In Your Pants with Dr. Susie G - Sex and Dating with Disability and Chronic Illness

Episode Date: October 5, 2021

I really appreciated Dr. Lee's perspective on mindful dating and red flags to watch out for  , tips for partners, and the gap between sexual health and medical care for disability and chronic illness.Dr. Lee Phillips specializes in couples sex therapy and lectures on topics including sexuality, chronic pain, anxiety and stress management, caregiving stress, depression in the elderly, mindfulness and cognitive strategies for chronic pain, reclaiming sexuality for couples with chronic illness, ethical decision making, the assessment of mental disorders, and exploring sexual communication, freedom, and pleasure for gender minorities with chronic illness, pain, and other disabilities.Discover your mental fluidity through the process and what makes you and your partner comfortable. Dr. Lee shares how you can have those deep conversations that define what pleasure means to you and what it means to your partner. Remember: slow down and let the process take its course. Get curious about your partner and get creative with sex!More on men's sexual and pelvic health www.drsusieg.com and connect with Dr. Lee Phillips at www.drleephillips

you're listening to in your pants with dr suzy g the physiotherapist for your private helping you get in the know down below hi friends dr suzy g here and welcome to another in your pants podcast thank you so much for being here with me today on today's show i have an amazing guest his name is dr lee phillips And he is a sex therapist, but not just any sex therapist, a sex therapist who has devoted his career to helping those who identify with having a disability or chronic illness regain and reestablish their connection with their sexual identities and help reframe a more sex positive experience in their lives. So, you know, despite society's assumptions around sex and disability, those who identify living with a disability or chronic illness are sexual beings with sexual curiosities, needs, and desires for sexual freedom and expression, just as non-disabled folks.

Disability and sexuality are not mutually exclusive. and in today's show dr lee and i really break down some of those barriers or myths related to sexual health disability and chronic illness in particular we discuss some of the worries and fears that someone who identifies with having a disability or chronic illness has when entering the dating world or is in a current coupleship you know how do we navigate those difficult conversations. And we talk about compassion, acceptance, and really finding ways to positively connect with one's own sexuality and perhaps re-establishing that connection as a sexual being and being comfortable and confident to be able to express our needs and

desires in perhaps some very difficult and challenging situations such as you know getting into the dating world. So we also talk about some red flags that one should notice when beginning to date. Dr. Lee shares with us his favorite dating apps and also we talk about how to effectively communicate our needs our desires for pleasure and eroticism especially if we're identified with having a chronic illness or disability and lastly we chat about how our partner or partners can respond to ways in which we discuss sex and our sexuality and how to go about that. So I hope you enjoy today's show. I had a blast and this episode is filled with insights of wisdom and really good advice. So before we jump into the episode, I'd like to

formally introduce Dr. Lee Phillips by sharing with you his bio. So Dr. Lee Phillips is in private practice in Reston, Virginia, where he specializes in couples therapy. He is a licensed clinical social worker in Washington, D.C., Maryland, Virginia, and Florida. He is a certified substance abuse counselor in the state of Virginia, and he is a certified sex therapist by the American Association of Sexuality Educators, Counselors, and Therapists. In addition, he is a certified sex and couples therapist by the Integrative Sex Therapy Institute. He has been in private practice for more than a decade working with individuals and couples on sexuality after chronic illness. Dr. Lee lectures on topics including sexuality, chronic pain, anxiety and

stress management, caregiving stress, depression in the elderly, mindfulness and cognitive strategies for chronic pain, reclaiming sexuality for couples with chronic illness, ethical decision-making, the assessment of mental disorders, and exploring sexual communication, freedom, and pleasure for gender minorities with chronic illness, pain, and other disabilities. He has published in the Journal of Baccalaureate's social work conducting a research study on LGBTQ affirmative teaching at historically black colleges and universities called understanding program director's views he has been a featured expert in teen vogue health line and the lily newspaper he writes for psychology today dr phillips is writing his first book sex and love when you're in pain

which helps couples overcome shame and the sexual limitations caused by illness and give strategies to create and reclaim a sex life that works. He is the host of the Sex and Chronic Illness podcast. His podcast features stories from individuals, couples, and other experts in the field of overcoming shame and the sexual limitations caused by illness and disability. He holds a doctor of education degree in organizational leadership with an emphasis in behavioral health from Grand Canyon University in Phoenix, Arizona. In addition, Dr. Phillips is is an adjunct professor in the Masters of Social Work program with the School of Social Work at Western New Mexico University, and he is an instructor for the Integrative Sex Therapy

Institute and with Modern Sex Therapy Institutes. He can be found at drleephillips.com, and all of Dr. Lee's information and resources that he shares with us in this episode will be linked in the podcast show notes. So please be sure to visit DrSusieG.com for the podcast show notes. So without further ado, please let me introduce you to Dr. Leigh Phillips. Hi, Dr. Leigh. Thank you so much for being on the show today. You're so welcome. Thanks for having me. I'm excited to be here. I am so excited to have this conversation with you. I think, you know, talking about sex and disability and chronic illness is a topic that no one is bringing attention to. I mean, well, I don't want to say no one, because we're having this conversation, but it deserves more of a spotlight and recognition, that's for sure. Yes, it does. And you're right, in the field of sexuality, we're not hearing a lot about it. And I think we're starting to see a shift now in that where we are because 40% of the US population is chronically ill. And so people want to be sexual, despite having a chronic illness. So yes, we're starting to see more work in it.

And so that's a great to have a chronic illness or disability. And I know there are, you know, two, I don't want to compartmentalize, but technically kind of two camps, you know, a parent versus non-apparent. Could we talk a little bit about that and what that means? Yeah. So with disability, you know, it could be a number of things. You can have a chronic illness and you can completely be disabled. There's disabilities where you're born with a disability. So for an example, some folks are born with cerebral palsy. We have dynamic illnesses that come on the scene, different autoimmune disorders, neurological diseases. I work a lot with folks that have fibromyalgia, multiple sclerosis, lupus, Lyme's disease. So those are more of your dynamic illnesses where they go into relapse and remission, but then we do have static disabilities where they kind of remain the same over time. And I see that with

cerebral palsy. So those are the groups that they kind of go into. I work a lot with chronic pain patients. So they may have chronic pain due to an injury or pre-surgery, post-surgery, or they've got chronic pain due to a chronic illness. And with chronic pain, it's lasting three months or longer. We know that there's the chronic issue that is there. So those are the folks that I primarily work with. Right. So complimentary to my practice as well, especially when we're dealing with sexual pain or men or male identified individuals who have chronic prostatitis, chronic pelvic pain, any type of sexual pain that you just can't see on the outside, so to speak, right? It's, you know, an invisible illness, but so, you know, can be very disabling, frightening,

scary. And then what does that mean for our sexual identity, our relationships? You know, how does that all pan out? So I'm so excited to dive into those details with you. So what would be your advice, Dr. Lee, for those who find it frightening to share what they're living with to a potential partner, which is, you know, potentially hindering someone from stepping into the dating world? Right. So I work with a number of people that have chronic illness and disability. Some of those folks are single and they're wanting to date.

And then I work with couples or people that are in relationships that have a chronic illness and the other partner does not. And so one of the things that I think we look at first are the stages of a chronic illness that folks go through. So a lot of times there's a crisis phase where there's a lot of chaos. There's a lot of symptoms. They don't know what's going on. The rug's been pulled out underneath their feet. They don't have no idea what's going on. So in that stage, they go to seek medical attention first. However, I've had couples and individuals show up in my office that are in that stage, very sexual. They're not feeling very sexual then, but then we see something called stabilization where maybe they've gone to a doctor or they've been bounced

around to several doctors and now they have a diagnosis. So now they're learning to adapt to the illness. They're learning to see what the symptoms are. They may have started medication by that point. They're around a lot of specialists. And so sometimes in that stabilization phase, they're coming into therapy and they're learning to adjust to this new normal that's happened to their body and so with that sometimes in that stage they're ready to talk about sex they still want to have sex they want to see what that is like and a lot of times it's having this sexual communication that has to happen instead of looking at what is achievable it's looking at what is possible because it's kind of like this idea of being in a new body and so I may not have

the same sexual desire, or I may not initiate sex as much. So we see a lot of that as well. We also see a resolution phase where they are trying to integrate parts of their old self into the new self and make those adjustments. And so one of the things that we do a lot of as sex therapists is a lot of normalizing. Like, you know, this happens to people a lot, right? We know that there's been a change here, but guess what? You can still be sexual. You don't have to have penetrative sex. You can do other things. That's what's so great about sex is that we have options. There's no right way to have sex. And it's crazy because I have people that come into my office thinking that there is all the time. So that's how we approach it, I think, as therapists.

And I'm sure you do the same as you do a lot of normalizing what you're going through. Hey, This happens to identified males. We see this and I'm going to help you to be a sexual being. So I love that. Yes. The sex positive message here as far as yes, it's challenging, validating, very affirming and saying, what can we do to reconnect, you know, reestablish your connection to your own sexuality or sexual identity as you know a sexual being who has sexual energy and it doesn't have to look like this cookie cutter mainstream social cultural uh framework of one way of having sex or doing sex I mean these are such um debilitating messages to all beings I think you know because it just sets us up for these unrealistic expectations and when those

are not being met, that's a huge hit. It really is. And, you know, there's a lot of shame that goes with it because I have people that come into my office and they're like, my body is broken. So therefore I'm not supposed to have sex or they will come into my office and a doctor has never mentioned anything about sexuality to them. You know, I've had cancer survivors come into my office and say you know my doctor told me I should be lucky just to be alive well I am I am lucky to be alive but hey I'm also a sexual being right that doesn't mean I stop having sex you know right right right right and I want to reclaim that I want to reclaim my sexuality I want to be able to be a sexual being and so one of the things that they do is we come into my office

and there's first of all there's two things that really have to happen too there's a grief process so sometimes in that grief process they're not sexual and so when we get into a place of acceptance which i think is very powerful doing acceptance work then they're able to say okay this is my body this is where i'm at i i built a relationship with my illness now let me work when they can do that so dr lee you're bringing up a really um important point about grief and loss and how it's important to really acknowledge and to help support someone through that process of reclaiming their sexual identity. But it sounds to what I'm hearing you say is that in order to be able to reclaim and

go through that process of acceptance, one has to also work through the grief and loss or navigate the grief and loss. So could you share with us like what that process would look like? And I know that's variable from person to person, of course, and coupleships and stuff like that. But could you share some insights into what someone might be able to do as far as, hey, how do I recognize that this is what's going on for me? And then what are some things that I can do to help myself through that process? So one of the things that I think is powerful, and I call therapy the safe container. sometimes it's just coming into the space to be able to process and talk because a lot of times

I find of the majority of my patients they can't talk to family about it family doesn't understand chronic illness they don't understand chronic pain there's this idea that if you're able to walk and you can see and you can hear you're healthy that's not the case and so there's so much going on inside of the body and you know that with the work that you do and so what we find is there's stages that folks go through. And sometimes there's a denial phase and they have to sit with that and process that. And they can't believe it because it's a chronic illness is a trauma. And so they're wondering how did this ever happen? You know, and then after this trauma that they're going through in this denial, you know, we go into anger. There's a lot of emotions. So being

able to process those emotions, looking at the thought process, being able to sit with the client, being able to offer supportive therapy. And then there's bargaining. They're wishing they could just go back to the body that they had. So giving them a chance to talk about that, to say it out loud. And then of course, there's a lot of depression that comes with it. And that shows up with everything. There's a lot of comorbidity with chronic illness, right? That's why psychotherapy is now becoming the number one treatment for it. Because when you're able to decrease your anxiety and depression, you can manage your chronic pain a lot better, you know? And so then after that, we have acceptance where you accept where you're at. And that's where I really see

people want to become sexual. So we go through those stages. The thing to keep in mind too, is that people oscillate in between those stages. So you may get to acceptance, but you have a flare up and then you're back to anger or you're, you're at depression. So we have to work with that. Absolutely. I'm glad that you brought that up. It's not a linear process by far, right? This is definitely, you're going to have some detours, um, other life events may happen. Exactly. And I'm hearing more of this. You're going to have to go left. You're going to have to go right. You're going to have to go left. You're going to go right. You're going to go this way. You're going to stop. You're going to back up. Yeah, absolutely. Yes. Up and down, maybe stop for a

second, you know, that sort of thing. Absolutely. This flexibility, what I'm hearing, this mental flexibility, right? Fluidity through the process. Fluidity through the process because everyone's different in their illness, right? Or their disability. Right. Absolutely. Absolutely. And Dr. Lee, how much does compassion play a role in all of this? Self-compassion, compassion for others? It is such a critical role. And, you know, I facilitate a chronic pain management group. And we started to talk about that last night in group, the antidote of shame is self-compassion. That's what it is. And so it's being able to get to a place where you can talk about your shame. The other antidote of shame is growth, being able to grow into yourself

in this new normal and have self-compassion know that your chronic illness is not your fault. you know a lot of times people feel guilty because they may feel great one day and then they end up cleaning the entire house and they should not have done that because of the following day they feel like they've been hit by a mack truck so there's the shame and guilt that comes on and so what we do as psychotherapists is really work with that normalize it and know that it's important to be self-compassionate to yourself because we know that you can do that and you can reduce the guilt and shame. Guilt is I did something bad. Shame is I am bad. Then we see a process there of the self-compassion to where it can reduce flare-ups and you can be more into your body and being kind

to yourself and allowing yourself to feel in your emotions when you need to. That is self-compassion. Oh, that's such a beautiful process. It's not easy by any means, I think, but it is such a beautiful process of growth and transformation, um, and self-actualization. It takes a lot of time, you know, and that's why I always say that psychotherapy is a journey and it's your personal journey, right? And everyone's body is different and everyone's sexuality is different. And so we, we talk about that and it's very validating to the client that's coming in. Mm hmm. Absolutely. Absolutely. So I'm going to segue us a little bit to talk, go back to potential like dating, you know, dating, sexuality, when you are when you have a chronic illness or disability. And this is something that comes up in my practice a lot because men who have pelvic pain don't feel comfortable communicating, especially when it's a new partner. Again, there's a lot of expectations for performance, what that looks like, and that is all part of the sexual encounter, which really I feel like, A, like you said, the question that we were talking about earlier, it hinders people from stepping out into the dating world thinking that, you know, hey, how can I possibly be able to have a sexual encounter in the state that I'm in?

And so, yes, let's talk about, um, you know, what is available for folks who want to be dating, go into the dating field while still sick, um, especially during a pandemic, which actually adds to the layer of complexity of, um, yeah. What do you recommend? well again I you know I think it's it's it's being able to to validate them that hey you know it's so great that you want to date it's so nice that you want the connection because you are a sexual being you're a human being we crave that we want that right illness no illness and the thing that I have to say that I love about dating apps these days is that you could write a dissertation on

them that sounds like a fun dissertation yeah I know right I mean you can like list everything that you want everything that you're looking for back in the day with dating apps you took you wrote like three sentences and then you you posted a picture and then you were done right now you can really be very specific on what you want which I think is great you know often I have clients that come in and they say, you know, Dr. Lee, I'm ready to date. I know I've got a disability or illness. And one of the things that I have helped my clients do is write their bio. I mean, we've sat with it and we're like, what do you want to say? If you want to disclose, you can disclose. Sometimes, you know, clients, they want to put it out there. So when they do

start dating someone, they're not sitting at a dinner table one night saying, oh, by the way, I've got multiple sclerosis, you know, it's like, let me put that out there now. And if this is something that you don't want to get to know me because I have, well, then you can keep it moving. Right. Yeah. A lot of times people like to disclose in the beginning. And I find that is because of where they're at with their illness. If they are in this acceptance area and they are embracing their illness which can be very beneficial you know who wants to embrace their illness but if you can form a relationship with it and know how your body works now and you accept that that's going to propel someone into wanting to date um and they're

going to have the well i don't i don't care attitude about it you know um and i think that's when they've got that motivation so i think that's out there for them there's also support groups you know, like if they're, you know, single chronic illness support groups where people can talk about dating and hold that space when it comes to sex and you're really wondering what to do with that. I always recommend solo sex. What do you find pleasurable in your body? Pay attention to that. And because you want to know what you like before you go into meeting someone and telling them what you like, right? What feels good to you? What doesn't feel good to you. And so a series of that is this non-demand touching for yourself on what feels great. And

people really like that. They're like, you know, I really haven't experimented much with that. And so we talk about that when they're single. So I think those are things that are very helpful to people to be able to do so they can date. They can have a dating life just like someone else does without a disability. It's there. Right. Absolutely. Absolutely. Uh, and what you mentioned some dating apps, are there any favorite apps that you like to recommend to your clients as far as for dating? Well, if they're, if they're female identified and they're wanting to take the risk, Bumble's always great because you have to ask the guy out. there you go take charge you know yeah you know okay cupid is great because you can really um

it's broken into so many sections of what you want to include so people love okay cupid i mean i have a lot of clients that come in and they may have a kink or a fetish and they're able to include that on their app or on the platform of it um so those are like my two and there's hinge that people like if they're gay identified you know tender tender scruff grinder if you're looking for sex grinder is always great i mean but you know there are people that meet on grinder and they end up having a relationship with each other so or or they meet friends you know they meet friends on an app so you know I think I think that's great I think what's really hard though with some LGBTQ folks is that they had to come out of the closet one time and they're coming out again

with a disability and I think that's hard you know because then they're having this like flashback of when they had to come out as a queer person and now it's like okay now I am I am in my sexuality. I accept my sexual orientation. And here I am now having to come out with my illness or disability. And that can be really hard. And so sometimes we really have to sit with that for a while. Right, right. Absolutely. Because it's, it's, it's almost like that double negative, right? You know, had to do it again. It was so hard, but how in those experiences, Dr. Lee, do you feel that some people use those previous experiences to shape the future experience of that? Do you think that going through the process the first time, is it all beneficial for, you

know, future life challenges, such as what we're describing? I'm really glad that you brought that up because I really do believe that when they're able to gain what they learned through the first time doing it, they're able to repeat something like that again. So it's more empowering and hopefully by that stage, they have embraced their sexuality so much that it's easier to disclose having a chronic illness or other disability. And I like that, you know, being able to say, look, well, this worked for me last time. I'm going to apply this again. And we want to be around, you want to date someone and be around someone who's going to accept you, you know, that's really big. And so, yeah, we talk about that in therapy. What does your ideal partner look like?

What do you want them to be like? It's okay that you want to be specific. It's okay that you have expectations. We all have expectations, right? Yeah. Yes. And own them, own them, name them, embrace them. Um, and, and finding those shared values with someone else too, you know, I mean, we're all different and we all have, um, a right to, to honor them and, and to have others also respect them too and take part in that mutual partnership yeah absolutely that's what it's about yeah yeah that's great so as far as any red flags dr lee so what are some red flags you're in the dating world you're trying to navigate this space it's challenging amidst the pandemic what are some red flags that someone should notice while beginning to date

I think just the lack of empathy if there's no empathy if there's like this agenda about the other person and they're overpowering the conversation they may not be very serious about a relationship feeling safe while you're having the conversation where you're going to meet the person you know I've always recommended take your time really getting to know someone because unfortunately there are scary people out in the world and you don't know who you're really talking to, you know, talk, it's like a vetting process. That's what it is. That's what you have to do. Making sure that you have a very strong support system, because if you don't have a strong support system already, you're going to take that energy and throw that onto someone else. And maybe

you're not taking the time to really get to know them. So I think those are some of the big red flags. And if you are, if you have a therapist, process that with your therapist, so you can decrease those red flags. Talk about it out loud. And if it's not going to be with your therapist, talk about it with your friends, your family, just get that extra support before you start getting out there to date someone or to want to be in a relationship, you know, because I find when people don't do that and they jump the gun and they go right into it, then they're feeling hurt or they go through it multiple times. And what happens is when the hurt comes on, the emotional hurt than the physical hurt. We see more flare ups. Yeah. So you want to make sure

that you're really taking the time not to, to jump the gun on things. I always call it mindful dating. Be mindful. I love that. Be mindful, be aware. And I would imagine that that's hard to do or challenging to do especially when we're not like comfortable and confident in recognizing you know those like visceral cues right like i just know for me it took a lot of work to recognize like oh my radar detection system or danger detection system was like oh yeah it's ramped up there's a reason why i'm feeling like that right um but but sometimes you know, I just know from my own experience, you just kind of ignore it or you push through thinking, well, I shouldn't feel that way. And I need to be a people pleaser or whatever. And that,

that totally can, can kind of set you up for a very, um, unhealthy dynamic. Um, right. That was just from my own experience. Yeah, no, no, but I'm glad you brought it up because there is this people pleasing aspect that goes with it. And, you know, I, I think a lot of that, you know, of course comes from childhood when we look at attachments and looking at sexual self-esteem and how that affects you as a people pleaser. But the thing that we have to realize too is that there are these things from your past that show up and you can change those things. You can adapt differently. You don't have to stay stuck in a people pleaser mode. You can adapt to things. Change can be scary, but man, it's so needed. Oh, a hundred percent. And it's so

beautiful once you're kind of like I always tell I always use the image in my head of a caterpillar like in a cocoon and then that process of like just it's so much work to just kind of get out and then you're like this beautiful butterfly and you have wings that are expansive and just free and and but but but that wouldn't happen without that that process that transformation of change that struggle. And so through that struggle is like the silver lining, so to speak of, of just such growth and transformation. If we are willing to embrace all of it, the whole process, the whole process, if you can embrace all of it, right. What's going on sexually, what's going on emotionally, what's going on biologically, what are all these things that are happening? You know, like if

there's when I have a client that's having more flare-ups, continued flare-ups, what's going on psychologically? What's going on there? And a lot of times, unfortunately, when it comes to anxiety, we internalize it onto ourselves. Yeah. And how can we, how can we change that? How can we make that different? Yeah. So, yeah. Oh my gosh. That's where cognitive behavioral, yeah, yeah. That's where cognitive behavioral therapy comes in. That's where we look at the thought process and restructure those so you can change the behavior that's happening. Thoughts are nerve impulses, folks. They are. They are. You're absolutely right.

So, Dr. Lee, what are some things an individual living with a chronic illness should make clear ahead of time, ahead of being intimate with a potential partner, and to open, to be open and comfortable as far as communicating. So how would you, what advice would you give around that? I would really, I would really like someone to know what they like sexually. What is it that pleases them? What are the arousals? What are the accelerators? What are the breaks? Knowing what that is, being able to just share that with them, consent, of course, at telling them, hey, I don't like to be touched here, but I like to be touched here. I like to be spoken to like this. I like to feel comfortable when I'm doing this. So I always

say that sex at its heart, it's about communication. That's what it is. It's about sexual communication and really talking about it before you do it. So working up to it, having those deep conversations of what pleasure means to you, knowing what desire is, knowing what pleasure is, knowing what eroticism is. Like if you're wanting to take that sexual risk, talk about what that eroticism is, right? I use a scale with my clients, an eroticism scale from one to 10. What is the low end of the eroticism? Is it to touch a different part of your body? That could be erotic to you. Maybe you haven't explored that too much, or maybe you, you do it to a 10 where you dress up in leather and you try something different and something kinky, you can do that. And then what is your

satisfaction? What does satisfaction mean to you? Is it about having an orgasm? Because there's a lot of folks out there that are not able to have an orgasm. So are you able to have a bodily orgasm? Think of your body like a blueprint and map the places that are great to be touched and that are not great to be touched and share that with your partner yes and that it's yummy stuff I love that and you had so many wonderful pieces of advice um which I can imagine though like when your first you have a first intimate encounter with someone like sexual intimate encounter like how do you work with someone to initiate the conversation maybe because that can be quite intimidating? So one of the things, if there are a couple, then I use a dialogue. I'm a big fan of

Imago relationship therapy, Imago meaning image in Latin. So when we're born into the world, we develop all these images on what life should be like, right? We get those images from our peers, from our caretakers. So the theory behind Imago is that we unconsciously pick a partner based on the positive and negative characteristics of our caretakers. So you may hear someone say, man she does act like my mother or he's a lot like my father and so that's in the unconscious the old brain but then we have the new brain and in the new brain there's this consciousness so one of the things that's in imago relationship therapy is something called the imago dialogue that i use where the first step is mirroring where you send a message to your partner they

can be your spouse or they could be a sexual partner so you send the message and then your partner mirrors exactly what you said that way you're feeling heard and there's a presence that's a good way to initiate i want to talk about this what this is what's on my mind that way you're talking about it and you're not getting reactive with each other and there's a presence the second part of the dialogue is validating where you're you're acknowledging their feeling you're not having to agree with them i have couples that will come in and they say you know Dr. Lee I don't feel like I need to validate her because I don't agree with her well you're not agreeing with her you're just acknowledging how she's feeling so it makes sense

to me that you're scared to have sex because you're afraid it's going to be painful is that what I'm hearing you say yes that's what I'm that's what I'm saying and so maybe we need to take it slow maybe we need to do some non-demand touching first to work me up to that folks that have a chronic illness, they really have to go slow with things because there's a lot of fear base there of what's going to happen. And then the third step of that dialogue is showing empathy. It's putting an emotion with what they're saying. So that dialogue is great to use when it comes to initiating any type of conversation. And then we talk about what does that look like? What does it look like when you initiate sex? How would you want it to look like? And so they're able to

process that in the session so then they can practice that with their partner so i use a lot of that oh i i love it that practice that role playing and in a safe space too because they can again when you're alone it's like who's going to be moderating this we don't want you know because there's a lot of emotions that can come up and part you know we all have various different parts that show up in our life um internal parts that you know want a voice and and sometimes we need that moderator, that guide to say, okay, this is coming. Right. Right. Yeah. Right. Sometimes we need, yeah, sometimes we need structure. And so sometimes they do that in the therapy session, if it's a couple, but even if it's, even if I'm working with an individual client,

they can have the dialogue on hand so they can use it with a partner. And so we work up to that. And I think that can be very helpful. Sometimes people don't know how to talk about sex. So if they don't know how to talk about sex. They need something to start the conversation. So there's these sentence stems that they can use. I want to talk about pleasure. This is what's pleasurable to me. And then they can share that. So really starting off with the basics when it comes to that, because there are some folks that have chronic illness that don't even have never had a sex life prior to the illness. So what was sex like prior to that? If they were a couple, What was your sex life prior to a chronic illness? Were you sexual? Were you not sexual?

So sometimes we have to really start slow and at the basics. You know, when I first became a therapist, I wanted to help her so much and I've learned to really slow down and just let the process take its course. Wise, wise. So on that note too, um, what if, let's switch the gears about how their partner or someone's partner could respond and as well, you know, yeah. How could the partner respond and what are some appropriate ways of discussing sex and how to go about it in, in this special, in this circumstance? So I think the partner can just, I think one thing that I would really recommend is a presence and to just listen. I think listening is very powerful, not jumping the gun. Because a lot of times I find if there's a healthy partner,

they really want to get back into the sex that they used to have. That's a big thing. I see that a lot. And so they're adjusting to, they're full of anxiety. One of the things that they're really scared about is are they going to hurt their partner? You know, sometimes it's the chronically ill partner that's like, Hey, I want to get back into it. Take me, let's do it now. And then the other partner's like, wait a minute. No, because you have, you have this condition and are you going to be safe? Are we going to be safe? So sometimes there's a lot of anxiety. So when I work with couples, I'll do some individual sessions with each partner, or I will recommend that the other partner get a therapist so they can voice their concern. They may have some

caregiving stress going on where they have switched roles into a caregiver, but a lot of times they like being a caregiver. It can be an intimacy builder. It can be something new for them. So it's not always a negative thing. So I think holding space, I think being present and just asking, getting curious. So my mantra is get curious about your partner and get creative with your sex. Get curious about your partner that has a disability. What is it that you like? What is it that I can do? What is it that I can make you feel comfortable? So there's a curiosity that has to happen. Oh, I love it. And just, you know, just leaning into those, the strengths and vulnerabilities of ourselves, it sounds like, right? And again, you know, you're creating this

sexy team, this intimate team. It's an intimate partnership. Right. It's an intimate partnership and you're getting creative which is so needed so instead of looking at the chronic illness like it's gonna it's doomed your relationship look at it like okay there's a change here and that that goes into the integration stage of a chronic illness that it is one part of my life it does not define who I am it's something that I have it's not me and I think in the beginning of treatment at it's very much this is me this is who i am well okay it's a part of you but it doesn't define who you are as a person and who you are as a sexual being a hundred percent and my mother she was born with spina bifida and also had a lower limb amputation when she was in her teens

she modeled that so well for me just so well she's just like i'm still a badass talking about sex you know i love that i mean i i mean it really she she modeled that and just on her own honestly i mean she never really like let that get in the way at all and it's even even when you know um you know my grandmother loved her to death but you know the generation of the mindset was that of like, Oh, you can't act like that. You can't wear a skirt. You can't show your prosthesis. You can't, you know, et cetera, et cetera. You need to be with somebody who's going to accept you for who you, you know, for who you are, because who would, you know, they're like a martyr, right? Like all of those messages, which were so negative. And I remember just as a kid

and as a teenager, like when I used to live at home, like so pissed off, like what the, you know, like no and and then seeing my mom be like sorry like to her mom like sorry mom but fuck that i'm wearing leggings i'm gonna wear a skirt if i want to take off my prosthesis and go swimming in the ocean i will because i can i don't or if i'm gonna take it i'm gonna take it off and i'm gonna have sex that's right exactly exactly a hundred percent a hundred yes absolutely you know because there's these messages, we get negative sexual messages. And if you are born with a disability or you end up, you know, coming down with a chronic illness, your family or people tell you, you know, you, you can't, and I've had clients come in and talk about this, that you can't be sexual. You were

asexual, meaning that you don't have sex. It can hurt you. You don't need to be asexual. And I've had clients come in and they say, you know what, Dr. Lee, I feel like maybe I should believe that i am if i've heard because these messages are traumatic they become ingrained in you and they and they carry with you and so when you have these messages that's going to determine your sexual self-esteem you're going to have a positive self sexual self-esteem or you're going to have a negative one and that's going to hinder you and have this um performance anxiety that happens with it or there's the low sexual desire that comes with it. Totally agree. Oh my gosh. I could talk forever. Dr. Lee with you on this topic. You are so fun. And honestly, your wisdom has been just a

breath of fresh air. And I'm so privileged and grateful that you took the time to be here with us today to share this and have this conversation. So what resources for someone who wants to learn more for people who are listening or watching, you know, are there any resources that you would recommend? And a little birdie told me that you're working on some projects yourself. So please shameless plug away. I am. I'm working on my first book, which is called sex and love when you're in pain, which is going to be about reclaiming sexuality due to chronic illness and disability. I also have a podcast, which is called the sex and chronic illness podcast, which is part of the invisible, not broken network. We are four podcast hosts with four

different podcasts. We have explicitly sick. We have the human care podcast, discomfort zone, and then mine. Um, you can access that. You can access that podcast at my website, drleafillips.com. If you also go to my website under the resources tab, I have a list of resources there for chronic illness and disabilities. Um, I have some of my favorite books that are listed there that you can, that you can read about. And then if you feel like you ever need to get in touch with me, you certainly can at Dr. Lee Phillips on Twitter and Instagram and Facebook. And you can also contact me on my website, which is drleefillips.com. This October, I'm going to be doing a big interview with Esther Perel on sex and chronic illness and disabilities,

which I'm really excited about on her online sessions platform, which will be great for clinicians that are wanting to really learn more about this, but also for, for, for clients and people too. So I'm really looking forward to that interview. Um, that will be very helpful and will be a great resource because it will be on a, like a hour platform with a live Q and a that will come with that. So, uh, stay tuned for that. I'm really excited about that interview. thank you so much dr lee for sharing all of those resources we will be sure to link all of those in the podcast show notes for folks and also deepest gratitude for being on the show today and taking your time to share such beautiful wisdom and encouragement for folks to ignite their sexual

identity and reconnect with themselves and to really get that sexual freedom no matter what may come our way as far as what life may bring us so thank you so much for all the work that you do it is so appreciated by myself and others and to all of our listeners out there thank you so much for being here and as always in loving wellness for your pelvis this is dr suzy g bye thanks for listening to today's episode be sure to head on over to drsuzyg.com where you can get more information show notes and related articles on today's topic also if you like what you're hearing head on over to itunes subscribe to the podcast and leave us a rating review we'd love to hear feedback thanks again