29: Now Let’s Do Something About IT – Your Sexual Health Toolkit for Perimenopause Part 2

INTRO

Good morning and welcome back to Mornings with Megan. I’m Megan Pfiffner, Certified Nutrition Specialist and perimenopause expert.

This is part two of our three-part series on sexual health in perimenopause. If you have not listened to part one yet, I want you to go back. We covered a lot of ground: the hormonal picture, what declining progesterone does to anxiety and cortisol, what is happening in vaginal tissue, the cultural weight women carry around sex, and the very important question of whether you believe you deserve pleasure. Please start there. It sets everything up for today.

Because today we are getting practical. We are talking about what you can actually do. And I want to open with something I said at the end of part one and I am going to keep saying throughout this series: you are not broken. This is not your fault. And most of it is addressable.

Let’s go.

STARTING WITH YOU

The first place I want to start is not with your partner. It is with you.

I want to talk about solo sex as a health practice and as a tool for body literacy. I know that might feel like a strange place to open, but stay with me.

Here is the reality: it is very hard to communicate to another person what you want if you do not know yourself. I learned this the hard way. I spent years assuming my partner should just magically know. I had absorbed from every movie and TV show I had ever watched that good sex was spontaneous and intuitive and if you had to talk about it, something was wrong. Wrong.

Solo sex is how you learn what is happening in your body right now. Not what worked five years ago. Not what you think should work. What actually works for you today, in this body, in this stage of life.

And here is why that matters during perimenopause specifically: your body is changing. What felt good at 35 may not be what feels good at 44. The stimulation you needed before may be different now. Your arousal pattern may have shifted. Things that used to happen quickly may take longer. Things that never interested you before may suddenly be interesting. Your body is not broken. It is different. And paying attention to that difference is genuinely useful data.

There is also a diagnostic piece here worth naming. If you have no interest in solo sex AND no interest in partnered sex, that is one picture. If you are interested in solo sex but not partnered sex, that is a completely different picture, and it tells you something important: the issue is likely relational or contextual, not physiological. Your body is capable of desire. The environment around partnered sex is what needs attention. That information matters when you are trying to figure out where to put your energy.

THE STRESS CUP AND CHORE PLAY

Let’s talk about the relational environment. Because this is where I see the biggest gap for most women I work with, and it is also where the most immediate change is possible.

I want to introduce a concept that I first heard from Dr. Sally Greenwald, and the moment I heard it I thought: yes. Every person who has ever managed a household and tried to also have a sex life needs to hear this word.

Chore play.

Let me paint you a picture. Think about those sexy calendars. The ones marketed to penis owners: scantily clad bodies, wet t-shirts, very suggestive fruit eating. Now think about the sexy calendars marketed to vulva owners. Scantily clad bodies as well, but they are vacuuming shirtless. Washing dishes naked. Folding laundry in a wet t-shirt.

Do you see the difference?

For the person who is managing the brunt of the household, the kids, the lunches, the laundry, the doctor appointments, their own parents’ needs, the car that needs servicing, the mental load of tracking all of it, when their partner wants to be intimate and the to-do list is still running in the background, desire is not going to just appear. The body knows the work is not done. The nervous system is still in logistics mode. And a person who is utterly exhausted and does not feel supported is not a person who can drop into pleasure.

This is not about not loving your partner. This is about the nervous system needing safety and support before it can access desire. Those are not separate things.

Now let’s imagine a different scenario. A vulva owner with a partner who notices what needs doing and just does it, without being asked. Who sees that she is stretched thin this week and shows up differently. When lubrication starts to shift, instead of it becoming a silent source of stress, there is a conversation: should we slow down, use something, check in about where you are? There are regular conversations about energy levels, about stress, about desire, not just when something is wrong, but as an ongoing practice of paying attention to each other.

That environment produces different outcomes. Not because the hormones are different, but because the nervous system feels different. Supported. Seen. Safe enough to be present.

THE MYTH OF SPONTANEOUS SEX

Let’s talk about something that causes a lot of unnecessary shame around scheduling sex or being intentional about intimacy: the idea that good sex is spontaneous.

It is not. It never was.

Think back to the beginning of a relationship. Those early dates felt electric, right? Like things were just happening naturally. But were they really spontaneous? You put that person in your calendar. You planned to see them. You thought about what you were going to wear. You shaved your legs, or whatever your version of that is. You showed up having thought about this person, having anticipated seeing them, having made yourself available in every sense of the word.

You called it a date. Or dinner. Or a movie. You did not necessarily say out loud: and then we will have sex. But you probably thought about it. You anticipated it. You made the possibility of sex, well, possible. You did not go in your laundry day underwear.

That was not spontaneous. That was planned intimacy with the planning kept quiet.

And here is the other version of spontaneous sex: you go to a bar, a party, a wedding. You end up connecting with someone. Things happen. That feels spontaneous. But were you really just going about your day with zero awareness? Or were you open to it, maybe even fantasizing about it a little, traveling prepared for the possibility? You wore something that made you feel good. You were in a social headspace. You showed up ready.

Spontaneous sex is mostly a myth we have been sold by romantic comedies. What we are really talking about is readiness: the mental and physical state of being open to and anticipating intimacy. The difference between early relationship sex and long-term relationship sex in midlife is not that one was spontaneous and the other is scheduled. It is that the readiness used to happen automatically because everything was new and exciting, and now it has to be created more deliberately because life is full and bandwidth is thin and your nervous system needs more help getting there.

Scheduling sex is not a sign that something is wrong. It is a sign that you are taking your relationship and your pleasure seriously enough to protect time for them. When you were dating, you protected time. You just called it something else.

So if a 0-10 rating scale and a calendar invite is what gets you both there, that is not clinical. That is intentional. And intentional is actually more intimate than accidental.

The conversation around it, are you overwhelmed right now, do you need support, how is your sleep, where is your stress, that is the new version of the week of anticipation. That is your foreplay. It just looks different than it did at 28. And that is okay.

WHEN YOUR BODY IS CHANGING: LUBRICATION

Now let’s talk about some of the practical physical tools, because this is where a lot of women have questions and not enough information.

Lubrication first.

As we talked about in part one, declining estrogen changes vaginal tissue. Less natural lubrication is one of the first things many women notice. And here is what I want to say clearly: if you are noticing a shift, you do not have to wait until sex is uncomfortable to address it. The earlier you have this conversation with yourself and your partner, the better.

The first conversation is with your partner: more foreplay. More time. More attention to what your body actually needs to warm up before anything else happens. That is not a limitation. That is information about how your body works right now, and working with it rather than around it changes the experience entirely.

The second conversation is about lubrication. And I want to spend a few minutes here because not all lubes are created equal, and some of the most popular ones on the market are actually making things worse.

This is where I want to bring in the concept of osmolality. I know that sounds very clinical but bear with me because Dr. Sally Greenwald taught me this and I have never forgotten it. Once you understand it you will never look at a bottle of KY Jelly the same way.

Osmolality is essentially a measure of how concentrated a solution is, specifically in terms of how it interacts with water. Your vaginal tissue has its own natural osmolality: its own water balance. When you put something inside the vagina, you want that product to have a similar osmolality to your tissue. When the osmolalities match, everyone keeps their water. Nobody is losing anything.

But when you put something with a very high osmolality into the vagina, something much more concentrated than your tissue, it pulls water out of your vaginal walls. Your tissue is literally being dehydrated by the product that is supposed to be helping it. Products like KY Jelly and Astroglide can have osmolality levels that are many times higher than what is safe for vaginal tissue. They are popular, they are in every drugstore, and they are working against you.

So what do you use instead?

Two options I recommend. If you want a water-based lube, Good Clean Love Almost Naked has an osmolality right in the ideal range, around 280 to 300. It is clean, it is gentle, and it does what it is supposed to do without the tissue damage.

If you want a silicone-based option, Uberlube is excellent. And here is the thing about silicone: osmolality is a water-based measurement, and silicone contains no water at all. So the question of osmolality does not apply. Uberlube does not interact with your tissue’s water balance in any way. It just reduces friction without pulling anything from your tissue. It lasts longer than water-based options, it does not get sticky, and it has four ingredients. And it is compatible with latex and polyisoprene condoms, so if that is relevant to your situation, you do not have to choose between protection and a lube that actually works for your body.

I will link both in the show notes.

One caveat worth knowing: silicone lube is not compatible with silicone toys. So if that is relevant for you, Good Clean Love is your go-to.

DIFFERENT STIMULATION AND TOYS

Which brings me to toys. Let’s just say it out loud.

As your body changes, the stimulation that used to work reliably may need to be revisited. This is completely normal. It is information, not a problem. And one of the most useful things that solo sex gives you is the space to figure out what your body is responding to now.

Toys can be a genuinely useful part of that exploration. Solo, to learn what you like. And with a partner, as an addition to what is already happening. The key, as with everything we are talking about today, is communication. Introducing anything new with honest conversation takes the awkwardness out of it and turns it into something you are doing together rather than something that might feel like a commentary on what was happening before.

There is no age limit on this conversation. There is no stage of life where it stops being relevant. And if the idea of it feels uncomfortable, that is probably the cultural baggage we talked about in part one showing up. Notice it. And then consider whether it is actually serving you.

REDEFINING SEX FOR THIS CHAPTER

I want to close this section with something that I think is genuinely freeing if you can let it in.

Sex in your 40s does not have to look like sex in your 20s. It probably should not. Your body is different. Your life is different. Your relationship, if you are in one, is different. What you need to feel present and safe and turned on is different.

That is not a loss. That is information.

Sometimes more frequent sex that is good enough is more useful than rare sex that tries to be perfect. Sometimes the reverse is true. Sometimes the most important thing is just making time for it at all, in whatever form that takes. Sometimes the priority is learning what you want right now, in this body, which is its own project worth taking seriously.

The cultural script says midlife is when your sex life winds down. That women past their fertile years are past their peak. I want you to hear me clearly: that is not biology. That is a story. Biology says your body is changing and needs different things. The story says that means it is over. Those are not the same thing.

You are allowed to rewrite the story. You are allowed to decide what sex looks like for this chapter of your life, based on what actually works for you, not based on what you did at 28 or what you think you are supposed to be doing or what anyone else’s relationship looks like from the outside.

What do you want? What serves you? What serves your body, your relationship, your life right now? Those are the questions that matter.

WHEN TO TALK TO YOUR DOCTOR

Before I close, I want to give you a sense of what is worth addressing on your own versus what deserves a conversation with your healthcare provider.

Talk to yourself and your partner first: decreased lubrication, changes in arousal time, shifts in what stimulation you respond to, low desire that feels situational or relational. These are conversations to have with yourself through solo sex and body awareness, and then with your partner.

Talk to your doctor: persistent vaginal dryness or discomfort that does not improve with lube, pain during sex, recurrent UTIs, a significant decrease in libido that does not seem to track with stress or relationship factors, and anything that is affecting your quality of life regularly.

That last one is important. If something is affecting your quality of life, it is worth raising with your provider. You do not need to have a crisis to deserve support. You do not need to be in pain to bring it up. If it matters to you, it counts.

And if your provider dismisses you, if you are told this is just aging, just stress, just something to accept, that is a signal to find a provider who is current on the research. Because the research is clear. There are good tools for this. You deserve a doctor who knows about them and will have the conversation with you.

CLOSE AND SERIES TEASE

So that is part two. We covered solo sex as body literacy and diagnostic tool, chore play and what it actually takes to create an environment where desire can show up, the myth of spontaneous sex and why scheduling intimacy is actually more intimate than leaving it to chance, the osmolality piece and why your lube choices matter more than you think, toys, and permission to completely redefine what sex looks like for this chapter of your life.

Next week is part three, and it is one of my favorites. We are going deep on vaginal estrogen: what it is, what it does, why the warning label that scared everyone off of it for decades has now been removed, and why the FDA is actively working to make it available without a prescription. We are also going to talk about what it does beyond sex, for UTI prevention, tissue health, and long-term comfort, and I am going to share some client stories that I think will feel very familiar.

I will see you next week.