Session 248 ICYMI: Increasing Sexual Confidence

Summary

---

Therapy for Black Girls – Session 428: ICYMI: Increasing Sexual Confidence

Host: Dr. Joy Harden Bradford
Guest: Dr. Pia Goff (Sex Therapist)
Release Date: September 10, 2025

---

Episode Overview

In recognition of "Sex Positive September," this episode revisits a popular conversation between Dr. Joy Harden Bradford and sex therapist Dr. Pia Goff, focusing on how Black women can increase their sexual confidence. The dialogue explores the discomfort surrounding discussions on sexuality, the roots of sexual shame, common sexual concerns such as desire and arousal disorders, the importance of sexual self-reflection, and practical ways to build confidence and pleasure—including a deep dive into sensate-focused therapy. The episode is geared toward destigmatizing sexual health conversations and empowering listeners to reclaim pleasure and intimate confidence.

---

Key Discussion Points & Insights

1. The Persistent Discomfort Around Sexuality

• Lack of Language & Education: Many, especially Black women, were not taught how to talk about sex at home or in school, leading to embarrassment and fear of judgment.

  "There's a level of embarrassment, there's a level of fear of judgment and shame that I particularly see, especially with black women, that oftentimes they feel that they've been oversexualized... All of these different factors impact a woman's discomfort with, you know, talking about sex with other people."
  —Dr. Pia Goff [05:39]

• Media & Stereotypes: Black women may downplay their sexuality to avoid feeding stereotypes, leading to additional self-consciousness and hesitance towards sexual exploration.

2. Taboo Topics in Sexuality

• Acts Most Stigmatized: Oral sex, anal sex, and masturbation remain highly taboo, even as stigmas shift.

  "I think the new biggest thing now is a taboo around anal sex... and then the next one that I see a lot with women is a taboo around masturbation."
  —Dr. Pia Goff [07:31]

3. Steps Toward Comfort and Confidence

• Self-Reflection is Key: Understanding personal sexual history and identifying sources of internalized shame or stigma can be the first step toward sexual confidence.

  “Doing some more self reflective work... will allow them to have knowledge and tools and skills about how to talk about sex with others.”
  —Dr. Pia Goff [08:26]

• Normalize through Community: Following sex-positive accounts, reading books, and hearing from others can normalize experiences and reduce feelings of isolation or shame.

  "Being able to hear others talk about this, it's like, oh, wow, okay. Like, this is something that a lot of people experience."
  —Dr. Pia Goff [09:33]

4. What Sex Therapy Looks Like (Even When Single)

• Sex Therapy Isn't Just for Couples: Single clients often seek therapy to heal from trauma or address barriers to intimacy.

  "The main reason I tend to see folks who are not in a relationship: they're saying, I don't know how to be in a relationship. I don't know how to be in a sexual relationship."
  —Dr. Pia Goff [10:22]

• Understanding Disorders: Dr. Pia screens for sexual dysfunctions like vaginismus (painful contraction of pelvic muscles) and female sexual arousal disorder (lack of sexual desire/arousal). Many clients don't realize these are issues that can be addressed with a professional.

  “I see a lot of women who come in with vaginismus… I see a lot of women who suffer from female sexual arousal disorder... And funny enough, sometimes when women come into my office and they see the books on my wall, they're like, oh, I was just coming in for anxiety. But... I usually don't have orgasm."
  —Dr. Pia Goff [11:17]

5. Female Sexual Interest/Arousal Disorder

• What It Is: Not wanting or enjoying sex over a period of at least 6 months; often, women internalize the problem.

  "A reduced interest in sexual activity, or a reduced interest in thoughts or fantasies, a lack of excitement or pleasure during sexual activity... over the course of at least six months."
  —Dr. Pia Goff [18:29]

• Self-Defined Normalcy: Normal sexual desire is unique for each person; issues become clinical only if the individual is distressed by the change.

  “We all get to decide what our normal is.”
  —Dr. Pia Goff [19:12]

• Distress vs. Identity: Differentiated from asexuality because asexual people are not distressed by lack of desire, while those with arousal disorder typically are.
  —[20:20]

6. Discussing Desire and Arousal with Partners

• Vulnerability and ‘I Statements’: Self-reflection and using “I statements” can make conversations safer and less accusatory.

  “If we're able to come to our partner and speak in I statements about what's going on personally for us... it puts us on the seat of being vulnerable, but it allows your partner to be a little bit more receptive.”
  —Dr. Pia Goff [21:00]

• Many Factors Influence Desire: Stress, medication, childbirth, relationship dynamics, and previous trauma can all play a role.

7. Vaginismus Explained

• Pelvic Floor Tension: A psychosexual issue that causes pain and difficulty with penetration; tied to anxiety, trauma, or fear of pain.
  —[23:57]

8. Reimagining Sex Education

• Ideal Sex Ed Components:

  • Accurate anatomy terminology
  • Consent
  • Normalization of masturbation & pleasure
  • Inclusion of birth control and contraception
  • Realities of sexual pleasure for all genders

  "I think first teaching, you know, proper terminology and anatomy. Definitely teaching consent... normalizing self exploration and masturbation and also normalizing pleasure."
  —Dr. Pia Goff [28:44]

• More Information, Not Less: Research shows more information correlates with safer and later initiation of sexual activity among teens.

9. Introduction to Sensate Focused Therapy

• What Is It?: A stepwise, evidence-based therapy for individuals or couples facing desire/arousal challenges, originally developed by Masters and Johnson.

  "Sensate focus does is it teaches clients to focus on the sensations of temperature, texture, and pressure...to explore touch without any sort of motive or any sort of goal or expectation about arousal or pleasure."
  —Dr. Pia Goff [30:48]

• Key Steps (Therapy can last 4–6 weeks):

  • Begin with fully clothed touching, progressing to nude.
  • Focus is on non-genital, non-goal-oriented touch.
  • Communication uses “handwriting” (guiding hands) to express comfort/discomfort, not words.
  • Remove intercourse from the equation for the duration, which often heightens anticipation and rekindles desire.

  "It's like the longest foreplay ever... but that's what's needed to rekindle desire and remove the expectation that we're going to touch and this is going to lead to sex."
  —Dr. Pia Goff [37:47]

• Helps Build Trust & Reframe Expectations:

  “Engaging in a sensate focus exercise removes that pressure... because I also instruct people, look, this should not be an exercise in which you’re talking to one another.”
  —Dr. Pia Goff [34:53]

10. Recommended Resources

• Booklist:
  • Come As You Are by Emily Nagoski
  • Rekindling Desire & Sexual Awareness by Barry & Emily McCarthy
  • The Guide to Getting It On by Paul Joannides: An accessible, comprehensive, and sometimes humorous reference.
• Find Dr. Pia:
  • Instagram: @sexdrpia
  • Practice: resiliencechicago.com

---

Notable Quotes & Memorable Moments

• "There's a level of embarrassment, there's a level of fear of judgment and shame that I particularly see, especially with Black women..."
  —Dr. Pia Goff [05:39]

• "We all get to decide what our normal is."
  —Dr. Pia Goff [19:12]

• "A lot of times folks who are having issues with desire, they feel this expectation to perform in a certain way... Engaging in a sensate focus exercise removes that pressure."
  —Dr. Pia Goff [34:53]

• "It’s like the longest foreplay ever."
  —Dr. Pia Goff [37:47]

---

Important Timestamps

• [05:39] – Discomfort around sexuality and its roots in cultural and generational attitudes.
• [07:31] – Taboo acts: oral, anal sex, masturbation.
• [08:26] – Steps for self-reflection and growth.
• [10:22] – Sex therapy for individuals who are single.
• [18:29] – Defining female sexual arousal disorder.
• [21:00] – Tips for communicating about decreased desire with a partner.
• [23:57] – Explanation and causes of vaginismus.
• [28:44] – Blueprint for an ideal, sex-positive high school curriculum.
• [30:48] – Sensate focused therapy explained in depth.
• [37:47] – Unexpected challenges and benefits of taking intercourse “off the table.”
• [39:29] – Recommended reading for further exploration.

---

Tone & Takeaway

The episode maintains an accessible, affirming, and empathetic tone—gently dismantling shame while celebrating self-discovery. Both Dr. Joy and Dr. Pia emphasize the value of self-knowledge, normalization, and patient, compassionate communication—both internally and with partners. Listeners come away empowered to view sexual confidence as a vital, learnable aspect of well-being.

---

For more resources or to find a therapist, visit therapyforblackgirls.com. Follow Dr. Joy and Dr. Pia on Instagram for ongoing support and conversation.

---

Transcript

[Dr. Joy Harden Bradford]

Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr. Joy Hardin Bradford, a licensed psychologist in Atlanta, Georgia. For for more information or to find a therapist in your area, visit our [e-mail] while I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey y', all, thanks so much for joining ME for session 428 of the therapy for Black Girls Podcast. We'll get right into our conversation after a word from our sponsors. This is an iHeart podcast.

[Elise Ellis]

The best kind of help is the.

[AT&T/Merck/LG XBoom Ad Voice]

Kind you don't even have to ask for.

[Elise Ellis]

Like your friend pulling up on moving day with a truck, a speaker and snacks ready to go. Well, that's the energy you get with AT&T's new guarantee. If there's ever a network interruption, they make it right by giving you credit.

[Dr. Pia Goff]

For a full day of service.

[Elise Ellis]

Proactively credit for Fiber downtime lasting 20.

[AT&T/Merck/LG XBoom Ad Voice]

Minutes or more or wireless downtime lasting.

[Elise Ellis]

60 minutes or more caused by a.

[Dr. Joy Harden Bradford]

Single incident impacting 10 or more towers.

[AT&T/Merck/LG XBoom Ad Voice]

Restrictions and exclusions apply.

[Elise Ellis]

See att.com guarantee for full details. AT and T Connecting Changes Everything.

[Dr. Joy Harden Bradford]

Many of us play lots of different roles in life partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree Holder. That's where National University comes in. They've been busy since 1971 creating more ways for you to work earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half being earned by women. With flexible online formats, NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu. this episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you are booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When you use your Chase Sapphire Reserve card, you get eight times points on all purchases made through Chase Travel and and even access to one of a kind experiences like music, festivals and sports events. And that's not even mentioning how the card gets you into the Sapphire Lounge by the club at select airports nationwide. Travel is more rewarding with Chase Sapphire Reserve. Trust me. Discover [e-mail] Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply.

[AT&T/Merck/LG XBoom Ad Voice]

Parents of Tweens if you're familiar with far off drop offs.

[Dr. Pia Goff]

Dad, stop. Stop. Stop right here. Or get DMs about what's for D? You may be experiencing tween milestones for your son or daughter. These can start at age 9. HPV vaccination, a type of cancer prevention against certain HPV related cancers, can start then too.

[AT&T/Merck/LG XBoom Ad Voice]

For most, HPV clears on its own, but for those who don't clear the virus, it can cause certain cancers later in life.

[Dr. Pia Goff]

Embrace this phase, help protect them in the next. Ask their doctor today about HPV vaccination brought to you by Merck.

[Dr. Joy Harden Bradford]

We can't let September go by without acknowledging Sex Positive September. Over the years, we've done dozens of episodes exploring sexual liberation, sexuality and sexual health. So we wanted to pull from our archives to bring you this essential conversation. You know how sometimes you can feel amazing in every other area of your life, but when it comes to intimacy, that confidence just disappears? Well, we're talking all about that today with Dr. Pia Goff. In this episode, we get real about what chips away at our sexual confidence, why some of us struggle with arousal and pleasure, and how to actually talk to your partner about what you need. Plus, Dr. Pia breaks down Sense8 focused therapy and how it's helping couples reconnect. This conversation is all about reclaiming your confidence and your pleasure, which is exactly what Sex Positive September is all about. Press play and let's dive in.

[Elise Ellis]

Thanks so much for joining us today. Dr. Pia.

[Dr. Pia Goff]

Thank you so much for having me.

[Elise Ellis]

Yes. I'm so excited to have you here. So for those of you who are not following Dr. Pia on IG, you definitely have to, because she has this feature that she calls Just the Tip Tuesday, which is super fun and she gives great information about sexuality and to help you start thinking about how to think differently about your sexual relationships and just, you know, great information overall. So definitely check out her ig.

[Dr. Pia Goff]

Thank you.

[Elise Ellis]

Yeah, so I wanted to make sure that we kind of started. I know. And when we were talking about planning for the episode, you shared that you feel like there is still a significant level of discomfort with people even talking about sexuality. Can you share more about like what you've seen and why you think there is still so much discomfort?

[Dr. Pia Goff]

Absolutely. I feel like people often lack the verbiage of how to talk about sex. Right. A lot of us weren't taught about sex, whether that was in school or in our home environment. It's just There's a level of embarrassment, there's a level of fear of judgment and shame that I particularly see, especially with black women that oftentimes they feel that they've been over sexualized, maybe in the media or maybe even just growing up being told, okay, well you know, you can't wear certain clothing because men will, you know, look at your body if they're more voluptuous. All of these different factors impact a woman's discomfort with, you know, talking about sex with other people.

[Elise Ellis]

That is a great observation, Dr. Pia, because, you know, I think we see a lot of conversations online and there's I think even been research, I'm sure, about, you know, like really wanting to kind of maybe play down your sexuality as not to feed into stereotypes as a black woman.

[Dr. Pia Goff]

Correct? Yeah, absolutely. And so that, you know, causes people to be very self conscious about either their appearance or, you know, playing into how they should, you know, quote unquote, should, I hate the word should, but how they should present as a sexualized person. And so it causes folks to not want to explore their own sexuality or have knowledge about what they prefer or don't prefer.

[Elise Ellis]

And are there particular sexual acts or aspects of sexuality that you find this happens more often with? So I know, like when I was in college and we even talked about this, you know, like the idea of like giving oral sex was a really big taboo, right? Like that was not something that you did, not something that you talked about. And I don't know that that still exists or maybe not to the same level, but I do think that there is still some taboo around that. Can you talk more about any particular acts that you feel like have more of a stigma than others?

[Dr. Pia Goff]

Absolutely. So I think that there is still not as greatly as it used to be, but there is still a huge stigma around oral sex and who you're going to give oral sex to to or who you're going to allow to perform oral sex on you. I think the new biggest thing now is a taboo around anal sex. Not wanting to have conversations about that and what that might mean about you if you're engaging in anal sex. And then the next one that I see a lot with women is a taboo around masturbation and feeling like a feeling of shame for masturbating or feeling like they don't need to masturbate or oh, that's gross. I don't want to touch myself like that or wanting to even have conversations with others about masturbation, oral, sexual or anal sex.

[Elise Ellis]

So of course I think conversations like this really help people to get a verbiage to talk about some of this. But what are some of the other things that people can be doing to become more comfortable, not only exploring and, you know, maybe engaging in some of these aspects, but just the idea of talking about it.

[Dr. Pia Goff]

Yeah. So I think first recognizing for themselves what is causing the barrier. You know, a lot with my patients, I go through a sexual history review with them to learn, well, what images did you see growing up regarding sex? What conversations did you have about sex? How did you build a stigma around sex? If you did? Or perhaps you grew up in a really open sexual environment. So really learning from them, what is their schema about sex? What are their thoughts about sex on an individual basis? So doing some more self reflective work that will allow them to kind of have some knowledge and tools and skills about how to talk about sex with others. Then I often recommend, you know, hey, like, read some books about sex, follow some podcasts, follow some things on IG to see how other people are communicating about sex, to allow yourself to have an open dialogue with either your, you know, girlfriends or your partner, et cetera.

[Elise Ellis]

And you mentioned, like, following different like accounts on social media. I know you and lots of other sex therapists are very active on, particularly Instagram, but I think also Twitter and Facebook in giving information. Do you think that that kind of stuff is helpful?

[Dr. Pia Goff]

I do, because I think it normalizes what they might be going through. A lot of times when women come into my office, they have such a feeling of shame and think like, oh my gosh, I'm the only one going through this because they're not talking about it with their friends or girlfriends or perhaps whatever they're going through. You know, no one else is experiencing that. So being able to hear others talk about this, it's like, oh, wow, okay. Like, this is something that a lot of people experience. There's more of a comfort to ask more questions or to learn more knowledge.

[Elise Ellis]

So I think you bring up a great point which leads me to a question that actually one of our listeners submitted around the idea of, like, would somebody come to see you as a sex therapist if they're not actively engaged in a sexual relationship? Like, what benefit would it be to come and meet with a sex therapist if you're not actually in a sexual relationship?

[Dr. Pia Goff]

Yeah, absolutely. And you know what? That tends to happen a lot more than folks would think. The main reason I tend to see folks who are not in a relationship because they're saying, I don't know how to be In a relationship. I don't know how to be in a sexual relationship. And while I'm in my single phase, I want to try to figure out, you know, what's creating these barriers. Sometimes that's an impact of sexual trauma and trying to figure out, how do I heal from sexual trauma? How can I be, you know, this sexual being with a new partner when I don't feel comfortable, right. So if there's a sexual trauma or two, if there's someone who, you know, hasn't had positive sexual interactions in the past and they don't engage in self exploration of their body, so they come in to figure out, well, what do I do with that? So how can I be, you know, a more fulfilling partner and being more fulfilling relationships?

[Elise Ellis]

And so what are some of the things that you will introduce to somebody who comes in and says something like that? Like where would you start?

[Dr. Pia Goff]

So I start with the sexual history to, you know, again get their background on their thoughts about sex, their past sexual encounters and any sexual trauma, the age at which they first engaged in sex, and you know, typically just how they think about sexual. And then we start talking about it and ruling out any type of sexual dysfunctions. I see a lot of women who come in with vaginismus, which is a contraction of the pelvic floor in which they're not able to be penetrated. I see a lot of women who suffer from female sexual arousal disorder in which they just simply aren't desiring sex, whether that's been, you know, lifelong or it's occurred perhaps after childbirth, et cetera. So sort of reviewing some of those things and putting a name to symptoms and which women say, like, wow, I didn't even know that was a thing. Like I didn't even know this is something that I could come in to talk to someone about. And funny enough, just sometimes when women come into my office and they see the books on my wall, they're like, oh, I was just coming in for anxiety. But I see that you have this book about, you know, she comes first, like, what's that about? I usually don't have orgasm. Sometimes a conversation ends up being organic that leads us down the road of exploring their sexuality.

[Dr. Joy Harden Bradford]

More from our conversation after the break.

[AT&T Ad Voice]

There's something special about folks who come through without being asked. Like your coworker surprising you with your favorite coffee just because or your friend handing you the ox cord the moment you get in the car. No debate, no fight, just positive vibes. That kind of love, it just hits different. And that's exactly the energy. AT&T is on with their new guarantee. If there's ever a network interruption, AT&T will proactively credit you for a full day of service. No calls, no emails, no jumping through hoops. It's just handled. It's like the universe saying I got you. Except this time it's not the stars aligning, it's your network. And let's be real, that connection is everything. Whether you're holding down the group chat, checking in on your parents. Scrolling TikTok. Your network's gotta come through. And if there's a problem, AT AND T is on the case. No stress, no drama, just real backup when it counts. Credit for Fiber downtime lasting 20 minutes or more or wireless downtime lasting 60 minutes or more caused by a single incident impacting 10 or more towers. Restrictions and exclusions apply. See att.com guarantee for full details. AT&T connecting changes everything.

[Dr. Joy Harden Bradford]

Many of us play lots of different roles in life partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree holder that's where National University comes in. They've been busy since 1971 creating more ways for you to work, earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half being earned by women. With flexible online formats, NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu. living with a rare autoimmune condition comes with challenges but also incredible strength, especially for those living with conditions like myasthenia gravis or mg, and chronic inflammatory demyelinating polyneuropathy, otherwise known as cidp. Finding empowerment in the community is critical. In the latest season of Untold Stories, Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenics host Martine Hackett, explores what it means to reclaim your identity, discover resilience, and cultivate self advocacy. From the frustration of misdiagnosis to the small victories that fuel hope, every story told is meant to unite, uplift and empower, and that inspires us all to take one step closer to being a better advocate and seeing life from a different point of view. If you or a loved one are living with an autoimmune condition, find inspiration along your path. Listen to Untold Life with a Severe Autoimmune condition on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This episode of Therapy for black girls is brought to you by Chase Sapphire Reserve. Whether you're booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When I travel somewhere, I'm typically determined to try the best local pizza and find the best spa experience. With Chase Sapphire Reserve, you have access to everything from private dinners hosted by award winning chefs to VIP treatment at the most sought after events. Chase Sapphire Reserve allows you to take advantage of one of a kind experiences while earning three times points on dining worldwide. No matter your destination, travel is more rewarding with Chase Sapphire Reserve. Discover more with Chase sapphire [e-mail] Sapphire Reserve cards issued by JP Morgan, Chase Bank NA member FDIC subject to credit approval terms apply.

[Elise Ellis]

I'm wondering how often that does happen either for you. And you know, it would be interesting to even talk with other therapists about that. You know, like how often somebody will come in for one thing and then it leads to this other thing. Or are you seeing that people are presenting with one thing but really the sex stuff? Is that what they really want to talk about?

[Dr. Pia Goff]

You know what, I think that right now what's been happening is people are coming in under the guise of anxiety. And anxiety is so prevalent that even like scheduling the initial session, they're unable to see that they're coming in for sexual concerns. And then I think coming into the environment and seeing the books or hearing me first, you know, put it out there like, let's talk about your sexuality, let's talk about sex. It's like, oh, okay, she's comfortable with talking about this. I've had, you know, some folks come in and say, my last therapist, they didn't want to talk about sex. So I felt uncomfortable in doing so. I didn't know how to bring it up. So by me initiating that conversation and showing that I feel comfortable talking about it will help ease them into it. So I would say more. So I'm seeing people who don't necessarily intend on coming in for that.

[Dr. Joy Harden Bradford]

Right.

[Elise Ellis]

And I think that's another benefit of, you know, so many therapists being active on social media and giving videos and information because it does let people know that this is the thing that can be talked about in therapy. But as you mentioned, I do think that some therapists are still uncomfortable. You know, like, if they're not necessarily a sex therapist, that may not be something that they ask, but it is important because it is a part of the whole person.

[Dr. Pia Goff]

Right? Absolutely. And I think when you asked earlier, why aren't people talking about sex and why aren't therapists talking about sex? We're not taught it, you know, we're not taught it in our graduate programs. How to have these conversations. Feel like oftentimes it's something that you have to, you know, specialize in or, you know, get additional training in. So there's, you know, there's just, again, not the verbiage of how to have these conversations.

[Elise Ellis]

Right. So you mentioned a couple of sexual disorders that I want to follow up about. So specifically female sexual arousal disorder. Can you say more about what that is and maybe speak some of the things that may lead to someone struggling with that?

[Dr. Pia Goff]

Yeah, absolutely. So female sexual interest or arousal disorder pretty much means a reduced interest in sexual activity or, you know, a reduced interest in thoughts or fantasies, a lack of excitement or pleasure during sexual activity majority of the time. And, you know, this happens over the course of at least six months to be able to receive such a diagnosis. I sometimes joke with folks and say, like, this is like a heterosexual woman watching ghost on power and having, you know, it's like watching paint dry. There's no reaction to the stimulus at hand.

[Elise Ellis]

I would imagine that it may be difficult to kind of gauge, like, whether somebody is struggling in this area. Like, how do you know what normal would be?

[Dr. Pia Goff]

Yeah. And so I tell folks, you know, we all get to decide what our normal is. And oftentimes when I see women coming in, heterosexual women, it's because their partner might say to them, well, you don't want sex as much as I do. And we're socialized to use men as the default narrative to how frequently we, quote, unquote, you know, should be having sex? And so working with a woman to normalize, well, how often do you desire it or what, you know, what is the amount of times that you would feel comfortable having sex? And sometimes one might say, you know, not at all. And then it's exploration of what's causing that lack of desire to happen. Are we feeling really overwhelmed? Are we feeling really stressed? Are we not having pleasure? Are we not being able to get aroused during sex? So it's kind of like, well, I don't want to engage in this activity that doesn't bring me any joy or any pleasure.

[Elise Ellis]

So the understanding is that you should have some arousal. I mean, because I'm thinking about people who identify as asexual. So how do you, like, make the distinction between, like, somebody who identifies as asexual and someone who may be struggling with, like, a sexual arousal thing?

[Dr. Pia Goff]

Right. So I feel like the person who's struggling with the sexual arousal, they are distressed that they're not experiencing desire.

[Elise Ellis]

Got it. Okay. So that's really the key.

[Dr. Pia Goff]

Right. They're distressed that it's causing conflict within their relationship. Or perhaps they're saying, you know, I used to be really sexual. I used to be really horny and want sex all the time. And now that's just not happening for me.

[Dr. Joy Harden Bradford]

Okay.

[Elise Ellis]

Okay, got you. So I do think that that can be really delicate. Right, Dr. Pia? Because I think sometimes when you're in a partnership and maybe you're not feeling aroused or maybe you used to and you're not feeling anymore, that can be really difficult to talk to a partner about. So what are some suggestions you have for, like, how you might be able to have this conversation with a partner?

[Dr. Pia Goff]

Sure. I think it comes with first, some self reflection on what going on for yourself first. Right. So if we're able to come to our partner and speak in I statements about what's going on personally for us, it puts us on the seat of being vulnerable, but it allows your partner to be a little bit more receptive to express like, hey, this is something that I'm going through and I don't know why it's happening. I'm noticing this shift. I really want to be more connected with you, and I'm struggling with that right now.

[Elise Ellis]

Right.

[Dr. Pia Goff]

It distresses me that this is happening. So really figuring out for yourself what's going on and perhaps why that's happening and then bringing that to your partner.

[Elise Ellis]

Yeah. And I think it also is important to make sure, like you said, like, really talking about the fact that you are struggling with it and that it's not that you don't care, but you're not sure what's going on either as a way of making sure that you're not like blaming the other person for your lack of interest.

[Dr. Pia Goff]

Exactly. And oftentimes what I hear is that a person's partner might say, well, do you not. Are you not attracted to me anymore? Do you not want me anymore? Are you not physically responding to me anymore? And majority of women, arousal starts for us in the brain. Right. We need to be intellectually stimulated and mentally stimulated. And a lot of times that happens via conversations or having date night or all types of things of that. So part of having that conversation with the partner can involve, well, have you noticed there's been a shift in the relationship in general? Is there, you know, feelings of resentment or have we gotten so busy that we don't experience pleasurable times together, like date nights, etc.

[Elise Ellis]

And I would imagine that another thing that may really be a struggle is an internalizing of arousal issues. So is something wrong with me? Am I broken somehow?

[Dr. Pia Goff]

Yes, absolutely. That's like, the actual word that so many women use of like, I feel broken. It just. It's not working anymore. Why do I not desire this person? And then there's. There's, again, those feelings of shame and embarrassment.

[Elise Ellis]

So it sounds like typically you would see these clients in your office maybe after a partner has suggested, like, hey, something's really going on here.

[Dr. Pia Goff]

Yes, yes. Or after a woman has given birth and desire changes. Or perhaps they are adjusting to new psychotropic medication that says inhibiting them from lubricating like they used to, so they're stopping to desire sex. Or perhaps, like I said, if they've had vaginismus or any sort of pain or discomfort with sex, you know, that's when I'll see them more so coming in on their own, not just because their partner has, you know, suggested.

[Elise Ellis]

So can you talk more about vaginismus? Because I don't think that is, again, another disorder that we hear about often and the fact that it is psychiatric disorder. So it's not necessarily a medical thing, though I think, you know, some of that coexist. Can you talk more about what that is and what kind of things may lead to vaginismus?

[Dr. Pia Goff]

Yeah. So vaginismus is the inability to be penetrated vaginally during intercourse. A lot of times I see women, they're unable to insert a tampon or even get a finger into the bowl because the pelvic floor muscles are so tightly closed. And so this can happen for a variety of reasons. I see this a lot with women who have had unconflimated marriages. They're just very scared that it's going to be painful. I've seen this with women who've suffered some sort of trauma, whether that be rape or perhaps when they were a child, they fell on a bicycle and broke their hymen and had a really distressing experience happen in that way. I've seen this happen after women have given childbirth, and there's just so much pain associated with thinking about being penetrated.

[Elise Ellis]

Got you. So it sounds like much of it is related to maybe a past trauma or some kind of traumatic experience that results in this and.

[Dr. Pia Goff]

Or just like extreme anxiety or fear about penetration being painful.

[Elise Ellis]

And I think that goes back to your earlier comment, right. About not even being taught as young people about, like, what sex is and that, you know, it may be painful the first time. And you know, like, how do you manage some of the anxiety that may come later in life? You know, if you decide to become sexually active? That could be avoided if we were giving kids the proper information about sex early on.

[Dr. Pia Goff]

Absolutely.

[Dr. Joy Harden Bradford]

More from our conversation after the break. Many of us play lots of different roles in life partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree Holder that's where National University comes in. They've been busy since 1971 creating more ways for you to work earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country, with more than half being earned by women. With flexible online formats, NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu living with a rare autoimmune condition comes with challenges but also incredible strength. Especially for those living with conditions like myasthenia gravis or MG and chronic inflammatory demyelinating polyneuropathy, otherwise known as cidp, finding empowerment in the community is critical. In the latest season of Untold Stories, Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenics host Martine Hackett, explores what it means to reclaim your identity, discover resilience and cultivate self advocacy. From the frustration of misdiagnosis to the small victories that fuel hope, every story told is meant to unite, uplift and empower and that inspires us all to take one step closer to being a better advocate and seeing life from a different point of view. If you or a loved one are living with an autoimmune condition, find inspiration along your path. Listen to Untold Stories Life with a Severe Autoimmune condition on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts. This episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you're booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When I travel somewhere, I'm typically determined to try the best local pizza and find the best spa experience. With Chase Sapphire Reserve, you have access to everything from private dinners hosted by award winning chefs to VIP treatment at the most sought after events. Chase Sapphire Reserve allows you to take advantage of one of a kind experiences while earning three times points on dining worldwide. No matter your destination, travel is more rewarding with Chase Sapphire Reserve Discover more with Chase sapphire [e-mail] Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply.

[AT&T/Merck/LG XBoom Ad Voice]

Stop settling for weak sound. It's time to level up your game and bring the boom. Hit the town with The Ultra Durable LG XBoom Portable speaker and enjoy vibrant sound wherever you go. Elevate your listening experience to new heights because let's be real, your music deserves it. The future of sound is now with LG XBoom and for a limited time, save 25% of LGBT with code Fall25. Bring the Boom X boom.

[Elise Ellis]

How would you design a perfect sex education class for like high schoolers if you were in charge?

[Dr. Pia Goff]

Ooh wee, that's a good one. I think first teaching, you know, proper terminology and anatomy. Definitely teaching consent. I think that's something that, you know, is totally a void within sexual education and normalizing self exploration and masturbation and also normalizing pleasure. I feel that from what I've seen, sex ed is more so like, these are the parts. This is what happens. This is what your menstrual cycle is going to be like. This is what a, you know, an erection is and then you have sex and the baby comes and here we go. And it really lacks just providing more information, more real life example information to teenagers and to talk about what happens in sexual relationships, talking about birth control, you know, other contraceptive methods. I know there's a lot of folks, myself included, I went to Catholic school. So contraception was never discussed. Pleasure was never discussed in sexual education. Teenagers are trying to surf the Internet to get that information or, you know, talking to their friends, where it's sort of like the blind leading the blind sometimes to disseminate that information.

[Elise Ellis (co-host or guest)]

Yeah, parents get really freaked out about us giving kids lots of information. But how often do we give kids information about other things and they don't follow up?

[Dr. Pia Goff]

Absolutely. Absolutely. And you know, research is showing us that providing children with information is not leading them to be, you know, more quote, unquote, promiscuous or having sex at younger ages. We're actually seeing that teenagers are having sex at a later age, more historically now based on them having that information because it's not as taboo as it once was to talk about it.

[Elise Ellis (co-host or guest)]

I also really like that you included the idea of sex being pleasurable for everyone because we often only hear about sex being pleasurable for guys when of course, women deserve to receive pleasure as well.

[Dr. Pia Goff]

Absolutely. And just exploring one's sexuality and normalizing that. Absolutely.

[Dr. Joy Harden Bradford]

So I don't know very much about.

[Elise Ellis (co-host or guest)]

It, Dr. Pia, but I know that you practice sensate focused therapy. Can you tell us more about it?

[Dr. Pia Goff]

Yeah, absolutely. So sensitive focused therapy was first started by Masters and Johnson. It has now been readapted by Linda Weiner and Constance Avery Clark. And we use this a lot when patients are coming in with desired disorders. And it's just like the name sounds, sensate sensations, focusing on the art of touch. I feel like so often sex has become this idea of being very procedural. And a lot of folks, when they think of sex, the first thing they think of is penis and vagina sex. And that's become like the heteronormative explanation of what sex looks like, and we lose the art of foreplay and touch. So what sensate focus does is it teaches clients to focus on the sensations of temperature, texture, and pressure. And it really encourages patients to explore touch without any sort of motive or any sort of goal or expectation about arousal or pleasure. Right? Because when someone's coming in with a desire disorder, they feel like I'm not performing how I'm supposed to. My partner is upset because I'm not doing what they quote, unquote, expect me to do. So there's a lot of judgment there. Right? So when I lead someone through a sensei focus exercise, I invite them to take some time and allow themselves to relax, get themselves into an environment where they're good with the temperature of the room, the lighting of the room. There's not going to be any distractions. And you instruct them to explore their body from head to toe. Again, focusing on the temperature, whether that's cool or warm, the texture, whether that's smooth or rough, and the pressure, whether that soft or firm, and just allowing them to notice what comes up. And oftentimes folks tell me, oh, my gosh, like, I'm supposed to be touching myself for how long? And you know, this is going to get boring and all of these things. And so it's encouraging mindful exploration of the body and to have an awareness that you might have come up during this touching exercise. And those are distractions. They're there and to acknowledge them, that they come up and then just turn back to focusing on temperature, texture, and pressure.

[Elise Ellis (co-host or guest)]

Is this something that you do in the office, or is this something that you're instructing them to do outside of the office?

[Dr. Pia Goff]

No, no, no. This is definitely something that's done at home. I sometimes adapt it for patients. Like if someone's coming in with a history of trauma or a Significant reluctance or fear to engage in partnered sex. I'll have them complet exercises by themselves before introducing their partner. So usually I say, week one, I want you to go home and engage in this touching exercise for about three times a week. And that should range anywhere between five to 20 minutes. Focusing on again, temperature tester and pressure. Week one would be doing this with perhaps like pajamas on. Next week they'll move up to perhaps just like a bathing suit or underwear. The following week, they'll move into being completely nude, exploring without insertion of any sort, or touching the breast or genitals in any way. And then fourth week, you can involve touching of genitals and insertion. So that's when you're working with someone just on an individual basis. When I'm working with couples together and there isn't a significant trauma history on board, I will invite them to take turns with one person being the toucher and one person being the touchee. And so they'll take turns touching one another head to toe. And that can be adapted to not having any clothing on, but again, it can kind of staying away from the genitals and breast as well and focusing on just temperature, texture and pressure. I know I keep saying that over and over again, but that's what we want them to focus on versus trying to explore for pleasure or trying to have any expectations that sex is going to occur after this. Really just getting comfortable with touching and the senses.

[Elise Ellis (co-host or guest)]

It sounds like that could be really important. Sounds like that could go a really long way in establishing trust in the relationship without the expectation of sexual touch.

[Dr. Pia Goff]

Absolutely. Because a lot of times folks who are having issues with desire, they feel, you know, this expectation to perform in a certain way. Right. And there's a lack of verbiage. Right. To talk about sex. So engaging in a sensate focus exercise removes that pressure. Right. Because I also instruct people, look, this should not be an exercise in which you're talking to one another. I want you to really focus on just those sensations. And so clients may ask, well, what do I do if I don't like where I'm being touched or I really am enjoying that certain area that's being touched. And that's what reinstructs them to engage in what's called handwriting. So that's either placing your hand on top of or underneath your partners to either guide them away from an area that feels uncomfortable or to invite them to stay on an area that does feel comfortable. So that helps take away this pressure to. People feel like, I don't know how to talk dirty or, you know, I don't know how to, you know, share that I'm really enjoying something. So taking the verbal part out can be really, really helpful.

[Dr. Joy Harden Bradford]

Ah, okay.

[Elise Ellis (co-host or guest)]

That sounds like it could be helpful even outside of this activity.

[Dr. Pia Goff]

For sure.

[Elise Ellis (co-host or guest)]

Maybe something that would be good for people who have trouble initiating sex or things like that.

[Dr. Pia Goff]

Absolutely.

[Elise Ellis (co-host or guest)]

You know, as you were talking, it made me wonder if this might also be helpful for people who struggle with sexual arousal disorder. Because I think a lot of times what happens is that they may be afraid to even initiate any kind of affection for fear that their partner will expect something more.

[Dr. Pia Goff]

That is exactly correct. That is exactly correct. To remove that idea of expectation of any sort and to just focus on what is coming up. Right. And during these exercises, you begin to learn that sex is a natural function. It's not something that can be taught. Right. It's kind of like breathing that comes natural to us. We might be able to teach people different breathing techniques, but the basic tenets of breathing were born with same with sexual function. We're born with those firing any dysfunction. We're born with that as a natural function. So touching for, you know, exploration of the sensations. You're going to begin to notice your body becoming aroused. What happens? What do you need in order to have arousal or desire come up? So we're moving that expectation there.

[Elise Ellis (co-host or guest)]

So how long might you be practicing sensei focus techniques with someone before you might see a difference in their arousal state?

[Dr. Pia Goff]

Yeah, I think that definitely differs from client to clients. I think that in the first few weeks, they begin to notice different areas of their body that produce the feelings of arousal.

[Elise Ellis]

Right.

[Dr. Pia Goff]

Like, I've had women come in like, oh my gosh, I didn't realize, like, the back of my thigh really, you know, brings up these experiences for me or brings up the feeling of pleasure for me, or I really don't like it when, you know, the small of my back is touched. And so it becomes an exploration, explorative exercise for them. The whole course of sensate focused therapy tends to last between four and six weeks.

[Elise Ellis (co-host or guest)]

It sounds like it's a pretty structured thing that you're taking either the person or them with their partner through.

[Dr. Pia Goff]

Yes. And the hardest part of it all is that when they're engaging in this, I ask them to refrain from having intercourse. And people, you tend to get really upset. They're like, wait a minute, I'm coming in here to have intercourse. And oh my goodness, the partners are like, I'm not signing up for this. But I tell them, you know, it's just like anything else. Think back to when you first, you know, were having sex with a partner. That thrill and anticipation and, you know, hoping that it'll be tonight that you finally get to have sex. Right. So it's building that anticipation. It's like the longest foreplay ever. Right. But it's like, that's what's needed to sort of rekindle desire and to, again, remember, remove the expectation that we're going to touch and this is going to lead to sex. So taking that away, knowing, okay, we can't have sex, allows the person with the arousal disorder to feel more at ease and more comfortable to engage in that exercise.

[Elise Ellis (co-host or guest)]

So you're saying that you take sex off the table the entire time they're working with you on this?

[Dr. Pia Goff]

Yes.

[Elise Ellis (co-host or guest)]

So they're saying, okay, we'll do what Dr. P has said for the next six weeks, and then we'll see how it goes.

[Dr. Pia Goff]

Yeah. And it's funny. Like, people will come in, like, week two or three, Like. Like, all right, we gotta tell on ourselves. We have sex, you know, and so it's kind of like, because it becomes this thing you're not supposed to do, they want to do it. Right. And it's like, oh, okay, now you get why we're having these instructions. Yeah.

[Elise Ellis (co-host or guest)]

I would imagine that this then allows for a great conversation about what happened and how we might be able to reconstruct that for the future.

[Dr. Pia Goff]

Exactly.

[Elise Ellis]

Got it. Got it. I got to read more about this. This sounds Great. So, Dr. Pia, what are some of your favorite resources that you find yourself going to and recommending over and over again?

[Dr. Pia Goff]

Absolutely. So, first and foremost, I think most sex therapists will swear by this book, come as you are by Dr. Right. It's just such a great book to normalize sexuality and, you know, to teach about sexuality. Then Anything by Billy McCarthy is awesome. I really recommend Rekindling desire to my couples and women in particular, also by Barry McCarthy and Emily McCarthy. It's a book called Sexual awareness. Then when I find couples or individuals who are coming in who maybe have never had sex or have really just not had a really good sexual education, I recommend the book the guide to getting it on. I mean, it's a huge book, but you can kind of flip through and, you know, learn about different techniques, learn about different. The sexual response cycle. So it's a really. And it's. It's written in a kind of like a joking nature. So it's an easy, easy read.

[Elise Ellis (co-host or guest)]

And where can people find you online, Dr. Pia? With your website as well as any social media handles you want to share?

[Dr. Pia Goff]

Yeah. So definitely follow me on Instagram @sex Dr. Pia and then the website for the practice I'm a part of is resiliencechicago.com and of course all of that.

[Elise Ellis (co-host or guest)]

Will be included in the show notes so that people can find it easily. Thank you so much for joining us today, Dr. Pia. I really appreciate it.

[Dr. Pia Goff]

Thank you so much for having me. And thank you so much for having this platform. I mean, I know you hear it all the time, but it has just really changed the game for Therapy for Black Women. I'm seeing so many more people coming in because of your website and so I just I have to give you big kudos to that. Thank you so much.

[Dr. Joy Harden Bradford]

I'm so glad Dr. Pia was able to join for this conversation. To learn more about her and her work, be sure to visit the show [e-mail] session 428 and don't forget to text this episode to two of your girls right now and tell them to check it out. Did you know you could leave us a voicemail with your questions for the podcast? If you want to suggest movies or books for us to review or have thoughts about topics you'd like to hear us discuss, drop us a message at Memo FM therapyforblackgirls and let us know what's on your mind. We just might feature it on the podcast. If you're looking for a therapist in your area, visit our therapist [e-mail] directory. Don't forget to follow us over on Instagram at Therapy for Black Girls and join us over in our Patreon community for exclusive updates, behind the scenes content and more. You can join us at community.therapy for black girls.com this episode was produced by Elise Ellis Indechubu and Tyree Rush. Editing was done by Dennison Bradford. Thank y' all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care. Many of us play lots of different roles in life. Partner, employee, caregiver. And many of us also think about another role that could take our life where we want it to be. Degree Holder that's where National University comes in. They've been busy since 1971 creating more ways for you to work, earning a degree into your hectic life. NU confers more graduate degrees to diverse populations than any other institution in the country. With more than half being earned by women with flexible online formats, NU makes higher education possible and achievable for busy working adults. Learn more today at nu.edu. this episode of Therapy for Black Girls is brought to you by Chase Sapphire Reserve. Whether you are booking your next trip or a weekend escape, Chase Sapphire Reserve is your gateway to the world's most captivating destinations. When you use your Chase Sapphire Reserve card, you get eight times points on all purchases made through Chase Travel and even access to one of a kind experiences like music festivals and sports events. And that's not even mentioning how the card gets you into the Sapphire Lounge by the Club at select airports nationwide. Travel is more rewarding with Chase Sapphire Reserve. Trust me. Discover [e-mail] Sapphire Reserve cards issued by JP Morgan Chase Bank NA member FDIC subject to credit approval terms apply.

[AT&T/Merck/LG XBoom Ad Voice]

Stop settling for weak sound. It's time to level up your game and bring the boom. Hit the town with the ultra durable LG X Boom portable speaker and enjoy vibrant sound wherever you go. Elevate your listening experience to to new heights because let's be real, your music deserves it. The future of sound is now with LG XBoom and for a limited time save 25% at LG.com with code Fall25. Bring the Boom XBoom parents of tweens, if you're familiar with far off drop offs, dad, stop.

[Dr. Pia Goff]

Stop. Stop right here or get DMs about what's for dinner. You may be experiencing tween milestones for your son or daughter. These can start at age 9. HPV vaccination, a type of cancer prevention against certain HPV related cancers, can start then too.

[AT&T/Merck/LG XBoom Ad Voice]

For most, HPV clears on its own, but for those who don't clear the virus, it can cause certain cancers later in life.

[Dr. Pia Goff]

Embrace this phase, help protect them in the next. Ask their doctor today about HPV vaccination brought to you by Merck.

[Dr. Joy Harden Bradford]

This is an iHeart podcast.