sexual way is enormous.

But backing up to the physical they have done studies on self pleasure and seeing that it is helping. , Psychology today just came out with a study that , they think it's lowering menopausal symptoms. If you are having self pleasure and orgasming [00:31:00] through self pleasure that they think it's staving off menopausal symptoms or lessening them to a degree, which is great news.

Love that. And then there's quite a bit of research on, why you would self pleasure and have orgasm through self pleasure like stress relief and lowering cortisol as well as like ways to even wake yourself up or go to sleep. There's different ways that you use the energy of sexual pleasure and orgasm and I think.

That gets left off the list of things too. So when I, talk about the priority of having sleep, if you have an orgasm before sleep, for some people it wakes them up and so that wouldn't be the right thing. But for others it puts them right to sleep, which is a great way to put you into your own lulling to it.

But sometimes it doesn't work. Like if you're partnered but you don't wanna have sex, but you'd like to have an orgasm. You're like can you gimme like 10 minutes? Or, can I have half an hour? And you go sleep over there or you're sleeping separately so that you can have that. Sometimes that's the recommendation as well.

It's really just finding how your body is responding to pleasure and orgasm and how you stack that [00:32:00] individually and if you're in a relationship, in your relationship that I think you've realized the health benefits from it. 

Yeah, that's a great new way of thinking about it . And you've brought up, potential benefits in menopause.

I think one thing just, Sarah and I were both primary care doctors for a number of years, and it's really a very unique position to be in, similar to yours, in that you get to know. A whole lot of people on a very intimate level and bringing up sex was not something I did all the time, but I did do it.

Fairly regularly and particularly with menopausal women, I would always ask about vaginal symptoms. That's usually how I led into it. And almost every time I feel like I'd lead off with, are you having any vaginal changes? They're causing pain or dryness. And usually they would say something about yeah, I have no libido. I'm just trying to get the act done to keep our marriage going, but I'm not really worried about it. 'cause I talk to all my friends and they say the [00:33:00] same thing. And then I usually said something, which is terrible in hindsight of that's really what I hear from my other patients too.

So know that you're not alone in that. But I didn't really know how to take it from there as far as, I could advise them on. Vaginal symptoms, vaginal, estrogen are things to do for pain, which we'll talk a little bit more about in a minute, but I didn't really know how to advise them on how to deal.

With this libido issue. Yeah.

And Kudo, thank you for being somebody who was bringing it up because that's not very common , they've done some studies that show that a doctor needs to bring it up three times in order for a patient to actually be willing to say the truthful answer to it.

So it's great that you've set that up, that someone would even just say it the first time that you say it. But even still I'll have clients that will tell me that they they'll be asked for their doctor and they won't tell 'em the truth. They won't say they, they're like, oh, everything's fine.

Or it doesn't matter to me. And then like, why are you bringing it up? But but then they'll say to me, oh, I really wish this and I, [00:34:00] we still have, we still such a hurdle of figuring that out. And a lot of the times what I'll hear is they don't want to say it because they don't feel like there is a solution or there isn't a solution that's gonna happen in enough time that you have a doctor's appointment as well.

So it's complicated. I get it. But I'm glad you're bringing it up because we have to keep saying it. So about libido. So I use the word desire like I don't say masturbation, I self safe pleasures. Just those wording feel like it's a new way of associating with it. 'cause we often have kinda a negative libido and masturbation in our growing up years.

And it's very similar to the word body image. I really do a lot of work and groundwork to say that it is, there's no low or high libido. It is just our relationship to our desire. And I always start the discussions outside of it. So what makes you feel sparky is a word I'll use if someone isn't really comfortable in talking about sexuality stuff.

It's what? Like, how do you feel vibrant? Where in your life do you feel vibrant? Where in your life do you feel alive? And it invariably, if someone is not happy with [00:35:00] their relationship, with desire, Oh, it's a hard answer for them to say. Or it'll be, oh, my kids. Or it'll be positioned outside of themselves.

And when I say no, but you, but where do you feel vital? What do, what about you do you feel good about? That is a really hard thing, especially for women to to get to because we are so positioned to have roles instead of who we are. So once we get through that and it's and a lot of.

Women are like, I just wanna figure out either how not to have sex and have my relationship still be okay or help me. want to have sex again, I don't wanna go through all this like psychological Bible stuff. And unfortunately there is, there's really no shortcut to figuring out a new relationship with your desire.

And it's one of the first things I say when people come to me for that, either they come alone or in a couple, is that there, there are some products, there are some things that you can do for sure, that make a difference depending on what your issue is. But I have yet to have a client and I've been doing it over 20 years that they only had one thing that was impeding their [00:36:00] relationship with desire.

It's usually a spider web of things and I have a whole thing that we do, again, like an audit just on what's impeding your relationship with your desire. And some of that is cultural, but also some of it is lifestyle stuff. A lot of it is lifestyle and physical, our are where a lot of it resides.

And clearing that up makes a really big difference too. But I also wanna take the pressure off. So usually what comes with that is like, , how many times a week is good, to have sex? Very common question. Yeah. And what's normal, what isn't? And of course, the answer is there isn't.

 they have done some studies, but I think a lot of studies with sexuality aren't great in how they're done because I think a lot of people don't tell the truth and they're afraid to tell the truth. So you really can't rely on the data. and I guess the most reliable data we're seeing , you know, once a week really is good for your body and it's good for your relationship.

But you certainly, there's certainly, I know couples that they haven't had sex in, 10 years and they're very happy, very in love because it's mutual and I think that the biggest [00:37:00] problems with someone's relationship with desire is When they're in a relationship and that is mismatched.

And then there is a really great book. In fact, it's the number one sex book is come as you are. She's fabulous. She's one of my favorite. Sex experts in general. But this book is a really good book. And she really revolutionized the conversation about desire and really talked and for a lot of women it was surprising to learn the difference between responsive and spontaneous desire.

That there are a lot of people when they have a mismatched libido and desire, it's because of that difference that they have an expectation that. Everyone should have a spontaneous desire or everyone should have a responsive desire, but oftentimes they'll it'll match differently. And so you never wanna have sex or you always wanna have sex, or it doesn't take much for you to be aroused takes forever for you to be aroused.

And it's oh no. There's actually technically a difference. And if you work with that, then that's great. And the stereotype is that women are responsive desire and men are spontaneous and that's not. That's not the case. [00:38:00] There, there is certainly a tendency towards one than the other, but there are lots of women who have spontaneous desire and lots of men who have responsive desire.

And they are the ones that feel lots of shame because they feel like they're outside of the norm. They're not though. 

 And as Kitty brought up, what are some of the things that you recommend for women in this stage of life that. Are dealing with some of that vaginal dryness and just have that physical component.

They may have the desire, but they physically are struggling with it at this time. 

Like it having pain. Yes. Yeah. Yes. Yeah. Some of it depends on how long it's been happening and women wait. Too long to come in for help. Again, other thing we've already talked about a lot so some of it is we have to unwind.

The fear of having pain during sex too. But , I wouldn't say it's the best problem to have but it's the best in that there are a lot of more solutions that had the potential of being quicker in responding to it. But a lot of times women come [00:39:00] to me it's been a long time and so that is a hard aspect of it.

For them and for their partner. But, so you wanna know, is the pain coming from like micro tears? Is it thinning the vaginal wall and the tissue? Is it lack of lubrication? Is it the wrong lubrication? Is it positioning? And you can. Pretty quickly figure out what is causing it. There are some that are a little bit more difficult and and that's where, to me, pelvic floor therapists come in are just absolutely incredible.

And at the conference I talked about, I just, I worship them, they do so much good. And it still surprises me how few people know that the profession exists and don't know how to find one. And the wait lists are often very long. I love pelvic floor therapist. In fact, when someone comes in and is talking about any kind of pain I want them to go there first.

And then I love doing a, the three of us, a triad together. And so I talked to the pelvic floor therapist. I talked to the client, and that's just a beautiful way of , doing the talking part and then doing the physical aspect [00:40:00] of it too. and sometimes it's the. That the way your hormones have changed or any kind of trauma, that there is a, tightening that happens that you have to figure out and work yourself through.

And there's products like dilators that can make a really big difference with that too. , Even though you can buy them on your own, I really don't encourage anyone to do it. You really wanna work with a professional with that too. Then there's the kind of leap through a pelvic floor therapist is that there are lots of different professions that can make a really big difference.

Especially with pain, but also with any kind of thing that you feel the way that you are functioning sexually isn't how you want it to. And there's sex coaches, there's sex therapists like myself. There's sex surrogates . There are a lot more professions that can. Where talk therapy has to end ethically, where they can get in differently.

And I, I wish that was less stigmatized as well. I work with a sex surrogate group and they do miracles, absolute miracles, but it's so [00:41:00] stigmatized. That is not a lot of people say yes when I suggest it, but those who do it changes their life.

 And if you want to know more about what pelvic floor therapy might entail, we did do an episode on that back in the spring with Kelsey Karnes. And so she really goes through, if it's something that you've thought about, she talks in that about exactly what she would be doing in there, just so you can be prepared.

But if you are experiencing discomfort with sex, it's definitely worth. Seeing a pelvic floor PT. 

It is and if they can afford it, I require it when we're dealing with pain, because I want to make sure that we're ruling out that it is anything physical. And sometimes it isn't.

Sometimes it really is all psychologically based and then I know that we don't have to worry about that aspect of it. But but a lot of times there's a physical element to it. That you wanna have addressed and they can address it pretty easily too. Not everyone is a quick fix, but it's it's something that talk therapy is never gonna change.

And I had a lot of patients where vaginal estrogen was incredibly [00:42:00] helpful because sometimes the pain really is just due to that estrogen lowering thinning of the vaginal wall and getting tiny tears from various things, not even from sex. You can get tears from. Minimal contact. But a lot of people don't want to put medication vaginally.

I can't even think of how many times someone said, can't you just give me that in a pill? Yes. And actually you can, that's inserted vaginally. But do you have any tips for someone to try to get over that hump of their uncomfortable putting something vaginal? On a regular basis, 

this topic gets me fired up because it, it feels like just such a perfect example of how we have failed women, that if we were properly sex educated, that it would never be an issue, never.

Never be an issue. We don't, there's no other part of our body really that I have encountered. Maybe you all have it different that people would, this resistant to doing something that is so clearly gonna help and [00:43:00] like quickly help you. And they're like, Nope, I don't wanna do that. And and I of a close family member who was having recurrent UTIs, and.

And I was like, yeah, just vaginal estro, that's all. This will really make a huge difference for you. And she was like, gross, no, I would never do that. Yuck. And I couldn't believe it. I couldn't believe the hurdle that I was having to overcome with her to even consider. And she didn't wanna touch herself and she thought, said it was gross to sit in it.

I was like, how much are you putting on what it's supposed to be at thin I know tiny. Little pea size. Right. And that, And that was something that she misunderstood too, that it was. She thought she had just cake it on, like zinc oxide, it was, but so how do you get through that? Is you start now you start I'll talk to the woman who doesn't need it.

Who hears that question is oh, that's not for me. Yes, it is for you because the chances are pretty high. That at some point in your life, you're gonna need to do something that you'd be touching. And I think people should be using daily moisturizers [00:44:00] for their vulva anyway. You want to start getting comfortable touching yourself, and it doesn't have to be within the context of arousal and pleasure, but just knowing what it's like to touch your labia and, and then knowing that this, it isn't dirty, it isn't gross. It's just a part of our body that needs you to give attention to it at times. And you just do it. You just put it on your fingers and then you put it on your vulva and then you move on your day. Or you go to sleep.

 What I wish was that we were doing this at a much younger age. I wish we were teaching, see we start marketing for young teenagers to be using skincare on their face for acne. And I wish that we were able to at, at a younger age to say, and also your vulva health.

It's super important. It's face and vulva. That's where we need to put a lot of our attention and need to be educated and you need to be practiced and you need to normalize it, and you need to be doing this now [00:45:00] as a preventative measure, but also is something that when, we know that in nursing homes that so many women are dying from sepsis, from UTIs.

I'm convinced it's because that generation in particular, that there are nursing homes now that you were not talking about sex, you certainly wouldn't talk about vulvas and labia and you were not gonna talk about putting creams on there and don think it's the only reason why it's happening there.

But I, I think it's a huge reason why it is. And so I hope that those who are teenagers now, that stats can be very different when they're in nursing homes. 

And I'm going to confirm that it makes a large difference, huge difference. When women use vaginal estrogen. The decrease in their UTI symptoms is crazy different and that is something that I feel like women don't even know or even.

Bring it up to their doctors that they're having it. 'cause so many times people don't even go to their primary care. When they have a UTI, they'll see an urgent treatment center or whatnot, and they start adding up and they could really be improving their overall health by the simple measure. 

It's not as [00:46:00] simple for some people, and I want people to feel okay with it being a hurdle for them. And so instead of so a lot of people are like, oh, there's a hurdle. I don't wanna do that. They're like I'm just not even gonna deal with the hurdle. So I just won't do it.

So gimme the pill gimme the other thing, and or they just won't take the treatment, which is surprising to me. So I, what I want is, if you have a hurdle to this, then accept the hurdle and also ask for help around it. And ask for those like, how do I get more comfortable with it? Or ask your friends to do it.

I know, like my mom was talking about it in her bridge group and she just brought it up and it, at first they were just like, why are we talking about this? What is Julianna doing to you? And then it was just everyone started talking about it and normalizing it. And I know there were several women in that group that were having recurrent UTIs, and they specifically went and to the doctor and said.

Okay. Just, what am I supposed to do here? I don't wanna do this, but that's what they said because they're not on social media the same way. They're not getting exposed to it the same way too. And it's no matter what age it is, it's, I think, sharing information. It's finding out what your own hurdle is [00:47:00] and figuring out how to overcome that or getting resourced so that you can overcome it.

But I also think it's sharing women are so great at being connectors. We need to be connecting. Women to information. So when you get the pelvic floor therapist in town, that's awesome. Share it proactively. And and if you find out that vaginal estrogen is the way to go talk about it. Let everyone make their own informed decision on what's right for their body, but share that information.

You'd be surprised how people don't even, that's the biggest hurdles, not having an access to it. 

 That's great advice. You have told us so much. I would love to hear just one message that you wanted women to hear, they're listening to this show and most of them are attracted to the show.

They're in that perimenopause and menopause stage of life. What is that big takeaway that you would want them to hear? Your 

superpower is sexual agency, so learning your terms and learning how to live them, it'll be what changes so much for you. And if you learn that inside of your sexual life, then it really can change [00:48:00] who you are and can change how you feel about yourself, your relationships and it is a much deeper concept than just having sex.

So when I work with women and they're learning about sexual agency. People start saying, you just seem different and like you just have a different pep in your step, but it's not because they're having more sex. It's because if they are sexually active, the is the kind of sex they wanna be having for maybe the first time.

And outside of Sexual Connection Agency in and of itself is something that reinforces self-trust and instinct. And when a woman is. Trusting herself, and she's not self abandoning and she's feeling good about the decision she's making. And there becomes this ripple effect that spills out to all areas of her life and frankly to all the people's lives that she touches.

And when especially in perimenopause, if you are somebody that, that has children or influences children, we, and in particularly women, it's we need to be able to have agency. [00:49:00] To be able to stand up for ourselves, to provide for each other, to help heal some of the things that are happening in our world.

And sometimes it feels really big that how can we make a difference? I don't think it's too bold to say if you learn sexual agency and you change you, you're really gonna be changing a lot in your community and your world. And that is enough to do. And in fact, it's I think it's, I think it's our birthright and I think it's our responsibility.

Love it. Make it a priority. That's right. 

So tell us where people can hear more from you. 

So I'm on all social media platforms, is Dr. Juliana Hauser, and then my website is dr-juliana.com. And then on, I can sign up for my newsletter on my website also. And I have different content on my newsletter than I do on social 

media.

 I mentioned your book earlier. You just had your book come out. Is there anything specific our listeners should be thinking about? If they want to . Get your [00:50:00] book or what they should expect from it? Yes, so the book 

Is really based on sexual agency. It's a framework that is meant for everyone to be able to walk through, depending on no matter what your age, your background is, and to be there to go to multiple times.

Is I give personal stories, I give client stories, I give exercises and journal prompts. I have people that go through it have book clubs that are doing it. I have couples that are going through it together. You can do it on your own as well. And then I love highlighting that at the nine pillars, at the end of the chapters of the nine pillars, there's a QR code.

And if you go to the QR code, it goes to a, like a private place on my website. That goes through more content. So like the one on sensuality there'll be more stories there. There's audio, there's people telling their own stories within sensuality. There's products that I really like there and playlists that would be related to sensuality.

So I, I really like having the book be interactive and there's a place that you can tell your own sexual stories too depending on what the pillars are. And they're already starting to come in, which is really [00:51:00] exciting. 

Oh, that's awesome. If this is something that you have thought I probably need to address at some point or even if you feel like you're doing well, I haven't had a chance to read the whole thing, but it's really a different way of thinking about it and I think your book brings up a lot of great questions.

Highly encourage. Women to do that. And yeah, if you do it as a book club, then you're getting that social connection as well, which you know, is one of, one of our life's on medicine pillars, 

so we love that. Thank you for making this topic approachable. 'cause I know that Kitty and I were a little nervous.

We're like, oh my gosh, what are we, how are we gonna make it through this show? 

I don't think I was really red faced. We did It sounds good. Got, we made it. 

So I really do appreciate that because I do feel like so many people just feel uncomfortable even bringing it up. And I feel like this was a very approachable conversation for us.

To have today. And we are just excited that you made it a part of our menopause series here on our podcast and we part of the conference last week [00:52:00] and just helping the women in Lexington live a more fulfilled life. I hope you all join us again next week. We will have our final menopause episode where we talk about the importance of movement.

In menopause, specifically talking about resistance training and yoga. We have two local professionals that specialize in women in menopause, so be sure to tune in to that show as we wrap up this whole series. See you next time.