Anita Rao
I am a firm believer in therapy. I've been going regularly for more than a decade, and it's truly transformed every aspect of my life. I've always been a curious, analytical person. So thinking about how I think comes naturally to me. But over the years, I've actually found that this tendency to analyze is the starting point for most of my work in therapy. I've had to learn how to move from thinking all the time to feeling and being present in my body. There's a group of therapists who I haven't worked with personally, whose work sits right at the intersection of thinking, feeling and the body — especially when it comes to sex.
Krista Nabar
There are a few misconceptions about the process of sex therapy that I encounter on a regular basis. Many people think that sex therapy involves contact between the client and the therapist. Sex therapy is talk therapy. Sex therapists just happen to know more about sex than other therapists and are more comfortable talking about it.
Christina Mathieson
Another myth is that all you talk about in sex therapy is sex. Although sex can play an important role in people's lives, it does not exist in a vacuum. Life is not a porno. People bring their whole selves into the bedroom. Much of their previous experiences and current context are important to explore and understand when discussing the topic of sex. Being curious about the cause of the symptoms rather than just the symptoms can lead to more effective and lasting outcomes.
Machel Hunt
Most people think that by having one session with a psychosexual therapist, or having a couple sessions with a sex therapist, that it will solve their concerns and solve their issues — and that's simply not true.
Anita Rao
You just met sex therapists Krista, Christina and Machel.
I'm Anita Rao, and this is Embodied. So let's get one thing straight. If you're under the impression that sex therapy involves having sex in front of or with a therapist, that is just not the case. Misconceptions like this one aren't plentiful, but, at its core, sex therapy is a profession that helps people get curious about how they relate to pleasure, intimacy and their physical body.
Dr. Lauren Walker
Different therapists have different focuses, but I could speak to what I deal a lot with, which is people who would describe having a sexual difficulty. So this would be some area of their sexuality that they may be struggling with or that they wish was improved in some way.
Anita Rao
That's Dr. Lauren Walker. She's a registered clinical psychologist and associate professor at the University of Calgary.
Dr. Lauren Walker
Sometimes it's people who are wanting to get a little bit more confident about their sexuality or improve their communication skills, perhaps with a partner. And other times it's people who come and say: There's something going on with my body, or there's something going on that's really just not feeling right for me. Maybe they have difficulty with arousal, or difficulty experiencing orgasm, or difficulty with desire. So I do tend to see a lot of folks who would say: Something's not quite right, and can you help me out with that?
Anita Rao
Sex therapy as it exists today is a relatively new field. If you watch the show Masters of Sex like I did, you know some of this history already. But for those of you who didn't, the term "sex therapy" was first used in 1958 by gynecologist and sexuality researcher William Masters. He and his then wife, Virginia Johnson, developed early techniques for sex therapy in the 1960s. Since then, the sexual medicine profession has grown to fold in psychologists, social workers and physicians. You can go to sex therapy solo, or with a partner or multiple partners. Lauren mentioned a few common reasons folks seek out sex therapy and talked in depth about one in particular: mismatched desire between partners.
Dr. Lauren Walker
People always are bringing in their expectations about what they think is right, what they think they should be doing, and if they don't meet those expectations, then they often feel like there's something wrong with them. And we need to examine where those beliefs come from. Our sources of information are really biased. We often get our information from media, from movies, from pornography — where we really don't have a sense of what real sex is like. We just see what is presented to us on the screen in kind of an idealistic fashion, and when you actually sit down and look at the science, you look at what we know about human sexuality, we realize that there are multiple models of desire. That the model we learn about in film is this spontaneous desire that just comes out of nowhere and makes us feel really excited and really interested — almost ravenous for sex. And for a lot of people, that model just doesn't really fit.
And we know from the science that there is a lot of really good evidence that for many people, desire can come and be quite strong. Once we're in a sexual scenario, and we start feeling sexy, and we have some stimuli around us that kind of get us going, that's when we start to feel desire. So I work with couples to help them access that, in the absence of maybe more of that spontaneous desire that they've learned to expect from themselves from media.
Anita Rao
That's so helpful. And it brings me to the point that I'd love for you to address, kind of, how you define sexuality and helping us frame that for this conversation. We're not just talking about what happens in a bedroom between two partners when we're talking about sexuality and healthy sexuality.
Dr. Lauren Walker
Absolutely, I think a big misconception is that sex is strictly about what is done between genitals. So particular types of genitals, particular types of activities, but I like to think about sexuality as more of a way that we conceptualize ourselves or view ourselves that even if we're not engaging directly in sexual activities, that we can still view ourselves as a sexual person. For example, we can have sexual thoughts, we can have connections with our body in terms of sensations — I often liken it to other ways of being sensual with ourselves. For example, you may find that you're dancing, or you're listening to music, or creating art or exercising even in a way where you're feeling empowered and strengthened within your body, and you can still feel sexy, and you can feel sexual. So I do like to look at sexuality as a much more broad phenomenon than just what kinds of activities people are engaging in with their genital organs.
Anita Rao
In addition to learning new stuff, particularly about sex, y'all know that I'm also a big fan of unlearning things to make way for the new. That's something that sex therapists work on too.
Dani Leah Strauss
Hi, my name is Dani Leah Strauss and I'm a sex, intimacy and embodiment therapist. There are so many layers of conditioning around sex: who we're meant to be, how we're meant to look, how we're meant to act. That's a huge part of the process of intimacy therapy — at least how I have learned it and practiced it — is about unlearning. Unlearning all of the scripts and the boxes and the cis-heteronormative structures that have confined us to have such limited imagination around what sex can be and what we want sex to be. The journey of sex and intimacy therapy for me is actually about reinvigorating our desire for aliveness and for our own wildness to come forward., to welcome the parts of us that have long been hidden because we've learned that they're unwelcome.
Anita Rao
Unlearning is critical when unpacking our relationship to sex. Because how we feel in our bodies is shaped by systems of oppression, like racism.
Dr. Donna Oriowo
Unlearning is at the basis of what we do, and it needs to be at the basis because of how racialized sexuality is and how sexualized race is.
Anita Rao
Dr. Donna Oriowo is a sex and relationship therapist with a PhD in human sexuality. Her practice is focused on helping folks think about the links between colorism, texturism and their mental and sexual health. Texturism, if you haven't heard the term, is the preference for looser, straighter, smoother hair, and discrimination against other hair types. One of the things this discrimination leads to in the bedroom: disconnection between mind and body.
Dr. Donna Oriowo
Something that I have seen in working with Black women specifically is sort of a dis-embodiment that happens by way of their own hair, for example. So it's like: Oh, well, what type of hair is considered sexy hair? And if you close your eyes, and you think about that, Hollywood has already given you an idea of what is meant to be sexy. So if you don't already have that, then what do you do? How does that then impact how you show up in the bedroom at all? There's this idea called spectatoring where a person is no longer in their body, they're more looking down on the scene, they're trying to perform what it would mean to be sexy for their partner, as opposed to enjoying the sexy time that they have created with their partner.
Anita Rao
How do you unravel that? Like there's the intellectual work around noticing what it is? But how do you get folks to unravel that in terms of their partnership and how they are sexually?
Dr. Donna Oriowo
Well, usually, I like to say that if you don't understand that there is a problem, then there's nothing that you're going to solve. So first, we have to start there, because a lot of people are coming into therapy with the absurd idea that they are broken. And I'm like: Well, you're not a broken person, you have done adaptive things, and those things are no longer adaptive. We are looking to change to something that is more adaptive for you now. So with that, that means: Okay, what were you doing before? And where did you get these ideas? Where did you learn this idea of what it means to be sexy? Like, how do you describe it — what does sexy looks like? What does sexy act like? And let's talk about what you know about yourself. What part of sexy feels natural in the way that you have defined it and what parts don't feel natural? So really, I have them sort of redefine and broaden their own definition of what it means to be sexy, so that they are actually included in sexy — not sexualized in the way that they have already been sexualized, by really, white supremacist heteronormativity.
Anita Rao
So Lauren, we have been talking about disconnection, and I would love for you to speak to the kinds of body disconnection you see specifically with folks who you work with who are in cancer treatment.
Dr. Lauren Walker
I see dis-embodiment so frequently when working with people who have been through cancer treatment, people who have had surgeries that have impacted their body — they've had perhaps organs removed, they have scars, they're dealing with the aftermath of having very invasive procedures to the body, which absolutely affects our capacity to connect with our body. In many cases, in order to be able to go through these kinds of procedures, people do disconnect from their body as a protective mechanism. And then after treatment, as they're recovering, they are still in that disconnect mode. They haven't re-engaged and reconnected with their body in a safe way.
And another significant component is the actual health care treatment experience. So when you typically go into a hospital, you may have several physicians of different specialties. You may have residents and fellows who are observing, and so sometimes people will describe feeling like almost a guinea pig, and so there's both the connection to self, and there's the experience of having been medicalized by other people. Then a partner is also impacted by this and they're wanting to respect their partner, and make sure they feel safe and comfortable, and they don't want to rush them to get back into sexual activities if they're not ready. And you know, there's a whole navigation of how do you know that you're ready to resume sexual activity following such a difficult experience as going through cancer treatment.
Anita Rao
Feeling disconnected and estranged from your body is uncomfortable, but also really normal. In addition to chronic pain, illness or a diagnosis, it's also a common experience during phases of a lot of hormonal fluctuations, like pregnancy, postpartum or menopause. Lauren helps people find healthy sexual connection, no matter what stage they're at, by encouraging them to ask one particular question: Where do you find the reward?
Dr. Lauren Walker
When we go into sexual encounters, hopefully we gain something by engaging in them. Hopefully we leave our sexual activities feeling some sense of pleasure or connection or empowerment — something that we get out of it where we feel good afterwards. And I think a lot of people forget about that or they get into a pattern of engaging in sex where they just do it because they should. And when you go into sex with those kinds of things motivating you, it's really unlikely that you're going to leave those encounters feeling that reward.
So often when I'm talking to people with low desire, I quote unquote that, because they are usually coming in and they're describing no rewards. Really, that makes sense, then if you're not getting anything out of it, why would you want to have sex? And so when it comes to cancer, and going through cancer treatment, I think it's important that we adjust what our expectations are in terms of reward. There may be limitations to capacity that are physical or mental, with regards to comfort, or fatigue, or pain, that these are all things that may come into play and influence a sexual experience. Maybe some of the activities that you used to engage in are just not accessible to you right now, and so I encourage couples to have a conversation about what can they still get out of sex, and what can they still enjoy with each other.
And remember, I'm always referring to sex as being this larger umbrella of the ways that we can intimately connect with our partners, and so it may mean that couples decide not to engage in intercourse or even not to engage in genital contact, but to still engage in cuddling and kissing, and maybe sexual talk or other ways of really being intimate together — and that might be temporary. We don't know how long that may last, but it still allows couples to have that reward accessible to them during treatment and following treatment.
Anita Rao
If you listened to our episode a few weeks ago about reimagining sex education, you may remember our conversation with sex therapist, Dr. Lexx Brown-James, and this snippet in particular about talking to kids about pleasure.
Dr. Lexx Brown-James
At this age, we talk about pleasure in our bodies, right? So it feels really good to laugh, but it doesn't feel really good to keep secrets. It feels really good to talk about surprises, it doesn't feel really good to hurt your friends or to be hurt by your friends. All of that is part of sexuality as well.
Anita Rao
That basic education about pleasure is not just for kids. Donna often helps grown up clients with that education too.
Dr. Donna Oriowo
White supremacist, patriarchal society and its capitalism, and all the things that sort of come with it, often follow us into the bedroom. It follows us with its ideas of who we are, what type of pleasure we are allowed to access and with whom we're allowed to share that access. So being able to strip away the ideas of what someone else told you and getting to the root of what it is that you are telling yourself, what brings you pleasure and to get people to get back into pleasure — I like to take it back to its basics. I'm talking the five senses, what are some things that bring you pleasure, that you've seen today, that you've smelled, that you've tasted, that you've heard, that you've touched, and getting people to get into that space, so that they can remind themselves that their body is like this beautiful lightning rod of information. And it is constantly processing both things that feel good and things that don't.
Anita Rao
I love that. And it's part of kind of rewriting that script that we've talked about — about what sex means and what it can look like. And you really look work with folks on kind of how these scripts that are inherited are often not inclusive of Black sexuality. So tell me more about what you mean by that and what Black sexuality is.
Dr. Donna Oriowo
Black sexuality is sexuality specifically for Black people. Keeping in mind all of the things that have defined our sexuality for us. So Black women, for example, often only get access to the Jezebel, the Mammy and the Sapphire. Black men often get relegated to the Black Buck. So, Black Bucks are big, they're huge. They are very sexually voracious. That's all they want all the time, and the rhetoric around it, particularly from racist, white America has been about like: Oh, we got to keep these people away from our pure white women.
And for Black women, the Mammy is often thought of as dark skin with kinky hair, maybe she wears a headscarf. So you can think, like, the old bottle of Aunt Jemima's syrup. And she is asexualized. She is said to not be sexually desirable at all. Then you have the Sapphire. Basically, it's this Black woman that has this attitude, and she is emasculating and you must dominate her sexually in order to put her in her place. It makes consent from Black women in particular, almost like somewhat unheard of. It's like: Well, you have to dominate her and you are doing your job by dominating her by not listening to her no. And then the Jezebel is this supposedly light skin with maybe long, wavy hair, and is said to be so sexual that she borders on masculinity. And she constantly, is in a constant heat or desire for sex, that to have sex with her is to do her a favor. But these things often strip Black women specifically of their agency, and for Black people as a whole it strips us of our humanity.
Anita Rao
When you've recognized all the ways you've been programmed to believe a certain type of sexuality is right or wrong, how do you call in a sexual partner to build something new with you that values your own unique preferences and desires? Dr. Donna says you've got to start the conversation by addressing power.
Dr. Donna Oriowo
Being able to talk about power: what it is, who has it and how it is used within the context of their relationship with self, with partner, with family, with friends and at the workplace — all these places. It's important to do because I think that oftentimes we think that our bedrooms are this beautiful, sacred white slate where nothing else touches it. But the fact that you left your house today, or engaged on the internet for those of us who are still working from home — it means that all of these ideas are still coming in to the bedroom, they're still coming into the interactions, it's still coming into how you build your relationship. I mean, the orgasm gap, if that's not evidence, what is?
Anita Rao
The therapy room is a great place to unpack and reset. It's a safe space. But then you get on your Twitter feed, watch a TikTok your friend sent you or browse erotica, and you start to get confused again. Is this messaging harmful? Empowering? Ah. Reframe with Donna's support.
Dr. Donna Oriowo
When you watch this thing, what are they telling you? What are they not telling you? And often I say if you are feeling pretty crappy, someone is probably trying to sell you something. Who's trying to sell you something and what are they trying to tell you about your life as it is in this moment? I'm thinking about the dual control model, about brakes and accelerators. So specifically thinking: Okay, what are the things that are hitting the brakes for your sexual enjoyment for you moving forward? What are the things that are hitting the accelerators? What are the things that say yes, go go go, let's have awesome, great sexual experiences in my primary or other relationships? And what are the things that say: Tap the brakes, don't do that.
By the time people add up all the things that are sort of tapping the brakes, some of it is other people's expectations, their own, other people's definitions, something that they saw on TV that made them feel some type of way — and so we begin to unpack those things. And really getting into a space of deciding what is for them to keep? What is for them to trash? And what might they want to return to sender? And when I say return to sender, sometimes that means who can you have a conversation with about this thing that has invited itself into your sexual relationship, either with self or others, that you — maybe want to write a letter or maybe you want to have a phone call if it's a friend or family member or something, and really get them to stop shoveling their garbage into your yard.
So it ends up being a lot about boundary-building. So setting the boundaries, but also enforcing the boundaries. And for that I use a lot of bibliotherapy. I'm really heavy into books. So I usually recommend like "Set Boundaries, Find Peace" by Nedra Glover Tawwab. When we are talking about their bodies and whether or not their bodies are allowed to be sexual bodies, I usually recommend the "The F*ck It Diet" by Carolina Dooner. And when it's about the color of those bodies, or whether or not their Black body is allowed to have pleasure, I might recommend "Pleasure Activism" by Adrienne Maree Brown. So I'm often recommending a book or let me read this quick message to you, and let's see what comes up for you because I am getting them to trust their own gut about what is right for them and their sex life.
Anita Rao
I love bibliotherapy. In addition to all of Donna's recs, I highly recommend "Mating In Captivity" by Esther Perel, and "Burnout" by Amelia Nagoski and Emily Nagoski. Both of those books helped me place my own thoughts about desire, arousal and stress in context and feel much less alone in my own sexual experience. Books also let me educate myself about sex when I wanted to and felt ready.
When I was living in New York City a decade ago, I went to a talk at a sex toy store. And one of the things I learned there that stuck with me ever since is that it's really important to make space to talk about intimacy and desire outside a sexual context, where there's no pressure to put things into practice right away. There are more and more tools for helping start these conversations, including some you can access directly from an everyday device — your smartphone.
Zoë Kors
I met the founder of Coral Isharna Walsh, and when I heard about what she was attempting to do, I found it incredibly exciting because we are so attached to our phones. So the idea of being able to have this resource in the palm of your hand, at any time, was super exciting for me.
Anita Rao
That's Zoë Kors. She's the resident sex and intimacy coach for an app called Coral. Coral is one of several smartphone apps on the market designed to support sexual wellness. They're not trying to replace in-person sex therapy, exactly. But they're trying to make sexual health information more widely accessible. Coral launched in 2019, but Zoë was professionally interested in intimacy and sexuality long before that, in part inspired by her own relationship experience.
Zoë Kors
I had a really wonderful marriage in all areas except for the bedroom, and I loved my husband very much. And he was beautiful inside and out. And somehow I completely had no desire for him. And at the time, in my 20s, there really wasn't anybody to talk to about it. And my gynecologist, I thought for sure, I had some sort of hormonal imbalance, and she assured me that I was a healthy young woman, and she did the blood tests that I wanted her to do. And in fact, she was correct. So we ended up together deciding, you know, to sort of complete the marriage, and I felt like he needed to go and find somebody who could love him in the way that he deserved, but it really set me on this path of discovery really trying to learn. I've been on a mission pretty much since then, to understand sexuality and mental health and relationships and how it's all related.
Anita Rao
Zoë has her own private coaching practice, but she was initially brought onto the Coral team to help with one of the key components of the app: helping users embody some of the new information they've learned.
Zoë Kors
We have a lot of information to sort of take up where our pretty much non-existent sex education in this country leaves off. Then we also have my favorite part of the app, maybe that's because this was originally why I was brought to Coral to create experiential exercises, which help our users really embody the concepts that they're learning about, and to have an opportunity to rewrite their scripts. And so some of the exercises are, you read them, and we have quizzes and polls, and all kinds of sort of interactive ways of engaging. But we also have this library of guided audio exercises, which can be anything from a meditation to exploring erogenous zones to more explicit sexual experiences where you put earphones in and can be guided through giving your partner a pleasurable experience.
Anita Rao
I'm curious about the community piece because I know — we've had Emily Nagoski, author of "Come As You Are" on the show. I know she also works with you on the app, and one of the things that she says is that at the end of the day, a lot of people are so soothed by just knowing that they're normal, and that they're not alone in whatever version of an experience of their sex or sexuality that they're having. And so I'm curious about the community piece of this app and how people connect on something like sexual struggles and the meaning that that has for folks?
Zoë Kors
It is one of the most robust areas of our app and our community is filled with — it's not unusual for us to talk about some of the comments and discussion threads in our team meetings and get emotional about them. Because our Coral users are so supportive and compassionate and validating of each other. It's really incredible. So we have discussion threads, you can post a comment, you can post a topic and then comment. Most of our users don't use their real names. So we get the opportunity to pick a user name, so that you can remain anonymous. We have a team of experts, myself included, sort of moderating the threads and contributing, and so that gives it a real sort of grounded feel.
Anita Rao
Of course, tech can't be the answer to all problems, and sometimes it really distracts us from getting in touch with our desires, or our feelings about our sexual life. It's important to recognize that if you need in-person help, that's something you should seek out.
Zoë Kors
If you have trouble actually taking action, if there's something that stops you from actually being able to take steps towards your goal, whether that's to be able to get out of your head in bed, or to master your erection or to increase emotional intimacy in your relationship — if you're having trouble taking the steps, even though you recognize that that's your goal, then it's probably appropriate for you to seek the help of a therapist in-person or through an app to be able to explore what is stopping you.
Anita Rao
A journey to sexual healing and discovery can look so many different ways. There's the apps, the in-person therapy, the supportive community. For me, honestly, doing these interviews and hosting this show is a big way I've learned more about myself and what's important to me regarding sex. So I'm going to throw it all the way back to an interview from one of the very first episodes of Embodied and leave you with an important lesson that rings true no matter where you are in your journey from sex educator Emily Nagoski herself.
Emily Nagoski
The way I boil this down is to say that pleasure isn't a measure of sexual response, sexual experiences. It's not how much you crave it, how often you do it, where you do, who you do it with, what positions — it's whether or not you like the sex that you have.
Anita Rao
Embodied is production of North Carolina Public Radio-WUNC, a listener-supported station. If you want to lend your support to this podcast and WUNC's other shows on demand, consider a contribution at wunc.org now. Incredible storytelling like you hear on Embodied is only possible because of listeners like you.
This episode was produced by Anthony Howard and Kaia Findlay. Amanda Magnus is our editor. Audrey Smith also produces for our show. Jenni Lawson is our sound engineer and Quilla wrote our theme music.
The show is supported by Weaver Street Market, a worker- and consumer-owned cooperative, selling organic and local food at four Triangle locations in North Carolina. Now featuring online shopping with next day pickup, WeaverStreetMarket.CoOp.
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Until next time, I'm Anita Rao, taking on the taboo with you.