Permission for Pleasure
A podcast to educate and equip women with the information and confidence they need to express, experience and enjoy their sexuality. Cindy Scharkey RN, BSN, brings her 35+ years of experience as a healthcare professional to open the doors to healthy conversations about sex. This is a community where you can listen and learn to give yourself permission for pleasure. Visit www.cindyscharkey.com for educational blogs and newsletter.
Permission for Pleasure
The Truth About Desire: Part 1
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Do you want to know how sexual desire actually works and how to cultivate it? Dr. Lori Brotto shares the research-based truth about desire in this two-part episode. Part One includes the causes of low desire, and the things that affect it. If you thought it was all about the hormones, Brotto says, “Mood, sense of well-being, body image, self-esteem, and how a woman feels about her partner turned out to be far stronger predictors of her level of sexual desire than a single hormone.” What you hear in this conversation might literally transform your sex life!
Dr. Lori Brotto is a Professor in the UBC Department of Obstetrics and Gynaecology, and a Registered Psychologist in Vancouver, Canada. She is the Executive Director of the Women's Health Research Institute of BC, director of the UBC Sexual Health Laboratory and author of Better Sex Through Mindfulness: How Women Can Cultivate Desire.
Read my book review of Dr. Brotto's book
ORDER my Book: Permission for Pleasure: Tending Your Sexual Garden
JOIN my Newsletter: Good Education for Good Sex
FOLLOW on Instagram @cindyscharkey
VISIT my website and blog
You know, I I can't um overemphasize enough the impact of energy versus fatigue on sexual desire. And desire is part of the same gas tank that fuels the other activities of our day. And you know, maybe a stereotype or a myth is that there's this separate gas tank that fuels desire. And it doesn't matter how exhausted you are, you'll always have energy for sex. It's simply not true.
SPEAKER_00Welcome to Permission for Pleasure. I'm Cindy Sharkey, your host, and wow, we have a really rich episode for you today. One that can really truly transform your sex life. We're talking all about desire. And friends, because this conversation was so informative and practical, I divided it into two parts for easier listening. Part one focuses more on the causes of low desire and things that affect desire. Part two is more focused on practical tips and ideas around cultivating desire. My guest is the amazing Dr. Lori Brotto, a professor, psychologist, researcher, and author of the book Better Sex Through Mindfulness. Dr. Brodo, welcome to the show.
SPEAKER_01Thanks so much for having me, Cindy.
SPEAKER_00I would love for you to share a little bit about yourself. Just introduce yourself and your work in the world.
SPEAKER_01Sure. So I have uh the real pleasure and honor of being able to do research as a professor in the Department of Obstetrics and Gynecology at the University of British Columbia. My program of research focuses on sexual health, mostly in women. I'm also a registered psychologist in British Columbia, and I lead the Women's Health Research Institute in BC, which is a research institute focused on all aspects of women's health research.
SPEAKER_00Yes, and you you focus a lot of your career on reasons for low sexual desire in women and non-pharmological, meaning not medicine, not drugs, to treat sexual desire. I really appreciate that, that you're that work that you're doing in the world. Tell me a little bit why you're drawn to that.
SPEAKER_01Yeah, um, well, I I think it is so important for women to have options, for sure. And there has been a lot of effort, a lot of research, a lot of pharmaceutical funding that has attempted to be the first to cross the line in terms of finding the female Viagra. So lots of different experimental medications have been tested over the years, including um hormonal medications, namely testosterone, et cetera. And while we do have two approved medications for the treatment of low desire in Canada and the USA, the data indicate that the uptake has actually been quite low. Um, and in part it's because these medications are expensive, in part it's because also these medications have side effects. And I think that we live in a world where people increasingly are recognizing the role of their mental health, their stress, their well-being in so many different facets of their health and life. And as a result, um, really want to take personal steps towards improving their own wellness. So it um there's a real appetite for um psychological and skills-based approaches to improving low desire. And so that's really been the core of my own research over the past many, many years is developing, testing, and then disseminating mostly mindfulness-based, but also education-based treatments for low desire.
SPEAKER_00Yes, and your book, which I highly recommend, is called Better Sex Through Mindfulness: How Women Can Cultivate Desire. So let's talk a little bit about your book, and you provide so many tangible practical tools for women in there, but let's start with maybe some reasons for low sexual desire. People think maybe it's all about the hormones, and that's just one factor, certainly.
SPEAKER_01Mm-hmm. Yeah, and it's a logical first question, which is you know, could my hormones be out of whack? This has been an area of a lot of research that has attempted to answer that question. And I think there's been to date at least two dozen studies that have looked at whether blood levels of testosterone in particular predict whether a woman has low desire or not. And very consistently across those two dozen studies, there's really no relationship. And we can think of examples of health conditions where a person might have even very high levels of testosterone. And if that were true, you would expect to see high levels of desire and you don't. One example being polycystic ovarian syndrome, PCOS, indeed, where the person has has quite high levels of androgens and in fact low levels of desire. So that relationship between blood levels of testosterone in particular and desire simply doesn't exist. And so, you know, it is really important to look at what might be many of the other causes for the person who says, you know, I'm really struggling with desire. I used to have desire, I used to want sex, something has changed, and I can't quite put my finger on what that change is. And it is complex. I'll say that at the outset. There could be other medical factors, certainly health conditions in general. I do a lot of work with cancer survivors, where chemotherapy and radiation therapy and the effects on fatigue, et cetera, can directly impact a person's level of desire. There's a whole long list of various psychological factors, such as body image, anxiety, stress, depression, feelings for a partner, et cetera, can directly impact desire. And then there also might be social factors. So the influence of kind of societal messages about what desire should look like and what desire shouldn't look like. Also, maybe social role expectations can also impact desire. So there for any one person who is really struggling with their desire, there might be any combination of all of those different factors that can be contributing.
SPEAKER_00For sure. And you recently teamed up with some other researchers and published a theory paper called The Heteronormative Theory of Low Sexual Desire in Women Partnered with Men.
SPEAKER_01Yeah, essentially, so this is a theory paper and was written and led by my great colleagues Debbie Herbenick and Sari Van Anders. And essentially it looks at, you know, what is the role of gendered social scripts that play out in the kind of domestic and home environment? And could those scripts directly predispose a person to low desire? So one example would be, you know, and again, this paper, um, while it's a theory paper, it is very specific to heterosexual relationships because things might play out a bit differently in same-sex uh relationships. But, you know, one example would be the kind of maybe stereotypic condition where she is kind of expected to do all the domestic activities of the home, you know, cleaning and taking care of children and making plans for what has to happen, etc. And we argue that the the way these scripts play out in a relationship can actually predispose her to low desire. Um, and there's been all sorts of memes over time that, you know, might suggest that the key to a woman's desire is, you know, having help around the home. Um, either her partner helping or um having other help uh around the home. And in the paper, we speculate on the multiple ways, like the kind of the underlying mechanisms by which those scripts lead to low desire. One could be resentment, right? Um, one could be time. And, you know, I can't um over-emphasize enough the impact of energy versus fatigue on sexual desire. And desire is part of the same gas tank that fuels the other activities of our day. And, you know, maybe a stereotype or a myth is that there's this separate gas tank that fuels desire. And it doesn't matter how exhausted you are, you'll always have energy for sex. It's simply not true. You know, on top of work and caretaking and planning and organizing and cleaning, there's sex added to the list. It's simply going to get the small drops that are left in the bottom of the gas tank. So the invitation in that theory paper was really for the field to think critically about like, let's not just dismiss these um heterosexual scripts that play out in day-to-day life, and rather let's look at them as a possible source of low desire.
SPEAKER_00Oh, 100%, because this is this is what I hear from women that I meet with in workshops, and it so often we don't have the framework around how desire really works. And and so so many women that I meet with feel like you know something's broken with them or wrong with them because maybe they don't have any desire. B they had desire previous, you know, in younger years without the responsibilities like you're talking about, and caretaking that they have now, right, and how that shifts things, as well as just especially the for women with the who are mothers or caretakers, whether uh uh their parents or children, or if they feel like they're a caretaker to their spouse, then then these things, these things all come into play.
SPEAKER_01Yeah, and that is um in in the theory paper, that is one of the four you know possible routes that we talk about is this blurring of the lines of the roles from two lovers to now possibly could it be that she takes on more of a caretaking role of her partner because she's having to put the to-do lists up, because she's having to remind and do in the way that arguably a parent does for a child. And um, there's nothing less sexy than that, I might argue, is feeling like you're babying a partner. And again, what I really um appreciate about the theory paper is we're taking a lot of the conversations and observations that people are having in their life and we're we're putting them out there, and we're saying these are legitimate and real possible explanations and parts of um struggles with desire that we need to take seriously and talk about.
SPEAKER_00Well, and that's that's what I love is it opens the conversation for people to say, well, hey, that's interesting. I didn't even think about that in relation to my desire, right? So helpful for people. There's been so much silence around sex, desire, uh, all of it, that that that's one thing I love about this. One of the other things you brought up in the in the theory paper was the gender norms surrounding sexual initiation. Could you speak to that a little bit?
SPEAKER_01Yeah, so you know, the kind of the gender norms are that he initiates. Uh, and and it sort of portrays women as being passive and receptive, but also suggests, um, and I certainly see this in my clinical practice, is that women perceive a lot of kind of pressure to accept when when that invitation is made. Um, and and it can play out such that it um diminishes those opportunities when actually she does feel desire and might want to initiate, but then again, the gendered script comes in and says women don't initiate, you know, it's not appropriate for women to initiate, or it might throw her partner off. Like, why is she initiating? Um, what's going on here? There might be some kind of skepticism around it. So what is very, very interesting that plays out, certainly in the in the clinical context that I see, is couples just don't talk about it. They don't they don't talk about how they plan sexual activity, right? If if we could just be very open in our communication and have an understanding that it's okay for either of us to ask the other person whether we wanted to have sex rather than this kind of expectation that it's only you and I only accept. Sexual communication, we know from the large, large studies is a major predictor of long-term sexual satisfaction and sexual happiness. In other words, those couples that can talk to one another about what they want, what hurts, what doesn't feel good, postponing sex, can we try something different? That they are able to weather the effects of aging and health issues on their sexual function. It's actually one of the strongest predictors of long-term sexual satisfaction. So the topic of initiation is really um immersed in this bigger topic of sexual communication. And it's it's an area that I think most people could stand to use a bit more training in.
SPEAKER_00Oh, I agree. I agree. I I'm thinking of like every time I do a workshop or a small group, there's always one woman who wants to talk afterwards and says, this conversation around not having any desire and not wanting sex as much as a partner, just I'm out in left field with that because I'm the one who has more desire for sex or wants sex more often. Or I always say, you know, this some of this is just the mantras and the garbage you've taken in that you feel like something's wrong with you that you can't initiate or can't experience desire, or can't have a high appetite for all things sexual, that you're normal. It's perfectly a beautiful way to be. But these women feel in minority, they feel sort of out of the mainstream conversation, so to speak.
SPEAKER_01Yeah, for sure. And that's why having these conversations like we are now are so important because these are topics that healthcare providers rarely ask about. Um, we also know that um women themselves might not even bring up discussions about sexuality when they're struggling with it with their friends or even with their partner. We've seen many, many women who've kind of struggled internally for a long time without really telling anyone about it. So bringing these conversations out into the open, normalizing communication, planning, initiation, um, normalizing the fact that fatigue and stress impact desire. And thus, when it is planned, it should be planned with those factors in mind. These are all really important ways to preserve sexual health among the population.
SPEAKER_00Absolutely. So, Dr. Barato, how do we cultivate desire? I love how you say attention training through mindfulness may be part of the recipe for cooking up sexual desire. Let's talk about what you've learned in your research and how we can cultivate desire.
SPEAKER_01So, you know, we live in a multitasking world where multitasking has almost become like the gold standard. I hear many, many times a week uh reference to people saying, I'm a great multitasker. And yet the science tells us very clearly that we don't actually multitask. When we think we're multitasking, our brains are actually shifting from one task to another. And every time our brains do that, there's a toll it takes on our brain. There's a cognitive load that results in slowing, more mistakes, lack of satisfaction with the tasks that we're doing. But because many of us multitask so much in our day-to-day life, it becomes really hard to turn that off during sexual activity, which is a unitasking task. It's not a multitasking task. There is one job, and that is to show up and be there. So, what we find in our research and others have done this as well is so many people are lost in thoughts during sexual activity. And sometimes their thoughts about the sexual encounter, will it hurt? Will I have an orgasm? Will my partner be satisfied? Will the kids walk in? Will there be an odor? Will I make a sound? Right? All of these kind of sex-related thoughts that come up. And then there's also benign, but still distracting thoughts, you know, thinking about work tomorrow, thinking about did I put the laundry in? Did I lock the front door? Did I turn the stove off? Did I, right? The kind of mundane to-do list creeps in. And these are the these kinds of intrusions into the brain are not benign when it comes to sexual response because sexual response is a brain-body communication and relationship. Sexual response is not a reflex. It's not simply the case of touching the right body part in the right way produces sexual satisfaction and pleasure. It doesn't. If the brain is elsewhere, there can be no transmission of information from the body up to the brain. So for sexual response and sexual satisfaction to happen, the brain and body need to be communicating with one another. And the brain needs to get that feedback from the signals from the body, and then in turn send signals back down to the body to increase response. So distractions, intrusions, catastrophizing, worrying, multitasking directly sever that communication between the brain and the body. And one of the best ways of enhancing that communication is through mindfulness, which essentially is present moment non-judgmental awareness. And so in my work now over the past two decades, we've adapted mindfulness-based programs that exist for depression and pain and anxiety and have adapted them to different populations of people with specifically sexual concerns.
SPEAKER_00Yes, and you've seen a drastic improvement for people who actually practice this mindfulness or attention training.
SPEAKER_01Yeah. And um, I can say that now because it's been 20 years of studying this. In the beginning, I was skeptical. I remember the very first study that I had done when I was a um a postdoctoral fellow at the University of Washington. It was with cancer survivors, gynecologic cancer survivors. And I had learned about mindfulness through a completely separate route. I was doing some training in dialectical behavior therapy, learned about mindfulness as a way of helping people with extreme emotions to kind of ride out those emotions and stay grounded and stay present. And what struck me at the time was the stories of the cancer survivors I was hearing about kind of the disconnect from the body, not feeling any sensations in the body, the sense of betrayal and the extremes of emotions with the sense of loss and et cetera, but also gratitude for having survived their cancer. And it just struck me that, you know, could mindfulness possibly be a tool for this group of survivors? So that's really how it started. I was learning, I immersed myself in the practice, started reading books, started going to groups, started practicing mindfulness in my life, and then was teaching the skills I was learning to cancer survivors and then measuring the outcome. And so the very first study, there was no control group, it was a small, a small sample, I think 25 or so survivors over the course of three months, and was blown away that, you know, not only did they say that their sexual response increased from before starting the mindfulness to after, but they came into our lab and we measured their sexual response through a little vaginal probe. So they would watch an erotic film and then we would measure their actual capacity for sexual response in watching the film. And from before the mindfulness program to after, there was an increase. Didn't believe it. I thought it was just fluke or maybe there was something wrong with the equipment. So of course I replicated the exact same study in a larger sample and with a control group. The effect held. It was then that I said, there might be something here. Yeah, I I can answer your question, Cindy, definitively today and say there is strong evidence that mindfulness can improve desire, arousal, satisfaction, decrease sexual distress, and that people are very motivated to continue practicing it as our data tell us. And when they do that, the effects are sustained.
SPEAKER_00I love hearing that. And because I learned a lot through your book, Dr. Brato, and I have been practicing, you know, what you taught, and it's made a huge difference in my own life. So I'm just a believer. I'm just a believer in what you say in the book, which is you know, attention is a key factor to sexual arousal, and inattention is a potential inhibitor of a healthy sexual response. Attention versus inattention. Friends, we'll pause here with that phrase on our minds. Thanks so much for listening. Please be sure and cue up part two where we get into those practical tips and processes to increase and cultivate your desire. Please don't forget to leave a review on Apple Podcasts, and you can now rate the show on Spotify as well. Please take a moment to do that and help our community to grow. For our pleasure practice, I'm going to leave you with just a few lines of poetry from Mary Oliver. Instructions for living a life. Pay attention. Be astonished. Tell about it. This is good instruction for learning to give ourselves permission for pleasure.
