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Idea #2: Mindful Sex

Dr. Lori Brotto has a new application for an old idea.

By Danielle Egan 18 Dec 2007 | TheTyee.ca

Danielle Egan is a contributing editor on The Tyee.

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Bright ideas for 2008.

[Editor's note: Rather than look back over the year that was, the Tyee is offering its readers a dozen New Ideas for the New Year. We'll publish a new one every weekday from now through Jan. 1. They're textbook cases of thinking outside the box, all of them from people trying to make B.C. a better place to live. Later in January we'll be asking you to suggest your own new ideas for 2008, and publish a selection.]

Close to a third of women report not being turned on by sex. The news has neuroscientists scanning women's brains during masturbation, while pharmacorps scurry to develop drugs, skin patches and potions to notch up libidos.

Vancouver-based sex researcher Dr. Lori Brotto says low sex drive isn't caused by physiological wiring and plumbing problems, but by a psychological mind-body disconnect. In other words, our minds too often have no clue what our vaginas are doing. And Brotto's key weapon to bridge that gap is the ancient Eastern technique called mindfulness.

Buddhists have practiced this type of meditation for thousands of years and Western doctors have recently adapted it as a support treatment for patients with cancer, chronic pain, attention deficit disorders and anxiety but Brotto and her colleague Julia Heiman, director of the famed Kinsey Institute, are the first to use mindfulness for sexual disorders.

Turning off the background chatter

It starts with a raw egg.

In a group therapy session, her patients have to balance the egg on one end on a tabletop. "That's really difficult to do," says Brotto, who opened The UBC Sexual Health Lab in 2005. "But even harder than that, especially for women, is learning to turn off the background chatter and focus on sexuality. They're always multi-tasking, even during sex. The egg exercise introduces the concept of mindfulness: focusing all your attention to one task, being 100 per cent wakeful and attentive, in the present, but also relaxed."

After her patients, ranging in age from 19 to 70, master the egg balance, Brotto moves on to "body scan exercises" done in group therapy and in daily life. "As distracting, annoying or otherwise irrelevant thoughts come up, you put them on a conveyor belt, notice them roll by and bring your senses back to the present moment," she says.

After several weeks of training, Brotto shifts focus below the belt, first as a sort of ice-breaking get-to-know your vagina exercise. "That means looking at and touching her genitals, not creating arousal," reminds Brotto.

"Concentrate on the sensations and simultaneously note any distracting thoughts coming up, so that she stays focused on the present. That's actually a really difficult exercise to do. A lot of women haven't even really looked at their genitals, so we often spend a fair bit of time on that."

Lots of homework

The next stage involves a lot of homework: "reading a fantasy, watching erotica for a few minutes or using a vibrator which should pretty reliably bring about her arousal," says Brotto who was introduced to sex research while studying the sexual lives of rats at UBC.

"Then the goal is to stop after a few minutes and do a mindfulness exercise. By first exciting her body, she can then tune into her sexual sensations even more. Then we talk about how to incorporate that with a partner when all of their relationship factors are at stake: worrying about performance, how your partner is reacting, all the cognitive stuff, like rationalizing the choice to have sex in the first place because he took the trash out, etc. It is a gradual progression towards being more mindful in our sexual lives."

Graduation day

The course actually begins and ends with a test. In the "arousal room" at Brotto's lab, women are hooked up to a vaginal photoplethysmograph that monitors "vaginal pulse amplitude" while they watch erotic videos, interspliced with non-erotic footage to show baseline responses.

Initial tests almost always indicate that women with sexual arousal disorders "will genitally respond to erotic videos even if they report that they didn't feel turned on," according to Brotto. "It's proof of the de-synchronicity between mind and body with many women."

So far, 70 women have graduated from Brotto's mindfulness program. Post-mindfulness training, both the physiological and subjective tests scores -- measured through questionnaires -- improve for a significant majority of her patients.

But competitive types take note: there's no such thing as an ideal or even an average score; the tests are done to track post-therapy changes, so the goal is not to compare one patient with another. "We spend far too much time worrying about whether we're 'normal' or good enough," says Brotto. "Mindfulness is about cutting out that kind of noise and tapping into what your body is doing."

Brotto has 23 sexuality studies currently in the works and just received a five-year provincial grant to beef up her mindfulness program. In 2008, she'll also start an online educational course for women in remote spots and plans to add male students to her programs since up to 34 per cent of men report sexual disorders.

"We're such an eroto-phobic culture and it takes a lot of work to change our internalized attitudes about sexuality," says Brotto, who hopes everyone puts sexual health on the 2008 resolution list.

"Sexuality is a quality of life issue, not this dirty, taboo thing. Why do we have so many hang-ups about something we all value as important? Ultimately we all just want to love and be loved. If people are sexually happier, they'll be happier in general. It's the new anti-depressant."

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