#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. 

Biography: 

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.” 

Links: 

https://linktr.ee/worriertherapy  

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

 

#208 – Endometriosis – Dr. Allyson Shrikhande 

#208 – Endometriosis – Dr. Allyson Shrikhande 

Listen to “208: Endometriosis – Dr. Allyson Shrikhande”

Endometriosis 

Dr. Allyson Shrikhande, a rehabilitation doctor who specializes in pelvic rehabilitation medicine, gives us an in-depth discussion about endometriosis. What is endometriosis, the disorder affecting one out of ten women? How does it show up and what are the treatment options? 

What is endometriosis? 

Endometriosis is a disorder wherein cells that are similar to the cells lining the inside of the uterus (endometrium) grow outside of the uterus. These cells can settle basically anywhere in the body but most commonly in the pelvic cavity and can cause pain and infertility.  

How common is endometriosis? 

Depending on the study, one out of ten, or one out of nine women can have endometriosis. It is as common as breast cancer with a strong genetic predisposition. 

What are the symptoms of endometriosis? 

The challenge is that it is a silent disease, making it hard to diagnose. The way it presents itself is as a person being infertile and/or having pelvic pain. Pain during intercourse, tampon use and the like as well as GI problems (constipation, abdominal bloating, abdominal pain), and a UTI that will not go away are very common symptoms. 

Treatment options for endometriosis

The major challenge in the medical community is that there is no proper diagnostic other than surgery right now. The gold standard for a proper diagnosis is laparoscopic surgery, then some pathology. Because of the complexity and systemic nature of endometriosis, Dr. Shrikhande also takes on a holistic approach to treatment, discussing additional things like nutrition and even medication with patients. 

Endometriosis awareness 

Dr. Shrikhande underlines the need for more research and studies to help in diagnosing endometriosis in its early stages. Unfortunately, it is a very complex disease with strong genetic disposition making it even harder to prevent. Awareness is key as there is still nothing conclusive as to what is causing endo. It’s important that women are diagnosed in an efficient manner and have access to skilled medical and rehab providers who can help them with proficient treatment. 

Biography: 

Dr. Allyson Shrikhande, a board-certified Physical Medicine and Rehabilitation specialist, is the Chief Medical Officer of Pelvic Rehabilitation Medicine. She is also the Chair of the Medical Education Committee for the International Pelvic Pain Society. She is working with other experts in the field of chronic pelvic pain to develop training modules for residents and physicians interested in learning about the diagnosis, treatment, and management of chronic pelvic pain. A leading expert on pelvic health and a respected researcher, author and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment. 

Resources and links: 

Website: pelvicrehabilitation.com 

Instagram: @pelvicrehabilitation, @doctor.allyson 

Twitter: @PelvicRehab 

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
#184 – Anorgasmia in Women – Dr. Rachel Needle

#184 – Anorgasmia in Women – Dr. Rachel Needle

Listen to “184: Anorgasmia in Women – Dr. Rachel Needle”

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 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
#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”

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 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
#181 – When Sex Hurts – Dr. Irwin Goldstein

#181 – When Sex Hurts – Dr. Irwin Goldstein

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

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. 

Background 

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 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

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