Sex, Relationships, & Peri/Menopause with Couples & Sex Therapist Marissa Nelson
3 minute read
It’s time to have THE talk…again. It’s kind of like the one you remember from grade school, but menopause-ified.
And who better to have THE talk with than Marissa Nelson, a Licensed Marriage & Family Therapist (LMFT), AASECT Certified Sex Therapist (CST) and Certified Sexuality Educator (CSE) who has been helping couples and singles for the past decade? Nobody, that’s who.
Her focus stems from her own experience with trying to conceive and IVF. For four years prior to conception, she endured the pain and challenges of infertility and pregnancy loss, suffering in silence. She chose to transform hopelessness into empowerment as a FemTECH founder of Haven Wellness, an AI-Powered Emotional Wellness App to support employees’ mental health, relationships, and work life during their journey. She is also a champion for equality, reproductive and social justice, particularly for communities of color.
She is a TEDx Speaker and sought-after Sex and Relationship Expert. She is a Clinical Member of The American Association of Marriage and Family Therapists (AAMFT), American Association of Sexuality Educators, Counselors, and Therapists (AASECT), The American Society for Reproductive Medicine (ASRM), The Association of Black Sexologists and Clinicians (ABSC) and holds a certificate in Divorce Mediation & Conflict Resolution.
We recently welcomed her to our webinar series with our community manager, Rachel Hughes. We recommend you watch the whole webinar on YouTube, but are sharing some highlights here.
The interview has been edited for clarity and brevity, and, as always, is for educational purposes only and should not be used as personal medical advice or therapy.
Rachel Hughes: Welcome! We’re so glad you’re here. Let’s go ahead and get started. Can you tell us about who you are and what you do?
Marissa Nelson: Thank you so much for having me.
So, I’m in private practice in Washington D.C., and outside of being in private practice, I write articles, I do speaking engagements, and I talk to women around the world. My clients are here in the U.S., and I have clients abroad, and so I hear a lot of stories about what women are going through. Many of my clients are between 35 and 70 years old, with, of course, outliers on both sides.
A little about how I work: I am an attachment-based therapist, so, I always look at family and family systems. How did you learn about relationships? How did you learn to be in relationships? What were your parents like? This matters, because when we are young, we turn to our parents for survival. This is where we learn the building blocks of pleasure, trust, and connection.
I’m also looking at how you grew up, how you communicate, how you resolve conflict, how you work within the condensed time you have, and how you’re able to prioritize yourself. I look at your own energy. Especially as you go through perimenopause and you’re dealing with things like brain fog, chronic fatigue, vaginal dryness, sexual dysfunction…all of these things have an impact. What’s going on health-wise? What do you want sexually? How has your body changed?
Menopause and perimenopause do not happen in a vacuum. It happens at the epicenter of all of these different aspects of who you are.
Rachel Hughes: That makes so much sense. I’m curious, what is a mistake you see between couples during this season of life?
Marissa Nelson: Assumptions. Part of the breakdown in communication with couples, and with all relationships, is that we operate, act, and react based on assumptions. And when it comes to intimacy, one of the biggest mistakes we make is that we make assumptions about our partner’s motivations, our partner’s wants, our partner’s needs, and then we operate based on those assumptions. One partner might assume something like, “They don't want to have sex. They don't want to be intimate,” and the other might assume that they’re being rejected, or that their partner isn’t interested in their body anymore. And it can just spin out.
Instead, we should approach intimacy with curiosity. Curiosity is my big word, because in reality we don’t know the answers to a lot of these things. There are a lot of reasons people experience the feelings they’re feeling. It could be something as big as trauma, or something as straightforward as low iron. It could be perimenopause. There’s a constellation of factors. What we always have to come back to is, “How do I not make assumptions about who you are, what your motivations are? How might I be able to ask better questions and really lead with the empathy and the connection that is necessary? Listen, as a partner, I may not understand what's happening, but I want you to help me understand what's going on with your body. I want you to help me understand what your boundaries are. I want you to help me understand what pleasure is going to look like for you right now. And if pleasure is not intercourse, that's okay, but what do you need from me right now? What do you need from the relationship right now?”
Rachel Hughes: What are a few strategies for improving communication in a relationship?
Marissa Nelson: I think that people are really concerned with listening, which is good, but sometimes, they’re listening just for the sake of listening. You need to be listening to hold space for each other, and sometimes that means hearing something you’re not comfortable with. But the point is not agreement. I think too often people think that communication is about compliance. Communication, at its essence, especially between couples should be about, “How can I better understand who you are, and what you need? And how can I support you?”
Rachel Hughes: Amazing. I’m thinking about women in midlife, in perimenopause and menopause. You’re irritable, your patience is lower, and the person who is closest to you may not be aware. What are good questions you and your partner should ask each other regularly in order to maintain open communication?
Marissa Nelson: Two things come up for me when you say hormones. And it doesn’t really matter how old you are. I have clients who are going through egg retrievals, or are taking medication that affects their mood. Perimenopause and menopause will also do that. And often, we don’t even have the awareness of it, but our partner feels the impact. So, it helps to be attuned to what is going on with our own bodies and our own emotions. And, it helps to think about who we are and how we respond when we’re not our best self. Because we’re all going to have those days.
So a good place to be is a place where both people are working together to say, “Hey, let me check in with you today.”
And it might be a good idea to say, “I just want to let you know that right now I'm on this hormonal panel,” or, “Right now I'm taking this medication. We're really just trying to understand how this medication is working for me. Sometimes you might experience me being a little bit irritable, but I want you to know that it has nothing to do with you. And if I've said something that really hurt you or bothered you, I'm really sorry. Can we talk about it?” And then you have an opportunity to communicate. Because a symptom is not your entire personality.
Rachel Hughes: Thank you for all of that. So you’ve really laid out some strategies for communication, considering each other’s humanity, and holding space. Let’s pivot to sex. Couples so often find that having dialogue about sex is uncomfortable. I’ve heard from women that it’s because they’ve just never really talked about it. Is there a way to listen and speak that is nonjudgmental about the topic of sex in perimenopause and menopause?
Marissa Nelson: One thing I believe is that if you create conversation safety and hold space for each other, that just because it’s safe, doesn’t mean it’s always going to be comfortable. And that’s okay. If you haven’t talked about sex, for any number of reasons, and you don’t have language around sexuality, it’s going to be like anything else in your life that you don’t give attention or oxygen to. I also think that sexuality is very charged. We come with our own opinions, belief systems, vulnerabilities–it's sensitive. And there are preferences. And it can come with a lot of shame and guilt and judgment, particularly if you’ve had a previous partner who has made you feel that way.
My point is, it doesn’t have to be the most comfortable conversation. You’re going to have to try it on for size, and, like riding a bike, you’re going to have some missteps. And you’re going to work through them.
I think sometimes people feel scared to work through things because they don’t want to offend their partner. But I think that what it’s costing you is your intimacy, and your relationship with pleasure.
One of the things I hear a lot from my clients, particularly during perimenopause is menopause, is that if you've had children, maybe you don't feel like your body is the same or maybe you're going through perimenopause, you're like, you're not feeling desire the way you used to. And we have these unconscious belief systems and insecurities, and all of it can make sexuality feel a little scary. But, I’m here to tell you that you can do it, and that it is possible, and I want you to lean into it because when you do, you’re able to learn so much about yourself and also about your partner.
Rachel Hughes: That's so interesting and so helpful. Can you talk a little bit about body image, which I think is a big thing for women in midlife?
Marissa Nelson: Yes. So let's talk about body image, the way in which we look at our bodies, and how that can be affecting intimacy. It’s important for us to do our own self-work around our bodies before we can do it with a partner. If you were in my office, there are a few things I would do. One is a sexual history. I’d want to know what your belief systems and values are around sex in order to be able to step into intimacy and to be able to feel pleasure. And I also do body mapping. You have a drawn out figure of the body and we want to look at different zones in your body, and learn where you feel pleasure and where you feel shame. And then we can troubleshoot. Because you deserve to feel pleasure. You do not have to suffer while going through this life transition.
Rachel Hughes: Thank you. When you see couples in your office, is there something you leave them with, like a small daily practice or gesture to impart in between sessions?
Marissa Nelson: Yes, there's a couple of things, but I think one of the biggest things is, I want you to take a piece of paper. You and your partner do this activity together, and it’s called the letting go exercise, and it should take about 10 minutes. You identify all of the things you want to let go, and you write down anything that is impacting your intimacy and your pleasure. It could be everything from sexual trauma, criticism, shame, performance anxiety, religious shame, all of those things. I want you to write down and identify at least five big things, and your partner will do the same. And then on the other side, identify all the possibilities. Then, you share with each other, and you have a conversation about it.
And, I want you to play. I want you to have fun. It doesn’t have to be so hard.
Rachel Hughes: Can you tell us more about that?
Marissa Nelson: I want you to come to a place where you invite more ease into your life. Allow yourself pleasure. And correct what’s not working. If you have dryness, there are things that can support you. There are choices and solutions. I want you to have fun again. And if you are not having fun, you can create pathways to have more fun, because you deserve it.
Rachel Hughes: Thank you so much!
Marissa Nelson: Thank you.
For more, watch the whole webinar on our YouTube.
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