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Conversations with my Therapist

I recently had the pleasure to meet with Josh Miller and Clark Aegerter for their new podcast, Conversations with My Therapist. Josh is a Clinical Mental Health Counselor in Mapleton, Utah and Clark is a videographer and overall creative in Lehi, Utah.

Clark came up with the idea for this podcast after realizing the importance of therapy and, simultaneously, the difficulty of finding a good therapist (and of even understanding how therapy works). This podcast is designed to take the mystery out of therapy, introduce the listener to therapists with different specialties (like sex therapy!), and answer some of the most common questions people have for therapists.

In this episode, I share the difference between spontaneous and receptive desire, explain the dual control model, and describe how having a lion in the bedroom causes erectile and orgasm difficulties. I also share sensate focus exercises, which are evidence-based exercises to get that lion out of the bedroom and create a sexual scenario that has no pressure, no expectations, and no demand.

Ready to take the conversation to the next level?

Enter your information below for a free download of the first two phases of the sensate focus exercises and a sexual menu and get started today! By agreeing to download these free resources, you will be added to Dr. Rullo’s email list. You can unsubscribe at any time.

    Cancer can set the stage for amazing sex

    You’re probably thinking, there’s no way cancer sets the stage for amazing sex. And, of course you’re thinking this. Cancer has caused loss after loss after loss. Loss of your breasts, breast sensation, vaginal health, sexual desire, confidence in your body image… I want to propose a shift in your focus. Focusing not on the losses in your sexual health, not on how you feel stuck with these sexual changes you didn’t ask for, but instead on the potential gains. I am not telling you to just think positive. I hate that. I’m a realist. I am telling you that there are more gains than you may realize. I want to share with you how cancer can set the stage for these gains. How cancer can set the stage for amazing sex.

    I live in Utah and the way I think about cancer is it’s an avalanche. There have been a lot of avalanches in Utah lately. And recently the main road to my favorite ski resort was closed because of an avalanche. No going up and no going down. What do you do when the main road to your destination is closed? 

    Again, think of cancer as the avalanche. Cancer, this horrible diagnosis, may have closed your main road. The main road is how you experienced sex before (e.g., how your body responds, breast sensitivity, how you felt about your body image). For some of you, cancer has forced you off of the main road that you knew, and the way you experienced sex before may not ever be the same again.

    If your main road is closed, you’ve got 3 options:

    • You can patiently wait for the main road to re-open. You can wait for your sexual response to return to what it was before cancer. However, sexual side effects caused by cancer typically do not get better over time without treatment or action. Patiently waiting is a gamble that is likely not to pay off.
    • You could give up. The main road is closed, why even try. OK, that’s certainly an option. But, do you really want to give up on your sexuality?
    • You could get creative and find a different path or a different destination. This is your best option if you want to maintain or create a healthy sexuality.

    How do you get creative and find a different path?

    1. Focus on the journey and not a goal: Just like skiing, enjoy riding down the slopes instead of focusing on getting to the bottom. Whatever your sexual destination was before, for many it’s orgasm, consider shifting the focus to the journey and not a specific destination. How do you do this? Mindfulness. Mindfulness is being fully present in the moment, without judgment. Being fully present enjoying the experience without demand or pressure, and not striving to reach a goal. Mindfulness Has been shown to improve women’s sexual desire, arousal, orgasm, and reduce sexual pain – and this research has been done with cancer survivors! You can do mindfulness solo or with a partner. Check out: Better Sex Through Mindfulness  by Lori Brotto, PhD to start this journey. Also, with a partner, engage in mindfulness based Sensate Focus exercises.

    2. Expand your sexual menu: Sex can sometimes be focused on just the erogenous zones, like breasts and genitals. If your breasts do not feel the same sensitivity or they aren’t a source of pleasure like they may have used to be – it’s incredibly important to expand your sexual menu. One easy way to expand your sexual menu is to start with sensate focus. Then get a little more advanced with a sexual menu. Want to get even more advanced? Check out Mojo Upgrade.

    3. Tap into receptive desire: There are actually two different types of desire – although we really only hear about one, spontaneous desire. Spontaneous desire is the type of desire where you think “I want to have sex right now!” This is in many ways driven by hormones. If you’ve had any treatment or surgery, such as AIs or an oophorectomy, that has impacted your hormones, then likely your spontaneous desire has also been impacted. Treatments that suppress hormones may also suppress spontaneous desire, so you need to get creative and tap into the other desire, receptive desire. Receptive desire is a type of desire where you are sexually neutral at first, sex is not on your mind, but the ingredients are in place that allow you to be receptive. Perhaps those ingredients are that you have energy, you’re not in pain, you feel relaxed. Then, your partner initiates and you think, “hmm. . . sex wasn’t on my mind, but I’ll be receptive.” Or, if you don’t have a partner, maybe you pull out an erotic novel, or put something sexy on TV– and you think, “hmm. . . I wasn’t thinking about sex, but all the right ingredients are in place, so yes, I’m receptive to have solo sex.” Bottom line, if your hormones have been impacted by cancer treatment, then receptive desire will likely be your more prevalent desire. They key is to identify what ingredients need to be in place in order to be receptive, and then set aside time to get those ingredients in place. Think about these ingredients and share them with your partner, so they know when you’re more likely to be receptive. Or, if you don’t have a partner, set aside time to cultivate these ingredients for solo sex.

    4. Accessorizing: For those of you on AIs or who have had an oophorectomy and are now in surgery-induced menopause, the loss of hormones may impact vaginal health. We have lots of estrogen receptors in our vulva and vagina, and when we no longer have that estrogen, those receptors essentially starve because they aren’t being fed with estrogen. As a result, the vulvar and vaginal tissues may become dry, rough like sandpaper, the vaginal opening loses its elasticity so with penetration it can rip and tear and be painful, and you lose vaginal lubrication. Estrogen also facilitates blood flow to the genitals. Without that estrogen, there’s much less blood flowing to the genitals. And blood flow is needed for sexual arousal and orgasm. Blood flow is also needed for genital sensation – which means less blood flow equals less genital sensation. If you’re experiencing these sexual side effects, you’re going to need to accessorize. You absolutely need to be using a lubricant. Water based lubricant is a great option. Put it on yourself and on your partner, you really can’t use too much. I recommend lubricants by Sliquid or Ah!Yes. You will also need a vaginal moisturizer. Now a moisturizer is different than a lubricant. A lubricant is as needed for friction reduction in the moment of sex, whereas a moisturizer is something you use daily or every other day to maintain moisture in the vulva/vagina. Think of it as face cream for your vagina. Just like how you may wake up and put on your face cream every day, this is maintenance for your vulva/vagina. I recommend Hyalo Gyn. If these don’t alleviate the vulvar/vaginal dryness or sexual discomfort, then you may want to talk to your oncologist about vaginal estrogen. It comes in a cream, a ring or a tablet, and can be applied directly to the vulva and vagina to feed those starving estrogen receptors. It’s the most effective treatment to reverse the sexual side effects caused by lack of estrogen. Finally, consider a vibrator. If your sensation is less due to less blood flow, a vibrator is a great way to experience increased stimulation. There are vibrators made specifically for external, clitoral use only or for penetrative use, or both. Most women have used a vibrator at some point in their life and nearly half of men have used one as well. My recommended brand is Lelo or you’ll find great products at Smitten Kitten.

    Now remember that image of cancer as the avalanche that has closed your main road. The main road was sex the way you knew it before cancer. If cancer has closed the main road you knew, then use this as an opportunity to let cancer set the stage for amazing sex.

    Don’t patiently wait for your sexual experience to return to what it was before. Don’t give up, you are still a sexual being. Instead, find a new path. That path includes mindfulness, expanding your sexual menu, tapping into your receptive desire and accessorizing.

    Ready to start creating this new path?

    Enter your information below for a free download of the first two phases of the sensate focus exercises and the sexual menu and get started today! By agreeing to download these free resources, you will be added to Dr. Rullo’s email list. You can unsubscribe at any time.