Hello, hello, and welcome to today's podcast, here on Rev Up Health. Today we are going to have "the talk" — let's talk about sex. This is probably something that affects the majority of people out there, whether male or female. And then there's a whole other topic of discussion: what is it, and how do we fix it? So today, hopefully, we can shed some light on some basic topics. This is not meant to be all-inclusive; it's meant to start a conversation of curiosity, to help people understand, "Well, what am I going through? What are the problems I've got, and maybe I need to look into that."
What Is Sexual Dysfunction?
We'll start first by talking about what sexual dysfunction actually is, for men, for women, and for both. There's evidence that says 50 to 60% of men and women have sexual dysfunction. It's multifaceted, and it can affect literally everyone at some time in their life.
For women, sexual dysfunction looks like vaginal dryness, pain with sex, decreased sensitivity, and low desire. Those topics are very common — if you don't have those problems as a female, you know somebody who does. And for men, it's pretty common too; it just takes a little different form. That could be erectile dysfunction, a decrease in sensitivity or stamina, or a delayed or premature ejaculation, or low libido.
For both men and women, this could be a disconnection from your partner. Life is busy — during midlife there's a lot going on. We've got maybe kids at home, maybe parents we're helping to take care of, a lot pulling us in different directions, a lot of daily stress, whether it's work, finances, or you name it. That tends to affect us all. Also, this isn't something that's had a lot of conversation around it in the past. We're hearing more about it now, but shame or fear around the changes that are happening, not wanting to hurt your partner's feelings and tell them the desire just isn't really there, performance anxiety — these things happen to both men and women. For men, it's like, "Okay, well, I'm not the man I used to be, so I can't run with the horses anymore."
Truly, what we're here to do today is dissolve some of those myths — there's a lot more to it — and create some curiosity where people can look into this a little more. One thing to note is that a lot of these things people just get used to. It comes on slow, and then all of a sudden you've gone from what was the norm to this new norm that feels like just what it is. With vaginal dryness, for instance, women just feel like this is just what it is — and the truth is you don't have to live with that. There are a lot of things you can do to help, not only to improve libido and sexual function, but also urinary and vaginal health.
Something as simple as the fact that, as human beings, we weren't intended to live this long — we were meant to go through our reproductive years and not live much longer than that. Now that we're living longer, we're starting to understand that things happen to us, and it's not just getting older; it's part of the midlife decline that happens, and hormone changes are a big part of that.
The Changes That Happen in Midlife
The changes that happen in midlife are those hormonal shifts, both in women and men — perimenopause and menopause, and declining hormones in general. For men, testosterone and DHEA have been a common thing that's talked about, but with women, with all the rise in talking about hormones, it's not just the testosterone we think of with libido — it's the estradiol and progesterone. The estradiol keeps that vaginal tissue healthy, and it all plays a part. And changes in blood flow make a difference too. There are metabolic things that happen that can affect blood flow. We all focus on the big killer, cardiac disease, but sexual health is a blood flow issue as well. So it's certainly part of life that we need to look into.
We already touched on this a little, but when you're not sleeping well, you don't have as much energy to be ready for sex — and mental health, stress in general. Not to mention the medications we're taking now that affect libido.
Medications That Affect Libido
Medications are becoming a more known problem, with side effects that affect libido, performance, and general sexual health. One thing to note is that just knowing you're on a medication that may affect your libido can be a little reassuring — it's not just you; there are other chemical factors going on.
The first thing that comes to mind is antidepressants, and this is one a lot of people recognize. A lot of antidepressants affect libido, because they increase serotonin levels, which then blunt our dopamine effects and lower our sexual desire and arousal. Dopamine is the hormone that sets up the mood — we're really anticipatory. Whether you're looking forward to that brownie at the end of the day or looking to have some sexual activity, it's a dopamine release that creates that.
Birth control pills and other hormonal contraceptives can affect libido by suppressing natural hormone production, which can reduce the circulating androgens, especially testosterone. Blood pressure medications can affect it too — that's a blood flow thing and an energy thing; they often affect our energy level, which inadvertently affects desire, and they affect blood flow and the nervous system's role in sexual signaling. A lot of people are on these things — these top three medications hit just about everybody, so it's no wonder we have troubles.
Antihistamines — something you take for generalized allergy symptoms — are going to create dryness, whether it dries out the mucous membranes inside your nose or the vaginal vault. Anti-anxiety medications play with that dopamine response and blunt it, affecting the central nervous system. Opioids — there's a lot of press about opioid addiction, but opioids also reduce libido and the production of testosterone; they affect the HPA axis (the hypothalamic-pituitary-adrenal axis), which can affect our central nervous system and general well-being. Antipsychotics can inhibit sex hormones by increasing prolactin. Chemotherapy and hormonal cancer treatments directly affect hormone levels and tissue health. Finasteride, which is often used for hair loss and an enlarged prostate, will also affect libido and erectile dysfunction — it affects the conversion of testosterone to DHT, a more active form of testosterone in our system.
And even alcohol and cannabis — a lot of people out there are drinking alcohol and using cannabis, but that's going to blunt our central nervous system's sensory input. Physical performance is what really gets taken down with those, and they affect our oxytocin production too. That's an interesting one, because a lot of people use alcohol or cannabis to wind down and get relaxed, and sometimes that helps increase sexual desire — but then looking at how it affects performance is really important. Pay attention to your body and how you're feeling.
The Root Causes and Real Solutions
So what are the root causes, and what are some real solutions we can actually hang our hat on? First, the roles of sex hormones: testosterone, estrogen, DHEA, and oxytocin are all vitally important for sexual function, sexual health, and libido. The importance of blood flow — specifically nitric oxide for vascular health — is also vitally important. Just to look back while I'm on this topic: what was Viagra initially developed for? Angina — blood flow. It just happened to have a side effect of helping with the erection. So that's how vascular health and blood flow play into this.
Stress and cortisol have a big effect on arousal and connection. We've already hit that nail, but you can't forget about it. Sometimes people just don't understand how stress can impact so many different facets — literally everything, specifically gut health. Gut health can affect the root causes of problems, along with the medications. And nutrient deficiencies — vitamin D, B12, zinc, and iron — these are things people are frequently deficient in, and unless you're having these labs drawn, you may not be taking care of the problem, so it's good to know where your numbers are.
From a functional medicine perspective, we've got BHRT — bioidentical hormone replacement — to get these hormones back to the optimal level, which can help. We've talked about how they decline with middle age, so testosterone, estrogen, DHEA, and thyroid are things we try to optimize. There are supplements like maca root, zinc, omega-3s, and L-arginine that can help improve sexual health. Even certain peptides, like PT-141, for improving libido. There's a lot of new information on peptides. And nervous system support — breath work, mindfulness, trauma-informed care — making that connection again. There are some good courses out there for sexual health, whether it's trauma-induced sexual health problems or your physical intimacy connection.
Reframing Intimacy and Connection
A reframing of intimacy and connection: it's not totally about performance. It's about pleasure, safety, and making that connection — and you can do that without the physical act of sex. So if that does tend to be a problem, there are ways to still create that connection, and in turn grow and support. It's difficult to find support sometimes in these fields, because "I'm ashamed, I'm embarrassed" — but there's a lot of support out there.
Another thing to mention is how the idea of sex changes from when you're younger to midlife. When you're younger, a big part of sex is reproduction and having babies — hormones, aging, and reproduction, that's our design, our human design. Honestly, when you're transitioning from the point of having babies to not having babies, that also adds a level of concern with sexual health, because you don't want to have a baby — so sometimes that can make you not want to have sex, and then you get into the whole thing of birth control and different methods, which we already talked about can affect libido. It's a big change. And not only that, by midlife you may have been in a relationship with someone for 25-plus years, so that changes things too, and you have to take into account how to really make a new connection as a midlife person.
Establishing that role of trust and communication with your partner, to work through the emotional and physical intimacy that needs to occur as we get older and through midlife and beyond, is something that will help. And how expectations change — things change as we grow and age, and helping each other know what those changes are and how expectations may have changed. It's really just about opening the conversation and being vulnerable in a lot of ways.
Practical Tips for Connection
Daily check-ins can be a kind of ritual — ask each other, "What was the best part of your day?" or "What's one thing you need tonight? Do you just need me to support you, do you need some space to work through your daily stress, or do you need connection?" That communication is what really makes a difference. It creates emotional safety and mutual awareness, and it doesn't need to take very long — just a couple of minutes. What it typically does is open up doors for conversation, and then you start to understand, "Okay, maybe that's how you feel — so that's why you act like this. It's not because you don't want to be with me, it's because you're tired, or fatigued, or sore." How you communicate can make a huge difference.
Another option is to go for a walk, do something without technology — not a TV, not a phone. And if you can go for a walk in nature, that would be amazing. Technology is everywhere, from our back pocket to our wrist and our fingers, so if we can try to just unplug — there's not one person who can't get back to nature and feel better about themselves. Make it a point to have a connection date, where the whole point of the date is just reconnecting — conversation without pressure.
Try something new together. We did this for a while — a "something new" date night every month, and that was a lot of fun. One person picks a week or a month and is in charge of designing and organizing the event; you don't even have to tell the other person. It's like, "Okay, you've got to get dressed, here's what you've got to wear, and we're ready to go at 5:00." That's an exciting, anticipatory thing, and it helps the old dopamine production.
We've actually done a post on the six-second kiss and the 20-second hug — intentional touch. There's lots of evidence that hugs and kisses really do increase connection and get the oxytocin flowing. Just rubbing somebody's shoulders or their legs — that touch is a way of communication and connection.
The next tip is a no-tech hour before bed, which is another example of how everything is connected. No tech before bed is great for improving your sleep, but it also gives you the opportunity to make a connection. This is something we're guilty of, and you always have to check yourself and come back to reset, because you say, "Okay, good intentions, I'm not going to open this phone, I'm not going to look at my emails," the hour or two before bed — and lo and behold, "Oh, I've got to check this, I've got to order that." It's so hard, but you just have to place boundaries and keep yourself in check — and sometimes keep your partner in check too. Having an accountability partner is huge.
The other thing is to practice appreciation out loud. A lot of times we fall into habits where we get used to assumptions — the things each other do — and we forget to say, "Hey, thanks for making that dinner," or "I really appreciate that I don't ever have to take the trash out because you do that," or mowing the yard, or feeding the chickens. Those little things — little gifts — help.
This next tip is one of my favorites — I don't know that it's one of your favorites — getting curious about the past and asking questions about earlier years. I picked poor timing for my questions, I think. That's another topic of discussion, but these questions are fun and entertaining, and they create connection and conversation — but there is a timing issue. I personally don't think you want to be creating questions when it's time to unwind. If you're dropping off the phone and the emails, then you also need to be dropping off things that are going to create a lot of thought and really fire up my brain and get it working. So this is another example of the importance of that conversation. I don't know that we've talked about love languages on any of our previous podcasts, but knowing that about each other — what are your love languages, what works for you, and when is a good time to ask questions? There's that communication connection coming back around.
What about rituals? The morning coffee together — we like to have morning coffee to wake up and start moving around, so we try to work in some morning sunlight. In fact, we talked about it today: going out and having our coffee on a walking trail instead of coffee-then-go. Why don't we just take our coffee with us and make it a wake-up and movement thing — gets the dog up and out and gets us going too. Little things like that, or Sunday evening planning, or Friday night drives — whatever's fun and entertaining and keeps it real.
Talk About Sex Without the Expectation of It
We've talked a lot about talking, and it is important to talk about sex without the expectation of actually having it. That's really the time you can express what you like, what you don't like, your turn-ons or turn-offs. Women and men are different — there are differences in intimacy and connection — so voicing those opinions and creating that conversation is what will really start to open up more connection and more intimacy.
Obviously, we're not experts. If we found an expert, we'd love to have them on the podcast to talk even more. But our hope is that normalizing the conversation about sex can open that door for people and help them understand you're not alone, you're not broken — this is a moving thing, with lots to explore, and there are root causes and things that impact our sexual function and dysfunction. So hopefully we've created a little curiosity where you can go into the medicine cabinet and see, "Okay, what am I taking?" or go to your labs and ask, "What am I deficient in?" But that connection is certainly something we hope you can take away from this too.
Well, thanks for joining us today, and we'll look forward to talking with you next time. Have a healthy day.