SHE+ 59 | Dr. Lori Brotto

Dr. Lori Brotto joins Sex Care is Self Care for a powerful conversation on women’s sexual health, pleasure, and the science behind sexual wellness. Hosted by Patty Brisben, this episode explores how stress, trauma, menopause, desire, and communication all shape women’s sexual well-being—and why sexual health must be treated as whole-person health.

From her early research journey to becoming a leading voice in women’s sexual health, Dr. Brotto shares how mindfulness-based interventions transformed care for women experiencing pain, low desire, and disconnection from their bodies. She breaks down common misconceptions around libido, lubricants, aging, and pleasure, while emphasizing that healthy sexuality is defined by the individual—not by societal expectations.

Together, Patty and Dr. Brotto discuss the urgent need for better provider education, increased research funding, trauma-informed care, and accessible support for women navigating sexual health concerns. This episode is both educational and empowering—a reminder that pleasure matters, communication matters, and asking for help is a form of self-care.

Because sex care is self-care—and women deserve evidence-based care, better conversations, and better outcomes.

Transcript

SPEAKER_01 0:03

Welcome to Sex Care is Self-Care, a conversation on women's sexual health brought to you by the She Plus Foundation. I'm your host, Patty Brisbane. I'm coming to you today to introduce you to one of the amazing sex researchers. Our medical advisory board here at the She Plus Foundation absolutely screams your name. So I know that there's a lot to your work. Can you introduce yourself to our audience and tell them exactly what you do on a daily basis?

SPEAKER_00 0:38

Yeah, I'd love to, Patty. Thank you. I'm Lori Brotto. I'm a uh professor of OBGYN. Um, I'm a registered psychologist in the province of British Columbia. I'm an advocate and teacher. And I to sum up my work, it is about bringing the science into the lives of women so that they can lead better, more fulfilling, more pleasurable sex lives.

SPEAKER_01 1:07

That's uh yes, that is much needed. Um what inspired you to study sexuality?

SPEAKER_00 1:18

Yeah, great question. Um, I now I wish I had a story of kind of a light bulb moment or an inspirational conversation, but to be honest, I fell into this field by accident. Um I was a you know young undergraduate student, very interested in research and psychology. And as I began looking around for any opportunity to volunteer, because of course I learned that it was very important to be mentored by scientists in the field, the only person willing to take me on because I had no experience, was very young, turned out to be someone who was studying animal models of sexual dysfunction in rats. So I absolutely accepted right away and swore to myself I would never tell my parents because they would not approve that I was studying sexual dysfunction. Um, and then I spent the next six years looking at the impact of things like chronic stress and SSRIs and housing environment on rat sexual activity and uh learned a lot about the kind of external factors that shape sexual behavior. Um, and it really kind of excited excited me. I had this kind of passion that you that there was an entire science of sexual behavior. Um but over time I got kind of tired of the rat lab. And I was uh in my degree, I was studying clinical psychology and um made the switch the year Viagra was approved. And that was notable because here we had, so this was 1998, this blockbuster medication that worked, easy to use, discreet, accessible. Everyone was talking about Viagra to treat erectile dysfunction in males. Um, and then I did a literature search and discovered that there was nothing comparable for female sexual concerns. And yet that same year, there was a huge study that came out that showed that sexual concerns in women were really prevalent. So I made the switch. And um uh of course, the more I spoke to women, learned about their concerns, uh, examined what we could do to help improve their sexual health. Um, I've just been that that fire within me has grown and grown and uh feel very fortunate to be in this field today.

SPEAKER_01 3:52

Yeah, can you imagine? I mean, well, I you hear it, I hear it, that blue pill and women have two medications. I mean, we need we need to do better, be better.

SPEAKER_00 4:06

Right.

SPEAKER_01 4:07

Yeah, right, right.

SPEAKER_00 4:08

And in my country, in Canada, there's only one. So only one of them is approved. Yeah.

SPEAKER_01 4:13

So as I said, we need to do better. Yeah. Um, was there a moment in your training, your early career, that made you realize this is the work I was meant to do?

SPEAKER_00 4:28

Yes, I absolutely had that moment. And this was um, I was a resident at the University of Washington, and my research was focused on cancer survivors, uh, so survivors of gynecologic cancer. And I was really interested in measuring sexual response in these, in these survivors, looking both at their physiological response or the body's kind of capacity to get excited and aroused, and then also the mind's uh capacity. And then um importantly, I was most interested in how those two aligned or it turned out to be didn't align with each other. So, in other words, um their sexual response, they had some response in the body, they would, the body would get aroused and their minds were completely turned off. And I had just started undertaking training in mindfulness as a as a as a treatment not for sexual health, but for a completely different population. And I had a moment in speaking with, and I still remember her to this day, young, a young cervical cancer survivor who shared stories of just a profound disconnect from her body after her treatment, a sense of mourning and loss. And it just struck me that this skill, which works so well in other populations, might be useful for this uh young cervical cancer survivor. And so I dove into practice and learning and went to classes and read all the books and asked her if she would be willing to allow me to teach her and share with her what I was learning. And of course, she accepted. And that was really the start of uh our now 25 years worth of work looking at mindfulness-based interventions for uh a broad variety of female sexual concerns.

SPEAKER_01 6:21

What a great story. I mean, that story has probably helped so many other women. So thank you for that. You know, misconceptions are everywhere. What misconception about sex research um did you have before entering this field?

SPEAKER_00 6:41

Yeah, um, well, I mentioned that I didn't tell my parents for many years that I was doing sex research. And it's because, I mean, I grew up in a household um with sex-negative messages that it was, you know, inappropriate, in particular for women, um, particularly before marriage, and and even thinking about sex was inappropriate and people would know. And so I grew up with a lot of those messages. I'm grateful to say my parents uh now are tremendously proud of this work and and talk openly about sexual health. But at the time, I think I went into this field with a lot of those same biases. Um, and it was really in working with women and hearing their stories of just how profound their concerns, their sexual concerns impacted all facets of their life. It didn't just live in this tiny place in the bedroom.

SPEAKER_01 7:35

Right.

SPEAKER_00 7:36

It affected their relationships, their communication, their sense of self, their confidence, their mood, um, their ability to sleep. And um, and so yeah, uh thankfully, you know, those stereotypes for me were debunked. But I'll say that today, those stereotypes still exist. And um, increasingly my interest has moved into kind of menopause and sexual health, where those stereotypes around aging women and sex are rampant. They're rampant and they must be dismantled because they're completely inaccurate.

SPEAKER_01 8:12

Right. You know, it's it's funny because we kind of align, because my family felt the same way. Please don't tell anybody what you do. And, you know, and at the end, you know, of my mother's life, I remember her saying to me, I'm so proud of you. You've helped so many women. And that's what it's about. It's about being able to listen and to be able, and that's where your passion grows. Has there been anything that really has surprised you that you could share with the audience about sexual health research?

SPEAKER_00 8:48

Um, yeah, I mean, one of the things that surprised me is certainly when I um got into the field and started my professorship um at the University of British Columbia, there was sort of an air of, oh, you'll never get funded to do this work. And people are very, you know, reluctant to even talk about sexual health. You'll never get participants for your research studies. And also a lot of my work has involved somewhat, you know, invasive measurement, right? We're measuring the body's response. We bring them into a research lab where they're watching erotica or we're using virtual reality exposure. Um, and what has uh surprised me, at least in the beginning, it's it's very easy to have per to get participants to step up. Um, and I think it's in part because a lot of them are suffering in silence. And so they see research as an opportunity not just to contribute to knowledge, but also to derive some personal benefit. For some of them, this is very therapeutic to participate in research. So I often talk to, you know, students and and and promising um scholars, this is a wonderful field to get into, and you'll have no shortage of people ready to participate in your science.

SPEAKER_01 10:05

There you go. Um, how do you define healthy sexuality, especially today? How do you define that?

SPEAKER_00 10:14

Yeah, entirely based on the person's self-report. And this is really important because, again, I think there are societal myths around a certain frequency of sexual activity or a certain, you know, stereotyped uh look at what healthy sex is. And yet the the large studies tell us, and there have been many of many of these now, that people define sexual health and well-being in quite different ways. And it doesn't even require sexual activities, um, and let alone with a partner. So um I've I've my work has focused much more on pleasure. What does pleasure mean, especially in the context of women's sexual health, where there's so much pain uh for a lot of women, or, you know, they might be engaging in frequent sexual activity that's not rewarding to them. And so it's really important that we understand, you know, what does sexual health mean to you? And is it that you can be, you know, borrow some of my work in mindfulness? Um, is it that one can be really present and aligned and fully in the here and now, right? Where nothing else matters. And so I think my own definitions of of sexual health and well-being have really evolved over time, again, on the basis of what women have shared with me.

SPEAKER_01 11:35

Um here at the She Plus Foundation, we've talked a lot about connection between stress and trauma and sexual function and people. Can can you speak on that a little bit more?

SPEAKER_00 11:52

Yeah. So um then these are all kind of somewhat separate but related, and and uh quite a lot are scientific. Let me start with with uh sexual assault history. Uh sadly, in both the US and Canada, we know that that one in three women are victims of sexualized violence in some form. And while a history of sexual assault doesn't necessarily mean you're going to have sexual difficulties, when we look at the characteristics of women who do have sexual concerns, there is a higher proportion of them who have had a history of sexual assault, either as a child or an adult or even repeatedly. And so that um that that is a you know very sad situation because for a lot of those women, and our research has shown this that when they are then in consensual and happy relationships where they want to be engaging in sex, some of them might have repeated traumatic memories of what happened to them in the past. And it can be very upsetting to them. They they want to have arousal and yet they have this kind of flashback back to a past event. So that's a really special situation that deserves research, but also really careful clinical care. Stress is so interesting because um, you know, there's been big surveys like the Stress in America survey that has shown us now people's sense of chronic stress is increasing year by year. Our sense of that just that burden of stress is increasing. And as I noted, I've I've been doing a lot more work in midlife women and menopause, where we know that there's there's kind of the impact of the sandwich generation because we're having kids later, we might be perimenopausal and have young children and be taking care of elderly parents at the same time. And that's chronic stress. It fundamentally changes our brain, our ability to regulate stress in in quite significant ways that also impact sexual function. And so you know, whether it's a single traumatic event or just the day-to-day burden of the roles that we carry and the things that women do, um, they they can quite significantly impact sexual health and well-being in ways that we need to start talking about more.

SPEAKER_01 14:21

We do need to start talking about because you think about what women carry, that load that they carry every single day. You know, children. And then you think after your children leave and go away, go go on their own, that you're kind of free. And it doesn't turn out that way at all. No. Because then you have concerns about their significant other and their children. And so the load sometimes just gets heavier.

SPEAKER_02 14:50

Yeah.

SPEAKER_01 14:51

Yeah. And people do we we really do need a better dumping crown for the things, the stress that a lot of women carry. Um what are some of the small things that people can incorporate into their daily lives to improve their relationship with their body, with their mind? What can they do?

SPEAKER_00 15:15

Yeah, there's actually quite a lot. I mean, uh obviously I'm a psychologist and sex therapist, so um I'm a strong advocate for talking to a professional, but there's actually quite a bit that we can do. You if if you're in a relationship, talk about sex, not in the bedroom. Schedule a time outside of sex to say, oh, I heard this great podcast, you know, conversation talking about the importance of women's sexual health. Um, don't be afraid to tell or show a partner what feels good, and especially if there's pain to stop what hurts. So that's kind of in this whole domain of sexual communication. And um, none of us were taught how to do this in, you know, in grade school. It's something that we we learn and we practice and we refine. So that's definitely something really important. And the big studies tell us that sexual communication is actually a predictor of longer-term sexual satisfaction, right? So the the more that you can actually talk about these things with a partner, the the better sexual satisfaction you'll have in in the long term. Um, again, if you're in a relationship with someone, is prioritizing those times for intimacy and sexual activity. Don't rely on spontaneity. Very few things we do in our life are spontaneous. In fact, the the things that are really important and meaningful, we plan them. Right. And we think about them and we sort of imagine them and we eliminate barriers and distractions and and whatnot. Um, and then of course, for for women who don't have a sexual partner, you're still a sexual being. You still have incredible, you know, inner sexual strength. And so exploring your body, um, getting at handheld mirror and looking at your your parts and um identifying them, knowing the different parts of your body, using a lubricant every single time, with or without a partner. Um, and so these are you know basic, basic, but but not simple always um skills that I think anyone can undertake.

SPEAKER_01 17:19

Right. I I think if people, if women can incorporate that in their daily lives, being able to communicate with their significant other, to know their body, and to know that because you don't have a partner doesn't mean you should be deprived. So um great advice, thank you. Um for the listeners, navigating pain or low libido or even shame, what's the most important thing for them to know?

SPEAKER_00 17:50

Yeah, ask for help and there is evidence-based treatment. Um, and so I think it can be um common and understandable that women feel like they're suffering in silence or they're broken. Yeah. Um, because maybe they don't know anyone else who is experiencing this. But again, sexual pain, when we look across the age group in women, it probably affects as many as one in five women. There's peaks of a woman's life where that gets higher. And low desire can affect up to 40% of women. And we do have evidence-based treatment, both psychological and pharmacological. Um, and uh, so knowing that can kind of give you that confidence to ask for help. And if you don't get the help that you need, ask for a second opinion. Keep asking until you get the help that you deserve.

SPEAKER_01 18:41

I agree, I agree. And I love that you know, the question before that you talked about lubricants and uh using them. Use a lubricant. So many women think that if I have to use a lubricant, I must be broken. Something must be wrong with me. And that's so not true because sometimes this doesn't connect with what's happening below this.

SPEAKER_00 19:06

So I you know, again, thank you.

SPEAKER_01 19:11

Good advice. Um where do you see the the biggest gaps in our healthcare system when approaching sex sexual wellness?

SPEAKER_00 19:22

Yeah. Um I mean, I I can think of Benny. Um, so um at the kind of you know, most proximal level, we're still not training our healthcare providers in sexual health consistently. Right. So some universities, uh especially if there's like a sexual health expert on faculty. So at my university, University of British Columbia, they actually do a lot of teaching to undergrad medical students and in residency about sexual health. That's not the case in other programs um uh across uh well, across both of our countries for sure. So that's first and foremost. We need to be teaching our health care providers that sexual health is health. It's it is health. Generally, and so as you're as you're studying health, sexual health should be a component of that. So that's still a major gap. And it doesn't mean that we're producing primary care docs who are all experts in sexuality, but they do need to know how to ask questions in a trauma-informed and compassionate way. And they do know how they do need to know what the resources are and how to refer. That's a huge gap. The second one that I'll mention is um women who are uh underserviced because they're living in rural and remote communities. They're perhaps marginal marginalized in other ways, facing poverty, um, minoritized through their racial status or other things or disabilities. And that group really has uh tremendous barriers to accessing care. And so I'm very excited about a lot of the science that's looking at, you know, telehealth and digital health tools to help close the gap. Our team is doing a lot of research in this area as well. And what we're finding is, you know, we're able to access those women who have never had access, let alone to a sex therapist, but to basic primary care. Um, so still a lot more work that we need to do there.

SPEAKER_01 21:23

Yeah. It's just I would love to see our colleges um be able to incorporate more information when training our doctors, because most of them are not comfortable with asking questions when it pertains to you know your sexual health wellness. So we've gotta we've gotta continue to do better in that area too, because so many women are looking to one another to provide information, and that's great. But we also need To have our doctors weighing in on this. Yeah. How can partners navigate mismatched desire without it becoming a source of conflict?

SPEAKER_00 22:15

Oh, yeah. Yeah. Sexual desire discrepancy. I actually, my I have a postdoctoral fellow who was funded by ISWISH, the International Society for the Study of Women's Sexual Health. She's doing a large online study on this very topic on sexual desire discrepancy. And for the listener who may not know what I'm talking about, you know, we often think about low desire in a person. Well, that often shows up in the context of a relationship. So you can't address a woman's low desire, say, without also addressing, well, maybe her partner's desire is too high. So we should, maybe we should be focusing on reducing partner's high desire. So this notion of sexual desire discrepancy, looking at it through a couple's perspective, is really helpful because it lessens the blame on either one of them. Right. And it helps engage both people on what they can do? What are they bringing to the relationship to create, you know, a more equal kind of uh context for the two for the two of them? So um I think that is really important, is just viewing it through a couple's perspective.

SPEAKER_01 23:25

I'm gonna throw in one that in um there's a lot in the news right now about uh decisions impacting women's health funding, anything that has women in it, uh, especially with this Trump administration. Yeah. Uh can you can you give us your thoughts on that? Because it for me, it keeps me up at night.

SPEAKER_00 23:53

Yeah.

SPEAKER_01 23:54

But it's not right.

SPEAKER_00 23:56

No, no, it's absolutely worrisome, and I think is a is a testament to the priorities of that administration that you know women's health doesn't matter. Like, who cares? Women live longer, right? That's kind of usually the the very trite um assumption is well, women live longer, they must be doing better. And yet, I mean, I can cite you statistic after statistic. Yes, women live longer on average, but they also spend 24% more of their life in ill health compared to men. So that's number one. There have been big surveys through the McKinsey Foundation, both in the US and Canada, that have showed us the burden of um uh ill health in women and lack of funding in women's health. And if we can close those gaps, it contributes to several billion dollars return to the economy, both the US economy and the Canadian economy. So that's the McKinsey report that I highly recommend that listeners read. And um and and uh so you know it's it's frankly wrong. And it's quite uh honestly uh harmful and and disastrous to be cutting funding in women's health, especially when promises were made, right? Right. So under the Biden administration, as an example, there was the promise of many millions of dollars that was going to go to menopause research that has been completely slashed. So those teams were started, grants were underway, teams were put together, and then all of a sudden, no, women's health is not a priority. And it gets completely defunded, not to mention programs that support women that have also been have been cut. So I think it reflects a fundamental error in how important we see women's health. And yes, it's for women's health, but it's also about healthy society. We know when women are healthy, societies do better. They have higher metrics of health and they have higher meth metrics of GDP.

SPEAKER_01 26:00

Thank you for sharing that because even here at the She Plus Foundation, because all of our research is based on women's sexual health and trying to open up somebody's wallet is it's been very, it's been a very difficult couple years. And research is so important. It might not be anything that's gonna help you today, but I don't think about what is gonna help me. I think about what's gonna help the generations to come because I don't want my granddaughters or generations after that to experience a lot of the things that I've experienced. Um I would like to leave this world knowing we're a little bit more progressive than what we have been. So I'm so grateful for you sharing your thoughts and with us here today.

SPEAKER_00 26:55

Um Yeah, Patty, I mean, you you said it so well. The research we do today translates to the health care we deliver tomorrow. Yeah. And I think if people really understood that, um, you know, I often also say, like, research is the train track and healthcare is the train. We we can't deliver good care without research and we can't do research without funding. Right. Um, and so I think that that we need to do everything we can to kind of share that message far and wide.

SPEAKER_01 27:26

We have to share that message. I mean, you know, these some of these generations really feel like they're so used to driving through McDonald's and getting what they want. And this is not what our health is all about. Yeah, you know, we really have to put time and effort and money towards making this a better world, making it better for men and women both. Yeah. Um I always ask this one last question. I know that we've covered a lot here today, and I'm grateful for every all the input that you have given. But is there anything that I missed that you might want to share before we close out?

SPEAKER_00 28:09

Yeah, I mean, and I guess this is a message to the listener. And, you know, Patty, I I know you have uh an incredible reach and platform, and people might be listening and hearing something they've never heard before. Share it with someone. Yeah. Don't don't kind of hold on to it. Share it with three people that you trust. Hey, I listened to this great conversation. And did you know that sexual health can get better with age? Did you know that sexual health is health? Did you know there are evidence-based treatments for all the sexual concerns? So that would be my plea. Um, and it's it's, you know, in one way it's simple to do, just share something you learned. And I'll acknowledge that it's also hard to do because of the stigma that still clouds sexual health. So that's, I think, what I would want to leave the listener with.

SPEAKER_01 28:59

Thank you. You have been an absolute joy and full of so much knowledge. And I appreciate everything that you do. And I know our audience who is listening, it it's right back at you. Thank you.

SPEAKER_00 29:15

Thanks so much.

SPEAKER_01 29:17

If you liked what you heard today, please rate and subscribe on our podcast. For more information on the She Plus Foundation, go to www.sheplusfoundation dot com. Remember, sex care is self-care, and sexual health matters,