MedEvidence! Truth Behind the Data

Mental Health, Sex, Porn, And Intimacy Across A Lifetime

• Dr. Michael Koren, Noelle Pomeroy, PhD • Episode 370

Share episode

Send us a text

Dr. Noelle Pomeroy, PhD, joins Dr. Erich Schramm to discuss mental health, particularly from the perspective of relationships. The two discuss the value of therapy and the importance of talking with an expert in areas that are new to us, and then get into sexual health and relationships. They talk through the changes that happen as people age, the challenges that pornography can create for chronic users, and how intimacy can change over the life of a relationship. Dr. Pomeroy then gives practical advice for couples on sex, nonsexual intimacy, and the importance of communication.

Visit Noelle Pomeroy on the web at https://jax-therapy.com/

Be a part of advancing science by participating in clinical research.

Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.com

Listen on Spotify
Listen on Apple Podcasts
Watch on YouTube

Share with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.

Follow us on Social Media:
Facebook
Instagram
X (Formerly Twitter)
LinkedIn

Want to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.com

Music: Storyblocks - Corporate Inspired

Thank you for listening!

Announcer:

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Erich Schramm:

Hello and welcome back to another episode of the Med Evidence Podcast. I'm your host, Dr. Erich Shramm. I'm sitting in for Dr. Michael Koren today. I'm a board-certified family physician and longtime clinical research investigator with the ENCORE Clinical Research Group. And I'm very excited to be talking to Dr. Noelle Pomeroy today.

Noelle Pomeroy, PhD:

Hello.

Dr. Erich Schramm:

Hi, Dr. Pomeroy. Welcome to the Med Evidence! Podcast.

Noelle Pomeroy, PhD:

Thanks for having me.

Dr. Erich Schramm:

Oh, you've got a wonderful bio. And I just wanted to touch base on a few things here. So you're the founder of JAX Therapy.

Noelle Pomeroy, PhD:

Yes.

Dr. Erich Schramm:

You're a clinical sexologist, and you earned your PhD from the American Academy of Clinical Sexologists.

Noelle Pomeroy, PhD:

You might be familiar with our football team.

Dr. Erich Schramm:

What is that team, by the way? Should we refer to them as Go?

Noelle Pomeroy, PhD:

We don't know. Most of the cheers are probably not allowed.

Dr. Erich Schramm:

Okay. Well, that probably will come up as later in this episode of this podcast. So we'll be on the on the uh edge of our seats for that. Okay. You've worn uh earned a master's degree in counseling as well. You are a licensed mental health counselor. You have been and hosted a very popular podcast called Reel Sex with Dr. Noel. That's R-E-E-L. So for so a lot of interesting uh things. And so for today, we were thinking there would be a number of interesting topics to discuss. And we talked about expectations of sexual functioning as we age. And as a family doctor, I get those questions all the time. Sure. Also, we can touch on some of the misconceptions about what's possible for mind and body in terms of our expectations for that. Perhaps talking a little bit about some pornography associated dysfunction, touching on female health and female sexual dysfunction, and wrapping up with maybe some giving us all good advice for couples to have a better sex life. Does that sound like a like a good uh docket uh

Noelle Pomeroy, PhD:

Sure

Dr. Erich Schramm:

Oh, cool.

Noelle Pomeroy, PhD:

Count me in.

Dr. Erich Schramm:

Sounds good. Okay. So tell me a little bit about your background. I'm curious what got you interested in sexual health.

Noelle Pomeroy, PhD:

Well, I originally became a mental health provider because of my own issues with depression. I had moved down to Florida 20 years ago and couldn't find a job doing what I wanted to in my chosen field at the time, which wasn't mental health yet. And I was having a lot of issues. So I went to a provider and got therapy for the first time in my life. And it was transformative. And so when I was trying to figure out what I wanted to go back to school and do, I thought, I want to do for other people what that man helped me achieve, which was life-changing. So I said, oh, go back to school. I didn't look into it to see how much they make at the time. I probably should have done that. Uh so I pursued a general mental health counseling degree and then became interested in sexual issues when all of my classmates were uncomfortable talking about it. I thought it was kind of interesting. So I thought, well, they're gonna have to refer to somebody once they graduate.

Dr. Erich Schramm:

So it's a nice little kind of niche kind of develop. So to ask the question, I mean, was there anything particular in your childhood or developmental that kind of kind of resonated to you in terms of thinking about your interest in sexual health or-

Noelle Pomeroy, PhD:

No. I actually grew up, we didn't really talk about sex in my house at all. And I was never I I kind of had a little bit of a shame attached to it, but I always kind of found it fascinating because when we studied it and I realized, well, this is pretty natural, and you know, other than eating, it's probably the only other thing almost all humans do and sleeping. So why am I having this shame about it? And I realized is more I found that that was an issue that a lot of people had about it. So I kind of that kind of provoked my interest in it as well.

Dr. Erich Schramm:

Did you find like and you said you grew up in the Midwest.

Noelle Pomeroy, PhD:

Michigan

Dr. Erich Schramm:

Okay. Did you see coming to Florida as being a little bit different in terms of cultural, societal?

Noelle Pomeroy, PhD:

Well, I since I didn't practice in Michigan, I can't really say from that perspective, but what I have noticed since I've wor- lived down here and been practicing is the amount of shame and attached to religion as a as a foundation for a shame attached to sex that comes from, you know, we don't talk about sex or we don't have sex until we're married. And then when you're married, you know, you're on your own, enjoy. And it's not a switch you flip.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And so I work with a lot of people from very conservative Christian backgrounds, Hindi backgrounds, Muslim backgrounds, Catholic backgrounds that had real difficulty becoming okay with the sex lives they wanted to have in their marriages, even though that's not what their gut was telling was okay.

Dr. Erich Schramm:

Right. Sounds like that could be very challenging. So already you're kind of touching base on a little bit some of the different kinds of patients. And tell us kind of some of the conditions that you're seeing and treating.

Noelle Pomeroy, PhD:

Well, I would say the most common that we see is a desire discrepancy in couples. Okay. So and about 90% of the time in heterosexual couples, it's men want to have sex more frequently than their female partners do. Right. And so it's figuring out, and a lot of times it's fix me. Okay. And then just tell me how to want to have more sex or tell my wife how to have want to have more sex. And it's there's a reason sex therapy is a component of mental health therapy because it's very rarely about square peg and round hole.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

I haven't seen too many square pegs. I'm just kidding about the square pegs. But it's it's about, their relational dynamics. It's about what drives each of them to want to be intimate with one another. And very frequently, what drives them to want to be intimate are completely opposite things. And so educating them about that, getting to know if their backgrounds. People come in with a lot of trauma sometimes, whether its sexual trauma or emotional/psychological trauma; they were told that they were worthless or that they didn't have anything to offer anyone or that they were ugly or that they didn't deserve to be attracted to anyone. And sometimes you got to kind of piece through all that to even get to the thing that brings them in.

Dr. Erich Schramm:

Right. And it sounds in that way too, trying to get and re-establish intimacy in those relationships. And that seems like that can be very challenging.

Noelle Pomeroy, PhD:

Yeah. And you know, I'll tell you what the most challenging part is is someone, a couple will come in and say, We wanna, we wanna have better sex, and then I'll sit with them for and I'm not trying to make this funny, but you'll sit with them for 40 minutes and they clearly don't like each other. And I think, okay, how do I help you have better sex? Well, I think we have to work on you not wanting to smother each other with a pillow first. And so that's really a big portion of it. I think people have seen too many movies where people fight and fight and fight, and then they have this passionate sex, and then okay, all better. That's not how it actually works.

Dr. Erich Schramm:

So you're trying to tell me that the movies and and real life are completely different? Is that right?

Noelle Pomeroy, PhD:

Oh, very much so. Yes.

Dr. Erich Schramm:

And you are a movie person, I understand.

Noelle Pomeroy, PhD:

I am very much a movie person.

Dr. Erich Schramm:

Okay, cool. Well, we can circle back to that too.

Noelle Pomeroy, PhD:

Thank you.

Dr. Erich Schramm:

So there's dealing with couples, and you also, but you also I understand you do gender identity counseling. Work with that?

Noelle Pomeroy, PhD:

Yes.

Dr. Erich Schramm:

What that what does that work look like?

Noelle Pomeroy, PhD:

So I work with all adults at this point in my career, and they are coming in to me to talk about they have questions about their gender identity. They may, they may be long-term questions about their gender identity, they may be more recent. Usually they it's become distressing to the point that they are thinking of doing wondering if they should do something medical about that in order to alleviate their symptoms of depression and anxiety that they're getting. And sometimes they're coming from situations where they have no support, they don't have any family support, sometimes they don't have any financial support or they don't have any finances themselves. And then sometimes people come in with extremely supportive situations and they're just trying to figure out what the next step is. I've worked with people who might have transitioned 25 years ago and they want to come talk to somebody about their depression or their anxiety, but they want to come somewhere where them being transgender is not going to be a topic that I insist needs to be discussed. It's just part of who they are.

Dr. Erich Schramm:

Right. You're you're can convey a comfort level with them and a safe space and given a given that opportunity. I mean, do you end up having fairly long-term, you know, relationships with these patients? Do they tend to stick with you for for for years or do they..

Noelle Pomeroy, PhD:

Specifically the ones with gender identity issues?

Dr. Erich Schramm:

Well, in general, because I mean this sounds like in all your patients, there's just kind of a lot to work on, a lot to impact unpack.

Noelle Pomeroy, PhD:

I I mean, there's some people that I kind of just talk to about whatever they've got going on in their lives that day. I have one patient I've been seeing for 12 years. And I have one specifically transgender patient that I began seeing when she was a man. And now she is probably seven or eight years post-all of her transition surgeries that she chose to have and is happy as a clam. And so I've been working with her-

Dr. Erich Schramm:

That's great

Noelle Pomeroy, PhD:

-for a long time. And then there's people I see once.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

Because they come in and they say, What do I need to do? And I say, This is try this, and they're like, bye-bye. And I hope it works.

Dr. Erich Schramm:

Well, yeah, that's right. Or so your patients generally uh what's what's the age range of patients that you typically see?

Noelle Pomeroy, PhD:

Probably I think my youngest patient is probably 18 and my oldest is 85.

Dr. Erich Schramm:

Wow. Okay.

Noelle Pomeroy, PhD:

Yes. And I I probably about right now, about a third of my patient load is probably over the age of 60.

Dr. Erich Schramm:

Wow. Well, maybe that's an excellent point to kind of segue to our different topics of discussions about expectations of sexual functioning as we age. So maybe you could tell us a little bit about your perspective on that.

Noelle Pomeroy, PhD:

Yes. I think that a lot of people go into their sex lives as to what they expect their bodies to be able to do or what they expect of their partner as if as when they are most excited about themselves in the past. So you might have a 52-year-old man in front of you who says, I want to have sex like this, this, this, this. And they'll say, Well, when was the last time that that was a reality in your sex life? And they'll say, I almost when I was 24. And I'd be like, Oh, well, cool. Cool. The Reagan administration. I mean, I thought I think that was a good, yeah, good time. You all had a pretty good time back then. Okay, you're right. Right. And I mean, I'm sure we would all love to function in every way, well, most ways. Well, like we were when we were 24, but I don't know how realistic that is. So once and I'm I'm gentle about it, I swear I don't laugh. They say that, but it's about okay, well, what is what is your body actually capable of? Because the largest organ in our bodies is our skin. And how much does our skin change from the time we're 24 until we're 53? It's so much thinner. Right. There there might be less sensitivity or more sensitivity. When couples have been together for 30 years, and I ask them, well, when was the last time you asked each other how you like to be touched, even on your arms or your legs or your back? And a lot of times they're going off of information they have from when they first got together 30 years ago. Right. And maybe a caress to the back of the leg felt good when the person was 24, but now maybe it feels like nails on a chalkboard and they're just too nice to tell you. Right. Or it's certainly not turning them on.

Dr. Erich Schramm:

So communication is key.

Noelle Pomeroy, PhD:

Absolutely. The number of couples that have sex with one another that don't ever talk about their sex is really high. They just don't talk about it. And I don't know, I think it comes from discomfort because if you don't start off a relationship discussing sex, then you're probably not going to just bring it up one day 10 years into your relationship. So I always try to encourage people that are in newer relationships that come to see me to to get into the habit of communicating about it.

Dr. Erich Schramm:

No. And maybe that they're a little more pliable that way.

Noelle Pomeroy, PhD:

Yes.

Dr. Erich Schramm:

So let's just say, take a scenario, because I'm a family doc, and and if uh say a 40 to 50 year old comes in as a guy and he's like, you know, talking about the issues that he may be having with intimate intimacy and having sex, and he's like, you know, um, you know, my wife and I, we only have uh sex like once or twice a month. Is that normal? And you know, I'm like, well, well what is there kind of an expected kind of typical like frequency for sex, you know, I think saying like a 40-year-old versus a 50-year-old versus a 60-year-old.

Noelle Pomeroy, PhD:

I think it depends on the person and what their libido is and what they can work out with their partner and what works for their partner because people only come into my office if they have a problem with their sex life. I mean, I've talked to them about other things too, but I've worked with couples that might rate rate their relationship overall a nine or a 10 out of 10, and they have sex twice a year. Okay. And I work with couples who have sex every day of their marriage. Okay. This has happened and they're miserable. Right. So the frequency of the sex doesn't really mean anything except what it I looking at from the outside, it only really matters within the couple themselves. Right. So a lot of times what is really realistic is, you know, a couple's in my office, or one of them's in my office, and the man might say, Oh, I'd like to have sex twice a week, and the and they're having sex once a month. So it's just sort of figuring out, well, what are your barriers to having sex? People aren't putting down their phones long enough to actually give each other the attention and time that they might need to actually get their engine revving to start with. Right. So that it's sometimes it's just making adjustments practically. Right. Particularly men tend to, there's exceptions, but men tend to operate like microwaves and women operate like crock pots.

Dr. Erich Schramm:

Okay. Tell me more about this.

Noelle Pomeroy, PhD:

So let's say you are going about your day and maybe you had dinner and you are doing things around the house that need to be done, and you rest for a little bit, and then you decide to go into the bedroom. Women might need time once she's in there to kind of decompress, think about things other than all the things that she was managing throughout the day. Even maybe before that started, might have actually liked some sort of individual attention from her partner. Right. Maybe asking her about her day and get this, listening to what she says without a phone screen in between the two of you or watching the news that's across the room.

Dr. Erich Schramm:

Exactly.

Noelle Pomeroy, PhD:

And sort of that connection, whatever it is that she needs to feel validated and appreciated. And you know, maybe it's an act of service, like you helped her, you know, you unloaded the dishwasher or you took the dogs for the walk or whatever it is, but something that makes her feel valued.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And then once you get into the bedroom, you know, she she may want to take a shower or relax, talk to you some more. It's not just a but most men, not all of them, most can walk in and be like, all right, when are we going? Bye now.

Dr. Erich Schramm:

The microwave.

Noelle Pomeroy, PhD:

And you, you know, the the the house could almost be burning down behind them, and they'd be like, We'll get to that. Don't worry about it. So that's a very different way of looking at it. And so what happens is you if the woman says, No, no, no, I'm not ready. I'm not in a mind space where I can I have a headache or I I can't even really think of this right now. I've got too much of my mind. That's not intended a lot of times to be a rejection of him. It's the rejection of the time in the setting.

Dr. Erich Schramm:

Right. And it sounds like a lot of that is contingent on understanding, you know, you know, like the maturity of a couple, you know. And I imagine, and I think young newlyweds probably struck uh struggling a lot with that and understanding each other, just coming to understand each other. And, you know, men are historically correct, you're correct that we are not seem to have the necessary hardwiring, but you know, we can we can learn, you know, we can adapt. But but I can see the the challenges and and and depending on where couples are in the relationship.

Noelle Pomeroy, PhD:

Absolutely. And another place where we sometimes see some difficulty in couples, which since you mentioned newlyweds, is for about the first 18 months of a relationship, usually the desire on both people's end is really, really high.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And that's some I think it's physiologically called something like limerence. And then you get to a point where it's like that kind of goes away, the butterfly feeling. It's okay, now we're now we're in it. We're now in the nitty-gritty. And so I'll have people in my office and they say, Well, I want what I had at the very beginning of our relationship. And I'll say, Okay, we we can get a new normal for you, perhaps, but unless we drug you to get you back to that state, or you end up meeting somebody else. Like it's really just a bio logical thing. And because love transforms, like our relationships with people transforms. So we just can't. That's lightning in a bottle. We're not gonna get it again. But you know what? We we can really work with what we have and see if we can get you to someplace that's also great.

Dr. Erich Schramm:

Right. So it's it's it sounds like quite a daunting challenge to continue to help people to evolve in with their intimacy, their communication. So it's not just in like, hey, let's really spice up your spec sex life. It's-

Noelle Pomeroy, PhD:

right

Dr. Erich Schramm:

-it's it's a lot more than that.

Noelle Pomeroy, PhD:

Right. Because you you have people who uh when they're cohabitating, sometimes it's there really is like the logistics of their life is pretty much takes the the forefront of their day-to-day. Did you pick up this person? Did you drop off the dog? Did you, you know, take get the mail, all these things.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And there's nothing particularly uh spicy about that. And it's sometimes really hard to uh to kind of give the intimate, you know, physical intimacy, sexual intimacy, give it its time. What I see happening a lot with because of that microwave versus crockpot thing, I see this a a lot in so many couples, is where they would both like physical but not sexual intimacy. They would like hugs, they would like kisses, they would like cuddling. Right. And it doesn't always have to lead to sex.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

But what happens is when women don't want that constant turning of this I hugged you for a second too long, you got the wrong idea that you've wanted to turn this into a sexual thing. I develop women develop what I call the cringe, which is when their partner that they love dearly and they would love to share a hug with, when their partner hugs them, they cringe because they think, oh boy, this is what this is gonna happen.

Dr. Erich Schramm:

But see, we can't actually see that, right?

Noelle Pomeroy, PhD:

No, you don't see it. It's it's an internal cringe. Right. It's an internal cringe. But what happens is it causes her to close down and not enjoy the physical touch. And then she probably will even avoid it a little bit.

Dr. Erich Schramm:

So you can sense that if you're if you know.

Noelle Pomeroy, PhD:

Yes.

Dr. Erich Schramm:

So you don't just have to see it, but you uh if you're open and receptive, you can you'd understand that from from that.

Noelle Pomeroy, PhD:

So he ends up losing out because he's not getting the physical, non-sexual, physical touch that he wants, and she's not getting it either because she's either not enjoying it when it's happening because she's cringing or she's just avoiding it. So one of the steps I'll tell people is we want you to have sexual intimacy, but for the physical intimacy, let's assume that it will not lead to anything other than you just enjoying touching each other for a while.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And then if you if you want to have sex, like put it out there. Say, like, let's go ahead and be intimate in the other room. But

Dr. Erich Schramm:

Let it happen naturally.

Noelle Pomeroy, PhD:

But if if a hug for now is just a hug, a cuddle for right now is just a cuddle.

Dr. Erich Schramm:

Great.

Noelle Pomeroy, PhD:

And then allows. People to lean into it rather than cringe.

Dr. Erich Schramm:

Oh, that's great advice.

Noelle Pomeroy, PhD:

I hope so.

Dr. Erich Schramm:

Oh, you're well, you are the sex expert. So

Noelle Pomeroy, PhD:

My grandmother's so proud.

Dr. Erich Schramm:

Oh. So question. What about the value of having like date nights or set times to have sex? Like, hey, we're gonna have this window. You see that as a successful strategy for couples?

Noelle Pomeroy, PhD:

I think it works for couples really well if for the right kind of couple. You get a lot of like really high-performing couples or people who are very, maybe I would maybe say a little more type A, who really like strive on structure and that type of thing. It's ideal for them. Okay. As long as you can get your partner, even if they're not they're oftentimes not with someone who's kind of as structured, um, maybe a little bit more laid back. And so you have to get them to buy into that idea that sex is not always about complete spontaneity. So sometimes that's where the buy-in with the scheduling, you might run into a problem. But spontaneity can only come from practice. So if you get good at something, then maybe you can do it spontaneously from time to time. The other part of that is that date nights are great as long as you don't do the same thing all the time. A lot of couples will go to the same two restaurants and then maybe they'll go have a grab a drink at the bar or whatever it is, and then they head home. The newness that you the excitement that you want to get that makes you feel good and even a little bit different about your partner comes from new things. So maybe the two of you go axe throwing or you go

Dr. Erich Schramm:

I I like that. Except for that couple that that wasn't getting along very well.

Noelle Pomeroy, PhD:

No, no, no. Yeah, don't throw them at each other.

Dr. Erich Schramm:

We're gonna smother each other with pillows. Let's be clear that the axes involved in these activities probably not so great.

Noelle Pomeroy, PhD:

No, organized axe throwing where you're throwing it at Target. Okay. Yes.

Dr. Erich Schramm:

Okay, all right, thank you.

Noelle Pomeroy, PhD:

Or maybe you go stand up paddle boarding, or maybe you go walk on the beach because that you don't normally do that, or it doesn't have to be an expensive activity. It can be just something that you don't normally do. And then you will have that newness. The chemicals and you get in your brain from that newness will then make you feel a little bit differently about your partner because it's exciting. Yeah. And you want to be excited about your partner, you're not gonna do that from doing the same thing every time you go out. So you have to introduce newness.

Dr. Erich Schramm:

Oh, I love that. That's brilliant. All right. Note note to self. Yes. Come up with creative ideas to keep things out that interesting and and exciting. Well, you've talked a little bit about brain chemistry, and I was gonna kind of use that to kind of segue to talk a little bit about pornography. Yes. And again, you've I know I've written read the things you've written and said about how pornography can be, you know, significantly have negative impacts, especially for like male erectile dysfunction and how that can negatively impact, you know, uh, you know, that kind of men's sexual health. Yes. Can you tell a little bit about that?

Noelle Pomeroy, PhD:

Sure. So what we're seeing a lot of in my office is men who are coming into the office who don't have any health symptoms of or medical reason to have erectile dysfunction. Maybe they've been to their urologist already or to their primary care doctor, they've gotten a cleared with their cardiac system, or everything's good, and they can't get an erection with their partner, or they're dating and they can't get an erection, or they can't maintain one for more than a second or two. However, when they're by themselves and they're masturbating, they have no problem. And then when you ask them, well, is it just you or is there a video device into the in the room with you? Okay. And almost all the time that they're watching porn. And the first sign of erectile dysfunction induced by pornography is if someone can get an erection while they're watching pornography, but not with a partner that they have a healthy relationship with, okay, then that's a really good indicator. Because and anybody that's listening that is a neuroscientist, please forgive my sloppy use of some of these terms. But to the best of the way I can explain it is when you watch porn, you get a lot of dopamine in your brain. And it is sort of like a fire hose of dopamine because we get more dopamine when something is unique. And the way that people watch porn is there's lots of uniqueness. It's not, they don't have no one has their favorite porno film that they go watch every night.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

It's always different varieties, lots of different windows open. Lots of different windows open. So it's a lot of newness. And then when they so they're getting a lot of dopamine and their body and their brain respond to that, and that's what allows them to have an erection. Well, when they go to have partner with go to have sex with their longtime partner or even their relatively new partner, their dopamine is like a dripping faucet.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And it's not enough to get them to function and to have an erection. But the reason that this causes issues besides the erectile functioning is because most people say, Well, I'm able to get it when I'm watching porn and I can't with my partner. What's wrong with me and my partner?

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

So it has them going down the wrong path.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

So fortunately, when the because this is talked about more and more now, there's more education about it, there's more research being done on it, there's more providers out there that know about it. We're able to tell them, okay, what we need to do is figure out what is your what's going on with your relationship with porn. Because I'll tell you, there are men who watch it for hours every day. And it's not watching it once that I'm talking about that's causing this problem. It's men who watch it daily for years.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And we have a generation of men who've been raised on porn right now.

Dr. Erich Schramm:

Thanks to the internet.

Noelle Pomeroy, PhD:

Right. Because particularly for young men or our sons or grandkids or whoever is watching it, like their sexual development has been through porn. The first thing they ever saw sexually was through porn when they were 11 and now they're 24.

Dr. Erich Schramm:

Wow.

Noelle Pomeroy, PhD:

And their entire sexual development was based on porn. So we're running into a significant problem with sexual functioning in men who 30, 40 years ago very rarely had erectile dysfunction.

Dr. Erich Schramm:

Right. And in clinical practice, I mean, historically that I've treated a lot of older adults, and those are medical conditions that come in a lot of times. People will get older and that's natural. But yeah, it brings up a good point about otherwise younger, healthy, the younger, healthy male population. How do you treat the those kind of patients?

Noelle Pomeroy, PhD:

Well, with people who are coming in to talk about how to talk to their really young men about it or the men that are in my office, I try to say treat pornography if you don't have a moral obligation or a moral objection to it. No one has a moral obligation to watch porn. Moral objection. Treat it like you're supposed to treat dessert from a healthy perspective. It's okay to have from time to time, but if you're eating it every day or multiple times a day, it's going to cause you a problem.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And in addition to it causing issues, it can cause erectile dysfunction with the dopamine, like we talked about before, it also causes relational issues with their partner because they're watching people on a screen, they're removed from the situation, engage in an unrealistic sexual experience.

Dr. Erich Schramm:

We were talking about unrealistic.

Noelle Pomeroy, PhD:

Unrealistic. Watching porn and thinking that's how you're supposed to be performing would be like watching the Avengers and thinking that's how you should run. That's not what your body's capable of.

Dr. Erich Schramm:

All right. Got it.

Noelle Pomeroy, PhD:

So it but it also causes them to objectify their partner. So a lot of partners of men with problematic porn use will tell me, I don't have sex with my husband. My sex, my husband has sex with my body.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

And so that can cause a lot of issues as well.

Dr. Erich Schramm:

And did I see that you had said that maybe a period of like three months of abstinence as a means to try to kind of reset the chemical pathways?

Noelle Pomeroy, PhD:

Yes. For men who have not been watching porn on their phones for their entire sexual development. So I'm gonna say like guys over the age of about 28 right now, who started watching it more frequently, maybe when they were a little bit older, all the way up to men who are 107. Three months with no porn use is what causes is about the right amount of time for their brain to rewire. And we usually start to see sexual functioning return with their partner.

Dr. Erich Schramm:

And do the partners typically are they involved in that therapy or are men just coming in on their own?

Noelle Pomeroy, PhD:

It depends. I've worked with people whose partners say, I just want you to fix it. I don't care what you have to do to fix it. And then you have partners who are there for every step of the way, good or bad.

Dr. Erich Schramm:

So, okay. So that's so that's actually a kind of a really good synopsis to talk about male erectile dysfunction and how pornography has such a negative impact on that. So maybe we can go a different little bit different route here and talk about women's health and female sexual dysfunction and and some of the things that you see and things that you might recommend for for women.

Noelle Pomeroy, PhD:

Well, so a lot of times what brings women into my office is desire discrepancy. They're with someone that wants to have sex more frequently than they do, or it does happen, it's not as common, but would they want to have sex more frequently than their partner does. But for the most part, it was women having a lower desire libido, whatever you want to say, than their partner does. That's probably the most frequent thing that brings them in.

Dr. Erich Schramm:

And I guess it begs the question what is the normal sexual, you know, desire for a for for a woman? And and and how do we even really even define that?

Noelle Pomeroy, PhD:

Yeah, well, what what usually happens is what brings them in is because it's different than their partner. So it's if it's less than their partner, then it can be problematic.

Dr. Erich Schramm:

Okay.

Noelle Pomeroy, PhD:

So that's prop but a lot of women will tell me that it they would be okay not having sex for the rest of their life if they didn't have to. And it's they might love their partner very, very much, but they don't particularly think about sex anymore. They don't necessarily want it in their lives, but they're they're usually pursuing therapy because they want to do that for their partner.

Dr. Erich Schramm:

Is that true for a particular age group, say women that are post-menopausal versus pre-menopausal? Or is it not that defined?

Noelle Pomeroy, PhD:

I think that the menopause part is important. Is it an important piece of it? But I would say over the age of 40, it I do see it relatively common. I see it in younger women younger than that who are what I would call highly anxious women, because they're more likely to be less aware of what their body- how their body feels because they spend so much time in their in between their ears and their head. So that they don't really get a lot of the signals their body's sending to them.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

But over yes, and I think that from an evolutionary perspective, women's spontaneous sexual desire doesn't really have a whole lot of use in once you're past childbearing age, like it doesn't really do the species any good for you to have a sense of sexual desire.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

We all know that women want to have sex for a variety of reasons once they're past childbearing age, but I don't know that there's always the biological drive for it.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

Yet we're men can have babies till the day they die.

Dr. Erich Schramm:

Terrible disconnect, right?

Noelle Pomeroy, PhD:

Absolutely.

Dr. Erich Schramm:

How did that happen?

Noelle Pomeroy, PhD:

Yes. So well, how we usually start talking to women about that is there's spontaneous like sexual desire, and then there's responsive sexual desire. So you may be 50 years old walking around and not necessarily going, ooh, what was that? Or feeling it just because you're, you know, you look at your partner a certain way and think, oh wow. But if you're connected to your partner or the you're relaxed and the the setting is right, you and maybe they start touching you in a way that you enjoy that then your body will start revving up and you'll have a responsive sexual desire.

Dr. Erich Schramm:

Okay.

Noelle Pomeroy, PhD:

So just because you're not having that spontaneous sexual desire doesn't mean you're a lost cause. It's just that we have to change your expectations of-

Dr. Erich Schramm:

-the fire's not out.

Noelle Pomeroy, PhD:

Absolutely.

Dr. Erich Schramm:

It's still there just waiting for for the right opportunity to be rekindled. And in fairness, you have to think, and and and talking about menopause, you know, in the last decade, we really didn't have not done women a favor in terms of addressing, you know, postmenopause symptoms by denying them, you know, you know, hormone replacement therapy. So, you know, here, you know, this is just now more recently, you know, we're going back to to being able to do that or physicians doing that for for their female menopausal patients, but you know, we really didn't do them any favors. And, you know, so it's it's it it'll be interesting to see with the next decade if we're gonna be as a as uh physicians providing consistent hormone replacement therapy. So I think I think hopefully that'll make your job a little bit easier.

Noelle Pomeroy, PhD:

We'll see.

Dr. Erich Schramm:

I hope so. But you know, women have not fared well in the in the female sexual dysfunction. They never got a an official female Viagra, though, you know, I know some women were using that off label. And

Noelle Pomeroy, PhD:

-right.

Dr. Erich Schramm:

But and quite honestly, you know, there's not been a huge uh number of studies that I'm aware of that that looks at, you know, female, you know, sexual health, unless you're aware of, you know, some of those that have been done.

Noelle Pomeroy, PhD:

Not p- you know, not particularly even some of the medications that have been put on the shelf that that are supposed to help women's libidos, I think their efficacy was only slightly better than the placebo.

Dr. Erich Schramm:

Right. They're not game changers, right? They were all they're offering uh an at least some opportunity, but they really weren't game changers.

Noelle Pomeroy, PhD:

Definitely not. So, you know, a lot of the times what happens with women when I see them is well, understanding if they are in menopause or perimenopause, or kind of getting them to understand that no, you're not losing your mind. You're just experiencing some of these things and trying to normalize it for them, but then also trying to explain to them that your body is very different than it was when you first started dating, and maybe when you first met your partner, and that's not the end of the world. And we just need to, you know, this is this is the car we've been given now. Like, let's learn how to drive it.

Dr. Erich Schramm:

Right. Well, that's sounds like you're doing fantastic work. And finally, maybe we can talk about some things that some things, pointers that we can encourage couples to to have a better sex life. I know you've already t touched on a couple of things, but maybe some pointers that you might offer for couples.

Noelle Pomeroy, PhD:

Sure. I think the first one is understanding that the way you you get turned on is not necessarily the way that your partner gets turned on. So a lot of times what I'll hear people say is, well, you know, when she's walking across the house and I grab her booty, uh why doesn't she turn to me and look like, oh my wonderful, that's the most wonderful thing anyone's done to me all day. Why does she look at me like she wants to stab me? Well, and then I say, Well, and they say, Well, I would love it if she grabbed my booty.

Dr. Erich Schramm:

Yeah.

Noelle Pomeroy, PhD:

And it's like, well, that the two of you are very different. You're probably with your partner because they're different in many ways from you. We have to understand that this is one of those ways. Right. There's a book that lots of people have read called The Four Love Languages, and it's about how we give and how we receive love. It's acts of service, words of affirmation, physical touch, and gifts. Actually, it's five love languages. I just shorted them a love language, and there's another one thrown in there. But just because we feel love and attracted to someone when they give us physical items does not mean that that's how they feel love. And how we I might really want to oh, quality time is the fifth one. I might really enjoy spending quality time with my husband.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

But what really might do it for him is if I tell him, You're a great man, you know, you you're a great father, you're a great provider. I really appreciate that. That that's how he feels love. But I might also really, really, really enjoy giving him gifts to show him that I love him. That might not matter to him at all. So the you have to kind of figure out where the other person's coming from.

Dr. Erich Schramm:

Right. And that takes time in relationships.

Noelle Pomeroy, PhD:

Absolutely does.

Dr. Erich Schramm:

Because it does. And that involves that whole communication thing and and and and helping to understand that. So understanding your your significant other's love language is is is hugely important.

Noelle Pomeroy, PhD:

Very, very important. And also one exercise we have a lot of couples do that are trying to figure out how to pair better or how to have a different sex life than the one they have is to encourage them to do something called sensate focus. Okay, you don't have to worry about that part. But basically it's non-sexual touch.

Dr. Erich Schramm:

Okay.

Noelle Pomeroy, PhD:

So it would be to have your partner lay down as unclothed as they feel comfortable. Okay. And to set a timer for 15 minutes and to touch them on their non-sexual body parts. Okay. You can do it with your fingers, you can do it with a feather, you could do it with, I don't know, a spork.

Dr. Erich Schramm:

You could do it with whatever you have handy. Certainly not an axe, right?

Noelle Pomeroy, PhD:

Definitely not an axe.

Dr. Erich Schramm:

No, not a the the implement, potentially a uh okay, I got that.

Noelle Pomeroy, PhD:

Yes.

Dr. Erich Schramm:

Okay, that's right.

Noelle Pomeroy, PhD:

So that 20 minute or 15 minutes is spent, you you you know, dragging your fingers or that feather or the spork along their body and and then giving you feedback on how it feels.

Dr. Erich Schramm:

Okay.

Noelle Pomeroy, PhD:

So that you're learning about what feels good to them and what and if something doesn't feel good, they should tell you that as well. And then you switch positions, and then one of you do that does that for the other person. And so it's learn and it the goal is to not have sex at the end of this practice, but it is to learn more about practice communicating, practicing, stop that. It's really annoying when you keep doing that, even though I don't like it.

Dr. Erich Schramm:

Enlightenment.

Noelle Pomeroy, PhD:

Or please, you know, spend more time on touching the back of my knee. I really like that. And the number of people who and it's funny, people say, Oh yeah, that makes a lot of sense. And then I'll say, Did and they'll say, But my partner rubbed my back for about four minutes and then he stopped, and then we turned on the TV or we went back to our phones. And so that's why you have to set the timer for it to hold each other accountable. Because okay, right. In this day and age, 15 minutes of non-distracted time feels like a year.

Dr. Erich Schramm:

Right.

Noelle Pomeroy, PhD:

So it's really important to set that timer and to do that. And I recommend that people try and do that once a week and just to sort of get to know each other and have that intimacy that's not necessarily sexual.

Dr. Erich Schramm:

Wow. That sounds like a great practice to develop. Yeah, it would be a good thing to do on date night. There you go. I love that. So, Noelle, I do have one more question.

Noelle Pomeroy, PhD:

Yes.

Dr. Erich Schramm:

Favorite film of yours?

Noelle Pomeroy, PhD:

Either Shawshank Redemption or Heat.

Dr. Erich Schramm:

Okay. Tell me-

Noelle Pomeroy, PhD:

Maybe Pride and Prejudice.

Dr. Erich Schramm:

From a from a sexologist standpoint?

Noelle Pomeroy, PhD:

Oh, from a sexologist perspective?

Dr. Erich Schramm:

No, I love your film choices. But I'm um we're here about moving it from a sexologist perspective. Let's see. What films uh or films resonate.

Noelle Pomeroy, PhD:

You know what? I could list a thousand of them where the sex in it is hor like horrible from a you could never do that on this planet. But I would-

Dr. Erich Schramm:

one that you liked, you felt like really was hey, this film really embodied or captured, you know, the essence of like a healthy or a cool kind of sexual.

Noelle Pomeroy, PhD:

I would say there's a a movie that came out about three years ago, and it's actually two women that are having sex with one another, and it's called Part Portrait of a Lady on Fire. And it's really kind of steamy, but it's actually also a really good build up to them Getting to know each other and then to get there's like touching before there's you know, they don't just go for the gusto right away.

Dr. Erich Schramm:

They didn't pop it in the microwave.

Noelle Pomeroy, PhD:

No, they did not.. It is definitely two crock pots in action.

Dr. Erich Schramm:

Crock pot. Oh, I love that. I was looking, uh thinking back, and for me, I'd I'd have to say that Risky Business checked off a lot of boxes.

Noelle Pomeroy, PhD:

Yeah.

Dr. Erich Schramm:

That was back in back in my youth, but I, you know, I was like, gosh, that one just still kind of resonates thinking about back.

Noelle Pomeroy, PhD:

That is a good scene. That that is a good sex scene in that movie. So many of the scenes, sex scenes from movies in that era had them having sex in water. And let me tell you, we all think that water is slippery, but it is not slippery enough to be having sex in. And so that was lots of people in film and TV have sex in in pools or hot tubs, and then you might try it in real life and go, ooh, wow, that was not a good choice.

Dr. Erich Schramm:

Yeah. Just just don't do it. No. Cool. All right. Well, Dr. Pomeroy, thank you so much for a gracious uh use of your time.

Noelle Pomeroy, PhD:

Well, thanks for having me.

Dr. Erich Schramm:

Any question that I should have asked that I didn't?

Noelle Pomeroy, PhD:

No, but I can tell you that Jax Therapy is the name of my practice. And we have a website, it's Jax J A X, like short for Jacksonville, hyphen therapy.com (jax-therapy.com). And we see people for all sorts of mental health issues from age five, not sexual issues with five year olds, obviously. But uh we because we do mental general mental health as well. So we people see people to five to a hundred and five.

Dr. Erich Schramm:

Wow. That's very impressive.

Noelle Pomeroy, PhD:

Thank you.

Dr. Erich Schramm:

Right. Well, hopefully, maybe we'll get you back another time

Noelle Pomeroy, PhD:

I'd Love it

Dr. Erich Schramm:

and cover some other interesting topics. Sure. All right. Thank you so much.

Noelle Pomeroy, PhD:

Thanks.

Announcer:

Thanks for joining the MedEvidence Podcast. To learn more, head over to MedEvidence.com or subscribe to our podcast on your favorite podcast platform.

Head Shot

Dr. Michael Koren

Host