#184 – Anorgasmia in Women – Dr. Rachel Needle

#184 – Anorgasmia in Women – Dr. Rachel Needle

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. 


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 



#183 – [Personal Story] Living with Lichen sclerosus – Tammy

#183 – [Personal Story] Living with Lichen sclerosus – Tammy

Listen to “183: [Personal Story] Living with Lichen Sclerosus – Tammy” on Spreaker.

Living with Lichen Sclerosus 

Tammy brings her journey with Lichen sclerosus and the experiences of many other women to light in this episode. We hear everything about what it’s like to live with Lichen sclerosus, its challenges, treatment options, and how to get support. 

What is Lichen Schlerosus? 

Lichen sclerosus is an autoimmune condition where the body attacks itself. It is thought to be genetic. It usually occurs in the genitals, but can also affect other areas of the body, where it can cause itching and discoloration on the wrist, inner thighs and stomach. Lichen sclerosus affects young and old women. 

Tammy’s history with Lichen sclerosus 

Tammy started experiencing extreme itching and burning beginning in her 20s. Others may experience visual symptoms like white patches of skin. At the age of 44, she was diagnosed with Lichen sclerosus after doing a punch biopsy. She believes stress and genetics played a role in her diagnosis. Shame and discomfort made it harder for her to find the right diagnosis and thus she emphasizes the importance of finding the right doctor. 

Impact on sex life 

Tammy warns people against looking up their condition online. She talks about how many women go through this process with unsupportive partners. Other than sexual and mental issues that make sex difficult, pain is a big factor. It can change the way your vulva looks when the labia of both sides fuse and are sometimes absorbed entirely. The vaginal opening can shrink, causing sex to be incredibly painful. Clitoral phimosis is a condition when your clitoral hood fuses with the clitoris making it less sensitive. Other than affecting your sex life directly, it makes even performing menial tasks extremely painful.  

Treatment options for lichen sclerosus

Talking about her history, Tammy says she started off using triamcinolone, a moderate steroid. Clobetasol cream and ointment is the most common treatment that’s specifically used for Lichen sclerosus. Hydrocortisone is used to soothe itching. She talks about the “Monalisa touch” used by Dr Andrew Goldstein who uses a specific machine to improve collagen production. While it may seem like a dermatological issue, many doctors don’t seem to know much about it. 

Impact on Mental health 

This grueling process in which women receive little support is hard on their mental health and sexual health. Tammy says the process of finding the right diagnosis takes its toll. The shame and embarrassment around Lichen Sclerosus can be helped by having a supportive partner. 

Available support 

Women with Lichen sclerosus are at a higher risk of getting vulvar intraepithelial neoplasia and other autoimmune conditions. Tammy found a supportive environment for women who have both Lichen sclerosus and intimacy issues in Facebook support groups. While finding support and acceptance of Lichen sclerosus is hard, it’s helpful to be surrounded by people going through the same thing on this journey. 

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://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 



#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 


#161 – Menopause – Dr. Michelle Gordon

#161 – Menopause – Dr. Michelle Gordon

Listen to “161: Menopause – Dr. Michelle Gordon” on Spreaker.


After having gone through menopause and being surprised by the event, Michelle discusses her journey to finding out more about it and how to make it easier for other women. She shares her experience after taking the pill, then finding out that she had a mass in her uterus thus leading her to undergo an Endometrial Biopsy. Michelle was unhappy with her body and realized that other women were probably going through the same horrific experience. 

Common Problems in Menopause 

She discusses how disruptive menopause can be especially since we are not prepared like we are for other age milestones in our lives. From her experience, externally women report weight gain and on internal issues women struggle with their ability to make decisions and encounter an identity crisis.  

Michelle notes that doctors don’t know enough to help patients and this can leave women in a worse position. She also discusses loss of libido that comes up as a very common symptom of menopause and bleeding into our relationships. Michelle explains vaginal atrophy and urethral atrophy that can come with menopause. 

The Four Pillars of Thriving in Menopause 

The key to understanding menopause is to understand hormones. Dr. Gordon discusses 4 pillars  which include science, supporting ourselves with diet, movement and the brain. 

In terms of dealing with menopause, Michelle says there is no single answer for every woman. She encourages reflection and reinvention during our menopause journeys as each one is unique.  

Links and Resources 




Dr Gordon is a Board-Certified General Surgeon and founder of Gordon Surgical Group, a multi-specialty group practice in 2005. GSG serves the lower Hudson Valley of New York. 

She is also the author of Managing Menopause which you can find on her website. 

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