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The Laura Dowling Experience
Reclaiming Intimacy: ADHD, Sexual Trauma and the Right to Pleasure with Dr Natasha Langan
Dr Natasha Langan, a chartered clinical psychologist and accredited psychosexual therapist, explores how childhood sexual abuse impacts intimacy, and how ADHD in women can increase vulnerability to traumatic relationships and sexual exploitation.
• Women with ADHD face higher rates of sexual victimization, unplanned pregnancies, and relationship dissatisfaction
• Trauma includes both major events (sexual assault) and smaller experiences that accumulate over time (public humiliation, feeling "different")
• Shame plays a central role in both ADHD and sexual trauma, creating beliefs that "something is wrong with me"
• Compassion-focused therapy helps address shame by understanding our "tricky brains" that evolved for survival, not happiness
• Vaginismus involves involuntary pelvic floor muscle spasms making penetration painful or impossible
• Women's pain has historically been dismissed by healthcare providers, creating barriers to proper treatment
• Sexual healing requires broadening ideas about what constitutes sex beyond penetration
• A multidisciplinary approach combining physiotherapy, psychology, and sometimes medical care is most effective
• Sexual health is a fundamental human right that includes pleasure, not just prevention of STIs or pregnancy
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Intimacy fears. As an adult with CSA, which is child sexual abuse trauma, how do I relax and enjoy after a history of child sex abuse?
Speaker 2:If there has been trauma, there might be a real disconnect from the body. So some people might notice that they disassociate during sex or experience intense anxiety. Others might experience pain. So there's a massive fallout sexually. And it's the work around healing from child sexual abuse, giving yourself permission to not feel disgust when you feel pleasure.
Speaker 1:Them feeling shame that they were abused. That's awful.
Speaker 2:Maybe they've been told by their abusers that they wanted it, they enjoyed it. How does a woman or a man make sense of that experience? So we develop ways of being in the world or compensatory behaviors. How are other people going to treat me? Will they reject me? Will they abuse me? So we might externally engage in people pleasing? Or maybe we become perfectionistic. You know, if I'm always good, then people will love me. So all of these beliefs and compensatory strategies might have unintended consequences in our life.
Speaker 1:How do you get rid of guilt and shame regarding sex?
Speaker 2:So it's understanding where that shame comes from. Yeah, Is it yours or does it belong to someone else? Giving them permission for pleasure? A lot of self-exploration, self-focus work, masturbation, get comfortable on your own before you're with someone else.
Speaker 1:Welcome back to the Lower Down Experience podcast, where each week, I bring you insightful and inspiring guests that will open your mind and empower your life. Today, I'm joined by Dr Natasha Langen, a chartered clinical psychologist and accredited psychosexual therapist. In this episode, we explore ADHD in women and particularly how it can impact self-perception, increase vulnerability in romantic relationships and make them more prone to traumatic experiences. We also talk about vaginismus, painful sex and difficulties in reaching orgasm, topics that are still too often overlooked or misunderstood. We delve into the difficult but important subject of childhood sexual abuse as well. Please be aware that this conversation may be triggering for some listeners. However, we approach the topic with great care and compassion and love, and Natasha shares powerful insights on healing, the importance of acknowledging trauma and how, with the right support, women and men but mainly women, because this is what we're focusing on in this episode can go on to experience fulfilling relationships and learn to love themselves again. This is a deep and meaningful conversation. It's one that I've really wanted to share for some time, and natasha's empathetic and grounded approach makes this episode both powerful and empowering. I really enjoyed sitting down with her.
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Speaker 1:This episode was produced by podcottseditingcom. Check them out at podcottseditingcom. Tell them, laura Dowling sent you and they might even do your first podcast free of charge. Natasha, you came all the way down from Sligo. I did, yeah, and it is wonderful to have you. Thank you, your work is. It just is so vast. There's so many areas we go to today. But just tell me why you got into it in the first place.
Speaker 2:I did applied psychology in UCC back in 2003 to 2006. And in final year I did a human sexuality module and Sean Hammond was the lecturer that taught that and it was the first time ever that I knew that anyone could study sexual behavior and he took us through like studying, like forensic kind of psychology, like sex offenders, all the way to just the human sexual response cycle and I was blown away and it was my final year and I decided to do my undergrad thesis on the experience of female orgasm. So this is back 2005-2006. Racy Natasha, yeah, it was back then and it was a qualitative study and I interviewed people just about their experience of it and even back then I was really there was a lot of research on sexual dysfunction but I was really interested in pleasure like normal sexual functioning.
Speaker 2:When I finished my degree I thought, oh, I'd love to be a sex researcher but there was no funding at that time. So I thought I'll do clinical psychology, I'll specialize in psychosex and actually at that time I thought I wanted to work in HIV kind of sexual medicine. I went off, got into clinical in Southampton Uni and did a final year placement in sexual health in central London and they actually had a psychosex therapy clinic and it was there that I worked with individuals and couples with vaginismus, dyspareunia, painful sex, low desire and anorgasmia, and that was another area of sexual medicine. I was like this is amazing and I said I want to specialize in this and so finished my clinical training, worked a few years in sexual health as a psychologist and then I went back to do a diploma in psychosex and then became fully accredited with the College of Sexual and Relationship Therapists. Okay, and that's been my journey and you've picked up ADHD along the way as well?
Speaker 1:haven't you, yeah, kind of specialise in that too? Is that just?
Speaker 2:a totally different thing to the psychosexual, or do they merge, or after clinical training I thought I was getting a bit too specialized in psychosex and sex and I thought I really love working with young people. So I took I did some clinical work in CAMHS and it was doing more work around you know ADHD and young people and I met my husband. We moved to Oxford and I started working in the Oxford counselling service and was working with a lot of more 18 to 25 year olds and started doing some work actually in a private ADHD clinic, for it was actually the Oxford Autism and ADHD clinic. So I was doing ADHD assessments and then ADHD kind of therapeutic work with adults and, yeah, so that's how I got into more of working with like neurodivergence, neurodiversity with young people.
Speaker 2:And then when I moved home to Ireland in 2021, I we wanted to get a mortgage, so I was was like I need a permanent job, had my qualifications validated with the government to work in the HSE and in Sligo there was an adult ADHD service. So it's the National Clinical Program and I was lucky enough, got my panel, got my place to position on the panel, start working in the adult ADHD service. So I've been there three years and so whilst working there, I was thinking is there an overlap between ADHD and psychosex? And when I started doing research around that there's not much research out there. But the research that is out there is saying that, particularly women, there's higher rates of sexual victimization, girls being more vulnerable to unplanned pregnancies and also the impact of ADHD on relationships. So we know that there's higher divorce rates, more or less relationship satisfaction, but again there's not that much research happening.
Speaker 1:Does the less relationship satisfaction come from the partner of the person with ADHD or the person with ADHD or both.
Speaker 2:Or both. So the research would say that maybe people with ADHD would have less satisfaction, but they're not sure why that might be. They need to tease that out. But we know that and I see that anecdotally, like in my work that there's a lot of distress sometimes for both partners in the relationship because there's a partner with ADHD experiencing maybe high levels of shame around their ADHD or not managing it and the impact on their life and into a relationship, and then for the partner that maybe doesn't have ADHD, that they're really struggling or feeling overwhelmed or can take on more of the responsibilities at home and in terms of a sex life. You can imagine how that might. So it impacts the relationship.
Speaker 1:But then in terms of intimacy, yeah, if you don't feel you're on an even keel with someone, it's harder to be intimate with them, and it's kind of that vicious cycle then.
Speaker 2:Yeah, exactly, the research says that it doesn't look so good, know the high risk sexual behaviour on planned pregnancies because of vulnerability. They think there's more risk to sexual exploitation and high rates of sexual victimisation because of the vulnerability. And, they say, because women with ADHD might be marginalised, feel different, feel left out, and then they might seek intimacy and connection through sex. And then they might seek intimacy and connection, true sex, and then end up there's predatory people out there and end up maybe being victimized and in that in turn, the knock-on effect that has on their, you know, sense of self, their confidence and their sexual selves as well. So, and we know there's higher rates of trauma in women and girls with ADHD, so they're really vulnerable by trauma. What do you mean by that? So we can think about sexual victimization, but also intimate partner violence is higher rates of that. But also what we mean by trauma, there's the big T's, like big traumas that happen in our life. We think about a sexual assault, child sexual abuse. And then there's the small t's, but that might be the comment that the teacher made in class that left them, you know, shamed in front of the whole class, feeling stupid, not good enough. That's a trauma in itself. So we know, because of their experience maybe of living with untreated, undiagnosed ADHD, it might mean that they're vulnerable to in our work it might be, you know, assessing someone, maybe helping them understand that and help them make sense of it.
Speaker 2:They may they not use that language, trauma language, but when, as psychologists, when I work with people therapeutically with ADHD, maybe post-diagnostic, helping them make sense of their ADHD and their life experiences, we might help them understand it through that lens, like a trauma lens and fuck me, there's so many layers to it. Yeah, and shame is one of the most common experiences when, when you're working with people ADHD and they're ashamed that they have it. Lots of things around that, so it can be. They've been shamed in education, in their relationships at home, growing up, told they're messy, stupid, disorganized, maybe being punished for talking too much, interrupting, and so they're left thinking there's something wrong with me, like, and maybe they won't. I work with adults being diagnosed later in life. So they're making sense of their life experiences and all of the things that might have been challenging or hard for them maybe dropping out of uni, failed relationships, maybe not being able to get on the property ladder, financial difficulties, occupational challenges and that can leave them feeling there's something wrong with me, what's?
Speaker 1:wrong with me?
Speaker 2:and shame. I think it's. Brené Brown says shame is that you know guilt is there's I've done something wrong. Shame, I'm wrong. Okay, and you in the work again. Someone may not have a language around, I'm experiencing shame, but the work is to help them understand shame and how some of the experiences they've had in their life have shaped how to view themselves and and how they relate to themselves, being incredibly self-critical or else even perfectionistic or developing compensatory behaviors to protect against feeling shamed. So self-compassion is a big part of the work helping people cultivate a compassionate relationship with themselves and their past experiences. So I talk a lot about how a compassionate reframe of life experiences. So to understand well, why was school challenging, why were relationships challenging? Because you were living with undiagnosed, unsupported ADHD and because people say I thought that was just me, I thought I was bold, I thought I was naughty, I thought I was stupid, I thought I was messy.
Speaker 1:Yeah, messy, disorganized. I was diagnosed late in life as well and I, even though I was diagnosed with ADHD late in life, I was still questioning whether or not it was real or not. I went, I went and got diagnosed twice, yeah, then, because I had two different doctors, because I literally was like I actually don't really believe this. Am I just thinking this because I'm hearing it a lot? Yeah, yeah, is this just hormones? But it is interesting that shame that you talk about yeah. So I don't talk about ADHD deliberately, because I just don't want it to be like the Laura show.
Speaker 2:Yeah.
Speaker 1:But I did feel ashamed when I was diagnosed first. I remember saying to my husband I said do you feel that you married someone that was like totally different to what you thought she was going to be, and I did feel that there's something wrong with my brain, even though people are like, oh no, it's a superpower. And yeah, it is a superpower in some ways. Dr Sarah Carty refers to it as a Ferrari brain with bicycle brakes or a Ferrari with bicycle brakes, and that's grand to some extent. But then there's those limiting things that like the messiness, like the disorganization, like the unable to get back to emails, even though it's in your head to get back to the email, or it's in your head to do the job and you spend weeks procrastinating about it. It could be done in five minutes but you just don't do it. Like that happens to me a lot and it's that, I suppose, that constant feeling that you're not doing enough. Yeah, this is not the Laura show, but it was just that, but I hear that a lot.
Speaker 2:Laura, when people get so, some people might deny it or think she's got it wrong, or are you sure? There is that idea and I can never explain it properly internalised ableism. We take in these ableist views of what it means to be healthy and well in our culture. So if you have a disability, then we're again less than so. We can reject diagnoses like ADHD.
Speaker 1:Yeah, it's such a recent thing as well. But then I was reading something about like we needed a certain amount of people to have ADHD back way back when it's a genetic thing, it's passed down generation to generation and we needed people that were risk takers, that would go and, you know, swim in the river, across the other river, across the other area, hunt to actually move forward. So, yeah, it shouldn't actually be considered a disability as such, even though some people need a lot of help. But when you're living in like a neurotypical to the other area to actually move forward, so it shouldn't actually be considered a disability as such, even though some people need a lot of help. But when you're living in like a neurotypical society where everyone is following this road and you meander around it, you can be made to feel that you're different and obviously it affects people in different ways. There are different spectrums.
Speaker 1:I never had an issue in school. In fact, I excelled in school but that was probably the hyper focus. There was nothing was going to stop me doing well in the leaving search. So I suppose and that probably affected my family life because I was like no one could, they couldn't move in the house because I have really sensitive hearing, which is another sign of the ADHD, so I could hear the grass grow. The poor fuckers had to like have the TV on three If it went above three. I was banging down down, saying you need to be quiet. So the house when I was studying had to be silent.
Speaker 2:So when I and my sister was like I grew up thinking that was normal, laura, and I thought that was normal so it's just, there's a whole spectrum, there's a huge spectrum and there is still, I think, stigma and shame and around ADHD, and we hear quite negative views at times in the media and or else people saying, oh, you're just jumping on the ADHD bandwagon, you're just lazy, which is really unhelpful, yeah thing to say to anyone.
Speaker 1:Yeah, that's like saying you're jumping on the depressive bandwagon, you know? Yeah, you're not actually depressed, you're just mopey. So, yeah, it is interesting. Yeah, all of that. Do you mainly see women there in your practice, or do you see a lot of men as well? Or do you focus mainly on women in my private practice.
Speaker 2:I work online on a Friday. I see women and women's partners, so really interested in women's health, so that includes the whole psychosex piece. But also work with a lot of women with you know, that might have endometriosis or other. So I'm seeing quite a lot of women that might have dyspareunia, but they might also be living with endometriosis. So dyspareunia, by the way, is just painful sex. Yeah, polycystic ovary syndrome and they're also questioning neurodivergence and we know there's an overlap with that women with ADHD or neurodivergent women. They're disproportionately affected, impacted by endometriosis.
Speaker 1:As in, the symptoms are worse or just they experience the symptoms worse than neurological Higher rates found Higher rates.
Speaker 2:Yeah, adhd and autism. Why we don't know yet, and I think there's some link. Well, I don't know for the cause of the link between the two, but we know that in terms of hormonal sensitivities, we know that painful periods, conditions like endometriosis, difficulties postpartum and also around menopause, perimenopause because of hormonal shifts and interaction with neurotransmitters.
Speaker 1:Oestrogen levels are linked to dopamine as well. So you have those hormonal shifts and decreases in oestrogen. That's when a lot of women they realize they may have ADHD, because it's more profound then in the perimenopausal years. But then they look back on their life.
Speaker 2:But like I did yeah, yeah, oh right, it was glaringly obvious and we're seeing that in the clinic more awareness and more women coming forward, maybe their early 40s, saying I know that in the next few years I may be perimenopausal.
Speaker 1:Yeah.
Speaker 2:I really want to manage these symptoms now and be prepared, which is really great to see. Also, premenstrual dysphoric disorder. We're seeing a lot more PMDD, yeah.
Speaker 1:Oh yeah.
Speaker 2:Really common with women with ADHD and autism when I was in college or anything like that it's really only something that I've come upon recently, but women have, and girls suffered for years, yeah, and the UK government came out with a report earlier this year on medical misogyny and medical gaslighting. I don't believe that happens at all. What are you talking about? And they were talking about endometriosis and women being dismissed and told to kind of suck it up.
Speaker 2:Oh yeah, that's just a period pain go home now, yeah, so it was really good to see the government in the UK really acknowledging that and thinking about how they're going to work to improve, I suppose, more compassionate healthcare for women.
Speaker 1:Isn't it so interesting that women's pain has been dismissed for so long? It's really unreal how much it was minimised and how invalidating it is.
Speaker 2:I hear so many women that might have went to their GP about painful sex and been dismissed, maybe, and they never sought help again after that. So hearing really unhelpful kind of feedback or comments and if you're brave enough or have the courage to come forward and even say this is happening for, have the courage to come forward and even say this is happening for me and then to have that experience, yeah, now there's some other women that are really good at advocating for themselves and saying, well, if this gp says that, or a doctor, I'm going to seek. I'm going to seek a second opinion until they get the information that they need. But that's not the case for some women.
Speaker 1:No, and then some of them don't have the means to do that, of course, might be doctors, exactly yeah. And then if you've a medical card, you can't just switch from one doctor to the next either, so it's really difficult.
Speaker 2:I would see that a lot in my practice too.
Speaker 1:So if a woman has painful sex we know that there's lots of different reasons for that yeah, but you know, if they come to you and say sex is painful, what do you normally do with them?
Speaker 2:So I get curious about that and, like doing an initial assessment for a psychosex will do the whole background really ask about physical health. I'll ask about menstrual cycle, any gynecological issues, even about IBS symptoms. I'll ask about mental health history. I really like to ask about even what's a typical day look like for you, like what's? Is there anything stressful going on in their life which might be caring or stressful? A work situation, caring for parents? Maybe they've got young kids. Asking about you know birth histories, if there's been any birth trauma, you get a more general picture at the start and then we talk about what's led to the referral. They don't self-refer. Self-refer to me in private practice. Okay, in the NHS in the UK we would have received referrals from GPs or health psychologists or pelvic floor physios and gynecology so the UK.
Speaker 2:They had specialist psychosex services that clinicians could refer into, but in Ireland we don't have public services like that, so people are so sorry we still don't have psychosexual services services here in Ireland no, isn't that very interesting.
Speaker 1:Yes, what about the north of Ireland?
Speaker 2:I don't think so okay in the north of Ireland. I don't think so Okay In the north In the UK. Yeah.
Speaker 1:Like, and you know, you think you come so far and then you hear that and you go, oh my, and there is such a need for it because we're going to go a little bit deeper here and speak about why people might need the services. And there are reasons to do with, like, child sex abuse and abuse in general, and there's other reasons. And there's trauma, yes, but given our history as a country.
Speaker 2:Yeah, the fact that there isn't that in place is quite shocking actually. So we have the national counseling service so people are able to self refer. Clinicians can refer in for trauma-informed work, particularly if, if there is an abuse history in childhood but it's. If you do that work around say the child and sexual abuse or abuse and you want to feel empowered in your sex life or you're still experiencing sexual pain, who is going to offer that service? And I think then people might have to pay privately or have to pay privately.
Speaker 2:And there is only about 11 or 12 fully accredited psychosex therapists in Ireland, and so the Sex Therapist Ireland website has the list of all the accredited COSRA accredited clinicians. So there aren't many of us. Yeah, and it's quite a specialist psychological intervention.
Speaker 1:Yeah, of course, and so, yeah, actually, interestingly so, I only put up a little question box about an hour before we met. Yeah, of all the questions that come in, the vast majority of them were similar to this one Intimacy fears as an adult with CSA, which is child sexual abuse trauma, is it possible to recover and how to get there. And then another one was how do I, how do I relax and enjoy after a history of child sex abuse? And so there's out of 20 or 30 questions that have come in in the last half an hour, about 10 of them are in that similar vein. So it's obviously something that is necessary and that people need to know about, and they're obviously people that don't know where to go for help.
Speaker 2:Yeah, and what's really good is there are people saying I want an intimate life I've had this trauma in my past and I want to be intimate with my partner, or I want to date, or I want to be in a relationship with someone, which is amazing. So well done to even you know acknowledge that. But we do know that childhood sexual abuse and sexual assault can have a negative impact on someone's experience of their sexual self and how they are sexually. If there has been trauma, there might be a real disconnect from the body or you might feel triggered during the sexual experience. So some people might notice that they experience out-of-body experiences or disconnect or disassociate during sex or experience intense anxiety. And then others might experience pain because they may not be aware that their pelvic floor is tightening and tensing, or they might experience all over body tension, as some people might use substances to help them relax but they're not very present or it might put them at more risk of sexual victimization again because they're not really present.
Speaker 2:Or people can experience difficulties with boundaries and negotiating safe sex or negotiating to get their needs met. So there's a massive fallout sexually from childhood sexual abuse. The work around healing from childhood sexual abuse it takes time and you need quite skilled clinicians. And, as well as talking about the abuse, we need to be talking about beyond that, how healing might be being empowered in your sex life, giving yourself permission to you know, experience pleasure, to negotiate safe sex, to say what you want, to ask for your needs to be met, to not feel disgust when you feel pleasure because of, maybe, how you felt growing up. You know. Where is that information?
Speaker 1:you know, I've had messages from women, even that I've been to like a couple of my shows, and saying that it was the first time they'd heard their body, that they'd felt actually that they were somewhat connected to their bodies. And this was.
Speaker 1:These are women in their mid-40s, yeah, and said that they were somewhat connected to their bodies, and these were women in their mid-40s. Yeah, and so they went and booked a smear for the first time ever, or a breast check or something like that, and that the show lifted the shame of the child sex abuse.
Speaker 1:Not that it lifted the shame entirely, but they felt a shift and some of the shame. But when they said that about the shame them feeling shame that they were abused that to me was that's awful, isn't it? And and what we do? Know that victims, survivors, do carry the shame and it's been internalized.
Speaker 2:Or maybe they've been told you know by their abusers that they wanted it, they enjoyed it, like in those memories and comments get internalized and shamed, or maybe their body responded in a way that felt really outside of their own control, and they've been told that they enjoyed it. Yeah, which?
Speaker 1:well, I suppose some like it is a physical experience, yeah, and then you can feel shame because your body is protecting it.
Speaker 2:It is a physical experience, yeah, and then you can feel shame, because your body is protecting it.
Speaker 2:It's a really physiological reaction to what's happening and our body might respond with lubrication or orgasm to protect against harm.
Speaker 2:Yeah, but how does a woman or a man make sense of that experience? And sometimes that is part of the work educating them on their body's response in a really non-shaming way, and that might be the first time they're aware of that that this is their body's response, yeah, normal physiological response. So shame is, yeah, pervasive in this work and I think if you can name it, can tame it. If you can name that this is shame. If you can understand your experiences in a really compassionate way with someone you feel safe with and to be witness that your story and your experiences are. You know, maybe seen or heard for the first time by. It might be a friend, it could be a therapist, it could be another clinician that you see. So for some women they go for the first smear or it's during a birthing experience that it might come up, they might get a flashback about an abuse and hopefully at that time you might have a clinician that you could talk to about what's going on.
Speaker 1:Yeah, I was speaking with Dr Maeve Owen in the Rotunda there and she was saying like obviously the ideal situation would be that every healthcare practitioner is trauma-informed first and foremost but obviously we're not at that level yet but that it will be important for women to know that what they, I suppose can do is they can just say to a clinician or a secretary when they book an appointment I'm going to find this difficult. They don't need to give any other explanation and I might need more time than someone else. So book an early morning appointment or a late evening appointment so they can have that time and they don't have to go into any detail. But that someone that is the doctor will understand that they have to take that bit of extra time, but without having to go into any kind of detail. So that will be something important that women can take away now. But I suppose it's even getting to that stage because some women don't even want to say that.
Speaker 2:Yeah, and some people don't remember until they're in the situation. Yeah, but it's really good to hear about your show that people coming away feeling they're able to acknowledge the shame and how it's maybe had an impact on their health. Yeah, having a smear, having breast checks or any other like Just mentally.
Speaker 1:I suppose the love and association they have with their own body.
Speaker 2:Exactly that relationship and how it's impacted maybe on their relationship history or dating history, and yeah, so. So how?
Speaker 1:do they start, though, natasha? So how do they start getting the help for people that have not never been to someone like you? Yeah, they may or may not have a counselling about it. Where do they go for? How do they start it? Because I think that we were saying earlier, before we started the pod, you're saying they need to deal with the trauma first.
Speaker 2:Maybe that's what I might recommend if I were working with someone that. So what I've had an experience in recent times is that I've worked with people that have done a trauma informed piece of work around their experience of a sexual assault abuse. And then what does that mean? A trauma, informed piece of work or abuse? So what does?
Speaker 2:that mean A trauma-informed piece of work. So that's where they're working specifically with the trauma memories and the impact of trauma on their brains, their bodies and some of that disconnect. So they might do some grounding practices and might do some processing work around the trauma memories Can that be very difficult, though, because it's bringing it all back up.
Speaker 1:It can be In my mind I'd be god, I just don't want to fucking bring it up, as in just bury it. Bury it or don't bring it up, because then if you don't talk about it, then it doesn't happen. I would suspect but maybe this isn't the case for everyone that if you're bringing that up, it's you're reliving it and it's actually almost worse yeah, yeah, and there's a lot of women or men that will avoid coming to therapy for fears around that.
Speaker 2:And what we do beforehand is give people you know it's a slow kind of gentle approach that you'd want to do a really good assessment. Give people skills so that when some of those uncomfortable experiences come up, they feel resourced and able to manage. So you don't want to do too much too soon. You want someone to feel that they're ready and take it at their pace as well. We know that it will help with the distress.
Speaker 2:So sometimes they talk about trauma being a bit like you know, if you have a wardrobe filled with clothes and when you go to open it it all spills out. Sometimes the work is about being able to take out some of those pieces, put it back in so that when you come to the wardrobe it's not all spilling out and that it feels like you've integrated some of the memories and feel resourced enough so that it's not kind of intruding on, like you're having intrusive thoughts, reliving the experiences, experiencing high levels of anxiety, distress that's impacting your daily life. That it feels like I've processed some of that, I've made sense of it, I've integrated it and I feel a resource and have skills to manage. But it takes time. It takes working with a clinician you feel safe with and you might have to meet with different clinicians to see, and isn't that difficult?
Speaker 1:too, because then you're financially yeah but then you're telling your story a couple of times or three or four times before you find the right person. Like I know people people that haven't had child sex abuse or that kind of abuse trauma that have been to counsellors to deal with all kinds of things but they didn't get on well with cancer counsellor and then to go and see another one. They're like god, I have to tell the same fucking story again. So it'd be like reliving it all over again and that's difficult, isn't it?
Speaker 2:Well, you may want to say I don't want to get into all of my history, but I want a first session just to check, like you're interviewing your therapist as well, or psychologist so you can say how do you work, what approaches do you use?
Speaker 2:have you worked with people that have abuse histories or sexual assault? And then checking in with your body when you're in the session. How do I feel in the room with this person? Do I feel listened to? Yeah, do I feel listened to, heard? Do I feel safe? If you can connect with that? I know for some people connecting with the body, if there's a trauma history, they may not be able to understand what you mean by that as well. So, yeah, and checking their accreditations as well, just to ensure that they're fully accredited and in public services, you could go to the National counseling service and you can self refer into that service and they're trained to work with abuse histories as well I don't know in the.
Speaker 2:I think it's not as long as other services I know in the northwest, where I am, I think it might be a few months, so it's not like years. Okay, and again, if you're working with clinicians around pelvic pain and you recognize there may be an abuse history, you could speak to your physio. They might be able to direct you to clinicians they refer people to. Okay, the other thing I would say I just want to say that for some people. So I worked with a founder, grainne Byrne, and I'm sure she wouldn't mind me sharing this, but she shared that she experienced primary vaginismus. So that means that there's a pelvic floor tightening and tensing and there can be a fear of penetration or use of tampons or having a smear and one of the common assumptions where you must have been sexually abused or you're sexually assaulted and that can irritate a lot of people in the vaginismus community or people with dyspareunia to be assumed. That's happened.
Speaker 2:So that may not be the case for some women. So again, it's for us not to make assumptions around that. Not everyone that experiences a sexual difficulty will have a trauma history, but we know that some people that have been abused will experience sexual difficulties as well.
Speaker 1:I found it interesting that you said there as well about you know if they could speak to someone, so either a friend or a family member or a clinician, obviously, but a lot of the time the abuse occurred in the family and that can cause a massive family fallout or disbelief or just burying it or no one wanting to deal with it and address it. And how do people navigate that?
Speaker 2:I know that's incredibly difficult if you've been silenced in your own family or when you did come forward about the abuse, that you've been dismissed or minimized or told you're a liar and or taken sides with the abuser which we, these dynamics we know play out.
Speaker 2:Oh god, love him like you know for him type thing, it wasn't his fault, he was young too, or that kind of thing and what we do know, especially with children that have been abused, that when they do disclose, it's so important how they're heard and listened to because it could end up re-traumatizing them, okay.
Speaker 2:So it's really important that we take, you know, validate people's experience, take them seriously, but that isn't the case for a lot of people. When they do come out and I think it's working with the rape crisis services they're incredible at, you know, supporting survivors of child sexual abuse or sexual assault or rape survivors, and they really advocate for the person and maybe, when they feel rejected or isolated by their own families, it might be that a service like that will you know, validate and believe and advocate for you and finding your people that are going to be maybe your family. Maybe your family or origin aren't the people that are going to support you through this, but maybe, hopefully, you have friends that can or partners that can support you around this, but it's incredibly painful and there's a lot of grief and loss and re-traumatization from that, the shame around that as well and how it's placed.
Speaker 2:so I think again the therapeutic work is going to be really important to heal from that, to recognize that the dynamics that play around that systemically, culturally around silence and shame and sometimes male misogyny- and I suppose you know when you're dealing with someone.
Speaker 1:It's not like you follow an algorithmic protocol like one would if someone's going into hospital and they've got a broken arm, and this is what we do, and then we send them to radiography and we do this, that and the other thing, and then we put the arm in a cast.
Speaker 1:No, if you go with mental health, everyone has a different story a different childhood, a different family of origin, like you say, a different relationship with their partner and, like you say, some may have been abused and some may not have been abused either. How do you navigate that with someone?
Speaker 2:It must be tricky, I know, I know and that's the importance, like in your psychological training, it's importance of a good, thorough assessment and that might need to happen over a number of sessions. And as psychologists we don't diagnose. We can but we work with formulation which is an understanding of the difficulties or the challenges and looking at strengths as well so it can be really individual. So we might use frameworks from different models like cognitive behavior therapy, compassion focused therapy, and you know our questions can be interventions in itself. But what we're trying to do is get a picture of I love, is it the Bruce Perry and Oprah Winfrey where they say it's not what's wrong with you, it's what's happened to you, and it's trying to understand from your life experiences why things might be challenging for you in your life right now. We're trying to understand through that formulation and we'll share that with a client, so we call it collaborative, so we'll think about together about what made them vulnerable in the first place. What are the key? It might be if I'm using, say, a compassion focused therapy formulation, it might be what are the key? Shame memories, what are your key fears internally like? Is there fear you're not good enough? Or key fears externally, or how are other people going to treat me? Will they reject me? Will they abuse me? Can they be trusted With these key fears? No one wants to feel them.
Speaker 2:So we develop ways of being in the world or compensatory behaviors so to protect yourself against these beliefs. So we might externally engage in people pleasing, or we could get really angry and irritated and angry and aggressive with people to protect. If we believe they're going to hurt me, I'm going to hurt them first. Or people, please are with ourselves. Maybe we become perfectionistic. You know, if I'm always good, then people will love me. If I always do everything right, then I'll be accepted. And so all of these kind of beliefs and compensatory strategies might feed into, have unintended consequences in our life and it's almost like a negative feedback loop. And that's just one example of how a psychologist might formulate with one model. There's lots of different ways of formulating and again, if you're working with a therapist, it might be like what models do you use?
Speaker 2:so maybe do a little bit of research on the types of therapy they get and try and find a psychologist that does that compassion focused therapy is a lovely model and it's come out of research with paul gilbert in the uk and it's I'm nodding like as if I know what it is, but I don't know he was a psychologist back when he's still alive now and he developed and created compassion focused therapy and he was working with a lot of patients with depression back in the 80s and finding that cognitive behavior therapy like clients could get things logically, like I can. I recognize that thought is unhelpful but I don't feel it in my heart. So it's like this head, heart lag. Your head gets it. I know I'm good enough, but I have these really strong beliefs that I'm not good enough and you kind of, and that feeds into the shame and that's.
Speaker 2:He developed compassion focused therapy to help clients that experience shame and that head, heart lag and it uses a lot of compassionate formulation, collaborative formulation, and the three premises are, if I remember these are that we all just find ourselves here. We don't choose the families we're born into, the culture we're born into. We don't choose the bodies that we have, our looks, our brains, that we have these tricky brains that we've evolved to survive, not to be happy, so that we are vulnerable that's interesting.
Speaker 2:We evolved to survive, not to be happy, not to be happy, but there's this idea we should be happy in the culture that we live in but like life is hard and air, the way our brains are wired are for threat and survival, so that can make us vulnerable to, you know, mental health difficulties, to cognitive ruminations, to self-critical thinking, like he gives examples, like a pig doesn't think I'm a big fat pig or a wolf doesn't think I have anger management difficulties. But humans, we do that. We have these meta cognitions, our way of thinking.
Speaker 1:That's hardly evolved for survival. That kind of wiring in our brain Is it?
Speaker 2:He would say the wiring we've evolved to survive. But we have these old brain and new brain. This is it basically. I'm not a neuroscientist.
Speaker 1:Oh, that's fine. No, just blame her. I'm not a neuroscientist.
Speaker 2:Oh yeah, it's fine. No, just claim her she's.
Speaker 1:I'm not a neuroscientist. She knows what she's talking about. But no, this is really interesting, so proceed please.
Speaker 2:He would say we have these new brains and the old brain, that basic part of the reptilian brain, and, as we've evolved, we have these higher cognitive functions, the ability to think and plan and communicate, and we have all this amazing technology, the things that we can create. But we experience anger, we experience anxiety, and then we can give ourselves a hard time about feeling anxious. Or it's three o'clock in the morning, you're lying in bed and then you're thinking about a past event that happened three years ago, when you were shamed, and then all of a sudden, your body's responding as if you're back there. Or you're thinking about an interview or something that's going to happen in the future, and again your body starts responding as if it's happening in here and now and as if there's a saber-toothed tiger trying to chase you. Yeah, so this is what he talks about. Us having these tricky brains are amazing, but it makes us vulnerable to mental health.
Speaker 2:Okay, it's hard like yeah, you know that there are these vulnerabilities and we're not educated about our nervous system and our brains and how they function and why we're vulnerable to mental health until we're in the mental health system okay you know, until you're a psychologist as well yeah I think it'd be great if children and young people were educated about their anatomy and their nervous systems and thinking about evidence-based strategies and skills to help them manage but do they say now as well?
Speaker 1:you know the way that kids use the term anxiety now a lot, whereas they wouldn't have. So now there's this like almost over correction. Yeah, so where do you stand on that? You know, child, I mean, it's normal to feel worried about an exam. So kids are kind of now saying flippantly, like I feel really anxious about this. As I said, is it an over correction? Are they bandying the word around too much? Now it's great that children can express themselves, but then there is a school of thought that we're talking too much about this and then we're putting ideas in their head.
Speaker 2:But where are they getting this information from? Like we're not educating them in school about their emotions, so maybe they're going online. And I know the Guardian had an article last week on mental health misinformation on TikTok mental health misinformation on TikTok. So they took researchers, took 100 videos and gave them to psychiatrists and psychologists to analyse or review the material and they said over 50% of the videos had misinformation over pathologisation of normal human experiences or emotions and quick fix. We know mental health that the information is so important, the education, the right information. Sometimes, as psychologists we might be, if someone's coming in using that language, we might educate someone around. You know, just saying I have an anxiety disorder, like I'd be really compassionate and validate their experience, but then I'd maybe work with them to to explore what they mean by that okay when I have had that before people saying that they maybe have borderline personality disorder.
Speaker 2:They're labeling themselves before they come in yeah or even ADHD, before they come for their assessments. Yeah, I think it's important to hear what someone's saying and validate their experience and to make. What I always say is, when we're working together, we're trying to make sense of, say, for example, does ADHD best explain your symptoms or is it something else?
Speaker 2:yeah and even for someone that says they're experiencing anxiety, depression, to make sense of what they mean by that. And I remember one experience in the UK where, just by chance, I'd been doing an induction. I had an induction week, so I sat in with a GP and there was a young person come in and said they were feeling really low and the GP took the history in that week. And then, by chance, I was in the counselling service and a young person came in to see me and they disclosed that they'd had a breakup the week before.
Speaker 2:So their experience of, you know, low mood, low motivation, feeling like shit, struggling with sleep was connected to the breakup as opposed to needing an antidepressant. Yeah, but he was offered an antidepressant, so it's important to having time to be with people to make sense of their experience and to make sense of the context around their experience as well.
Speaker 1:That is very interesting. So can we get on to now things like the vaginismus, because you did mention that, and the painful sex and how people can help themselves with that, because that's a huge issue. What percentage of ladies suffer from definition?
Speaker 2:I think one in five women experience painful sex. So, in terms of vaginismus, I know Maria McEvoy was the first researcher in Ireland to do research on vaginismus in 30 years and she published her study about two years ago. So it's available online and she's like an expert in this area. But even reading, I think, maria's dissertation and and some of her work across different countries, the rates vary. Yeah, so we know more traditional, conservative cultures where there's a high, um much, priority put on purity and the purity of a woman.
Speaker 1:Being a virgin.
Speaker 2:And that ties into family honour as well, yeah, and purity, that we see higher rates of vaginismus, so it's like psychosomatic. The ideal way of working, I think, with vaginismus would be with a physiotherapist and a psychologist, yeah, and a gynae gynecologist, to make sure there isn't an organic cause for someone's experience.
Speaker 1:Yeah, vaginismus just explain what it is actually before we yeah, yeah.
Speaker 2:So I don't think we've necessarily explained what it is properly so vaginismus is when there's a tightening or spasming of the muscles around the vagina. Those are your pelvic floor muscles and they are like a hammock from your belly button all the way around to the back and they hold all of our organs. So you know our reproductive organs, our bladder, our bowel, and they wrap around the vagina. And so for some women, the experience is involuntary, and what we mean by that is that they're not consciously trying to tighten their muscles. So what can happen is that they may, for the first time, want to be with their partner and they love their partner, they're really attracted to their partner, and then they attempt penetration for the first time and they might think what's happening here, People describe it as like hitting a bone or a wall, and their partners will describe it in that way.
Speaker 2:And despite them trying to relax that, the pelvic floor has tightened and spasmed so much that nothing is getting inside the vagina. So the vagina is almost closed over.
Speaker 2:Closed over and some women might experience some stinging around the entrance of the vagina and then the pelvic floor tenses and tightens. So you might also have pain as well as the tightening of the pelvic floor muscles, and when you attempt penetration it can be further pain. And there's also then the anxiety around that and for some people there is a phobia around penetration or real anxiety, and maybe they've heard reports that sex is going to be painful or it's going to hurt, or if you have sex you're a bad woman or you're shameful, you're going to bring shame onto the family. So there can be messages we receive from culture, from family origin, from sex education. You'll get pregnant, you'll get an STI, and they can lead to a fear and an anxiety around penetration for some women and for others they might find out for the first time they have vaginismus. They can't use the tampon or they can't use a moon cup or for some. So primary vaginismus is where you've never been able to use a tampon or moon cup or had penetrative sex or had a smear. And secondary vaginismus is where maybe you've had no issues before with penetration or using a tampon or moon cup, but some things happened, like a birth trauma, maybe you've had yeast infections and for whatever reason, or an assault, that, or sometimes even an abusive relationship or a relationship that's not going well. Sometimes your body can speak as well, I think, and then they develop what's called secondary vaginismus. So again, it's the same thing. There's the pelvic floor tightens and spasms around the vagina, meaning that penetration is impossible.
Speaker 2:We talk about the biopsychosocial model, so it's a holistic way of thinking about, say, vaginismus, and Maria McEvoy also spoke about this in her work, about how there's the physical side of vaginismus which we're talking about pelvic floor and vaginas and just the impact you know when it tightens and tenses, and the experience around the vaginal entrance or inside. And then there's the psychology, all the thoughts and feelings around it. So a lot of women will describe feeling broken, that there's something wrong with them, or feeling really anxious about pain, and pain is very real. So you can think about then the physiology, but how we think and feel about pain can dial pain up or dial pain down. And then there's the context is, or the social.
Speaker 2:So the biopsychosocial is the messages we receive in culture or society around, or the misinformation we've received, or, like the what's happening in the relationship as well, the ideal gold standard way I think of working with vaginismus would be seeing a physio, maybe a gynecology and psychology or psychosex therapist.
Speaker 2:So that holistic way of thinking about. Maybe you need pelvic floor exercises, an assessment with a pelvic floor physio and they'll give you exercises to help relax the pelvic floor muscles for women with vaginismus. A lot of women are educated around kegel exercises or we're told to tighten and tense her pelvic floor. But there's a group of women that they have what's called hypertonicity in the pelvic floor, so the pelvic floor is tight and tense and they actually need exercises to relax the pelvic floor. Sometimes those women have heard the messages about kegel floor exercise and they've been using them daily and their pelvic floor or their whole tummy is so tight and tense. So women's health physio or pelvic floor physio really important. And then as a psychologist, I might help someone around understanding what's happening in the body, their anxiety, the negative, and that there'll be anticipated anxiety then too around it.
Speaker 1:So what happens then? You'll be like, oh shit, it's going to happen again, which makes it even worse. Yeah, so that's a vicious cycle of avoidance can happen.
Speaker 2:So what can happen and what you hear with a lot of people is they start to avoid any intimacy, so they stop kissing their partners because they're afraid it'll lead to xyz. So you hear that over time that this vicious cycle really starts to impact a relationship and also their mental health as well. And also when we're working with people, it's really good to get, if they're in a relationship, to get partners involved in the work. Okay, and I've worked with women that are in heterosexual relationships where the partners have come along being really, really supportive and really there in all the sessions and really patient. So I think for anyone the single at vaginismus to know that psychosex therapy it's not just for couples that you can come along, even if you're on your own, but also to know, I'm sorry.
Speaker 1:I would have thought that psychosex therapy. I would have thought that you mainly see people that are by themselves.
Speaker 2:Yeah, we see couples, and we also see people from different, like the LGBTQI plus community. We see people across the lifespan as well. So people that in the NHS our services were commissioned to work with 16 years all the way up to seeing people in their 80s. You can see people that maybe have been through like oncology services for prostate cancer, breast cancer so going to cancer as well, yeah, yeah, and that's so.
Speaker 1:That's a. That's a podcast in and of itself, isn't it dealing with post-cancer?
Speaker 2:yeah, so psychosex therapists and you know you can develop vaginismus dyspareunia from having treatments.
Speaker 1:I actually wrote a chapter about that in my book because yeah, because it's just a topic that I don't think is discussed enough it's your life after cancer, because, although you can have an amazing life, of course, sometimes for a lot of people it may not be quite the same your relationship, your sense of self, your relationship with your own body, how you're physically changed, and there's a lot to work through with that.
Speaker 1:But, there is help out there for people and I think that they need to try and access the care, and it's about advocacy for themselves too, isn't it advocacy?
Speaker 2:and clinicians asking the question how are things in your intimate life? And actually.
Speaker 1:Do you find that? Do clinicians ask?
Speaker 2:that enough.
Speaker 1:Well, we know from the research, that, from the research, there's a lot of shame, says no, there's a lot of yeah, yeah, there's a lot of.
Speaker 2:There can be a lot of shame for clinicians to ask around as in they're embarrassed to ask about it.
Speaker 2:Yeah, okay yeah, so but what we do know is that when people ask, most people really or can be relieved it's an invitation to share what's going on. Even if things are going well, that's great to hear, yeah. If things aren't at the start of a conversation, yeah, and then they may not know in that moment, but they could maybe find out that information for you, like where can you go for support and help? So, yeah, I think it's a podcast in itself, but it's really important to recognize. What I've seen in my work is that people wanted you know their intimate lives can be really important, that even after cancer it's something that they the important part of readjusting to life and is their intimate relationship with their partner, and it might mean re-evaluating and readjusting to to what their sex life is going to look like. So in our culture there's a big emphasis on penile-vaginal intercourse.
Speaker 1:I don't know I should be telling people listen. The clitoris just needs a little rub, not a pounding, you know, and if people only knew that.
Speaker 2:That's the truth, though, isn't it? Yeah, yeah, 80% of women orgasm through clitoral stimulation, so the clitoris is really important, but also to widen and broaden the idea what sex means. So it's not just saying that inter, like, say, intercourse, is the main course, or penetration at all. Exactly, so we talk about center play rather than foreplay, like what are all the other things on your sex menu that you can try?
Speaker 1:I call it chore play, chore play. So you get, yeah.
Speaker 2:So I'm telling you, I say you get most women going, but a chore play chore play oh is that like doing the chores yeah yeah, I often say that it's not what's happening in the bedroom, but like what's happening in the house of course, so sorry, I threw you off there.
Speaker 1:You're talking about center play that's.
Speaker 2:That's another name center play. It could be that um, what does that mean? So it's just the things that we call foreplay actually being center play, being, so, you know, like oral sex. Oh yeah, that is sexual masturbation.
Speaker 1:Yeah, touch, kissing, snogging yeah, all all that good stuff.
Speaker 2:That's part of a sexual experience, but what gets prioritized is penetration. But actually can we widen and broaden our ideas about what sex means? And that forces us to be creative and experiment, to be playful and particularly playful and particularly say, after a prostate cancer or where you know there can be organic reasons for permanent erectile difficulties, that there you really might need to think about what other ways can we be sexual and intimate together in our relationship?
Speaker 1:and yeah, it's really important to just be creative in our sex lives because I suppose you're saying that, though, but then to a couple that are married a long time, yeah, and there's prostate cancer has or prostate removal has caused erectile dysfunction, permanent erectile dysfunction what does that mean? Be playful to a couple in their 50s that have only ever known you know when sex and who are? I suppose in some way maybe both parties are frustrated, or they're sad, or they're, you know, they're grieving for their relationship. What, what does that mean for them?
Speaker 2:So I think working with a couple like that is naming some of that grief and loss yeah and what has been lost. So sometimes there can be a relief the cancer is gone. But actually I didn't know that actually treating the cancer would mean that it'll have an impact on my intimate life in this way yeah, really exploring what that means for them in their relationship. I wouldn't go straight in saying, oh, we need to be playful now, yeah.
Speaker 1:It would be like You're like a red magic bull. Sorry, you're like a red magic, I know, just a playful Mary. Yeah, you know.
Speaker 2:Yeah, so it would be meaning making at the start, helping them understand, name a lot of those emotions the loss, the grief, the anger and if they're open to doing a couples informed psych, a psychosex piece of work. I used to work in a urology service in Oxford and I'd seen couples in their 60s and the good thing about working with couples that age is they've been together a long, long time, they're pretty resilient and their communication is normally pretty good at that time. So I found that they were able to navigate this. They maybe needed some support and some ideas and, like in psychosex therapy, we give people exercises to rebuild intimacy and connection. So that's called Sense8 Focus.
Speaker 2:What does that look like? So basically you ask the couple to engage in touching exercises and so one person takes turn to experience being touched and the other person is the toucher. So what you're encouraging them to do is to touch to bring a quality of mindfulness. It's a presence, and they're not touching for arousal, to touch in a very curious way for themselves, and they're not communicating during this part of the practice and then they'll swap and at the end so both partners experience being touched and being the toucher and what we're the kind of the goal of the practice is to experience intimacy or touch that isn't going to lead to sex. So it's non-demand, non-goal focus. So we're taking penetrative sex off the agenda. So we're putting boundaries around this exercise. Okay, because for some people it can be a lot of anxiety around intimacy, fear, shame, and what you're doing is it's almost like an anxiety management or exposure practice where you're building in safety by having these boundaries. And is this to do with the? Is this?
Speaker 1:to do with with ed.
Speaker 2:When it comes to prostate as well, this is like this is the core sex therapy practice that we use with couples with like low desire, even couples that maybe experience erectile difficulties. Okay, although it's it's a, it's a standard psychosex technique that was developed back in the 60s 70s that we still use now in our work, so it can be used like trans diagnostics, so in a range of different conditions.
Speaker 1:So it doesn't, and it can be used for heterosexuals, for homosexuals by all kinds. Yeah.
Speaker 2:And so it's about rebuilding intimacy. And so the second part of the practice. You get them to do this over a number of weeks and you're also saying to the couple they have to plan this together. And so of weeks, and you're also saying to the couple they have to plan this together and so they might come back the next week and say we didn't do it. Life got really busy and in that in itself can be really interesting for us as sex therapists what, what was happening, and it's like data collection. And then we get them to go back and maybe do that work. So this is homework or home play. It's not anything we do in the session that that's really important to say.
Speaker 1:Oh yeah, oh, I assumed that. I assumed you were in standing there watching them touch each other. But I wonder, though, as well, like can that be deeply frustrating for people? If there is erectile dysfunction there and I know I'm focusing on the erectile dysfunction, but only because I know it from you're from, yeah, touched when they'd normally be aroused by it, but their, their penis, in their mind, isn't working. That can be frustrating in and of itself. I'd say there's layers to that work, is it?
Speaker 2:okay, yeah, and that's the psychology and cognitive behavior therapy, or look it, you know, noticing those negative cognitions, like it's not working. What's wrong with me, what does it mean about me? Or, you know, have really negative beliefs, like around masculinity. So, teaching them skills like mindfulness, or we call it cognitive restructuring, what's another way of thinking about this? Easier said than done, you know, sometimes people will challenge us in the room around the work that we're doing, because that acceptance piece can be. That's a journey to acceptance. You know, experiencing anger, frustration might be part of that journey, but if they continue to engage with those thoughts, that could lead to avoidance of any intimacy and it's a barrier maybe to, I know, re-exploring or readjusting or having an intimate life with their partner just some people just shut down.
Speaker 1:They don't want to talk about it because it's embarrassing and it's that shame and everything. Jesus, so much to it. I could talk to you forever about stuff. So, as a sex therapist, is your sex life perfect then? Oh yeah, not at all. I want to see. Is there any other questions that I need to get, but are there any other important messages that you'd like to get across to people?
Speaker 2:Just to say to people that you'd like to get across to people, I suppose, just to say people that you're not alone. I work in this area. I hear it all the time in clinic that how common sexual difficulties are, so some people feel really alone, like they're the only one having painful sex, they're the only one having, say, erectile difficulties, the only one not experiencing orgasms. So because of what we see, say, in social media or Hollywood or porn, and just to say you're not alone and there is help available, like working with a psychosex therapist, because people can wait years and it can have a negative impact on, say, fertility if you don't get help and maybe it comes too late or you have avoided relationships all your life because you thought that there was something wrong with you, because your experiences. So you're not alone. There is specialist help available.
Speaker 1:I'm just looking at some of the questions here how do you get rid of guilt and shame?
Speaker 2:or regarding sex I've carried guilt over sex with first partner my entire life and sexual shame is what what we see a lot in the clinic room, so it's like the fact that you may have had sex when you're younger and you were you shame around that you might messages.
Speaker 2:You might have been shamed by your peers or your parents, so it's understanding where that shame comes from. Yeah, is it yours or does it belong to someone else? It's empowering someone in their sex life and giving them permission for pleasure. Sex positive sex education is really important. A lot of us don't get sex positive sex education or any yeah growing up.
Speaker 2:So the messages we get where are we getting those messages from? And doing, like your, a lot of self-exploration, self-focus work, masturbation, like that's really important to do that work, get comfortable on your own before you're with someone else. So we will give women or men exercises to practice Okay, getting to know their bodies, getting to know what they like and what they don't like and being able to communicate that with someone. So a lot of people might know what they want. Yeah, they know what they like, but are too ashamed to say that to someone else.
Speaker 1:Okay, so they might, because they might think that the other person's going to think they're a bit kinky or something, yeah or dirty or shameful.
Speaker 2:Okay, and it's really important that we're able to communicate. So Emily Nagoski talks about brakes and accelerators. What are all the things that turn you on that accelerate? Yeah, internally, externally, what your partner does, what a partner does what, what you do, what you like, and what are all the things that are a break, that turn off your arousal or desire? So that might be negative thoughts, shame, or it could be you'd like with ADHD, getting really distracted by the clothes in the corner of the room.
Speaker 1:To, externally, something your partner a lot of women could relate to that without adhd.
Speaker 2:I heard someone say that's why blindfold like kink and uh mask can be really helpful to just block that out.
Speaker 1:Yeah I just heard that, just seeing up, there is now a mask across the country. Um, can I ask you, if you're not there, questions and if you're not on the same level as your partner? Not necessarily it's about desire, but it's about they want to do something like a threesome and you do not want to do that. Yeah, so do you meet couples that are on a different level?
Speaker 2:Yeah, and how do they navigate that if they want to stay together?
Speaker 1:I think it's well, yeah, or if the dirty talk is fine, but then it's the realization that the partner thinks that dirty talk is actually going to come to fruition. You know all of that like fantasies.
Speaker 2:We can all have fantasies, but not everyone wants to, you know. Act them out so. But it's really important, I think, that both couples are able to be heard and non-shamed for their wants or desires. But it's also about having open communication because for someone it might be a big break. Like group sex is like the last thing they want to do, it could re-traumatize them, whereas someone else it could be their accelerator. It could be, you know, there's lots of stimulation, diversity, novelty, novelty and that could be their accelerator. So it's how do you negotiate that in your relationship and communicate around your expectations? So it's an it might be an ongoing conversation, not a one-off one, and important that you're able to hear and respect and non-shame, I think, is really important.
Speaker 1:There's a lot of stuff that comes into my confessions on a Sunday about you were saying that group sex, but like swinging and orgies and threesomes, and I think maybe it's something to do with porn and the increase in it and people being more open to that now, Because I know that certainly when you were growing up in the 80s and 90s it was absolutely not discussed. But now they say young teenagers are being exposed to threesomes and thinking that sometimes that it's normal to to take part in a threesome and then I suppose as a 45 year old woman I'm thinking like is that part of? Is that a normal thing for them to want to explore? And am I just prudish because I'm? I grew up in a different era or is it not normal or is this something so?
Speaker 2:what are your thoughts on that? What is normal?
Speaker 2:What is normal In terms of someone's sex life.
Speaker 2:Emily Nagoski says don't yuck someone's yum, and it's really important that we're able to hear someone's and I think to explore alternative, say we call it alternative sexual lifestyles. To explore alternative, say we call it alternative sexual lifestyles, there really needs to be safety and consent and communication and how that's negotiated. That's really important. So I think to work with a clinician that you know is expert on that, if a couple or a person wants to navigate those experiences, that's what I'd be recommending and there's information that they can receive around that. But it's making sure that we're not being drawn into activities we're not comfortable with and that we're unable to say no or not consent to and what we know in neurodivergent women. They might find themselves in situations where they don't know how to negotiate their way out of and it's easier to go along with than afterwards the shame, afterwards Regret, shame or trauma. Really interested in engaging in those practices or like BDSM, kink, yeah, and group sex, and just finding good information around that and just ensuring there's there's safety, communication, clear communication around consent.
Speaker 1:Well, if you look back on the Greeks and Romans, we're all at the origins back then, I suppose. Then religion kind of came in. Yeah, yeah, you know. So it is interesting. That kind of I suppose, oh, what do you came in? Yeah, yeah, so it is interesting. That kind of I suppose, oh, what do you call it? The evolution, isn't it? Yeah?
Speaker 2:and I think people are curious and interested and we're more liberal now in Ireland, but we still have hang-ups from, maybe, the Catholic Church. It was only in the 80s that contraception was in 1985 that we were able to get it, and so, yeah, yeah, I think it doesn't surprise me that more people are interested in.
Speaker 1:Yeah, exploring that. You spoke with anorgasmia there at the start. Maybe we'll just have a little talk about what that is. And certainly I would see it in people that are on SSRI, so antidepressants they women can't orgasm or men have erectile dysfunction as a result of it. So I suppose when I'm asked about that, my standard answer would be you could take your antidepressant at a different time. So say, if you take your antidepressant in the morning, maybe delay it by a couple of hours so you can have sex in the morning, because the half-life of it may have worn off by that time. Or you could talk to your doctor about reducing your dose, if that was clinically appropriate, or changing drug. So there are the three kind of standard answers as a pharmacist that I would give, but that may not get people very far. So, as a clinical psychologist, how can people help to navigate anorgasmia due to antidepressant use and then just organic anorgasmia?
Speaker 2:Yeah, so I think a good assessment is important to realize, like someone's mood, what medications are on and the impact they're having on their intimate life. We know that some people will not stop their medications because of sexual side effects.
Speaker 1:So it's really important that we ask about that, and even antipsychotic drugs will sometimes find the effects of that on their sex life. Yeah, it's just. Or body image, yeah.
Speaker 2:So I think it's really important to ask about that. And on orgasmia, there can be psychological reasons for that, which you know. Maybe shame, not being able to shame. Maybe on their own they're fine, no issues by themselves, but when they're with a partner they really struggle to orgasm. So that might be more psychological components.
Speaker 2:So helping them understand what's happening, what's interfering with arousal, so that could be their attention, negative thoughts, more focus on the partner, more kind of what we call spectator in they're kind of looking on themselves having sex and thinking how they're lookingator in they're kind of looking on themselves having sex and thinking how they're looking and what they're doing. Right and that gets away, being in the moment and the erotic stimuli. So what we want is and teaching skills like mindfulness and being able to bring awareness into the present moment, to notice sensations and notice what feels good. But again, you might need permission to do that if there's been shame, so you might have to do a piece of work around that. So a lot of people fear losing control around someone else or how they're going to look their orgasm face or what you know, or if they're going to squirt or if the noises they make.
Speaker 2:So it's really important to check and understand. Like what? Are there any fears and anxieties? Or has someone shamed you in the past? Or, for some people, there's a lot of pressure nowadays put on them having an orgasm, as if the orgasm is the goal yeah, the goal.
Speaker 2:And if you're not having an orgasm, you're not having good sex. So you can still have pleasurable sex without having an orgasm. And people have sex for lots of different reasons. So it's not just about an orgasm and we may not have an orgasm. And people have sex for lots of different reasons. So it's not just about an orgasm and we may not have an orgasm every time we have sex. And so we know that with heterosexual couples there is an orgasm gap. So that if you're in a heterosexual yeah, the research does say I can't think right now, but I think it's something like is it like 40 percent, something like that women no, it might be more than that, so don't quote me on that but the gap is that if you're in a heterosexual relationship, you're going to orgasm less than if you're in the same sex relationship. So lesbian couples going to orgasm, probably 86% of the time, something like that consistently, whereas in a heterosexual relationship there is a gap.
Speaker 1:So it's not surprising though, isn't it no, that lesbians can give each other orgasms.
Speaker 2:Yeah, because there's a focus on collateral stimulation and less maybe focus on penetration. So in terms of treating the anorgasmia, but if someone's on, say, a medication and there is that organic reason for it because the meds, like you said, talking to your health provider about changing your medication, we do see that with ADHD medication sometimes it can have an impact for men on delayed ejaculation. Or someone else I work with said I'm really able to focus during sex, which is great, great, but I can't orgasm.
Speaker 1:Time to be the swervers. Yeah, I'm not looking at the laundry, but I can't orgasm. Yeah, okay, interesting.
Speaker 2:So it's interesting what the medications or maybe other treatments- are on and how they impact on your sexual arousal, whether that's your desire arousal during sex orgasm. That's your desire arousal during sex orgasm. So just being curious yourself, maybe tracking your symptoms can be really good.
Speaker 1:Different times of the month we might experience different symptoms as well, and I heard a joke there saying like something like women for six hours in the month are horny as hell. You know, you rip the clothes off off and then the rest of the month they're just like grand that's good. Yeah, those six hours where you're ovulating, yeah ovulating yeah okay, well, it's been a lovely conversation. I feel that we could talk more about all the things that might get you back.
Speaker 2:I think it's important that people know that there is help there yeah, I know it takes a lot of courage to kind of reach out and have that initial conversation, particularly I suppose with the whole sex thing it's something that I suppose maybe isn't seen as part of healthcare.
Speaker 1:We don't have clinical sexual psychologists even in the public sphere as such, so people don't necessarily think of it as my intimate life is affected negatively. It's not really healthcare. It's something that isn't necessary to me living a long and healthy life but like it's part of our holistic health isn't it. And for some people it's very much attached to their mental health and physical health.
Speaker 2:It's very much a part of who they are and like sleeping and eating yeah, and it can have an impact on mental health and our relationships and quality of life yeah so I heard laurie brotto, who is an amazing sex researcher and clinical psychologist. She studies mindfulness, says sexual health is health and sexual health is not just about contraceptives and not getting an STI checking yourself. It's about pleasure. It's about your sexual rights, boundaries pleasure that word again is really important and about sex positive education.
Speaker 1:So it's a really broad term and it's a right, I think, to understand that sexual health is a human right, okay, and pleasure is included in that okay, so what advice would you give young people today, then and this doesn't have to be anything to do with what we've talked about, this is just my standard question- I was thinking about that question and I just related a little bit back to when I'm in the ADHD clinic oh yeah, people that do really well in their lives, I find, have found what it is that they love to do and whatever that thing is, whatever they can hyper focus on for hours and problem solve or fix or create, and they're able to do that thing and then maybe there's more movement allowed in their working conditions.
Speaker 2:And so I think for young people, permission to find that thing that you want to do and that you do better than anyone else, that you can spend hours studying or fixing or working with, and do that because we're given these messages of successes like money, fame, fame, power, and fuck it when you see what's going on in america.
Speaker 1:I know exactly. Yeah, you wonder what the bloody?
Speaker 2:world is turning into, but yeah, so they're not. They're not what's going to make you happy in life exactly it's finding occupation, that's whatever work, hobbies, interests that you know give your life meaning purpose, and that it doesn't necessarily have to be the traditional route, and people normally find their ways back to the things that they enjoyed when they were younger and they maybe had years like doing a job that they hated. So study, your training, that thing that you know that you love, because the world needs more people doing what they love and using their gift, unique gifts.
Speaker 2:Yeah, you know, I think in neurodivergence it's recognizing there is neurodiversity, that we're all different and giving ourselves permission to we're not all going to fit into particular traditional jobs. So, thinking outside the box and, yeah, that it's okay to think outside the box.
Speaker 1:Okay, sure enough, but I loved acting and entertaining and singing and dancing when I was a kid and teenager and I thought I wanted to be an actress and all that pharmacy, and then you're doing all this, yeah, so it's kind of like a it's a mix of everything that I do love to do. So, yeah, it interesting. And then what's the meaning of life?
Speaker 2:I think, relationships. So Esther Perel says the quality of her life depends on the quality of our relationships. So I think our connections, and that's romantically, family, friends, community, and also nature around us, like you know, animals, the modern human world. So I think, to be in connection in community with all of those things really important for our well-being, for life, I think, and to be respecting all of those relationships and doing what we can yeah, yeah, wow.
Speaker 1:I could listen to you for hours. I find you really calming, thank you. I can see why you're a really good um psychologist. Like I could come to you now and have just a chat, why you're a really good um psychologist like I could come to you now and have just a chat. Really, you have a really calm voice and you you carefully consider your answers as well.
Speaker 2:Really, sorry, I feel like at times you're, on the podcast, a bit clunky with my thoughts, no, but um, but no, I think it's important you don't necessarily shoot off an answer.
Speaker 1:You're tentative and make sense, yeah, and you take breaths, and I've actually really enjoyed this and it's a Saturday afternoon and it's been lovely. Thanks for having me on, thank you thank you, laura are you feeling wired by day and restless at night? Well, fabio Oronora Lax is your daily blend of botanicals, b vitamins and magnesium to help you feel calm and balanced, ease into deep rest and wake up refreshed. Check out our amazing reviews on fabiwellnesscom. Available on fabiwellnesscom and in pharmacies and health food stores nationwide.