Behind-the-scenes exploration of libido

WILD SESSIONS PODCAST

Behind The Scenes Exploration of Libido

With Olivia Hum

Henrietta: Well, welcome Olivia, it's such a pleasure to have a conversation with you today, your reputation goes before you, I've heard some incredible things from you, professionally, and so it's a real pleasure to be able to have this opportunity to talk to you and particularly around an area that I know that you are both passionate and very experienced in, which is sexual health and wellbeing, and we're going to zone in a little bit more on libido and unpick that a little bit more. So, just give us a little introduction into who you are Olivia and, and how you landed where you've landed.

Olivia: So my name is Olivia Hum, I'm a GP, and I work in Lewes, and I've been a GP for about 16, 17 years. And I've always really specialized in women's health, but have also used to work at the sexual health clinic in Brighton. And, when I arrived in Lewes I realized that there was no sexual health service there at all for young people. So, if you work in a city, you get all the facilities, but if you're in a rural area, then it's as if they, you know, teenagers don't have sex in rural areas, so there's absolutely no services for them

Henrietta: There's little else to do in rural areas isn't there

Olivia: Nothing else to do I mean, it makes, it makes contact tracing a lot easier, but, um, and so I set up a service there called the Circle Room about 12 years ago and it did really well and, we are still going strong, so 12 years on and it's a sort of drop-in open access, and young people come from all over Sussex to come along and see us. And we see a real wide range of issues from contraception and sexual health, but also what we call sexual dysfunction. So other issues with sex in young people. And then about five or six years ago I started becoming a lot more interested in menopause as well, so I'm now one of a very small number of British Menopause Society menopause specialists. And I do a lot of menopause within my NHS work, but I also run a clinic called Women's Health Sussex, where we see women of all different ages with lots of issues with hormones, mostly perimenopause and menopause, but, sex and libido is a really important topic, it's a topic that we don't know very much about as GPs. It's a topic that women often don't want to talk about, and it's an off topic that doctors often don't ask about and that's why it's so important.

Henrietta: So do you find that the, the conversations that you're having with that sort of more adolescent group and the older perimenopausal, menopausal women is very different in nature? Is it for the perimenopause, menopause group of women. Are the concerns very different to those in the more adolescent group? Or are there any threads that are the same?

Olivia: I suppose what is similar is that sex is a really important part of people's lives, and it is something that helps relationships function, it's something that brings people a lot of pleasure. And the converse of that is when it's not going well, and when you are suffering with a problem, it's actually very difficult because there's not much help available, and it's very difficult to talk about. So I think that thread runs through all age groups, but definitely the problems that I see and the things that influence libido are different from different ages, I think. Some of the things like stress are common to all age groups, but there are specific issues that arise in teenagers, and there are specific issues that arise in women in midlife, in older women as well. And the other thing is I've got women in their seventies who are deeply distressed at the lack of their sex life. So it doesn't just sort of finish when you get to 40.

Henrietta: Absolutely not.

Olivia: Yeah.

Henrietta: Which is why this, this conversation is so important. So kind of zoning in a little bit deeper into libido and what that means. What are the main influences that affect our libido in that age scale from adolescents up to the older years?

Olivia: There are absolutely huge number of influences to libido both for male and female. Um, and I think the first thing, the most important thing is, is stress I've got a brilliant photo that I use when I'm doing talks of sort of male and female libido and it sort of represents female libido as this really complex machine with loads of like buttons and bells and whistles and little lights that go on and off. And the male libido is just a big on off switch. And it's just, it's very, and definitely what I observe in my clinics is that male libido is often a lot less affected by external factors than female libido. And especially for the perimenopausal women I see. I mean, you know, I'm a woman in my forties, we're all juggling a million different things, whether it's children or work or elderly parents. We're often in relationships that have been quite long, you know, we've been in a relationship for 20, 30 years, um and there's all sorts of things then that affect that, and that sort of feeds into then the perimenopause and the body changes in the way that you feel about yourself. In younger women, what's been really interesting, in the 12 years I've been working in this field has been the influence of social media and the effect of body image and the effect of pornography. And that is definitely something which affects younger people, both men and women a lot more than the older women that I see.

Henrietta: So with that, would you say, would it be fair to say that body image and the psychological aspects that go with physical vulnerability and body image and shame is more common in this sort of adolescent conversation, because of social media because of what they're exposed to?

Olivia: I think body image comes into every age group, because with perimenopausal women, it's often this feeling of getting older you're possibly your body is changing. You're possibly gaining weight, you don't feel like you used to. Often it's because you haven't slept, you feel anxious. All of these things are feeding into making you feel really unsexy and really losing your confidence. It's loss of confidence is something that comes through a lot of loss of confidence in your body. Um, and especially after you know, for people who've been through childbirth has had traumatic childbirth, there's all sorts of things that feed into that. With younger women it's really interesting as I've seen social media evolve and the effect of things like Instagram and these really stylized idealized images of what female bodies are supposed to look like, which makes a lot of women, not only feel very unconfident, but also feel somehow I think that their own bodies are somehow dirty or imperfect. So, a real issue that we saw, especially a few years ago when this became a big thing, was, women worried about the appearance of their genitals. And again, you know, I'm 47. I can absolutely tell you that in our, my teens and twenties, it never even occurred to me to worry what I looked like, but the provation of porn and the fact that so many, most, you know, young people now have seen porn and it's so easily available. And women in porn do not look like real women, often. They've had operations to make their genitals look prepubescent, they've removed all their hair and women see that young women and they think this is the way I need to look, and then men say that to them. They say, oh, you don't, you look weird, your labia are weird. They're kind of, you're not right, you've got hair, it's disgusting. Um, and that is definitely something after, you know, 20 years I've been examining women and you really can see the change in how women feel about their own genitals, um and how women look after them, and it's something that's really changed and it's pretty damaging to having a healthy sex life, when you feel that you're unclean and that you somehow look odd.

Henrietta: Absolutely, and I can imagine why it's even more important for you to be holding your Circles, because then it's an opportunity for young women to be able to talk about that safely, as well, in a space where they might not want to talk to their friends about it, they might feel that they're the only person that's experiencing it. It can feel like a very private and shameful conversation. I think for me libido is a perfect illustration of how incredibly complex and sophisticated our body is and how we are as, as living beings influenced by so many different factors, the biological factors the psychological factors, social factors. So, obviously we've got our biological drive, that drives a lot of libido, which I would like to speak about as well, but you've already mentioned a psychological factor and that is stress. Can we talk about how on a biochemical level, how stress affects our libido, or our sexual drive and our sexual ability?

Olivia: So in the perimenopause, for instance what we are seeing is that people's hormone levels are beginning to really fluctuate. And there are these two major hormones that affect this, which is your oestrogen and your progesterone, which go up and down during the month. And what I notice with women in the perimenopause is that even if their periods are regular, they start becoming much more sensitive to these hormonal fluctuations. And there definitely seems to be some relationship between oestrogen and your stress chemicals, so adrenaline and cortisol. And what I find is that when women's oestrogen levels start to drop, it's exactly like the people that I see with anxiety, you suddenly get this release of adrenaline and cortisol, which sort of heighten all your body symptoms. So often people will come in going. "I just feel like I can't take a full breath in, or my heart races or I lie down at night, I get palpitations, I feel really keyed up, my stomach's churning". These are all physical symptoms that are caused by adrenaline. And often when we add back oestrogen in either through using so sort of supplements or by using HRT or the other ways of regulating your hormones, people start feeling much better again, it boosts your serotonin, which is your sort of calm, happy hormone. But the thing is when you're feeling anxious and stressed, the biological reason for this is to enable you to run away from danger, so that's what it's there for. And when you're running away from danger, you don't need to feel sexual desire, that's not part of what is involved and what happens with our incredibly stressful modern lives, is I think a lot of us have gotten to this situation where every day is quite stressful, we're really busy, our adrenaline level is constantly high, our cortisol level is constantly high. And I think that just sort of dampens down your desire, your feeling of wanting to have sex, of being attracted to your partner. And for a lot of women, I talk to them and they say, "really, it's at the end of a long list of things to do".

Henrietta: Including a good night’s sleep!

Olivia: Exactly, including sleep. It's just the last thing that I want to be doing, there is so much else going on in my life.

Henrietta: I think that's a really wonderful way of seeing how incredibly clever the body is, still. And we're primarily, still primarily wired to be able to survive against a threat, against stress. And when it is that very chronic exposure to stress, it becomes a kind of a chronic threat to the body, so it switches into that constant state of down-regulating the things that are not seen as key for survival, so sexual desire and reproduction say, and how difficult it is to override that, you know, it's such a strong… that biological influence is so incredibly strong and that weave between our biology and our psychological perception of, of what is, what is stressful. And so, if there were some tips as it were to reduce stress in a woman's life, what would you say from your experience in clinic have been the most effective ways of reducing stress and therefore having a positive impact on sexual drive?

Olivia: And that's difficult isn't it? Because it's always difficult to even get time to think about reducing stress, but it is so important. I think part of it firstly, also is to look at other lifestyle factors, so we know that for instance, things like smoking, we know alcohol decreases your serotonin level, it increases your level of adrenaline and cortisol. So a lot of the women I see are stressed, so they're having a glass of wine every night to release their stress, which then makes them wake up, it drops your serotonin level the next day, they wake up feeling anxious, so they have a glass of wine that night and it kind of goes on in that cycle. And then as you mentioned, sleep, which is so important, and it's so important. We know that screens for instance have really impacted on sleep, taking your screen into the bedroom, scrolling through Instagram in the middle of the night. We're all guilty of doing that, but sleep for me when I'm seeing, especially perimenopausal women, sleep is the big thing. If you can get more sleep and we work really hard at trying to do that, often then you will find that you can cope better with the stress. But then the other things are just the things that I'm sure, you know, Iwe all tell our clients who have anyone who's working in any kind of health-related area and that's exercise. And so, and again, not stressful exercise. A lot of people I see are like, "yes, and I'm doing, you know, hit classes seven times a week". And I don't, you know, this is not going to make you any less stressed. So, yoga, amazing. If you look at what yoga does to your stress chemicals in terms of the conduction of messages to your brain. It's absolutely fantastic. Yoga, pilates, relaxation, going for walks. Mindfulness, a lot of my clients find really, really useful. Just trying to sit and think and just sort of trying to do things to reduce just this level of constant stress in your life .

Henrietta: And I think also, you know things like that, that we might not think to do for exercise and literally dancing. Just sticking some music on at home and dancing, and I think that's a really kind of liberating, joyful thing to do anyway. And we know that also that helps with circulation, particularly circulation to the pelvic area as well. So, I absolutely agree. It's one of the first things that when we're talking to clients through our nutritional service at Wild Nutrition, we're often talking about exercise and other lifestyle factors that go obviously with, with improving hormonal equilibrium, hormonal balance, um, but also the psychological factors that affect those as well. And also, we talk about the adrenal glands being very important for testosterone production as well, and I wonder if we can talk about testosterone and that natural decline that we experience. And it's not just linked to menopause, is it?

Olivia: And this is a really interesting area, isn't it? Because there's absolutely huge amounts about testosterone on social media. Um, so it's been a really big cause of concern of a lot of women. So a lot of women are coming to see me to talk about it. And the thing with testosterone is that the link between testosterone and libido, especially, and the energy is not totally clear. So a lot of people will come to me, they're like, "I'm really stressed. I've got absolutely loads going on in my life. I'd like to have some testosterone to see if it makes it all better". I think because there's so much of it on social media now, people are seeing it as this sort of elixer of like, I'm going to have this and everything will immediately get better. Testosterone does go down, but how much that affects women is difficult to say. So some of the women I see will have, be absolutely exhausted and have no libido at all, and their testosterone level is completely normal, and other women will have absolutely no testosterone at all and feel completely brilliant. So it's very difficult to correlate the actual level in the blood with the, how people feel. And so I very much go on, not on blood tests, I go on symptoms and how people feel. There are some women, however, who feel absolutely fantastic when you replace their testosterone. So probably I'd say in the women I prescribe it to, about 10 or 20% feel really brilliant on it, and it's the missing link in their hormones. It's the thing that just makes them get energy back, their sleep back, it makes them feel much, much better, but for a lot of women actually quite disappointed, they take it and they're like, “oh…”

Henrietta: I just want my money back actually.

Olivia: Really? How am I actually, it's really not that great. You know? So, it's um because exactly as you've said, there are so many other things that influence energy levels and libido, it's difficult to pinpoint to just one thing, but for some women, it is life-changing absolutely.

Henrietta: I find that, and I don't know if that you echo this from your experience in clinic, but from the women that I was seeing, particularly around that perimenopausal stage coming and saying, one of the things that's happened is my libido and my sexual drive has, has really decreased. And actually when you investigate that a little bit further, their libido has been dropping from a very much earlier than the menopause. The menopause tends to cop or perimenopause tends to cop the blame for a lot of things that are declining, an inability to be able to cope with stress and inability to be able to, and my sex drive is going and feeling overwhelmed, increased anxiety, and there are some very, very clear as you've already mentioned, some very clear biological, biochemical influences that are causing that. But I think we also need to take into consideration, the years of wear and tear that we've gone through, you would be naturally feeling like that anyway. Anxious, overwhelmed, not sleeping so well, from simply from your body having been exposed to the level of demand that we have been put under for years, and for many women that starts when they start to have a family.

Olivia: I completely agree with you, you're absolutely right, and if you think of what our natural life expectancy is about 45, really? So 200 years ago we would have been done and dusted.

Henrietta: I would have been gone by now.

Olivia: Yeah, absolutely. we'd have all have died in childbirth. That was the joy, the joy of what would have happened to us. But I think you're absolutely right, is that we are, we put so many demands on ourselves, and I think one thing that I observed and I'm sure you do with your clients, is this essential people feel "I must cope, I must be a coper". And that I'm asking for help is somehow bad because it means you're not coping, and sort of looking around and going everyone else is coping apart from me. But actually with taking on so much 30 or 40 years ago, women of our age probably wouldn't have been working, and they definitely wouldn't have been working the hours that some of us are. They would not have been as involved in their children's lives, I mean, when you have children, you really do have to be there for every this and that and make the Christmas decoration out of a bottle and do all of that kind of stuff. I talked to my mom and she's like, “oh God, I never did any of that, we never had to”, like, you know, "we just sent you off to school, and then we just forgot about...

Henrietta: Hope for the best!

Olivia: you until the end of the day”, yeah it was all like that. Or, you know, even in your 50s, the children would've been outside playing, you know, you wouldn't have been there micromanaging their lives and taking them to 15 after school activities. But then there's also the fact that because we're having children older we've also got elderly parents coming into the equation, so a lot of the women I see are actually part of what we call the sandwich generation. They've got ,still got dependent children at home and children remain dependent for a lot longer now, you know, a lot of them still have 25 year-olds living at home. But then they've also got a mum who's falling over twice a week and they have to go up and get phone calls in the middle of the night and sort them out. So, they are just sort of carrying all this stuff. And what I always say to women is what you're telling me is you're looking after everyone and who's looking after you? And often that's when the tissues come out and everyone starts crying and it is it's so that! I think there's so much people are carrying.

Henrietta: And I think it's ,it's Uh, you know, if we look back in history, culturally, there were always communities of women that would come together and, you know, they're, they're saying that it takes a village to raise a child. You know, there was that community spirit, there was that support network, which is, there is this sense that I've experienced, both actually personally, as a, as a woman, but also working with women in women's health. There is that sense of women feeling that they're doing it on their own. They need to do it on their own. And there is, that can be a slightly more masculine edge of competition as well between women and who's doing it better. So I think it's so important for us to be having very honest conversations about how we're feeling and it's a very natural stage to get to once your children are a little bit older to get to a point of recalibration, really, sometimes that can sometimes coincide with going through the menopause or approaching menopause, is why you start to think, well actually, what about me? Where am I in this equation? Where is my health, my balance? And questioning it in a really healthy way of, what can I do to feed back into me? What can I do to turn inwards and improve my own experience of my life? I think that's a really healthy place to be in, and quite often that can coincide with going through the menopause as well.

Olivia: I think that what's so good is that now people have started, as you know obviously, it's only really been the last year that people have really started talking about menopause and that is a really sort of good aspect of that. But the other thing I think we mustn't forget is partners in this equation. You know because, actually I think for a lot of men who, or women, female partners, or male partners who love the woman in their life who's going through the perimenopause. It's actually a really distressing and scary time, you watch the person you love change and lose their confidence and become unhappy. And you don't know what to do about it. So a lot of the women I see, appointments have been organized, but you know, their partner, who's just saying, I've got, I can't see you like this anymore. I've got to do something. And so it's really important, the other thing is just trying to reconnect, because often after you've had a long bit of child rearing, which quite frankly puts a strain on any relationship. And then you get to the point where you're sort of, your children are a bit older, but then your body starts changing and you start feeling knackered and anxious and unconfident. And so it just putting off and again, your relationship with your partner comes way down that list of priorities. So somehow putting that into a priority again, it's very difficult to rekindle libido if you actually feel that you've lost that essential connection with your partner.

Henrietta: Absolutely, and I think, you know, uh, sexual, sexual activity and libido maybe represents something different as we grow older as well, from that kind of more lustful drive, and essentially biologically to reproduce as well for some women it's that, that sexual drive. And then that deeper need for intimacy and connection, that doesn't change. That doesn't change whether you're in your nineties or you're in your forties. And that's how to reframe, I believe, sexual activity. It's actually, it's, it's an opportunity for that more intimate, deeper connection between two people.

Olivia: Yeah. Yeah, absolutely I agree, absolutely! And people say to me is it's not often the sex they miss, it's the intimacy. It's exactly that, it's that connection. I always say, I think sex papers over quite a lot of cracks in a relationship. You know, it's quite hard to keep a longterm relationship going, and keeping that intimacy going is just so important for longevity, I think.

Henrietta: Especially if you have a, a lifestyle where quite often partners can feel like passing ships, where everybody's busy and doing their own thing, and then actually it's, it's so important to find those opportunities to connect on that level, and to prioritize that. And so we've already touched on some of the elements. So we've touched on exercise and how important that is. We've touched on managing stress. Everybody's very individual in how they manage their stress, whether that's being in nature, or, it's going out with friends. But managing techniques that resonate with you to manage your stress levels. And then obviously with my professional hat on as well there are some dietary changes and supplement changes as well, that can really add benefit to this conversation, particularly, you know, ensuring that you're getting enough zinc rich foods, protein rich foods. There are phytoestrogen rich foods like pulses as well, which we know have a significant effect on balancing those fluctuating hormone levels particularly around that perimenopausal menopausal stage of life. Things like gut health for example. Incredibly important supporting the body's own production of those hormones and clearance of the hormones that it doesn't need as well. Um, and that's at any age, whether in adolescents or all the way through to the end of our life, those things are really important. If you could pick three things that you would love every person who's listening to this to take away to support their kind of sexual wellbeing and libido, what would those be?

Olivia: That's a really interesting question. I think, one would be trying to carve out some time for yourself to just think about what it is that you can do to reduce your stress levels and to try and keep yourself healthy. And I think the second would be what we were talking about, maintaining a connection with your partner. However it can be… prioritizing time between you, remembering that if you want the relationship to continue for a long time, I think you can't have libido without having a connection, without having that psychological connection, as well as your physical connection. The other thing that we haven't touched on actually is pain, is pain and discomfort during sex, which is a huge thing for women in the menopause and the perimenopause, and which often kills your libido dead. Because if sex is painful, then you're not going to want to have sex however much you fancy your partner. And that I would say, please, please go and seek help for that. It is really easy to treat dryness, pain, itching. It's not been something that's historically been well-treated in the past. I see a lot of women who've been really suffering with it for years and it is so treatable. So please, please go and see a sympathetic GP or even a practice nurse and talk to them about it.

Henrietta: Thank you for bringing that up actually, because it's one of the points that I wanted to discuss and have neglected to. So thank you very much for bringing that up. Because also, I think it's important to widen the meaning of what, what we're talking about by sexual connection and libido. It's about touch it's about intimacy, and as you've just said about carving out space, it's not necessarily, carve out an hour twice a week for you to have sex. It's not as simplistic as that, it's about the small moments of connection. Intimacy, I mean, I love the saying that intimacy is, in-to-me-you-see, as in it's that time where you as partners can really be with one another and say how are you? And connect. And then what comes from that comes from that. If that happens to end up being a wonderful sexual experience, then great. But it's, it's so much wider than that, isn't it, intimacy?

Olivia: Yeah.

Henrietta: And that's a really important point to bring in, particularly if there are physical barriers to having sexual intercourse, as a start. Olivia, you've shared some incredible pearls of wisdom, and I know that you could share so much more and there is so much that you can offer women going through any form of needing sexual health support or hormonal support. Can you tell us a little bit more about where people can find you and what services you offer?

Olivia: So, I'm on www.womenshealthsussex.com. There are two of us, there's me and Dr. Rebecca Walker, who's just joined me. And I work at the Nuffield in Haywards Heath and at the Hove Therapy Rooms in Hove. And Dr. Walker also does the same as me, but she also specializes in migraine, which is another really important thing that we see a lot of in women, especially in perimenopause. And so if you just get onto our website, give me an email. I can often give a letter. Especially, often people email and go, "is it worth me seeing you?" And I'm very honest. And if I think that actually you need to go somewhere else, I will tell you. And the other thing is, I just say to people, although I run a private service, I'd also really encourage people to try their GPs first. I'm an NHS GP at heart, I hate charging people for this. I am working really hard to try and get this service set up as an NHS service as well, so that's all sort of going on behind the scenes. But try the GP. I always say that my tips for that I'll ask the receptionist, they will always know, usually because they've consulted them themselves. They'll always know who the best GP is who deals with women's health. And try and book an appointment in advance if you can, using things like e-consult is really, really helpful. Some people have a terrible experience with their GPs, I know, but there are a lot of really good ones out there, so, really try and get through to them first. But obviously I'm there if anyone needs me.

Henrietta: And everything that you're doing, and I know there are a cluster of other women or GPs doing the same, have been increasing awareness around menopause in the NHS. So, thank you for all the work that you're doing there as well to increase awareness, because I think it gives license for more women to go in and actually speak to it, feel that they are being listened to and heard and will receive the information that they need. Do you also offer virtual consultations as well?

Olivia: Yeah absolutely, yeah , people not in Sussex. I've got patients all over the place, I've got patients in Wales and Manchester and all over the West Country. So yeah. So people do, we do lots of online appointments. Um I prefer face-to-face if we can, but we obviously still, we can see everyone, but we do offer a face-to-face, well for anyone who's local. But yeah, absolutely, we do a lot of online appointments too. We can send medication very quickly overnight, if it's needed. If people don't want medication, we want to talk about a more natural route instead of using supplements and other things, then we can do that as well. So, we've covered a really broad range of what we can offer.

Henrietta: It's one of the reasons why you were just the absolute guest that I wanted to speak to for this, because there is very definitely a very much rooted in Orthodox medicine, but there are some additional, you, you definitely have that view of, of us as holistic beings. We are, we are a melting pot of all many, many different factors and you can't pull one thread without pulling the other, so.

Olivia: You can't, and I think that's where the strength of both of us being GPs come in, because the one thing that GPs do offer is a really holistic service, because we've just got to look at everything. It's not just about your hormones, and it's not just about your vagina. It is about you as a whole woman, and as you said, in your introduction, the biological, the psychological, the social, all the different things that influence your feelings and your symptoms. And it's not just as simple as chucking some medication at you and telling you it's all going to get better. It is much, much more complicated than that.

Henrietta: No quick fix, unfortunately. Um, thank you so much, Olivia, that was a really lovely conversation and I'm sure it's going to offer a lot of support and have been of great interest to many women, certainly to me listening. So thank you so much for sharing all your wisdom and knowledge.

Olivia: Yeah. Excellent. Thank you very much.