Pre-menstrual dysphoric disorder : How to experience sex and intimacy when you have PMDD

Recently, I was asked to be on Triple J’s The Hook-Up program to talk about how to navigate sex and intimacy when you experience pre-menstrual dysphoric disorder (PMDD) and they did a fabulous segment on it.

Click the link above if you want to be taken to the podcast, otherwise, read on to learn what I said AND to get some bonus suggestions that I didn’t have the time for in the live recording.


The Hook-Up episode started by describing what PMDD is. They report (abbreviated):


PMDD is a nightmare that can lead you to intense physical pain, and can even bring on depression and anxiety. It's a condition that no amount of chocolate or heat packs can fix.


People often call it ‘PMS on steroids’, but truly reckons that kind of underplays it really sort of dresses a bit of a disservice describing it as severe PMS, because it really is its own condition.


One listener said: “A bad month is like two weeks of symptoms. So when it's bad month after month, it's essentially 50% of your life is taken over by this thing. PMDD is essentially, symptoms of depression, anxiety, you know, an inability to stop crying - basically an inability to function. PMDD is like having a dark cloud to send over you out of nowhere. And once you get your period, it’s like one day you were feeling like everything in your life is wrong. And there was an overwhelming sense of unkindness about yourself and everything in your life. The next day, you feel joy and gratitude and you have perspective on your life. I feel relieved.”


It’s estimated that PMDD affects about 5% of women. Some women turn to hormonal based contraceptives to try and quell the symptoms but for other women, this makes things worse. For some women, antidepressants are also an option and they can be effective if you just take them part time. One of the studies on PMDD stated that they can be effective within 14 hours and that women are actually able to use antidepressants for half the cycle so they might be on it for two weeks.


So Lauren, I will start with you. PMDD clearly has a large effect on women’s mental health but what impacts can it have on your relationships?


A huge impact because PMDD really infiltrates a woman's identity. And with all of those significant mood changes that were just discussed in the info segment, it can cause women to really turn inward and feel intense frustration and disappointment and disconnection at a time where what they really need is lot of understanding and lots of compassion, and lots of other forms of intimacy if they're not feeling really receptive to touch and sexual contact.


So how can partners deal with it when their partner suffers with PMDD? And what can what can partners do to help?


The most empowering question a partner can ask is:


What do you need right now?


It's so, so clear, and it's so comforting: What do you need right now?


And that gives the woman who's experiencing PMDD a chance to answer in a way that really that means that she's more likely to get her needs met - its nice and open ended. And sometimes that might mean accessing different types of touch that still facilitate intimacy. Because there are a number of different sorts of touch like affectionate and sensual and healing touch that the couple might need to harness at times where her symptoms are most problematic.


Can you feel, I mean, it's two weeks out of the month, which is almost like half your life or it can be up to that much. What is arousal like? And how do you experience when you have PMDD? Can you be sexually aroused or experience pleasure, Lauren, when you are kind of in the throes of this of this feeling?


You most certainly can still experience pleasure because your body, if you think of arousal and your nervous system, there are some different layers to it. And that feeling, it might sound strange, but that feeling of anger can actually be channelled into a form of sexual arousal. Yes, they're kind of far apart but then at times they are kind of similar in the way the blood gets flowing and the way that our heart gets racing. So if there's any way that she can re-conceptualise that anger and that frustration and turn it into something, some sort of creative expression in the bedroom, then that's an empowering way so that she doesn't feel so power-less.


I think the most, the hardest thing about PMDD is the powerlessness that goes with it and that causing her to really shirk away from other forms of intimacy. And we know that sex can be a form (and orgasm especially), can be a form of pain relief. So if there's any way that her mindset can kind of move into touch that really meets her needs and that might be really, really firm touch and she can express some of that then it can be cathartic. Sex can be cathartic - but she’s got to be open to it.


It's the Hook-up on Triple J and I'm here with Lauren White. She's a sexologist and she's worked with a lot of women who experienced pain and discomfort and stress in their relationships – PMDD being one of those stresses.


PMDD is a vicious cycle because it makes you stressed, which causes more stress! Lauren, how can you disrupt the cycle?


You can start to disrupt that cycle by starting to get really clear on what you feel angry about and other facets of your life, maybe what you're grieving, what you feel sad about, whether you've been recently triggered by some old trauma and just really releasing that by going and talking to someone about it.


It never ceases to amaze me how when women come to the sex therapy process, how – it might just be a side note, that's like: “I just noticed I've had the best period that I've had in a while, like, usually, it's painful, and usually I go through all of these mood symptoms…” And somehow having that compassionate ear, getting clear on how you can express your femininity can really bolster your own set of resources, so that you feel heard, like that's what so many women need - is to feel heard and acknowledged. And when we're in pain at some, that's usually the first thing that we deny ourselves. We close ourselves off and when we feel stress, the best antidote is connection so that we can feel that oxytocin, you know, we might not necessarily want to feel it in sex and orgasm right now but we just need to feel that bonding and that sense of being understood. So that's a really, really powerful way of starting to move through those really frustrating emotions.


Well, you know, one of the issues or one of the things that PMDD can do is impact your libido your sex drive, or maybe your desire for connection. How can you navigate having a healthy sex life and, and finding that connection that you’re talking about when you have PMDD?


The first thing I'll say is complete permission to not necessarily be sexual when your symptoms are at their worst. I just want to make sure that no woman feels like “even though I feel this way, I should try and be sexual”. Certainly try if it feels right for you to kind of like I said before, to channel some of that intensity into some form of sexual expression but maybe just start with something non-sexual, that can still have erotic tones, like your own version of what I call lounge room dancing, like really express yourself that way. And then see whether you want to progress that into some form of self-pleasure, or approach your partner.


I really believe that if you're the one experiencing symptoms, that any sexual intimacy or contact really needs to be on your terms, because you're the one that's in discomfort. And that way you can choose and express to your partner: What exactly is going to meet your needs, what you need from them what it is that you feel, okay for on this occasion? Or maybe what's not okay, on this occasion that's had a green light or a yes, in the past.


So yeah, my one of my biggest tips to my clients is:  use the touch to meet your feelings. So you might need something really firm, we might need a lot of warmth like I love how the segment talks about, heat packs in the very beginning – bring heat packs into sex. Bring them in and use them over your body on places that really need your attention. So they are just a couple of things that you can do but if your symptoms are really, really intense, then it just might not be the time to be sexual, but you might want to tap into the other forms of intimacy that are available.


Our listeners are saying one of the most important things to them is that they are heard and believed…


Yeah, yeah, most definitely. For any issue that but any issue that you're experiencing, it's just that is that relief and it is that ahhh I'm not alone. That is being feeling alone makes us feel so stressed and makes all the symptoms worse. And you're not alone in this if you have PMDD.




If we had more time on air, here are a few other points I would add:


1) Be sure to use a different dialogue about your womb/uterus and menstrual cycle…


The language of your body being broken or faulty keeps your growth and healing stuck. Our lady parts are wonderful oracles and really aptly gauge how we are truly feeling about our lives and relationships.


Talking about your body in terms of what is working, how it does support you and being compassionate goes much further than we might think. It also takes us from a place of: I am in combat with my body to I am trying to understand what I need to address or what I need to stop (or start) have completely different tones.


Language matters and influences how you feel.


2) Try to drop into the full spectrum of what you do feel rather than focusing on what you don’t feel or what you don’t want to feel…


There was a great question about pleasure in the segment and the pleasure in the more challenging phase of your cycle might look different to the pleasure that comes more easily in the first half of your cycle. Pleasure might be all up and outward and sociable in the first half and move to go into down-regulating and restful (aka SLOW) in the second half of your cycle. Maybe the foods of pleasure are different for you because they bring different kinds of comfort or alignment.


It might sound basic but when you feel or taste something good, actually say: that tastes good or that feels amazing! Acknowledging with your voice is powerful and I believe works to cement an experience in so we aren’t so disconnected and focused on what is hard and painful.


3) Sex can be used as a form of regaining power and control when you feel powerless.


Not feeling like you want to lie down and receive pleasure when your PMDD symptoms are bad? Feeling powerless? Could you use this time of your cycle to regain some control in the bedroom and take charge? Do you feel able to tell them what to do and be a little dominating? Lots of people need relief from making decisions and are craving being told what to do. Could you take your powerlessness with PMDD and use it to be in control and tell someone else exactly what is going to happen?


Feel into it. So many women need this opportunity to be in control instead of: “I’m fine, we’ll do what you want to do”.


Lastly, use sex in this part of the cycle to only give to your partner if you really don’t want to receive but only do this if it gets your full yes.


If you are depleted from giving and serving then don’t push yourself to do this. It’s an option if your energy levels are OK and you’re really sure that going into receiving is going to make things harder for you.


Permission slip: Giving can look like whatever you want it to. You might even need to say to your partner: This is what I can give you right now – I can give you touch in this way but not in THAT way. Check in with your heart first, take a deep breath and know that you aren’t there to serve someone else’s needs or be there to sexually gratify someone. Giving, especially sexually, needs to feel good and generous.


If you’re experiencing PMDD and your sex and intimate life could use the expertise and support of…well, me, then read my sessions page to learn how my signature process: Open to Receiving could change your relationship with your body and your relationship with your life. Book your free private discussion now and let’s move you out of contraction to comfort and pleasure.


Lauren xo