Why Hormones/Prescriptions Alone Won't Save Your Sex Life (or anything else)

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If you are told this, in most cases, you are being SOLD.

I have prescribed hormone replacement to thousands of women. Some have dramatic improvements. Others don’t feel much change. The difference usually isn’t the prescription—it is everything else that goes along with it! 

-Not just what you are TAKING, but also what you are DOING.

I recently listened to a podcast and then a TED talk from Dr. Tara Suwinyattichaiporn, a professor of Sexual and Relational Communication and Research at California State University. And listening to her speak made me want to share this really important message with you!

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One common misconception I see in our practice is the belief that libido, desire, good sex, and satisfying orgasms are something a doctor can prescribe.

As women, we're often taught to think about sexual health the same way we think about many other areas of health. We assume that if something isn't working, there must be a medication, a hormone, or a procedure that fixes it.  

Unfortunately, most of medicine and even the “wellness industry” perpetuates this incomplete truth. Why? Because we are SOLD things to take and procedures to have, as this is how the seller (often the provider) makes his money off of us.

Certainly, things to take and procedures to have can be PART OF great medical care! But, my additional goal as a physician is to help each patient we work with to best understand what she may need to take, short term and long term, but to ultimately limit that dependency on external factors by being her partner in learning how to self manage daily robustness, satisfaction, and health span.

In regards to Sexual Health: 

As a physician, there are many things I can help with:

• I can listen and be interested in your story.
• I can perform a thorough examination of the vulva, vagina, pelvic floor, and surrounding tissues.
• I can treat infections, address vaginal tissue changes associated with low estrogen, and help improve blood flow.
• I can help identify nerve-related issues, pelvic floor dysfunction, and pain conditions; and provide treatments and/or referrals to providers like physical therapists or a urogyn to help work on resolving these.
• I can evaluate hormones and determine whether hormone therapy is appropriate.
• I can also help identify medical conditions that contribute to low libido, fatigue, discomfort, and sexual dysfunction. AND, I can help connect the dots between overall health and sexual health, including sleep, stress, exercise, nutrition, relationship health, emotional wellbeing, and chronic disease.

BUT, as a physician, there are other things I cannot override the lack of with a prescription or procedure alone: (If you are told this, it is not true, and you are being SOLD.)

No prescription exists that can completely override the lack of connection, desire, emotional intimacy, communication, curiosity, attraction, playfulness, and vulnerability.

This is where some people become frustrated because they expect libido and orgasms to fall out of the sky after a hormone or other indicated prescription or procedure.

(In the same way, many people expect weight loss and optimal health to fall out of the sky after a GLP-1 prescription - another huge misleading misconception.)

Medications can remove barriers and create opportunities, but they don’t do all of the work for us. Testosterone can improve sexual thoughts, energy, responsiveness, and desire in appropriate candidates. Estrogen can improve comfort, blood flow, tissue health, and arousal. Other prescriptions, both oral and topical, can help with skin conditions, infections or inflammation, pain conditions, menstrual disorders, and other factors.

Physical therapy and procedures can help resolve pain, and identify muscle and nerve weaknesses, but in and of themselves cannot create lasting strength and resolution without consistent work from you to stay strong. 

Most importantly, none of these things teach an individual or couple how to communicate, resolve resentment, create emotional safety, restore curiosity, or repair disconnection.

Holistic healthy sexuality is not something that happens automatically. It is not something that you can pay for, but rather it is a skill. Just like taking care of your health in every other way is actually a skill that YOU are in charge of! This requires attention and practice.

My role as your physician is to help treat and remove medical barriers over time and give you guidance through the process.

Your role is to engage in the emotional, relational, physical, and behavioral work that creates a healthy sex life - what makes you feel desired, emotionally connected, turned on or off - the keys to restoring intimacy.

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Interesting tidbits from Dr. Tara Suwinyattichaiporn:

• It is estimated that ⅓ or even ½ of couples in long term relationships go months or even years without intimacy and/or sex.  

• The biggest predictor of long-term sexual satisfaction is communication, not attractiveness, sexual technique, frequency, or relationship length.

Common Problems:

• People Expect Compatibility Instead of Building It - "If we're meant for each other, sex should just work naturally." But, successful couples continuously adapt instead of assuming compatibility is permanent. 
• Shame Is a Huge Barrier - people believe Sex is dirty, Men always want sex, Women should be passive, Desire should happen automatically.
• Social Media Creates Unrealistic Expectations - Endless comparison, Fantasy relationships, Constant novelty, Unrealistic beauty and sexual standards. This creates chronic dissatisfaction. 



How to improve Sexual Communication?

Your partner won’t magically know, so discuss what feels good, what doesn't, frequency preferences, fantasies, emotional needs, desired changes.

Why Relationships Become Sexless?

Emotional Disconnection because partners stop listening, sharing, and appreciating. Resentments accumulate and destroy intimacy and eroticism- over unequal household/childcare work, feeling unseen, feeling unappreciated, and even the other partner not taking care of his or her physical/emotional/mental/spiritual wellbeing.

Becoming “too comfortable” and the Lack of Novelty are also a problem: long-term relationships require intentional creation of novelty forever to avoid the loss of excitement.

Stress is also one of the biggest libido suppressors: Parenting, Careers, Financial pressure, and Poor sleep are all common culprits. 

Loving someone and sexual desire are not always the same thing. Love seeks safety, stability, and predictability; while Desire seeks novelty, uncertainty, and discovery. Couples in long term healthy relationships learn to balance both!

Respect and Attraction are both critical too! One or both partners “letting him/herself go” in any area of life and health can become a problem. When respect erodes, loss of attraction will follow. Criticism, Contempt, Dismissiveness, and Belittling will also never help.

A Few Long-Term Successful Relationship Practices: 

1. Weekly Check-Ins - Discuss emotional connection, sexual satisfaction, stress levels, needs, and appreciation
2. Appreciation Rituals - Regularly communicate gratitude, admiration, and respect
3. Intimacy Conversations - Talk about fantasies, preferences, curiosity, and boundaries

Remember: 

• Communication predicts sexual satisfaction more than technique.
• Shame prevents couples from discussing what they need.
• Most sexless marriages begin with emotional disconnection, not lack of attraction.
• Desire does not fall out of the sky, but comes from connection developed and nurtured over time.
• Respect is a foundation of erotic attraction.
• Compatibility is built, not discovered.
• Novelty and security must coexist.
• Couples should schedule regular intimacy conversations.
• Curiosity is more useful than criticism.
• The healthiest relationships continuously evolve rather than relying on chemistry alone. 

And last but not least!!! - 

A great tool for communicating something hard or uncomfortable:

THE SHIT SANDWICH



I appreciate you because . . . . . .

But, I’d really like for us to work on . . . . . 

Even with that, I’m still so happy we . . . . . .

We are happy to help you on the journey of navigating these foundational action steps through IFM's Functional Medicine Matrix here at Mint Health.

Stay strong. Stay consistent. Keep moving forward.

—

Elizabeth Buchert, MD, IFMCP

Mint Health

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