Too Tired For Intimacy

by Mona Saint MD

I am 36 and my husband wants to have sex a lot more than I do. Sometimes I pretend I’m sleeping because I don’t have the energy anymore after a full day with the kids. Is this awful?

Great question- this is such a common situation, that I get this type of question all the time.

I always start out with this question: when you are on vacation and have a night or two to catch up on sleep – how is your romance and sex life then? (I know many of us never get this opportunity to go on vacation and rest, but try to think back to this time or even imagine). For many, once they are away from all the stress and responsibilities and are no longer sleep deprived, the sex comes back and is nice again.

The good news is there are easy ways to improve it.  First, it would be great to talk with your partner at some point when it is not immediately relevant. Sometimes even starting in an observational way like, “I know we haven’t been connecting intimately like we used to. I miss that and it is important to me, and I wanted to check in to see how you were feeling about this.” You’ll be amazed, how often they are so relieved to be able to discuss this and know it is important to you too.

Then you can brainstorm ways to change little things in your lives to improve the situation. Sometimes it can be simple changes like scheduling a “date”, or trying to connect in the morning or day, when you are often less exhausted than at night. Scheduling this date also gives you both something to look forward to and sometimes the anticipation and even courting before hand can add some excitement and set the tone. If your planned date is at the end of the night once the work is done and kids are down, anticipating it allows you and your partner to work together to get all of the tasks done and may reduce your load and exhaustion and help with desire. Laura Berman, a famous sex therapist, feels that foreplay starts often days before for women, by having a husband help with everyday chores and responsibilities that are meaningful and helpful to you. Once you make it a priority, it is amazing how you will find opportunities to work together for intimacy which is so good for the relationship in so many ways.

It is also helpful to think about what you would each like in terms of frequency, and work towards it just like we do with exercise or other life goals. The saying “use it or lose it” actually has some relevance here. For women, the more often you have sex, the more desirable it becomes and also there is increased blood flow to the area which means more lubrication, less pain, less dryness and muscle tension, and more orgasms.  Also, really figuring out what is desirable for each of you is helpful. It can be awkward at first, but it will increase intimacy and further strengthen your relationship to feel like you are both really listening to each other’s needs. It can be really helpful to communicate with your partner to find ways to satisfy both of you. Often small acts of intimacy can be satisfying for both partners and can bring you emotionally closer, and can be less daunting when you are exhausted. Oprah has a great activity on her website that has been getting recent raves from her viewers.

If the exhaustion is overwhelming, see your doctor for an evaluation for common conditions including thyroid disease, anemia, and depression. Also if you are having significant pain, dryness, or hot flashes and other perimenopausal symptoms it is worth seeing your gynecologist for an evaluation. In your mid 30’s, your body can have some early midlife changes due to hormones that will continue and become more significant in your 40’s and 50’s. These can include: decreased vaginal blood flow with more dryness, pain and infections, more time and stimulation needed to achieve arousal and orgasm, changes in bladder symptoms, sleep disturbances, and overall decreased libido. I list these not to make you discouraged, but to reassure you, that these are changes that often occur so you know you are not alone and can be aware of your symptoms when you see your gynecologist.

Be aware that common medications like antidepressants, birth control pills, and antihistamines can cause decreased sex drive and dryness- so bring a list of all your medications to discuss with your doctor. Also, visiting a couple’s or sex therapist can be helpful for many who would like some professional guidance to help improve their relationship.

Patients always ask if there are any new great medicines for women-unfortunately not yet, but I’ll let you know ASAP when this changes! For women who are nursing or perimenopausal, severe vaginal dryness can be an issue, and estrogen cream added to generous lubricants can be helpful. With aging, testosterone levels can decline and there is a compounded testosterone cream that can be prescribed, but the results haven’t been too promising. And in studies, blood tests for testosterone levels haven’t been helpful in predicting who has problems due to this or for guiding treatment.

Finally an ongoing theme that I always emphasize is finding ways to recharge. It is so difficult to think of our partner’s needs when we are exhausted and haven’t even had time to have a moment to ourselves amidst the hectic day with all of life’s responsibilities. So be sure and do something to nurture yourself this week, even if it is something little like a nap, a warm bath, or enjoying a good book in your pajamas. Good luck!