November 7, 2022

Ep. 78 – Dr. Lori Brotto – Sex After Kids: Cultivating Desire

  • 3 universal pleasure-diminishers for parents and how normalizing their presence provides some relief
  • The importance of sex for ‘approach-related’ reasons rather than ‘avoidance-related’ reasons
  • What is responsive desire and how to get it?

This episode is all about sex and pleasure and how we cultivate those kinds of desires after having kids. We’re with UBC professor and director of the Women’s Health Institute, Dr. Lori Brotto.

Universally, sexual desire diminishes after having kids, but even at other times, female sexual dysfunction is extremely common, affecting up to half of women at some point in their lives.

Dr. Brotto’s work brings the issue of low sexual desire in women into the open so that women feel less shame and are empowered to cultivate their feelings of sexual desire if that is what they wish.

All about this and more in this episode. Join us!

Episode Guest

Dr. Lori Brotto

Dr. Lori Brotto is a professor in the UBC Department of Obstetrics and Gynecology and the Executive Director of the Women’s Health Research Institute. She is also the author of the fabulously encouraging and insightful book, Better Sex Through Mindfulness: How Women Can Cultivate Desire.

Sexuality is an integral aspect of well-being and strongly influences relational happiness. However, often relational, political, cultural, and medical factors get in the way of healthy sexuality. Lori’s work aims to identify and mitigate these forces so as to cultivate each woman’s own human sexual potential.

In addition to all her research and writing, Dr. Brotto was recently featured in the Netflix series, The Principles of Pleasure, an eye-opening mini-series that celebrates the complex world of women's pleasure - and puts old-fashioned myths to rest.

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Ep. 78 – Dr. Lori Brotto – Sex After Kids: Cultivating Desire

Rachel Cram – Good morning, Dr. Lori Brotto. This topic and conversation we’re about to have, I drove to the studio this morning listening to calm piano music because I have so many questions to ask you, and I’m fearful that I’m going to race into this conversation to try to get them all in an hour. But I thank you so much for agreeing to speak with me today.

Dr. Lori Brotto – It’s a real pleasure to be here, Rachel. Thank you.

RC – I feel like I’m meeting with a wise oracle who’s got the answers to the problems of the world, and you do! Some of them anyways. The ones I’m seeking at the moment. Now a review of your work says this. “Acclaimed psychologist and sex researcher Lori Brotto offers a groundbreaking approach to improving desire, arousal, and satisfaction inside and outside of the bedroom. Drawing from the latest research, she provides exercises we can do on our own to increase desire and sexual enjoyment, whether our goal is to overcome sexual difficulties or simply to give our love life a boost.”

And another one says this. “Lori Brotto’s research on mindfulness is the most exciting thing that has happened to sex therapy in many years.”

Are you, like, super popular? Like, do you want to parties and everyone just lines up to want to talk to you? Do they?

LB – No, not at all. I’m just a scientist and a clinician.

RC – Yeah, but you study sex and pleasure and how to have better sex and more pleasure through mindfulness. LIke, your work must be creating a mighty move toward mindfulness practices.

LB – Yeah, you know, mindfulness is pretty important. It’s pretty sexy. So I think it’s the appeal of the work. But it is incredible that such a simple but not easy practice can have such transformative effects on all facets of our life, including sexual health.

RC – Ok, well I often start interviews with a broad question, but I don’t want to leave it that broad because I want to know more specifically from you, did you grow up in a sex-positive family? Did you have parents who were teaching you about exploration and desire?

LB – No, no, no. So there’s hope for all of us and for any listeners who feel like they’re a late bloomer or feel like their awareness about their own sexuality and sex education came much later in life. That was definitely the case with me. We grew up. I love my parents dearly, and our home was completely devoid of any sort of sex education. In fact, we were taught that thinking about sex was as bad as having it, and if you were having it, everyone would immediately know and it would bring tremendous shame on the family.

So quite a sex-negative, not just sex neutral, but sex negative. So I didn’t talk about sexuality. My own sex education at school was minimal if at all. And my own entry into this as a career really came about by accident when I started volunteering as an undergraduate student in a research lab. In fact, the only lab that would take me because I was so junior at the time and had no research experience. But I knew I loved science and had this great passion for being able to ask questions and use science to answer those questions. So thankfully, there was one person at the UBC Department of Psychology at the time when I was knocking on doors who took me on. And it’s so interesting because when I knocked on his door, I had no idea what his research was. I just knew that he was a professor in psychology. And so my very naive view at the time was that everyone was studying things like depression and anxiety and trying to understand how to improve the human suffering condition. Well, it turns out that he spent his days watching rats have sex.

RC – Oh my goodness.

LB – Which is what I then spent the next six years doing, watching rats have sex.

RC – I’m not sure I can even imagine what that would have entailed. But, was it the sex life of those rats that changed your perspectives on sexual function and behavior from what you’d been taught as a child? Did you feel yourself evolving?

LB – Yeah well. I felt myself evolving but I had always been a curious child and never took on those sex-negative views that my culture and my upbringing attempted to bestow upon me. I kind of pushed back against it. So my own evolution was really in recognizing sexuality as a serious science, as recognizing that there was actually a lot we could do in the way of environment and behaviors to improve sexuality and sexual function. And this, of course, was happening at the same time where there was a lot of interest in Viagra and pharmaceutical and drug treatments, given their huge success in improving sexual function in males. And through my rat studies, I was recognizing that, “Oh, actually, environmental manipulations can have these profound effects on sexual activity. Why aren’t we studying these in humans?”

So following my master’s degree, I made the switch. I left the rat lab, and I started a sexual psycho-physiology laboratory that allowed me to bring humans. And I was most interested in female sexual response, brought them into the lab, and was able to measure sexual arousal and sexual response in women, and haven’t stopped since. I’ve been almost exclusively focused on human sexual health since then.

RC – Well, thinking about your research on sexual response in women, and pairing that with viagra, I grew up always hearing about viagra in commercials and ads and wondering, “Why is there no female counterpart pill to this? Because I’m pretty sure women are also struggling to get themselves up for sex.” Well can we even start there? How prominent is concern about low sexual desire in women?

LB – Yeah, very, very common. There have been many large-scale studies of women in different countries across different ages and when the question is asked in a very broad way, “Over the past year, have you had a period of time where for at least three months or more, you have experienced a decrease in your level of interest in sex or absent sexual desire altogether?”

The studies indicate that at least 40% of women will say, “Yep, that’s me.”

Now, importantly, not all of those 40% of women will be distressed or bothered by those changes in their desire. For some of them, they might say, “Well, I just had a baby. It makes sense that given sleep deprivation and fatigue and breastfeeding and changing demands that my interest in sex has gone down, therefore I’m not distressed by it.”

Or maybe the person has just had a surgery and is in the recovery stages of their surgery and their desire for sex has gone down. That also would be what we call an adaptive decline in sexual desire. So once we rule those groups out and we look at the people who say, “Yes, I’ve had a decrease in desire and yes, I am significantly bothered by it. It interferes in my quality of life, my mood, my relationships. I think about it. I worry about it.”

Those numbers drop down to about 20%. So around one in five women will actually meet the criteria for what we call a sexual desire disorder.

RC – You were mentioning that sometimes we realize we’ve had a baby and so, “of course, my sexual desire is down.” I wonder if it’s always as “of course, as that?” Because I think sometimes when we’re experiencing low sexual desire, an anxiety comes in with that because you feel like, “Well, I got to be showing up for my partner, I’ve got to be showing up as a woman, or have I lost touch with my body?”

And it doesn’t seem like it’s an “Of course.” You can almost start to panic. Is there such a thing as a healthy level of sexual desire? Are there markers for a sexual desire that is too low or too high?

LB – Yeah. Healthy sexual desire is when it feels right for you, and it feels right in your relationship and you’re not bothered by it. That’s what healthy sexual desire is. When it comes to sexual health, it’s entirely subjective. So, let’s say, within a relationship, one person has much higher desire for sex than the other person. We focus on that as a discrepant-sexual-desire issue. Rather than labeling one person as way too low or the other person is way too high, we focus on the fact that there are different levels of kind of ideal sexual desire and ideal sexual frequency. And how can we teach that couple skills and strategies and homework exercises to compromise, to find a middle ground where sexual desire feels acceptable for both of them.

RC – I have to say, “Compromise” it feels like a real ‘blaaah,’ goal, like, neither of us are going to come out of this getting what we want. I wish you could say, ”Here’s the ideal level of desire for health. Live at this level and you will be right. You will be hitting the expectation.” I feel like that might be easier on relationships? Do you get people wanting that from you Lori? To know what is the ideal level of desire?

LB – Yes. So unfortunately, the answer to the question of “What’s an ideal level of desire, what’s an ideal frequency of sex per week?”

We’re left with whatever feels right for you.

RC – Which is challenging.

LB – It is.

RC – Because sometimes you want the outside voice to come in and tell you, “This is the expectation. Here’s the goal.”

LB – Yeah. Yeah.

Musical interlude #1

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RC – I think especially after having a child, a lot of women feel like they could live happily without sex and that their motivation for sex is focused on appeasing their partner. Apart from relational obligation. And I think that word itself, ‘obligation,’ probably kills desire right there. And I think men might feel like this too. You can tell me if you think this is true. Your sexual desire goes down and you can think to yourself, “Well. I actually could live a long time without having sex.”

LB – I’m perfectly fine without it.

RC – Are there other reasons, apart from obligation? Because I think as as a culture, we’re moving away from thinking that we’re obligated towards having sex, especially as women. What else makes women in your research want to increase their sexual desire apart from that feeling of obligation after they’ve had a child or at any time?

LB – Yeah, it’s a great question. And thankfully, this has been an area where there has been a ton of research really asking people, women and men and all types of gender expressions, what are your reasons for engaging in sexual activity?

And broadly speaking, those reasons that people provide fall into two big groups. The first group is to get something good. We call those ‘approach-related’ reasons. So to obtain emotional intimacy, to obtain an orgasm, to obtain the feelings of relief that allow me to sleep better. To obtain feelings of empowerment and confidence and the mood-elevating effect. So those are all approach-related reasons.

Then the second big group, not surprisingly, are the avoidance-related reasons. And this is to avoid something bad; to avoid to fight, to avoid conflict, to avoid a partner who maybe is belligerent or angry towards the main partner or the rest of the family. And what we know is that an individual who engages in sex only for those
avoidance-related reasons, to avoid something bad, that is a direct line to resentment in the long term.

So even though the person is engaging in sex, those are not good reasons to be engaging in sex. And that’s really going to lead to destruction in the relationship and have a whole host of other consequences on her own sexual response.

RC – I know your research extends to people across all periods of life, but knowing that the majority of our podcast listeners are parents or expectant parents, how relevant are those approach-related reasons; wanting an orgasim, wanting to fall asleep more easily, wanting empowerment, when we have young children? Because I remember back to when my kids were young, NONE of those reasons felt applicable to me. There were so many sensations going on in my body. Thinking about an orgasim – I was sensationed out! And falling asleep at night was not a problem – staying awake was the problem.

The avoidance related reasons would have been my main motivation and it does, that creates resentment. So knowing this to be true for many women, how common is it for partners sexual intimacy to suffer after having a child?

LB – I’m going to say nearly universal. Nearly universal. So very common. Maybe even normal. And when we look at the demands of parenting and the requirements of attention and nurturing, some would argue that’s it’s an adaptive shift that couples make in focusing on themselves and their own kind of internal pleasure or pleasure in their relationship towards focusing on the child. Now, lots of people will hear that and disagree with it, and I’m just presenting it as one theory. But I do want to normalize the finding that for a lot of new parents, particularly, let’s say a mother who is also breastfeeding, who is more likely than a father to be getting up in the middle of the night and tending to a crying child through feeding, etc.. And so those kinds of domestic demands, whether we like it or not, they are almost unequivocally more borne out by the mother than the father.

So changes in sexual desire are near universal in that situation. So how does desire come back? Well, the context has to change. Right. So as kids sleep more, as the mom is more well-rested, I mean, it sounds so trite, but it is absolutely true. We don’t have a separate gas tank that fuels our sexual response. So if a person is completely fatigued because they’ve been up all night, it’s understandable that there would not be that fuel for sexual desire, sexual activity, orgasm, you know, an incredibly energy, costly event.

RC – Sex is?

LB – Sex is.

RC – It can all feel like a lot of work.

LB – Yeah.

RC – And at a time when you’re really not feeling sexy in your body in any shape or form. For so many reasons.

LB – Hundred percent. And unfortunately, so many women, so many new moms are so judgmental of themselves regarding their bodies and changes in their bodies that happen after pregnancy and delivery and into the postpartum period. And those preoccupations of the body directly impact her willingness to engage in sex. Where her attention level is during a sexual encounter. And, yes, whether she will experience arousal and an orgasm. So, you know, there’s so much that’s happening at a psychological and brain level that contributes to a healthy sexual response in the post-baby or postpartum period, way more than the physical healing after a delivery.

RC – I just feel like sex is so unfairly stacked against women. You know, right at the beginning you were talking about the way that you were raised. But I think that there is reasons, some very valid reasons why originally our parents and grandparents were more conservative of sex, because when you didn’t have contraceptives, you had that risk of getting pregnant. Which is not the case anymore. But then you’re working through periods. You’re working through your hormones swinging with periods. That’s just not helpful for a sexual relationship. You’re looking at UTIs, bladder infections, so painful. Then you’re looking at being pregnant and having your body change and you know, with my first child, everything ripped. That is so challenging. So I feel like we’re starting from so far below zero.

LB – Yeah. Yeah.

RC – Are you sensitive to that? Like, are you sympathetic to that?

LB – Yeah. Yeah. It’s interesting because I’m teaching a course to graduate students on women’s mental health across the lifespan. And yesterday was our first class, and my entire lecture was devoted to the fact that you know, women were not included in scientific clinical trials until 1990. The fact that we still know so little about the female anatomy and physiology compared to male anatomy and physiology. The fact that when you look in a lot of medical textbooks, the sections on male anatomy are far longer than the sections on female anatomy. The fact that we still are not doing nerve-sparing surgeries in females like we are in males because we don’t know where those important nerves are.

It is a long legacy of a historic omission of women and females in science in general. So we just know far less about women than we do about men. Viagra was approved in 1998 in the United States. We do have a female sexual desire drug that was approved 16 or 17 years after that. And it’s a terrible medication. It barely works. It has all sorts of side effects and it’s really expensive compared to Viagra, which is discreet, works, has minimal side effects, is covered under many health insurance plans. So yeah, clearly I could go on and on about this inequity, but it has a direct bearing on our understanding of sexuality in women versus men to the point where there’s still a lot we don’t know when it comes to healthy women’s sexuality.

Musical Interlude #2

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RC – You’re explaining how we still know so little about the female anatomy compared to male anatomy. I think growing up even your clitoris, I never knew about that growing up. I feel actually I grew up in a fairly sex-positive household, but that wasn’t a term that ever came up. I thought that you had orgasms through, you know, penis into a vagina situation. And it’s only been fairly recently that I realized that’s not how it works. My daughters are much more educated. Thank goodness. Not necessarily through me, but it’s more available for them to know differently now.

LB – Thankfully.

RC – But that’s huge. Really a few decades ago, maybe from all of history previous, women didn’t know about that.

LB – Correct.

RC – And men didn’t either.

LB – And in fact, if we dive even deeper into history, if we look at the late 1800s, women’s symptoms, whether it was pain or dizziness or, abdominal issues or anxiety, it was all labeled as hysteria.

RC – That’s…what did that entail? That’s appalling.

LB – Yes. Well the idea was ‘hystera’ is the Greek word for uterus. And so the thought at the time was that women’s uteruses were wandering around their body, like literally swimming around, floating from place to place, giving rise to all of these symptoms. And that was the predominant belief and diagnosis for decades. That hysteria accounted for women’s symptoms.

And again, there’s a legacy of that still today where women are more likely to be dismissed by family doctors. They’re less likely to be taken seriously. They’re more likely to be told it’s all in their head. And the translation to sexual health means that women are far less likely than men to report concerns about their sexuality to their primary care doctors and get help for it.

RC – Well, I think part of that is because we still grew up with the mindset, and I think this is changing now, but that, this is your obligation. You put up with these things. You put out to keep your partner happy. And you don’t complain about it.

LB – Yeah, that’s exactly right.

RC – Yeah. Well, we can’t change all of the patriarchy now in this conversation,

LB – No. Slowly.

RC – Well, that’s the aim. But you do through your book, talk about notorious sexual desire diminishers that we can address right away in our own lives if we want to. Ways that women, or anyone, can cultivate sexual desire on their own terms. And one that you’ve already touched on a little bit, but I’d love you to expand on is, ‘our beliefs about sex.’ What are the beliefs about sex that set us off course in our desire?

LB – Yeah. One of them, we covered it, and that is, ‘If I don’t have desire, this must mean there’s something wrong in my relationship. Or this must mean I no longer love my partner’. Right?

RC – Right.

LB – Another really common one is, ‘Sex must be spontaneous’. In other words, if you plan sex, it makes it dry and clinical and boring.

‘Sex can only happen at night’. That’s another common one.

‘Sex. Good sex culminates in an orgasm’. So if an orgasm doesn’t happen, then it’s not real sex.

Similarly, ‘Intercourse is the definition of real sex’. And so if we engage in sex in other ways, with our hands, with our mouths, with other parts of the body that don’t involve penetration, that’s not real sex.

‘Sex ends at a certain age’. And for women, that would be menopause. So menopause is the end of sex life. And women have a sexual peak in their early thirties, and after that, it’s all downhill.

Yeah. So I could go on and on. There’s just a handful of main ones, but there’s actually been a lot of research looking at the impact of holding fixed irrational beliefs on sexual response. And the data are pretty clear that the more of these kinds of negative or stereotypical views you have about sex and sexual desire, the more likely you are to be distracted during sex, the more likely you are to have sexual problems, the more likely you are to not be satisfied with sex in your relationship.

So there’s a lot we can do around making sure we have access to good information, that we have accurate facts about sex, and that we’re not persuaded by societal messages around what sex should look like because a lot of them are just frankly misleading.

RC – I’m thinking about that list of myths that you just gave. One was that sex can’t be planned. And you’re saying we can or even should schedule it. And that’s something my partner and I have started doing quite a few years ago. And at first I just felt like this is such a failure on my part that we had to schedule it. Because I felt like it should just be this romantic outpouring that just happened as we were swept into each other’s arms and that was just not happening. And then I thought, “My goodness, I schedule everything else that’s important to me in my life. Like, why would I not schedule this?”

And he was fine with that. And that has been so helpful. And, and I wonder if, if we can schedule different experiences into that as well? And is that unromantic or is that or is that beautiful?

LB – Yeah. Well, I would ask you the question, Rachel. What has been the impact? And you don’t need to answer, but maybe it’s a thought-exercise your listeners can think about is, you know, what has been the impact on you and on your relationship by having these planned sexual encounters?

RC – No I’ll answer this. I will tell you for me, scheduling sex has had lots of positive effects. One of them is that it lets me know on the days it’s not scheduled that I’m not needing to feel guilty, that I’m not needing to feel like.

“You just looked at me romantically or you just gave me a hug. Is that because you’re hoping for a passion filled sexual experience once we get the kids into bed? Do I need to start taking inventory of my desire and energy so that I’m not leading you on? Can I respond warmly to your look or to your hug or is that giving a misleading message?”

Your brain can spend so much time spinning with concern about how you’re showing up. And and I found that knowing, nope, it’s going to be on for us these two nights a week. And we’re both comfortable that, then when we’re heading into one of those nights I can show up knowing, “Okay, here’s the plan. Here we go.”

It takes a decision out. I think that’s part of it. Because there’s so many decisions to be making in a day and that’s one that I don’t have to be making. Does that make sense?

LB – Oh, my goodness. It completely makes sense. Yeah. So it allows you to prioritize it on the times and days when you scheduled it. Just like when you plan a dinner party, you know you’re not going to set the table and get your nice wine glasses out four days in advance. You’re going to do it the day of, when you’re in the right headspace and you’ve prioritize and you’ve set the day aside.

So Planning sex is not only sexy, it can be a wonderful way to fantasize, to anticipate, to plan, to make sure you’ve slept well, to make sure distractions are turned off, kids are out of the room, and that you’ve done whatever you need to do to take care of yourself to make sure your gas tank is full. You want to bring that full gas tank to sex. So yeah, I want to not only normalize it, but in fact celebrate it that planning sex makes for a much better sexual encounter.

RC – One of the comments you make is that foreplay starts the moment, the last sexual encounter ends. And I find that’s much more accessible if I know when the next one is going to be.

LB – Yeah, yeah. It’s like a campfire kindling, right? You don’t go from no campfire to a big raging fire. It’s a slow kindle with the right placement of the sticks and the paper and so that means that over the days or hours or weeks between your planned sexual encounters, you’re maybe thinking about it, you’re planning it, maybe you escape in a fantasy briefly, you make sure you have lubricant. You sort of do all the things that are really important for a positive sexual encounter.

RC – Um hmm. Okay. So our beliefs about sex is one of the renowned sexual desire diminishers. Then you talk about stress. Stress is a big sexual desire diminisher, according to your research. How does stress diminish our desire for sex?

LB – Yeah. You know, stress has become almost that near universal term. How are you doing? Oh, I’m stressed. Everything is stressful, and what we know is that the accumulation of stress, like day to day stress, can be very toxic for our brains. So there’s the physiological consequences of a lot of stress, such as changes in our body’s ability to regulate the stress hormone cortisol. So a normal, healthy stress response system means that we might have a high level of cortisol in response to something stressful, but then the body regulates it by bringing cortisol down. And a person who’s chronically stressed is unable to do that. They have chronic elevated levels of cortisol all the time. And that can have pretty dramatic effects on the organ systems of our body, on the other hormones, on our brain, on our tissues that in a way that directly can impact our sexual arousal and sexual response.

Then, of course, there’s the psychological effects of stress, and the person who is chronically stressed in their mind is distracted, is preoccupied, is more likely to have worries, is more likely to have irrational thoughts. So we come back to those beliefs about sex. Is far more likely to be prone to believing those negative expectations and stereotypes about sex.

So stress can wreak havoc on a person’s ability to become aroused, to feel desire, to reach orgasm. We also know, I do a lot of work with women with genital pain, vulvovaginal pain, a condition called Vulvodynia and stress is a major contributor to their experiences of vaginal pain because of the way stress interacts with the pain system in the brain. So not something we want to be taking lightly. It’s definitely worth examining your own stress levels in your life and getting help in finding ways to manage stress.

RC – Which can feel like a tall and unfair order for a parent whose struggling to keep it all together. There’s that period of postpartum where you’re tired and exhausted and maybe understandably, you’re giving yourself the freedom to realize that you’re just not in the mood at that point in time. But then stress does continue because you’ve got a child that you’re raising. It doesn’t stop then, and then you probably are going to have another child. And you’re concerned for them. Your life is complicated because now you’re not your main focus. Your child has become that. So stress, it almost feels unavoidable.

And I wonder, it seems like for men, it almost can sometimes do the opposite. Like stress for women, it can shut you down sexually. But for men, it almost seem sometimes like it can elevate their sexual desire. Is that true? I’m just thinking in my own very limited research.

LB – Yeah, well, there is actually some data to support that. That stress can be pro-sexual for some men. It can actually lead to physiological sexual arousal like erections in men. And because for men there is a much tighter relationship between physical sexual response, i.e. erections and mental sexual response, if they notice they’re having an erection it can actually trigger sexual desire in their mind for them. Even if the source of that erection is from stress and not from something sexual like their partner or an erotica. So you’re absolutely right that for some men stress can be actually pro sexual.

RC – Which can make dealing with stress even more stressful if you’re in a heterosexual relationship.

LB – Right.

RC – Ok, for all these reasons and more we need Better Sex Through Mindfullness which addresses all of these concerns, and also one last huge sexual desired diminisher I want to ask you about because it’s a perceived biggie for parents, especially for Mom’s, and that is the notion of multitasking.

LB – Yeah.

RC – Is there such a thing as multitasking?

LB – No.

RC – I was very interested to read that in your book.

LB – No, we think we’re multitasking.

RC – We certainly do. Yeah.

LB – Our brains are not capable of multitasking. We switch tasks, right? We read the newspaper, then we take a bite of our food, then we talk to the person beside us, then we glance at the news and listen. Then we come back to our food.

RC – We do our laundry, We watch our child.

LB – We feel like we’re doing all of those things simultaneously, and maybe behaviorally it looks like we’re doing them all simultaneously, but our brains are not doing them simultaneously. Our brains are switching attention from one task to another. And every time we switch the focus from task A to task B, there is a cognitive load. Which means that our brains have to sort of adjust to the new focus of attention, and there are consequences of doing that in terms of slowing the brain down, making more mistakes, feeling less engaged in what we’re doing. And so, yeah, multitasking is definitely a myth.

RC – And how does that affect our sexual desire? Multitasking? Because a parent’s life is full of multitasking, even though it’s not really multitasking. We are doing so many things at one time. How does that affect our sexual desire?

LB – So if you can imagine the person who is engaging in sex and suddenly gets swept away with, “Oh goodness, did I sign that permission form for my kids field trip coming up? Oh my goodness. It was due yesterday and I forgot. Does this mean that they can’t go on the field trip? My kid’s going to be really upset with me. There’s going to be all sorts of consequences.”

Right. And this is happening real time.

RC – Oh, you’re living in my brain, yep.

LB – It’s universal. And so their body might be going through a sexual activity, but because now the attention has shifted on to this story about the kid and the field trip and the permission form, it means that the brain is not fueling that really important brain-body connection that’s important for sexual desire and sexual response. So there is a direct impact on the body’s ability to continue to produce arousal and desire when one is multitasking and thinking about something else.

Musical interlude #3

Thanks for listening to family360 and our conversation with Dr. Lori Brotto. There is more to come!

For our next episode, we’re with Dr. Hillary McBride. Hillary is a CBC podcaster on her own show called Other People’s Problems and author of the award-winning book The Wisdom of Your Body. We’re talking with Hillary about body image – why little children who freely run, roll, wiggle and laugh become so unhappy with their appearance later on in life, and how they can learn to engage and delight within their bodies once again. Most of us have complicated relationships with our bodies and when we work that relationship out we’re more capable of supporting our children on their own journey. Join us!

And now back to our conversation with Lori as she begins to describe how we can be taught to pay attention to our bodies in ways that trigger sexual desire.

RC – Hmm. Okay, Lori, we’ve looked at these renowned sexual desire diminishers. The patriarchy is a huge, huge one. Belief about sex, stress, multitasking. From my understanding, there was a particular question that led to your research on how women cultivate sexual desire. And it was this. “Could women be taught to pay attention to their bodies during sexual stimulation? And would this increase brain-body communication in a way that might trigger sexual desire? Could mindfulness be a way of enhancing that connection?”

And I wonder if I can jump right into something that just fascinated me. And you’ve already alluded to this a little bit, and that is the brain-body disconnect for women. This was so interesting.

LB – Mm hmm. Yeah. Again, lots of research has shown this, and how we measure it is we bring women into a lab. I talked earlier about my sexual psycho physiology lab. So you bring women in, you seat them on a comfortable recliner. Internally locked room. They have privacy. They put on a headset and they’re watching a TV screen in front of them with an erotic movie. And at the same time, they have a small vaginal probe that looks like a tampon. They insert it into their vagina. And this small probe measures what’s the body doing in response to her attending to this erotic film clip? So it measures something called vaginal pulse amplitude, which tells us how much blood is rushing into the genitals while she’s watching this erotic film.

At the same time, she’s holding a mouse, like a computer mouse, and she’s moving this mouse back and forth to correspond with how turned on she is in her mind. And study after study after study, doesn’t matter where in the world the study is done, women are far more likely than men to show desynchrony between their physical response and their emotional or subjective sexual response.

RC – So what does that mean for a woman?

LC – Well, so she might be very turned on in her body. The vaginal probe is lighting up and you see this immediately on the screen in the other room. You can see this huge spike in blood flow that’s happening. And then you look at the screen that corresponds with how turned on she is in her mind or how often she’s moving that mouse. It’s flatline, or maybe it’s increasing just a tiny bit, or maybe it’s going down. She’s actually getting turned off while she’s watching the film. She’s comparing herself to the actors in the film. And so contrast that with the same set up for men and it is usually always perfect synchrony.
As there’s physiological response, there’s a corresponding increase in mental arousal.

RC – Well, again, this is I feel one of the setbacks for women is we don’t have a penis that’s going erect to let us know like “Oh look down I can see what’s happening.

LB – Exactly.

RC – It’s much harder to gauge. Oh. Why do you think that is? Why is that disconnect there?

LB – Yeah, lots of researchers have speculated on why that is. Your speculation is one of the reasons. So just that kind of physical feedback, we call it haptic feedback as simply by, you know, a man being able to see his erection. It strengthens the brain-body connection because he can feel it, he can see it, he can visualize it, even if his eyes aren’t even gazing in that direction.

And for women, the source of their physical erotic pleasure is the clitoris. Far more hidden? You know, unless your hand is there, you really wouldn’t know if your clitoris was aroused or erect. Lubrication is not a sign of sexual arousal. Lots of women lubricate when they’re not sexually aroused and lots of women don’t lubricate when they are sexually aroused. So there’s many anatomic explanations for why there might be more discordance or synchrony in women than in men.

There’s also lots of patriarchal societal reasons. Women are taught not to touch their bodies. They’re taught that touching is bad and dirty and body exploration and masturbation are dirty and wrong and they’ll be punished for it. Whereas it’s celebrated. It’s kind of a rite of passage in young boys. And wet dreams are normalized in boys. And, the box of tissues and the container of Vaseline by the nightstand is normalized in young boys and it is demonized in young women. So those are just a few of the reasons that are probably contributing to that discordance. There’s probably a whole host of other reasons as well.

RC – Well, wonderfully your work is all about helping people, especially women, strengthen their mind/body connection and in your conversations about mindfulness, one of the practices that you give people to do is called sensate focus. I think it’s always with two people to bring mindfulness and to bring connection between what your body is physiologically doing and what your brain is doing.

You say as a species we respond automatically to touch. How does sensate focus work? This is a fantastic practice.

LB – Yeah. So Masters and Johnson developed it in the fifties and sixties, and it involves indeed a couple where one person touches the other person head to toe in a non-sexual way, in a non goal oriented way. And the role of the person receiving the touch is just to tune in to it.

They never used the word mindfulness, but those of us who have written about it since then have very much labeled what they were doing as celebrating and practicing mindfulness.

So the receiver of the touch is just tuning in to the sensations. They’re letting distractions fade. They’re letting expectations of sex fade. They’re not in it for the hope of arousal. They’re just in it for the hope of tuning into the physical feelings that are emerging in the moment. And then after about 15 minutes, the two switch. So the giver becomes a receiver, the receiver becomes the giver. And and now that person has the opportunity to really tune in to what it feels like.

And sensate focus progresses through different stages, beginning with non genital, non breast, non-chest touch and over time and with some training progresses to include more erotic kinds of touch, but with the same goal. The goal is always to just tune in and feel rather than to get somewhere like arousal and climax.

RC – Do you report to your partner what you are experiencing?

LB – Yeah. So after the half an hour of touching, we recommend that couples stop the touching and have a conversation at the end about what came up for them. What did it feel like? How did they feel emotionally? Any struggles that they may have experienced, anything that they would want to do differently the next time they practice? So there is that opportunity at the end for that kind of discussion.

RC – Yeah, I think you said that one of the key factors was that people had to be motivated to want to increase their sexual desire and if they came motivated it works.

LB – Yes, that’s so true.

RC – Yeah, I wonder if the concept of pleasure is problematic for many people? I’m not even used to saying the word. I think it can be really difficult to know our own preferences for pleasure, let alone trying to appreciate our partners.

LB – Yeah, it’s an important point. And the reality is, is that we are not very well practiced in how to have conversations about what our preferences are, what gives us pleasure when sex should happen, that it’s almost easier to jump right in and just do it.

So the practice part, really can’t be understated. It comes about from having day to day and regular conversations with a partner outside of the bedroom. For some people, that may involve scheduling a time to actually talk about sex. You know, what one wants to do, what one fantasizes doing. But also an opportunity to share if something hurts, if something doesn’t feel quite right or someone is having maybe an emotional reaction to what transpired during a sexual encounter.

So there’s no shortcut towards getting to it. Pleasure is something that is very accessible but also takes some time and intention and effort and practice. And again, all of that is within reach.

RC – Yeah. Going back to what we were talking about a few moments ago about scheduling times when you’re going to experience sex together. I think another great thing about doing that is that it lets you relax into days of knowing, this isn’t going to go to a sexual experience. But I’m just going to enjoy being affectionate, hugging, holding hands, sitting close together, getting changed in front of your partner without feeling like, “Okay, this is a sign for saying that we’re going to have sex.”

And you reveal this interesting research that was done on 90,000 people around the world that said that couples in long term relationships miss non-sexual, touching and physical affection even more than they miss any decline in sexual frequency. And I think those things might go together.

LB – Yeah. Yeah, they sure do. That was Pepper Schwartz’s national study, done in collaboration with others.

And it’s so interesting because, you know, it’s also a very gendered phenomenon. And so often we hear women saying, “Oh, all my partner wants, especially if it’s a male partner, all they want is sex. Every touch is the start of a sexual encounter.”

And yet when we actually ask people what they want, very, very often, including men, will say, actually, what they miss most is that non-intimate touching, hand-holding, kissing, the flirtations, all of the things that were far more prevalent at the start of a relationship and that decrease with time. And it’s important to unpack, you know, what our assumptions are about those activities. If one is believing that those activities is the start of a sexual encounter and one doesn’t want to have a sexual encounter, then they’re going to start to avoid those really important non-sexual but still very intimate kinds of exchanges and touches.

So we come back to the central premise, which is communication is the key, and sometimes a touch is just a touch. A kiss is just a kiss. And we want to be including those in relationships. They’re also really important for people who experience pain with sexual activity or perhaps for other reasons, health-related reasons, can’t engage in sexual activity, but there’s still plenty that can be done that’s very intimate in the way of those non-sexual, intimate exchanges. So again, we want to promote those as much as we can.

RC – I think what you’re talking about here might lead really well into one last question that I really want to cover because it’s been so important for me, and that is about spontaneous desire versus responsive desire. I grew up hearing about sex drive and my understanding was that sex was kind of like food or water, that if you didn’t have it for a while, you would become hungry for it and crave it. Can you talk about responsive desire, because this is a game changer?

LB – Yeah, the earliest writings really talked about sexual desire as something being purely innate, something that emerges within like food, like thirst. And we fast forward and look at the research that’s emerged over time and it turns out that sexual desire is much more similar to other emotions in the sense that it is elicited.

RC – What do you mean by elicited?

LB – Yeah. So this is what my dear colleague and friend Dr. Rosemarie Bisson wrote about in the year 2000 was that sexual desire very much is responsive. It occurs in response to sexual triggers. It occurs in response to having concrete reasons or motivations for sexual activity, and then having a context in which it is safe to express that sexual response and perhaps even memories about previous sexual encounters that were positive and pleasurable.

So viewed through that lens, when sexual desire is responsive, it means that it’s much more under our control. There’s actually quite a bit more that we can do in terms of influencing the environment, thinking about different reasons to engage in sex, varying the kinds of triggers and eliciters that bring about sexual arousal and therefore sexual desire. So when we move away from this idea of sex as spontaneous, like a light switch and thus not within our control, we suddenly are much more empowered to consider what are the things that we can do to cultivate that experience of desire?

RC – Well and that’s not foreign to us. I think of something like exercise, like frequently I don’t feel like exercising, but when I get into it, I’m like, “Oh, why am I not doing this all the time? Like it feels so much better. It feels so good.”

LB – Right? That’s exactly right. Yeah. And so it’s not about, you know, the Nike “Just Do It” model, like just do it and get it over with it. It is about contemplating what are the reasons? What’s in it for you? What’s in it for your relationship? And maybe what’s in it for your partner that in turn is rewarding to you? And that is something we can be very deliberate about. The reasons might differ.

On one occasion it might be to celebrate an anniversary, and on another occasion, it’s to feel better about yourself. And on another occasion, it’s because you want to have an orgasm. And on another occasion it’s to give a gift to your partner. And all of that is normal and healthy. And in fact, the more reasons that one can have at their disposal, then the higher likelihood that they’ll move out of that place of neutral, sexually neutral, towards being open.

RC – Just as we close, last night, my husband and I, we have an hour where we just watch TV and eat a little bit of junk food and just relax before we put our kids to bed.

LB – Oh, that sounds lovely.

RC – It is lovely. And I said to him, “Hey, I have an interview tomorrow. And the woman I’m interviewing, Dr. Lori Brotto, she has a Netflix series,” and he was kind of looking me like, “You’re going to bring work into our bedroom?”

And I said, “It’s called the Principles of Pleasure and it’s about women’s sexuality. Do you want to watch it?”

He was like, “Ah, yeah,

LB – Yeah. Great.

RC – So we watched the first two episodes. And just for listeners, fantastic series. So there’s so much more that you can talk about that we haven’t even scratched the surface of in this conversation. So I highly recommend that.

But I’m just wondering if we can close with you talking about ‘belief is everything’, because I kind of saw that as maybe a banner over what that series is about, that who we see ourselves to be sexually is so important.

RC – Yeah, yeah, definitely given how prevalent sexual stereotypes and myths are and how powerful what we think about ourself is in terms of translating into how we feel. The flip side of that is when we can tune into our body and be present to what is already there and let go of judgments, that it gives rise to sexual empowerment, a sense of sexual esteem. And that it’s not bound by age. It’s not bound by the constraints of a relationship or the availability of a partner. It’s something that can be ever expanding over time.

So yeah, I think it gives all of us hope that sex is something that can absolutely evolve over time and that there’s a fair bit that we can do to cultivate sexual wellness and sexual pleasure.

RC – Laurie, thank you so much for your time. I’ve really appreciated this conversation. I have loved reading your book. Highly highly recommend that. And the and the Netflix series. You’re a woman with so much important information to share, and I just don’t know why you’re not popular at every party. If I ever see you at a party, I am lining up to talk to you.

LB – Oh, that’s sweet of you. Thank you so much, Rachel. It’s been a great conversation to have with you.

RC – Thank you.

End Banter
This is a tough conclusion for me to banter with you in some ways…because
Yeah, say why that is. What’s making this awkward for you?
Well, we’ve talked about this as we’ve been putting the episode together. It’s such important research Lori is doing at UBC, and such important information…for everyone, and commenting as a man at the end of the conversation feels…it’s tricky.
Well, yes, absolutely sensitive, but also, I have so much learning to do as well. I grew up in an era and culture where, as the old comment goes, sex was a dirty and terrible thing that you should save for someone you love.
There is so much unlearning and relearning to do…for most people I would think.
In western cultures for sure.
Yeah. I loved this conversation. I would love to ask Lori back again because I have so many more questions.
Um humm. That would be great.
But, with respect for your sensitivity, you were spared putting your own mark into the artistic ending to this episode,
With finding a poem.
Yes. Because Lori had her own suggestion. She said she would love to have Rumi’s poem, The Guest House with her episode because she uses it with her mindfulness groups with women all the time.
And so, with much thanks to Dr. Brotto, for her work and for her time with us, we are ending with that poem. The Guest House.

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice.
Meet them at the door laughing and invite them in.

Be grateful for whatever comes.
Because each has been sent
as a guide from beyond.

Episode 58