#182 – When You’re the One Who Cheated – Tammy Nelson

#182 – When You’re the One Who Cheated – Tammy Nelson

Listen to “182: When You’re the One Who Cheated – Tammy Nelson” on Spreaker.

When you’re the one who cheated 

Tammy Nelson, the author of the book When You’re The One Who Cheats, joins me to talk about cheating and infidelity from the point of the cheater. She offers her interesting insight on why people cheat, what it’s like to be cheated on, and the recovery process.  

Is it Infidelity? 

Tammy defines infidelity as forming a relationship outside of your primary partnership; a relationship with a sexual context such as flirting online or paying a sex worker, in which you are dishonest about these relationships with your primary partner. The pandemic has caused an increase in online infidelity. People cheat for various reasons, but Tammy says that defining what infidelity means to you can help to start a conversation with your partner and can establish an agreement of implicit monogamy. 

Kinds of Infidelity  

While some people cheat to break up, for others, it’s a wake-up call to turn something around in their relationship. In Tammy’s words, “People rarely look for someone to cheat with, they look for someone to be.” Only 7% of affairs end up in marriage with the other person, while most affairs don’t last longer than a year. People who choose to make it work after the affair should acknowledge their changed relationship and incorporate their needs and desires into the new relationship to avoid another affair or any resentment. 

Recovering from Infidelity

Before sharing anything with family or friends, it’s best to deal with the trauma in the conflict/crisis phase. The partners should process everything, from how it happened to how they’ve changed, in the insight phase. In the vision phase, the partners make decisions about moving forward. The goal of recovery is not to forgive, but to work on building a new sex life that is fulfilling. She points out red flags that people need to look out for before deciding to move forward. 

Should You Tell Your Partner? 

A partner who confesses to an affair after it’s over to feel good about themselves, knowing it could devastate their partner, is selfish. Many feel that they would want to know if their partner ever cheats, Tammy suggests, considering the extent of information you would want to know. 

How to Avoid Cheating 

Tammy believes people also cheat because they have experienced developmental challenges of a second adolescence and seek to evolve their personalities. They rebel against their partners as they did with their parents. To avoid cheating, partners can work through this stage together to reinvent themselves and have fun. She also advises seeking therapy and outside support to grieve the end of the relationship instead of using your partner for it. 


Tammy advises us to differentiate between intuition and fear because intuition allows us to trust and move forward. 


Tammy Nelson Ph.D. is a Board Certified Sexologist, an AASECT Certified Sex Therapist, a Certified Imago relationship therapist, a Licensed Professional Counselor, and Executive Director of the Integrative Sex Therapy Institute as well as Director of the Ph.D. program in Counseling and Sex Therapy at Daybreak University in Southern California. She is the author of several books including Integrative Sex and Couples Therapy, When You’re the One Who Cheats, The New Monogamy, Getting the Sex You Want, and What’s Eating You? Her latest book Open Monogamy will be released in November 2021 with Sounds True Publishing. Her work has been featured in the Wall Street Journal, NY Times Magazine, CNN, Rolling Stone, and Time Magazine. She is a TEDx speaker and host of the podcast The Trouble with Sex. She is in private practice in Los Angeles CA. 

Resources and Links:

Website: https://drtammynelson.com

Podcast: https://www.thetroublewithsex.com/podcast

Book – When You’re The One Who Cheatshttps://www.amazon.com/dp/1999481003/

Email Tammy and get your free E-book! https://drtammynelson.com/contact/

More info

Sex Health Quiz – https://www.sexhealthquiz.com

The Course – https://www.intimacywithease.com

The Book – https://www.sexwithoutstress.com

Podcast Website – https://www.intimacywithease.com

Access the Free webinar: How to want sex again without it feeling like a chore: https://intimacywithease.com/masterclass

#181 – When Sex Hurts – Dr. Irwin Goldstein

#181 – When Sex Hurts – Dr. Irwin Goldstein

Listen to “181: When Sex Hurts – Dr. Irwin Goldstein” on Spreaker.

When Sex Hurts 

Dr. Irwin Goldstein, the founder of field of sexual medicine, joins me in the conversation about female sexual pain. He drives the talk with tons of fascinating information about sexual pain, including what are the different categories, common causes, and treatment options. 

The prevalence of female sexual pain 

Within the last month, 1/3rd of women reported experiencing sexual pain or some form of discomfort during sex, while only 2% to 7% of men reported sexual dysfunction or secondary pain.  He urges women to ensure they find the correct medical professional and find answers to their questions as he has found many women go untreated due to misdiagnosis. 

Dr. Goldstein best categorizes various kinds of sexual pain by the area it originates. The pain in the vulva is diagnosed as vulvodynia. However the vestibule is often overlooked as the source of pain, and more than 90% of the time is misdiagnosed as vulvodynia. 

Hormonally Mediated Vestibulodynia 

Dr Golstein warns against birth control pills as they have harmful side effects that can eventually affect your sex life.  He urges women to consider other birth control methods like Long-acting reversible contraceptives (LARC) – IUDs, Nexplanon and Implanon contraceptive implants, and progesterone. He further informs that The American College of Obstetricians and Gynecologists and The American Academy of Pediatrics no longer consider birth control pills as the leading method of contraception. 

Causes in Older Women and Treatment Options 

For older women over 40, the hormonal challenges of menopause are a leading cause of pain. He mentions that women go through two stages of menopause, where the first one causes low testosterone levels and the latter causes low oestrogen levels. He shares available treatment options for this. 

Other Common Causes and Treatment Options 

Among other causes, Dr. Goldstein talks about Neuroproliferative vestibulodynia, a condition where women suffer from life-long pain. Monistat is the number one medicine women use that causes neuroproliferative vestibulodynia. The only treatment option available is surgically removing the vestibule, which has an 80% cure rate and is completely non-disfiguring.  

Tune in for valuable advice that can make a huge difference in your life. 


Dr. Goldstein has been involved with sexual dysfunction research since the late 1970s. He has authored more than 350 publications as well as multiple book chapters and edited 6 textbooks in the field. His interests include penile microvascular bypass surgery, surgery for dyspareunia, sexual health management post-cancer treatment, genital dysesthesia/persistent genital arousal disorder, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women. 

Dr. Goldstein is Director of Sexual Medicine at Alvarado Hospital, Clinical Professor of Surgery at the University of California, San Diego, and practices medicine at San Diego Sexual Medicine. He is also Editor-in-Chief of Sexual Medicine Reviews and past Editor of The Journal of Sexual Medicine. He is a Past President of the International Society for the Study of Women’s Sexual Health and of the Sexual Medicine Society of North America. He holds a degree in engineering from Brown University and received his medical degree from McGill University. 

The World Association for Sexual Health awarded the Gold Medal to Dr. Goldstein in 2009 in recognition of his lifelong contributions to the field, 2012 he received the International Society for the Study of Women’s Sexual Health Award for Distinguished Service in Women’s Sexual Health, in 2013 he received the Lifetime Achievement Award from the Sexual Medicine Society of North America, and in 2014 he received the ISSM Lifetime Achievement Award from the International Society for Sexual Medicine. He is happily married to his college sweetheart Sue, and together they have three children and five grandchildren. 

Resources and Links: 

National Vulvodynia Association: https://www.nva.org/ 

International society for the study of women’s sexual health: https://www.isswsh.org/ 

Book: When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain 

Schedule a Courtesy Call with San Diego Sexual Medicine: http://sandiegosexualmedicine.com/courtesy-call 

More info: 

Sex Health Quiz – https://www.sexhealthquiz.com 

The Course – https://www.intimacywithease.com 

The Book – https://www.sexwithoutstress.com 

Podcast Website – https://www.intimacywithease.com 

Access the Free webinar: How to want more sex without it feeling like a chore: https://www.intimacywithease.com/masterclass 



#180 – Wheel of Consent – Dr. Betty Martin

#180 – Wheel of Consent – Dr. Betty Martin

Listen to “180: Wheel of Consent – Dr. Betty Martin” on Spreaker.

The Wheel of Consent 

Dr Betty Martin, the author of the new book, The Art of Receiving and Giving: The Wheel of Consent, is highlighting the importance of giving and receiving and maintaining that balance in sexual relationships. Today, we get to hear about what it means to set boundaries, follow consent, and how all of that comes into play in terms of taking care of oneself. 

Why is it important to be selfish sometimes? 

While giving to your partner and thinking about their needs is an important part of the sexual relationship, being stuck in that position and being deprived of your own needs is not sustainable. It’s an opportunity taken away from your partner to give, and an opportunity that you are missing to receive. The relationship becomes strained when your partner has to figure out what to give, and things only become worse when they do it wrong. There has to be a balance of giving and receiving. 

Dr Betty’s Wheel of Consent takes apart the acts of giving and receiving and allows each aspect to be examined individually. In real life, it is not necessary to do these things one at a time, but this practice allows you and your partner to understand each other’s needs.  

Why are we so poorly equipped to receive? 

The reason that we’re programmed to not receive touch as we are supposed to, is because we assume receiving to be ‘done to’ us. Since touch is given to us, we assume that we’re supposed to like it, and from that, confusion arises about what’s wrong with us for not liking it. According to Dr Betty, this confusion began during our childhood when things happened that we didn’t like. Things such as changing diapers, noses being wiped, being picked up, going to bed early; our bodies were taught that there was nothing that we could do about it. 

Since then, this dislike has been reinforced by things ‘being done to us against our will in ways that we didn’t like or didn’t want’. On the other hand, we keep giving ‘touch’ in a way that we think other people like without ever asking how they’d like to be touched, either because it’s an awkward conversation to have, or because the thought to ask has never occurred to us. 

How can people get better at giving and receiving? 

For one to get better at giving and receiving, Betty suggests going through her book and following the processes stated in the book, beginning with the 3-Minute Game. In this game, one must give to their partner for three minutes, and then their partner must give to them for three minutes. She suggests starting with areas that don’t feel too sexy so that you can give yourself space to notice those areas and ask for what you want. Over time the game becomes more natural, and every time you play, you can discover something new about what you like or what you don’t like. More than touching itself, observing what you want and asking for it is key. 

Negotiating Boundaries and Limits 

Dr Betty urges people to say no without adding any polite justification if they don’t feel comfortable doing something. If you’re not entirely against the idea, she suggests negotiating the parts you want to do and the parts you don’t want to with your partner, such as telling your partner to touch an area, but not tickle it. She emphasizes the importance of setting limits. By setting those limits, you can be playful within those limits without the worry that your partner is going to do something you don’t like. 

She encourages people to listen for the ‘pull and not the push’ while considering their partner’s request. If they suggest something edgy, you can decide to try it if it feels like it could be fun, even though it’s edgy. However, if you’re telling yourself to do it simply because you don’t want to let your partner down, then it’s better to simply say no. 


Dr Betty Martin has had her hands on people professionally for over 40 years as a chiropractor, and upon retiring from that practice, became a certified Surrogate Partner, Sacred Intimate and Somatic Sex Educator. Her explorations in somatic-based therapy and practices informed her and allowed for her creation of the framework, The Wheel of Consent®. 

As part of her work with the School of Consent, Betty travels around the world, teaching practitioners how to create empowered agreements in their client sessions in her highly sought-after training, “Like A Pro: The Wheel of Consent for Practitioners.” Originally developed as an offering to teach much-needed consent skills to sex workers and touch providers, this training is now attended by somatic therapists, massage therapists, sexuality educators, medical and health care workers, activists, human resources folks, and the spectrum of touch-based professional providers – all of whom complete the training with a clear understanding of how consent starts with our own bodies, and then expands outwards into all forms of human relating, with or without touch. 

Resources and Links: 

Website: https://bettymartin.org/ 

Book (Get your free chapter!): https://wheelofconsentbook.com/

Workshops: https://www.schoolofconsent.org/ 

More info: 

Training video – https://jessazimmerman.mykajabi.com/video-choice

Sex Health Quiz – https://www.sexhealthquiz.com 

The Course – https://www.intimacywitheasemethod.com 

The Book – https://www.sexwithoutstress.com 

Access the Free webinar: How to want sex again without it feeling like a chore: https://www.intimacywithease.com/masterclass 


#179 – The Logic of Our Fantasies with Michael Bader

#179 – The Logic of Our Fantasies with Michael Bader

Listen to “179: The Logic of Our Fantasies with Michael Bader” on Spreaker.

The Logic of Sexual Fantasies

Michael Bader, the author of the book Arousal: The Secret Logic of Sexual Fantasies joins me in a fascinating conversation about sexual fantasies. We get to hear his ideas about sexual fantasies and what they mean.

Decoding Sexual Fantasies

Michael recognized the need for an applicable approach to sexual fantasies to help patients with their shame and guilt surrounding their sexual fantasies and preferences. His arguments originated from a theory from Joseph Weiss. Michael argues that sexual fantasies are constructed to express our sexual desires and arousals in a way that is acceptable to our guilty conscience.

Michael gives an instance of dominance and submission, and the fantasy of having or giving up control over our sexual stimulation. That control could look like a masochistic fantasy or desiring partners with a rough exterior or self-centered. Curating this fantasy is exciting because ‘they don’t have to feel guilty about hurting the other person.’ A person assuming the role of a dominant knows that they are going to assume control over this person and that person would feel aroused by it and not be hurt and the same goes for the person assuming the submissive role. This fantasy dissolves the guilt of hurting each other. Sexual fantasies are strategies that our mind unconsciously develops to allow us to free our sexual excitement from things like guilt.

The Purpose of Sexual Fantasies and their role

Michael believes a person’s sexual fantasies act as a window into their unconscious psyche. When a person harbors feelings of guilt, shame, or responsibility for another person’s wellbeing, it inhibits the person’s sexual desires and thus resulting in the development of sexual fantasies to avoid such feelings. These inhibited sexual desires can interfere with other aspects of life. In the consulting room, when we analyze these sexual fantasies what we discover is “the revelation of someone’s core beliefs’’, which show up in the other parts of life and not just sexually. Analyzing these sexual fantasies can help the patient’s guilt and shame around their desires and also inspect the roots of their beliefs that caused their sexual fantasies.

Sexual Fantasies Are Not Meant To Be Changed

As long as there’s an innate need for attachment, the feelings of worry, care, responsibility, and guilt towards loved ones will be present. These needs tend to almost always show up in people’s sex lives. There won’t ever be a time where people will stop feeling these that stem from our core needs. And since sexual fantasies arise to overcome those feelings, they will always be needed as a way to express our sexual desires.

Are there Problematic Fantasies?

Every fantasy is enjoyed by somebody. Porn has tons of types of pornography for every population and some of the unpopular categories wouldn’t exist if there weren’t people to consume it. The problems with these fantasies coming true are they produce porn and sex addicts that take people away from being emotionally and sexually present in relationships and marriages. These fantasies could be anything.

Talking about limits to our sexual fantasy, Michael says, unless our sexual fantasies take us away from being psychologically present, being aligned with our values, and doing something meaningful from other people, sexual fantasies are not problematic. Michael also believes sexual fantasies that are illegal in reality are not problematic to think about unless they’re acted even slightly in any way.


Michael Bader, DMH is a psychologist and psychoanalyst with over 40 years of clinical experience in the San Francisco Bay Area. He has written extensively about the interaction of psychology, culture, and politics and has produced a podcast – Mysteries of the Mind—about these issues. He is the author of Arousal: The Secret Logic of Sexual Fantasies, and Male Sexuality: Why Women Don’t Understand It, and Men Don’t Either.

Resources and Links:

More info:

#178 – Holistic Approaches to Erectile Dysfunction – Dr. Tracy Gapin

#178 – Holistic Approaches to Erectile Dysfunction – Dr. Tracy Gapin

Listen to “178: Holistic Approaches to Erectile Dysfunction – Dr. Tracy Gapin” on Spreaker.

Holistic Approaches to Erectile Dysfunction

Dr. Tracy Gapin, a board-certified urologist joins me today to talk about all things that constitute Erectile Dysfunction (ED). In this episode, you’ll hear a lot about various causes of ED, treatment options, and how to improve your health.  

Define – Erectile Dysfunction vs performance anxiety  

Dr. Gapin defines ED as an inability to attain an erection that is satisfactory for intercourse; however, he points out the subjectivity of an erection and brings down the definition to “an inability to have satisfactory intercourse”. He distinguished ED from performance anxiety by addressing the psychological component of a person’s psyche that acts up when one worries and develops anxiety over underperforming.  

Various causes of ED 

He distinguished various causes of Erectile Dysfunction into four categories and briefly talked about the disorders that could cause these dysfunctions.  

  1. Disruption of normal nervous function
  2. Disrupted blood flow to the penis
  3. Hypogonadism, thyroid, hyperlysinemia from poorly controlled diabetes, and hypercortisolemia from chronic stress.
  4. Cognitive component plays an important part in erectile function. According to Dr. Gapin, stress can act as a disruptive component in a person’s life driving them away from the thought of sex.

Evaluating ED 

Dr. Gapin addresses the systems-based approach that is followed in healthcare practice. He alerts people to recognize the multiple components that could cause ED before trying to fix it with a pill. He promotes the human systems approach with his patients where he understands and addresses the sleep patterns, stress, vascular health, hormones, and all other factors that could affect erectile function. He advocates adjusting to healthy nutrition and change in lifestyle to reverse the effects of ED by improving glycemic control, weight loss all of which have an effect on energy, hormones, and cortisol which ultimately come down to sexual health. 

Improving erectile function by improving six areas of health 

Dr. Tracy emphasizes improving six areas of health – Nutrition, sleep, mindset and stress, hormones, detox, and fitness to ultimately improve erectile function. While quantity is an important factor of sleep, he focuses on the quality of sleep. Poor sleep is said to raise cortisol levels and blood sugar, make you store fat, and lower testosterone levels ultimately affecting sexual function. He counsels on following a healthy diet by following an individualized plan on what foods to eat and avoid, as genetics play a big role in nutrition. As stress is an important component that men take up about various aspects of their lives, he emphasizes practicing gratitude and mindfulness by the following meditation and breathing through the nose. In the area of fitness, Dr. Tracy recommends strength training, cardio, low-intensity activities, and stretching. For more than 50% of men, improving their health in all the above areas will profoundly improve their sexual function. 

Treatment options  

Dr. Tracy talks about “band-aid treatment” including oral medications and intracavernosal injectables. Commonly used oral medications are Viagra and Cialis and they last from 24-48 hours depending on the medication. Intracavernosal injectables like trimix, bimix, or quad mix are taught to be directly injected into the penis and it gives an erection for up to two hours. These treatments are short-term fixes and won’t fix the underlying cause.  

Fixing the underlying cause will help in improving the blood flow to the penis for the long term. He suggests a Vacuum pump that acts as an actual vacuum by sucking the blood into the penis to create an erection. A penis ring can be used to maintain the erection and to help with penis compression. It’s a non-invasive procedure, and he recommends using it 10-15 minutes every day to have a profound effect.  

Two of the regenerative treatments are gain wave and PRP. Gainswave is a low-intensity shock wave therapy used to focus the shock waves at a specific point under the skin to cause neovascularization and angiogenesis to create new blood vessels in the penis. It’s done by stimulating stem cells and growth factors to produce new blood vessels and can be done over 8 to 10 sessions. Platelet-rich plasma (PRP) is when you draw a patient’s blood to separate the layer of platelets and growth factor and inject it in five different spots on the penis to stimulate stem cells and growth factors to produce new blood vessels. It’s done in a single session.  

Dr. Tracy talks about Penile Implant as a last resort. It’s a surgical procedure done by placing an inflatable cylinder-like device into the penis which can be manually pumped to stimulate saline to go from a reservoir placed in the belly into the cylinder to create an erection. He explains several downsides to the procedure like a slight penis shortening, losing sensitivity, losing the feel of a natural erection, and damaging the chances of ever having a natural erection. 

Testosterone Pandemic 

Dr. Tracy opens us up to some shocking numbers of drop in testosterone levels and fertility levels over the last 30 years. He talks about the chemicals and endocrine disruptors in the environment that are decreasing the hormones, causing immune disease, obesity, infertility, hormone issues, and cancers. He points out the difficulty in avoiding those as they are present everywhere in our food products, plastic water bottles, packaging containers, household cleaning products, personal care products- shampoo, deodorant, cologne, sunscreen, soap, etc. To curb the effects, he says we need to teach and learn how to minimize exposure to these chemicals. 


Tracy Gapin, MD, FACS is a board-certified urologist, world-renowned men’s health & performance expert, best-selling author, and professional speaker. He has over 20 years of experience focused on providing Fortune 500 executives, entrepreneurs, and athletes a personalized path to optimizing their health and performance. 

Dr. Gapin incorporates precision hormone optimization, peptide therapy, state-of-the-art biometric tracking, epigenetic coaching, and cutting-edge age management protocols to help men not just optimize their testosterone levels but radically upgrade their health and vitality and reverse aging, so they can be the most amazing version of themselves. 

Resources and Links: 

Website: https://drtracygapin.com/ 

Free copy of the book – Male 2.0: http://drtracygapin.com/limitless 

More info: 

Training video – https://jessazimmerman.mykajabi.com/video-choice 

Sex Health Quiz – https://www.sexhealthquiz.com 

The Course – https://www.intimacywitheasemethod.com 

The Book – https://www.sexwithoutstress.com 

Access the Free webinar: How to help your partner want more sex without making them feel pressured or obligated: https://intimacywithease.com/free-webinar 

#177 – Urology for Women – Dr. Lamia Gabal

#177 – Urology for Women – Dr. Lamia Gabal

Listen to “177: Urology for Women – Dr. Lamia Gabal” on Spreaker.

Urology for Women 

Dr Lamia Gabal is a Urologist with a sub-specialty in Female Pelvic Medicine and Reconstructive Surgery. She talks about all kinds of concerns women bring to a Urologist, information about the treatment options, and how to go about it.  

Sexual issues that bring women to urologists 

Women come to urologists for various kinds of sexual concerns. While traditionally urologists were thought to be “Male gynecologists”, Dr Lamia says urologists deal with much more than that. Women come with issues of Urinary Incontinence, Urinary Tract Infection, orgasmic dysfunction, female sexual dysfunction, libido issues, and more. Many women who come with these concerns back away from having sex with their partners because of the embarrassment they feel around it. Sometimes fixing their medical problems also helps them with their sex lives. While male concerns around this subject are already well understood and treated, female sexual dysfunction has only received a “trash can diagnosis”, says Dr Lamia. There are several types of female sexual dysfunctions and each needs to be treated accordingly. 

Urologists also deal with hormonal changes and core dysfunction. Thinning of vaginal tissue as women age can also lead to sexual dysfunction. Pelvic organs prolapse after childbirth can also lead to sexual dysfunction and can be painful. 

Medical concerns that drive women away from having sex 

There’s an overlap of urologists and gynecologists in the sub-specialty of female pelvic medicine and reconstructive surgery, with each performing their roles. However, not all urologists or gynecologists specialize in the field Dr Lamia does. She categorizes the kinds of concerns patients come in by their age. While most of her patients are post-childbirth age, she also treats young women who come in with issues of painful sex which could be pelvic floor dysfunction or dyspareunia and is usually associated with sexual trauma or PTSD. Women who are of child-bearing age often come in with recurring Urinary Tract infections. Women who are getting older and are past having kids struggle with pelvic organ prolapse, urinary incontinence, and fecal incontinence. All the concerns Dr Lamia mentioned can drive women away from having sex or from having a satisfying sex life. 

According to Dr Lamia’s advice, women who experience Urinary Tract Infections that have constipation, pelvic prolapse, and vaginal atrophy (thinning of vaginal tissues) should consult a urologist.  

Where does sex intersect in terms of conversations with patients?  

As a doctor, there’s no training you get in medical school that prepares you to have these conversations about sex with your patients. It’s often one’s interest to seek out more information and awareness that leads to these conversations with patients. Dr Lamia says it’s important to talk about sex with their patients to provide better health care, it aids in understanding how it affects their body and to make important decisions. However, most doctors don’t have these conversations for reasons of not having enough time or not being comfortable enough. Sometimes because of the assumption that an older patient might not be sexually active, which should not be done. 

Pelvic Organ Prolapse – treatment options 

Pelvic Organ Prolapse commonly occurs after childbirth and is more common with vaginal deliveries. All of these factors put pressure on organs making them lean into the vaginal wall. It increases the risk of urinary incontinence, fecal incontinence, and UTIs, and the most severe case can cause kidney dysfunction. It can be treated by “Pessary” which delays or prevents the need for surgery. Surgeries like cystocele repair, rectocele repair, and slings for incontinence are also an option, but patients can expect them to be redone after 15-20 years. It can impede sexual intercourse when the patient is constipated or something else. The surgery fixes vaginal laxity caused by this which can benefit sexual intercourse for both partners. 

Treatment options for Urinary Tract Infections 

To treat Urinary Tract Infection, all the other causes of the infection has to be ruled out through either a physical exam, an ultrasound of the kidneys, or a cystoscopy. Dr Gabal explains some treatments that could help such as maintaining good sexual hygiene, treating constipation, emptying bowels regularly, consuming fiber and a lot of water, peeing before and after sex, using plenty of lubrication that isn’t “warmed or flavored” can help to reduce the infection. Using antibiotics after intercourse and using probiotics to normalize vaginal bacteria can also help. She suggests supplements like cranberry and D-mannose prevent certain types of UTIs. 

Conditions That Can Cause Sexual Pain  

Dr Lamia talks about pelvic floor dysfunction as the most common cause of dyspareunia or painful sex. It causes mild pelvic floor muscle spasm to vaginismus where the vagina doesn’t open and causes pain. To treat this, she suggests soaking in a tub, putting heat on the area, or taking muscle relaxant drugs prescribed by the doctor. Pelvic floor physical therapy is the most effective of all and is done by specially trained pelvic floor physical therapists. Post-menopausal vaginal atrophy could also be the cause. She talks about birth control as an understated cause that causes thinning of vaginal tissue and a change in PH levels causing painful sex. She recommends putting topical testosterone mixed with estrogen to treat it. 


Dr Lamia Gabal, MD, FPMRS, is a board-certified physician who specializes in several areas of medicine, including urology and restorative surgeries. Dr Gabal has more than 20 years of experience in the field of general medicine and urology. The doctor and her staff take great pride in offering many of the newest, cutting-edge treatment options and strive to continually provide the latest in technological advancements. 

She graduated from the University of California at San Diego Medical School in 1995 and performed two separate residencies at the UCSD Medical Center. She was the recipient of the “Patient’s Choice Award” from 2011 to 2013. Currently, Dr Gabal serves residents of Southern California at Prestige Medical Group in Santa Ana, CA. 

Resources and Links:  

Website: https://www.drgabal.com/ 

Services: https://www.drgabal.com/services/ 

More info: 

Training video – https://jessazimmerman.mykajabi.com/video-choice 

Sex Health Quiz – https://www.sexhealthquiz.com 

The Course – https://www.intimacywitheasemethod.com 

The Book – https://www.sexwithoutstress.com 

Podcast Website – https://www.intimacywithease.com  

Access the Free webinar: How to help your partner want more sex without making them feel pressured or obligated: https://intimacywithease.com/free-webinar 


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