Ten Percent Happier with Dan Harris - 435: Mind-Blowing Sex | Dr. Lori Brotto

Episode Date: April 4, 2022

What role does mindfulness and meditation play when it comes to sex? It may be the key to alleviating sexual distress in your relationships, and in this episode Dr. Lori Brotto talks about scientific evidence that shows how mindfulness can improve your sex life.Dr. Lori Brotto is a clinical psychologist, the director of the University of British Columbia’s Sexual Health Laboratory, the Canada Research Chair in Women’s Sexual Health; the Executive Director of the Women’s Health Research Institute; and the author of Better Sex through Mindfulness.We talk about: Mindfulness practices for individuals and couples who want to improve their sex livesThe number one cause of sexual distress and how it manifests in different gendersThe importance of “interoception” or awareness of our bodily sensationsIdentifying the most common myths about sexContent Warning: This episode includes conversations about sex.Full Shownotes: https://www.tenpercent.com/podcast-episode/lori-brotto-435See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This is the 10% happier podcast. I'm Dan Harris. Okay, we got a, we got a, we got a doozy for you today. By way of background, I just want to say something interesting has happened recently in my little world. Three deeply experienced female meditation teachers and friends have each remarked to me that the frontier, the leading edge, the very cusp of their personal meditation practice is sex. One of them said, and I'm quoting here, I feel pretty strongly that opening

to sexual slash sensual desire is the next step in the evolution of awakening. I'm not going to name all of these teachers because some of them have not yet gone public on this extremely personal subject, but I will say that one of them is Seven A. Salaci, who wrote about this issue in a recent edition of her newsletter, which is excellent, and you should check it out. I'll post a link to the newsletter in the show notes. In any event, all of these conversations really got me thinking. I can imagine that for many of us, sex is an area of our lives that is

so fraught, so taboo that it might somehow seem exempt from our meditation or mindfulness practice. So we're going to try to change that today with a fantastic guest. By the way, this guest was recommended to me by the wife of yet another prominent meditation teacher, Jeff Warren. Jeff's wife, whose name is Sarah Barmac, is a dedicated practitioner and a journalist who has written on these subjects extensively. And she recommended that I check out Dr. Laurie Brotto, who is a clinical psychologist, the director of the University of British Columbia's Sexual Health Laboratory, the Canada Research Chair in Women's Sexual Health,

the executive director of the Women's Health Research Institute, and the author of Better Sex Through Mindfulness, which has a forward by a previous guest on this show, Emily Nagoski, in this interview, which I enjoyed enormously. We talk about the scientific evidence, much of it pioneered by Dr. Brato herself, that shows mindfulness practices can improve your sex life. The number one cause of sexual distress, how sexual distress manifests in different

genders, the importance of what Dr. Brato calls inter-oception or awareness of our bodily sensations, identifying the most common myths about sex, which is very interesting, specific mindfulness practices for individuals and for couples who want to improve their sex lives. And what she says is the most important ingredient in satisfying sex. Heads up, this is obviously a conversation about sex,

so you may want to put some ear muffuffs on the kids if you have them around. I will say there's nothing overly racy here, a few double entendres, etc. But just heads up. We will get started with Dr. Laurie Brotto right after this. Before we jump into today's show, many of us want to live healthier lives, but keep bumping our heads up against the same obstacles over and over again. But what if there was a different way to relate

to this gap between what you want to do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral? Learn how to form healthy habits without kicking your own ass unnecessarily by taking our healthy habits course over on the 10% happier app.

It's taught by the Stanford psychologist Kelly McGonical and the great meditation teacher Alexis Santos to access the course. Just download the 10% happier app wherever you get your apps or by visiting 10% calm. All one word spelled out. Okay. On with the show. Hey y'all, it's your girl Kiki Palmer. I'm an actress, singer, and entrepreneur. On my new podcast, Baby This is Kiki Palmer.

I'm asking friends, family, and experts the questions that are in my head. Like, it's only fans only bad. Where did memes come from? And where's Tom from, MySpace? Listen to Baby. This is Kiki Palmer on Amazon Music, or wherever you get your podcast. Dr. Laurie Brotto, welcome to the show. Thank you so much for having me, Dan. This is going to be an unusual conversation for this show, but I think a really good one. I'd like to hear your origin story a little bit.

How did you get interested in this nexus between meditation, sludge, mindfulness, and sex. Yeah, it wasn't destiny for me to become a sex researcher, sex therapist, mostly because the environment I grew up in was quite sex negative. And along with that came inaccurate messages around sexuality and really quite negative messages around premarital sex and that sort

of thing. So it was really through chance that I landed a volunteer research experience in a research laboratory where I was studying the effects of antidepressants on sexual activity of rodents and did that for about six years and really became very keenly interested in the impacts of stress and antidepressants on sexual behavior. And the really great thing about studying rats is that you can control a lot of their environment. You can control what they ingest. You can control their social interactions, et cetera. But of course, there's a lot of limitations that come with studying rodents. So I made the switch over to studying human sexuality the year that Viagra was approved.

And that's notable because in that same year that Viagra of course blockbuster medication as a treatment for rectile dysfunction in men. In that same year, large study was published finding very high rates of sexual problems in women upwards of 40% of women report lack of sexual desire and interest problems reaching orgasm pain with sex and yet no comparable treatment to Viagra for women. So I made the switch from the rat lab to the human lab and

continued to do that for about five years. And then I moved to the University of Washington to do a residency in post-doc fellowship and was introduced to mindfulness as a component of treatment for individuals who really struggle with extremes of emotion. So these are folks, you know, they'll go from feeling quite manic to feeling quite empty, to feeling euphoria, to feeling anxiety within a matter of minutes or hours. And the treatment that I learned dialectical behavior therapy, which was founded by Dr. Marshall Linnahant, the University of Washington,

taught these individuals that tuning in to that kind of rollercoaster of emotions was far more beneficial for coping than tuning out or distracting. So I learned the therapy, I worked with these individuals and really saw firsthand the benefits of mindfulness meditation and helping them cope and reconnect with their

emotions. And in parallel, I was doing research with cancer survivors with sexual problems who reported, I think, somewhat similar concerns, feeling extremes of emotions at the loss of their arousal, feeling a sense of disconnect with who they were after their cancer surgery. And it just dawned on me, could this skill of tuning in and reconnecting that was so useful for this other group of individuals also be useful for survivors who were struggling with their sexuality. So that was sort of the origin story and the bringing together of mindfulness and sex.

And I believe you've said in the past that when you first started to introduce meditation to people who's struggling with sexual dysfunction of one variety or another, that some people said, what is watching my breath have to do with sex? Yeah, absolutely. And of course, your listeners will be familiar with the kind of basic tenets of mindfulness meditation, present moment, non-judgmental awareness. And through a series of exercises, including paying attention to the breath. So if you can imagine the person who is struggling with a lack of

interest in sex with their partner or even struggling to reach orgasm They might say how can present moment noticing of my breath at my belly be connected to improvements in my desire to have sex with a partner, right? And even just when I sort of presented in that way, it feels like a paradox. And of course, I've learned a lot from my meditation teachers over the years in that meditation is an experience and it's a felt experience. And so rather than me explaining the connection of how mindfulness might be useful for them, I simply encourage them to practice and give it a try.

And fortunately, I guess for me at the time, because there were so few other options for treatment of sexual difficulties in women, even today in 2022, there's only two FDA-approved medications. They work marginally better than placebo. It can be really challenging to see a qualified sex therapist. So what I've found is that people were willing to take that chance and give it a try. And then of course the proof is in the pudding through the experience.

You've been doing this for a while. So what do the data show about how meditation can be helpful for people in this position to use a loaded word? Yeah, of course, because this position is actually, it can manifest in so many different ways. So I've mentioned a few times now low desire, which is the most common sexual concern in all genders, men, women, and non-binary folks. And that's no longer being interested in sex, maybe no longer responding to a partner's attempts to initiate, etc. But we can also have pain with sex, extreme anxiety about sexual activity, fears of losing interaction, loss of arousal. So we've been able to

over the last 20 years adapt our mindfulness intervention to these different populations, depending on what the main sexual concern is. And the data are fairly consistent. They show first and foremost a reduction in sexual distress, right? So sexual distress is how much that this sexual concern really bothers you, interferes in your life, maybe creates conflict in your relationship. And so that's always been our primary outcome of interest, if you will, the extent to which practicing mindfulness and adopting a regular practice can reduce that sexual distress. And so every study has very consistently found not just a significant reduction in sexual distress,

but a very meaningful reduction in distress to the point where people will say, wow, this is really working for me and I feel better in my life and my relationship, et cetera. And then we also find improvements in those more specific domains of sexual response, improvements in desire, improved intensity of orgasm, improved ability to retain an erection,

as well as improvements in pleasure. I imagine some people might hear reduction in sexual distress as resignation. Okay, well, I still have the problem, but it's not bothering me as much as I used to. And that's a really good question, because for a lot of people, that is their situation. They might have a decrease in their desire and say,

well, of course, I have a decrease in desire. I have a two-month-old at home, and I'm juggling multiple demands, or I'm going through a stressful period of my life. So they might have a sexual difficulty, but not necessarily distress that goes along with that. So we don't want to pathologize or give that a diagnosis. In fact, what we want to do is validate the person. I let them know that sometimes sexual problems are transient,

and they will improve over time. Your question is really, I think, does mindfulness sort of lead to an acceptance of the difficulty, right, kind of resignation in that way? Well, it is what it is and I'll just have to learn to live with it. We've actually studied that question and it turns out not to be the case. And what the data actually find, or the data actually show, is that along with the improvements in distress, it actually leads to an improvement in those areas of sexual function.

Right? So an improvement in desire and these other domains. And in fact, the decrease in distress can predict the improvements in desire and arousal and pleasure and sexual satisfaction. That goes to one of the things I wanted to talk about with you and I know that this is a huge emphasis for you and something that you're finding that people get very interested in, which is as people reduce their stress, then their distress, then the desire can come back. And so, I also know that you've talked a lot about the relationship between stress generally

and sexual function. Does this flow for you, this connection I'm making here? Yeah, it sure does. That wasn't originally why our team set out to apply mindfulness to sex and see if it worked. We didn't kind of go into this with the hypothesis that stress was the cause and the maintainer of sexual problems. But it sure is the case when we look at the data and when we ask people to self-report their levels of stress.

And when I talk about stress in this way, I'm not talking necessarily about a you know, a single traumatic event that happened in a person's life, although that is the case for some people, natural disaster, sexual assault, witnessing death, etc. Rather, the stress that we're talking about and we're seeing and other surveys are documenting on a very large scale is the day-to-day grind, the never-ending to-do list, the feeling of never being able to sort of accomplish anything to the quality that people feel comfortable with. And this kind of chronic stress, as we call it, results in changes in the brain, and our ability to not just regulate day-to-day stress, but also our ability to experience sexual response.

So there's a direct link between day-to-day stress that's chronic and impairments in sexual function and also the mechanisms by which mindfulness can improve sexuality. The stress manifests differently for different genders as it pertains to sexual function or dysfunction. Yeah, that's a great question. It actually does. And for this is work, not that we have done, but others have done. But I've certainly seen it in my clinical practice. And what we often find is women might be more likely to say, my low desire is a problem for my

relationship and makes my partner unhappy and thus our relationship satisfaction goes down. Whereas male partners might be more likely to say the distress from my sexual problem is an insult to who I am as a person. It sort of conflicts with my ideas of who I am. So it's more personal distress that men will express and it's more personal distress that men will express. And it's more interpersonal distress that women will report. Now, of course, there's exceptions to that. And of course, we, in the context of a relationship, we never want to say one person is responsible for the kind

of relationship happiness that both contribute to that. And so that's sometimes in the context of couples work. When we bring mindfulness into couples. We help frame these issues from a couple or a diatic perspective. I was laughing when you were talking because yes, it's true that we need to be careful. But speaking in generalizations here as necessarily when we talk about the difference among genders, I was laughing though, because it's like men take it as a personal insult. They go in a very self-centered direction with this. Myself included, so I'm not putting them, I'm not commenting from on top of Mount Olympus here.

And women go to a more commutitarian relationship, interpersonal, and it really just reflects the messages, the society, the culture, send to men and women about what you're supposed to be doing. Many men get the message that your life is about personal achievement and dominance in some way and doing better than other people. And so it's interesting to see how this ramifies in this context. Yeah, and even in how, if we go back to stress for a moment,

how stress is experienced, it differs by gender. And there's a much more significant kind of interpersonal if we go back to stress for a moment, how stress is experienced, it differs by gender, and there's a much more significant kind of interpersonal or relational aspect that women experience, right? So a fight or disappointing someone for a woman can be a major contributor to her feelings of stress, whereas for men, it would be much more based upon those kind of personal markers

of achievement versus failure. And I realize I'm talking in dichotomy there on purpose. So that's true to me in that this is the type of reaction I might have. Why is it that you think you get so much response when you talk about this connection between stress and sex? Why is this so resonant for people? There's probably a variety of reasons, but I think one reason is that there are so many myths and stereotypes about sex in our society,

and one of which is that sex should be automatic, that it's purely biological, that it acts like a reflex. In other words, if you kind of stimulate the right area that it's purely biological, that it acts like a reflex. In other words, if you kind of stimulate the right area with the sufficient tension, that a body will respond. And I mean, even as I'm saying that,

I'm sure that your listeners are shaking their head, saying, I don't believe that. But the reality is, is in these large surveys, we see that these kinds of myths are really quite pervasive. So, to present to folks the idea that actually stress is probably a bigger contributor than your own biology, than your own hormones, than your own neurotransmitters in your brain, is on the one hand a bit of a paradigm shift for them. But on the other hand, it's, a bit of a paradigm shift for them. But on the other

hand, it's also an opportunity for people to say, oh, okay, well, is there something I can do about that, right? Where is the suggestion that is purely biological? I mean, apart from a medication, as I mentioned earlier, there really aren't many options for women in the domain of effective and safe medications. So the conversation about stress and sex opens up the opportunity for, well, what can I do about it? And yes, mindfulness is very effective, but there are other psychological and skills-based techniques that we can use that address and reduce stress as well. So I think that idea of being able to have some self-efficacy or some control over your sexual difficulties

is really empowering and inspiring for people regardless of the person's age or social situation or race, ethnicity, or even sexual orientation. I would imagine for people it makes them feel like you're not uniquely broken. That this is biologically lawful. This is totally natural. All right, yeah, that feeling of, you know, I'm alone.

I'm the only person that suffers from this sexual concern is so common. And it's a large part of the reason why we often run groups. So our mindful sex groups for years and years were face to face. Thanks to the pandemic, we moved to online. Had some concerns about our ability to really have this conversation, about sex and stress and practice mindfulness online. All of my own concerns were completely washed away when we noticed that being able to do

this online meant that individuals who have barriers to attending say a hospital setting or a clinic, suddenly those were eliminated. So the ability for connection, feeling not alone, feeling validated, observing that, wow, there's all of these other individuals that are going through exactly what I'm going through and along with that came a fair bit of relief and connection that then allowed them to dive even deeper into the mindfulness. We've talked about how mindfulness can improve sexual function because it reduces stress. What are the other ways in which it is helpful?

Yeah, this has been a major part of my own research in the last five years. We sort of got to a stage in the research where we showed mindfulness works, here are the different populations for whom it works. And then I became fascinated with the question of how, right? So stress absolutely, it reduces both the kind of the physiological stress response, right? So looking at our cortisol levels, it helps the body regulate cortisol levels and return

to baseline or homeostasis. We also have observed that mindfulness helps with something called interoception. Interoception is a person's ability to know what's going on in my body. So, the individual who has a really good sense of their own heart rate, or their own blood pressure, that's a person who has a high interoceptive awareness. And there's quite a big literature showing the link between low introspective awareness and things like depression and anxiety. And mindfulness improves that. And maybe it's no surprise because of course when we do a body scan, we're spending minutes and maybe even hours paying attention to body sensations.

And so that improvement in our ability to be interceptively aware, we've found in our research directly translates into improvements in desire. We've got a number of other mediators as well. Another one is self-compassion. And for people who have sexual concerns, although not exclusively, I think a lot of people have negative judgments about their sexuality, right? My desire isn't strong enough or I don't perform in the way that my partners, previous sexual partners performed or it takes too long to reach an orgasm. A lot of people

are just riddled with these negative beliefs and self-judgments during sexual activity in a way that can directly get in the way of sexual response. And so we've found in our research that improvements in self-compassion, so that ability to be kind to oneself regardless of what one is experiencing paired with reductions in self-criticism. So letting those beliefs just kind of exist

like clouds in the sky passing by. It's not about ignoring them. It's not about turning them off. It's just about saying, oh, there goes a sex-related judgment I'm having. I'm going to let it just be in the background. So both of those, being more compassionate and letting self-criticism be and not dominate center stage

are major mechanisms by which mindfulness helps sex. Let's just go back to this awareness of your own body. Something is coming to mind that my friend and co-author, we wrote a book together this guy Jeff Warren, meditation teacher based in your country, Canada. Jeff talks about meditation, getting out of your head, going south of the neckline, reminding you that you're a creature, that you're an animal. And I'm wondering if that's an aspect of reinvigorating sexual desire or improving sexual function, enjoyment of sex, just getting out of your own head.

Yeah, absolutely. I mean, I often say to the people I work with, you know, we spend more time, our bodies showing up for sex, and our minds not showing up for sex. So the mind is elsewhere. And it's often, it's sometimes in those judgmental places,

but it's often in just those distracting arenas. Did I turn off the oven? Who am I meeting tomorrow? What's happening this weekend? Are the kids asleep? Is someone going to walk in? And all of these sorts of ideas, because, of course, we multitask, you know, the rest of the time, and we're not having sex, we're multitasking.

And so, of course, our brains become very skilled at being anywhere but the present moment. And so then when one attempts to be sexual, the body might respond and show up. But if the mind is not present, it's not going to notice that blood flow has started. That skin sensation has started to emerge that other signs of physical excitement in a rousal have kicked in. So it's almost as if they're not even happening. The brain is not registering the onset of those physical sensations. The brain in turn can't feed back information to the body to continue to respond. So it's the brain and the body working in concert with one another.

And mindfulness is really about how do we harness the attention and tune it into the arousal that's already happening. Much more with Dr. Brotto coming up after this. Celebrity feuds are high stakes. You never know if you're just gonna end up on page six or Du Moir or in court. I'm Matt Bellesai. And I'm Sydney Battle,

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You can listen ad-free on Amazon Music or The Wondery App. Alright, so let's go into the boot war now. It just say having sex or doing something sexual. And I notice that I'm multitasking. What's the move? How do I use my meditation to get back in the game? This reminds me of the question that I get asked by a lot of the people that I work with,

which is, you know, can I fast track the sitting on the pillow part and just get right to, how do I be mindful during sex? And I should start by answering that by saying in our groups and in our research, we do encourage people to adopt a formal mindfulness practice in their life where they know when their minds take off because it becomes even more difficult to do that during sex when emotions are higher, when there's more at stake, when there's another person usually beside you. So let's suppose that the person does have an

established mindfulness practice. They have been able to notice when their minds go to those distracting places and bring it back to the present moment. So during sex, it's the same thing. And there's additional skills that we can implement, such as using all of your senses during sexual activity to ground you in the here and now. So something as simple as opening your eyes to look at who you're with, to look at the colors, the shapes, the movements. You can also pay attention to sensations, not just in your body, but sensations of those points of contact, the feelings that your fingertip smells, tastes, sounds,

of course. And so we use all of our existing sensations and we deliberately integrate them into the sexual encounter. And we've studied this phenomenon. So what actually happens when a person who is bombarded with distracting thoughts, again, whether they're judgmental thoughts, or just these kind of benign distractions, and they deliberately use and bring in these mindfulness skills into sex. And it works better, again, if a person has an established practice, but even for someone without an ongoing body scan

on the pillow practice, these skills can also be very, very useful. So it is about being intentional and deliberate about them, as opposed to just kind of waiting for the mind to come back to the present moment. Let me go back to some of the inhibitors to sexual function and we'll return to modalities for improvement, but I just want to make sure everybody feels seen here.

Another inhibitor that comes to mind and this strikes me as perhaps particularly prevalent among women is shame. It's not like the society, the culture to my eye is sending lots of encouraging messages to women about letting loose and enjoying bodily pleasure. I mean, most of the messages that come to mind about women and sex are like Jezebel, or what's the term that the kids are using these days, slut shaming. So I could imagine, I'm not a woman, but I could imagine that shame would be an inhibitor. Am I onto something here? Yeah.

Unfortunately, you are. And back in the late 1800s, early 1900s, there were only two diagnoses for women's sexual ailments, fragility and nymphomania. And both of those terms have had a lasting legacy. I mean, you'll often hear even in kind of daily conversation, I know I still do the term, she's a nympho. daily conversation. I know I still do the term, she's a nympho, and people don't actually understand the historical context of that or the implications of it, because even though in many ways, I think we've progressed around sex education, although arguably it's country dependent, and even within my own country, it is province dependent, huge variation in the quality and the depth of sex education that really matters in the long term for people. So we've got much more

open discussions about sexuality. We've got a decent sex education system. We've got much more kind of openness online with apps that promote dating and that sort of thing, but the legacy of Nymphomania still holds today. And it holds both overtly when you hear people refer to women as being a slut, et cetera. And it also holds more implicitly with women holding onto those beliefs themselves. And it can shape a woman's entire life so that even if she wants to engage in sex and has pleasure and has desire, it's a double-edged sort. It's often coincides with feeling guilt and shame afterwards. And then of course she carries that with her not just into her next sexual encounter, but really into her persona, her sense of identity of who she is. So we're seeing more conversations around pleasure and the importance of pleasure,

and in fact, an upcoming Netflix series focused on women's pleasure, called the Principles of Pleasure, but I think it's going to take some serious conversations, some serious early education around the importance of talking about pleasure to really change this. So that's why I'm glad that opportunities like this to normalize and validate and celebrate the importance of women's sexual autonomy and finding ways to improve sex even when there is a difficulty that that message be shared as far and wide as possible. I have just been so struck be shared as far and wide as possible. I have just been so struck by the fact that three female friends of mine who are accomplished meditation teachers, three of them have said to me of late that getting in touch with pleasure

and their own sexuality is a huge aspect of their current practice. One of them said, and I'm quoting here, I feel pretty strongly that opening to sexual slash, sexual desire is the next step in the evolution of awakening. So I dump all of that on you just to see if you have a response. Well, first of all, I agree. And I'm really glad that your friends are sharing this information with you and feel brave enough to say that because that's the other part of it is people often suffer in silence women far more likely than men to suffer in silence and the vast majority of women who have low desire or will never talk to a healthcare provider about it. They might hop on to Dr. Google and see what's available and come across a list of

unvalidated, questionably safe techniques to improve their desire. So the conversation around pleasure that takes pleasure outside of the bedroom. Yes, there's sexual pleasure and there's sexual autonomy and there's orgasm, but there's also emotional satisfaction, which women will argue is as important as physical and sexual satisfaction.

And it's the link between pleasure and her overall identity as well. And so I've been a proponent for a long time around how do we set the stage as early as possible in sex education, in school age kids, to give them permission to begin to ask themselves, who am I as a sexual person? Of course, you're not going to say that to a five-year-old per se, but we're also not going to condemn that five-year-old who discovers their own body by accident, say, in a bath with the bathwater running on them and then scolding them for enjoying it, which I hear on an almost definitely weekly basis from the women that I see.

They can trace back the origins of their own sexual difficulty to this one episode of feeling intensely shamed as a young person where it wasn't even sexual for them. It just felt good. There was pleasure, but the very strong reaction of shame instilled that stayed with them for the rest of their life and really prevented them from accessing pleasure. And I think what makes it so challenging for people, the older that they get, is that they know this.

They can see the double standard. They understand intellectually that pleasure and autonomy is an important thing, but emotionally, they feel gripped by their own past experiences. They feel sort of locked in time. So I agree, I think pleasure is the next frontier, if you will, to true human connection and identity. I have so many questions. Let me just get them out and we can pick. We can go and, but one is I'm just curious how could meditation help with this shame that such an inhibitor? Two, as I would imagine, the shame, we're talking about a variety of shame that seems like

a huge inhibitor for women, but there's lots of shame and you already talked about it for men around performance and virility, et cetera, et cetera, and how can meditation or other modalities help the guys here? Three is if this is the next frontier in awakening and psychospiritual development, but how do we pursue that? Like, what do you actually do? And four, as you may know, there's been an increasing talk of late about pleasure as a kind of radical act, you know, a thing we need to do in order to fill our own cups so that we can pour from it so that we can be positive players in a world

that's totally jacked up. So that's four big things I just tell you. Let's take them apart and whatever order at whatever pace you would like. Yeah. Well, I'll start with the first question, which is how does mindfulness help individuals become aware of and be with shame in a way that then might help them move past shame? So at its most fundamental level, shame is an emotion, right? It's a feeling in the same way that happiness or anger or guilt or anxiety even is an emotion.

And of course, in our mindfulness practice, we're doing a bunch of things, but one of the things that we're doing is we're embodying equanimity, which is this ability to bring the same kind of attention, awareness, acceptance to all of the feelings that arise, the ones that feel really good, the places in our body that feel very comfortable, as we do to the more unpleasant ones, the areas of tension, the pain, the emotional discomfort. So we have, in our own research, done this a number of times, specifically with individuals who have a history of sexualized violence and experience a lot of shame, despite the fact that

they're in a happy, healthy, consensual relationship, they still have a lot of shame and guilt over their past experiences. And I just want to emphasize that they were victims in those past experiences. They weren't agents in them. And so our mindfulness practice with those individuals was not about turning the shame off, but rather how can we bring a gentle, you know, John Capitziin often talks about toe in the water. Can we take a glimpse even just momentarily

to what shame is, where it shows up in the body? What are the actual sensations that make up shame? And so when we do that, we start to loosen its power, right? It doesn't become this thing that defines us and follows us everywhere. Rather, it can become an emotion like any other emotion. And the more that we can practice equanimity, again, bring the same attention to the feelings of shame as we do to the feelings of comfort and happiness and looseness and tension, then

again, the more that its power becomes deflated over time. And so in our own research, we found that particular strategy of bringing equanimity to emotions, including shame, was pivotal for helping this group of survivors identify, be with, and eventually overcome their shame. Now, it didn't mean that their shame was entirely gone, but they were no longer afraid of it. And that shame no longer dictated what happened during their subsequent sexual encounters, and in particular, consensual ones. So, yeah, huge role for mindfulness in bringing shame, what shame is and where it shows up into familiarity. I also wanted to get at men and shame

because it seems like a different flavor of shame around the kind of individual achievement messages that dudes often get. Yeah, absolutely. And it's ironic because I was just having a conversation a few days ago with a young man, a very young man who had heard about my work in mindfulness and women and explained his own feelings of shame when during a sexual encounter, he noticed that he was beginning to lose his erection, and I asked him, well, what's coming up for you? And he said, well, I'm just so focused on my

partner noticing it, that my mind stays there, and I'm no longer in my body. And an extreme sense of shame, because he was young, he was virile, he was attractive, he had high desire. And, you know, one is supposed to have a rock heart erection that lasts the entire direction of penetration. And so that can be the instigator of shame for a lot of men. Those sort of very specific performance related concerns. And so mindfulness as a tool to just remain in the body and treat that that worries some thought of am I starting to lose my erection as just a thought in the same

way that we might have a thought about what we're going to be doing after the sexual encounter was really, really powerful for this individual that I spoke to. So yeah, shame, it is gendered in that women are more likely to experience shame and long historic cultural reasons for that. But men are most certainly not immune to shame as well. And increasingly, I am seen and my sex therapist colleagues are seen increasing levels of shame and low desire in young men. I do want to congratulate you because I think you're the first person to utter the words rock hard erection on the show.

So we'll see if it gets edited out. If it gets edited out, I'm going to be mad. No editor in the fuse a lot of, I sent in your direction. The other one was this notion articulated to me by my female Dharma teacher friend, that sexual slash sensual desire is the next step in the evolution of awakening.

If people take that seriously or find that intriguing, like, how does one pursue that path? Yeah. So I've uttered the word pleasure now, a number of times, but we haven't actually defined it. And I think it is important to define it because when we talk about pleasure, it's an entirely subjective feeling. And the same way that awakening is entirely subjective.

We can't put numbers to it. There's no, you know, external device to measure it or tell you once one has reached pleasure. So really important that when we talk about pleasure, that we give lots of leeway and room for people to define what pleasure means to them. And it might be an orgasm, it might be emotional bliss, it might be a feeling of connection, it might be a release in the body in the same way that, you know, say after a deep breathing exercise, one goes from a state of tension to pure relaxation. So that's the first step is helping people to really define their own pleasure. And we can of course talk about some conventional definitions of pleasure,

if someone doesn't know where to start. But that becomes important because it helps us get away from some of the against stereotypic ideas about a certain intensity of sexual desire, a certain frequency of sexual activity that one must have, a certain number of orgasms per week. And that was the original work that Kinsey did actually back in the fifties, which really counted things, looked at numbers and was an amazing beginning to sex research. But in some ways also locked us into this idea that sex and pleasure could be quantified by zeros and ones as opposed to something that was far more nuanced and experiential

and full body felt. So that's kind of all the preparatory work before we get to your real question, which is the link between pleasure and true awakening. If we talk to people who experience truly mind-blowing sex, and some of this work has been done by my colleague, Peggy Kleinpatts at the University of Ottawa. She collected dozens and dozens of stories from people

who have this kind of optimal sex experience. They will use the language of awakening, kind of, you know, tolling presence, immense synchrony between one and their partner, a state of all knowing and ever presence. Again, all these constructs that are not only difficult to measure, really hard to describe in words as well, but people are experiencing that and talking about it. Now, the how-to, well, that's where our work needs to take us, is how do we create a culture where we give women and everyone permission to start to explore that?

So there's the, how do you give permission, but then there's also that what does the exploration look like? What are the exercises we should be doing individually and as couples in order to get toward this mind-blowing sex that becomes a mystical experience, or even just like good sex. Yeah. Well, body awareness is heavily gendered and, you know, in part it's because young boys have external genitalia that makes it much easier to feel things like stimulation and thus a

rousal. Whereas women's erogenous zones are hidden, right? The clitoris is buried, if you will, often young girls aren't aware it's there, they might discover it by accident. And so when we come back to the conversation around really adequate sex education, that's developmentally appropriate, of course. How do we talk about body parts and anatomy, but start to give all genders, all bodies permission to know what they have? There's a really important research that finds kids who know the correct names for their genital anatomy are significantly more likely to report a sexual assault when it happens than those kids who don't know the proper names for their own genital anatomy or were just told that it's private part or down there.

So apart from the eventual link to pleasure and body autonomy and body awareness, there's a safety issue as well that comes with people knowing and being given permission to really know their own body. And then of course with time, exploring the feelings when their body is stimulated, recognizing that it changes over time through menopause, through aging, through hormonal changes,

through physical issues, through surgeries that our bodies respond differently to touch over time. And that's also part of the pleasure conversation is how do we encourage, and it's also part of the mindfulness conversation because how do we encourage, and it's also part of the mindfulness conversation, because how do we encourage people to treat their body as not fixed as a kind of constant source of new and different sensation in the same way that when we sit on the pillow and pay attention to our body and a body scan, that yes, what we're attempting to do is the same as the hundreds of times that we did it before, but the actual sensations we notice are never identical. They're always different. So here we're making that bridge

between the skills we're cultivating in mindfulness and bringing this into the skills that we hone in body awareness. Yeah, I mean, we've talked a lot about meditation as a modality that one could use to improve one's sex life, but I'm curious, are there things that couples can do together that would get us down this path of, you know, desire pleasure as a path of awakening to be grandiose about it? Yeah, so I do often recommend that couples practice mindfulness together, so they might listen to a recording, if you will, and sort of do this independent practice. But then there's mindfulness skills that couples can actually

do that involve one another. So one that I love is back-to-back sensing. And you can do this either standing up back-to-back or sitting in chairs. The chairs positioned in a way that your backs are actually touching one another and spending 10 minutes bringing awareness not just to your own sensations of your body's point of contact with the other person, but also the feelings of their body against yours. And that might not sound like a distinction when I say it, but it actually

is when you practice it. There's sensations on your end, and then there's sensations sort of externally. So that's one that's not very sexual, but can be a way to ease couples into mindful sex. Another practice that I love, which has been around for 50 plus years, is Senseiit focus, developed by Masters in Johnson in the 1960s, and Senseiit focus involves a progressive series of touching exercises that start non-erotic. So one person will touch the other person head to toe, excluding the chest breast genitals, and the person receiving the touch is practicing mindfulness.

They're tuning in, they're relaxing, they're bringing awareness away from, oh, is this for play? Is this going to lead to something sexual and bringing it into those sensations in the present? Then they switch and the giver becomes a receiver, receiver becomes the giver for about 15 minutes. And then at the end, they talk about what that was like.

That's the first stage in sense, eight focus. It becomes progressively more sexual and it includes the more erotic parts of the body. But I think it is probably the most powerful couple-based mindfulness exercise that exists because it exposes you to all of the thoughts and worries and anticipations that come up when you're receiving touch and being undressed. It exposes you to the, oh gosh, I'm getting aroused, I'm getting an erection, what am I going to do about it? And the answer is, you notice it and you come back to sensations in your body. So it helps people really confront

anticipation and gives them permission to just stay really present. And of course, it can be a really powerful tool and communication as well because the giver of the touch can see the body's response from the receiver and can actually see relaxation or can see tension that the other person is experiencing. So I often advocate that couples practice this on a weekly basis until, you know, they feel like they have been able to really bring their on the pillow mindfulness skills onto the other pillow. So to speak, the bedroom pillow. That's really interesting. I could see how this exercise would be like a practice space or a dojo where you can safely get mindfully attuned to how your mind is reacting in sexual situations without actually being in a sexual situation so that you can then bring that skill

into sex. Yeah, exactly. Yeah, it's a bit of a, you know, a window into the patterns of the mind that happen during sex, but in this context that is highly controlled and safe and prescriptive, but also really fun as well. I've encouraged hundreds of couples to practice, sense, eat focus, and even the most skeptical of them have come out of it with feedback that this is really powerful, And I've learned something even in my 30 year relationship that is really useful for me moving forward. Much more with Dr. Brotto coming up after this. Let's talk about individuals. Are there, I can't believe I'm about to ask this question, but are there like masturbation practices that you recommend?

Yeah, I'll share one that we've developed and we've actually tested it to see if it works on its own outside of a formal eight week mindfulness program. And it's called sexual sensations awareness. We don't call it a masturbation practice just because the word masturbation conjures up that kind of goal-oriented nature, right? People masturbate in order to reach orgasm. Whereas when you talk about sexual sensations, it's about the sensations. And that's where we stay. And if it leads you to orgasm, sure, fine. And if it doesn't sure, fine as well. So what we do in this particular

exercise is we first encourage the person to engage with some kind of sexual tool. So it could be a vibrator, it might be reading or watching some erotica, maybe it's conjuring up a fantasy or listening to a fantasy, and we encourage them to do that for about 10 minutes. So a sufficient amount of time to elicit some physical arousal, but maybe not to the point of orgasm. Then we ask them to set that aside, turn the vibrator off, put the erotica away, and then we have them listen to our sexual sensations meditation practice, which sounds a little bit like a body scan in that we're guiding the listener through different parts of their body, but unlike most freely available body scans that omit

erotic parts of the body, we include those. So, we, and we've got gender-specific ones as well as a gender-neutral one. So we'll encourage the person to notice sensations at the clitoris or the space between the inner and outer labia and just bring awareness there. So the idea is that by first kind of priming the body with arousal by engaging with this tool, can they then use mindfulness as a way to really connect with those sensations? It turns out in the research studies that we've done that among the rather large number of women who say, I don't feel anything, I'm numb, right? Nothing's going on, it doesn't matter what I do.

Even among them that this pairing of the erotic tool and mindfulness allows them to tune into even the most subtle of sexual sensations that then gives them hope and confidence that mindfulness can be a tool to notice even more. When we've done this same sexual sensations practice with gynecologic cancer survivors who say after their radiation therapy, they truly did believe that they were numb and there were no sensations anymore. In fact, many of their oncologists and surgeons and doctors would say, yeah, this person is incapable of feeling any sexual response anymore, given the extent of the medical intervention that we did. But mindfulness paired with the erotic tool, again,

gave them just enough of an awareness of the most subtle sexual sensation that they could then build on that over time, and indeed, we're able to feel arousal again. So that's an exercise I love because it brings together, you know, use of a tool which a lot of people engage with, though a lot of people feel a lot of shame with. So we talk about a tool in this way as opposed to get your vibrator out as the way of giving people permission to do this exercise. So that's one. Great. The last question that I threw at you during the earlier barrage was there's quite a popular book out now called Pleasure Activism and this notion that pleasure isn't some

ferviveent shameful thing. Now I'm broadening beyond just sexual pleasure, but sensual pleasure has a geopolitical aspect in that you're allowing yourself to get replenished so that you can get back in the game or in the fight at a time when there are so many huge issues that need to be addressed. Yes, so I love that.

And I love books like that that really put pleasure, center stage, and normalize it, and take it out of the specifically sexual context that I think a lot of people think about pleasure in, and frame it within this bigger context of loving oneself, self-care. I think one of the consequences of COVID,

if COVID has taught us anything, is the importance of feeling our own cup as a way of being resilient and caring for others and for ourself as well. So I'm hopeful that books like this will start to turn the tide. Part of it though, again, will be being really broad and casting a wide net in how we talk about pleasure. Again, because there are so many stereotypic views about, you know, what this means, and does this mean masturbating white by yourself

to orgasm in privacy, that sort of thing. But pleasure can take many, many forms. We also know that sexual pleasure can bleed into other forms of pleasure, self-pleasure, and self-atonomy as well. So, yeah, I think between the book and the upcoming Netflix series, I'm hopeful that this will be the start of many more conversations about the health benefits of pleasure. You've talked a lot during the course of this conversation about myths as it pertains to sex. And I know one of the myths that you like to bust and I want to give you an opportunity to do so now is the notion that planning sex is not very sexy. So go ahead and do some myth busting.

Sure. Oh, I love this one because so many people are, you know, they believe that to plan sex and put it on your calendar suddenly takes the sexiness out of it. And I respond with a really simple question to that, which is, you know, what else do you do in your life of value that is meaningful, that takes effort, that is not planned. And most people would be hard pressed to come up with any example of something that was really important to them that wasn't planned. So planning in and of itself does not make sex clinical and boring.

Rather, what it can do is it can afford opportunities for anticipation, fantasy. I often say to people I work with, for place starts the moment your last sexual encounter ends. This sort of idea that kindling ideas and kindling plans for the subsequent sexual encounter can transpire over hours, days, or weeks or months even depending on the frequency of your sexual activity. So that's a myth that really deserves debunking that planning sex is somehow unsexy. And I just encourage your listeners to try it. You just mentioned frequency of sexual activity.

One of my producers asks, is there a standard by which we should gauge whether our sex lives are good, like a certain amount of times a week or a month? Yeah, how you feel. That's your gauge. That's your barometer. I often get asked that question, what is the optimal number of times per week that I should be engaging in sex in the context of, let's say, my long-term relationship. And yes, there are data, there are big national studies that have asked that very question,

and they find a huge range. So I can throw a number out, but I would rather answer the question with it really depends on the quality of those encounters, because low quality or semi-coversive sexual encounters that are frequent can do a lot more harm in terms of building resentment and eliminating pleasure than far less frequent, but full-bodied, fully attentive and mindful sex can be. But I know you want a number, so I'll give you a number

or maybe your listeners want a number. And the big surveys do find that on average, and lots of variability, apologize for all the caveats, but couples in long-term relationships engage in sex about once a week. Sex broadly defined, that doesn't necessarily mean intercourse,

it can be other kinds of sex as well. This naturally leads to another question from my producing team, which is how do you handle couples that are not aligned in how much sex they want? Yeah, we address that from the couple perspective as opposed to saying that one person doesn't have enough desire or the other person has too much desire. And you know, it's hard to compromise between two numbers that are vastly different because neither person will be satisfied. So sometimes that does take a turn into couples therapy.

If there are relationship issues and struggles that is really contributing to that and the lack of satisfaction with that discrepancy, but really importantly it gets addressed from a couple perspective. Discrepant desire is the most common of all the sexual difficulties. So, you know, 30% of couples in America will find themselves in a discrepant desire relationship. Am I hearing you say that that's a little bit out of your purview? That's a couples counseling question. Not necessarily. Sometimes it's out of my purview. If say there's issues of betrayal or lack of trust or other kind of relationship and communication conflict-related

issues contributing to that. Sometimes it's purely a sexual issue, right? So one person never thinks about sex, never has any desire or motivation, and the other person thinks about it a lot. And yes, oftentimes that is gendered. So we can do things like planning and scheduling and bringing mindfulness into non-sexual encounters and really normalizing the buffet, if you will, of different ways that people can be sexual besides traditional intercourse as a way of increasing pleasure

and enjoyment for both of them, but in particular for the lower desire person. It doesn't have to be a death sentence. I'm hearing you say. No, it's usually not a death sentence. Do you think there's perhaps too much emphasis on sex as a gauge for a healthy relationship? There's a ton of sex in the media, so we're getting messages about it all the time, but is it perhaps overemphasized?

So yes and no. The yes part to it being overemphasized is when people are comparing themselves to some unrealistic ideal that is perpetuated in media. The no side, however, is that sex can be a really significant part of a person's quality of life. The World Health Organization has declared sexual health as a component of global health and not separate from. So it is about how do we explore that individual person or couples satisfaction and ways to experience pleasure that's not guided by these external goal posts of how it should be. Mindfulness is really

relevant to that conversation because of course, in order to find your own internal goalposts, you need to know the external ones that you're adhering to, even inadvertently. I think that, you know, we can also look at literature that shows the relationship between orgasms and other markers of health. Prostate health, for example, has been found in a number of studies to be highly correlated

with regular orgasms in men, in women, the data are harder to measure and more diffuse. So there are health benefits and there are relationship benefits to satisfying sex. The devil's in the details around how we define that, though. In your book, you talk about the most important ingredient in satisfying sex. What is that ingredient? Mindfulness. So, to all of your listeners right now, if I were to pose the question, think about a wonderful and amazing and an optimal sexual encounter that you've had in your lifetime.

We would probably hear hundreds of different encounters, the details of who they were with, what they did, etc., etc. But the commonality across all of those encounters would be being present, being fully in sync with myself and with a partner, if it happened to be with another partner, feeling like nothing else mattered, being so attuned to every sensation that one was almost on edge waiting for the next sensation. And that's mindfulness. And that's why I believe that mindfulness as a tool for improving sexual dysfunction, for cultivating sexual satisfaction really should be a staple in every healthcare provider's toolbox.

And for the broader population too, you don't have to have a difficulty to benefit from mindful sex. This can be something that everyone practices. And it's in our back pocket. Mindfulness is right there. If we take the time to pay attention non-judgmentally moment by moment. I'm mindful that my sensitivities may be limited given that I'm a man. So I may miss something big and obvious to other people.

So let me just ask you before we go, are there things you would have like to have said that I have not given you an opportunity to say? I think healthy skepticism is a good thing. And listeners may be somewhat intrigued about bringing their mindfulness into sex or adopting a mindfulness practice and bringing it into sex. But in the same way that I've encountered countless people

who just don't believe it, that it feels like a stretch from mindfulness to improving in some cases cases longstanding or lifelong sexual problems. I encourage people to give it a try. To hold on to skepticism, skepticism is not a bad thing. It's something that often steers us on the right course and helps keep our values and our judgments in check, but really to give it a try and to try it on their own through some self-touch and if they're in a relationship to gradually bring that and just to observe with an open

mind what happens. In closing, can you please plug your book and also any other offerings that you're putting out into the world? With love to. So my book is Better Sex Through Mindfulness, which is a distillation of the science of mindfulness as it's been applied to sex. And then my workbook, The Better Sex Through Mindfulness Workbook is in press and coming out in September 2022 by Grace Stone. And it goes into the how to and the specifics of each of these exercises. I've mentioned also the Netflix special called The Principles of Pleasure.

I and one of your former guests, Emily Nagoski, have some features on that three episode series, as well as a lot of regular day-to-day people talking about their own pleasure and how it's experienced. The barriers as well as the opportunities for experiencing it. So I think that's going to be part of us continuing to pave the way for a pleasure-filled society.

What about people who might want to sign up for some of your digital offerings, et cetera? Yeah, so we have a research website, which is Brottolab.com, LabStands for Laboratory. And we currently are recruiting women and gender diverse people who experience low desire to test out our online mindfulness intervention versus an online cognitive behavioral therapy intervention for improving low desire. All right.

Well, this was really fun. And we get to some first right here on the show. So that was fun too. So thank you very much for coming on. Oh, thanks so much. I was going to say my pleasure, but maybe that is that for Poe. Thank you so much, Dan. Thanks again to Dr. Brado. That was really enjoyable. I do want to give another shout out to my friend Sarah Barmac, who recommended that we talk to Dr. Brado. Sarah published her own interview with Dr. Brado in a Canadian magazine called The Walriss,

in case you want to check that out. And Sarah also wrote her own book called Closer Notes from the orgasmic frontier of female sexuality, which you should also check out. Big thanks to everybody who works so hard to make this show a reality. Samuel Johns, Gabrielle Zuckerman, DJ Cashmere, Justine Davy, Kim Baikama, Maria Wartell, and Jen Plant with our audio engineering aces over at Ultraviolet Audio. We'll see you all on Wednesday for an episode with Orin J. Sofer. Hey, hey, prime members. You can listen to 10% happier early and ad-free on Amazon Music. Download the Amazon Music app today, or you can listen early and ad-free with Wondery Plus in Apple Podcasts.

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