Most people think sex therapy means Masters and Johnson-style homework or uncomfortable demonstrations. Dr. Shannon Chavez explains what it actually is—and why sexual concerns are rarely about sex at all. They're about intimacy, attachment, and learning to feel safe in your own body.

Dr. Chavez has spent her career helping individuals and couples navigate sexual shame, intimacy disorders, and compulsive behaviors through a trauma informed, non-pathologizing framework.

We discuss how shame is learned, not inherent, and why the opposite of shame is acceptance. We talk about how she approaches vaginismus and pelvic pain patients in therapy, why pain can live in the body even after the physical issue is resolved, and how mental rehearsal and visualization help people reclaim pleasure.

We also discuss compulsive sexual behaviors not as addiction in the traditional sense, but as intimacy disorders rooted in early trauma and attachment.

Dr. Chavez explains why the sex negative addiction model has done more harm than good, how porn is designed to overconsume just like doom scrolling, and why education around healthy sexuality is more effective than abstinence only approaches. We cover pleasure literacy, the difference between healthy desire and compulsive use, and why sex should feel like play, not another item on your to-do list.

Highlights

• The body keeps score even after physical pain is resolved, which is why sex therapy is essential for sexual dysfunction issues.
• Compulsive sexual behaviors are often rooted in early trauma, attachment issues, and lack of self-soothing skills rather than traditional addiction.
• The sex-negative addiction model has created more stigma and hasn't been effective healing intimacy disorders is more successful.
• Pleasure literacy means understanding what pleasure means to you personally, not fitting into a prescribed definition.
• AI companions and technology are creating more isolation, which amplifies sexual and intimacy issues.

If you've been struggling with sexual shame, pain, or compulsive behaviors, know that you're not broken. These are things many people navigate at different points in our lives, and reaching out for help doesn't mean years of therapy sometimes it's just getting permission or validation from someone who understands.

Get in Touch with Dr. Chavez:

Website

Instagram

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Youtube

Get in Touch with Me:

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Substack

was finishing and the other person came in like five minutes early. But they actually knew each other, so it was kind of funny. Anyway, hey y'all, it's me, Dr. Samina Rahman, Gyno Girl. Welcome back to another episode of Gyno Girl Presents, Sex, Drugs, and Hormones. I'm Dr. Samina Rahman, board certified gynecologist, sex and men gynecologist, and menopause expert in downtown Chicago.

On my podcast, we move sexual health out of shame, fear, and misinformation and back into evidence, embodiment, and agency. Today's conversation is one I think many clinicians and patients are likely craving. I'm joined by the amazing Dr. Shannon Chavez, a licensed psychologist, certified sex therapist, and the founder of Shape Psychology. Dr. Chavez specializes in integrative sexual health, intimacy, and relationship wellness.

Her work helps individuals and couples reconnect with desire, deepen emotional intimacy, and develop a more mindful relationship with pleasure, one that moves beyond the performance and metrics and pathology. Importantly, she also works with individuals and couples navigating compulsive sexual disorders and behaviors, including concerns around porn use, through a non-shaming, trauma-informed, and clinically grounded framework.

And so hopefully we're going to talk about that. She's been featured in Oprah Daily, Vogue, GQ, Women's Health, and Huffington Post. And today we're going to talk about pleasure, literacy, sexual shame, compulsive disorders, behaviors, and how clinicians can do better when patients bring these concerns to the exam room. Welcome Dr. Chavez.

Thank you for having me! I'm happy to be here.

So exciting. I met her just like a month or two ago. I think we were doing a Perry live or was it a Perry live? It was for the Perry community and you and I and garbage mom. That's it. We had a great time and I was like, wait, how do I not know you? I like, I thought I knew everyone in the sex med space, but I was so happy to learn about you because some of the things you said just really struck a chord in terms of like,

Yes. Very good.

I love Beth, that was so much fun. We had such a great time.

same.

when we were talking about sexual shame and communities of shame, which brings me to like, my Instagram handle is gyno girl. So that means that I love comics and I love a good backstory. So I wanna hear what your backstory is, like how you came to become a sex therapist and what brought you into talking about this out in the open into the world.

I love it. was just telling this back story. Actually, I was talking to my mom about it because it starts with a book that was on her book here in her nightstand. So I would say as a kid, I was always curious and I grew up in the 80s and sex was not talked

I don't know.

Really?

Hmm. Yeah. Yeah.

So we grew up in a conservative culture, but my parents were young. mean, my mom and I are about 20 years apart. So they were young and trying to do things different and they had the joy of sex in their nightstand. And I remember being five years old, you know, peeking around mom's room and I found the book. And I remember being like.

Yes. Yeah. that's cool. Yeah. Yeah.

really?

Yeah.

the joy of sex and I would sneak it and read it and I was just so fascinated by the idea of sex. And as a curious kid, of course, what do you do? You ask your parents, like, what's this? And I just remember my mom being mortified. Like, what do I tell a five-year-old? What do I tell a six-year-old about sex? And I was curious and comfortable and it was a fascinating thing. And for me, it seems like a natural part of our life. So, you know, the older I got, the more interested I got into it, but I saw how uncomfortable

Yeah.

my god, yeah.

Yeah, absolutely.

it.

it made people feel and I don't even know a sex therapist existed and I remember watching Dr. Ruth on TV this cute tiny lady and going wait I want to do what she's doing she was so approachable and sweet and I'm like she gets to talk about sex and and help people and educate and to me it just was a it was a natural calling and

Yes.

All right.

was awesome. I love that.

It's kind of interesting because when I was in high school, my sex ed teacher, because we always talk about lack of sex ed in education, you know, she was a health teacher like many high schools, and she was actually the one to start the AbSudense Only program across the nation. So I always say I would love to interact with her again and be like, what? Like now I'm educating people and the stereotypical sex ed.

Yes, of course. Yeah.

I know it's so funny. my God. That's so interesting. I mean, it's true about Dr. Ritsu when I was in college. I remember people would joke like because I also grew up in the eighties, but you people would joke and my because she was kind of big back then and then she continued to be big and it's you're gonna be like the Muslim Dr. Ruth one.

Yes, there you are!

she reached out to me recently, this old friend, she's like, I can't believe you're doing what you said you want. I mean, I didn't say I want but they knew I want like women's health and I was like trying to break down taboos and whatever but that's so funny.

That's how I feel too, because I remember being a kid like, I want to be a sex therapist. And in my culture, like, therapy is kind of taboo anyways. And then on top of that, sex is...

Totally mental health in general, right? Like it's not a real thing. Yeah.

Exactly. Then you tack on sex along with that and people are like, a sex therapist. I mean, my mom doesn't even want to say it. She's like, Shannon works with intimacy and I'm like, mom, you can say sex. And now my mom's so open, her and I chat about everything. In fact, I'm mailing her a little care package this week. So she's like, something to blue, are there any new products I need? So I love that we have that relationship.

My mind is full.

Thank you.

That's so funny because I mean to this day I probably I like my I would just tell my parents and my mom passed away last year about my dad and I'm just like oh I just talked about menopause and they're like oh okay I still can't say that like I'm a sex man doctor this is what I'm about.

Isn't that amazing? mean, as we talk about shame, even the more you talk about it, I still feel that at times too, you know, when you go in there, you know, something will kind of, you know, hit a a hit a note and you're feeling like, oh, there's still that that old feeling in there no matter how evolved we get.

Yeah.

It's so weird. It's kind of like, it was like, you know, a few months ago when I had my book cover, my book isn't out yet, obviously it's gonna come out next year, but I had the book cover. So I posted it on social media like a few months ago. And I was this is my cover, this is book coming out. And so then my dad's like, I heard you wrote a book because your uncle follows you on social media. What's that about? And I was like, you know, women's health stuff, it's stuff about women's health. that's so amazing.

Okay. Anyways, so crazy. I'll send you one.

I can't wait to read your book. love that. That's sort of a niche and an area you're speaking about too. I'm just so happy we connected. There's so much class ever.

I know, I know, I'm so excited. Well, let's talk about sort of, you know, the idea of shame and how you approach it in your practice, right? Because first of all, you said you grew up Catholic and sort of sex-shaming. I would say like after the number of Muslim patients I see, think the second biggest is Catholic population, you know, because of the same similar, you know, underlying terms, right?

Exactly.

Tell us how you approach that in therapy.

Well, first I normalize shame because I tell people we're not born feeling shame. It's a learned behavior. We learn to feel certain ways about sex or sexuality or our bodies or our gender or our roles. so normalizing it and creating a safe space. I think people think of shame as something's wrong with me. And that's probably the second question I get. Is this normal? Is something wrong with me? These questions where people just feel so broken. And shame is something that

Yeah.

Yeah.

Yeah.

will all experience, but I normalize it. give people a space to talk about it. And then overcoming shame is more of an empowering lens that I use. It's not about fixing something or changing the way you think. It's basically evolving and learning more. So I really create, you know, a collaborative approach for people to get good information, ask questions. I always say no question is a dumb question because I see people coming in like, I don't know.

Yeah. Yes. Yeah.

Can I these words? so I'll use language and kind of match the language that a client's using or if they're using kind of slang terms, I'll use those as well just to create kind of a safety around talking about sex and learning about it. And I always say we're learning about sex our entire lives. So even if we're embarrassed or we feel like we don't know enough, I just create space for that and a little bit of humor because

Right.

Yeah.

Yeah.

The opposite of shame is acceptance. And the more we can accept that sexuality is kind of this vast and bizarre and sometimes weird thing that we all go through, it makes it so much easier and so much more approachable.

Absolutely, I think you're totally right. I think that's so much of what when they come to the office and they're just, can't even, you know, it's interesting because sometimes we don't even, they don't even have words to describe their pain sometimes, right? Cause it's all down there or, know, like these euphemisms that we use for women's anatomy even, right? Like I have a whole chapter in my book about it, but like,

It's just like, if we can't even say the word, how can we diagnose anything? And so that's why it's so important to teach early on that like, you know, my six-year-old knows vagina versus vulva. know, like, that's just, you know, the reality is that's not what we were taught. And that's not, I mean, we're, we're even censored on social media still, right? We can't even say these words on social.

Yes, that's a whole nother soapbox but you know the fact that we're out here trying to educate and I remember I was talking about endometriosis, which is something that I Have experienced throughout my life and I got censored for that So I've just yeah the the social media and and how they you know You can't say these certain words and then it just yeah that kind of reinforces shame because if you don't have a space if you can't talk about it in a social platform Where are you can ask the questions? How are you gonna have the the language?

Peace.

reason.

the skills to feel comfortable advocating for yourself.

Absolutely. And so we were talking offline that both of us treat a lot of sort of pelvic floor dysfunction vaginism in these populations that come kind of grow out of sexual shame. And so whenever I say to, you know, like tell my patients is biopsychosocial, like I'll, you know, handle the bio part with the pelvic floor with my therapist. And you need to see a sex therapist. So I tell them that. And so they always like get into a little bit in their head about it. Like, what will they do? Like, what is sex therapy? Like, you know, then they start thinking masters and

Right, are we gonna make me watch porn? I know, get so many misconceptions about what the work is and what it isn't.

Yeah. So walk us through like a patient with say vaginismus, right? They come to see you or which is a severe form involuntary pelvic floor contractions, a form of pelvic floor dysfunction that leads to either unconsummated marriages or sexual pain. So tell us about how you kind of approach that like a patient that comes in. So say I refer you to someone, how would they, how would you start that interaction?

Yes, I create a safe space. I always like to meet the person before the problem because every person is different, even vaginismus, our background, our culture, what we've learned, what we've tried, our relationships. So it's such an intimate relationship in therapy. It's very subjective. So getting to know you, understanding your lifestyle, your background, that's where I kind of get a sense of your language and how you communicate and what you know about your body. There's a lot of education as well. So I'll do a very thorough sex history. And even if you don't have sexual experience,

Yeah.

Yeah.

Yeah.

I want people to know sex history is many things. It's what have you been exposed to? What are the messages that that you've received? If you had any education, what was it like? Was it a shaming? Was it negative? Was it did it scare you? You know some of the ways that we can kind of normalize, you know the gaps that are in

Yeah.

Yeah.

you know, a person's sex history. And then we, you know, very collaborative, we develop goals together. I always tell people there's a beginning and a middle and an end. So it's about progressing through at your pace and, you know, what do you want to learn? And I'll say, you know, in an ideal space, you know, what would be everything you would want to know to make you feel confident about your sexuality? And it can be, you know, the basics, you know, understanding the mechanics of sex, but also a lot of people will say, I want to feel confident. I want to want sex. I want to feel, you know, I want to get over these mental

Yeah.

Mm-hmm.

Okay.

boulders and blocks that make me feel that I'm not good enough. So, it's like traditional psychotherapy, it is talk based, but I do a lot of behavior modification, very body based, very mind body based because our body stores so much. I mean, that's where our emotions lives. So helping people connect with what's going on in my mind and how it affects the body. And then slowly introducing things that can help sexual wellness. So that might be things like products and devices.

Yeah.

Yeah.

or ways to kind of get in touch with your body, learning things like genital massage. And so someone with pain, I right away think helping you feel comfortable in your body and not feeling that there's expectation around having sex, but to learn about your nervous system and learn to connect with what your own, yeah, your own sensations are and what feels good for you.

regularly.

Yeah, no, that's great. I think that's one of the things is also, you know, someone that's lived in pain for so long, even when I feel like the biology of it is fine, right? Like their pelvic floor is perfect. Like they are now, you know, they've had all the treatments, they've had vestibulectomy if they need it, you know, whatever it is. But if you're someone that lives with it, what is it the body keeps score, right? It's a book that about.

Exactly. Exactly.

And so that's why I think it's so imperative what's done in the mental health space on this. And so how do you help them kind of over, know, someone like that, like where they've lived in it, but, know, like now they can put in dilators, could technically should be able to have sex, right? Like there's not this automatic contraction, their pelvic floor is not, you know, hypertonic, but they still can't mentally get past it.

Yes.

Exactly, you know, it really is a mental rehearsal. Sometimes we'll do a lot of visualization and imagining what that looks like. Because when you lived with pain, and I have as well with endo, you're used to just feeling not so great in your body. And then that affects how you feel, your self-esteem and not wanting, even your nervous system is over-activated. So a mental rehearsal or a visualization maybe, what would that look like? How would your body move if you were feeling desire? Or when you imagine having sex that doesn't hurt.

Thank you.

No.

Yeah.

You're good.

What do you imagine that looking like? And it can feel a little vulnerable, but then people think, well, I actually have to picture that. If I can't picture that, then it's gonna be really hard for me to actually go out and have that happen. So we do a lot of work like that. I also do things like hypnosis or really working on deeper, deeper subconscious beliefs that affect our core beliefs about ourselves. So I find that a lot of that can help. Just giving people permission to feel sexual, even if,

Do you know what I mean?

you know, to your point, know, pain can be resolved, but we don't always say, you know, is it, it's okay for me to feel desire or it's okay for me to get horny and feel excited about sex, especially women. And we feel, we kind of need that permission and especially coming in a safe space and therapy, it's important like, yeah, yeah, it's okay for me to want sex. It's okay for me to enjoy it. And I'm

Yeah.

And not identifying with the pain is also really important. I always say you're a person experiencing pain, but vaginismus is not your identity, or endo is not your identity. It's just something we go through. And we go through a lot of things through our lifespan that affect sex. So it's important with the mental health piece that you don't identify and feel like these these stigmatizing diagnoses that just carry around with you and affect how you feel about your sexual self.

Yeah.

That's so true actually, yeah, because I think that's what people just automatically, and you know, some clinicians do that too. that's my vaginismus patient. No, that's your patient with vaginism, right? Because that's how you start to, and that's our own implicit bias. And sometimes you can see the forest from the trees to help them in that respect.

Yes.

I even see that, you know, when my clients are dealing with, you know, depression and anxiety, when they start to alleviate some of those symptoms and they're like, wait, I'm not a depressed person anymore. I actually feel joy and I'm, you know, taking control and, you know, letting go of the identity that you've carried around for so long. There is sort of a grieving process, even though you're feeling, you know, better and you're feeling stronger. So it's just interesting how we, you know, internalize what we're going through and then it affects our mindset. So we've got to do a little

Interesting. Yeah.

shifting and working through that in therapy.

Yeah, yeah, it is work, so I think that's one something that people have to realize is that you have to put in the work or it's not going to just usually happen on its own.

Exactly. wish it could be a quick switch, you know, permission, really giving yourself that path to move forward.

I know.

I want to talk about something that comes up a lot clinically, also culturally. And that's when patients we often refer to as porn addiction, but we know it's compulsive behaviors. And it ties into shame a lot, right? Because when we were talking about growing up in the eighties, like porn was not as accessible back in the day. You had to wait for the HBO, like the great, the great.

Yeah.

You scramble boy, yes.

That's maybe where you'd see something scandalous. But it's not like it was so accessible back in the day in terms of that. And now you can just pick up your phone and literally look at it. so obviously there's phone addiction in general. feel like people are just compulsive about, and I myself am not the best at it either, but you get a little bit attached to this thing. But I feel like the compulsive behaviors plus the shame that we already have around.

what is moral and moral behavior when it comes to sex and porn? How do you distinguish this compulsive behavior versus a healthier desire? And how do you kind of treat these patients?

Yes, well I always tell people anything can claim our consciousness, to your point. So it's not just porn that's an issue, but it's how we're using it. So for a person that might be more compulsive in use, they are...

developing a sense of dependency. So it's not just about, you know, I'm feeling, you know, desire. I want to masturbate. I'm using porn. It becomes a coping mechanism and they need that coping mechanism in order to regulate. And some of the things that they're regulating are stress, anxiety, depression, and boredom. Those are probably the four main areas that I see and it creates escaping, you know, escaping behavior. It's, it's not, it's isolating. So oftentimes there's a cycle. So it may be I'm getting that alleviation or I'm

Sure.

engaging in the porn, afterwards there's a lot of shame, there's a lot of guilt. So then they're coping again with those uncomfortable drivers. And so it's this cycle that keeps repeating itself and it becomes something that's out of control. So they may want to try to stop or cut back. They also can develop kind of a tolerance and, you know, even more of a seeking out of the behavior. it kind of, you know, tolerance and withdrawal that makes them engage in it even more. And it's not

Yeah.

it.

something that feels good. So most people will have a level of distress. So that's how I sort of distinguish compulsive use and maybe healthy engagement and using porn. It's the distress that comes along with it. So I feel I'm feeling more depressed or I'm isolating more. It's affecting my day to day functioning. I'm not able to have healthy, intimate relationships, sometimes performance issues. They're not physiological issues that come up. And so it starts to create a lot of kind of whole body issues that come

Right? Yeah.

across and it creates a lot of distress, lot of self-esteem issues, not feeling good about self. And I see a lot in relationships. I would say most of my cases now are couples coming in where one partner is having issues with porn and it's affecting every aspect of their intimacy, physical, emotional communication.

Yeah, and then, it's interesting that what you're saying that so you deal with a lot of the couples that come in and the person that's being affected and the person that's actually doing it. How I mean, obviously, it's you have to deal with a lot of their, you know, issues and anger issues that come up. How do you kind of help them navigate this?

a of education, I think at times it becomes, you for the partner who's not the one that's using porn compulsively, it's, you know, why can't you stop? you know, there's a lot of betrayal. There's maybe the partner who's using has said that have affected how they feel about their body. It's come into the bedroom in terms of how they're having sex. So I create a lot of education and a lot of communication because oftentimes there's a lot of defensiveness or avoidance and there's complications.

Yeah.

You don't want to talk about it, right?

They want to talk about or they don't know and they get defensive and then there's more hurt feelings so creating a communication and understanding around what it is and then helping behavior modification Replacement behavior if you're using porn to cope with stress, let's come up with other You know safer more effective ways for you to deal with with what it is and seeing it not as sexuality I mean what's complicated about porn addiction or sex addiction or any of these? You know so-called process addictions is

Yeah.

You know, we don't want to complete abstinence. You sexuality is a really healthy part of our life, but a lot of that education requires kind of helping people to reset good coping mechanisms. So they're not using porn as that outlet and then learning how to have sex in a healthy way, especially a lot of young, young men that have had more compulsive porn use. They've had no education. Porn is all they've known. And so they've learned about sex and intimacy through porn. And as we know, porn is sensationalized in entertainment and it's not giving you.

Yeah.

Right. Right.

anything about intimacy or communication. I'll create a lot of resources so that they understand what it is and what it isn't. And it's entertainment. I also teach them it's not designed to, it's designed to overconsume. Porn is not designed to just be like, let me like watch a quick film and enjoy it. It's meant to really keep you engaged and keep you coming back to it. Just like scrolling, doom scrolling wasn't even in our approach.

Yeah.

But it was growing.

ago and now you know it's all of these platforms are not meant to just be you know kind of looking at here and there they're kind of meant to keep you on there and just consuming, consuming,

Yeah, no, end up, know, and you can't stop sometimes. I like, I need to figure out how to stop myself sometimes, you know, because, yeah.

I do too, I'm like phone out of the room, know, all of us, it's just sort of technology as you said, you know, it's designed now to be accessible and always available. So yeah, you're not, you're feeling sad, here's porn, you're bored, here's porn. So it's just, it's everywhere. So it's really important to kind of notice how it can capture people's consciousness quickly.

I'm really okay now.

Totally. What do you think? obviously this is an area you treat. and we see patients in the office that, you know, might have.

premature ejaculation. mean, I'm not a urologist. I'm thinking of my patients, spouses who tell that because I always ask about the significant others. And so, you know, you have these people that might have this sort of issue around their sexual health causing a problem for the sexual couple. But what do you think clinicians kind of get wrong? Because, you know, we all we all have implicit bias. So then, you your mind always goes toward one direction, like when you think of some of these things. And so what do think clinicians get wrong when we think about this as a

Mm.

as an addiction or you know that kind of thing.

You know, I think even just the word addiction, it sort of implies that it's very similar to kind of chemical substance and that if you just sort of remove the thing that's causing the addiction, then that'll solve the problem. And that's really what the sex addiction model started in. was just basically, let's take substance addiction and apply it to sex. And so it was very sex-negative, very abstinence only. And I was actually in that world. I did a post-doc in that world and I saw people going through

Right.

Okay.

continually relapsing back into old behaviors. So I think for clinicians to know that a lot of it's based on early trauma, early attachment. It's not just about an addiction that got out of control. A lot of it is kind of diving deeper into a person's early life and their early behaviors. I think at the core of most of these compulsive behaviors are intimacy disorders. And the more you heal and create healing around intimacy and

Yeah.

education around intimacy, the more people are able to overcome these concerns. So I think the sex negative, sex addiction model has actually done a lot of damage. It's created more stigma and more pathologizing.

Sure.

hasn't had a great success rate. So I think that was the big piece that was missing when I was in that field was we have to create some way for people to get healthy sexuality and not sort of demonize sex or porn or masturbation as these things that we can't control, but give them some resources and ways to understand what their behavior is telling them or what is it? What is their behavior stemming from?

Yeah.

Sure, yeah. I mean, guess do you treat a lot of people that have the compulsive behaviors around sex on top of just porn use?

I sort of say sex addiction falls into three categories. It's either love romance or sex, which can be masturbation porn. And I actually did most of my doctoral research on love addiction because I was so fascinated by it. like, can we be addicted to love? And then they were saying at the time, know, men are sex addicts, women are love addicts. I'm like, what is this all about?

So friendly, yeah.

Or actually kind of wrote a manual, you know, an attachment-based theory on how to work with it. know, attachment therapy is incredibly helpful for early trauma and intimacy issues. So I think it's just so much more than what the addiction model shows.

You think so you're saying kind of starts from maybe a lack of appropriate or maybe a longing for love early on that didn't sort of translate and then.

Yeah, was regulated nervous system, not knowing how to get your needs met and then internalizing that, like learning to escape or being, you know, finding ways or behaviors. Cause if you really go into someone's history who might have compulsive porn use, sometimes I'll see very similar themes. There might be childhood neglect or they witnessed a lot of, you know, abuse in the family or they sort of had this, you know, unsafe, dysregulated household. So they didn't really learn how to take care of their emotions. So they learned to find,

Yeah.

external sources for that. kind of think porn and masturbation as process addictions, the same as people might overeat or they work or things that... Exactly. So if you look at someone's childhood behaviors who might have more compulsive masturbation in their adulthood, you might see some of those same things, some things that look like we would put under the category of more obsessive compulsive behavior.

turn at reward pathway.

Sorry, my lighting's getting jacked up in my office space. So I'm just trying to figure it out. Yeah, and I think when we talk about some of these things, even this sort of like, you know, this compulsive behaviors, I don't think we do a good enough job either clinically or whatever in looking at sort of adverse childhood experiences, right? There's so much more data coming out about ACEs and how it's impacting patients across the board, not only in their like,

you know, sexual health, obviously, but so many other arenas, right?

Yes, exactly. I'm happy that research is coming out because it helps people kind of put all the pieces together because back to shame, right? You can come in and say,

I'm having out of control behavior around masturbation or I'm using too much porn and there's so much shame around it you feel like something's wrong with you. But when you kind of make those early connections, you're able to find out so much information about what their nervous system was going through in those early experiences. just even, I always say even mothers, most mothers go through postpartum and postpartum is incredibly, it's incredibly intense experience for any mother and a lot of mothers don't have

Absolutely.

support around that and they're raising young kids and then the kids are developing those senses of you know anxiety and early know early a dysregulation around their nervous system and how that can lead to a lot of these behaviors.

Absolutely. I did a sub step because I, you know, I don't know if you watch stranger things, I was, um, you know, I had been doing some research on ACEs and how I could think about it was like, my God, what are these people going to experience later in What kind of trauma? Well, I was like, oh my gosh, just imagine anyway. Um, but I think, I think we don't, we don't bring that into account enough. So I'm glad people are doing it now. Um, talking about, um,

I I just finished the finale.

So true, right?

compulsions and when people say that, you know, maybe come over it and they say maybe they don't feel like they trust themselves anymore versus what normal, when you're talking about trying to normalize what like a healthy sexual experience for these patients, how do you help them to make that distinguish that like this desire is normal, but trying to like break from that compulsion where they might not feel like they trust themselves anymore? Does that make sense?

It does. think your point is good, You know, what's normal desire? Because people will ask that, you know, do I just have a high libido or is this a problem? And that's where we want to distinguish. And I think...

Yeah.

Even understanding desire, you know, when there's urges, you arousal is sort of this complicated thing because people look at arousal as just sexual. You know, if I feel something, it's sexual and then that's an urge and then I have to go take care of myself. But I do a lot of education around, know, arousal. There's a lot of ways we're aroused. We have emotional arousal, physical arousal. so how do people understand? And I think also creating a lot of space and technique around self-soothing. I find that most of my clients that are going through any compulsivity

Yes.

have no skills around self-soothing. When they're feeling overwhelmed, they don't know how to self-soothe. So we do simple things, learning breath techniques, checking in with the body, even self-sensei focus. Sensei focus is a very popular exercise in sex therapy, even learning how to soothing touch, because if we think back again to infancy and childhood, self-soothing is our most natural way we learn to connect with our bodies, even before we have all this intellect and language. And it can be simple things, you know, learning to tolerate touch. And I'll find that a

for it.

of my clients with compulsivity have a lot of neglect around touch growing up. They didn't have a lot of healthy affection. They didn't really learn when they were crying or overwhelmed how to normalize and take care of themselves. They were told to avoid it or cut it off or not talk about it. So they hold that in their bodies. So I really give them simple tools on how to self-soothe. And then just learning what I call primal intimacy.

Yeah.

for good food.

Yeah.

Yeah.

Sex is not just all about intensity. It's also about, you know, slowness and sensuality and connection. And so they look at sex as less of this mechanical thing that we do and that it's all about the physical body or the generals and more about, you know, the connection. It's a social connection. It's just one of the ways we socially connect out of all the ways that we do as humans. And those are our drivers. You know, I always tell people we can live without sex, but we can't live without love and connection. That's really our, you know,

special.

all the studies that we've seen, know, love can actually affect your physical health, know, lack of love or neglect. So I help people see that sex is not just this thing we need to either do more of or do less of, and it's, quantifying it, but learning how to have quality intimate experiences. And a lot of that starts in therapy, you know, I'll model that, good eye contact, reflective listening, giving them the sort of a pace where they can feel things and kind of sit with their uncomfortable emotions.

Tell him in time again. Yes.

without having to intellectualize them. it's a lot of skill building. I think that's the most important part of these concerns.

Yeah.

That's so, because I think that's stuff we just don't learn. know, like, especially if you, if you were raised by like a boomer, you're, you're not learning any of that. Right. Well, I mean, you know, especially because you and I are both, well, I'm not sure. I'm not sure if your parents immigrated or there are your grandparents did, but, um, you know, I think when you're a product of immigrants too, most of them are just in survival mode coming into a new.

Exactly, think we all can agree on that one for sure.

Like I feel like my parents when they came here really were trying to figure out the best way to make a quality life for themselves and establish themselves here. And that trauma in itself is so huge, right? It's just like a huge change and a huge like loss of your former land. And I just think about some of those things sometimes, you know, I my mom passed last year. I just think so much about her and how she...

Mm-hmm.

left everything behind to come to here to make a life for us really, really.

Yes, and that's good point, you know, that intergenerational trauma and things that are sort of normalized and even, you know, those generations wouldn't identify that we're just now starting to make trauma more of a, you know, a topic that people are really understanding. And I always tell people we're kind of born into trauma. Trauma is a big part of our life. know, birth is traumatic.

and

We're just in survival mode constantly in our lives. So that's why connection is so important. That's why intimacy is so important. Whether it's community or romantic intimacy, it's just part of human nature. We need that. We need to be in community. And that's why I see with these compulsive issues or other issues, a lot of it is isolation. So many people are isolated and all this technology is creating even more isolation. And that's just amplifying all these issues and sort of creating

So I think I know.

creating even more generations where this trauma is sort of unresolved. it's,

I think what the Surgeon General a few years said that loneliness was a pandemic, or epidemic, sorry. But it feels that way.

Yes.

I mean, for sure. Yes, it really is. And then now we have AI and people having AI companions. I mean, it's a whole area that I think all of us in this field are going to be doing a lot of work around to figure out how to help people.

Absolutely. Actually, I don't know if you're coming to Ishwish this year, but we have a, I'm the scientific chair for the International Society for Study of Women's Sexual Health. We're doing a whole symposium on AI technology and how, you know, some of these things are affecting. So don't know.

Yes, I will be there. can't wait to hear it because I want to know too. I want to learn as well. know AI is going to be a part of our lives whether we want to or not, and it's going to affect sexual wellness, whether we want to or not. I was just speaking with a client the other day. Now there's a whole AI around writing your own erotica. And so the whole AI and erotic world are starting to collide. so, yeah, we're going to have to be talking about the ethics and the consent and all the boundaries that are boundaryless.

Yes.

of some of these, you things.

Well, some people use AI for their own therapy. have like patients who tell me like, well, I just asked chat GPT blah, blah, blah. And all of a sudden, you know, he reassures me and he does this and he does that. And I'm just like, okay, but you know.

I'll go back to I asked Chachi Chachi BT agreed with what you told me. I'm like, well, I'm glad that Chachi BT is with me and not against me here. At least for now, right?

I'm glad you did.

Right. At least for now. My husband always jokes. Well, I feel like my future self, my future self is going to come back and warn me about what's going on. He's a sci fi kind of guy. Anyway.

It's a wild world, but we're going to see a lot. It's going to affect our work definitely.

I mean, did you see, think I saw on the news recently that like some woman married her chat GPT or AI person and somewhere in Asia, I can't remember.

Oh, the statistics are wild. I was at a conference recently and I think there was something like, it wasn't 50%, 30 some percent of people in surveys said that they would prefer an AI companion over a human. it's,

Thank

It's a thing and it's, because again, you know, you're getting needs met and building intimacy in a way that's safer. I mean, there's certain things we can kind of take from it. What does that provide that they're not getting in the real life? But you also want to be able to, you know, intimacy is also about vulnerability, you know, being able to deal with let down and not everything has to go perfect. And sometimes you, you know, boundaries. And that's what I get concerned about as a clinician.

Hmm.

Yeah. You know, someone always said, like, great idea. This is perfect. You know, like how.

Right, or I'll do anything you want sexually. That's what I'm concerned about AI companions around sex is that they're sort of, it's sort of like a porn, same issue with porn, it's sensationalized and performance based and it's not going to teach the skills of, you know, one-on-one partnered intimacy, which is just a whole different experience. It's not, you know, it's not quantifiable. It's about creating an experience that's mutually enjoyable. So yes, there's some big concerns there.

Ryan.

Hmm.

Right? my God, you're so right. You've also talked a lot about pleasure literacy, like as foundational for so many relationships and your sexual health. How do you think that really works to prevent some of the stress that we're talking about? Obviously, think because most of us lack a lot of this. Most, we know and grew up with any of this literacy. guess that's why.

Exactly. Or even thinking about pleasure in terms of sex. think people think of sex as this thing we do, penis and vagina, or genital focus. And I try to bring in just the idea of we've been pleasure seekers since birth. Pleasure is a way that we experience life. It's so many things. It's not just sex, but understanding that it's different for everyone. That's usually the first step. I always remember this case that came in, a client that said, I want to have great sex. And was hoping you could tell me exactly what that was.

And it'll always stick out to me because I remember telling her, know, my definition and your definition and this person's definition are all going to be different. But my goal is to help you figure out what that is. So with pleasure literacy, it's really helping people figure that out. You what's pleasure mean to you? How do you seek pleasure? What does pleasure look like in your life, even outside of sex? And when I start, especially when people have more shame getting into what they do in their life, you know, I'll put sex to the side for a moment and be like, what are you passionate about? Tell me about your hobbies. What do you do? What makes you happy?

Yeah, totally different.

Yeah, yeah.

and they light up, I see the libido, like, yes, I do this and I have this hobby. I'm like, great. I mean, that's the energy we want to bring into sex and pleasure. so it's kind of creating that connection that, know, sex is just part of that. How do you then tear that passion in a place where you can feel good? And maybe it doesn't have to involve your genitals, you know, maybe it's about, you know, other forms of sensuality. And a big part of it is creativity and play. I think that's such a big part of our human nature.

you.

Absolutely.

Yeah.

I mean, we've been doing it since we were kids and as adults, I think that our biggest crisis is that we don't play enough. We're not, you know, in our creativity. Everything is, you know, what do we do? And we don't have enough time and you know, just the adult mindset of an over responsibility and then sex gets tagged onto that as well. It's just another thing we have to do or figure out or the responsibility and so.

Yeah, it's true.

Go, go, go. Yeah.

Another typical list.

I try to kind of rewire that a bit and recondition that, like, let's make that about playing fun. I mean, if you were thinking about having, you know, play, what would that look like and creating, you know, creating a sex life that you want rather than having to fit into a certain number of times a week or, you know, I have to, you know, boost my libido or all these things we hear in the articles we read in the books. So I just want to give people more permission to really design their sex life and think of pleasure as something that we can always access, even with low libido.

you

Sure. All right.

that we can always access. It's just about kind of opening that up rather than feeling like we're waiting for like a pill to work or a switch to go on or you know my desire falls out of the sky and I finally feel different. I want to empower people to take control of that and not feel like there's a magic solution that's going to fix everything.

Yeah.

No.

So take that and keep moving.

Right. No, it's so true because I mean, even when sometimes we talk about just what brings someone happiness and some people can't even define it. You know, I was asking a patient one day, what brings you joy? Like, what is it that you're looking for? And they're just like, you know, it's like they haven't even thought about it, you know?

Or when is the last time you felt some pleasure or happiness about something? And sometimes they can't, know, and I don't know if it's retributive. Obviously there's so many factors, you know, given where our state of the world and all the things happening around us all the time. But I think also just, you know, nobody thinks about what pleasure means to them, right?

You got it.

Exactly. Exactly.

Exactly.

Exactly. And it feels overwhelming. always say, you know, pleasure is all connected to our senses. So sometimes we'll talk about, you know, just what's your sensory experience like, you know, and it could be simple things. Sometimes, especially with women, I'll get into grooming routines. Like, do you like putting lotion on? Do you what smells like? Do you like to light a candle? Do like to put music on and move your body? Sometimes it's simple things that you do when no one's looking that bring you joy. You don't really register that, but it's sort of that freedom to sort of be embodied and in a

Yeah.

Thank

Yeah.

sensual space and we all are sensual whether we're registering it or not. I try to that's sort of the primal intimacy. I try to get people to connect back with you know, sex is really simple intimacy and pleasure is simple and it's not meant to be I mean humans intellectualize it to the point where we don't want to have it. We overthink it to the point where it feels overwhelming. So I try to know, reset that and so people can see it as you know, the simple things it can be flirting it could be brushing by your partner it could be

Yeah.

Yeah.

putting lotion on and feeling just good in your body. It could be moving and walking in a new way. There's so many ways that you can reconnect with that. So it's gonna be different for everyone. There's no manual that you're coming into sex therapy and you must do all these things to be sexually empowered. I mean, that's what I love about it.

Yeah.

No.

No, wait,

Right? It's trying to figure out your... Exactly. Well, that's great. I love that you're doing that. And I love everything that you're doing in this space. Actually, it's really amazing. My husband, Joseph, my listeners are like Vagilantes. But I have this thing I do at the end of our podcast, Vagilante Verdict. Like, what's your hot take?

Everyone's journey is going to be

Yeah, I love that.

that you want the listeners to either remember or to think about more or do more of.

I want to say just take charge of your sexuality. know, every day is a different day and it's different every day. As a woman in perimenopause right now, I can tell you it is different every single day.

No.

every single day.

And you're not broken, that's most important too. We all, 100 % of us, myself included, we all go through sexual concerns. It's a part of our lifespan and we'll continue going through it and it's going to evolve and change. And don't be afraid to reach out for support and help. And it doesn't mean you're going to be in therapy for years and years. I've seen some people come in and get one session of just getting permission or meeting with a doctor like yourself who's positive and just informing. And yes, you're not alone. We're all going through these things.

you

Thanks.

Yeah.

If someone's, I've seen so much healing just someone being able to say, that's my experience too. Or, my body looks like your body. yes, we all can connect and support each other. So you're not alone.

Yes.

Yeah. It's all not the made up social media world that like everyone looks, you know, or it's. Yeah.

Sex is the most imperfect thing we do, so let it be weird, it be, you know, let it be ebb and flow and change, you know, it's not meant to be Hollywood's version, it's just, it's our own, we gotta make it our own and we gotta take charge of our own sexuality for sure.

True.

I love that. love that. Well, thank you so much, Shana. This has been great. I'm so glad I connected with you and that we have so much in common. didn't even know. So hopefully I'll get to see you in Long Beach in February. Are you coming? Yeah. Awesome. So I'll look forward to meeting you in real life. And then this has been a great conversation and I hope to have another one with you, you know, so we can delve more into some of this, but I really appreciate you being on today.

I will be there. I'm gonna be there, yes. Yes, I will be there.

Thank you. Appreciate it.

Thank you so much. Thanks everyone for listening. I'm Dr. Smeena Mangyal girl. Remember, I'm here to educate so you could advocate for yourself. Please join us again next week.