#212 – Performance Anxiety – David Khalili

#212 – Performance Anxiety – David Khalili

Listen to “212: Performance Anxiety – David Khalili”

David Khalili 

Performance Anxiety 

Feeling anxious before sex is normal. But how about feeling nervous that you cannot have or enjoy sex for fear that you will be unable to “perform” during sexual activities? Sex therapist David Khalili talks about sexual performance anxiety, predominantly among men, and what can be done to overcome that fear or condition. 

“Men don’t ask for help” 

David shares from personal experience how men would come in looking for certain toys, prostate massagers, cock rings, lubricants and the like – shrouded by shame and anxiety. Mostly men are affected by sexual performance anxiety because of society’s expectations of what they should be doing during sex. Because of the men-don’t-ask-for-help narrative, they are afraid to come into sex shops to look for things that could amplify pleasure or to seek intervention from professional sex therapists and admit that they are having trouble in sex. 

There’s a whole body to explore, not just the penis 

The pressure that men are under usually focuses on the “performance” of their penis – to get hard fast, stay hard for a long time, etc. As David puts it, penises are wonderful, and they’ve got lots of purpose and pleasure. But you are whole as a human and there’s also the rest of your body to play with and that could give you pleasure. The body is a whole map and we need to learn how to explore that map. There might be lots of nerve endings in the genitalia, but there are lots of nerve endings all over the body. So, relieving that penis-centric pressure on men really opens up their repertoire and their definition of intimacy and connection and pleasure. 

How to cope with performance anxiety 

The first step to coping with performance anxiety is recognizing and normalizing that the penis, just like any other body part, cannot always perform as expected. Also important is removing any shame you might be feeling about not having an optimal sex life. David also underlines the fact that men who do not hit one or all the criteria/markers associated with “expected sex performance” should not feel like it’s their failure as a man. Men should build that self-compassion and accept that it’s not going to be perfect all the time and that good is enough. 

Be creative in getting sexual 

The truth is you can be sexual without needing an erection. David explains the circular model of sex versus the linear model that most people know about. With or without penetration, learn how to spice up that sex life and how to potentially help in relieving performance anxiety. 

Get help and communicate your anxiety 

Sexual performance anxiety is a valid concern but should not be a reason to avoid having sex altogether. Figure out a way to communicate it to a partner or potential partner in a way that it’s normal and that it’s okay to go slow to soften expectations. If you feel safe enough with the other person, it is important to talk about the anxiety and explore it together. It is a normal ebb and flow of human function and getting sex therapy intervention is perfectly normal. Learn more about different treatments or interventions you can use to help with performance anxiety. 


David F Khalili, LMFT is a sex and relationship therapist licensed in California. He works with individuals, relationships and also runs groups for men who experience anxiety around sex and dating. His main areas of focus are sex and anxiety, kink and open relationships, multiheritage couples, and first-generation American-born individuals. David recently released a workbook called “Sex Worriers: A Mindfully Queer Guide to Men’s Anxiety Around Sex and Dating.” 



More info and resources:
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast


#192 – Men Raped by Women – Kelvin Pace

#192 – Men Raped by Women – Kelvin Pace

Listen to “192: Men Raped by Women – Kelvin Pace”

Men Raped by Women 

Breaking myths about male victims of sexual assault, Kelvin Pace joins me in talking about changed parameters, frequency, the societal narrative of men raped by women, the path to healing, and resources of support. 

What Drew Kelvin Into Working With Victims?  

Kelin observed that 80-90% of the transitional youth that he worked with were sexual assault victims, prompting him to work in the field. After CDC came out with the National Intimate Partner and Sexual Violence Survey, which included a new parameter of ‘made to penetrate’, it was found that at any given year, 1 out of 4 men are sexually assaulted.  

Change in Parameters – ‘Made to Penetrate’ 

Before the new parameter came out, the sexual assault of men only included men being raped in prison and men sexually assaulted by other men. However, the new parameter of ‘made to penetrate’ changed it to include men being made to penetrate by other men or women by coercion, influence under substances, or by guilt. He noted that 75% of men reported being made to penetrate by female perpetraors.  

Societal Myths 

Kelvin explains that we grow up believing that men can’t be raped because men must want sex all the time; that men can’t sleep through sex with an erection, and if men have erections or ejaculate they must have consented to sex, all of which are societal myths that push men away from reporting their sexual assault.  

As 7% of victims experience some form of sexual assault before the age of 25, they grow up believing a narrative that pushes them to become hyper-masculine and defensive. Kevin works to provide victims a safe space to be vulnerable, express their feelings, and tell their stories.  

Process of Healing – What to Expect? 

Kelvin builds trust with his clients He takes his clients through the process of talking about their feelings and thoughts, has them ask questions about the emotions triggered, and gathers information as a result to form decisions on the behavior. The clients then sit with those negative and positive behaviors and decide which one to act upon. This helps them feel empowered and in control.  

Connecting Past Thoughts and Present Emotions 

Kelvin helps his clients to sit with their emotions in the present and connect them to the thoughts of their past. After contemplating questions like “what if?” and “should I have?”, his clients have an opportunity to come to a place of acceptance. Kelvin then gets his clients to answer what they’ve learned about the experience and themselves. The responses would usually include resilience and empowerment. While it’s important to learn and not ruminate about the experience, it’s also important to recognize what happened.  


Kelvin Pace, MS, LPC-S, CST. He graduated with a master’s in clinical psychology from the University of Alaska Anchorage in 2009.  

Kelvin is the owner of Kpace Counseling, LLC where he serves clients in private practice. He does contract work with Full Spectrum Health as a behavioral health clinician where he works with an integrated care team delivering evidenced-based care to persons of the LGBTQ+ community. Kelvin has worked for a local non-profit delivering mental health services to children and young adults that have suffered from complex trauma. With a firm foundation in trauma, he delivers trauma-informed sex-positive therapy to his clients.  

Kelvin provides services to couples and individuals dealing with sexual or relationship issues that include low desire, anxiety surrounding sex, and infidelity. His current focus is on mindfulness-based interventions to manage sexual concerns and he works with persons that are either in or looking to explore non-traditional relationship orientations that fall under the umbrella of consensual/ethical non-monogamy.  

Resources for male sexual assault survivors: 

Resources and links: 

More info and resources:
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
#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”

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 and resources:
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
#174 – How Men Can Talk About Their Sexual Desires – Shana James

#174 – How Men Can Talk About Their Sexual Desires – Shana James

Listen to “174: How Men Can Talk About Their Sexual Desires – Shana James”

How men can talk about their sexual desires  

In this episode, Shana James shares how men can talk about their desires and their vulnerability toward having a thriving sex life. 

Shana’s drive to support and guide people into a healthier relationship stems from her younger self who was confused and wanted to understand what a healthy relationship looked like. Now, Shana’s work on communication extends beyond men and can be applied to all heterosexual relationships. 

Communication Breakdowns in a Relationship 

According to Shana, the most important part of communication in relationships that people need to improve is respect. Drawing on personal experience, Shana suggests that we reflect on the way we treat our partners. While trust is built on actions, words have the power to shake that foundation. Our emotional responses, like name-calling and blaming, are a part of that communication that needs to be fixed for a healthy relationship. 

What Makes a Lower Desire Partner Say No to Sex? 

A partner can push their lower-desire partner away from saying yes to sex when their conversation takes a turn into complaining and blaming. Instead, Shana suggests having a conversation filled with passion, excitement, and collaboration. Asking questions about what their desires are and talking about what you want to try is a good way to bring them around the idea of opening up about their wants. Depending on the tone of our conversations, lower desire partners can feel the blame and put off their desires. “Innately, there’s nothing wrong with our desires”, Shana says while urging people to work through their desires and initiate collaboration. 

Shame Around Expressing Sexual Desires 

Shame is one of the biggest hurdles people feel around their desires that makes them say no to affectionate advances or sex. Their partners can offer them a safe space to express those desires by fulfilling their desires outside the bedroom – to be seen and understood. Shana says it’s a collaborative effort of both partners to connect and form an intimate and emotional bond outside the bedroom. It enforces their trust to be playful and explore each other’s bodies, what they like and need, and what you like and need. It’s an experimentation-stye approach of constantly being curious about each other’s desires and your own. It helps face the shame and fears with compassion and love. 

How To Make Your Partner Feel Safe to Be Aroused & Sexual 

Shana’s advice to make your partner feel safe and comfortable to be sexual is to be vulnerable and honest with your reasons for wanting that experience. Unlike many assume, men do feel the need to have sex to connect and bond on a deeper level or to express the love they feel. It’s a way to leave behind the stresses of the day and focus on being a good partner. Shana also points out that when we assume the best of our partner, we start to understand where they’re coming from and show more compassion towards their needs and our own, that’s how collaboration is possible. 

Advice on How to Have Vulnerable Conversations 

Having conversations about desires and needs can be difficult for many, and Shana advises people to communicate before having sex. The conversation could be about how we’re treating each other in terms of respect and acknowledging each other’s wants and needs. During the conversation, it’s important to hear what the other person is saying and instead of dismissing an idea, try entertaining the thought. You can brainstorm with your partner about how they can accommodate you in a way you feel safe and comfortable to try this new thing. This is where curiosity comes into play, says Shana. In terms of putting your desires forward, Shana suggests the ABC communication method. When you put an idea forward and get a “B” response from your partner that’s surprising, instead of walking away try asking what caused them to respond in that way and be curious to find out. 

Final Thoughts 

Shana leaves us with a reminder to have those vulnerable conversations in the moment and avoid the build-up of resentment and irritation. Having conversations about sex during a casual time other than in the bedroom can boost that habit of collaboration and teamwork. She also suggests making your pleasure your responsibility by getting to know your body better. She urges people to be playful with sex and not keep orgasm as a goal and be exploratory with it. 


For 15 years Shana coached more than a thousand leaders, CEOs, authors, speakers, and people with big visions to find love, rekindle the spark, step into more powerful leadership, start and grow businesses, increase their impact, create a legacy, and become more personally inspired and fulfilled. 

Referred to as a secret weapon, she cuts through distraction and provides direct access to confidence, power, and clarity. She is also a translator between women and men, providing effective tools to transform conversations and dynamics that have gone awry into connection and collaboration. 

With an M.A. in psychology, DISC certification, Coaching training, more than a decade facilitating groups and workshops, starting multiple businesses, and helping hundreds of entrepreneurs start their own, her range of skills is unlike many. 

Resources and Links:  

Website: https://shanajamescoaching.com/ 

TEDx talk: https://shanajamescoaching.com/tedx/ 

Guides: https://shanajamescoaching.com/dating-guide/ 

More info and resources:
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast
#125 – Testosterone – Dr. Serena McKenzie

#125 – Testosterone – Dr. Serena McKenzie

Listen to “125: Testosterone – Dr. Serena McKenzie”


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. 

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. 


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: 



More info and resources:
How Big a Problem is Your Sex Life? Quiz – https://www.sexlifequiz.com
Access the Free webinar: How to make sex easy and fun for both of you: https://intimacywithease.com/masterclass
Secret Podcast for the Higher Desire Partner: https://www.intimacywithease.com/hdppodcast
Secret Podcast for the Lower Desire Partner: https://www.intimacywithease.com/ldppodcast

We use cookies to give you the best online experience. By agreeing you accept the use of cookies in accordance with our cookie policy.