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Sex can change fast after birth, and it can change again in perimenopause and menopause, but that doesn’t mean you’re broken. We dig into why libido, arousal, and comfort often shift when estrogen drops postpartum and later in life, and how that hormone reality shows up as vaginal dryness, painful sex (dyspareunia), and the sense that your body isn’t responding the way it used to. We also talk about the common brain-body mismatch many women experience and how mental load can shut desire down even when the relationship is solid. 

We walk through the postpartum hormone landscape, including the steep fall in estrogen and progesterone after placenta delivery and how breastfeeding keeps estrogen low through prolactin and oxytocin. Then we get practical about what helps: pelvic floor physical therapy (and what to expect so it’s not a surprise), using plenty of lubricant, considering vaginal estrogen for atrophy, and expanding intimacy beyond penetration while healing happens. 

From there, we transition into perimenopause and menopause, including genitourinary syndrome of menopause, irritability and sleep disruption, and why libido issues are often tied to androgens like testosterone. We cover options clinicians may consider for hypoactive sexual desire disorder, plus the overlooked impact of medications like antidepressants and blood pressure meds. We wrap with the PLISSIT model so midwives and clinicians have a clear framework to open these conversations with permission, simple education, specific suggestions, and referrals when needed. 

If this helps you feel more informed or less alone, subscribe, share the episode with a friend, and leave a review so more people can find honest, evidence-informed sexual health support.

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