← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Moment: Why You Feel “Broken” in Bed (And How to Stop Hating Your Body)
00:22:40
In this episode, Dr. Rena Malik, MD and Dr. Charmaine Borg discuss overcoming self-disgust, performance anxiety, and the role of intimacy in sexual wellbeing. They explore practical strategies to navigate negative self-perception and reveal how intimacy and connection can impact both pleasure and restful sleep.
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- [00:00]
A
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B
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A
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B
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A
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B
Think that sometimes people also develop a disgust towards themselves. Not necessarily a disgust towards like a specific body part or a specific odor or fluid, but more like, oh, I discussed that maybe the appearance of their body, maybe the performance of their body, maybe they just feel broken. That can then translate to sort of disgust. So how is that different? And how, and can that also be overcome similarly? Or is there a different approach?
- [01:26]
C
Yes. So what you're referring to we call self disgust and sometimes it overlaps very much with what we refer to as mental contamination. And we see this sometimes towards specific parts of themselves, but can also be, I think it's best phrased as the distance between your actual self and your ideal self. And some men experience it, for example, when they think of having sex with a younger person, for example, and they, they feel so much shame, so much disgust towards parts of like their being or when they, when a woman is sexually mistreated that they feel this yeah, like philosophical dirt. We on movies we watch people that have been cheated on or they cheated on their partner and then they are washing away this philosophical disgust is this philosophical dirt. I think this is the best way to see it and that's even more complex to unlearn when compared to the disgust towards external stimuli. And for this type of disgust, I would try to understand what is the cognitive snapshot of the person that is triggering this anxiety, this disgust towards their thoughts or parts of their being and try to focus on the positive aspects. The unlearning of this type of self disgust is very harsh. It's very, as I'm Saying it's way more complex than towards external stimuli. And I know of cases where they wash so intensely that they create.
- [03:22]
B
Yeah.
- [03:23]
C
Wounds on their skin because they want to really wash it away. And the pilot study that I have read some years ago used for, so it was more for mental contamination. But it's very similar to self disgust. Use this imaging rescripturing that when you are like when the skin of the snake is changed, that they first send them to search for information and then they look up the information to understand how quickly the mucosa and the skin changes. So then they understand cognitively that the skin that they have now is very different than the skin that they had when they were misused as a child. So they cognitively understand that now this skin is new. The skin has nothing to do with the skin of when you were an abused child. And in addition to that, they applied strategies on how you imagine yourself now as a snake, removing this skin and having fresh new skin. So I think these strategies or similar strategies can help you unlearn disgust towards the self. When they are taught it becomes even deeper, it becomes even more complex. But I would find strategies specific to that, to that person and to that particular trigger to try to unlearn it.
- [05:04]
B
Let's give an example. Someone who maybe is struggling with erectile dysfunction or something like premature ejaculation, where they are now feeling like, oh, my body's now not functioning the way I want it to. And they're feeling disgust at themselves. How, what's, what are things that they could use, like what are actionable tips that they could do to help them sort of work through those thoughts so that they don't feel that disgust.
- [05:29]
C
Yes. So I think when men and women, men when they have premature ejaculation or erectile dysfunction or delayed ejaculation, they do say things like, I don't feel a complete man or a woman with vaginism. They say I don't feel a complete woman, don't feel normal. And they have, they focus very much of I'm failing, I'm not complete. So they won't use the words like I'm disgusted or yeah, it's more about that they are failing. So it's from a very judgmental stance. And I would say that the culture, the sexual scripts and the culture that we have now, at some point we were very much neglecting female sexual. Sexual pleasure like we were. And I'm guilty of that as well, that we focus very much on re examining and try to put now woman sexual pleasure on a platform. But in this process, I believe very much neglected or impose certain ideas on men. But men are under tremendous pressure. They need to come not too late, not too early. Always be ready and steady. And I think now it's a very anxiety state to be in in a way. So I feel it is. It might be helpful to focus from the judgment to really exploring to try to understand rather than oh, I'm failing again, I'm not gonna do it again. To really stay with the feeling of what am I feeling now? How do I like it? Like exploration rather than a judgment point of view. So. So in this scenario I wouldn't associate it so much with the pool of literature and data and discussed, but more about moving from judgment towards more exploration and giving time and play and joy rather than like. I have one of my colleagues who always says, Kober Eisenman, sex is not a performance sport. And it's the same what Esther Perel says. It's a place you go, right? Not not what something you do. And I strongly believe that the fact we're focusing on how in time we come not too late or not too early, it's very much focused on performance. I think sex, it's really about being about enjoying. And it's good to crack a joke and to be together and give time. It doesn't need to be a task. We have so many tasks and especially in long term relationships, sex becomes a task, yet another task. And because of that, and this is more common indeed in long term relationships where we also conducted some studies on. On this where because sex is now on the back burner, we don't give time, we don't have time for it. So we do it as quickly as is possible. So we don't have time for pleasure, we don't have time to really be. And this is why I say for women it increases the risk of pain. And we know the high incidence of pain during intercourse in women is way more higher than we used to think. But in addition to that for men, we're not. It's not because we see an erection, there is a pleasure, but it really creates anxiety. And. And then we see more problems of delayed ejaculation or, or if you have a problem with coming girly, this is fueled with this anxiety because the pleasure is sucked out of this environment. And yeah I think like from the background or the beginning of sex because it was so associated with reproduction and with male with main focus, as soon as the erection is no longer there, then sex ends. But this should not Be so right. I think so you do it quickly, you do it fast. So erection is gone. Then, then sex ends. That's a task without. We do it quickly, check. But we do not give time to really enjoy and, and have fun. Like Craig's joke. Really like this is something that we don't do or do less. When you have less time in the beginning of a relationship, you go to a place, you have many hours to enjoy each other. But this changes when you have a family, when you have small children or a demanding job or all of this together.
- [10:16]
B
Absolutely. Sex is play, right? And I think, yeah, there, there needs to be a focus on, on sex being playful and a reason to connect. Not just the act of sex, but it's really about being intimate with another human being and connecting with them. And so it's not about like the mechanics. Like we're not men are not robots and women are not always ready to go. Like there needs to be sort of a build up and a connection so that everyone can feel arousal and it can gradually build and lead to, you know, connection and eventually hopefully orgasm. And that brings me to my next point. You, you sort of did some research and I think a lot of people think that orgasms. And I do too. I did too, until I read your research. Orgasms reduce pain. But you had found something different. So explain that a little bit.
- [11:07]
C
So this is a research line conducted by or led by one of my PhD students who is now graduated. So doctor, I must say Lara Laxisi and she found in a series of studies that sexual arousal, so we had subjective sexual arousal does not, is not sufficient to reduce pain. But this does not contradict what you just said. So your idea, your hypothesis is still true because we believe you need more than just subjective sexual arousal. You need genital stimulation, you need orgasm for the pain to be reduced, for the tolerance to pain to be increased. And this idea, I had it from someone that asked, but don't you think that sexual arousal reduces pain? And we looked in the literature and indeed there was nothing but anecdotally, we know that women might masturbate if they feel a headache is coming or to feel better if they like an emotional release, which of course will help with the experience of pain. So we did not confirm the finding that subjective sexual arousal reduces pain. But there is some animal data and also orgasm studies that show that when there is Genesis stimulation and orgasm, it does reduce the experience of pain and increases tolerance to pain.
- [12:34]
B
Okay, so meaning that arousal itself, like, meaning just maybe watching something or fantasizing about something and doing the act of masturbation doesn't necessarily reduce pain. It's actually, you have to reach climax for the benefit of that to occur.
- [12:51]
C
I would say the genital stimulation will help in this process. We only looked at the sexual arousal, the subjective sexual arousal. So as you're saying passively watching a neurotic movie, orgasm would be a stronger input, but genetic stimulation will get you close to an orgasm. And we did these studies in a lab. So when you're in a lab, you expect 40 to 60 out of 100 subjective sexual arousal. So it's very far from orgasm or climax. So I think with Genesis simulation would get close to 80, 90, and that might have a stronger impact on the experience of pain.
- [13:30]
B
Meaning on a scale of arousal, like 40 to 60 out of 180 out of 100 towards like maximum arousal. Okay, okay. Interesting. The other thing that orgasm seems to help with is sleep. And you've done some research that I thought was really interesting that actually, of course, I think a lot of people can anecdotally understand that when they have an orgasm, they sleep better. Sometimes people actually use it as a means to fall asleep, but it's not just necessarily sometimes actually an orgasm, depending on how you get it. So by yourself or with another person can have an impact on the quality of. Of the restful sleep that you get.
- [14:07]
C
So this is another line led by another PhD student, Carlotta Osterling, that she also finished this year. So I was a happy supervisor. And she conducted a series of studies looking at the impact of sexual behavior on sleep. And again, I had an idea that discussing with friends that when you have a good sexual experience, most people feel they sleep better. And this is true as well for masturbation. However, in the literature there were only three studies. And we thought we want to really deeply look into this question. And we found that the masturbation with orgasm was perceived by both men and women equally, that it will help sleep retrospectively what they think. But when we looked at a diary study, we found that only intercourse with a partner will actually lead to better sleep latency. So how quickly you fall asleep and the feeling of restfulness, so how good you feel you slept. And this could be for many reasons. It could be that the feeling of safety with your partner, so intimacy driving the. The whole structure of falling asleep quickly. And I also remember when I had my. My children small, that when you, as soon as you hold them, they fall asleep and you put them in the cod and they start crying again. So it's more than sex or sexuality. I think it's. It has to do more with the intimacy. Skin to skin contact, feeling safe. On the other hand, we also know that orgasm will lead to a bigger hormonal release like prolactin and oxytocin. There are various aspects that can explain this finding. Then Carlotta conducted another study controlling for all these factors that we thought might be playing a role. And intimacy seems to be driving this data. Now another study that we haven't yet published, but works in the process, which we conducted with the University of Amsterdam in the Netherlands, it actually shows that intimacy is helpful for allowing you to fall asleep quicker and for the feeling of restfulness. But when it's medium intimacy, when it's with someone that you know, this is very different when it's a one night stand than this. High intimacy or what's considered a high intimacy will actually disrupt the sleep, makes you wake up very often during the night. So this was a qualitative study, the latter one that I'm mentioning and I find this very. Yeah. Interesting to look at it. I can imagine that when you're with a partner that, you know, the safety is also higher versus with someone that you know for a few days or a few weeks. So the intimacy might be higher, the excitement, the connection might be higher because it's more novel, but the safety might be less strong, the feeling of safety. So that makes you perhaps more aroused. I don't know how it works, but I have a lot of ideas what we can do to test this relationship.
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B
Yeah, I wonder if also say you had a very novel experience with your long term partner and intimacy was significantly higher, would you still, would that still hold true? Like is it just the in, is it the actual intimacy level or is it the, the type of stimuli that's creating the high intimacy? Right. Like if it's a new person, that makes sense from a safety standpoint. But if it's just like you're having a very intense experience, like you've tried something very novel with your partner who you feel safe with, will you still then, you know, sleep really well and feel safe?
- [18:12]
C
Yeah, I don't have data for that, but it's a very interesting question. I would say that once it is with the partner that you feel safe with, independent of the dose of intimacy, you will still have a stronger sleep.
- [18:29]
B
Yeah, I think that's, that's so fascinating. The other thing is, you know, you mentioned that like with a partner, you know, I think people will start asking like, what if you masturbate with your partner. What if you, you know, you're. You're like not touching each other, but you're masturbating next to each other? Like, is that going to be different? I'm sure you didn't study that, but what is your thoughts on.
- [18:48]
C
I haven't studied this, but it's a really good point. And I would say that if you're together, so you're naked in bed, still feeling safe, and perhaps body is still touching, you're still intimate. I would say that perhaps I would see it more on a continuum. So it would not be as much as if you're having intercourse, like connected as one to. To romanticize, perhaps, versus when you are masturbating next to each other. So it would be more somewhere in the middle. I wouldn't say it's similar to when you're masturbating alone. So somewhere closer to the intercourse.
- [19:35]
B
I suspect there's something about physical touch that plays a role just based on biology. Like maybe if you're caressing each other and you know, because I mean, some people can't. Like, females don't always orgasm through vaginal penetration, right? So like, if they're not orgasming, does that mean they're going to have less quality sleep? Right. Like if the orgasm is necessary for quality sleep, then, you know, okay, so say they do have intercourse and then she masturbates to finish, or he supports her in that and holds her. Like, I think that would still be the same in terms of quality sleep because you've been intimate, you've been close. But if it's like very separate but you feel connected, I think you still probably have to touch to get that. Activate those like c. Afferent fibers on the skin to tell you brain, you know, I think you probably have to touch. Yeah.
- [20:26]
C
Yes. The touch and the being naked together, I think that is what will trigger this effect. The intimacy, the medium intimacy.
- [20:35]
B
Yes. I mean, it makes sense. Like, you know, when I can't sleep, like, I'm like going to my husband to be like, hold me like I want to. I need help falling asleep. And it works, right? And I think there's a reason for that, right? Because it's that safety, that feeling of another person. I think the orgasm is just another added benefit, right. Because it releases such a tremendous amount of hormones and, and all, you know, those changes that happen in the brain that help calm you to this like, very relaxed state. But even just the intimacy of being together and touching and holding, I think is. Is really overall valuable for quality restful sleep.
- [21:10]
C
I agree. And I also feel when I'm on in a hotel and I'm alone that it's a different structure than what I'm used to. Then I feel, oh, I have so much time. I can really watch Netflix, read a book. I don't have this urge to fall asleep, but when I try to fall asleep, there is no way I can fall asleep. It takes me longer to fall asleep, I think because there is no. Not the usual environment that you have while if say my daughter is sleeping next to me, I will fall asleep easy as well. So I think it is this intimacy. It doesn't need to be sexual intimacy, but it's like bodies in close contact as the example that I gave of when the children were babies. Then you have this intimacy, the skin to skin contact. The relevance of touch is undeniable, I would say.
- [22:00]
B
If you like that clip with Dr. Charmaine Borg, make sure to check out the full episode right here.