← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Moment: The Myth of “Sex Should Be Natural” — Why Good Sex Actually Takes Work ft. Dr. Charmaine Borg
00:23:43
In this episode, Dr. Rena Malik and Dr. Charmaine Borg discuss how sexual arousal can reduce feelings of disgust and share strategies for addressing discomfort in intimate relationships. They also highlight the innovative INV bracelet, designed to use aversive odors as a means of protection, and offer practical advice for improving communication and intimacy.
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- [00:01]
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- [00:32]
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- [01:01]
Interviewer / Podcast Host
A specific body part is disgusting, let's say for example, you find you like you give an example, the head of the penis, I don't know, for whatever reason you find it off putting as a female or as a male, you all of a sudden find the odor of your partner unappealing. Basically what you're saying is think about, okay, this organ provides me a lot of pleasure and just continually expose yourself to it. Like kind of focus on the positive and just keep having sex or being intimate or viewing that body part. Is that what you're sort of saying?
- [01:37]
Dr. Charmaine Borg
Yes, exactly. So more prolonged physical contacts. And if it's say the vaginal fluid, I would really encourage the client to stick with it. Like to touch it, to let it dry on the fingers till you get used to it. The other, it's quite difficult to get used to it because other is so implicit when you have a very disgusting aversive order. It's not as simple to say stick with it because I think it's minimizing, it's suppressing the arousal part, the sexual arousal part. So it's again, it's an interplay constantly. So I would try to focus on increasing sexual arousal by maybe distracting away for this from this other and focusing more on what gives you pleasure. And I think practical things in this case like, like adding candles or specific perfumes that can outshadow this particular other body lotion. So I would think in this case I would more focus on things outside of the box rather than focusing on that specific odor because we Know, once the other is there, it's difficult to use counter conditioning, for example, to now start liking that other. That's very hard to work in that direction, I guess.
- [02:57]
Interviewer / Podcast Host
I'm listening to this and I'm like, okay, is it all worth it? Like, I think it depends on your individual relationship with that person. Right. And like, is it valuable to you? But it seems like it could be a very uncomfortable and sort of like just an uncomfortable situation where you just feel like you're forcing yourself to do something that you really don't want to do. And particularly that involves sex. So then it sort of. Are you now linking sex with this, like, sort of uncomfortable feeling of being, putting yourself in a situation that's uncomfortable? And now sex has overall, like, you're now associating sex with this discomfort.
- [03:31]
Dr. Charmaine Borg
So I would say never go for sex if you feel discomfort. If you have pain or.
- [03:37]
Interviewer / Podcast Host
I mean the discomfort of like dealing with whatever the stimulus is that's causing you disgust, not specifically pain or, or like the actual act of sex is feeling forced, but like the, it's. You're not feeling forced to have sex. You're feeling forced to have prolonged contact with the thing that's causing you disgust because you really want to make it work. So does that then sort of transfer those negative feel things towards the act of intimacy?
- [04:01]
Dr. Charmaine Borg
Yes. So again, you need to study the case per case. However, it does not sit right with me to encourage someone to sit through something or to stay with something that makes them very uncomfortable during sex. Because as you're saying, this is the most raw, the most intimate part of your being. So I would very much focus on trying to use other perfumes, other stimuli to outshadow that. But sitting with it through to discomfort seems very harsh.
- [04:37]
Interviewer / Podcast Host
I'm trying to sort of understand because prolonged contact. Right. Means sort of sitting with it, but you're sort of saying like sit with it, but maybe not always in the bedroom, or if you're in the bedroom, try to focus on the other aspects of it. Right, that's sort of. I just, I'm trying to clarify for the. The audience is like, we don't mean like force yourself to, to be with someone when you're feeling disgust, maybe try to have contact with it outside of a sexual experience. And then also when you're in that sexual experience, highlight the other arousing things. Is that what you're saying?
- [05:08]
Dr. Charmaine Borg
Yes and no. I would say it's not easy. It's a complex situation. I would always start by working on sexual arousal, trying to Minimize the disgusting stimulus. Use other concrete aspects to overshadow or try to highlight the sensuality. Improve the context in order to minimize the disgust capacity. Now, when I say prolonged physical contact, I'm thinking more about specific stimuli about the individual by themselves, like for example, the ejaculate or for example, vaginal fluids or some women experience their vulva as ugly skin and smelly of fish. So I would expose them with a mirror to try to get used to their genitals and then highlight the functionality of, for example, this fluid. So more at that aspect. I would have a hard time to encourage anyone to sit through the discomfort. Ideally, highlight the positives to minimize the capacity for the negative. So to say, trying to unlearn this gust remains to be very difficult. So working on pleasure and sexual arousal seems to be the more efficient way to go when you are having sex or an intimacy with another person.
- [06:42]
Interviewer / Podcast Host
Sure. So I guess when there's obviously a concrete thing like a, like a fluid that you can expose yourself to, that's a little bit easier because you can do that separately. But what if it's like a body part? Like how then do you. Because if it's your partner's body part, for example, like as a whole, like it's not a fluid, but just the body part, how do you expose yourself to that? I think is what I'm really getting at.
- [07:04]
Dr. Charmaine Borg
I would create a safe environment first and foremost. And once you start discussing. So by not looking at it or finding ways how to avoid contact with this part will probably elicit more negative emotions in, in your partner and in yourself as well. So I would say addressing this problem and creating a safe environment where you express what you're feeling, that you're not aroused and that this is distracting and disrupting your arousal might be difficult to approach such a topic. Especially if it's for example, an oncology related surgery or treatment that now elicits specific smells or the negative reaction in yourself. So it might be very painful and difficult to approach. However, I think if you put it on a platform in that I want you, I want to improve our well being and our sexual being because I want to be with you, I think you can turn it into more giving sex and erotic space for you to make connection and to be intimate together. So there is ways and ways, but I would confront the issue and try to discuss it in a safe place. And in that way you are still offering a prolonged contact. You know, like it's not just exposure without any reinforcement, but you're really discussing it. In a safe environment, as I said. And by trying to highlight the positives of this relationship and why you want to improve it because this person is so meaningful for you, I think that.
- [08:50]
Interviewer / Podcast Host
In theory sounds wonderful. I think that in reality, people feel very, they love this person potentially if they're trying to work, you know, through this potential feeling of disgust, they obviously love this person or care for them deeply, so they don't want to hurt their feelings. And you know, it's sort of like a very affront to someone's self esteem to say, hey, this part of you I just don't find appealing. Right. You might not say disgust me. That's a little bit of a harsh word. But I think you could say like, I'm, I'm struggling with finding this appealing all of a sudden. And I think that's really difficult for the other person to hear. And I think people realize that. Right. So I think that's also, if you have any tips on how to sort of talk through that sort of thing. Being mindful of, of sort of a place I know, like in, in other countries, like not in the US Sex is much more accepted. Talking about sex is much easier. But like in the us people tend to not talk as much about sex and they sort of struggle with that.
- [09:42]
Dr. Charmaine Borg
It totally makes sense. And I think this is not only for this particular item that now it's triggering aversion, but it's for sex in general, as you're saying. So when you have a partner with erectile disorder, delayed ejaculation, premature ejaculation, as soon as you encourage the person to speak with the partner, they say no, then it becomes too mechanical, I will hurt their feelings and it will become worse. Because now anxiety will feed the, and fuel the premature ejaculation, so to say, or whatever the condition is. So I think when you're discussing a sexual problem, there is always the fear that it will become mechanical, that it will hurt the feelings of your partner, that the relationship will change. I think the risk is of course always there. But my suggestion would be try to highlight the positives of the relationship that you are discussing. This problem because you want better sex, this better quality sex with this particular person out of love, out of affection, and because you find this person appealing. I think most clients come with this issue that say the partner wouldn't like to start therapy because she or he thinks it's very mechanical. And there is this myth that keeps on being said and reinforced. I believe that sex should be natural. If the relationship is great sex should be following and sex should be automatically great. You don't work on sex because that's something that everyone shall be good in this. So I think again, it's trying to find the right words and the right context to communicate, to give space to sex.
- [11:37]
Interviewer / Podcast Host
So I think that's, you know, that's great points. I think you have to sort of invest in sex and sex is not always going to be good. And of course it does require practice and work and dedication to have a good sex life. Right. And to maintain a good healthy sex life. So I want to switch gears a little bit. You had actually your work on disgust led to this creation of a bracelet essentially which was called the envy bracelet, which was a device that was basically designed to emit a very foul odor so that attackers, if you were being attacked sexually, would be turned off and disgusted and hopefully not proceed with the sexual attack. So tell me, how did that, that come about and does that actually work?
- [12:21]
Dr. Charmaine Borg
The start of this envy bracelet was founded by the idea that sexual stimuli are disgusting. So how do we have sex? Like if sexual stimuli are disgusting, how we approach and come in contact with these stimuli? And we conducted an experiment where we induced sexual arousal and provided 90 women with very disgusting stimuli, disgusting behaviors that they had to conduct. And the group that were in with sexual arousal induction, they perceive these stimuli as less disgusting and conducted more tasks. So there we confirmed that sexual arousal lowers the subjective feelings of disgust, but also independently increase the willingness to come in contact with these previously considered disgusting stimuli. So that's the impact of sexual arousal on disgust.
- [13:17]
Interviewer / Podcast Host
Let's go into the nitty gritty there. So what were the women asked to do for to elicit disgust and what were, I'm assuming the men if this was a study, like what were were they watching erotic films to get aroused? Like what sort of what? Tell me a little bit more about what happened in the study.
- [13:36]
Dr. Charmaine Borg
Yes, the study was quite simple in its design. So I had 90 women, 30 in each group. We had three groups, an erotic group where they had to watch indeed female friendly erotica, then sexual arousal group and they had to watch people, couples and interaction, but with no sexual connotation. And the group that were watching the video via Norway or something like this. And then we had 5 minutes video to induce the mood and then 2 minutes video again, 2 tasks, 2 minutes videos, etc. Till we had 16 tasks conducted. We did it this way. So we keep a proper satiation of sexual arousal throughout the study. Otherwise the sexual arousal will withdraw and then you cannot really say that sexual arousal driving this behavior. But what we could confirm is that indeed, sexual arousal reduced disgust. The tasks were extremely disgusting. For example, we had a cookie with a living worm and they had to take a bite from the biscuit. We had a cockroach in a cup with water that they had to take a sip from. And we had very intense behavioral experiments, which I now feel very anxious to repeat. But this was quite some years ago, and apparently I was more disinhibited then. But we had a dog penetrating a woman and the woman had to say on the mic, I, Charmaine, for example. So the name feel very horny with the dog inside me. And you could see that the emg. So the measuring of the levator here, which is a unique physiological marker of disgust, explodes. Right, Like. And they would really say, almost whisper, because they couldn't bring themselves to say their names. They would say Jeremy, because they just can't. But it was very clear that sexual arousal drove these women to conduct a higher percentage of tasks compared to the woman in the general arousal or in the neutral group.
- [15:48]
Interviewer / Podcast Host
The ability to overcome disgust was based on how many sort of activities they completed.
- [15:54]
Dr. Charmaine Borg
Yes. And how they rate them. So we had the EMG measurement, the levator measurement, as I said, as a unique physiological marker of disgust. And the subjective ratings. So how disgusting. They find these tasks before and after completion of the task and the number of tasks completed of these behavioral tasks.
- [16:19]
Interviewer / Podcast Host
Have you done this work in men too?
- [16:21]
Dr. Charmaine Borg
No, we have done this study in women because at that time I was really focusing on women with vaginismus, women that have sexual pain disorders and dyspareunia now the gppd. And at that time, I wanted to understand how these women are expressing disgust in the fmri, in the scanner, versus sexual arousal to penetration specific stimuli, like the stimuli that are creating most anxiety in these women. So that kind of led me to try to understand if indeed sexual arousal is lowering this disgust that we're seeing or not. We confirmed that hypothesis. And at some point, quite some years after Rule, who is an innovation scientist, he told me, I read your study, and I really would like to test the other side of the story. I want to look how disgust can kill sexual arousal. And at first, to be honest, I kind of could not understand his reasoning. I was like, that's not what I do, really. But he had a very compelling story why it's relevant to kill genital sexual arousal, for a lack of better word. At the time, I thought very hard. Together with the team, I was working with what we can do to test the impact of this gast on genital arousal. And the study now was with men. And we discuss the using smell. Because odor can be controlled better. And once you learn it by an odor, while the aversive smell is learned by the disgust is learned by a smell, it's even harder to unlearn. It sticks more. And we indeed done the study with a lot of help and different dialogues with various professors from chemistry universities in the Netherlands and also in the US we came up with a smell that we couldn't use via what it's called an olfactometer. And this smell will be in puffs. In a number of puffs. The smell that we used was diluted 1 in 100,000. So it was a highly diluted smell. In the bracelet, the actual neat smell is used and we control this. This experiment was very well controlled. We had a solvent like smell in the other nostril then, because otherwise you can say yes, just because of the tube and the puff that the sexual arousal is lowered. So we controlled very, very well for this. And we could confirm that with the very first puffs, the group in the experimental condition, the erection was gone. Now what it means, of course it does not eliminate rape. So the bracelet is this. This is the inver bracelet. And with a man will move, you can break the smell tube here inside and the smell is released. Now, it doesn't eliminate rape, of course, because rape can be done with many other different aspects or things, but it gives space to the person to escape. And it has this very aversive component to it that the people in the surroundings will try to understand what's going on. It's like this threatening alarm almost that will withdraw people to try to understand what's going on. The problem with this bracelet, and I must say I have nothing in marketing or financial input from the bracelet, so let's put it out there. But what we're finding now is that over 65% of women under threat will freeze. So they won't be able to activate it. And this is not only for the INV bracelet, but for most of the safety tools that we have today. And the inva bracelet is doing very well in that it's being used in the hour of Congo, Burundi. And it's a lifeline really for people that have a high risk and high anxiety and fear to walk down the street alone and for people that were already victimized. So it's part of the prevention and treatment for these women. However, because of the problems that I'm saying that under threat, women do not respond, do not react, and if you're grabbed from behind, there is nothing you can do. We are now trying to understand, using VR, like the virtual reality lab, where we create a very threatening environment for women to try to understand first, how do they feel wearing the INV bracelet, wearing no bracelet, or wearing the NAI automated bracelet. But to try to understand the psychological and physiological stress. How are they responding? Is it really true that the confidence is increasing, that the person is feeling more safe, more confident? So that's one level of the study. And the data will be transferred to an AI department where they will study how the person is reacting physiologically to try to build an automatic activation of such a bracelet or any other tool that can be applied. This mechanism can be applied to. Of course, there's many challenges in this because if you are sporting, it can be activated. So you need to make sure there is a window where the person, if it's falsely activated, can switch it off or turn it off. So that's something. A project that we're starting with a new PhD student this November, which I'm looking very much forward to it. First to understand what. What are these safety tools doing to the individual, if they are really helping, and then eventually to hopefully develop something more automatic automation.
- [22:40]
Interviewer / Podcast Host
That's fascinating and I think that's really amazing to. To basically work sort of hacking into your normal biology to protect people. I think that's amazing. Yeah.
- [22:48]
Dr. Charmaine Borg
I feel very privileged that I had this opportunity also because it developed very organically, like it didn't. I didn't assume we will get here with the first studies that were conducted. As I said, we started with looking at women with sexual pain disorder. So to arrive at this stage, it's quite a privilege. Yes.
- [23:08]
Interviewer / Podcast Host
If you like that clip with Dr. Charmaine Borg, make sure to check out the full episode right here.