How Mindfulness Can Lead to Better Sex
At the turn of the 21st century, sex in America changed forever — for men, anyway. It was 1998 and a little blue pill that promised to end the vexing problem of sexual dysfunction for millions of men hit the market. It lived up to the hype, too. In the twenty years since then, Viagra, and 25 similar drugs, have entered the bedrooms of millions of men, and prescriptions for the pills have continued to skyrocket. In 2017, erectile dysfunction drugs brought in around $4.82 billion globally, a sum that is expected to reach $7 billion by 2024.
But what about women? Flibanserin, also known as Addyi, the one medication currently on the market to address female sexual dysfunction (FSD) has seen lackluster results and sales have not taken off. In the three clinical trials evaluated by the FDA for approval of the drug, just 10% of participants reported that their problems were “much improved” or “very much improved.” What’s more, the list of side effects is long, including dizziness, nausea, hypotension, and more.
That doesn’t mean there are no options for women with low libido, however. A new, non-pharmacological treatment for FSD has sprung up in recent years and it is showing encouraging results: mindfulness.
“We live in a hyper, multitasking society, and therefore we get very good at being at multiple places at once — and that applies to sex as well,” says Lori Brotto, PhD, a clinical psychologist, sex researcher, and the author of Better Sex Through Mindfulness: How Women Can Cultivate Desire. “Sexual mindfulness simply encourages people to show up when they are engaging in sexual activity.”
Brotto began researching female sexuality around the time Viagra hit the U.S. market. That year, a study was released reporting that 43% of women experienced sexual difficulties compared to 31% of men, and yet very little was being done to address this chasm. At the same time, Brotto was introduced to mindfulness as a way to treat borderline personality disorder, a condition characterized in part as a detachment from the self.
“It struck me that there were actually a lot of similarities between the individuals with borderline and women I was seeing with sexual concerns,” she says. “Mainly, it was this feeling of being disconnected.”
Brotto conducted an experiment to see if mindfulness exercises could help a small group of female cancer survivors who, after their treatments, reported no sense of genital pleasure, arousal, or desire. She provided three sessions of mindfulness-based cognitive behavioral therapy coupled with sexual arousal exercises. The women were then asked to practice mindfulness exercises five to seven hours per week.
The women reported more desire, more awareness of body sensations, and as a result, more sexual satisfaction after the regimen. The effects remained six months later.
“That really planted the seed for the subsequent 15 years of a variety of different studies in larger populations of women, and women expressing sexual concerns for a variety of different reasons,” Brotto says.
To understand how mindfulness works when it comes to female sexual dysfunction, it’s also important to understand what FSD really is — and why drugs like flibanserin don’t seem to help.
FSD can manifest in many different ways, ranging from simple lack of interest to pain during sex, vaginal dryness, and difficulty having orgasms. Researchers such as Brotto tend to rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) definition of FSD from the American Psychiatric Association (APA), which lists six characteristic symptoms: loss of interest in sexual activity, lack of sexual thoughts or fantasies, not initiating sexual activity and not responding partner’s attempts to initiate, lack of pleasure during sexual encounters, inability to become aroused by internal or external sexual cues, and lack of sensation during sex.
The APA considers a woman to have FSD if she reports having at least three of these six symptoms for at least six months. These symptoms also must cause her “clinically significant” distress.
While some of these symptoms could stem purely from a physiological or hormonal issue, Brotto and other researchers argue that it’s more likely that there are psychological and psychosocial roots to the problem, including issues with body image, shame, chronic stress, anxiety, confidence, and societal pressure — all of which can affect women more than men.
“As women become more aware through mindfulness… there’s the potential to benefit their sexual enjoyment, their sexual connection, and all of the elements that contribute to their sexual satisfaction.”
“We know from a number of studies that women feel less satisfaction, sexual pleasure, and even arousal than men do,” says Chelom Leavitt, PhD, a sex researcher and professor at Brigham Young University. “As women become more aware through mindfulness, specifically through sexual mindfulness, there’s the potential to benefit their sexual enjoyment, their sexual connection, and all of the elements that contribute to their sexual satisfaction.”
Generally defined as the practice of giving your attention to the present moment without judgment — whether you’re brushing your teeth, washing the dishes, or simply breathing — mindfulness has been shown to help treat everything from stress and anxiety to heart disease, high blood pressure, chronic pain, and insomnia, all by making people more aware of their body and less consumed with the rampant thoughts rolling through their heads.
Sexual mindfulness uses the same principles, but with a targeted focus. Instead of following the distracting and often self-defeating thoughts that can come up during sex (Does my body look okay? Will I have an orgasm? Is my partner happy?), mindfulness encourages women to let their thoughts go, come to the present moment, and pay attention to how their body is responding during a sexual encounter. The result is a reduction in distraction, an increase in acceptance, heightened mood, and a heightened awareness of inner body sensations — all of which can lead to better sexual satisfaction, according to a number of studies from Brotto and others.
A recent study led by Leavitt looked at the role of sexual mindfulness in the sexual satisfaction, general well-being, and self-esteem of men and women. It found that more “sexually mindful” people had better self-esteem, were more satisfied with their relationships, and, particularly for women, were more satisfied with their sex lives. A 2018 study from Brotto found that women who were given brief mindfulness sessions showed a greater sense of arousal both mentally and physically, the latter of which was measured by a vaginal photoplethysmograph, a device that measures the amount of blood in the walls of the vagina. The more blood, the higher the level of arousal. And a 2017 meta-analysis of 11 trials with a total of 449 men and women found that “all aspects of sexual function and subjective sexual well-being” improved significantly under mindfulness-based therapy.
Brotto and Leavitt emphasize that sexual mindfulness encourages women to view sexual desire in a new way. Instead of thinking of it as a spontaneous feeling, it’s something more akin to an emotion that needs to be triggered.
“We feel desire when things around us or within us elicit desire,” says Brotto. “So, sometimes when desire is low, we need to look at: What’s in our environment and within ourself that could be creating a barrier to that desire? At the same time, what elicitors can we add into the mix, so that desire can become elicited?”
“That’s where I think mindfulness comes in,” she says. “It’s a pretty potent way of addressing the barriers that get in the way of desire.”