Reclaiming Sexual Pleasure in Midlife with Dr Maria Sophocles

0:00 [Music] If you are a woman of a certain age and sex has slowly disappeared from your life or if it's starting to feel like something that you dread rather than look forward to and you're not sure whether you should blame your hormones or your relationship or your exhaustion or just yourself, you are going to love this episode. My guest today is Dr. Maria Sophocles. She's a board certified Ob-Gyn, Menopause Society Certified Practitioner. She has spent 30 years working with women on the clinical front line of this exact problem. She is the author of the brand new book The Bedroom Gap and the creator of a TED talk on midlife sex that has now been watched over a million times. She is also, I can confirm, one of the most warm, friendly, refreshingly frank and brilliant people that I have had the pleasure to have on the show.

0:47 Maria coined the term The Bedroom Gap to describe something that she observed of a decades of practice which is the very real and unspoken difference in sexual expectations and abilities between men and women in midlife and across the lifespan actually. But this is not just about low libido, it's about the physical changes happening in your body that nobody explains to you. It's the cultural messaging that tells women that their discomfort doesn't matter and a medical system that created Viagra in 1998 but left women largely without any equivalent solutions. And the shame that keeps so many of us from even raising the subject with our doctors. In this conversation, Maria breaks down the physiology of what is happening in our bodies at this time in a way that is illuminating and honestly a lot less bleak than you might expect.

1:35 Because it is very treatable. We also talked about what is happening with our younger generation, what porn is teaching an entire generation about sex and how we can start having better conversations with our daughters. I think you're going to love Maria just as much as I do. Here she is to talk about The Bedroom Gap. Maria, welcome to the Crappy to Happy Podcast. Thank you. I'm so, so glad to be here, Cass. I have been very fortunate. You were very generous in sharing with me a manuscript of your upcoming book The Bedroom Gap. I have spoken to you in the past and I've told you that I had Dr. Louise Newson on the podcast twice talking about menopause and the issues confronting menopause and the benefits of hormones, etc.

2:20 But one thing we did not touch on really was this sexual aspect of it. We talk about low libido, but we don't really talk about the physical difficulties associated with sex that come up at this time of life, which is why I'm so interested to see your book coming out in the work that you do and the things that you talk about. So having said all of that, can you first explain for the listeners, Maria? What is The Bedroom Gap? Absolutely. The Bedroom Gap is a concept really about the difference in sexual expectations and abilities and perceptions around sex that heterosexual and homosexual couples can have different partners. But it's very particularly problematic in heterosexual couples where men are fed certain expectations about sex and scripts about sex and so are women and we're fed this as children, we're fed this in the media, we're fed this through sex ed and we take this information and we go become sexually active couples, partnered sex and it's like we follow these scripts but then in midlife our bodies change, right? Testosterone drops for men, 1% a year, women undergo menopause and they're estrogen and testosterone drop pretty dramatically and this has changes in the brain in terms of our libido. This has changes in vaginal health.

3:45 This has changes in erectile function and sperm count and all that stuff too. So both parties are having changes and they're trying to navigate it and you couple this with really poor communication skills around sex. We're actually taught not to talk about it. Now couple this with big pharma which has wonderful meds for erectile problems, not so much for women. So now the playing field is uneven. The bedroom gap is widened and now add 4,000 years of history that teaches us that sex is for men. They have needs. Women if they're in pain or miserable should probably just be quiet and deal with it and you get this disconnect that really is relationship wrecking, self-esteem wrecking and so the bedroom gap is a great little book looking at all of that and how do we rewrite the rules of sex for ourselves as we go through peri-menopause and menopause. How do we make sexual pleasure actually a priority and part of our overall wellness goals because I think sexual health is a pillar of health and we have there's lots of scientific data to support it Cass when you're sexually active, when you have a good relationship with intimacy, affection, mutual respect, you have lower depression, lower anxiety, lower stress, you live, you know, lower blood pressure, all kinds of stuff. So all that is wrapped up into this little book. It just came from that concept that I sort of coined about I thought the

5:19 term bedroom gap was the right term because it's sort of encompassed all of it. It's a lot more than an orgasm gap. Yeah. It's really relationship and society. It really is and it was such an education for me. There's so much information in there and we can talk about the book when it comes out later but the bedroom gap and all of the things that you just mentioned just then clearly this is an issue that affects couples and women across the lifespan. I want to start talking about the menopause and perimenopause issue but you know then perhaps we can talk about those other age groups and different demographics and different people affected. Right. It seems to widen in midlife Cass. That’s why to me I had already written a book about menopause and I actually chose not to publish it because so many of my peers were starting to publish the same thing and I just thought we don't need one more book about hot flashes and menopause but this is directed to women in perimenopause and menopause because those are the patients that for 30 years I've seen come in and say I'm broken. Something's not right.

6:28 I don't have interest, sex hurts, my husband's frustrated, help me. I can't even find a place to read about this. I think maybe it's just me. So I wanted women to know about what really happens to your body as you go through your 40s and your 50s. That's why even though you're right this could be read by a woman of any age. It's really that 40 to 60-year-old woman who's putting her hands up going I'm so frustrated. I think I just want to watch TV or scroll my Instagram feed and go to bed. Yeah. And I want them to know you don't have to do that. You don't have to throw your arms up. You can understand what's going on and you can build little micro habits that change it and take little baby steps to turn that around. Yeah, that's the important part.

7:18 So Maria, what happens to women's bodies? We know that there's a loss in libido. We know that that can be hormonal. I just don't have interest. But when I do have interest and I want to have sex and it isn't working like it used to. What is actually happening? Sure. So the physiology of what's happening is when there's less estrogen, estrogen is a growth hormone. It's food. It's literally food for our tissues. And on my TED talk, if you care to link that, there's a little part of it with a wonderful animated video that a woman created for my talk about what I see when I look out of China of a woman who's lost estrogen. That deep, dark pink becomes pale or even yellowish.

8:04 The blood vessels leave. So the moisture leaves. The collagen breaks down. So the ridges flatten. I mean, this sounds very depressing, but this is actually what happens. And when you lose collagen, you lose elasticity. So of course, things hurt. When you lose blood vessels, you cannot bring moisture into the vagina, even if your brain is turned on. So no matter how much you say, I'm loving this. I want to have sex. I want to have moisture. There aren't enough blood vessels to bring moisture. So lube certainly helped. Thank goodness. And there shouldn't be any shame about using lube. But lubes are a bandaid. And the real way to fix it is to fix the problem, not put a bandaid on it.

8:49 So the real way is actually vaginal estrogen, which we know is safe for literally every female on the planet, everybody with a vagina on the planet. And vaginal estrogen or CO2 laser or even a couple of other medications that have been made that will turn on the production of estrogen and bring back blood vessels. That's the crux of it, is the loss of blood vessels and the breakdown of collagen. And when that happens, the opening in particular becomes constricted, tight, uncomfortable. Once something's uncomfortable, our brains, the next time, say, actually, I think I'd rather do something else, you know, or we get nervous and tight in our pelvic floor muscles. And that's called vaginismus, the kind of awkward, odd word that reflects that psychogenic repulsion and desire not to have pain again, go figure, right? I mean, what happens when we rip off a bandaid and it hurts?

9:49 The next time you go to pull a bandaid off, you squit your eyes and you raise your shoulders and go, oh God, oh God, it's going to hurt. Women do the same thing with sex. So not only do we have to fix the tissue with estrogen or laser or other meds, we have to undo that outch response. And you can do that with a pelvic floor physical therapist or with what we call vaginal trainers or dilators. They're like little fake silicone tampons or penises that you work with. I mean, this may be TMI, I don't know, but this is how we do it. This is how we do it. If you come to me as a patient and say, I can't stand it, it hurts. I'm probably going to see the dryness, the lack of the riginess. And I'm going to say, you have something in the old days we called it vaginal atrophy. The new term is this big long term, genitoneurinary syndrome of menopause, which I hate because who wants to be called told they have a syndrome, you know? But the nice thing about the term is it also implies what's correct that when we lose estrogen in the vagina, we also do in the bladder. And when you don't have the support of estrogen and all those beautiful blood vessels in the bladder, you get urinary tract infections more often, your vaginal microbiome shifts. And you don't have protective bacteria in the vagina protecting the bladder. See, the opening to the bladder is actually in the vagina. People forget

11:19 that. So when you don't have vaginal health, you actually lose bladder health too. Because the good guy bacteria aren't there to protect the bad bacteria from getting in. I hope I'm not confusing all the listeners. But you need it. You need estrogen for both bladder and vagina. This is why much older women get UTIs, urinary tract infections. It's not a coincidence. And by the way, they can be quite deadly for an 80-year-old woman. And so the best thing you can do to not be that 80-year-old woman going to the doctor with the urinary tract infection is to use vaginal estrogen from 50 on forever. Like think of it like moisturiser or sunblock. You just never outgrow those benefits. Same with vaginal estrogen. I don't work for the vaginal estrogen company. I promise.

12:10 But you know what occurs to me, Maria, is that it's much easier now for women. I mean, getting better. But getting better for women to be able to go to the GP and ask for a hormone replacement therapy. And thankfully, we're starting to shift away from all of that really damaging, messaging that, causes cancer. Right. All of that sort of stuff. So we don't need to spend time going over that. Again, listeners can go listen to my Dr. Louise episode about that. But you know, GPs and slowly, slowly, slowly they're coming on board. But typically they will give you an estrogen gel or a patch. And they might give you something like a progesterone, like a mirena or a progesterone tablet.

12:51 In my experience, and from the women my friends and who I speak to, offering for genital estrogen isn't standard. That's not a upfront off the bat. And women wouldn't know to ask like a Can I tell you why? Yeah, go. Please do. In this relates to the bedroom gap and what is the message in this little book is that it's not that we don't have a good option. We can't even blame pharmaceutical companies. It's been out since the 1940s. Can you believe that? It's a cultural shame and stigma around female genitalia. We don't even say the word and in America, it's now censored off of our social media. If you and I post too much with that V word, we're going to be asked to please take down the episode of crappy to happy. Really? Yeah, I'm not kidding. It's their censorship. And on the state floor of our Congress in Michigan, a state congresswoman stood up and she was talking about an abortion bill or something. And she used the word vagina three times. Shameful. What was she thinking? Three times. And she was asked to leave. I found that so stunning. Wow. That we can't use an anatomical term. It's not slang. This isn't a porn video. This is an anatomic part of the body. So there is a cultural shame and stigma. And in medical schools, we are not taught how to get over our own awkwardness.

14:22 So if you're a 30-year-old, 40-year-old male physician and you did not grow up in a family that was open-minded and talked about parts of the body, yes, what? You're not going to mention that to Cass Dunn You're going to ask her about her blood pressure and her stress level. And you're going to think you're doing a great job. And if you're really a superstar, you talk about HRT and the benefits to bone and you pat yourself on the back to say, I'm a great doctor. But 69% of people have never spoken to a doctor about sexual problems. And the reverse is true too. Most doctors will not preemptively bring sex up. They feel it's just not part of health. It's not something on my radar and guess what?

15:09 They hope you don't bring it up. But if you do bring it up and your doctor says, well, I'm giving you HRT. So everything's going to be great. Let me warn you. HRT, and I'm a big fan, Louise Newson and I are both cheerleaders for this. It's not quite enough down there. The vagina is sort of the last, think of it as it gets diluted, right? You put that patch on, it goes through the skin. It has to help your whole body head to toe. There's very little left by the time it gets to vagina and bladder. So you might notice improvement and some of my patients, that's all they need. But many say, gosh, Dr. Sophocles, I was really hoping for a turnaround when I put that patch on, but sex is still painful. Well, it needs local vaginal estrogen. It needs it locally right there. And it also is that you might need some physical therapy to undo that out reflex. So just putting a patch on may not be enough for the genital/sexual/bladder symptoms. So advocate, you have to advocate for yourself. You cannot wait for your doctor to bring it up. Maybe the next generation for my daughter is in her 20s. I'm hopeful that if Louise Newsman, I and other people keep yelling, please, please, please, we can get the doctors retrained. Yeah. You know, for the next generation, but for you, your friends and my friends, they have to go in there with a little sign saying, "Vaginal estrogen, please, not leaving

16:44 without it." And if they don't get it and if they're dismissed, they should just smile and go to another clinician. They shouldn't wait. Even if that doctor was a lovely person who delivered their babies, good for them, but right now they're not serving you. Yeah. One of the other issues that we have discussed before is not just the benefits of HRT or replacing, you know, with bioidentical hormones, but the risk of not. And you just mentioned about the bone density. And of course, there's lots of risks of not replacing those hormones. One of the reasons I can put my hand on my heart and say, it is so darn safe, is that it is primarily a locally acting thing. And so we can use it for specific things. We don't over promise and say it will make your legs longer and make your wrinkles go away.

17:34 I would love it if it would. And there are plenty of people who now put it around their eyes and face. Really? Oh yes. Are you kidding? That's a big trend in the United States now. Patients come in and say to me, could I get some vaginal estrogen? And I say, "Oh, you told me sex was comfortable." Oh, it is, but oh my girlfriends are using it on their face. And the truth about that is that we have some little small early studies saying, "Oh, it may stimulate collagen." And we all want fewer wrinkles. But you do need to be careful. These aren't big, properly done studies. And it's possible that you could be giving yourself more estrogen than your uterus once. And you could start having some bleeding. So tread lightly with that.

18:18 And to me, you want to use retinols and things that have a lot of data before you go throwing that on your face. Although, look, I get it. I love the idea of something that really works for wrinkles, right? So one of the big issues that has a big contributing factor to this whole bedroom gap has been the gendered lack of attention to women's health by the medical profession forever. To that end, now we know that women experience these very real, very biologically, not just psychologically, but biologically, physiologically, problems with sex in middle age. So to men, when men started to have, they noticed that men had problems with sex in this age group. Lo and behold, of course, immediately they developed a solution to that. And in the form of a viagra.

19:09 But there has not been, to date, there is, we've got the general estrogen. But, of course, women's issues have not been addressed in the same way by the medical profession. And in fact, what was really stunning to me, what's so obvious is that this solution for men only makes the problem for women so much worse. Look, why don't you say that gap? Can you talk about the reality of that? That is exactly what inspired the writing of the bedroom gap. I first wrote it as an article for a magazine called Viagravation, how Viagra widens the bedroom gap. And then I morphed that into a TED talk and then into this book. Right. And look, Viagra didn't intend to make a mess in middle-aged bedrooms or any bedrooms. But it was a highly profitable blockbuster drug.

20:01 At the time, it was the most successful drug launch in history. It was a blood pressure drug that accidentally also prolonged directions as a side effect. So Pfizer quickly said, "Holy cow, we have stumbled across gold." And they hired a brilliant spokesperson, Bob Dole, was, well, their brilliant marketing team hired this veteran politician and he gave a famous ad and told men across America to find the courage to treat their shameful condition. And this was one of the first times someone went on television urging Americans to go to their doctors to fix this. And they went in droves and it sold like crazy. Then Pfizer said, "Holy cow, this is so profitable. Let's make it not just about men who have erectile dysfunction. Let's market it showing men and women comfortable and happier fixing this problem." Which is kind of BS because if a woman's got a drive a China and now her partner can have a four-hour erection and wants to have sex all the time, you're just making stress for her. Then Pfizer said, "Why don't we even market it to all men?"

21:14 Which made it even worse. So now men who just want to have even better and more erections feel more amped up to have sex. And this is very disturbing relationship-wise to my patients who say, "I thought we were sailing off into the sunset together. My body's changing. His body was changing. Now he's having sex with his administrative assistant who's 25 because I don't want to have sex five days a week." And so yes, it has been relationship-wrecking. It's also been relationship-saving by the way. So it's not fair to only paint it one way. There are couples where the erectile dysfunction has been, I'll just say a bummer for both parties. And women come in saying, "I actually really want him to take Viagra because he's so ashamed of the lack of erection that he doesn't really want to even talk about it. Remember communication is terrible around sex." So it's a mixed blessing, but mostly it's been a curse for women. Now we do have a couple of FDA-approved men's for female sexual desire. And one was approved in 2018 called Flabancerin. The brand name is ADDYI Addy.

22:33 And in December 15th of 25, so just a month ago, it was approved. Yeah, this is hot off the press. News, it was approved for low libido in post-menopausal women. This is the first medication to be specifically approved for a sexual indication for post-menopausal women. Because remember, really we've been left hung out to dry. Once you're menopausal, your value in society, now, your value to pharmaceutical companies, now. And so this is the first time that the FDA has said, "Huh, maybe women after 50 do want to have sex and do want to have sexual vitality. Maybe that's okay." So that's new news that's exciting. Let's be grateful for the beginning of that. Celebrate the win. But in the meantime, having said that, there has always been testosterone, which again, we know is so important for women's right, libido. And yet, it's still not FDA approved. And yet, it is not considered to be important enough to approve it for women, except in Australia. Well, in a few countries, I was good at to say the philosophy and South Africa and a couple of other countries around the world. But shame, shame on the UK and the US for saying, "No, not ready. No, is it really necessary?" Yes, it's really necessary. Testosterone is something we are born with. When you are a little fetus in your mom's

24:03 womb, you are making testosterone. When you are a three-year-old little girl and a 20-year-old and a 40-year-old, you are making testosterone in your ovaries. It's part of your health. It's actually part of brain health. The use is for testosterone around the body are multiple. And when you remove it with menopause, naturally, we can see those changes again in the vulva in the vagina. When we, as clinicians, apply topical testosterone to the lower third of the vagina and the vulva, which are places that have testosterone receptors, because everywhere doesn't in women, just some. We see that tissue magically get better. When we apply it to the clitoris, we see new nerve endings and new blood flow. And guess what? Clitoral health improves, which means orgasm can improve, can be more robust and happen more quickly. So it's not perfect, you know? But it's used in appropriate doses. It's incredibly safe. And people say, "Well, we don't have data. We don't have studies. So don't know.

25:11 That's actually not true. We've been studying testosterone use in xx-humans for a long time in the transpopulation. We've given huge doses to chromosomal women who are converting and becoming men. And even at those enormous doses, which are higher than you and I would ever take, they're safe. They have had, yes, they can get hair on their face and acne, but they're choosing to take that high dose to get the masculine features. At smaller, safer doses, we don't see that. We see a boost in energy. My patients come in and tell me it's like someone just turned a put growth plant food in their water. They feel alive. They feel they're better at the gym. They exercise and they actually see muscle tone. Again, I don't work for any testosterone company, but I get to hear these stories day and day out. So it's really hard to think that there isn't some health benefit there.

26:10 Yeah. The problems that we experience, we're talking about the women experience in mid-life when they get to paramedicals and menopause, this is really often the culmination of many years before of a mismatch in sexual interest, desire, etc. And so we can talk about how this comes up in the menopausal period, but really we need to be talking about how, like you said, the expectations and the messaging to women and men. Well, this is also where porn comes in.

26:50 Because porn has become the most prevalent sex ed instructor of men and women. It's easy to blame it all on men by the way. Oh, men watch porn all the time and that's where they learn sex. That's true. But they then have that messaging and they then expect that of women and think that's what women want. And women watch porn too. This is how they learn too. Now there is female friendly porn out there. And I think if we even remove the word porn and just say adult entertainment or sexual videos or erotic content, maybe women will be more comfortable checking it out. And I actually urge women to find videos that speak to you, that turn you on or that teach you or that are interesting to you. And I really need Ted talk to watch also is by Erica Lust, L-U-S-T. That's her name.

27:46 Okay. She's a video director. She directs female forward porn because she wants, she says, we can't destroy porn. We can't take it out of our society. So let's use it through the female gaze. So women can feel empowered and we can get proper messaging out. Her Ted talk was done in Athens and it's pretty neat. Oh Lincoln. Yeah. And the other thing is there are sites that women can go to to learn about sex in the most basic way that I think we should. We shouldn't be ashamed to say, I don't know how to masturbate. Nobody told me. Nobody showed me.

28:28 I don't know where the clitoris is. Nobody told me. Nobody shook. Because remember sex ed classes at least in America are focused on preventing pregnancy and preventing disease. Yeah. Not on sexual pleasure. So young men and women never learn that sexual pleasure is a mutual thing. They learn that you do this script. These series of actions until the man ejaculates and then you both collapse exhausted. And that's how evolved. That's it. The evolution can stop. You know, and when big porn, Erica Lust refers to big porn, meaning there's several companies that sort of own and dominate the industry. They're very profitable and they're all videos through the male lens, male directed, four men. And unfortunately, they're so prolific and they're so prevalent in our society that that's what people assume sex is supposed to be. And this has dangerous effects too because there are trends like choking that have become very popular, especially of college campuses and resulted in the UK and the US in aggressive kind of assaults because men thought that women liked choking because they saw it in a porn video. I kid you not. And of course, we all know that porn also pushes this myth that women can have an orgasm in seven seconds while standing up in a restaurant bathroom or wherever the scene takes place from penis and vagina sex.

30:02 Okay, we know that 80% of women don't even have an orgasm from penis and vagina sex. So if that's you and you're listening, you're not broken, you're normal. You know, most women need literal stimulation from a faucet or a finger or a mouth or a penis or a toy, but they don't just orgasm as is often portrayed in porn. So I think the porn miseducation can be corrected. There's a site, OMG, yes, OMG, why yes, it's wonderful. It's real videos. It's people like you and I say, you know, when I was a teen, I didn't know, but you know what I found? I had a C section and it hurt.

30:44 So now I angle my hips this way and it's comfortable. Well, guess what? If you had a C section and you have pain with sex now, that's actually really helpful. You know, not everybody is a porn star. Some people are disabled. Some people have back pain or arthritis or had radiation for cervical cancer. These are real people and they need to be taught how to continue to have comfortable sex and the bedroom gap deals with that. We do talk about that because I think that's that's called real life and we need to unhook real life sex from the sex of porn and Hollywood. I mean, look at Hollywood. It portrays sex in young, vibrant, new, biol people. You know, you really don't see 80-year-olds trying to have sex, struggling with erectile dysfunction and I don't expect a director to do that. They have to make money doing this, but people do who love sex, they want to stay sexually active and they want to overcome the issues we talked about and we know my lecture at a wellness event yesterday, we spoke about the loneliness epidemic and socialization as part of being healthy, staying sexually active is a wonderful antidote to loneliness and isolation and staying sexually active longer in your life actually keeps you healthier longer. How cool is that? No medications, no side effects, you know, so anyway, sorry, get off the pedestal. No, it's all good. It's all good. As a parent of a,

32:20 my daughter's 19, that the issue about porn and young people getting their sex education from porn, that's really concerning to me and you can find that, you know, as a parent of a girl, I'm thinking this boy, you know, she's going to be with some boy who thinks that she enjoys, like you said, being choked or all this rough sex and it's so degrading, some of that porn that's out there. And I guess for me, that's the other issue, isn't it? We've got this generation of women now, like my generation. So we're talking about genx women and, you know, millennials nipping at our heels who are having our children who have been raised with this whole stigma around sex and to be around sex and shame and you don't talk about it and it's men have their needs. That's the messaging that I got when I was going to school when I was a young woman and now we have our daughters entering adulthood and it's so important, I think, for us to talk to them openly so that they don't get that same messaging, but we have never been taught how to do that. So it's another gap because we weren't spoken to. Right. And it's a communication gap that we can only change it one conversation at a time, but that's why I love being on your podcast because every person that listens to this, if I could ask them to please pick a person and actively talk to them about this and ask that person to talk to someone, then whether they're talking to a clinician and helping a clinician to

33:51 feel more confident or their sex partner and beginning a conversation about, you know what I love or you know what I don't love, those are also important conversations and they just can happen at any age. It's harder the longer you've been together. It's harder when you've been married 30 years to say, I know we don't talk about this, but I would like to because I actually don't like my ear like to. It makes me cringe, but I do love when you give me a back rub when I'm washing the dishes. Believe it or not, that's a turn on. I know I'm washing the dishes, but I love it. And actually I love it when you wash the dishes. Or talk to a child, a young adult and just say, I want your generation to do better than my generation and say it shouldn't be this weird awkward topic. I know this feels weird right now, but let's just initiate it. Let's just see what you know, think of ways to creatively come out. It used a newspaper article you saw, used a book like the Bedroom Gap and say, you know, I thought that was just for menopause, but it hit me when I read that. That it's important that your generation start, that you start being open and that sexual pleasure isn't a dirty bad thing. Sexual pleasure is a sign of sexual health. And I want you to have a healthy relationship to sex, not a shameful one.

35:19 Exactly. I think if we could rehearse a line or two like that, I think you would need to do a workshop. I think we do. But you know, on the flip side of that, then we've got these girls coming out who, you know, are the only fans and the Bonnie Blues of the world who are under the guise of like taking back control or taking, you know, empowering themselves have gone that right exactly, empowering themselves financially very much. So do you have any thoughts on that about, like, how we talk to our girls about where this healthy balance is or I guess we're just getting them to explore their own values and what's important to them. It's a really slippery slope and my own daughter's 23 and she's a stand-up comedian in New York.

35:59 She's phenomenal. She's charismatic. And she and I have these conversations and sometimes I find myself feeling like at me, I talk sex all day long and I have for 30 years almost uncomfortable with that exact topic is when have you crossed the line from I'm owning my sexuality, which I love, go for it. Don't wear a bra if you don't want to wear a bra whatever, but I'm actually playing the role that men want me to play. And and then am I kind of giving in or am I choosing to do it so I'm owning it. I haven't been able to sort that for myself yet. So I'm sorry, I want to have a pithy perfect answer for you. No, no, no, I'm struggling too. I'm struggling with it too. I think just you and I both being professionals and acknowledging that is probably helpful for listeners who are in the same position and they're struggling with it too. It's another, there isn't a pithy perfect answer.

36:55 There isn't a clear solution to that problem with that dilemma. But I suspect your daughter and my daughter are going to get there. I think they're going to trail blaze and they're going to find their place so that they own their sexuality. When my daughter went to college, I bought a whole bunch of copies of Emily Nagoski's book, Come As You Are, which has a lovely part about how to masturbate, here's your anatomy, you know, all that's in the bedroom gap too. And I distributed it and passed it around and she shared it with people at her dorm and they all decided we're young women going to college and we didn't really learn that much from our mothers or sex ed class except how to put a condom on a banana which doesn't really help us. And we were told just don't have sex ever which isn't going to work. So how are we going to learn our own bodies? And actually I brought some of the girls vibrators and they started saying, you know what? This feels great. And when we know what makes us feel great, we feel empowered to tell a partner that's not actually doing it for me. I think I'm going to not continue this or I'd like to explore using this toy because I don't orgasm from penis and vagina sex. So if we can begin to break down some of those silly myths that porn is propagated, maybe, you know, we can help them seek pleasure for themselves and safety. I mean safety number one, of course.

38:24 But also ultimately pleasure in their relationships, not just acquiescence. I'd be satisfied if that's all there is that's fine. And if there's only fans, people who are making money off of sex, that's not new in society. It's right. Prostitution is the oldest profession. So I think we don't aim for fixing the entire problem but we aim for starting with education, information and empowerment. Yeah. For middle-aged women listening who are having difficulties, there's so much in your book. We'll refer them to the book and all those resources that you mentioned. But is there one takeaway or one message that you would like to leave women with? Yes, that sexual pleasure is yours to claim. You don't have to dread sex. You don't have to say, oh gosh, I have to do it for him or for my partner. Same sex relationship, same goes. You can with some communication and even a tiny little micro habit like just cuddling, reframe sex for yourself, redefine it and make sure that pleasure is in your life because pleasure is a stress reducer. And sex is happy. Sex should be about play and happiness, not about dread and pain and obligation. You can find me on Instagram if you want to ask me a specific question. I love answering people's questions. So I think it's Maria Sophocles MD on Instagram. You can find me on LinkedIn and ask me a question. I love love to help you just pivot

39:56 from sex has become something negative to something positive again. It's really possible. You just have to look in the mirror and say, I can do this and I do want this. Yeah. Thank you so much for that. And if they ask questions, would you come back on the show and answer some more? If I collected, yes. But why don't we do it in person? Let's do that. Let's pick our city. I'll collect questions and we'll arrange a city to meet and we will do a Q and A. Q and A. Yeah. I have done that. I'm actually doing that this afternoon and listeners love it because it connects all this dialogue to them. Yes. And I'd love to be there for your listeners. Yeah. Perfect. Thank you so much for your time and your work. Dr. Maria Sophocles.

40:37 You're welcome. Thanks, Cass. [Music]