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
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
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:
Listen to “150: Talking To Your Kids About Porn – Braxton Dutson” on Spreaker.
How to Talk to Your Kids About Porn
With children being exposed to porn as early as 10 today, Braxton, teaches us how to deal with pornography and kids. He defines porn as content that is intentionally created for a sexual purpose like arousal.
For many parents, the task may seem daunting and confusing to broach. In this episode, Braxton takes us by the hand and explains exactly what we need to do to raise healthy, aware and responsible children.
His advice is to start by knowing your own parameters and values. The journey starts as early as the infant stage where we are encouraged to use the correct terms for body parts. With many kids having access to electronic devices, Braxton expresses how important it is to create a system for your child to respond correctly to unexpected, inappropriate material. He suggests explaining to your kids as young as 6, that if they do come across any naked people on their screens, to call you instead of getting curious and clicking on it.
Talking to your child openly and ensuring that your child knows that they will not get into trouble, helps them approach you therefore Braxton encourages communication. Curiosity comes up as a common thread with children, and we are encouraged to teach them how to respond to that. Braxton explains the three C’s about why your child may look at pornography:
- Clicking (accidental)
As parents, he suggests we respond with these three C’s and explains these in more detail:
- Stay Curious
- Stay Connected
- Stay Calm
Dealing with teens requires a specific approach, as many parents may already have discovered. We learn that approaching teens openly and explaining your rationale to them in line with your values as opposed to dictating to them, works best. While teens are in an exploratory phase, parents may encounter teens using porn for masturbation. Braxton gives us a helpful way to gently correct this while ensuring your teen can still explore their sexual impulses.
Being responsible and not shaming your kids when they enter this phase of their lives is key to keeping an open line of communication and being there to help them into adulthood.
Braxton Duston , LCSW, CST is the Clinical Director at The Healing Group in Salt Lake City Utah. He is also host of the Birds and Bees Podcast. In addition to this Braxton is an adjunct professor of human sexuality at the University of Utah.
With a broad spectrum of experience, Braxton helps couples, dads and parents in unique ways.
Links and Resources
Find him on IG :Birds and bees
Find him on FB: Braxton Dutson
Listen to “141: Doing Non-Monogamy Well – Tristan Taormino” on Spreaker.
Doing Non-monogamy well
On this episode we dig into non-monogamy with Tristan Taormino. She discusses how the processing of both parties feelings is a crucial element to open relationships. Interestingly, she shares how working on yourself is a big part of the open-minded approach required to make this type of thing work.
The Importance of Boundaries in Consensual Non-monogamy
Tristan recommends a slow start and provides clear guidelines and examples on how to do this. Knowing what you want and need makes setting boundaries easier. These boundaries include whether or not you and your partner wish to keep your non-monogamy close to home or not. This ultimately bleeds into how much time you will be investing in non-monogamy and the depth of the relationships you will be seeking. Tristan shares the types of boundaries that could come up.
Decisions to make regarding non-monogamy
Tristan’s advice for couples with different feelings about non-monogamy is to go at the pace of the slower partner. Ultimatums are not encouraged especially if your partner agrees to give it a try.
Tristan adds valuable advice about making decisions during the heat of a moment, advocating a more thought-through approach when put in these situations. People trying non-monogamy also struggle with certain behaviours including jealousy. We learn more about this and how to constructively handle this.
The Common Pitfalls of Consensual Non-monogamy
Time management is considered one of the pitfalls of non-monogamy. With many tools available at our disposal, Tristan unpacks the subtle and obvious scenarios that eventually lead to your time being consumed and the negative impact it can have if not managed.
We hear about emotional privacy and how it involves considering the preferences of all the parties included in your non-monogamous arrangement. Tristan’s suggests the ‘don’t ask, don’t tell ‘ method if all parties can agree to it. Vito power comes into play here and we hear about how it can be used fairly.
Considering the Past
Trauma and negative childhood experiences eventually manifest in our relationships. Tristan urges us to investigate these issues so that we are informed when entering a relationship and acutely aware of our partner’s triggers and understand why they exist.
Tristan Taormino is an award-winning writer, sex educator, speaker, filmmaker, and radio host. She is the editor of 25 anthologies and author of eight books, including Opening Up: A Guide to Creating and Sustaining Open Relationships. She lectures at top colleges and universities and teaches sex and relationship workshops around the world for nearly 20 years.
Tristan hosts Sex Out Loud, a weekly radio show on the VoiceAmerica Network and is the creator of Sex Educator Boot Camp, a professional training program while still running a coaching and consulting business for sexuality and creative professionals.
Links and Resources
Sex Out Loud
Listen to “135: Optimal Sexual Experiences – Dr. Peggy Kleinplatz” on Spreaker.
Optimal Sexual Experiences
On this episode, Dr Kleinplatz introduces her findings around “optimal sexual experiences” based on actual interviews she performed. After much research, she shares these eight components couples need to have to eventually reach an optimal sexual experience:
- Being totally absorbed in the moment
- Sharing a connection with your partner
- Deep sexual and erotic intimacy
- High levels of empathic communication
- Fun, laughter, exploration and good risk-taking
Her findings show that people begin to seek these experiences around their mid 50’s. Part of the process of discovery is unlearning much of what we know about sex growing up. Spontaneity arises as one of the behaviors to “unlearn “ as Peggy candidly shares her views on this.
Anyone can get there!
Peggy has found that people with chronic illness are enjoying magnificent sex! In an unexpected twist of events, Peggy’s co-workers proved that presumed stereotypes are false. She shares that consent is a major piece of the puzzle and contributes to empathic communication.
Peggy educates us about moving from good to magnificent sex explaining that getting to know each other on an ongoing basis builds trust to explore deeper levels of your relationship.
We learn about differentiation and how it impacts reaching optimal sexual experiences while identifying that therapy has to be customized to each individual.
To reach for the optimal sexual experience goal, Peggy highlights that respect for each other is crucial.
Resources and Links
Book: Magnificent Sex: Lessons from Extraordinary Lovers (routledge.com/9780367181376)
Peggy J. Kleinplatz, Ph.D., is a Professor in the Faculty of Medicine and Director of Sex and Couples Therapy Training at the University of Ottawa, Canada. She was awarded the Prix d?Excellence in 2000 for her teaching of Human Sexuality. She is a Certified Sex Therapist and Educator.
She is the Director of the Optimal Sexual Experiences Research Team of the University of Ottawa and has a particular interest in sexual health in the elderly, disabled and marginalized populations.
Kleinplatz has edited four books, notably New Directions in Sex Therapy:
Innovations and Alternatives (2012), winner of the AASECT 2013 Book Award,
Sadomasochism: Powerful Pleasures with Charles Moser, Ph.D., M.D. (2006)
Sexuality and Ageing with Walter Bouman, M.D. (2015).
She is the author with A. Dana Menard, PhD of Magnificent Sex: Lessons from Extraordinary Lovers
In 2015, Kleinplatz received the American Association of Sexuality Educators, Counselors and Therapists Professional Standard of Excellence Award.
Listen to “132: The Pleasure Gap – Katherine Rowland” on Spreaker.
The Pleasure Gap
Katherine explains her initial interest in sexual pleasure gaps began with her journalistic coverage of the search for a female version of Viagra. She describes being intrigued by the prevalence of the notion that there is something fundamentally wrong with women’s level of sexual desire.
She argues that feminine sexual desire is an ephemeral state that stems from myriad sources and appears as a final state that is or isn’t reached. She says it’s not a single trait that can be manipulated directly. Upon seeing this attempt to manipulate female sexual desire, Katherine began to interview women about their own sexual desires and what brings them sexual satisfaction.
Men and Woman Experience Sex Differently
In broad strokes, Katherine explains the Pleasure Gap is a measure of social inequality. She explains three intersecting ideas, the first being the differences men and women give in the accounts of sexual experiences. She says men report higher levels of sexual satisfaction than women, they achieve orgasm more readily, and are happier with their sex lives overall. She also informs us that men feel less stress, pain, and anxiety related to sex.
By contrast, she tells us women commonly report low desire, absent pleasure, muted or unfulfilling orgasms, sexual aversion and disinterest. She points out that women beat themselves up for feeling that way about sex. Katherine reiterates that these are common female experiences of sex, but woman are prone to blaming themselves for their problems.
She suggests that even women who report some satisfaction during sex may not be experiencing the event completely. Katherine mentions one study in which 50% of female participants reported having an orgasm when the scientific monitors for orgasms indicated no orgasm had occurred. She says this suggests that women’s education about their bodies and their possibilities is distressingly subpar.
Female Sexual Dysfunction
Curious about this disparity in human feeling, Katherine shares that many women express sexual dysfunction, asserting that their genitals feel numb or dead, all while lab tests report ordinary, healthy function of those organs. In other words, she noticed that women were responding physically to sex without any pleasure or intimacy being experienced in their brains. She suggests that because the mental and emotional aspects of sex are so important to women’s pleasure, that medications that aim to help women enjoy sex by affecting their genital performance miss the mark.
Sex in Media vs. Sex in Life
The third gap Katherine mentions is the gap between the sex we’re sold in the media and the sex we actually want and find fulfilling in life. She suggests that our modern notions of a liberated identity suggest that women should want and exude sex constantly, but real women often experience the opposite reality. She suspects that the problem is rooted in the lack of education women receive about sex and pleasure.
Ms Rowland also cites the stereotypes that men, the socially dominant sex, are supposed to desire lots of sex, while women are limited to being a gatekeeper restricting sexual access. Katherine believes that women need to be taught that pleasure is worthwhile and healthy so that they can feel comfortable exploring what gives them pleasure and allows them to enjoy sex.
What genuinely leads to satisfying good sex is intimacy, freedom of expression, creativity, safety, and being empowered to explore what genuinely turns you on.
The Effects of Sexual Trauma
Sexual trauma and abuse can also hinder women’s experience of their bodies according to research. She explains that women with this history may feel numb and distance themselves from the experience of sex or be hyperactive and hypervigilant during sexual encounters, leading to them feeling too stressed to enjoy sex. Women Katherine talked to also noted that women are inevitably objectified in pornography, which can lead to women objectifying themselves, instead of seeing sex as an avenue to express their own desire.
What Woman Want
She tells us that the scant research available on what makes good sex suggests that sexual satisfaction has nothing to do with the physical aspect of genitals coming together.
Feeling fully present in the moment—often achieved through mindfulness and the like—and feeling overwhelmed and encompassed by their experience to the extent of forgetting about daily obligations are markers Katherine found in women’s reports about good sex.
Katherine also found women asserting a need for safety, and the need to feel confident exposing the full extent of their sexuality with their partner. She mentions that many women who discuss transcendent sex often describe it in spiritual terms – as if sex is a way to break into people’s spiritual interiors as a homecoming in the other person.
What Women Can Do to Improve Their Sex Lives
Katherine asserts that her book is not proscriptive, though she does provide resources for self-inquiry and erotic amplification. Katherine does suggest that women can try to shut off the external noise distracting them from sex as much as possible to increase sexual immersion. She also suggests that they can explore their bodies and fantasies to enhance their knowledge of their bodies and their sexual experiences.
Katherine Rowland holds a masters in Sociomedical Sciences from Columbia University. At the same university, she was a National Science Foundation Graduate Research fellow in medical anthropology. In the past, she published and served as the executive director of Guernica. She’s contributed to Nature, the Financial Times, Green Futures, the Guardian, the Independent, Aeon, Psychology Today, and more. She is the author of the Pleasure Gap.
Resources for Katherine Rowland: