by Jessa | Jul 6, 2021 | Latest Episodes, podcast, Sexual Dysfunction
Listen to “184: Anorgasmia in Women – Dr. Rachel Needle” on Spreaker.
Anorgasmia in Women
Dr. Rachel Needle joins me in a discussion about anorgasmia. We speak about how it manifests, what we can do about it, and if it’s something that can be turned around. We answer questions that most of us have asked at one point or other in our lives.
What is anorgasmia?
Dr. Rachel defines anorgasmia as ‘a sexual dysfunction characterized by a persistent or recurrent delay in the absence of achieving an orgasm. Some women with anorgasmia have never had an orgasm, and others have experienced a delay. She says that 5 – 10% of biological women have life-long anorgasmia, whilst others have orgasms depending on the situation or the person. She addresses anorgasmia by studying the person’s sexual and relationship history.
What does an orgasm feel like?
Dr. Rachel says that one can recognize an orgasm when one has an involuntary muscle contraction. It can be felt throughout the whole body and can sometimes cause you to lose control of your body. However, recognizing it can depend on whether you’re focused enough to experience all of the sensations that are leading up to it.
Struggles with orgasm & treatment options
She talks about the importance of exploring and experimenting with your body. We miss different sensations when distracted and when we’re thinking only about orgasming. Communicating your needs to your partner and practicing mindfulness can help one to be in the moment. She gives some effective tips to keep yourself and your partner engaged throughout.
Women who have trauma related to sex are prone to life-long anorgasmia. This makes it difficult to be vulnerable during sex; obstructing arousal and orgasm. Biological issues, medications, and the kind of language we use are some contributing factors that can prolong arousal and orgasms.
Acquired and situational anorgasmia
People with acquired anorgasmia used to have normal orgasms, but now cannot. Dr. Rachel suggests figuring out and understanding what and how things have changed since the diagnosis. Those with situational anorgasmia might have difficulty reaching orgasm with one partner, but not face the same difficulty with another partner. They could easily reach an orgasm by themselves, but not with a partner. This happens when one is not comfortable letting themselves be vulnerable experiencing things with a certain partner.
Faking an Orgasm
Dr. Rachel urges people to focus on figuring out how they can achieve an actual orgasm. Instead of telling your partner that you’re faking it, communicate with them about trying new things until you are comfortable enough to experience the orgasm.
Biography
Dr. Rachel Needle is a Licensed Psychologist and Certified Sex Therapist in private practice and the founder and executive director of the Whole Health Psychological Center, comprehensive psychological practice with therapists with a broad range of specialty areas. Dr. Needle is an Adjunct Professor of Psychology in the Department of Behavioral Sciences, in the masters in forensic psychology, and the Doctorate in Criminal Justice programs at Nova Southeastern University. She is the founder and CEO of the Advanced Mental Health Training Institute and Co-Director of Modern Sex Therapy Institutes which provide continuing education to Mental Health and Medical professionals and Sex Therapists around the world.
Dr. Needle has specialized training in the area of substance use disorder. She is a professional consultant to facilities specializing in the treatment of substance use disorders and assists them in expanding and enhancing clinical programming. She also does expert training for staff members at residential and outpatient facilities that specialize in alcohol and substance abuse. Dr. Needle is a business coach and consultant and helps therapists build and thrive in private practice both in-person and online! She is the co-owner of My Private Practice Collective which offers a course on how to start, grow, and thrive in private practice.
Resources and links
Website: drrachel.com
Practice: wholehealthpsych.com
Training & certifications: modernsextherapyinstitutes.com
Email: drrachelneedle@gmail.com
More information
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
by Jessa | May 18, 2021 | podcast, Sexual Dysfunction
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.
Biography
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
![#138 – [Personal Story] Pelvic Organ Prolapse – Erin](https://intimacywithease.com/wp-content/uploads/2020/08/IMG_4846-400.png)
by Jessa | Aug 18, 2020 | Personal Stories, podcast, Sexual Dysfunction
Listen to “138: [Personal Story] Pelvic Organ Prolapse – Erin” on Spreaker.
Personal Story: Erin Underwood
Once a casualty of prolapse, Erin is completely asymptomatic today. Having encountered this long before support groups and information was easily available, Erin was forced to learn how to help herself. After the birth of her fourth child, her body had surrendered.
Symptoms
In addition to incontinence, Erin explains the symptoms of prolapse as the feeling of a tampon falling out or sitting on a tennis ball. After being advised to live with her condition, Erin did some searching of her own.
Working Solutions
Her search led her to a biomechanist, marking the beginning of her recovery. One of the methods she discovered was the belly release. She notes the role of the ribcage and how important it is to select non-underwire bras to allow movement in the ribcage. Erin credits a book by Katy Bowman (available on Amazon).
Erin advocates walking and tackles the superficial elements of kegels, explaining how critical control is for this exercise. With unnecessary shame around pelvic floor prolapse, Erin encourages women to take look at recovery as very achievable.
Background
Erin Underwood is a functional movement therapist from Oregon that specializes in prenatal and postnatal health. She is passionate about education around pelvic floor and core strength and function.
She has studied biomechanics extensively and in addition to her in-depth yoga training has continued her education by certifying and training with the top minds in the country connected to pelvic floor and core wellness.
She currently is focusing on her local community by serving through workshops to the prenatal and postnatal community as well as local health care providers, providing them with the most up to date science broken down into practical and helpful tools.
Erin has four beautiful boys and, post deliveries has personally healed from a grade 2 uterine and grade 2 rectocele prolapses and a four-finger Diastasis Recti using all the tools she teaches in her movement therapy, which further fuels her passion for seeing women fully functional and getting all the information necessary to heal.
Resources and Links
Website: https://www.erinunderwoodmovement.com/
https://www.facebook.com/erinunderwoodmovement/
https://www.instagram.com/erinunderwoodmovement/
Book by Katy Bowman: https://www.amazon.com/gp/product/B01A00CZIE/ref=dbs_a_def_rwt_hsch_vapi_tkin_p1_i1
by Jessa | Jun 30, 2020 | podcast, Sexual Dysfunction
MS and Sex
Living with MS
Six months after her daughter was born, Kimberly stopped nursing, and soon went completely numb on the left side of her body. An MRI uncovered that she had 8 lesions on her brain, which she says led to a quick diagnosis of MS. While her MS has been in remission for 12 years, her prognosis could change at any time.
Despite her remission, Kimberly tells us that situations exist that can still trigger MS symptoms. She informs us that many people with MS have trouble with heat which affects her sight. Difficulty swallowing and walking and feeling a tingling along her body are also common, she explains, especially in the heat. At a psychological level, Kimberly reports that people with MS have to live with a great deal of the unknown, as they can’t guarantee their level of functioning from day to day.
Listen to “131: MS and Sex – Kimberly Castelo” on Spreaker.
Support for the Newly Diagnosed
Kimberly tells us that many support groups exist for people newly diagnosed with MS, some of which can be found in the Resources section of these show notes. She recalls when she was first diagnosed, she thought MS was a death sentence, which she now knows is incorrect. However, she counters that while MS doesn’t kill, it does hinder functionality, which she found devastating enough to trigger all the classic stages of grief. She attributes her acceptance of MS and her emotional recovery to the love and support of her partner.
Difficulties with Sex in MS
Ms. Castelo points out that many people with MS are depressed, which leads to wide usage of libido-lowering SSRIs. Even without SSRIs to reduce sex drive, Kimberly informs us that 85% of women and 90% of men with MS suffer from sexual dysfunction.
For both genders, Kimberly tells us about spasticity issues, generalized pain, and difficulty moving legs that can impede sexual function. Kimberly says that another common problem is that MS affects the bowels, causing some people to lose bowel control during sex.
She warns that people with MS can fall into having obligatory sex to please their partners, which she describes as incredibly damaging. She believes that sex should prioritize both you and your partner’s satisfaction, never just one person’s.
Kimberly explains that the partners of MS patients can suffer too. Many partners become caregivers, and amongst partners who become caregivers, switching hats to make sex possible can be difficult, especially when their partner needs a lot of care. Kimberly encourages caregiving partners to compartmentalize moments and force themselves to have fun and playful events as well as their required caretaking.
Another problem amongst caregivers that Kimberly sees in her practice is that people operating as caregivers often don’t share their own struggles. In those cases, she reminds caregiver partners that humans enjoy helping each other, and by not sharing their struggles, they are depriving their partners of that joy and intimacy. Helping partners with problems, she asserts, is also empowering to the partner with MS, because they are given the opportunity to be a caregiver as well.
Improving Sex with MS
Kimberly says that for people partnered with someone who has MS, it’s important to allow space for grief before they can begin problem-solving. After the grieving gives way to acceptance, she states that couples may be surprised to discover that sex with MS can create phenomenal sexual connections due to the incentive MS creates to explore new avenues of sexuality. It can even raise the quantity of playful erotic moments in peoples lives.
She describes her concept of daily erotic moments as simmering with her clients. Just like making a soup, she suggests that first, you get things started, then it starts to smell good, then better, and in the end, it’s so amazing that you have to eat the stew. She mentions that having multiple sexually intimate moments throughout the day can produce an identical effect.
Expanding the Meaning of Sex
Kimberly suggests expanding the definition of sex is important. She says it’s not just about genitals touching genitals. She says it’s about flirting, touch, cuddling, holding hands, passionate kisses, and learning to bring those acts to a level that facilitates deep pleasure and connection in both people. She teaches that slowing down sex to accentuate and be more mindful about each action increases the eroticism of life. She insists that sex can’t just be about genital-to-genital contact and orgasms.
Sex Therapists and MS
When you’re figuring out how to plan sex and keep it romantic, when is a good time to have sex to avoid fatigue, and how to get involved in sex in the first place, Kimberly says a sex therapist can help. She also suggests that sex therapists can help MS patients and their partners figure out how to really connect emotionally and share their sexual challenges with each other. She says sex therapists can help couples plan sex around the best times of day to avoid the crushing fatigue of MS. Despite popular conceptions that sex should be spontaneous, Kimberly says people with MS in particular need to schedule sex sessions.
She also warns that it can be difficult to cope with partners about the changing, day-to-day pains that people can feel with MS, but therapists can encourage communication, creativity, and being mindful and appreciative of sexual actions that don’t involve intercourse.
Background:
Kimberly Castelo is a Licensed Marriage and Family Therapist, a Certificated AASECT Sex Therapist, and a Certified ETF Couples Therapist. As a Certified Integrated Intimacy Professional, she believes in treating mental health in a holistic way, exploring individuals, couples, family systems, sexual health, medical issues, and spirituality to create a full picture of her clients’ lives and resources. As a woman who’s lived with MS for 13 years, Kimberly intimately understands how medical maladies can influence the mental health of families and individuals. This experience combines with her training to provide invaluable insight into relationships and sex.
Resources for Kimberly Castelo:
https://www.healingmomentscounseling.net/
https://www.nationalmssociety.org/
https://mymsaa.org/
by Jessa | May 19, 2020 | podcast, Sexual Dysfunction
Testosterone
Dr. McKenzie explains both sexes produce testosterone however it’s much more prevalent and important in men. Serena informs us that puberty is driven primarily by testosterone. She notes that testosterone production increases exponentially in men during puberty, peaks around age 30, and subsequently declines. From driving growth and facilitating sexual function to retaining bone density and cognitive function, Dr McKenzie describes testosterone as a hormone with lifelong importance in men’s health.
Listen to “125: Testosterone – Dr. Serena McKenzie” on Spreaker.
Causes of Low Testosterone
Serena tells us the most direct cause of low testosterone, clinically diagnosed as testicular hypogonadism, occurs when the pituitary gland produces insufficient hormones to trigger adequate testosterone production. But she explains that many cases of low testosterone are caused by obesity, diabetes, insomnia, sleep apnoea, a sedentary lifestyle, smoking, excessive alcohol consumption, and other varieties of poor self-care. She also mentions that many clinicians understand lower testosterone levels as a natural result of aging, and not as a condition requiring treatment.
Symptoms of Low Testosterone
Dr. McKenzie admits that most of her patients present with sexual dysfunction. She often finds problems such as low libido, trouble gaining or sustaining an erection, fatigue or depression. One symptom she describes that points directly to hypogonadism is a measurable decrease in testicular size. She mentions the loss of non-sexual erections as indicative of low testosterone. She points out that these symptoms can also be caused by vascular disease or pituitary dysfunction, but she reassures us that true cases of testosterone dysfunction can be diagnosed fairly easily by physicians.
Low is Low?
To diagnose hypogonadism, Serena explains that labs look for reproducible testosterone levels below 300 or 350. The doctor explains that testosterone levels vary from day to day and hour to hour, which is why testing a man’s testosterone more than once is necessary for a correct diagnosis. She admits that some practitioners will skip this second test, which can lead to inappropriate diagnoses. She explains that most men should have testosterone levels between 200 and 900 for full sexual health, but the exact levels vary for different individuals.
Treating Low Testosterone
Dr. McKenzie believes that it’s important to assess lifestyle variables and consider alternative treatments like testosterone stimulation before rushing into testosterone replacement. For many men, correcting poor self-care, addressing relationship problems, and learning to foster romance in their relationships can solve their sexual and energy complaints. She remarks that these treatments are especially useful for younger men because hormone replacement shuts off the body’s natural ability to produce testosterone, which can prevent men from fathering children or require lifelong testosterone supplementation after treatment.
But for men with primary testicular failure or pituitary dysfunction, Dr. McKenzie acknowledges that testosterone treatments will be a necessity for the rest of their lives. Men whose testicular tissue has been damaged by chemotherapy or alcohol abuse may also need continual testosterone treatments to maintain sexual function.
Treatment Types
Serena describes a market that has produces 15 to 20 different methods of administering testosterone for patients, including injected doses of testosterone, injectable pellets, transdermal gels, sprays, and pills, but she says insurance usually decides the form of treatment.
Risks of Different Treatment Types
Dr McKenzie prescribes transdermal gels and lotions most often. For those, she warns that it’s important for men to wash their hands after application and for them to allow the gel or cream to dry after application, otherwise accidental transmission of testosterone to partners or pets may occur.
She implies that most other methods are even safer, though high-dose injectable varieties of testosterone have been shown in some studies to increase the risk of blood clots, making heart disease important for prescribers to consider.
Testosterone Abuse and Misuse
Serena believes that testosterone is a wonderful substance, but she recommends it only be used with a clinician’s oversight. Because of testosterone’s ready availability online, she meets many men who buy themselves testosterone and are puzzled by the substance’s tendency to reduce, rather than increase, libido in healthy men.
Producing Testosterone Again
For men who don’t need lifetime testosterone treatment, Dr. McKenzie explains that results vary when treatment is discontinued. She says that some men—usually those who did not require treatment—produce adequate levels of testosterone immediately after treatment stops. Other men must wait for three to six months for their testicles to resume testosterone production, a time period that she warns can cause men to feel the depression, fatigue, and other symptoms associated with low levels of testosterone. She says that people who recover more slowly may require testosterone stimulating therapies to regain sexual function or fertility treatments if they intend to conceive a child. She also warns that a few men never regain their fertility or sexual function after undergoing testosterone treatments.
Finding Treatment for Sexual Dysfunction
Dr. McKenzie admits that medical treatment for sexual problems can be difficult to find. She describes some doctors as being disinterested in hearing about their patients’ low libido and sexual problems.
To meet the needs of this under-treated population, Serena tells us that pop-up sexual health clinics began to appear. Because pop-up clinics often provide inadequate or inappropriate treatment, she explains that more clinicians began to understand the need to provide sexual health services to their patients. Thanks to these changes, Serena shares the encouraging news that getting medical help for sexual problems is becoming easier every day.
Background:
A healthcare worker since 1992, Dr. Serena McKenzie is an evidence-based, holistic primary care physician with expertise in sexual medicine, healthy aging, and the pelvic floor. She is certified as a sexual medicine fellow (IF) through the International Society for Women’s Sexual Health (ISSWSH), as a nationally certified Menopause Practitioner (NCMP) through the North American Menopause Society (NAMS), and as a sex counselor through the American Association of Sex Educators and Therapists (AASECT). Using a multi-disciplinary approach that assesses her patients holistically, Dr. McKenzie helps her patients treat sexual dysfunction at every stage in life.
Links for Dr Serena McKenzie:
https://www.drserena.com/
https://www.huffpost.com/entry/how-much-testosterone-mak_b_8833162
by Jessa | May 12, 2020 | podcast, Sexual Dysfunction
Bridging Sex Therapy and Sexual Medicine
Today’s show is going to delve into talking about sex with both your therapist and your physician, potentially, and how that collaboration can benefit your struggles can make a difference.
Listen to “124: Bridging Sex Therapy and Sexual Medicine – Dr. Pebble Kranz and Dan Rosen” on Spreaker.
I interview Dr. Pebble Kranz and Dan Rosen. He is a sex therapist, and she is a family practice physician. Both of them have had extensive training in sexual health and sexual treatment, and they started a clinic together.
What we talk about applies to you if you have some sexual struggles, because it is essential that your providers be communicating and collaborating and that you are getting the best of both worlds.
Dan Rosen became licensed as a Clinical Social Worker after attending NYU’s school of social work. He became a Certified Sex Therapist in 2014 and chaired the AASECT Ethics Advisory Committee from 2016-2018.
He has been providing local training for psychotherapists and medical residents since 2008 as well as teaching sex therapy as an instructor at the University of Buffalo 2016-2017.
While the European Society of Sexual Medicine does not credential social workers, Mr. Rosen participated in the same training program as Dr. Kranz benefiting from the truly global perspective on sexuality and sexual health. Integrating sex therapy with psychodynamic psychotherapy, treatment of sexual abusers, EMDR, CBT, IFS, and couples counseling has been uniquely rewarding.
Now, as a member of the Rochester Center for Sexual Wellness team, Dr. Kranz and Dan are bringing this global perspective on sexual health to Western New York.
Dr. Kranz is Board-certified as a family physician and trained at the University of Rochester Family Medicine Residency Program with an area of focus in the psychosocial aspects of primary care.
Family medicine appealed to her as a specialty because of its whole-person, whole-family, and whole-community approach to medical care. Family medicine residents at the University of Rochester train alongside marriage and family therapy trainees and are explicitly taught to work systemically and to collaborate with mental health providers.
Dr. Kranz’s prior medical training included almost no information on sexual function and dysfunction, nor did it expose me to a range of interventions for treatment. All along, her patients made it clear that this was an important part of their lives.
She completed a fellowship through the European Society of Sexual Medicine. Dr. Kranz now participates in both the medical school and residency curricula to improve exposure to sexual medicine. She and Mr. Rosen opened the Rochester Center for Sexual Wellness in 2017, providing comprehensive assessment and treatment for sexual concerns in individuals and couples of all genders.
Rochester Center for Sexual Wellness: https://rochestercenterforsexualwellness.com/
The organizations mentioned:
ISSWSH: https://www1.statusplus.net/sp/isswsh/find-a-provider/
ISSM: https://www1.statusplus.net/sp/issm/find-a-provider/
SMSNA: https://www1.statusplus.net/sp/smsna/healthcare-provider-search//index.php
KinkAware Professionals: https://www.ncsfreedom.org/resources/kink-aware-professionals-directory/search-kap
