The Radically Well Podcast · Season 1, Episode 3
Perimenopause Libido, Dryness and Desire: Talking About Sex When Your Body Changes
For Rosie Acosta, one of the most vulnerable parts of perimenopause was what happened to her libido, and how hard it was to say so out loud. In this episode she and Tessa Tovar talk openly about desire, dryness, testosterone, the orgasm gap and the conversations that make intimacy possible again.
The part of menopause nobody mentions
There is more information about perimenopause now than there was when Rosie went through it, and more people talking about it in public. What still rarely comes up is sex. Rosie describes losing her desire inside a long, loving relationship as one of the most vulnerable and inadequate feelings of the whole transition, and the reason she wanted this episode on the record.
Tessa, who is in perimenopause now, joins her for a frank conversation that covers the physical side (dryness, hormones, testosterone and how to approach treatment carefully) and the harder emotional side: feeling unattractive, worrying a partner will take it personally, and learning to say what you want.
What this episode covers
- Why losing your libido in perimenopause can feel so isolating, and why it is more common than people admit
- Vaginal dryness, and why it deserves the same open conversation as hot flashes
- What the hosts have learned about testosterone and compounded treatments: start low, go slow and retest
- Why tracking sleep, mood, brain fog and fatigue makes it easier to notice when something shifts
- How feeling at home in your own body comes before feeling desire
- The orgasm gap, and why women are conditioned not to say what they want
- How to practice a hard conversation before you have it
- Mindfulness as a way through the shame, and a message for supportive partners
Feeling like a stranger in your own body
Rosie is candid about the years when her body stopped feeling like hers. She was in pain, she could not work out the way she used to, her shape was changing, and in intimate moments with a partner who never made her feel anything but beautiful, she kept wondering why he would want her at all. She remembers telling him she wished she could see herself the way he saw her.
What made it harder was that it felt too embarrassing to name. Admitting to the person you have been with your whole adult life that you have no desire right now feels like admitting something is broken. Tessa adds the other side: the worry that a partner will hear it as a judgment of them.
Dryness, testosterone and doing your homework
Both hosts are on testosterone prescribed as part of hormone therapy, and Tessa describes a prescribed topical she has found helpful for dryness and arousal. They are equally clear about the cautions. Compounded treatments are made by a pharmacist rather than mass-produced, so they can vary from batch to batch, which is why both of them start low, go slow and get retested regularly. Rosie describes testing high at one point and working with her doctor to bring her dose back down.
Their broader point is about paying attention. Writing down your sleep, mood, brain fog and fatigue gives you something concrete to bring to an appointment, and makes it easier to notice when a regimen that worked three months ago needs another look.
This is a personal conversation, not medical advice. Talk with a qualified clinician about libido, vaginal dryness and any hormone or compounded treatment.
Saying what you want, out loud
Women are often raised not to say what they want in bed and then expected to be understood anyway. Rosie and Tessa talk about the orgasm gap, the well-documented difference between how often men and women report orgasm, and connect it to exactly that silence. Rosie credits the openness in her own long relationship for the fact that their sex life is better now than it has ever been.
They also talk about the practical side: foreplay, lubrication, novelty, and the fact that a dependable routine is not boring if you both enjoy it. For women dating again in midlife, the advice is the same but braver: practice being vulnerable, and pay attention to how a new partner responds. If they make you feel worse, you have learned something valuable.
Connect with your own body first
Rosie’s main takeaway is that desire starts with your relationship to yourself. She describes mindfulness simply as being present without judgment, and suggests using it to notice the thoughts that arrive in this season (I am broken, I am not enough) without holding on to them. It is hard terrain, she says, and it is also temporary.
Tessa’s takeaway is practical: rehearse the hard conversation. Write it down first, try it out with a friend, and expect it to be an ongoing conversation rather than a single announcement. They close with a message for partners: you will get things wrong, and that is fine. Your effort is seen.
Timestamps
Times refer to the YouTube video.
| 00:00 | Introduction: hormones, relationships and what changed |
| 01:30 | Shame, mixed messages and the libido nobody mentions |
| 04:33 | Prescribed topicals, testosterone and compounding pharmacies |
| 09:10 | Feeling sexy starts with feeling good in your body |
| 10:42 | Testosterone as part of hormone therapy |
| 13:45 | Adjusting a dose, and why tracking symptoms matters |
| 15:15 | Rosie’s story: feeling like a stranger in her body |
| 19:49 | When low libido changes the relationship |
| 22:51 | Dropping the shame and saying what you want |
| 25:54 | Libido mismatch and how often couples have sex |
| 28:55 | Novelty, routine and the orgasm gap |
| 30:28 | Dating in midlife and practicing vulnerability |
| 33:31 | Mindfulness: connecting with your body first |
| 36:32 | How to rehearse a hard conversation |
| 38:03 | A message for partners |
Explore the conversation
Questions explored in this episode
Is it normal to lose your libido in perimenopause?
It is very common, and both hosts experienced it. Hormonal changes, vaginal dryness, pain and how you feel in your body can all play a part. Rosie’s message is that nothing is wrong with you, that this stage does not last forever, and that there are medical and therapeutic options worth discussing with a clinician.
What helps with vaginal dryness during perimenopause?
Lubricants and prescription treatments both exist, and a clinician can help you choose. In the episode, Tessa shares her own experience with a prescribed topical, and both hosts stress asking questions, starting low and getting retested.
What should I know about compounded testosterone?
Compounded products are prepared by a pharmacist rather than mass-produced and FDA-approved, so they can vary from batch to batch. That is why both hosts start on a low dose, go slowly and have their levels retested regularly with their doctor.
How do I talk to my partner about low libido?
Say it out loud, and practice first if you need to: write it down, then try it with a friend. Reassure your partner that it is not about them, give them a chance to respond, and expect it to be an ongoing conversation rather than a single one.
What is the orgasm gap?
It is the difference between how often men and women report having an orgasm during partnered sex. Rosie and Tessa link it to women being conditioned not to say what they want, and see open communication as the most practical way to close it.
How can mindfulness help with sex and body image in midlife?
Rosie describes mindfulness as being present without judgment. It helps you notice thoughts like “I am broken” or “I am not enough” without holding on to them, and reconnect with your body before trying to reconnect with a partner.
Nothing about this means you are broken.
Rosie offers mindfulness coaching grounded in self-compassion, with practical tools for anxiety, sleep loss and the emotional side of midlife. Coaching is available in English and Spanish.
This episode is a personal conversation and is educational in nature. It does not replace care from a qualified healthcare or mental health professional.