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The Biggest Myth About Female Sex Drive That Women Still Believe · The LIVING Room Podcast | Inside The WNDR Lab

0:00
SPEAKER_01: First and foremost, sexual health is health.
0:02
SPEAKER_01: In the same way that we prioritize other facets of physical, emotional, spiritual well-being, we also want to nurture sexual health.
0:10
SPEAKER_01: It's desire that emerges in response to arousal.
0:14
SPEAKER_01: It can be normal, healthy, common to go into an encounter totally neutral and have desire be the last thing to emerge at the end.
0:22
SPEAKER_01: In my clinical practice, I will hear people say, my body is having sex, my mind is not.
0:27
SPEAKER_01: When we look in at females with menopause, when estrogen and progesterone start to decline, it doesn't directly affect desire.
0:35
SPEAKER_01: What it does directly affect is feelings of sexual pleasure and pain.
0:40
SPEAKER_01: 43% of females in this cross-national study had clinically significant sexual dysfunction.
0:48
SPEAKER_01: About 80% of men with sexual concerns that are prolonged will seek treatment.
0:51
SPEAKER_01: Less than 10% of women will seek treatment.
0:54
SPEAKER_01: There's also ongoing shame, stigma, stereotypes that continue to this day around women's sexuality.
1:03
SPEAKER_01: And as a result, a lot of women just never talk to anyone.
1:06
SPEAKER_01: They suffer in silence.
1:25
SPEAKER_00: Either we have it or something is broken and we just live with it.
1:28
SPEAKER_00: But what if desire isn't something that we wait for, but something that we can actually train?
1:33
SPEAKER_00: Today's guest has spent her entire career proving exactly that.
1:37
SPEAKER_00: Using mindfulness to help women rebuild desire, reclaim pleasure, and heal from sexual pain and distress.
1:44
SPEAKER_00: Today we welcome Dr.
1:45
SPEAKER_00: Laurie Brotto, Canada Research Chair in Women's Sexual Health and professor at the University of British Columbia, where she spent the last two decades studying mindfulness and women's sexual health.
1:56
SPEAKER_00: So without further ado, please enjoy my conversation with Dr.
1:59
SPEAKER_00: Laurie Brotto.
2:01
SPEAKER_00: Laurie, you've spent your entire career studying, you know, one of the most probably misunderstood but sort of intimate parts of human health.
2:13
SPEAKER_00: How did you end up dedicating your life to human intimacy?
2:18
SPEAKER_01: Yeah.
2:19
SPEAKER_01: So the honest answer is totally by accident.
2:23
SPEAKER_01: So I started volunteering in a research lab.
2:26
SPEAKER_01: I knew I loved science and loved discovery.
2:29
SPEAKER_01: Um, and at the time, the only research lab I could find that was willing to take me on, someone with no experience whatsoever, turned out it was someone who was studying animal models of sexual dysfunction.
2:42
SPEAKER_01: So I would go into the rat lab, rodent lab.
2:47
SPEAKER_01: I would inject male rats with different medications, corticosteroids, expose them to stressful environments, and then measure their capacity for sexual behavior and specifically how long did it take them to recover after an ejaculation before they mounted another female rat.
3:06
SPEAKER_01: Um, and I learned a lot about the science of sexual behavior, the impact of stress, um, and how antidepressants and uh other agents could potentially block some of the effects of stress and continued to do that for about six years.
3:21
SPEAKER_01: And then the year that Viagra was approved in the United States.
3:25
SPEAKER_01: When was that?
3:26
SPEAKER_01: That was 1998 in the United States, um the a landmark study was published and it was called sexual dysfunction in the human population predictors and prevalence.
3:39
SPEAKER_01: And the study found that 43% of females in this cross-national study had clinically significant sexual dysfunction.
3:49
SPEAKER_01: And so I said, Oh my gosh, 43%, that's almost half the population of women with sexual problems.
3:54
SPEAKER_01: Surely there must be something like Viagra, which was just approved for women.
4:00
SPEAKER_01: So, of course, I was a PhD student at the time, dove into the science, and it was a, let's just say it was a very short literature search because there was virtually nothing.
4:10
SPEAKER_02: Yeah.
4:10
SPEAKER_01: Uh, not only were there no medications that were approved for treating sexual problems in females, the overall scientific body was relatively sparse, not much even in terms of psychological treatments.
4:23
SPEAKER_01: Um, so it was after that that I made the switch from doing uh research with non-human animals to humans, and was mostly interested in um factors that contribute to sexual response and sexual arousal in women.
4:38
SPEAKER_01: So I set up a psychophysiology lab, and essentially it's a private room that um uh well, really any person can be exposed to erotica, and you can measure both the body's physiological capacity for arousal.
4:52
SPEAKER_01: And then really importantly, they hold on to a handheld lever on their recliner, and as they're watching the erotic film, they move this lever to correspond with how sexually excited they are in their mind.
5:04
SPEAKER_01: And the main thing I was interested in was the degree to which the physiological response in the body uh was concordant, or in the case of females, discordant with their self-reported response and tells us a lot about kind of mind-body synchrony and factors that contribute to that.
5:21
SPEAKER_00: How are you measuring the physiological response?
5:24
SPEAKER_01: So it's called it's a small um photoemitting diode called a vaginal photopletismograph.
5:30
SPEAKER_01: And so they would insert it into their vagina and it emits a pulse of infrared light.
5:36
SPEAKER_01: And then the amount of backscatter off the vaginal wall, so the greater the degree of backscatter corresponds with more vasal congestion, which is an indirect and imperfect measure of arousal, but it is a measure of blood flow, which is one marker of sexual response.
5:53
SPEAKER_00: Um so you were seeing the looking for the correlation between the physiological response and their self-report how aroused they were.
6:02
SPEAKER_01: Yeah, yeah, we call that concordance.
6:04
SPEAKER_00: And what was the outcome?
6:07
SPEAKER_01: The agreement is almost non-existent in females.
6:11
SPEAKER_01: And in in contrast, when you bring males into the lab, and of course, how you measure physiological response in males is different.
6:17
SPEAKER_00: A bit easier.
6:18
SPEAKER_01: It's with a strain gauge, which is essentially like a plastic ring, an expandable ring that's placed over uh the flaccid penis.
6:25
SPEAKER_01: And so um the agreement between that physiological response and sexual and self-reported arousal is almost perfect.
6:32
SPEAKER_01: It's almost 1.0, which is a perfect correlation.
6:35
SPEAKER_01: Uh, and in and in females, it's highly discordant.
6:39
SPEAKER_01: So typically what you would find is uh, you know, a robust physiological response in females and either a much smaller self-reported arousal, or even women who are saying, I feel nothing, or I'm even turned off.
6:52
SPEAKER_01: So you find kind of that inverse correlation between the two.
6:56
SPEAKER_00: So they were physically aroused and mentally unaroused.
7:00
SPEAKER_00: Correct.
7:00
SPEAKER_00: What do when you say um sexual dysfunction, yeah, what what does that mean?
7:05
SPEAKER_01: Yeah.
7:05
SPEAKER_01: So this would be, I mean, there's big categories of of sexual dysfunction.
7:10
SPEAKER_01: And I use that word because in formal classification um nosologies, that's the language that we use.
7:18
SPEAKER_01: So this this would be things like clinically significant, low or absent desire.
7:22
SPEAKER_01: So this is the person who says, I no longer have any desire for sexual activity, and I experience a great degree of distress.
7:30
SPEAKER_01: It interferes with my quality of life, my relationships, my well-being, my depression, mood, et cetera.
7:35
SPEAKER_01: Um, so desire is one category of sexual dysfunction, and it appears in females and males, although to a much higher prevalence in females compared to males.
7:44
SPEAKER_01: Um, there can also be difficulties with orgasm, so female orgasmic disorder, which is absence of orgasm or significant delay or muted experience of orgasm.
7:56
SPEAKER_01: Also, sexual pain is really common, affects about 15% of females.
8:00
SPEAKER_01: So this is sharp shooting, burning, pain with any kind of vaginal insertion.
8:07
SPEAKER_01: So those are the main kind of female categories of sexual dysfunction.
8:10
SPEAKER_01: And importantly, they need to be distressing to the person, right?
8:15
SPEAKER_01: We don't, we don't want to pathologize something that maybe is an understandable change.
8:19
SPEAKER_01: If you're going through a period of stress and your desire is changed, we're not going to put a label on that.
8:24
SPEAKER_01: So we're really focused on prolonged, chronic, and consistent sexual problems.
8:30
SPEAKER_01: We would call that a sexual dysfunction.
8:31
SPEAKER_00: What would prolonged be?
8:32
SPEAKER_00: Like how long?
8:33
SPEAKER_01: Three months or more.
8:34
SPEAKER_00: Right.
8:35
SPEAKER_00: I imagine, correct me if I'm wrong, and I will probably be wrong a lot on the subject.
8:39
SPEAKER_01: That's okay.
8:39
SPEAKER_00: Um but I imagine this is something that not everyone will seek medical help for.
8:48
SPEAKER_00: You know, I think obviously throughout different periods of our life we peek and trough with arousal and desire and um appetite for sex.
8:59
SPEAKER_00: But even those people that are probably experiencing prolonged um dysfunction might find it difficult to seek medical attention for it.
9:08
SPEAKER_01: Yeah.
9:09
SPEAKER_00: How common is it?
9:10
SPEAKER_00: Yeah.
9:10
SPEAKER_01: I mean, yeah, absolutely.
9:12
SPEAKER_01: And here there's a a stark gender difference.
9:14
SPEAKER_00: Yeah.
9:15
SPEAKER_01: So males are far more likely to seek treatment for, let's say, erectile problems.
9:20
SPEAKER_02: Yeah.
9:20
SPEAKER_01: And I think in part it's because, you know, I can say ED, and most of your listeners will know exactly what I mean by ED.
9:28
SPEAKER_01: Um, and it's not executive director, it's erectile dysfunction.
9:32
SPEAKER_01: Um, but when it comes to sexual concerns in females and women, we don't have the same kind of awareness, right?
9:41
SPEAKER_01: You don't see celebrities talking about their own struggles with sexual problems in the same way that we have had that with erectile dysfunction in males.
9:50
SPEAKER_01: Um, and so we actually have data on the proportion of men versus women who will seek treatment, and about 80% of men with sexual concerns that are prolonged will seek treatment.
10:00
SPEAKER_01: Less than 10% of women will seek treatment.
10:03
SPEAKER_01: Yeah.
10:03
SPEAKER_00: Do you think that's something to do with the fact that it's just so easy to diagnose for men?
10:11
SPEAKER_00: And it's an easy fix, easy-ish fix, right?
10:14
SPEAKER_00: You you we all know about Viagra, and that seems to be a very quick, very effective fix that's readily available and easy to access.
10:22
SPEAKER_01: Yeah, I think there absolutely, that's probably one of the reasons is, you know, someone who's struggling with these issues might say, Well, I could talk to my primary care doctor, but there's no treatments for this, so why bother?
10:36
SPEAKER_02: Yeah.
10:36
SPEAKER_01: Um, but there's also, you know, ongoing shame, stigma, stereotypes that continue to this day around women's sexuality.
10:47
SPEAKER_01: And um as a result, a lot of a lot of women just never talk to anyone.
10:52
SPEAKER_01: They suffer in silence.
10:53
SPEAKER_01: And so when they discover that these are well-known, well-studied entities, we actually do have evidence-based treatments for them.
11:01
SPEAKER_01: They I mean, and I often hear in my clinical setting, you know, the sense of, gosh, I wish I knew about this, you know, 20 years ago.
11:09
SPEAKER_01: I could have spared myself all of the hardship and suffering that I've endured.
11:14
SPEAKER_00: Are there any pharmacological equivalents to Viagra for women?
11:17
SPEAKER_01: Yeah.
11:18
SPEAKER_01: So in the United States, there are two FDA-approved medications.
11:22
SPEAKER_01: They work very differently, and neither of them work quite like Viagra.
11:26
SPEAKER_01: So Viagra, you know, works on the periphery.
11:29
SPEAKER_01: It works to prevent the nitric oxide pathway to sustain an erection in males.
11:35
SPEAKER_01: So the first medication in females that was approved is called phlebanserin, and essentially it's a failed antidepressant.
11:42
SPEAKER_01: So it's an oral medication that women take, um, and it takes about eight weeks to show some benefit.
11:49
SPEAKER_02: Wow.
11:50
SPEAKER_01: It's rather expensive.
11:52
SPEAKER_01: Um, and it does um it does work on the kind of central processing of sexual desire.
11:59
SPEAKER_01: So pathways of norepinephrine, dopamine, and serotonin in the brain.
12:04
SPEAKER_01: And so it literally is a failed antidepressant.
12:06
SPEAKER_01: It was originally tested for a depression.
12:08
SPEAKER_01: Mood didn't improve, but sexual desire did.
12:11
SPEAKER_01: But when we actually look at the data, what you see is that less than half of women who use it see a benefit.
12:19
SPEAKER_01: And the benefit that they do experience is not necessarily an overall desire, but rather they'll say that their sexual encounters are more satisfying.
12:28
SPEAKER_01: Right.
12:29
SPEAKER_01: So the FDA measured something called sexually satisfying events.
12:32
SPEAKER_01: So that's one medication.
12:34
SPEAKER_01: Um, there's also quite a significant placebo response as well, as there is in all pharmacologic studies.
12:40
SPEAKER_01: The other medication is called bremalanotide, um, and it's an injection that the person does to themselves, just below subcutaneous, below the skin.
12:48
SPEAKER_01: And it also is centrally acting, but it works on the melanocortin receptors in the brain.
12:55
SPEAKER_01: So, unlike phlebancerin, that needs to be taken chronically to show an effect with bremelanotide, it does have that kind of more immediate PRN effect.
13:04
SPEAKER_01: But a lot of people have a hard time injecting themselves.
13:07
SPEAKER_01: So there's so when you think about kind of motivation to use medication like that, it would have to be fairly high.
13:12
SPEAKER_00: Yeah.
13:13
SPEAKER_00: Side effects?
13:14
SPEAKER_01: Both of them have significant side effects.
13:16
SPEAKER_01: So phlebancerin, things like sleepiness, grogginess, difficulty concentrating, right?
13:21
SPEAKER_02: No one loves that.
13:22
SPEAKER_01: And for the longest time, it was there was a black box warning uh with uh contraindications with alcohol that's been slightly lessened now.
13:29
SPEAKER_01: And when you think about sexual desire and sexual activity, sometimes alcohol is in the mix.
13:34
SPEAKER_02: Yeah.
13:34
SPEAKER_01: Right.
13:35
SPEAKER_01: And so that would not be appropriate for for users.
13:38
SPEAKER_01: Again, they've kind of lessened some of that restriction, but but still, um the the side effect profile, the limited efficacy has meant that the uptake has not been as staggering, certainly not as staggering as it is with Viagra.
13:51
SPEAKER_00: Hey Lori, why do you think that you know, go back to that 10% of women that are seeking help for this?
14:00
SPEAKER_00: So there's 90% of them are having to or or continue to struggle without getting any kind of help and treatment.
14:07
SPEAKER_00: Why do you think there is that stigma f or or that reservation to seek help or talk about this?
14:15
SPEAKER_01: Yeah, I mean, I think until we can appreciate sexual health as health, it's still going to be viewed as this niche, private.
14:27
SPEAKER_01: Um and there's still a lot of stereotypes around, you know, healthy sexuality is for young people, a lot of beliefs around aging and sex, and in particular among women, yeah, that menopause marks the end of your sex life because that's really the end of your reproductive life, but it's certainly not the end of your sex life.
14:47
SPEAKER_01: So there's still a lot of lingering societal myths and stereotypes around sexuality.
14:54
SPEAKER_01: Um, and even among professional circles, I mean, when I write research grants, I have to work hard to justify to the reader on the other end that sexual health is a part of health, that it's a part of overall quality of life, that we have striking data that show sexual health to be highly correlated with other markers of physical health in general.
15:18
SPEAKER_01: Right.
15:18
SPEAKER_01: And so we sort of have to work to kind of make that claim.
15:22
SPEAKER_01: And I think we've had to do less of that in the domain of men's health, where it's just we've had this public discourse about it for so long that no one questions that it's an important part of quality of life in the way that we do with women.
15:33
SPEAKER_00: And it so is, right?
15:34
SPEAKER_00: And we we had this discussion prior to going um going live today, but that that sexual health is health that carries so much weight when we're talking, you know, we always talk about the things that improve length and quality of life.
15:50
SPEAKER_00: That is the purpose of our business and this podcast.
15:52
SPEAKER_00: Yeah.
15:53
SPEAKER_00: And, you know, when I think about this domain specifically, you could have everything else, you could be doing everything else right.
16:01
SPEAKER_00: But if you don't have that intimacy, desire, that human connection with your partner, to what end are you doing it, right?
16:10
SPEAKER_00: Like I think it's so critical to address and get right that it deserves the time and attention that the rest of these pillars.
16:21
SPEAKER_01: I agree.
16:21
SPEAKER_00: And it's absolutely but clearly something that we don't speak about enough or address enough.
16:27
SPEAKER_00: Um I hey, let's talk specifically about your approach to this.
16:31
SPEAKER_00: Sure.
16:32
SPEAKER_00: Um, you know, I think this term mindfulness, I feel like the wellness industry has maybe overused it or used it in a way that is a little misleading and fluffy.
16:45
SPEAKER_00: Um, but there are like actual clinical data and a very clinical approach to weaving this into um improving your desire.
16:53
SPEAKER_00: Can you maybe start by defining that and how that you how you use that as a tool?
16:58
SPEAKER_01: Yeah.
16:59
unknown: Yeah.
16:59
SPEAKER_00: So my long question.
17:01
SPEAKER_01: Yeah, no, fan a great great place to start because even among scientists, there's a lot of disagreement around what do we actually mean by mindfulness.
17:08
SPEAKER_01: And so we think about mindfulness as a secular practice that has roots in Eastern Buddhism and meditation, um, but that is accessible to anyone.
17:19
SPEAKER_01: And it essentially combines two components.
17:22
SPEAKER_01: So half of mindfulness is about paying attention on purpose, right?
17:27
SPEAKER_01: So you think about focusing on attention like I am right now.
17:31
SPEAKER_01: I'm focusing in on what we're talking about, on kind of visually what I see.
17:35
SPEAKER_01: So it's about harnessing the attention when it takes off, because it does multiple times.
17:42
SPEAKER_00: Yeah.
17:43
SPEAKER_01: And bringing it back to a particular target.
17:46
SPEAKER_01: And then the other half of mindfulness is how we do that.
17:49
SPEAKER_01: And how we do that is compassionately with non-judgment.
17:54
SPEAKER_01: So if my mind in the course of our conversation starts to drift off and think about other things, and I catch myself and I say, Oh, Laurie, there you go again.
18:04
SPEAKER_01: You can never pay attention.
18:05
SPEAKER_01: What's wrong with you?
18:06
SPEAKER_01: This is why you failed yoga.
18:07
SPEAKER_01: This is why, you know, you're a chronic multitasker.
18:11
SPEAKER_01: Um, then I'm not really practicing mindfulness, am I?
18:15
SPEAKER_01: So it's rather noticing that the mind has taken off and say, of course, my mind has wandered.
18:20
SPEAKER_01: This has kind of become the nature of our minds, is to wander.
18:25
SPEAKER_01: And then with a smile on my face, I guide my mind back.
18:29
SPEAKER_01: And I told you before we started that I'm a dog lover.
18:32
SPEAKER_01: And, you know, I think about when I was training my own dog, and every time she would take off and have a lapse of attention, and you know, she'd dart across the room.
18:43
SPEAKER_01: I wouldn't yell at her.
18:44
SPEAKER_01: I would gently tug on the leash and I would say, come back, come back.
18:48
SPEAKER_01: And that's the same kind of compassion we want to embody to our minds.
18:51
SPEAKER_01: When our minds become distracted, is we want to accept that this is what our minds do, and we want to gently, compassionately bring it back.
19:00
SPEAKER_01: So a simple definition of mindfulness is present moment, non-judgmental awareness.
19:07
SPEAKER_00: Do you think that the modern world is killing desire and the ability to stay present?
19:14
SPEAKER_00: You know, I think again, we we spoke about this briefly, but it's so difficult to stay present and mindful.
19:22
SPEAKER_00: And when that relates to you know, the topic that we're talking about, it's so easy to get distracted and not pay attention.
19:29
SPEAKER_00: Do you think that we're being sort of set up to fail with the amount of distraction we're exposed to?
19:36
SPEAKER_01: Yeah, uh absolutely.
19:37
SPEAKER_01: And I can think of you know, the number of times in my clinical practice where I will hear people say, you know, my body is having sex and my mind is not.
19:46
SPEAKER_01: My mind is elsewhere.
19:48
SPEAKER_01: Um despite the fact that the sex is enjoyable and the kinds of exchanges are pleasurable to me, my mind is somewhere else.
19:57
SPEAKER_00: Yeah.
19:57
SPEAKER_01: Right.
19:58
SPEAKER_00: And so I I imagine that's happened to all of us.
20:00
SPEAKER_01: It's happened to all of us.
20:01
SPEAKER_01: But if you can imagine that if that happens chronically, yeah, yeah, yeah.
20:05
SPEAKER_01: Um, and of course the brain is the biggest sex organ of all, you it almost sets the person up for really not experiencing pleasure or experiencing a far diluted version of pleasure.
20:17
SPEAKER_01: Um, and so over time, this can contribute to a loss of desire, can contribute to a loss of arousal, maybe even orgasm capacity.
20:27
SPEAKER_01: And it's simply because, and I use that word very carefully, simply, uh, because mindfulness is certainly not simple, right?
20:35
SPEAKER_01: Um, but it but a lot of it does have to do with that kind of you know discordance that I talked about earlier that we measured in the research lab is the body is showing a physiological response and the mind is somewhere else.
20:48
SPEAKER_00: The body is having sex, but the mind isn't.
20:50
SPEAKER_01: Correct.
20:51
SPEAKER_00: That's the exact equivalent to the research.
20:55
SPEAKER_00: So how do we counter that?
20:57
SPEAKER_01: Yeah.
20:58
SPEAKER_01: Well, the answer is obvious, and that is we bring those two back in sync with one another.
21:05
SPEAKER_01: Um, and again, the answer is obvious and simple, but the practice is not simple because we have become so well trained in being everywhere but the present moment.
21:17
SPEAKER_01: And so, even a three-minute practice of doing a you know, mindful breath practice, the mind will get distracted multiple times.
21:27
SPEAKER_01: Do I feel better yet?
21:28
SPEAKER_01: What is this doing?
21:29
SPEAKER_01: I don't like the voice of the person who's guiding me.
21:32
SPEAKER_01: And all of this is really useful information for really observing the nature of our mind, which is that in addition to being uh highly distractable, we're also pretty judgmental.
21:44
SPEAKER_02: Right.
21:44
SPEAKER_01: So we criticize the voice that we hear, we criticize that it's taking too long.
21:49
SPEAKER_01: We're judgmental that we don't instantly feel better.
21:52
SPEAKER_01: How long is this going to take?
21:54
SPEAKER_01: Um, and and then when I hear that, I say, This is fantastic.
21:58
SPEAKER_01: This is exactly the experience.
22:00
SPEAKER_01: Experience that we want you to have.
22:02
SPEAKER_02: Yeah.
22:02
SPEAKER_01: Because we want to really familiarize ourselves with the kinds of patterns that feel so out of reach to us, right?
22:10
SPEAKER_01: They happen so sort of below the surface that we're not aware of them.
22:14
SPEAKER_02: Yeah.
22:14
SPEAKER_01: So mindfulness is also about becoming really intimately aware of the present experience.
22:20
SPEAKER_01: Right.
22:21
SPEAKER_00: Um you talk in your book about there's an exercise you do with patients that involves staring at a raisin.
22:30
SPEAKER_01: Correct.
22:30
SPEAKER_00: Can you maybe explain to the audience about that?
22:33
SPEAKER_00: I've actually done this, by the way.
22:34
SPEAKER_01: Yeah, yeah.
22:35
SPEAKER_01: I mean, John Cabotzin was really the first, you know, back in the late 70s at Mass General when he was introducing this kind of secular practice of paying attention to people who had chronic and and really intractable pains.
22:50
SPEAKER_01: And you pass around a plate of raisins.
22:53
SPEAKER_01: And um, and so I've also taken to doing this very, very regularly in my own practice.
22:58
SPEAKER_01: And, you know, essentially what you do is you you you invite the person to take the raisin.
23:03
SPEAKER_01: If anyone's listening, you can go grab a raisin or grab a piece of dried fruit, and you spend the first minute or so just having it rest in your palm and you look at it and you notice patterns of light, the shape, the size.
23:17
SPEAKER_01: You can sort of move it around in your palm to feel the weight of it.
23:21
SPEAKER_01: And of course, all the while the mind is getting distracted.
23:24
SPEAKER_01: And so the voice guides you back to noticing the raisin, its colors, et cetera.
23:30
SPEAKER_01: And then we sort of systematically go through all the senses, bring it to your nose, bring it to the other nostril, hold it up to your ear.
23:37
SPEAKER_01: And of course, the person's thinking, what do you mean, bring a raisin to my ear?
23:40
SPEAKER_01: What will I hear?
23:41
SPEAKER_02: Yeah.
23:41
SPEAKER_01: But when you really stop and pay attention, there are sounds, right?
23:45
SPEAKER_01: Sounds that are usually we simply don't pay any attention to at all.
23:50
SPEAKER_01: And then something incredible happens when you ask the person to put the raisin on their lip.
23:57
SPEAKER_01: And uh, again, if anyone's listening, you can try it yourself.
24:00
SPEAKER_01: And usually what happens is you start salivating, right?
24:05
SPEAKER_01: And so it's this beautiful illustration of anticipation.
24:08
SPEAKER_01: The raisin is not yet in the mouth, but the body is preparing itself.
24:13
SPEAKER_01: Um, spend a minute there, and then very slowly raisin in the mouth, one chew, notice the taste, the aftertaste, and then very, very slow and intentional chews while the remnants slip down the back of the esophagus.
24:27
SPEAKER_01: Um, and the link to sexuality and sexual desires when I do this exercise, and the first question I ask is, you know, what was that like?
24:36
SPEAKER_01: What did you notice?
24:38
SPEAKER_01: And usually the response is, wow, I had no idea the raisins had so much flavor and texture and all of that sort of thing.
24:47
SPEAKER_01: And then um I ask them, how was eating the raisin in this way different from how you normally eat a raisin?
24:53
SPEAKER_01: And again, usually they'll say, I usually grab a handful, swallow without chewing, don't even know how many I'm eating, etc.
25:01
SPEAKER_01: And then the most important question that you ask is how is this exercise of observing the raisin in this way relevant to your sexuality?
25:12
SPEAKER_01: And they say at that moment when I placed the raisin against my lip and I salivated, it made me think about the role of anticipation of sexual activity.
25:23
SPEAKER_01: It made me think about if I can spend a fraction of the attention that I paid to this raisin, to what I'm actually engaged in during sex, how much more sensation I would feel.
25:34
SPEAKER_01: And so, although it's it's uh in part, it's kind of a brief introduction to mindfulness, it also provides the incredible hook for how this tool can be the missing link in their own sexuality.
25:48
SPEAKER_01: And so I find as a mindfulness teacher in the groups that I lead, I never have to explain to people why mindfulness is so critical to sexual health because they experience it firsthand through the raisin, through sitting on the pillow, through breath practices, et cetera.
26:04
SPEAKER_00: Can you explain to the listeners this concept of responsive desire?
26:11
SPEAKER_00: Right.
26:11
SPEAKER_00: And the reason I ask that is I found that kind of baffling.
26:15
SPEAKER_00: I think it's very different for men and women.
26:17
SPEAKER_00: Um, I didn't know that was a thing.
26:20
SPEAKER_01: Yeah.
26:21
SPEAKER_01: Yeah.
26:21
SPEAKER_01: So when we think about desire, sort of, you know, contemporary definitions of desire or media portrayals of sexual desire, you typically see someone who is turned on in the mood for sex, and they will then that will then lead to initiation of sexual activity and then arousal, pleasure, orgasm comes after that.
26:42
SPEAKER_01: So the the kind of a series of steps is desire first.
26:47
SPEAKER_01: And it's it's often portrayed as um in the body, there's a feeling of desire, there's this kind of strong motivational pull or push towards your sexual target, et cetera.
27:00
SPEAKER_01: And that was definitely the dominant model of sexual desire for a long time.
27:05
SPEAKER_01: And so a person would be labeled as having a sexual desire disorder or dysfunction if they lacked that, right?
27:14
SPEAKER_01: If they didn't sort of have a have a motivation for sex that led them to then engage in sexual activity.
27:20
SPEAKER_01: And yet what we often experience in longer-term relationships or maybe through different seasons of your life is that people don't always feel desire at the outset of a sexual encounter.
27:33
SPEAKER_01: Maybe they say yes to sex for another reason.
27:37
SPEAKER_01: Maybe it's, you know, celebrate a birthday or um have intimacy and connection to communicate something for the promise of arousal and pleasure on the other side.
27:50
SPEAKER_01: But so often we might go into a sexual encounter feeling neutral, yeah, open, consent, consenting, but sexually neutral.
28:00
SPEAKER_01: Uh, and yet over the course of the interaction, arousal would happen if, again, the kind of touches and stimulations are appropriate to that person and they're able to stay focused.
28:11
SPEAKER_01: And then arousal happens, the body starts to respond.
28:13
SPEAKER_01: And then at some point during the interaction, the person might get that feeling of, oh, now I want it.
28:20
SPEAKER_00: Right.
28:20
SPEAKER_01: Right.
28:21
SPEAKER_01: And so it's it's desire that emerges in response to arousal.
28:27
SPEAKER_01: And so it kind of takes this whole idea of desire first and then the rest, and it flips it on its side and says, actually, it can be normal, healthy, common to go into an encounter totally neutral and have desire be the last thing to emerge at the end.
28:44
SPEAKER_01: And so once this new kind of model of responsive desire was proposed, suddenly the huge numbers of people who felt totally broken because they didn't have that kind of spontaneous desire felt validated and also felt empowered to say, all right, if if if desire happens after, what are the sort of things that need to be in place in order to feel arousal first?
29:09
SPEAKER_01: And so arousal is really the gateway to desire.
29:12
SPEAKER_00: And that's where the mindfulness practice comes in.
29:14
SPEAKER_01: Correct.
29:15
SPEAKER_01: Correct.
29:16
SPEAKER_01: Yeah.
29:16
SPEAKER_01: Because in order to know what feels good, we need to be paying attention.
29:20
SPEAKER_02: Yeah.
29:20
SPEAKER_01: In order to be able to buffer against all of the multitude of inhibitory factors like depression, anxiety, performance-related thoughts, benign distractions like did I lock the front door?
29:35
SPEAKER_01: You know, did I turn off the oven?
29:37
SPEAKER_01: Mindfulness is a real tool to be able to address all of those factors.
29:41
SPEAKER_01: So it decreases the in the inhibitions, but it also increases the facilitators, the excitatory factors, if you think of this kind of dual control model.
29:50
SPEAKER_01: Um, and so it I uh my stance is that it's absolutely critical for healthy sexual response and responsive desire.
29:58
SPEAKER_00: Yeah.
29:59
SPEAKER_00: And a bunch of other different and a bunch of other things as well.
30:02
SPEAKER_00: Can you give us some um strategies, techniques by which we can actually use some of these tools?
30:11
SPEAKER_00: You know, I know the the raisin is a great one.
30:14
SPEAKER_00: I think you talk about body scan.
30:15
SPEAKER_00: Yeah.
30:16
SPEAKER_00: Maybe, maybe unpack that.
30:18
SPEAKER_01: Um, the body scan is uh is another exercise that involves paying attention to sensations in the body, starting with, you know, the extremities of your of your toes and and and really sensing even the spaces in between your toes and then moving all the way up through different parts of the body until you get to the tip of the head.
30:38
SPEAKER_01: And um, part of the reason why the body scan practice is so important is because we know that for a lot of people, they really don't have a sense of what's happening internally in their body.
30:50
SPEAKER_01: So we call that interoception.
30:52
SPEAKER_01: We have low interoceptive awareness.
30:55
SPEAKER_01: And interestingly, uh, low interoceptive awareness is also highly correlated with depression.
31:02
SPEAKER_01: So, not that it causes depression, but there's something about having a lower sense of what's happening internally in your body that is also associated with higher proclivity for depressive symptoms.
31:14
SPEAKER_01: So, a body scan, which really teaches you to become familiar with internal body body sensations, improves interoception.
31:22
SPEAKER_01: And we've found in our research that's also a key mechanism by which mindfulness improves sexual desire and sexual response.
31:30
SPEAKER_01: So the body scan is almost like a staple of practice.
31:33
SPEAKER_00: How often would you do that?
31:34
SPEAKER_00: And like at what point?
31:36
SPEAKER_00: Yeah.
31:36
SPEAKER_00: Would you do is that like a daily habit that you weave into, you know, five, 10 minutes a day?
31:42
SPEAKER_01: Yeah.
31:42
SPEAKER_01: I mean, we would love for it to become a habit, but for most people who are new to this, it really is a structured practice where they set aside time, they might set aside, you know, depending on the person, when we look at the original um kind of protocols that John Cabot's in and others wrote, it was, you know, 45 minutes a day, every day for six weeks, which is a considerable investment of time.
32:02
SPEAKER_01: Tough gig, right?
32:03
SPEAKER_01: I'm out.
32:04
SPEAKER_01: Yeah.
32:05
SPEAKER_01: Um, and and so since then, mindfulness researchers have really looked at this question of what's kind of the needed dose of mindfulness.
32:12
SPEAKER_00: Minimum effective.
32:13
SPEAKER_00: Minimum effect, right?
32:13
SPEAKER_01: What's the least amount I can do while still exercising?
32:16
SPEAKER_00: You were big fans of that.
32:17
SPEAKER_01: Yeah.
32:18
SPEAKER_01: Um, and so we now know that, you know, even 10 minutes every day of structured practice, right?
32:24
SPEAKER_01: So this means carving out time, going to a place that's quiet and actually practicing a formal mindfulness practice, either one that's guided or one that you kind of self-self-lead on on your own.
32:37
SPEAKER_01: But then we want to integrate this into our life in general, right?
32:42
SPEAKER_01: So as you're walking, as I did to the studio this morning, rather than staring at my phone, as I'm walking, I'm actually paying attention at my brisk walk.
32:51
SPEAKER_01: I'm, you know, paying attention to the sights and sounds and colors all around me.
32:56
SPEAKER_01: So you can start to integrate this into really all aspects of your life in general.
33:00
SPEAKER_00: So it's not just something good hack, by the way, that when walking.
33:04
SPEAKER_00: I'm terrible for this.
33:06
SPEAKER_01: Yeah.
33:07
SPEAKER_00: But on the occasion that I catch myself just staring at a foam walking along the street and actually just become a little more present.
33:17
SPEAKER_01: Yeah, we'd see fewer accidents out there, that's for sure.
33:20
SPEAKER_00: People mind crossing the street.
33:23
SPEAKER_01: So uh yeah, so the body scans are is a really great practice and people learn a lot in terms of awareness.
33:29
SPEAKER_01: And then there's one more that um, especially in this kind of application of mindfulness to sexual health, that I think is really, really important.
33:37
SPEAKER_01: And that is when we apply mindfulness to to paying attention.
33:41
SPEAKER_01: So mindfulness of thoughts specifically.
33:43
SPEAKER_01: And this might sound a little bit, you know, metacognitive and a little bit frou-frou, but when you actually imagine that thoughts are byproducts of brain activity, right?
33:55
SPEAKER_01: And so if we can adopt that kind of position that thoughts are something that our brain produces and not necessarily statements of truth, they're not necessarily, you know, accurate reflections of who I am as a person.
34:10
SPEAKER_01: And we know that because neuroscience has taught us that most of us have random thoughts that make absolutely no sense whatsoever.
34:17
SPEAKER_01: But it's just the brain essentially doing what it does all the time.
34:21
SPEAKER_01: Now, if you're someone who's has obsessive-compulsive disorder, this could be very bothersome to you because you think that every thought means something.
34:29
SPEAKER_01: So, in the context of sexuality, when we know that people also can be prone to negative and judgmental thoughts, oh, I'm not getting aroused enough.
34:37
SPEAKER_01: This must mean I'm sexually broken.
34:39
SPEAKER_01: This must mean I'm incompatible with my partner.
34:42
SPEAKER_01: And we can just label those as byproducts of what the brain is doing in this kind of high-stakes scenario, then suddenly our ability to be much more present is that much greater.
34:54
SPEAKER_01: So, what a practice would look like in a in a mindfulness of thoughts is, you know, I would guide a person through to just notice the kinds of thoughts that they're having, not the details of the thought, but the kinds in terms of that's a planning thought, that's a memory thought, that's a you know, negative one, that's a, you know, catastrophizing thought.
35:16
SPEAKER_02: Yeah.
35:16
SPEAKER_01: So you sort of have this, you know, dispassionate observation of a thought where there's a bit of space between you and the thought.
35:23
SPEAKER_00: Love that.
35:24
SPEAKER_01: And ultimately that particular practice is really critical for reducing distress.
35:31
SPEAKER_00: Right.
35:31
SPEAKER_00: So you're trying to stop yourself judging yourself for the thought that you have quite often crazy.
35:36
SPEAKER_01: Yeah.
35:36
SPEAKER_01: Yeah.
35:36
SPEAKER_01: And and again, it's it can be quite um, you know, humorous even to just kind of sit back and just watch the patterns of the mind, like the thought, the random thoughts, the, you know, the the the net the memories, the future-oriented thoughts that we have.
35:51
SPEAKER_01: And so that as we kind of advance in the mindfulness uh practice in our sexual health programs becomes probably one of the more important practices that we do.
36:00
SPEAKER_00: I love that.
36:01
SPEAKER_00: I'm gonna practice that today.
36:03
SPEAKER_00: I do this all the time.
36:04
SPEAKER_00: Okay.
36:04
SPEAKER_00: I'll be like, where did that even come from?
36:06
SPEAKER_01: Report pasting maniac.
36:08
SPEAKER_01: And importantly, just be kind to your mind when it does that.
36:10
SPEAKER_01: Yeah and and remind yourself that you know, in the same way the gallbladder produces bile and we don't think about it, the brain also produces thoughts that are totally nonsensical and don't have any.
36:21
SPEAKER_00: Everyone does that right now.
36:22
SPEAKER_01: Everyone does that.
36:23
SPEAKER_01: Absolutely everyone does that.
36:24
SPEAKER_00: Hey, in your book, you also talk about this practice of um looking at yourself in the mirror naked.
36:32
SPEAKER_00: And that really struck me because I think, and I've spoken about this publicly before, that we have we are in a position now with this you know, the Instagram highlight reels and the cover models and just different forms of media that have led us to believe that we should all be looking ripped and perfect and toned the whole time, and that's not reality.
36:57
SPEAKER_00: And I think our idea of what is good, yeah, or what is or what looks attractive or sexy is is probably kind of misleading.
37:06
SPEAKER_02: Yeah.
37:07
SPEAKER_00: And so I don't think, and I'll let you explain what that practice is, but I don't think anyone looks at themselves in the mirror and naked and is like, I wouldn't change a thing, you look great.
37:16
SPEAKER_00: Like we all have these things about us that we'd like to change or improve.
37:20
SPEAKER_00: And I just love this concept of you know being compassionate and you know picking the thing that you do like, or like a not not being so judgmental about yourself in the same way we just said for the mind, but like for your physique.
37:33
SPEAKER_01: Yeah, yeah, absolutely.
37:35
SPEAKER_01: And you know, in particular for women, where um, you know, social comparison is highly problematic because you know, when you think about where where do we see female naked bodies, more often in pornography, yeah, right, where which is a highly, highly artificial depiction of the human body, but also what sex looks like.
38:00
SPEAKER_01: Um, and there's been some theorizing also of the role of pornography in the rise and things like labia labia plasty, so plastic surgery to make the labia symmetrical or you know, these kind of rejuvenation techniques and things like that.
38:17
SPEAKER_01: So um the the exercise, whether it's looking at your body in the mirror naked or even looking at your own genitals with a handheld mirror, just for the sole purpose of awareness and acceptance, not to change anything, not to analyze, just not to arouse anything, just to sort of observe and and appreciate what's there, can be um really difficult and really, really emotional for a lot of people.
38:44
SPEAKER_01: And I've now given this exercise to thousands and thousands of women.
38:49
SPEAKER_01: And um, even among those women who have said, Oh, yeah, I'm I'm fine with my own anatomy.
38:54
SPEAKER_01: And then they do an exercise like this where you invite them to just pay attention to what comes up uh with non-judgment.
39:01
SPEAKER_01: And it can be really emotional for them because they suddenly realize that it's almost impossible not to have that judgment, to not compare yourself to what you believe are standards or what you believe is normal.
39:14
SPEAKER_00: Can we can we talk about pornography for a minute?
39:17
SPEAKER_00: I feel like over the past maybe decade or two, it's just become so accessible and so extreme as well.
39:26
SPEAKER_00: And the variety, and I think the human brain has been in so many ways like primed for novelty.
39:33
SPEAKER_02: Yeah.
39:33
SPEAKER_00: And I would uh hypothesize that some of the um either lack of attractiveness or arousal or desire between couples might be because of a lack of novelty.
39:45
SPEAKER_00: Yeah, you know, when you've been in a relationship for a long time, um, you know, same-sexual partner, monogamous, that that is where it gets difficult for some people.
39:55
SPEAKER_02: Yeah.
39:56
SPEAKER_00: How much of a role do you think pornography has played in that?
40:00
SPEAKER_00: And I suspect it's a lot for a lot of young people, especially.
40:03
SPEAKER_00: Yeah.
40:03
SPEAKER_00: And what can we be doing to help like prevent that?
40:07
SPEAKER_00: I don't want to call it familiarity, but like to keep that novelty so that it still feels, you know, um exciting.
40:13
SPEAKER_01: Yeah.
40:14
SPEAKER_01: Yeah.
40:15
SPEAKER_01: Uh I mean, there's a lot of questions in your question.
40:17
SPEAKER_01: I mean, let me start by saying that um, you know, I'm I'm not against pornography.
40:24
SPEAKER_01: So I'm I'm I'm definitely, you know, pro-sex.
40:26
SPEAKER_01: And I I absolutely um invite the role of erotic cues and erotic tools like erotica pornography, if used in a very kind of intentional way.
40:37
SPEAKER_01: So one of the ways that I'll often use it, say with women is especially women who have difficulties with arousal, is I'll you know, help them source out ethical erotica and then experience the kind of natural response in the body that you can then pair with something like mindfulness after that.
40:54
SPEAKER_01: So um I just want to kind of give that overall context.
40:58
SPEAKER_01: But on the other hand, when you combine the highly accessible pornography with lack of sex education, which is still an almost universal problem in this country, also in Canada, it's not yet universal.
41:14
SPEAKER_01: Then it means that pornography also serves as a source of education to young people, right?
41:19
SPEAKER_01: So suddenly these kinds of depictions of penis and vagina is the only kind of sex that people have, right?
41:27
SPEAKER_02: Yeah.
41:27
SPEAKER_01: Never mind all the kind of gender variance and all the various ways that people engage in sexual activity.
41:33
SPEAKER_01: Also depictions of simultaneous orgasm, which almost never happens in real life.
41:38
SPEAKER_02: Yeah.
41:38
SPEAKER_01: Um, not to mention vaginal intercourse leading to orgasm.
41:43
SPEAKER_01: That's just not an experience in the vast majority of females.
41:46
SPEAKER_01: So it does mean that a lot, a lot of young people are really relying on pornography for their source of education.
41:52
SPEAKER_01: So then they enter a real life relationship and things don't quite look and feel and function the way they do in pornography.
41:59
SPEAKER_01: And um, it can lead people to feel really, really broken.
42:03
SPEAKER_01: So I think that's important to state is, you know, if if one is going to consume pornography, maybe make sure it's buffered with some really good sex education at the same time.
42:14
SPEAKER_01: And that it's, you know, pornography is entertainment.
42:17
SPEAKER_01: That's the only purpose of it.
42:18
SPEAKER_01: So now to your other question around this kind of fading desire that happens in long-term relationships, that's, you know, dare I say, inevitable.
42:29
SPEAKER_02: Right.
42:29
SPEAKER_01: Right.
42:30
SPEAKER_01: Um, and it is because of familiarity, right?
42:33
SPEAKER_01: So you think about when does sex tend to be the most fiery at the beginning of a relationship when everything is new and novel.
42:42
SPEAKER_01: And we have dopamine centers in the brain, the reward center of the brain that's responding to all of this novelty and mystery and things that are unknown.
42:50
SPEAKER_01: And it really creates a different kind of sexual feeling, sensations-wise in the body, than, you know, fast forward 20, 40, 60 years of doing the same kind of patterns of sex where we don't have that same kind of reward.
43:05
SPEAKER_01: And so certainly any opportunity to infuse novelty into your sex life is going to go a long way to making sex feel better, but also to driving more of that dopamine system in the brain.
43:18
SPEAKER_01: And, you know, before your listener thinks, is she recommending like having sex in a totally different place and doing strange things that I don't want to do?
43:27
SPEAKER_01: Maybe for some people that is the case, but even varying up the pattern, altering the time of the day, having, you know, using different methods of being aroused, things that don't even involve intercourse.
43:41
SPEAKER_01: Maybe there's other things that can be pleasurable that a couple has never thought of doing before.
43:45
SPEAKER_01: So all of those things, which would be things that someone like a sex therapist like me would talk to couples about, will be really good for that kind of novelty and therefore dopamine driven response.
43:55
SPEAKER_00: I can ask you a naive question.
43:57
SPEAKER_00: Of course.
43:57
SPEAKER_00: I think it's naive.
43:58
SPEAKER_01: Yeah.
43:59
SPEAKER_01: Everything that
44:00
SPEAKER_00: You've explained so about makes so much sense.
44:02
SPEAKER_00: And I think like that anticipation is just so powerful.
44:08
SPEAKER_00: We we're led to maybe there's some stigma attached to like this idea of like planning sex or like scheduling it.
44:15
SPEAKER_00: But everything you've said scientifically makes sense, that would make sense to schedule sex.
44:21
SPEAKER_00: But is that like a no-no?
44:23
SPEAKER_00: Or like to me, it sounds like it would be more beneficial long term if you had scheduled these sessions with a partner.
44:32
SPEAKER_00: Is that crazy?
44:33
SPEAKER_01: So let me ask you this, Chris, and that is You can't ask me questions.
44:37
SPEAKER_01: I will ask you a question, and that is, and it's a deeply personal question.
44:40
SPEAKER_00: I'm here for it.
44:41
SPEAKER_01: Um, when was the last time that you had or organized a fantastic dinner party with absolutely no planning that it was completely spontaneous and just occurred?
44:57
SPEAKER_00: Never.
44:58
SPEAKER_01: Correct.
44:59
SPEAKER_01: And so we're so comfortable with the notion of planning for incredible events and that it can take days, weeks, months to plan.
45:09
SPEAKER_01: And yet when we apply that same rationale to sexual activity, suddenly we feel like it's clinical and boring and structured and not fun.
45:18
SPEAKER_00: So it wasn't naive.
45:19
SPEAKER_00: It wasn't naive at all.
45:20
SPEAKER_00: Love that.
45:21
SPEAKER_01: It's an it's an excellent question.
45:22
SPEAKER_00: Okay.
45:23
SPEAKER_01: And one that comes up um all the time when I highly recommend that people do planned sexual activity.
45:29
SPEAKER_01: And that doesn't mean that you forego spontaneous encounters or quickies for that matter.
45:35
SPEAKER_01: Yeah.
45:35
SPEAKER_01: But those are, you know, those are more icing on the cake.
45:39
SPEAKER_01: Right.
45:39
SPEAKER_01: And so when you think about what what um you stand to gain from planning, well, there's fantasy.
45:46
SPEAKER_01: There's making sure distractions are minimized or eliminated.
45:50
SPEAKER_01: There's timing sex for a time of the day or the week when you have the most energy, right?
45:55
SPEAKER_01: So there's so much to benefit from with planning sex.
45:59
SPEAKER_01: And we I think we really need to do away with this idea that you know planning makes it un makes it boring.
46:06
SPEAKER_00: Okay.
46:06
SPEAKER_00: Love that.
46:07
SPEAKER_00: I'm on a roll now, so I'm gonna ask another one.
46:09
SPEAKER_01: There you go.
46:10
SPEAKER_00: So when you've been in a relationship for a long time, I think sometimes the the perceived effort involved in like initiating moments of intimacy or sex make it feel like laborious, right?
46:28
SPEAKER_00: Like you've you've it it's so familiar, you've done it so frequently that like quite often you're like, it's just easier, it's less it's easier just to be on your phone or just to like fall asleep or do something else.
46:41
SPEAKER_00: But then once you start, and then you then you're like, oh, I remember like how much I love you or how much I love this or how how attracted I am to you.
46:48
SPEAKER_00: How do couples get to that point without having that middle bit of friction?
46:54
SPEAKER_01: Yeah, yeah, excellent.
46:56
SPEAKER_01: Um, especially if people are having sex, you know, at the end of the day after a long day when they're exhausted and you know, they've just watched the 11 o'clock news and they get into bed and they sort of look at each other, and the last thing on their mind is sex.
47:10
SPEAKER_01: So, you know, I think first of all, um it it's something we need to intentionally think about, which is what's in it for me, right?
47:18
SPEAKER_01: And not from a kind of narcissistic perspective, but what is a kind of added value of sexual activity to me personally, to my partner, and to our relationship.
47:28
SPEAKER_01: And so here's where we really um there's been beautiful, elegant series of studies using the approach avoidance model, which has been applied to human behavior in general, but it's been adapted to look at why people have sex.
47:41
SPEAKER_01: And um, it turns out there are 237 distinct reasons why people engage in sex.
47:47
SPEAKER_00: Two, three, seven.
47:48
SPEAKER_01: Two, three, seven.
47:49
SPEAKER_01: Two so a lot of choice in there.
47:51
SPEAKER_00: In other words, those numbers.
47:53
SPEAKER_01: Um, and so everything from, you know, again, to celebrate an event, an anniversary, a birthday, because we're away, um, because it helps me get to sleep, um, because I want to feel close, because it's good for our relationship, because I want an orgasm, the list can go on and on and on.
48:12
SPEAKER_01: There's also a list of avoidance-related reasons.
48:16
SPEAKER_01: So things like to avoid a fight, to avoid tension in the relationship.
48:21
SPEAKER_01: And those are not good reasons to engage in sex, by the way.
48:24
SPEAKER_01: And if those become the exclusive reasons why people are engaging in sex, it's a fast track to resentment in the long term.
48:31
SPEAKER_01: And so if, you know, if someone's listening and they kind of look at, well, why do I engage in sex?
48:37
SPEAKER_01: And they realize, oh, it's because if I don't, we don't get along.
48:41
SPEAKER_01: We tend to fight quite a bit.
48:43
SPEAKER_01: That's not a healthy and or sustainable.
48:46
SPEAKER_00: And I bet that's very common.
48:48
SPEAKER_01: It's very common.
48:48
SPEAKER_00: Just playing devil's advocate there, though, like some people probably certainly in long-term relationships might feel like it's a bit of a box-ticking exercise to keep the peace or like just to keep the intimacy up.
48:59
SPEAKER_00: But then they would start in that moment of intimacy and then realize that you know how enjoyable it is both ways.
49:06
SPEAKER_00: Yeah.
49:06
SPEAKER_00: Well, hopefully.
49:07
SPEAKER_01: Yeah.
49:07
SPEAKER_00: And then that is a valid reason to have done it.
49:10
SPEAKER_01: Yeah.
49:11
SPEAKER_01: Yeah.
49:11
SPEAKER_01: And I think even for the person who, you know, the immediate feeling is it's just box ticking.
49:16
SPEAKER_01: And here's where mindfulness can be very helpful is I would invite them to actually really pay attention to what are the personal rewards, again, for them, for their relationship, that they could draw from in the moment.
49:28
SPEAKER_01: Right.
49:28
SPEAKER_01: So maybe it's thinking about a past sexual encounter, maybe it's trying on a reason.
49:34
SPEAKER_01: So what I do in in my clinical setting is I don't hand them a list of all 237 reasons, but I will hand them a list of, you know, 50 reasons.
49:43
SPEAKER_01: And I'll have them try an experiment where they, you know, might adopt a couple of those reasons and try them the next time that they're feeling that place of neutrality.
49:53
SPEAKER_01: And so as they look at this reason, is that enough of an incentive for them to either be receptive to a partner's invitations or to initiate on their own?
50:02
SPEAKER_01: So it's about being really intentional about what those reasons are rather than kind of a passive recipient.
50:08
SPEAKER_00: 237 reasons.
50:10
SPEAKER_00: You know, I think this is just reinforces why this is such an important conversation for the just the topic of health in general.
50:17
SPEAKER_00: And we we spoke um previously about human connection and that being just such a powerful driver of longevity, of our of our uh the length and quality of our life.
50:27
SPEAKER_00: Where do you see this um research playing out as we move forward with regards to its impact on aging and and healthy aging?
50:37
SPEAKER_01: Yeah.
50:38
SPEAKER_01: Yeah.
50:38
SPEAKER_01: I mean, there's there's been a few studies that have these kind of large population-based studies that have looked at um the qualities of people who continue to report satisfying sex, you know, in their 70s, 80s, 90s, and beyond.
50:53
SPEAKER_01: Um, we don't have enough studies that have have looked at that.
50:56
SPEAKER_01: But what we do know is that sexuality remains important to people.
51:01
SPEAKER_01: Now, it's not necessarily sexual frequency or the intensity of orgasms, but people will continue to define sex for them in a very personal way, well into the old age.
51:14
SPEAKER_01: Um, so I think that's first of all very, very important.
51:16
SPEAKER_01: And we need to kind of debunk this idea that sex is only for the youthful and able-bodied people who have a certain phenotype, et cetera.
51:24
SPEAKER_01: Um, the other really interesting thing, and I think I alluded to this earlier, is better sexual health is highly correlated with better physical health and mental health.
51:35
SPEAKER_02: Yeah.
51:35
SPEAKER_01: Right.
51:36
SPEAKER_01: Now, there is a the question of kind of directionality there.
51:40
SPEAKER_01: Is it that better sex, uh better sexual health and satisfaction leads to better physical health and better mental health?
51:46
SPEAKER_01: Or is it the other way around?
51:47
SPEAKER_02: Or both.
51:48
SPEAKER_01: That, or both.
51:48
SPEAKER_01: And probably it is both, but nonetheless, that relationship is very stable and has been found in study after study.
51:56
SPEAKER_01: So I think as we continue the conversation around longevity, as lifespan continues uh to increase, right, with better innovations in health, et cetera, that sexual health should be part of that equation and and we should really kind of include sexual health as an aspect of health.
52:15
SPEAKER_00: Yeah, for certain.
52:16
SPEAKER_00: Laurie, how does desire fluctuate throughout life?
52:22
SPEAKER_00: You know, I I suspect there are, and again, this is probably highly gender differentiated, but how how do we typically see that trend over the course of your life?
52:33
SPEAKER_00: And, you know, as as women reach menopause, um, perimenopause, even how does that influence desire as like a sort of baseline?
52:42
SPEAKER_01: Yeah, yeah, excellent.
52:43
SPEAKER_01: So, you know, first of all, we think about sexual desire less like an on-off switch and more like a dimmer, right?
52:52
SPEAKER_01: So something that's kind of fluid and flexible, completely turns off, never completely turns off.
52:58
SPEAKER_01: And uh um, and and also this idea that, you know, once it's gone, you can't get it back, which is often what I hear in the clinical setting, is you know, where did my desire go?
53:07
SPEAKER_02: Yeah.
53:07
SPEAKER_01: And um, it hasn't gone anywhere.
53:09
SPEAKER_01: It's just we'd sort of need to look at the context around it.
53:12
SPEAKER_01: So we also need to keep in mind that there are some basic sex differences.
53:16
SPEAKER_01: So males have 10 times the level of circulating testosterone compared to females.
53:22
SPEAKER_01: And that certainly contributes to higher feelings of sexual desire in males versus females, although even testosterone over the course of a male's life, you know, gradually declines with each decade.
53:33
SPEAKER_01: Um, and uh so there are some kind of basic differences that we can attribute to hormones right there.
53:39
SPEAKER_01: When we look in at females, um, we uh certainly with with menopause, when estrogen and progesterone start to decline, it doesn't directly affect desire.
53:51
SPEAKER_01: What it does directly affect is um feelings of sexual pleasure and pain.
53:57
SPEAKER_01: And so if pain is now a constant during sexual activity, of course that's going to have a bearing on sexual desire.
54:04
SPEAKER_01: So there's this kind of indirect effect of menopause on sexual desire.
54:10
SPEAKER_01: But then guess what?
54:11
SPEAKER_01: If she's in a new relationship or she's on a, you know, a new health program and her confidence is has returned, desire goes up.
54:19
SPEAKER_00: Yeah.
54:19
SPEAKER_00: Right?
54:20
SPEAKER_01: So inspirational it's so impacted by all of these other contextual factors beyond hormones in her life.
54:27
SPEAKER_01: And so that's why with desire in women, we tend to see much more of this kind of up-down pattern compared to in in males, where we see a little bit more of a steady decline because it is slightly more testosterone-dependent.
54:40
SPEAKER_00: Yeah.
54:40
SPEAKER_00: What can men be doing to help foster moments of intimacy and desire?
54:46
SPEAKER_01: I mean, all the same things that we've talked about, right?
54:49
SPEAKER_01: So presence, attention, a focus on pleasure more so than frequency counts, sexual communication, an understanding of what feels sexual.
54:58
SPEAKER_00: We're really not very good at that, right?
54:59
SPEAKER_01: I mean, none of us are very good at sexual communication because again, if we root this back to sex education, you know, the extent of the kind of teaching in sex ed is around consent, which is a very important conversation.
55:13
SPEAKER_01: Um, but we don't actually have any, you know, instruction or modeling around how do you tell someone what feels good or how to make something feel better.
55:23
SPEAKER_01: Or the flip side of that, how do you tell someone when sex hurts?
55:26
SPEAKER_01: Right.
55:27
SPEAKER_01: And you've been having sex with them for years and you don't want to tell them because, you know, an umpty number of consequences for that.
55:36
SPEAKER_01: So we're just not good at talking about sex.
55:39
SPEAKER_01: And um, there's there's this feeling of, oh, if I talk about it, something makes it dirty or the words will come out wrong.
55:45
SPEAKER_02: Yeah.
55:46
SPEAKER_01: And so I have people practice on me in my office.
55:48
SPEAKER_01: I'll say, pretend I'm your partner and you know, practice on me so that you kind of get that discomfort out of the way and then you can go back home.
55:54
SPEAKER_00: And do you do you have couples that you'll have work on that together?
55:58
SPEAKER_01: Absolutely.
55:58
SPEAKER_00: I bet that's tremendously beneficial for them.
56:01
SPEAKER_01: I love it.
56:01
SPEAKER_01: I love it.
56:02
SPEAKER_00: Yeah.
56:02
SPEAKER_01: Yeah, because it's, you know, it's one of those low-hanging fruits.
56:04
SPEAKER_00: Yeah, of course.
56:05
SPEAKER_01: Because the the barriers they feel like they're insurmountable barriers.
56:09
SPEAKER_01: I can't possibly talk about it.
56:10
SPEAKER_01: And then you give them some words, they practice, and they realize, oh, it wasn't that hard.
56:15
SPEAKER_00: I bet counterintuitively as well, it is less awkward having someone else there for some people, like prompting and exactly wedging the door up.
56:23
SPEAKER_01: Yeah, coaching them along for sure.
56:25
SPEAKER_00: What if someone has experienced all these feelings?
56:30
SPEAKER_00: Um, you know, they feel like they have this lack of desire and arousal, they try the mindfulness practices.
56:38
SPEAKER_00: Um, are there cases where that doesn't work and it requires pharmacological intervention or something more serious?
56:45
SPEAKER_01: Yeah.
56:45
SPEAKER_01: And I think, you know, before we would launch into any kind of treatment approach, we really need to understand the nature of that person's sexual concern, whether it's low desire or something else, and have an understanding of what are the, you know, major causes of it.
57:02
SPEAKER_01: So you and I were chatting about sleep earlier and sleep being kind of one of those, you know, foundational pillars.
57:08
SPEAKER_01: Um while mindfulness will help you sleep better, chronic sleep problems is an absolute, you know, it's going to extinguish desire completely.
57:18
SPEAKER_02: Yeah.
57:19
SPEAKER_01: Right.
57:19
SPEAKER_01: So here's where being able to customize a treatment program around that person's issues is really, really important.
57:26
SPEAKER_01: Having said that, I think we all could benefit from more mindfulness in our life, and certainly in our sex life, um, given that the minds do wander, um, given that we all are prone to performance concerns and worries and even judgments of ourself or of our partner.
57:44
SPEAKER_01: So I mean, I would rather see mindfulness as like a core staple in any good sexual health program rather than just a, you know, an add-on for some people.
57:54
SPEAKER_00: What's your mindfulness routine?
57:57
SPEAKER_01: My own personal mindfulness routine.
57:59
SPEAKER_01: So I do structured practices about four days a week.
58:02
SPEAKER_01: And I um I still prefer personally to follow a guide.
58:06
SPEAKER_01: So I will use guides, whether it's a particular app, or I'll even go onto YouTube and I've got a whole library of recordings that I can draw from.
58:16
SPEAKER_01: And then I try and weave it into my life in general.
58:20
SPEAKER_01: So mindful eating for sure is something I try and pay a lot of attention to.
58:24
SPEAKER_01: And of course, it can be really hard if I'm eating in a hurry between meetings.
58:28
SPEAKER_01: Um, but then I'll be mindful of of you know, eating in a rush and sort of what that feels like.
58:35
SPEAKER_01: But the idea is that there's the structured practice and then there's the functional application of that throughout.
58:41
SPEAKER_00: Do you find yourself forgetting to do that at times?
58:44
SPEAKER_00: No, I I I say that because, you know, I get to speak to the most brilliant scientists all day, every day about um, you know, these different tools and techniques to optimize our health and performance.
58:57
SPEAKER_02: Yeah.
58:58
SPEAKER_00: And I and I still don't weave some of these things in even knowing it and even speaking about it and even being mindful of that.
59:05
SPEAKER_01: Yeah.
59:06
SPEAKER_00: Might being mindful of mindfulness being so beneficial, it's still really difficult.
59:10
SPEAKER_01: Oh, yeah, absolutely.
59:11
SPEAKER_01: I mean, I stand in line at the grocery store staring at my phone.
59:14
SPEAKER_01: Uh, I've I've been really, really trying to when I'm in an elevator, uh, not reach for my phone and just kind of sense the feeling of, you know, weightlessness and and sort of tension and pressure changes of being in the elevator.
59:28
SPEAKER_01: It's something I've been paying attention to.
59:30
SPEAKER_01: But the habit is to grab the phone.
59:32
SPEAKER_00: Yeah.
59:33
SPEAKER_00: It's an easy habit, right?
59:35
SPEAKER_00: Sylvia is here right now, and we spend a lot of time going back and forth to our other office.
59:40
SPEAKER_00: And I'm sure you can testify to this.
59:42
SPEAKER_00: Standing in line.
59:44
SPEAKER_00: Yeah.
59:44
SPEAKER_00: I mean, I'm we're I'm a New Yorker these days, and so we don't love standing in lines, but the elevator is yeah, that's try it, try it and report back.
59:52
SPEAKER_01: Just stand and experience the feelings in your body when you're in an elevator.
59:56
SPEAKER_00: I know, but this elevator is so slow.
59:59
SPEAKER_01: It's a more time to practice.
1:00:00
SPEAKER_01: All right.
1:00:02
SPEAKER_00: Okay, I'm gonna practice.
1:00:04
SPEAKER_00: Because I do think it's has such a high carryover to every facet of our health.
1:00:08
SPEAKER_02: Yeah.
1:00:09
SPEAKER_00: Um, and I I I bet I'm not the only one who struggles to stay present.
1:00:14
SPEAKER_01: Oh gosh, no.
1:00:16
SPEAKER_01: No, you're in good company.
1:00:17
SPEAKER_00: Yeah.
1:00:18
SPEAKER_00: The phone is the killer.
1:00:19
SPEAKER_01: Yeah.
1:00:20
SPEAKER_00: Yeah.
1:00:21
SPEAKER_00: Can you think back to when you first started in this field?
1:00:26
SPEAKER_00: If you knew everything that you knew now, how would you have approached it differently?
1:00:31
SPEAKER_00: Or would you?
1:00:32
SPEAKER_01: Oh, uh, I mean, that's a it's a great question.
1:00:35
SPEAKER_01: I think um, well, I I think I was like a good scientist.
1:00:42
SPEAKER_01: Um, I was really, really skeptical about about the potential utility and wide applications of mindfulness.
1:00:52
SPEAKER_01: So I was very, very slow in even in publishing our early studies before we had amounted quite a bit of data.
1:01:01
SPEAKER_01: And I remember, um, so I'd started doing kind of applying mindfulness to sexual health in 2002.
1:01:07
SPEAKER_01: Now it's the University of Washington.
1:01:10
SPEAKER_01: And within um seven years, I was approached for uh a cover story for a New York mag New York Times magazine.
1:01:19
SPEAKER_01: And they wanted to do, they had found out about some of my research and they wanted to do this spread on mindfulness as being like the next panacea.
1:01:25
SPEAKER_01: And I said, no, no, no, you know, you can't.
1:01:27
SPEAKER_01: We've only published 10 studies in this area.
1:01:30
SPEAKER_01: Put the brakes on.
1:01:31
SPEAKER_01: And um, they ended up publishing the piece back in 2009, but it was, you know, another 10 years after that before I even started to write my first book.
1:01:41
SPEAKER_01: So a real um tentativeness and skepticism about this, which is not a bad thing, I think.
1:01:49
SPEAKER_01: And so I think what I would have done differently was um uh I think I would have enlisted, you know, more different research groups around the world, uh, so that it wasn't just this kind of effect that we were seeing in my lab only.
1:02:01
SPEAKER_00: Do you think that's something, you know, 2002?
1:02:04
SPEAKER_00: I imagine even the word mindfulness we weren't really as familiar with, but then connecting that with sexual health, did did you receive pushback on that?
1:02:14
SPEAKER_01: Um put put pushback, but more in the way of like skepticism.
1:02:19
SPEAKER_01: Like how on and from and I think understandably from a lot of people.
1:02:23
SPEAKER_01: So you're telling me that sitting on a pillow and breathing is going to restore my orgasm.
1:02:28
SPEAKER_02: Yeah.
1:02:29
SPEAKER_01: Right.
1:02:29
SPEAKER_01: I mean, and and really when I present it in that way, it seems like unbelievable.
1:02:34
SPEAKER_00: Yeah.
1:02:34
SPEAKER_01: Um, so I think that's where the original kind of disbelief came from.
1:02:38
SPEAKER_01: And and it's also something that I've incorporated a lot into the groups or the individual work that I do.
1:02:44
SPEAKER_01: And that is I spend almost no time explaining the scientific rationale for how mindfulness works.
1:02:51
SPEAKER_01: And instead, we jump into the practice.
1:02:52
SPEAKER_00: Yeah, I love that.
1:02:53
SPEAKER_01: Right.
1:02:54
SPEAKER_00: Yeah.
1:02:54
SPEAKER_01: So people can sort of make that connection for themselves.
1:02:57
SPEAKER_01: It's not coming from, you know, a so-called expert who's telling them the parts of the brain that are changing as a result of practicing this and how that lends itself to a better experience of desire, but rather they experience it firsthand.
1:03:10
SPEAKER_00: Well, yeah, now, but you now have like just very robust data, right?
1:03:14
SPEAKER_00: And it's much easier to stand behind that.
1:03:16
SPEAKER_00: That's what I love about science.
1:03:17
SPEAKER_00: Yeah, we're all trying to scientists are all trying to disprove a hypothesis.
1:03:22
SPEAKER_00: So when we figure out there's something that's kind of irrefutable, we know it works.
1:03:26
SPEAKER_00: We know it works for a lot of different people a lot of the time.
1:03:28
SPEAKER_00: It's very easy to defend.
1:03:30
SPEAKER_01: Yeah, yeah, exactly.
1:03:31
SPEAKER_00: What what have you got wrong?
1:03:33
SPEAKER_00: What what would you, you know, what was something that you used to believe that you now have completely changed your mind on?
1:03:38
SPEAKER_01: Yeah, I think, you know, in the early days, um, and some of this came from the broader mindfulness literature that uh mindfulness could actually be dangerous for certain people.
1:03:48
SPEAKER_01: For example, someone who had a trauma history, where mindfulness might um contribute to having increased feelings of flashbacks, or a lot of extreme anxiety in the moment.
1:04:02
SPEAKER_01: And so for many years, we would exclude people from our research studies who had a significant trauma history or were prone to dissociation or anything like that.
1:04:13
SPEAKER_01: Um, and we got that completely wrong.
1:04:16
SPEAKER_01: We actually, uh and we we've also done some of this research ourselves, where mindfulness carefully dosed by a skilled practitioner in a kind of very careful way can be exactly the missing piece for helping people to stay very, very present and connected.
1:04:33
SPEAKER_01: So, as an example, um, sadly, I've seen a number of women and people in general where arousal, the earliest signs of arousal can be enough to trigger dissociation for them because arousal happened in the context of a sexual assault or something like that.
1:04:50
SPEAKER_01: And if you can help a person to stay very, very present with the moments before arousal, right?
1:04:57
SPEAKER_01: Kind of the microseconds that lead up to arousal, and we sort of build up in this very, very careful way, then arousal doesn't become scary anymore because it's not suddenly there.
1:05:10
SPEAKER_01: Right.
1:05:10
SPEAKER_01: Yeah.
1:05:10
SPEAKER_01: Right.
1:05:11
SPEAKER_01: They've kind of you know eased into it.
1:05:13
SPEAKER_01: So we don't no one's um excluded from this kind of practice.
1:05:18
SPEAKER_01: It's it's open and available to absolutely everyone, albeit with some modifications.
1:05:23
SPEAKER_01: If a person have has sensory difficulties or things like that, then we'll want to adapt in in certain ways and maybe have slower um uh or sorry, shorter mindfulness practices.
1:05:34
SPEAKER_01: But I can't think of any person who can't benefit from mindfulness.
1:05:40
SPEAKER_00: Is there a um a like a digital version of this that that people could, you know, maybe people who are um listening could Yeah.
1:05:48
SPEAKER_01: So we developed a digital tool called eSense.
1:05:51
SPEAKER_01: And it um coming back to our earlier conversation about, especially in women, the large proportion of women who will never talk to a healthcare.
1:06:00
SPEAKER_01: Provider.
1:06:00
SPEAKER_01: So even the mindfulness practices that I'm telling you would require someone to reach out, disclose, ask for help, find the resources and means.
1:06:09
SPEAKER_01: And so we developed eSense as a way to really mimic what we were doing in our eight session groups.
1:06:16
SPEAKER_01: And we've tested over the past 10 years in several hundred, mostly women and gender diverse people with sexual problems, mostly low desire, and found it to be pretty much equivalent, if not better in some cases, to what would happen when they saw a person face to face.
1:06:33
SPEAKER_01: And so we're kind of now moving that along a commercialization pathway.
1:06:37
SPEAKER_01: And we're actually halfway through a commercial pilot right now.
1:06:39
SPEAKER_01: And we're looking at, you know, can clinics recommend this to women?
1:06:44
SPEAKER_01: And what's the uptake there been like?
1:06:46
SPEAKER_01: But we've had a lot of interest from menopause centers around North America because that's really a missing component of their care is the sexual health.
1:06:55
SPEAKER_01: We've also had a lot of interest from cancer centers because sexual problems in the context of cancer treatment are very, very, very high.
1:07:04
SPEAKER_01: And I mean, upwards 80, 80% of women and men will have sexual problems after cancer treatment.
1:07:10
SPEAKER_01: Yet it's never talked about.
1:07:20
SPEAKER_01: So we have a whole version of our uh treatment research on essence that's been tested with cancer survivors.
1:07:27
SPEAKER_01: And again, really, really great outcomes.
1:07:29
SPEAKER_01: So that's our hope of ours in the long term is that centers can make it available.
1:07:33
SPEAKER_00: But it's not available right now.
1:07:35
SPEAKER_01: Only in a commercial pilot.
1:07:36
SPEAKER_01: So people can sign up for it and uh we're collecting some data.
1:07:40
SPEAKER_01: So they can just go to essencehealth.com.
1:07:42
SPEAKER_00: Okay, and we'll add that link in the show notes.
1:07:44
SPEAKER_01: Perfect.
1:07:45
SPEAKER_01: Essencehealth.com.
1:07:46
SPEAKER_00: Okay, lovely.
1:07:47
SPEAKER_01: Um, and then uh, like I said, our hope is to make this uh available hopefully by the end of 2026.
1:07:52
SPEAKER_00: That's so cool.
1:07:54
SPEAKER_00: Can I ask you?
1:07:55
SPEAKER_00: Um, you know, we we all we often talk about the need for there to be an appropriate level of scientific discord and discourse even.
1:08:04
SPEAKER_00: Um and you know, we we've spoken about the rest of our board collectively, the rest of our council across all these different fields.
1:08:11
SPEAKER_00: Um, would you say that there is anything that your peers would disagree with that you strongly agree with?
1:08:22
SPEAKER_01: Oh, I mean, this is the kind of the nature of scientific inquiry, right?
1:08:27
SPEAKER_01: Is uh also you'll you'll notice that I never use the word prove, right?
1:08:32
SPEAKER_01: Like we don't prove something, we just test the null hypothesis.
1:08:35
SPEAKER_02: Yeah.
1:08:36
SPEAKER_01: So I think there's there's probably um, I think there's probably some disagreement in our field around the role of medications, right, as a as a as a treatment.
1:08:48
SPEAKER_01: So I try to share the science in the most unbiased way possible.
1:08:52
SPEAKER_01: And at the end of the day, the medications that are available might help a small subgroup of women to a to a certain extent.
1:08:59
SPEAKER_01: And I think others would disagree with that.
1:09:02
SPEAKER_01: Um, maybe out of their own clinical experience where they're prescribing medications a lot and seeing seeing uh benefits that are different than what I've observed.
1:09:11
SPEAKER_00: Yeah.
1:09:12
SPEAKER_01: So that's probably the main point where there'd be some disagreement.
1:09:16
SPEAKER_00: Is there something that you see consistently online you just wish people would never say again?
1:09:23
SPEAKER_00: So any kind of like just obvious myth that we're being misled by?
1:09:27
SPEAKER_01: Yeah, I mean, we've already covered the myth of planning sex as being dry and boring sex, so that's not one.
1:09:33
SPEAKER_01: I think aging, aging is another one that we still maybe don't hear explicit, but kind of these implicit ideas that only young people have sex, and you know, when you hit a certain age, certainly with women, yeah, right.
1:09:48
SPEAKER_01: And when you lose reproductive capacity, like sorry, shops closed.
1:09:53
SPEAKER_01: Um, so that one needs dismantling altogether.
1:09:57
SPEAKER_01: Right.
1:09:57
SPEAKER_01: Um, and then I think another really, really common one we've kind of touched on it throughout our conversation is this idea that you know, sex is fixed, right?
1:10:06
SPEAKER_01: You either have it or you don't.
1:10:08
SPEAKER_01: You either perform well sexually or you don't.
1:10:10
SPEAKER_01: You have desire or you don't.
1:10:12
SPEAKER_01: And yet we've talked about many, many examples where sexual desire waxes and wanes.
1:10:17
SPEAKER_01: It's very flexible, it's very responsive to contextual cues.
1:10:21
SPEAKER_01: And so from that perspective, I think we should expect better sex with age.
1:10:27
SPEAKER_02: Yeah, yeah.
1:10:27
SPEAKER_02: Right?
1:10:27
SPEAKER_02: As long as there's intention.
1:10:29
SPEAKER_01: Raise the bar, right?
1:10:30
SPEAKER_01: Like let's understand what are the factors that can lead us to have optimal sex when we want to have it.
1:10:37
SPEAKER_00: Yeah.
1:10:37
SPEAKER_00: So and I love that.
1:10:38
SPEAKER_00: That's what we're trying to talk about across every episode here is how do we how do we improve some of these baselines?
1:10:45
SPEAKER_00: I think we get so used to living at a seven out of ten.
1:10:49
SPEAKER_01: Yeah, at the good enough level.
1:10:50
SPEAKER_00: Good enough, exactly right.
1:10:52
SPEAKER_00: Okay.
1:10:53
SPEAKER_00: If you had unlimited funding and resources, is there a question that you want to answer that we haven't yet answered?
1:11:01
SPEAKER_01: I mean, I love the idea of really personalized care.
1:11:05
SPEAKER_01: And um, you know, certainly in our in mindfulness, we have done this quite a bit with groups, but even within a group, there's a lot of nuance based on a personal's a person's history and lived experience and biology and makeup.
1:11:19
SPEAKER_01: And, you know, we would love to be able to personalize a sexual health and sexual wellness protocol that's specific to that individual and maybe specific to their relationship and have a component part for their partner as well that we've just not been able to do in research studies given the amount of you know resources that be required to do that.
1:11:42
SPEAKER_01: So instead we look at large groups of people and we make generalizations that hopefully land for the majority of people, but there's also always going to be people who don't sort of kind of fit that, you know, that overall phenotype.
1:11:54
SPEAKER_00: Yeah, I agree with you.
1:11:55
SPEAKER_00: I think we're we're entering the age of hyper-personalization over the next few years and as we get more agency and the ability to do our own N of One studies with some of these different tools and technologies.
1:12:07
SPEAKER_01: Right.
1:12:08
SPEAKER_00: What I mean, do you over the next five, ten years, and even right now, do you think that this sort of landscape of funding has changed with regards to the gender breakdown?
1:12:19
SPEAKER_00: Because it's been embarrassingly small amount of funding for women's health research.
1:12:23
SPEAKER_01: Yeah.
1:12:24
SPEAKER_00: But we're starting to see that shift somewhat.
1:12:26
SPEAKER_01: Yeah.
1:12:26
SPEAKER_01: We're, I mean, Melinda Gates recently just announced several millions towards women's health.
1:12:32
SPEAKER_01: And I mean, in in both of our countries, Canada and the US, you know, less than 7% of national health research funding goes to women's health topics.
1:12:41
SPEAKER_01: And today, uh, today.
1:12:43
SPEAKER_01: That's correct.
1:12:43
SPEAKER_01: This is this is today.
1:12:44
SPEAKER_01: And that's, you know, on the whole.
1:12:46
SPEAKER_01: And when we look at what are the areas of women's health that tend to garner more research funding, it tends to be cancer and specifically breast cancer and even gynecologic cancer.
1:12:56
SPEAKER_01: Um, but when we look at other medical health conditions, even like endometriosis, which affects 10% of females, yeah, takes them 10 to 15 years to get a diagnosis.
1:13:06
SPEAKER_01: And there's almost no national health funding to address this incredibly debilitating condition.
1:13:12
SPEAKER_01: And I mean, I could I could give you a list of different women's health conditions that are are very similar.
1:13:18
SPEAKER_01: Uh, but that's an that's an obvious one because the burden on quality of life is so profound, so incredibly profound.
1:13:26
SPEAKER_00: And many don't even know, right?
1:13:28
SPEAKER_01: Don't even know.
1:13:29
SPEAKER_01: And again, we we normalize painful periods, and so that continues for a period of time.
1:13:35
SPEAKER_00: And diagnostic imaging and testing is I think it leads to like a huge degree of gaslighting as well, where you it's sort of it's all in your head.
1:13:43
SPEAKER_00: Yeah.
1:13:44
SPEAKER_01: It's all in your head.
1:13:44
SPEAKER_01: So a lot of and that's why again it can take up to 10 years or or even longer for women to get diagnosed, is you know, and there has been research that shows that when women present to the emergency department with chronic pain, they're more likely to be told it's all in their head than men are, right?
1:13:59
SPEAKER_01: I mean, that's just a fact.
1:14:00
SPEAKER_01: I'm not I'm not in inflating the findings there.
1:14:04
SPEAKER_01: Um, and so, you know, we can take a step back and say, yeah, this is kind of a feature of women's health research in general.
1:14:11
SPEAKER_01: And um yet at the same time, we know that when women are healthy, they contribute significantly to the to the economy.
1:14:20
SPEAKER_00: Of course.
1:14:21
SPEAKER_00: Yeah.
1:14:21
SPEAKER_00: You know, I think the thing that does give me optimism though is that that that that tide is changing slowly.
1:14:28
SPEAKER_00: Yeah.
1:14:28
SPEAKER_00: You know, um, it wasn't until you know, the last two decades or so, there was, I suspect that 7% was a fraction of that.
1:14:36
SPEAKER_02: Yeah.
1:14:36
SPEAKER_00: Um, but now I think that we're not having to wait as long to to test these hypotheses as we were.
1:14:44
SPEAKER_00: And I suspect that's going to get even quicker.
1:14:46
SPEAKER_00: Yeah.
1:14:46
SPEAKER_00: And so I hope that that that tide changes very quickly.
1:14:50
SPEAKER_01: Yeah, I I agree with you.
1:14:52
SPEAKER_01: I think the innovations that we're seeing in science is so, I mean, it's an amazing time to be a scientist.
1:14:58
SPEAKER_01: If you're a young trainee listening and you're sort of, you know, just entering this field of scientific inquiry and working with a research team, it's a very, very exciting time to be in this space.
1:15:09
SPEAKER_00: There's also just some really gangster female entrepreneurs and scientists that are leading the charge.
1:15:14
SPEAKER_02: Yeah.
1:15:14
SPEAKER_00: Um, yeah, and and men as well, but like there's a few that, and you just name one of them, and I think it's um incredibly promising.
1:15:22
SPEAKER_00: What's giving you optimism about the field right now?
1:15:26
SPEAKER_01: Um, I mean, I'll come back to I think the the number of youth, uh, young people that are uh interested in contributing to the science of women's sexual health.
1:15:37
SPEAKER_01: And, you know, I think back when I started going to sexual health conferences um in the late 1990s, and first of all, there would be no students in the room at all.
1:15:47
SPEAKER_01: Um, and it was mostly male-dominated.
1:15:49
SPEAKER_01: And of course, Viagra was the topic of conversation in all the conferences.
1:15:52
SPEAKER_01: And we just hosted a huge international sexual health conference in Vancouver and several hundred people, many, many trainees, and just the broad diversity of topics that get covered.
1:16:05
SPEAKER_01: Um, you know, really soup to nuts when it comes to understanding sexual health from this truly biopsychosocial perspective.
1:16:12
SPEAKER_01: So I'm really excited about that.
1:16:15
SPEAKER_01: I mean, I have to turn down students every week because there's so many that are stepping forward saying, can I volunteer?
1:16:20
SPEAKER_01: Can I participate?
1:16:21
SPEAKER_01: What can I do?
1:16:22
SPEAKER_01: Can I do a literature search?
1:16:23
SPEAKER_00: Um must be incredibly vindicating, you know, given that if it wasn't for brilliant scientists like you, that that wouldn't be the case, right?
1:16:32
unknown: Yeah.
1:16:32
SPEAKER_01: Not as quickly, at least.
1:16:34
SPEAKER_00: Congrats.
1:16:35
SPEAKER_01: Well, thank you.
1:16:36
SPEAKER_01: Love that.
1:16:37
SPEAKER_00: Um, okay, I'm mindful of your time, so I'm gonna give you one last question.
1:16:42
SPEAKER_00: If a viewer was tuning in just for the last 60 seconds of this episode, what would be your high-level strategic takeaway?
1:16:53
SPEAKER_01: So, first and foremost, sexual health is health.
1:16:56
SPEAKER_01: That love.
1:16:58
SPEAKER_00: I love that type.
1:16:58
SPEAKER_01: Right.
1:16:59
SPEAKER_01: So we, I mean, we could even stop right there.
1:17:00
SPEAKER_01: Sexual health is health.
1:17:02
SPEAKER_01: And so, in the same way that pri we prioritize other facets of physical, emotional, spiritual well-being, we also want to nurture sexual health.
1:17:12
SPEAKER_01: And what that means for any individual person is extremely individual.
1:17:16
SPEAKER_01: It may be wrapped up in a partnership or it may not.
1:17:20
SPEAKER_01: Um, and that it's accessible to us regardless of your gender, your race, your religion, and certainly your age and stage of life.
1:17:29
SPEAKER_00: I love.
1:17:30
SPEAKER_00: I love that.
1:17:31
SPEAKER_00: Laurie, thank you so much.
1:17:32
SPEAKER_00: My absolute it has been a real privilege and a pleasure, as always.
1:17:36
SPEAKER_01: Thank you.