Straight Talk About Libido Over 40 with Dr. Maureen Slattery

Erin: Welcome to Hotter Than Ever, where we uncover the unconscious rules we've been following, we break those rules, and we find a new path to being freer, happier, sexier, and more satisfied in the second half of our lives. I'm your host, Erin Keating.

Welcome new listeners, I'm so thrilled that you found your way to this conversation. And to longtime fans, it's great to know that you're out there listening to this show. I hope it makes you feel seen and heard and optimistic about all the choices and options there are for how you're going to live the next year or five or 20 years of your one and only beautiful life here on planet Earth.

Today, my guest is Dr. Maureen Slattery. She's a board certified OBGYN with 20 years of clinical experience. She has advanced training in sex counseling and education, and her clinical practice also focuses on menopausal care. Thank God, we need more doctors focused on menopause. Maureen teaches health care providers about menopause and sex in Rochester, New York, and teaches about medical causes of sexual dysfunction in the sexual health postgraduate program at the University of Michigan.

We have a great conversation about why healthcare providers need more education about sexuality and menopause. It's just something that is not taught to the degree that it needs to be taught in medical school. And this is something, a gap, that Maureen is really passionate about closing. We talk about low libido, what is it, how do we define it in women in midlife, this gets thrown around and our bodies and our current situations with our sexuality and our changing hormones get pathologized.

So we talk about what you can do about low libido, if you feel like this is impacting your life in a negative way. We have a great talk about raising girls who are comfortable with their own bodies and talking about sexuality, which I think a lot of parents are afraid to do. But that is so critical. I pitched Maureen an idea that can help educate women, many of whom do not know what an orgasm looks like and feels like and how it comes in kind of different shapes and sizes and how it's different for all of us.

This seemed like a radical and revolutionary idea to me when we were talking about it at the time. You tell me what you think. It's a great girlfriendy conversation and Maureen is a really fun hang. All right. Let's get hot.

Erin: Dr. Maureen Slattery, welcome to Hotter Than Ever.

Dr. Slattery: Hi, Erin. Thanks for having me. I'm excited to be here.

Erin: I'm so happy to have you here. There are so many conversations we do not have about sex and sexuality. My listeners know this is my favorite subject.

Dr. Slattery: Yeah, mine too.

Erin: And then. Yes, good. Well, we have a lot in common already.

Dr. Slattery: Yeah.

Erin: And this podcast is for women over 40, which is when we start to experience perimenopause and menopause, things that we never thought. Thought about in our youth and never knew would become such a meaningful part of our lives. And some of us, like me, just want to ignore it and pretend like it's not happening. I think I'll be in perimenopause for all of my 50s. It seems that's just where I'm at. But I would love to hear your story and how you came to do the work you do today. It is no small feat to become an OBGYN and then to take on this specialization in sex and menopause. Like, have you always been interested in sex?

Dr. Slattery: Oh, God, yes. I mean. I mean, I don't know. I mean, I always thought I was weird. That was something that excited me, and I guess I was raised by a single mother, and I have two. Yeah, I have two younger sisters and my mom, because my dad wasn't, like, super great at supporting us. We were on welfare for a while when I was a kid, and my mom just instilled in all of us that, like, you need to go out there and get educated and have skills to do something. She's like, don't go to college to study English. Learn to teach English, if that's what you want to do. Or go learn to be a welder, but, like, be, like, skilled to do something so that you can support yourself. But any mom raising, like, three teenage girls, you know, each one of them is going to have. They're things that kind of probably drive her crazy, and she could not be everywhere and all things to all of us. And it was the 80s and the 90s where, like, we were freer to do lots and lots of fun things unsupervised. Yeah, right.

Erin: Some would call it neglect.

Dr. Slattery: Right, right, right. Drinking from the garden hose and, like, being home alone for hours on end.

Erin: I watched three or four hours of TV every day.

Dr. Slattery: Right. Yeah. And see what kind of trouble you could get into without really getting into trouble. And my baby sister was a lot younger, so I don't have a lot of memories of her kind of in her Teenage years. But I would, I like to say that, like, I was the one that was out like, having sex with her boyfriends, which gave my mom a small heart attack. My other sister was the one who was like smoking pot and drinking. But I mean, we both, we all turned out okay. But I mean, even from when I was younger, I was always like interested in sex and sexuality.

And I don't have to say without like really outing myself. But like, I had a healthy curiosity and would try to find out as much as I could. But it was hard back then. Like there really were not a lot of resources. And honestly, like, I remember finding our neighbors had this garage that you could get into and out of, and it was full of stuff that they stored. And there were like stacks and stacks of Penthouse magazines. And so the whole neighborhood would go in there and kind of look around. And of course that was all naked women and not really naked men.

But like, that was kind of where my curiosity lied. And I always thought I probably would be a doctor. I had like a roundabout, like course through college and then deciding I wanted to go to medical school because it was not initially my plan. But once I got into the thick of being an OB gyn, there was a few things. One, I was getting very tired of being up all night. I can be honest about that.

Erin: I did it for waiting for those babies.

Dr. Slattery: Yes, I did it for 20ish years. And it's a little brutal. It's not great on your body. And I'm always have been someone who needs a little bit more sleep. And I liked the variety of my job, like doing some obstetrics, being in the hospital, operating, being in the office. But being in the office, I think is where I shined. I like to say that, like I had a preschool teacher of. One of my kids used to wear this button around that says, I teach preschool.

What's your superpower? And I used to think, like, I talk to people about like, sex and that's my superpower. And I was trying to find a way that I could be more of an expert in that. And so it kind of led me down the rabbit hole after like some particularly bad calls and just being exhausted all the time and missing out on things my kids were doing that I was like, how do I learn more? Like, there is no fellowship for this and I'm not going back to residency to do something completely different. So it's kind of how I stumbled into the program at Michigan so that I could take my knowledge of sex up a notch and use it in my everyday life, I also had found myself just looking up everything I could about sex as a professional, so that when people would ask me questions, I had an actual good answer for them. Because, honestly, medical school education about sex is a joke. It's one.

Erin: Explain that to me. Yeah, I don't. I mean, is that just, like, a legacy of puritanical values?

Dr. Slattery: I mean, maybe somewhat. Because I feel like our whole society is, like, steeped in that, like, puritanical crap, and then patriarchal, too, where, like, obviously women's sexuality and sexual health and deserving of pleasure is not something that we talk about much, whereas. And girls don't know a lot about their bodies growing up either. Men have, like, an erection hanging off their front and they get, like, morning wood and stuff. And so it's a little bit more in their face. Right.

Erin: They're not subtle?

Dr. Slattery: Yeah, not at all. But no. So even back when I was in training in the early 2000s, I remember, like, all of the lectures about all the stuff you need to know to not kill people. Right? Like, how do you deal with someone who's hemorrhaging and pregnant and when do you deliver someone early, and what happens when someone might have cancer and you have to take them to the operating room, or how do you operate in an emergency with ovarian torsion. And all of that stuff is really important. And in a surgical subspecialty, which obstetrics and gynecology is, you need to learn that. And it's the same thing for all the general surgery subspecialties. And the training is really specific to being able to succeed to that, but they just don't talk about sex or sexuality.

Like, we talked all day long about prevention of disease and STIs and how to not get pregnant, and then, honestly, if people didn't want to be pregnant, how to help them with that. But beyond pregnancy and sexually transmitted diseases, there's really nothing about sex. And it's a shame. And I remember that because the minute I got thrown out into clinical practice, I was like, holy hell, these women have, like, pain with sex. And I don't think anybody ever addressed that, like, in a lecture in medical school or residency or in, like, my clinic, because those weren't the kind of things people would come in for, or at least they. I wasn't asking about it as a trainee trying to learn how to, like, see 15 patients in, like, three hours and have to precept with someone who knew all the answers. So it was. It's bad.

But statistically, like this is where my kind of my passion now besides like helping women with their sex lives, really dove into some of the research about medical education in residency and in like med school and it's just abysmal. There's something like less than four hours average period between the two. And that's if you're lucky because most of the subspecialties in medicine don't even have any kind of. They don't have any educational objectives or guidelines that are just being ignored. They don't have them, period. So it's pretty, it's pretty sad. And so my new side mission is to educate up and coming doctors, residents locally, at least for now. I haven't been able to take my show on the road yet, but that and actually existing clinicians, because there are so many nurse practitioners, PAs, midwives, physicians who like can do real harm when they don't know what they're talking about or when their own puritanical views or their own religiously heavy views influence what they are telling people. And they tell people wrong ass shit all the time.

Erin: So what is it that they don't know?

Dr. Slattery: Oh God. Well, first of all, they just don't have the ability to be open and understand that sex is normal, that pleasure is normal, that our bodies, especially women's bodies, like our Clitoris, it's got 10,000 plus nerve endings. It has no other purpose.

Erin: Like a penis is fucking magical. We are, we are magical. It's a miraculous thing.

Dr. Slattery: It totally is. I mean I want to jump up and down and yell at people because men's penis will bring them pleasure, but they also have to urinate through it and they ejaculate through it and it has multifunction kind of like purpose. It's a multipurpose tool. Whereas like our clitoris.

Erin: Swiss army knife, right?

Dr. Slattery: It's the Swiss army knife of the body for men. But vagina owners, people who are born with a clitoris, like we are so lucky because why on earth were we given an organ that has 10,000 nerve endings that is only function is our pleasure. Right. That like we. Why wouldn't we be talking more about sex? Why wouldn't we be paying attention to this? Like clearly our bodies were meant for pleasure. And so.

Erin: Yeah, and maybe pleasure is the way that we get incentivized into getting pregnant.

Dr. Slattery: Right? Well, yes. And though. Right, because like our clitoris is so far from our vaginal opening that like some women struggle with like having an orgasm just from penetration alone. Right. Like lots of women.

Erin: Most women, yeah.

Dr. Slattery: Right, Yeah. I think it's like 10 to 15% of women have orgasms from penetration. And even then it's not reliable.

Erin: Um, yeah, you know, depends on the guy.

Dr. Slattery: Depends on the guy. It depends on, like. Ooh. It depends on, like, where you're on the skill set. Yeah. For me, it depends on, like, what the hell I'm thinking about. Like, if I'm like, oh, God, this is never going to happen, or, oh, shit, I have to do six things for the kids before tomorrow morning. Like, I'm not thinking about it. Right. But if I'm thinking about it or I'm like deep in a fantasy somewhere, like, it'll happen. Yeah.

Erin: Yeah. So interesting. So what do you think? Wires women for being interested in sex versus not interested in sex?

Dr. Slattery: Oh, gosh.

Erin: Because I feel like that changes across our lives.

Dr. Slattery: Oh, it totally does. I mean, especially when we're unmedicated and younger. So by unmedicated I mean, like, if we're not on something that's really going to kill our drive, or as I like to say, our drive, because it's not really a drive. It's kind of like a car with a gas and a brake or a stopper and something that makes you go and something that makes you stop because it's twofold. But yeah, if we're not on like something that's going to kill any biologic part of a sex drive, or we're.

Erin: Not like an SSRI or something else.

Dr. Slattery: Birth control, like, God, oral birth control is like, it's sucky for a number of reasons. One is it can kill any kind of like sexual excitation drive, kind of. That's like a biological inert drive because it stops ovulation, but also because of how it gets broken down in our body after being metabolized through our liver. Yeah. It increases this circulating protein called sex hormone binding globulin. And that will circulate at a higher.

Erin: Level, by the way. Hot name it is.

Dr. Slattery: Yeah. But it does. It binds to sex, sex hormones. So it'll bind to estrogen and it'll bind to testosterone. So your liver pumps out more of it, more of your hormone is circulated, bound to it, and then it's like it's not freely able to be active. Plus we're taking the whole ovulation piece out of it, which is when most of us get super horny.

Right, Right. Yeah. So oral birth control, you'd think it would be freeing to be like, yeah, I can fuck whoever I want, but I'm not actually going to get pregnant. But with time, it can actually kind of be a damper biologically without those things. We definitely have an evolutionary kind of, like, protective mechanism. As women, we are like, we have this hidden kind of ovulation, right? So it's not obvious. We don't go into heat per se, like dogs, right? So it's like we have hidden ovulation. We don't have, like, obvious, what they call estrus.

Like, so we can kind of. It's a safety mechanism, I guess they think, evolutionary biologists think. And so we definitely have times during our menstrual cycle where we're more obviously horny, where our desire seems spontaneous per se, instead of, like, responsive, which it is. But, you know, I think. I honestly think that lack of education, lack of information about it, lack of moms knowing or even growing up in the ability to know that, like, ooh, my body's for pleasure. If your mom wasn't super open with her own sexuality and wasn't talking to you about it, you weren't really learning this stuff at school. The Internet didn't exist back when most of us were younger. We didn't have free ways to find really good information.

Like, everything was censored. So it's kind of hard to. To say for sure why we're wired for this, but we don't know. But I think a lot of it is, like, society. A lot of it is how we were raised and how we're. I don't know, how we're, like, almost groomed by, like, things that we have no control over.

Erin: Mm. Mm. Yeah. And then fast forward to this phase in our lives when our hormones are changing and maybe we've been in long relationships. And what my personal experience was that I was married for 17 years, and for the last 10 years, we did not have sex. And I had come into the marriage a very sexual person and was like, okay, great. This is going to be what our sex life was in the first couple years. I was like, great, this is what I'm signing up for.

This is really what I want. And then gradually through a series of life, interpersonal and biological stuff on the part of my partner and what was going on with him. Like, gradually we just stopped having intimacy and trusting each other and wanting to be vulnerable and being willing to connect in that way. And I sort of said to myself, this is what happens. People get married, they are married for a long time, and then they stop having sex, and then that's just what their life is. They don't. You just don't have a sex life.

Dr. Slattery: Yeah.

Erin: And then of course, when I get divorced, I'm a maniac.

Dr. Slattery: Yeah, good for you. I like, live vicariously through you because that's awesome. But yeah, I mean, it's a real problem. Like, the majority of women I see for counseling when they have problems with their sex lives is one of two things. It's either pain with sex and it's either because, like, they've kind of been through your scenario and then they all of a sudden are sexual again, but they went through menopause during that transition time.

Erin: Right.

Dr. Slattery: And then all of a sudden their vagina is like super dry and it's uncomfortable and they're like, what happened? This didn't used to hurt. Or it's low desire. Like so much like low desire. And it just, it's like almost every person I see. With the small caveat, I've seen a couple of very young women whose bigger problem is like, orgasm or comparing their orgasms to others because of like, social media and I mean, I'm knee deep in a lot of sex stuff online and the media and in the actual, like, academic literature, I have lost track of where people are, like, comparing their orgasms to others. I haven't fallen down that rabbit hole yet, but it's.

Erin: I haven't either. I want to, though.

Dr. Slattery: It's out there though, because I've seen a couple of younger women who are like, like, I don't. I think I'm having an orgasm. I don't know if I am. And it's not that good compared to what other people have because I actually had a patient who I helped her with it because she really wasn't sure. And she came back and she's like, oh, I'm having it now, but it's still not as good as everybody I see online.

Erin: And I'm like, what does that mean in porn?

Dr. Slattery: No, I don't like, it wasn't. She wasn't watching porn. No, I think it's like people on. I don't know if it was TikTok, but somewhere there were girls that she was following or talking on social media that were like, talking about how mind blowing their orgasms are. Well, first of all, good for you if that's real. Like, go out there and get it. Because a lot of women are missing that and have been for a long time. But too, it's like, God, I hate that we're comparing things because it.

The more lousy you feel about your body, your sex life, your body's response to things. Like, it's kind of a vicious cycle. Like, you don't do well if you're. If you've got a negative body image or a negative kind of, like, mindset when it comes to, like, sex.

Erin: There's so much to unpack here, Morgan. Like, first of all, it never occurred to me that there are no models of knowing what it looks like or feels like for women to have orgasms.

Dr. Slattery: Yeah.

Erin: Like, oh, the culture is so focused on male erection and ejaculation and satisfaction.

Dr. Slattery: Yeah.

Erin: And it's like, did you come? It's like, well, I. A, how come you can't tell?

Dr. Slattery: Right?

Erin: And B, like, every woman's orgasm is different.

Dr. Slattery: Yeah.

Erin: So, I mean, that's what I hear from men is like, oh, like, I had a partner who orgasm like this. I had. I love to talk about sex. So when I'm in a sexual relationship with someone, I want to know about all their things and what they know and what they've heard and what they've learned and what they've seen. And I. And it's so interesting that the reporting from the field, from these guys is, oh, yes, some people are quiet and some people, like, kind of sink into themselves and their eyes roll back and some are shaking like maniacs, and some. But I mean, it's so interesting to me that we don't even know what orgasms look like and that there are. There's such a wide range because culturally, who gives a shit, right?

Dr. Slattery: Right? Yeah.

Erin: Like, except that it's so good for us.

Dr. Slattery: It is.

Erin: As your friend Dr. Nan Wise has studied and reported. Like, yeah, it is so good for us. It oxygenates our brains. It makes us. Us younger and more alive, like, and more connected to ourselves and our partners. Like, yes, it's so healthy. It's built in.

It's clearly meant to happen. I'm surprised even to realize that I had never realized that there wasn't like, a. Somebody needs to make maybe this is you a little book that's like the sexy book of orgasms. And it's like. And there's a little button you can press to hear it. And maybe it's like. Or maybe it's like flipbook of videos. How are we going to learn what other people are experiencing and then go, well, is what's going on with me is normal? Like, we don't even know how to talk about it, report on it.

Dr. Slattery: No, we don't. And we make everything kind of like a pathology, too, in the world of sex. Like, it's either you're either it's everything's fine. Or it's like you have some kind of disease or disorder. And we tend to think that there's lots of stuff in the world of sex that's abnormal too, which is, I think, another place where education falls off. Like, people think that things aren't normal. And literally almost everything that our bodies do and that we do with sex is normal. The orgasm spasms one piece of it.

But, like, fetishes are normal as long as you're not hurting yourself or someone else. But people look down their nose at you. If you've got a fetish where you like to come, but you like to do it wearing, like, I don't know, like a strap on something.

Erin: Reindeer antlers.

Dr. Slattery: Right, right, right, right. Like knee socks and fairy wings, whatever it is, whatever. Right. That's not necessarily wrong. As long as you're not inflicting harm on yourself or your partner. Like, it's all. There's so much that's normal. But you're right, the orgasm thing is interesting.

And I've had several women who are afraid to get there. I mean, when I try to explain it to them, what it's like, clearly I only have my own physical experience of it. But a lot of them will tell me. I'm like, it's this tension and it builds and you feel like things are getting really intense. And then I'm like. And then I bet you back off. Because when they're trying to, I give them homework and sometimes I'll have them work on their own orgasm. Go get some toys. Go do this. And they'll--

Erin: I needed to do that. When I came out of my marriage, I had not. I had sort of lost my connection to my orgasm and I had to get it back.

Dr. Slattery: Yeah. Oh, no, you got to get it back.

Erin: Yeah, yeah.

Dr. Slattery: And so when we. When they're out there with these toys and they're like, oh, it's just. It gets really intense. I'm like, but it's going to be amazing. It's not going to hurt you. Like, it's going to feel like it's going to feel so good it's going to blow your mind. You just have to stick with it and not back down. And I've had a couple women come back to me and they're like, oh, yeah, I finally figured that piece of it out because they were almost afraid.

Erin: And sadly, is that about fear of losing control?

Dr. Slattery: And it might also be that they just won, like, their background. They never knew about it. They never knew they could have this kind of pleasure. Especially older women, the younger women know a lot about this stuff, whether they've experienced or not, because they've got the endless like pile of misinformation and information that's out there on the interwebs these days. But the women, like the Gen Xers, the ones who are coming to me going, like, I still want to have sex, my vagina's dry, help me. Those women didn't have the same kind of like education, like formal or not. We just didn't really get that. And if you had a partner for most of your life, like a long term relationship, right.

And it was like not good sex or it was pretty perfunctory. It was like, we do. I take my own clothes off and then you maybe go down on me, but then you just decide to penetrate and then that's the end of it. And I don't think I've ever had an orgasm. Like those women who just get stuck in this rut of like boring, same old stuff and their partner's not looking to pleasure them. Like it's like rewriting a big script to get them to realize, like, yeah, your body will do this and your sex will be better if you do it. And then they sometimes run into the problem where they're like, oh God, I know what this feels like now, and I want to do this, but their partner has no interest. And I'm like, oh, what do you mean no interest? Yeah, I mean, sometimes it's bad.

Sometimes they have a very excited partner and very supportive partner, but sometimes the partners are just as clueless. And when women find their bodies and they find their pleasure and they actually get to that, when their sex isn't like accommodating that, it's hard. I've had a lot of women, when I counsel them, they don't talk to their partner. And if they're having a problem with their orgasm and they overcome that, they still don't want to talk to their partner about what's going on. So sometimes they don't give their partner a chance because they're just like, oh, I'm just. He won't listen to me. But sometimes they do and their partners are like clueless. And then it's like the onus is on her to like completely educate them and like change everything they've been doing forever. It's hard and frustrating for them when they have like these kinds of issues.

Erin: Yeah, yeah. I want to go back a little bit to low libido. This idea of low libido and Low desire. Because I think this really needs to be unpacked.

Dr. Slattery: Oh, God.

Erin: For women. So I have just a lot of questions. Like, when we're saying low libido, what are we comparing it to? Like, how is it measured? Because who's to say what one person's low libido is relative to one person's high libido? Is it in relation to men and what they want or your partner and what your partner wants if you don't sleep with men?

Dr. Slattery: Like this kind of stuff. Yeah, right. Because, like, women who sleep with women have way more orgasms than the rest of. But no, I mean, so stuff that's kind of falls along this diagnosis line. And low libido is kind of a common term. There's a code for it. But what we really use is like hstd. So Hypoactive Sexual Desire Disorder.

And that's usually doesn't. It's really subjective, but it's the person's own complaint. So, like, if you feel like you have no interest in sex and it's been bothering you and existing for about six months or more, whether it's relative to before or you just feel it's a problem, it's a problem. And that's when we give that diagnosis. So fortunately, we're not in this case comparing it to men or anyone else. It's your own. It's your own sensation or your own feeling or being bothered by that low.

Erin: Desire or bothered by it because your partner's bothered by it.

Dr. Slattery: Right.

Erin: Because it's impacting the dynamic in the relationship.

Dr. Slattery: Yeah.

Erin: And then is it your responsibility or people like you to convince women who don't care about sex to take steps to increase their libido? Like, because I had just have heard over and over again, like, I am doing a podcast where I talk about sex all the time in midlife because it's interesting to me and I like it and it's been a. A rebirth for me and I want it for people if they want it.

Dr. Slattery: Yeah.

Erin: But so many women like I was could tell you, eh, take it or leave it. My life doesn't really have space for that. Why should I care about that? That doesn't really matter.

Dr. Slattery: God and kids and our careers and like, parenting and like the 80 million hats that we wear.

Erin: Domestic fucking labor misery.

Dr. Slattery: It's so hard. Like, when we get to be in our 40s, we're like, usually we're like pretty experts in our careers. We're pretty productive. Most of us are like parenting kids that aren't necessarily babies anymore, but still need parenting. So the craziness of everything we're doing does get in the way of it. And so some women are like, eh, I don't miss it. But some of them are. And what I find is when I bring it up, whether it's just in my regular, like, gynecology practice or to the women that kind of seek me out, like, if the more they think about it, the more they realize I am missing this and it matters.

A lot of them, some of them don't. And when they don't, that's okay. Everything's a spectrum in sexuality. Like, literally everything. Like romantic attraction, who will partner with who, we'll have sex with, who we love, how we love, you know, gender orientation, sexual orientation, all that stuff's a big spectrum. And there are people who are asexual or who are closer to asexual or demisexual, kind of where it takes a lot to be interested. But then there are people who. I have a friend who, like, he.

He's great, great friend of mine, but I think he'd pretty much have sex with anyone very openly, very kindly, like, doesn't matter. Male, female, and.

Erin: And that's pan-everything.

Dr. Slattery: The other end, right? Like, that's the other end of this where it's like, sex is just sex and I love it and I don't care who you are for the most part. Like, I want to do it. So it kind of again, depends on where that woman is. But man, we get snowed by, like midlife, by parenting, by careers, by the hustle and bustle of, like, running kids to travel, sports and trying to, like, I don't know, maybe get to the gym, maybe sleep, walk a dog. Like, it's easy for sex.

Erin: See a friend, have a phone call. Like, yeah, yeah.

Dr. Slattery: So it's easy for it to fall behind. But when women kind of wake up a little because you either bring it up and most doctors don't. Like, there's a recent study that showed that, like, women wanted their doctors to ask them about it whether they had problems or not. And only, like. Like less than a third of people will. Even physicians or clinicians will even bring it up in the exam room, which is stupid. It's just especially for, like, gynecologists, neurologists. Like, that's what we do.

Dr. Slattery: That's where we're supposed to be experts and we're not.

Erin: So interesting.

Dr. Slattery: Yeah.

Erin: I also think that women get dissociated from their bodies and sexuality in midlife because their bodies change.

Dr. Slattery: Oh, God, yeah, I'm there, and it's horrible. I'm trying with everything I know academically and intellectually and professionally, to not let it kill mine because I've got two teenage girls and they are busy. One of them is going to be a senior in high school, and my husband is busy. And we spent the entire summer in, like, different locations. He was with one, I was with the other. We didn't do anything fun but sit on softball fields, if you can count that as fun.

Erin: And so I wouldn't, but other people might.

Dr. Slattery: I mean, I love watching my kids play, and I don't have much longer with my oldest. But the thing is, like, things are so busy because we still both had to work full time, and then we both had to run people places. And it's like, meanwhile, like, I am squarely in perimenopause. I have never been thin. I was always athletic. I had boobs and kind of a rounder butt and thighs. But I did kind of have a flat abdomen. I haven't really gained weight in the last year, but I had to go up a pants size. I'm, like, so pissed.

Erin: So insulting. Yeah, it is.

Dr. Slattery: And it's killing me. And I know that it is going to kill any sex drive that I. Or drive again in quotes. But, like, that desire, that interest, like, when you're starting to get pissed off about your body and it's hard to undo some of this stuff that happens when our estrogen levels start to fail. Like, it really puts a damper on even a healthy sex life because you really internalize those body changes. It's miserable.

Erin: But we believe that aging makes us unappealing to our partners. We do, but it makes us unknown to ourselves.

Dr. Slattery: Oh, it does. It's like, I don't recognize this body. I barely recognize my white head of hair because I.

Erin: Which is gorgeous, by the way.

Dr. Slattery: I just. I got fed up. I was like, I can't keep coloring my hair anymore. I don't have time to go every three or four weeks. So it took me about 18 months, but I grew it out. And my kids are like, mom, it's him. And I'm like, it's hip for now, but when I'm 55 or 60, it's just going to be like, oh, yeah, you're old. It's hard to start doing it at, like, 45, 46, when I could have done it movement. I could have done it in my mid-30s. I know. But that's what I say to my kids.

Erin: Right? You never would have Though you never would have. Like, it's so. It takes a very certain, I know person to say, this is. I'm cool with my gray and this is going to be how I rock it.

Dr. Slattery: I'm trying to own it, but, man, like, you know how fads are. Like, right now, my daughter's dressing like the 90s, and I'm like, oh. Oh, shit, that's back again. Like, what are you doing?

Erin: Little tiny low rise pants are happening in my house. And it's like, oh, girl, those were never flattering. No.

Dr. Slattery: But then there's part of me that goes, God, if I looked like you guys did when I was a teenager, I would have been all over that. Like, I would have been half naked all the time. Like, show it off.

Erin: I mean, and I live in Los Angeles. Like, people wear nothing. Like, the kids really wear, like, the shortest shorts and the littlest shirts. And like, I grew up in Baltimore, Maryland. Like, yeah, east coast in the 70s and 80s. Like, we did not dress like that. And so it's about, how do we raise young women to embrace their bodies, to embrace their sexuality, and to be comfortable in their own skin and also empowered? I mean, it's so interesting. And this is a pivot to a totally other topic.

But we were talking about this in advance of the call, which is like, how do you raise sex positive daughters? And there's so many role models out there. These young singers who are the most popular performing artists in the world now, like Chapel Roan and Sabrina Carpenter. And these girls talk really frankly about sex and sexuality and what it means to have a casual sexual relationship and guys wanting to call it casual, and, like, they're interrogating all of these things so publicly and frankly. And like, my ex sent me a text like, you need to listen to this song Casual by Chapel Rona. And I said, she's the coolest. And I said, no, actually, our daughter and I have had a conversation about it, and she's aware that the song is a social commentary about the nature of sexual relationships among young people. And I know. He was like, I love it. So psychedelic that I was having that conversation.

Dr. Slattery: I love it because I just actually bought my oldest, the Midwest princess hat. Because our homecoming theme is like, is kind of. They're doing like a army kind of camo thing. And she's like, that's the hat I want. And I'm like, all right. But I said to her the other day, I was like, you know what she's talking about when she goes, I hear you, like, magic I've got a wand and a rabbit. And my daughter's like, yeah, Mom, I know.

Erin: My daughter had to tell me. I was like. Because I hadn't really thought about it. And she was like, oh, my God.

Dr. Slattery: I'm always. My brain is always there. And I'm like, yes.

Erin: Like, yeah, it's amazing.

Dr. Slattery: It is.

Erin: It is amazing. But it's still so hard for them to figure out how to navigate. My son, too. My twins are 13. My son is like, there's a kid in a boy in my school who has a folder of pictures of girls bodies that he's taken without their consent at school. Like, he's taken pictures of them. And that guy is a creep. And that's not cool.

And I love that I have a child, a son, who brought that up with me and just kind of wanted to check it with me to be like, what do you think?

Dr. Slattery: Oh, that's awesome. You know, I mean, what I found in a lot of this, whether it's like, people's relationships with their partners in my office or just in general, it's like, we've got to talk more. And, like, you're doing everything right, like, being able to have an open conversation, having enough of an. Just a basic education so that you're not doing harm. I mean, that's the same premise that I need to take with all of these clinicians who say dumbass things to their patients, like, don't do harm. Well, I had a patient recently who was like, yeah, you know, our sex life was just starting to get better, and things were good. But then my. She had a couple of issues, but then her partner started to have erectile dysfunction problems.

And I was like, did she. Did he see his doctor? And she was like, oh, yeah. But, like, it started after he went on, like, blood pressure medication. And the doctor said, oh, there's no way that's part of it. And I'm like, well, first of all, yes, there is. And how do they not know that if they're prescribing beta blockers? And, like, that's totally wrong. I mean, one. When you have erectile dysfunction, you're a higher risk for, like, cardiovascular disease as a man, because, like, our sexual dysfunction in men goes up as they age.

But erectile dysfunction, because it's a plumbing problem, it is kind of a marker of cardiovascular health. And there's, like, a risk of having a heart attack in three to five years if you are not also paying attention to other stuff going on when you've got erectile dysfunction. But the thing is, like, you're doing the right thing. You're treating the high blood pressure, but there's other things you can use. If this created erectile dysfunction where there was none. Like, don't just tell them that. Oh, no, it couldn't have anything to do with that medication. Or tell women like, yeah, you're having trouble, just go have a glass of wine or try to relax more or what? I mean, it's just, that is stupid stuff. And people get told that all the time.

Erin: Yeah. It's so unfair. It's so unfair that we suffer from the lack of our, the clinicians that we depend on.

Dr. Slattery: Yeah.

Erin: When they don't know enough.

Dr. Slattery: Yeah, yeah. And I hate throwing my whole profession under a bus, but like, you're not, but you're.

Erin: This is the work you're doing. That's why you're called to do it.

Dr. Slattery: There are people out there too. I mean, you probably have, you've talked to Kelly Casperson and I mean, she's a urologist.

Erin: Absolutely. She's been on the show.

Dr. Slattery: And Rachel Rubin, another urologist out there jumping up and down. I'm trying to be one of the OB GYNs out there jumping up and down because again, like, we don't learn this stuff. A lot of us took this on ourselves or spent a lot of extra time trying to do the right thing and also to help people because this is so important to our lives and our happiness is. Like I tell my husband all the time, like, I'm tired of just wearing my mom hat and my wife hat and my, my professional hat, like my doctor hat. Like, I want to be me again. Like, I just want to get back to where I was for who I was when I was younger and somewhat carefree with this middle aged body. Do my best.

Erin: But it's so interesting though, because I think that is what is happening as a generation where we are, we had this era in our 20s when we were free and experimental and kind of said fuck it to the rules and all that stuff. The very Gen X of us. I loved that girl. I didn't have a full time corporate job until I was in my very late twenties because I was freelancing so that I could be an artist and I was traveling whenever I wanted and I was really trying to live my ideal bohemian adult life for what I saw was what I wanted. And then I wanted grownup things and I wanted a career with a capital C. I call it like the capital letter life. Like I wanted a career, I wanted a Family with an F. I wanted.

Erin: Wanted all the adulting stuff. And that for the last 20 years, is what we've been doing as a generation.

Dr. Slattery: Yeah, we have.

Erin: And now as the burdens of parenting lessen or the. Or we make changes in our marital status or whatever, we're going, hey, remember her?

Dr. Slattery: Yeah.

Erin: She was fun.

Dr. Slattery: She was. I miss her. Yeah, yeah, yeah, absolutely. I do, I do. I do miss her. And I mean, I say this all the time. Like, I wouldn't trade my kids for anything in the world. And I love them and I don't want to, like, wish them away or out the door because it's, it goes fast. Like, I've got a 17 year old and a 13 year old and the 17 year old, like, every time she does something now she's like, mom, this is the last time I'm gonna do this.

Erin: I'm like, stop it.

Dr. Slattery: But I love her as a, like a almost fully formed frontal lobe human being who has. Who's becoming kind of an adult. Like, not 100% there, but she turned out okay. And she's kind of navigating the world the best she can. And I think, again, just being open and talking about it. And most of the time she's like, I don't want to talk about this with you again because my husband's a pediatrician. So between the two of us, like, there was no question, like, we couldn't answer. Although he did terf everything sex and genital related to me always, because he's like, well, you trump me, like, more and I--

Erin: Well, you have the parts.

Dr. Slattery: I do, but. Yeah, but, like, keeping an open dialogue. Like, I'm surprised just through osmosis because my kids really, they don't want to talk about it a lot. Or they will ask me something and I'll explain it to them and then they'll be like, okay, that's enough. And they'll walk away. It's hard to strike the balance because like, like when I am with their friends, like, I've had them ask me like a gazillion questions. Like, we were at a softball tournament a couple years ago and we were walking around Target, like, waiting for our afternoon game. And, like, half of the girls were like, what happens when, like, a placenta doesn't come out? Or, like, what happens when you're like, how do you use a tampon the right way? How do you pick the right side?

Erin: Right?

Dr. Slattery: And I could see my daughter just like, she knew the answers. She didn't say anything because she's like, through, like, Osmosis, I think she's learned it's kind of like Otis from, like, Sex Ed, that Netflix series, Sex Education.

Erin: Yeah, yeah, yeah.

Dr. Slattery: Sometimes I call her Otis because she knows, but, like, they're asking me all these questions. And then she was like, God, that was embarrassing. I'm like, do you know how, like, how useful that is? Because if the girls didn't get it, they might not have never known, like, how to pick the right size tampon. And honestly, their moms are always like, if they have any questions, can they call you? And I'm like, hell yeah.

Erin: That's wonderful.

Dr. Slattery: Hell, yes. And I'm in New York, so, I mean, it's good. But I was like, if they need anything, if they get into trouble, like, I'm always here. You can always give them my phone number. And I have had girls text me, like, friends of my daughters or athletes who've played on teams in the past with any of my daughters just to ask me a question. And I'm open to doing that. I wish there were more people out there like that. And I hope I'm not embarrassing my kids by doing it, but I think ultimately I'm not.

Erin: I think, no, because they know that your heart's in the right place. And like, while you. That might feel unconventional to them, they're probably proud of you for knowing what you know and for being as open as you are.

Dr. Slattery: I think so, yeah.

Erin: My little one, they might not ever admit.

Dr. Slattery: No, no. I just. I almost, like, bawled my eyes out the other day because my 13 year old went from like, really kind of writing like a younger kid to they had this assignment, like, 10 things I've always wanted to tell you. And they had to kind of write this thing in the same, like, style of that author. And man, she wrote it to me and she was like, mom. One of them was like, mom, you're beautiful. Like, give yourself some grace. And mom, I'm excited at how hard you fight for things that are important to you and to us and to women.

And I'm like, what? I'm literally like, I was crying. I'm like, I gotta, like, print this out and frame it and, like, hang it up somewhere. Because, like, I mean, that's in the end of the day, like, I'm doing okay, but I want everybody to be able to do this. I want as many kids and adults as possible to, like, start talking about this stuff because it means a lot for your relationships. It means a lot for their health and safety. Because the more you talk about it openly. There's lots of studies that show the less likely girls are to, like, get pregnant, have sex without condoms, like, get a disease. Like, the.

They'll delay first having sex and. And do smarter things about having sex if they have, like, an open dialogue with their parents. And it's like, let give it up, man. We're all having sex. Sex. Like, we're having it. I wish we wanted to have it more. Most of us, but my husband, like, the last time I was at an outdoor concert, it's like a venue, like, 15,000 people.

It was mostly adults. And I said to him, look at this. There's like 15,000 people here. It's sold out. And he's like, yeah. And I'm like, they all have sex. They all have lots of sex. I'm like, that's 15,000 people.

And their relationships are important to them. And he's like, yeah, I know we need to talk about it, but you.

Erin: Get excited about that.

Dr. Slattery: Totally.

Erin: Right? Like, I get excited about that too, because it's such a beautiful part of life. It's so life giving and stress reducing and, like, it's unlike anything else we get to experience.

Dr. Slattery: It brings us pleasure. It helps get us. I mean, Nan likes to talk about this too, but, like, it gets us out of a. Out of our funk. Like, we have a lot of anhedonia. And by that, for people who don't know what we're talking about, like, it's the Eeyore. It's like, oh, bother. Like, this is just how it is.

I send people off sometimes with just the homework assignment to, like, go do the thing you used to do that made you freaking happy when you were 20. And for some women, that's like, hiking again or, like, painting or, like, going to concerts or being involved in, like. Right. I had someone the other day who used to do improv, and she, like, dipped her toe back into it, and she was like, oh, my God. She's like, I actually am, like, starting to feel like I've been asleep for years. And we sex and, like, the joy that we can get into our lives. Joy. The opposite of anhedonia.

The, like, involved excitement and interest in our life. Right. Like, those things play off of each other and they're both really important to, like, live a happy, healthy life.

Erin: Yeah. I so agree. I so agree. Okay. I could talk to you forever.

Dr. Slattery: Oh, I could talk to you forever.

Erin: Should probably go get a drink.

Dr. Slattery: This is. Yeah, next time I'm in California. Yeah.

Erin: Okay, good. Please. But here's my question. For you. What do you want our listeners to know about what their options and choices are about how they handle how they plan for and think about their sexuality and menopause at this stage in their lives?

Dr. Slattery: Yeah, well, I certainly don't want them to write it off. And, and the one thing I tell lots of women, and there are, trust me, it sucks. Medicine these days, we don't make money unless we see lots of people. And most of us work for health systems, so we have to see lots of people. And the key is, like, trying to get into that, like 15 minute visit, the ability to kind of be a human. And if people have needs that you can't meet to bring them back, or if people feel like their needs aren't being met and they're not being heard to find someone. There's lots of providers out there, not all physicians. There's some great NPs and PAs who've been, you know, trained in both menopause and sex or one or the other.

And there are places like the International Society for Women's Sexual Health, which is a scientific, academic kind of organization. It's worldwide, but they have resources on their website and you can find providers who are members. So clearly those docs and apps are interested in women's health. Same thing with the menopause society. There's lots of clinicians. Oh, Mary Claire Haver, who is an ob gyn who speaks the truth a lot about menopause and how to get what you need from your provider. Because she also is like, we don't get taught that stuff either. And we're freaking, like, female parts doctors who have to come out of residency surgically competent, but we don't spend a lot of time doing some of this, like, office based stuff.

She'll tell you that, like, you need to find someone who will listen to you and maybe go in there educated. If you've got an agenda, you want to know why you have no interest, you want to know how to fix it. Bring that up. But like, one of my superpowers, besides, talking about sex is like listening. And I'm like this with my patients too. Like, they know if it's been a week since I've had sex, sometimes I'll let that slip out. Or I had a lady once who was like, your sex life must be amazing. And I'm like, it can be at times. But you didn't ask me about my solo sex life, which is a whole other entity in and of itself, which.

Erin: Is a whole other episode. Yeah, it is. Because solo Sex teaches you what you like and what you don't like and what works for you.

Dr. Slattery: Yeah. So no, so I mean, as patients, be your own best advocate. I know it's hard, but you can seek out from like friends and family members who you can trust, like if they will listen to you or not. And you can find people on the these websites where professional organizations where they've done the extra work. And so your odds of kind of getting the help you need are better because let's face it, like, we are all aging. I say this to everyone. We're essentially all aging at the same rate at the same time. Like even me and my teenagers.

And we only get one kind of go around with this, Right? So like why not live it to the fullest and why not seek help from someone who's going to listen to you and who can help you? Right. Because there's all sorts of stuff we can do, especially in menopause. Like there's lots of good data about use of testosterone in post menopausal women. I love it. It works. It really does. And when your ovary shuts down, why not supplement what's used to be there? So yeah, yeah. So be your own advocate.

Find the people who know and care. It's hard, I think as a patient and it's hard for the clinicians. But there's some of us out here who love this and we're talking about it and I'm going to not only educate the physicians of the world, I'm starting to do some more like community stuff where we're just talking to groups, I'm talking to a group of older people and in a week or so at the Jewish Community center locally so that I can. Yeah, so we can get that information out there. Like I'm, I don't get paid for any of that extra stuff, at least not yet. But like it's important to me. So I'm out here trying to just make it comfortable and easy for people to talk about and find the help they need.

Erin: That's so amazing. Thank you so much for being here, sharing your passion, your mission.

Dr. Slattery: Oh, you're welcome. It was so much fun.

Erin: I'm excited to be an amplifier for you and the message that you're putting out there.

Dr. Slattery: Thanks, Erin. You too.

Erin: So much fun to talk to.

Dr. Slattery: Like the world needs more 40, 50 something women who have a drive and a purpose and like going out there and getting it done and living your best life.

Erin: Indeed. And amen. Thank you so much.

Dr. Slattery: You are so welcome.

Erin: Thanks for listening to Hotter Than Ever. On this podcast, I am here to help you claim and cultivate your pleasure and a positive relationship with your 40 plus body. I am doing that through myself that has been a lifelong mission for me and now I am sharing this with you because honestly the more work I do on myself in this space, the better I feel walking around just in my everyday life. If this conversation helped open your eyes to things you've been trying to avoid about how your body and sexuality are changing in this chapter of your life, please spread the word and tell someone near and dear to you to listen to Hotter Than Ever and to follow us on any and every podcast platform that they are on.

And if you haven't commented on any of our posts on Instagram, start that conversation now and I promise I will respond directly to you within a week. How does that sound? Comment on our posts, drop us a note, let us know if this conversation spoke to you.

Hotter Than Ever is produced by Erica Girard and PodKit Productions. Our associate producer is Melody Carey. Music is by Chris Keating with vocals by Issa Fernandez. I will talk to you next week, hotties.

Do you know how sexy and gorgeous you are in those videos? Fall colors. Jewel tones are really bringing out the color of your eye. It's funny, every time I talk about the seasons, I think, Do we have seasons anymore? I live in Southern California. It's about a hundred degrees here. Like, on any random day in the year, doesn't really matter what season it is. Anyway, I'm delusions about the fall, and you really do look great in those jeans.