Dr. Angela, why, because you hear this quite often where people will say, I still am so in love with my partner, I just don't want to have sex with him.

Well, I think it's really interesting that we're talking about talking to partners, but actually a lot of the time, there's a closer study that said that women don't even share, 50% of women don't even share with their partner that they're having these changes.

Yeah, I can believe it.

I think communication falls off over time, but there's also something about we get quite typecast.

I think you spoke to it earlier on about how often women will prioritise their partner.

They'll have sex in a way that isn't particularly exciting for them.

It's not particularly hitting their heights but we don't encourage women to talk about their needs in fact i would go the other way and say we sort of systematically tell women to push their needs down that's what you do when you're selfless being a mother that's what you do when you take care of everybody and then we kind of wonder why they get disconnected from what they want and don't have to name it in relationships so i obviously get people that come to see me with low libido and pain and we're starting from this really big break that's on their jaw control and they've also got a big fat break mentally because they are permanently in fight flight.

But again, that takes you

If people are wanting to protect their brain, what do you suggest they can do going forward?

I think that's a really good question because that's the underlying fear that we have, isn't it? I think most of us get to this point.

It feels like a point where our bodies are changing, our brains are changing.

you start to see the future and you want to do what you can to make sure that you're safe the research is still the really sensible really boring things that we all know so your brain's a bit like a muscle actually it you know we need to do the same things that we would do with looking after the muscles in our arms and legs to look after our brain health so we need to exercise it that means keeping learning new things keeping socially connected What we're doing now is brain exercise.

We're having to think and retain and talk.

So social connection.

We have to rest it.

those?

Would you say that's, that's when we need to start looking at hormones?

Again, I think it does all sort of blend together.

So you've got your, you know, your body is your tool.

Your body, the sort of soup of your hormones affects how you receive incoming stimulus, you know, whether that's sexual stimulus like touch.

It, it feels different in the absence of hormones.

You don't get such a lot of blood supply to the genitals if you haven't got estrogen going through your system.

So the feeling of being aroused feels different.

Mm.

You're like, you, you owned this, didn't you? [laughs]

Yeah, but I got to do, I got to do it slightly more easily.

So I did it, we's all, we all set off together, didn't we? But Gemma had, the, my walking partner, had managed to tear her calf like 72 hours, 48 hours before the walk.

And it was really evident from the beginning that she wasn't gonna be able to walk at the same speed as the march pace.

And I, and at one point I forgot she even existed, and I had to be nudged to remember that she was behind us, [laughs] which felt really bad.

So we, we did it more slowly than you guys did it.

So we took it at Gemma's pace, and actually that was, that was quite doable.

This is a bit mad, but I'm gonna do it"? [laughs]

Why do you feel when people come to you that they don't own the decisions and agency over their body? Where's that come from? Is it from seeing too many people who haven't been allowed to make decisions? Is it what you hear from your colleagues and doctors? Where's that come from, that frustration?

It's a good question, 'cause I suppose, uh, if you asked a load of doctors, we'd all probably have a different view on where that balance of risk sits, you know? Is, is the risk of a decision with me as a prescriber, or does it sit on the head of the person that is taking the prescription? And I think we probably all have different comfort levels.

But I guess I'm working in slightly murky bits of medicine, I suppose.

The, the, the things that I've done lots of work in have been palliative medicine, so I worked in a, a hospice for a decade.

There's a lot there which is about quality of life rather than worrying too much about being on the dot of, you know, guidelines and things, which maybe sets my direction.

I'm now working a lot in sexual function, where it's not full of guidelines and we're working off label with medicines.

And I suppose what I, what sits in me as a practitioner is I don't feel like I have the control in a consultation, and I think too often I feel that doctors can feel that because responsibility may sit heavily on their shoulders, that almost kind of control and decision can sometimes sit there too.

Is this what you mean? Is this what you mean when you talk about the agency?