by Lori A. Brotto, PhD, R. Psych
Sex is ubiquitous. It used to be delegated to late night television on the upper channels. Now innuendos and references to sex are common, perhaps even inescapable, on most of prime time television. Bus-stop billboards display larger than life posters of nearly naked adolescents selling perfume or the latest video game. In a society dripping with sex saturated messages, why are sexual hang-ups so pervasive? Television conversations about sex between actor parents and their teens come across as thorough, accurate, and comfortable on the screen, yet many people in reality experience enormous discomfort talking about sex with even their most intimate partners. Moreover, large-scale international surveys show that up to 40% of women experience sex-related difficulties lasting several months or more in a given year, with loss of sexual desire being the most common. The juxtaposition of an implied sexual liberty with our current sexual reality reveals a disconnect between the expectations of who we should be sexually and who we are.
As a sex therapist, I’ve seen countless young women who appear otherwise happy in their relationships, fulfilled with their life paths, and blessed with spirited children, who confide with me behind closed doors where their secrets are safe. A typical story goes like so: “In the first several months of our relationship, things were adventurous and exciting. We took spontaneous weekend trips to gorgeous destinations, dined at the finest restaurants in town, and danced until dawn. Our sex was fiery and frequent, and we felt a comfort with one another that we believed could supersede any curveball life threw our way.” Then their stories often took a sharp turn, one in which they described a lessening of motivation for sex, a loss of libido, and for some women, even an aversion to the sexual solicitations by their partners. I’ve met so many women who no longer undress in front of a partner for fear of “sending them the wrong message about wanting sex”.
Though the causes of a lost sexual desire can be multi-faceted, the most common culprit boils down to stress: too many things to do, immense personal and societal pressures to do those things well, and the perpetual feeling of running that hamster wheel to no end. A diminishing or altogether absent sexual desire can often be masked by the other joys in life: relishing in the role of being a mother, working in a fulfilling job, or having friends shower you with unconditional support. In many women, their lost libido flies under the radar for years before she becomes motivated to address it. For many of the women I see, they view their tendency to multi-task as their saving grace: “it’s the only way I can get everything done!” they typically say. But training our brains to multi-task means that our brains get very unsettled when we remain focused on a single thing in the here and now. And so often during sexual activity women’s minds are not focusing on the sensations of contact, or guiding their attention to the emotions unfolding in the moment. No, they may be running through their perpetual to-do lists, planning tomorrow’s events, and even staring at the clock wondering “how much longer is this going to take?” Many women (and their partners too) believe that sexual response is like a reflex: touch the erogenous area and it will respond. This couldn’t be further from the truth! Stimulating the body of a person whose mind is not fully present sexually is like turning the key in the ignition of a car whose engine has been removed.
Loss of sexual desire in women who are stressed also has a physiological counterpart above and beyond just the toxic effects of a “distracted mind”. The fight or flight response, which is triggered when faced with a stressor, activates our sympathetic nervous system—the branch of our brain that has evolved over time to help us cope in an adaptive way to serious life stressors. Blood gets shunted to our major muscles to mobilize us to fight or flee. However, the physiological changes that take place during stress do not allow most of us cope adaptively, and instead, backfire when stress is experienced on a daily basis.
For decades, scientists have been trying to identify a way to improve women’s low sexual desire and to improve intimacy between partners. In the United States a medication was approved in the summer of 2015 to treat loss of sexual desire in premenopausal women. However, side-effects of the medication and the fact that women using it cannot mix it with alcohol have meant that there has not been high demand for it, and Health Canada has not approved it. Given the significant role played by chronic daily hassles and stress on women’s sexual desire, I would propose to you a different approach. I believe that stress management is key to cultivating sexual desire, and targeting the sex organs with a pill will not translate into improved stress or better sex. We need a way to directly target the largest sex organ: the brain.
Mindfulness meditation has existed for millenia in the eastern world, and over the past 40 years, it has made its way into western medicine and health care. Mindfulness involves a series of practices that essentially entail focusing the attention on a single object in the present moment, and doing so with compassion and acceptance. Countless studies have shown the benefits of mindfulness for anxiety, depression, chronic pain, substance use, compulsive eating, and a variety of medical ailments from psoriasis to urinary incontinence to hypertension. Since 2002 I have been developing and testing mindfulness-based programs for women with low sexual desire and to date the results have been extremely promising. As women learn to bring their attention to the present moment, to focus on sensations of touch, to be kinder to themselves and let go of negative self-judgments, and to curtail the perpetual planning, anticipating, and catastrophizing that permeates their lives, they once again learn how to feel. With repeated practice, I’ve seen hundreds of women now benefit from mindfulness exercises, and to cultivate a sexual desire that they believed was lost forever. Mindfulness is such a simple practice, and yet, for so many women experiencing sexual concerns and who believe they have tried strategies to improve their low sexual desire, mindfulness offers a fresh opportunity to pay attention to what is already there.