EP 583: Got The Bedroom Blues? Try Sex Therapy To Make It Red Hot Again!

Today, Donna Lee is joined by Dr. Vagdevi Meunier, a licensed psychologist who specializes in sexual wellness and relationships. As the on-site sex therapy provider for NAU Urology Specialists, Dr. Vagdevi sees patients with a wide range of sexual dysfunction symptoms such as erectile dysfunction, early ejaculation, arousal difficulties, and more. Because the body mind-body connection is an integral part of sexual arousal and orgasm, psychological factors like stress, performance anxiety, and miscommunication between partners can sabotage sexual relationships. Dr. Vagdevi and our other sex therapists offer patients psychological care to help manage their physical conditions and improve sexual function.

To learn more about Dr. Vagdevi and her colleagues at The Center For Relationships, please visit her website or call (512) 465-2926.

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you. Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode!

Phone: (512) 238-0762
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Transcript

Speaker 1: 0:07

Welcome to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Donna Lee: 0:16

Welcome to the Armor Men's Health Hour. Welcome back. We have a very special guest as Dr. Mistry stepped away. I don't know if you all know, but Dr. Mistry has six children and one grandchild. So sometimes he just has to leave and go take care of stuff, and super busy. But we brought in one of our favorite guests who we haven't seen in a really long time, Dr. Vagdevi. Welcome back!

Dr. Vagdevi: 0:36

Thank you. Thank you, Donna. I'm glad to be here.

Donna Lee: 0:38

So tell me all about you and what you've been doing for two years. We haven't seen you in like two years.

Dr. Vagdevi: 0:44

I know, right?

Donna Lee: 0:44

We had you on the show. You're our sex therapist on site now. We have Dr. Oliver Davidson joining us soon.

Dr. Vagdevi: 0:51

Correct.

Donna Lee: 0:51

...from your practice. But going back to the beginning, tell us who you are, your website, what you all do, and how you're associated with us, because it's a beautiful relationship we've had for like 15 years.

Dr. Vagdevi: 1:02

I know. I know. So my name is Vagdevi Meunier. I'm a licensed psychologist in Austin, Texas. And in 2014, I started a center here in Austin called the Center for Relationships. And really our relationship with NAU Specialists goes way, way back, way before that. When I started my private practice, I used to supervise doctoral students from the University of Texas, and one of them wanted to work in behavioral health, particularly with sexual concerns. And she happened to have met Dr. Mistry at a, a sex therapy conference or sexuality conference. And she said,"Would you supervise me if I go and do you know, a few hours a week over there?" And I said,"Oh my gosh, that's a great idea." And so she started to do that. And then Dr. Mistry said,"We love this."

Donna Lee: 1:52

Right?

Dr. Vagdevi: 1:52

"Can you please keep this up? Can you keep bringing other therapists for us to have on site?" Because as you and I know, a lot of sexual concerns have a huge psychological component. Whether or not there's a medical part to it, which many sexual concerns might have...

Donna Lee: 2:10

Right.

Dr. Vagdevi: 2:11

...you still need to have some psychological care in a way, somebody that you can talk to that helps you manage what else is going on around the medical condition.

Donna Lee: 2:23

Right. And it's, it's, sex therapy is kind of misleading. It's, I think people think it's like, you're coming in with some sex toys and you're gonna show them how to have better sex. It's not that. So then explain...

Dr. Vagdevi: 2:34

No. Not in Texas, especially.

Donna Lee: 2:35

Right. I mean, you can find that, but that's not what we have....

Dr. Vagdevi: 2:38

That's not what we do.

Donna Lee: 2:38

...at our clinic. But, yeah. Tell patients what they should expect when they are coming to see you or one of your, your doctoral students.

Dr. Vagdevi: 2:45

So, yeah. So Dr. Oliver Davidson is one of our doctoral students, and he's going to be here on site. We've had other people, but this is the person that's gonna be here, starting I guess this week.

Donna Lee: 2:56

He's starting this week in our clinic.

Dr. Vagdevi: 2:58

Yes.

Donna Lee: 2:58

Yeah. We're so excited.

Dr. Vagdevi: 2:59

I know, and he's...

Donna Lee: 3:00

And you don't have to be a patient of ours at Urology Specialists to see Dr. Davidson.

Dr. Vagdevi: 3:05

That's true.

Donna Lee: 3:06

So if you have questions, of course, at the end of the podcast and radio segment, we're gonna give you the contact information.

Dr. Vagdevi: 3:10

Absolutely, absolutely. So, we have a therapist on site because when the doctors here see a patient for a medical condition that may be affecting their sexual performance, sexual function, that they have the ability to refer that patient to Dr. Davidson or a therapist on site. And what happens when they do that, is that the patient gets to meet with our therapist and just talk about what are some of the psychological components? So just to give you an example, if you have erectile dysfunction. Erectile dysfunction isn't just a medical condition. It causes a lot of distress. It causes a lot of confusion. People sometimes are like,"Why did I get this? And where does this come from? And what do I do while I'm waiting for the medical treatment to take hold? And maybe the medical treatment isn't a hundred percent restoring my sexual function, my erections. Then what do I do? How do I talk to my spouse about this?" Like we might have a young man who, you know, wants to date and he doesn't even know how he's going to let his dating partners know.

Donna Lee: 4:20

Right.

Dr. Vagdevi: 4:20

"Hey, I have this situation. I have this condition. It's not my fault. It's not a lack of attraction to you. It's just that my body doesn't function..."

Donna Lee: 4:28

Right.

Dr. Vagdevi: 4:29

"...the way that I want it to." Right?

Donna Lee: 4:30

Right.

Dr. Vagdevi: 4:31

And so, you get to meet with the therapist. The therapist will do a little assessment to see what are some of the psychological aspects to your condition? We do a lot of education around sexual issues. I think the numbers that I've seen, and this is, don't quote me on it, but something like 70% to 75%...

Donna Lee: 4:51

Wow.

Dr. Vagdevi: 4:53

...of sexual conditions have a psychological component.

Donna Lee: 4:56

Oh, I bet. That sounds appropriate to me.

Dr. Vagdevi: 4:58

Exactly. So...

Donna Lee: 5:00

And you're talking about not, with erectile dysfunction, delayed ejaculation or premature ejaculation, or any type of...

Dr. Vagdevi: 5:07

Just arousal difficulties, you know?

Donna Lee: 5:09

Right.

Dr. Vagdevi: 5:09

Difficulty getting and maintaining an erection. Right?

Donna Lee: 5:13

Gotcha.

Dr. Vagdevi: 5:14

As well as, like you said, you know, delayed, you know, early ejaculation.

Donna Lee: 5:18

Right.

Dr. Vagdevi: 5:19

We don't call it premature anymore because premature makes it sound like there's some gold standard.

Donna Lee: 5:25

Right.

Dr. Vagdevi: 5:25

And that if you don't, you know, maintain your erection and don't have your orgasm 7 minutes in or 10 minutes in, then something, you you're having a premature, but really it's a subjective experience.

Donna Lee: 5:39

Right. That's a good point.

Dr. Vagdevi: 5:39

And for some people it's just earlier than they want it to be.

Donna Lee: 5:43

Yeah.

Dr. Vagdevi: 5:43

Right? They were hoping they could last longer. And you know, whether you last a short time or a long time has a lot to do with not just your body, but how you're feeling about yourself, about your own body, how you're feeling about this person that you're having sex with, right? And what's...

Donna Lee: 6:02

To me, it's how many dishes are in the sink. But that's, that's just me. How many chores need to be done? That's how fast I need this to happen. Hurry up.

Dr. Vagdevi: 6:12

Well, so, you know, your partner maybe...

Donna Lee: 6:16

Yeah, he doesn't deal with the dishes. We both know this.

Dr. Vagdevi: 6:19

Right. But what I'm saying is if you're a man and you're early, it could be because your partner is actually stimulating you quickly or too much in order to make you come quickly so that you can, she can go get the dishes done.

Donna Lee: 6:34

That's our household.

Dr. Vagdevi: 6:35

That could happen.

Donna Lee: 6:36

That's exactly right. That's what's happening in our household.

Dr. Vagdevi: 6:38

Yes.

Donna Lee: 6:38

So a patient, I know that we treat, of course, every type of erectile dysfunction, and then we offer medications and supplements and we have all these amazing things, but I want patients to, to drop that stigma of sex therapy. Like...

Dr. Vagdevi: 6:50

Exactly.

Donna Lee: 6:51

It's so hard. We have patients that we talk to, and it's so hard, though, to get them to make that next step and see the therapist.

Dr. Vagdevi: 6:56

Right. Right.

Donna Lee: 6:56

So how do we help patients understand that it shouldn't be a difficult decision. It should be like seeing another provider.

Dr. Vagdevi: 7:03

Yeah. Unfortunately, I think in our society, we've separated the body from the mind for a long, long time. And so anything connected to the mind, people feel some stigma, some hesitation, embarrassment. Right?

Donna Lee: 7:15

Right.

Dr. Vagdevi: 7:16

And they also have the mistaken belief, if it's connected to the mind, then I should be able to use my willpower to make something happen.

Donna Lee: 7:23

Yeah.

Dr. Vagdevi: 7:24

And the fact is that your body and mind are very intimately connected. So if you're feeling something like anxious, fearful, nervous, angry, depressed, then it's going to affect how your body functions.

Donna Lee: 7:39

Yeah.

Dr. Vagdevi: 7:39

Something that might have been really easy for you to do when you were 15, 16, and maybe even happen without you wanting to...

Donna Lee: 7:46

Right.

Dr. Vagdevi: 7:46

...is going to suddenly become much more difficult to do.

Donna Lee: 7:49

Right.

Dr. Vagdevi: 7:49

And you cannot really take a pill or, you know, have a medical treatment that changes that. In rare cases, you can go on some medication, maybe if you're depressed and the antidepressant both helps you not be depressed, but a lot of antidepressants also suppress libido and sexual function.

Donna Lee: 8:12

Gotcha. Oh my goodness. We'll cut that out. Keep going.

Dr. Vagdevi: 8:15

So, you know, a lot of antidepressants can affect your sexual function and your libido. And so if that's happening, then psychotherapy is the perfect adjunct, sex therapy is the perfect adjunct to really help you learn about where this might be coming from--your anxiety, your nervousness, your depression--and also what are some behavioral things you can do.

Donna Lee: 8:40

Right.

Dr. Vagdevi: 8:41

What are some changes you can make? Dr. Davidson actually is one of our absolute specialists in self-compassion.

Donna Lee: 8:50

Oh.

Dr. Vagdevi: 8:50

And one of the things, he worked with Dr. Kristin Neff, I don't know if you know her name, but she's a local expert in compassion and self-compassion in particular. She wrote the book on it.

Donna Lee: 9:00

We never talk about that. That's a great point.

Dr. Vagdevi: 9:02

And you know, one of the biggest problems with any sexual dysfunction is how we feel about it and what we tell ourselves about it. And so you were talking about the stigma. So part of the stigma that people feel is,"I shouldn't have to go to sex therapy. I should be able to just tell myself to do better."

Donna Lee: 9:21

Right.

Dr. Vagdevi: 9:22

"I should be able to just will myself to do better." And actually, the it's sort of like, if you're, if you have a driving instructor in your head that's really yelling at you and talking harshly to you, are you gonna be a good driver? Probably not.

Donna Lee: 9:36

Good point.

Dr. Vagdevi: 9:36

Yeah.

Donna Lee: 9:37

So you're probably being hard on yourself.

Dr. Vagdevi: 9:38

And so the harder you get on yourself, those darn genitals don't work....

Donna Lee: 9:43

Yeah.

Dr. Vagdevi: 9:43

...the way they're supposed to.

Donna Lee: 9:45

Right.

Dr. Vagdevi: 9:45

And so it's actually kind of a, what's the word? You know, it's a kind of contradiction. It's a quid pro quo. One thing, if, if you're hard on yourself, the body actually resists you. Right? And so the easier you are on yourself. Now, you can't also just say,"Oh, I'm just gonna relax. And I'm just gonna say to my penis,'Please work.'" And it won't work...

Donna Lee: 10:09

And guess what?

Dr. Vagdevi: 10:10

...that way either.

Donna Lee: 10:12

It's probably not going to.

Dr. Vagdevi: 10:13

Yes. It's not going to.

Donna Lee: 10:14

I wanted to continue the discussion we were talking about with sex therapy, sexual health and wellness, and then we talked maybe about discussing orgasmic difficult, delay. What were...

Dr. Vagdevi: 10:25

Yeah. Yeah. Orgasmic difficulties or dysfunction.

Donna Lee: 10:28

Right. Because everything's connected.

Dr. Vagdevi: 10:30

Everything's connected. That right.

Donna Lee: 10:32

The mind is connected directly to the penis, as we know. There's no elbows or an in-between, it's just...

Dr. Vagdevi: 10:37

That's right. That's right. Sometimes the penis seems to have a mind of its own.

Donna Lee: 10:40

It does. In every case that I've ever known.

Dr. Vagdevi: 10:43

Right.

Donna Lee: 10:43

Yeah. But let's talk about that--orgasmic delay. And you said there's three categories that the patients...

Dr. Vagdevi: 10:48

Three stages.

Donna Lee: 10:49

Three stages.

Dr. Vagdevi: 10:49

So, you know, the research on sex began with Masters and Johnson. And one of the things they did was they went in and actually videotaped people having sex, both internally and externally, and just watched what happened in the body. And they identified these three stages: desire, arousal, and orgasm.

Donna Lee: 11:06

Okay.

Dr. Vagdevi: 11:06

Right? And everybody has sex with the hope of having an orgasm, but really, sex is much more fun along the way. If you looked at a chart of how sex progresses, orgasm is a little tiny blip at the very top. It's a little beep and then you're done.

Donna Lee: 11:26

Right? And then it's over and you get back to your chores.

Dr. Vagdevi: 11:29

And then you get back to your chores. Yes, as Donna said in the previous segment. Yeah. So actually the biggest part of sex is desire and arousal. Desire starts hours, days, weeks, even months before you have sex.

Donna Lee: 11:44

Oh.

Dr. Vagdevi: 11:44

And desire starts in the mind. It starts with an interest in sex. It starts with a curiosity. It might start with an attraction to somebody. You start having images. The images you have in your mind are really potent in making the blood flow go down to your genitals. That's how you achieve an, an erection is that you imagine, you, it's almost like your mind salivating and waiting for this awesome experience you're about to have.

Donna Lee: 12:16

Right.

Dr. Vagdevi: 12:16

And so then the erection happens. And sometimes, what we do just before we get into sex is we do foreplay. And foreplay gets your erection nice and strong. And when you're arousal threshold is met, you are now ready to have intercourse. But your arousal threshold then has to, you know, be crossed, and you have to reach your orgasmic threshold in order to have an orgasm.

Donna Lee: 12:43

Okay. So my idea foreplay is,"Hurry up. I've got three minutes." Does that count?

Dr. Vagdevi: 12:49

Well, that's actually arousal. So foreplay happens way before that. So foreplay might be that he comes up behind you and gives you a little peck on the neck and says,"How about it, Donna? How about tonight?"

Donna Lee: 13:03

Oh, no. I think he became behind me, he better start doing the dishes. And that's, for me, arousal. I don't wanna deviate too much...

Dr. Vagdevi: 13:09

No, exactly. You know?

Donna Lee: 13:10

Yeah, that helps.

Dr. Vagdevi: 13:10

Next time we, we should absolutely talk about sex and women, because I think men need to know this. There's a book called Porn for Women, and you know what it is? Every single page shows a picture of a good looking man doing household chores.

Donna Lee: 13:23

Oh, that's perfect.

Dr. Vagdevi: 13:24

Exactly.

Donna Lee: 13:25

That's all we want guys.

Dr. Vagdevi: 13:26

Exactly. So the desire for women really begins with emotional connection, support, having the partner, male partner, doing things around the house, doing things with them--that's what creates desire. Arousal begins when you've decided we wanna have intercourse tonight and you begin the foreplay. That's when your sensory sort of nerve endings begin to awaken and you have all your erogenous zones, your lips, your neck, your, for some people, their arm pits, you know, wherever in your body. You could have erogenous zones everywhere.

Donna Lee: 14:05

Right.

Dr. Vagdevi: 14:05

And, your genitals are your biggest erogenous zones. And then, so at some point after kissing necking, petting, whatever, you might go to stimulating the genitals. And then for women, they get lubricated. For men, they get erect, and that's when you know, you're ready for it. Intercourse. If you try to have intercourse without that, without meeting that arousal threshold, either it's gonna be painful, especially for women, sometimes for men, especially if they have what you were saying earlier, the condition of the curved penis. Right?

Donna Lee: 14:35

Right. We talked about Peyronie's off air, but that's curved penis, another erectile dysfunction issue.

Dr. Vagdevi: 14:40

Exactly. Exactly. So...

Donna Lee: 14:42

Yeah, it's stressful for sure.

Dr. Vagdevi: 14:43

It's very stressful. And it's particularly painful if your erection is not good and strong.

Donna Lee: 14:47

Right.

Dr. Vagdevi: 14:48

And so you have to meet that arousal threshold. And you have to continue with sensory and, and physical stimulation. You don't stop when you get the arousal threshold. You continue. And sometimes you might continue with more foreplay, and that might be also where you begin the intercourse. And remember intercourse for a lot of people is friction plus fantasy. And so you might close your eyes and you might just be riding the wave as you're penetrating your partner. And at some point, that stimulation level, the total stimulation level rises to the point where you meet your orgasmic threshold. And orgasm is really a muscle contraction. And it's a repeated automatic muscle contraction that produces a sense of euphoria. It produces oxytocin in your brain. The oxytocin makes you feel close to your partner, makes you feel loving towards yourself, towards your partner. And you have this beautiful muscle contraction on the inside and the outside. And then you're like,"Ha."

Donna Lee: 15:51

Nap time.

Dr. Vagdevi: 15:52

Yes.

Donna Lee: 15:53

So I don't wanna deviate too much, but I was just thinking about this for younger men. When is porn too much porn? Like we've talked, I know this is a long time ago, but when we've talked about like young men watching so much porn, and then they have this elevated, you know, sense of what their partner should be or look like, or...

Dr. Vagdevi: 16:10

Oh, yes.

Donna Lee: 16:10

I'm sure you get a lot of that in sex therapy.

Dr. Vagdevi: 16:12

Yes, we do. We do. There's actually a lot of research looking at porn and what it does to men's sexual function. The first thing is, when you watch a lot of porn, you are really reinforcing and training your brain more than your body to be stimulated and aroused by visual stimuli. So then if your partner doesn't meet the visual stimulation or the visual appearance of the porn star, you're gonna have a hard time achieving your arousal threshold. Right?

Donna Lee: 16:44

Yeah.

Dr. Vagdevi: 16:45

And so you might then have more and more difficulty having sex with somebody that doesn't have the enhanced boobs and the, you know, the hourglass figure. And, you know, a lot of porn stars spend a lot of money making their bodies look a particular way. And so then your brain begins to think that is the way that all women should look. And the fact is most women aren't gonna meet that look for you. And so you're gonna have difficulty arousing.

Donna Lee: 17:12

Right.

Dr. Vagdevi: 17:13

The second thing is that the research shows that porn creates what's called a super stimulus. A super stimulus is basically they, the research, they did looked at birds. They created this fake bird that had all of the colors and all of the features of the most attractive birds out there of that species. And then they found that the male birds did not like the available real birds because they all wanted the super stimulus.

Donna Lee: 17:44

You're serious?

Dr. Vagdevi: 17:45

I'm serious.

Donna Lee: 17:46

What an interesting study.

Dr. Vagdevi: 17:47

Yes.

Donna Lee: 17:48

You men men. You all suck. Even at birds, even the male birds.

Dr. Vagdevi: 17:52

Well, no, I think it's really sad because all the male birds were constantly trying to peck and, and have sex with this...

Donna Lee: 17:59

Fake bird.

Dr. Vagdevi: 17:59

...female fake bird. And she, you know, even though she couldn't do anything for them, they kept going after her. And all the other real female birds were standing around the side, kind of going,"Look at that guy." You know?

Donna Lee: 18:11

Oh, how funny. How interesting.

Dr. Vagdevi: 18:13

He's got the real thing over here, and he's over there looking at, looking at this fake bird.

Donna Lee: 18:18

Isn't that interesting.

Dr. Vagdevi: 18:19

Unfortunately, porn can really train your brain to only respond to the super stimulus. And you're gonna have a lot of difficulty with arousal. You may have difficulty with desire as well, because your desire centers in the brain are all now trained to look for that visual stimulus that looks a particular way. And then you're gonna have difficulty with orgasm, right? Little bit of porn, not a problem. Porn that you and your partner watch together. And I don't like encouraging people to watch porn. What I say is watch erotica. Erotica is different. Erotic movies, erotic films are very different. There's actually a huge movement on the internet. There's a website called"Make love, not porn."

Donna Lee: 19:03

Oh.

Dr. Vagdevi: 19:03

And it's actually a beautiful website where you can go watch other people having sex and use that as stimulation for you and your partner. But it doesn't have the same super stimulus quality...

Donna Lee: 19:15

Gotcha.

Dr. Vagdevi: 19:15

...to it.

Donna Lee: 19:15

Gotcha. To me, I, I must have been warped in my younger age and for whatever I saw, but porn just sounds dirty and painful to me. So what was the website? Make love?

Dr. Vagdevi: 19:24

"Make love, not porn."

Donna Lee: 19:25

Well, that's interesting. If people are interested in wanting to see one of your colleagues or you, let's go over your website again, and your phone number, and how to reach out to you.

Dr. Vagdevi: 19:35

Absolutely. So we're the Center for Relationships and our website is https://www.findmycenter.org. And our phone number is(512) 465-2926.

Donna Lee: 19:50

And you can Google the Relation, the Center for Relationships, or the, what was the, the website again?

Dr. Vagdevi: 19:55

Findmycenter.org.

Donna Lee: 19:57

Findmycenter.org. You can reach out to us, too, for Dr. Vagdevi. If you have very specific questions that you would like answered anonymously, reach out to us by emailing us at armormenshealth, gmail.com. Our website is armormenshealth.com. Our phone number is(512) 238-0762. And thank you again so much, Dr. Vagdevi, for joining us.

Dr. Vagdevi: 20:18

Oh, thank you, Donna, for inviting me.

: 20:20

Of course. You'll have a good day.