Wellness Connection MD

Sexual Health for Women with Valerie Padd

October 26, 2023 James McMinn MD, Valerie Padd, RN Episode 35
Wellness Connection MD
Sexual Health for Women with Valerie Padd
Show Notes Transcript Chapter Markers

On the Functional Medicine Podcast we attempt to help you achieve "optimization"  in every aspect of your life, and your intimate life is no exception.  As a functional medicine doctor, I heard the concerns of my women patients, and sadly, the majority of them complained of issues related to sexual health.   The medical community has largely ignored these issues, and we have taught these women to suffer in silence.   Today on the show, we are excited to present to you Ms. Valerie Padd, RN, a sexual health expert and certified sex counselor.  Together we explore what a healthy thriving sex life looks like, and we also discuss many of the common problems that women experience in the sexual arena.  We discuss  pain with intercourse, along with low desire, difficult arousal, problems with orgasm, and many other sexual health concerns.  Throughout this discussion, we also present practical solutions for improvement in these areas.  So sit back, tune in and enjoy the show!

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Speaker 1:

Welcome to the Functional Medicine Podcast with Dr McMinn and Coach Lindsey. We're coming to you from McMinn Clinic in Birmingham, alabama, where Dr McMinn is an integrative in functional MD and Lindsey Matthews is a registered nurse and IIN certified health coach. In this podcast, we'll be discussing the latest information on a wide range of topics in the field of functional medicine, which looks for the root cause of disease, and integrative medicine, which incorporates both conventional and alternative therapies. Our overall goal is to help you be the best that you can be in mind, body and spirit. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without approval from your personal doctor. And now on to the show with Dr McMinn and Coach Lindsey.

Speaker 2:

Hello and welcome to the Functional Medicine Podcast, where we share with you evidence-based and up-to-date information on integrative and functional medicine, along with practical take-home solutions so you can live a healthier, more vibrant and optimized life in mind, body and spirit. We thank you for joining us today. I'm Dr Jim McMinn and our co-host, lindsey, is off for the day, but we have a very special guest for you on the show today. Ms Valerie Padd is with us today. I'll tell you more about her in just a moment, but today we'll be talking about sexual health for women. So just a little bit of a heads up.

Speaker 2:

This show may not be appropriate for the kiddies to listen to. Before we get going, let me remind you that our podcast is commercial free. However, it does cost us money to produce these podcasts, so think of us like Public Radio and consider making a contribution to the show to help us keep this coming to you. There are a couple of ways to contribute to us. First, we're not asking you to buy any supplements that you don't already take, but if you do buy nutritional supplements, then consider purchasing supplements through our full script dispensary, where you get a 10% discount. You can see the link to full script below in the show notes. It's quite simple just click on the link and they'll guide you through the process. It's a win-win you get high quality supplements, add a discount and we get your support for the show. To keep that coming to you, and so a big thank you in advance. You can also make a contribution to the show directly via credit card or by PayPal at the support the show link, which is also in the show notes below. And don't forget to subscribe to the show and hit the notifications button so we can keep these shows coming to you. I'm getting these out generally about once a month these days, but we'd love to be able to notify you when a show comes out so that you don't miss it.

Speaker 2:

One brief disclaimer before we start the show. It looks like it's going to be another long one. I promised you last time that we'll never waste your time with Needless Banner, but there are lots of things to talk about on the show today. On this subject, on the Functional Medicine podcast, we don't shy away from difficult topics. On our podcast, we hang our hat on three things. Number one we're evidence-based. Number two, we're outcomes-oriented, giving you practical solutions. And number three we're thorough. At the end of the day, I'd rather put my emphasis on being thorough than on being brief, so feel free to think of this as sort of a mini audiobook and break it up into segments that fit into your life. I hope you'll enjoy it and learn something from it that is helpful to you. And now on to the show.

Speaker 2:

Many years ago, when I opened my integrative and functional medicine practice after working in the ER for 20 years, I placed an emphasis on being a good listener. I think it's the most powerful tool in medicine, quite frankly and truly really understanding the needs of my patients. I found that there were many concerns that my patients were struggling with that were not being addressed by their other providers. One concern in particular that surfaced as a very common and serious problem for some of my patients was their struggles with sexual health issues. I had an intake form to ask women about things like low libido, vaginal dryness and such, and at least half the women who presented to my clinic complained of serious or extreme problems with low libido or other sexual health issues. For some women it was their main complaint. These women were often quite distraught with feelings of inadequacy, frustration, self-doubt, and they sometimes had strained and failing relationships and marriages often related to these sexual health issues. Now I confess that I, like most doctors, had very little training in the field of sexual health in medical school and residency. In fact, the subject was hardly ever discussed. Therefore, most doctors have very few tools in their toolbox to help women with these issues and, quite frankly, the way things are going, where doctors had to see more and more patients to keep up and spend more time on the electronic medical record, quite frankly they really don't have time to adequately address these complicated issues. I'm sure that, especially in the conservative South, it was embarrassing and awkward for many of these women to bring up sexual health issues with their doctors.

Speaker 2:

Usually, by the time they got to me, these women had already complained about these issues to their primary care doc and to the OBGYN doc, and the concerns were usually falling on deaf ears. One patient in particular that stands out went to her OBGYN doctor and I know this doc. She's really an excellent physician and the patient complained of low libido. Her female GYN doctor said to her in all seriousness but you're 52 years old, why do you still need libido? And the patient was floored. She was made to feel terrible and ashamed of this and many women are in their sexual primate 52, and the kids are out of the house. They're still young enough to enjoy a robust intimate relationship. I felt really sorry for this patient and, quite frankly, I was quite surprised and disappointed that my excellent female GYN doctor had taken this attitude with her.

Speaker 2:

Now, I never claimed to be a sex guru, but after hearing these issues over and over again, I decided that enough was enough of this suffering and these patients were not being taken seriously. So I ramped up and, with the help of my wonderful staff my nurses, my health coaches, my counselor we put together a cutting edge program to help these women with their sexual health issues. The vibe around the clinic was definitely sex positive. Patients knew that they could bring their concerns to us without fear of judgment or shame and they would be dealt with in a professional and compassionate manner. We even went so far as to put together a sexual health support group that met after hours once a month. Everyone in the community was invited. You didn't even have to be a patient at the clinic. We would meet and discuss all sorts of topics having to do with sexual health. We developed a core community of wonderful folks who are dedicated to improving their relationships, their marriages and their intimate lives.

Speaker 2:

The four main concerns that we heard over and over again from these patients were number one pain within a course. Number two, low desire. Number three, lack of arousal. And number four, difficult or no orgasms. The good news is that the vast majority of these women got better, sometimes dramatically better, like day and night. Better in all four areas and it was really wonderful to see their transitions to a healthier state of sexual intimacy. They were thrilled and their partners were happy, and it was really satisfying for us in the clinic to witness their positive transition. Another good news result was that during this process I was super blessed to meet and work with nurse Valerie Pad. She was our sexual health counselor. Valerie has dedicated her life and career to helping women and men with this important aspect of their lives.

Speaker 2:

Let me tell you just a little bit more about my friend Valerie. She's a registered nurse with a bachelor's degree in nursing. Once she got the calling to pursue specialized sexual health training, she completed a postgraduate certification program in sexual health at the University of Michigan, which, to my knowledge, is one of the better programs in the country. Valerie is a member of the American Association of Sexuality Educators, counselors and Therapists, and she is the founder of the Center for Sexual Health and Wellness in Hudson, ohio. She's applied an integrative and functional model to sexual health and she partners with patients to discover the why behind the problem, allowing her to put together an effective and personalized plan to resolve their issues.

Speaker 2:

Having worked with Valerie for many years, I can testify that she's a very kind, caring, smart and thoughtful healthcare provider who is passionate about her work. She also enjoys life to the fullest and work to serve others outside of her workplace. She treasures time with her family and friends and enthusiastically holds volunteer roles with compassion, international and youth for Christ. So, without further ado, welcome to the show today, Valerie, and thank you so much for joining us. I'm really excited about picking your brain today concerning this really important topic.

Speaker 3:

Thank you, dr McMinn, for that kind introduction and let me just say the opportunity to be on your podcast is both an honor and a highlight of my career, and you know that comes from my heart. What your listeners may not know is that you are the reason I've pursued sexual health in my career. When we worked together years ago, you took me down this very challenging path of sexual wellness. You mentored me, you encouraged me and you were patient with me as I dove into the art and science of sexual health With any book I could get my hands on, and the rest is pretty much history. So again, I'm really happy to be here in studio with you today.

Speaker 2:

Yeah, Valerie, we felt that these women had been ignored, gaslighted and made you feel guilty and really ashamed for too long. If they're PCPs and GYN docs weren't going to deal with it, then the bucks needed to stop somewhere. So we decided that it needed to stop with us. So I'm really happy and proud of you that you took the baton and ran with it. So let's get right into it, Valerie, Before we get into discussion about what we call sexual dysfunction, please share with us your view. What does a healthy, thriving sex life look like for a woman?

Speaker 3:

Ah, dr McMinn, that's the million dollar question. So let me first say that a healthy sex life for anyone, including women, can vary greatly based on individual preferences, desires and relationship dynamics. However, there are some common factors and I would like to say number one and you'll hear me say this over and over again today is communication, and that includes something I like to call courageous conversations, and they are. They're both courageous and vulnerable, so they are not easy. It's really a non-negotiable, though.

Speaker 3:

When I'm working with a couple, it may be for the first time ever that a couple agrees to talk about sex, their preferences, their desires, their wants and dislikes, and I know it may be awkward at first. However, by opening up to their partner, it can transform the relationship both inside and outside the bedroom. I think what happens with some women, dr McMinn, is that they assume that their partner knows exactly what they want. They've been together, let's say, for 10, 20, 30 years, mind you, lying only about 12 inches between each other. And she thinks how could he not know what I like and what I want? But my response is pretty clear how could he know what you want and what you don't want if you haven't told him?

Speaker 2:

You know I really like your phrase courageous conversations, Valerie. Historically we've been brought up not to talk about sex, and so to do so we have to kind of step out of our comfort zone, and that really requires a lot of courage. It can be a challenge for both partners and certainly can create some, as you say, vulnerability.

Speaker 3:

Definitely. And that being said, there is one major prerequisite to help that courageous conversation go well, and that is for her to know what her needs, desires and wants are, and this calls for some exploration. For example, what does she need to feel in the mood for this encounter? Does she need to listen to her favorite playlist, or maybe read some erotica short stories, or maybe put away all the laundry that's sitting on the bed? Another example would be more physical what are her preferred sexual activities that bring her pleasure? Does she like oral sex or does she not?

Speaker 3:

Are there specific places on her body that's out of the questions that she doesn't want to be touched? Are there places on her body that she wants to be touched? Does she like her clitoris stroke softly or maybe with a little bit more pressure? Are there other places that she likes more pressure, let's say, for instance, the nipples? Or are there other places on her body that are more erogenous than some? So she really needs to know these factors first and then share them with her partner, and then both will have that opportunity to enjoy sex like never before.

Speaker 2:

Okay, valerie, that's great. And you say once she knows these factors. But how does she do that exploration? How does she get to the point where she knows these factors to start with?

Speaker 3:

Yeah, that's a really good question. It's a very personal journey, but yet it's one I highly suggest women take the time and the effort to do if they want to improve their sex life. Dr McMinn, it starts with sexual self-awareness. What are your own thoughts and feelings and belief about sex? First, not your partners, but your own. Is there any negative messages that you've adopted, perhaps from your past or handed down by the church? Start to work on those first and develop your own positive feelings about what you want and how you want to express yourself as a sexual being. Then it's about giving yourself permission permission to explore your own body a self-discovery, if you will to the most intimate parts of you.

Speaker 3:

We call the external part of our genitalias the vulva, our intimate parts, but oftentimes we don't have an intimate relationship with our intimate parts, so we really need to change that.

Speaker 3:

So in practice, when I'm working with a female client who is kind of stuck in that low desire area or maybe having difficulty with arousal or orgasm, I'll have them start off day one with homework to do what I call a vulva self-exam. In this case, women are sitting down with a good old light in a mirror and they're viewing their external genitalia, sometimes for the very first time. From there I'll often recommend using a small vibrator. A vibrator, you know, can reach those deeper nerve endings easier than your own touch. So her own touch, so she can explore the areas of her vulva that bring her pleasure, and not just the vulva either, but other areas of her body too. There are so many, so many arogenous areas on the body that are sensitive to pleasure. But here's the bottom line If she doesn't know what her pleasure areas are, then how can she explain them to her partner and what she wants?

Speaker 2:

Well, I value you just gave some really great tips about physical intimacy, but what about emotional intimacy?

Speaker 3:

That is a great area there, too, and I feel it's super important for a healthy, vibrant and fulfilling sex life. Emotional intimacy is that emotional bond between two people. It's like being in sync with your partner. Now, it does include a lot. It includes trust, understanding, vulnerability and, of course, good old communication. These, though, I feel are the necessary ingredients for partners so they feel safe and secure in their connection with each other. That often leads to a desire to be physically close, leading to more, let's say, a more robust sexual connection.

Speaker 2:

But isn't it the case that not all couples have emotional intimacy, yet they continue on with their relationship, often with an unsatisfying sexual relationship.

Speaker 3:

Yeah, yeah, you're right on that, Dr McMahon. Emotional intimacy is not just about being in love or having strong feelings for someone. It really goes deeper than that and it takes intention and effort. Both parties must be open and honest and vulnerable with each other. They need to take time to talk about their hopes and dreams and fears and, most importantly, they need to listen to each other, to be present, which today, you know that means no devices. Right, they need to spend time together, do activities together. Another way is to be affectionate right, We've forgotten how to do that. Hold hands, show your love and affection through actions, not just the words.

Speaker 2:

That sounds very old fashioned, though.

Speaker 3:

It does, doesn't it? Yeah, yeah, but it still works, right.

Speaker 3:

It still works. I have a tool that I use that I'll share with you, and they're called Story Cards, and this helps get the conversation going Now. These Story Cards look like a deck of cards, but each card has a question on it. These can be related to just life in general, they can be related to fears, they can be even related to sex, but I typically will give couples just the ones related to life in general. They may say something like my biggest fear is dot dot dot, and then the partner answers. Another one might be something like the thing I regret most in life is dot dot dot. Right, I can't tell you, dr McMahon, how effective these cards in are into couples opening up. I've done this with my husband just to run through, and I have to tell you I have found more out about my husband than I thought I knew in the 25 years we've been married, just through Story Cards.

Speaker 2:

Love Story Cards. It sounds like this might need a little bit of wine or some truce serum before we get started.

Speaker 3:

Yes, and I have some advice. There, too is don't do it in the car because, my husband. The last time I pulled them out to practice we were in the car and he said you have me trapped this is not fair. You have me trapped. But all in all, Story Cards can be a great tool to start to open up that conversation, that vulnerability, trust, all of that.

Speaker 2:

Now it seems like I heard of those in context of our. I'll call her my good friend, esther Purrell, although she doesn't know why I am Me either. Yeah, she's an amazing, wonderful sex therapist, if you ever get a chance to read some of her books or watch her YouTube videos or whatever. But you have your own, don't you? You have some story projects come up with. Yes, yes, I do.

Speaker 3:

I've come up with my own because of just what I was saying. I don't want to introduce those topics of sex right out of the game, right? I want people to start talking to each other again, opening up, being more vulnerable, before they get into the sex topic. And you're right, esther Purrell was the one who came out with Story Cards first. She has an entire game to go along with a Story Cards. Other people have followed suit and there seems to be lots of Story Cards out there.

Speaker 3:

So another key ingredient of a healthy sex life we got off in a tangent there a little bit sorry, but another key ingredient, I believe, for women is something I learned from the famous sex educator and author of Come as you Are, and that's Emily Nagoski.

Speaker 3:

I know you follow her as well, and she uses a phrase that I just loved, dr McMahon, and it's pleasure as the measure. I'll say that again pleasure as the measure. And she explains, and I quote here it's not how often you have sex, or who you have it with, or where you do it, or in what positions, or even how many orgasms you have. It's just whether or not you like the sex you're having. So she goes on to say that if everyone is glad to be there and likes the sex we're talking about your partner and you that they're having, then you're already doing it right. Don't get caught up in. What are we doing right, what are we doing wrong? And then those things like desire, arousal, orgasm they're all just going to fall in place when you put pleasure at the center of your sexual well-being, and pleasure is a great barometer for a healthy sex life, don't you think?

Speaker 2:

I think so, and I think sometimes, for instance in the media, like, say, if a woman reads Cosmo she might think, well, gee, I mean she might have been satisfied with her sex life. But she reads Cosmo and she think, whoa, I should be like up there in some other pleasure place, and so she compares herself with societal norms, which is really not necessary. But yeah, I think Emily hits it on, hits the nail on the head. I love her book. Come as you Are, I highly recommend it. I've had some patients who said, Dr, this book has changed my life and so if you get a chance, take a look at that one for sure.

Speaker 3:

Yeah, it's a good one, Much better than Cosmo, much better, much better.

Speaker 2:

But you know every time you check out at the counter, right? Yeah, yeah. You've got things like Cosmo right, so anyway. Right right.

Speaker 3:

I am just as excited as you are to dive into these areas of sexual health that we're going to focus on today, and I don't want to belabor this point. However, I must emphasize that everything we're talking about today, all these tools that we're going to share with your listeners, effective communication is going to affect every aspect of our intimate lives. It is absolutely essential there. I've said it Okay.

Speaker 2:

Okay, we did it. Emphatically understood, valerie? It all starts with communication and it's the foundation for everything else.

Speaker 3:

Right, right, so we've said that. So we, now that your listeners know how important communication is, I'd like to give them some suggestions on how to go about those courageous conversations. And since you, dr McMahon, have taught me a lot in this area, I invite you to join me with your thoughts as well.

Speaker 2:

Well, there are a couple of pearls I'd like to share on this issue. The first one is that it's the day-to-day discourse, spoken in a loving, honoring tone, that sets the stage for a healthy, intimate relationship. Second, I'd like to point out the importance of ongoing communication. It's not just a one-off Like we have one conversation, clear the air, we get it all done and we move on and never talk about it again. Third is to use some resources to help you move forward in your relationship, to get to a better place. For instance, when you're traveling, make a habit of listening to an erotic book, audio book, or maybe a book about sexual health, like one of Esther Perrell's books, or, come as you Are, they're all on audiobook and if you might be struggling with your relationship then that might be helpful for you. Then, after you listen to it, have a discussion about it. Similarly, read a book and agree to sit down once a week and talk about it. That's like a regular book book rather than an audiobook and we'll have a list of many such books, which you can find at McMinnMDcom's forward slash sex dash resources or at functionalmedicinepodcastcom forward slash sex dash resources. You'll have lots of resources there for you books, audio books, whatever that you can turn to for some help.

Speaker 2:

The fourth thing is that it's important is the importance of nonverbal communication. It's not just what you say, but it's how you act and what you do, your body language. Check out the wonderful book the Five Love Languages by Gary Chapman for more information on that. I'll also have the name of that book on the resources for you. And the last thing I'll point out is the importance of being a good listener. I know in medicine I've always felt that listening is the most powerful tool in medicine. Likewise your partner's putting himself or herself out there and being courageous and vulnerable. And you owe it to your partner to listen and to follow up. For instance, if she says it turns me on when you do this, well, you need to start doing more of this. And likewise, if she says, well, it really turns me off when you do that, well, chill it on to doing that.

Speaker 3:

Yeah, yeah, that's great information there, especially the listening part.

Speaker 2:

Because if she says it, for instance, or he says it like over and over and over again and nothing ever changes, then she's going to stop talking, right, it's falling on. Deaf ears doesn't do any good. You have to be a good listener and you have to follow up with your actions.

Speaker 3:

Right, it's so funny that you say this. I, just before I left here, I had a meeting with a couple and that's exactly what she said. And when we drill down, you've taught me well to look at that root cause of what's going on. He was oblivious to the fact that she's told him things over and over again.

Speaker 2:

How many times do I have to tell you that I don't like this?

Speaker 3:

Exactly exactly, and he was completely oblivious and he looked at me like dear in the headlights and what we found out? That he has a problem with paying attention, that he has in his work at home with the kids obviously with her. He really has a problem with concentration and focus. So there's a root cause to that. So we're working on those things. But that just highlights how important it is to women that their spouses listen to them especially. I mean, it's hard to have that conversation to begin with right, let alone to fall on deaf ears. So so important that both partners are listening to each other, but especially when somebody speaks out that clear.

Speaker 2:

What's that old trick some counselors recommend, where you somebody says something and the other person repeats it?

Speaker 3:

Right, right, tell me about that. How's that go? Yeah, I can't think of it right now, but yes, I know exactly what you're talking about.

Speaker 2:

But it wouldn't like, let's say, if she says something to the fact of and mirroring, that's it, yeah, mirroring. Like it really bugs me when you, you kiss me, like that, right, and he should say well, or the partner should say I get it, it bugs you when I do this, and so if he can mirror it, then she knows. Okay, he heard it, he's got it. But then once again, he's got to follow that up with actions right, right, right, change behavior, yes, yes.

Speaker 3:

One more thing about that mirroring too, there's two steps to it. Not only do you mirror back what you heard, but then the other person who asked the initial question says and says is there more?

Speaker 2:

In other words.

Speaker 3:

Okay, you heard what I said. Now is there more to this.

Speaker 2:

Yeah, yeah, let's dig deeper.

Speaker 3:

Very good, okay, great, okay. I want to tag on to those great pearls that you just shared with us, dr McMahon, and this is some advice from a well-known sex expert, dr Emily Morris. She hosts a podcast named Sex with Emily. I think you've heard of that before. So, when it comes to these courageous conversations, she suggests three tips for better communication, and I love these. I use them all the time, and these three tips are time, turf and tone.

Speaker 2:

What the rhymes yeah.

Speaker 3:

Yeah, sounds good, right, okay. So what does time mean? Time means that, regardless of how urgent the issue may be to you, you, the spouse, pick the right time to talk about it, certainly not when either of you are cranky, hungry, tired or stressed, or on the tail end of another issue you are arguing about. Instead, strive for time when you both are relaxed, energized and at ease. So that's the tip for time Sure.

Speaker 3:

Okay. So now we go on to turf. Although the bedroom might seem like a natural place to talk about sex, and most people think it is, it is not Okay. So the living room is your sanctuary. It's a safe space. It's where you can be vulnerable, where you cross over to this other side of that proverbial bridge, into fantasy. So instead opt for a more neutral space, maybe on the living room couch, in the kitchen table, when you're having coffee or while you're on a walk together.

Speaker 2:

Yeah, another tip is some guys are really not necessarily comfortable with an eye-to-eye contact. So, for instance, consider going for a walk and having a discussion while you stroll, or maybe in the car when you're on a road trip.

Speaker 3:

Yeah, that's so true.

Speaker 2:

Although I think that you said that doesn't work for your husband.

Speaker 3:

he feels trapped Well just don't include the story cards, but you can have your discussion.

Speaker 3:

So the last one is tone. Okay, this is an important tip too. Your tone should be one of curiosity and compassion, certainly, rather than blame or criticism, and I think that's hard for us. When we are so amped up to talk about something and we finally find the courage to do it, we sometimes can come across more blaming or criticizing, right, but instead have this tone of curiosity and compassion. You want your partner to listen to what you have to say, so you don't want them to be on the defense right away, right? So start by telling him, really, or them, what you enjoy about your sex life. Okay, start by maybe the concern or issue, and then adding another positive statement about how important this sexual relationship is to you. It doesn't have to be scripted, but that's often what we call a compliment sandwich. Right, you have the positive, you have the concern, and then you have another positive. So now two-.

Speaker 2:

Like, I really like the way you do this, but this drives me crazy. And, by the way, you're good at such and such, right, yeah, not like that, but you get it so now two be aware of facial expressions and body language too.

Speaker 3:

Okay, try to convey more of a relaxed state and maybe even hold hands or just touch your partner's hand while you're talking. Okay, so those are important as well.

Speaker 2:

You know, I think these discussions can become adversarial, but ideally it would be helpful for us to not turn them into like an us versus them discussion and realize that we're both on the same team. We're trying to reach a common goal and that is to have a mutually satisfying, intimate relationship.

Speaker 3:

Right, there's one more golden rule here too. What?

Speaker 2:

was that.

Speaker 3:

Okay, go slow. Okay, all right, both in the speed of your voice.

Speaker 3:

Okay, most of us kind of speed up our voice when we're nervous or when we're upset, and the other slow part is just tackle one issue or concern that you have at a time right. This can be tricky, though, especially if it's been a long time since you've had a conversation about your sex life, or maybe you've never had a conversation about your sex life, so you want to get it all out there on the table, but I recommend just taking one or two issues and take it slow. Try it on for size right. Rome was not built in a day.

Speaker 2:

So, for instance, don't talk fast like Dr McMinn does, yeah, okay. Well, again, it's not just a sit down talk but it's a day to day vibe in the tone that you put out. I'll never forget a woman who says to me one day Dr, my husband yells at me all day and wants to have sex at night. It just doesn't work for me. And yeah, she's right, I get it, and I use the analogy it's easier to start a fire if you keep some embers burning than if you start a fire with some cold, wet logs. So if you can kind of keep a warm, loving, honoring and slightly playful or even sexual vibe going where she feels respected, honored and wanted, that can go a long way as far as just getting the intimacy going.

Speaker 3:

Yeah, that's so true and I've heard you say that over and over again to patients when we work together and I see them after you and it was a light bulb moment for them. That is a great advice on.

Speaker 2:

Yeah, I remember that wonderful book. I think I'll mention a little bit the Supermerital Sex that was. One of the key points is that the day to day conversation has to have what to call an honoring tone. If it doesn't, then yeah, it makes it so difficult to make that transition into an intimate vibe.

Speaker 3:

Right, right, it does. It does, and these recommendations we've been talking about can really rev up the sexual vibe inside the bedroom. That's what we're aiming for, but two and I think we're going to talk about this later it's outside the bedroom too. You know that intimacy inside the bedroom does spill over to outside, and vice versa, right? It makes your entire day more pleasant. Right yeah, yeah, yeah.

Speaker 2:

So what's next? Okay, well, you know. Another sexual issue that involves good communication is called initiation. That means getting the intimacy started. This can be a big challenge for some couples. Seems like a lot of couples. They might desire sex and once they get going they enjoy it and they have a hard time. But they have a hard time getting started.

Speaker 2:

One of my patients told me one time that she and her hubby were very busy with their work, really stressed out and not having much sex, maybe once every three months or so, and they're both kind of bummed about it and it was causing a lot of friction and, I think, affecting their relationship. But they were about to go to Hawaii on a week-long vacation and she was really excited to it, looking forward to it. She went out and bought some sexy new outfits and was really enjoying the anticipation. It was really exciting. So anyway, I asked her when she got back at her next appointment how it went and, oh my gosh, she was so embarrassed to report that nothing happened. It was really like two ships passing in the night. She was so embarrassed and she wanted to connect with her husband but she never initiated, and he wanted to connect but he never initiated, so it never happened. The entire romantic vacation. They both felt so empty and disappointed. So talk to us about initiating sex. Do you have any suggestions for these folks about how to get things started?

Speaker 3:

I do, but that story just strikes me as being so sad, but it's so common. She's waiting for him, he's waiting for her and all that time is passing between them and time, as we know, is so valuable today. So it's sad, but, yes, okay. So often the issue of initiating sex, or the lack of initiation, is a hot button for couples. It is very common. I even meet some women in my practice who don't initiate at all and when I ask them why, it comes back as believing that it's the man's job. Isn't that sad?

Speaker 2:

Well, and where does that come from? Is that our pure technical opinion? I think so. The Patriot RP Right, right, right right.

Speaker 3:

But still today. Come on, I think we've come far further than that, right, Okay.

Speaker 2:

so I think it's fair to say I think we had the women's lived generation in the 60s and 70s and I know that there's a lot of context to that Equal work for equal pay that we don't want to get into here. But I think sometimes it takes multiple generations, once you have a major shift like that, for it to really take hold. And I do find, I think, the younger generation now coming up what do you call them? Gen X or whatever. I think they're kind of more in tune with some of these things then, because, let's say, a woman my age which is like agent when she was little girl she grew up before women's lived right.

Speaker 2:

So she's still, I think, programed with all that notion that she should not initiate.

Speaker 3:

Right, right, yeah, bad girl.

Speaker 2:

Yeah, right exactly.

Speaker 3:

Yeah, I think you're right though today, but still, it depends on the person, right. Some people are learning by our mistakes two generations here, but others are not. So anyways, I do think it's fair to say, though, that initiating sex is never one person's responsibility. Or is it very erotic to think of it as a job, a J-O-B right?

Speaker 3:

That's not erotic at all. Instead, though, I think if partners would look at the suggestion, also known as initiation, to have sex as an invitation to connect with each other. Right, I think, if you looked at it as an invitation, there might be a whole lot more of yeses and a lot less of noes.

Speaker 2:

You know, use the word job and I find that interesting and of course that has a real negative connotation. One word I sometimes use with my patients was think of it as a gift, like for instance okay, she'll say, oh, I love him dearly. I say, well, if he begged you for a new set of golf clubs for Christmas, would you give them to him? Of course I would right. Well, what he's begging you for is initiation, right, it's free. So why can't you like just, even if you're not necessarily in the mood, just out of love and caring just every now, and then just initiate? It'll rock his world, right?

Speaker 3:

Right, yeah, and a gift goes both ways receiving and giving right. Correct, so yeah that's a good point.

Speaker 2:

Now, at the outset, the message does not necessarily have to be like let's have sex, but instead let's spend some time together. You know, whatever it looks like in your relationship, like how about a massage? Or you put on some nice music and have a slow dance or whatever. So it doesn't, you don't have to necessarily come across as so. So finally, like let's have sex. It can be a seller message, which then let's see where it goes from there. Right, and I found that women, many women do not necessarily have the desire upfront, but once they get going they really enjoy it and in the aftermath they're glad they did it. It's the getting started. That's the hard and awkward part for many people.

Speaker 3:

Right, right. So to help in that area, dr McMinn, feeling a little bit more comfortable for initiating sex if a listener is thinking well, you know, I'm just not comfortable here is to first know your own turn on preferences, okay. And then after that you can learn the turn on preferences for your partner too. But really zero in on yourself first, okay. If you're going to really make this comfortable, you have to be comfortable with yourself. So what is what turns you on? Okay. So there's physical cues. Okay.

Speaker 3:

Does a soft caress on your neck or your thigh or directly on the genitals, does that turn you on? Do you like a little bit of teasing, like a bite or nibble on the ear, or maybe a massage, as you were saying? Or does passionate kissing on the lips, right on the lips, does that turn you on? So those are a few cues. Or maybe you feel more excited or more in the mood when it's fun and lighthearted, you know, when sex is less serious, maybe you jump at the chance to play some good music and escape from the here and now. Does that do it for you? Okay, will that help you initiate? Or maybe you're even more turned on knowing in advance that you'll be having sex, and I know you're a fan of scheduled sex, dr McMinn. So this allows you to prepare what you'll wear, what playlist you might queue up, and it allows you to bask in the anticipation of it all. So these are all different initiation styles. Everybody has their own, and the key to initiating more, or feeling comfortable with it, is to tune into your initiation style.

Speaker 3:

And then guess what? Don't keep it a secret. You need to communicate it to your partner.

Speaker 2:

When I do this, that's a good clue that I'm trying to initiate sex right, but now does there need to be in a negotiation there, Like, for instance, what if partner A has this initiation style but partner B doesn't like that initiation style and wants some different initiation style. So it's going to be some back to communication in negotiation on that right.

Speaker 3:

Right, yeah, yeah, so it is. It's vice versa. It's knowing your own initiation style, but also knowing your partner's initiation styles as well. Okay, and then embrace those differences right. Perhaps your partner doesn't initiate sex at, or perhaps he does or she does, but it's different from the way you initiate sex. Just like you were saying, there's direct initiation styles and there's indirect. Okay, so research does show that indirect initiation is more common. So tune in, listen, as you were talking about earlier, and don't miss those clues.

Speaker 2:

Oh no, does that mean us guys have to start paying attention?

Speaker 3:

Yes, you do, you should. Oh my gosh, anyways, right.

Speaker 2:

It's getting difficult, okay. Well, I do agree that knowing each other's initiation styles is very important. But what about when one partner is almost always the initiator and the other partner hardly ever does? This may be okay with some couples. It's just the arrangements they've come out with and it works fine for them. That's cool. However, for others, this could be a situation that causes some resentment along the lines of quote since you don't initiate, then that means you don't find me attractive or sexy unquote, or I don't turn you on Bottom line. We all, men and women, want to feel wanted by our partners, and if the partner never initiates, then we don't feel sexy and wanted. So any thoughts on this situation, bob?

Speaker 3:

Yeah, yeah, that's common as well, and, you know, in a healthy relationship, the ideal would be that both partners actively initiate sexual or even romantic encounters. However, as we know, in reality and maybe for some of your listeners this is going on in their relationship too. One person is usually the one initiating and, as you said, this easily can lead to resentment, frustration and feeling undesirable or even unwanted. So if the two of you are going to resolve this issue, it's right back to the communication table. There may be reasons or barriers to one partner not initiating sex or even intimacy, and it could have nothing to do with the partner who's feeling resented or who's feeling frustrated or feeling unwanted. There could be a root cause to that problem and again, Dr McMahon, it's about communication.

Speaker 2:

There we go. This may be a good time to introduce the concept of what I call the love candle. After working with many couples on this issue, I got to thinking about how can we make initiating super easy, you know, less threatening, less vulnerable, etc. And so that's when I came up with the concept of what I call the love candle. And here's how it works. Y'all again, we're in the south. We can say y'all up north, you're in Cleveland. I say use guys, buddy.

Speaker 3:

So yeah, you guys, y'all buy a really nice candle.

Speaker 2:

you can pick it out together like a big fancy red candle, whatever, and place it in a place where you will both pass by and see it to frequently, for instance in the kitchen, and only the two of you know the significance of the candle. The kids don't know, nobody else knows. It's your inside joke.

Speaker 3:

I love the love candle idea. You taught me that a long time ago. I use it in practice and it works. That's the important thing. So if you're in the mood and you think that your partner might be in the mood as well, you simply light the candle. So if you're passing through the kitchen and you see the candles lit, then you'll want to start to wrap up whatever you're doing, put your phone away and then move in that direction of intimacy. It is a great nudge Right right.

Speaker 2:

It doesn't mean you have to stop what you're doing right now, but you just need to put things away, sort of moving that direction, and then ultimately you'll get there. Now there are a couple of what I call corollaries of the love candle, and the first one is that you need to be careful when you light it. So, for instance, if your partner's engaged in the most exciting time of his or her favorite TV show, movie or game, then you might want to wait till later. In other words, be considered of your partner and don't try to initiate when you know that he or she is distracted by something else that is important to him or her. So I tell my wife, for instance, if an Alabama football game is on and we're on the one yard line and behind by three points and there's like 10 seconds left, that's not the time to light the candle.

Speaker 3:

Right, right, right, or the Buffalo Bills Can.

Speaker 2:

I throw that into. Yeah, buffalo Bills, there we go, there we go.

Speaker 3:

Okay, well, another corollary is called the philosophy of yes.

Speaker 2:

I like this one.

Speaker 3:

Yes, yeah, you've taught me well. This implies that when one person sticks her neck out to ask for intimacy, thus making her vulnerable, then the default answer from the other person should be yes, right, nobody likes to feel rejected, and if one who is rejected repeatedly, then he or she will stop asking. I'm a big fan of this philosophy of yes and I often suggest it, as I said, in my practice and have good results. So thank you for that, dr McMahon.

Speaker 2:

You know, valerie, I learned that when I was at ER doctor, and I think it could apply to most aspects of life really, but sometimes when somebody in the ER the patient lying in the gurney, they ask you for something, the first thing out of your mouth should be yes, although you can then come back with qualifiers yes, but we have to do this other thing first, or whatever. So usually, though, you can find some way to say yes.

Speaker 2:

And I think in this situation once again. If your partner is making himself or herself vulnerable and they're asking if you've got a broken arm and the bone sticking out, okay, you got a good excuse there, but otherwise, I think for the most part, the answer should be yes and you should move in that direction.

Speaker 3:

Right. And the other thing you taught me about that is, if the answer is no, as it sometimes may be, someone's got cramps, one of the kids have a high fever and they just can't get themselves. You know, their mind wrapped up in it is that the no comes with a qualifier.

Speaker 2:

Or the yes comes with a qualifier. Yes, but let me take a shower first. I've been working in the garden, right.

Speaker 3:

Or no, not tonight, but guess what Thursday? Night is going to be better, so I really think that you can say no. It's not a force to say yes, but then it has to be with some plans for another time.

Speaker 3:

And before we leave that initiating sex, I just want to say that it's been my experience that when both partners enthusiastically show each other more often that they're interested in connecting sex will just become more fun and interesting. Right, they've gotten over that hump of initiating Sex becomes fun and interesting and then it's like a cycle. Then initiating sex will just happen.

Speaker 2:

Right. Initiation can be kind of a learned type of thing, can it Right?

Speaker 3:

Let's go.

Speaker 2:

We get better at initiating what gets her going or him going, and then it's easier to do as we work on it. So now that we've discussed some of the keys to healthy sexual audio, let's move on to a few items that fall into the category of sexual dysfunction. We're just another way of saying the common sex-related problems that many people deal with. The four main ones that I saw in the clinic and once again we had just so many women who came in with sexual issues I kind of took track over the years and I think the four big ones were number one, pain within the course. Number two, low interest slash desire. Number three, poor arousal. And the last one is difficulty with orgasms or no orgasm.

Speaker 3:

Right, I think you're spot on with that. Before we start talking about those, I do want to mention and I think your listeners know this that talking about sexual health carries a stigma, right, just like mental health did at one time. Now mental health is slowly losing that stigma and I believe sexual health will follow that trend thanks to conversations like this that we're having. Right, these sexual health concerns that we're going to talk about today are just health conditions. That's what they are Nothing to be ashamed about, feel judged by. They are nothing to be embarrassed about or hide from your physician or even your partner or suffer behind closed doors. So let's take the stigma out of sexual health and just look at it like a health condition.

Speaker 2:

So let's move on to what I call pain within the course. This seems to be very common and so many times when I talk to women it's really a major deal breaker for them. Who wants to have sex have a, hurts every time like the dickens. So another patient I'll never forget was a post-menopausal woman sadly not on hormone replacement therapy who had terrible vaginal dryness and atrophy to the point where she said it was really hard to get even one finger in. And this is a patient who had a primary care doctor and a GYN doctor and doing their pap smears every year and their mammograms every year, but nobody was taking care of her vaginal health.

Speaker 2:

Well, her hubby was on Viagra and testosterone, see, he was all amped up and rare to go and he wanted sex several times a week. So a real disconnect there. But for her it was just sheer torture, even with lube. And as she dreaded it, this created a huge desire discrepancy in quite a bit of what I call marital discord. It made her feel inadequate as a person and as a wife. She dearly loved her husband of many years and truly wanted to make him happy. But the pain was. Intercourse was so terrible it was a deal breaker for her. She said to me one time in all earnestness, doctor, if I could, I would hire a conchibon to live in my basement to service my husband.

Speaker 3:

Oh, my goodness.

Speaker 2:

In the terrible. I felt so sorry for her. However, the good news is that we got her tuned up. We got her on HRT, we worked with her on her dryness, her atrophy, and we made great improvement to the point where she could once again enjoy intimacy with her beloved husband. So it was just a marvel to turn about for her A win-win right, and by the way. For those listeners interested in more information about vaginal dryness, please check out our podcast number 27,. Pretty good podcast on that issue.

Speaker 3:

Right, right, that's absolutely right. Sex cannot be enjoyable if there's any pain really, which brings up a very important point.

Speaker 2:

Let me interrupt here by saying I want to make sure the listeners know what the word atrophy means.

Speaker 2:

It is kind of a medical word, but we know what dryness is. But sometimes if that goes on too long and we don't have any hormones, that mucous membrane there, it actually starts shrinking and drying out and hardening to the point where the actual vaginal opening closes and again, like in her case, it's just hard to even get one finger in. So you have to really work with those patients and bring those tissues alive again. And in her case we actually got her a set of what we call vaginal dilators that she would work with and she would almost like pelvic floor therapy work with those tissues. I actually sent her to a pelvic floor therapist as well. But yeah, we got her tuned up. It was a process, it took a while, but it can be done.

Speaker 3:

That word atrophy is pretty scary right when you're receiving it while your OBGYN just says oh yeah, you have vaginal atrophy. I remember a patient bringing in a test result and it had diagnosis vaginal atrophy and the physician never explained to her what it is. So can you explain to our listeners? Is that reversible?

Speaker 2:

Yes, yes, well, I feel we should never let it happen. To start with, quite frankly, if we did to men what we're doing to women, oh my gosh, would have riots in the street. Let's imagine I don't know what percent of women have dryness and atrophy after, say, 50, I'd say half of them. Half of them for sure, right? Let's say if half of the men in the world had shrinking penis right, yeah, never revolt, oh my gosh, absolutely Absolutely. We'd certainly have an umpteen billion dollar drug company effort on that.

Speaker 2:

We'd have a bill for it. Right, we'd have a bill for it. But yet women suffer in silence and we let them go down that path, and they should never have to go down it to start with. It drives me crazy how we don't attend to women's vaginal health issues and we cause so much suffering. Let me tell you a little brief little story. I've mentioned it on the podcast before. A lady came to me one time and her main complaint was diarrhea. Well, once again, I'm a good listener, so I asked well, why, do you have diarrhea?

Speaker 2:

Well, I've got C diff. Well, why do you have C diff? Well, I've been on antibiotics, doctor, for years. Well, why are you on antibiotics? Because I have urinary tract infections. Well, why do you have urinary tract infections? Because I have vaginal dryness and atrophy. See, if somebody had taken care of her vaginal dryness years ago, she wouldn't be on antibiotics, wouldn't have the C diff in the diarrhea. So, yeah, it's really a disservice we're doing to women. So we should prevent it. And, yes, when it does happen, yes, it can be treated Absolutely. I have a good G way in France. She sees 50 patients a day. She hardly she takes her hand off the doorknob long enough to do a pap smear and breast exam, that's it, boom onto the next patient, because along with those 50 patients she also had to do all the electronic medical record stuff. It just takes forever, and so she doesn't have time to listen to a woman talking about her libido or her dryness or whatever. So yeah, I think the medical community has really let these women down.

Speaker 3:

I agree. Yeah, there's not so much the physicians themselves, because we don't want to throw the physicians under the bus, it's healthcare system, right. You have to see a patient in eight minutes, even if you wanted to talk to them. You have to see them in eight minutes, would you agree? Well, I do.

Speaker 2:

And I'm thinking back. It's also, I mean, most physicians I know are smart, hardworking people who go to work every day to help people, but most doctors never even learn about how to deal with vaginal dryness, right? All the stuff I learned I learned on my own by studying it and having a focused attempt to be the best doctor I could be in that area. But most people, if I think back to my medical school or residency, I think most people never really learn how to adequately treat vaginal dryness, like this lady I just talked to you about, right Could they have gotten it fixed up.

Speaker 3:

No way, no way, I didn't know that. I didn't realize that at all, which you know. A good take home message for that is to be your own advocate. Right, and your having vaginal dryness is, don't wait for the physician to ask you about it. But you tell the physician, hey, I'm having vaginal dryness, right, is there anything I can do about this?

Speaker 2:

Well, see, in my clinic we had an intake form on every single female patient. We asked the question do you have low libido, Do you have vaginal dryness? We kind of rated them on a scale of one to five, you know. And so they came in with five. It was extreme. That gave me the opportunity, you know, even if it wasn't their main complaint, it gave me the opportunity to bring it up. Sometimes for some of them, well you know, they didn't want to go there, didn't want to deal with it. That's fine. For some of them it's awkward and embarrassing to bring these things up. So that took it off of their shoulders and put it on mine to bring it up for them. And once I brought it up, yeah, they were interested in doing better there. So we got a lot of good program for it. But yeah, it can be prevented and it can be treated. Okay, good to know. Good to know.

Speaker 3:

And so pain as well. I want to bring this up as well, because there's a lot of misconceptions out there, misinformation, and that's that there should never be pain within her course, and I think, even though it is true, that 75% of women will experience pain during sex at some point in their lives it could be vaginal dryness, there could be some other reasons for it, but it should not be accepted as normal, and I have spoken to a lot of women who say, oh yeah, I have pain, but you know it's okay, I can tolerate it, but really, pain with intercourse is not normal. So we should highlight that Just as much as vaginal dryness is not normal. Right, right.

Speaker 2:

Well, when we do have pain, there are different causes of pain and it can really differ. It depends whether it occurs on entry or, for instance, with what I call deep thrusting. So pain with penetration or entry can be caused by a lot of things, like once can we talk about dryness, atrophy, not enough lubrication, not enough foreplay, a drop in estrogen levels, factor menopause, childbirth, breastfeeding and some medications like antidepressants, high blood pressure meds, sedatives, antihistamines and certain birth control pills can contribute to it. The entry pain also can be caused by infections in the genital area or ureteract and skin infections like eczema and lichen. Sclerosis can also be a problem. Involuntary spasms of the muscles around the vaginal wall contribute to a condition called vaginismus, which can make sex pretty much impossible for some of these women, and the pain that occurs with a deeper penetration might be worse in certain situations like endometriosis, pelvic inflammatory disease, fibroids, ovarian cysts, pelvic floor dysfunction, scarring from pelvic surgery, including hysterectomy, medical treatments for cancer or radiation to the pelvic area.

Speaker 3:

Yeah, and two, I don't think many people realize this. Those are all medical reasons that people have pain, but there can be emotional cause too. These are the people that I'm typically seeing, right, emotional triggers such as anxiety, depression, body image issues, fear of intimacy or relationship issues show up as emotional pain in the bedroom, and this can decrease a person's arousal phase right, and without sufficient arousal, the body isn't even necessary or ready, isn't necessarily ready for pain, excuse me, for sex. So if sex continues when the body isn't ready, there's discomfort or even pain that occurs. So you mentioned, though, earlier the pelvic floor, and the pelvic floor plays a huge role in intercourse. These muscles respond to emotional stress by tightening without you even realizing it. So your emotional pain can be affecting your pelvic floor muscles, which then can give you the vaginal pain. Right, we should mention, too, sexual abuse, a history of sexual abuse, even inappropriate touching, which is more common than you might expect.

Speaker 2:

It's alarmingly common.

Speaker 3:

Yeah, that too can cause painful intercourse as well these emotional, painful intercourse.

Speaker 2:

Yeah, yeah. And sometimes this can create this sort of cycle where the initial pain can lead to a fear of recurring pain and then you can't relax and it leads to more and more pain. The cycle can contribute to avoiding sex altogether, and now you have a relationship problem along with your painful sex, which is at the center of it.

Speaker 3:

Right.

Speaker 2:

So bottom line is Valerie says pain with intercourse is not normal and you don't have to put up with it. So you might want to start with your primary care doctor, your GYN doctor and there are actually pelvic pain specialists out there, we know we have a really wonderful one in town here Rule out some of the physical causes. But, as Valerie says, there are also emotional issues that you might have to deal with as well. But yeah, I'd say, get to the bottom of it and get treated for it. Now that we've discussed the pain with intercourse, valerie, let's move on to some issues of what are called desire, arousal and orgasm. Talk to us about. Some of the challenges that women deal with is such as, for instance, lack of knowledge about her body, about sex in general, disinformation, insecurity, fear, shame, body image issues and not being comfortable with her own sexuality and so forth. It seems to me like such education in America is just so bad, and I'm guessing that I don't know. I wasn't never a high school, a junior high school girl.

Speaker 2:

I don't know what they tell you, but my guess is they tell you about your periods, but they never tell you about your clitoris or about giving or receiving pleasure or healthy sexuality, and usually it's up to the parents, and often they don't talk about it as well. So tell me, valerie, where do girls and women learn about this? Are they getting good information, and how do they become sexually competent, optimized and confident?

Speaker 3:

Right, right, so not in the Catholic school.

Speaker 2:

Let me just state that.

Speaker 3:

And still not in the Catholic school. Okay, so this is a big topic. We could go on forever about this, but I won't. But the downfall in our society is not having effective sexual education, Not in schools, not in the church community and not often with parents even though parents went through it themselves.

Speaker 3:

You would think that they don't want to repeat that disaster, but often they're not getting the information at all. I know I didn't. And so women? Therefore, as they continue to grow up, they start off behind the eight ball right.

Speaker 3:

And if that was a scenario for many women listeners, I would say that the first step and it was for me as well and that's starting with education, basic education, the anatomy, right, Our anatomy. You guys have it made. Everything's out there in the open. You play with it, you touch it. It's all there out in the open, but for women, it's all hidden, right?

Speaker 3:

So I think that, starting with the basic anatomy and the function of your parts, all of your parts there's wonderful books now available, podcasts, webinars all of those things can get you started in the right direction. And then, I think, with that education, learning to be comfortable in the body that you were made in, right, Using this as your body, the one you are giving, given, rather stop comparing it to other bodies or wishing that your parts were different. This is your wonderfully made body and I think it's important to come to peace with your body. This is where your sexual confidence begins. Right Is with the knowledge and then being comfortable with your body. And, of course, that's just the beginning, because now you have to add other people into the mix, the emotions, the trials and tribulations that come with relationships right.

Speaker 2:

And sometimes rejection.

Speaker 3:

You know, yeah, yeah.

Speaker 2:

I mean, that's country music in this life, yeah exactly Right, right.

Speaker 3:

So sexual confidence, then to your point, is ongoing. We learn as we go right Right.

Speaker 2:

And it could ebb and flow, couldn't it Right? There's actually a syndrome called good girl syndrome. I looked it up, I didn't make it up. It's complicated, okay. It's been kind of laid on women over the years, specifically in the sexual arena. It has to do with that little voice in your head that keeps telling you that sex is wrong, dirty or sinful. You know all those things that you were told for so many years as a little girl as to what you should be like in order to be labeled a good girl.

Speaker 2:

Things like good girls don't touch themselves down there right, right, right, ridiculous, right, yeah, yeah yeah, and I've had women in their 30s and 40s, valerie, who asked me, or their nurse, where their clitoris was. Yeah, and I used to actually keep a printed like a diagram by my chair in the office to show them. And I guarantee you, if they didn't know, then their partner didn't know for sure, neither of knew what to do with it. So, anyway, there's a kind of a corollary to the good girl syndrome I call slut shaming and, again, I didn't make that up either. It's defined as the practice of criticizing women and girls who are perceived to violate expectations of behavior and appearance. So if you're not a good girl, then on the other end of the spectrum you're called a slut.

Speaker 2:

And I've always been interested in, for instance, the guy who might be the quarterback, who's sexually promiscuous, and they call him a stud, which is a word that has positive connotations, right? But if a woman wears some suggestive clothing or is known to be sexually liberated, then she's called a slut, which certainly has a very negative connotation, right next to or to a witch, or condemned to go to hell in our puritanical society, right? So it helped me make sense of this, valerie. How can we as a society have a more sex positive culture and get girls and women the information they need, create a healthier, more positive perception of sexually liberated women and care for these women to learn not to be ashamed of their sexuality or shackled by cultural excuse my French bullshit but instead to be proud of their sexuality and confident with it.

Speaker 3:

Well, that's a perfect world what you just described, right, and I really don't know the answer other than bringing more awareness, because we're not going to change sex education in the schools anytime soon. People have tried to do that and been defeated doing that, so I think it's really up to women, young adult women, to do this themselves. To again, as I said, education become comfortable in the body you're in. Seek out this information talks like well we're having today are great, but it needs to happen at a younger age for all of this to come to fruition. So, dr McMinn, I really don't know the answer to that. That's a tough question. Do you have any thoughts on that?

Speaker 2:

Yeah, I think that it is getting better. I mean, we have the wonderful esturoporales out there, the Sex with Emily, just tons of podcasts. I think we're getting more and more information out there to people. It reminds me of Mother Teresa's all saying one by one, by one, I think we have to each individual woman as she marches forward towards a healthier concept of sexuality, then we'll eventually reach this critical mass. But yeah, I think we can't stop talking about how can we improve sexual education.

Speaker 2:

I'm going to go and jump on to this right now, although I was going to mention it later, but I'll go ahead and mention it now. Years ago, when my kids were growing up, we went to this thing called the Unitarian Church and they had a wonderful program there called OWL program. Owl like the bird, in a sense, for our whole lives, and it was basically a sex education program that started when these kids were in grade school and went up through the entire time until they graduated until 12th grade, and it was just wonderful, and so that would be a good model, for instance, that others could look into. But yeah, I think we need to do a better job for boys and girls. Boys, we got some funk laid on us too in terms of what it means to be a man, and I think we need to change perceptions for everybody and move in a healthier direction and stop things like slut shaming and stuff like that.

Speaker 3:

And you know I'll say one more thing, and I know we're not really going to talk about porn on the podcast today, but porn is doing us all a disservice. So here we are not up to speed to get the correct sexual education out there, right, but instead now we have porn. And.

Speaker 3:

I'm seeing younger and younger guys in my practice because of the influence of porn, the pressure you were talking about, on young men as well as men in general right. They see the porn, but they don't see the before. They don't see the foreplay, they don't see the lubing up. They don't see any of this stuff that starts before a sexual encounter. They see a bunch of guys thrusting as hard as they can on porn and when that doesn't happen in real life for them, they feel they're broken.

Speaker 3:

So it's such a pressure on guys in general.

Speaker 2:

So, yeah, I get it. So let's move on to lack of desire, also known as low libido.

Speaker 3:

All right. Great Sexual desire can be thought of as having an interest in engaging in sexual activity. That's kind of the definition for sexual desire, right. So I like to consider it as an appetite or a motivation for sex, and sexual desire can manifest as having sexual thoughts, feelings, fantasies. But we know what desire is. But unfortunately there's more talk about low sexual desire, or that's what we're seeing in practice is complaints of low sexual desire.

Speaker 3:

So we know what sexual desire is and low sexual desire generally shows up as this consistent lack of appetite or motivation for sex, almost like a disinterest in sexual activity, and that often bleeds over into intimacy, right, they have a disinterest in sexual activity and they almost discount intimacy altogether because they're afraid that that might lead to sex, and they have a disinterest in it, right? So?

Speaker 2:

yeah, it seems like there are two kinds of desire, and one would be more spontaneous, just like the spark of eruption. I think it and therefore I want it sexual desire to come right out of the blue. The other kind is called responsive desire. This is where there's a growing interest in sex based on a reaction to a sexual stimulus, such as a physical or emotional stimulus, often sparked by senses such as touch, physical closeness, erotic story, a visual turn on or a smell that triggers sexual feelings. For instance, hearing the song that reminds you of past sexual encounters makes you think about and want sex.

Speaker 3:

Yeah, I'm so glad you mentioned these two because I think a lot of women are oblivious to anything else other than what they see in the movies or in Netflix, and that would be spontaneous desire, like you described right. It happens right away, but there is this responsive desire, and they're not hearing this explanation of the two desires, oftentimes until they're in my office after going through years and years of distress wondering what is wrong with me. Spontaneous is not the type of desire I have, so there must be something wrong with me. So sexual desire is complex and it's not always the case that you'll have lots of desire or you don't have any desire at all. Sexual desire can ebb and flow depending on so many variables, and I think women listeners can really relate to this ebb and flow business, because I know I can, for sure.

Speaker 3:

So let's talk about some of the reasons that desire ebbs and flows, because I think that will be really helpful to your listeners. They're understandable when you think about them, like the fluctuation of desire with a menstrual cycle we know that happens or with relationship problems obviously right. Or even feeling rejected time and time again from your partner. So those are more understandable. But there's other reasons that are a little bit more elusive, like when desire for sex fades in long-term relationships. I love my partner, I like being with them, I like traveling with my partner, but I just don't want to have sex, or I don't want to have it very often. That is a little bit more elusive. What's the reason for that?

Speaker 2:

That reminds me of Esther Perrell's wonderful book Medi-Conceptivity, which delves into that in great detail.

Speaker 3:

That's okay. And then with the onset of menopause okay, all the women out there know who are going through it or have gone through it already you just don't have the desire for sex, or maybe when working through a chronic health condition or even starting with new medications. So a lot of those reasons lower our sex drive. So if this all sounds rather complicated, it is. It is complicated, and many women have been sold a bill of goods that our desires should be natural and spontaneous and always be there. And if it's not, then we're broken. And I'm so glad you brought up responsive desire, because that's about, if I'm not mistaken, I'm going to say 70 plus percent of women have responsive desire, and men too, men too.

Speaker 2:

So yeah, and then that creates this desire discrepancy thing we talked about. So when women do have low desire, once again we could do an audiobook on this. This is going on forever and ever. But any just pearls of wisdom. As far as how they can ramp it up again, where would they start?

Speaker 3:

Yeah. So my first recommendation is knowing what you pointed out earlier spontaneous and responsive desire. What type of desire do you have? Okay, and I'm going to guess there's more responsive than spontaneous out there. Once you do understand what your desire style is, then embrace that, have fun with it. Figure out what external sexual stimulus turns you on and do more of that. Don't try and force yourself to be spontaneous. That could be disastrous just because that's what you see in the media or porn. Most importantly, communicate to your partner what type of a desire you have. Educate it. Draw it out on a piece of paper. You need to.

Speaker 3:

Don't leave them in the dark. It's one thing for you to discover that you have, let's say, responsive desire. Oh, that's why I don't automatically feel turned on when I see my husband walking across the room naked, but you have to tell them about it. Listen, honey, this is what it takes for me to get myself going.

Speaker 2:

Okay, yeah, so that goes back to communication, right. It goes back to that right.

Speaker 2:

Yes, Educating your partner as far as what gets you going, but at the end of the day, I'm puzzled by this question really, who's responsible for your turn on? I think Esther talks about that a little bit Once again. This has been years ago since I read her book, but something to the effect of he doesn't turn beyond versus. I don't allow myself to get turned on. At the end of the day, I think some people might feel that each person is really ultimately responsible for their own turn on. Right, they do have to work with their partner in the context of a relationship to make that happen. But we sometimes blame other people for our lack of turn on, and maybe we should also take some ownership for it right, right, yeah, which brings me to context, sex in context, because it's not just desire.

Speaker 3:

Okay, having desire is going to depend a lot on the circumstances, the environment and what's going on in your brain at the time, right, that internal state of your brain. It's about creating a space that is conducive to be physically intimate with your partner. So perhaps it's making sure for you it's going to be different for everyone, but I'll throw out a couple of thoughts. Perhaps it's making sure that the laundry sitting on your bed is put away and there are not any bothersome odors lingering in your room that you're planning to have sex in, right? So maybe that will help get you turned on. Or maybe it's triple checking that the kids are all tucked in bed. You know, not just once, not just twice, but three times, or it could be.

Speaker 3:

In order to get your head in the game, you need to read a few erotic short stories. You can do that beforehand, you can do it with your partner. If you want to Take that book out of the nightstand, prop up a pillow and get yourself in the mood. Because, like you said at the end of the day, dr McMinn, it's the responsibility you have to take on yourself. It is not your partner's job, right?

Speaker 2:

Yeah, I think if you go to Amazon, listen, I'm a believer in local bookstores as well, so maybe you could go to your local bookstore. But if you go to Amazon.

Speaker 2:

Just type in erotica, You'll see lots of stuff, or you can go to the erotic short stories. But anyway, so you know. A common scenario I used to see all the time in the practice was this modern woman who goes to work all day to a stressful job. She comes home from work, picks up the kids from school, stops by the grocery store to do some shopping, gets supper on the table, does the dishes, helps the kid with homework and washes the clothes, All while she's drinking a beer and watching the ball game on TV.

Speaker 2:

Oh my goodness, stop right now so she's totally stressed out and as exhausted and she just wants to go to bed, get a good night's sleep so he can start all over the next day. But now the ball game's over and he wants to have sex and, oh my God, can you really blame her for having a headache at that situation? No way, I think we're in the context of modern day society. I think we really are expecting women to be the superwoman.

Speaker 2:

You know, that she has to do all this and she's supposed to be hot in bed. How does that happen?

Speaker 3:

Right, right. Well, first of all, I'd have to-.

Speaker 2:

Oh, by the way, my wife says I'm the sexiest when I'm washing dishes, taking out the trash, helping with the kids. Oh, and I have a room in my hands.

Speaker 3:

Yeah, yeah, exactly. I can picture that right now, and I have to agree with her on this one right. Okay, for sure.

Speaker 3:

Yes, and you know I think there's some good news here. We've talked about a lot of, you know, bad news, but I really think there's some good news. The dynamics of marriage and family responsibilities really have shifted over the last 20, 10 years, and let's say 10 to 20 years. And I have two younger brothers and I saw this when their babies were being born and just the role that they took in changing diapers, giving the baby a bottle, you know, getting up with the baby at night, even though they had a full-time job. So I do think it's changing. I think most couples are figuring it out that one person cannot take on all the responsibilities of home work, kids, aging parents, even health situations. So I think women have really stood up in this area and demanded the help and for the most part, I think they're getting it. For the most part, that's not for everyone, so that, yeah, that being said in the bedroom can be another story right and

Speaker 3:

we're right back to communication, Dr McMinn. So, just as your wife tells you how sexy it is for you to be holding a broom, more of that type of conversation and less of shutting down from women not saying anything other than I have a headache is the first step. So, in other words, if there is this imbalance that a woman is feeling and that is deterring her from having any type of desire because, like you said, why would she Then she needs to express that and they need to negotiate this. We need to negotiate everything. We negotiate to what restaurant we're going out to grab and things right.

Speaker 3:

So that's no different about the sexual matters. So negotiating this is what I need from you in order for me to feel like the sexual being that I am right. I really do think that's the first step. I think women in the past have just shut down and said I have a headache, and then the guy has left thinking, wow, where are these headaches coming from? I keep hearing that, whereas a conversation about listen, you know what? You didn't even take out the garbage this morning. That was one of the that would be so sexy if you did that.

Speaker 2:

And then eventually he stops asking and then you get these couples that just kind of drift apart and they become roommates. Right, it seems like having kids around can be a huge desire buster, and so how can we outsmart those kid years and learn to make a transition into that what I call intimacy bubble? We're sort of fully engaged and in the moment with our partner and not thinking about kids, work, the news or whatever.

Speaker 3:

Right. This is a common problem, and it's certainly one that brings couples into counseling for short right, and I hear it all the time. Our sex life has really gone south since our two children were born. My wife is always afraid of being heard or interrupted in the act. Again and again she rebuffs my advances by asking what if the kids walk in? So that's a common scenario, right?

Speaker 2:

I think a lot of families have become what I call kids-centric families rather than marriage-centric families these days. Yes, yeah, you know we never miss a soccer game, right? But unfortunately we don't find time for each other. So, yeah, I think, as much as we keep the focus on the marriage, that will benefit the kids ultimately. Right, the family stays together, right yeah?

Speaker 3:

Yeah, you took the words right out of my mouth because before any of this can be done and I have some recommendations, but before it can be done it takes time and it takes intent. And we, like you said, we go to every soccer game and we intentionally do this, this and that for our kids make sure they're eating right, pack their lunches with healthy snacks but oftentimes we ignore the intent and the time that our sexual relationship deserves and needs right. So it is a common problem that we're just talking about and most couples find their sexual dynamics disrupted when there are children in the home. Lack of privacy and fatigue from the hectic demands of family life lead to those communication breakdowns. So it's important not to let that situation continue, since, left untended, it can easily become a threat and to the stability of your marriage, just like you were saying, a healthy sex life is gonna give strength and protection to this marital relationship, so everybody's happy, right?

Speaker 3:

So they need to find ways to be intentional about nurturing sexual intimacy. So here's my thoughts on this. Talk about the issue, right, communication. Make sure your spouse clearly understands it's not them and that's not the reason why you're afraid to have sex. It is not them. It is that you're worried about the circumstances, the situation around right, explain the factors of why you feel this way. Don't leave your partner in the dark about this, okay, because right away we're going to think something's wrong with us, right, when we're and we're going to, it'll lead to resentment too. So talk about expectations and desire. Your spouse may be afraid of having the kids, meaning your spouse might feel that, because you've had kids, you'll never have sex again. Right, because that can be a true feeling and a worry. And then that spouse keeps asking for it more and more to make sure that's not happening, right, so you need to figure it out.

Speaker 3:

Be creative. Put locks in the bedroom door, music in your room to maybe muffle the noise. Now, this is all dependent on how old kids are. Use baby monitors in your room to alert to any emergency. Okay, talk to the kids when they get older about the need for mommy and daddy time I often ask. One of the questions in my intake form is what was intimacy between your parents like, right? And most people will say none at all right, because their parents didn't model that for them, whereas some, surprisingly, will say oh yeah, I remember as a teen that my parents closed the door and said that they were having mom and dad time. That is healthy. You're modeling for your kids.

Speaker 3:

That is not just all about them too, and so that's really important. And if the kids are older, have a degree and a code word or a sign. I have to tell you a story. I don't think my in-laws are listening to this podcast so I'll share this with you that you know where they live is out in the country, and we all go over there any time of the day or night. And so my husband's father said listen, if the garage door is down, don't come in right.

Speaker 3:

So everybody knows that Now the garage door is open 90% of the time, but when it's down, the kids know, and the kids are all adults and they know that their parents are still having intimate time together. I think that's a wonderful way to model intimacy.

Speaker 2:

Yeah, I had a couple of super nice folks who they told their kids they were growing kids like don't call on Sunday afternoon. We're turning our phone off. That doesn't mean they couldn't have spontaneous intimacy some other time, but Sunday afternoon was their time. They had another wonderful trick that I have recommended for others they made this little intimacy bubble. It was really great. You could have the intention. But then how do you make that transition? How do you get all that kid thoughts and world?

Speaker 2:

stress thoughts and works thoughts out of your mind. So they would sit there in this love position I don't have time to go into it, but basically sit there in front of each other and they would take their hands and would create this sort of artificial bubble oh, I like that over themselves and they say it would take a little time to take it. I'm taking out of this bubble my thoughts about the kids. I'm taking out of this bubble my concern about my erectile dysfunction. I'm taking out of this bubble the war in Israel or whatever. And they would kind of take turns saying what am I taking out? What am I bringing in?

Speaker 2:

Right, oh, I love that and so, within a matter of five minutes they've gone from a stressed out, distracted situation and they've made a wonderful sort of transition into the intimacy bubble where they can be totally focused in the moment.

Speaker 3:

Wow, I love that. Oh, the pearls that you have.

Speaker 2:

Dr McMinn.

Speaker 3:

I'm taking that one back with me, because it doesn't have to be just about kids right. It can be about all the things going on the world around us. I like that.

Speaker 2:

Yeah, that was a good one. As I've always said, I learned more from my patients than they learned from me Mm-hmm, yeah great. I would give them credit and name their names, but HIPAA, hipaa.

Speaker 3:

Exactly.

Speaker 2:

So anyway, so another strategy that I have learned with some people is to tune into what are called their sexual bio rhythm, and that can come in handy a couple different ways, you know, in terms of morning, energy, evening and drip, but also back to the thing we were talking about with kids. So she might say, hey, honey, how about coming home for a nooner? Mm-hmm, right, well, the kids are off to school, right, and so that's a great way to initiate, see, and it gives them time without the kids. But also they might tune into their bio rhythm where they have better energy the time of day than they do in the evening.

Speaker 3:

Right, right. Yeah, I've just started to work with clients who are going through a cancer journey.

Speaker 3:

And that's something we actually talk about. Okay, when in the day and we're talking, maybe, just intimacy, not just intimacy, but intimacy not necessarily intercourse right, in what time of the day do you feel that you're most energetic, or this bio rhythm to where you can just be close? Maybe it's just lying close together, rubbing each other's feet or something like that, but that is something we start to talk about. So, you know, a lot of people tend to be wiped out at night after the stress of a long day of work, okay, and so, like you said, they might find having sex in the morning or at noon or afternoon works better for them. But again, Dr McMinn, it goes back to intent in time, making time and having an intention to do something different. So another recommendation close to that that I'd like to share is pretty straightforward, and I don't mean to judge anyone here but create sex worth having right.

Speaker 3:

And this goes back to our friend Emily Nygowski. She doesn't know you or I, but she's our friend, we'll just go home.

Speaker 2:

Hey, we're big shots. We have all these great friends.

Speaker 3:

Exactly A couple of Emily's is to make pleasure of the measure. So let's face it if the sex you're having has turned into a boring routine or has become predictable and well as just plain old, stale, then desire for that kind of sex is going to plummet. So no amount of erotica is going to get you in the mood if you're dissatisfied with the sex that you're having. And so also. Others talk about this and have studied this. The Sexual Medicine Society of North America. The quote that novelty is the ultimate remedy for boredom. So experimenting with role-playing sex toys, new positions, new sexual activities or even a new location can bring a refreshing new quality to sex that once felt monotonous or overly rehearsed. And I'm quoting from their article. And so of course we're back to communication. But partner communication, especially around the topic of sex, has been and this has been well studied, has been linked to increased sexual satisfaction. And who doesn't want more of that? Increased sexual satisfaction? Really it's a win-win.

Speaker 2:

Yeah, yeah, yeah. Well, what about the role of fantasy in women's sexual desire? In the past, I think was a controversial issue Women shouldn't fantasize or don't fantasize, but certainly in this day and age we recognize that most people do. But anyway, what role does that play in their desire?

Speaker 3:

Well, first of all, I will say that you say it used to be. I think it still is in some settings right. Yeah, I do think that sexual fantasy does have a stigma to it that hopefully people can get it over. But, quite frankly, we could do a whole podcast on fantasy. Right, but the finer aspects of it, and I wanna start with science, I know how you love evidence-based right.

Speaker 2:

Evidence-based, for sure.

Speaker 3:

So let's start out by saying the science is that sexual fantasies are generally understood as any mental imagery that is sexually arousing. Now, that's hugely subjective, right? Okay, Mm-hmm, Different folks, you know, have different ideas of what's sexually arousing, but the thing is to figure it out, right? So this mental imagery, the benefit of having this is that it can facilitate mental stimulation. Remember, sex starts in the brain, right? It can rev up or say amplify motivation to indulge in a sexual encounter. Maybe you're on the fence, right? You have the responsive desire. You're not so sure you really wanna partake in this. So if you can fantasize a little bit, that might give you the motivation to get over it, right? Or it's just an exercise of imagination. Now, come on, let's admit we don't use our much imagination during the day, right? We're very task-oriented. We go here, we do this, we finish that, we do the next thing on the list. We don't have a lot of time for imagination. So fantasy can help with our imagination. It sounds pretty healthy, doesn't it?

Speaker 2:

It sure does. You know. I think, historically, we think of the most important sex organs as the penis, the vagina, blah, blah, blah blah blah. But really the most important sex organ is the brain, right? Yeah, that's where it kinda starts.

Speaker 3:

So I find that with clients, when I mention using fantasy as a tool, right to help with their low desire.

Speaker 3:

They or let's just say some, some immediately discounted it all, and I think this is due to people pretending that fantasy doesn't exist, that they ignore it okay, or they suppress it because of this shame-based belief or irrational conclusions, almost the if-then game. Right, if I fantasize, then I'm cheating on my partner. If I fantasize, it must mean I don't love my partner. If I fantasize, then I'm sexually perverted or deviant or just a bad person. Right, when in reality, fantasy has its benefits, as we just talked about. It can get you in the mood, it can drive comfort or pleasure from an alternative reality and it is just make-belief.

Speaker 3:

I think, that's what we need to really drill home is remember when you were a kid, you pretended to be a princess and be kissed by a prince, or maybe you played cops and robbers and Indians. It was just make-believe, it was just fun. It was fun in the moment, wasn't it? So that's what fantasy can be. None of this is going to come real right. So I think the take-home message here is having fantasy doesn't mean that you're going to act on the fantasy. And on the other hand too, if you don't want to have fantasies or you have never experienced a fantasy and you just like to turn us off right now, that's okay too. Okay, that's a normal feeling. You don't have to have fantasies. But what we're saying here I think you'll agree is it helps with low desire or it can be a tool for low desire.

Speaker 2:

Right, right, right, right right, and also for arousal and for orgasms as well. Yeah, yeah, for sure. Another major factor that plays a role in all areas, including desire, is the hormone issue. For instance, if a woman has low estrogen, she'll likely have the vaginal dryness, some atrophy and therefore pain within the course and therefore no desire. If she has low testosterone, she'll often have low desire, poor arousal and more difficulty with orgasms. So the studies are quite clear on this issue. They show that, for instance, testosterone therapy can help with interest, arousal and orgasm, and we don't have time to go into this in greater detail.

Speaker 2:

But things like pregneedalone, dhea, progesterone can also affect sexuality and as well as thyroid, in sort of an indirect way. For instance, one of the major causes of low desire is that she's just too tired. Thyroid is huge for energy and so, for instance, if her thyroid is low, she has no energy. If she has no energy, then she's not interested in sex. It just makes common sense. Energy is the key to life, and sexual energy is just a subset of life force energy. So for more information on energy, check out our podcast number two. Also, for the sake of time, we won't go into hormones any further. However, if you're interested, go in hormones and check out podcast number 13. And for more information about testosterone for women, our podcast number 30, and for more information about thyroid, podcast number 15.

Speaker 2:

There are also, by the way, some herbs that can be helpful for women, like maca, ashwagandha, stuff like that. I've had some women who responded quite well to maca. But before we leave the subject of hormones, let me say loudly and clearly that optimization of hormones can be a major game changer For some women. It's really like a light bulb coming on in an otherwise sexually dark world. And I'm just saying I've seen it over and over again with the women folk.

Speaker 3:

Yeah, I'd have to agree. In working with you, I have seen that as well and personally I'm on bio-identical hormone replacement therapy and have been for what?

Speaker 2:

15 years now and have never felt better have never felt better About all of the above, so I'd have to say yeah, I'm reading a wonderful book right now by Peter Adia, I think it's called Outlive. It's really wonderful. But he, early on in the book he said one of the major disservices we've ever done in medicine has been the withholding of HRT from women based on the WHO study, women's health initiative study, and we have let women suffer needlessly because of that and it's really unfortunate. But yeah, I thought I'd mention that because it does affect all four areas.

Speaker 2:

We're talking about pain within the course interest, arousal and orgasm and, above and beyond those things we've already mentioned, there's still if there is still a desired discrepancy. Are there any other suggestions of pros and wisdom you might have that can help close that gap?

Speaker 3:

Well, we've shared so many already, but one thing comes to mind. One tool that I suggest for my clients when this issue is a problem is that for each person to write down on a sheet of paper, without the influence of another person, the frequency that they would like to have sex, just a number right. Then compare notes and so, for instance, if one person says once a month and the other person says three times a week, then at least it's a starting point for negotiation, like you talked about right.

Speaker 3:

And for finding a compromise. And then, after you've done that successfully, let's go on to the next thing. Let's go on to repertoire.

Speaker 2:

Okay, I like it when you dot dot dot, okay, and then each person writes down what they like and it's just a great way to feel less vulnerable in a way, but to get these things out and written down, so I would say, and that sounds like that's something a couple can work on, back to intention and that kind of thing. It also sounds like this, something somebody can work on with a person like you right, a third party in the room that can help them negotiate that and counsel and coach them along the way, and we'll get into more of that a little bit later. But yeah, let's start by if you could provide us with an overview of a female arousal as a part of the sexual response cycle.

Speaker 3:

Okay. So this does get a little technical, so listeners bear with me, but I really think back to education and how important education is. We have to understand what arousal is and what's going on in our body too. So we've moved beyond the desire state. Okay, Partners are mutually motivated to engage in sex. Okay. So we know there's a sexual stimulus, and that sexual stimulus can be anything from kissing, foreplay, erotica, and now we've got the brain and the genitals communicating with each other. Okay. So this is where this arousal phase begins. In women, the sex organs engage with blood and swell. So we're talking about the clitoris, the labia minora, the labia majora in the vagina. All of the blood is flowing to this area, to almost prime, the pump, if you will, for sex. The muscles around the opening of the vagina grow a little tighter, the uterus expands and natural vaginal lubrication is produced, right. In addition, the breasts swell and the nipples become a little bit harder. Did I leave anything out?

Speaker 2:

No, I think it's good. Yeah, I like that Okay all right. So what about the concept of sexual accelerators and brakes, as she explains in the wonderful book Come as you Are, and are there any kind of common accelerators and brakes that women have?

Speaker 3:

Okay, so this is a great time to explain those accelerators and brakes. Okay, it's technically called the dual control model and if you read this book, come as you Are, which we're recommending, you'll see it described as the dual control model.

Speaker 2:

Yeah, and let me explain. Accelerators means what turns me on Right, yeah. Brakes means what turns me off, yes exactly as I was going to explain.

Speaker 3:

Okay, so, yes, so arousal can either move forward. Can either move forward if your brakes are not on and your accelerator is on, or, conversely, it can stop arousal. Okay, it can stop that body's way of going into arousal by having too many brakes and not enough accelerators, right, of course.

Speaker 2:

Just think of your car. You know You're standing there in the carport. If you put on the accelerator, boom moves forward right. So likewise.

Speaker 3:

It's a great analogy. So let's talk, then, about some of the things that can be accelerators and some of the things that can be brakes. I'll start with brakes. Okay, brakes could be kids outside the bedroom door. Okay, brakes could be a child with a fever of 103, right Brakes for some people could be body image issues, and so accelerators, on the other hand, can be as we were talking about with kids earlier just making those arrangements so the kids aren't coming in the room. Okay, accelerators can be something like the candle, the philosophy of yes.

Speaker 2:

Listening to a song that you find kind of a turn on. You mentioned erotica earlier reading a short story. What do you think about this, valerie? I think that historically people keep saying that men are more visual than women. What do you think about that? Like looking at a picture or whatever, are men more visual than women or do women get turned on by visual stuff?

Speaker 3:

Yeah, I think for the most part, I think those are the exceptions to the rule, but I think you're exactly right.

Speaker 3:

It is visual, because, yeah, I was gonna give you some personal examples but we'll keep my husband out of this but, yes, men are visual and we give them a hard time about that, but we can learn something from men in that area okay Is to be able to block everything out, all your senses out, and just focusing on that visual and what I hear from men mostly and I give men a lot of credit here for being vulnerable and talking about this it's their wife or their partner, excuse me, that turns them on.

Speaker 2:

You know what's so interesting, Valerie? I've heard women so many times. They have their own body image issues, but their partner finds them very sexy, Exactly right. She doesn't think she is, but the partner does Right, and so it's kind of interesting how that works.

Speaker 2:

Right, it is yeah, it is, but I actually often encourage women just to get out a sheet of paper and write at the top what turns me on or what are my accelerators, and get another piece of paper and write what turns me off, and then you go about your life in ways that you can gradually start introducing more accelerators and taking some breaks away, right, I mean, an accelerator might be like getting a babysitter for the kids Saturday night and planning a really wonderful sensual time together, and I think the nice thing about that is you can make it exactly like you want it, right, you can, if you like, the love candle on you, like nice music on whatever, but those would be accelerators.

Speaker 2:

But yeah, and it takes some of your breaks away. So I think that really helps out. It's kind of a process of discovery. It might take a while, but you gotta stick with it and keep working with your partner or like with a good counselor like you. Are there any other specific techniques, exercises, activities, strategies, that kind of stuff that you can recommend to enhance female arousal?

Speaker 3:

Well, one of kind of piggybacking on what you were just talking about, and I'm not sure that we talk about this later or not, but it's the yes no, maybe list. It's going back to writing these things down. Right Is finding out what these breaks and accelerators are. A yes, no, maybe list will list activities, sexual activities, and you each take this individually, like you were talking about writing things on a piece of paper, and you write whether you want to participate, yes, in this activity or no, absolutely not. I have no desire to participate in this activity or maybe, and you fill these out separately and then you come together and what a woman will find when she fills hers out is just what we were talking about, what her breaks and accelerators are right, and so that's very helpful. And then it's very helpful too to negotiate, maybe, a different repertoire or to add different things in to your sexual encounter.

Speaker 2:

And the part will say Wow, you're interested in that. I had no idea, Right. Right, I've been there for 30 years.

Speaker 3:

I had no idea, Right exactly, exactly, so it can create quite a new repertoire Okay.

Speaker 2:

So how can somebody find a yes, no, maybe list?

Speaker 3:

Okay, so I have my own.

Speaker 2:

Yes.

Speaker 3:

No, Maybe list, and I think we're going to share in the notes my website. So I have that and that I'll put up on the website for everyone to enjoy. Emily SexWithEmilycom yes Also has her yes, no, maybe list as well.

Speaker 2:

Or you could get creative and take both of those and make your own?

Speaker 3:

Yes, exactly. Maybe some things are not on yours or hers that y'all might want to explore, right, exactly Right and, like you said, make up your own too.

Speaker 2:

So no, okay, well, wonderful, well, yeah. So, valerie, let's move on to what we call it the big O orgasm, and we'll start with the basics. What exactly is female orgasm?

Speaker 3:

Right. So during an orgasm phase? Okay, so the desire excuse me excitement, arousal, orgasm is all part of a sexual response cycle. Okay, so this is what our bodies go through when we have a sexual stimulation. So now we're going to talk about orgasm. So, during this phase of the sexual response cycle, the pelvic, the uterine and the vaginal muscles rhythmically contract and there's a heightened sense of pleasure that the body experiences, and then it releases that tension, that tension that's been built up. That is the orgasm. Okay Now, the orgasm is also very subjective. It's been described by others as a buildup of tension that arches your back and curls your toes. It's also been described as a series of pulses radiating from head to toe and everywhere in between, and still others simply feel a slow wave of pleasure through their body. Now, if this is not your experience of an orgasm, no worries, because everybody's body experiences orgasm differently.

Speaker 2:

With so many things with sexuality, it's very individual, even back to the concept of fantasies etc. So you just go online to Google and you Google and what do women say about what orgasm feels like? You'll see lots of opinions about that and so that might be interested in exploring that. But it is unique to each individual and it can be elusive at times. Some women it can be very difficult to come by or even impossible. So how common is female sexual orgasm disorder and are there any common misconceptions about it or myths about it that you encounter?

Speaker 3:

I think the one that comes to mind first, dr McMinn, is the myth that most women have an orgasm with vaginal sex. And this can be quite damaging, because science tells us that actually only 20% of women are able to orgasm through vaginal penetration. So what does that leave 80% of women who aren't? Now how do they typically orgasm? That would be with clitoral stimulation. So if a person doesn't know this, the woman or her partner doesn't know this, that she can feel she's a failure. If they get into the missionary position and he's thrusting and he has his orgasm and she doesn't, then she thinks again that oh no, I can't have an orgasm. Clitoral stimulation is the way that most women are able to orgasm. So I think that myth right there, busting that myth will help a lot of people realize that it's the stroking of the clitoris, near the clitoris that is going to bring women to orgasm.

Speaker 3:

Now we're on audio here. I wish we had a picture, but there is an entire clitoral network. So we think of the clitoris as a little bud on top of the vagina, right? But actually those nerves of the clitoris are inward and they go around through the labia majora, the labia minora all the way down to the perineum, so there's a lot of clitoral area there. So, yes, on the clitoris is going to be probably the most direct way to have an orgasm, but there's lots of territory there and that goes back to exploring yourself. Where in that area are you most turned on?

Speaker 2:

Do you have a good diagram of that clitoral network?

Speaker 3:

I do, I do.

Speaker 2:

Can you send it to me? I can put it on the website. Well, what about the concept boundary of? Women require a lot more time in foreplay and stimulus than most men do to get there right. So he comes in five minutes and takes her 25. So then that creates a problem, right yeah?

Speaker 3:

So the orgasm gap is what you just named. Yeah, we had discrepancy.

Speaker 2:

The desire gap and now we have the orgasm gap. Yeah, exactly.

Speaker 3:

So again, this goes back to spontaneous and responsive desire, but it's well known also and I like to use the analogy of a thermostat and a light switch Men are able to go through this arousal phase and into orgasm, just like you would a light switch on or off right.

Speaker 3:

Whereas women and technically, men take, the science says about four minutes to achieve this, and I think all the women would agree out there with me, right, okay, so women in general can take anywhere from 10 to 20 minutes to become fully aroused and their body ready for sex and their brain and some longer right and some longer definitely so.

Speaker 3:

That's more of the thermostat, right. So women in general think that if it's taking 10, 15, 20, maybe even 30 minutes, that something is wrong with them. But it is not. It's their own body and their own way of becoming aroused, and the worst thing would be to have penetration without those arousal mechanisms in place right. Then you get into the painful pain with intercourse. So there is a difference, quite a big difference there, between four minutes and 20 minutes right. But again, that's something to learn and then to communicate with each other.

Speaker 2:

And we can negotiate ways to work around that, right? So sometimes you're talking about the clitoris, the importance of that, and so we hear this term clitoral orgasm versus vaginal orgasm. And I've even heard that some women have an orgasm with things like just nipple stimulation et cetera, although that would be rare. But are they really all just kind of one in the same? It's really kind of a brain orgasm, but it's just from different stimuli, right, right, exactly Right right, right, yeah, you could yeah.

Speaker 2:

It seems like there's some commonly used medications that can seriously affect women's interest arousal and orgasm. Is that right?

Speaker 3:

Right, right, yeah, and I think some of these medications we'll go back to your OBGYN or your primary care physician not having the knowledge, when they prescribe these medications, that they may interfere with arousal, interest or orgasm. And they prescribe them. And probably the most common and the most common medication prescribed today is an antidepressant and we know that the category of SSRIs antidepressants can have an effect on interest, arousal and orgasm and then it gets that would be like Prozac and stuff like that. Right, right exactly right, yeah, yeah.

Speaker 2:

I think something on the order of a quarter of American women are on antidepressants which is kind of a sad state of affairs.

Speaker 3:

Right, it is right it is Now also. Women are not always revealing to their primary care physician who is prescribing the antidepressant that they are having problems. Again, the shame and the stigma attached with that. But there are some antidepressants if one is on an SSRI and having any problems. There are some antidepressants that lessen the chance of having these side effects.

Speaker 2:

Yeah, so you can work with your provider on that. But if you need an antidepressant but also birth control pills, gosh, young teen jillian women are on those and they can definitely cause issues in that area. But back when I was in practice, we had so many women came in with orgasmic disorder and viagra type drugs are kind of interesting. They're not FDA approved for women. There are some drugs that are, but quite frankly I don't think they work very well and they have a lot of side effects. But there's some really kind of interesting data that's somewhat supportive of the use of drugs like Viagra and Cialis and women.

Speaker 2:

There was a study back in 2014 published in the journal Drug Design, development and Therapy which showed that in post-menopausal women sexual arousal disorders, some participants experience or improved arousal, vaginal lubrication and orgasm. So since it's not indicated for this, it would have to be prescribed what we call off label. But that is permissible based on the judgment of the provider, and I did prescribe it for quite a few of my patients and some of them came back and said, wow, doctor, it really helped me and they wanted to continue, and others it didn't work very much. But if you think about it, it's basically increasing blood flow to the clitoris and the genital organs, which makes them more than likely to be responsive. In my limited sample size, I really didn't see many side effects with these women. Of course I would use a low dose, but I think if one were to have side effects it would be things like dizziness, headache, facial flushing and nasal stuffiness. So that's one option for women who just cannot orgasm or find it difficult. There's another tool we use sometime called Scream Cream.

Speaker 3:

You're familiar with that, right? Yes, I am, yeah. So Scream Cream and I did not make that up, nor did you, right Are often is often available through compounding pharmacies, not your regular pharmacy. It is the name which is commonly used in the trade for a topical mixture that they put together to help women with sexual pleasure, so your compounding pharmacist will know it by that name. It is its mechanism of action, if you will, will be to improve blood flow and heighten sensitivity to the clitoris and the labia, and therefore to enhance pleasure and perhaps help to achieve orgasm. This cream must be prescribed, though, by your doctor, and it's custom made by a compounding pharmacist, so many regular doctors may not be familiar with Scream Cream, so one strategy would be to have a discussion with your compounding pharmacist and ask him or her to contact your doctor and kind of just to put like a rubber stamp of approval on it.

Speaker 3:

Now, in addition to this, it's not quite as powerful as Scream Cream, but there are some products out there in the market and we could put this on your website as well. There are arousal gels is what they refer to as.

Speaker 2:

Over the counter. Right over the counter.

Speaker 3:

That kind of work to heat up the clitoris and the labia. So not nearly as powerful as Scream Cream, but at least available over the counter. Easily obtainable. Yeah, yeah.

Speaker 2:

And so, yeah, we prescribed quite a bit of Scream Cream and it doesn't work for everybody, but we had quite a few patients who loved it and wanted a boatload of it. So, yeah, I think it's another tool in our toolbox. And we had also some women just use a little bit of what we call testosterone gel on the clitoris about 30 minutes before intercourse and seem to find that was also helpful. Now, moving on, what do you think about sex toys for women, valerie? Like vibrators, can they help women achieve orgasm, and what do you do in a situation when a partner doesn't feel comfortable with a toy? For instance, I had some women who would tell me that their husband won't let them have a vibrator. I think he was concerned that the vibrator was going to take his place.

Speaker 3:

Right, right Any thoughts on that.

Speaker 3:

Yeah, Well, that's a wide open subject as well, and we alluded to it a little bit earlier that a vibrator, the benefit of the vibrator, is able to get down into the deeper nerves. So especially with someone who's having difficulty with orgasm or even arousal, they just are in their head too much that often just by introducing a vibrator gets them out of their head and gets to more of those nerve endings. So there are external vibrators, there's internal vibrators, there's little small bullet vibrators. There's a number of different types of vibrators on the market and it really comes down to self-exploration, like what works for you. So really it's a matter of finding a vibrator that works for you.

Speaker 3:

Number one, and again we're back to communication and just, you don't whip that vibrator out in the middle of a sexual encounter without letting your partner know. Okay, so it's a conversation that you're having with your partner that you'd like to try this. You've tried it on your own and it seems to work. You can bring it in as a sex toy into your encounter or you can just primarily use it for what we call solo sex. So that certainly is a tool for women for orgasms. And again, the conversation with their partner will dispel any of those thoughts of being replaced by their partner.

Speaker 2:

And I think that the bottom line for me from my experience of treating these women is that a personalized program that has the potential to help women in the orgasm department and I had a lot of women who came to see me in their 30s, 40s, 50s who had never had an orgasm. But with a good, focused, personalized, integrative program, using all those different tools in our toolbox, sometimes for the first time ever, they were able to achieve orgasm and you just say they were pretty happy about that.

Speaker 3:

You know, one thing I forgot to mention, Dr McMinn, is the use of lubricants. So commercially prepared lubricant First of all. I recommend it regardless of the age, and we won't go into all the benefits of a lubricant, other than to say, since we're talking about orgasm, it has been shown through clinical studies that using a lubricant a good body, safe, sex positive lubricant can help both men and women improve their orgasms. Okay, so you've got water based, you've got silicone lubricant and you've got a hybrid. So take your choice making sure it has less chemicals in it, at least as possible, and something you're happy with, but that can help with orgasm as well.

Speaker 2:

Again, an entire podcast can be done on that.

Speaker 3:

Yes, appreciate it, appreciate it.

Speaker 2:

So pain within the course, desire, arousal and orgasm Just a few more loose ends I'd like to tie up with you while I have you here. Some people are very negative about what we call scheduled sex. I've had a lot of patients who shun date night, insisted it just has to be all spontaneous all the time. And I often asked them when's the last time you had sex? And I'll say, well, let's see three months ago. So I'll ask them, well, how's that working for you? So talk to us about the concept of scheduled sex. Does that have to be boring sex, or can folks make it fun and interesting and exciting?

Speaker 3:

Okay, well, you taught me the most on this, so you were the first one to introduce it to me, and about three times today during our conversation.

Speaker 3:

Scheduled sex was a remedy to what we were talking about, so it's not the end all be all, but it certainly can be for some people. So what we mean to say by scheduled sex is just agreeing on a time for sex. It can be in conjunction with a date night Okay, we all know what that is or it doesn't have to be. It can be just simply put on the calendar. Right, and this is a tool that I use when I'm doing couples counseling when there is this desire discrepancy you refer to, where one person's frequency does not meet the other partner's frequency, sometimes agreeing in between and getting it on the calendar. Now listen, dr McMinn, we schedule our lives right.

Speaker 3:

We schedule everything that goes on in our lives. We even did this when we were courting. Think about it. You scheduled the date. You scheduled, or you planned what you were going to wear. You had reservations at a restaurant and then, when the relationship got further on, you scheduled time away at a nice resort, etc. We plan everything, so why not sex?

Speaker 2:

We're not even the young couples these days hooking up on Tinder that I'll meet you at so and so, at such time, right, yeah, exactly.

Speaker 3:

Yeah, so it's already planned right.

Speaker 2:

Right, right right.

Speaker 3:

But scheduled sex, getting it on the calendar, is getting it done.

Speaker 2:

Right right.

Speaker 3:

And then everything. And then you talk about this emotional intimacy part of it that we were talking about and the anticipation Anticipation is the ingredient of desire, right? So if you're anticipating, wednesday night we're going to have sex. My partner is going to come home at noon, okay, just to shake it up a little bit. And the kids aren't around. They're in school and now I can get the bedroom ready. There's no laundry on the floor, the room smells good. I maybe purchased some little special panties for the event. Scheduled sex can be fun sex.

Speaker 2:

Good, good, glad to hear it, yeah, and now, what about the role of erotica and pornography? Seems like it can go both ways. Some people can find it can be helpful to get the juices flowing. Others it can be devastating to the relationship, especially seeing it with the guys. Sometimes they get porn addicted and they substitute porn for their partner, which is really tragic. On the other hand, it was really interesting back. What? When was it? 10 years ago when Fifty Shades of Grey came out, right, right, oh my gosh, she sold like 50 Cajillion copies of that and it was actually on the shelf at Walmart, right, right, yeah, but I think it really kind of proved that women respond to erotica, right, and it kind of dispelled that myth. And so any thoughts on that and using that as a tool to help with desire or arousal?

Speaker 3:

Yeah, so keyword, there is tool right. Anything overused. A tool overused can become problematic and there's a whole group of problematic porn behavior. So we'll just really focus on how to use it as a tool in a positive way. And one of the things if I've got a client who's having difficulty getting aroused or even the desire for sex, oftentimes I will suggest erotica, short story erotica, and to almost put themselves in the story. Okay, and put their partner in the story too. It doesn't have to be about Fireman Joe.

Speaker 3:

It can be about their partner. Just plug that in. What it allows us to do is to get out of the everyday stress of what's going on in our lives. Right, because again we've talked about this. Sex starts in the brain, so you've got to get your brain wrapped around something other than the grocery list, laundry list, et cetera. So erotica can do that. Now there's a new genre of erotica out there called erotica platica. Okay, did you know, about that?

Speaker 2:

No, I didn't, that's okay, erotica doesn't have a plot? Okay, this has a plot. Yes, you got it.

Speaker 3:

And so these are stories that have a plot, that are a little bit more realistic. So erotica platica now is a choice. Erotica itself or even romance novels. If you don't want to go down the erotica alley, then just romance novels can start to get to you in the middle. You know what it's about, Dr McMinn? It's about using your imagination, putting yourself in stories using your imagination and just getting out of your head.

Speaker 2:

Yeah, I had a lady one time used to come see me and every time I walked in the room she was reading a book. And I finally asked her what are you reading? I thought it might be James Joyce or something like that. She says no, dr, I'm reading a smut romance novel. That was her word. So, she said, it kind of kept her in the mood all the time. Good for her. But yeah, she gave me the names of some authors I could share with my other positions for what I did.

Speaker 3:

So it's kind of cool. That reminds me Dr McMinn. We talked about Esther Perrell. On her website, which is esterperrellcom, she has an entire resource list of books, novels, films, etc.

Speaker 2:

Yeah, we're going to have a lot of those on our list as well. But yeah, by the way, that's estherperrellcom, if I recall. Is that correct? And so, yeah, valerie, I think we're approaching the end here. Before we let you go, let me talk to you about the role of masturbation in sexuality for women. Is it normal, is it healthy? And speaks to the issue of what we call masturbation shame. Oh gosh, again, you have to pop this in at the end, right, yeah, yeah, yeah. Another whole podcast.

Speaker 3:

I'd love to come back.

Speaker 2:

Well, let's do it. We can keep it a regular thing.

Speaker 3:

Yeah, attack some of these issues. Yeah, it's a hot button, for sure. There's two camps there. There's camps that frown upon it and there's camps that enjoy it, and there's a problematic camp too, right, due to porn. A lot of guys will have problematic masturbation to where it's interfering with their activities of daily living, which is always the time in which it becomes a problem. But as far as using it, dare I say, clinically, because, that's where I feel that I use it the most.

Speaker 3:

It goes back to a woman who's not familiar with their own body, and so it's a self exploration tool, if you will. How will she know what turns her on if she doesn't know herself? And oftentimes masturbation can help with that. She can figure out for herself by masturbating exactly what turns her on right and some of the erogenous zones in her body, so therefore she can let her partner know. So I use it mostly as a clinical tool in that way.

Speaker 2:

I think it's unfortunate that we put this masturbation shame on people because it is, I think, a normal human activity To your point. I think it can be excessive, to the point where a guy can't go to work, he's masturbating all the time. But yeah, I think it can be used as a tool. I think of like, for instance, years ago there's a book called the Orgasm Loop that I read Because I saw so many patients with this issue and I did a lot of reading about it and I put together a program which I called the Personal Pleasure Session for Masturbation, which would give women a template of like how can I get from no orgasms to orgasmic on my own using masturbation and some other things. Ultimately, they can then translate that into the relationship, the interaction with their partner. Part of your set.

Speaker 2:

I can put that also on the website. So if you have any references or sources that you can send me as far as like ASACT or other places where women can turn to for help, then let me know and I'll also post that as well. And also feel free to share with me your web address and any contact information you would like to share, and I'll put that on the resource page for you. So you see patients locally, but do you also deal with people over the phone?

Speaker 3:

Yes, I do yes, so men, women and couples. Men, women and couples, so really the conversation doesn't need to stop here. If we've discussed or spoke to any issue that speaks to a listener's heart here, I'm happy to discuss any follow-up questions via my website. My website is IntimacyHealthcom and I know we'll put that in the show notes. So on the homepage of that site you'll find a what's on your mind chat box and you can enter any question you want on there and I'm happy to help. Great, really happy to help.

Speaker 2:

Well, that's a wonderful resource, because in a lot of, say, small towns, people don't have a good sexual health counselor, right, and one thing I'm always trying to do on this podcast is give people practical solutions, and we're trying to do that today.

Speaker 2:

But at the end of the day, sometimes it can turn into what I call an us versus them thing, and it's hard to find a common ground and you need a third party mediator, and so I think it could be helpful to have somebody like you, and so we'll certainly give people that practical solution. So, in closing, one final pearl of wisdom I'd like to share with the audience is that, in order to have a healthy, intimate relationship, we have to make intimacy a priority in our lives. I read a quote many years ago from that wonderful book I already mentioned called Supermerital Sex by Paul Pearsall something to the fact that we find time to take out the trash, we find time to mow the lawn and we also find time for each other. It's really good for people, especially committed couples, to take a look at things like that. That's a wonderful book and that can help them maybe take the next step forward, as we're wanting this up. Is there anything else, valerie, that we have left out today, anything important that women need to know about sexual health.

Speaker 3:

I know, dr McMinn, I think we've covered everything we thought about covering, and more so I'd have to say, especially what you just ended with, I totally agree, totally agree.

Speaker 2:

Yeah good, this is a journey that people aren't, and it's never over. You never like are there. I think you always have to keep plugging away and trying to make it better, and I think giving each other some grace along the way is a good idea. I think the world needs more grace in general, but especially in this situation, because, once again, people are vulnerable and stuff like that. But in closing, I'm happy to announce that Valerie will be back with us next month to talk about men's sexual health, so stay tuned for that and, however, that will about do it for this episode of the Functional Medicine Podcast, and I hope that we're able to share some information with you that was helpful to you, and would also like to thank Ms Valerie Pad for joining us today, and thank you so much, valerie.

Speaker 3:

Oh and thank you. I'm so excited about next month. My wheels are already turning, I'm willing to discuss Wonderful. In men's sexual health, and there's so much to talk about, oh there is, there is.

Speaker 2:

Well please do take a moment. We think of a five star rating on iTunes. These reviews do make a big difference for us, so I thank you in advance and, by the way, it can be difficult to do so. We've written out the directions for you on how to do this on your iPhone. You can find this information at McMinnMDcom. It walks you through the process step by step and once you get the hang of it, it really takes a few seconds to do. It's really easy. Also, help the podcast grow by telling your friends and family about us. In this day and age where people are looking for unbiased, evidence based information, then this is the place to go. So please help us share the word and thank you so much for listening today. This is Dr McMinn signing out. Until next time, take care and be well.

Sexual Health for Women
Healthy Sex Life for Women
Emotional Intimacy and Communication in Relationships
Effective Communication for Discussing Intimacy
Initiating Sex and Communication in Relationships
Treating Sexual Health Stigma and Issues
Improving Sexual Education and Empowering Women
Understanding Sexual Desire and Its Fluctuations
Understanding and Communicating Sexual Desire
Enhancing Sexual Desire and Satisfaction
Understanding Female Arousal and Orgasm
Enhancing Sexual Pleasure and Orgasm
Exploring Erotica and Masturbation for Health