Written by: Dr. Lori Brotto (she/her), PhD, Psychologist.
Edited by: Zahra Taboun (she/her).
The World Health Association recognizes sexual health as a fundamental component of general health and well-being. Sexual health 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 people 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 people who identify as women, large population-based surveys show that over 40% will experience a lasting sexual concern over the past year, regardless of age. And, there are two sexual pharmaceuticals approved by the Food and Drug Administration (FDA) to address women’s low desire, yet both have had minimal updates due to marginal improvements over placebo, and significant side-effects such as dizziness, sleepiness, and difficulties concentrating.
What we have lacked for a long time is an intervention that gets to the heart of why people experience sexual concerns.
What we have lacked for a long time is an intervention that gets to the heart of why people experience sexual concerns. There could be many reasons why a person struggles when it comes to sex, and often times, it is difficult to point a finger to any specific cause. However, for many, 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 people, in particular over the past year with the COVID-19 pandemic forcing lockdowns and social distance around the world, stress, distractions, and lack of sleep are major culprits in people’s waning sexual desire. A person 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.
It turns out that the answer to improving many of the most common sexual complaints is right in our back pocket. It is paying attention. On purpose. And moment-by-moment. This mindfulness. 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. Many of us can be very judgmental of ourselves, especially when it comes to sex. Mindfulness is a skill that helps us 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 in particular be less judgmental, to be much more present during sexual activity, and ultimately to have improved sexual desire and arousal.
It is paying attention. On purpose. And moment-by-moment.
I often encourage participants to really pay attention to the points of contact between their body and their partner’s body during sexual activity. Surprisingly, our participants 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.
One exercise that we teach people who attend our mindful sex 8-week group sessions is mindfulness of breath. It involves guiding participants 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 people 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.
Our work has shown mindfulness to improve sex-related distress, or in other words, group participants 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 participants are with many aspects of their sexual response and life, they had a 60% improvement in this domain. And, these benefits are retained a year later when participants are re-assessed!
So where to go from here? There is no short-changing the importance of the formal “on the pillow” practice. For people 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.
Mindfulness takes advantage of a skill that everyone already possesses: that of being present.
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. Of key importance is that 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. And this is available to everyone.
