← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Why Couples Fight About Money… Then Stop Having Sex
01:27:22
In this episode, Dr. Rena Malik, MD talks with Dr. Heather Howard about how financial stress can impact intimacy and relationship dynamics. They discuss power imbalances, communication challenges, and ways to foster trust and pleasure, offering actionable insights for couples navigating money and sexual well-being.
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Marvel Television's Wonder man, an eight episode
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series now streaming on Disney.
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A superhero remake. Not exactly what we'd expect from an Oscar winning director. Action. Simon Williams audition for Wonder Man. I'm gonna need you to sign this. Assuming you don't have superpowers, I'll never work again. If anyone found out, my lips are sealed. Marvel Television's Wonder man all eight episodes now streaming only on Disney. If someone's feeling like they're car all the responsibility, all of the load for taking care of the family or, you know, making all the decisions, they may feel a little bit resentful, they may feel a little bit withdrawn. People were feeling like sex was all required, it was an obligation. I'd be afraid if I did, my partner might leave. And I'd say, and what would be wrong with that? And they'd say, well, they make all the money now. I left my job to care for the family. I don't know how I'd take care of myself. It's very hard for sex to be desired if it feels performative or it feels like it's a requirement. Distress isn't about whether we have enough. It's about our perception of distress around money. And it's our perception of imbalance and lack of autonomy. So people could be financially very well off, but it's how they perceive this that leads to how they really experience their world and how they feel in their relationship. If you have pelvic pain, you are broken. It's a common misconception. The cause of challenges in a sexual relationship is the partnership not being able to adjust to the changes in the partners.
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What if I told you that financial stress might be the real reason you're not enjoying sex with your partner? I'm Dr. Rena Malik, urologist and pelvic surgeon. And welcome back to The Rena Malik, M.D. podcast, your trusted guide for leveling up your health, relationships and sex life with evidence based tools. I'm joined by Dr. Heather Howard, a financial counselor and sex counselor and and someone who's dedicated her career to understanding how money and your sex life overlap. In this episode, we're diving into power imbalances in relationships, how financial stress kills desire, why duty sex happens when someone feels financially trapped, how separate bank accounts and retirement can change your relationship dynamic. And what happens when couples can't talk about money or sex. Before you dive in, I just have one small, small ask. If you guys are enjoying this podcast, do me a solid favor. Hit, hit, subscribe or follow wherever you're watching this podcast. It is zero cost to you and helps us immensely. All right, let's get into it. Thank you so much for joining us today. I'm so excited to have you.
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A
Thank you so much for inviting me. I'm really honored to be here.
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B
You have an interest in sex. Obviously, you're a sex counselor, and you have interest in finance. So I really want to talk about how those two mix in together. So how do issues with finance affect the sexual relationship?
- [02:55]
A
So I think what I find most is that women, we find power imbalances, and often there are financial power imbalances. If someone's feeling like they're carrying all the responsibility, all of the load for taking care of the family or, you know, making all the decisions, they may feel a little bit resentful, they may feel a little bit withdrawn. And as we know, sexuality has so many different variables that affect, you know, desire and the desire to connect. And so finance is one of the major reasons or, you know, differences that may cause people to disconnect. So carrying too much responsibility can cause people to withdraw or feeling completely disempowered, you know, feeling like someone doesn't have agency over their financial decisions in their lives.
- [03:39]
B
Being the person who doesn't. Doesn't have the financial power feels they don't have.
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A
That's right. So the imbalance itself, someone could be on either side of that and may feel really disconnected. Yeah.
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B
And does the person. Does it ever feel like the person who makes the more financial, let's say, gain in the relationship, they feel sometimes that they're owed sort of more intimacy.
- [04:02]
A
That happens. And so that. That can show up going back. You know, I started out in finance in the financial world, and then I had a health problem. And as I was recovering, I realized that sex, that it affected my sex life and my, you know, arousal affected my. My pain levels. And so I kind of found my way into the sex counseling world. So I was really focused for most of my career as a sex counselor once I made that transition. But money, Things were coming up over and over again with couples. And so back to your question. Can the person feel more owed if they make more money? Yes. They might feel like they're carrying way more of the load in, you know, in the relationship where they feel like they may be working more, they may be carrying more responsibility, and they really want their partners to meet them. And the way they want to feel met is sexually. And yet the partner, you know, the other partner may feel like, again, they don't have the same agency, the same autonomy. And they may feel as if they don't feel like an equal in the relationship, they may withdraw.
- [05:04]
B
And did this. Did you find that, like, people were connecting this, like. Or were you seeing the connection between finance and sex?
- [05:12]
A
So it was a lot. There were clients who, for instance, I'd be working with a partner with a relatively low desire, let's say, in a couple. And so, you know, and I would say, so how do we get you to a place where you feel that it's safe to say no? Because often people were feeling like sex was all required, it was an obligation, and they didn't feel like they really felt entitled to say no in their relationships. And so I was inquiring, how would you get to a place to say no? And they said, well, I'd be afraid if I did, my partner might leave. And I'd say, and what would be wrong with that? And they'd say, well, you know, they make all the money now. I left my job to care for the family. I don't know how I'd take care of myself. And so I thought, wow, wow. You know, if you don't feel like you have the right to. You don't feel like an equal in the relationship, and you don't feel like you can take care of yourself if you don't show up with this obligation, then how do we get you to a place where sex is something that you want? It's very hard for sex to be. To be desired if it feels performative or it feels like it's a requirement. So that was coming up over and over again, that connection. And so I realized I can't just address for. I mean, again, it depends on what the concern is someone seeing me for. But quite often it's the dynamic in the relationship and all of the social pressures that people may feel and all of the cultural messages about our roles in a relationship. And it just felt like I really couldn't. You can't treat sex in a vacuum.
- [06:44]
B
Yeah, absolutely. Absolutely. And I think that's a big problem that we have in society and in medicine is that we think sex is this, like, extracurricular thing, which is, like, supposed to be fun and, like, it's optional almost. But it creates, as you sort of described, and we'll get into your story, too, is. Is it creates so much havoc on your entire life when you're having problems in the bedroom. And that can, you know, go the gamut from having real biological problems or real psychological problems or, you know, it's usually both. And. And I think It's. It's a huge issue, but it's. It's so fascinating to me. Do you find that it has changed, that when people are financially both contributing that there's less of that discord?
- [07:22]
A
I do. I work with some couples with both sex and money, and some I work one or the other. But I find for those where there's an overlap, absolutely, when they feel that there's more transparency, when they feel that there's more partnering around their choices in life, around their savings, around their visions, they're really working towards a joint vision. They also feel more connected when it comes to sexual, you know, physical connection.
- [07:47]
B
So what kind of advice do you have for people who may not even realize that that's really the issue where they're feeling conflicted because they probably never even thought that far. They're just like, oh, I can't say no because of a variety of different reasons, but they've never really thought the steps, like, where this might be related to the fact that they feel, you know, like, bound to this person financially. How can one person identify that, and how do they sort of work through that with their partner?
- [08:13]
A
I would say, you know, the first thing is to question what. What would make you feel like you have the right to. To advocate for yourself, to say yes and to say no. You know, if the answer is, I can't afford that, then that would be a good indicator that maybe figuring out how to get to a place where you feel like you have autonomy, you can take care of yourself, that would be the first step. So how to get there? I mean, for some people, that would mean I haven't been bringing an income for a while, and I don't know that there's any way for me to feel like I'm going to have any power in this relationship unless I earn some money. That may be going out and finding a way to earn money so that you have something of yourself and you're in a better bargaining position. It may be figuring out a way to work together as a partner. And here we're talking about the financial overlap. You know, finding a way as a partner to talk to your partner and understand what would make them feel you're a contributor. So sometimes going to work and making money feels like it's a contribution. Sometimes it's simply, you know, being the one who takes care of the bills. Sometimes it's being able to talk about it openly and understand what keeps your partner up at night. Because often the person who feels more responsible and who's earning the Income is trying to figure out how they can make enough to cover the expenses. It also may be if. If you don't curb your spending, you know, you don't. You don't even know. Often what happens is it's not that someone's spending indiscriminately. It's that they don't even know where the line is.
- [09:46]
B
Yeah.
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A
Because they don't know.
- [09:48]
B
They don't make a budget or.
- [09:49]
A
Yeah, right. They have no idea. So they don't know that when they're out, you know, even shopping for groceries, that. That could be a strain to their partner because they don't really know where the line is. Similarly, I found a lot of cl. Because they don't know. They just keep themselves so far from any potential line that they don't ask for anything that they want. You know, just the not knowing can be really challenging. So I would say the most important step is to try to figure out how to open up a dialogue around money. But it's not just money. It's really. I think it's asking your partner, like, what keeps you up at night? What are you concerned about? What would make you feel like I'm, you know, I'm a partner for you or what?
- [10:30]
B
I can imagine that maybe people who don't contribute enough feel, you know, feel that. But their partner has no idea. Right. They really, like, have never even. Never crossed their mind. They're like, I love you. I appreciate you. I value you. They have no idea what's going on in the brain of the other partner.
- [10:49]
A
That's right. And this is where talking is so important. Most of us have zero modeling for talking about money or sex. And that's why it's really fun what I do, because I'm typically trying to bring out into the open things that have been really hidden or taboo, or we've just seen our parents fight about these things, or we. We feel like these are areas, you know, the only modeling we've had is really fighting or shutting down, so. Or worry. And so being able to learn how to talk about these things without judgment and feel like we're developing a partnership again, everything comes down to feeling like we're working together. So many of these challenges come from feeling like we're on to, you know, you're. You're an opponent versus you're my collaborator. And so if. If partners can start to see that the patterns that they're living in are the problem and try and improve their patterns.
- [11:43]
B
Yeah.
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A
Then they can be working together and really towards a Solution. Rather than feeling shame like they're the cause of the problems or resenting their partners for being the cause of problems,
- [11:54]
B
you think that sometimes the low desire is because of the stress. And once they sort of alleviate that thought that maybe like, oh, my partner might leave me because I'm not contributing, that they can actually enjoy sex again. Right. Like it may be that they're, it's become duty sex. Right. They're doing it because they feel like they have to, but when they realize they don't have to do it because they want to, they actually start finally enjoying it.
- [12:17]
A
That happens a lot. What I say to my clients is, you know, I, I'm not a prescriber like you, so I, I can't, I can't give someone drugs to help, but I can certainly refer them to someone like you who can do that. What I can help with is to try to red negative factors that can create some of that load. And that distress is the biggest one really. You know, feeling like, feeling like the cause of all the problems, feeling like we're letting our partner down, feeling like if we don't, if we don't do this to regulate our partner's emotions, they're going to be upset with us. Getting a couple to a place where it is okay to speak up, it's okay to work together towards a solution and you know, finally feeling like I'm allowed to feel into my own desires rather than feel like I'm just responding to yours, that can allow someone to ultimately get there. But that's a, it's a process to get people there. Yeah, it really is. But what I can do is to help reduce that stress so that, you know, once we get people in an optimal situation, then they can notice what, what their innate desires might be.
- [13:22]
B
So in addition to doing self reflection, what would it look like for a person who one may be financially stressed? Like, what can they do to sort of alleviate that stress? Because we know any stress is bad for sex. Right? So let's just talk about just that in general, someone who's having financial stressors whether they're contributing or not, or they're worried, you know, because maybe they, they don't know what the financial situation is. What would be sort of the first steps? You'd tell people to sort of navigate that and start taking some ownership and understanding their finances.
- [13:51]
A
Okay. So if, if we realize that financial stress is one of the major contributors, then it's taking a step and helping people get a handle on where they are. So sort of like some People don't even know where they are on the map. And so you know what it's like to feel lost. Right, when you don't even know where you are. Whereas if you can pull up a map and see where you are related to other things, you can already feel a lot calmer and more grounded. So we start with just taking. Taking a snapshot of where you are right now and helping people feel more educated. So it's really looking at how much do you bring in, what do you spend, you know, basics of budgeting. Often people think of budgeting as. As a form of. A form of control, where really I think of it as a form of having education and information so that you can have more power over your life. But so it's. So it's understanding where you stand, looking at the map, and then deciding where you want to go on the map. And that can often help people feel way more grounded from the beginning. Feeling like you can see the path towards your ultimate goal can help people feel a lot calmer. Whereas if you just feel lost and you don't know how to get out of distress at all, then it keeps you up at night.
- [15:00]
B
Yeah. And I think it's become a lot easier because a lot of the credit card companies, if you use credit cards, which I think most people do, they break down your spend. They tell you where you're spending money, they tell you your subscriptions. I mean, that's a huge place where people lose a lot of money. And I think that helps a lot just looking at that. And I'm guilty that I forget to look every now and then. And then I'm like, oh, I forgot to cancel this subscription. And so it can be frustrating, but I think it can be really helpful. And you can call and be like, hey, I forgot. They may not reimburse you completely. They might give you a couple months back. But, like, those sorts of things can be helpful. The other thing I've heard many times is that most Americans don't have any money in their savings or very little. So how do you tell people to start sort of thinking about savings and actually how much should they have?
- [15:46]
A
I don't tell people what they should do really, in my. They may be working with a financial planner to figure out what their targets are for retirement. But what I'll be doing is helping them first to identify their wishes and their goals and their visions. Without a vision, you know, I mean, I can't just say, pick out of thin air what someone should have. But what I can do is Say, all right, if we understand your vision now, what you want your life to look like, you know, is your goal to sleep better at night? Is your goal to be able to have enough to put your kids through school? Is your goal enough to be able to, you know, stop working by a certain age? Then once we know that, we can, we can operationalize that right? We can turn that into dollars and cents and figure out then what behavior changes would get someone there. But it's really, it starts with helping envision. And often when people are feeling stressed and they're feeling like they don't see a way forward, they stop dreaming, they stop envisioning. So being able to take a step back, you know, curb. Sometimes we want to figure out how to plug leaks right away. You know, what do we need to do to plug leaks or curb these things right away? But just to help someone see, you know, start to envision again and wish and see that there is a way out is important. For some people, that's a matter of negotiating debt. You know, they may be drowning in debt, but for a lot of my clients, they're actually, they're in a pretty good financial place, but they don't know when it's enough, and they don't know when it's okay to even enjoy what they have.
- [17:14]
B
I find that's a common thing. I mean, I'm an immigrant. I'm a daughter of an immigrant. Sorry, I'm a daughter of an immigrant. And my dad used to say, every napkin is one cent. I mean, that's the kind of budgeting he would do. And he knew the cost of everything. He knew. And because of it, we became very financially stable as I grew up, so I never had to worry. But I also learned the value of it. But to some degree. And I find this in a lot of people who are first generation immigrants. First generation people who grow up in the US Find that they are worried about money even when they're financially totally fine. And it sort of holds them back from making larger expenses or thinking it's too frivolous or the other way where they get money and they just go wild because they finally have.
- [18:01]
A
They never had it.
- [18:02]
B
And so there's definitely a lot of sort of thought work that goes into how you treat money.
- [18:07]
A
Yeah. Yeah. I think one of the most exciting things in my work is just working with people on their money histories. And it's really great to do with a couple because understanding, you know, sometimes we just have no idea why our partners do what they do. And we think that doesn't make any sense at all. It's not logical or doesn't make sense based on my conceptualization of money. But when we can understand more about their histories, their. Their models, their references, then it starts to make a lot more sense. And we can. We can be much kinder with their quirks and figure out, you know, is this a quirk that's serving you still or, you know, is it one that's actually becoming destructive? I mean, it's similar with sex, right? We have references, we have ideas about how things should be. We have our own histories, our own traumas, our own.
- [18:53]
B
And no one talks about it. Same thing with finances, right? No one really. There's a lot of judgment about finances, and I think it's more vocal, whereas judgment about sex is a little bit quieter. But I do think that, you know, there. There's a lot of it. And, you know, when we're talking about this, I'm thinking about a couple, actually, who is a good friend of mine, and the. The wife is not frugal, but, like, mindful about how she spends her money. She didn't grow up with any, you know, she was like, middle. Middle class, like, you know, fine. No. No financial history. The husband has a financial history where he grew up poor and he now has come into some wealth, and. And he's very extravagant on his expenses. And so they do have this struggle back and forth where she's like, look, this doesn't make sense. And he is like, oh, I finally come into these finances where I can enjoy my life. And I don't think either way is wrong. It's just about coming to like, hey, this is. How do we make that work together?
- [19:44]
A
Right? And what creates a sense of safety? I mean, that's the thing. If our partners are extravagant, we may worry that, you know, that we may run out. We may run out of money. And so if we feel like our partner has no sense of a limit, then we can feel really stressed. Whereas if we understand that our partners will only, you know, they. They want extravagant things, but they also know where the bottom line is, or, you know, they know where the limit is, then we can feel safe. But again, that's something that. That can be talked about between people.
- [20:15]
B
What about when the partner who is. Is financially doing well, right? Who's maybe supporting the family, sees the other partner not just like, overspending on groceries, but like, really being extravagant? How does that play in to their sex lives and their relationship?
- [20:29]
A
Yeah, I actually see this a lot where someone feels like I'm working so hard to take care of us. And everything I'm. All I'm working for is run is going out the door. Right. And, like, I can't ever get ahead. And it just kind of feels like someone's drowning and being able to talk to the partner and say, look, I feel really alone in this. I feel like I need your participation in this. And when you do these things, it leaves me feeling unsafe. And that's often a really great first conversation. It can be hard to have. But the partner may not understand how their choices or how their behavior is affecting the other partner. They may feel like, you work hard and you do it. We have enough.
- [21:08]
B
Right? Right. And that's really. I hear this a lot. And I think the challenge is men aren't taught this often happens. And less. Sorry. This often happens when it's a male partner and a male partner working in a female partner at home. Now, this is changing, but I've seen it a lot where the male partner feels this way. But they were never taught how to have conversations. They were never taught to be open with their feelings. Societally, men are told to just suck it up and be quiet. And it's a real. It's really challenging, I think, in those circumstances, because they just don't feel like they can say something because their partner, like, oh, we're fine, and they'll just shut down, and that's it.
- [21:44]
A
Right. And in a lot of families, it's like your job is. Or it's your responsibility to care for the family financially. No one even questions it. And so there are all these unquestioned narratives that we have either consciously or unconsciously, and both partners might be colluding on. And so being able to talk about these things and bring these out into the open and question them can be helpful. Where did you get that idea? I mean, same with sex. I have a lot of people who will come and say, well, females maybe in a heterosexual relationship may say, to me, sex is something that. That a man takes from a woman, and they'll just have. It's this notion they've always had. It's my job to protect my body, to protect my virginity, to protect my purity, to protect my family's reputation. Sex is something a man takes from me, so I have to protect that. And when someone has had that narrative, you can imagine then how that may affect your relationship. So again, we may have these narratives about money too. Right? It's my partner's job. I. I contribute in this way. Maybe my job is to Take care of the family, take care of the kids, and to be a good sexual partner and take care of them. It's their job to make sure all of our financial needs are met. Now these roles are changing, but even if they're changing, these underlying unspoken narratives may be controlling what we do. And we may not even recognize that they're in the room. I mean, you know, we have our ancestors in the room with us when it comes to sex. We have our ancestors in the room with us when it comes to money. And unless we're conscious of these things, they're going to continue to control us.
- [23:27]
B
And they're subconscious things too, right? Let's give this example, because it's not always the case, but let's say the male partner is like, well, that's your job is to be my sexual partner. And the partner feels like, yeah, that's my job. That's what I've been told to do. And there's. There's no. There's either one person feeling, like, resentful because they have to have duty sex, the other one's feeling, like, entitled because that's what. But they don't know they're even feeling it. Right. Because they've always been told that. And it's challenging. Because I think also as. As the sort of dynamic has changed over the years, we're actually seeing, if you look at demographic data, younger men are becoming more conservative in their views, whereas younger women are becoming more liberal in their views.
- [24:07]
A
That's right.
- [24:07]
B
And so there's more distribution disparity in that same thought process. Right. Whereas the conservative view would be that you stay home, you take care of the kids, you're my sexual partner, blah, blah, blah, blah. And that's just a normal thing. And the liberal view is, well, I have agency. And not to say that they don't think women have agency in these circumstances, but there's this underlying thought process. I don't think anyone. I think any good person thinks, oh, it's a duty of my wife. No, I don't think they think that consciously. I think it's just these are subconscious things, right?
- [24:41]
A
And it's like I'm showing my love and my care for my family in these particular ways or in these love languages, and I want to receive love back in these. In the ways that I envision. And without breaking it down consciously, we just don't. We're not aware of these. These narratives that really, once you say them out loud, they may not sound very good. Right.
- [25:01]
B
Like, as I'm saying, It I was like, oh, that doesn't sound great.
- [25:03]
A
Right, right, right. And again, like, when someone says, you know, sex is something that a man takes from a woman, it's like, that may not be what was consciously said, and that may not be, you know, what they've discussed with their partner. But when that's the underlying feeling until it's brought out into the light and we can really look at that and figure out if it really needs to be that way, it can be hard to overcome whatever challenges someone has.
- [25:28]
B
Yeah, absolutely. So when you look at couples who keep separate bank accounts, so I've always found this interesting because when I grew up, you know, my parents, they came to the US with $1,500 in debt. Like, they had no money to their name, and they built their wealth together. There was never a question about, you know, having separate bank accounts, even though my mom did work. I mean, she was a registered nurse and my dad had his own business, and so they worked, but there was never a question about that. And. And so it was always. When I first found out that, like, couples keep separate bank accounts, I was like, what? I literally. It blew my mind. And I don't think that's bad or good. I just had no idea. Like, I was naive to it. And so is there. Do you see a differ, the relationships between couples who keep separate spending money or bank accounts compared to those that join them?
- [26:17]
A
That's a really good question. I'm not sure I've ever. I've ever thought about. You know, I haven't really researched the differences between the two as much. What I would say is the people who can handle joint accounts well are ones where they have trust between them, and they also know that. They know that their partner has some. Some similar goal as them. And yet if they feel like they have very different goals or very different ways of wanting to spend the money, then it may be helpful to have some set aside for oneself so that they know what can be allocated for their spending. It can be challenging when someone feels like they have to hide their spending from their partners. You know, like, they come home from shopping and they hide all the shopping bags because they don't want their partner to see. And the question is why? And so I'm always curious about why someone feels they need to hide it. Is it that they just don't think their partner values that is, that they think they'd be judged? Would they be made fun of? You know, what are these things? And, you know, so I think it's really being Able to talk about these things and understand what is it that makes you feel safest when it comes to money is important. So a lot of people feel like they may have seen their parents. I mean, it sounds like your parents had a really great relationship and a great relationship when it came to money. But for people who didn't have those models where they saw their parents fight a lot or they saw one of their parents scraping by to make sure there was enough food, whereas the other partner may have just gone out and spent frivolously, they may feel like in order to make sure I know my family's safe, I need to know that I have a certain amount in my account to take care of my needs or my family's needs. And I need to be able to see that and know no one can get to that.
- [28:04]
B
Yeah.
- [28:05]
A
So again, it really depends on someone's history and what creates a sense of safety and trust.
- [28:12]
B
Yeah. I mean, I think it's fine as long as both partners are, like, okay with that. Right. Because I think it could be seen as a you don't trust me phenomenon as well. Right. And so it could go both ways.
- [28:24]
A
Yeah, yeah. And I mean, what I find sometimes it helps to have separate accounts and a joint account. Right. So where. If both partners are contributing or one partner's contributing, the joint account is where. And people will decide what comes out of each account, but it's intentional. So the joint account is where, you know, is where we put our fun money, you know, our vacation money or whatever. And so once that's done, once we see that that's depleted, then, okay, we know that we can't spend more until we put more money into it. Or this joint account is where all of our bills get paid out of. So we. That first. And, you know, we make sure there's. That's in there every month. And then everything else that we don't put in there is our own to spend how we want to, or we may be pulling out a certain amount for, you know, for 401k or for investing or, you know, but so I. It really, I don't think there's a right answer. I think there's ensuring that people understand how they're. How they're organizing their money and that they agree on it. I mean, I know in my relationship, you know, my partner and I both like to just know what we have in our own accounts to spend for ourselves and then know what we have for. For our expenses, our household expenses. So we like to know that there's Something that's just for us, that we don't have to worry about. Someone else might have depleted and we didn't realize it when we go to buy something. Yeah, right.
- [29:44]
B
Yeah.
- [29:45]
A
So it's just. It helps us to be more accountable, too, to know that I'm the one who's responsible for this amount.
- [29:50]
B
In some relationships, there's one partner who manages the finances, and that's sometimes a great thing, right? Because, like, you're like, I can't think that's one less chore for me to do. Or that's one less thing I have to think about. Or. Or they're just better at it. They can do the budgeting quickly or whatever it is. Do you find that as long as there's a discussion between the partners, that's fine, but do you find situations where, because there's someone else doing all the budgeting, the other partner has no idea? And then that creates stress and anxiety.
- [30:17]
A
Quite often the partner who may be managing it is doing it often as a gift to their partner. I'm good at this, or I take care of it. We're totally fine. I've seen the other partner who doesn't. Who's not really been tracking it, feel like, how much do I have to spend? You know, is it okay if I buy, If I. If I splurge on something? And they're asking permission at all turns, and they don't feel like, you know, like they have a right to do anything without asking permission. So I've seen that. You know, whereas one partner is seeing it as, I'm just trying to give you a gift to not worry, the other partner's like, I'm worried because I don't know. And so being able to talk openly in a way that both partners can understand. And that's the other thing. One partner might say, you have access to the books, or you can call our financial planner anytime. And the partner's like, that's great. But that language doesn't make sense to me. Like, what I really want to know is, like, how much can I spend every month and not strain our relationship? And they may be trying to contribute to the relationship by saving. So I've seen, you know, partners who aren't earning money, like clipping coupons, you know, online, or like, you know, waiting until everything's on sale, because that makes them feel like they're a contributor too, when they're not, they're not working, they're not bringing in cash anymore, you know, so they're doing what they can. Where as their partner's, like, feeling like, you know what? I really wish you wouldn't spend your time on that and you could actually just enjoy because we have enough. But what's enough is going to be really dependent on this, this couple and what their goals are.
- [31:52]
B
Yeah. And sometimes I can imagine that, like, doing those things, like, the partner's almost annoyed sometimes if it's taking away time from other things. Right. Potentially, like, and they're not valuing it because they don't think they need it.
- [32:04]
A
Right. They may not understand that this is a way the partner's trying to show their contribution, you know, because they may have stopped working to care for a family or, you know, their, their partner may earn way more money. And so they're helping in other ways in the house. But it may be, you know, it may be unpaid labor and, you know, they may feel like I'm not really contributing because I'm not bringing in money, whereas they may actually be contributing significantly. But I think it's really always down to how do the partners think about this, the distress. I mean, it's interesting when we look at the research, distress isn't about whether we have enough. It's about our perception of distress around money, and it's our perception of imbalance and lack of autonomy. So people could be financially very well off, but it's how they perceive this that leads to how, how they really experience their world and how they feel in their relationship, how safe they feel in their relationship, how trusting they feel. So anything that builds trust and safety financially is often going to help with their sex lives, typically, unless some people get off on riding the edge and they really like risk. But that's a whole different. That's a whole different topic and conversation.
- [33:20]
B
What percentage of people are stressed about their finances?
- [33:23]
A
You know, I, I would imagine a very large percentage. I don't know the actual numbers. It's a good question. But I will, I will look that up. And you're welcome to put that in your.
- [33:32]
B
I imagine it's quite high because, I mean, so what I'm, what I'm gathering from this conversation is like, this is very common and I think the perception piece is so important. Important because, look, I think I know a lot of, you know, well off physicians who, who struggle. Right. Or, or who perceive that they're struggling. Right. They're, they're fine, but they struggle because they have to make these bigger decisions about money, about what to do about money, how to protect their money, what's going to happen when they retire if they want to keep the lifestyle. They have all these sorts of questions that come up and, but they're, they're financially very well off. Right. They're, they're in the top percentiles of the country in terms of their economic well being. But they, and it's like rich people problems. Right. Like what are you worried about? Right. And we've all sort of, everyone has at some point worried about money. I can't imagine that there's absolutely, I can't imagine there's a single person who hasn't. But I think the perception piece is really, really important.
- [34:25]
A
It is the perception and really it comes down to when you're talking about people who are stressed about this, it may sound like a rich person problem, but they may not have a roadmap for it because perhaps they didn't ever see or how to live with money before. So they feel very out of their element. Right. They didn't know, they, they may know how to earn it, they don't know how to live with it.
- [34:48]
B
Yeah.
- [34:49]
A
So learning how to live with what you have and how to make sense of it when you're in another phase or state is important. And so that's an. Really people need some help with their financial adjustment. Really.
- [34:59]
B
Absolutely. And you know, I think the other thing is like the unknown. And I think that, I mean that even bothers people because in medicine we have very stable jobs, right. Like we're taking care of patients where there's always going to be, unfortunately, there's always going to be a need for physicians. So that's not as huge of an issue. But I find that people, when they're in positions where the income is dependent on sales or other sorts of factors, where it's really the unsure, like, am I going to be able to make money like I am right now? And I find that I think about that a lot with even the very, very wealthy. And like one, they live in excess, right. Because they have so much. But then they, they also like never know when their next job is coming. So they just keep working. And you're like, you have so much money, like, why are you still working so hard? And I think that's, that's the only thing I can conceptualize because I have never lived with that amount of wealth. But I imagine that that's what's going on.
- [35:55]
A
I think you're right. I mean, I think again, each person's story is different, but when someone doesn't have a consistent income or a consistent way to earn income, and as you, you Know some people who are like gig workers or who work project to project and they don't know where the next project's coming, then it can feel like really people are coming from a mind frame of deficit. Right. And at any moment, like, I might have something now, but I don't know how long this has to last me. I mean, it's been hard. I've been seeing a lot of my clients. You know, I'm up in the Bay Area, and a lot of my clients work in tech. And seeing people go from this market where they just felt like there was always money to come, you know, they. They went into the right field, they studied all the right things, and suddenly their jobs have been threatened, they've been losing their jobs. There's a lot of trauma that goes with that. And so they haven't. Suddenly they're like, wait, I have this money that I saved, but how long is this going to have to last me while I'm looking for my job or my next job? And so that's really scary. And, you know, one layoff is enough to make someone feel traumatized and never feel safe again. And then how does that again, affect the relationship? Affect intimacy?
- [37:07]
B
Yeah, it's crazy. What about retirement? So when people are retired, obviously they know if they have some pension or whatever, but they know what their income is, essentially, if there's any coming in and what they have. How do things change during retirement?
- [37:23]
A
Yeah, well, if people are lucky enough to get to a place where they can retire, they have enough. And they can. They then have a. They have knowledge of how much. How much they can spend. Right. In order to continue this indefinitely. You know, they can feel way more relaxed and they can learn how to enjoy what they have. But it's. It's the unknown that is difficult. Right. Often when people get to a place where, where they can retire and they've done it by choice, and they've been able to also choose when they retire, because that's another thing. If people are laid off and they just decide, well, I guess I'm retired, that's different than choosing the timing of it and again, feeling in control. But once people feel like they. They have been able to envision their lives and they are intentional about when they stop working, that leaves them in a place where they hopefully have been on top of their money up until then. So they're usually people who are way less stressed about money.
- [38:20]
B
Yeah, well, and you made a good point. The knowledge of, of being able to retire, they've probably spent some time doing some financial projections to know that they'll be okay.
- [38:30]
A
That's right. That's right. I mean, not everyone's lucky enough to retire, right? Not everyone's lucky enough to. They may be retired, someone may have retired them and they may not have what they need. But it is very different when someone has had the freedom to choose, you know, to have enough and to actually retire. And so when they do that, they usually have way more knowledge about where they are. And yet I have worked with some couples in retirement where they've had very different ideas, again, about what they have and how long it's going to last and how they should be spending their time and their money. And so again, just being able to get people in to talk about their visions and come to a joint vision is super important.
- [39:13]
B
You know, what I found a lot is that, and this is just anecdotal, is that people retire and then they, at least in high powered professions, they've worked so hard. They've been like long hours in the office. Then they come home and their partner's like, what do I do with you at home? I'm not used to having you around all this time and I don't know what to do with you and you don't know what to do with me. And so they just sort of are like, okay, now what? And they don't really have a passion project or something to keep them interested, so they go back to work.
- [39:45]
A
That's right. Yeah. I would say this is where both of my fields overlapping is so much fun because I really love working with people on envisioning, you know, and sometimes it comes with sex. Right. They haven't really been able to envision what they want. They've just kind of done what they thought they should do. They haven't really thought through what they, what they want, what they crave, what they may want financially as well they want to do with their lives. But I'm working with. I'm thinking of a couple couples that I'm working with right now that are in, that are working with me on both. And they've been. And they're in this transitional phase where they're nearing retirement and they're starting to envision what is a good retirement going to look like for us? How do we want to spend our lives? Now we've worked on helping our figuring out how we enjoy pleasure together. And this is sexual pleasure, but certainly all the ways in which we enjoy pleasure, not just sexual. And now what is this going to look like in our next Phase and how are we going to make a transition that works for us? So they're envisioning where they want to live. They're envisioning how much travel they want to do. Do they even need to have a house, or do they want to just move on to a cruise ship? But they're doing this early before they kind of reach this point, and suddenly they're stunned because now they have nothing to do tomorrow, and they never had a day like that before. So they're starting to make the transition now and learn what they enjoy that's separate from work so that they. They can then build that transition, right?
- [41:18]
B
And the same thing with sex, right? I think that people think, okay, I'm retired. We're going to have all this great sex. But they haven't had sex in a while, and so they. Things may not work the same way. They haven't really put the time and effort into maintaining their sexual lives. And so that's a part of what I talk about often is like, you know, you. You have to also maintain your body so that you can have the sex you want to, as when you're in your 70, your 80s, and your 90s, right? Because it will inevitably decline with. With age because your VO2 max is going to get lower. You're. You may start having blood flow issues, which will affect arousal in men. You may have changes in the vulva after menopause for women. And so so many things are gonna happen that will affect sexual function if you do nothing. And so I think that that's a big part of it too.
- [42:09]
A
It is, it is. And. And I think when people come to me and they're so out of the habit with sex jumping, right? It's like if you haven't been to the gym for a while, you don't go. And you do like the hard workout you used to do the last time you went to the gym, you have to work up to it, right? And so if your body has changed, if you now have joint pain or you can't find a comfortable position like you used to, rather than just trying to dive in the way you used to, it's time to reconnect and figure out how your body works today and what feels good today. I mean, I would say that to anyone at any time, transition in their lives, because our bodies do change all the time, and what we want changes all the time. Our nervous systems rewire. Things that used to feel good last year may not feel good anymore. And things that never felt good before or never Even seemed interesting might suddenly seem curious or interesting to us. So I would say starting with experimentation, when we talk about sexual adjustment, it really is experimenting and finding out what our bodies can do. Often sex. In order to have pleasure, we may need to be doing something for a period of time. Often people give up if they don't have a response right away. I'm sure you talk about this all the time. So people may have an idea of how quickly they're supposed to be. Right. They're supposed to be aroused or, you know, if I. If I do this, this should. I should. This should just feel good. And if it doesn't feel good, it means it's just not working.
- [43:33]
B
Yeah.
- [43:34]
A
And so this idea of it just doesn't work. Whereas, you know, I'm going to take a step back and say, well, tell me a little bit more about, you know, what were you trying? How long were you trying to. It. Can we make some little modifications or tweaks to see, you know, what. How this might feel? But rather than focusing on outcome, whether something works or doesn't work, we want to think about process and learning and just what we notice. And so helping people to readjust, it can be an experiment of noticing, noticing what feels good and doing a little more of that if it feels good. And then when it stops feeling good, maybe changing to something else, maybe sticking with something for a while before we decide it's not going to work. And instead we're just going to notice what we do feel. So I would say it's like we've been away from the gym for a while. Just like with sex, how do we get back into it? We don't know if we're going to ever build up to the same strength we were at before, the same endurance. But that's okay. We may not need that. Instead, we can figure out what we can do and slowly build to that. And sex is like more of a marathon than it is a sprint. And so we want people to be able to have the ability to be comfortable and to be able to be in positions for a while or do activities for a while that don't cause repetitive stress. So it's a matter of learning with our new bodies what we can do and how we can make some adjustments.
- [44:51]
B
Absolutely. And I think people really hate the idea of doing work around sex. And I always say that anything worth having is worth working for. And. And, you know, sex is a natural thing, but it's not something that you are always innate in terms of how to give pleasure. All the Time or receive pleasure. Right. It is something that may evolve, and it's okay to figure it out and to take time for it and to just, like, luxuriate in the experience of being with your partner. It doesn't always have to be the way it looked the last time. Even it can look different, and it can still be great.
- [45:29]
A
I think often people presume their sexual goals, and this is one of the other unspoken, unconscious narratives. Often that sex is about orgasm or sex is about my partner having an orgasm, or the sex is about, you know, whatever they think it's about, but they haven't really stepped back. And, you know, for a lot of people, when they really think it through and talk to their partners, sex is at the heart of it, about connecting. You talked earlier about. About challenges with sex and how our social cues matter. Sex is a social activity when it's between partners. And so when we start losing the ability to socialize, we can feel very isolated and broken. And so figuring out how to re socialize that could look different than the way it used to. I mean, you think about COVID right? And people used to do lots of things that suddenly they shut down in Covid and they're learning how to even get out of the house and socialize, like, literally socialize. They don't have the same endurance they used to. To hang out with people. You know, they need to spend more time at home or have more control over their schedules. Same with sex. Right. We have to learn how to re socialize after an injury or as we're aging or after childbirth. And so this adjustment that comes with learning about what. What our bodies experience is important, but also how we engage with another person with this new body, with this new state of being, with this new. Our new values is important. But it all. I feel like it starts with understanding what the goal is here. And often people don't even think it through. But the goal may be, I want to be close to you. Yeah, I want to connect with you. And for some times, it's. I feel like I have this incredible intense feeling in my body, and I need release. That's a different goal. And they're all valuable, but it's important to understand what's the priority here? What are you aiming for?
- [47:25]
B
And oftentimes, a lot of people mistake sex for just being close with someone. Right. Like, that's how they've been. That's the only time they're close with their partner. And so they're like, I need that because that is my time to be close. To my partner because we. Maybe they're not an affectionate couple. Maybe they don't hug and kiss and cuddle, and this might be the time that they do that. And I think that's also important. Important to realize when people are going through adjustments themselves and their partner is like the same. Right. They haven't necessarily had the trauma. Maybe they haven't had a baby, Maybe they haven't had an issue with their health. How do you tell them to talk to their partner about what they're experiencing?
- [48:02]
A
One of the biggest challenges with the adjustment is a partner's expectation that, you know, once my partner goes through this, they're going to be. They're going to be back to normal, whatever normal was before. And so often it's about. Sometimes it's really important to work with partnerships. I find it super important because often when someone's going through a health problem or a challenge, they have all the support in the world. They're going to see doctors, they maybe have been referred to therapy. They have support, but their partners have not been supported in the fact that they've lost that connection or the need. So I think being able to get support for both partners is important. I think having the understanding from the beginning that I may come out of this different and we're going to figure out what our new normal is going to look like together is super important. I think the partners that have been hoping, I don't think I see this all the time. The partners that have been hoping, just waiting and thinking, okay, once this is over, I'll get my life back. Everything's going to be back to normal. My partner is just going to be back, feel really disappointed and feel really hurt and often abandoned because they, they weren't expecting their partners to change. And so being able to support both partners and set realistic expectations of an adjustment is huge.
- [49:21]
B
I think that's such a good point. I never thought of it that way. Whereas, like, the partner's actually feeling abandoned. Right. Because they. They never were told that things might change irreversibly or they were never educated on that. And that's why I think it's so important, the conversations we have here. Because, you know, learning about yourself is important, but also learning about what other people go through and how, it doesn't mean it's the end, it just means it's different. And like, learning that, you know, you can work through this, but we all have to sort of manage our own expectations and our own feelings and thoughts.
- [49:53]
A
Yeah, I mean, I think of so conversations I Have with so many partners of people going through menopause, either surgical or natural menopause, and the fact that it changes how their brain. Their partner's brains work. It changes how their partner's, you know, perhaps their hunger for sex. They may no longer be hungry where they used to have hunger, you know, and then the partner feels like, why are they rejecting me? Not understanding that this can happen when your hormones change. This is a biological thing that happens. And how we experience the world, what are sensations like on our skin, you know, what. What we're hungry for, how hungry we are, that all changes. And so people feel like, you know, they're alone. Like, why did my partner abandon me? You know, what's wrong with me, that I'm not desirable anymore? Rather than understanding that this is actually something that happens for a lot of people when they go through these changes. And it doesn't mean that your relationship's broken or your partner doesn't love you or want you. It's just that that desire presents very differently. You know, they're showing up to meet you when they know that you're hungry is a way of showing that they love you and they want you. Even if they may no longer feel hunger themselves. Some people have never felt that hunger. But people can feel very alone. They feel left or abandoned.
- [51:10]
B
So for the person that might feel abandoned, right, where they're like, I just want my partner who used to enjoy sex, how can they start that conversation? Because I feel like when they try, I don't think they intentionally want to hurt their partner's feelings, but it's like, hey, why aren't we having sex anymore? That's the. The question, right? That's pretty much the most common question. And then the person's like, I just don't want it. And that's the end of the conversation. And it doesn't go any further. And then they feel even more abandoned. So how do you. How do you tell people to approach that conversation?
- [51:37]
A
Yeah, I mean, I happen to love structures of nonviolent communication where it's speaking about our experience. So, you know, not like, what's wrong? But rather, like, I've noticed a change. So it's like talking about what you objectively notice. I feel lonely or I feel unmet, you know, and what I need or what I may request from you is that we connect again. But I don't know what that looks like. So, you know, being able to use a language that's not blamey, you know, it's not just a yes, no, like why aren't we? But rather, I'm experiencing a change and, you know, I really want to be able to feel like we're connected again. I need that from you. I don't know what it looks like, though, but I need to have a conversation with you about it, you know, because otherwise I feel as growing apart.
- [52:23]
B
Yeah.
- [52:23]
A
So I think it's that way. It's really. I feel as separating or growing apart, and I miss my partner. The way we used to do that seems like it was sex. I don't know how to interpret the changes without talking to you about it.
- [52:37]
B
Yeah.
- [52:37]
A
And this is where having a sex counselor can be really helpful, you know, to normalize the conversation and help when emotions get really heated and someone's feeling really blamed, then, you know, to really be able to redirect and help. Help someone come up with a language that may be better.
- [52:55]
B
Well, I think the other issue is, I would love the idea of sex counselors is that how do you get that partner to go with you to the sex counselor? Right. Because that still requires a conversation. So if. If you. And again, I always tell people, like, it's not one conversation, it's many conversations. And so that's. Right. It's. It will take some time, but I find that after being rejected over and over again, it becomes very difficult. Right. And so I find that. How do you even get the person, the partner, to a sex counselor?
- [53:22]
A
Yeah, I think it's a good question. I think a lot of people are afraid to go because they think when they come to see me, I'm going to tell them, you have to start having sex again. So they're afraid I'm going to start telling them to do things that they may not feel ready for, that can feel really, really scary. Rather, I think it's a matter of I'm feeling distress and I would like to. And our relationship is in distress. And so I'd like someone to help us figure out how to get out of this distress in our relations. I don't know what that looks like. It doesn't mean you have to change, but it means that I would like to figure out how we come to understand each other again. And that's different. Right. It's not I'm going to take you to someone to fix you because you're broken and you're the cause of all of my ills, all of my problems,
- [54:09]
B
which is, I feel like that's the common thing that people feel or even think that's going to happen during therapy.
- [54:14]
A
And what normally happens is actually that person who's the most distressed and who's blaming the other partner. I'm really going to work with them directly on their distress to understand it and be able to make sense of it and figure out what they need to get out of distress. The one solution they may have thought of before is, well, my partner can just show up sexually the way they used to and then I'll be out of distress. That's great, but that's not working. So let's think of some other ways you can get out of that distress.
- [54:42]
B
So I want to talk a little bit about you. You sort of mentioned earlier that you went through a health issue that sort of changed your trajectory. So tell us a little bit about that.
- [54:52]
A
You know, since I was a young child, I've had urinary stuff. So you know, I've worked with urologists my whole, whole life. I have something called bladder pain syndrome. It's been called interstitial cystitis, painful bladder syndrome. So. And that was diagnosed as I was a teenager, but it fully debilitated me when I was 29. So I was working in finance and you know, I used to have some flares of my condition with bladder pain, back pain. And so I could take some days off of work and you know, feel like, okay, I've taken care of myself, I could go back. But I kept doing the same thing the same way all the time. I would just kind of take some days off and then go back and work the same way until one day I had a flare that just wouldn't stop. And I was kind of, of surprised when my physical therapist said, oh no, no, we'll, you know, we'll reevaluate you in a month. And I thought, well, this is usually just a couple days. So I had a, I had spasm in my pelvic floor muscles that was completely debilitating. I could not sit, stand, find a comfortable position. And I was in physical therapy five days a week. And it took a long time before I, you know, before I learned to self manage and do a lot of the work at home. Home. And I wasn't seeing a physical therapist pretty much at least once a week. So it was quite a journey. But in that process I was searching. So I think I mentioned earlier when I had that pain, sexual arousal made my spasm feel worse. So, you know, my condition was completely, you know, sex was tied up in this condition. So certainly. And then I learned also though, if I could have a sexual, an orgasm or I could have a pelvic release, and I learned how to do a release that could help my spasm a little bit. So one day I went to see a physical therapist, and I had timed my pelvic release like the physical therapist would do, but I did it at home with a partner, you know, releasing my muscles around orgasm, like, during arousal, through orgasm, and after. And I went back to the physical therapist, and the physical therapist said, hmm, your pelvic floor looks different today. And I thought, wow, you could see what I did. So I don't know, you know? Right.
- [57:06]
B
But.
- [57:06]
A
But it was. I mean, thankfully, I've always been really comfortable talking about sex. I'm very grateful to my parents for that, and I know all my clients are thankful for that, too. Thank you. But so. So because of that, I could talk openly with my. With my pts and my physicians and. And I was asking for more information because I thought, if you can see that if what I did at home is actually changing my pelvic floor muscles, maybe we're onto something so I could feel better. The process was that I was talking to all of my physicians and physical therapists looking for information, looking for research, and there wasn't much. And yet they started sending clients to me as a patient advocate because I could talk about sex comfortably. As I started talking to other patients, I realized, I think I'm good at this. I think I want to do this. So I went back and got a PhD. So I felt like I really knew what I was doing. All that means is I learned a lot. But I know what I don't know. That's. That's the great, you know, thing about getting a degree. Right. You just. You. You know what you know, and you know what you don't know, and you know where to find the information when you need it, which I have to
- [58:11]
B
just say, stop you for one second, because that is so important. And that is really why you want to look for sources online that are credible and have done some education. It's not because they are superior in some way, but there is some education that's done where we know what we know and we know what we don't.
- [58:28]
A
We know what we don't know, and
- [58:29]
B
we know how to interpret data and. And give it to you in a way that's nuanced as. As it should be. And I think that's really, really important.
- [58:37]
A
Yes. And when someone knows what they don't know, they. They help find someone who does know.
- [58:43]
B
Absolutely.
- [58:44]
A
And so that's. That's key. So much of my work is you know, I work collaboratively with other professionals. It's knowing when to refer out and knowing to whom to refer at certain times. You know, who would have the answer. But my job isn't to know everything. My job is to help people move along their clinical pathway until they get what they need. So that's all of our jobs. Right. And we're not supposed to be the be all and end all for any one person. I went back to school and decided, I think I'm doing this. And it was really rewarding to be able to be helping people in ways that, you know, having a background with pelvic pain gave me a unique perspective that I could understand what my clients were going through. I did my dissertation research looking at exactly that thing. Wow. You can see what I did where I really. I got couples together. I did a pilot study and clear my throat. I did a pilot study in my dissertation where I was testing protocols to include partners in doing pelvic releases at home. So they trained with a physical therapist. We measured how the pelvic floor overlooked before doing any of these protocols. We trained the partners to know how to do pelvic floor release. And then they went home and they did the release and they timed it around arousal or orgasm, and then they went back to measure the resting tone of the pelvic floor. I didn't do a large study. I did a pilot study to even see how the protocols would work. And if I could do a larger study, I haven't gone back to do it yet.
- [60:14]
B
Safe and feasible.
- [60:15]
A
Feasible, exactly. And. But it turned out that of the couples who did it, no one got worse, which was great. We were able, but yet there's no statistical significance here because it's a small number, but that they were able to learn how to manage this on their own. And in my work, you know, I'm. I'm. Of course I want people to be able to work with the best providers, but what I'm hoping for is that people learn how to manage themselves. Absolutely right. So, like, the goal of my clients is to graduate with a toolbox and a few. Like, they're experts on their own process. And then they know. It's like they have a PhD where they know what they know and they know what they don't know, and they know where to reach out for resources when they need it. So it doesn't mean they never ask for help again. But that's really the goal. Right. Self management. And so what was really interesting when I did my dissertation was I was thinking of this as, okay, we can learn how to help the pelvic floor change the resting tone to help with pain. And yet the couples that were interested in participating in the study were looking at it as, this is a way to make my sex life better. It's also important to be thinking about, like, what. What does motivate people? People's motivation for what they do is crucial for people to be invested in something. And so that really helped me learn more about in my clinic. You know, we need to truly understand people's motivations to make sure that all the. Everything that we're giving them makes sense to them and keeps them invested. Otherwise, they're not going to reach their goals. They'll give up.
- [61:39]
B
And I think that's so important for people listening is when you see anyone, you need to make sure it's very clear what your goal is. Is, because for a lot of people, like, for doctors, for example, we know, like, this is a debilitating problem, and you probably want this to be better, but that might not be your goal. Right. Your goal might be like, I want to fix this so I can have sex, or I want to fix this so I can do xyz. And it may be a very specific thing, like, I want to go dancing, or I want to walk my daughter down the aisle, or I want. Whatever it is. But you need to be very explicit about that goal and the timeline for that goal so that the person that you're talking to can say, this is feasible, or this is not, or this is what I can get you likely. And I think that that's so important because oftentimes you're nervous. You're going in to see a professional about something that you're not comfortable about or that you're feeling vulnerable about. And so you're in a situation where you're like, I don't know how to. I'm just going to go. But I think it's always so important. Bring notes, Know what you're going to say. I have never been upset with a patient for bringing notes and being like, oh, wait, let me bring this out. And literally reading from it, because I want them to tell me. They may feel embarrassed, but if they have to read off something and. And just say it, that's fine, right?
- [62:48]
A
Absolutely. Yeah.
- [62:49]
B
And so I think that's so important.
- [62:51]
A
Totally. And, you know, a lot. I have forms that people fill out before they come and see me. They can fill out as much or as little as they're comfortable filling out, but it's really. It Helps them to structure their thoughts so that they feel prepared when they come in. Some people, as you say, do better writing and it's harder just talking at first. Some people have, haven't really thought through why they're coming and so, so they're not. It's harder to get what they want out of their experience if they haven't thought it through. But. So that's why I try to help them structure that. And if they haven't done it, I'm going to ask those questions directly anyhow. But everything as a sexologist, like everything I do in a sex counseling setting is patient focused. They have to define their goals. I don't define their goals for them. You know, that would be inappropriate. And that actually is, it's really not ethical that I tell them what they should want. I don't have all of my clients background even with pelvic pain, right. I have pelvic pain but I'm not in my clients bodies. My pain was different from theirs. And that was the other thing. When I did my study I also did, so I did mixed methods research and I was really looking at people's qualitative experiences. I did interviews with people just looking at how they perceive the overlap or the integration between their pain and sex. And I think what's crucial is to understand that everyone's narrative and everyone's associations with look different. And so I can't tell someone what their sex life should look like, what their experience is, you know, what good sex looks like, what healthy sex is. That's not for me to say. It's for me to help them to define, you know, based on their own, their own value system, based on their, all of their frames of reference. And just because I have pelvic pain, I can't ever say that I know what you should do, but I can help you figure out the direction based on what you're comfortable with and what you want.
- [64:45]
B
Yeah, yeah, absolutely. I think it's so valuable. I love qualitative research because I think you really get a good in depth understanding of what people are thinking. And the beauty of it is it's meant to be to saturation. Right. So when you look at these studies where they've interviewed people, they've actually, they do these complex sort of analyses on the back end to say, okay, we are seeing the same thing come up over and over again. And yes, it could be limited by the sample, but generally if you look at, at who they're studying and what the sample is, if that reflects you or reflects whatever sample you're looking at. That's like the likely what most people are thinking. And so it's really valuable.
- [65:25]
A
Yes. And I mean, I experienced it in my body as the interviewer. You know, you start seeing, you know, doing grounded theory, you know, you, you start building the theories as you go based on what the, you know, each person tells you in an interview. It helps, you know, what questions to ask of the next person. And so you build the theory. It's very beautiful. It was exciting. I was so passionate doing my research. It wasn't just a numbers thing. It's like I felt it in my body and I felt pregnant. By the time it came time to write my dissertation, it was like I couldn't get it out fast enough. I just, I woke up writing, and it was crazy.
- [66:01]
B
Yeah. Yeah. And, you know, we've done some work on Reddit and we've looked at forums about, like, orgasm and what people are saying about them, and I think that's also great. And I do think that AI is going to be so helpful in this space because it'll be able to, like, analyze, you know, all the information on forums and really get a sense of what people are feeling and thinking. And I think once we are able to harness that, you know, more broadly, I think it's going to be just transformative for how we learn about what people are really, really experiencing.
- [66:34]
A
Right. But the real concerns are. Because they're. They're talking. That's right. They're doing it out there on Reddit. They're not necessarily telling, you know, all their doctors.
- [66:42]
B
Yeah, so. So you developed something called ergo erotics.
- [66:46]
A
That's right.
- [66:47]
B
And that's supposed to help people get certain positions when they're having chronic pain, is that right?
- [66:53]
A
Right. So ergorotics is, you know, applying the science of ergonomics to erotic activity. So an ergonomic is simply the adjustment of the environment and the activities to fit the needs of the people involved. So it may be a matter of adjusting positions. It may be a matter of adjusting what tools you're using to stimulate. It may be a matter of adjusting, you know, the movement strategy. Yes. So. So I did create some materials to help people with those adjustments. And. But, yeah, but ergorotics is a process, really. I created videos. I. I picked the very top most common health concerns people will have, which are. I needed to start somewhere. Right. Because I can't address every issue in a video, but. So I started with back pain because it's ubiquitous, knee and hip pain, and Pelvic pain. So I did videos on all three of those. And it's really helping people understand the mechanisms of their pain and what their limitations are, and then how to make adjustments so that they feel like they're experts. So, for instance, like with spine, when someone has spinal pain, what we've learned through studies is that people have directional preferences of movement, meaning my body feels better when I'm bending forward or I'm in flexion, whereas my body feels better when I'm arching backwards or in extension. So based on what my directional preference is, if it's bending forward or backwards, or having no weight on my spine or keeping my movement really limited, those are five directional preferences. Once I know what that is, then I can help design what activities would work best for you. Yeah, once we know someone's directional preference, which they may have worked out with their physical therapist. A lot of physical therapists are getting much better at helping people, even with sexual adjustment. But not every physical therapist specializes in that or wants to talk about it. But I created some videos that couples can watch together and then figure out if my directional preference is extension or arching my back backwards, then these are the ways I would try to modify some classic positions. And it's not just a matter of the static position. So one of the challenges is often materials are pictures. Right. It's like be in this position, but we're not thinking about the movement strategy. I might first get into position where I'm in extension, but when I'm moving, I'm moving flexion a lot. So it's not just the static position, but it's how we're moving. So I really tried to address that in videos so people could see the moving video and, you know, showing samples of movement. Every people are clothed in the videos. We're in a physical therapy studio. So just giving people so. So it should be comfortable for people. It's not. It's not porn. It's not meant to entice. It's meant to teach. But so it can be used in a medical office setting as a course, or it could be use as a course for couples at home. But it's really intended for people to feel like they be. They have more expertise in their own adjustment.
- [69:56]
B
I think that's so helpful. And, you know, there are aids as well, furniture aids that you can like, different types of things that you can buy. And I've made a couple of videos on that on my YouTube channel. And honestly, when I first learned about it, I was like, why didn't we learn about this in training, right? Like, why did nobody teach me this? I had to literally go myself and find it. And it's interesting because it's the way I learned about it was actually, it was shown for people who have spinal cord injury and they want to have sex, but they are limited because they're paralyzed in certain ways. And so I was like, but these aids are also very helpful for people who have back pain or have mobility limitations or. And I feel like no one ever talks about that. It's so important, right? You want to be able to be intimate regardless of your limitations. I was just talking to a patient the other day and I was like, well, can you physically have sex? He's like, oh, I have heart issues. So I asked him, can you do the physical act of sex? He's like, well, I have back pain, so I don't know. And I said, well, there are ways. And we talked about it. There are different ways where you can overcome. You can have positions where your pain is supported, your back is supported, so there's no pain. And so I just think it's so important. And I wish we talked more about it.
- [71:01]
A
It is, it is. And actually, in the videos we show the use of some of those positional aids, we demonstrate when you need. For instance, I'm thinking the hip video a lot showed what we can do to keep our hip in a safe range based on what the medical recommendations would be and so how we would use the position or the tools to get us in a position. So we do that with all the videos, in fact, showing the positional aids because we need to be able to be comfortable and in a sustainable position. Otherwise we're not going to be able to do it long enough, enough to feel pleasure.
- [71:38]
B
We really need to be having our PM and R doctors and our orthopedic surgeons talking about this because that's who ends up seeing. And the primary care doctors, because that's the people who end up seeing patients with chronic back pain, hip pain, who do the surgeries for these issues. That really needs to be sort of widespread.
- [71:58]
A
When I was working on putting together the videos, I mean, the materials have been out for a long time, but putting them in packaging them in a way that people could actually access the information takes time. First book that came out on occupational therapy and sex was like in 2012, which, I mean, it's mind blowing because sex is an occupation just like anything else, like eating or breathing for people. And so, you know, being able to integrate that in occupational therapy is important, but we want this to be available and accessible to all people. You said something earlier, you know, talking about people's motivation, understanding people's motivations. When I was doing my research for Ergorotics, you know, I was. I came across studies that showed that people chose to have their hip replacement or to have surgery often in order to have sex. So often sex was the motivator for surgical interventions or for, you know, and. But if the doctors didn't know that, they might not have considered the approach. Perhaps that would be best for this person to adjust or even understanding, like, what positions are important to you. So being able to talk openly with our physicians, you know, like, I used to like to have sex standing up. It's really important to me. It's what turns me on the most, to watch my partner from behind, you know, whatever. That's something we should be able to talk to our providers about, or if not to be able to talk to someone who can help translate that to the providers on a team. But to say, listen, this person needs to be able to have sex standing, so what are we going to do for them now? So, I mean, I might think about positional adjustments where someone can have more support for their backs if that's what they enjoy. Some people may not be able to make that adjustment, but it's really, you know, figuring out what can we do to give this person as much function based on what they enjoy and why.
- [73:41]
B
Yeah, absolutely. So, so helpful. So you've been in this field for some time now. You dealt with your own pelvic pain.
- [73:50]
A
I have.
- [73:51]
B
What is something that you believe when you started that you've changed your mind on?
- [73:55]
A
I think the finance part, that's a big one. Like, I think, you know, being able to treat people with sex in a vacuum, you know, and just focusing on sex, you know, sometimes we do need to think of the bigger, you know, the other issues. So I would say I feel like I've expanded my focus, you know, to be broader, because I realize a lot of people need that, and there weren't that many people who are able to integrate the two. So I would say that's something I would say that I hate. Hit a place in my practice, really, where I. I was feeling very frustrated with how much the cultural narratives, you know, how debilitating they were to people. And so I felt like often having group therapy or having support groups, you know, I feel so committed to that. I. I'm not doing them myself, but I like to refer out to them because being able to have These things normalized, where people feel broken is super important. And so these cultural ideas, you know, we've seen so much in the media, we see more movies where people are having sex, which is unrealistic. I know you talk about this on other podcasts.
- [74:55]
B
Right.
- [74:55]
A
Our cultural, you know, framing is that sex is easy. It's always, you know, explosive. You know, we should know exactly what to do. It works well every time. So understanding those messages, you know, people are getting these unrealistic messages. Being able to have models that are more realistic is important. And I think being able to normalize for people. So this is where groups can help, because people feel so alone if people aren't talking about, like, how common it is to have pelvic pain or how common it is to have erectile difficulty, or how common it is to have changes in desire after menopause, or, you know, so being able to talk to other people in the same boat and realize you're not alone, I think is incredibly valuable. And I think that I've come back to believe that that is. That is crucial. This normalization is everything for people.
- [75:45]
B
Yeah, absolutely. What's the most common misconception about pelvic pain and sexual dysfunction? That you think people continue to believe
- [75:55]
A
that if you have pelvic pain, you are broken and that you are the cause of the problem, of the. Of the sexual challenges in relationships. That is, it's a common misconception. The cause of challenges in a sexual relationship is the partnership not being able to adjust to the changes in the partners. I found people with pelvic pain who have been able to have very satisfying sex lives by changing their activities because they have. They're creative and they are very flexible with how they envision sex and how they define sex versus people who are incredibly able bodied, who have no health issues, but feel they may have very, very limited sex lives because they define sex so narrowly. So what I find is that sex is typically a function. Sexual satisfaction is a function of the partnership and the way that people can partner together and work together and the flexibility in someone's definition of sex. And so I think once we understand that, people can feel less broken immediately.
- [76:59]
B
Yeah. Sex is not just one thing. And I think that's so important for people to realize, like, you can be intimate, you can have sex. And it doesn't just mean that you have one specific way to have sex and one specific position or, you know, whatever.
- [77:16]
A
Right. That's like the myth, right. Of sex is a particular activity which looks a certain way.
- [77:21]
B
Yeah, right.
- [77:22]
A
Sex is not necessarily defined any particular way. You get to define what sex means to you. And if you can no longer find a way to have the sex that matches your narrow definition of. Of what you think sex is, then maybe it's time to see which needs to change. Either your activities can change, your body can improve if possible, or you need to change your narratives or ideas of what sex is. But somehow those things need to be able to work together again.
- [77:49]
B
Yeah, absolutely. Where can people find out more about you, Your video courses, how to work with you?
- [77:56]
A
So My website is heatherhoward.com, very easy. They get to choose their own adventure, whether they go more to the finance route or the sexuality route or both. The ergonomics website is ergoerotics.com I call it Ergorotics, but it's ergo erotics. And that also there are links on my website to ergorotics as well to find the materials I mentioned, the videos that are video courses. There is also a library of an ergonomic position library that's available for providers to help them to make clinical recommendations. That's great. And yes, I mean, so we think about, we go to a physical therapist office and they have like a whole library of like, exercises to do, but we really didn't have that for sex. So I had like 106 positions for penetrative sex and also for oral sex and manual stimulation. And so there's a video library of those positions and the movement strategies. Because often the repetitive stress isn't just from again, the position, but it's from the movement strategy. And I think it's also important to be talking about activities that are not just penetrative. So I couldn't find a library of materials that was beyond penetration. I wanted to find something that normalized and showed modifications for oral and manual stimulation as well. That's wonderful. So that is also on the Ergotics website, that library that's available to providers only right now, really, because we want people to be able to work with someone to make appropriate clinical recommendations and so that. So they're again, learning how to approach it. Not just these are positions, but rather, you know, a lot of my work with people on ergonomic adjustments is understanding first what they like, what they don't like, and then coming up with suggestions or solutions based on their likes and dislikes, their partner's likes and dislikes.
- [79:44]
B
They're not overwhelmed either.
- [79:45]
A
Right. And so then we can say, okay, I can take that information, I can synthesize it. And so this is the direction I'd be looking now. Let's look together. And I find using the library is a great tool for me too, because I can't remember all of these options, like, off the top of my head. But I can look with my clients and I can say, okay, I'm thinking you might do well with a position where you're lying on your back. Let's look at those positions, and then let's talk about how you feel about them. So it's not just here's a position, but it's how do you feel about this when you see it? What does it bring up for you? And then often there are these unconscious or unspoken things that come up. Oh, I'm really not comfortable if I can't see my partner's face. Great. That gives me more information. So now I can make the next recommendation for you. Or I really, you know, I do better when. When I can control the movement. That's something that's really important for people with pelvic pain is, you know, our. Our pain is not just a function of. Of, you know, what we feel in our body, but actually our. Our emotional state will mediate the experience that we have, the pain levels that we feel. And so if we feel stressed or we feel out of control, then we will guard. And also we will have. We'll actually experience pain or there's a direct correlation. And so if we can have someone feeling more in control of the movement or more knowledgeable, then their pain levels will already decrease just from that. So. So looking at positions or adjustment that let someone feel more in control.
- [81:17]
B
Yeah, that's so helpful. Thank you so much. I will definitely look at that and share it with my patients. So we end our podcast with four questions that we ask everybody. They don't have to be about your career. They can be about anything. So what is something, you know, now in life that you wish you knew earlier?
- [81:33]
A
That everything to me is about process, not outcome. You know, and I would say when I was younger, I was really very, very solution focused and very outcome focused. And once I went through a pain, you know, debilitating pain condition, I realized that I couldn't keep doing things the same way. I had to approach things differently. I could manage my life differently and learn to listen to my body differently. So, you know, the process of listening is way more important than the outcome. And everything in my work, actually, with clients is about helping them learn how to be in a process that works. Works for them and be process focused versus outcome focused. Then they can manage the process better themselves.
- [82:13]
B
Yeah, yeah. What's a non negotiable? Something you have to do every day.
- [82:17]
A
I've learned I have to listen to my body. My body. Before, you know, I was fully debilitated by health. I've always had health problems, but I used to always think that, you know, my, my, the role of my body was just to carry my brain around. And now I've really learned that I have to check in and my body will tell, tell me exactly what I need. So it's a non negotiable to really check in. Am I breathing? You know, am I feeling. Usually I find out I need to eat. I'm someone who gets hangry. So, you know, like I have to listen and realize if I'm starting to feel like I'm, you know, agitated, it generally it means I'm hungry. But, you know, so listening to my body, it tells me everything I need to know.
- [82:55]
B
Yeah, yeah.
- [82:56]
A
And it didn't come naturally, by the way. It's something I had to learn.
- [82:59]
B
Well, I don't think, I think so many people don't listen to their bodies. Right. Like I think we just, as you mentioned, you were kept going, going back to work the way that you used to. Exactly right. And so we just keep powering through because that's what we're taught to do.
- [83:09]
A
It's what we're taught and you know, that's what's, that's often what's rewarded. But I will say, you know, it's been so crucial and, and the reason I think I'm good at helping my clients learn to listen to their bodies is because it didn't come naturally for me either, you know, so I can, I know lots of ways that I had to learn and lots of tools to get to that place. Place for someone for whom it doesn't come naturally. You know, it's great when someone just already knows it and it's just come easily for them. But they may not have had to learn all the different ways to get there.
- [83:40]
B
Yeah. If you couldn't be a sexuality or financial counselor, what would you be?
- [83:45]
A
I've gotten to try on a lot of things in my life. So before all of this, I was a singer. Oh, wow. And so I might go, I would say maybe I'd go back to performing. Yeah, I really enjoy. I think I got to the point where I stopped singing when I, first of all I had health problems and it wouldn't be easy to tour as a singer. And it really also the technique that I learned affected my pelvic floor, so I had to relearn my technique. What I really like is engaging with the audience. So I really got to the point where I didn't love singing because I was doing recording and it's not exciting for me. The recording part is not like being able to have that engagement with the audience. And this is what I love about my job every day, is I'm getting to work with people talking about what really matters to them, and I'm able to feel the connection and really to help make a difference in their lives. I mean, they're doing all the work. To be fair, they're doing all the work, but I get to be a part of it and I get to make some. Some recommendations that may change the course of their lives. And that feels really, I'm so honored to be able to do that. So I would say there's something, though, about being an artist, you know, being able to connect with people through art and to allow them to also have experiences which they may not be able to have without the modeling and the vulnerability of the artist. So I might go back to that maybe.
- [85:05]
B
Yeah. I mean, I think expression, creative expression can really move people in different ways. So. Absolutely. Yeah. Awesome. Well, thank you so much.
- [85:13]
A
Thank you so much. And thanks for those great questions.
- [85:16]
B
Thank you guys so much for your time and attention on today's episode. And as always, remember, take care of yourself because you are worth it. Two Good and Co coffee creamers are made with farm fresh cream, real milk and contain 3 grams of sugar per serving. That's 40% less than the 5 grams per serving in leading traditional coffee creamers
- [85:34]
A
for a rich, delicious experience.
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B
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- [85:51]
A
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