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All right, let’s get on with this interview. It’s kind of a long one, but it is so important, and I am so happy to share it with you, and please reach out to me if you need any help.

Amanda Louder: All right, my friends, I have my good friend, Dr. Cami Hurst, back on the podcast. You may recognize her from episode 160 where she and I talked about sex and menopause, but she has recently completed her doctoral research and we’re going to talk all about that today. So welcome, Cami. 

Cami: Thank you. I really appreciate it. Anyone who wants to kind of be a nerd with me and talk about research, I’m excited to do it. 

Amanda: Well research about sex, I am definitely on board.

Cami: You’re down. Nice. 

Amanda: Okay, so why don’t you just kind of give us a background on who you are for those who don’t know you. 

Cami: Sure, sure. My name’s Cami Hurst. I’m in Meridian, Idaho where I have a private practice. I have my master’s degree in Marriage and Family Therapy. I’m a licensed therapist here. I am an ASEC certified sex therapist, and I just finished my PhD in Clinical Sexology. 

I have a little podcast called Sex Therapy 101. I didn’t touch it this year because I was doing research, but it’s coming back I promise.

Amanda: Yes. I can’t wait for it to come back because I love it. 

Cami: It is next month, I promise. And so I spent the last year in this deep dive researching and writing my dissertation before graduation. So I’m honored people are interested. 

Amanda: Yes. Oh, I’m very interested. And you had sent out a request for participants for your research and I sent out that email to my email list.

Cami: Thank you so much. 

Amanda: If people have been on my email list for a good little while, then they probably got that email and maybe some of you even participated in it. 

Cami: I’m sure they did. I had 1300 women participate and they all just came from friends like you that I have who were willing to share with their audience. And so I’m sure some of your listeners did. I’m sure, and I’m grateful for their participation.

Amanda: Yeah. I mean, this was a huge study, right? 

Cami:  That’s unusual to have a group as large as I did. And it was because of people like you and listeners who care. And so it was fantastic. It was a large sample. Yes. 

Amanda: Yeah. So you were sampling women over the age of 30, right? Who don’t have a history of sexual assault, abuse, or violence. And the main focus was women who are consenting to unwanted sex. 

Cami: Yes. Yeah, we wanted to know what those outcomes were for people. Some people have a hard time with that language because they’re like, if it’s unwanted then it was non-consensual but we can’t hold people accountable for information that’s withheld. So this is mainly people who are consenting externally to sex, but inwardly really wish they were able to go to sleep or do something else. So you aren’t really enthusiastic about it. 

Amanda: Yeah. Yeah. So I say that when I read through this research and I’ve listened to some other, you know, interviews that you’ve done on it, I would say many, many of my clients fall into this category.

Cami: Yeah. Yeah

Amanda: Which is why I was so interested in talking to you about it, because I think this is going to be really helpful for a lot of my audience. And I get, you know, a lot of these women. But I also get a lot of their husbands. And so I kind of just want to start out by saying, you know, when we’re talking about this, we are not saying these men are horrible people, we’re not blaming the men. Right? But this is something that just kind of happens systemically and from a lot of the conditioning that we’ve been.

Cami:  Yeah. It is really rooted in false beliefs about sex and our roles and responsibilities as wives. Um, and when we talk about this as a possible trauma response, it’s trauma without a perpetrator, meaning there was harm done, but it wasn’t ill willed. You know, and the research also talks about coercion. We made sure that none of our participants had experiences with physical coercion, you know, forced, you know, violence, assault, or sexual abuse in their childhood. But we also measured how much verbal and emotional coercion there is, meaning, you know, which is repeatedly asking-anything after a “no” is coercion.

Amanda: Oh, I like hearing that. 

Cami: And so really, that’s the first principle of sexual health is how well do we practice consent together. And so we made sure in our research to measure these outcomes for those who have some verbal coercion in the relationship and those who didn’t have any verbal coercion in the relationship. And of course it was found that those who had some verbal coercion, this was more damaging, but it was still damaging if you didn’t. 

Amanda: Yeah. And I think maybe we should just address too. I know that there, when I saw you post about it in some different groups, that there was a lot of pushback on not allowing women who had experienced violence or sexual assault or abuse in this study. Can you talk a little bit about that? 

Cami: Yeah, that’s because we have a dozen studies about those outcomes. We know that’s not good. We know what happens. Current research people are doing are, they’re looking for what’s unanswered, and so we have the answers to what happens when someone experiences sexual assault, sexual abuse, we have all those answers, but we didn’t have the answers to this question, so it wasn’t an erasure of that experience. It was looking in a different corner of the room.

Amanda: Yeah, I totally see that. I just wanted to make sure that we called that out because I, 

Cami: Yeah, we’re not trying to sign important to erase victims. We have full sympathy and we’ve got treatment models. We’ve got so much research around that. This is just something that was unanswered and that’s the point of a dissertation. Find a question that hasn’t been answered and figure it out. 

Amanda: So yes, so, okay. So let’s talk a little bit more about coercion. You said anything beyond a basic no is coercion.

Cami: Anything that comes after a no. Anything comes after a no. Attempts to change the no. So the most common forms of coercion in this population from our research was someone repeatedly asking or trying to talk them into it by repeatedly asking, that’s verbal coercion. And I mean, coercion exists in our relationships, but it’s not helpful. You know, we may ask repeatedly for our children to clean their room, and we’re trying to coerce them, right? And so, but when we’re trying to coerce someone to do something with their body, there’s different levels of impact than just trying to get someone to clean their room. So, you know, the most common was trying to repeatedly talk someone into it. That’s verbal coercion. Continuing to kiss or undress you after you said no, hoping it will be seductive. That’s coercion. Unless there’s an agreement that your partner likes that.

Amanda: Yeah. 

Cami: So there should be a discussion of what’s implied consent. If I said, try and talk and touch me into it, that’s not coercion because I asked you to, or gave you permission to. Um, so that’s how we’re dividing verbal and emotional coercion is less damaging than physical force, but it is still damaging.

Amanda: Still damaging. Okay. So you had, you were measuring a lot of like emotions of what these women were feeling before, during, after in distressing situations where they’ve consented to unwanted sex. 

Cami: Yep. Yeah. 

Amanda: What were some of those emotions that you found most prevalent with women? 

Cami: So we were looking at four outcomes. One, what’s the emotional outcome? Two, what’s the psychological outcome, which that’s where we measure for PTSD. Those are all psychological outcomes, and those are, they’re how they impact what we, how we think, and that’s different than an emotional outcome. Then we looked at the sexual outcomes, and then we looked at the outcomes on the relationship. So the emotional outcomes were, and we, statistics are helpful because I’m going to say 70% of women felt upset, that means 30% of women didn’t. Right. So we’ve have to ask the women how do you feel without assuming they feel a certain way.  If you and I, Amanda, we were in a car wreck today, one of us could end up with some PTSD and one of us might not.

Amanda: Right. 

Cami: So it’s not the fact that we were in this terrible car crash. So we’re guaranteed trauma. It all depends on our own coping skills. So, I get worried about being misunderstood and saying this is a thing and it’s always damaging. We found for the majority it was damaging, but there’s some protective factors that we’re going to get to. So 70% felt upset when they consented to unwanted sex during and after, not before, but we’re really looking at that during and after. 

Amanda: Okay. 

Cami: People who weren’t glad they participated, who didn’t feel closer afterwards. 

Amanda: Yeah. So these are not the women that are, you know, have responsive desire where they’re like…

Cami: This is so different than responsive desire. I’m so glad you picked up on it. 

Amanda: They’re, you know, okay. You know, I maybe don’t feel like it. I’m not really in the mood, but I’m willing to try and then I know I’m going to get in the mood after and as we’re going. 

Cami: Yes. That was the protective factor. People who had a responsive desire were protected from this as being traumatic because they were reluctant at first, but they had a good time during and after. Okay. That was about 30% of women. Had a fine experience. This was not traumatizing, this is not damaging, but 70% of women, it was, they felt upset. They felt irritable. They felt distressed. They felt guilty. They felt ashamed. They felt nervous. 31% felt hostile. Just like seething, these are the women.

Amanda: That’s significant. Those are some significant numbers and some really, you know, difficult emotions to deal with. 

Cami: Yeah, yeah, yeah. I have pages and pages and pages of participants’ comments, you know, and one of the, you know, participant 86 said he was never coercive, but he was pouty and then he was mad at me. And so it was easier to consent than to deal with it. So she’s not having a good time. She’s trying to avoid him being mad at her. So it’s not bonding, it’s not enjoyable, it’s not pleasurable. Yeah, you know, women who say they roll over and cry after, or go cry in the shower. 

Amanda: Yeah, that’s, I mean, that’s traumatic. That’s showing it’s traumatic for them. 

Cami: Yeah. Yeah. So we needed to establish that there’s negative emotional outcomes and we did, you know? Up to 70% of women had negative emotional outcomes when they consented to unwanted sex, and it wasn’t because they knew they had a responsive desire style. You know, they continued to say, you know, I felt like I can’t, couldn’t even be in my own bedroom without feeling nervous. And I would just dread that he would start touching me with the expectation of sex or the blame and the guilt he gives me makes me angry. I feel disrespected because he puts his needs first. I feel guilt and shame, spiraling. You know, these are the quotes about how they feel about it. The emotions…

Amanda: It breaks my heart. Oh, you said, oh, let’s see. Participant 170 said It feels easier to cope with, to just have sex and know that I will have a day or a few days of peace where I don’t have to worry about his advances because we’ve already done that recently. My feelings of anxiousness have progressively gotten worse over the years, and I hear that from so many. So many women just like, Yep, It’s just easier to get it over with. And actually I lived that for many, many years myself. In my first marriage.  Because I mean, we’re, so many of us are taught that like, you know, we need to meet his needs. It’s our responsibility. There’s not, you know, when we’re in these conservative Christian religions and believe in monogamy, then there is not a legitimate source for him to go elsewhere, right? When we don’t believe in masturbation or, you know, stuff like that. lt just breaks my heart.

Cami: Yeah. So, you know, the driver for this research was exactly what you’re saying is, almost all clinicians who work with couples and sex are familiar with this idea where there’s a woman who says, I want to want to have sex, but I really, but I hate it. I think maybe I’m asexual, maybe I’m demisexual, maybe. Maybe I’m biologically something is just totally wrong with my hormones, but if you start to ask yourself, how do you feel during and after sex? This is a conditioned response, of course, you are going to have absolutely no desire. I’ve told women, if you get punched in the face every time you eat ice cream, you’re going to lose your taste for ice cream really, really fast. And so if most of the time you’re having sex, you’re feeling shame and guilt and hyper aware and avoidant and anxious, and you start to develop an aversion to sex, that’s different than being asexual. Asexual is fair. It’s about 1% of the population. So really rare. And I have way more percentage of my couple saying this than 1%. And it’s usually not acquired. So if they can say, no, I felt really pulled towards this boyfriend in high school or this other person I dated, I actually could feel arousal. If it’s an acquired aversion, we’re looking at this not an orientation issue. 

Amanda: Yeah. I can’t even tell you how many times I’ve had that conversation with women where they’re like, I think I’m asexual, or I’m demisexual and I’m. Okay. 

Cami: That’s valid. Yeah. Let’s look in all the doors and windows.

Amanda: Right? But let’s not just immediately go there. Let’s look at what else this could possibly be. And you know, I mean, even in a question like, you know, have you ever enjoyed sex? Were you looking forward to it when you were getting married? You know, like, and they’re like, oh yeah. Like I used to get turned on. I’d have an orgasm when we were just making out. You’re not, not then. 

Cami: Yeah, probably not. This is probably a conditioned response because you have been continually coerced to have bad sex. 

Amanda: Yeah. Yeah. Okay. So that’s, that was your hypothesis one, the emotional stuff, right? Yeah. Emotional outcomes, yeah. Okay and the next one was.

Cami: And then the next one was psychological outcome. So we’re looking at how this impacts us psychologically. So I used a really traditional PTSD survey for this looking, and this is so sad. 

Once we scored that, we found that 53% of our survey population was experiencing moderate to severe post-traumatic symptoms just because of this situation. So it said, when you think about consenting to unwanted sex, when you think about in all of the screening questions that came up with the majority, 53% of the population were now having moderate to severe post-traumatic symptoms, which created anxiety, sexual anxiety, sexual avoidance, and sexual aversion. So those are like the three hallmarks for this is do you experience sexual anxiety, sexual avoidance, and then sexual aversion is what ultimately develops for these women. So there’s a clear psychological impact. There’s a clear emotional impact.  

Vignettes from the participants talking about these psychological outcomes, you know, say I now feel aversion to any sexual art activity. Sometimes I do things to avoid my partner, like go to bed super late or super early to avoid being in the bed awake at the same time. 

Another woman said, I avoid vacations because it’s another tactic he uses to get more sex. I mean, so they’re really avoiding participating in life in certain ways because of this. 

Man, the numbers I really thought when I started this study, I had a hunch that this was going to be significant, but I thought it would be a severe minority. Like I thought we would have like 20% of the participants this really didn’t work for and it was severe and I knew that just by my clinical experience, but I was shocked that it was actually the majority, but I still want to be really clear. I’m not saying everyone, I’m saying this is right, like 70, 60, 50% of women. I don’t want to paint with too much of a doomsday brush, but…

Amanda: Well, and I think that’s an important thing, like, you know, we’re talking about these significant statistics because we are learning and learning through your research this, then we understand how we get to help. We get to help them in different ways and better ways because we understand what’s actually happening. So this isn’t just a doomsday episode, this is just informational with hopefully some.

Cami: It’s like, Hey, here’s a major blind spot we have as a culture and we need to really understand it and promote healthy relationships. Too often if we’re saying, oh, we have sex and we have it regularly so we’re fine. No, no, no, no. We need to be saying, how are each of you experiencing the sex that you have? Is it enjoyable? 

Amanda: Yes. Yeah. I mean, this is not about frequency. This is about what’s happening when it’s happening.

Cami:  Yeah. And so then the third question was, well, how does this impact the woman’s sexuality? We found undeniably they experience a plummet in desire. So if you are a woman who says, I think I have hypo sexual desire disorder, I have no desire, my libido has completely tanked. Yeah. We’re going to look at your hormones and yeah, we’re going to look at maybe some skills, but how many years have you been consenting to you didn’t want, okay.

Amanda: Right. Yeah. 

Cami: That is going to play an impact here. And undoubtedly these women experienced almost, you know, very little desire, low desire. They started to develop an aversion to just basic physical touch. They didn’t want any physical touch because they thought it might lead somewhere. They of course weren’t having sexual orgasm. So then it became an orgasm issue too, because you can’t orgasm during, most of us need to be in a state of pleasure to orgasm. These women are not in a state of pleasure. So it’s creating sexual dysfunctions for them.

Amanda:  But do you think that sometimes they think, oh, well, I had an orgasm, or the men think my partner had an orgasm so it was good. 

Cami: Oh yeah. That’s totally a whole nother conversation. And for sure, I’m a hundred percent on board with that. That’s a yeah. Yeah.

 Amanda: But just like, even if you do orgasm during these kind of unwanted, consenting to unwanted sex, right? Yeah. That doesn’t mean that it’s actually a good encounter.

Cami: No. So it really highly contributed to the woman experiencing sexual dysfunction, experiencing low desire, low arousal, low orgasm. So then we looked at, well, how did it affect the relationship of the two? And the areas that were affected as far as the relationship function was a real drop for 44% and a lack of physical affection. 

So then the lack of comfort and co-regulation and non-sexual affection just plummeted. And those are really vital to us as humans. The sex became really predictable. The women stopped initiating. There was a feeling of hopelessness. 38% felt sex was hopeless. 32% felt like they weren’t normal. They felt like it threatened the security of the relationship. It really painted the picture for us in these four areas. 

That consenting to unwanted sex long term, that we had enough criteria about the emotional, psychological, sexual, and relationship outcomes to say this is a form of trauma. This is a form of sexual trauma without a perpetrator. There’s not abuse, there’s not violence. Most of these women withheld their lack of consent. Like they said, no, were coerced into it, but most women.  were keeping this to themselves. They were saying, I need to be good at sex. I need to give my husband sex. I need to take care of his sexual needs. And so a lot of it was internally motivated as it was both externally and internally motivated, is one I want to say here. I think you’re going to post the slides in the show notes. 

Amanda: Yes, we are. 

Cami: But you can look at all the tables, you can look at all the correlation and all the graphs, or you can see how highly correlated these were, that they are all going together and pointing to this one situation as responsible for these negative outcomes.

Amanda: Yeah. Participant one said, I lost my strength to stand up and say no in sexual encounters with him, as well as in the larger context of life. I lost my ability to know what I really want because I’ve consented so many times to something I didn’t want, but didn’t want to say no to. Oh, that just again, breaks my heart because I see this constantly with my clients. That they don’t know what they want in life.  Because they’ve just been saying yes, because they think they’re supposed to say yes, or they feel pressured to say yes, or they’ve been conditioned to say yes for a myriad of reasons, and they’ve just lost themselves in the process.

Cami: And they might not have the relationship skills to handle what happens if I say no. What happens if my husband gets upset? You know?  Is the real, like a lack of skill to deal with us wanting different things at different times. 

Amanda: Yes. Yes. 

Cami: This participant 183, this is one that stands out as I have actually seen this play out in my office, and I don’t think this was a client, but I’ve seen it enough that I think you’ve seen it too, is this participant said Recently I told him that I am done with sex and I feel so relieved. At the same time, I feel very guilty. I feel that I can go on with our marriage by cultivating a supportive, platonic friendship, but he, of course, is extremely unhappy that I’ve said, I’m done with sex. In fact, he immediately broke out in a full body rash and had hives. Our marriage is very shaky over the sex issue.

Amanda: Yeah. I mean, sex is a big part of marriage. I mean, it’s what sets it apart from other relationships that we have. So if you’re not having good sex, enjoyable sex, right? Then, you know, it can greatly affect the relationship overall. 

Cami: Yeah. I’m a Barry McCarthy fan and his research indicates that for couples where sex goes well, it contributes to about 20% of overall relationship satisfaction. However, when sex is not going well, it’s rated as being 80% of the problem. So it’s not concordant if it’s a problem, it’s a big problem. 

Amanda: It’s a big problem. 

Cami: If it’s going well, it’s one of many things going well. 

Amanda: Right, right. Do you think that we just… I mean, I think one, a lack of sexual education,  is really prevalent in this country. But we just don’t have the skills for good relationships and how to work through conflict. We end up being codependent and so focused on, you know, regulating our spouses emotions and stuff, and we just don’t have the skills. 

Cami: Yeah, I think it’s a lack of skill development, but it’s also a lack of coping individually also.

That’s why, you know, when we get down a little further into the research, we asked, why are you consenting to the unwanted sex? And I think that really highlights why this is happening. And, in this study, like 75% said it was, they felt it was necessary to satisfy their partner’s needs.

73% said, I didn’t want to hurt my partner’s feelings. 70% said I wanted to avoid tension in the relationship. 64% said, I didn’t want them to feel rejected. 61% said, I feel guilty for not participating in the sexual activity. 

And so what this is saying to me is, consenting to unwanted sex is a bad strategy for maintaining your security in a relationship. These are attempts at not rocking the boat. These are attempts at trying to have a happy relationship, but they’re maladaptive because they have bad outcomes. And so it’s a strategy we kind of come up with, but it’s not a good strategy. 

And so then we start talking in the research about social safety really because some research Lisa Diamond has done recently about social safety is indicating that we as humans don’t enter a situation feeling safe and then get anxious when something goes wrong. We actually do the opposite. We enter a new situation asking the question, is this safe? And when we have enough experiences that it is, our nervous system calms down. So that’s what’s happening here is think, I need to do this thing that feels threatening to get my safety. And we’ll never have a well regulated nervous system if we’re trying to offer sex to get safety in our relationship. 

Amanda: When we are  doing things that are, our body is telling us not to do.

Cami: It’s a form of self betrayal. You’re trying to override.That is your inner wisdom. If your inner body is saying, I don’t want to do that right now, and you say, hush, don’t be bothersome right now, and you try to override that, then you’re going to have these traumatic responses. 

Amanda: Well, and it’s not just even hush, it’s, I have to do this. I have to do this to be safe, right?  And I can’t find it right here. But there was a participant that said like, you know, I didn’t know how I would take care of myself and so I wanted to make sure that he wouldn’t leave the relationship. 

Cami: Yeah, yeah. Many women said, I have no financial choices and sex is what keeps him in the marriage. And so that’s her strategy. It’s a losing strategy. It’s not going to work over time. 

And there’s other fears that women are trying to cope with. Many women wrote about, I don’t want him to have an affair, so if I give him sex, he won’t. 

That’s actually not true. That’s such an old useless wives tale.

Amanda: Thank you Dr. Laura. 

Cami: Right. Such a useless wive’s tale. No, no, no, no. Yeah. You know how I feel about her book. 

Amanda: Yeah. I feel the same. 

Cami: And you know, or I wanted to make sure he didn’t develop a porn problem because I have all kinds of feelings about porn. 

So if I can keep them sexually satisfied, I won’t have to deal with the choices that I think they might make. That’s a losing strategy. And you have very little power over that. 

And couples with fantastic sex lives have affairs. People with good sex look at porn like, and so it’s a myth. It’s if I can keep the man happy, I won’t have to deal with these things about sex that scare me. That could happen. It’s a false sense of control. It’s trying to give ourselves a false sense of control. 

Amanda: Yes. Well, and I mean, I think maybe you touched on this, but it’s also just not an ability to not be honest when our safety is threatened. Right? 

Cami: Yeah. That part of it feels like is a self betrayal.

Amanda: Right. I mean, if I say, no, I’m not ready to do that with you right now. And there’s consequences for that whether that be, you know, he’s going to try and be coercive. He’s going to be pouty, he’s going to be upset, he’s going to look at porn, he’s going to have an affair. He’s going to leave. When we don’t feel safe, to be honest, then we’re constantly self betraying, which then just makes things worse and worse and worse. The longer we do it, the more we self betray, the worse it gets. 

Cami: Yes, totally true. And you know, you’ve seen those consequences and I’ve seen those consequences play out. But finally we have some data to back it up because there was nothing about low desire being an outcome of consenting to unwanted sex long term. 

And we found that it really is a major player in why women in middle age have no libido. 

And so toward the end of this research in the paper, you know, I proposed this as a form of sexual trauma without a perpetrator, which there’s other things in our life that cause sexual trauma without a perpetrator. 

Withheld information about how sex works can create a traumatic sexual experience for people. There are a lot of things where there’s not a perpetrator where we develop sexual, you know, trauma responses to sexual stimuli. And so the criteria here is what we found, the women I’m talking about, these are women who experience emotional distress before, during, and after a sexual encounter. They experience sexual resentment, sexual guilt, sexual inadequacy. 

Second, these women are scoring high, moderately to high for situationally based post-traumatic symptoms such as sexual avoidance, sexual anxiety, sexual aversion and this is being seen in the relationship as low sexual frequency, sexual arguments, a decrease in female sexual desire, the presence of sexual dysfunction, and eventually for many couples, you know, a cessation of sex in the relationship which is another coping strategy. It’s better than continuing to participate in unwanted sex and so those are after all the research and after all the results and after all the analysis, we boiled it down to this form of sexual trauma, consenting to unwanted sex. Looks like this, you know, so, I mean, I’d be interested to see how many people comment on this or write into you and say I qualify for those.

Amanda: Yes, for sure. 

Cami: You know, and a low libido can come from a lot of areas, and this is now another one of them. It could be hormonal, it could be medication side effects. It could be a representation of an orientation you didn’t know about, but it could also be from consenting to unwanted sex over a long period of time.

Amanda: Yeah. Okay, so let’s offer them a little bit of hope now.

Cami: I know I’m genuinely like, usually fairly happy. And I research though… 

Amanda: Yeah. It’s like, oh, oh my gosh. Oh yeah. I know. Like, I mean, as I listened to some other podcast with you on them about this, like, I just, like, I walked away just going, it just kept getting like worse and worse and worse, you know, because it is so heartbreaking all of this.

But, there is hope because we understand this better now because of this research. There are ways to work with it to hopefully bring it back to a better place. 

Cami: Yeah. I mean, I wouldn’t be a very good practitioner if I didn’t believe in change, so I do. And as sad as this is, these women’s experiences deserve validation. It deserves sunlight. These women deserve to be seen. 

Amanda: Absolutely. 

Cami: Because they feel so abnormal compared to what they think other women are experiencing. And I do want them to hear that this is really painful and this is really private, but it doesn’t look super abnormal. You might not be alone in this. 

You’ve got, you know, 50, 60, 70% of women who took the survey having the same experience as you.  Women who aren’t having the same experience as you, who say, oh, they talk and touch me into it, and I end up having a good time there. I mean, those are women who have a responsive desire style, and I know you’ve done podcasts on those so your audience is going to totally know what we’re talking about. 

Where I would start. The second half of the paper is brainstorming. How are we going to treat this? So, what I want men, women and practitioners, those who work with them, to understand is, if this is why the female’s desire is low, you go through those criteria and it seems like, oh yeah, they’ve really had this pattern. We are not going to start with the normal desire interventions. Someone who didn’t have this on their radar would be like, okay, well let’s schedule sex. Okay, well let’s do sensate focus. Okay, well let’s jump into all these desire interventions. But that is asking the woman to continue the pattern of consenting to something she doesn’t want. And so we have to go way, way, way, way back.  First, a couple needs to establish sexual health principles.  

Amanda: And if you need to know what those are, episode 94,  Healthy Sexual Relationships.

Cami: Yes. And we need to start by talking about what are our agreements around consent? How are we going to avoid coercion?  Instead of saying, you’re a coercive, you’re a narcissist. No, no, no, no, no. They probably did not know other strategies of how to deal with this. 

Amanda: Right. And I have quite a few episodes on consent as well. (Episode 168 – Consent within Marriage, Episode 247 – Enthusiastic Consent)

Cami: So that’s first we’re going to establish how you and I as partners practice consent in our relationship and have some agreements. 

Amanda: Yes, I love it.

Cami: Because we have to rebuild trust in this relationship. And trust is only earned. And it never should, should never just be given. It is always earned and trust grows when we see our partner keeping our commitments. 

Okay, so make consensual agreements and keep them so you can both rebuild the trust. That would be first and second, you know. 

Third would be let’s come up with some desire discrepancy strategies that are not coercive. I have many that I offer my clients when I work with them. One of them is, this is how it would go, Hey honey, I’d love to connect and maybe have some physical pleasure. I mean, nobody really talks like that, but I, Cami I do. So it’s weird, but I say, Hey, what’s the goal? The goal isn’t sex. The goal is connection and pleasure. So can we plan some time for connection and pleasure. That’s the initiator. The responder, which in this case would probably be the lower desire partner, would then have the challenge of saying, let me come up with three things that I could picture being physically pleasurable and emotionally connecting. So they’d come back and say, Hmm, why don’t we take a bath together? But I don’t, that’s, I just want a bath together. 

Amanda: Yeah. Or this bath does not include you groping me. 

Cami: Right, right. And they would offer three things that sound…It could even just be, let’s take turns giving foot rubs. It could be. It could be, let’s have animalistic penetration, but she’s only going to offer that if it’s what sounds nice.

Amanda: What sounds good to her. Yep. 

Cami: So then the initiating partner’s choice is to pick from those three of what was offered and say, I really think I’d like to do that. If they’re disappointed, they can learn to deal with their disappointment. 

Amanda: Yes. That is something that I work on with my clients all the time, is you are going to say things and they are going to be disappointed, and that’s okay. It is not your job to manage their disappointment. That’s their job.

Cami: Yeah, and your partner might get aroused, and that’s okay too. An erection doesn’t always need attention. And if the erection does need attention, then we come up with some consent agreement about what do we believe about masturbation? What do we believe about the release? So that is one example of a non-coercive strategy for desire discrepancy.

Amanda: Love it.  

Cami: That looks different than I don’t want to tonight. Well, how about tomorrow night? That’s not what I’m talking about here. So the goal is mutual enjoyment. 

Step three is let’s reestablish safety, sexual safety. And what I mean by this is let’s have consequence free consent. So this person, this individual needs dozens and dozens and dozens of experiences of saying no and it being tolerated by their partner before they can learn that they can give an enthusiastic yes or an honest no and it’s going to be okay. And so we have to have this social safety and sex with each other. 

I’ll challenge the husband and say, I want her to have a hundred experiences saying no to you. With her knowing it’s safe. Unless she knows in her bones that she can safely say, no, you are not going to get an enthusiastic lover.

Amanda: Yep. Love that. 

Cami: And I can get by in usually that way of the key to what you want is tolerating this process for a while. 

Amanda: Yeah. And self soothing through it, right? Because it’s not easy, but that is a skill that we all need, is learning how to self soothe in the face of invalidation, in the face of rejection, all of that. 

Cami: Yeah. And usually when that social safety is established, then we can do things like evaluating if maybe the partner needs a little EMDR or a more severe trauma treatment. Or if the sexual safety establishment is enough to heal the resentment, that’s a clinician’s call, or the woman can probably feel it in her body is how much treatment was needed. 

Amanda: Yep. I recommend EMDR or other things of trauma therapy to my clients all the time. 

Cami: Yeah. And then, and then the next phase, once that phase feels secure, would be, now we’re going to practice desire driven consent where instead of me hoping she has a hundred experiences of saying no and it being okay, I want her to have experiences of do I want something and can I initiate it? 

So this is all her work with the support of a generous spouse. And discovering her sexual self. Just like I said, you know, if you get punched in the face when you eat ice cream, you’re not going to like ice cream. This is like a reintroduction of ice cream. What do I like? Is there a flavor I like?  And so there needs to be that sexual self-discovery and this is all going to, and then we’ll do the desire interventions, right? 

So, and then maybe we’ll talk about scheduling or then maybe we’ll talk about sensate focus. But all this other work has to happen before we just jump in that way because we’re seeing it now through a lens of safety and consent and trauma instead of just, this is a desire issue. 

Amanda: Yeah. Which was why the way that my program works is we work on relationship with self first. 

Cami: Yes. Ah, exactly. Same idea.

Amanda:  It’s like we have to work on so that we’re not self betraying anymore. We’re being honest and open, and we’re willing to let our spouse feel whatever they need to feel without feeling responsible for fixing it, right? 

Then we move into relationship with your spouse and reestablishing safety and trust and you know, being able to have conflict in a healthy way so then after we do all that and we work on the trauma, if it needs to be all that, then we can start to work on the sexual part.

Cami: Yeah. Yeah. So, you know, toward the end I created this prevention model of, okay, we’re going to deal and treat as a generation. If we were given this people-pleasing and the not being honest and taking care of sexual needs to avoid a bad outcome. We’re going to do all the work and to heal that and change up, but what are we going to give to the next generation to prevent this? And those four principles of prevention are one, sex needs to be consensual. But that’s not just it, you know. 

Two, it also needs to be wanted by both parties. There are a lot of people who consent to things they don’t want. 

So one, it needs to be consensual. Two, it needs to be wanted by both parties. 

Three, the motivation needs to not be based in fear of, I’m scared they’re going to slam the door, or I’m scared they’ll go sleep in the other room. Or, if your motivation to consent is based on what your partner might do, we’ve got a lot of work to do.

And four, it needs to be free from social safety consequences.

Amanda: Yes. I love it.

Cami: So that’s what I’d be talking to all of our children about but it is going to take all parties to create this sexual social safety. Men and women. And all kinds of partners. 

And you know, we mentioned the protective factor of responsive desire, style, and basically the outcome here of this research was consent is not enough to prevent trauma. There needs to be more factors here. 

Amanda: Oh, I love your prevention model, proposed prevention model. Because I think, I mean, if, if we all had those, that in mind and had the skills to, to do these things in a healthy way, we would not be seeing the amount of women that we see in our practices and other clinicians see in their practices with this trauma.

Cami:  Yeah, I mean, it’s a major problem that, you know, pharmaceutical companies are trying to solve, therapists are trying to solve their alternative. 

Amanda: I know everybody’s like, why isn’t their Viagra for women? I’m like, this is not a blood flow issue, people. 

Cami: It’s not a blood flow issue. No. This is a social safety issue. And a consent issue. And a desire issue. 

But, even if I pumped you full of euphoric drugs,  if that’s what it took, I’d be concerned. It was such an amazing experience to be able to put what I was seeing into a research project. It was such an amazing experience to see women show up authentically the way they did. It was such an amazing experience to score this and see that what I was suspicious of was in actual reality happening.  I’ve had so much outreach from people when they listen to these results and I do want to put out there that this, that this is a, maybe a system that failed us. This is maybe beliefs that failed us. This can come from religious influences about people-pleasing, but it can also come from cultural, Cosmo magazine type things about who we need to be for men to keep them. It’s just junk all around.

Amanda: All around. 

Cami: That isn’t helpful, that we all are unlearning in the second half of life. We learned all this junk during the first half of our life, and now we’re unlearning the stuff that isn’t helpful. And this is a major piece in why so many middle-aged women have absolutely no libido. 

Amanda: Yep. I totally see that. Well, Cami, this has been amazing. Thank you so much for sharing your research with us. Thank you for doing the research. I know that,

Cami:  Thank you for being interested in my research . 

Amanda: So I mean, this is my life, right? Just like it’s yours. This is our life and, and I love that you’ve given us the research and, and a model of what we can do to hopefully make it better for these women and future generations.

Cami: I appreciate it. Talk to your friends, talk to your sisters. Don’t be afraid to talk about this as, you know, be concerned for the people in your life and for yourself. 

And hopefully, you know, I painted enough of a picture of hope that I think this is pretty addressable. This is not like, tackle this, we’re going to tackle it. But it’s very different than tackling an systemic abuse or a violent rape, like this is harmful and we need to fix it. But sometimes people get really scared of that word trauma. And I don’t want to scare anyone, but if anybody’s experience resonated with this, then look into some of those suggestions that I proposed and see if with the professional or on your own, you can start chipping away with first, examining the consent in your relationship and then examining the enjoyability and your own motivations. See if your spouse is up for creating an agreement that we practice consensual enjoyable sex. We’re going to get coercion out of the bedroom. And those conversations can be hard, but they’re really, really necessary. 

Amanda: Absolutely. Well, thank you so much. 

Cami: Thank you so much too. Your audience is fantastic, so thanks for sharing them with me today. 

Amanda: Okay, friends, I hope you found that interview so enlightening and so helpful.  You can see the slides that we were talking about in the show notes. There’s a link to them and if you are interested in getting help with this, please come into my program. I think that Cami has outlined a great treatment model, which falls right in alignment with my Embrace You Elite Society membership. So I would love to help you work through this and help you have more successful marriages and sexual relationships. Thank you everyone, and we’ll see you next week.