#29 | Birth Control and Your Libido: Interview with Ann Konkoly, Certified Nurse Midwife

June 10, 2020

Today, we are having a different kind of conversation--one about how to not get pregnant and yet another on how to rev up that lagging sex drive after having kids. We have Ann Konkoly, Certified Nurse Midwife, on the line to give us the run down on the best available contraceptive options from IUDs to implants to the withdrawal method, as well as sharing her tips on how to boost your libido. Be sure not to miss the questions from our community at the end! You are sure to learn some fun facts from this episode.


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View Episode Transcript

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast.
Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

We're very excited today to have Ann Konkoly from Ohio. She's a certified nurse midwife here today to talk to us about birth control. And thank you for being here. Can you give us a little bit of background information on yourself? Thank you for having me. It's a pleasure to be here and talk with you guys. So I'm a certified nurse midwife and a certified coach. I'm the founder of a company called authentic coaching, where I help women by creating time and space and tools to help them cultivate the change that they want in their lives. As a certified nurse midwife. I've also served as a medical director and in my role, and I've been in healthcare for about 15 years. One of my favorite portions that I do is counseling and most of the time that's around contraceptive counseling, and so use some of the elements of being a coach and being a mentor, and also the shared decision making tools that we use as midwives to happen conversations about contraception with women and really around that idea of what do you want, you know, in terms of your reproductive life, and you know what works for you best. And it's a really good conversation to have with women, but doesn't necessarily center just on contraception, but it's a much larger conversation about, you know, what do you want terms of your reproductive life?

So typically, women have 15 minute appointments with obstetricians about this. What are your conversations? Like? How long do they last? And where does the conversation take you?

Yes, you're correct. I mean, most of our visits are every 15 minutes, sometimes 20, maybe sometimes even a little bit longer and minor, really no different. To be very honest. Part of the conversation usually centers around the reason that someone's coming to me, right, and maybe for some sort of contraception and maybe for something else. But in that once I understand, you know, the need, then we can kind of work through it. But it isn't something that centers around like Okay, well, here's a birth control pill prescription, it usually tends to take on a bigger form, like, do you plan to have children ever? Yes, no, you know, it's like using a decision tree or an algorithm to say, well, do I do I ever plan to have children? Yes, no. Yeah. If yes, then do you have? Do you plan to become pregnant within the next one to five years? Yes, no. Then we go, Well, have you thought about any options or ways that you would like to prevent pregnancy to help you get to that one to five year mark, of where you want to be? Then once I have that information, we can work backwards. And this is the same process I do in coaching, which is like, Where are you now? Where do you want to be? How do we get you a method or a plan that will help you get from point A to point B?

And can I just interrupt you for one second, and I'm curious how, how young Are you starting with women? Are you talking to teenagers about this? Or is it usually women who are getting ready to have getting ready To have a baby or in their reproductive, more in their reproductive time frame.

I think this is a conversation we have, regardless of age. I mean, I think if you're, you know, at a point where you're coming to a midwife, at least to me, you've probably hit a certain threshold of age, you've maybe been referred, if you're on the younger side under 18. Maybe you've been referred from the pediatrician or maybe there's something that's come up with your mom, where you don't necessarily feel comfortable talking to your pediatrician or you don't quite want to talk to your mom, but you need a little bit more. And so the conversation start early. And I think that's appropriate. And that continues through lifespan for a lot of women are up until they reach a natural age of menopause or the age that their bodies begin to go through, you know, pretty much a positive event.

Yes. So you mentioned the term Lark in the beginning of the conversation, can you explain what that means to our listeners, and then start to give us some examples of what you would bring up We would start with the conversation around yeah larks are long acting reversible contraceptives and it's a blanket term umbrella term for methods that are long term and that can be put in place they can be removed and they're not permanent. So larks include intrauterine devices.  Yes, those are all the copper IUD the pair which is Paraguard and Catalina so you have a couple of different options works for IUDs. In addition to the IUD is you also have methods like next block, which is a contraceptive implant or a small single rod that is inserted under the skin and can go for anywhere from five years roughly and based on where you are if you're in the states versus in Europe. These methods have different time frames in terms of when they can stay in, how long they're effective and when they are recommended to be removed. So but larks are a great method and it's interesting in that Trisha, I don't know, you know your experience, but mine has been that when I first started in practice roughly 15 Well, roughly about 12 years ago at this point, I we didn't start conversations off with larks, it was much more of a discussion about pills, or maybe it was, you know, it was probably bring up maybe even the ring I don't even know I think the ring was out at that point. And this is back when the patch was out. And and so it was a little bit more of a limited conversation meaning if somebody wanted to come in and talk about it, you know, we had a couple of options. We really though, even though their IUDs were out, they were available. They were not used nearly as often now, then as they are now that's why I was really curious about it. The younger age group because in my experience, it was pretty much anyone prior to having a baby was thinking about the birth control pill. And then maybe after they had a child, they were thinking about an IUD or something or something else. But I think the conversation today is really different. And the conversation needs to start at a younger age about the longer term reversible contraceptives that you're going to explain to us.

Yeah, and I think the key is that if you have women who are just beginning to become sexually active and they want something, you know, their, their, their teens, they, in addition to pretty much every other woman out there deserves to have the most effective method and I one thing that I commonly discuss with patients is this idea of, you know, when I used to, when I used to do counseling, I was always talking about, you know, pills or numbering or whatever. And we've we've shifted now in part Because the reality is that when you have to think about it, like, we know that once we remove the daily issue of taking it remembering it, oh, what do I forgot it. So now I gotta double up on pills. If we remove that whole piece, we increase the ability of the method to work to help you prevent pregnancy bait, you know, based on what you want. So I know that we've totally shifted, I think, you know, in terms of the way that we do counseling, and I think that's, that's appropriate.

So what would the scenario be for a woman let's say you have a 25 year old woman who is in a long term committed relationship comes to you for contraceptive counseling. She doesn't want to have a baby right now because she's in her career and in a new relationship or whatever. And she's, you know, thinking maybe in her mid to late 30s, she'll have children. Tell us how the conversation will go.

So I think the important part that you mentioned was that she doesn't want children right now. So let's get you. So if you say, Well, yeah, I'm in my mid 20s. But I really, you know, don't want to consider having children until I'm 30. Great. So you've got about five years that you would like to effectively prevent pregnancy. Let's figure out what methods are available. And honestly, I'd start with a five year method. Now we always have a conversation about what's your past medical history? Are there reasons are there really few reasons to be honest that you couldn't use hormonal IUD like a marina or a kylene are Skyla berry very few reasons to be honest, and really not really many reasons that you couldn't use a paragard of hormone free IUD, but we would review past medical history and then decide, okay, well, if you want a five year gap, and the Cadillac option is in essence, an IUD because it's so Good at providing pregnancy meaning that in the first year of use, there's less than six out of 1000 women will get pregnant when they use this information by Marina. but less than six out of 1000 in the first year of use will get pregnant. And then that's your one and then years two through five, we're seeing that that rate actually drops down to less than two out of 1000, roughly. So I mean, those are good numbers. So we're talking about a way to get you from age 25. And barring that your past medical history says that you can use you know, a marina, let's say, and I would say if you want to get five years and you want to have the best method, then this is the way that you do it. And it's a once and done one visit. It's a one and once and done come in it is inserted. It's in there for five years. If In the meantime, that you decide that you plans change, you you know two years from now you say take it out, I will I'm ready to you know, try having a baby one Come in, we pull it, you're done, you know return to fertility as quick.

Is that method hormonal? marinas hormonal? What do you say to all the women who don't want to have anything hormonal?

I, you know, that is a very personal choice. And we can have a long, you know, a lot of conversations about, you know, the drawbacks, the positives and the negatives around hormones. And Rena is not only FDA approved for prevention of pregnancy, but it's also FDA approved for treatment of heavy menstrual bleeding. It's appropriate to have a conversation about what these are heart, there are some hormones that can assist you that can decrease the amount of bleeding that you have, thus reducing the number of pads that you go through the number of times that you bleed through your pants. So the there are, you know, women, some women will say I prefer not to have hormones, and that's absolutely, you know, up to their individual choice.

I think it's important to mention too, there's a difference with the hormones from an IUD versus hormones from a contraceptive pill, and that the IUD hormones are acting locally. And you're not taking the hormones orally, which has a much stronger impact because they have to be metabolized through the liver and processed differently. So that was always part of my counseling for women that, you know, this hormone effect is quite different than what your might just be thinking in terms of, Oh, I don't want hormones, we're really talking about just working locally in the uterus.

That's interesting. I didn't know that. But if you do have a client who does not want hormones, what would you say beyond that?

So if the next step is to say yes, I would like a method that will help me that's very effective. I declined to have her I don't want to have hormones. Then I would say the next step is the paraguard, which is a wonderful IUD. It's a copper IUD. It's good for 10 years. We see that sometimes there's some data to say that women in the first year of use of a paraguard will experience heavier menstrual bleeding, and then at the year mark, it's, it is reported as not as bad. And we don't really know if at the your mark women have just adjusted to the change in amount of their menstrual bleeding at that point, or if it truly has, there's been an actual an appreciable change and amount of bleeding. But paraguard is a great method. It's uh, you know, it's again, it's a simple, it's a simple procedure that is done in the office, just like Marina and all the hormonal IUDs takes a couple of minutes to put in. And, you know, there's not much to it. I mean, that's the beauty.

Plus it doesn't impact your population, which is great if you are somebody who is influenced by the mood changes of population or it influences your sex drive. I think that's really important point.

It's they they actually don't get their period again for a while or they don't oscillate again for a while, even after they come off of it.

Not necessarily usually I mean, especially with pills. Because it's the acting life of a birth, the hormone doses in a birth control pill doesn't isn't lasting much beyond 20 maybe 48 hours right which is why with with a combined hormonal birth control meaning a birth control that has estrogen and progestin, we see that you you really if you miss a dose, you got to double up the next day right because it just doesn't last more than maybe one to two days. Before we can see that those hormones without essentially suppression or an adequate hormone dose, we will start to see that there then the body starts to kick in and that's when you when you can isolate so usually by roughly about seven days, you know, if you take a traditional birth control pill and it is in for you know, there's three weeks of hormone pills, right and then that last week, usually of sugar pills which don't have any hormone in them, but it's a pill that you can take as a reminder to keep on schedule. So usually though within a couple days into the the show pills or that last week, the body will, will have a withdrawal bleed, which is where the hormone levels have dropped off. The body has essentially which is it this is a period, right we call it a period. When we are not on birth control, when we are on birth control pills, it's a withdrawal bleed mean it's a hormone hormonal induced bleed, right? So we withdraw the hormones because you stopped you complete that third week, you go into the fourth week, then within a couple of days, you bleed. So if you don't restart those pills, your natural hormones will start to kick in and you will then have a cycle in which you may be late. But the key is that with after those first couple of days of being off a pill, like it's game on, your hormones are you know, they are essentially coming back they're doing what they're supposed to be doing. So pregnancy is a possibility in that first month, you may be very likely tabulate in that first cycle that you come up with pills, which is another reason we have a conversation often when people say You know, we'll Okay, we want to try next year, should we stop? Should I stop my pills now? And I say no, I say, Look, just keep going literally until the moment you decide. I'm ready now. We will stop when you're ready. Because the reality is, it could be like a boom, I'm pregnant next cycle, which happens. And you know, we don't want you to go through that until you're ready to go through that.

And it only seems when my friends and I are discussing birth control that no one ever feels there's a perfect one out there. What do you see going on?

Well, there's there's probably two pieces to this talk, right? There are women who who have heard from either their grandmas or aunts that IDs are terrible, because the old slogan not your grandmother's on you. This is not your grandmother's. Yes, you're absolutely right. And they're there that thought alone is good birth control.

But there there are there are stigmas and myths that have been perpetuated and We take as gospel. And and so and we see that and so, you know, part of the discussion that sometimes it's challenging in the beginning when we're talking about birth control is there's resistance that that comes with IUDs or with larks in general. And so it's, it's more of a conversation about, you know, yes, if someone comes in and self selects and says, I would like a non hormonal intrauterine device, and I want long acting very good and effective birth control. Wonderful, you're a great candidate for it for a pair guard. Let's do this. And then you have this other segment of women who come in and say, Well, I really, you know, I just want a pill, because that's what they know. And they've been told that IDs are bad and larks are terrible and all of these myths and and then it becomes more of a nuanced conversation that has to occur between a patient and a provider and this is if it's an A nurse practitioner. midwife, an OB GYN doctor, whoever it becomes that we have to have more conversation about what's the best method for you based on where you are right now and what you want.

One of the things I experienced was that women were uncomfortable with the IUD if they had not had a baby because they were afraid of the discomfort of insertion.

Okay, so for years there was with IUDs, there was information that said, you know, they shouldn't be put in women who've never had a baby before. And and that is absolutely not true. Now. We have evidence we have data to support that IDs are effective, and they are appropriate for women who have never had children before. And so the insertion you know, I have had women come to me who have never had children before and we put in IUDs. And those IUD, some of them they go in easily. The procedure is quick, some of them it's a little bit more challenging, and we're working on Essentially with a cervix and a cervix that if it's if a cervix has never gone through the process of labor on birth, it's never had to open, it's never had to go to 10 centimeters that cervix is is is sometimes a little bit more challenging to access. And in order for an IUD to get up into the uterus, that does not mean it's impossible. That does mean it The procedure is a little bit, it's just a little bit more uncomfortable. Some of them slide in very easily. And it's a quick, painless procedure. And some women who have had children before they too have discomfort with the insertion. So it's it's, you know, for women who are saying, Oh, you know, I've never had a child before I can't get an IUD, not true. And for women who say, well, I've never had a child before and so it's it's dangerous for me. Not true. And if I've never had a child before, it's going to be really, really painful for me. Not true, it may be uncomfortable, there may be discomfort, there may not be discomfort. And honestly that happens with pretty much everybody to be quite honest. Right?

That was also my experience.

Yeah, for all of the women out there listening, if you're if you cannot remember these, don't worry, this is exactly why we as certified nurse midwives, the physicians were out there that nurse practitioners, like this is our bread and butter, it's our jam. So we know this information. And if you need a very visual depiction of what your options are, bedside er is a really, really good website where you can actually look and see, oh, here are the different ones. And these are the rates of which one's effective and which ones are not as effective and how do you use them and so there's tons of information so that's just a plug for Ben cider, which I love. It's a tool I use use a lot in the past with patients.

And so and there is a difference in terms of the bleeding profile, which means that you're more likely to experience that or that small amount of spotting in with the use of it. than you are with Marina. So for most of my patients, I tend to recommend that if they want a hormonal IUD that they go with Marina because it's the longest or the generic of Laila. It has the longest span that it's good for. Right. So we're reducing the number of Kobe's number of times you come into the office and the number of procedures that you need. And we're also increasing the chance that you may not have that as much of that, or regular bleeding that sometimes happens especially in the beginning of using an IUD with a hormone on it. The Just a quick note about Layla, it's same hormone leaving adjuster all is good for it's approved for up to six years. They're both good options. I've put in both, no difference to them, except that they're made by different companies. That's all.

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Okay, so you got next one on which is next line is good for five years. This is a great method. It almost looks like a matchstick. It is put on into The skin like right under the top layer of skin, usually in the arm, essentially on the underside of the arm. So if I were looking at you and you have next one on and I could not see it, and it stays, it is a quick procedure that is done in the office that takes maybe about two minutes, where we numb the skin and insert it. And it is the easiest birth control ever. Hands down ever, no questions asked. And I have a lot of patients who like the removal of the device, sometimes a little bit more more of a procedure, meaning it takes a little bit longer. We have to go into where the device was inserted and use some tools to help us remove it. But it's this is like be easiest birth control option I've ever seen. In addition, the fact that the insertion is often painless

and it's equally as effective. As an IUD

equally as effective as an IUD in terms of its

in terms of its prevention of pregnancy, the one change we see with the next line versus using a hormonal IUD is that we the bleeding can change and so more often I have women who are next one have some irregular bleeding and who to end up having a little bit of heavier bleeding. That is a regular so next one, I wouldn't say it's a really good option for women who have super heavy periods and and and their regular to begin with. We may just see a continuation of that. Now if you're like, Oh, I'm okay with that. That's fine. I'll deal with heavy irregular as long as I really good birth control protection, and it's not a big deal. But it but it's a great method.

Okay, so I sent a text message to a group of my friends and said I'm speaking with a midwife about birth control, what questions do you have and they have exceeded my expectations with excellent questions, the last of which is the best and most important one, I think, but we'll work our way to it. All right. midwife A this is from my my friend midwife. He says if done correctly, the withdrawal method is 100% effective, and pre ejaculate does not contain sperm. midwife B says this is false. And it's how she got pregnant with her third daughter who is right.

I'm so glad she asked this. Why are you


Because it because it's everybody's question. It's such a good question. Everybody is curious about this.

It does it contain sperm or not.

So why do you use withdrawal method? Okay, so we're talking about pullout method withdrawal method, right? When you use this it's a very effective method of preventing pregnancy and there are a lot of couples who use this. So the when you start to look at Okay, well, there's semen and then there's pre ejaculate, okay? And we have in semen, all of our special firm that are ready to do their job pre Jacqueline, we have no semen. Now the key is that it is a timing issue. So when you use or commit to using withdraw method you must have two people in or at least if you have a male partner, your male partner must be aware and comfortable with withdrawing when appropriate prior to ejaculation so this is not an easy feat for every male out there. Okay, there are many that so this is a great method for for couples who who do not want to use or for partners who do not want to use birth control any kind of hormones, an IUD or a lark. The issue with it is that you have to have a partner who can actually withdraw prior to ejaculation that is the issue and that's probably where we see this conversation about. No, no, no, that's how I got pregnant with my fourth now. It withdrawal works great.

Can I add one thing to it? Yeah, I totally agree with you works. It's a great method with two committed people. However, sometimes people will re insert have multiple have intercourse multiple times in a short interval and that is how you can get pregnant from the initial ejaculation you can't do that encounter the withdrawal method denisha

so the answer is no, there is no sperm and pre ejaculate there

for a while, is

not Alright, so let's go to the next question. Will hormonal birth control affect my emotions? And my libido? And if so, how?

Yes, and it depends on the type of hormonal birth control that you're using. So we usually see with pills especially because the dose is higher right with with birth control pills, you're looking at a higher dose of these of our higher concentrations of hormones. And so oftentimes we can see that yes, libido is impacted in terms of how much circulating unbound testosterone you have. And then in addition, we sometimes can see some of the mood issues that come up too. So that tends to happen less often with our IUDs because the dose of hormone, again, is on the device which sits in the uterus, and so it's absorbed locally. So we don't see, I would say as much in terms of decreasing libido. And interesting what I actually see happen sometimes with IUDs, or with women who use the hormonal IDs is that they have concerns about mood issues with IUD. And sometimes we sometimes it might be the IUD because they're hormones. And you know, if you've not used them before, like they'll you have to kind of figure out how they work in your body. But sometimes it's at the dose of that hormone is so low, and so sometimes our other hormones are still in flux. And so we we still can get elements even with an IUD we can still get some elements of PMS and some elements of the cycle but not necessarily experienced the blues. And so, so the hormone dose may be low enough in an IUD where it's not worth helping to control the bleeding and decrease it and prevent pregnancy, but it's not taking away all the symptoms. So sometimes patients chalk that up and say, well, it's the IUD is causing me to have you know, the emotional swings and stuff. The reality is the dose may be so low that it's just this is your some of your now normal your baseline,

that's your base, but you have been in with the oral contraceptive pill, you do see that women can have a lot of wide range of sensitivities to it

and the libido going up or down. We're talking

usually down,

usually usually going down. And I'll admit, like I wouldn't, I wouldn't take any of that at this point. There are too many options on the market. So if you are in the moment of saying, I feel terrible on this pill, because usually with a pill, get like, make an appointment get changed, because there's there's other options there for you.

Here's the next question. What about the statistics that 20 to 30% of men have chronic lifelong pain after their vasectomy. I did not know that or the idea that vasectomy may be linked to autoimmune disorders because you're releasing sperm into the body into places it's not meant to be. You're about shaking your head. So now you haven't heard anything to support this.

I don't think it's getting really important now. They just stopped producing it because they're they stopped producing because it's like a negative feedback system where they don't write you don't MTM and so there's no reason to then refill a lot.

salting, okay. I don't know. I mean, that that is probably a very generalized way of explaining it, you'd probably have to have to talk to urologist to really know exactly how the rate of sperm production and what happens when it's you don't know what happens the guy who's not having sex.

All right, and we're down to the last question and I think everyone's gonna appreciate this one. This is not directly related to birth control, but what are the best natural ways to increase libido after giving birth? Seriously, everyone always wants to talk about libido. When you know there's there can be such an imbalance for couples after they have a baby. Be and it's such a it's such a tough situation. You know, it's something that partners can take personally, it's not personal, it's biological. Yet what do you say to women who want natural ways to increase their libido? I think that's a great question. And I'm grateful to Natalia for asking it. What do you say to that?

I would say this I mean, the number of true women who you know, who have a child and then who have issues with libido, like from a from a hormone standpoint, if you're especially if you're not on birth control and you're not breastfeeding, it's probably low. I mean that because it's not like libido, dysfunction or change in libido occurs naturally because of having a child pregnancy, labor or birth. What happens though, and that we say, Well, you know, low libido is a symptom of oftentimes the conversation that we don't have in the postpartum period or in the period around you know, when you have children, which is that life changes a lot. responsibilities change, right scheduling rules change, fatigue levels change, stress levels, change, finances, change all these other things and we chalk it up to like, how do I increase my libido? Well, the reality is your libido is probably fine. The question is, what do you do with your libido? Do you allow things like how do you manage your stress? How do you manage the stress and the fatigue that comes with being a new parent? How do you manage the anxiety and the overwhelm that can sometimes result from you know, trying to figure out a newborn or trying to figure out, you know, toddlers or small children, I mean, sleep schedules, you know, the whole kit caboodle. So, I would say my, my easy fix solution, if you're really looking for something is that recognize it can be a normal change in the period after having children. And it's important to find some coping mechanisms and tools that help us manage stress. And that also allow us to schedule time, for intimacy and for conversations with our partners that don't involve All the finances, they don't involve the bottles. They don't involve talking about sleep schedules, right? Like, if you really want to work on libido, get your schedule out and every week schedule 45 minutes to an hour. It doesn't have to be nine hours long. We're not talking about like hours, oodles and oodles of sex.

Like Trisha is example of a few times a night, okay.

Right. And I'm not sure you know, I've got you know, it

might like,

but this is this goes back to literally scheduling it. And so if libido is an issue, or let's say libido is code talk for like, I'm not getting the intimacy with my partner that I really crave. Then it's time to schedule some time on the calendar, literally put it on your calendar, work it into the schedule, so that you're starting to have moments and opportunities where your libido and where your drive is all of a sudden charged up where you're like

yes, I want it's a bit like exercise. Like you got to do it. Yeah, you got to work the muscle like like Really,

I've heard watching your husband do chores is a really great method of foreplay. I've heard that from numerous people out there there. We can get creative here. But I, but here's the thing I want to ask, what if it's beyond the what if it's beyond that of having babies being tired, because that is an incredibly hard time for couples to be intimate. But this is still a question for so many women 510 years later when they're getting their sleep, but they're worried or they're maybe perimenopausal and they're worried and they have maybe even a negative belief system around it. Is there anything they can do? Are you saying general wellness, keeping your stress levels low? Getting sufficient sleep and having emotional intimacy with your partner are really what it's always going to boil down to?

Honestly, yes. Now look, there are some concerns. I mean, if you started getting into more of like the depressive issues or the depressive symptoms, well or you start to use additionally, as we age oftentimes we develop conditions that require us or that you know where we need to take medications on a day. The only basis that can affect our sex drive, and that's legitimate, but for the for the majority of people, it has to be a conversation between you and your partner about how do I feel that we can achieve intimacy? How do I feel that we can have the, you know, the relationship that we that I need us I would like us to have whether that is a physical relationship, or it's an emotional one. And it's, it's not the same for everybody. But it often boils down to making the time making the commitment to the relationship. And then if you get into the if you get into that you say, but and I scheduled the time, we are having the conversations we are we're, you know, we're we're trying to become physical and I still can't get comfortable. Then this is when we reach out to our professionals. We have tons of therapists who are literally just this is their jam, like they do sex therapy, and they're wonderful. They're wonderful resource to us. So if we will Really get to the point where you're like, I set aside the time I'm communicating what I want. My partner is listening to me but I still just don't feel right or I'm having issues with actual penetration, whatever it is, this is when you go to your, this is when you go to your professional, you say, Okay, I either need to talk to my midwife, my doc or I need to maybe call a therapist and start talking about it a little bit more, explore other

any supplements that you recommend for low libido or nutritional things that people can do. I mean, I completely agree with you on everything you've said. And I think that a very large contributing factor outside of just relationship stuff. to women having low libido in their 40s is high stress, high cortisol specifically, and how that really suppresses other hormones in our body. So there's some things that we can do to supplement or lower cortisol levels that are maybe not quick fixes. There's no real quick fix. to any of this, but something that can just assist a little bit, one of the things that I used to use in my practice was something called Makkah. And it, you know, it seemed to energize women and it seemed to stimulate their sex drive a little bit. And if it just can give you that

nudge, right, if, like you said, it's more issues of cortisol levels, and we're having more issues of stress and more issues of a lack of good communication between partners, a lack of talking about what it is you want, then I think we have to intervene with stress management tools, and I you know, we start talking about meditation. I mean, five minutes of meditation a day, like, what what if we all said, Hey, in order to improve our sex lives, we're going to meditate for five minutes a day with our partners or without our partners, but we're, we're going to do an intervention to bring the cortisol levels down. Breathe deeply, and then like, Okay, what do I want, you know, start again. So we're Emotional Freedom Technique or tapping. I mean, There are a handful of interventions that we you know, that I think can in, that can help us that don't require meds that don't require, you know, a long list of side effects and get a book on tantric sex. Get a book on tantric sex. So I mean, there's so many. This is why it's so it has to be there's so many little things and it's individualized like what what turns one woman on doesn't turn on another woman and it's all it that's like the conversation we often don't have.

Well, here's the conversation we often don't have, as well that the brain is the most sexual organ. Oh, absolutely. Either way, it starts with the brain. It starts with that emotional connection, for sure. And resolving whatever, like you guys are saying stress struggles within herself or in the relationship and

just to bring it back to the contraceptive conversation that this all started around. I would recommend getting off the birth control pill. If you You know, you're in your 40s and you're in, you're in between children and you're really struggling with libido. It's time to have that conversation about different contraceptive method. Absolutely. And that's, you know,

yes, yes, yes.

Yes, it's we have to do some mind work, we have to do a little bit of, you know, working with the stress. And yes, we should also look at some of the other medications that we're using, especially to the antidepressants, we see a lot of, you know, hormone, or just a libido, you know, decrease libido with antidepressants, which, you know, are more commonly used as we have more conversations about mental health and they're wonderful for so many so many people in so many women, their life changing. You know, and with it comes kind of the second conversation of, Okay, I feel better with my mental health, though. I don't feel like my sex drive is there. What do I do now? And, you know, it's just a continued conversation to have, but it's not that easy. one stop shopping like,

do this. It's very holistic. It's affected by so many things. There's so many libido killers.

Yes. I hope that You know this conversation with you was really evidence as to why appointments with our women's health care providers need to be longer than 15 minutes.

I would agree with that for sure.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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