The Case:  Cindy is experiencing hormone imbalances, fatigue and a low sex-drive She has consulted with a gynecologist but was dismissed and told it was common for her age She wasn’t willing to accept that she just had to get used to having a low libido so she came to see me Investigation While it is true that hormonal shifts in peri-menopause and menopause can cause a decrease in a woman’s sex drive, there is more to take into consideration. I knew that we had to look a few different avenues to get to the bottom of her health mystery, and find a solution that would reinvigorate her sex life. Shifting Views on Intimacy Susan Bratton is an intimacy expert and an advocate for shifting how we talk about and approach desire, intimacy and passion. She’s a best-selling author and has published 34 books and programs on the subject. She advocates for better experiences not only for those like Cindy, who are experiencing low libido, but for all women.  She does this through her work teaching passionate lovemaking techniques, reframes what communication sounds like in the bedroom, and covers the physical limitations that a woman may be experiencing that can impact enjoyment or pleasure.  Getting the Root Cause of Intimacy Issues Susan says that couples seldom investigate what is causing issues in the bedroom as it relates to the three areas she focuses on (technique, communications, and physical pleasure). Most will find the root cause in our cultural depictions of intimacy derived from our patriarchal society.  When it comes to getting the root of issues with libido or physical arousal for women, it can have to do with the first two categories but sometimes, the issue stems from menopause or peri-menopause, an immune issue, or a hormone issue like hypothyroidism.  Many are unaware of the connection between hormone issues and low libido because they are less likely to list it as a symptom to their doctor. Even if they do, the doctor is unlikely to treat it as a concern.  Switching the Patriarchal Paradigm of Intimacy One of the issues Susan discusses at length in this episode is the challenge women face becoming aroused (and overcoming low libido) in the patriarchal paradigm of what intimacy looks like. She says that the patriarchy has created the male-focused approach to intimacy which centers around intercourse. And, she says, many women go along with it because it’s all they know.  To reframe this paradigm, women need to think of their partner as someone who can help with the healing through the creation of a good relationship including making you feel vital again, focusing on your satisfaction, and connection through orgasm.  The Fatigue and Romance Conundrum When you are dealing with things like fatigue, insomnia, gut issues, or chronic pain - romance may be the last thing on your mind. Mustering up the energy for a kiss might seem like too much effort. However, Susan says orgasms can be very healing. They reboot your nervous system. They send out feel good neurotransmitters and hormones. They are a vascular event so they are like a little workout for your blood system. They improve sleep. And they create a deeper connection or bond with yourself and your partner. So, even if you don’t feel like it, it might be good medicine. However, you may want to take it slow and be patient as you build up desire - especially if you are dealing with a physical issue (like hypothyroidism or hashimoto’s) that has depleted desire or moved intimacy way down on the needs list. Solutions for Vaginal Dryness Vaginal dryness can be one of the reasons women avoid intimacy. This can be caused by a drop in estrogen (likely after the age of 50 because this is what happens during menopause). Or, it could be due to diet. Natural lubrication of the vaginal tissue is created through nitric oxide production. This is supported by a diet rich in leafy greens and vegetables - specifically celery, beets, dill, cabbage, arugula, and romaine. It can be impeded by t