The most frequent reason that folks will come to a sex therapist is because they're experiencing what we call a desire discrepancy. All that really means is that one person wants to have more or less or a different kind of sex than their partner does, and they're having trouble navigating that.

Welcome to the Taboo to Truth Podcast, unapologetic conversations about sexuality in midlife. I'm your hostess, Karen Bigman, certified life and menopause coach and sex educator. Whether it's a dwindling libido, a dry vagina, a challenging erection, or the emotional ups and downs of midlife, we're here to talk about it all. I'm going to bring the often quiet into the light to create a safe space where no question is too awkward or taboo. Together we're creating a community of support and education where you can learn, share, and laugh about the intricate beauty of sex in midlife. So grab your favorite drink and put me on speaker. It's time we broke the silence.

Hello and welcome. Today I have Doctor Rachel Zar with me. She is a licensed marriage and family therapist and an ASEC certified sex therapist. That's the association of Sex Therapists, educators, coaches and something like that. It's a very important organization. She holds a master's of science in marriage and family therapy from the Family Institute at Northwestern. She's a PhD in clinical sexology from the modern sex therapy institutes and holds certificates in sex therapy and sexuality education from the University of Michigan. Doctor Zahr is also a clinical supervisor at Avid Intimacy, which is a sex and relationship therapy private practice in Chicago and she's passionate about educating and mentoring other clinicians. She frequently writes lectures and is an expert on a myriad of sex and relationship topics. Welcome Rachel.

Thanks for having me Karen. I'm excited to be here.

So we just talked. I've just mentioned like a whole bunch of stuff, but just in your words, what does a sex therapist do?

It's a great question because we do all kinds of things. I mean, first of all, anyone who's a sex therapist is a therapist first. So that means that for me it's marriage and family therapy. I'm really trained in doing couples work. You may also see sex therapists who are psychologists, who are counselors, who are social workers. Being a sex therapist just means that not only are we sex positive, we welcome the idea of talking about sex in the room, but we have specialized training in working with sexual issues. So that may be sexual issues, issues within a relationship, maybe sexual functioning, issues within an individual, any kind of work that folks want to do. Sexual identity, sexual shame, gender kink, folks who are sexual minorities, those who have, especially if you see that someone is a certified sex therapist, that means that they have a lot of specialized training and supervision around treating these issues. Particularly.

It's interesting because I would have thought that all therapists do sex therapy too. So what makes. Obviously, I've learned more in the last year than I've known my whole life. But one of the things that actually really surprised me is how important it is and how different it is to be particularly trained in the area of issues around sex than just being a generalist as a relationship counselor or therapy.

Right, right. It's a common assumption. And it's things that, you know, folks think that like, oh, well, you're a couples therapist, of course we could talk about sex with you. And the truth is that, you know, I got my master's in couples therapy and I had one semester that included a sex therapy class. And that was only true a few years prior to when I graduated. It used to be an elective, and that's better than most programs. A lot of programs you won't even. You may talk about sexuality and gender, hopefully inclusivity, but really, someone saying that they're a couple's therapist or having marriage and family therapist or counselor after their name at baseline tells you nothing about their ability to work on sexual issues. And the problem with that is that a lot of folks will have really bad experiences bringing sexual issues into the therapy room, right? Because they think this is a safe space. And when a therapist or counselor isn't prepared to have that conversation, sometimes their own shame or embarrassment comes up. Sometimes even folks who are super sex positive and want to create the spaces talk about these issues. They just don't have the training to actually be able to do something with it. So they may be a compassionate ear, they may create a safe space. And that's wonderful. I hope that all therapists get to at least that sex positive level. But if you're having a really specific sexuality issue or you want sexuality to be the focus of your therapy work, seeking out a sex therapist is probably your best bet.

So what are some of the main issues that you see and that someone would come specifically to a sex therapist?

For sure. The biggest thing that I see, especially with couples, the most frequent reason that folks will come to a sex therapist is because they're experiencing what we call a desire discrepancy. All that really means is that one person wants to have more or less or a different kind of sex than their partner does, and they're having trouble navigating that has someone having a desire discrepancy actually tells us very little about what's actually going on in the relationship. I'll see a lot of folks who are working on getting to know their sexual identity, who are unfortunately coping with a lot of sexual shame or sexual trauma, that they're needing help on getting to know their sexual selves and feeling competent or confident and compassionate towards that part of themselves. I specifically focus on sexual functioning issues and those assigned female at birth, which means difficulty with low libido, difficulty with orgasm, or painful sex. And that's something that I've really focused a lot of my work on. My dissertation was focused on folks who are navigating painful sex and the lived experience of that.

And I would assume, and I know from personal experience, not from the painful part, but they're all intertwined. Oh, of course, libido and the whole thing. I'm actually putting together my keynote and talking about my issues with anarchy and orgasmia, which for the audience is the clinical term for difficulty with orgasm. I fortunately did not have painful sex, but I hear that repeatedly. And I would love to talk a little more about it because I know there are a lot of people in the audience, both men and women, who are suffering, whether it's the male partner who's suffering because of the female issue or. I guess that would be your area for men have their own. Their own issues, but let's talk about.

Absolutely.

So, yeah, what the issues might be and how one could treat them or.

Sure, what we see, and this is part of why I'm so focused on this particular issue, is that what we see is that it's actually really common for folks with vulvas and vaginas, especially to experience painful sex. People with penises also have painful sex issues, is far less prevalent, and there are many more solutions for them, because also what we know is that there's just been a lot more research on penises than there is on vulvas and vaginas. But the data, as we currently have it, tells us that up to 20% of those assigned female at birth will have an experience of painful sex that is chronic or long lasting. That number goes up to 75%. When we're talking about, like, a one off, like, oh, I had an experience that can be, you don't have enough lubrication, or you have a yeast infection or an ingrown hair. There are all kinds of reasons that one could have a painful sexual experience. But we're talking about chronic, long lasting. We're still looking at about one in five, which is huge. And part of the reason that it's so big is because girls, when they're learning their sex ed class, are never actually taught in most cases that sex is not supposed to be painful. In fact, we often hear the opposite. Right. When you lose your virginity, it's going to hurt. Right? Brace yourself. And what does that do to our nervous system? It puts us in a situation where we're clamping down and it can mean that sex is incredibly painful. And we've normalized that. So we don't do anything about it. We don't worry about it. We just think this is what it's like to be a woman. That's not true. Sex is not supposed to be painful. Intercourse is not supposed to be painful. Even your first time, right? That is a myth. It is a myth. And it's become so ingrained in our culture, in our expectation for sex, that often folks who are experiencing painful sex, even regularly, aren't talking to their doctors about it, aren't talking to their therapists about it, aren't telling their partners that they're in pain. Pain. And what that can mean is that we start to adapt to that and it becomes chronic. And then, of course, we have the issue that a lot of doctors don't even know what to do. If you say to them, you know, I'm having painful sex, I've heard some absolute horror stories from folks who have doctors who will say, you know, just have a glass of wine or just relax, or, you know, sex is supposed to be painful. And it's like, no, no, it's nothing. Not, that's not normal. Thankfully, there's more and more research about the conditions that can cause painful sex. There's more and more sex therapists like me who are getting trained in this, in the psychosocial and relational aspects of chronic painful sex, which is what we work on in sex therapy. And there are solutions out there. There's no reason, even if you've had painful sex for years, that you can't seek solutions and that you can't get to a place of a pain free sexual experience.

And I think it also just perpetuates that whole myth that women don't want sex and as we get older, like, we don't need it and we're washed up. And, I mean, if I was having painful sex my whole life, I wouldn't want it either.

Well, exactly. This is so often when I see folks who are seeing me because they have a low libido, and I'll say, well, how does sex feel? Does it hurt? And they'll say, well, yeah, it's always hurt. And then it's okay. You don't have a low libido. You have good judgment. Right. We don't desire things that cause us pain. So, like, yay. Your desire has appropriately adapted to what sex feels like for you. Let's get you to a place of sex worth having, and then you can assess where your libido actually is.

So what are some of the top few causes and treatments that you might. Obviously, every person is different. Everyone's issues are different, and some have more than one. But let's just sort of high level.

Sure, sure. This is where I get into the big medical words, but the most frequent thing that we'll see is what's called vaginismus, which means that the pelvic floor muscles, all of the muscles that surround the vagina, get really tight and clamp down. What this means, of course, is that if you're trying to have intercourse, it can feel like you're hitting a brick wall and can be incredibly painful. For some folks, vaginismus is a trauma response that could be after sexual assault or just having a few bad sexual experiences. Your vagina is so smart, so your vagina is going to remember, and then the next time you go to do the thing that didn't feel good for your body, those muscles clamp down. And then with time, that adaptation becomes chronic. What's so complicated about vaginismus is it's often actually secondary to another issue. The term vulvodynia starts with the word vulva. The vulva is the outside of the female genitalia. So those are all of the parts of our genitalia that touches your underwear, that you can see with the naked eye, probably with a mirror, and with your leg spread. But vulvodynia tells us almost nothing about what's actually going on, but it just means pain on the vulvar area. The most common form of vulvodynia that we see is what's called provoked vestibulodynia, which means that the entry point to the vagina, which is called the vestibule, can be extremely painful to the touch. So if you're trying to have intercourse, it's that searing pain. Like, as soon as you try to put anything in, you may also notice this with a tampon. You can notice it with a finger. But if it's right around that opening that's probably provoked vestibulodynia. Then, of course, vagina smart. So those muscles will then clamp down to prevent it. So you often see a lot of different forms of, or a lot of different conditions that are overlapping and intermingled, especially if it's been there for a long time. The most common reason that folks will have provoked vestibulodynia is due to hormones lack of estrogen, which we see in, first of all, folks who have been on a low dose birth control pill for a long period of time, most people aren't told to look out for that when they're put on the pill at 16. But it is something that can happen. We also see this after pregnancy, during breastfeeding, that kind of low estrogenic state, hypoestrogenic state, which can lead to vestibulodynia and of course, perimenopause and menopause, when those hormones, that estrogen level takes a huge drop. And that can really impact your experience of pain during sex. Again, a lot of folks aren't told when you go through menopause, sex may be painful, and of course, then they don't know what to do about it. And Lube doesn't help if it's an estrogen issue, may help a little, but it's not going to do the trick.

Yeah, I mean, women aren't told a lot of things.

Well, that's the theme.

Plenty episodes on that, right?

The thesis statement of this podcast is that you were never told that.

Exactly. Exactly. I mean, I met someone, I joined this group. It's an empty nest, or women. And I was sitting next to this woman, and literally, she. I told her what I tell people what I do. Most of the time, they want to talk about something related to menopause, whatever, but sometimes they don't want to. You know, they'll just be like, oh, nice to meet you. Most of the time they want. And she. I don't know how it came up. Something about libido. She's like, oh, my husband's upset, too. But like, I just didn't think there was anything. Like, I just thought it, like, that's what just happened. Just like, there's no. You just don't have sex when you're like, at a certain point. And I'm like, all right, wait a minute, lady, back up here.

We need to.

We need to teach you something here. Go read the literature. Right. So, yeah, it's really unfortunate. And like you said about sex therapy and your therapy training, as you well know, from your mom, too, who's a very well known sexual medicine doctor, that there's very little training about menopause, and I'm sure sex as well. Well, maybe a little bit more about sex because it has to do with babies, but in medical school as well.

Right, but that's all they're getting. Right? Reproductive medicine and sexual functioning are actually totally different topics. And most doctors, even gynecologists, are getting maybe a 20 minutes lecture on sexual functioning issues. And yeah, they can tell you a lot about reproduction, but if you come to them and say, you know, it feels like a hot knife is stabbing into my vagina when I try to have intercourse, they may be able to empathize. Right. But they probably didn't get a whole lot of training around what to actually do. That being said, there are, I mean, my mother, Lauren Stryker, is one of them. And there are really excellent sexual medicine doctors that are specialized in this that have done a ton of extra training. And if your gynecologist hasn't referred you to one of those, they should. You can also do your research and find someone who specializes in sexual medicine, who specializes in sexual functioning.

Yeah. And I learned about that from my own experience. But it took me a lot to actually tell my gynecologist I was having this issue. And of course, it always starts, starts with your head. You're going through divorce. You know, she didn't quite put it that way because I think she's a lot more evolved than most.

Good.

She put me on hormone therapy when it wasn't the thing to do, so I fully trust her, but it wasn't an obvious way to go. And eventually I ended up in this great sexual medicine practice, and that sort of sparked my interest in all of this. But it is so true that the first thing is being able to even admit that you have this problem, which you're embarrassed about. Although if, like something else is going wrong, that, you know, if your back hurts, you've no problem going talking about. But if your vagina or your vulva hurt, you're like, oh, how do I even tell my doctor? And then from there being told, I'm sure you heard the story of Halle Berry and how her doctor told her that her and her partner have the worst case of herpes he's ever seen. I mean, a 50 something year old woman complaining, like you said, like knives every time she had sex. And.

Right.

How did that not compute at some level?

Right? Because doctors get training in STI's, they don't around sexual functioning and you bring up such a good point, Karen, that for so many people, the hardest thing in the world is to just say it out loud. Right. That that takes so much because there is so much shame and embarrassment, even though this is nothing to be embarrassed about. Right. As I said, the prevalence is high. It happens to a lot of folks. It's not okay, and it's not embarrassing. It's not shameful. It's why also, a lot of what you get when you seek out a sexual medicine physician or a sex therapist is that there's that blanket permission there. I'm going to ask you what's going on in your sex life. I'm not going to wait for you to bring it up. And for a lot of folks, that's the most important part. It's just the permission. For most people, their gynecologists aren't asking them, are you having orgasms? Is the sex that you're having pleasurable? Are you experiencing sexual pain? And they don't ask because they don't know what to do if you say yes or if you say that you're not having orgasms. But there's something about seeing a specialist that just offers this permission that can instantly make it feel easier to just say the words out loud.

I remember the conversations as I was just, you know, as I keynote, it's all coming back to me. And I remember they actually had paired me with a nurse practitioner and a sex therapist. And, you know, she, her name's Batsheva Marcus. I've actually interviewed her like a doctor, Ruth. And they start asking you, like, do you get aroused? Do you get wet? Do you need clitoral stimulation? And you're like, you're so uncomfortable. But then it's just like, I'm in doctor's office. Like, I may as well, you know, I mean, they went so far as to say, like, here's a vibrator, go try it in the other room. And I was like, really? Oh, yeah.

Wow, that's progressive.

That was New York City, you know, but it was, I mean, it's what led me to say, like, this is not shameful. This is something like, hey, I'm single and I'm in my fifties. Like, this is time to go get late and have fun.

Yeah, what a time to have great sex. And you know, what's interesting is what we see. Like, to your point earlier, around folks saying, like, well, my libido is gone, so I guess it's just done for me. Is that for folks who put in the effort who make it a priority to continue to have sex perimenopause, menopause, post menopause, into their sixties, seventies, eighties, nineties, that they do report that the sex that they're having actually gets better. And that's something that often surprises folks, that we think, like, oh, well, yeah, you can keep having it, but to what end? And it's like, no, actually, we see that for the folks who intentionally continue to prioritize their sexuality, they're having better sex as they age, which is pretty cool.

Totally. And it's like, I mean, however much time you got left, like, you missed it for the first 50 or 60 years of your life, like, let's go out with, you know, with a smile on our face.

Right. There's so many ways that, I mean, you have more free time. Your kids are out of the house. Right? Like, maybe you're not working or working as much anymore. There's just so many ways that sex being the priority at this phase, in this phase of life, just makes sense.

Yeah. Yeah. I think in Lisa Moscone's research, she also said that there's some of what she found is that maybe, I don't know if it was her research or someone else, that there's this kind of I don't give a fuck attitude that women start to have as they get older as well, post menopause. Right.

You're focused less on performance. You're focused less on, what does my body look like? You're just in it for the pleasure. And that's where the best sex is. When you're just in it for, like, what makes my body feel the best. Right, right. Those are the folks who are having the best sex. They're not worried about what they look like or how they're performing. They're just worried about how they're feeling.

Yeah. Yeah. So let's segue that into away from pain and into pleasure.

Yay.

Let's talk about. You recently either wrote the article or quoted an article about foreplay. Yes, let's talk about foreplay. And, of course, like everything else, we were not taught or taught, foreplay was always that little thing you do before you get wet and you get penetrated. So let's dispel that myth to begin with.

Yeah, let's just cancel that right now, because it's not serving anyone, especially folks with vaginas. Right. When we use the term foreplay, what we tend to be talking about in, like, greater society are things like manual stimulation of the genitals, oral sex, rubbing up against each other even using, like, vibrators or sex toys. Even the word foreplay means it's, like, before the main event.

Right.

And that stinks because for most people with vulvas and vaginas, intercourse is not the main event. Intercourse may. May feel nice, it may not, but it's not the best way for most vulvas to receive pleasure. And it's definitely not the best way to have an orgasm. In fact, it's like, the number is something like less than 2% of folks can have an orgasm without clitoral stimulation. Can that happen during intercourse? Yeah, if you're conscious of it. But the idea of penetration alone being enough for a vagina to really get to that peak of pleasure is just false, because when you look at the vaginal opening and you look at the clitoris, like, if you can see a vulva or, like, Google vulvar anatomy. Right. Just a reminder that we didn't see that in sex ed. We see the penis, and then we see the reproductive organs.

There you go.

Right, but have you actually seen a drawing of a vulva? Or better yet, have you looked at your own vulva?

Yeah, take a mirror.

Exactly. If you have one, take a look. Because the clitoris and the vaginal opening can actually be. It varies from person to person, but it can actually be pretty far apart. So for a lot of folks, the clitoris isn't getting any stimulation from intercourse. So when we think about the idea of foreplay comes first, and then main event is intercourse. It's really based on a male model of sexuality. And when we think about a female model of sexuality, it's much more circular. And for a lot of folks with vulvas and vaginas, intercourse doesn't even feel all that good, right? Like, if they had it their way, it wouldn't even be on the table. So this idea of foreplay being before the main act doesn't really make any sense. So what a lot of sex therapists, including myself, are saying is that all of these things that we traditionally called foreplay, oral sex, manual stimulation, dry humping, deep, heavy making out, all of these things are actually part of what's called core play. They're the main event in and of itself. They are sex. Whether or not you have intercourse, it's still sex. And the thing that I think about as foreplay as being more important is what's leading up to that point in which you start being sexual with your partner. So that means flirting throughout the day. That means getting ready for your date. Like, what are you doing to feel sexy, to feel good in your skin, means planning the date, right? Like, are you picking out the wine, going to drink? Are you shaving your legs or spraying on some nice cologne or whatever that looks like for you? Those are the things that are foreplay because you're setting up the context to be able to be sexual with a partner. Once you're being sexual with a partner, it's core play. It's sex, whether or not you have intercourse or not. And that becomes really, really important for folks with vulvas and vaginas. This can be really hard shift to make, especially for straight couples, because we get so locked into the sexual script that all roads lead to intercourse. And it's part of why, when we talk about low libido in women, that it might just be good judgment if you're having sex where you get three to four minutes of oral sex and then the rest is intercourse. Not going to desire it all that much either.

Yeah. Yeah.

And it's not to bash intercourse. A lot of folks love intercourse, and it's great, you know, big fans of intercourse if it does it for you. Just this idea that it's on this, like, higher level than all other kinds of sex. We don't need that.

Right. I'll give you another term that I learned in my program, which they call outercourse. And outercourse, or the core play, I guess it's the same, the same idea. Although I would say that the, the foreplay is not even, in a way, like, not the sexual piece of it. It's all that it could be anticipating a date that you've never even had before.

Right, totally. And outercourse is a great term. And what that term is even acknowledging is that the pleasure center for folks with vulvas and vaginas is actually the vulva, not the vagina. Right. Like, the back half of the vagina doesn't even have any nerve endings in it. Right. And yet we've kind of internalized this idea that, like, oh, yeah. The deeper you get into the vagina is better. That doesn't make any sense. It doesn't match with our anatomy.

I actually did not know the word vulva before I started doing this work. I'd never, I'd heard it, but I didn't really know what it meant. So. So the, that print back there is. You can't really see it in detail. That's all.

Vulva. Nice. I love it. It's a beautiful thing. Right? And. But that's exactly it. A lot of folks don't know the term vulva. We use the term vagina to mean all of the female genitalia. And it's like using the term throat to describe your face. It doesn't make any sense. The throat is completely separate. Right. And it's internal. You can't see it. Your face is what's on the outside. The same with female genitals.

Right. I like that analogy. That's a good one. Yeah. Wow. Interesting, interesting. So now, another area that I saw that you wrote about were exercises to get people ready for sex or in good shape for sex. Bring it on.

I don't take credit for writing that article. That was, I think it was women's health that reached out to me to speak on that story. I think that the main takeaways that I have and a lot of what I'm working with my clients on is the experience of being embodied during sex and exercise and moving your body are actually really great way to do that. Right. Because it's all about moving in a way that feels good. There are also other aspects, like, okay, if you have, like, a lot of aerobic activity, you're going to be able to do more things sexually. Right. If you like to have more active sex, being more active will help with that. If you're more flexible, if you're more comfortable, you know, if you've got, like, a really tight hips, right. And then you're trying to do certain positions, it's going to be painful. And we know that sex that hurts isn't sex that folks desire, right. So it serves you to stretch to do your yoga classes. Yoga is also really great for mindfulness, getting into your body. Right. And folks of all activity levels can have great sex. It's just about if you want to have better sex, being embodied and getting attuned with, like, how are all the different ways that my body can move can be really great. Also, exercising, moving your body right before sex can really help. It gets your blood flowing, especially if you want to do some, like, core activities or anything that gets your blood flowing towards your core, towards your pelvic floor. For folks of all genders, that can be really helpful in just, like, speeding up the arousal process because we need blood flow for all of those things.

Exercise.

So exercise. Moving your body. Right. What is sex?

Exercise.

Exercise, yes, exercise. Yeah. And I think it makes exercise more fun. If you're thinking about, ooh, this is gonna. Right, that's foreplay. If you're working out, thinking, absolutely right. I'm working out my hips so that I can have better sex later and.

You make it fun and more playful, which we both know is another way of making something. It's something that you want because of course it's not a chore. Yes, let's pivot a little more. I know from just getting to know you a little bit that you also have a certification in or kink informed. What does that mean and why does that matter?

Sure. I don't have a certification in kink informed therapy, although there are folks who do. I have. However, I'm a kink affirmed affirmative clinician. I've done a lot of research and coursework around being a kink affirmative clinician because I think it's just so important and core to what we do as sex therapists is being inclusive of sexual minorities. So being kink friendly, Kink informed, what that basically means is that I welcome folks kinky or vanilla into my office. I'm not going to assume that just because you're kinky that that's the problem that you want to work on. Right. It's just a thing about you. And the range of sexual health is wide and broad and ever expanding. I'm constantly learning about new kinks that I didn't know existed. And as long as everyone's happy to be there having a good time, great. What's the problem? Right. And for a lot of folks who are sexual minorities, they have a lot of experiences with clinicians, with therapists. Assuming rather that the kink is problematic, is unhealthy, that that's the thing that they're wanting to work on. Where I'll have folks come into therapy, they'll tell me that they're kinky. They'll tell me that they're in another category of sexual minority. Maybe they're non monogamous. And okay, that's a thing about you. What is it that you want to work on? It also means that if folks are kinky and they're having issues with that, I'm not going to try to convince them to not be kinky because their kinkiness is not the problem. And unfortunately, there is a lot of shame that exists. A lot of folks have trauma around trying to share who their authentic sexual self is and having that rejected or not accepted. And my main goal as a therapist is to do not repeat that trauma in the room. So there are a million and one ways to be sexual, and we're not saying that any one way is better than another.

And I'm just going to disagree with you that it's a sexual minority because I think a lot more people are practicing kink again, depending on how you define it, than we would imagine. I had an experience where I was telling somebody about a couple I was interviewing that were open and kinky. And, you know, I was expecting this guy to, like, to, like, be like this. And turned out he was kinky, as I got to know. I mean, he has a wife and a partner, and we all went to lunch, the four of us. It was just like, oh, I would never have imagined you, you know, partaking in this kind of lifestyle. So, you know, there's probably a lot more of it and now.

Right.

Talking about it more, just like.

Like, it's so true. There's becoming more sexy in the past.

Yeah.

And there's, you know, kink is a subjective term. Right. There are so many things. Like, one man's kink is another man's vanilla. Is spanking kinky? Some folks would say yes. Some folks would say no. That's totally vanilla. Oh, my goodness. What? It just depends. Right. And it's where there's a difference between, like, I practice a kink and I identify as kinky. For a lot of folks, it really feels like an identity, like a part of themselves. And for other folks, it may just be like, oh, this is something that I like to engage in sometimes. So one thing that I'll always make sure to do is just mirror whatever language folks are using for themselves. And I don't question it. I would never tell someone they were kinky if they didn't. Or tell someone. Actually, that's not that kinky. It's vanilla.

You have no idea what I've heard.

Exactly. Folks get to decide where that line is. And it's a lot of what we see in terms of desire discrepancy, right. Is that one person is more kinky than the other, and they may have been the more vanilla person in their last relationship. Right. It's all about that space between them.

Yeah. Interesting. Interesting. When does or does touch therapy ever come into play in your practice? Or. I mean, I'm assuming that you are not somebody that does touch therapy, but how does that. If it does?

Right. So there's. So as a therapist, per the rules of my licensure, I'm not touching clients. It's really important as a therapist that we're respecting boundaries. There's a lot of misinformation about what sex therapists do. I mean, there was an episode of Grey's Anatomy a couple years ago where a sex therapist was watching their clients have sex. We would never do that. That doesn't happen. Sex is private. It's not happening in my office. Might there be affectionate touch between couples in the therapy space? Sure, that will happen in all couples therapy spaces, but I'm never prescribing touch. That's to be done in front of me, and I'm never touching my clients. What a sex therapist will do, however, is offer opportunities, offer guidance around touch outside of the therapy space. So I might be offering folks, per their comfort level options for guided masturbation. I may be offering them homework around touching each other. There's a really common intervention that you'll hear a lot in sex therapy called sensate focus, which is when couples go home and they touch each other for their own pleasure. It's really a mindfulness exercise where you're practicing being in your body and noticing the sensations that come up for you as you're touching your partner. It's not goal focused, it doesn't lead to intercourse. And when done correctly and in accordance with the client's comfort level, it can be really healing. So there's definitely touch that happens as a result of sex therapy, but I'm not touching my clients and I'm not watching you have any sexual touch.

And I also like that. The example you gave of the sensei focus, I've never done that, but I have started to get more in the moment. And I think that really helps with the orgasm issues, too, because, as you know, we all know, women are thinking about 100 other things while they're in the middle of sex. So, yeah, I think anything that gets you more focused on yourself and on your partner is going to make your whole experience, experience better.

Absolutely. The more embodied you can be, the more noticing of what's actually happening in your body as you're having sex, the better your experience tends to be.

Right? Right. Anything we touched on? A lot. Anything you want to add that we have not touched on?

No. I mean, I could talk to you for hours about this stuff, but I think, no, the main thing that I want your listeners to hear is that however you want to have sex, you deserve to have it that way. There's nothing broken or embarrassing about your body or the way that you're having sex. And if there is something that's not going the way you want it to, if you're struggling to get to know yourself sexually, if you're experiencing pain, if you're experiencing conflict or difference in a relationship around sexuality, there are resources out there. You just need to know where to.

Look and I'm going to ask you, although you kind of answered my final question, which I ask all my guests before we give the folks how to find you, what is your personal definition of sex?

Sex? Well, I think that we make a mistake when we think of sex as a thing that you do. I really like the idea. Esther Perel, who's a very well known sex therapist, says that sex is not a thing you do, it's a place that you go. So it's this idea that sex is anything that you're doing that feels erotically charged, attached to you. Right. Because you can be having intercourse, for example, and if it's not consensual, if you don't want to be there, if it's painful, it's not sex, right? No. But you can have the most erotically charged massage with your partner, and that is sex. That is definitely sex. You could have the same massage from a massage therapist, and it's not sex, right? Because it's not radically charged. Because both folks who are involved aren't in that headspace. So I really like the idea of sex as this huge umbrella term that can mean whatever you want it to, right? Your genitals can or cannot be involved. There can be an orgasm or not. There can be intercourse or not, but it's more about a place that you go by yourself or with a partner.

I love that. That's a great way to end and tell the audience where they can find you.

Sure, you can find me@rachelzartherapy.com. i practice at avid intimacy in Chicago. Follow me on Instagram. I'm trying to grow my Instagram followers. Achelzahertherapy and feel free to reach out. I love hearing from folks and I.

Will definitely put links in the show notes. And I do follow you and you do have a wonderful Instagram with some really great information. You so much for being here. It was great to see you again.

Me too. Thanks for having me, Karen.

Thanks for joining me on the taboo to Truth podcast where I'm spicing up midlife one episode at a time. If you've been enjoying the sizzle, why not turn up the heat by giving me a scorching five star rating and leaving a steamy review? It's the best way to help others discover pleasure in their sex life. So don't be shy by show me some love and keep the midlife adventure alive. And until next time, grab your favorite drink and put me on speaker. It's time we broke the silence.