Lori Brotto has a hot tip to improve women’s sex lives—and it isn’t an over-priced piece of European lingerie or a brand-new vibrator that looks suspiciously just like the decades-old Rabbit. It is both simpler and much more complex than the usual quick-fixes hurled at women’s sexual miseries: It’s breathing, basically.
Brotto, a Canadian sex therapist and researcher, is the author of a new book, “Better Sex Through Mindfulness: How Women Can Cultivate Desire.” In it, she writes that satisfying sex is “quite simply not possible” without mindfulness, an ancient Buddhist practice involving attention to the breath.
Perhaps this all sounds a little woo-woo—or even a bit culturally appropriative. But, unlike the current breed of capitalist, Goop-y lady-business spirituality—like high-end vaginal steaming or $66 jade yoni eggs—there is robust scientific evidence to back it up. (As for appropriation, Brotto details at length the practice’s origins, as well as how it has been popularized and mainstreamed for Western audiences.)
Back in 2002, Brotto, a Canadian sex therapist and researcher, started investigating the potential for mindfulness to be used to improve women’s sex lives. Over the years, her lab at the University of British Columbia developed an eight-week mindfulness course, in which women were introduced to mindfulness and coached through a series of exercises. Many of those exercises are included in the book for readers to try at home—from “body scans,” where you quietly focus on each part of your body from head to toe, to breath exercises, where you tune in to the subtle sensations of breathing. In scores of peer-reviewed studies over the years, Brotto has demonstrated that her lab’s mindfulness courses led participants to report experiencing significantly more desire and arousal, and greater sexual satisfaction.
Her findings have added to a growing body of scientific evidence around the benefits of mindfulness meditation for addressing everything from anxiety to body dissatisfaction. Brotto’s work has also built on a depressingly necessary wealth of research around women’s sexual problems. Research has shown that female sexual dysfunction—a frustratingly broad term that applies to a host of issues, including everything from difficulty orgasming to pain during sex—affects somewhere between 15 to 32 percent of women long term. Low desire is the most common subset of that, impacting up to half of women at some point in their lifetimes. (A glaring blindspot in this abundance of research is around transgender women’s experiences with sexual desire.)
As Brotto puts it in her book, the causes of low desire in women are “multifaceted and often unclear.” There is plenty evidence, however, that it often has little to do with chemistry or physiology, and much more to do with the mind. But that hasn’t stopped the medical industry from attempting to solve the problem with a little pill. In 2015, the multi-year, multimillion-dollar push for so-called “female Viagra” came to fruition with the Food and Drug Administration’s approval of Addyi, a drug intended to treat persistently low libido in women. But for all the anticipation, the drug has been a massive flop, failing to come even close to meeting its sales expectations.
Brotto’s answer to low libido in women is a perfectly antithetical counterpoint to the medicate-it-away approach—somewhat frustratingly so in our on-demand, instant-gratification era. But that’s exactly part of the problem, she says. We’re often far too busy in our fast-paced and relentlessly multitasking lives to pay attention to or get in touch with our bodies—and yet we expect desire to pop up unbidden as a consuming physical experience. “Brain-imaging studies show that distraction and inattention impair our ability to attend to and process sexual cues,” she writes in the book. “It is as if the body is present but the mind is elsewhere—lost in thoughts, memories, or plans.” She believes mindfulness is a way to effectively sync the body with the mind.
I spoke with Brotto about her new book, many women’s brain-body split, and what sensually eating a raisin has to do with good sex. Our conversation has been edited for length and clarity.
JEZEBEL: You write in the book that satisfying sex isn’t possible without mindfulness. Those are very strong words. Why do you think mindfulness is so essential to sex?
I’m sure your readers can think about a fantastic sexual encounter, one that they would describe as being that kind of pinnacle of sexual experiences. When you ask that person to describe what that was like, what made that so mind-blowing, what made that so pleasurable, they inevitably invoke the language of mindfulness. They’ll describe it by saying, “I was fully there. I was fully present. I was totally tuned in to what was happening. Nothing else mattered.” We can deduce from those descriptions that when sex is great it’s because mindfulness is present.
We know that satisfying sexual encounters, and sexual response for that matter, is not a reflex. It’s not simply, you know, stimulate the genitals and the person has a satisfying encounter. Stimulation of the genitals might evoke a little bit of a genital response, maybe some blood flow, but it certainly does not predict whether the person is going to be sexually aroused or turned on or have desire in their mind. It’s really when the mind tunes in, that’s where mindfulness as a specific tool can be used to really enhance the ability to tune in to what’s happening in the moment.
And, finally, the research has shown that, among women who have sexual difficulties, mindfulness not only improves their desire but improves their overall sexual satisfaction, too.
How can you apply mindfulness directly to sex in the moment of the act?
In the the same way that we practice mindfulness in the non-sexual setting. So, in a non-sexual setting the instructions are, you know, guide your attention to a particular focus, notice all of the sensations that are unfolding, pay attention to the spaces in-between those sensations. Can you describe it in terms of texture and temperature and pressure and vibration?
Once we’ve cultivated that ability to really tune into sensations in general, we can then generalize those same skills to a sexual encounter. While a person is actively engaging in sex, can they actually pay attention to what is happening? Can they notice the increase in physical arousal and can they pay attention to, if they’re with a partner, the sensations of their partner’s body or skin? Again, they’re tuning in to what that feels like. Can you pay attention to sound and might that also be a way to further bolster sexual excitement in the moment? Can they tune in to breathing? In the same way that we pay attention to breath sensations and body sensations in general, we can use those same skills during sex.
How does mindfulness help with desire itself, in those moments before sex happens?
Probably in the same way. If we extrapolate from what I just described, it might be the case that as soon as a woman has either made a decision to initiate sex, or in the moment that her partner makes an invitation for sex, or they have a planned sexual encounter, she can actually start to tune in to her body in anticipation of that encounter.
One of the ways that we do this in our groups is through an eating meditation with a raisin. The instruction for our participants is to hold the raisin up to your lips and simply notice what happens. Then after the mindfulness practice we talk to the women about what that was like. What did they feel? What did they notice? They unanimously describe the feeling of salivation while the raisin is just sitting at their lips, before they even put the raisin inside their mouth. Then we ask them the question, “How might paying attention to a raisin in this way be relevant to your sexuality?” I’m consistently struck by the number of women who will say, “When the raisin is against my lips and my body prepares itself by salivating, I can see how that might generalize to anticipation of sex, and how readying the mind and readying the body before the encounter even begins could serve to heighten the sexual response.”
One of the things we know is that when sex is satisfying we’ll have more desire for it. The flipside of that is when sex is not fulfilling, when it’s not satisfying, those reward centers in the brain don’t become reinforced, and we eventually lose interest in that activity. So it might be that one of the mechanisms by which mindfulness improves desire is by improving the quality of the sex therefore making it more rewarding—and by really extending pleasure beyond a sexual encounter and well into that kind of anticipation phase.
Is there something unique about the positive impact of mindfulness on sex as opposed to anything else in life? Shouldn’t we basically be meditating to make everything better in our lives?
[Laughs] I would say yes. I feel quite strongly that this is a skill that benefits so many areas and the science certainly shows that as well. So, what makes mindfulness apply to sex different from, say, mindfulness as it’s been found to benefit stress or depression or anxiety? Some of the underlying mechanisms might be similar. For example, mindfulness improves mood—and, again, mood is highly comorbid, or consistent, with desire. We also know that mindfulness increases our ability to focus and let distractions be—and, again, distractions can be a major inhibitor of sexual arousal for women. So it’s possible that if someone were to adopt a mindfulness practice in general as a way of just quite simply living better that they might also find a benefit to their sexuality.
The one thing I’ll add to that is our own treatment program of teaching mindfulness to women with sexual concerns makes some of the mindfulness practices very sexuality-specific. So, for example, we might encourage women to engage in a sexual fantasy or watch some erotic films or use a vibrator for a few minutes to feel those feelings of sexual arousal—then, after about five minutes, to engage in a mindful body scan. The idea here is that by first boosting sexual arousal in the body, they can use their mindfulness skills to really tune into that and take note of that and feel what that feels like. We’ve shown both in our eight-week groups and in an experimental lab paradigm that it actually works.
When it comes to sex, desire, and satisfaction, is mindfulness any more essential to women than men?
My research program has focused almost exclusively on women. But, over the last two years, we’ve been applying mindfulness strategies for men and one of our studies was in men with situational erectile dysfunction. These are men who have no problem getting erections for masturbation but have great difficulties with erections when they’re with a partner—so there’s probably a significant performance-demand component. We found in a pilot study that mindfulness was quite useful for those men for improving their erections and improving their sexual satisfaction. So there’s probably sub-populations of men where mindfulness can be a fantastic tool for addressing their sexual difficulty. This is, I think, where the science needs to go next.
A huge number of women experience sexual dysfunction, and low desire in particular, but many do not. So what makes some women more prone to it?
Funny you should ask. I’m just in the middle of reading a recently published systematic review that looked at over a hundred different papers that have tried to quantify how common sexual difficulties are among women. The paper arises out of some debates in the field around pharmaceutical companies [allegedly] inflating those rates to create a bit of a market. Interestingly, what this meta analysis found was that when you combine all of these different studies, whether they were funded by drug companies or not, they consistently find this 40 percent figure. When you ask women, “Over the last year, have you had a sexual difficulty for at least a couple of months or more?” consistently about 40 percent of women will say “yes.”
Now, of course, not all of these women are going to be distressed by it, nor are all of those women going to want to seek treatment for it. So this is where some of the more refined research has focused: Who are these women who have a difficulty and are significantly distressed by it? In that domain, much less research has been done. But some of the things we know are that if there’s been interference in a relationship, those women are far more likely to be distressed. We also know that women who previously experienced quite satisfying levels of sexual desire and then have a change in their desire are far more likely to be distressed as well. There’s some evidence that younger women are more likely to be distressed than older women. Women who have a co-occurring depression or anxiety are also more likely to be distressed.
When we talk about low desire are we talking about an objective, measurable definition of low desire or are we talking about individual women’s subjective senses of low desire?
My own view is that sexual desire is always subjective. There’s no objective measure or marker of low desire. There is no blood level of testosterone or physiological measurement device that can objectively measure when a woman has low desire. In fact, the research that attempted to develop some of those more biological or objective markers has consistently found there’s no relationship between testosterone levels and a woman’s desire or vaginal sexual response and sexual desire. So we entirely base this on a woman’s self-report. It’s a woman who says, “I’m bothered by my level of sexual desire—it’s either absent, it’s lower than I would like, it’s lower than it used to be, and it’s significantly distressing for me personally.”
Now, we need to be mindful of the fact that sometimes, maybe even often times, women are bothered by their low desire because it interferes in a relationship. So it may be the case that her partner is unhappy with her level of desire but she’s not. This would be kind of a classic case of “discrepant sexual desire,” where the woman’s level of desire is not consistent or on the same level as her partner’s desire.
Our culture is full of examples of women with low desire—there’s the old joke of, “Not tonight, honey, I have a headache.” But there’s also this fantasy of the insatiable woman who can’t get enough. How do you think those sorts of representations influence the way women view their own level of desire?
It’s highly problematic, because women are continually comparing themselves to some societal ideal of what is considered normal. So if she has a very high level of sexual interest and craves and wants and seeks out sex on a daily basis, she’s unfortunately automatically labeled as, you know, being the old Victorian term “nymphomaniac.” It’s coming from this societal belief or stereotype that there’s a certain level of sexual desire that’s appropriate for women to have.
Similarly, on the other end, what if a woman desires sex quote-unquote infrequently—let’s say once a month—and yet the quality of those encounters is positive and she feels pleasure and she feels orgasm? Nonetheless, she might still be labeled as having low desire. So it becomes really important that we try and think about desire in terms of within the individual, within individual differences. For example, how is your level of desire now compared to how it was before?
Do you see differences in low desire in women when it comes to sexual orientation?
Actually not—and that’s been a question that researchers have explored from really both perspectives. There’s the one perspective, that kind of archaic notion of, you know, lesbian bed death, which has actually been completely disproven. It’s this idea that lesbian women in long-term relationships inevitably are going to lose their desire and find themselves sexless. Sociologist Pepper Schwartz originally coined that term in the early ’80s and a few years ago she declared that that was a mistake, that actually the data don’t show that.
So why do women generally struggle more with sexual desire than men?
Let me just back up and say that low desire is the most common sexual difficulty in both women and men. In men it is consistently found to be more common than erectile difficulties. So, for both men and women it’s a common sexual complaint. But you’re right in that there is a gender difference. We consistently find women to have at least 10 percent higher prevalence of low desire than men.
There’s probably a lot of different explanations for that, starting with the purely biological. We have evidence that in men testosterone is more strongly linked with sexual desire. In other words, hypogonadal men, or men with low testosterone, are far more likely to have low desire. That’s not the case in women. Also, by the same token, men have 10 times the level of testosterone that women have. So it might be possible that those much higher levels of testosterone are contributing more to men’s healthy levels of sexual desire whereas women without that contribution of testosterone—again because their levels are 10 times lower—are not getting that testosterone contributing effects to their sexual desire.
There’s also a whole host of psychological as well as sociocultural reasons. We know that concerns with body image are far more common in women than men, and body image is a major predictor of desire. Similarly, depression is higher in women, and rates of depression and low desire are highly comorbid with one another. There’s also the contribution of negative beliefs and judgements—again, higher in women—and a consistent predictor of low desire. So there is probably a variety of different reasons why women are more likely to have low desire than men.
You write in the book about this brain-body disconnect that has been observed among many women in laboratory tests, where, essentially, their genitals experience one thing and their minds experience another. How can we make sense of that split, and does it play a role in the gender differences we see when it comes to desire?
The brain-body split has been mostly demonstrated through measurements of sexual response—so, sexual arousal, not desire per se. The typical kind lab experimental paradigm involves showing a participant an erotic film, measuring their genital response, as well as measuring their self-reported sexual arousal. Essentially, we’re asking the person how sexually aroused they are and then the genital measure tells us a bit about blood flow.
There we consistently find that in heterosexual women the level of agreement between the physical arousal and the self-reported arousal, or what’s called concordance, is significantly lower than it is in men. In other words, when men experience an erection after seeing an erotic film, they’re much more likely to have concurrent self-reported arousal—they’ll say, “I’m turned on in my mind.” Whereas for women it’s far more likely that their body might be showing a physical arousal response but their mind is not turned on to the same degree—or not turned on at all.
These findings have allowed researchers to kind of extrapolate and make predictions about whether there is more of a disconnect in women than there is in men. It’s a bit of an oversimplification of the research—it’s not that women are disconnected, they are connected, however there is room to be even more connected by teaching women how to tune into those physical sensations in the body and the question of whether that can be a vehicle for further increasing her self-reported arousal response. My lab has focused on mindfulness as a strategy to do that.
There seems to be an almost paradox around women’s low desire: They desire more desire. Why doesn’t that translate into...desire?
Can wanting to be happier make us happier? Can wanting to feel a certain other emotion make us that emotion? The answer’s no, that’s just not the way that it works. Willing yourself to have it is just not enough to have it. I think it’s important to think about desire as an emotion—and here is where, when you’re draw a parallel to a different emotion, the absurdity is so evident.
Desire really is an emotion like any other emotion that needs to be triggered, right? We trigger that emotion of desire with sufficient cues, so that desire emerges in response. This is where some of the outdated notions of desire come into play—of it being something that’s just intrinsic and lives within us and, you know, that bursts at the surface if we don’t tend to it. Those dated notions don’t serve anyone well because they presuppose that if you don’t have that kind of biological level of desire then too bad.
But if we think about desire as an emotion, then we start to pay much more attention to the question of: What are the things that cultivate it? What are the things that can trigger and elicit my desire? Can I start to pay attention more to those triggers and can I start to include more of those in my life and in my sexual encounters?
After all the years of hype around the potential for a “female Viagra,” we now have Addyi—but it hasn’t nearly been the blazing success that it was expected to be. Why has the project of the “pink pill” failed?
Frankly, the medication is marginally effective. There’s been now at least 11,000-plus women that have participated in trials. Yes, the women in the Addyi condition showed significantly more sexually satisfying events than women in the placebo group, but when you look at the actual absolute figure, it amounted to about one additional sexually satisfying event per month compared to the placebo group.
Interestingly—and this is something that does not get very much attention—women in the placebo group also had a significant improvement in their sexual desire and in their number of sexually satisfying events per month. So, it might have been the process of filling out a questionnaire about sex, paying more attention to sex, planning it, talking to a health care provider about sex—all of which they had to do to participate in the study. Might all of those things have contributed to the more robust improvements that were seen in the placebo group compared to the marginally better effects that were seen with the Addyi condition?
It’s not the blockbuster that I think some experts were hoping it to be. And the race continues to find other medications that have different mechanisms of action that might offer better treatments than Addyi has shown. My own view is that we’re still a long ways off from getting there. And, fundamentally, until we find a pill that helps women to be present and to tune in and let go of societal myths and let go of negative expectations —the list goes on and on—then we won’t be in a place where we have that kind of panacea in the form of a medication.