Language of Love with Dr. Laura Berman - Sex Therapy 101

Episode Date: March 3, 2021

Have you ever wondered if you could benefit from sex therapy? On today’s episode of the “Language of Love,” Dr. Berman explains who really needs sex therapy and when sex therapy is the most productive. First, Dr. Berman helps a 43-year-old woman who says sex hurts lately and she isn’t becoming lubricated like she used to.  Dr. Berman also gets an email from a lesbian who has recently begun dating a transwoman. However, her new partner still has male genitalia--which makes this lifelong lesbian uncomfortable because she has never interacted with a penis and has no desire to do so.  Finally, Dr. Berman takes a voice message from a man who says his libido has disappeared lately and he is feeling rundown and out of sorts--could it be low T? Dr. Laura Berman's website: https://drlauraberman.com/ The Language of Love Podcast: https://drlauraberman.com/pages/the-language-of-love *Please note: this episode was recorded before the heartbreaking death of Sammy Chapman, Dr. Berman’s son. For resources to help you talk to your kids about the dangers of prescription pills and synthetic drugs, click here.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, I'm Dr. Laura Berman, a sex and relationship therapist. And for more than two decades, I've been helping people learn how to love and be loved better. And now I am so excited to introduce my new podcast, The Language of Love, a safe and inspiring space where I'm going to be answering all your calls and email questions from people just like you. My goal with the Language of Love, to give you all the wisdom you need to create more meaningful intimacy and lasting sexual pleasure. It's time we all become fluent in the Language of Love. Welcome to Language of Love with Dr. Laura Berman.

I'm really excited about this week's topic because it's something near and dear to my heart, as you can imagine. The topic, Sex Therapy 101. one. How do you know if you need it? What does it address? And most importantly, I'm going to be diving into your questions via email and voicemail all about sex therapy. And I'm going to be giving you my best advice as always. And remember, if you want to participate on the show, ask questions, suggest topics, I so want to hear from you because I want this show to be driven by what matters most to you. So go to drlauraberman.com and go to the Language of Love podcast page, or you can go to languageoflovepod.com and you can find the links there to both email

and to leave a voicemail if you want to. And as someone who has been a couples therapist, an individual therapist, a sex therapist, a relationship therapist for over 25 years, one of the things I think is really important to talk about during this time in the world's history, but also at any time, is sex therapy, okay? How do you know when you need sex therapy or not? Because I can tell you over the course of my career, lots and lots of people in the beginning, the only time I would actually see them and they would come to me is like when they were on the verge of divorce or someone had had an affair or there was like a huge crisis that was so bad and things had gone so far that they finally came for help. And, you know, that's

great. I definitely want those people to come for help. Although I will say that a lot of our work together until we can really get to the issue at hand that led to all the problems. We then have to do all this work first to undo a lot of the damage so that they can even get on the same page to address those set problems. So that's not the end of the world. It's just a little more complicated for the clients and for me. What I love and what I've seen happening more and more over the past several years as the taboos get lifted, as it becomes more normal and it does not mean you're crazy and people are finally waking up to that. If you get a little therapy that is really about building a more fulfilling connection, that therapy can be for maintenance

and small conflict resolution before they get bigger and communication skill building that most of us never really got a good model for growing up, how to communicate in an effective way, especially when things are stressful. So, you know, what I have found is that over the past several years, people are coming in earlier before everything falls apart. And I love that because they're still allies at that point. I don't have to get them back to being allies first. And it just moves a lot more quickly. So a sex therapy, who needs that? Certainly anyone who's had infidelity, anyone who has any sexual function issues, low desire, difficulty responding, difficulty initiating, inhibitions, miscommunications, sexless relationships,

which are at an all-time high, all sorts of reasons. And sex therapy, in my mind, is a combination of very concrete advice, but also, you know, sex is a reflection of the rest of your relationship. When sex is working in your relationship, it's only one small part of the larger working relationship. But when it's not working, it can definitely take on a life of its own. So what I want to do with all that said is that I have a lot of email questions, voicemail questions on this topic, and I wanted to spend some time answering them. I'm going to do this every week. All right, so let's get to some questions. This is the fun part. Here is a question from anonymous. Okay. They say, Dr. Berman, I've been a big fan of yours for years,

and I'm so excited about your new show. Thank you. Here's my question. I'm only 43 years old, but lately I feel like sex hurts and I'm not just wet enough down there. It takes me a long time to get aroused and lubricated and I don't know what I can do to make sex feel better or to make my body respond the way I used to when I was in my 20s? Aren't I too young to be going through menopause already? What lubricants can help me get in the mood and make things feel better? So this is a perfect example of what I would call a more practical sex therapy question. This is more concrete at this point. Assuming that this isn't affecting your relationship and there are some issues now that have grown out of the difficulties you've had sexually, I would say this is a

relatively easy fix for you. So first of all, at age 43, while you are not menopausal yet, you are pretty likely to be perimenopausal because starting around mid to late 30s, a woman's estrogen, progesterone, testosterone, all those hormones that play key roles in her sexual response start to diminish. So, for instance, a woman in her 20s has double the testosterone that a woman in her 40s has, and it starts to decline around this time to the point where you're going to see these symptoms. And the most common symptom of perimenopause, or the common symptoms, the first one you mentioned, dryness, difficulty responding. It can also include sleeplessness, mood swings, irregular menstrual flow, you know, where

your period doesn't come regularly. All of those are signs of hormonal changes. And you can talk to your doctor about the potential of bioidentical, in my opinion. I'm not an MD, I'm a PhD, but I shepherd a lot of women through this and I've been through it myself. Bioidentical hormones, you want to talk to your doctor about the possibility and if you're a candidate for and whether that would help. But more importantly, you need to know that this is normal.

It is normal that your lubrication is not going to be the same as it was before. And that's a result of decreasing estrogen levels primarily because estrogen plays a huge role in blood flow to the genitals. And lubrication, for the most part, is a symptom of that increased blood flow, believe it or not. So lubricants can really help you, but especially for any woman, but especially for the perimenopausal woman, the tissue is a little bit thinner, more brittle, and it becomes more so over time. So in general, you always want to be really careful about what you're putting on or in your vagina.

But basically, because the walls of the vagina and the labia, you know, the vulva are all mucous membranes, same as inside your mouth, inside your eye, inside your nose. And that's a direct line to your bloodstream. Your mucous membranes, you know, don't go through the stomach before they get to your bloodstream. They go right into your bloodstream when you put things there. So any lubricants with lots of chemicals or weird preservatives or ingredients in it, I would stay away from and really focus on all natural.

I'm a huge fan, assuming you're not using condoms because condoms can break when exposed to a lot of oil. But if you aren't using condoms or if you're in a monogamous relationship, organic coconut oil is one of my favorite lubricants to recommend. Another one, you know, could be vitamin E oil. You can use coconut oil all over your body. And there are lots of companies starting to create organic, healthy lubricants. But the main thing is to remember that this is normal.

Enjoy the transition. Don't fight it. You can talk to your doctor about hormones. you're not going through menopause yet but definitely explore lubricants because those are going to really help you and it's going to make you feel better as well so I hope that helps all right let's go to a voicemail question I'm excited to hear these okay hey there I'm Rachel okay so I'm 25 years old and I've been dating this new guy for a few months now he's so sweet and the sex has been freaking amazing but sometimes when we're having a really good

time during sex it's like all this water suddenly comes gushing out of my vagina the sheets get wet and it's almost like i peed myself but i don't think that i did what the heck is going on and should i be concerned no you should not be concerned what you are describing is pretty likely to be female ejaculation now this is really interesting because a lot of people think that the woman is peeing when this happens. If you don't have to urinate, you know, if you went to the bathroom beforehand, if you didn't have a full bladder, 99.9% sure you're not peeing. What you are doing is ejaculating.

Now, the statistics vary on how many women report ejaculation with orgasm is typically when it happens. but here's the really cool scientific part that I just find so fascinating. Okay. So the first thing is that scientists have shown that female ejaculate, which happens at orgasm where fluid comes out of the urethra, not out of the vagina, but out of the same, just like with men, they ejaculate through the same hole they pee through. Women ejaculate through their same hole they pee through, the urethral opening. Now, obviously, initially everyone assumed that was urine, but then they analyzed it. It's not urine, okay? And more interestingly, it has a property in it

that semen also has in it, a biochemical called PSA. And so female ejaculate and male ejaculate both have that in it. Okay, so here's the interesting study they did to follow up on that. They took a whole bunch of women. Half of them reported that they ejaculate with orgasm, and half of them didn't, said they don't. They had them all self-stimulate to orgasm. And then they analyzed the urine of all of those people. And what they found is that the women who did not ejaculate had PSA in their urine. The women who did ejaculate did not have PSA in their urine. So what the scientists were able to glean from this is that technically all women ejaculate. It's just that for those of us that it doesn't come out with orgasm, it's going back up

into the bladder, something that forever doctors have referred to as a condition in men sometimes called retrograde ejaculation. And that is a condition where a man can't, when he reaches orgasm. He doesn't ejaculate. It doesn't come out his penis. It goes back up into his bladder. Sometimes that's because of a mechanical, anatomical issue. Sometimes it's a medical condition. It could be any number of things. But what's interesting is that women, for the most part, especially those of us who don't ejaculate, which is estimated to be at least the majority of women we are actually ejaculating we just it's just not coming out okay now the women who do ejaculate do not feel its pee because it's not and usually they will report that the orgasms

with ejaculation are much stronger than the ones without ejaculation and much more enjoyable so there you go for 50 years canadians have wondered what the names of ikea furniture mean like natopa the guardrail for children's beds natopa means giving your favorite person room to grow it means their safety and your piece of no in swedish not opa means night monkey mom he's back ikea 50 years of swedishness at home look he's wearing little pajamas so cute And there are a lot of people, believe it or not, I mean, I can't say I'm an expert in this, but there are a lot of people that teach women to ejaculate so that they will enjoy it more.

And, you know, I can tell you the general gist of it that I was told by a female ejaculatory teacher, which is that if you, you know, at the point of orgasm, most women who don't ejaculate just naturally tighten and squeeze their pelvic floor muscles, their vaginal muscles to, you know, just all around that area. It's like squeeze, squeeze, squeeze with orgasm, right? It almost is like an intense contraction. And I would say that the majority of women who do not ejaculate, if you pay attention to what happens with orgasm, you will notice that. So what the women who teach this say is that what you should do is that at the point of orgasm, instead of squeezing, consciously push, like almost like you're pushing pee out, but you're not,

and do it at the point of orgasm, and it will actually redirect the ejaculate out your urethra. Now, you know, I haven't analyzed the results of this technique, but, you know, it's a suggestion if you're out there and you want to try some experimentation with female ejaculation. But what you most need to know is that this is normal. It's not pee, and it's a sign you're really enjoying it and you're probably having better orgasms than most of your girlfriends who don't ejaculate. So don't feel bad about it at all. Totally normal. All right, let's go to an email question. Here's one from Kara who says, Dr. Berman, I am dating a super amazing, sweet, beautiful trans girl named Ashley. There's just one problem. Ashley still has her penis,

which doesn't make her any less of a woman in my eyes, but I've been a gold star lesbian my whole life, AKA never been with any dudes and I don't know how to interact with penis and I don't really want to interact with penis and I'm scared to bring this up to her and trigger her dysphoria. Yet we're getting to a stage in our relationship

where we want to be intimate with each other. How can we pleasure each other when I'm scared to interact with her genitals? So, Kara, I feel like it's totally cool and fine. You're a gold star. I mean, I don't know that there are silver and brown star, you know, lesbians, but I get it that you've never been with a man. You have no desire to be with a man and you don't want to be and play with a penis.

Now, what I'm concerned about is the fear around it. OK, so I want to talk about that for a second and then we'll talk about how to discuss this with Ashley, because both are related in my mind. Now, you, Kara, are a great candidate for sex therapy. Not because you're in a relationship with someone, you know, who's trans. That doesn't matter. You know, that's not the problem. The problem is your fear. And when someone has, and I don't care if you're lesbian, straight, bi, trans, not trans, pan, like, it doesn't matter. If you experience severe anxiety around certain body parts or sexual acts that are within the realm of your average repertoire, I'm not talking about heavy-duty S&M or crazy stuff. I'm talking about your average stuff. If that gives you significant anxiety, as it does in this case for you, Cara, that it

is probably a result of trauma. And that probably isn't a big deal to you most of the time, because my guess is, given how you feel about penises and your fear about them, that the trauma you experienced was at the hands of someone, you know, a man most likely who had a penis and that you associate the penis with molestation, abuse, rape, whatever horrific thing that never should have happened to you happened. Now, the reason I think sex therapy can be really helpful to you is certainly for your relationship with Ashley, and we will get to that. But in general, we don't want our fear to run our lives in any area, especially your sex life. And so if you were to tell me, look,

I'm just not that into her penis. Like, I don't mind it. You know, it's just there hanging, dangling, like whatever. But, you know, it doesn't turn me on. I can hang with it, but it's not my thing. How should I handle it? I wouldn't be as concerned about you. But the fact that you're like really resistant to going near the penis tells me that there's

some trauma. And if you can resolve that trauma with a sex therapist who has experience with this, then your entire sex life is going to get so much better. And so instead of having to, because people who have trauma, especially sexual trauma, that's impacting their sex lives, they're not even aware of it because we can learn to live with anything, you know, and we kind of get desensitized to things over time. We don't realize what we're living with until we're not living with it anymore, you know, for good and for bad.

But in this case, I'm saying that you've gotten so used to having an element of fear just embedded in your sex life that shouldn't be there and isn't your fault it's there. I mean, it was a part of your survival of your childhood, but it's time to let it go. And so much is going to get better in your life. Now, all of that said, Ashley, your girlfriend, the most important thing is that the two of you can have these discussions. As soon as you start the withholds of trying to avoid her being triggered, her trying to avoid you being triggered, but not speaking your truth and instead bypassing your own boundaries in order to avoid triggering the other, then you're moving into codependence, but you're also moving into a relationship that isn't really

authentic. And that's never going to lead good places or be as satisfying, of course, as an authentic relationship will. First of all, hopefully, you're constantly telling her how beautiful she is, how much you love her body, how much you love her different parts. I'm sure you've told her a million times that it doesn't matter to you that she has her penis. And it sounds to me, since you're worried about triggering her body dysmorphia, as you call it, or body dysphoria, it's that she really doesn't want that penis. And for whatever reason, a lot of times people can't afford it, or they're just not ready, or they're not a candidate for going through a full transition physically. So I don't know why she hasn't done it yet, but it sounds like she's

self-conscious about it, which is why you want to take care of her this way. So you can do it in a really gentle way. And I think you have to own it and you have to say, look, you know, I love all of you, including your penis, because your penis is part of you. And I want to learn to play with it and interact with it. But the truth is I'm scared. And it's not that I'm scared of you, Ashley, with a penis, I'm just scared of penises. It could be any penis on anyone and it doesn't affect my desire for you or my love for you. But what I would love to do is work through this because no inhibition is worth having if it's going to come between the two of us and the pleasure we can have with each other. So I'm going to go to a sex therapist, you know, I think, and just really work through this

earlier trauma that makes me so scared. Maybe you can help me. And remember, it has nothing to do with you and how attractive I find you. If she decides to go off the deep end, Kara, and make this all about her and her penis, that's on her. That's not on you. And I want you to call me back because we have more to talk about whether or not this partner can really handle an authentic, loving relationship with no major withholds. That's the relationship you want. My guess is she's not going to get triggered in the way you fear, especially if you phrase it the way I describe. But I want you to let me know how it goes and if you run into any problems. And you remember that you can call anytime or email me questions as well. Just go to languageoflovepod.com.

Let's get another voicemail, shall we? Hi, Dr. Berman. My name is Owen. I'm 39 years old. and lately I have felt tired, depressed, not in the mood for sex, just really run down and crappy. My girlfriend told me I could have low testosterone. How can I find out if I do and what can I do to boost my testosterone safely? Thank you. Interesting. So we've had two hormone questions this week and this is once again probably not like a hardcore sex therapy candidate assuming that your relationship is okay. It sounds like you and your partner communicate about stuff, that you've talked about this issue, that you're coming up with possible solutions. Now, just like I was talking earlier to the anonymous email that

was asking about dryness in her 40s, I mentioned that for women, and it is true also for men, testosterone starts to decline as well now testosterone which obviously men have a lot more of than women but women have a two testosterone is what's known as the hormone of desire so it plays a role in genital sensation in men's erections in their sexual response in their sexual desire in their energy in their mood like their general sense of well-being and in their muscle tone and ability to build and maintain muscle. Tassadar plays a role in all of that for men and women,

but men in particular have so much of it as it starts to decline, especially in their, a little bit later often for men, they always tend to have a little easier time with things, right? So in the late 40s, usually and onward, you can start to see men with these symptoms And it does sound like you are experiencing the symptoms of low desire, especially if

before you did have good desire and response. Now, some of the other things, so low testosterone is probably the most obvious culprit. I would go to a doctor. The nice thing for guys is that there are probably 30 different products out there, all FDA approved for men with low testosterone. So all you have to do is go to your urologist, urologist, U-R-O-L-O-G-I-S-T, preferably one who specializes or has a subspecialty in sexual medicine, the field is called, and you get a hormonal evaluation.

I do want to mention other reasons, in particular, that men, who are different in many ways than women, why men experience low desire, the most common is hormonal reasons, like I mentioned. It can also be caused by medications, in particular, antidepressants, SSRIs, in particular, can have a negative effect for both men and women in desire and sexual response. And for men, work or financial-related stress in particular. For women, any kind of chronic stress will affect our desire. But for men, it seems primarily it is work and financial-related stress, which a lot of guys in this country and world are experiencing right now, that stress can negatively affect their libido and sexual response because it kind of affects their sense

of manhood and virility and all of that. So there is your starting point, but I kind of agree with your wife and I hope that helps. Let me know if you have any further questions. Let's go to an email. We have one more email question in our sex therapy episode. Here is one from Sarah who says, Hey, Dr. Berman, I really hope you can help me. I've been on a weight loss journey and I've lost 75 pounds via the keto diet. Congratulations, Sarah. That's amazing. She says, it's been amazing and I love feeling so confident in my new body. But in the last few months, I've noticed my vagina smells really bad. It just has a different odor than it used to have. And I think it tastes different too, though my boyfriend doesn't complain. What is going on? Can your diet really

make your vagina smell different? And what do I do to taste sweet down there again without blowing My Keto Diet. Oh, Sarah. Okay. So we want you to have positive genital self-image. The good news is that your partner doesn't seem to notice anything. Okay. And you are absolutely right for men and women and everyone in between. Our diet impacts everything. Our blood chemistry, our hormones our biomes our bacteria our stomach linings I mean it affects everything so of course it affects lubrication because let me just explain what lubrication is and you're talking about the taste right lubrication as I was mentioning earlier tonight is a direct result of blood flow but how okay what happens is that when the woman gets aroused there's an increase a significant

increase of blood flow to the genital area. And especially in the walls of the vagina, in the capillaries of the walls of the vagina. And those capillaries get filled and engorged with blood. And then what happens as a result of that engorgement is that the walls of the capillaries of the vaginal lining start to almost leak or sweat. It acts the same way as sweating, but it's not sweat, leak plasma-like vaginal fluid. Now, a little bit of vaginal fluid comes from the cervix at the top of the vagina. A little bit comes from the skeins glands at the opening of the vagina. But most of it is a direct result of blood flow. So if you think about your diet, right, you're, you know, I'm sure you've noticed that as your diet has changed, your sweat

has smelled different as well, right? Your vagina is going to smell different, tastes different based on what you eat and, you know, often within hours. Now, what has been shown and I'm not an expert on the keto diet, but I know it's a low carb diet. And so this shouldn't be, you know, too hard for you to eat. The best thing for smelling and especially for taste, pineapple. That's true. Pineapple. And if you can work some pineapple into your diet on a regular basis and also get your start maybe taking some probiotics and make sure that you are maintaining healthy bacteria down there as well as in your gut because the two are connected and if you notice like a really funky bad smell or discharge or things seem really

out of whack go to the doctor because there may be an infection there that has nothing to do with your weight loss or anything else, but definitely needs to be treated. You know, if you're concerned about it, definitely go to the doctor, but otherwise try a little pineapple. And by the way, if you, this is just a side note, if you have a dog who, or a puppy, I should say, because it's usually the puppy who likes eating their poop, which I will admit I have had much to my dismay and horror. I learned through my research that if you feed them pineapple, it changes an enzyme in their gut and then when they poop they don't like the taste of their own poop as much as they liked it before and it worked it totally worked feeding my puppy a little bit of

pineapple in his meals every day so if it changes the enzymes in your gut that's probably I was very intrigued with that little exercise because I thought about this thing about the vaginal fluids and semen tasting better through eating pineapple. And I thought, oh, it must be the shift in enzymes. So anyway, that's just my anecdotal evidence. But let me know how it goes. I've had so much fun answering your calls, your questions. Thank you so much for sending them in.

You know that I am here. My whole mission on the planet is to help all of us learn to love and be loved better. We are in this together, supporting each other. I am here to always support you and give you my best advice. So make sure to visit me at drlauraberman.com for all kinds of blogs and articles and resources and meditations. And of course, check out the Language of Love page on my website. You can go to languageoflovepod.com and you can also follow me at the Language of Love

as well as at Dr. Laura Berman on all platforms on social media. I will meet you back here next week, same time, same place for The Language of Love with Dr. Mara Berman.