Before it was understood how the pandemic would stifle the desire of many cohabiting couples, and before most Canadians knew much about marriage counseling through Zoom, psychologist Lori Brotto was quietly testing innovative online therapy for struggling women. with their intimate life.
The researcher wouldn’t know how urgent these conversations would become, as couples struggled for time, space, and all semblance of sensuality locked out. Sexual activity between living partners declined in the summer of 2020, as did their desire, according to Dr. Brotto’s study of 1,019 Canadians, published in July in the International Journal of Sexual Health. Those first-wave assumptions about quarantined couples having more sex did not come true, said Dr Brotto, whose private practice saw an increase in appeals during the global crisis.
“This is the person who is exhausted and stressed by the daily grind. We have seen a lot of it through COVID, especially women, who, in addition to their full-time jobs, were now involved in full-time raising children, teaching and caring for the elderly ” said Dr. Brotto, Professor of Obstetrics and Gynecology at the University of British Columbia, Canada Research Chair in Women’s Sexual Health. “There is also the effect of too much time with a partner. It is a major deterrent for sexual desire, not to have distance between you and your partner, not to have the feeling of missing them. “
Dr Brotto and his team are now working to expand and market his online therapy model for women struggling with low desire, arousal and orgasm. The goal is to reduce wait times for in-person therapy and to reach women in non-urban areas, where sex therapy expertise is not easily found.
“The program bridges the access gap for women living in rural and remote areas, or for those who simply do not speak to a health care provider about their sexual concerns,” which represents the majority of women. , according to Dr. Brotto, director of the UBC Sexual Health Lab.
The therapy, called eSense, is a predefined online experience that participants go through on their own; there is no live interaction with therapists or other patients. Videos with mental health care providers are woven everywhere; educational information on anatomy, physiology, sexual response cycle and the prevalence of sexual concerns, as well as discussions on consent and communication. Sessions are open to anglophone cisgender women, transgender women, and non-binary people. Dr. Brotto developed eSense with Kyle Stephenson, associate professor of psychology at Xavier University in Cincinnati.
The researchers conducted around 200 women aged 19 to 65 in three feasibility studies to assess the program’s attractiveness. Here, participants reported that their sexual arousal and satisfaction improved dramatically, while sexual distress decreased after completing the eight in-depth modules of the program.
Participants enjoyed doing the therapy in their spare time, in short bursts or longer stretches, depending on their days; most took 11 weeks to complete the program. Some women said the privacy of the online sessions helped ease their reluctance to disclose these deeply personal issues to a therapist, according to Natasha Zippan, a research assistant at UBC Sexual Health Research who coordinated the feasibility studies. “A few women mentioned how difficult it was to raise their sexual issues with their primary care provider – usually a general practitioner – who was often dismissive and did not give them the care they needed,” Ms. Zippan said.
Sessions are currently free for women, regardless of where they live, as part of grant-funded research. Dr Brotto has received grants from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research, a funding agency in British Columbia. Dr. Brotto’s team is now commercializing eSense in British Columbia, working with established hospital-based sexual medicine programs and community sex therapy centers to make online sessions accessible to patients on patient lists. ‘waiting. Researchers want to know if their online program can replace or reduce the need for in-person therapy sessions. The objective is to develop internationally, possibly via a subscription or single payment model.
“Since people wait a year before they can see a sexual health professional, can this meet their needs? Said Dr Brotto. “People wait so long to see a qualified professional. These symptoms get worse over time, and none of these issues stay in a bubble. They affect so many other aspects of people’s lives.
Emma, 59, completed virtual therapy last summer in Sechelt, British Columbia. The Globe and Mail does not use its full name to protect its privacy. After menopause, Emma felt her desire vanish. She was troubled by the uneven libido levels between her and her 36-year-old husband.
“We are very open and we know each other very well but it is a delicate subject. There are a lot of years of overlapping prejudices, ”Emma said. “There was a lot of shame surrounding my situation and not being able to be as active as I would like. “
She said the therapy – which encourages the women’s partners to read the modules and add their perspectives – has helped her and her husband to speak up openly about sex again.
“A study like this can give you the opportunity to see things differently,” said Emma, administrator of arts and culture. “It revealed a willingness from both of us to try new things, to make things work.”
The pandemic blocked their progress: Emma’s working hours intensified and the couple found themselves locked up with their two sons, 19 and 21. Their efforts “are waiting behind the scenes to be relaunched,” Emma said.
Still, she thinks virtual therapy is a gift for women like her, living in smaller communities. “In small towns, everyone knows you,” Emma said. “The likelihood of a person specializing in sexual health is very low.”
Some sessions feature cognitive behavioral therapy, which helps women identify triggers, challenge thought patterns, and overcome self-blame. Others involve mindfulness exercises that Dr. Brotto recorded in a recording studio. Mindfulness work is intended to help women stop disconnecting, multitasking mentally, and judging themselves during sex, focusing instead on physical sensation.
Dotted with case studies featuring three women, drawn from Dr. Brotto’s 19 years seeing patients with sexual problems. “These are three very different cases but in some ways very standard cases,” said the psychologist. “Users can see what difficulties someone else might be facing and how they are overcoming them. “
One is a young lesbian whose loss of desire and arousal began after her treatment for cervical cancer. Another is a woman who has been sexually assaulted, is ashamed of sexuality, and lacks information about sexual health. The third is a middle aged nurse who watches overwork, lack of desire and a long history of depression.
“She’s exhausted. It’s probably the most common phenotype I see in my office, ”said Dr. Brotto.
Kirsten, a 32-year-old nurse in Vancouver, completed therapy in the fall of 2019 for a research study. She found that her desire had changed in her romantic relationship almost a decade ago, after the trauma of a sexual assault years ago.
“When I was sexually assaulted I lost a lot of my own power in my voice to be able to know what I needed or wanted in terms of sexual desire and arousal,” Kirsten said.
In-person therapy was not feasible with her demanding work schedule as a nurse. The independence of the virtual sessions appealed to her, as did the nuance of each module: “My family doctor would not have the expertise to be able to deal with this kind of thing,” she says.
The therapy has helped her and her longtime partner “be vulnerable in ways we weren’t previously,” said Kirsten, who would like to see a similar intervention developed for men.
The nurse said that eight weeks of therapy normalized her situation: “It reflects the real experiences of different women – that there is no ‘normal’ or ‘good’ way to be.”
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