#52 Sexless Marriages, Solutions & Cause with Dr. Nazanin Moali

So many relationships struggle with sexlessness and many couples aren’t aware of the fact that they can get help and save their relationships! Today on The Bad Girl’s Bible, sex therapist and podcast host, Dr. Nazanin Moali joins us to discuss causes and solutions for sexless relationships.

In this episode, you’ll hear all about Dr. Moali’s fascinating background, what made her want to be a sex therapist, her podcast, Sexology, her Farsi podcast, and so much more! We discuss what a sexless relationship is and what may cause it before talking about infidelity, pornography, and trauma and their effects on sexual experiences in relationships.

Sometimes, one partner initiates sex more than the other and may feel rejected often and today, Dr. Moali shares some tips to reconnect in this situation. We even talk about the differences between spontaneous and responsive desire, the main psychological causes of erectile dysfunction, and some cures for chronic erectile dysfunction. To hear all this and so much more, tune in now!

Key Points From This Episode

• Welcoming today’s guest, Dr. Nazanin Moali to the show.
• Dr. Moali tells us about her background and why she became a sex therapist.
• Her Farsi show and the demand for it among the Iranian population.
• The definition of a sexless relationship and the main causes of it.
• Infidelity causing anger and sexlessness and how to validate your partner to heal from it.
• How pornography affects relationships and how to handle the effects of it.
• Unresolved trauma and its contribution to a sexless relationship.
• How to handle when one partner rejects the other for sex or initiation is one-sided.
• Dr. Moali explains what spontaneous and responsive desire is.
• The main psychological causes of erectile dysfunction in otherwise healthy men.
• Some cures for chronic erectile dysfunction.

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Transcript

“NM: If the couple have sex less than 10 times per year, that would be considered sexless relationship. It’s significantly more common than people imagined. People have these hard and heavy sexual experiences early on, and life happens. Sex is no longer a priority for them.”

[INTRODUCTION]

[0:00:27] SJ: This is The Bad Girls Bible Podcast. I’m your host Sean Jameson, and this is the place where I interview experts and professionals and everyone in between to teach you how to dramatically improve your relationships and have more enjoyable sex more often. If you’re not already subscribed to The Bad Girls Bible Podcast, you just need to open your podcasts app, search for Bad Girls Bible, and hit that subscribe button, so you get the latest episodes delivered straight to you the moment they are released.

[INTERVIEW]

 [0:01:00] SJ: Today, I’m talking to Dr. Nazanin Moali. She’s a sex therapist, psychologist, and the host of the incredibly popular, Sexology Podcast. Dr. Moali Nazanin, thanks so much for coming on the show. 

[0:01:13] NM: Thank you for inviting me. I love your show. I was just recommended that oral sex and the blow job – one of my clients that she wanted to learn more about it. 

[0:01:25] SJ: Oh, great. Great to hear. I’d love to know a little bit about you, your background, how you became a sex therapist, why you became a sex therapist, and how you started the podcast, Sexology? 

[0:01:37] NM: Sure. I’m Iranian-American. I was born in Iran right after Islamic Revolution, so I grew up in a very conservative community, but my family are very progressive. My mom was a writer, and so from the childhood I realized I have the information that other people don’t have access to it, because of my family. I had this like incredible sex education book, so I started talking about sex with my peers when I was younger, so that was a comfortable conversation for me. 

When I got older, what I’ve noticed is my specialty actually is on treatments of eating disorders, but I think sexual health is really important. As part of my conversation with clients, I was asking them if there’s something about sexual health you want to talk about? You’re always welcome to bring it up. What I’ve noticed there’s an incredible need, like whenever I’m inviting people to talk about it, they were just so, they had so many questions. They just care about talking about that eating disorder challenges they had, because of how limited the information.

There is information out there and how challenging it is for people to talk about it. Back then, I was like, so I’m talking about it all the time and most of the work I’m doing is giving people information, like sex education that they haven’t received. That’s what I thought, I’m going to create my podcast for my clients, so they will have the resources, so we can focus on what’s needed for them when they’re coming in therapy. But soon enough the podcast grew significantly. I’ve been doing it for eight years.

I learned that I need to get more information that’s why I got ASAC certification, because what might be interesting for your audience is that many of therapists, they don’t have training in sex therapy at all. I have a PhD in clinical psychology. Before getting this specialty, getting information about this specialty after getting licensed, I only had one class on undergrad on human sexuality. That was it. Nothing else in graduate school, in my doctoral program. Sometimes people are not talking about it, because they don’t have providers, the information that would be useful for people.

[0:04:02] SJ: You run the podcast. You also have a podcast in Farsi?

[0:04:06] NM: Yeah. Yeah, I do have it. Yeah.

[0:04:08] SJ: Is there a big appetite for that among Iranians-Farsi speakers?

[0:04:13] NM: Yeah. I love doing that show, because with my English podcast it’s more about science of sex and pleasure, so I talk with other researchers. I talk about new findings. If we talk a lot about what is the newest things in the world of sexual health. With my Farsi show, I talk about sex education. I try to empower women who they haven’t learned about pleasure in that show, and it’s been incredible. I feel like the downloads for that show, although I do it bi-weekly and I’ve been doing it for eight years is, I would say twice the podcast downloads for my English one, because it is such a huge need. 

People don’t have resources to find the information. It’s very comforting for them to hear from a professional about it. They might think, “Okay, this is the person I can trust and I can listen to it in the privacy of my home.”

[0:05:10] SJ: Awesome. The main topic for today, we’re going to talk about is sexless marriages, sexless relationships. What do you see as the main drivers, the main causes of a sexless relationship, whether someone’s married or it’s just a long-term relationship?

[0:05:31] NM: It’s a great question. First of all, sometimes people ask me, what is the definition of a sexless relationship? Sexless relationship the way that’s been defined in research is if the couple have sex less than 10 times per year. That would be considered sexless relationship and it’s significantly more common than people imagine. What happens often people connect to the spark that they have. They have this hard and heavy sexual experiences early on and life happens. 

One common issue that I see is that maybe they start their family, they have children, they’re exhausted all the time. Sex is no longer a priority for them. So, that leads people to going to feel disconnected sexually and after a while if you haven’t been physically, sexually connected with your partner it can feel very uncomfortable to restart it. Many people they don’t know where to start and like they found themselves five years, ten years later living with a roommate. The passion it has died in the relationship which is very unfortunate. So, that’s one presentation I’ve seen. 

The other cause of sexless relationship is when there is a unaddressed sexual challenge. For example, what I see is one partner might experience erectile unpredictability, right? Maybe they struggle with maintaining an erection or they have lost that during sex. Then they don’t know how to tackle it, so the couple will start avoiding sex, because it’s just so uncomfortable to be in that situation, and as time passes by, they feel more disconnected and that leads them to end up in this place of sexless relationship. 

Going back to the conversation we had earlier, many people don’t know there are solutions out there, like sexual health challenges are something that you can cure, you can get treatment for it. It could be even as easy as few sessions, but oftentimes people feel, “Oh, my God. I’m defective. I’m broken.” So, they just don’t want to connect sexually with a partner.

The other presentation that I see is when there is an unresolved conflict in the relationship. For example, one partner has been going out of the relationship. There is some infidelity for example. That’s something that I see a lot in my practice. They have worked on rebuilding trust. Maybe they went to couples therapy, they were able to communicate what happened. It’s like the partner who went outside the relationship, took accountability, but they haven’t done the work to reconnect sexually. So, whenever they are trying to reconnect, the partner that’s been cheated on might feel flooded with negative emotion. They might feel insecure, and because of that they start and avoid having sex. They might end up at a sexless relationship. The other common issue that I see – 

[0:08:39] SJ: Sorry to interrupt, but they might be angry. Almost to the point of, fine we have this family. We got to raise the kids. We got a mortgage to pay. 

[0:08:49] NM: Well, Sean you brought up such a great point. Go ahead.

[0:08:51] SJ: No. No, I was wondering if you could speak on that, if that’s a common thing you see.

[0:08:56] NM: Yeah. Anger is very common after infidelity. Are we talking about infidelity or we’re talking about the sexless relationship? Because in both situations people tend to get angry. 

[0:09:06] SJ: I’m talking about infidelity leading to anger, even unresolved anger. It’s very easy to logically say, “Hey, I forgive you. Let’s move past this.” But I think deep down, it’s very hard to get rid of everything that comes with that to forget about it. The impact it has. 

[0:09:32] NM: Sean, you brought up such an important point with the anger, like unresolved emotions, like sometimes people feel that if I’m not paying attention to this emotion, if I’m distracting myself that emotion will get resolved on its own. But what happens is emotions are like a beach ball in the pool, right? We’re pushing it. They’re pushed back up. So, you might not even recognize how angry you were at your partner or you might have minimized it, but then what happens is that when you are trying to connect with your partner that you feel flooded with that anger, and resentment, and frustration.

You’re absolutely, right. Most people that they go experienced infidelity they might not seek out professional help, right? Maybe they have some conversation or maybe because of the dynamic of relationship they have avoided to bring it up with the partner, but they have unresolved emotions around it. That’s really important to get processed. One thing that we know from the research that can be helpful is that when the partner who went outside the relationship hear you validate you and like take accountability, because sometimes for people – 

[0:10:51] SJ: Sorry for interrupting, but how can they do that? What will be a practical example of validating your partner?

[0:10:56] NM: Well, I think first of all it’s important to be able to know that you are responsible for your own emotion and your action. What happens is that sometimes people try to approach it at a one-shot thing, right? Like I’m sharing with you that I went outside the relationship, maybe I say, “I’m sorry. I’m trying to, like take ownership.” Maybe we have done it for a week. Then I’m saying that like, “How many times I should say I’m sorry, like what else do you want from me?” Right? Because people feel that it’s confused maybe, that’s like I own up to it. What’s happening? There’s fear there. 

What if we never be able to move out of this space. But it’s really important to make sure that your partner knows that you’re there for their emotion, right? There needs to be some period of time for some couple is maybe three months, it could be six months that you are present for your partner from hearing them out, letting them to express their emotion. When they’re expressing their emotion, I know it’s really, really hard for many people to sit with the anger, but do your best to be present whenever they’re talking. Practice reflective listening. “Look, honey. I hear that you’re angry, because of this, this, this.” So, they know that you’re not there to zone out. 

It’s important also to take care of yourself at times, right? Sometimes we are outside our window of tolerance and we’re not able to hear another word from our partner. We can gently take a break and come back to it. I would say that if you have been taking ownership, talking about it, letting your partner process it and you feel you’re not moving to the next phase which is the repair, therapy would be a great thing, because sometimes you need someone’s help to identify what was the underlying emotion that keep your partner hooked in this situation. I don’t want to people feel minimized, because infidelity being a betrayal for people, but oftentimes, if we give ourselves opportunity to process our emotions, we can move past it.

[0:13:08] SJ: What about maybe not exactly cheating, but what about pornography? I get a bunch of emails about this every week. It’s usually female partner in a heterosexual relationship who emails to say, “Hey, I’m at the end of my tether husband, my partner. It seems to be addicted to pornography. He certainly seems spending a lot of time watching it and a lot more time than me.” Are there practical tools? First of all, do you see that in your own practice? Are there practical tools for couples for both partners to deal with this with pornography when it becomes too much?

[0:13:47] NM: Absolutely, like that they were up too much, right? I think everything in moderation is okay. I tell people that yes, pornography could be an issue, but the same way that if your partner didn’t want to spend time with you and they would go golfing, right? If they’re going every second that they have opportunity to do golf, then you feel rejected. So, for some couples it’s like that. That feeling of rejection. 

You’re not spending time with me. So, it’s important for people to think about, what is it about their porn consumption that creates this emotion for me? Is it because I feel that they don’t have appetite to have sex with me, now they like masturbated all day and they don’t want to feel connected, or is it about me comparing myself to women in porn and feeling not good enough? I think it’s really important for people to do the examination, exploration or it could be a value discrepancy. 

Some people have this belief that, I don’t want to be in a relationship with someone that watches porn. I don’t live in porn. I don’t like it. Because of negativity around porn and the different types of porn, sometimes people are not being honest with their partner. Saying that, “Honey, you don’t like it. I’m not going to watch it.” They have no intention of stopping. They’re just saying that I’m not going to watch it and their partner catching them and that creates frustration, and resentment, and the feeling of betrayal. 

The first step that I have for people is an invitation to talk about it with the partner, kind of like knowing that what’s underneath for you. Talk about it in a relational way. You can say that, “Honey, when you are watching porn and engaging with some like experiences. I miss being connected with you. I miss having sex with you.” So, whatever way that you feel you can be relational bringing that up. Sometimes people feel like their relationship is out of control. What it means that you have underlying anxiety, a trauma, and porn is a way for you to regulate your emotion. It could be one way of regulating emotion, but it cannot be the only tool in your toolbox. 

If your partner is saying that, “Okay, honey. I try to stop. I can’t.” You notice that that’s an issue when they’re talking about it with you, then you can perhaps refer them to a clinic, therapist that they can help them with other tools in the toolbox. Again, there’s nothing wrong with porn, the same with food, right? If we want to regulate our emotions through eating ice cream all the time, that might not be the best strategy, but having ice cream once in a while that could be completely pleasurable and healthy. So, that’s also something else I want people to keep in mind.

[0:16:31] SJ: You mentioned trauma. Can trauma past, maybe abuse, impact one partner, both partners libido and desire for sex, causing a sexless relationship?

[0:16:46] NM: Absolutely. Right. That is another thing that I see often, unresolved trauma. Trauma could be a sexual trauma. It could be physical trauma. There we have different types of traumas. When we talk about trauma, when people or a person in a situation that’s so overwhelming that they can cope with the situation, that could be a traumatic situation, or someone would be something that happened in their childhood, maybe even illness of the parent, for some people could be an assault they experienced or rape, right? So, how it’s impacting the relationship is how much the person have worked through that experience.

Trauma can be incredibly painful experience for people to have. It can really impact how our body responds to sex and sexuality. It can impact our responsiveness or lack of responsiveness. For example, in my female clients I hear from them that, yeah, psychologically, I have worked through the trauma experience I had. I was able to integrate it, but during sex I’m completely numb. I’m zoned out. I’m out of my body. So, that leads them to not feel connected during sexual experiences, maybe they have that lead to issues with desire, they can have experiencing orgasm. That could be something that’s impacting the person and in the relationship. 

How it’s impacting the relationship is sometimes the partner is not aware of their trauma. So, when the person doesn’t want to engage, they think it’s a rejection on them. Maybe that’s something that happened in the past. Now, the sexual experiences out of the blue the partner feels anxiety, panic attack, or push the partners away and the other partner they don’t have the context. They think about, “Oh, they’re rejecting me. What’s happening with this person? Why they’re irritable?” That is something important for the person who experienced trauma, if they feel safe enough, if they feel the relationship is stable. 

If they want, they can share some of the information or all of the information, but they don’t owe it to people to talk about their trauma history. They could just give them a context to partner. Sometimes we are in relationship with someone and maybe they experience trauma, like maybe they experience rape. Something happened. Assault happened. It’s really helpful to support them to feel safe in their body again. 

Feel the safe in body is really important. They could get a safe life approach earlier, maybe it’s just about holding hands, cuddling your partner, and then as they feel more safe, as they invite you to engage in more behavior is that’s something that you can do to get out to rebuild intimacy and sexual connection. But with trauma also, if people are working through a therapy, they have psychedelic-assisted therapy, now that’s very successful for trauma survivors. They can regulate their nervous system, therefore that can help them to be more sexually open.

[0:19:56] SJ: That’s really fantastic advice. Some couples fall into a routine where just one partner is almost always the initiator of sex and the other person either goes along with it or sometimes rejects that initiation. Often after consecutive rejections, the partner who’s usually initiating feels frustrated. They feel like giving up. They don’t communicate this to their partner and as a result the relationship ends up with less sex than either partner would like. It’s just happens sometimes. 

Are there practical steps if someone’s listening now to the podcast and they feel that they’re getting rejected, they make these attempts and initiation, and they’re constantly getting rejected? Are the practical steps they can take maybe with talking to their partner, discussing it and to resolve it, so that maybe they share the burden of initiation or figure out a way where neither of them feels rejected?

[0:21:05] NM: Well, feeling rejected by your partner can be incredibly painful, as you mentioned especially, if it’s a pattern. It’s with most people, it’s not only about sexual experiences. They feel invalidated, they feel they’re not worthy, so it should really impact their self-esteem. So, it’s really important to talk about it. I sit all the time with my clients in my practice that they feel, okay it’s no longer about sex. It’s about how my partner, how much they want me as a partner. 

Hand me down what happened that you guys ended at this place? There could be a different solution. One recommendation that I have for your listeners is I’m thinking about, when this cycle started, right? Was it like we were, like we had more sexual experience, that was great, and then something happened? It could be betrayal, anger, conflict. After that my partner is not – avoid, either avoiding sex. They don’t want to engage sexually with you. 

I think it’s really important to notice that. What was the beginning story of this cycle? Then if you are feeling, it’s just because of life, as we talked about. Sometimes it’s just life happens for people like they feel exhausted, they have children, their work is stressful, and then they’re just out in the mood. I invite people to talk about it. First step is having a conversation outside the bedroom with your partner. 

Talking about why sex is important for you. What is the meaning of sex for you and your partner? For people, it’s connection. For some people think, it’s expressing love. It’s about vitality. Having this conversation can be really helpful, or your partner can hear. It’s not necessarily about you wanting them to have sex, so they’re not in a negative way, like object of like sex machine in a way. So, you’re not using them in that way. It’s all about the relationship and relational dynamic.

Then starting with the open-ended question. Saying that, “Honey, I miss when we were connected. How can we make it happen?” Start talking about, like their experiences, going back to validation is really important. Reflecting our partner what they’re saying. You can then talk about, “I noticed that when this happened, when I initiate sex there’s not openness.” So, kind of talking about what’s happening. So, what’s underneath is for many couple could be a different thing.

One is for some traditional couples they feel that it’s men’s job to initiate, like regardless of the age, what’s happening, they want to feel like the man is at the job of a seduce or an initiator and they might feel less than if they are initiating. For some couples, it feels like, okay, so my partner has higher desire. They’re constantly initiating and there’s no opening for me to initiate. So, we’re talking about what’s schedule would work for you. For some people scheduling sex can be really helpful. 

I’m not saying that in a boring way, like schedule sex, so you feel it’s another to do on your list. It’s more about having this opportunity to connect sensually with your partner. Doing it in a time that’s there’s an openness, sexual openness from both parties. Some people are having higher desire in the morning, some people have higher desire in afternoon and maybe if you’re initiating every night after a kid’s going bed or every night as a last thing. Your partner might not experience desire. So, having this conversation is what time is optimal for us can be helpful. It’s like working together to create a plan around it can be very powerful.

[0:25:02] SJ: You mentioned desire. I’m talking specifically about male listeners. Could male listeners and female listeners also, perhaps, communicating the type of desire that you experience that you get aroused, how you get aroused to your partner help with that, whether it’s responsive or spontaneous?

[0:25:22] NM: Absolutely. That is such an important thing to talk about with the partner. I love that. It seems like you already have talked about it in the podcast, about spontaneous desire and responsive desire.

[0:25:34] SJ: Sorry for interrupting, but perhaps you could explain what spontaneous desire is, and then what responsive desire is and for those who don’t know.

[0:25:43] NM: Sure. Spontaneous desire is what people see in media, in movies like you’re going about your day and somehow you experience this spark of desire and you want to engage sexually, so that’s spontaneous desire. Responsive desire is that maybe you start at the place of neutrality, but when you are engaging in foreplay, you’re making out. You notice the desire shows up afterward, so because of how your desire works it’s like no matter like how many days passes you might not experience the desires spontaneously, but if you are in the sexual context and you might feel lots of desire.

I don’t want people to think about responsive desire is about having less desire. It’s just a different type of desire. If you are someone that think you have a responsive desire, it’s really helpful to talk about it with a partner. I think also, have a scheduling intimacy will be helpful, right? I’m thinking about maybe during this time we’re connecting sensually, erotically, maybe we’re making out, maybe we’re doing erotic massage, maybe watching something. Let’s see what happens. Maybe desire shows up. Maybe it doesn’t, but I think at least your partner doesn’t feel that you’re rejecting them all the time, because you don’t have the opportunity to cultivate desire.

[0:27:10] SJ: Absolutely. I also think what you said is focus on especially, I think guys sometimes have this focus at the end goal which could be orgasm or just, I want to turn my partner on. I can’t just have a enjoyable time. We can’t just kiss, or hold hands, or give her a massage. It has to be an end goal. All of us get the task done. I think a lot of guys, I mean I’m like that with a lot of things as well. 

Yeah. Just overly focusing on your partners, on your partner reaching orgasm, or you reaching orgasm. I think also, can contribute to unneeded pressure when it comes to sex. Yeah. If you’re feeling that pressure and you want to avoid it, I think that contribute to maybe wanting to have sexless in a relationship.

[0:28:03] NM: Right. I think one thing that’s helpful for people to think about is the erotic. Erotic things are aspect of sexual experiences that makes it juicy and exciting for us. Most people haven’t had opportunity to explore those. The way you can see what your erotic theme is, I’m thinking about the best sexual experiences you have. What was happening before? What were you feeling before? How things escalated, and what did you feel afterward? For many people when they do this exercise, they don’t think about, there are different themes. It could be feeling adored, maybe feeling powerful, adventurous. 

Knowing that theme can help you to create experiences that makes the sexual experiences so much better, right? Because like if you are only focused on end goal, you might have lots of mediocre experiences at best, right? But if you really knowing your erotic theme, like you are a screenwriter that you’re writing a really, really good story. Sometimes I hear from my male clients. I’m not into foreplay, like one, two, three it like what I do, is to get to the main act in a way, but I tell people that if you’re not into foreplay, you’re not doing it correctly. So, for foreplay you want to like engage in things that makes you feel excited and your partner excited.

It’s like this great erotic experience. It’s about that exchange of energy. It could involve so many different ways that you can build anticipation and excitement. Those are the things that you can incorporate. So, if you want to have great experience that it’s really important to focus on your erotic theme and your partner erotic theme, so you can have these incredible experiences.

[0:29:56] SJ: Erectile dysfunction. What do you see as the main psychological causes of erectile dysfunction in otherwise healthy people?

[0:30:07] NM: Well, there’s so many psychological factors that people they don’t know about. When you think about erectile dysfunction most people think about, okay, I have to go to my physician. There’s a hormonal issue or some physiological issue. But what’s really important for people to know that psychologically there’s so many different things that can impact your erectile functioning and kind of like being able to gain erection and maintain erection.

Number one, erectile killer, erection killer is stress, right? When you’re feeling stress, overwhelmed our body is at the place of fight and flight response. So, when we are at fight and flight response, it’s not productive for us to have blood going to our penis, because erection is purely blood flow to the penis, right? So, our body channels the blood other places like your legs, so you can move and it can slow down digestive system. 

If you’re stressed out your body doesn’t know that if you’re getting chased by a lion, or your sexual experience that you’re feeling stressed out, or maybe you have the stress from the work and now, you didn’t give yourself opportunity to de-stress and now you want sexual experiences and that could be that like a issue, like unmanaged, mismanaged stress. 

The other thing that psychological issue is anxiety. We see a lot of performance anxiety in people, even at the younger people. There’s nothing wrong physiologically with them is that they could have like at some time, some point, maybe they lost an erection, but it happens to everyone. It happens more than people think. Now, they’re worried about it. As undressing they’re making out with the partner. They think about, “Oh, God. What if I lose an erection.” That causes to people to loss it.

[0:32:02] SJ: It’s getting bigger and bigger in their head.

[0:32:03] NM: Yeah. Yeah. That’s all your thinking. Oh, my God – 

[0:32:06] SJ: The problems getting bigger in their head, not their penis.

[0:32:10] NM: Yes. You want the penis to be bigger, but that it usually happens. It’s like you’re pretty occupied with it, so that causes you to lose an erection. It turns to this negative cycle. The other thing possible psychological issue is depression. With depression what happens is we might not be interested to do the things that we were interested to engage in, like you might not enjoy your favorite food or exercise. That happens with sex as well. You might not feel desire and erection is a physiological and psychological response to desire, so if you don’t have desire then it’s hard to get an erection. Those are the few psychological challenges that I see. There’s just a list, it’s so long, but I want to talk about the top ones.

[0:32:56] SJ: You mentioned stress and anxiety. There’s performance anxiety as well, but could other types of anxiety impact, getting an erection, not getting an erection besides just performance anxiety?

[0:33:08] NM: Absolutely. I think about social anxiety, right? But for people that are socially anxious, I have clients that even they go on the blind dates days before they start feeling anxious or anxiety it can build up here in the experience. Then it’s really hard for us to feel calm in our body if you have social anxiety with someone new. Maybe this is a new partner, so that could be part of it. 

The other types of anxiety that could be like anxiety around, like sharing your experience. I talk about this what I mean with that, sometimes people feel, some men have no desire, but some research studies talk about how people are not sharing what they like, right? So, maybe you are, and you have a specific fetish or kink, right? That’s not what’s happening in the relationship. You haven’t talked about it with a partner. Now, then you’re feeling anxious. It’s about, “Okay, it’s not going to happen. I’m not going to be able to get an erection, because I’m not into this experience.” That can cause some issues and problems of getting an erection, because the desire is not there for you.

[0:34:20] SJ: I think that also could be the case for both partners in a sexist relationship. Maybe it would help sometimes, maybe not all the time to explore kinks, fetishes as a way to spice things up, but maybe to increase desire as well.

[0:34:36] NM: That is such a great point. What one of the things that I see in my practice, people coming in and I see lots of this and their couples. The male partner saying that, “My partner has female partner low desire.” I just want to fix her, like bring her to the session. We’re doing couples therapy and when I meet the female partner alone, they say that, “I feel uninspired. I’m like, I know exactly what’s happening, that happen. This is like with the same position, same foreplay we’ve been doing for 20 years. I’m just not interested.” For many women context is really, really important. 

Relationally, women like socialize to not ask for what they need, so they just going to start avoiding sex. But as you mentioned it sometimes kind of like spicing things up can really help with increasing the spark in the relationship. It could be small things, right? It doesn’t need to be something drastic that you have to go – if you’re not into going to sex parties you have to go to sex parties. It could be just trying a different position, or maybe introducing a toy, or a role play. It’s more about bringing new or energy into the relationship, versus what you’re doing.

[0:35:47] SJ: Do you see other common issues over and over again with couples, with all types of couples, but common themes that require professional help?

[0:35:56] NM: One other common presentation that I see that people are coming for sex therapy? What’s happening in the bedroom is by product of the issues outside the bedroom. So, like maybe they feel invalidated, disconnected, not supported by the partner, right? I see a lot of couples saying that, “I was doing all the work at home. I prepared the meal and my partner didn’t do anything. I just don’t feel connected with them, so that’s why I don’t want to have sex.”

It’s really important to like notice what’s happening outside the bedroom and how much it impacts the connection inside the bedroom, so that’s a very common, important thing that people – it’s important for them to keep in mind. The other thing is that the common issue is that people have these misconceptions about what sex supposed to be in long-term relationship? 

In early phase of relationship things are hot and heavy, you want to have sex all the time or most of the time. It’s just like, it’s easy or just like it’s spontaneous for everyone and it’s different. But now, you are two, three, four, five, 10 years into the relationship and you don’t notice that like you feel like that initial passion a little bit dimmed down. It’s like you feel really connected to the partner, maybe you have a great relationship, but it’s required – spontaneous excitement and all of those shining new energies are now there. 

It doesn’t show that like your relationship is failing, because many people feel that, “Oh, my God. It means maybe this partner is not right for me.” Or, “We’re no longer compatible.” But what in reality is having the right information. So, in this new season of relationship you need to be more intentional with like having sexual experience if you want to have, maybe you want to engage in seduction. Do things to make things more exciting, so you will be able to have the sexual experience that you want, because what worked for six months of the relationship is not going to work for most people like in five years, 10 years in the relationship.

[0:38:07] SJ: It’s fascinating. Coming back to the ED topic. What would you recommend people with ED that it’s caused by stress? Is there a simple solution? Should they take medication or is there something else you’d recommend or multiple things you’d recommend them to try?

[0:38:25] NM: How many times do you have? I can talk about hours. It’s how exciting, yeah. I’ll say like few days and people can look into it more. I think with erectile dysfunction, first thing is if you have like the idea is that if it’s like happens to you more than two-third of the time, that’s erectile disfunction, right? So many people have erectile unpredictability.

[0:38:48] SJ: Sorry to interrupt, but as you said before, it’s normal to happen from time to time. Perfectly, months – 

[0:38:54] NM: There’s nothing wrong, right, maybe you drank too much, maybe you were stressed out, for a number of different reasons, but if it happens consistently for you. You went to your urologist. You went to your physician. There’s nothing, like blood flow is okay. Hormones are okay. So, you know it’s psychological. 

I think it’s really important to examine what is the root cause of it. For many people it’s anxiety and stress, so what you need to do is to practice anxiety management outside the bedroom, so you will be able to use it during sexual experiences, because if I teach you for a breathing exercise in the midst of the moment you might not be able to practice it correctly, right? It’s important to practice it outside the bedroom.

I tell people like there are different ways for managing the anxiety that can help you with a performance in the bedroom. One is practicing breathing exercises, so when we are anxious, we tend to breathe very shallow and that triggers fight and flight response. So, you want to make sure that you’re taking deep breaths that’s something that you want to practice outside the bedroom with your breath. Practice shallow breathing, deep breathing, shifting between them, because that’s something that will help you deal in sexual experiences. So, that’s really, really important.

Also, I tell people that before, like if you’re doing schedule sex. Before engaging sexual experiences, do something that gives you joy and helps you to feel like you are in the right mindset. For many of my clients is doing exercise, maybe you go boxing, running, whatever, like biking that you think is yours that will help you to be more in flow state. That help your body to be more stable. The other thing is that sometimes people feel that like they carry this burden a lot. This is on their mind. They hope that nothing cannot go wrong, and that’s create this – more anxiety for them which caused performance issues. 

There’s nothing wrong with talking to your partner about it. I know it’s very, very difficult for men, but you can say that, “Sometimes when I’m excited, it’s hard for me to keep an erection or maintain the erection. I just wanted to let you know, I thought about you.” Because sometimes female partner, heterosexual relationship they feel rejected, they feel withdrawn that, “Okay, then my partner lost their erection, they’re not interested in me.” So, you’re unburdening yourself. Go ahead.

[0:41:18] SJ: It’s funny, because then the guy’s worried that he’s done something wrong and then equally their partner’s worried they’ve done something wrong. Maybe it can be, it can create this cascade or cycle of again avoiding sex, maybe causing things to become worse and kind of ED to become more prevalent.

[0:41:40] NM: Absolutely. Going back on strategies in the bedroom, like we learned that sex started erection, ends with male ejaculation. That’s like the narrative of the majority of the society, but what’s important to keep in mind when I talk to couples, when the people partner is disappointed. If you’re communicating with them, they are erectile unpredictability, they are disappointed, because when you lose an erection you withdraw, like sex ends in a way. Now, you’re in your own shell and just like that feels very unpleasant for them, but if you lose an erection one thing, they can help you and your partner is to want to focus on shifting attention to doing something else, maybe you can do oral sex for them or making out. That can help you with that abrupt ending of the experience which cause frustration.

Many times, when people shift their focus, doing something pleasurable for their partner, it’s common for their erection to come back. So, going back on the meaning of sex. You don’t need to have a hard penis to experience connection, right? So, it could be a number of different ways that you guys can connect sexually with or without a hard penis. 

[0:42:52] SJ: Nazanin, Dr. Moali, this has been fantastic. Thanks so much for coming on the podcast. If people want to know more about you, get in touch with you, learn about the podcast, what’s the best way for them to do that? 

[0:43:06] NM: Well, first of all, thank you so much for inviting me. I love your show. It’s such a pleasure. If people want to learn more about me, wherever they’re listening to this show they can just look for Sexology Podcasts, so – 

[0:43:17] SJ: We’ll put your link in the show notes.

[0:43:20] NM: Beautiful. All of my information is out there. These are topics I talk about all the time. 

[0:43:28] SJ: Awesome. Dr. Moali, thanks so much.

[0:43:32] NM: My pleasure. 

[0:43:34] SJ: One last thing before we go, if you want to hear more podcasts just like this one, open your podcast app search for Bad Girls Bible and hit that subscribe button.

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