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Mindful : August 2019
Q&A: LORI BROTTO PHOTOGRAPHBYPLAINPICTURE/WESTEND61/MARKJOHNSON Testosterone to Multitasking Lori Brotto, Professor of Obstetrics and Gynaecology at the University of British Columbia, illuminates why some women struggle with low sexual desire, and how mindfulness helps. Your work has received a lot of attention. Why do you think that is? Mindfulness has received a lot of attention. And we know that sexual-health concerns are very common among women; low desire is very common. There haven’t been a lot of evidence-based treat- ments for women—there’s a lot of interest in finding a female Viagra. So, the idea of seeing if mindfulness can help is not really revolutionary. The reality is that people are multitask- ing and dealing with negative self-judgment during sex. The questions then are: Can we bring mindfulness over to sexuality? And if so, how does it work? Why does it work? How long does it last? Is it true that men struggle less than women when it comes to sexual desire? Do men have a biological inclination or foundation that offsets or buffers against it? The answer is yes. And the answer is testosterone. Men have 10 times the amount that women have. Women’s sexual desire is much more influ- enced by the triggers in their environment, whereas men can rely much more on that internal drive in their body. Women in your studies practice mindfulness daily for 20–30 minutes. Do they need to continue that frequency to maintain the benefits? It’s definitely the practice that creates the change; just learn- ing about it from a didactic point of view is not enough. Fundamentally, it’s chang- ing the brain. I often use the analogy that it’s like going to the gym and building muscle. Mindfulness affects the brain in exactly the same way. When we follow up with the women, 6 and 12 months later, we check in with how they’ve continued. Yes, there’s some attrition. But the major- ity are continuing to practice to some degree. And they do so because they’ve benefited and in more ways than in just their sex life—they experience changes in their mood, anxi- ety, managing stress, general awareness of their body and body sensations. So, is mindfulness alone enough to increase a woman’s sexual desire? For some it is sufficient. And they’re quite happy, and they notice improvement in all domains. For other women, especially when there are relationship dynamics at play, things may need to be addressed at the couple level. Some literature has suggested that mindfulness can make you aware of some of the rela- tionship dynamics, like lack of attraction, which may be con- tributing to sexual difficulty. Can you talk about self-judgment and how it relates to sexual desire, and how mindfulness may help mitigate that? People can be ver y, very neg- ative in judging themselves in the sexual encounter. There’s also a lot of catastrophic thinking around, What if I don’t reach orgasm or What if I don’t move in the right way or have the right expression on my face... There’s a laundry list of thoughts that occur and just how those negative thoughts play out in terms of attention during sex and in sexual arousal. In our group work, we prac- tice together how to obser ve thoughts, even these really catastrophic negative ones, as just passing events of the mind. Then we encourage women to practice, first while touching themselves and then with their par tners. Women tell us that this specific skill, being able to obser ve thoughts as just passing events, is critical. It’s also very difficult. But ultimately it becomes the most important skill that they learn. What’s next? We are conducting a study with men who are survivors of prostate cancer and their par tners. These are men with permanent erectile dysfunc- tion, who really struggle with it. We often hear the criticism, “ Why just women? This could be useful for men.” That’s absolutely true. All of the findings on how mindfulness benefits women’s sexuality likely also apply to benefiting men’s sexuality. It’s just that the science just hasn’t been there yet. So we are really excited about this. You’ve been studying this since 2002. Can you now say that mindfulness is a viable solution for improving low sexual desire? My overarching statement that I can say, more than 15 years later, is that I have no doubt that it works. Even six years after studying it rather robustly, I couldn’t confidently say it worked. But now that we’ve run a number of studies with different populations, I can confidently state it does. — Kelle Walsh 66 mindful August 2019