Fully Present Sex

When the Buddha attained nirvana under the Bodhi tree all those centuries ago, it’s doubtful he had sex on his mind. But according to a popular Canadian psychologist, the mindfulness practices that millions of people have adopted today to help with the challenges of modern life can do wonders for their sex life as well.

Clinician and sex researcher Lori Brotto discovered the power of being in the moment in graduate school. Her team at the University of Washington used Dialectical Behavior Therapy, a mindfulness-informed practice, to treat clients with borderline personality disorder (BPD). She saw that the more her impulsive and deeply insecure clients engaged in focusing on the immediate present, the better they felt. “For people whose minds shuttled between a dangerous past and an uncertain future, the present was the safest possible place to be,” Brotto says.

Now a Canada Research Chair in Women’s Sexual Health, and the author of Better Sex Through Mindfulness, Brotto believes that much like other mental and physical states, sex benefits from an ability to shut distractions out and bring a sustained focus on the present in.

It’s become a kind of rueful joke that women have trouble climaxing because they’re distracted by the mountain of details that make up a busy work and home life. But Brotto points out that distraction is an issue for men too, especially those catastrophizing about erectile dysfunction and pre-ejaculation. (“Anticipation of pre-ejaculation causes pre-ejaculation,” she quips.)

She sees a striking similarity between her previous clients with BPD and the women and men she now studies and treats who struggle with sexual dysfunction.  Some of the latter have run-of-the-mill performance anxiety, low desire, or vaginal pain; others have undergone serious treatments for prostate or gynecological cancers or are sexual violence survivors. All, she says, can suffer from “a disconnection from themselves.”

Doing it, Mindfully

It turns out treatment for everyone begins in a very chaste way. Before trying to be like the Buddha in bed, Brotto says it’s important for people to understand just how distractible they are in other areas of their lives, and how challenging it is for any human being to maintain a prolonged focus on anything.

“At the outset we like to normalize the wandering mind. We teach clients and study subjects that their minds are like puppies, and puppies are going to wander,” she says.

Then, as she details in her book, Brotto teaches tried-and-true noticing practices. These are lead-ups to later skills that will make staying in the here and now during pleasuring activities with partners more possible. They’ll also, she says, help to keep catastrophizing thoughts about pain or poor sexual performance at bay, and ease self-criticism and frustration if there aren’t big fireworks.

One of these practices is the raisin exercise, which entails holding a raisin in your hand, and bringing your five senses to bear on it without gulping it down. First, divine its shape. How does it hold the light? If you sniff it, how does it smell? Touch it to your lips but don’t eat it—now how does your body react to that frustration? Holding it to your ear, do you hear anything? Finally, bite into it with deliberation and take some time with the various flavors that you taste. Keep noticing as you swallow and are left with the aftertaste. What does a raisin leave behind? If, during the exercise, some sensation elsewhere in your body or a thought or a sound grabs your attention, focus on it with the same level of mindful awareness until its importance begins to fade. Then turn your attention back to the raisin.

Brotto says clients and subjects in her study groups readily connect the exercise to the way they rush through or into sex; they “go through the motions,” often with eyes completely closed, and keep thinking thoughts unrelated to the actual sensations they may be having. 

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A next tier involves turning focused attention to the body. For this, she asks clients to practice doing a body scan, which borrows from the traditional relaxation technique of noticing sensation or tightness in your various muscles. But in this case, attention is also paid to genitals and other sexually sensitive body parts. That focus can bring worries to the surface, and provoke sadness, guilt, and frustration. It can also bring pleasurable sensations and excitement, or, for some, result in nothing much at all. But by observing and accepting the mix of good, bad, and neutral feelings the body holds, Brotto says we can build compassion for our experience, and a tolerance for the varied sensations that sex itself can contain. 

She eventually encourages clients to take a few minutes at home to elicit arousal in themselves through erotica, fantasy, or the use of a sex toy or vibrator—and to pair that arousal with body awareness. After those arousing few minutes, she asks them to stop what they’re doing and bring their focus to sensations, energy level, and temperature as well as what’s happening to genitalia and whether or not those genital sensations feel sexual and elicit an urge for more stimulation.

After all of this training in paying mindful attention, people tend to experience a new integration of their body and mind while in the act. By the end, they’ve also mastered something quite important: a kind of self-focus that’s nonjudgmental—that doesn’t seize upon negative or self-critical thoughts before, during, or after sex.

Brotto reports that most aspects of sexual desire and response that aren’t related to a medical condition or medication improve by as much as 60 percent after her program. And the gains are lasting with mindfulness, which is a tool that once learned, can always be resurrected.

If she’s right, tools like this may have real import for clients. The rates of sexual dissatisfaction and pain in the general public are quite high, and though surveys vary wildly, some say between 15 to 50 percent of women report being unhappy with the sex they’re having, about half of men ages 40 to 70 report some degree of difficulty getting or maintaining an erection, and a full third of American women have experienced pain during sex. Though Viagra and the like have been a boon for the men without cardiovascular issues who can take it, the benefits of drugs to treat sexual dysfunction in women remain meager.

Brotto notes that therapy and mindfulness go hand in hand, and that unlike other treatments for sexual dysfunction, mastering the practice is within reach for every client. She does advise going slowly if treating assault victims. They should try these practices in a safe space, for no more than a few minutes at a time. For clients whose medical issues might make orgasm and erection difficult or impossible—like some prostate and gynecological cancer survivors—the goal becomes enjoying all the other aspects of closeness and sex. And of course, she says, “never give a timeframe to someone with sexual dysfunction—it frustrates them!” 

In the end, Brotto says, despite what marketers of other sex books and products might say, “acrobatic moves or willful stamina are not what make sex truly magnificent.” When women she’s worked with share stories about great sex, they attribute their enjoyment to being “fully present, fully connected, fully there,” leading Brotto to conclude that “satisfying sex is simply not possible without mindfulness.”