This is an exclusive Arts of Thought Interview on the effectiveness of mindfulness in improving women’s sexual function and satisfaction. All content in this article was written and provided by Dr. Lori Brotto.
What are some of the major benefits of having a healthy sex life?
The World Health Association recognizes sexual health as a fundamental component of general health and well-being. It is viewed as a basic human right that many individuals strive to attain. Sexual satisfaction is associated with better mental health, self-esteem, relationship satisfaction, and communication both in and outside the bedroom. Despite this, sexual problems afflict up to half of women and men across ages, cultures, social situations, and life stages. And when sexual concerns arise, they impact many domains of the individual’s life, relationship, and context.
For women, particularly, large population-based surveys show that over 40% of women will experience a lasting sexual concern over the past year, regardless of her age. And yet, there is only one Food and Drug Administration (FDA) approved medication to address women’s low desire, and it has demonstrated lack luster improvements to women’s sexual desire and elicits significant side-effects such as dizziness, sleepiness, and difficulties concentrating. It is also completely contra-indicated with alcohol, which means that the majority of women faced with loss of sexual desire would not even consider this medication as an option.
I began to practice mindfulness myself in 2002 when I learned about it as a component of therapy for individuals experiencing suicidal tendencies associated with Borderline Personality Disorder. Mindfulness taught these individuals to “ride out” the discomfort of their emotional pain, and showed them that tuning in trumps tuning out when it comes to coping with the impulse to hurt oneself. At the same time, my research focused on women with sexual dysfunction secondary to their gynecologic cancer treatments. They described feeling disconnected, a lack of any sensations in their bodies, and no longer knowing who they were sexually. I saw similarities in these two different populations of women, and wondered to myself whether the mindfulness strategies that had proved so useful for women with suicidality to help them tune in would also be useful for the women with sexual dysfunction who lost a connection with themselves.
This started on a pilot study of teaching women with sexual dysfunction following cancer to breathe and tune into each breath. We started out with three sessions, and based on the promising findings, expanded this to four, and eventually to eight. Over the next 15 years, we adapted our mindfulness-based interventions to many different populations of women with sexual dysfunction and measured their improvements in sexual desire, arousal, orgasm, sexual satisfaction, relationship happiness, mood, anxiety, and stress.
In 2016 I decided to write a book intended for a general audience that served to:
(1) share the results of our research, all of which is published in peer-reviewed journals; and
(2) share the very exercises that we teach women in our face to face groups, in the book.
We know from your book that more than half of women experience some sort of sexual difficulty during their lifetime, with low desire being the most common. Why do you think so many women struggle when it comes to sex?
There could be many reasons why a woman struggles when it comes to sex, and often times, it is difficult to point a finger to any specific cause. However, for many women, psychological factors are central. Anxiety or depression often contribute to and perpetuate sexual concerns, and often the medications used to treat those issues can worsen sexual desire, arousal, and orgasm complaints.
For an increasing number of women, stress, distractions, and lack of sleep are major culprits in their waning sexual desire. Women might also have irrational beliefs that contribute to sexual problems, such as: Sex must always be spontaneous or it is boring; My partner and I must reach orgasm at the same time; and My partner should know what I want and like sexually or else we must not be compatible.
As a therapist, you’ve helped hundreds of women achieve more satisfying, fulfilling sexual experiences through mindfulness exercises. What, exactly, is mindfulness and how can it help?
Quite simply, mindfulness can be defined as present moment, non-judgmental awareness. It involves the practice of moving one’s attention to the here-and-now and focusing on sensations of the body and breath. It is well known that women can be quite judgmental of themselves, especially when it comes to sex.
Mindfulness is a skill that helps women to be less judgmental and to observe sensations as they arise, and accept them for what they are. Our research over the past 15 years has found mindfulness practices to help women be less judgmental, to be much more present during sexual activity, and ultimately to have improved sexual desire and arousal.
Aside from boosting desire, what are some other sexual benefits of practicing mindfulness?
Our work has shown mindfulness to improve sex-related distress, or in other words, women have significantly less concern or bother about their sexuality after participating in our groups. They have also reported an increase in their levels of sexual arousal, vaginal lubrication, and frequency of orgasms. When we look at a global measure of sexual satisfaction that takes into account how overall satisfied women are with many aspects of their sexual response and life, women had a 60% improvement in this domain.
Can you briefly walk us through what an exercise might look like?
One exercise that we teach women early on in the group is mindfulness of breath. It involves guiding women to notice the breath, including the individual sensations that make up the in-breath and out-breath. They are guided to pay attention to where in the body they feel sensations associated with breathing, such as at the belly, the chest, and the nose. They might also be guided to observe sounds associated with breathing, and any smells. An exercise like this in our group will continue for about 20 minutes, allowing women to experience what happens when their mind gets pulled into different directions, such as distractions or thoughts. They then practice what it feels like to notice their attention being pulled away, and then re-directing it back to the sensations associated with breathing.
We have exercises like this that focus on eating, body sensations, sounds, and thoughts. We also teach them mindful movement exercises such as gentle stretching and mindful walking, that they are encouraged to use in their daily life.
In your book, you describe a phenomenon known as spectatoring—that is, watching and judging yourself during sex, rather than fully immersing yourself in the experience—and how it can seriously diminish sexual pleasure. What’s one simple thing women can do to stop spectatoring and start enjoying?
I often encourage women to really pay attention to the points of contact between their body and their partner’s body during sexual activity. Surprisingly, women tell us that they often do not notice what it feels like to make contact with a partner! I ask them to notice the temperature, softness of the skin, pressure, tingling, vibrations, etc. of those places where their body meets their partner’s body. They can also open their eyes during sex to re-ground them into the here and now, and not lost in a myriad of judgmental thoughts.
What are some simple, easy ways that women can use mindfulness to reduce that stress and improve their relationships?
There is no short-changing the importance of the formal “on the pillow” practice. For women who are entirely new to mindfulness or meditation, I often recommend taking an 8-week mindfulness-based program at a local community centre or meditation/Dharma centre. There are also some excellent Apps intended to introduce people to mindfulness and link listeners to a new guided audio meditation each day. With some practice, people can lead their own meditation without the use of a teacher or audio file. In addition to the formal practice, I recommend choosing at least 3 activities each day that one will engage in mindfully. This might include the first 10 minutes of your dinner; waiting in line at the grocery store; or walking from the parkade to your place of work. You can also practice bringing mindfulness into your conversations—in addition to listening to the words spoken by the other person, really tune into what you see and feel in your body, and notice your breath, moment by moment. My belief is that it is this combination of formal practice as well as informal, or life activities, practices, that will position someone well for bringing mindfulness into sex.
What’s the most common sexual myth you encounter in your practice?
Sex should be natural! This leads women to believe that their body should simply know what to do and respond automatically to sexual touch. This is not typically the case, given that sex truly requires the brain and the body to be in close communication with one another, so that if the mind is preoccupied elsewhere, simply stimulating the body is not likely to elicit a sexual response.
What can a woman’s partner can do to assist her in remaining mindful, less self-critical and more content during sex?
Sensate focus is a couples exercise developed by Masters and Johnson in the 1950s that remains a staple in the toolboxes of most sex therapists today. Sensate focus is intended to reduce anxiety, improve communication about touch between partners, and bring the focus of attention into the here and now, and away from worrying about the anticipated disastrous outcome.
1.) In the first 15 minutes, the couple take time to prepare their space, including removing all phones and other distracting objects. They may also wish to shower or bathe and adjust the room temperature and lighting.
2.) In the second 15 minutes, person A touches person B from head to toes, excluding the breasts and genitals, and says nothing. Person B provides some gentle feedback about the touch, both verbally and non-verbally.
3.) In the third 15 minutes, the two partners change roles, and again the goal is to tune in and relax and provide feedback. The goal is not to produce sexual arousal, and it most definitely is not to substitute as foreplay.
4.) In the final 15 minutes, the partners end the touching, and spend some time talking about how it was for them. What did they notice? What was difficult? Often sensate focus is recommended to be repeated on a weekly basis, with progressively introducing breast and genital touch again as the couple’s learning continues.
Our experience with mindfulness is that it certainly improves a partner’s comfort with providing feedback to the other partner about the kinds of touches they like. By remaining in the present moment, they are less likely to engage in “spectatoring”, a term that Masters and Johnson coined that refers to watching oneself from a distance. Although Masters and Johnson never described it as a mindful exercises, to my mind it is the most powerful couples-based mindfulness exercise available.
Finally, what’s the most important thing you hope readers take away from your book?
Many people believe that sexual desire and passion are not features of a long-term relationship, or that you cannot re-acquire the sexual interest that you felt in the early stages of a relationship. While this may be true for some couples, there is also evidence that sexual desire can be cultivated. And paying attention with mindfulness is one way to boost sexual desire, even in long-term relationships. What is also important is that achieving mindfulness does not require expensive and potentially dangerous medications or ointments, but rather, takes advantage of a skill that everyone already possesses: that of being present.
For More Information on improving your sex life, please check out Dr. Lorri Brotto’s book, Better Sex Through Mindfulness: How Women Can Cultivate Desire. Click the Image below to see it on Amazon!