Latest / The XX Lab / Love Your Partner But Don’t Want Sex? A Kinsey Scientist Explains | Dr. Cynthia Graham #25

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Love Your Partner But Don’t Want Sex? A Kinsey Scientist Explains | Dr. Cynthia Graham #25 · The XX Lab

• speaker-0: I am so excited about today's episode because we are going to be talking about a lot of sexual urban legends and about myths surrounding sexual desire. Because most of us have been taught to think about sexual desire as something that should simply appear, like hunger or thirst or feeling tired. And then if it doesn't, we assume that there's something wrong with us or something wrong with our bodies or even something wrong with our relationships. But we may have been thinking about desire all wrong. And today's guest tells us that we might. Who is it? It's Dr. Cynthia Graham, one of the world's leading experts on human sexuality. She's a distinguished professor at Indiana University, a senior scientist at the Kinsey Institute, and has served as editor-in-chief of the Journal of Sex Research since 2009. She has published more than 200 peer-reviewed papers and has spent 35 years working clinically with individuals and couples experiencing sexual difficulties. In our conversation today, Dr. Graham and I explore why spontaneous desire may be largely a myth, what actually turns women on and puts the brakes on sexual arousal, and why the same cue can be really exciting to one woman and completely inhibiting to another. We also talk about desire discrepancies, aging, orgasm, body image, sexual communication, and why losing interest in sex does not necessarily mean that a woman is dysfunctional. or that her relationship is doomed. If you've ever wondered why desire changes, where it goes, or whether it can come back, this is a conversation you need to hear. This is the XX Lab. I'm Dr. Sarah Hill. Let's get started. Dr. Cynthia Graham, welcome to the XX Lab. speaker-1: Thanks for inviting me. It's good to be here. speaker-0: I I'm so excited to have you here because I've as I talked about with you off camera, I am a huge fan of your work. You've really been foundational in the study of human sexuality, especially women's sexuality. I think that you've really offered a lot of insights that have helped move us from the dark ages of thinking that the way that women respond to sexual stimuli is going be the same as men. And I wanna start by actually talking about some misconceptions that exist around sexual desire. And I think that there's this tendency to assume that sexual desire should appear spontaneously, right? almost like hunger or fatigue or flipping on a light switch where it just comes out of nowhere. And if we're not experiencing that regularly, or we if we don't experience that at all, that that must mean that there's something wrong with us. And so is this true? So is there any truth to this cultural narrative? And and if not, how do we get there? speaker-1: Yeah, that's a great question. So that I think it's absolutely a misconception. I think it's also a misconception for men, but focused on women. I've seen that both in research that I've done and other people have done, and also in my clinical work. So I worked clinically and saw couples and individuals for about thirty-five years too, all with sexual problems. with a clinic here at Kinsey Institute actually was for nine years. There's a couple of things that that are related and that make that myth persist. One of them is that people often think that nothing should really change. If if their first few weeks that they're with a new sexual partner, it feels like it's spontaneous, but actually you're really responding to cues and to things that make you aroused. And there's some wonderful work that's been done on the on this, particularly by Ellen Lann in the Netherlands and her incentive motivation model and her and her colleagues that really suggests that There's there's no such thing as spontaneous sexual desire. You're responding all the time. You may not be aware of what you're responding to, but you're responding. The other kind of myth I think is that spontaneous desire is better than desire that is actually something that you you what's the best word? You provoke or you you you have cues around you and you respond to those. So people really think that spontaneous desire is better. And just like they think spontaneous sex is better than planned sex. And there's some really good recent evidence, actually a recent study suggesting. Planned sex can be just as enjoyable and just as arousing as so called spontaneous sex. speaker-0: Really quickly, I want to follow up on that. What what did the study find? So was it was it making a comparison between people who have sex just, when it's on a whim, and then others people who plan sex maybe like by the calendar? speaker-1: Yes, that's right. It was a study just recently published in the last year. Amy Meuse and colleagues did the study. Got a lot of attention actually in the media as well. that's exactly right. In my own research that I've done with Kinsey colleagues, we've also found that one of the biggest triggers for feeling desired, sorry, feeling desire is anticipating, planning for sex. we had some wonderful quotes for that in a paper we we did on a focus group study many years ago. Where people said those that were in relationships said things like leaving little notes out in the morning, saying how much they look forward to which really goes against the whole idea that spontaneous sex is better. But it is a persistent myth. speaker-0: It yeah, it is. I had a a social media post asking about this question and asking people what they believed the answer was. And and people overwhelmingly believed that that planned sex was just like an absolute killjoy. And that, you know, that it was almost like, you know, planning to do your laundry on Saturdays or doing your grocery shopping on Sundays, and that it like will totally take the thrill out of that. But you're saying and and in this study, they they asked people about Did they ask them just about their sexual satisfaction and the satisfaction? Was it relationship? what were the dependent measures in that? speaker-1: Memory, I'm pretty sure that was definitely about not just relationship satisfaction, but sexual satisfaction. Then the findings were pretty clear, and that's why I think a lot people were were interested in them and the media attention was there. I think that it's a kind of something that is held more by younger people as well. That's my experience. So one of the things we did years ago, 80 women between 18 and 82 years old. And one of the things that we found, and we wrote a little bit about in the paper, we could write a separate paper on it, but is that young women really were focused on their partner. They weren't really aware of things that provoked their desire themselves. Older women were much more in touch with that. We found that really striking. And we had three age bands of women, and it was eighteen to twenty-four. They just didn't talk about cues to their own desire and arousal. They didn't talk about f using fantasy. They didn't talk so much about self-pleasuring either. Some real age differences and things that come with experience, I think, too. The other thing that I think is important and from a clinical point of view, you really see this when you see couples with sexual problems or desire discrepancies, is that they do really have to make time for sex. Prioritizing sex is important. And you know, in the lifestyles that we all have, working, kids, everything else, you you can't just kind of ab assume that spontaneous sex is gonna happen. And planning it does not is not a kill joy at all. speaker-0: A lot of times in sexuality conversations, I think that there's some awareness of the fact that there's a that there does seem to be some differences in what is typically called spontaneous sexual desire, right? Which is this I idea that you have sex that kind of pops out of nowhere. And then responsive sexual desire, which is where you have sexual desire that's building from presence of some sort of a cue. So whether it's, you know, seeing an erotic video or your partner. Is, cuddling up with you on the couch, and that that's eliciting a sexual response. And something that you said that I think is so fascinating is that, spontaneous sexual desire is a myth. And that even in the case of quote unquote spontaneous desire, that you're responding to a cue. So can you like can you expound on that a little bit? Cause I I that's like counter to what I think a lot of us think about when we think about sexual desire. speaker-1: It goes back a little bit to the the oldest kind of sexual model that was of sexual response, Masters and Johnson, right? That sexual response is a linear model. And what comes first, and Helen Singer-Kaplin added to this with the desire, desire it's a linear response. Desire happens, and then you feel aroused, and then arousal builds, you know, and then you may reach orgasm or not, less likely if you're a woman and imparted sex. But that that linear model has really kind of been disputed by a lot of research. And I think that what People might feel a spontaneous desire. It's actually they are responding. They're already a little bit aroused, maybe not as aroused as they're going to become, but it they they're so close together. And again, we also have quite a lot of evidence, still a little bit argued on this point, but that desire and arousal are not really discrete separate phases. Ellen Land's quote, she talked about desire and arousal being two sides of the same sexual coin. I really I love that. I love that expression. So I but I think it is an idealistic thing. It's it's the idea that you do not You should not have to plan, you shouldn't have to organize to make sure you you've got, a good situation. The kids can't come in your room, you're not thinking about doing the laundries, all of that. But actually you do have to do that for sex and particularly after the first few weeks and months. We know that. And and some people are more distracted by things and need need to do that even more. that's there's a lot of variability, right, in sexual response. speaker-0: Yeah. And so I I think that the the the idea that lives out in the world is that men have more spontaneous desire, which again you're suggesting is actually responding to a cue, and that for women that it's more responsive. And so maybe it is that the types of cues that women's sexual responses are responding to are less subtle. So like maybe for male sexual desire, like picking up on a cue could just be seeing, you know, the side of a woman's breast and and that's like all it you know, that's all it takes. And that for women that it could just require a little bit more than that. Is that like maybe idea or speaker-1: An idea. I think I I don't disagree with that, but I I also think that gender differences are overstated sometimes as well. the idea is there is some there's less work on men's sexual experiences, right? But there is some, we do have some and it's growing. But the idea that men are not kind of responding to things like relationship factors and and w but women are, I think that's a myth as well. And actually here at Kinsey, Eric Janssen did a parallel study to our one. We did it to inform development of a questionnaire on sexual inhibition and excitation. And he followed up doing a similar study with men and found that v many of the same factors that enhanced arousal or inhibited arousal, men reported as well. I think there are some gender differences for sure, but I think that a lot of times they're overstated. One example of that is the idea, which is still around, that women don't really respond to visual cues. That's just that's that's not the case. Right, respond to visual cue. Maybe sometimes different ones. I mean the research we've done here in the past on pornography and types of pornography suggest yes, there are differences in terms of what one of my grad students just finished her PhD looking only at women's experiences of pornography. So I think there are differences, but they're more subtle. They're less wide ranging than you might think. speaker-0: With women's responses to pornography, and I would be curious, maybe you can tell us just briefly what your students' research found, because I'm I'm really curious about it. But my understanding is that, you know, the issue isn't so much that women don't respond to visual cues in pornography. It's just more that the pornography doesn't necessarily click the right buttons for women compared to what it is, because a a lot of it was made for men, right? And it's sort of like it like dials, it's like really dialed into male sexual fantasies and less dialed into women's sexual fantasies. Is that supported by the research that's out there. speaker-1: This research that my student Katerina Litsu her name is in England did was more on motivations for pornography use, but some research that we did here suggest, yeah, women respond to different types of pornography. And there is women-centered porn, right? And and and a lot of people are not that aware of that still, which surprises me. The study we did here looked at gender differences in selecting video clips that were arousing. It was a it was a really cool study to do. And it ended up actually producing a set of videos that people have used in lab studies. since and referred to that paper. So yeah, women i in that study and in other studies as well tend to prefer porn that has some context. They definitely prefer not necessarily a a a relationship, a long term relationship, but some kind of sort of storyline and one that where women are shown as experiencing pleasure as well, which it shouldn't be surprising, right? At all. speaker-0: Yeah, well it's so funny because I so many I mean so much pornography again, you know, it's like very much dialed into male pleasure and you know it's like that the male is the star of the show and the male is the one who is being sexually gratified, usually by you know, a a whole cadre of women. And there are more forms of sort of female centered pornography that's coming out now. And for listeners who aren't aware of that, th it is out there and it's worth checking out if you're interested in finding erotica that's more tailored to female sexual fantasies. speaker-1: It's been over for a while, but I think it's increasing. I think pornography is definitely changing in terms of content. What the student, my student Katarina found was that there were many different motivations for using porn, as that's true for men as well. So some of them were sexual, other ones were more to do with relaxing, helping them sleep. Some similar things to what people say about masturbation as well. And so she found a diverse range of of experiences, but many of the women had good experiences, even in terms of feelings about their body. So there's the idea that, body shapes and and appearances in porn are going to make you feel really inadequate. She found that was not always the case. It it depended on the porn, of course, the type of porn. but that's still a new area, women's experiences on porn. speaker-0: I think it's here to stay. it's like now that we we have to, you know, our life is becoming increasingly digital. And so I think that that porn is here to stay. I'm really glad that that research is being done so we can understand more about the motivations and then also to be able to better design things that are well suited to the people who are using them. So in particular, looking at things that are going to potentially be interesting to women. One of the things that I I want to dig into a little bit is just this idea of context. I'm just wondering if you can tell us a little bit about what that means. what is context, right? And and why does it matter? One thing speaker-1: That we have found in our research looking at using a model that was developed here at the Kinsey, dual control model it's called, is that I mentioned variability already. The context is important, but actually what matters in the context is hugely variable. So we found in in more than one study, quantitative and qualitative studies, that for some women, a certain style of approach of a partner who's interested in having you know sexual contact. can be a real turn on. And for others that same that same approach is is a turn off as well. Another good example, a a really good example that I like is that for some people, having any kind of disagreement argument with a partner is a real turnoff. It really switches them off. They say the brakes go on and that's it. But for others that's not the case. And for some it's actually a arousing. It depends on how, not not like physically abusive arguments, but ones that are are definite arguments. Some people say that the slightest thing can put them off. Any distraction. And we had in the questionnaire we developed, we had one factor that really indexed that, where people said the slightest thing can turn me off if I'm aroused. And other people said, you know what? Anything can be happening around me. And I'm still going to be into it. So there were a huge amount of variability. I found the approach really interesting actually because there were some wonderful quotes we had where people talked about How how I'm approached it matters. What I really like is being taken by surprise. Now some people would not would find that really upsetting and and a turn on, but some women said that was their biggest turn on. And I won't give the quotes here, but they're kind of still in my head. speaker-0: If if if you have them, I would love you. speaker-1: I always remember and I've talked about it in so many presentations. She started by saying maybe it's because she was brought up Catholic. And so she feels guilty if she but taken by surprise, somebody coming up behind her, which again some people would really not like. For her, it was it it made her very aroused. And and there were other women that said similar things, but the Catholic quote always stuck with me. Yeah. so things like that. Context, I th I think context is really important for men too, going back to not being so many gender differences. For most people, some kind of, you know, positive feelings about the partner matter, of course, as well. But yeah, the context is is hugely important. speaker-0: And what you're also saying is that this isn't just w women don't have the market monopolized on this, that this also influences men. And I think that I think that this is actually like super useful. You know, most of the listeners are women. I I think this is useful information for women to have because I think that women assume that their partner should just always be ready to have sex. And then if their partner isn't ready to have sex, they feel like there's something wrong with them. And just recognizing that male sexual psychology may be more complicated than we've probably given it credit for. speaker-1: Yeah, a hundred percent agree. And I've seen I've really seen that clinically as well as in research too. And I again I can remember couples where that was the case. People often will think that for for men will always be up for having sex. And so in in interviews I've done, women have made jokes about that saying in terms of initiation, of course he would say yes. He's always up for it, always up for and just one anecdote. I saw a couple that long time ago when I worked in Montreal, where I did my PhD, I saw a couple who'd been ha married for a long time, had a really, really s good, satisfying sexual life, and they entered their 40s and they were still having sex rate, but they had sex every day, every single day. And when things started to change, the woman partner in particular felt it was because she was no longer attractive. And it was it was still happening several times a week, but the male partner also thought. This is aging. I've I'm losing my my sexual desire. Therapy with them was pretty easy because it was just really about normalizing that things change. And they they again they were still in terms of norms, they were still way more active than most couples would be. But they had this idea that it didn't matter whether or not particularly a male partner was sick. I mean, he might have a flu, he still would want to have sex. Stressed, like really crazy stressed at work, he would still want to have sex. and so those kind of trying to challenge those. those myths was important. And that was an unusual case, but I've seen that in more a little bit more subtle ways as well. speaker-0: I would think that that would put a lot of pressure on men. If they have to feel like they're constantly turn onable, always, that's gotta be tough. Do you hear, because I know that you work you do work clinically. Do you hear that? Is that a can do men feel this? Is this a burden that they feel? speaker-1: I think it is. I think it's not always something that they acknowledge or report. Sometimes they're not even that aware of it until you discuss it in therapy. I think it is. Someone who's done some work on this has written a book on it is Sarah Murray up in Canada. It's not a recent book, but it was great. She interviewed men for her study. It was actually her PhD research and it her book really kind of bears that out about men being much more similar in terms of and actually liking when their partner initiates rather than them initiating all the time. speaker-0: Hear that a lot. I even hear that from undergraduate men that, yes, that they, that they feel that they are always having to initiate and that they would like to feel desired also. And I think that, there's a lot of discussion about in female sexuality, just about the importance of feeling desired, because that seems to be like a really important button to push when it comes to women's sexual arousal and sexual desire. But it's not really discussed all that much with men because it's just assumed that. they're going to have the button pushed already and that we don't really have to do a whole lot to get the button pushed. But yeah, I I even hear that from these, young kids who feel like they wish that their partner would initiate sex a little bit more frequently. speaker-1: Yeah, yeah. And and in younger younger people, we recently postdoc that I'm working with Kirsten Greer and I did a talk at a fraternity. And it was really cool because we weren't talking about I do we're a lot of research on condom use. We weren't talking about condom use. We were talking about wanted sex and unwanted sex. And I think then the room was full. There were so many fraternity guys there. And they really I think a lot of it really resonated with them. We were talking about what's the difference between wanted sex and unwanted sex. And they could kind of talk a little bit about, well actually they didn't always want sex. even when they had it. And you you don't hear a lot about that. speaker-0: Yeah, not with men. Like the assumption is always just that men want sex and that, yeah, and that anytime that there's unwanted sex, that it's women who are who are having it. So another myth dispelled on the podcast today. I want to know about emotional connection and I wanna know about how important is it with respect to physical desire. Like so in order to experience sexual desire. And we can also talk about whether or not there are sex differences here. how important is emotional connection to sex? Can it make sex better? Is it necessary? Is there individual differences? because I I think that there are. And then to what extent, you know, sex plays a role in those individual differences. I'm just, I'm just curious. What is the role of emotion and emotional connection in sex? speaker-1: The research that we've done at Kinsey has suggested there's a lot of individual differences when it comes to how important emotional connection is to having a good sexual experience. For some people, it's really important. The questionnaire we developed actually one of the factors was relationship importance. That's the title of it. And so some of the items on our questionnaire would be I have to feel emotionally connected to a partner in order to enjoy sex. That's just one example, pretty much word for word. So there's a lot of variability. For some people, it's hugely important. For both men and women. And and I think there's definitely a longstanding belief that a connection, an emotional relationship with someone is really more important for women than for men. I don't think that's always the case. There may be some broad gender differences overall, but there's a within that there's a lot of variability. So some people will say, doesn't really matter if I feel an emotional connection. What really matters is you just mentioned feeling desired. That was one of the factors that came out most in our qualitative work. Women talked in our study about wanting to feel desired for them, not just because their partner wanted sex. I remember again, one of the quotes from that was, I don't want to feel like it could be any tree in the forest. That was a quote. But and and so feeling desired and really really f feeling that you're desired for you and that you're f found very attractive as well is important. But there were some women that said, I can have a good sexual experience when I have no emotional connection with a partner. So in some casual sex, and we know that women as well, of course, for a long time we've known enjoy casual sex as well. They tend to have different sexual experiences in casual sex. So we know that reaching orgasm for women less likely in partnered sex than when they're on their own, but also in casual sex encounters, less likely as well. And there's a myth around that too that it's going to take a really long time for women to reach orgasm. That's kind of I'm kind of going off an attention here. But that's that's another kind of myth which is that shows a lot of variability. So I think a push connection, yes, is important. I wanna speaker-0: put a pin in this idea about orgasm being more difficult in the context of a short-term relationship or a short-term sexual encounter with women. Do you think that when women have those, that they tend to be more focused on pleasing their partner than they are on pleasing themselves? And that that is ultimately what is happening there, that casual sex for women is almost like a performance, like where, they're trying to please their partner. speaker-1: Yeah, that's expressed really well. There are re there are recent studies that really bore that out. So s younger women in particular will say that's what they're concerned about, right? In pleasing their partner. Some of them too, I mean, age and orgasm experience are are related in women too, in a di very different way than in men. So younger women, there's some great research on this qualitative research mainly. Younger women saying they don't really expect to, they've never experienced an orgasm, and they're focused on on absolutely on pleasing a partner. And for them that that's what makes a good sexual encounter. sadly. But I think when you're in a longer term relationship, even even for younger women, you're starting to learn what you like and dislike. And if you can translate what you like and dislike in solo sex to a partner, that's great. Not everybody is comfortable doing that. I think it's absolutely the case that women are concerned about their partner being satisfied. And and y we know we know from studies that young people will see often, male partner, if they're in a a a mixed sex relationship, male partner reaching orgasm signals the end. Right, of the encounter. It's like it's to go on now. The main things happened that we were waiting for. And that might so it might be very short as well. You know? It could be extremely short. I do think that changes with age. speaker-0: I talked about it with Cindy Messon when I was talking with her on the podcast about the age effect is like pretty strong for women where they tend to have orgasms more frequently as you get older compared to younger and a sexual experience playing an important role in that. And do you think that it's just that women are getting more comfortable? I mean, is it that they're getting more comfortable with understanding what their body needs? And that's something that younger women can practice, as you noted with. self-stimulation or masturbation and learning to figure out what works and what doesn't work. To what extent do you think that it's that, or to what extent do you think that it is about being willing to communicate with their partner about this isn't working for me? And you know what would work for me is this. because I think that there's a lot of fear that prevents women from getting what they need sexually, also because they don't want to have the conversation with their partner about what they want, either because they're embarrassed. Or because they're afraid that they're gonna hurt their partner's feelings, because they're not gonna think that their incredible sexual maneuvering is working on their bodies. speaker-1: Yeah, I think both are true. I think experience and learning about your body, absolutely. And clinically, I used to see women come into clinic hoping to work on being able to have an orgasm in their 50s and single women and women in relationship. But communications is really crucial. And we know from so much research that sexual communication can be difficult. I think that does change with age. So to to go back to your question, I think that makes a difference. In one study that I did in the UK, and it was using nationally representative data. The Natsaal survey, the British National Sexual Attitudes and Lifestyle Survey. In this study, with with this one paper I led on, the biggest predictor of loss of sexual interest was not being able to share likes and dislikes with a partner. This was a study from my memory, 15,000 plus nationally representative, so really gold standard. And that came out as the strongest statistical predictor. But you know, this from therapy that people find it really difficult often to talk. For the reasons that you give. They're worried that they're gonna offend it. They see men as giving them an orgasm, which is such a you know, not a not a helpful and not not accurate either. When women start communicating more with a partner and learning more about their body both in solo experiences, that makes a huge difference. And we if you look at a graph and you look at how how often women reach orgasm at different ages. It does go up with age. And just one thing about aging, we recently, so this is going off your question, we recently did a study here, Justin Laymiller and and I are collaborating now, which is which is brilliant. And we did a study looking at older women and we found that if you look at whether or not not many people have asked this, whether or not the quality of their orgasms or the ease of reaching orgasms changes. Most women said the quality was about the same. Some women said it improved with age. speaker-0: interesting. speaker-1: Yeah, I know it was interesting. A smaller group smaller group said it worsened. And similarly with ease of reaching orgasm, the majority said it's no more no easier or more difficult. Some said it's it's more difficult. And but a small subgroup said it's easier now. So again, going back to the variability, right, of of sexual response. And there is some evidence that variability is particularly the case for women's sexuality than for men's, that the variability is and and again, in in all the research I've done. That has really been borne out. Yeah, I think is a really consistent finding. speaker-0: Yeah, it's one of these things where evolutionarily we got the short end of the stick as women because it's like you can pass down your genes without having an orgasm. And because of that, you have a lot more variability in female, ability to have an orgasm. For men, it's like if they didn't have an orgasm, they wouldn't have passed down their genes. And so men are just by nature, the fact that it it was selected for, they're going to have more frequent regular orgasms without as much work as it it might be to like learn what's gonna make your body feel good and not feel good as a woman. I'd read some work looking at twin studies. Have you seen this about the orgasm frequency? Where they Yeah, they look at the ease with which women are able to climax does appear to have a genetic component and that it seems to run in families. And there's some discussion about whether or not this has to do with that is it the the proximity of the clitoris to the vaginal opening. Yes. Yeah. And isn't the closer the proximity of the clitoris to the vaginal opening, the easier it is to have sex from penetration and and from sex for women. Is that correct? That's my really speaker-1: Memory of the the research. speaker-0: interesting. And you know, I think that there's so much sort of folklore around like what good sex is. and I think that one of the things that you highlighted that I'm so glad that you brought up is just this idea that communication, is so important. And, you know, I teach a class, as I was telling you off camera, it's called Evolution Sex in the Brain. And one of the things that we talk about is good sex. Everybody wants to know how to have good sex. And the thing I always tell them is communication because I think that we have this tendency to think that people like they meet, they have sex, and the first time that they have sex, it's just like lights out and and there's fireworks and a solar eclipse. And I'm like, the whenever that happens, it's a coincidence. like that, that really doesn't happen without a lot of conversations and practice about what does work. Everybody's bodies are different. They respond to different things. And so if you have immediate good sex, it's a complete coincidence, a one off. It's not gonna happen every time. And sort of recognizing that that's like a a a myth, that's like a sexual urban legend. speaker-1: Yeah, agree a hundred percent as well. I used to see here at the clinic when when there was a clinic at Kinsey, used to see young college students. And sometimes a young man would come in and he would say he lost his erection during a first sexual encounter with a partner, and it put him off having sexual relationships or seeking yeah, it was real and and so which just talking about why he'd be anxious in a first sexual encounter, how erections come and go. Just cause one goes, you you could they they wax the way they it's not like you're always able to maintain it, even during one sexual encounter. So there's a lot of reinsurance. And just how common I think too there's the myth around erectile difficulties are only only the case for older men. They do increase with age, the prevalence, but of course they can happen for younger men as well. And as you said, first sexual encounters often fraught with anxiety and all you know, all kinds of things. Negotiating about contraception use, whether condoms are used, adds to it. And for some people, sadly, condom use they'll see as interrupting the flow and the spontaneous nature, which we talked about at the beginning of sex as well. what we try and do in one intervention that I've worked on is try to make condom use sexier, try to make and there are organizations like the Pl Pleasure Project in London, you're putting this sexy back in safer sex is their expression. and there are ways to do that, and you're finding the right condom. that is is best for you, that feels and fits the best can make a huge difference. speaker-0: And with first sexual experiences, like the thing I always tell my students is it's a rough draft. You know, just like just just take it as a rough draft and and have that conversation with your partner, like, you know, this is a rough draft, but we can revise and and things can get a lot better because it is like everybody is is so different and the only way to get the sex that you want is by communicating. speaker-1: Yes, yeah, a hundred percent. speaker-0: Yeah. So I one of the questions that I get asked a lot about what happens in long term relationships. And we talked about this a little bit because you talked about the fact that, people when they're in the beginning of a new relationship, they feel like they're experiencing more quote spontaneous sexual desire. But you had noted that, well, that's actually you're responding to a cue, and the cue is novelty. Right. So here you have this new partner, and so and that's exciting. And so this might be something that is feeding into our sexual desire response, making us feel like we're dialed in and want sex with our partner. So why is it that we want sex more at the beginning of a relationship? And then as the relationship moves on, our sexual desire seems to decrease. speaker-1: Yeah, there's definitely strong evidence that frequency of sex for almost all couples will decrease, right? The longer you're in. There's some older research, but it's that's a consistent finding. Desire, there's evidence too that it does for s for some couples as well. The expectation, of course, as we talked earlier, is that it often doesn't. Why is it like that at the beginning? you already said novelty is one thing. People really it's expectations as well. You expect when you're in a new relationship. that you're going to devote a lot of time, because it takes time to have time to have sex, prepare for sex, things like that as well. As you're longer in a relationship, more likely to have competing, you know, demands on your time, including children, but work and and other things as well, it it's less, it's the conditions are not as as as positive in if you like for being able to have sex as often as you do. But one of the things that research the there's just starting to be a lot of new research on older adults. And sexuality. And that's one of the focuses that I'm having right now, particularly looking at menopause, but also older men too. And the the idea is that from a lot of research in the last five to ten years only, the frequency might decrease and desire might decrease. But some couples are saying that the quality of the sexual interaction is the same or increases. They do. Yeah. And the reasons that they give for that are actually interesting. So sometimes it's This is from a large study that I did, a six-country study with a team of investigators across Europe and in England. We had qualitative data, we had quantitative data from six different South and North European countries. One of the reasons they say that is because they say, well, penetrative sex is less likely to happen, sometimes because of erectile problems, which are not uncommon with with older men, but sometimes it might be something because of vaginal dryness or menopausal symptoms for the woman. So some couples talk about actually starting to be less focused on penetration and more open to trying other things and just enjoying other types of sex, including non-genital care caressing, but genital sex too. So that's that's one reason. In the studies we did, they talked about adapting to changes with their body. So they they they noticed that their their body had changed, but they were trying to accept and were accepting that. So that that's another thing. Other other factors that came up is they had more time now. Right, than they did before when they were working and when they had kids at home. A lot of people did talk about that. And there was definitely people that talked about having sexual problems and seeking treatment. But they were in the studies we did in Europe, they were in the minority. A lot of the people talked about how the emotional connection, going back to a question you had earlier, was more important than it used to be. When they felt emotionally connected, they said the sex could still be very, very speaker-0: Good. And so zoomed in on a little bit of a shorter time frame. So, imagine a couple has been together for five or 10 years, or even, two years, and they start to feel a decline in sexual desire. and I I've seen that women actually get a little bit more of a hit with the decline in desire over time than men do. And like, so I guess, like, is that normal? So just because I think a lot of people worry about that. And they worry that it means that there's something wrong with the relationship. So is that normal? And if it is normal, are there things that we can do to try to fight the good fight and and not, you know, kind of go quietly into that good night with our sexual desire within our relationship? speaker-1: I think that that does happen for for many people, but it's seen in a way that can be for some people like catastrophic, as you said. And not just that there's something wrong with a relationship, more often that there's something wrong with them as an individual. And one of the areas that I really have seen that is I'm sure you know there's been a lot of research trying to def and there are two approved drugs in the states now, looking at trying to look at how medication medication can help low sexual desire. If you look at the interviews that were done around the Food and Drug Administration's approval of that. The women in in those interviews talked about wanting sex to be exactly the same as it was when they first met their partner in the first few weeks as well. I think that's unrealistic. And I think so part what can be done, one of the things that can be done is to talk about it being normative. That, desire changing with age or with the length of a relationship, as you said, younger couples too, does not necessarily mean that their sex is relationship is going down the plug holes, it's it's not. It it's but it's changing. And you know, i sometimes when frequency goes down and desire goes down as well, the encounter sexual encounters that happen can actually be even better if they're anticipated. We talked about that planning. When I when I saw couples, I don't do couple therapy anymore, but when I did, some of the things we would talk about was first of all, not making it an individual. She has lost some desire. That is often how couples present for therapy. So what kinds of things can be done would be well coming back to the beginning of of our chat is planning for sex, planning for sex and making sure that for both partners, the conditions, the context are there. So they maximizes their chances of having a good, good sexual experience as well. And I think most couples would agree having one or two good sexual encounters in a month would be better than having some rubbish ones. Really. So most people would like to have good sex, not just sex for the For the sake of it. speaker-0: Right. Yeah, I know it makes it makes perfect sense. Right. I don't wanna eat I don't wanna spend money out at a restaurant, eat a mediocre meal. I'd rather go out for two really good meals and spend a little more, you know, and wait a little longer in between interludes than have kind of, you know, speaker-1: Yeah, yeah, no, that's a really good analogy. I like that. The the other things that can be done is sometimes there's assumptions that a partner doesn't like this kind of sex, right? Or a partner will never want to go down on me, let's say. That's another thing that women often do do think that, well, especially I've found younger women worry about that. They worry about how they smell, how they look, a lot of concern about bodily, appearance during sex. And and I think communication really can change about that. Another example is talking about masturbation with partner. A recent study that a different PhD student did, Dylan finished her PhD a few years ago. all of her research was on women's masturbation in the context of relationships. And one of the things she found in one of her studies, and she she actually looked at couples, she had one study with a hundred couples. Women worried that if they talked about masturbation with their partner, they would disapprove, the partner would disapprove. That was not the case. That's they actually liked hearing speaker-0: Yeah, I was gonna say like speaker-1: about it. They wanted to hear and they found it a turn-on to hear about it. So there's some of these kind of assumptions that I think when you're in a relationship longer, you can if you're working with a couple, let's say, or couples not in therapy working on their own, you can counter some of those again by communicating and trying trying new things. speaker-0: Some of the things I think about, and I I'd love your thoughts on this, is you know, there's Esther Perel's work about, you know, this idea about closeness and intimacy sometimes being a little bit antagonistic to sexual chemistry because that is about mystery. And and I'm curious, like, do you think there's something to that? And and do you think that adding in things that create distance between us and our partners, whether it's like time apart, not like getting separated, but your partner goes out with their friends, right? So we're not talking about we're not talking about big distance, right? We're talking about little distances. And even just doing things like where you have your partner, you see your partner in a new context where you go and do something different where all of a sudden you're seeing a new side of your partner. Is there something to that potentially in keeping sexual desire alive? speaker-1: I think absolutely there's something to I really like Esther Perel's work, and there's a lot I think that is accurate about it. So one of the things that we found in our study looking at enhancers and inhibitors of arousal, one of the things that would surprise us really, but it came out as a separate factor too on a questionnaire that we later developed was seeing your partner do something that's showing talent or some kind of ability and and there were lots of examples given, right? One of them was hearing someone give a talk if they were an academic and finding that really arousing. And they, again, the quotes for the study were were great. So I think that there absolutely are things and separation, having separate interests as well, important. Seeing your partner in a different role, you mentioned that, are really important. If you're in a relationship and have kind of nothing outside of that, I think that that can affect sex in a bad way. But a lot of people don't really f see sex as being linked to that. they see it again as being something biological, something that should just be spontaneous. But it's not. speaker-0: Yeah, I I I think it's so funny because there is this kind of push and pull where I think all of us when especially when when we're in a new relationship and even when we've been in it for a while, where you have this pull because you love your partner and you want to be with them all the time. Right. But then you turn into what I always call the two headed relationship monster, where it's just like always you and your partner. And and when you do that, it really can put a damper on sexual desire. And there's been all kinds of really fun studies in in the world of psychology, looking at time apart from partner and then sexual attraction. And it's like a little a little bit of time apart actually increases your interest in your partner. And so it's like even though you feel the pull to become the two-headed relationship monster, it can be useful to recognize that, this because I love my partner, but it's not necessarily because it's good for our relationship in the long term to always be together. speaker-1: Yeah, I agree completely. I've not heard that phrase, but I think speaker-0: I think I made it up. Did you? speaker-1: and I think some some couples naturally do that more than others. There are other there's others, you know, thinking about couples I always have had so many different interests, had some time apart as well. and you can't prove it's because of that, but they have really strong, really good sexual relationships as well. speaker-0: And I I loved your I loved your advice about seeing your partner doing something that they're good at. I know that for myself, there was a sno like a week where there was an ice storm and I had to work at home and my husband was working at home. And and he's an attorney and he does he has to deal with these like CEO types. So he has to have his like really authoritative voice and you know, and like kind of run the show on these calls that he's on. And I was like, hmm. Yeah, that was like I I enjoyed I enjoyed the speaker-1: We've seen that. It's a different context again. Yeah. speaker-0: It was a different context and seeing and and seeing him doing something that he's really good at. It's just like it's really it's really attractive. And so I I think that yeah, if your partner loves to play pick up basketball and they're really good, like go watch. Yeah. You know, or they you know, go speaker-1: instrument that's some of the the the examples gave I still remember one of them was seeing them play an instrument in a concert they found that really arousing physical doing a sport speaker-0: chopping wood. if I saw a man like a man chopping wood I feel like yes. Like I feel like excited. speaker-1: I know there's somebody on Instagram who does exactly that. really? speaker-0: Yeah, I should not follow him. speaker-1: Sh a woman who shows videos of this man chopping wood. It's they're hilarious. speaker-0: That's hilarious. Yeah, my husband will block that page from my Instagram scroll now that I've had this conversation. He'll be like, no. speaker-1: Yeah, I can't remember her name. You should check it out. She's really funny. Yeah, yeah. I'll send I'll send you the link. speaker-0: Love it. I love it. Thank you. That might help me out later. another question I get that is it's similar to this because is is the question about discrepancies in desire. And I think a lot of couples at some point, because it's you know, you can wax and wane where it's like you're totally, you know, sexually in sync and everything's great, and then all of a sudden one partner because of things that are happening externally at work or with the kids or whatever. They have a a a desired discrepancy. And s some people this even happens like out the gate. They meet somebody, they're really attracted to them, they have a great relationship, great chemistry, but one of them wants sex more frequently than the other one. And so is this something that can be resolved within a relationship, or is it something that should be seen as a deal breaker and then you just move on and find somebody else? speaker-1: I don't think it should be seen as a deal breaker. It's actually one of the more common sexual problems that we see in in sex therapy clinics and relationship clinics as well. There can be things that really help. I mean, one of them is that often when there's and you're right that it can happen at the right from the get-go of relationship or it can develop over time because all kinds of things happening for one person. One one of the things is when you see someone coming in with that, a couple rather, quite often they there is one partner who's seen as the problem, right? Problem is he wants sex all the time, or she doesn't want sex at all. stereotype example there, but but that can be, and I think that's something to really counter and work on early on in therapy is to talk about the fact that it's very common, right? It's unusual to be completely in sync. The other thing is that you can meet people in the middle a little bit. Might you might have to accept, well, you know what, we may not be having what my partner thinks is ideal frequency once a day. Right. But on the other hand, it may be more than a a month once a month. One of the things that happens, I think, with desire discrepancy is that the sometimes the person who has less desire feels even less desire when they feel pressured. Right. So so it's a vicious circle, really. It may start off that yeah, they want sex a little bit less. And then the other thing that can there's there's a few outcomes that are are bad ones. One is that they have sex even if they don't want it. Unwanted sex happens, it's not like queer sex, it's just not wanted. And sometimes you can get into it, right? And start to feel arousal and desire. But sometimes you don't. And so for those occasions, again, it can make the person with less desire think, I really don't want to repeat that experience anytime soon. And so so I think there's a whole lot of things that can happen because of how couples react to dis desire discrepancy. And and and absolutely seeing one person as the problem is Is a problem. Thinking there's nothing that can be done, it's a deal breaker, I think, is r is is really sad actually. Because things can change in in therapy. It's not the most easy sexual problem to to s to treat, to be honest. I think it's probably one of the more difficult ones, to be honest. But a lot of it is to do with communication, with the partners being really open about when they feel desire and when they don't. speaker-0: Yeah. And and it sounds to me like it is something where both people have to be working together. Right. Like like this isn't a one person solution. Like there has to be some meeting in the middle and recognizing that it's not because this person's broken and it's not because this person's broken. It's just because, you know, there's a a mismatch and we're gonna have to work around that. Yeah. speaker-1: Yeah, and and that that's a really good point, Sarah, because sometimes you start seeing a couple and you realize and relationship problems and sexual problems often do co co-occur. That we know that so clearly. But if you're seeing somebody and you really get the sense after two or three sessions, they're not going to be able to work together on this. I think it's kind of incumbent on you to feed that back. I remember years ago seeing a couple, it was again at the clinic here, although I've worked in other clinics, it was at Kinsey Clinic, and it was a couple that actually meeting them on their own and then as a couple we found out it was dual therapy too, two therapists. We found out there was actually some sexual abuse going on and some physical abuse as well. There's no way we could work on on the sexual problem with that couple. they had they they were referred to a relationship therapist. That's an extreme example, but I do think there has to be motivation. There's some really good old research. It's really old, it's like the 70s, but suggesting that motivation is one of the biggest predictors of success in sex therapy. So yeah, I think the study that I'm thinking of found in particular motivation of the male partner engaged speaker-0: Mm. speaker-1: in sex therapy is really important. speaker-0: Yeah, I I'm wondering if there is a person who's listening. I could imagine that there may be somebody who's listening who's thinking, Yeah, I've had that conversation. My partner just thinks that I'm broken, right? They're not they don't want to work on that. And I'm willing to work on this issue within our relationship. My partner's not willing to work on this issue in the relationship. What do I do now? Do you is it is it that they need to go see a counselor and in and deal with larger relationship issues? speaker-1: That's often what's what's the case. The other thing that's interesting you bring that up as an example because I have over the years sometimes seen an individual coming in whose partner has not r refused to come in, but I've still worked with that individual to try and it's not ideal, it is not ideal, but they still wanted to try and do something, especially when the sexual problem was really threatening breakup, you know, of the relationship. So yeah, it's definitely not ideal. It's good to see a partner. But if you have a partner that's just refusing to come in, relationship counseling would be the The best, I would say, if the partner's willing to go there. speaker-0: No, great. You had mentioned that you've been doing some work on changes in sexuality over the lifespan. And I would love to learn more about how women like and in particular women, but but you know, a lot of women, especially women in heterosexual relationships are in a partner with or in a relationship with an aging man. So how does sexual desire and sexual function change over the lifetime? speaker-1: Again, there's a lot of variability. I don't know, I keep coming back to that, but there is a lot of variability. There's definitely, I guess that the the concise way to say this, there's we know that there's changes in sexual function, right? There are changes related to things like vaginal dryness, vaginal atrophy, things like that. And for men, we absolutely know erectile problems are much more common. There are other changes with with aging as well, but those two really stand out, I guess, as being the most studied ones. There are treatments for things, right? There are and actually the the vaginal dryness one is interesting because there really are effective things you can do about vaginal dryness, but not everybody has those or is aware even. There's not much knowledge about sexuality and aging. People are told very little about it, I think. We hear that we've heard that a lot from qualitative interviews we've done. So I think the bigger the bigger evidences for changes in sexual function, but when you look at changes in experiences of sexuality. They are a mix, I think, of feeling that they've changed, they've adapted, but they're not necessarily worse. But I think it's gonna take quite a while to get that point accepted. Because when I've given talks, sometimes I've been in, this is in the last couple of years, I've been in a mixed group, some involving some pr professionals who are medical, some psychologists like myself, so you know, interdisciplinary. And some people will say menopause and aging, I'm focusing on women here. is o is pretty much all negative. There's nothing good that comes out of that. And I strongly disagree with that. But I think it's it's it's quite a prominent idea. there is a lot more focus right now on menopause in research and a lot of researchers applying for funding, getting getting funding, which is brilliant, to do research on menopause. There's a lot in the public in social media. There's grassroots organizations working on this as well. So it's great to see, but I think there's still a long way to go in terms of knowledge about what happens during aging. So that that's one thing. We don't know very much about older older adults. So the group, right? Rather than just around sixty, sixty five. Little research is done. speaker-0: the things that you hadn't said was that there's a lot of variability and that for some people as they get older sexual function is going strong they're feeling great for others it falls off a cliff they don't feel great and I'm wondering like do you know what predicts the differences? Do you know from your research or do you have a hunch based on what patterns that you've seen in the data? speaker-1: That's a great question. And I was thinking already while you were asking it. I definitely have a hunch. One of the things, and I can give an example of this that matters, that predicts it, would be the importance of sex. How how important was sex to you when you were younger as well? Because we've heard in in qualitative interviews that some people, when sexual function starts to decline a bit, they're actually pretty relieved. They they they're they're happy to have sex over. They may have seen sex mainly tied to reproduction. That's that ph phase of their life is over. And some people quite honestly are quite happy to to give it up and have a reason to say, well, I I and of course pain is a reason that not to have sex. But for some people it will be, I don't want to look into this. This is this is fine. I'm happy in our relationship not having any sex. And some couples have no sexual activity. That's not at all uncommon. But for others where sex has always been important and something that they see as kind of integral to their relationship, really key. those people tend to more likely say, I'm adapting. We're adapting. Yes, we don't have penetrative intercourse as much, but you know what, we're really enjoying, like touching each other and trying things that we've never tried, trying a sex toy is a good example. So that we really hear people saying that they're either relieved that things are declining, or they're upset, don't think there's anything they can do about it. Or some in another PhD student, Lauren Taller's work, she interviewed people well into their 80s, men and women. And what she found is that a lot of them had developed creative s strategies to try and and one of them was was not a creative strategy, but was c just communicating more about it. You know, are you willing to try this? Are you willing to try this sex tour? Things like that. speaker-0: Are there also differences based on physical health? I would I would assume that somebody who's, their their body's in pretty good shape, they take good care of themselves, they tend to pri prioritize health, that that would be a predictor. Maybe horm the use of hormone therapy. I don't know whether that's a predictor. I'm just curious whether there's other factors that you think might be at play that interact with somebody's ability to maintain or lose their libido and sexual desire over time. speaker-1: So in several studies, physical health is absolutely a predictor. So if you're having physical health problems, less likely to be able to adapt well and do other, try other things or for sexual life to continue. That's absolutely we in the studies we've done recently, we haven't the reason we haven't looked at hormone use is because in our s samples, we've had really low use of hormone replacement therapy, four or five percent, really low. And that's not that different. So that's not been a focus for us because of that. But taking other medications, mood changes and mood disorders. Absolutely. Although mood disorders are interesting because people think if you have depression or anxiety, you're always going to lose interest and desire, you know, lose desire for sex. That's not the case. For some people, they're actually more active and more interested when they have low mood, either as a strategy, yeah. There's a there's a a body of literature on that, looking at at what we call paradoxical effects of of mood. Sometimes it's is to try and improve mood. Sometimes it's more because they're not caring about anything and so are having risky sex. That's not a good outcome. Low mood is not always something that leads to a drop. Although that's the that's the stereotype. And it usually does it usually does lead to less interest. In women and in men, this this effect has been found. speaker-0: So that's yeah, that's so interesting. You have done a study where you looked and you asked women about what turns them on and what turns them off. And I would love for you to tell listeners about the study and then tell us a little bit about what you found. What types of things turn women on and turn them off? speaker-1: Yeah, and the the paper is really easy to remember. It's just called turning on and turning off. A folks study. That was our cool title. Actually, of all the studies I've done, this one is the most cited. It's been used a lot in college courses and things as well, which I I really like. So this the study was really simple. We wanted to find out what were women found were turn-ons and turn-offs, and we wanted to use that data to develop a new questionnaire that we wanted to test a theoretical model on inhibition and excitation. We found that there was a lot of variability. I know I've said that so often, but we found that some of the biggest turn-ons were one thing you mentioned earlier today is feeling desired, right? Feeling positive and comfortable with body, feeling desired, style of approach, which I mentioned earlier today, really mattered for some people as a turn-on, an enhancer. attractiveness, no surprise their partner, but what made up attractiveness was interesting. So again, seeing their partner doing something that showed talent and interest. We had some really interesting factors that were inhibitors of desire. And they they varied by age. So one of the ones we had some really great data collected on this, we expected this. worried about reputation for younger women was a real turn off. And they gave great examples of that. They talked about the fact that they felt turned on, they felt absolutely turned on, but the breaks, they talked about breaks coming on if they were concerned about. reputation, either their their reputation other from other people or the partner that they wanted to have sex with as well. Feeling the again concerned about body. So a lot of the enhancers had the flip side for things that inhibited. Relationship importance, I mentioned before, people felt if they weren't in a relationship where they could trust the other person and they could communicate well with the other person, some people found that a complete turnoff. But not everybody, not not all women. We had some that we felt were unusual. Feeling accepted by a partner was one that sounds vague, but they described it as being somebody that they it's a lot about trust, right? for sure. Once again, some women said that did not that was not necessary for that they didn't have to feel that. It could be somebody that they just met in a bar and they felt really comfortable. We found that women talked about being accepted. I said that was a turn on. Conversely, women felt being used. by a partner was a absolute turnoff. And they they gave again they gave examples of that. Used not always because of sex, but used because, you know, they were they were just there and and it wasn't anything really to do with them. They weren't desired. That was a huge turnoff. speaker-0: I think what's so interesting about that is I think a lot of times people here are feeling used and they think of the some guy who just sleeps with them and never calls him back. But I think that actually happens a lot in long term relationships where it's just like you can your partner wants to have sex, but you don't feel like they want to have sex with you. You speaker-1: That's that that came out really strongly, so strongly. And and in long-term relationships, absolutely, women talked about that as well, not just in short term. The other one that was a turn off was for some women. We had a name for this actor as well, which we kept changing the name because we didn't like the labels, but it was to do with being distracted by anything. So the items on our questionnaire that tap into that are when I am feeling aroused, the slightest thing can turn me off. And they gave examples. of that. You know, something like slipping off the night table or anything, hearing a child, which for a lot of people would be a turnoff, distracting thoughts, distracting thoughts about their body and how they looked would be one, but thinking about, you know, shopping lists and what to do, that what we found is there's a real continuum and people some people are find sex is a place where they can easily switch off. And other people find it's the time when they actually have to be focused and they find that difficult to do. But I think what what we found is the biggest finding was that some things that were real turn-ons for some women were real turnoffs. And some of them were really small things, but were mentioned a lot. Things like grooming things for younger women were a big thing that were turnoffs. Wearing socks in bed, that came on. That really did. And then on the on the other side of that, one of the things, and I was I've always been interested in odor and in sexuality, always. And we did some early research here on fragrance actually in arousal. But some people really talked about smell and just the smell of a partner. And it wasn't a fragrance or anything like that. They found some people that was a huge turn-on. Another thing that I I found very interesting was voices, the sound of someone's voice. And for some people, the examples they gained were really erotic. And they really talked about accents and they talked about just the sound of this person's voice was a really powerful turn-on. So those are the things I think more expected. Some of the things we didn't expect were things like the style of approach and planning for sex. I don't think we really thought that would come up. did speaker-0: In a lot of ways, this just reinforces the idea that we really need to talk to our partners because there is so much variability and somebody's, you know, sexual gas pedal could be the same as somebody else's sexual brake pedal. And so going into a sexual encounter with a new partner, assuming that you know it all and that you know exactly what buttons to push is is probably not accurate. Yes. speaker-1: And I've heard in I've heard in therapy sometimes people saying that their partners is a woman saying the male partner said, Well, my my last sexual partner was able to reach orgasm this way. And that's a good example of really what you know, what a thing to hear. But also the fact that the assumption is that everyone's the same and we're all reaching we we know that's not the case, of course, for a long time. But again, without communication, as you said, people are not going to talk about the fact, Well actually that's not the way I come. That that's just the that may be the way your last girlfriend did, but not for me. speaker-0: Yeah, I know if somebody says that to you, that to me that's a red flag. Like that person's not like that's no thank you. W one thing that I have heard, women will tell me, like, I my partner is attractive. I am attracted to my partner. I love my partner. But why is it that we can feel all of those things and at the same time not feel sexual desire for our partner when they want to have sex with us? speaker-1: Yeah, that's a great question. I think one of them is, and this there's not enough focus on this. There there's there has been some focus, and it's actually in things like diagnostic manuals on sexual disorders, too. Sometimes it's because you could find your partner really attractive, they find you, all of that. But the sex isn't very good. The sex is bad sex, basically. I don't like to use the word for Verena Klein, in in the UK and Germany has done some work on this. It could be that your partner is super attractive to you, everything else is is good, the relationship's good, right? And even you communicate well, but actually the the let's say if it's a mixed sex couple, the stimulation that you get is really not what and even if you ask about it, it's still not really something that's going to do it for you. It's not going to make you aroused. And it might even cause pain or or or turn off. You know, you you become less aroused than you were at the start of the of the sexual event. so I think that's one reason why, you know, some people can work on that, but not not everybody can, not everyone's willing to. But when you look at criteria for sexual disorders, I always do that with disorders, some of them in the in the current manual for mental disorders DSM will be without you know adequate stimulation. So you've got that in there. What that is is going to vary for every individual. So what's adequate for one person isn't necessarily adequate for another. But we know from years and years of research that a lot of women will not reach orgasm only during penetrative sex. We know that. And that's so established. Some do, but but it's the minority that do. So but that's not something that always translates into what happens when a couple actually are having sex together. And so I think that's one of the reasons. speaker-0: yeah, I was gonna say, so if if a woman is feeling this, right? So she is feeling like I'm attracted to my partner, I love my partner, he's attractive, et cetera, but I really don't feel like having sex with them. One question they can ask themselves is Is the sex that we're having worth it for me? Yes. That's great. Yeah. And so and if it turns out that when they do a little bit of soul searching with that, and the answer is no. then is the next step to have the conversation with their partner about ways to improve the quality of the sex that they're having and and how does a person have that conversation without it feeling like an attack. speaker-1: Yeah, that that's important, that last part with feeling like an attack. And there are really good self-help books that can help with that, right? And give you ideas for how to communicate. Nobody wants to hurt or criticize their partner. But but in a situation like you just described, that kind of conversation has to happen. It can not everyone has access to sex therapy. I know that. And it's not always financially or just accessible where they live, but it can be really helpful to do that in the context of a therapist who can guide you through. And give you exercises to do that, you know, that's a big part of sex therapy. But but not everyone can do that. So I think some self-help books can really help. And there's so many on and so much online as well. But sifting through the quality is can be difficult there. I don't think that necessarily means it's a done deal and it's never going to be good. The other thing I would answer that question is it may not be the sex is bad. It may be that everything else in the person's life is really going badly and nothing's going to be good right now. speaker-0: Right, right. Because I I think that a lot for a lot of people, it can be that the sex is gotten a little bit boring. And and I think you can just like kind of spice things like try to add some without even having a conversation, right? Just like, Hey, do you wanna try this thing and see what your partner says about that? But I I think that there's also a lot of women, in particular who have, you know, I think that we have a richer running dialogue with ourselves about the grocery list and what the kids need for school and what is going on in tomorrow. And and it's a little bit harder for us sometimes to focus on one thing because we have a lot of chatter. And like, is there anything like, does research give us any hints about tools that we might use or I mean, even just letting us know like how important is it to be able to work on learning to quiet the running grocery list in the back of the head? Like How much does this actually interfere with the sex or a sexual desire and is there anything that we know from research that would be helpful for for turning it off? speaker-1: There's research that things that can be helpful. Though the thing that springs to mind right away, because there's a lot of attention and research on it now, is mindfulness. So for some people, and Lori Brodo up in Canada has done a lot of research on that and has a great book on it as well. Very accessible book to read. So again, if you can't you find anybody to do couple therapy with, that could be a really good start. I I think you know it's gonna sound like a broken record here if I'm gonna say it. It matters more for some people to be able to switch off that completely. For others, they can actually really enjoy good sex and have have a little bit of that going on in the background. But for some people it can be really difficult. Yeah, going back to the example that you gave of of a woman saying find your partner attractive, he's attracted to her, everything seems if if she's having some major health problems, worry about her kids for various reasons, work is terrible, all of those things are going to affect. whether or not you're going to have good sexual experiences, not just the partner. It goes right back to the beginning about context as well. If you're in a really d difficult place, following grief is is another example, then it may be that you just need to say, well, actually things are pretty, pretty rubbish right now, but they may improve. And let's let's see this as a a quiet time, if you like, sexually. I think people find it hard to do that without thinking that it's it's headed for, the end. And it's important. Sex is important for most people in their relationship. speaker-0: Yeah, one of the other things that I think can really impact, and again, I'm focusing on women here, but can have an impact on their sexual desire is how they're feeling about themselves and especially concerns about their bodies. And I think that, you know, this is important to women who are younger because I think that a lot of a younger women feel self-conscious about their bodies just because they haven't lived in them as long. And they're not, they don't have as much experience with their body. And so they feel weird about, the way they smell or the way that they look. And then as we age and our bodies change and then women become self conscious then. And so I feel like there's always a trap with our bodies. It's we've always women always have a complicated relationship with their bodies. And this can really impede s sexual desire and and is it research support supports that, right? speaker-1: Absolutely, it does. And in fact, there's one study that I remember from again quite a while ago, but there were s further studies after that. It was done, I think, in Martin Miana's lab, but looking at for some women, distraction is it's mostly about body. It's mostly about body appearance. And for men, cognitive distraction, that's the term they use during during sexual activity, I should have said, during the during what's happening, for men it was not about body. It was more about the concern was performance. So for women it was absolutely how they looked during sex, was was any part of their body particularly aversive to their partner and and to them too. but for men it was about performing and being able to, do well in terms of their performance and also give their partner an orgasm, that whole masculinity achievement thing that people done like Sarah Chadwick work on. speaker-0: So it's it's it feels like a shame to me that women are oftentimes distracted by feeling like their body doesn't look good enough. And this could prevent them from having good sex. And men are worried about whether or not their performance is up to task, you know. So they're trying all of these like gymnastics and fancy maneuvers. And so they're not really in the moment of sex because they're so worried about whether or not their backflip is gonna be landed correctly. And Research doesn't show that men enjoy sex because of the way a woman's body looks or that women enjoy sex because of the man's sexual maneuvering. So it feels like we're focusing on all the wrong things. speaker-1: I absolutely agree with that. And I think that that it is it is sad. It is it is sad for both the performance concerns and the because we yeah, we know that when people talk about good sex, they don't talk necessarily about performance and how it they talk about how they feel. They talk about how good they feel. And they talk if they if they if an orgasm's important to them and it's more important to some women than others, but if they reach orgasm, how good the orgasm, they talk about that kind of quality, but not in terms of the sexual prowess, of of their male partner, or how their body looks as well. But I agree with your point about younger women worrying about that in particular. speaker-0: Yeah, yeah. And I I think yeah, it's I think that men sometimes can get caught up in what I've always called sexual theater, which is where they're like, trying to do this really impressive move and it's not at all pleasurable. It just, because they think that that's what they're supposed to be doing. And then women feel like their body is supposed to look a certain way, and then everybody is distracted and nobody's actually having good sex. And it's like, can everybody just calm down and and can we just Yeah, and focus on what matters. I feel like in some ways, even though I said, pornography is like here to stay, because I think it is. I kind of think that that's part of what's ruined it for everybody because they they see this as this performative act where you have to look a certain way and you have to do a certain type of maneuver in order for it to be good. And just like learning to really which is why I think the mindfulness, I think that that idea of mindfulness and just being present in the moment and enjoying it and not in trying to get outside of your self and thinking about the way you look or the way that you perform, I think could really do everybody a world of good in terms of ha giving them actual access to good quality sex. speaker-1: Yeah. And that absolutely relates to the earliest technique and still used a lot in sex therapy, sensate focus exercises. So the idea is you're focusing on you're trying to have a goal during sex. You're gonna definitely not even have penetrative sex. You're not gonna try and reach an orgasm. You're focusing early on on how your body feels, non genital touching first, no performance kind of anxiety or goals as well. And it can be really, you know, it's been used for for decades now. but it can be really helpful. It takes, someone who wants to be motivated to do that rather than to hope for there's a pill that's gonna sort this out. And there is still that tendency for people to come in and think it's a quick fix. speaker-0: Yeah. Is that still is Sensate Focus, which again is this idea that you start with slow touching and is that still one of the most widely used forms of and and and it's effective, right? That there's good research. speaker-1: definitely still used and people have variants of and introduce different techniques as well as sensei focus but it's still used a lot and and the principles are really make a lot of sense. It also focuses on communication as well. You do part of sensei focus is talking about what feels good and what doesn't. And again we talked earlier most individuals don't find that easy to do in a relationship sadly. It can take the pressure off hugely. If somebody's coming in who has never experienced an orgasm To s to say that's not on the table right now. We're not we're not even we're not aiming for that. That's weeks away. And they're following instructions and it's organized and they have permission. It's permission giving as well, right? But both partners have to be signed up for that for sure. But but absolutely still used a lot. speaker-0: Great. No, yeah. And that's something that I think that listeners can they they can do a DIY senseate focus if they can't afford therapy, you can read up on it, you know, and given that it has been used for so long. And and as you said, I mean it's variable success just because anything that anytime you have an intervention, it's going to have variable success. but that it does seem to work for some people. And like you said, if nothing else, I think that it would improve sexual communication because that's the whole point is to learn it like what feels good and then also to be able to communicate about it. Yeah. speaker-1: Yeah, agree with that. speaker-0: And speaking of sexual difficulties, I want to talk to you about this because I think this is a really important point and it's something that I know that you know a lot about. And it has to do with the fact that sexual difficulties are common. And in whether it's, you know, when you first meet somebody and you're not really sure whether you're having good sex or you're going through a little bit of a sexual gully or a little dry spot. we'll, we'll People have sexual difficulties, but not every difficulty is a dysfunction. And I think sometimes people get this confused. And so I would love for you to use your sexual expertise brain on this and be able to tell us what is the difference between a sexual difficulty and sexual dysfunction. speaker-1: Yeah, I love that question, first of all. So that's that's a question I'm always happy to answer. The the there's more than one thing, but the big thing that's different between a sexual dysfunction and a difficulty or problem is distress about it. And we now have in the last twenty years or so, we have a lot of data that suggests, just as you said, Sarah, that not everyone that has a sexual problem is distressed about it. Why that is, there's research on that too, why some people aren't. But There are so distress is number one. And I just want to give an example. As the editor of a journal, the editor of Journal of Sex Research, I still now, I've been doing this a long time, and still now, 2026, see papers, and it's not uncommon, that will start off or be in the abstract and they'll say, This did this cross-sectional study, postpartum women, women in the first year having given birth, 65% have a sexual dysfunction. And it drives me crazy when I see that. And it isn't gonna be, it's not it's not gonna be something that the study you can tell is not gonna be one that's careful because sexual difficulties following some things like postpartum childbirth, after childbirth are common and they don't indicate dysfunction necessarily. They must they may sometimes, if they persist. There's two other things that matter: duration, how long it lasts. So you mentioned that you might be going through a dry period or whatever. That's that's true for sex, some sexual problems are transient. Sometimes not only are they short-term, but they can be adaptive. So they may they may be you may be having sexual problems in a relationship which is going through a really rough patch, right? Relationship-wise. And so not having sex may be adaptive, maybe a good thing. There are other examples. And severity as well. We all have sexual difficulties. If if we're in a relationship, we're having sexual difficulties, but they may be quite mild and they may not happen at every time. If you're talking about a dysfunction, it should be. The criteria are all or almost all of the times you have sex and duration, strictly speaking, something that you have a sexual problem for one month would not class classify you as having a dysfunction. So I have a real allergy, it's a bit of an allergy to people using the term focused on women now, female sexual dysfunction or FSD, umbrella term. And in most cases, and I just read a paper the other day, so it's very recent, where people talk about prevalence of sexual dysfunction being implausibly high. And I th I think my my personal view is that that's really harmful. And it it it feeds on the idea that if sex if you have sexual problems you should be seeking treatment or you should be trying a medication or whatever. And I I think that's far far from the truth. speaker-0: I think that women get hit with this label a lot more frequently than men of having sex sexual dysfunction. And a lot of times the dysfunction is that they don't want to have sex as frequently as their partner does. And that's not necessarily dysfunctional. As you noted, it could be incredibly adaptive if they're having relationship problems or if they just had a baby. These are conditions in which it's not necessarily the best idea or in the woman's best interest to be having sex. And so it makes absolute sense that She's got lower sexual desire. Cause I the distress piece is key, right? cause if if a woman doesn't have sex for two years and it doesn't really cause her any problem at all. And and if she's a part has a partner and they don't really care either, then then we wouldn't call that a dysfunction, right? speaker-1: Exactly. Then that's a great example, what you just said. And that happens, right? That that both partners are actually equally not really interested in sex and that's it their relationship's great and it's fine. But so you wouldn't want to slap a label on of someone having a dysfunction. Absolutely. And there are lots of other examples apart from postpartum where it would explain why somebody's going through a period where they they're lacking desire and but it's not necessarily going to last at all. I think the distress thing though is key because if you look at prevalence rates of sexual problems. With or without distress, they are now markedly different. and they drop down. I see so many figures that are forty to sixty percent. But if Kirsty Mitchell, a colleague in the UK and I, did some study a study, sorry, looking at nationally representative data again from a big UK survey, and we found that the prevalence of most sexual problems dropped, if it was a dysfunction, to around one to four percent, depending on the problem. Problem that's most associated with distress is pain. Which I think really makes sense, right? Sexual pain is is more often than other problems associated with distress. And I think we would expect that to be the case. But still not always. So distress is key. And I think anyone that talks about dysfunction rates in in women, again, you're right, women are focused on of being, 65, 70%. and many, many years ago, I'm sure you know this study, a long time ago, the paper came out and it was published in the top medical journal, the National Survey in the US. Suggested that 43% of American women, 43%, had a sexual dysfunction. That was in the opening abstract of the paper. That survey did survey had a lot of good things about it, by the way, but it did not assess distress. And it didn't researchers didn't use to look at distress. They only looked at, did you have a symptom? Yes or no? speaker-0: Right, right. And if low desire is a symptom. Yeah. But without distress, then yeah, you can end up with a lot of people having it. If a woman is not feeling distressed by her low sexual desire, but her partner is, would we consider that a dysfunction? speaker-1: Yeah, that is a great question. Yes, we we w we would do, but it's it's important to look at the the reasons for distress, right? Is it because they are distress or is because they're worried that their partner is, even when their partner isn't, if that makes sense. So it's difficult because when you look at diagnoses of sexual problems, sexual disorders as they're called, it's an individual thing. But on the other hand, sex happens in a relationship and and the relationship really matters. So that's a that's a great question. But yes, you would still do. But if somebody's coming in for therapy, let's say, and they have a low sexual desire and their partner thinks they have a a real disorder and and they need they need treatment, they need fixed, and the person isn't distressed, that should not be classified as a sexual disorder. They need some work on their relationship, right? They need to work on the relationship rather. The other I feel strongly about this because I think it's often used as a reason to promote use of drugs, to to heighten sexual desire. And as I said earlier, we have two that have already been approved here in the US and there there are other ones in in other countries. But I I think it's really problematic to suggest that that be a first go-to treatment when you when you're not assessing whether people are distressed about it. speaker-0: Yeah. And d do you think that if a and again, most of my listeners are women, so if a woman is thinking about her own sexual desire and wishing that she had more of it. So she's wishing that she felt 'cause like is the first thing to look at the quality of the sex that she's having. So is the sex that I'm having worth having? Is it the quality of the relationship? Like is it is it true that there that lack of sexual desire within a relationship sometimes can be a canary in a coal mine? For other relationship problems. Agree. speaker-1: I agree with both of both of those things absolutely. number one and two. speaker-0: Good a good place good number one and two. So those are good first places to start. And then also asking about whether there's sexual pain. Because you mentioned that that's another important one. Yeah. And so speaker-1: medications or health issues that might be also leading to not ignoring biological factors at all. That we know that there are some medications that lead to reduced sexual interest. So being looking at at if they're on antidepressants, what type of antidepressant, things like that matter, health problems. But I think the first two you mentioned are key. speaker-0: Because you got me thinking about antidepressants. Are there, and you don't need to tell me what they are, because I know that you're not a psychiatrist who's and you aren't going to be diagnosing or prescribing, but are there differences in antidepressants in terms of their sexual related side effects? And so would you advise a woman that if she's on antidepressants and experiencing sexual dysfunction to maybe have that conversation with her doctor to see whether there might be a different one that she should try? speaker-1: Absolutely, yes. Yeah. And similarly, I know you've worked in this area a lot and I've done quite a lot of work too. If somebody is on if a woman is on a hormonal oral contraceptive, or any hormonal contraceptive actually, one thing, although we we need a lot more research always on this, one thing is to try switching to a different hormonal contraceptive. That's definitely worth trying for sure. And we know less about that than we do about SSRIs for speaker-0: Yeah, no, absolutely. One thing that I always tell people is that there's almost a hundred different formulations of hormonal birth control that are out there. And so if the one that you're working is creating a side effect that you don't like, you should you should see about switching because chances are you might be able to find one that works for you and doesn't make you speaker-1: The same thing. Yeah, we're on the same page. I say the same thing about that as well. speaker-0: Yeah, no, absolutely. Absolutely. As we begin to wind down our conversation, I want to talk a little bit more about the big picture because in addition to being a researcher, you are, as we noted, the editor of the journal of sex research. So you, I mean, you get to like see and help to shape the world of sex research. And so you you really have your finger on the pulse of what's happening in the world of sex research. So I wanna know what like what are some of the questions that people are asking right now. in the research world, are there one or two things that you can think of off the top of your head that are questions that are being asked right now in the area of sex research that you find to be really provocative or really interesting? speaker-1: Yeah, there are so many. so many things are just going through my head. Before saying to things about topics, they do change, right? I've been doing, I've been editor for 17 years, so it's a long time. I know it's really scary. So some research, I'll give you one example. We used to get a huge amount of research on hooking up and casual sex. That's that's actually reduced to almost nothing now. So really, really changes. Yeah, we get almost nothing on hooking up or casual sex. So that's a good example. One example of something that is never seems to stop. And the research quality, I think, is improving over the years. But in the 17 years I've been doing this, we've always seen a lot of research on pornography, and we still are. But what's I think what's exciting about that is we're looking now at different methodologies. We're looking at prospective longitudinal studies. We're looking at pornography use by women. So the area has really branched out. The methodology and the quality of the research, I think, is really improved in that area. The one of the things I think is exciting, it's really difficult research to do. It's not a topic, but it's a methodology. But we are seeing a lot more research on sexuality where researchers are using dyadic data. So they're they're recruiting couples. Not easy. I I've done it, not easy to do at all, but really, really important now. This is this is again a methodology thing because there's so many topics I could mention that are like for example, I'll give you one example. We're getting some really interesting research recently looking at incels. And we're looking at yeah, and a very recent review that just came out on the Manosphere, just published in JSR just about a couple of weeks ago, I think a month ago. Fascinating review. So so those that's a topic area. And I guess another thing which is set gonna sound negative, but it is really happening and it's bit something we're so aware of. And it's timely because today we're just working on the final proofs of this. There's a lot of concerns now in the research area, not just with JSR but other journals too, with the possibility of fraudulent data. particularly and not just bots, but in online surveys, but other types of research too, Zoom interview data, stuff like that. And the editor and colleagues as well, not just not only the editor of the Archives of Sexual Behavior, and myself and and colleagues at JSR are just working on a a new editorial on how to minimize that. So I think that that that's a good thing to mention because there's it's a real problem with some people finding big percentages of their data is just not valid. And online data is now what we we rely on for so many things, so many topics. and it's that's not going to go away, as you said. Pornography is not going to go using online surveys is not, but we really need to look at how to maximize the validity of the data. The topics that are submitted to JSR change all the time. And sometimes a completely new one comes up. we're getting more things looking at purity culture and sexuality in the states, focused on the states as well. interesting. speaker-0: Interesting. speaker-1: Yeah, a lot of research on. dating sites, online dating sites and sexuality. That's that's definitely a a big topic. But it it's it is so interesting if you look at ten years ago, we wouldn't have had anything on this topic. And now we're being and and the submissions for journals and sexuality journals are really going up. And that's been the same increase every year. It's it's it's it's yeah, I was gonna say it's exhausting. That sounds really speaker-0: You're like please, please stop. speaker-1: No, not at all. We're really grappling with the fact that we have to desk reject, we have to turn down reviewing some pa studies because the bar is quite high right now. when you receive over seven hundred right new papers in a year. speaker-0: Yeah, th that well, that's great. I think it's so great that there are people like scientists that are really interested in how to, help us understand sexuality. It's I I think that sex and sexual functioning and sexual desire, I think that it tends to get kind of put into a little box as being something that's not that important. I mean, even when you hear about drugs where it's like, sexual side effects, without understanding that, that's like that's like a really important part of a person's life because it's and and evolutionarily, of course, with my my training in evolutionary biology, it's so central, to our brain, just simply because we've inherited a brain that's really good at reproducing. And so so sex is is very central not only to the way that, we form relationships, but the way we feel about ourselves and see ourselves. And so I'm really I'm so happy to hear that there's all of these papers that are coming in and that Our thinking about human sexuality is just going to continue to evolve and improve and hopefully be able to give us better, healthier, longer lasting sex lives. speaker-1: Yeah, I agree. A hundred percent. speaker-0: Thank you so much for your time, Dr. Cynthia Graham. You're a treasure. And I'm I'm so glad that I had the opportunity to talk to you today. I know listeners learned so much about their sexuality, about their partner's sexuality. And so thank you for the work that you do, both as a researcher, the editor of the Journal of Sex Research, and and then of course being able to talk to people like me and my audience. So thank you. speaker-1: Thank you for inviting me. It was a pleasure talking with you.