← You Are Not Broken
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- [00:04]
A
Welcome to youo Are Not Broken, the podcast that challenges everything we've been taught about midlife, hormones and sexuality. I'm Dr. Kelly Casperson, board certified urologist, author, and a leading voice in women's sexual and hormone health. Enjoy the show. Hey, everybody. Welcome back to the youe're Not Broken podcast. I think I'm going to name this episode A psychologist and an OB GYN walk into a bar. Because today we have Dr. Kate White and Jay White, a married team who have separate jobs. But now they have one podcast that they do together. So welcome to the you're Not Broken podcast.
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B
Thank you. Yes, we are heads and tails. Obviously, he's the head and I spent a lot of time at the tail.
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C
Correct.
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B
And we saw so much overlap in our patients come home and talk about what was going on in their lives, especially in midlife, where we were seeing the different disruption of relationships, not just your relationships to their partner, but also to their job and their parents and their families, even their friends during midlife. The more we talked about it and the more that Jade saw what I was going through myself, I think it all kind of coalesced into we were talking about the same problems from a different perspective. The biology and the psychology and how they interact.
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C
Agreed.
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B
That's why we. The marriage works.
- [01:29]
A
You're like, since we talk about this all the time, we should just be recording.
- [01:32]
B
Yes, exactly.
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C
Exactly. Yeah, yeah, yeah.
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A
I love it. Well, I'm so glad you started your podcast. And, you know, a lot of midlife. I was just on NPR for the second time and like, the zeitgeist is like, why does midlife have to happen? Isn't it all shitty afterwards? Like, the cultural attitude of this, frankly, sucks right now. And I was like, this is like an amazing. And I never want to be Pollyanna, but I'm like, it's an amazing opportunity that, like, a lot of good comes from. But, you know, it's like any spiritual journey, like, the pain is part of the recipe. But it was just like, okay, they're asking on npr, why the hell does this even have to happen? So is that what you're hearing from from people? Like, they're coming in and they're like, why do we have to get older? Why do we have to grow spiritually and psychologically? Like, how's the attitude on this, on your end?
- [02:29]
C
Well, with my end, yeah. It is what I like to refer to as the side effects of success. We're lucky that we live long enough and there's not many animals on Earth. That do that, live past a reproductive age. I mean, if we want to just put a pin at a. At a point in time. And also the success of managing getting older and managing perimenopause, menopause symptoms and so forth. I run into this, and at first, I've said this on, on our podcast, at first I didn't know what it was. I didn't know what it was either. It had a lot of people mid-40s and above, kind of struggling with the same thing. And finally when I put it together, oh, I feel bad that I missed it for a number of years.
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A
I mean, but because you didn't get it into back up, just so people understand what your training was. You didn't get trained in, like the Rubbermaid hit the road at around 47.
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C
Right, right, right, right. And then once it. I don't know, it's like a movie where the last scene explains everything that's happened in the movie. Oh, my gosh, he's been dead the whole time. You know, that kind of thing. That's the energy I felt once Kate really got into this sort of menopausal care and midlife care. But when you reframe it for people, which is what I'm doing a lot, it makes a big difference. I mean, when you tell people, hey, we used to all die at 40, right?
- [03:57]
A
Because people, they'll argue that, they'll be like, it was all infant mortality. And when you took infant mortality out of it, the people who look at longevity factored that in, my friend, the wealthiest male landowners in what is now Britain, because those are the only people you're going to waste some ink and a piece of parchment on who didn't die in childbirth. Average age 47 of death.
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C
That's crazy. That is crazy.
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B
The healthiest people in the world, the
- [04:22]
A
wealthiest, healthiest, with no more. No death in childbirth. They had the money, they had the land, they had the food. 47. Was it, my friends, the other thing going into, you know, marriage. And why does it get rocky and what do we do and why is it so challenging? Because we get a little, like, whingy about it, to use a British term. We get kind of whiny about this, this, this consequences of our success. I heard up until very recently, an average marriage lasted seven years before somebody died.
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B
What
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A
I don't like, I haven't checked that fact in a while, but it's like you. She, she either died in childbirth, he went off to war. Somebody got a bacterial infection and there wasn't any antibiotics. Right. Like the average marriage lasted seven years until one of the two people died. I'm sure there was the outlier that
- [05:11]
B
takes care of the seven year itch. You're like, the itch might be the plague. Sam.
- [05:16]
A
Yeah, yeah, yeah. But, yeah, that's the other thing of like, the consequences of like, oh my God, we've got 60, 60 year marriages now.
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C
Right, right, right, right, right.
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B
And I feel like that, this, that when we have these transformations, because you have these hormonal transformations that change what's going on in your brain. We look at changes in estrogen, which inform the dopamine, the serotonin, all those things. We are going through a time of becoming that's very dramatic, akin only to puberty. And if you had to try to get married at 14 or 15, which some people did, and you're in the midst of all this change and come out the other side and say, is this the person I want to be with? You may not find the same desires or the same. You're not going to be the same person that you are. Your desires at 13 are not the same as your desires at 18. And just the very same, your desires at 30 may be different than your desires at 60. And so this gray divorce is a lot of what we would see and the struggles. And there are a lot of people, though, that say, things are changing my brain sexually, of course, and then also in anxiety, depression, all those things where we see 30 to 40% increase across the board, add, which is where I had a tremendous change in the ADD increases. If you don't have ADD symptoms before menopause, you have about a 30% increase in changes in executive functioning, which people struggle with.
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C
And if you have ADD, yeah, someone here does.
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B
It's about 70% increase in your level of distractibility, difficulty with organization, and all those executive functioning skills. And if you're the one who's been managing the chaos of life, which most of us have been, and doing pretty good job at it and trying to keep everyone on track, and that goes away and you feel like, why am I the only one doing all this? Then that can cause explosive changes. So. And I think what you hear a lot is, I haven't changed.
- [07:34]
C
Right. That's what the, that's what the man.
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A
Yeah, that's what the man says. I'm the same guy as I was when I was 24 when we met.
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C
I'm the same what happened. And I'll tell you another part of side effects of success. You folks like yourself have been, man, the Tip of the spear for fighting again, for testosterone, for. Thank goodness the hormone replacement therapy is back in the sunshine. And it has been so successful and so moving that I get a lot of guys that now. And this is a problem with couples. They look at menopause as something that's a phase. They look at it as temporary. And I had a guy say, all right, sent her to such and such, and how long till I get my wife back? I mean, it's like sending a car to a repair shop or something. It's like. That's the way he put it. He says, oh, is it like a month or something? And then she's back to back. Whoa, man. I mean, as if. Again, as if it's just a phase and a bump in the road. And, man, this is forever. This is the director's cut of your wife. There are going to be changes that are. Some that are manageable, some that are permanent, some that are better, some that. And just buckle up.
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A
I think there's a. The social stigma that staying the same is the better thing, though, because you're changing. That's the problem. There's a societal layer of judgment that benefits the status quo, as the guy's the right one because he isn't changing.
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C
I do see that, and I want
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B
to hear that predictability. And so he's like, it's the. It's the w. It's the known. And when we look at the longevity, we think of, like, I'm staying exactly the same as I was when I was 50, until I'm 104. And so that stasis of not losing muscle, you don't want to lose bone. That stasis is sort of in our brain. As everything's good right now, let's keep it the same. But it's not really what serves people, really.
- [09:43]
C
It is weird. Yeah, you're right. And that's a great question, Kelly, because it's every other phase where we change, and there's a bunch, obviously, from birth until 18, everyone makes us better. Every single change makes us, all in all, a better human being to suddenly say we need to stop. I don't get that. I mean, there are some parts of my dad. I mean, my dad's 84, and he just says, I wouldn't go back. I'm telling you, I like where I am now. I like the way I think. I like the way I don't like the way I groan when I get up in the morning. But, I mean. I mean, look, there's gonna be give and Take. But yeah, to think that we need to stay the same.
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B
I don't like the acne I had when I was 13.
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C
Correct.
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B
So, like, you want to move on to things. So you do have, you have some progress.
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C
I miss, I miss my hair.
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B
Right on. Actually, I, I like it. I like you hair free. But that's just personal.
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A
But I think it's an extra societal burden of like, not celebrating the change. You know, you got the right to vote at 18. Like, why do you gotta change after that? Right. Like, there's this like, societal stasis. And if you look at other cultures, older cultures, previous cultures, where the old people were the wise counsel. And you didn't earn that until you got to that place.
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B
Right.
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A
And here we are in our society being like, why are you changing? You know, you're like, you're missing what historically is. Like, it's the wise person, the person who's got the experience. Like, there's this like, reverence of having life's journey. And now we're like, why is my wife changing? Or the woman will say, why can't he change? Now it's time for an ad from MIDI Health, the online experts in menopause and perimenopause. If you're about to hit pause or grab a snack, give me 30 seconds here. If you've ever wondered whether what's happening in your body and brain is just in your head, it's not. Stay with me. Let's talk about what's really going on. Midlife hormone changes. This is where MIDI comes in. Created by women for women, they offer personalized treatment plans with safe, FDA approved hormonal and non hormonal options. I have so many women. Tell me about how they're so happy with their MIDI clinicians and they're available 247 and they accept insurance. It's time menopause care caught up with women. Book your virtual visit today@join midi.com that's joining,
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C
right? And it will. And if we take the social sort of the cultural, I don't know, you take the normal timeline, if you will. I don't like the phrase, but men get softer and women get harder. Men a lot of times also at this age, they will. Libido is down just, just a little bit. They have fought all their battles. They've slayed the dragons. They want to, you know, they've worked. They're tired of the fighting. And they become, and I can see why women say, why aren't they not still? Why are they not changing? They Turn into a. I want to golf, I want to nap, I want to. I want to travel. And they really kind of. I don't know, their life's become simpler. And it would be a lot easier if. Wow. If she would slow down also, or she would not change or she would stay. So, you know, so she would be
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B
another thing that became easier.
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C
Yeah. If she would begin. And it doesn't. And, you know, I wouldn't say the opposite happens, but certainly there is you. You've got to be ready for. To. To adjust and to pivot. And a lot of guys, they don't want to. And again, that's a lot of reframing in counseling.
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A
Yeah. It's fascinating.
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B
Well, I think.
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A
And then stereotype. Take the stereotype to the female. Like, she's taking care of all the other people. She raised the baby. She organized their life.
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C
She.
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A
Maybe she put her education on pause and she gets to midlife and she's like, I'm going to start a business. I'm going to go do this different career. I'm going to go double down on whatever she's changing.
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C
And so much of it is taken for granted. Also the man. I mean, you know, if you take just our Christmas presents. Kate buys presents for everybody. For my parents, for him. And I have to buy her presents, which I buy with her. We have a shopping day, and then I buy one thing for each kid, you know, and it'll be a T shirt that's like, dad's cooler than mom or something. You know, it'd just be something ridiculous. And I don't know. I mean, it's just kind of automatic. And they're opening their presents on Christmas morning. I can't wait to see what they got, you know? And so, so much of it is, man, I see so many guys pat themselves on the back where it's. I cook twice a week. That's fantastic. You know, but it's. When the change comes, man, they don't like it simply because even if it just means they have to do more and she's still off conquering the world and. Yeah, exactly. Like you say, what if I want to change jobs? What if I want to visit my friends more? What if I want to. Yeah.
- [15:04]
B
I mean, it's the conversation. It's always trying to meet who you want to be together because that you are one entity at some point. And you say, if you're like this, this doesn't work. So trying to keep that communication. And I'm all over the place doing new things at this point where he was like, what? And we've really had to have those conversations, which I think has been valuable for your counseling too, because it really has informed how he addresses couples in this time where woman is like, I'm becoming someone completely different, and you can be okay with that. And I'm just.
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C
I'm thinking of it when you. When you say, what would you say to a couple who. And then she just explains her life. Man. Wait a minute. Just us.
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B
Let's just say.
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A
Let's just say this person married Jay hypothetically.
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B
That's right.
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C
Yeah, yeah, yeah.
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A
But it is.
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B
It is trying to bring people in. And I think that a lot. Women have a lot more opportunities to discuss these things in general. The nature of women is more to talk through things than it is for men and maybe even to have better social support in general than men. And so if they suddenly find themselves in a situation where the person that they have been mostly relying on is a person who no longer is on the same page with them, that can be a really difficult problem for men. And I think that's a lot of what you were. We've talked about that you've did. Is that men without social support other than in their relationship can be a real problem. And so when women say, I'm done with what you're doing here, then the man is like, what do I do now? They ignore it or they think it's going to go away. They think it. They think they're just going to go back to work and go back to doing the things they are. And then the same person, they come home to the same person who. With the same dissatisfaction. And they never. They don't have a language to even speak to each other about it. And they don't have a social support where they can go out where we can be like, I'll see. I'm going to. I have a group called my third
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A
book club of the month. Yeah, Book club or Game.
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B
Game Gals. And so we go.
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C
I have a thing called Happy hour.
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B
Well, you're. So they. They do have happy hour, but it's not really about. It's really more a social communication.
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C
It is. It is.
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B
I mean, and that's. But a lot of men don't have that.
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C
Right?
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B
And. And so that's when a counselor really, really becomes valuable too. And a lot of couples really need that little bit of a push to be like. And I talk to patients about that a lot. I was like, hey, I think that maybe you guys need to have some talk To a counselor, talk through some of these things, because I've never seen you this angry. And they'll come in, and I'll actually have patients come in for their Pap smear. And they'll come in, and they are just enraged. After about a few minutes, I'm like, so tell me what's been going on? And I've known these women for 20 years, some of them. And they'll be like, oh, my gosh, I'm just done. I'm just done. And that is. They keep going back and saying, this needs to change. This needs to change. But they don't have a way. But they're getting no response, or they don't have the language to communicate their needs. And so they need a translator, really, is what I feel like in some ways. What are your. I know you're talking about where you would. Thank you. See, it just. This light works. But I think you talked about how you can be a good counselor. Isn't there taking you inside. But it's just.
- [19:01]
C
Yeah. The goal is to never be. Have a couple think that you're on one of their side, somebody's side. And the easiest way is just. I will find myself all day, every day saying, if you. I'll say something like, it'll go just like this. I'll say, I'm not saying. She's right. But when you say this, here's what she's hearing, and she's just over there nodding. Or you do it vice versa, you know, and it is. At least you get them on the same. On the same sheet of music.
- [19:32]
A
I mean, this is not the first time I've heard. I've had other men on the podcast before who've said, like, men aren't listening. Like, they have trouble listening. I told him 10 times, and he said, yes, yes, I will do blah, blah, blah. And then he doesn't like, is this like a neurological way the brain is built or what is it? Because it's not the first time I've heard this. I'm like, he is not listening. Can he not listen? What is it?
- [20:00]
C
Well, okay, so two things come to mind. I will ask a lot of couple, and this is fun. I will ask. I'll get a couple, and then I will see them individually. And usually when I'm with the guy, I. I will give him this scenario. I will say, all right, a mysterious stranger comes up to you Monday at noon with a satchel, opens it up. Inside is $10,000 cash. He closes it up, and he says, I will give you this money next Monday at noon. So one week, the condition is, your wife has not gotten mad at you, has not barked at you, has not snapped his hand, has not gotten angry with you this whole week. Two rules. One, you can't go home and tell her, hey, we get 10 grand if you don't get mad at me. And number two, you can't just go out of town, right? You know, and not see her for the week. So when I asked guys this, and I asked the whole group of my friends, this was fun. There was about 10 of us there that day. It was a big, big crowd. About half of guys, 50%. And it's terrible that it's only 50%, but 50% will say, they'll start coming up with the ideas. They'll start saying, oh, wow, I think I'd help around the kitchen more. I think I'd bathe the kids. I think I wouldn't play golf that week. And again, it's not that she gets mad every time I play golf, but that can make her mad. You follow me? I mean, so they kind of know. I don't think I'll go up and grab her boobs in the kitchen. They know. Then there's about 40% that won't change anything. So they'll say, this takes a lot of unpacking. These are the toughest ones in counseling. But they'll say something like, if I tried everything I know how to do, there'd be a 25% chance she'd get angry with me that week. If I just live my Life, there's a 30% chance, so the juice isn't worth the squeeze. And then about 10% say, my buddy Matt, he says I can go home and tell her tonight that we get 10 grand. And she'd yell at me about that. I mean, you know, so they just. They just argue all the time. It's kind of how they communicate. So to me, it's funny, if I get the person that is one of the 50% that kind of starts naming things, this is what I would do more of. This is what I would do less of. They know. So they know. So if they are choosing to grab her or to not take out the garbage or to something like that, they're just being either stubborn or lazy. And so that takes a certain type of counseling. If they just kind of shrug their shoulders and say, I don't. I mean, it's anybody's guess, you know, like they're walking through some minefield or whatever, well, then it's, yeah, okay, all right. Is it really, really. You have no idea. And then the 10%, they're just fun. Now what's funny is when I get the wife back in there and you can ask this question to the wife about the guy. If he is one that is more likely to start an argument, it's usually the other way around. And it's because it's well deserved that guys are getting barked, barked at. But if you then bring in the wife or the girlfriend and you say, I asked him this question, the first thing they want to know is what do you say? You know, they always want to know what he. But the second thing is they always think it would be easy. They always think, oh my gosh, all he has to do is. All he has to do is I've told him. So there is, for whatever reason, this disconnect. And it's fun. Once you get him in counseling. And she says, how many times have I told you not to grab at me when I'm in the kitchen? Especially when the kids are around. And he'll look at the floor and shuffle his feet. I don't know. Yes, you do. Until someone else hears it or until there is a reason to stop or accountability or something like that. But it's terrible. I hate it when it comes to. It eats away and it just becomes this cancer. You know, the guys have refused to change either in helping or doing less of something, and it now it becomes poisonous.
- [24:30]
A
Yeah, like hell hath no fury like a woman who's fucking done.
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B
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- [24:39]
C
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- [24:41]
B
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- [25:07]
A
If she's fucking done, game over.
- [25:10]
C
Yeah, the relationship's over.
- [25:12]
A
The relationship's over.
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C
And people ask me that. People will say, well, how many marriages do you save? I always give them the same answer. It's if they are still in love, then it's almost all of them. I mean, it's 95% rate if she's in love and he's an idiot. It's most of them. But if she's done, I mean, once apathy sets in, in a woman, and there's your. There's your 5% there's your. You know.
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A
Totally. And usually she gave years of warning. Right? Like, this is not like. I don't know. It's just the weirdest thing. On Tuesday, she was done.
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C
Like, no, well, listen, that. That is how it can be. I mean, sometimes gals will come in and say that. And why did you come to therapy? Well, she said she was done, and this time I think she means it. Okay. That's when you decided to come in, you know.
- [26:06]
A
Yeah, yeah. Watch out for the done. Do you think the statistics are true? Because we could Google it, but it's like 70% of divorces are initiated by a woman. If the woman has an education. 90% are initiated by the woman. Is it that high?
- [26:20]
C
Yeah, it's close to that.
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B
I would say that's probably.
- [26:22]
C
It's more than the 70%. I don't know if it hits 90, but it's close. And I think there is a point at which the woman has just said, this has to change now, or I'm done. I would rather just be by myself and with my girlfriends and travel and the kids are grown. College is paid for. You have to really be a partnership. Yeah, that doesn't surprise me, and I don't think it's right to. You'll hear that used as a weapon online. You know, in some of these interviews, 90% of women are. They're not doing that at just a roll of the dice. I mean, as if it's just luck that somebody asked for a divorce. I mean, you have not been listening for a long time.
- [27:12]
A
You haven't been listening for a long time. Yeah. What advice would you say as far as staying connected? Dare. Dare I ask, how do you stay in love? What are the tips and tricks of, like, do these moves, and, like, they're helpful moves to stay in partnership. What thoughts would you have for people?
- [27:31]
C
My favorite metaphor or analogy? My mom's an English teacher, and so is my wife. I should know the difference of those two things. But the. I think it's metaphor. But my best friend Ken came up with this. And. And what he does in premarital counseling, I use in marital counseling. And. And that is. And it's a sports analogy, so I apologize up front. And you say, when you grew up with your two sisters and your mom and dad and dog, your family wore a red jersey. And then you. And I'll ask their favorite colors or whatever. And then. And then, you know, she'll make memory. So then I'll say, okay, you and your sister and your mom wore a Blue jersey. Now when you get married or now that you are married and have kids and so forth, you have to pick a brand new color. So that is your color. So it can be purple, it can be yellow, whatever it is. And you can take your old jersey and frame it and put it on the wall, right? You can have the blue jersey sitting up, but you cannot take it out of the case and put it on when you get mad, right? This is the family and this is your team now. Because I'll hear it. Man, it's, it's so funny how people have been married for years and they'll use the phrase without thinking about it, they'll use the phrase, he just doesn't get along with my family. Your family is him. They don't get it. That's my husband. This is my family that lives. So you have to make that. And that's something that I think we did well. We did well. And our jerseys were pink in my fierce pink jersey. But when you do that, if it's you and not against the kids, but if the kids are trying to get between you, maybe mom will give me permission, maybe dad will give me. No, no. When they see you both wearing a pink jersey, they get it. They understand. And when people outside of your religion, when your mother in law comes over and says, this is the way I do it, and say, whoa, whoa, that's not the way my wife does it. If you can do that, it's a powerful thing. And again, you can use whatever kind of visual you want.
- [29:58]
B
So just maintaining the connection, thinking of yourselves as more of a unit. And when one person is pulling away, that's where it's hard. I mean, finding that shared time I think is very important, but also the appreciation. I think that women especially probably feel underappreciated, but a lot of men do too. And when we look at. I know we're not really probably have time to even talk about sexual function and how sexual intimacy. But intimacy is probably the cornerstone to relationships. Not necessarily the sexual intimacy, but when you're talking about it yourselves as a team, that's an intimate relationship. And trying to maintain that intimacy may or may not involve in what we think of as traditional sexual touching or sexual interaction. But it is the intimacy that if you lose that connection, that is going to be a big detriment to the, to the relationship. And I think that that, and when, when it's the loss of intimacy may even be the loss of the affirmations that you get from your partner and the reinforcement of Your worth. All those things are part of intimacy. I think when you start losing that, then the team falls apart. And I think that's true, even if I don't know how we got on this experience. Extended sports analogy. But no, if you don't have a cohesive team, if you don't have communication and you don't have that, then you don't feel the need to propel each other together. Forward. It's everything. It starts falling apart.
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A
And so it starts getting like, my way or the highway. Instead of like, we're a team. What does the team need? How can I support my teammate? You know, like more of a we conversation. I think this, like, people should know this. One person needs sex to feel intimate and close with somebody, and the other person needs to feel intimate and close with somebody in order to have sex. And those two people are living in the same house and they have no idea.
- [32:11]
C
Right. That's perfectly put.
- [32:14]
B
Absolutely.
- [32:15]
C
And you can see how when it's going well, it's a circle. They're both getting that. And it doesn't matter where it started. Yeah.
- [32:24]
A
You don't have to think about why it's working. It's just working.
- [32:26]
C
It's just working. And when it's not working. Yeah. Then it's. You gotta get the engine running again. And.
- [32:34]
A
Well, I want. Yeah, I want your two perspective on it. Because I've been a urologist for a while now, and when there's one person in my office, they blame the other person as the reason for why they're not having sex. Universally doesn't matter. The gender. The woman says, we're not having sex cause he has erectile dysfunction. He says, we're not having sex because she doesn't have desire for sex. They're always blaming the person who. Who isn't in the room as the reason why the unit doesn't have sex.
- [33:05]
B
So I think that when hypoactive sexual desire disorder. We know probably one that about. We would look at statistics. About one in ten women complain of hypoactive sexual desire.
- [33:16]
C
And that's hypo.
- [33:17]
B
Hypo meaning low desire. That is disturbing because when you.
- [33:21]
C
The first time you said that, I pictured hyper in my head. Yes.
- [33:25]
B
And I was, well, get into that.
- [33:27]
C
Sounds great.
- [33:28]
B
Sounds great. But hypoactive sexual desire disorder, which is something that. It's distressing to you where you're like, I actually just want to want to have sex. I think it would be valuable for my relationship or for our closeness, but it's just not there. Whether you want to call it decreased libido, that's probably the common name for impacts how they feel about themselves, how the woman feels, a lot of guilt that goes along with that. For women. A lot of times, if you get to that point where your brain no longer produces that desire sensation, which is just a mood that's biochemically created in your head, it can cause a lot of distress in the relationship. And so I think part of it is you can get it at different times. I'm sure I. I've seen it a lot postpartum, where I think is maybe a biologically protective to try to keep you from reproducing when you already have another small person in the cave.
- [34:34]
A
It.
- [34:35]
B
It gradually does typically come back within about a year, year and a half. I'm like, it's going to get better, it's okay. But when we go through that again in menopause with hormone changes in the brain, or just when you're busy, stressed anxiety, depression, acting on that desire center, which people feel like that it shouldn't be. We don't like to break everything down just to neurochemistry, because that's not very romantic. But I'll talk to people and I'll say, have you ever been on a keto diet or sugar busters or anything like that? And the first couple weeks that you're on it, you're like, oh my gosh, I would kill for Snickers. And then after a while you think about, oh, Oreos. Actually, those sound disgusting to me. And you think about sex and how if you're tired or you have anxiety or add, which happens in midlife, all of those things shut down your desire center, where like, I'd rather just sleep, I'd rather. I can't. My brain is going around and around and around of all the things I have to do. So it really takes either a medical refocus or a concerted effort to refocus your brain to get that desire center back online. And I know for just people with women with add, and I don't know if this is. I really don't see this talked about very much, but in order to have an orgasm, you really have to almost shut down your frontal lobe. And for women who have ADD and it gets 70% worse, and in hormone changes of midlife, you can almost not shut it down. It's very. So orgasm gets harder and then you're really just doing marriage maintenance. Sex is what we call it, where it's just. Okay, it's been about two Weeks, I bet we should probably just go ahead and do it because I know that things will start to get weird if we don't. And so to be able to talk that through and to be able to say to my partner, in my case, I'll just talk about me. This is too much information. I was like, I'm just gonna say it.
- [36:48]
C
Here we go.
- [36:48]
B
I'm like, I have to have sex first thing in the morning when I have nothing on my mind, because otherwise I can't even begin to start to have anything. It can focus. And so when I talk to patients
- [37:00]
C
every morning, I wake up at five and I just wait.
- [37:04]
A
I'm showered, caffeinated, I've got my pink jersey on.
- [37:11]
B
But it is. But I think when you talk to women, you say, you're not alone in this. This is actually normal. And we can work on things like sensate focus, where you talk to your partner about, I need foreplay. We need to think of this as sex. I need to feel, I need the sensations. I need to be able to focus my brain.
- [37:35]
A
I need to be able to. I need time to get into my body.
- [37:38]
B
Yes, yes, that's good.
- [37:40]
C
Of course, I hear this all the time. And it will be a focus on as a couple. It will be how much we consider intimacy. So I will say intimacy is everything from talking in the kitchen to holding hands to watching a movie together to. So. And people often use intimacy as synonymous with sex, and that's not it at all. And I will get what you get, Kelly, where people are blaming the person that's not in the room. And I get it where they're blaming them right there in the room. But it's a lot of times one of the best things that you can get from counseling is to take the pressure off. So to give yourself to make it so that, all right, what time of day or when intimacy or when are we going to talk about or when are we going to be a team or what? This just gives your body the chance to relax and mind the chance to relax. And I'll give you an example. I will. I will often sort of prescribe if you will. I will say we're not going to have sex this week. The two of you. I'm talking to a couple, you know, the two of you are not going to have sex this week. Now, you can do whatever you want. You can obviously sleep together, you can shower together, you can hang out together, you can hold hands, you can do whatever. Let's take sex off the table this week and you can't believe how often they come back and they said, oh, we had sex all week. Not every time, but it always makes things better in that man. I'm not going to. Not only are we not going to. We're not going to have the pressure. We're not. I'm not going to feel bad about this. I'm not going to have to perform if there's erectile dysfunction or something like that. It's. Man. And the closeness, you'll see it. You'll visibly see it. They'll sit closer the next week. They'll. I mean, it's. It's great. And so with enough of that, you. You kind of rebuild or at least set up the groundwork for rebuilding.
- [39:55]
B
And so the goal isn't more sex. It's less pressure and more safety to let that desire come out.
- [40:05]
C
Just more intimacy. Intimacy meaning, again, everything. Everything that involves closeness.
- [40:11]
A
Yeah. I think the other thing that's super interesting is what does sex mean to you? Because you're like, oh, I've been. I've been living with this person for 20 years, and I didn't know what sex meant to them. That's enlightening. And I just think it offers a lot more compassion to, like, he just wants sex. He just wants an orgasm. He just wants to use my body for pleasure.
- [40:29]
C
Blah, blah, blah.
- [40:30]
A
Like, no, no, sex means love to him. And that you're the special one that gets that you get to have sex with him. And, like, people don't know what sex means to people. And I think. And I want to flip the hypoactive sexual desire disorder conversation because we always talk about if it's bothersome, if it's distressing. We're not talking about, I am not interested in sex anymore. Sex is great to me, but I'm not bothered by it. I could take it or leave it, but it's distressing to the partner.
- [40:59]
B
Right?
- [40:59]
A
Like, we don't have hypoactive sexual desire disorder. Not bothered.
- [41:03]
B
Right.
- [41:04]
A
But to the partnership, that is a bother because we started out having sex, and I think this is what. Nobody wants to have this conversation. We started out having sex. I'm gonna stereotype, but this is. Any gender can be any of these roles, but she could take it or leave it. And he's not okay with that, but he's supposed to be okay with that. And he's like, but I'm not. That's not what this relationship was. And I'm like, we need to validate both people in that relationship.
- [41:35]
C
Right. If somebody were to say, my wife and I used to play golf twice a week and we did that for years and she's no longer interested in golf. So now I go play golf with a couple of buddies of mine a couple times a week. You can substitute any word for golf except sex. I go have sex with a couple of buddies twice a week.
- [41:58]
A
We had pizza. We had pizza twice a week.
- [42:01]
C
Anything. Anything except that. And so it is its own special animal.
- [42:08]
B
And of course you have to look at the changes that I also, when I try to go through these in the office, I'll say, okay, let's start with making sure there's no pain. Is there a physiologic reason that you stopped having. And some people don't even realize that's why they stopped. They're like, well, I started getting a little dryness. And a lot of times when people come in they say, I'm not really having any problems, just a little dryness. And like that is a change in your vagina and your vulva and your clitoris and all those areas that we need to address because your brain is never going to. That desire center is never going to activate. If it's like, well, if I don't have this, I don't have pain.
- [42:52]
A
It sounds like a no brainer. But maybe it's only because we've been well trained in that of like, I can't make you like hitting your thumb with a hammer.
- [42:59]
B
Right, right. It's a, it's amazing where there's, it's like, oh, just a little. So look at the physical and then we look at can you still able to have arousal in women? We think about it in men it's pretty obvious because they have, they're either got a boner or they don't. But with women it's really hard to say because we are not taught to look for arousal in women. For women, that's a new thing. And then, then we look at desire. So I think that if we have to go stepwise through these things and maybe the desire, lack of desire is coming from these other two problems that we haven't addressed. And then there's all kinds of things that change in midlife. Lots of health things that impact us. Medications. We maybe started taking SSRIs, medications for anxiety and depression, which are some of the first things that are prescribed for the anxiety and depression that you get in menopause with hormone changes, sleep apnea with the weight gain that you can get and changes sleep apnea, sleep disruption, how that impacts our Sexual function. So trying to go through some of these things and we try to give people a framework, like we've talked about this, of things that they can go through. Look at the medical things and also look at the relationship things. Look at your pain, look at the desire, arousal, pain. Look at the medications. Is it a blood pressure problem? Is the erectile. You know, with erectile dysfunction, you see that all the time with blood pressure medicines. Right. And. But why do we never talk about that for women?
- [44:37]
A
Well, it's the exact same thing. That's the thing. It's like arousal is blood flow. Right. And like, why would only one, one gender have blood flow to the pelvis for pleasurable sex? Right. Everybody has blood flow to the pelvis. I actually just did a reel on this today that like Viagra was FDA approved, expedited. FDA approved, less than six month approval because there was no other treatment for erectile dysfunction. This was groundbreaking and they needed to get it to the people. So we got expedited FDA approval in 1998 for a blood flow drug. 27 years later, we get the black box warning off of estrogen, which is a blood flow drug. So we've been destabilizing sexual health relationships for 27 years because these people got an expedited blood flow drug and these people had a box incorrect box warning around their blood flow drug.
- [45:28]
C
Wow.
- [45:29]
B
For 20 years. It's crazy. That's crazy.
- [45:31]
C
In 1998, we were just married and Kate came home from Residency.
- [45:39]
B
It was 2002. We were first married in 1998.
- [45:42]
C
Yeah. But we were in Galveston. So it was 99 or something like that. And so it was. I remember I came into the bathroom and I don't ever get headaches. And I had a headache. And she says, oh, take this and hands me something. She's a doctor, I trust her. And I took it.
- [46:02]
B
That's his first mistake.
- [46:03]
C
I took it. And I mean, within 20 minutes I still had this headache. But she had, she had given me a Viagra just to see what it would do. I was, I was her test dummy. And I said, oh my gosh. What? What? And she says, I've got to go to work. Okay. All right. I'm just. That was not, that was really not very nice. But, but it was.
- [46:29]
B
But if you're, if you have a 30 year old guy with no erectile dysfunction and you give it a. It is, it's impressive. That's one of those ones where if you have a erection for six hours or more, you gotta call.
- [46:41]
C
Yeah. Is it four hours. Or is it four?
- [46:45]
A
It's four. But you know that. You know that.
- [46:47]
C
Yeah. Yeah. Well, it was a good three, but it is.
- [46:50]
B
But it was. That was. That was wrong of me and I apologize. But it was. But you know, when they. We had these drug reps or come around and I'm like, gynecologist, I couldn't
- [47:00]
C
believe how fast she popped out of head. Headache medications. I know, it's like, man, I've got a headache.
- [47:05]
A
This. Well, it's a blood flow pill. You know, it does actually work in the brain. You know, there's data that men who take PDE5 inhibitors have less dementia.
- [47:13]
B
Well, really, I have seen that and recommendations that everyone really should be taking.
- [47:19]
A
Yeah, I mean, that's like in the longevity world, they're thinking like microdosing or lowest dose PDE5 inhibitor because it's a blood flow drug. And the blood. And it's not. It's actually not penis specific.
- [47:31]
B
One of the Viagra and Cialis and those kind of sarcopen.
- [47:34]
C
Taking a microdose.
- [47:36]
B
And you can use those on, like, you know, on the clitoris topically. And you can take them, use them orally.
- [47:43]
A
It works in some women. But it's very interesting. You probably know this, but for the listeners, when a man gets an erection. So when you give a man blood flow pretty strongly correlated to desire in the brain. Oh, I feel the blood flow. I've got an erection. Yes, I want to have sex. Pretty tightly connected. You can give woman a pelvic blood flow improvement, and she still might not be interested in sex. And they've done this. They've actually, like, given people Viagra, shown them erotic videos and be like, yeah, you know, your blood flow went up in your pelvis, but it wasn't linked to you wanting to have sex. And so when people say Viagra doesn't work in women, improves blood flow, but that doesn't always mean a woman's interested in having sex.
- [48:25]
C
That's interesting. Okay, that makes sense. So since they're connected in a man, if it's. If it happens, he's ready.
- [48:31]
B
Yeah.
- [48:32]
A
He's like, let's go. This means something to my brain. Let's go. Where she's like, I got some more blood flow down there. It doesn't mean I'm in the mood
- [48:38]
B
for sex though, right?
- [48:40]
A
Like, there's other things going on. Okay, so what takeaways for a midlife couple? What should we leave people with?
- [48:48]
C
Well, we covered most of it. We talked about being teammates. We talked about this is not midlife, is not a phase. I mean, it's midlife. I guess for me, if I could leave people with something, it would be how to restart intimacy. If it's not there currently and I would just start drinking. I would. Anything that you can do to sort of recalibrate or reset things. It would be starting with just 10 minute talks, 20 minute talks, no phones, no anything, just connection.
- [49:30]
B
Even scheduled, I think.
- [49:32]
C
Yeah, yeah, yeah, scheduled is fine. That's fine.
- [49:34]
B
Where you, where you say, hey, make this more of like a program or involved in and committed to and say, okay, we're going to do our 10 minute Tuesday talk, you know, and we're once a week we talk about what I think is working, what I think things that you would like to see in connection.
- [49:55]
C
And the more specific you can be with the time again in scheduling it. And so many of us have to schedule with two jobs and kids and so forth. That is fine. You can't just say, hey, let's try to do a couple of dinners together. No, it's got to be, we're doing it Tuesday and we're doing it Friday.
- [50:14]
B
And give a little appreciation during those. So you have a couple of things that like check things where you're going to give some appreciation. You're going to recognize where you think that someone has done a good job on things with intimacy, ways that you think that you could feel, something you think has been done well and maybe something that you feel like you'd like to see in the next week.
- [50:39]
C
And it is so funny how at first how odd or fake or whatever it will feel, but man, just do it. You can't believe how well it works. And just to sit and I am now going to think about something nice that you've done. Let's see. You know, it's fun. I'm not kidding. I mean, but it works. You will feel the closeness starting to come back. And if nothing else, I mean, if you find yourself fighting or battling or whatever. Gosh, you've just peeled back the next layer though. It's great because now it's okay now, now we'll face why we are and what, what is going well and what is not going well. And it's amazing. I did this with the kids growing up where if you are in a good mood, it is amazing what kids will do to try to keep you there. And it works with couples. Also, if somebody, if Kate is happy, man, if she comes home and she's singing or what I find myself, there's once where I just started unloading the dishwasher. It was. And it was dirty. And I was just taking and putting stuff back in. I mean, just to make it look like I was working. Man, this will keep her happy, you know, but it's. It's funny how, how much you want them to. To stay there. And so this will get you over the hump of resentment, over the hump of why does he keep doing this? And will allow for more serious conversations of things that you know that you want and that you need.
- [52:15]
B
So, so consistency of trying, of communication, just trying to. And even I almost think it's like journaling where it seems weird at first, and then you, it, it starts flowing because it's, it gets to be part of your practice. And the more you do it, the easier it becomes.
- [52:34]
A
Yeah, there's so many layers by the time midlife hits. And maybe some resentments and maybe some same things we keep having to rehash of. Like, allow yourself to be curious about getting better at being a communicator and getting better at being a listener.
- [52:50]
B
Right.
- [52:50]
A
Like, those two skills are like, maybe we didn't learn everything there was to know about communicating and listening by the time we finished college. Maybe we could get better at that in midlife.
- [53:01]
C
Oh, my gosh, yes. And there's so much out there now that's free, that is online. Becoming a better listener. When do I listen? When do I offer advice? When do I not? When do I, you know, I mean, it's so much is out there. You could do another hour just on listening. I mean, but. But it's for another day.
- [53:20]
B
I love it.
- [53:21]
A
Well, thank you for joining us. Head and Tails is the name of your podcast.
- [53:25]
B
Oh, Heads and Heads.
- [53:27]
A
Plural. Heads and Tails. Multiple heads. Multiple tails. We have a hype.
- [53:31]
B
Exactly. We do that.
- [53:33]
C
Many, many.
- [53:34]
A
I love it. I hope you guys continue. I always tell the. The brand new podcasters, keep going, keep going. You help people. They're listening.
- [53:42]
C
It's been fun. It's.
- [53:43]
A
Yeah, that's awesome. I think, I think I'm going to come over. I'm going to come over to your podcast. Coming up here. We got it. We got it. Yeah. So listen more over at the Head Heads Entails podcast.
- [53:54]
C
Hey, thanks for having us.
- [53:55]
B
Yeah, thank you so much.
- [53:56]
A
Thank you for coming on. I appreciate it. Till next time.
- [53:59]
B
All right, take care.
- [54:01]
A
If you found this episode funny, helpful, insightful, please take a moment to follow, rate and share the you are not broken podcast with someone who might need this conversation, too. That support is how this information reaches more people and thank you. For courses, books and my monthly membership and the Casperson clinic information, visit KellyCaspersonMD.com this podcast and all content from Dr. Kelly Caspersen is intended for educational and informational purposes only, and this is not a substitute for individual medical coaching or psychological advice, diagnosis or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here. And remember, you are not broken.