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Sex During Infertility Secrets

Interview with Dr. Naz Moali

Dr. Moali:
Well, thank you so much for inviting me. I’m very excited about this conversation. And as I shared with you, I’m so happy about this topic, because it seems like it’s been on so many people’s minds. I’m a clinical psychologist, and certified sex therapist, and also a podcaster (sexology). I used to work with trauma and was doing research and was on a different track. I experienced sexual pain in my personal life, which was devastating, and I didn’t know what to do to address it. I was going to therapists for years, and it wasn’t working out. Almost by chance, I found a sex therapist, and I went and saw her for a few sessions, and she changed my experience around sex. After that, I felt that this is what I was called to do.

Caryn:
Oh, wonderful. I love that story; that’s amazing. Often we get into what we’re doing because of something personal, myself included. The first thing that may come to some people’s minds when they hear sex therapists is Dr. Ruth Westheimer.   And, the second may be a negative connotation to sex therapy. What do you often hear that you want to debunk about sex therapy?

Dr. Moali:
Well, I think there are different levels of misconceptions. One of the first things people think is that they may be broken as a couple or as individuals by going to a sex therapist. Perhaps this relationship is not workable. But generally in therapy, but also specifically in sex therapy, the approach is teaching clients strategies and tips that they can implement. They can transform their relationships to their bodies. If you want to change your body, you can hire a personal trainer and get some excellent results quicker. The other misconception that people have is that they think they don’t quite know what sex therapy is? So they say, what are we doing? Do we have sex in front of you? NO! It’s purely talk therapy.

The way it works is that people come in and talk about their experiences with the sex therapist. The sex therapist will give them homework assignments. Things that they can do in between sessions to help them address some of the challenges that they are experiencing in their relationship. Everyone’s clothing stays on; again, it’s purely talk therapy. The third misconception that I hear is that people think if I go to a therapist to see results, I must go for years. This is not true as most people see some results within a few months. So that’s something else that people can keep in mind.

Caryn:
Oh, I love that because I, myself, didn’t even think about that question; what do you do when you go to sex therapy? Maybe some people think of whips and chains and a bed and a little 50 shades of gray kind of thing going on.

Let’s move on into the fertility space. As I mentioned, I’m a fertility coach. Going through infertility, having to do the baby dance, as we call it so many times in a row, makes sex feel like it should only be done to procreate and conceive. What advice would you have for couples out there who are going through sexual burnout?

Dr. Moali:
Absolutely. I think it can be very, very challenging because people believe they are on schedule. Like it’s an observation window that we must have as much sexual intercourse as possible. This can be very, very stressful for both partners. I’ve seen both struggling with several different challenges. And you’re right, that it can feel like a routine and not passionate. One piece of advice that I give my clients struggling to conceive is to have sex that you want to have instead of thinking about it more mechanically. So if you’re into role-playing or other things that excite you, do it.

The second piece of advice I have is over-scheduling is not necessary. In my experience, sometimes you don’t see results because of this because then it becomes a marathon, not a sprint. If you are not into it, sex can be painful, and your partner may not be able to perform. Keeping that up may leave you with some challenges long-term. So I think it’s essential to keep that in mind. And I think the other important piece is creating novelty. One of the funniest stories that I have is one of my colleagues was saying that people have leftover sex for years and years. We’re having the same kind of sexual experiences in the same position, the same type of routine. There is nothing wrong with that in the beginning.  It was working, and then it turns into this dance that’s not exciting. I invite people to think about the various ways that they can spice things up.

Caryn:
You mentioned something about not overdoing it in the sex department. This is probably a question you get asked often, and it’s not just about going through fertility, but what is normal? How many times a week is “normal” when it comes to having sex?

Dr. Moali:
I usually tell clients that whatever you and your partner feel applicable and doable for you. Some couples are satisfied having sex once a week. Some people are satisfied having sex two times or three times per week. And some couples are entirely content with once a month. I think what’s important is to think about where you and your partner are with your desire. Most couples that I work with at some point will experience a desire discrepancy. What you can do is to work on negotiating it and closing the gaps. These are the things that you can talk about and work through. It doesn’t mean that you are not compatible.

Caryn:
You mentioned that sometimes sex could be painful. I know this because I have endometriosis. There are certain positions for women out there who either have a misshapen uterus or have endometriosis or something else like that.  Are there certain positions that you feel could be more comfortable and still be complementary to conceiving?

Dr. Moali:
I think one crucial thing is to take time to engage in foreplay. What happens especially with fertility is that people want to have intercourse because it’s another item on their to-do lists. But many women’s bodies are not ready because it takes a while for a women’s body to get aroused. Having sex too soon can lead to pain if we’re not aroused enough. I tell my clients a minimum of 20 minutes of foreplay. So we have rule in sex therapy of  20/20, a minimum of 20 minutes for foreplay and 20 minutes of the core play. For four-play, what you can do is touch, caress, kiss, all those things that help your body get comfortable and in the mood. To prevent pain, it’s very, very important to make sure you are using excellent lube. A study was done at the University of Indiana, which found 97% of the participating women experienced more pleasure when they added lube. I think that’s something else that I want your listeners to think about, incorporating and investing in a good one. About positions, it’s more about working on increasing arousal to make it comfortable. I encourage people to experiment with different positions. Some people are worried about certain positions and that they might impact the chances of pregnancy. However, I was looking at studies. There was no proof to show that any position hinders a couple’s chances of pregnancy.

It’s more about the mobility of sperm and the position that you’re most comfortable with. If you are experiencing pain, you will not be willing or comfortable to have sex in the future. Overall with women on top, it’s more comfortable for many women because they can control the penetration and the clitoris is more accessible. That’s one of the things I hear from my clients that helps them to make sure that they are in tune with their bodies and they’re able to have a good experience.

Caryn:
So that means that the old wives’ tale that you have to do it in the missionary position and then hold your hips and legs up for 10 minutes to let the swimmers get to where they need to go isn’t true? I know this firsthand because I went through eight years of infertility, 15 treatments, and then at 42 with one tube, got pregnant with my last child, and I know that it was not in missionary. I think that is such useful information that there is no proof that you have to have vanilla sex to get pregnant. The one thing I want to circle back to, though, is what you said about lube. When you are trying to get pregnant, naturally, you have to use a baby-safe lube. If anybody is looking for one, it’s in my shop on my website. Let’s say a couple is just having sex, you know, for enjoyment, are there any particular brands or any specific things that we should be looking for when it comes to lube?

Dr. Moali:
I think it’s important to decide what you are using the lube for first. When having sex for pleasure, many couples like to incorporate toys or things like that. There are lubes that can be safely used with toys. I’m not affiliated with any of these brands, and I share what I hear from my clients and what I know is good. Uber Lube has high-quality lube that lasts for a long time and is organic. They have different lube types, so I encourage people to look into options and explore what feels right for them. Just make sure what you’re using is good quality and that it lasts a long time. When you are using lube, it’s essential not to put it on your partner immediately. Sometimes it can be jarring if the temperature is off. To avoid this, put it on your hand and then apply it to your partner, or your partner can apply it themselves.

Caryn:
There’s this misconception that lube is only for women who can’t get excited enough. I think you’re debunking that and saying that this will add to the pleasure, and there’s no, negative connotation. Indeed, when we’re stressed and trying to have sex for baby-making, there can be some problems. But that’s not the only time that you should be using lube. It sounds to me like you recommend with your clients that lube is a regular kind of thing that should be happening, right? Especially if we’re going for foreplay for 20 minutes, which I’m not sure how you do with children. I’m trying to rack my brain because I will sit here and listen to this with my husband later, but this is such useful information.

This month is the month of love. Valentine’s day is coming up, and couples can use this opportunity as a way to connect deeper. Do you have any games or techniques or things that you can recommend to spice it up a little bit on this night?

Dr. Moali:
I have tons of ideas because I think if you want to have exciting sex when you’re in a long-term relationship, it’s crucial to invest time, energy, and resources in it. I’m glad that you are encouraging your listeners to think about games and strategies and all of that. Two different kinds of play come to my mind. One that I invite all of my clients to do is naked happy hour. Maybe once every month, even if you’re scheduling a time, you can wear something that makes you feel sexy. You can make the context and environment sexy. And you’re coming into this naked, bringing three to five ideas of the things that you would be curious to explore. So it could be a new position, new toys, or role play. Whatever gives you some excitement. I have a list of 101 ways that people can spice up your relationship.

You feel stuck because of all the things that we’ve discussed. Come up with these lists with your partner, then exchange the lists, and each person can rank the items based on which would be a yes, a maybe, or a no. Perhaps once or twice, the other party can initiate sexual activity from those lists throughout the month. I think it’s vital to choose a five on a scale of 1-10 (zero is I don’t want to do it, and ten is I do). I say five and up because sometimes if you’re doing things that we’re not into, we’re not going to approach it with enthusiasm, and that’s just going to kill the mood.

The other recommendation I learned from one of my colleagues, it’s called Royal treatment. This can be perfect for this Valentines’ Day. You choose two different nights or days, whatever you want. On the days that it’s your Royal treatment, you’re going to be receiving. The other partner is making the food you wish to eat and wears what you want them to wear. And if you feel comfortable, they’re doing sexual favors that you both are interested in. Interestingly, many of my female clients feel more comfortable being a giver, but then the Royal treatment nights that they are the receiver, it’s tough for them to receive. On the nights that we are the receiver, that’s all we’re doing; we are receiving.

Caryn:
I love love, love, everything that you had to say. Some things came to my mind as you were speaking. When you said naked happy hour, the first thing that came to my mind is body image. I was interviewed for a podcast yesterday, and they asked about this very thing. Do I have an association between how I feel about my body and my sex life? Absolutely. Especially during a time like fertility, where if you’re taking fertility drugs, you could have black and blues all over. You could be very bloated; you could be very uncomfortable. What would you say to a client who came to you and just said, I don’t feel comfortable in my skin? What can I do to feel comfortable in my skin?

Dr. Moali:
You’re right; so many women, even outside of fertility treatments, are uncomfortable in their skin and have self-image issues. All of the medical interventions, supplements, and all of the things that we’re taking to increase our chances can also impact our bodies’ shape and feelings about our bodies? I think it’s imperative to know that sex is about how you feel versus how it looks. That’s an essential element because many, many women get their sex education from porn. So thinking about these women with these unrealistic shapes after a couple of seconds of penetration, they’re roaring; that’s not how real sex works.

Know that your body is perfect, and you are in the process of creating miracles. I think that just knowing that and having trust and belief in yourself will help. When it comes to naked happy hour, I invite people to do things that make them feel sexy. It’s not just a matter of wearing lingerie to see what kind you like, that would be only pleasing to your partner. I want you to choose things and wear things that make you comfortable in your skin. I think it’s important to remind yourself about all the things that our body does. When they’re struggling with their self-image, I invite my clients to stand in front of the mirror every day and identify three things that your body does. It could be my heart is beating, I’m able to walk, I’m able to move my hand to do the work I need to do. Every day, choose something new because our body can do a magnitude of things. It’s tremendous and essential to remind ourselves daily.

Caryn:
Oh, I love that. The other thing that comes up for me is when one partner feels uncomfortable bringing up something they would like. I’ve gotten to a point in my life where you don’t ask, you don’t get. But what advice would you have for somebody who’s sitting here saying, “I really would like it if he would do this, or I would like it if she would do this,” how do you approach your partner?

Dr. Moali:
I love that. You mentioned that you would not receive it if you don’t ask because our partners are not minded readers. I think it’s such a good thing to keep in mind. Most people grew up in a sex-negative environment, so it’s really hard to talk about these things. My invitation for everyone is if there’s something that you want more of, or there’s a new activity that you want to explore, definitely bring it up outside the bedroom. In the middle of or right before sexual activity is not a good time to talk about it. In the heat of the moment, your partner might not be in the right mindset, and you might not be able to approach it thoughtfully. I invite people to talk to their partner and say, “honey, when would be a good time for a 10 minutes conversation about something important to me.”

You choose a time that is optimal for you both. I usually say to start with a shorter duration if it’s uncomfortable. Knowing that this is only a ten or 20-minute conversation is essential. You can say something like, “honey, I’ve been reflecting on our relationship, and these are the things that I like about our sexual experiences. Is there anything that you want more of?” You’re asking your partner what they want more of in an open-ended question, and they may or may not have something they want to share. After they’re done and you’re present with them, you share what you want more off. I think it’s important to say that asking doesn’t mean there’s anything wrong with them because you want to work on the relationship.

Maybe you would like more clitoral stimulation, more oral sex, or whatever it is. Present your ideas to your partner and wait and see their reaction. Sometimes it takes a while for people to adopt the concept. Maybe at the beginning, it’s a no, but perhaps as you guys explore, it becomes a maybe, and you can talk about making the maybe a yes. These conversations are essential if you want to have fulfilling experiences throughout your life with your partner. We age, and our relationships and bodies change. What worked when you were in your 20’s may no longer work when you’re in the fifties or sixties.

Caryn:
It’s a cruel joke when a couple is in the early stages of pregnancy or just had a transfer that you’re not supposed to have sex for X amount of days. But after a transfer, there’s no reason why you can’t pick up again. Can you reassure the audience that once you are pregnant, it’s okay to have sex? Yes, your body does change down there, but certain positions might be better than others, but it’s okay to have sex.

Dr. Moali:
Absolutely. Unless it’s a complicated pregnancy, as you mentioned, or your doctor tells you not to have intercourse, you can do tons of different things. The fetus is covered in a sack to protect it. I haven’t heard of anyone creating a rupture with having sex. I don’t think that’s the case at all. I think it’s also an excellent opportunity for you to explore your sexual health and sexual potential. I hear from some of my clients that in the second trimester when they have more hormones, there’s more drive, and they can experience more intense orgasms. I have clients who have never experienced an orgasm, and the first time they encountered one was during pregnancy. There is a world of opportunity for you to explore. As we talked about before, I think the connection is sexiest, and it’s not about climaxing because you can do that on your own. It’s just about connecting with your partner and going through this beautiful experience together. So I’m glad that you’re talking about this. If the desire is there and it’s safe, I encourage it because it helps you and your partner connect.

Caryn:
I love that. What would you say to somebody unable to orgasm? Sometimes as women, I think we’re more cerebral when it comes to sex, and men are more primal, and it’s not so easy depending on what’s going on in life. Especially if you do have kids, or there’s stress of any kind in your life, sometimes for a woman, it’s hard to get there. I know from friends and myself that men take this very hard like it’s their fault. How can you constructively say to a man, and let them hear it, that it’s not their fault and that you can still enjoy sex without a climax?

Dr. Moali:
I hear that a lot from clients and even heterosexual couples that come in.  Keep in mind that orgasm is an experience you’re having. No one is giving you an orgasm; you’re experiencing an orgasm. So there’s a level of ownership to that. I think talking about it with your partner by saying that I appreciate all the effort you’re putting in, but this experience I’m having is not something that someone is giving to me. Many women are pre-orgasmic for many different reasons. It could be stress or hormones impacting our sexual drive and arousal. It’s not always about the relationships; that’s important to keep in mind. Talk to your partner honestly about what sex is about for you, why you like having sex. Reassure them of that fact, so they don’t feel defeated. I think every single woman wants an orgasm, but sometimes you are just so overwhelmed that it’s just tough to experience it. A study was done on women during Covid, and many women lost their orgasm during the early months of quarantine because of stress. So it’s not necessarily always about the relationship, but it’s crucial to invest in your body and pleasure.

Caryn:
Oh, a hundred percent. I love that. What would you have to say to somebody who’s embarrassed to have sex with the lights on? This goes back to body image, but what would you say? How do you get over that? What if one likes to have sex with the lights on and one wants to have it with lights off? What do you, do you get a dimmer? What do you suggest?

Dr. Moali:
It’s all about negotiation with your partner. I don’t want them to push themselves to do it because they are not in the mood when that happens. They’re always preoccupied with “Oh God, like look at my body” and all of that. Talk to your partner about their preference and then meet somewhere in the middle, like lighting a candle. The other piece is investing in getting connected to your body because, as I mentioned, many women are in their head during sex, and there’s a constant chatter that takes them away from the experience of their body, their relationship. I recommend engaging in mindfulness breathing exercises 10 to 15 minutes per day. That will help train their minds, refocus on the moment and what’s happening in their body.

The other thing that might be useful for your listeners is to know about the dual control model of response. I know it’s a fancy research name, but it means that it’s not about only accelerators for women to be present in sexual experiences. We all have an excitation system and inhibition system, and they are like the gas pedals of the car and the brake of the car. To be ready to have sex, there needs to be an accelerator going to accelerate.  This could be the connection you have with your partner or the scent of a candle in the room. More importantly, it is removing bricks and breaks. There could be things like worrying about your child walking in or about your self-image. It could be about feeling overwhelmed about work. One of the more powerful things that we as women can do to increase the desire is to work on problem-solving those bricks. So again, if the issue is around self-image overall, then one solution would be therapy or finding a support group.

Caryn:
That is so amazing. I tell my clients all day long to find their Twilight. When I was going through infertility, Twilight’s romance helped me even though it is a teeny-bopper romance. Today, Mommy novels can be essential. The first ones that I read were 50 Shades of Gray and This Man. There are many good graphic novels for women, but what do you think about that phenomenon? In some ways, I think it’s great, but in some ways, it has created this unrealistic ideal for what your sex life should look like. So tell me why they can be good or bad.

Dr. Moali:
I’m so glad that you recommend that to your audience. I think that’s so important. So I’ll start with the good, and then we can go to the bad. Women need to think of their sexuality or sexual desire like a garden. You must plant seeds there. Planting seeds can mean reading erotica, watching romantic movies, or buying things that feed that sexual desire in you. One of the challenges that many women have is that they haven’t planted any seeds. They’re not connected to what they liked or their erotic blueprint, so when they are in the moment, it’s hard to get really into it because you haven’t planted those ideas.

I think the other piece of it is what you described, knowing that these are fiction. If you wanted to learn how to drive and watch The Fast and The Furious, you might think you will drive just like them. That’s a movie, you’re not going to drive like that, but still, it’s an excellent movie. The same idea applies to these books. It’s just for entertainment and for ideas that excite you. But, you are responsible for knowing what works and having excellent sex education. Sometimes, women don’t know what works for them, so we have these mental images, and we get disappointed. I think it’s essential to explore your body and know what helps it feel good.

Caryn:
I have to tell you that this is probably the most fun I’ve had on an interview. Talking about a subject that is sometimes very difficult for individuals and couples to talk about and you have such a lovely way about you. I think that some people will see this interview and will not like it, but you have taken away the stigma of sex therapy. People need to hear you say that sex therapy is just as crucial for your sexual health as health therapy is for your mental health. That there’s no shame in asking for help, and there’s no shame in admitting that you need support when there is a problem. We don’t solve anything by digging our heads in the sand and saying that there isn’t a problem.

I think that when you’re with somebody for an extended period, it’s tough to keep that spark alive. You need to recognize that you need to put work into this relationship just like anything else in your life, or else it will stagnate. It’s such a meaningful relationship, and I think sex is a meaningful way to stay connected. When the children are out of the house, you still have each other, and sex is a considerable portion of that relationship. You have done such a beautiful job today that I cannot wait for my listeners to hear this and take the stigma out of it. I know that there’s going to be so many people hearing this who want to know where they can find you. So can you tell us a little bit about how people can work with you, and where they can go to follow you?

Dr. Moali:
Well, thank you so much for saying all these kind words, and kudos to you for bringing awareness to this aspect of fertility treatment; you’re right; when some people hear sex therapy, they have such an adverse reaction. Some don’t want to have anything to do with it. It’s terrific that you have your listeners back by introducing this topic and having these conversations. As mentioned, I have my podcast called sexology.. I’ve been releasing weekly episodes for the past four years. I have other psychologists, therapists, and researchers discussing the newest findings on the psychology of sex and pleasure. If people are curious about where they can learn more information, that could be a useful resource. I’m also a sex therapist located in California, and I do video sessions. So if people are interested, they can email me. My email is: DrMoali@Oasistocare.Com.

Caryn:
Awesome. And don’t you have a course coming out soon? Please share that with our listeners.

Dr. Moali:
The course teaches women how to experience orgasm because I know many women out there, even those in a relationship and their later life stages, may never have experienced an orgasm. Some used to be orgasmic and may have lost it. In this course, I teach women to connect to pleasure and what kind of touches work for them. I also talk about education, communication, and other things that can help them to improve.

Caryn:
I love it. You are a bundle of knowledge. Everybody needs to run right now, no matter what kind of relationship you have, no matter where you are, and follow  you like right now. Thank you so much; you have gained a listener in me. You are a first-class lady all the way.

How to stay in touch with Dr. Moali::
101 Way to Keep Your Relationship Hot
https://sexologypodcast.com/subscribe/

Podcast website:
http://www.sexologypodcast.com/

Book sex therapy appointments here:
https://oasis2care.com/sex-therapy-hermosa-beach-ca/

I would love to keep in touch with you.

I have a weekly email with killer topics that I just know you will love.


Caryn Rich

Caryn Rich

Is a fertility coach that helps women stuck in secondary infertility, recurrent miscarriage, and IVF failure make their next cycle the best.

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Caryn Rich Fertility Coach
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I help women stuck in secondary infertility, recurrent miscarriage, and IVF failure make their next cycle their best.

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