Disappearing clitoris? Underwhelming orgasm? Why it happens and what you can do – with Susan Bratton

0:01Dr Sophie Shotter:Hi, I'm Sophie and this is Age Well with Dr Sophie Shotter, a space devoted to all things health, wellness and longevity. Because for me, Ageing Well is about looking and feeling like the best possible version of ourselves, inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing new conversations from a range of interesting women, and men finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

0:45Dr Sophie Shotter:Susan, you're a global intimacy coach and expert. You've been described as the world's leading sexual biohacker. You've authored and published 34 books and programmes. You've been invited on to major podcast platforms from Dave Asprey's to Stephen Bartlett's Diary of a CEO. So it's wonderful to have you on my show. And you've been featured on a range of TV and radio shows, along with magazines and newspapers. So apologies in advance that you've talked about this so many times. But for the sake of my audience, I'm really interested in your backstory. You've spoken about your husband Tim's affair over 20 years ago, and you described yourselves as having been in a sexless marriage.

1:23Dr Sophie Shotter:I've heard you say on another podcast, I remember the shame of allowing a sexless marriage. And you said that you forgave your husband, Tim, because you saw that he was trying to stay in the marriage while still receiving his own pleasure. You've also spoken about how easy it is for women to lose interest and give up their sexuality and how many women expect men to do the same. So to get married, settle down and give up on their sexual needs. Obviously, there are huge generalizations here and there's so much to unpack just in all of what I've just said. But I'm especially interested in the fact that you forgave Tim and you both went down this path of so-called radical honesty.

2:00Dr Sophie Shotter:I know you've previously referenced the book Radical Honesty by Brad Blanton. But can you give us some examples of the radical honesties that Tim told you in the aftermath of his affair? And perhaps recap your story a little and how you coped and whether you would do anything differently if you had to do it again? Okay, sure. Well, first of all, thank you so much for having me on your show. You're doing so many interesting things in your practice that I want to talk to you about. But what led me into becoming what is essentially an author of passionate lovemaking techniques and bedroom communication skills and intimate wellness information, those three things, my husband fought for his sexuality.

2:53Thank God things came to a head and he told me the truth, that he was having an affair with a married woman who was also in a sexless relationship. And that they were just trying to cope with the fact that their partners, me being one of them, I was avoiding my husband for sex. And I can imagine as your listeners hear those words, they think to themselves, yeah, me too. and when I, God, that was 25 years ago now, and when I reel my mind all the way back and I think about the arc of the experiences that we've been through and where we are now, I am so appreciative that he was willing to fight for himself and honor his desire and sexuality.

3:54I'm so happy that he was willing to tell me the truth about how painful it was for him to feel rejected by his wife. I realized that what that did was it put us on a journey of learning and opening ourselves to experience and filling in the blanks that all of us have in our culture around a lack of sexual education partner-based pleasurable sex education, especially sex education that is about how to make love. We don't have that. We have information about procreation and contraception and avoiding STIs and what I would almost in some ways call fear-based knowledge rather than things that help us become good lovers for each other so that sex keeps getting better and better.

4:56And in his kind of fight for his own sexuality, I was in a marriage where I felt like it was my duty to have sex with him, that that was part of the contractor agreement. And that is, in fact, as you begin to dismantle patriarchal thought, not really true. That's what we've been told. It's our job as women to have sex with our husbands. You know, there's terms for it like mercy sex and beauty booty, things like that. There's a lot of women lying there like the starfish. You know, that's a term you hear about women who just lie there while their husbands basically ejaculate inside them. They're really just masturbating with their wife's vagina.

5:49And so there's just a lot of painful aspects to all of this, from the shame, from the duty, the mercy, all of these things. And I can't say that I can solve all of the problems of our culture, but what I can say is that if my husband hadn't stood firm in his desire to have an active and pleasurable sex life, I wouldn't be here today, 34 books and programs later, teaching people essentially the recipes for having great sex that keeps getting better. So I owe him a debt of gratitude for both fighting for what he felt he needed. And I'm so glad because now I have really great sex. I'm comfortable with my body.

6:44I'm wildly orgasmic. My vulva, you know, I'm going to use the word yoni, Y-O-N-I. It's my favorite four letter word because it's a tantric lovemaking word that means not just the vagina, which is the inside or the vulva, which is the outside, but our entire female genital system and its connection to our power and our confidence and our self-love and to not only ourselves, but to our partners and to source or God or whatever you want to talk, you know, whatever you want to call it. If he hadn't stood strong, we may have gotten a divorce. If I hadn't been willing to go learn how to have good sex at sex workshops, if we hadn't realized that really pleasurable sex is a series of learned skills that all bodies can do, I wouldn't be here talking to you right now.

7:43Dr Sophie Shotter:Gosh, what an interesting and inspiring story. One of the things that I was thinking of when we knew we were going to get you onto the show was Sophie released an episode last August on libido and the various options for men around ED. And we discussed the complexities around female libido and sexual desire. And we know that in the US there's a so-called Viagra for women. I think the brand name is Adi. But it's only licensed for pre-menopausal women because it works on a woman's hormones. So essentially, it tries to short circuit the overthinking that many women do in the prefrontal cortex, triggering, as Sophie told us, dopamine and serotonin.

8:21Dr Sophie Shotter:So women will be, in theory, more relaxed and more open to sex. So it works similar, they say, to an antidepressant. This reinforces the notion that sexual desire in women starts in the brain. But Sophie made another really good point that made me think, which is that with all of the medical research and the development funds and monies out there, Wouldn't it be great if women had more options for low libido, something more than just effectively an antidepressant that is only available in the US and only available for women in the US in their 20s and 30s? Because low libido seems to generally hit us women in their mid 40s, 50s, 60s and beyond.

8:57Dr Sophie Shotter:So my question is, what can be done for peri and post menopausal women who just don't feel like having sex? Do you have any really good tips or ideas for low libido, especially in women? but I guess also in men. Yeah. I think that low libido gets blamed a lot on hormones, and I think hormones are a factor. As estrogen declines, your tissues thin. Literally, the skin of your body gets papery. If you look at your grandma, my mother just passed. She was 88. and the last time I visited her before she passed, I could see inside her, her skin was so thin. And, you know, they took her off of estrogen when she was in her early 80s and it rapidly accelerated that thinning tissue.

9:51And because the vaginal mucosal lining is essentially inside skin in some ways, you know, like spongy inside skin, it thins and then it doesn't hold moisture well. And all of that thinning of the tissue leads to genital atrophy. The second thing that happens is that by the time we're in our 40s or 50s, we have half the nitric oxide production we had in our 20s. And nitric oxide is what our body, it's a gaseous signaling molecule that pumps the blood around in our body where we need it when we need it. Because we don't have blood everywhere all the time. I mean, we have a bit of it. But we need the erectile tissue systems of our vulva.

10:36We have as much spongy tissue in our yoni as our male-bodied partners do in their penis. So you can imagine, you've seen a penis go from flaccid, where you almost can't see it in some men, to being quite an impressive staff. And all of that is basically just blood. And the thing is that that blood, when men start getting erectile dysfunction and the blood doesn't get into the penis, can't get enough in, can't lock it off, can't get an erection, same thing's happening to our yoni, to our vulvovaginal system. And it's because we can't pump the blood into all the nooks and crannies of that yoni system.

11:19And so we have that. And then we have lowered testosterone, which is really the hormone that gives us the desire for the kind of like, I want to go have this. I want it. I want something. Give me something. It's that drive, if you will. and those are some things that I really feel like another big thing that we don't talk much about is mitochondrial decline. The mitochondria are the batteries in the cells of all of your body. We have, what, 70-something trillion cells in our body bag and as we age, our cells begin to not work as well as they did, and our flashlight doesn't shine as brightly. When we don't have energy, it makes it harder for us to get everything done that we have to do.

12:14Then you add on, in patriarchal cultures like yours and mine, we add on the fact that for most women, they're carrying a considerably larger load by doing often both working outside the home and carrying the load inside the home and all of the strategy and the activities and mental things that we carry that, you know, like when's everyone's birthday and all the stuff we think about. So we have that as an additional load that keeps us from being able to relax. And we need time to get to arousal. So our libido is just really tied to the health of our body. Our desire is another thing that gets impacted because we might be pissed off at our partner.

13:07We might not have a partner. We might not have frequent pleasuring. What else happens is that we sometimes feel like we're fat, we're ugly, we're old, we're wrinkled, our boobs aren't pretty, our butt's too big. All of this kind of, again, patriarchally oriented criticism where we're supposed to look like a 20 year old when we're 50 and we're not. We're supposed to look like a 50 year old when we're 50. And so there's all this pressure on us that seeps into our self love and desire. So it's hard to have desire if you don't feel sexy. Then you add to that the arousal. And for most of us women, most women in every, you know, humanity, our bodies are an operating system and they generally work the same given the inputs.

14:02but they're on a bell curve where some people get aroused more quickly, some people less quickly, but the average woman takes 10, 15, 20, 25, 30 minutes to achieve the same erectile function as their male body partner does in a minute or two. And so what's happened by the time we've gotten into midlife is that we've spent our whole sex life being penetrated before we were ready. Our partners have driven us toward intercourse and we don't have many skills. We don't like to have our breasts touched because we don't think they're pretty. We don't want you to go down on us because we don't think our vulvas are beautiful.

14:49We don't really have an orgasm from intercourse, or maybe we try really hard to have one. It's not an easy thing. Like why would a woman want to keep going when all these things are stacked against us? I really think the hormone piece is a very, very small part of a very big multivariate issue. And what I like to do is I like to help women use hormone therapy, hormone replacement, top up your hormones, keep yourself feeling young, protect, it's neuroprotective, bone protective, heart protective, skin protective, vagina protective, you know, itchy ear protective. I mean, the list of the things that estrogen gives us are so good.

15:41And then of course, progesterone helps us a lot. It's not just an estrogen modulator. It's a calming agent. And when we are carrying such a big load and living in such a stressful world, you can't even begin to climb the arousal ladder when you're stressed out. They're counterintuitive. Add to that the fact that if you're not having frequent, pleasurable intimacy, and it's not orgasmic and wildly orgasmic, which by the way, are all learned skills, then you're stressed out, which makes it even harder to get turned on. So there's just so many factors. But I think hormone replacement is good. Fixing your gut so you can generate oxytocin, dopamine, serotonin, the things that are beneficial for sex.

16:37learning how to have good sex one of the things that i teach is orgasmic intercourse i like to teach people what the vagina wants not just what the penis wants which is all we see in porn and movies and television and i'll tell you a lot of erotica is very male oriented as well we think we're reading the things that women want, but that's because we women have lived in a cultural miasma that centers male pleasure. So the deck is stacked against us, but we can dismantle it. We can tear down the house of cards that we're currently living in to rekindle our desire to love ourselves and to keep our systems working optimally as we age so that sex can become better and better over time.

17:36Because I'll end with this, and that is that sexual maturation is a part of your personal development and your personal maturation. Old people are better in bed than young people. We know more. We've had more experiences. We have more body consciousness. We're just better lovers. And if we believe that we're just as beautiful, just as sexy and just as orgasmic and we live into that mindset, we can have great sex till the day we die. We don't age out of pleasure. We need pleasure.

18:15Dr Sophie Shotter:So powerful. on the podcast that fee just mentioned on the episode that she was talking about i also said there's an argument that we've over indexed on the psychological factors to do with female low libido and dismissed the idea that there could be more biological reasons that women are struggling so you touched on hormones here and i'm thinking many perimenopausal and menopausal women on testosterone have reported the incredible things it's done for their libido i do want to get on to another menopausal issue that's rarely spoken about though and that's clitoral atrophy. But first, can we stay on female low libido and discuss supplements?

18:54Dr Sophie Shotter:I know that there's a few that have some small-scale studies behind them. So from what I gather, this is things like L-arginine, maca. We've heard interesting things about cordyceps mushroom and I believe that like me, you're interested in nitric oxide and we had Dr. Nathan Bryan on the show almost two years ago now and learned a lot from him on that front. What do you feel about supplements for both men and women? I am the CEO of Asexual Vitality Supplement Company. And the two products that I think are the most fundamental are a nitric oxide booster because of the loss of nitric oxide and the loss of nitrogen in our soils, especially in the US with agribusiness.

19:36You have a few more small scale farms here, which is good. But I think you probably get a lot of vegetables imported from various places as well. And so taking a nitric oxide booster, and I like food-derived supplementation and aphrodisiacs from natural botanicals wherever possible, instead of things that are synthesized in a lab. So the nitric oxide booster that I created is from citrulline rather than arginine. Arginine and citrulline are two precursors to nitric oxide production. But by midlife, the citrulline system is a little more powerful and works better than the arginine. As well, for any people who have any kind of HSV, herpes, viruses, for some, arginine can exacerbate herpetic outbreaks.

20:31And so citrulline is a very safe strategy. Citrulline actually comes from citrullus mulgarus, which is the watermelon. And watermelon rind has a high citrulline count. And so I make our flow nitric oxide booster out of watermelon rind, organic watermelon rind, organic spinach powder, organic bitter cherry, which has vitamin C, which helps with the integration and absorption of the citrulline. and the spinach, which is nitrates, and also some pine bark tannins. They help with the blood flow. So I'll drop this link. It's get flow free. If your listeners would like to have a free bottle, I'll send it to them.

21:21So I'm not on here selling it. I'll just give it to you. It's something that I do on podcasts. And then the second thing that I think is very important is to get, make sure that you're getting all of your vitamins and minerals. You've got to have your folate, not folic acid, with your good B12, so your methylfolates and your B12s, your B vitamins. But you also need minerals like boron, for example. Many of us have plenty of bound hormones, but what we need is free circulating hormones. And so it's very important to have tests, blood tests that allow you to see what your free and bound hormone circulation are.

22:06And so a vibrant and mineral complex is really just like a ground zero. And I would throw omega fatty acids in there too. That would be my minimal triumvirate for the middle-aged woman. And then I would, you know, take more than that, which I do. I take handfuls of things and I'm constantly, constantly working on different things. You know, I do sprints with my health. sometimes I'll be working on one aspect of my health and then another aspect of my health. I like to do things where I'm trying to, you know, really clean things up in various areas of my life as I age. I'm 64 now. And what I've done with my vitamin mineral complex, which is called the desire multivitamin, multimineral complex, is put in an aphrodisiac.

22:53There are five I have studied aphrodisiacs, and I like cordyceps. I think it's a fantastic one. It's a really good product. But the five that I have looked at, because humans have been taking, eating roots and flowers and berries and barks, you know, since we came onto this earth, because we like to feel horny and turned on and lusty. That's one of the things that's good about getting your sex life restarted. And it's never too late. It's not use it or lose it. You can always get it back. And we're going to talk about clitoral atrophy next. And I think that's another, don't worry if you've lost it, we can get it back and I'll tell you what to do.

23:40But the five, the five libido botanicals that have been both used traditionally in indigenous wisdom, but also have had decent clinical human studies, are maca, that's a Peruvian root vegetable, cacao, which is an equatorial plant, cocoa, cocoa butter, cacao, you know. Cacao is great for blood flow. Curbulous terrestris, which is really your European Mediterranean phalanine. It's a little flower. And Tongkat Ali, which is an Asian root, which is very good for stamina, very similar to maca. They're both roots that are very good for, you know, just like energy for sex. And then the last one is fenugreek, which is the Indian one, the Ayurvedic seed of a plant.

24:36And that's used for everything from helping you make more breast milk to improving your hormone panels, etc. But the interesting thing about botanicals is that, have you heard the term herb cycling? I haven't. No, me neither. It's an interesting thing. When you take an herbal remedy, it takes about 10-ish days, 8 to 14 days to build up in your system. You don't see immediate response with many herbal remedies. They take consistency. And the herbal remedies, after about a month of being on something, the benefits tend to wane. And so I like to herb cycle these types of things. And so what I did was I put together in my desire multivitamin, multimineral complex, I put all your vitamins and all your minerals in there.

25:37And then I put in one of the libido botanicals. You take that for 90 days. Then you take the next bottle. It has the other one. You take the third bottle and that has the next one. And then you can start over. and that keeps it kind of peak efficiency in your body. And then I recommend, maca takes a lot. You have to take a lot of it. So I didn't put it in the capsules because I don't want people to have to take five capsules to take their vitamins. But cacao, you just eat your dark chocolate. All you need to do is eat your dark chocolate. Nobody's complaining about that. So that's where I ended up with, you know, kind of what botanicals work well.

26:17Lots of people like different things, pine pollen, like you said, cordyceps and some of the other things. So you want your nitric oxide precursors to generate the blood flow and you want your aphrodisiacal libido-y type botanicals for more of that kind of lusty desire and all of your hormone production and blood flow.

26:40Dr Sophie Shotter:thank you so much as well for the link of the free sample you mentioned we're going to put that on the show notes that's very uh very generous and yes if he does want to talk to you about um clitoral atrophy and i'm interested too because i've been on a menopause forum and so many women are talking about that so we'll get to that first of all just one more staying on female desire we heard you describe on stephen's podcast the many different types of female orgasm we just wondered, can you possibly run through these and how a woman might get to these, either with a partner or alone? This is a bit of a mystical thing to me personally.

27:17Dr Sophie Shotter:We'd especially love you to describe as well the expanded orgasm, I think you call it. And I loved how Stephen's show, you almost related this to like a spiritual experience. It was astonishing, really. Oh, good. Great. Yes, of course. So we have, remember how I was just talking a few minutes ago about our human operating system and how our bodies basically work the same? So we all have an incredible orgasmic capacity. We all have the ability to be very massively multi-orgasmic. Orgasms are a learned skill and everyone can learn how to have all of them. And it's very much like following a recipe in a cookbook where if I tell you what the steps are, the first time you have, you make a recipe, you're like, okay, it was okay.

28:19I mean, you know pretty good I can see where it could be I could make it better next time I'm gonna make it again and I could make it better and the second time you make it it's oh yeah now I got exactly how to brown it and blend those I'm gonna cut that a little smaller and you know leave it in 10 more minutes or what have you by the third time you make it your family's begging you to put it in weekly rotation because it's you've perfected it it's so good and it gets better over time as you just become a better cook as you age. If you practice cooking, it's anything, playing an instrument, being a writer, learning how to dance, everything in our lives is mastery.

28:59This is why you get to be a better lover as you age. You have more experience and time to do it. So your orgasms, and I really started learning how to orgasm in my 40s. Because I wasn't orgasming from intercourse, I was determined to learn how to do it. And once I learned how to do it, I realized, oh, it's just, you just got to know what to do and then you can do it. So when women say to me, I'm not, you know, I'm not able to have orgasms from intercourse. I say, you are, you just need to figure out what it is that you're not, you didn't understand, or you're not trying, or you know, you got a little missing piece of information or something's not right.

29:41And you'll be able to orgasm in any way that you want to. So that being said, it's a reframe on your mindset, which is, oh, okay, I just haven't done it yet. It's not that I can't do it. It's I haven't gotten there yet. Okay, great. Now, what are these 20 kinds of orgasms? Well, 20 is a rough number because there are lots and lots of paths to orgasmic pleasure. And the 20th one is wild card because I'm always finding more ways to have orgasms. But there are three basic categories and then I'll go into what they are. The three basic categories of orgasm are locations to touch in your body. Orogenous zones, if you will.

30:29So of course we know about the tip of the clitoris with the 10 ,000 nerve endings, which by the way, we used to say eight, but that was from a pig study. No one had studied female genital structures. And they had dissected a pig and then they thought we were the same. It's actually more like 10 ,000, and we got that from the nerve-sparing surgeries, reconstructive genital surgeries of our surgeons in modern-day medicine. So we have the tip of the clitoris, but the tip of it, if you think about it, it's easier to think about a clitoris when you imagine a penis, because we've all seen that. It sticks out and it's quite big.

31:08There's the glands, which is the little helmet at the top with the foreskin over it or not. And then the shaft. we have that tip and we have that shaft and then we have little arms and little legs you may have seen something that kind of looks like a little starfish or something on the internet a little you know a little little funny little three-dimensional design and that's the clitoral structure but we also have two more structures in our genitals we have the periurethral structure which people call a G-spot, but it's not a spot. It's a long tube of erectile tissue. And then we have on the floor of the vagina, between the vagina and the rectum, the perineal sponge.