Why Women Feel Completely Different After Menopause | Tanya Leake

what happens to the clitoris during menopause?

Well, as you know, there's lots of different changes that are happening, and one of them has to do with the tissue itself, right? Which is— so people often talk about vaginal atrophy, right? There's the thinning of the skin, it's a little drier, not as much moisture. Well, the same thing is happening with the clitoral tissue. So between the blood flow and the tissue changes, there is this risk of atrophy. Right, the lack of use. So the blood flow reduction and then the skin changes, that all leads to potentially this, this basically loss of blood flow, which leads to, you know, to some degree, some death there. And ultimately, it can result in clitoral adhesion, which means that the hood of the clitoris actually fuses over. And so you don't— again, you get this sort of muted sensation or lack of sensation entirely.

Hi, this is Suzanne Noble, and you are listening to Sex Advice for Seniors. And I just want to let everybody know I'm back in London now. Actually, I'm in Folkestone on the Kent coast in the UK now, not in London. And that means that I actually have a stable internet connection, which I haven't had for the past 3 months while I've been in Southeast Asia. And I can't tell you how nice it is to be able to not just have a really stable internet connection, but also to be able to use that to speak to somebody about a topic I've never spoken about before over nearly 200 episodes. So I'm super excited to talk about that because I'm with a woman called Tanya Leek and she is a mindset, she's a lifestyle coach and She's about reframing wellbeing during menopause. And she's got this amazing newsletter that I started reading recently called Hot Flash. But what we're going to talk about today is something that she actually suggested to me. And I was like, wow, I've never spoken about this with anyone before. And that, ladies and gentlemen, is clitoral atrophy. Sexy, right? Super sexy. Tanya, welcome to Sex Advice for Seniors.

Thank you so much, Suzanne. It is my pleasure to be here and hopefully we're going to give everyone else more pleasure by talking about this.

Yeah. So I actually had a conversation with you about clitoral atrophy very briefly before you came on the show because of the many emails I receive from people which are mainly related to sexual health challenges. And a lot of them have to do with husbands writing to me about their partners who are going through the menopause and are going through some challenging times. And, and most recently, a guy wrote to me about his wife who was struggling with something around her clitoral health. And this was around adhesions, which I'd never heard about. But I know that clitoral health is just something that we don't talk about very much. We talk about— I've spoken a lot about vaginal health, about vaginal A trophy, which has now been renamed in the UK GSM. Don't even ask me what that refers to.

Genitourinary Syndrome of Menopause.

There you go. There you go. But tell me, is the clitoris— what happens to the clitoris during menopause?

Well, okay. So I actually am— I wanted to just take a moment because you mentioned that these men are writing into the show and they're telling you about the things that are happening to their significant others during this transition. And in all honesty, when we talk about the genitourinary syndrome, right, the changes that are happening in that area, you know, there are a number of things that we really need to be mindful of, particularly as we get older. And, you know, the recommendation is that after 65 we don't have to see a GYN. So I'm gonna have some recommendations there, but I wanted to just speak to last February, or this past February— gosh, it seems like the year is flying by— did a Hot Flash the Newsletter I did a series on all of the research that has been done since at least 2007, talking about the importance of men's education around menopause and how it changes the relationship. Right. And, and, and I, I, we don't talk about this sex stuff as much. So that's why I'm so excited that you have this podcast and that we're connected now. That is a critical part of the relationship. And as these changes happen and men are unaware, uneducated. They, and, you know, start to have maybe their own feelings about what am I doing wrong, or maybe in some instances they put it on the woman in terms of some sort of failure on her part. So I, I, you know, I have this whole emphasis on Menopause for Men, Love and Menopause, where the couples come together and create a shared language around this, which is absolutely critical. And this is part of it, right? Understanding what is clitoral atrophy, why is it happening, um, First, you mentioned what, what is it? What's going on within menopause that may cause this? Well, as you know, there's lots of different changes that are happening, and one of them has to do with the tissue itself, right? Which is, so people often talk about vaginal atrophy, right? There's the thinning of the skin. It's a little drier. Um, not as much moisture. Well, the same thing is happening with the clitoral tissue.

Yeah.

And, and this is all, you can read about it on the Mayo Clinic. You can, so it's, it's out there. But it's not out there, right? So the other thing that's happening is the blood flow is changing. Um, yeah, it can reduce unless it is used, right? Unless you're calling blood flow to that area. So that means that you have to stimulate it. Um, and that can mean pelvic exercises, that could mean, etc. So between the blood flow and the tissue changes, there is this risk of atrophy. Right, the lack of use. So the blood flow reduction and then the skin changes, that all leads to potentially this, this basically loss of blood flow, which leads to, you know, to some degree, some death there. And ultimately it can result in clitoral adhesion, which means that the hood of the clitoris actually fuses over. And so you don't— again, you get this sort of muted sensation or lack of sensation entirely. So that's what, that's what clitoral atrophy is.

And I, I know that when I've spoken to people like Dr. Lauren Streicher, people like that, one of the things that she's said is that during menopause, the nerves, the nerve endings in the clitoris, the smaller nerves start to deteriorate. And so the larger nerves take over, and that is why we need to be mindful of using vibrators, for example, which can reach those larger nerves and give us the stimulation that we are lacking from the result of the smaller nerves starting to deteriorate. Because I do have— again, I have discussions with men about, we don't need to bring vibrators into the bedroom, you know, like, I'm good, I should be good enough, I should be good enough to do this. It's like, look, guys, it's not a failure on your part. It's It's just, just about a physiological change that's taking place in our body, which means we might need a little bit of extra help. That's what we need. And bringing in this little bit of extra help shouldn't be something that gets repelled. It should be something that's welcomed because it's going to make your job easier. You can, if you, if you want to continue to have penetrative sex, she can just focus on the clitoral area with her. Little vibrator and you guys can go at it, right?

Yeah, it's again, right, this has to do with, are you able to have a conversation with your sexual partner? And, and it becomes more important as we get into menopause. And I, you know, some people might see that as a hindrance. I, again, you mentioned this at the beginning, my whole commitment is to reframing this experience. And so what that suggests is that you're going to get into much healthier relationships. Because you're going to have these conversations about what needs to happen. I mean, to be honest, some men have the same response to bringing lube into the— yes, they feel like if I don't make you wet enough, you know, then what's, what's wrong with you, or what's wrong with me, or you're not that attracted to me. And so again, this ability to have the conversation that it's not you. Yeah, yeah, it's some changes that are happening with me. I am still attracted to you, I am still into you, whatever. Um, and we have this these great tools that are available to us. All right, so, and I always tell my clients in menopause that this is about being really intentional. And there's something that's really beautiful about that too, is that this is our time of our season of intentionality, and we're getting really intentional because we're, we're really— I, I like to say squeezing the lemon. We're getting the most out of the time we have. So guess what? In the bedroom, or wherever else you choose to do it, you want to make the most of that time these days. You don't want to waste— like, when I was in my 20s, I might have had a couple of not so great, but now I want to make sure every encounter I have is quality.

Completely. And I, and I'm just going back a little bit. I'm curious with— so we talk about the fact that part of it is making sure that we maintain the blood flow to the clitoris to prevent the atrophy. By— so, and you mentioned pelvic floor exercises. So for women who are not with a partner, does that include just like solo pleasure, just like a regular exercise routine, which is I'm going to make sure that I have a regular orgasm. Like, is there something to do with like the frequency around that? Because I've noticed and I've spoken about it before, and I've been really honest about this, that if I overuse the, my vibrator, and I know there's scientific evidence that says it doesn't make a difference to my responsiveness, but it definitely does. It 100% does. And so for me, I have to kind of like space out. How often I do things either with myself or with somebody else, because if I overuse things like vibrators, then I find it takes me forever to have an orgasm.

I'm gonna high-five you on that because I have had the same experience. So, right, you're gonna make me dive into the research and see if I can find something that's a little more definitive, because what's interesting is typically there is research out there that's— that aligns with most of our lived experience. And I would agree that the lived experience that I have is that— and, and I will say, I will disclaim, of course, everyone is different. And even if you find research, right, it's always a bell curve. There are outliers, yeah, right, who can do much more and who have to do much less. So you have to figure out what, you know, try it out. Go for 3 or 4 times a week and see if it becomes harder and harder for you to have an orgasm, or it takes longer and longer, then maybe you want to cut back. So figure out what works for you. But the bottom line is it needs to stay in use, right? Yes, there are lots of— I would say definitely if you don't have a partner, and I've had many women tell me that, you know, it's not the same without a partner, and I get that, right? There, there is something that other person— I've found that my vibrator, my vibrator, my, my set of are quite Quite more than adequate. So, so yes, I think it really is about finding your rhythm, but really being intentional. I'm gonna go back to intentionality. Intentional about finding that, right, and making sure that you are— you know, one of the early signs of clitoral atrophy is that it is, you know, you have to distinguish between whether it's taking longer because you're masturbating as much, or if it's just that The sensation is, is dimming a bit. I also always recommend you should be able to pick your vulva out of a lineup. So I always tell women, you should look at it. You should know what your vulva looks like, the labia, all, everything in there so that you also have a baseline. And, you know, if you're feeling something weird, then you can look down and say, oh, well, that wasn't red before. That wasn't.

Yeah.

So, so, you know, We have to get— if we expect someone else to go down there, take a look, enjoy it, then I, I think that we should be at the very least willing to take a look, see what's going on. So I, I recommend to everyone that they should be grabbing that mirror, taking a look at what's going on down there. So, because one of the, uh, other signs of clitoral atrophy is that you'll see that the tissue is getting a little bit whiter, right? It doesn't, doesn't have that pinkness, and so it gets pale. And so if you're starting to see some of those changes, feeling some of that sensation loss, That's where you go to, you know, an OB-GYN. So when you talk about— there's, there's non-pharmacological, which is just keep it in use, you know, yeah, some pelvic floor exercises, do some of those contractions, um, bring the blood flow to that area. There's also some pharmacological stuff that you can do. Some people, uh, the research has shown that there's the DHEA cream that—

oh, I've read about that recently. Yeah.

And there's, there's been mixed reviews of testosterone creams and, and vaginal estrogen specifically for clitoral atrophy. But again, right, this is all related to the changes in your estrogen, your estradiol levels. So again, find the solution that works for you, but those, those are some options. And find a doctor that is willing to talk to you about it. Um, and I'm, I'm a board-certified patient advocate, so I, you know, kind of work with to, to my— the key thing that I tell women to talk to their healthcare provider is to ask, what's the downside of this? Because you want to know if it's contraindicated given your history. But to be honest, if they're just like, well, I've never heard of it, then if there's no downside, then you can try it. So that's what I—

yeah, completely. Look, I mean, it took me, you know, there's been recent research, as I'm sure you're aware, about the fact that vaginal estrogen is even safe in most cases for women who have struggled with breast cancer because it just goes into a minute amount in your bloodstream. I think there's a lot of confusion that women face around the difference between like an estrogen patch and vaginal estrogen. I get a lot of questions asking me this and it's like, no, this is a topical thing that goes down there. But I've also heard that if you use the cream version that you can apply it also around the vulva and stuff. I use a little Essure, so that's, you know, I can't do that. But I was going to ask around testosterone as well, because I suspect that with testosterone, that's also around more around your responsiveness, around arousal. And obviously, if you take a lot of testosterone, it can impact on your clitoris and your clitoris starts growing, which, you know, but that's when you start going—

So that's where it comes down to again, right? Even with the research with the localized, so the vaginal estrogen versus the systemic, like the patch. Yeah, right. Bell curve. You may be an outlier. You have to just be aware of what's going on with your body. Listen to your body. If your body seems to like it, enjoy it, things are changing in a positive direction for your sexual well-being, yeah, then go with it. Um, I think the key thing though is, I will tell you my personal experience, When I, I, and I, you know, it's really bad because sometimes I quiz my, test my healthcare practitioners and I'll say, oh, you know, I've been, I've been thinking about, you know, some vaginal estrogen. And one, I changed from that one. So then it becomes the thing where then I change. They said, well, that's too messy.

What?

And I was just like, you know, you can just use some lubrication. So let's be clear. Let's make sure. And I'm sure you talk to other people when we're talking about especially vaginal, right? This is not a matter of lubrication, right? This is tissue. This is micro tears. This is, so it's. Boggles my mind because the other thing is, right, there's some people think about, you know, okay, if you're going to do the suppository, you're going to do the gel, or, but there's also the ring, which you can just put. So there are so many formulations for someone, particularly a primary care doctor, to say it's messy. First of all, you don't know my, what's my level of messy, right? If my level of messy is, and I'm, I'm willing to get messy because I want to get messy with my, my partner. And you can't make that decision for me. Um, talk to me about the objective sort of perspective of that, but don't tell me it's messy because that might not be my perspective. So that was one. The second one actually said, well, same thing, use some lubrication. And so let's be clear, right? The lubrication is outer. There's inner. And again, that lubrication is not for your— this, this clitoral atrophy that we're talking about, that's not what that's for. So all of these things, when we're talking about blood flow and tissue changes, That's coconut oil is not going to get it.

No. And you know what? Like how many conversations I've had with people and it surprises me when I speak, it still surprises me when I speak to people like yourself who are working within the healthcare system and you are hearing this kind of, you know, narrative around vaginal care. That's what we're talking about here. We're talking about vaginal care. We're not talking about fucking lubrication. Okay. We're not talking, we're not talking about lube. We're talking about restoring the tissues, making them plump again, reducing the number of tears. Like, this is not about just like, as you said, like a bit of almond oil or some coconut oil or whatever. And these are doctors. I'm always shocked when I hear this and it makes me, as you can tell on my voice, it makes me really angry because I think we are dealing with healthcare professionals, sadly, who have not been trained in what solutions are available to support menopausal women's sexual health. They just haven't been trained. So they're talking on the fly. And rather than saying, like a person would say that doesn't know anything, like I'm going to have to look this up. I don't know. I'm going to check this out. Right. Thanks for asking me that question, but I don't know the answer to that. To respond with, that's messy. That's messy. Like, who are you to decide what's messy or not messy? And I'm sorry, but sticking a little pill up my vagina twice a week is not messy at all. There is nothing messy about that.

I've done more messy things. Than that, right, in my past, right? Even spermicides and things like that that I have done, you know, in the past. So yeah, I, I find that again, this is— healthcare is supposed to be a partnership. Because as one of my other doctors that I work with, she's, she's wonderful, you know, she says someone will tell you what's going on as long as you talk to them long enough. Because the important thing is you're the only one who can tell What's going on? How it's feeling? What does it feel like on a scale? So all of those things are the points that the healthcare practitioner needs, and they can't make that decision until they know. So, I mean, this came after not even asking, how painful is it? You know, so there are many questions that could have been asked before you jump to— because to be honest, if I want to have sex with my partner and it's an 8 on a scale of 1 to 10 in terms of pain, I'm probably willing to sacrifice a little messiness quote unquote. So you have to— this is the trade-off that I need to make, and you can't make that decision for me. So it is sad because it should be a partnership, because the patient slash woman— I hate to use patient, especially as it relates to menopause, but if it does become such that it's causing you distress or dysfunction, then clearly, um, you should see a healthcare provider so that you can address it. And I know this is why you're here, and that's what's so exciting for me, because our sexual identity, you know, who we are, especially if we are, you know, if we're someone that enjoys sex and wants to continue to have it into our, you know, our ages, you have to be able to take control of what's going on. Um, again, we're talking about the healthcare system. So I'm going to say, I know that, you know, you stop getting the PAPs and the HPVs after 65, unless otherwise indicated. I actually think that, you know, having someone who's a professional take a look is worth it. Right. They talk to us about that with our oral health, with our eye health, is that these changes are happening. So just do a check-in. So I'm, I'm of the mind that, hey, have someone take a look down there. You should, you should just like with breast exams, right? We do. And then we also get the mammograms. We get the professional sort of look over. You should. I'm, I would like to find some research talking about the over 65 and whether or not, you know, you should be checking in, especially if you're still sexually active.

Well, that's what I was going to say to you, because I think that, you know, I was just told I had a cervical smear. Like, I don't know, I guess it was about 6 months ago or something. And they said to me, that's your last one. And I was like, what, what do you mean? That's my last one. And they're like, yeah, we don't do it. We don't do it now for women over 65 anymore. That's it. You're done. And I thought, even if you're a sexually active woman, you're done. Surely that's kind of like the barometer is more around When was the last time that you had sexual intercourse and how often are you having sexual intercourse and how many partners do you have sexual intercourse with? Surely those are the questions that should relate to whether or not you stop being tested. Uh, not a cutoff date. I didn't really understand where this arbitrary cutoff date came from other than obviously in the UK, we had the National Health Service and I always think everything's cost cutting. Right? Like, the likelihood is these women are not probably very sexually active. So if we just cut them off, you know, the likelihood that a couple are going to get through, whatever.

What's interesting about that is just because you're not sexually active now, you don't have many partners now, doesn't mean that you don't want to in the future. No, exactly. This whole clitoral health— this is your pleasure center. This is ours. Women's pleasure centers. So I want to make sure that that's ready to go when I want to, when I want to get in the car. So I'm gonna guess what, I'm gonna keep taking the car to the shop and get my checkups, get my tune-ups, because I might want to drive somewhere. Maybe I'm not driving these days, right? So I feel like, yeah, there, there is a big question mark that I have around that cutoff. And, and I think it, again, it does not honor and respect where we are as sexual beings. Ultimately, which is why I think this, you know, and that's the other thing about clitoral atrophy is I read on the Mayo Clinic, etc. No one really knows the prevalence. Part of it because people don't know about it, so they don't know. They think, oh, well, I'm going through menopause. Oh, this is what happens. This is what's natural. No, it's actually not. And it can be addressed. It's similar to the other things you were talking about with respect to vaginal estrogen, etc., is I think there's this acceptance of it, and then there's shame. You know, if you don't, hey, your partner is unaware. Maybe they're, you know, feeling some way about it. You're feeling some way about it because you don't have that intimacy that you're sharing. So it's changing the dynamics of your relationship, and that's affecting— that's having a cascade effect on all the other things. So it's— I honestly am— this is kind of my little soapbox to stand on. I'm so glad that you were interested in, in covering it, because I honestly am— every woman that I tell It's like, wait, what? Wait, what? This is just going to happen?

Well, and, and, you know, I, the other thing I have to mention is the fact that of course the women that struggle with, that have had breast cancer, breast cancer recoveries, from what I've heard speaking to them, this is even more severe in their case is that often the medication that they're putting up, that they're put on to try and help them overcome breast cancer has detrimental effects on their clitoris, on their vulva, on libido, their— everything.

Arousal.

Yeah, totally. And mostly a bit like when men have had prostate surgery, mostly they're not told about this because they just— the doctors just want them to get through the surgery or the chemo or whatever.. And so when they come out the other end and then they look down and this whole thing has just shrunk and disappeared and they're, everything is like almost gone. I've got friends that were just absolutely shocked by this. They were traumatized. It was like, wait a minute, why did nobody tell me? And you know, similarly I've said to them, well, I think you can go on vaginal estrogen. You need to check with your doctor, but they're like, they hear the word estrogen and they're like, no, no, nope. I can't do anything with estrogen. I can't have anything with estrogen. So there's so little information around this, not just for healthy menopausal women who perhaps just need to get a bit more active down there, but for chronically ill women who have had breast cancer. And are now trying to get out the other side and have some sort of a sex life, right? I mean, this is just one of the— this topic is just, it's just invisible. I think it's almost invisible.

Yeah. I think, you know, with this 65 cutoff, it almost seems as if there's an assumption, right? That there is decline, that there is basically that we're pretty much in the grave, heading towards the grave. We're done. And that, that upsets me because that's, that's where this whole mindset thing comes in, which I do want to mention sort of two things. One, on the strictly physical side, there was some research that did show that hyaluronic acid can have very similar benefits to vaginal estrogen in some research. So there is a, there are a number of hyaluronic acid products out there, one of which I use personally. I'm not getting sponsored by anybody, so I'm not going to mention names, but there's a, there's a ton out there. So you can, you know, you can get those. I know there are people who use them actually in conjunction with vaginal estrogen. So, but the research, I think I covered that in one of my newsletters, does show that it has, it can have similar benefits for some people, particularly those who may be concerned about vaginal estrogen. So give it a try.

It can't hurt.

Other, the other thing is this whole concept of one of the research pieces that I covered in Hot Flash, the newsletter was around cognitive behavioral therapy. And cognitive behavioral coaching and motivational interviewing and how it actually can help move the lever. Because the other thing I talked about, intentionality, the other thing that changes for us as we age is we are more, again, I mentioned we're more into these quality experiences and that actually does change what triggers our desire, what triggers our arousal. And so there are some, some cognitive behavioral shifts that we can make around mindset. That can support a healthy— now, I do think, again, when we're talking about blood flow and tissue thinning, and, you know, there are those who will say, you know, you can, you could mind over matter. Um, I will say do both.

Yeah, for sure.

So that you can, you can have the fullest experience. So yes, I, I did want to, to kind of add that to— one is the hyaluronic acid, kind of. Um, I actually did one on which I was So this was another missed piece, which is that apparently for women, the majority of the zinc in our body is in our vaginal area. And what they've seen is when you use zinc pessaries and you put zinc up there, it actually does help more than even hyaluronic acid, which is more— you know, we use it on our skin, so it's that outer skin, but it actually helps with all of the internal mechanisms. And so I actually contacted the company who provided the product that was used in the research, and they said, "We've been looking for a distributor in the United States and we can't find one." I don't know if it's available. It's actually a Saudi Arabian company.

I've never heard that. Never heard of it.

There has been some research. I don't think it's conclusive yet that taking zinc can be beneficial because of the fact that as it absorbs, it can be used in that area. But to me, that's a, that's another sort of thing that we don't know that, hey, it's a simple thing to get a, to get a zinc pill, get it with copper. So you don't, there's a whole thing about zinc and copper balance. But that's another, and this is, this is why I do Hot Flash, the newsletter, because there's so much research out there. And I don't know if you're familiar with the research practice gap. Um, if you've spoken about it with—

yes, yes, yes.

I mean, 15 years, right? We know something, but it takes 15 years. For doctors to, to, to change, because ultimately it is difficult to change. You're talking about insurance covering it, National Health Service approving it, all of that, even in, in various countries and however they're set up. So the key thing is what I try to bring is information so that you can go to your doctor and at least talk, because they may not be aware. And my hope is that, to your point, they actually are interested in being aware. You know, I don't know about that, but I'm gonna look into that. That's what I'd like to see more of. And if we can push more, I think we can see more of that.

Yeah, definitely. Look, I think as we wind up the show, I think there are very definitely— there's a need for people to advocate for their own sexual health and their own health in general. I think we both agree on that one. And also newsletters like Hot Flash are essential for people to just be able to see the research that's out there find out what's out there. I mean, it does vary by territory to territory. In the UK, we've only just had bioidentical female testosterone approved for distribution. We're probably not going to get it for at least another year. When I spoke to doctors, you can get it privately, but you can't get it on the National Health Service. Things like DHEA, I've not seen that in the UK, if I'm really honest. Um, it may be available privately, but I don't I don't think it's available to the general public unless you go private. So everything is on a very much on a case-by-case and where you live basis. And in some countries, as you said, they might have zinc pessaries, and in other countries nobody will have heard of it. But I think the very least we can do is try and educate ourselves as to what is available, find out if it is available where we live, and then move on from there. And as you said, and I agree that if you don't get the response that you're looking for from your doctor, if you feel dismissed, if you feel ignored, if you feel gaslit, then you go and find someone else. And I think that's super, super important because we want to be supported with our health.

We deserve to be. Supported and we need to reinforce that so that the doctors that are seeing us, hearing us, respecting us, um, are actually held up and are made more successful as a result so that we can reinforce them.

Totally. Tanya, it has been a joy to talk to you. Feels like the time has just flown by. All the way in Georgia. And ladies and gentlemen, if you want to get ahold of her, I think you're just at Embody Well pretty much everywhere, aren't you? Yes. Just type in Embody Well and you will find Tonya Leak in Atlanta, Georgia. Have a lovely day.

Have a lovely day. Wonderful talking to you. Thank you so much, Suzanne Noble.