Sex Gets Real 227: Better sex through mindfulness with Dr. Lori Brotto

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The power of mindfulness on our pleasure, connection, and desire.

In person interviews are some of my favorite, and Dr. Lori Brotto was able to pop over for this in-person conversation all about her 15 years of sex research on the power of mindfulness, which she’s turned into a fabulous book called, “Better Sex Through Mindfulness.”

So, this episode is  all about what mindfulness is, how it affects our levels of libido and desire, why mindfulness might be a key to more pleasure, and how to balance mindfulness and fantasy.

We also talk about depression, responsive desire, responsibility in relationships, and how we can get started with mindfulness.

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In this episode, Dr. Brotto and I talk about:

• Her new book, “Better Sex Through Mindfulness” and the moment she found mindfulness and its deep connectedness with women’s mental and sexual health.
• Skepticism towards mindfulness and how often we don’t realize that it’s something that we practice and experience almost everyday.
• Finding the time to practice being mindful and not just for the sake of a new sexual experience but as a sense of being.
• How women’s desires are held to a certain standard, the myth about desire levels and what our libido should be. Plus, how all desire is responsive and what that means.
• The universal struggle of how women perceive their own physical body and their internal sensations, and how we limit ourselves to being touched where it feels good because of the dislike for a certain part of our body.
• What a stepping stone to practicing mindfulness is by experiencing the many sensations and body changes in an encounter we often overlook.
• Feeling obligated to have sex for the sake of a partner and the impact it has on our own sexual desires. The trope that women who want to fulfill their own sexual desire is labeled as selfish.
• Actually communicating what you want to happen to you and your body in a way that makes you feel good helps your desires and edges become clearer to you and your partner/s.
• The ongoing research that is being conducted around practicing mindfulness with men who have difficulty with an erection during masturbation or sex and still be sexual without a boner.
• The relationship between depression and sexual problems and the study of how mindfulness can help get through onset depression and effectively prevent future depressive relapses.
• The rich dichotomy between fantasy and mindfulness and how we should fully emerge ourselves when we’re in our fantasy but also alternate and be in the moment when we are in the sense of being mindful.

About Dr. Lori Brotto:

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Episode Transcript

Dawn Serra: You’re listening to Sex Gets Real with Dawn Serra, that’s me. This is a place where we explore sex, bodies, and relationships, from a place of curiosity and inclusion. Tying the personal to the cultural where you’re just as likely to hear tender questions about shame and the complexities of love, as you are to hear experts challenging the dominant stories around pleasure, body politics and liberation. This is about the big and the small, about sex and everything surrounding it we don’t usually name. The funny, the awkward, the imperfect happen here in service to joy, connection, healing and creating healthier relationships with ourselves and each other. So, welcome to Sex Gets Real. Don’t forget to hit subscribe.

Hey you! Welcome to this week’s episode. It is an in-person interview, which is rare and exciting and I love it. It is with Dr. Lori Brotto, who I will tell you more about in just a minute. But she lives here in the Vancouver area and we were able to meet up in person and have a delightful conversation about her new book, “Better Sex Through Mindfulness,” which we’re going to be talking all about sexual pain, sexual dysfunction, feelings of not being able to get connected and not experiencing pleasure during sex. We go some really interesting places. We even talked about fantasy and erotica versus mindfulness and how they can both be used as tools in the bedroom. So this is something that I am ridiculously excited about. 

Also, welcome to the new intro and there’s an outro for the show. We will also be having some really exciting giveaways and prizes coming up over the next couple of months, from sex toys and books to money and all kinds of stuff. So totally stay tuned. 

Dawn Serra: Of course, for this week’s bonus, head to patreon.com/sgrpodcast. If you support at the $3 level and above, you get bonus audio content. Sometimes it’s extended interviews with guests. Sometimes it’s erotica writing and all kinds of other yummy fun random things. Plus, if you support at $5 and above, you can help me field listener emails by providing your thoughts and advice, and then I may read it on the air in a future episode. So totally check that out. 

Let me tell you a little bit about Dr. Brotto. Dr. Lori Brotto completed her PhD in Clinical Psychology from the University of British Columbia, where her research primarily focused on psychophysiological aspects of sexual arousal and women diagnosed with sexual dysfunctions. Her psychology internship at the University of Washington specialized in the use of cognitive behavioral therapy for mood, anxiety, substance abuse and psychotic disorders. Following her internship, Dr. Brotto’s fellowship in reproductive and sexual medicine at UW was mentored by Dr. Julia Heiman, director of the Kinsey Institute. As a registered psychologist, Dr. Brotto offers psychological therapy to patients referred from both UBC Departments of Obstetrics and Gynecology and Psychiatry, as well as the BC Cancer agency. Dr. Bravo also sees private patients. 

Dawn Serra: Her new book, “Better Sex Through Mindfulness,” published by Greystone Books, is a scientifically informed translation of her research on mindfulness to improve women’s and all of our sexuality. One last thing that I just want to mention, this book is incredible and much like “Come As You Are” with Emily Nagoski, it is about research done on women and is presented as being for women. The research though is something that works for any gender and anybody. 

Lori does mention in the episode that while she’s been working for 15 years with women, that includes both cis and trans women and she works in private clients with queer and non-binary folks, even though you’re going to hear us talking a lot about women, just know that so much of this translates to us regardless of gender and body type. So I hope you enjoy it. Here is my in-person chat with Dr. Lori Brotto, which is why it sounds a little different than my chats usually do. 

Dawn Serra: Hey, everyone! I am here with Dr. Lori Brotto. We are in person which is such a treat. I don’t get to do that very often. This is going to feel amazing and magical. The last time I did this in person was with Zena Sharman, whom we adore. So this promises to be amazing. Anyway, welcome to the show! 

Dr. Lori Brotto: Thank you so much for having me, Dawn.

Dawn Serra: You’re welcome. We’re here because you just had this incredible new book come out that’s all about better sex through mindfulness. I would love it if you could tell us a little bit about what got you studying mindfulness and sex. 

Dr. Lori Brotto: Great. So I’ve been a sex researcher for some time. I started as a graduate student. Actually, I started as an undergraduate student volunteer watching rats have sex in these large, cylindrical glass tubes. I did that for about six years. I looked at the influence of different medications, different stressors on sexual behavior in these beautiful little rodents, who I loved. It was in the year 1998, the Viagra was approved in the United States – a year later in Canada – and it was a watershed moment for the field of sex, sexual dysfunction, sexual health. Suddenly, countless and millions and millions of men, who were struggling with erectile dysfunction, had a discreet, easy, effective way of improving their sexual function. 

Then shortly after that, there was a large publication that indicated that over 40% of women struggle with sexual concerns. That number was far higher than the comparable rate for men. So we had this effective and safe medication for men, far higher rates of sexual dysfunction in women and that took me on a detour away from the rat lab into the field of women’s sexual health. I quickly discovered that not only were there no safe and effective and approved medications for women, when you look at the more psychological approaches, that literature was also quite sparse. There were not very many trials that really looked at effective treatments. 

Dr. Lori Brotto: Then, fast forward a few years and I was at the University of Washington. As part of my training as a psychology resident, I had the amazing opportunity to study with Marsha Linehan, who developed a behavioral treatment for people who really struggled with identity and their sense of self and a lot of cutting behavior and suicidal tendencies. As part of that behavioral treatment, mindfulness was a core aspect of that treatment. So essentially, we were teaching these individuals who struggled with wanting to hurt themselves that if they could pay attention in the present moment and really sit with their discomfort and their suffering and their suicidality, that they could tolerate it. That they didn’t have to hurt themselves.

For me, I mean, it was completely a profound experience that tuning in could be a way of coping. At the same time, as I was learning dialectical behavior therapy, I was continuing to do sex research studies with different populations of women with sexual concerns and I was working closely with the Seattle Cancer Care Alliance and in particular with women who, after their surgeries for gynecologic cancer, really talked about a profound disconnect from their sense of sexuality, their bodies no longer feeling any pleasure at all. I had a little bit of a light bulb moment where I was noticing some similarities in the people with suicidal tendencies who talked about a disconnect and the women with sexual concerns who talked about a disconnect. 

Dr. Lori Brotto: Because I had seen mindfulness be so effective in the first group, I thought, what do we have to lose nothing by teaching these women who reported a complete loss to just tune in and see what happens. And so, I brought these women one by one into my office. I, of course, immersed myself in the practice and the theory and the reading around mindfulness and then began teaching these women about it, as I was learning about it myself. 

The initial findings were striking. These women were saying, “Oh my God.” They’re still feeling there. Like, “I still feel pleasure. I thought it was dead. I thought it was gone.” That really started the next 15 or so years of studying this much more formally. 

Dawn Serra: How incredible to have these wonderful mentors who are doing this really powerful work. And then to see this nexus of, “Wow. Maybe I can actually help people with pleasure using this mindfulness technique.” What an incredible and important thing to study. It must feel… I don’t know. Mindfulness isn’t easy, but it is simple. It’s something that you can offer to people that isn’t really expensive and it’s not really complicated and it doesn’t have all kinds of side effects. I mean, that is beautiful. 

Dr. Lori Brotto: Yeah. You’re right. It is simple, because in mindfulness, what are we talking about? We’re talking about paying attention and doing so non-judgmental. So it’s simple, but it’s not easy. Particularly around sex, as you know far too well, we live in a judgmental culture ecosystem where sex inevitably evokes judgmental thoughts, mostly about ourselves, especially if you’re a woman listening. It’s a difficult practice, even if it is a simple practice. 

Dawn Serra: In your book, you talk a lot about mindfulness and techniques that people can try. One of the things that really stood out is there’s a lot of clarity when you ask people, “What was your best sex? Describe that for me? What was going on? Why was that the best?” So what was revealed by asking people about that? 

Dr. Lori Brotto: Yeah. It’s interesting because when I talk about mindfulness, whether it’s to a client or to another researcher or to anyone for that matter, there’s inevitably some skepticism like, “What are you talking about? Isn’t sex totally biological? And isn’t it rooted in the blood vessels and the neurotransmitters in our brain?” etc. All of those things are absolutely important. But I often ask that question, “Can you think in your mind any encounter you’ve had in your life related to sex, whether it was with someone else, on your own, with multiple people, what have you – the details are irrelevant – and describe that situation and what made it so fantastic and mind-blowing?” People will say, “Oh. I was in the zone. I was so there. I was so connected with my partner. I felt every morsel and tingle of pleasure.” All of that is the language of mindfulness. Being so present that you can follow a single sensation, microsecond by microsecond and that feeling of it being so alive and so connected. That is mindfulness. 

So when I point that out to said skeptical person, they say, “Oh. That’s what that is. I didn’t even know I was practicing it.” And that is true. We all inherently have this ability, if you will, to be mindful. Any child in a bed of flowers or doing anything for that matter, we were inherently born with this ability to be present and then experience in life and culture and media, layer on the judgments and then put on top of that all the technology which moves us to multitask, we feel like we lose that ability. But its inherent in us. So, again, I think regardless of the quality or the type of sex, I think most people have brought that ability to be mindful into a sexual encounter. It’s a matter of how do we evoke that again and deliberately practice that? 

Dawn Serra: What would your recommendation be? Because I had a lot of questions around this very thing. I know you encounter this as well. So for people who feel like, “I just don’t have the time,” that time piece because we’re so busy and often, specifically for women, there’s so much emotional and health labor that’s going on that’s on their mind. So for people who are worried about the amount of time that it takes to really get present and turn off those distractions, what would you suggest? 

Dr. Lori Brotto: First of all, I think those same concerns around time apply to sex and a lot of people that we talked to– First of all, there’s this prevailing myth that sex has to happen at night and it has to happen late at night after you watch the mundane or sometimes emotional news. It happens at a time when our resources and our energy levels and our ability to really invest energy are at their lowest. Then sometimes we wonder why the quality of sex is so poor. So we rush it. We get it over with because we’ve got to get it on the calendar or else there’s all kinds of consequences if we don’t meet a certain standard of what we think is normal for sexual frequency. 

So I often talk to people about what else in your life that’s important to you do you not plan and do you not prioritize? And we should apply that same kind of importance and prioritization to sex. I would say that that also applies to mindfulness. Again, although it’s a simple practice, it’s challenging. It’s not an easy practice. It does require the time, the investment of time.

Dr. Lori Brotto: For someone who is brand new to, whether it’s mindfulness or meditation or any kind or form of contemplative practice, it does require the time to put into the “on the pillow practice time.” When we invest that time, the formal practice, we then become– Slightly it becomes easier, a bit more automatic, to then bring that into the different encounters of our life, whether it’s while we’re eating a meal or while we’re going for a walk or while we’re having sex or while we’re having a conversation with someone else. So the formal practice is important. 

I do often get asked, “Well, what’s the minimum number of minutes? What’s that sweet spot? How much do I really have to practice?” You know, we don’t know the answer. Mindfulness researchers have tried to investigate that. It’s kind of hard to study because how do you randomize people to five minutes versus ten minutes versus 15 minutes and control everything so we can make our best guess. One of the things we do know that the mindfulness scientists have taught us is that more frequent practice, even if they’re shorter, seems to be more beneficial than a single long practice like meditating for an entire day. It’s much more beneficial to say, formally, have a mindfulness practice ten minutes a day, but every day. 

Dr. Lori Brotto: So the question of I don’t have enough time, I don’t have a magic wand that gives people more time. But I do know… Well, we know that we also waste a lot of time doing things that maybe we feel are important. Don’t get me wrong. I love spending an hour on Twitter, but we can waste a lot of time on social media or doing things that are less important. In part, it’s a little bit about prioritizing sex and prioritizing this as not only a skill to be more present in sex, but it’s also a way of being. I mean, how great would it be to enjoy every meal without quickly scarfing it down and forgetting what we’ve eaten. So it’s something– It’s a way of being that we can take into our life. 

Dawn Serra: Okay. I don’t know if you’ve seen it, but as I was researching for our talk today, I went to Amazon and I was checking out reviews, which overall are fantastic. But I read one review of your book that made me feel some feelings. I wanted to bring it up just for people who are listening, because the review said women need to take responsibility for their own deficiencies and stop blaming others, which is why they liked your book. That was like you so missed the point. 

For people who are tuning in, so much of the book is really about being present with yourself and tuning into sensations. They don’t even have to have genital or sexual sensations, but just what is the feel of the hand on your back and really enabled– to get really clear about what it’s like to be in your body and in your anxieties and in your fears. How would you respond to this reading of, “Well, this is your thing to work on. This is your problem to fix. Go sit on the cushion. It has nothing to do with me.” 

Dr. Lori Brotto: Yeah. Wow, I didn’t read that review. I’m kind of glad I didn’t and I’m noticing a little bit of increasing blood pressure right now as I’m trying to sift through that. Unfortunately, I do hear that in my clinical practice quite a bit when let’s say a woman, who is in a relationship with a man, although not exclusively or not necessarily, and she’ll come to the first session. I have spoken to her on the phone and I’ll say, “Oh. You’re here. Is your partner on their way?” and she’ll say, “No. He decided that this was my issue.” Then I would do some sessions and then we would check in in a couple of months, “Once I’ve gotten better.” And it’s like, “Alright. This is going to be an educational session. We’re not actually going to do any mindfulness. We’re just going to provide some education about how women’s sexuality unfolds and what is women’s sexual response?” 

I think that there is a belief, unfortunately, it persisted within the sex therapy field for a long time. That we’re born with a set level of desire. We’re born and we’re given this unit of desire. And so if your desire is down, that you’ve got to get it back up to this level. You have to work really hard to get it to this level. So the idea is that women who have low desire that something likely intrinsic in her has caused it to decrease and she’s got to work to get it to that level. It’s completely false. 

Dr. Lori Brotto: Desire, as we know in women, in men, regardless of gender, etc. – orientation – is responsive and it responds to triggers. Sometimes those triggers are external. So a relationship, if there’s something in the relationship or that a partner does or says that turns you on. Sometimes those triggers are in the environment – seeing something sexy that turns you on. Sometimes those triggers are internal – having an erotic thought, having a fantasy, having a subtle change in your body that creates tension that might give you a twinge of sexual arousal that then turns you on. 

But the point of all of that is that desire is responsive just like emotions are. I’m sad because something sad happened to me or I saw something or heard something that made me feel sad. We’re not born with a set level of sadness. Obviously, we might fall along the curve around our predispositions to feeling sad versus not. So our threshold for feeling that. And that’s the same with desire. Some of us it might take fewer triggers to turn on the desire or less triggers. So understanding that desire is responsive is fundamental to your question around the woman who says, “Well, it’s all in me.” 

Dr. Lori Brotto: When we really understand the importance of those triggers, we quickly and immediately see, “Oh. Of course not. It’s not all within her.” That the environment, her relationships with other people, her relationships and connection to her sexual partners or intimate partners, all of that is so important when it comes to her own feelings of desire.

So where does the book fit within that, especially since the book says for women in the title? I can see how a reader might perceive it as women just need to go off into a cave and read this book and sit on a pillow in a cave. Then they’ll come out with their restored level of desire and they’ll re-enter into their relationship and everything will be great. It’s so silly, isn’t it? It’s so, so silly. 

Dr. Lori Brotto: I’ll say – and I can say this now since the book is out – I’m not totally happy with the title because, well, first of all, it’s not just a book for women. First and foremost. And, mindfulness, it’s a bit paradoxical because mindfulness is about not changing anything. It’s just about paying attention. So this notion of trying to get to a better level– Well, by paying attention, we might experience sex and desire in a different way. But it’s not like a prescription to get women to a certain level again, so they can re enter into their relationship. 

So I think what I would say to the person sitting in front of me who says, “You know, I just want to do this on my own and fix things and then I’ll be able to re-engage in my relationship.” My response is mindfulness can be a fabulous tool for helping you to reconnect with the feelings in your body. It can also attune you to feelings in the relationship, positive and negative, that might be directly affecting your desire. I’ve heard that story now from countless women that mindfulness has actually allowed them to notice things that are not okay in their relationship, that they were putting up with or wiping under the rug or having a sense of, “Well, it’s my duty and my obligation to deliver, so I’m just going to ignore all of these terrible things that are happening.” When you observe, when you start to pay attention, you can notice some great things. You might also notice some upsetting things, as well. 

Dawn Serra: Maybe there are some things that really need to be addressed before we start talking about sex. Yeah. I agree. 

One of the things that rings so true through the book and also just in so many of the experiences that I’ve had is your research has shown that through being able to really develop that trusting relationship with body and also being able to develop that key attention, which so many of us are really terrible at these days, whether the frequency changed or not, and whether the satisfaction had a small gain or a significant gain when it came to sex, that overall, there was so much more ease in just stopping the avoidance and lowering the anxiety. That could be such a massive win for people. What are some of the things that really surprised you as you met with all of these people over the past 15 years? What came up and you were like, “Whoa! I was not expecting that.” 

Dr. Lori Brotto: Yeah. Well, you mentioned body. I think I was surprised – and maybe I shouldn’t be – at how hard women are on themselves when it comes to body, both external physical body and internal body sensations. Really horribly judgmental of themselves. And many stories of avoidance, of sex with the lights off or even though it feels good, but don’t touch there because I don’t like that part of my body or let’s quickly get this over with, again, even though it’s pleasurable for me, because I don’t want you to notice this part of my body that I don’t like. So those stories are very sad. They make me very, very sad. And I’ve heard them in younger women and older women, women across cultures, premenopausal, post-menopausal women, almost universal and universal in a really not okay way. 

We need to stop being so hard on ourselves, about our bodies and it directly impacts sex. Because when we shorten what feels good and we don’t give our bodies and our brain the time that they need to communicate with one another and we know that there’s a really important feedback loop. When the body starts to respond through touch or through what have you and starts to produce physical sensations and the brain starts to pick up those signals, which mindfulness really helps with tuning into those signals, the brain then further communicates down to the body, increase in the feeling. Now, it’s not just touch, but it’s pleasure and it’s sensation. We foreshorten that which negative body image directly affects. The outcome is a completely unsatisfying encounter completely. 

Dr. Lori Brotto: So again, it’s something that maybe I shouldn’t be surprised with. But I wish we had a method of pushing back against this, around negative body image is actually disastrous for sexuality, for healthy sexuality. That’s been a surprising finding. 

I think, totally taken in a different direction, another surprising finding is the individuals who were really, really skeptical at the (outset?). The person who says, “Well, I tried yoga once and I hated it and I never went back” or “I’m, frankly, just too busy to do this. I literally don’t have five minutes in my day where I can do this.” And the individual who says, “How on earth is breathing and paying attention to breathing going to help my sex?” So different flavors of skepticism. 

Dr. Lori Brotto: It’s something that we’ve actually studied empirically. We’ve actually measured skepticism at the outset. We’ve measured confidence in the mindfulness approach and beliefs around, “Do you think that this is really going to help you?” We’ve measured those different things and then actually correlated those indices with improvements in desire, reductions in sexual distress, improvements in sexual satisfaction, etc. I couldn’t have asked for a more perfect ending to the story. It turns out it’s irrelevant. It doesn’t matter your level of skepticism at the beginning, how much you bought into it, how many years of Buddhist formal meditation practice you had versus the total skeptic. They improved on those measures of desire and satisfaction and distress to the same degree. So it’s awesome. It’s an awesome, awesome finding That you don’t have to be a believer at the outset. All you have to have is a willingness to try it. 

One of the ways that we introduce it and try it– And the book talks about the raisin. It’s certainly not original. It’s a component of mindfulness-based cognitive therapy, mindfulness-based stress reduction, formal programs in mindfulness that have been around for 20,30 years. We will spend about 15 minutes interacting with one single raisin. One raisin, 15 minutes. You start by looking at it and looking at how the light bounces off the ridges. Then you roll it around in your hand and you feel the weight of it. Then you hold it to your ear to hear are there any sounds of the raisin. And you smell it and you hold it against your lips. At that moment of holding it against your lips, something amazing happens – the body changes. You start salivating and you haven’t even put it in your mouth, yet. Then when you finally put it in your mouth, your mouth is now fully lubricated and you bite into it. When you do it slowly and deliberately, you notice, “Oh my gosh. Raisins are amazing. They may not be delicious, but they’re amazing. How can this one little shriveled and dried piece of grape produce so many sensations?” 

Dr. Lori Brotto: And so, in our groups, we always start with the raisin because through experience in the mindfulness… Actually, doing the practice and doing that raisin exercise, women learn that, “Oh my gosh. First of all, I have the ability to pay attention. Secondly, something that I’ve interacted with countless times… How many times that we dug into a bag of raisins and popped ten into our mouth without noticing? We could interact with this object, that we’ve seen many times, in a new way and it produces so many sensations.” I think that exercise is the critical exercise to turn the naysayers and the skeptics into being open to try this. 

Dawn Serra: I did that reason exercise about 15 years ago. I was at Kripalu, which is a mindfulness and yoga center in the Berkshires in Massachusetts. We did that exact raisin exercise. I remember that moment of biting into the reason and how there was marvel and wonder, so present in that moment. That’s something that I wish for so many of us to feel with our own bodies and with a partner. That’s like inherent sense of wonder and marvel, of just being in the moment and what a beautifully simple way for people to be able to engage with that and not feel like they’re going to get it wrong or that they’re going to fail. Because it is hard to sit and really be mindful for an extended period of time. So I love that you start with that raisin exercise because my experience of that, so long ago, was profound and it’s just a fucking raisin.

Dr. Lori Brotto: I know. I know. It is. It’s shriveled up. Actually, I got to tell you something really funny. So we do the practice and actually we dive right into it. So we don’t provide any background before we do the raisin exercise around, “Here’s how mindfulness is going to work and here’s what you can expect.” Our belief is that through the practice and through your firsthand experience, you’ll be able to make that connection. 

So we do the raisin exercise, and then we move on to something we call an inquiry, which is where we’ll ask the women, “What did you notice?” “How is eating a raisin like this different from how you eat raisins in your life?” Then, thirdly, “How was eating the raisin in the way you just did, how is that relevant to your sexuality?” Of course, they make all the connections. But what’s really interesting is how many women will say, “It looks like a vulva. I never noticed. It looks exactly like a vulva.” I love that answer. Because every raisin is different. The folds and ridges are different. There’s tons of asymmetry. So after a little chuckle, I say, “Well, that’s not really the point of the exercise. But fantastic that you notice that about this raisin.” 

Dr. Lori Brotto: What’s interesting is when we start to pay attention, it can trigger memories. It can trigger memories that were otherwise buried away. Sometimes for sex, that’s a good thing. Sometimes it’s not a good thing. We sometimes have to manage how elicited memories may impact us in a negative way. But again, there’s so much safety in the present moment. We can tolerate the present moment because look it’s gone. That moments gone and you got through it. 

For the women that are so focused on the outcome and, “Oh my God. Am I going to respond? Is a partner going to leave me? Is this going to end in disaster?” The message of come back. Like come back to the here and now. Not only can you tolerate this moment, when you start to notice and observe, can be amazing just like noticing the raisin in that moment. It was amazing. You can actually notice things. It’s just a hypothesis, but maybe when you notice things in the present moment, it changes the outcome. Right? 

Dawn Serra: Absolutely. I think that that is such an invitation. Because you’re right. I mean, if there’s anything I’m really skilled at, it’s spending a lot of time in the past and in the future. What gets revealed through your research and your book and the raisin exercise and moments like that is, when we really give ourselves the opportunity to just pay attention, incredible things reveal themselves that we might have just zoomed past in our eagerness to get to the next thing on our list or that little check mark that’s in our head, the next to do. 

Something I encounter a lot with listeners who write in to the show and also something that comes through over and over and over again in your book with so many women… I think this is based on a lot of cultural assumptions and mythology about so many women end up in positions where they’re having sex out of a sense of obligation. Where, “I don’t really want to have sex. But if I don’t give it to my husband, he’s going to suffer. So I’ll do it for him” and how doing that over and over again pushes them away from their own pleasure and creates this immense sense of dread. 

Dawn Serra: So for people who are in that place of, “I just mostly have sex for him because he needs it and I could live without it” or “I’m doing it because I should, since I’m in a relationship,” what is the process like that you found for people who come back to their pleasure, even if they’ve maybe never been there before?

Dr. Lori Brotto: It’s like finding that long lost treasured toy in the closet that you completely forgot about and you discover it decades later. It’s a feeling of wonderment and amazement and a bit of giddiness, maybe. I hear that from so many people like, “Yup. I’m having sex, but don’t enjoy it.” And then I’ll say, “Well, why would you have sex that you don’t enjoy?” When we think about the reward centers in our brain, we want the things that give us pleasure. So maybe your low desire for sex is low desire for the sex you’re having. Not low desire for sex, per se. So let’s look at the sex you’re having and figure out how we can make it sex worth having. 

So then, we start to examine those feelings of obligation. And that always takes me, as a psychologist, down the pathway of, “Is this consensual? Is this sex you don’t want, but still consensual or is this really non-consensual? Are you worried about the– Are you worried about your safety? Are you worried about the stability of your home or your family or your well-being if a partner, unfortunately, sometimes becomes belligerent or difficult to live with?” Those stories are heartbreaking. And it’s no surprising that these women have lost desire. A medication is not going to make her enjoy that situation at all. 

Dr. Lori Brotto: First of all, we sometimes take a detour into some conflict resolution, communication training around stop having sex that you don’t want to be having. Then, we slowly move towards how can sex become something worth having for you? What’s in it for you? Then that often takes us down another interesting direction around women feeling guilty for wanting something that feels a bit selfish. They say they feel selfish to ask for what I want, or to move or do things in a way that will make it feel better for me. “What about my partner?” And it’s like, “Well, you’ve been doing this for your partner and what your partner wants for 38 years. I think you’re entitled to be a little bit selfish.” Let’s lose the language of selfish. Selfish is so negative. It’s so laden with, “You’re a terrible person and you’re completely self-centered.”

When you have a satisfying sex life, however you define it, it’s linked to your mood. It’s linked to your sense of self, linked to your well-being, linked to your optimism. It’s linked to your communication levels with other people. Sex, it doesn’t exist in an isolated bubble. It’s an intrinsic part of who many of us are. And so, view it through that way. That you will be a happier and overall, a person that you love, that you can have some self-love towards, by asking for what you want. 

Dawn Serra: Yes. 

Dr. Lori Brotto: It’s not selfish. It’s actually an act of– It’s a fundamental part of being a whole being. 

Dawn Serra: Yup. Agreed. There are a lot of us struggling to find our voices, and me included, asking for what I want, navigating boundaries, especially when other people have feelings about those boundaries. I just think it’s so clear with the mindfulness that if I’m just utterly present and really tuned into my body, my desires and my edges become so much clearer because I’m feeling what I’m feeling and I’m noticing and I’m able to communicate that. Instead of telling stories and guessing and hoping and not really being sure because I’ve cut myself off from my body. There is so much power in that, too. Of just being utterly in your moment and in your body. 

Dr. Lori Brotto: Totally agree. And I wish everyone could experience that all the time.

Dawn Serra: All the time! Yes! One of the things that I wanted to bring up for people that are listening is “Come As You Are” by Emily Nagoski. It’s one of my favorite books. Emily is one of my favorite people. Even though that book is similar to yours and the research is about women, it’s written for women. The book is so universal in so many ways. I really do absolutely find that true with your book. Whether you identify as a man or you’re trans, non-binary, whether you’re asexual or single, there is so much richness in the research and in really paying attention and just being there. What do you want to offer around mindfulness to people who don’t identify as women or maybe who don’t identify as sexual, even? What can mindfulness offer for them? 

Dr. Lori Brotto: Yeah. Great question. I have been asked many times, “Well, what about mindfulness for men or mindfulness for non-binary folks or mindfulness for other types of people in different relationship configurations?” You know, part of the– Well, big part of the reason that the term women is in the title is because a lot of our research has been with self-identified women, cis or trans women and women across sexual orientations and relationship configuration. In our research, it’s been focused on people who self-identify as women. 

So because the book is really based on the science and is a translation of the scientific findings to a general audience, that’s a large part of the reason why women is in the title. However, all of the same processes that we’re talking about in terms of the importance of paying attention, the incredible value of being non-judgmental, the impact of multitasking on all of us, regardless of what type of human being you label yourself as and the importance and the role of paying attention non-judgmentally, there is no one type of person that could do this or could benefit from that. So in my clinical practice, I see all types of people and use mindfulness almost universally, regardless of the type of person that walks in the door to see me. 

Dr. Lori Brotto: Now, the research hasn’t been done on all those different groups. Although increasingly now, over the last two years or so, we have been running groups for men. Men either who have difficulties with erections situationally. So these are men who have no difficulty with interaction during masturbation, but as soon as they’re with a partner or more than one partner, they lose their erection. We’ve done some research with those groups and currently have been working with prostate cancer survivors, who will likely never get their erections back. So they face the reality that, how do we continue to be sexual without a rock hard boner? Right? 

Dawn Serra: Yeah. 

Dr. Lori Brotto: And guess what? There’s a buffet table of different ways. You can be sexual without a rock hard boner. So mindfulness has been challenging with that group because they’re so intent on getting their erections back. That study, that’s currently well-underway, is the men with their partners as well. So the partners play a really important role in encouraging the prostate survivor to think about sex in a multitude of different ways. So, yeah. The short answer is the book is really for anyone willing to try on that new way of being that includes paying attention non-judgmentally, moment by moment. 

I’ll say a thing about sex, too. Because, again, when we think sex, I think for many people, it elicits a certain image of intercourse. And that’s it. I don’t think about sex that way. I know you don’t think about sex that way at all. So much broader than that. The book– There’s many sections of the book also for sex on your own. And that’s the reality for many people that they’re having sex on their own. Mindfulness can be an equally important tool for that type of sex, as it would be for say, penis in vagina intercourse. 

Dawn Serra: Okay. I would love to talk a little bit about depression. I have received a number of emails over the years from people who are experiencing depression and it’s having an impact on their sex because of it. Either because of the medication they’re on or because of a number of other factors. It can be really complicated. In the book, you talk at length about the impact of feeling stress around sex and how that can lead to depression. But also the way that depression then impact sex and how it’s this circular thing. What are some of the things that you’ve discovered through your research around depression and sex? 

Dr. Lori Brotto: So long before I started researching mindfulness and sexual desire, there has been a wealth of research that has essentially proven – and we’re always careful with that word proven in science because we don’t actually prove anything – but it’s been found over and over and over and over again, that depression and changes in sexual function tend to go hand in hand. So when we think about depression, strip down its definition, is really a lack of interest in things that you used to be interested in. And sex is one of those things that used to maybe give you pleasure. So for the person who’s experiencing a depression, it makes sense that their interest in sex has gone down. Then, as you mentioned, sometimes the antidepressant treatments, which can be really effective – sometimes absolutely essential for some people in lifting their mood – can further wreak havoc on sexual response. So getting in the way of ability to orgasm, getting in the way of physical sexual arousal, which then can further reduce sexual desire. So they do go hand in hand. 

We also have found in research that individuals who have sexual difficulties, if this becomes chronic, that also can trigger low mood or maybe even trigger the onset of a depression. So there’s a tight bidirectional relationship between depression and sexual problems. 

Dr. Lori Brotto: Again, when we think about mindfulness– Mindfulness, well before I began to research it within the context of sex, has been studied in the context of depression. There have now been several studies that have found mindfulness to be a very effective way of preventing future depressive relapses. So this is a person who has a history of say, bouts of depression, ongoing practice of mindfulness can actually prevent depression from coming back. It can also be a way for the person who’s in the throes of a depression to get through it. There have been a few studies now that have compared it directly to medication and find it to be more effective than that. It’s becoming frontline care. It’s something that when the depression expert opens their toolbox, it’s sitting on the top. So really effective. 

In our own research, because many of the people we see with low desire have had a history of depression or maybe even have symptoms of low mood at the present moment, we’ve always measured it. We have consistently found across all of our studies that there’s an improvement in their mood. We’ve also began studying, could their improvement in mood be the reason why their sex improves. So we do something statistically fancy called mediation analyses where you can actually measure mood throughout the meditation treatment, mindfulness treatment and look at changes in mood as a predictor of changes in sexual function. We’re starting to find that that is one of the mechanisms that sex improves. Not unanimously across all people because not everyone is depressed at the outset when they come into our groups, but it’s an important mechanism.

Dr. Lori Brotto: For anyone who’s listening who might be struggling with depression, either now or in the past, I’d invite them to consider starting a mindfulness practice and to observe that it will very likely have this two-prong impact on their mood, on their sexual function and also on other aspects of quality of life like sense of stress, sense of well-being. It’s got these multiple positive beneficial outcomes. 

Dawn Serra: I think we have time for one last question. Squeeze it in before the end of the hour. I would love to talk a little bit about fantasy versus mindfulness and attention. Because often, fantasy is about leaving and going someplace really exciting and using that as a way to have some excitement or to feel something new, to try new things out that maybe we do or we don’t actually want to do in real life or both. 

So mindfulness is about being very present and feeling what’s happening and the now and being in your body. How can we navigate that dichotomy of fantasy being exciting and allowing us to go someplace new and mindfulness really inviting us to get super present and attentive? 

Dr. Lori Brotto: Great question. I’m so glad you asked it because  mindfulness, as a way of being, doesn’t necessarily mean that we’re actively practicing it per se 24/7 or during the entire sexual encounter. I’m a big fan of fantasy. Fantasy allows one to go to a place that maybe they wouldn’t in their actual real lives. It can be very sexually arousing. So in terms of stimulating the body, which in turn stimulates the mind. Novelty, we know, is really important, especially for someone who’s been in a long term relationship and fantasy allows one to experience something totally new in a very maybe old and familiar relationship. Lots of research studies have found that fantasy can be really powerful for cultivating arousal and pleasure. So I’m a big fan of fantasy and in my clinical work, spent a lot of time talking about, can you dip your toe in the water around fantasy? And can you start to introduce this and what would that look like? And can that evolve into a role play and etc.

That said, make no mistake. Fantasy is not mindfulness. Fantasy is about going somewhere else. Mindfulness is about staying right there. So they’re very different. But to have the agility and ability to – when you’re fantasizing – fully immerse yourself there, fully go there. In the same way that let’s say, an athlete before a big race might have an imagery and an exercise in imagining themselves performing well at their sport and crossing the finish line. That’s not mindfulness. That’s imagery going somewhere else or hypnosis for that matter, which is also not mindfulness. Hypnosis, again, is about going somewhere else. So all really important tools on their own, but they’re not mindfulness. Again, I would say to the listener, yeah, dance and dabble in fantasy and go there. Then alternate, maybe at a different time, with experimenting being right there and noticing every sensation as if for the first time.

Dawn Serra: Oh. That’s so beautiful. It’s wonderful to have. I think the takeaway really is when we have the opportunity to invite ourselves to be present and to try different tools and to have different skills, it gives us this opportunity to be open to so many more possibilities. I think, also, it’s really clear around so much of what you’re offering, both with the mindfulness and the attention and the opportunity to use something like fantasy or erotica, is when we can loosen the reins a little bit on those expectations that we hold around all of this having to look a very specific way. It just sets us up for anxiety and feelings of failure. I love the invitation. People, do all the things. 

Dr. Lori Brotto: Yeah. Do it all. Just expand that buffet table. Right?

Dawn Serra: Exactly. For people who want to stay in touch and find out more about the research you’re doing and the book, how can they find you online or learn more about the lab? 

Dr. Lori Brotto: So my Twitter handle is @DrLoriBrotto. Love engaging with people on Twitter. Our lab website is brottolab.com. That’s where people can read about the current studies we’re doing. We also post links to the findings and create videos of the findings. Then I also have a separate website that talks about kind of my own practice, my clinical practice. That’s just loribrotto.com. 

Dawn Serra: I will have all of those links in the show notes so people can check it out, as well as a link to the book. This is going to be very high in my arsenal, folks. When you’re writing in with questions, you will hear me offering this book down the road many times over. So thank you so much for being here on the show and offering all of your wisdom. This has been wonderful. 

Dr. Lori Brotto: My absolute sincere pleasure, Dawn. Thank you so much.

Dawn Serra: A huge thanks to The Vocal Few, the married duo behind the music featured in this week’s intro and outro. Find them at vocalfew.com. Head to patreon.com/sgrpodcast to support the show and get awesome weekly bonuses. 

As you look towards the next week, I wonder what will you do differently that rewrites an old story, revitalizes a stuck relationship or helps you to connect more deeply with your pleasure?