The Pelvic Floor Project
Embarrassing symptoms deserve better conversations.
Whether you're dealing with bladder leaks, prolapse, pelvic pain, painful sex, erectile dysfunction, constipation, pregnancy, postpartum recovery, or simply wondering if what you're experiencing is normal—you're not alone.
Hosted by pelvic floor physiotherapist Melissa Dessaulles, this podcast helps you understand how your body works and why symptoms happen. Through conversations with leading researchers, physicians, surgeons, sex therapists, midwives, psychologists, and other experts, we translate the latest evidence into practical information you can actually use.
No myths. No shame. No confusing medical jargon.
Just honest conversations that connect the dots—so you can feel informed, confident, and empowered to make decisions about your health.
The Pelvic Floor Project
118. Why do I not want to have sex? Is it my pelvic floor? With psychotherapist, Lucy Snider
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In this episode, I sit down with psychotherapist, Lucy Snider to discuss:
- Low libido, low sexual desire
- Spontaneous vs Responsive desire
- Pain with intercourse
- Is something wrong with me if I don’t want to have sex?
- Is it my hormones?
- Differences in male vs female anatomy when it comes to arousal?
- The sexual response cycle (desire, arousal, orgasm, resolution)
- How is the pelvic floor related?
Lucy Snider (she/her) is an experienced Psychosexual and Relationship Psychotherapist and Sexual Health Educator based in Kelowna, BC. She has been working in the field of mental health since 2009. Originally from the UK, she spent 10 years in London working in sexual health for the British National Health Service (NHS) and in private practice. She received her master’s degree in Psychosexual and Relationship Therapy from the renowned Tavistock Relationships training centre in London. Lucy has extensive training and experience in working with relationship and sexual difficulties, including with survivors of intimate partner and sexual violence. She also has considerable experience in the field of sexual health and sex education. She can provide treatment for sexual dysfunction where no organic cause can be found and is experienced with helping people explore their sexual and gender identity. She is an approved hormone and surgical assessor for TransCareBC. She specializes in helping couples and individuals who are experiencing relationship or sexual difficulties by providing a safe, non-judgemental space for you to freely explore these sensitive issues as well as practical help and advice to help you overcome your problems. She works in a holistic, sex positive way with all clients regardless of ethnicity, gender, sexual orientation, age, or disability. She uses an integrative therapeutic approach which combines a variety of therapeutic models to tailor an individual treatment plan for each client.
HOW TO CONTACT LUCY:
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mel@pelvicfloorprojectspace.com
Welcome to episode 118. Today we're talking about sex. As a physiotherapist, I had no idea I would be doing as much education on the topic of sex, but to help the pelvic floor, you need to understand how it all works. This topic comes up all the time, whether my clients bring it up or I ask. Symptoms such as pain with intercourse, low libido, decreased pleasure. It's easy to think something's physically wrong with your body, and I think many people hope that it's a quick fix with their pelvic floor. In this episode, I'm joined again by psychotherapist Lucy Snyder, and today we're going to be talking about the sexual response cycle and what we actually need for desire, arousal, and orgasm. Listeners, we do not learn enough about this topic, and most of our education comes from what we see in movies, porn, or books, which are not great representations of how it really happens. And when it doesn't go this way, perhaps this is why so many people think something's wrong with their mind or their body. Please share this episode with your friends and maybe your partner. I hope it sparked some much needed conversation. I'll be right back with Lucy Snyder. Listeners, have you ever heard of the benefits of using a high quality compression garment during pregnancy, after birth, or to address feelings of vulnerability, maybe in your tummy or heaviness in your undercarriage? Did you know the evidence tells us that using these garments can decrease pain, ease apprehension, and increase the ability to move with comfort in your day if you have these unwanted symptoms? I'm grateful to have SRC Health as a podcast sponsor, and I want to take the time to tell you about their high quality products. 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Low estrogen means drier, more sensitive tissues and can result in UTI-like symptoms, pain with intercourse, or feel like an irritated feeling from just wearing underwear or sitting on a bike seat. That's where iris fits in. A female-led Canadian company with a daily vaginal moisturizer for baseline discomfort or a water-based lubricant for moments of increased friction, like intercourse. Vaginal moisturizers help alleviate symptoms of low estrogen by replenishing moisture and improving tissue health in the vaginal area. Iris products have an ideal pH of 4.5 to complement your vaginal microbiome, and they have no unnecessary ingredients like flavors, fragrance, or glycerin. Check it out at lovemyiris.com and enter the code PelvicFLOREPROJET for a discount. All right, Lucy Snyder, I am thankful to have you back a second time. It's always so nice chatting with you. I see many people alongside yourself and other people that are also working in the area of psychotherapy. I love that we can tie together the physical and kind of emotional or psychological components for people. My favorite is when they feel like what we're talking about in our physio sessions kind of complement what they're working on with someone like yourself. And so today we're gonna talk about sex. And and this like this is not something I thought like when I was became a physio, I did not think that physio and sex education went together. It's crazy how things start making more sense as you go. And I really wanted to have an episode for people that they could take home and possibly listen to again or maybe share with their partners in a non-threatening way. Because so often people come and they might not bring up that they have issues with sexual intercourse. Like it might be that they're coming in for different reasons and they also share that that is a problem that they want to address. But I always ask to, are you sexually active? And if they say no, then I always ask, tell me more. Like, is it something that you'd even like to be? And and and and why not? And just so that I can understand a bit more as to you know their interpretation of of of what's going on, but helps to open the door of conversation. I feel like a lot of people, when they don't enjoy, if they want to enjoy sex or in any type of intercourse, whether it be penetrative or not, if they want to, but it's not something they do enjoy, it's easy for them to think something's wrong with them. And so I think it's such a complex topic, and I look forward to having it with you. So before we keep going, will you share a little bit about yourself?
SPEAKER_02Absolutely. Uh, and thank you for having me back. Um, always a pleasure. And you're absolutely right. I think these, you know, when I refer clients to you, I know that it is going to mirror the work. But I say that to clients as well. I say, like, look, this is gonna dovetail with what we're doing. So I think that is nice for holistic wraparound care. Uh but yes, uh a little bit about me. So I am a sex and relationship psychotherapist in BC. I'm also a registered clinical counselor, approved clinical supervisor, and I work mostly in private practice, um, and my practice specializes in sex and relationship issues. Um, I worked for many years at back in the UK in sexual health. So I do have a little bit of a medical sexual health background. Um and I also work at the Central Elizabeth uh Fry, Central Okanagan Elizabeth Frye Society, uh where we support survivors of intimate partner and sexual violence. Um so another big chunk of my work is supporting people who have experienced sexual trauma. Uh so yeah, that's me.
SPEAKER_00I think it's and it always is a topic that we don't necessarily feel comfortable talking about. Like it's one of the most intimate conversations. I don't think many friends talk about this. And and I think, especially if you're if your friends know your partner too, you know, you don't want to throw anyone under the bus or you don't want to make it sound like there's something wrong in the relationship. And so I think a lot of people will secretly listen to this to learn a little bit more.
SPEAKER_01Here's the thing.
SPEAKER_00Before before I get you to start talking a little bit, I want to share maybe some of the most common things that I hear as a physical therapist that people come in with. Um I don't want to have sex, like I have no desire. I feel like I could go the rest of my life without having it. It hurts, it doesn't feel good. Um, or there is less sensation. Like I just don't feel as much as I used to, possibly after like they may have an event that they tie that to, like after a birth, or maybe after some sort of trauma, like a medical trauma. Or I had one lady not that long ago that had um started as um like an older woman having flashbacks around a such sexual trauma as a child, and as she was reprocessing that, everything changed for her sensation-wise. Um, or just like it's just they'll describe it's not the same as before I had babies. I must be damaged. Those are some of the most common things that I would say that I hear. And I want to maybe get you to start a little bit around kind of like why, what are some of the things that you notice when people first book an appointment with you? What are some themes? I this is a big part of your caseload. So, what other things do you see pre-people come to you with?
SPEAKER_02For sure. So I would say I really agree that I also see a lot of that. I think the most common issue that causes couples to seek out relationshipslash sex therapy is what we typically refer to as mismatched desire, which typically just means one person identifies as having a higher desire for sex than the other person, right? So there's kind of a mismatch. So it's definitely the most common reason. Um I would say that, like, of course, like there's no um like hard and fast rules, but generally speaking, it's more common for women to be the identified partner as having the lower desire in a heterosexual couple. And we'll talk a little bit about why that might be. Um, but certainly that is a very, very common presentation for me. So I do either see couples coming together trying to work on that, or very often I do see women coming on their own and saying exactly the same thing. So saying, you know, I just don't really have this desire to have sex. I could go the rest of my life without having it. Um, you know, I there must be something wrong with me. I wasn't like this in the beginning of our relationship. Um like very classically, uh, the um I do enjoy it once we get going, but I have no urge to initiate or I don't ever really think about it is a very common one as well. Um, alongside, like you're saying, maybe the very like obvious, like it hurts when we do it, or I have pain, or I have lack of sensation, or it's just not that fun or pleasurable or enjoyable. Um, but certainly the overarching um feeling seems to be there is this is not okay. There's something wrong with me because of this, and this needs to be fixed because it's creating problems in my relationship, right? So that is that is often the main thing that comes out of it, right?
SPEAKER_00And it's funny because I think you and I will probably end up at some of the same conclusions, but we will start in different places. Because I think like I'm just gonna talk a little bit about as a physiotherapist. If I think like when they come in and they're describing maybe that some of these symptoms or lack of desire or lack of arousal, I know that there's lots of things to consider, but I have to meet them where they're at because I have to first ask, like, what do you think is going on? Or or tell me why you think this is happening. And they think of me as with the pelvic floor. So I think first I almost need to help them understand their pelvic floor and how it works. Um, you know, what do those muscles look like? How do they behave? How are they related to our brain? How are they related to our nervous system? So that we can start with like, okay, so physically, let's talk about how this all works. And then generally I like to put help them put the dots to like connect the dots to still in until they start to realize, oh, this is related to something bigger. And so I want you to kind of start now because that's where I I would start physically. I'm guessing that you rarely start there with, you know, like the physical pelvic floor or the physical entry point, maybe if if someone's having penetrative sex. But um a lot of times I think that's where it comes for you, and that's why you might refer out. Can we talk a little bit about let's say um with some of the things you're talking about, like where do you start and how do you explain this to people? Like what's going on behind the scenes um in the body, in the brain, when we're talking about sex and and desire and arousal and even wanting to absolutely.
SPEAKER_02So, yeah, one of the um most important things to understand is like the biggest sex organ in the body is the brain, right? So a lot of this does come down to how the brain is interpreting sexual information. So when we look at like commonly misunderstood concepts in our society, so people talk about sex drive, and they often will say things like, I don't have a sex drive, I don't have a libido, um, or I have a low libido, and these are things that people say as if they're facts and they're not and they're not. So when we talk about drives, drives are things that keep us alive, right? So we do have drives, biological drives. For example, we have a drive to eat food, we have a drive to drink water, um, we have drives to that are all about self-preservation, right? Because as human beings, we're wired for survival. So we do have these like intrinsic biological mechanisms that will drive us towards certain things that keep us alive. When we talk about interest in sex, sex is not a drive in that same way. Sex is very much about how does your brain perceive this? Our brains are wired to seek out pleasure and avoid pain. So, very simply put, if your brain is associating sex with pain, obviously, or just like boredom, not that fun, pressure, anxiety, it's a chore, I feel like I just have to do it. If your brain is associating sex with any of these things, it is not going to feel motivated to engage in that thing. If someone says to you, hey, do you want to engage in this thing? And your brain goes, Well, no, that's not a fun thing. We're not going to be motivated to engage. But it's important to understand that that's that is coming from the fact that your brain is associating sex with these negative attributes. That is not coming from this like inherent biological place that we either have or we don't have. And I think that is the first thing that's really important to understand because again, it goes back into this idea that there's something wrong with me. You know, often as well, like you're saying, you know, people come to you for the physical stuff. Is it my public floor? Even though people are coming to see me, I often get like, well, I saw my doctor and, you know, I'm having all these tests done because I think it's hormonal. But my doctor suggested that maybe I come and talk to you. So I thought, hey, I may as well. But what they're saying is, I don't really believe that it's psychological. I don't really believe that you can help me. I think it's going to be a medical issue. And that's understandable, right? We it we want it to kind of be a medical issue in some ways because that's easy to fix, right? If your blood test comes back that you're deficient in some hormone and you just get a pill to fix that, great. Like that would be very lovely and easy. Unfortunately, that's just very rarely the case. Um, and what we're looking at is much more likely to be uh this um brain association piece. So again, it's understanding that like we're often not talking about this idea that there's something wrong or that there's a deficit or there's a problem. We are more just talking about like, okay, let's look at your association with sex. And so that would be where I would start to really unpack for this person their experience of sex. And very often that's where we start to hear, like I said, well, yeah, it's, you know, it's fine. Or, you know, it's the same thing that we've always done, or we have this formula that, you know, works most of the time, or you know, or I feel like I'm supposed to do it. I feel like it's something I have to do, it's a duty, it's a chore, it's uh this is what you're supposed to do in in a relationship or in a marriage, so that's why I'm doing it, right? But again, we can start to understand, okay, well, it sounds like this is not super fun for you, right?
SPEAKER_00Well, I think about I just I think about one woman that shared with me the other day. She's like, I'm having a really hard time because we have a new baby, and um my husband sees I there's something about me being a new mom and the changes in my body that makes him very attractive, attracted to me. Like he's kind of like touching me affectionately all the time, and it comes from a very kind of like loving place. But I'm having a really hard time right now. Before I might I might have been interested in this, but right now I just feel like my breasts are for my baby, and so I do not see them as like you know, sexual parts of my body. I'm feeling my tank is empty, so I can't even go there. But but um that's a big one I find for postpartum women is just like yeah, I can't, I can't get there, and he he doesn't understand.
SPEAKER_02So so now we're talking about context. This is another piece, right? So we experience everything in context. Um, if you think about maybe somebody tickling you while you're in a good mood or even when you are aroused, that would probably be fun or a pleasurable experience. But if somebody tibbled you when you were already irritated, that's probably going to be a very unpleasant experience, right? So same stimulation, different context, different experience. Right. And so another part of um understanding ourselves sexually is understanding we all have different contexts that will either motivate us towards engaging in sex, positive context, or context that will motivate us away from sex in negative context. And yeah, that will change as lots of things do uh with age and with life changes and things like that, right? Um, so again, I think what happens there is like understandably there's perhaps maybe some mourning, this grief lost over the person that I was before I had a baby or before we got married or before we got these busy jobs or whatever, right? We we go through these life transitions and it's not that they're not positive or that we don't love our babies, um, but there's still, you know, recognition that like there's change and with any kind of change there will be lost, right? Um and so I think that shows up in in the way that it's like it's frustrating that maybe I used to enjoy this thing and now I don't anymore. But instead of, you know, just looking at that again as like, well, that means there's something wrong with me. What we need to look at is like, well, no, like can we help you to identify what would be positive context for you and what would be negative context for you? And then hopefully we can work to increase positive and decrease negative, and we're gonna create more opportunity for you to feel like you can engage sexually, right?
SPEAKER_00Well, and this is where all the differences come in. And I think that's what I try to get across to everybody is that you know, this is not going to be experienced the same by everybody, but just again, the understanding and this one lady that I'm talking about right now, as we talked about it more and more, she's like, I think I know what I need. I just need a little bit of time by myself to get someone off of me. And then I think I I think I will get there. Like, and no two people this say the same thing, but I think as she talked through it, she's like, I think I know what I need. I need um I need him to understand what I'm going through in the day. And I need to just walk out and leave him with baby a little bit more because I find that attractive when he can manage baby.
SPEAKER_02Perfect. Exactly. Such a good example of someone that's starting to think about like what is my positive context, what is my negative context. Okay, how can I get this positive context met, right?
SPEAKER_00So, can you talk a little bit about um maybe talk a little bit about before we talk about some specific examples around maybe how people are affected? Can you talk about like there's kind of a cycle that often we go through when you know we need to have desire, we need to have arousal. I think a lot of people get a little bit confused about like, is something wrong with me I don't if I don't have orgasm. Like, can you just explain a little bit about kind of a cycle that we go through in generic explanation at the beginning? And let's talk about how people have differences. Absolutely. And um, what might be happening at different stages.
SPEAKER_02For sure. So um, yeah, so what you're kind of touching on is again in the biz, we talk about the sexual response cycle. Um, so like you're saying essentially what happens for somebody when they uh from start to finish during a sexual experience. So one experience might be starting from a place of feeling desire. So again, desire is a thing that's commonly misunderstood and and um mislike talked about in our culture. So we talk about desire for something or the urge, wanting to engage, right? So I might start with desire. I might also start with arousal. Arousal is the physiological changes that happen in our body to get our body ready and prepared for sexual intimacy. Uh, common changes are gonna be uh increased heart rate, uh, increased blood flow to the genitals. So both men and women are gonna experience engorgement of the genitals with blood, which is gonna help with sensation and pleasure. Um, for women, we're gonna see uh lubrication of the internal vagina, uh, contraction of the pelvic floor to lift the um uterus up out of the way to create more space at the back of the vagina, as well as things like maybe like uh redness of the skin, uh sweating, um you know, feeling that we're breathing a little bit more quickly. So these are these this is arousal, right? The physiological changes in our body. So we can also start there. That might also be our starting point. So either of these, either desire for sex or a physical, physiological arousal in the body, or both of those at the same time, right? If we start there and then we do engage in some kind of sexual intimacy or connection, typically it's quite a short road to having a good time, enjoying ourselves. Um, if we then do get to the point of uh achieving orgasm, that is typically because we have reached a high level of arousal. Um orgasm is uh essentially release of energy from the nervous system that is built up during the arousal phase, accompanied by rhythmic contractions of the pelvic floor and typically a sensation of euphoria. And for men, there is also ejaculation. Um so we may achieve that. Might not. And then resolution, which is when everything goes back to baseline. So heart rate goes back to normal, breathing goes back to normal, blood goes back to where it's supposed to be. So that might be one experience of a response cycle. And typically, if that is our starting point, we refer to that as spontaneous desire. Because when our starting point is desire, nothing sexual is happening. So that desire for sex is spontaneous, it's coming out of nowhere, right? Spontaneous desire is typically more common when we're young. And typically speaking, is also a little bit more common for men. But also in terms of how our society talks and promotes and shows how sex happens. Spontaneous desire is very much the only way really we talk about desire for sex. And it's this the way that's kind of portrayed on film and in media and television, things like that, right? It just happens. It just happens. Two people just look at each other, they both seem to have this urge at the same time miraculously, come together without talking, have some kind of amazing sexual experience of both orgasms simultaneously, right? That's what we're shown. So it makes sense that people kind of think, oh, well, that's how sex happens, right? And again, it can absolutely happen that way. It's just not the only way that it happens. Okay. So what is the other way? So the other way is if we're not starting from a place of spontaneous desire or arousal, we're actually starting from a place of neutrality. So if we are neutral about something, it is just that. If someone says, Hey, do you want to have sex and you're neutral, you're like, I can have sex, I can also not have sex right now. Like these are the same for me, right? I'm neutral. Okay. So what can happen in a neutral space? Well, we can still either seek out or be receptive to uh sexual intimacy. The problem is, is because of this like reinforced belief that we're supposed to start from a place of spontaneous desire, if someone says, Hey, do you want to have sex and you're a neutral, most people will interpret that as I'm not in the mood. So a lot of people will say no in that neutral place, and that will shut down any opportunity for sexual intimacy straight away. So there's a little bit of a pivot here where we can start to understand, like, if I'm neutral, maybe I can still think about that a little bit differently. So I can still seek out sexual intimacy from a neutral place. I can still potentially initiate or or suggest some kind of connection from a neutral place, right? Um there was a study that was done about people's reasons for seeking out sexual intimacy. Do you want to hazard a guess as to how many reasons they found? Oh, like I don't know, 10? 10? Okay, 275. Oh my god. Yeah. So again, there's this idea that the only reason that we would seek out sex would be because we are experiencing desire. And that's not true. They found all of these different reasons. We can probably think about some of them. You know, you want to feel close to your partner, uh, you want to increase uh emotional intimacy, um, stress relief, uh, repair after a fight, sleep aid, make a baby, right? You can think about it, right? But you know, again, if we're thinking from this place of neutrality and we start to think about, well, why would I want to seek out sexual intimacy? And we have these other reasons that are personal to us, not about what anyone else is doing, maybe gives us more opportunity to reach out to partner, right? So seeking out is one thing we can do. Being receptive is another thing we can do. So being receptive is someone says, Hey, do you want to have sex? And and you're neutral. And so the question can become, are you open? Is there a willingness to engage? And that is an important question, right? There is gonna be like a yes or no to like, am I willing to engage? Um, the analogy that I use, and if any of my clients are listening to this, they will laugh because this is the same analogy I always use. But the the analogy is if your partner says, Hey, do you want to go get pizza? Right. And if you are generally neutral about that, you're gonna be like, Yeah, I mean, I could go get pizza. I could also just stay here and not like I'm neutral, right? So your partner's gonna say, Are you willing to go with me? Are you willing to get up off the couch, put on your pants, get in the car, drive to the restaurant? Are you willing? And again, there's that question of willingness, and you're gonna decide, okay, yeah, sure, I'm willing to go with you. Great. Okay. So now we go there. Once we get to the restaurant, we see and smell the pizza. Our belly starts to rumble, our mouth starts to water. Now we want pizza. So our desire for pizza was in response to physiological arousal in our body, right? And we call that responsive desire. So again, if you've cracked my you know amazing code analogy, you know, it's again back to neutral. Hey, are you willing to engage in something? Yeah, I'm willing to engage. We start, we are exposed to some kind of stimuli. Our body becomes aroused, that physiological arousal in the body, then desire. So desire is like the fourth step in that journey. And that is that is not that there's something wrong with you. Uh, it's not that that's a problem. That is just a different way of experiencing desire from maybe your partner who started in that spontaneous place. But these are very normal experiences. Most people in life, most things are can be charted on a bell curve. So most people will experience both spontaneous and responsive. But there are some people that uh only experience responsive. There are some people only experience spontaneous. Most of us are in the middle experiencing both. Um, but yeah, that you know, it's just understanding the difference, right?
SPEAKER_00Totally. And I would say like a couple of things that I that come up quite often would be that um like I almost don't have they'll they'll say like I almost don't have time. Like it's almost like I feel the pressure right away. Like I just need to be given some time to think about whether I want to, or you know, I've already gone till something's wrong with me. That's one thing that I hear a lot. And then another is that in your example, like in your pizza analogy, it's almost like the pizza's not good. And so, and and this is where a lot of the like I look forward to talking to you a bit about this because it's not that it's again, it's not that the person, I think sometimes these people are just like, well, and that's just obviously the way it is. Like that's obviously just what it's gonna look like for us, and therefore I'm having a really hard time wanting to go for the pizza because the pizza style. Absolutely. And I think this is where the lack of education I look forward to you kind of helping people understand is that sometimes like you just need to figure out what kind of pizza you like because absolutely because um I think that again, sometimes the partner is possibly not offering good pizza, right? Like 100%.
SPEAKER_02So again, um, what I say about this is imagine your favorite restaurant, okay? Like the the most favorite restaurant that you enjoy going to, imagine, okay. Imagine you won a competition where you got free dinner there every night for a year. How quickly are you gonna get bored of eating? Exactly. Okay, now imagine there's only like two or three things on the menu that you're allowed to pick from.
SPEAKER_00Yeah.
SPEAKER_02Now how quickly are you gonna get bored? Yeah. So yeah, it's exactly the same. And actually, interestingly enough, when they did studies about this, um, women's brains require more novelty than men's. So typically, men, you know, we joke in the UK about meat and two veg. So men will have the same dinner, which is meat and two veg every day for the rest of their lives and be fine with it. Um, women need more novelty. We our brains will basically get bored more easily. So you're right. Like it can't, it's not that we maybe don't necessarily enjoy what's happening, but if it's exactly the same every single time, then yeah, inevitably we're the the brain is just going to start to feel like this is not super fun. It's just kind of a bit boring. I've done this before, I and therefore I'm just not really motivated to engage in this.
SPEAKER_00Listeners, I know many of you are physios that are perhaps new to the area of pelvic health and feeling like you could benefit from some guidance as the complexity of your caseload goes up. I offer mentorship and I'm here to help. Let's figure out a structure that works best for you. My contact details are in the show notes, so please do reach out. Also, too, Lucy. Like, I think there's a also a misunderstanding. Like, I'll explain that, you know, in in male anatomy, with with the engorgement of the genitals, like blood flows to the penis, the the shaft of the penis gets hard, it fills with blood, and it feels good to a man when there's like friction on that, right? And they I think quite often we're led to believe that the same thing feels good to women, that basically in in heterosexual relationship, like penis and vagina sex should the same thing should feel good to a woman that feels good to a man, right? And so I think that sometimes that's what people share is that um, well, it doesn't feel good, but we have to back it up and explain like your your organ that it that that um engorges is different. It's located up here. And sometimes you need a little bit more time for that to become excited or the neon light to come on, and the friction inside your vagina is not necessarily going to be what feels good to you. So can you talk a little bit about that? Because that is, I find, where people think their pelvic floor is the issue, when really it's more that there's just a lack of knowledge, I think, around like the difference between female and male anatomy.
SPEAKER_02Absolutely. And so, I mean, you're speaking to the biology, which I will talk about, but I there is also the sociology of this. So, you know, again, in our society, we kind of have this idea of what sex is. You know, we do live in unfortunately a heteronormative, cisnormative society. And so when if you were to ask most people, hey, what's sex? Most people are gonna say, oh, well, a man and a woman, a man gets an erection, puts in a vagina, ejaculates, that's sex, right? And we actually have a term for that. We call that penis and vagina or PIV sex. Um, and again, it's kind of not only is it kind of held up as this kind of like default of like what sex is, it's also kind of held up held up on a bit of a weird pedestal around being like the gold standard of what sex is. And so there's a lot of the ideas around like if we're talking about having sex, that's what we're talking about. Going back to my menu, that's the one option that you have on your menu. Um, and that we have to do that every single time, right? So again, you know, there's this pressure on it, it's not that fun. And that also I think contributes to people's maybe experiences not being that great. Um, but yeah, and so in terms of sensation, um, I can't remember if you I can't remember the exact stat on this. Is it the first third of the vagina is has nerve ends endings and the rest of it doesn't? So there's no nerve endings further down inside the vagina. Um, whether or not you've had, of course, like difficult births, if there's scar tissue, um, if there's uh issues with um lubrication, we should always be using a lube, but you know, sometimes it can feel like there's maybe friction or burning, um, skin conditions, you know, just not being aroused enough, right? There's lots of reasons why penetration might not be super like, you know, on one end of the spectrum, painful, the other end of the spectrum just not super pleasurable, right? Versus when we look at, of course, the clitoris, which the is predominantly internal but has lots of different access points, if you will. So we have the glands clitoris, which is the part of the clitoris which is visible with the naked eye, the bit that you can see externally on the body, but that's very small. It's only about you know the size of the tip of your pinky finger, has a lot of nerve endings. For some people, actually almost like too uh sensitive at times for direct stimulation there. But we can look at you know, stimulating the rest of the vulva, the labia, um, the perineum, and then even the rest of the body, right? Again, the brain is the biggest sex organ. So when we start thinking about perceptions of stimulation, that can be anything: breasts, nipples, like having your hair brushed, like having, you know, a sensual massage, right? Whatever is kind of coded for you as being pleasurable, enjoyable, fun, exciting, whatever. Again, to quote Emily Nagoski, she talks about pleasure is the measure, right? That is what we should be striving for. What do you find pleasurable rather than like, oh well, sex means penetration, so I guess that's what we're doing, even though I really like that or it's just not super fun for me, right?
SPEAKER_00And I think I think that's one of the biggest things that comes up is that the education around like this is not what it needs to look like, and just the education to and I think it becomes awkward for some of these clients, like um around like having that conversation with their partner. How do I explain that maybe what what we always do is not doing it for me, right? Because I think that they're like, Well, I don't want him to think or her to think that I don't love them or that I don't appreciate them. It becomes a very um hard thing. I think when you can see when they learn about it, yeah. I feel like I have to be creative with how to send home homework that their partner can read without feeling criticized, maybe, or kind of like, oh, I'm there's a lot of pride in in me being able to help you with pleasure or what have you. Right. I think that that's that becomes, I think, one of the most awkward parts is like, how do we now talk about this together and start back at square one sometimes?
SPEAKER_02Absolutely. You know, I do I completely hear that, and I have a lot of clients who will say similar. But in my experience, like anything that you're bringing to your partner that has the potential to improve sexual intimacy typically is gonna be well received. So I think often it is just about understanding that like we're coming at this from a from a point of view of like, we want to make this better and more fun and more pleasurable. And most people are gonna be on on board with that, right? Um, but yeah, you know, what I often talk about with that is we are all creatures of habit, right? You know, that is in terms of like even like neural pathways in the brain. If you use a pathway often, it gets stronger and then it just becomes automatic to use that one. That's how we build habits. Uh, it's as if, you know, if you were to leave your house and walk over your lawn at the same place every day, at the end of the month, there's gonna be like a little path where you've walked, right? And then your brain is just gonna automatically go to that path. You're not even gonna think about it. So, you know, we are all creatures of habit. That's very easy to do. Sometimes with sex, we will even figure out a formula that kind of works, right? Often people will say, like, yeah, we we kind of do the same things, and it does kind of work. So it kind of makes sense. But it's just again, it's understanding that, like, okay, but that's probably not super exciting, super fun, has the potential to be a little bit boring. We're not saying stop doing that if you enjoy it, but can we just broaden our definition of sex, right? Again, I do use a menu analogy. I say, like, look, let's think about all of the things that you would consider sexual, sensual, pleasurable, fun. If you were to put them on a menu, you know, the more choice you have on your menu, you know, the more you're going to increase novelty and fun and also opportunity, right? Because then maybe we're going to be able to have things that, you know, things that we can do when we have a little bit less time. You were talking about the busyness, right? You know, things that take a little bit less time, things that take a little bit less energy, things that we can fit in that make sense in our schedule, rather than again, if sex becomes this like it's it has to be this one thing or nothing, again, we're really reducing the amount of opportunities we might have to fit that in, right? So we're broadening, increasing, adding to. Yeah.
SPEAKER_00Sorry, I didn't mean to it's okay. Would you say then that kind of like that's one of the first things that people can do is almost like come up with their own menu of what's interesting to them in an ideal menu, what would be on there? Because obviously each partner might have a different menu. So, how like how do you suggest? Because I well, I think some people don't know what's on their menu, right? Because maybe they haven't explored enough. But can you give some ideas then for that for people if they're kind of like, okay, I'm gonna start looking at this a little bit differently. Suggestions on where to start.
SPEAKER_02Absolutely. So, yeah, I mean, I do genuinely give uh clients a handout to create a menu. So this is absolutely something you can do at home. And I would just, you know, start with uh the sort of template I hand out has four categories. Uh the first category is things that I've tried and like. And that is a category where hopefully you already have stuff you can put in there, right? So it's really just kind of almost thinking back maybe over sex that you've had in your life, um, maybe even thinking like what would be like the top five or the top three times um in your life where you would say sex was great, these these times stand out in my mind as being the best times for me, and trying to break that down for yourself, like why? Why was that time so good? You know, and there's going to be information in there around context, perhaps, but also maybe around the activities or around the things that you were doing, right? So then you're really starting to build that section of your menu of like these are things that I know that I like, right? And then the next section is maybe things that I would like to try. And this is where we can really be creating more novelty and more excitement. And the things that I'd like to try, that might be, you know, chatting with your partner about things that you've both tried outside of your relationship, perhaps before you met each other, that you maybe would like to bring into this relationship. Um, but also, you know, fantasy can be a fun thing to explore. Um, obviously, maybe different types of erotica, whether that's like written erotica or erotic fiction, or just like plain old like romance movies, rom-coms, like, you know, lots of different ways that we can maybe think about like there's something that maybe I'm curious to try or to look at, right? And even having that conversation can be fun and exciting. Um, and maybe we try those things and actually they end up not being that great. But you know, it's the experience, it's the trying it that is hopefully kind of fun, playful, reduces this pressure around what sex should be. And then yeah, over time you just start to really build your menu. Every time you find something that you enjoy, it goes in that section of like I tried this, I really like it, until hopefully you just really feel like you've got lots of different choice in there, right?
SPEAKER_00What are what about for the people like the there's always people that maybe one of their goals that they bring up to me, it's very rarely the first thing that brings them in. But as we start talking, they say, Is something wrong with me that I don't have an orgasm? Right? What can you talk a little bit about that? When people have that question, obviously there's a lot to consider because all of the stuff that you've just suggested in the menu is important, like you need to have that build in order to achieve something like an orgasm. But what else when like a lot of people think they have an anatomical problem that doesn't allow them to achieve orgasm?
SPEAKER_01Yeah.
SPEAKER_02Um, which can be true. There is a very small percentage of the population that can't achieve orgasm, but that's incredibly rare. So what is more likely is yeah, they're just they're not getting to that higher place of arousal. Um, there is also so going back to our sexual response cycle. Um, so for men, there is what we call the point of inevitability. So essentially that means that they just need to have enough stimulation to get themselves to that point. And then essentially the body takes over and they will orgasm and ejaculate, nothing will stop that happening, right? So that point of inevitability is kind of a threshold that they just have to cross and then that will happen. Women, we don't have that. We don't have a point of inevitability. So often what happens there is uh women might describe, like, I feel like I get very close to orgasm, but then I can't get over that final hurdle. Often what we when we really drill down into that is um stopping stimulation or pulling back from stimulation when you're feeling like you're getting close to that point, um, and then actually you're reducing that arousal, and then you're not able to shift into the orgasmic experience. So just remembering that we do often need to have constant stimulation as we approach and then even into the orgasmic experience in order to experience orgasm. Um but yeah, high levels of arousal is often the biggest issue. Again, everything we're talking about. If your brain is kind of perceiving what's going on as kind of mid, we're probably just not getting up to those higher levels of arousal in order to have had that build of energy in the nervous system to release uh during uh orgasm. So again, are you really enjoying yourself? Are you feeling like sex is really meeting your needs? Um, or is it something that you're just kind of really focused on the other person, or you're just kind of going through the motions in a way that you think you're supposed to? Um, and then, you know, of course, there can be other psychological factors to that. You know, orgasm is often a place of vulnerability, a place of expression. Um, and so there can be maybe like a withholding that comes from maybe feeling self-conscious or for other reasons, you know, that we don't feel safe to express ourselves sexually with our partner. It's obviously something we can deep and dive into uh more deeply in therapy. But yeah, again, understanding like, you know, if you're not, if you're just kind of like feel like you're supposed to perform, you're supposed to tick these boxes sexually, you're not really connecting with who you are authentically as a sexual being. And you're not probably able to really just be pres present in your experience of pleasure, and therefore it is probably going to be less likely that you would reach those higher levels of pleasure for sure, right?
SPEAKER_00It's funny. This is where sometimes it comes up because again, not many people will come in just thinking of someone like myself when it comes to sexual pleasure. So maybe there's also something going on with their bladder, like incontinence, or maybe hemorrhoids or having a hard time with constipation. And so the more we talk about. It and they understand, the more they start to see that like a lot of what I work with requires parasympathetic nervous system activity and the ability to let go. Right. And so sometimes then when we start explaining like you need to let go to have a poop, or you need to let go to let your pee out, that's when they start to connect the dots that, for example, like, oh, maybe some of this is also kind of my inability to let go or be vulnerable. And this is where the this is where I think they're okay, this is starting to make sense. This isn't my clitoris, isn't a problem, or my pelvic floor isn't the problem. I can see that like I actually have a hard time just letting go.
SPEAKER_02Yeah. And I think as well for like, you know, new parents, there's such a focus on like keeping this infant child alive. So, you know, there's a lot of essentially external focus, right? You're focusing on everything else around you, what needs to get done, and you're not focusing internally on what you need or what's going on for you, right? But yeah, that can start to be about that shift of like, you know, yeah, self-care, being more connected with the body. Um, what does your body need to function well? That includes even things like food and water and rest. Are you are you able to do those things for yourself? Or are you just go, go, go, go, go, go, go, go, and then collapsing into bed at the end of the night, right? Um, in which case sex and or orgasm is going to be way down on their priority list in the first place, let alone being able to get to a place of feeling, you know, high levels of pleasure and and expression, right?
SPEAKER_00Well, and I think that's what a lot of people also share, is just that um I can see that we need to both figure this out because I find that I get to a point where I shut down because I don't think I'm um it's almost like I um I feel like I'm on a timeline. Like I have to, or I have a pressure, like I'm gonna disappoint my partner if I don't have an orgasm. Like it reflects poorly on them, or I need to get this done because the baby might wake up. Like just sometimes pressures around like I only have a certain amount of time for myself to feel good, and then I almost have to shift to them. I hear that a lot too. And so I think again, coming back to like your idea of a menu so that both people, because I think sometimes we just don't know what the other person has on their menu. Absolutely. Yeah, and it's an assumption. And yeah.
SPEAKER_02Yeah, and again, you know, pressure. Pressure is never good. Pressure is like ice cool water on any flames of desire arousal, right? So, you know, it's an annoying, annoying paradox of life that the more you try to have an orgasm, the harder it will be to have one, right? So again, and that, you know, society going back to the sort of PIV sex, often the orgasm is included in that idea. Like, that's when sex is finished, when we both have an orgasm, right? Um, but again, if we just kind of like remove all this and really just shift into like, did you enjoy yourself? Okay, like that's all that matters, right? And then it becomes like if you have an orgasm, sure, that's nice, but it doesn't mean sex is incomplete if you don't have one, right? And then paradoxically, the less you try to have one, chances are the more likely it is that you will have one, right? But still, like coming from this perspective of like, yeah, whatever we have space for or time for, how do we want to use this time and space in a way that we can connect and experience pleasure rather than like we have to take these boxes, otherwise we haven't done it properly, right? There's no there's no rules around sex as long as everyone is safe and consenting and having fun, right?
SPEAKER_00Are you seeing a shift? Um, I'm seeing a shift with how many young people are addressing this at a young age. I I I would say that I'm thoroughly impressed when someone comes in and is trying to sort this out. Maybe they're working with yourself or one of your colleagues and their partner might may or may not be involved, but the goal is to have a healthy sexual relationship. And I don't see that in um many people as they get older. It's just the the thought process around this or the expectations was very different. Uh whereas I think people are starting to think about this differently. Would you say you're noticing that trend? Definitely.
SPEAKER_02Yeah, definitely. You know, and I think shame has a big role to play in that, right? Like um, Breni Brown, of course, talks a lot about shame and that shame survives when we don't talk about it or in isolation, right? And so because there is so many negative messages around sex and sexuality, we've touched on some in this conversation, right? Even just the idea that like if you don't want sex all the time, there's something wrong with you. Um, if you don't have an urge for sex, there's something wrong with you, if you don't enjoy penetration, there's something wrong with you, if you don't have an orgasm, there's something wrong with you, right? These are pervasive myths that exist in our society. And I think particularly for older generations, those myths were very pervasive. Um, and the the lack of education meant that those were never challenged. Carrying the weight of that shame for many years, the idea of even like talking about that can feel so painful. And I do think for younger generations, there is a lot more access to information and there is a lot more sort of challenging of roles, gender roles, sexuality roles, these types of things. Uh, young people seem a lot more able to think about I wanna, you know, I want sex that is going to be about me and like my agency, and you know, having my needs met is often what I see young people coming to work on, versus maybe older people are coming because it's about their partner or or they feel like they're letting their relationship down, right? I think that's a big difference.
SPEAKER_00The number of women, like I would say over 50, that um, yeah, I am sexually active, but I could take it or leave it. I I do it for my partner. Yes. I um had this one referral not too long ago. I can't remember if it was from a gynecologist or a urologist, but this woman was having pain with intercourse. She had been starting on started on some estrogen because she was menopausal and she, you know, her tissues weren't happy. But honestly, mostly what we did is I just helped her understand all of this. And she sent me back an email. Um, I feel heard and have so much hope that at 69, I still have time to have quality sex with my husband. You have no idea what that feels like. 43 years of hiding my tears, stifling my cries of pain, and hating every moment of it. I now feel empowered with some tools. And it was just education actually, around this is the pelvic floor. This is why you've started estrogen, this is what happens in menopause, and this is how pleasure and desire and arousal work. And I think I saw her twice.
SPEAKER_02Yeah, yeah, fantastic. Oh, I'm so happy for her.
SPEAKER_00Yeah, I think I find myself really thinking as a parent how much I have to have awkward conversations with my kids a bit around I have a boy and a girl. Okay. Just making sure that I talk to both of them when it's the right time around kind of all of this, because again, I know where they're gonna get their information. And sure, they have the sexual health classes in school, but I sure didn't really listen to those. I was too embarrassed to listen to them. Yeah, but our responsibility as parents, I think, to just help them understand that you both matter in a relationship. Yep. Both of your needs matter, and you know, it's supposed to feel good.
SPEAKER_02And yeah, I think that is what is missed. I I know that there's a little bit of a shift, I think, in sex education in schools um from my day. Um, but what I talk about with sex education is that it is very sex negative. Typically, what that means is it's often focused on the negative aspects of sex, right? So, you know, this is how you can get pregnant, which is a bad thing. And like here are some horrific photos of SDIs that you can catch, and you'll be called these memes if you do it too often or not often enough, right? So it's all very negative. And what is it's not that those things aren't important, but when we don't balance that with like the positive aspects of sex, right? We're giving a very skewed um information to young people. And what we know is shame does not help people, right? When we just feel scared about something and we feel ashamed about it, we just end up either ignoring it or not engaging with it. And that is unfortunately how maybe young people can end up in situations where in hindsight they look back and say, I didn't really enjoy what was happening there. Or at worst, unfortunately, maybe even like abuse or assault situations, right? So, you know, balancing that important uh risk reduction information with, yeah, sex is about pleasure, it's about fun, it's about connecting with somebody, um, it's about sharing pleasure, you know, helps young people to understand, oh, okay, like this is why we have sex, right? Again, like you're saying with your older client, there's so much messaging around, like this is just something we do in a relationship, right? And so we're shifting that narrative into like this is something that you can choose to do if you want to, but if you do choose to do it, it should be fun as well as safe, right? Both of those things are important. And so I think that's that's an important piece that's missed for people, right?
SPEAKER_00The analogy I use, similar to your pizza analogy, is that you might love my company like as a friend, but if I invite you over for dessert every Friday night and I suck at baking, you're pretty soon not gonna you're gonna make excuses to not you might like my company and I'm a good friend to you, but my baking sucks. You're gonna start making excuses as to why you shouldn't come because otherwise you just have to make you have to pretend that you enjoy my dessert and because you don't want to hurt my feelings. But at the end of the day, if I'm not a good baker, and I'm not asking you what you like or what have you, then I'm gonna have a hard time getting you to come over, right?
SPEAKER_02Absolutely. Yeah, exactly.
SPEAKER_00Anything that you think I haven't asked you that's important for this conversation?
SPEAKER_02I mean, I guess I just I hope we've covered relevant points for people to feel like if you're listening to this, I hope your the takeaway is that there's nothing wrong with you if you're not feeling a strong urge to have sex. Um, that might just be that you're a person who's more likely to experience spontaneous, sorry, more likely to experience responsive versus spontaneous desire. So, where can you maybe create opportunities to connect that can give yourself a chance to have that experience? And also really asking yourself, yeah, do I like his dessert? Do I like what is being served? Or do I need to kind of talk about can we maybe add some things to our menu just to to keep things interesting, a little bit more fun, a little bit more exciting, right? Yeah.
SPEAKER_00I can imagine working with someone like yourself, Lucy, it would just help to um bring up some of these awkward conversations because I think it's easier sometimes to be asked and answer than it is to bring up, right? And so I'll make sure that I share where people can find you in the show notes. But um any thoughts on that? Like what I don't know how to formulate my question here, but when might it be a good time besides someone that's just like, okay, great, I'm or what if someone's partner won't, you know, maybe not willing to come. Just can you talk a little bit about maybe when it would be the right time to come, or what if only one person is willing initially?
SPEAKER_02Absolutely. Or I'm sure people have even questions of like, you know, where are we even gonna start? Like, how do we figure this stuff out? So I do think that it's important to note that, like, yes, having these conversations for a lot of people, like you said with your older client, can just feel very validating to even have the conversation and understand chances are that there's nothing wrong with you. That's usually very helpful. And then a language is another piece, right? So, of course, like working in this field, I just have a lot more language than the average person. And that is something I can give to my clients who can then go home and share that with a partner, right? Because it's it is often feeling like I don't know how to articulate this, I don't know how to say this. Uh like you were saying, I don't want to hurt people, I don't want to hurt my partner, of course. So I, you know, I'm there with you know a whole bunch of language, um, as well as honestly like worksheets, um, different exercises that people can do, uh, readings. So again, that it hopefully becomes like, okay, this is just about like learning and then going back to a partner and saying, like, oh, you know, I she gave me this worksheet that I thought was really interesting. You know, do you maybe want to have a look at this together? Or do we want to fill it out together? Or do you want to fill one out and I'll fill one out, right? So it gives kind of like more tangible tools and like ways into these conversations rather than just like, yes, sitting and staring at each other and and and thinking, like, where do we start? Right. There's a lot that we can do to just, you know, like explore and broaden our definition of what sexual intimacy is. And honestly, in terms of timing, uh, there is no right or wrong time to do that work. Um, as you said, I'm seeing a lot more young people coming who maybe even haven't been in relationship very long, um, but are saying, like, no, I just like, you know, we're we're hoping that this is going to be more long term. So this is something we want to address now, you know, and that's great. Um, or even, like you said, the people that have been married like 30, 40 years and are looking at, you know, the hopefully like much more free part of their lives, their retirement or whatever, they don't have the same stresses that they had before and they want to really enjoy uh those years. So honestly, there's there's no right or wrong time. Uh, but if you're feeling like sex is not something that is fun and pleasurable and enjoyable, um, and you want it to be, then that's a time to definitely look at it for sure. Awesome, Lucy.
SPEAKER_00Well, I appreciate you and I appreciate your your time today. Thank you. I'll make sure that I share everything about you in the show notes and I hope you have a good rest of your day. Great, thank you too. Take care. And that's a wrap. If you enjoyed the show, can I ask you a big favor? Would you do one of three things for me? Number one, leave a review because we could all use a little positive feedback sometimes. Number two, download the episodes because it helps me see what people are interested in. Or number three, share it with somebody else. Because sharing is caring. I'll catch you next time.