Sexual Anxiety (with Dr Lauren Fogel Mersy) | Ep. 330

You guys, I am literally giggling with excitement over what we are about to do together. Last year, we did a series, the first series on Your Anxiety Toolkit where we talked about mental compulsions. It was a six-part series. We had some of the best therapists and best doctors in the world talking about mental compulsions. It was such a hit. So many people got so much benefit out of it. I loved it so much, and I thought that was fun, let's get back to regular programming. But for the entire of last year after that series, it kept bugging me that I needed to do a series on sexual health and anxiety. It seems like we're not talking about it enough. It seems like everyone has questions, even people on social media. The algorithm actually works against those who are trying to educate people around sex and sexual side effects and arousal and how anxiety impacts it. And so here I am. No one can stop us. Let's do it. This is going to be a six-part sexual health and anxiety series, and today we have a return guest, the amazing Lauren Fogel Mersy. She is the best. She is a sex therapist. She talks all about amazing stuff around sexual desire, sexual arousal, sexual anxiety. She's going to share with you, she has a book coming out, but she is going to kick this series off talking about sexual anxiety, or we actually also compare and contrast sexual performance anxiety because that tends to better explain what some of the people's symptoms are. Once we go through this episode, we're then going to meet me next week where I'm going to go back over. I've done an episode on it before, but we're going to go back over understanding arousal and anxiety. And then we're going to have some amazing doctors talking about medications and sexual side effects. We have an episode on sexual intrusive thoughts. We have an episode on premenstrual anxiety. We also have an episode on menopause and anxiety. My hope is that we can drop down into the topics that aren't being covered enough so that you feel like you've got one series, a place to go that will help you with the many ways in which anxiety can impact us when it comes to our sexual health, our sexual arousal, our sexual intimacy. I am so, so, so excited. Let's get straight to it. This is Episode 1 of the Sexual Health and Anxiety Series with Dr. Lauren Fogel Mersy. Lauren is a licensed psychologist. She's a certified sex therapist, she's an author, and she is going to share with us and we're going to talk in-depth about sexual anxiety. I hope you enjoy the show. I hope you enjoy all of the episodes in this series. I cannot wait to listen to these amazing speakers—Lauren, being the first one. Thank you, Lauren. What Is Sexual Anxiety Or Sexual Performance Anxiety? Are They The Same Thing? Kimberley: Welcome. I am so happy to have you back, Dr. Lauren Fogel Mersy . Welcome. Dr. Lauren: Thank you so much for having me back. I'm glad to be here. Kimberley: I really wanted to deep dive with you. We've already done an episode together. I'm such a joy to have you on. For those of you who want to go back, it's Episode 140 and we really talked there about how anxiety impacts sex. I think that that is really the big conversation. Today, I wanted to deep dive a little deeper into talking specifically about sexual anxiety , or as I did a little bit of research, what some people call sexual performance anxiety. My first question for you is, what is sexual anxiety or what is sexual performance anxiety? Are they the same thing or are they a little different? Dr. Lauren: I think people will use those words interchangeably. It's funny, as you say that, I think that performance anxiety, that word 'performance' in particular, I hear that more among men than I do among women. I think that that might be attributed to so many people's definition of sex is penetration. In order for penetration to be possible, if there's a partner who has a penis involved that that requires an erection. I often hear that word 'performance' attributed to essentially erection anxiety or something to do with, will the erection stay? Will it last? Basically, will penetration be possible and work out? I think I often hear it attributed to that. And then sexual anxiety is a maybe broader term for a whole host of things, I would say, beyond just erection anxiety, which can involve anxiety about being penetrated. It could be anxiety about certain sexual acts like oral sex giving, receiving. It could be about whether your body will respond in the way that you want and hope it to. I think that word, sexual anxiety, that phrasing can encompass a lot of different things. WHAT ARE SOME SEXUAL ANXIETY SYMPTOMS? Kimberley: Yeah. I always think of it as, for me, when I talk with my patients about the anticipatory anxiety of sex as well. Like you said, what's going to happen? Will I orgasm? Will I not? Will they like my body? Will they not? I think that it can be so broad. I love how you define that, how they can be different. That performance piece I think is really important. You spoke to it just a little, but I'd like to go a little deeper. What are some symptoms of sexual anxiety that a man or a woman may experience? Dr. Lauren: I think this can be many different things. For some people, it's the inability to get aroused, which sifting through the many things that can contribute to that, knowing maybe that I'm getting into my head and that's what's maybe tripping me up and making it difficult to get aroused. It could be a racing heartbeat as you're starting to get close to your partner, knowing that sex may be on the table. I've had some people describe it can get as severe as getting nauseated, feeling like you might be sick because you're so worked up over the experience. Some of that maybe comes from trauma or negative experiences from the past, or some of it could be around a first experience with a partner really hoping and wanting it to go well. Sometimes we can get really nervous and those nerves can come out in our bodies, and then they can also manifest in all of the thoughts that we have in the moment, really getting distracted and not being able to focus and just be present. It can look like a lot of different things. SEXUAL AVOIDANCE Kimberley: That's so interesting to hear in terms of how it impacts and shows up. What about people who avoid sex entirely because of that? I'm guessing for me, I'm often hearing about people who are avoiding. I'm guessing for you, people are coming for the same reason. You're a sex therapist. How does that show up in your practice? Dr. Lauren: One of the things that can cause avoidance-- there's actually an avoidance cycle that people can experience either on their own or within a partnership, and that avoidance is a way of managing anxiety or managing the distress that can come with challenging sexual experiences and trying to either protect ourselves or protect our relationships from having those outcomes as a possibility. There used to be a diagnosis called sexual aversion. It was called a sexual aversion disorder. We don't have that in our language anymore. We don't use that disorder because I think it's a really protective, sensible thing that we might do at times when we get overwhelmed or when we're outside of what we call a window of tolerance. It can show up as complete avoidance of sexual activity. It could show up as recoiling from physical touch as a way to not indicate a desire for that to progress any further. It could be avoidance of dating because you don't want the inevitable conversation about sexuality or the eventuality that maybe will come up. Depending on whether you're partnered or single and how that manifests in the relationship, it can come out in different ways through the avoidance of maybe different parts of the sexual experience, everything from dampening desire to avoiding touch altogether. Kimberley: That's really interesting. They used to have it be a diagnosis and then now, did they give it a different name or did they just wipe it off of the DSM completely? What would you do diagnostically now? Dr. Lauren: It's a great question. I think it was wiped out completely. I haven't looked at a DSM in a long time. I think it was swiped out completely. Just personally as a sex therapist and the clinician I am today, I don't use many of the sexual health diagnoses from the DSM because I think that they are pathologizing to the variation in the human sexual experience. I'm not so fond of them myself. What I usually do is I would frame that as an anxiety-related concern or just more of a sexual therapy or sex counseling concern. Because I think as we have a growing understanding of our nervous system and the ways in which our system steps in to protect us when something feels overwhelming or frightening or uncertain, I think it starts to make a lot of sense as to why we might avoid something or respond in the ways that we do. Once we have some understanding of maybe there's some good sense behind this move that you're making, whether that's to avoid or protect or to hesitate or to get in your head, then we can have some power over adjusting how we're experiencing the event once we understand that there's usually a good reason why something's there. Kimberley: That is so beautiful. I love that you frame it that way. It's actually a good lesson for me because I am always in the mindset of like, we've got to get rid of avoidance. That's the anxiety work that I do. I think that you bring up a beautiful point that I hadn't even considered, which is, we always look at avoidance as something we have to fix as soon as possible. I think what you're saying is you don't conceptualize it that way at all and we can talk more about what you could do to help if someone is having avoidance and they want to fix that. But what I think you're saying is we're not here to pathologize that as a problem here. Dr. Lauren: Yeah. I see it, I'm trained less in the specifics. I think that makes a lot of sense when you're working with specific anxiety disorders and OCD and the like. I've, as of late, been training in more and more emotionally focused therapy. I'm coming at it from an attachment perspective, and I'm coming at it from somewhat of a systemic perspective and saying, what is the avoidance doing? What is it trying to tell us? There's usually some good reason somewhere along the way that we got where we are. Can I validate that that makes sense? That when something is scary or uncertain or you were never given good information or you really want something to go well and you're not sure about it, and it means a lot to you, there's all kinds of good reasons why that might hit as overwhelming. When we're talking about performance anxiety or sexual anxiety, really the number one strategy I'm looking for is, how can we work with what we call your window of tolerance? If your current comfort zone encompasses a certain amount of things, whatever that might be, certain sexual acts with maybe a certain person, maybe by yourself, I want to help you break down where you want to get to and break that into the smallest, manageable, tolerable steps so that what we're doing is we've got one foot in your current window of what you can tolerate and maybe just a toe at a time out, and breaking that up into manageable pieces so that we don't keep overwhelming your system. That is essentially what my job is with a lot of folks, is helping them take those steps and often what our nervous system needs to register, that it's okay, that it's safe, that we can move towards our goals. Cognitively, we think it's too slow or it's too small. It's not. We have to really break that down. If there's something about the sexual experience that you're avoiding, that is overwhelming, that you're afraid of, what I do is validate that, makes sense that that maybe is just too much and too big all at once. And then let's figure out a way to work ourselves up to that goal over time. Usually, slower is faster. WHY DO PEOPLE HAVE SEXUAL ANXIETY? Kimberley: I love that. I really do. Why do people have sexual anxiety? Is that even an important question? Do you explore that with your patients? I think a lot of people, when I see them in my office or online, we know there's a concern that they want to fix, but they're really quite distressed by the feeling that something is wrong with them and they want to figure out what's wrong with them. Do you have some feedback on why people have sexual anxiety? Dr. Lauren: I do. I think it can stem from a number of experiences or lack thereof in our lives. There are some trends and themes that come up again and again that I've seen over the years in sex therapy. Even though we're taping here in the US, we're in a culture that has a lot of sexuality embedded within the media, there is still a lot of taboo and a lot of misinformation about sex or a lack of information that people are given. I mean, we still have to fight for comprehensive sex education. Some people have gotten explicitly negative messages about sex growing up. Some people have been given very little to know information about sex growing up. Both of those environments can create anxiety about sex. We also live in a world where we're talking openly about sex with friends, parents teaching their children more than just abstinence, and going into a little bit more depth about what healthy sexuality looks like between adults. A lot of that is still not happening. What you get is a very little frame of reference for what's 'normal' and what's considered concerning versus what is par for the course with a lifetime of being a sexual person. So, a lot of people are just left in the dark, and that can create anxiety for a good portion of those folks, whether it's having misinformation or just no information about what to expect. And then the best thing that most of us have to draw on is the Hollywood version of a very brief sex scene. Kimberley: Yes. I was just thinking about that. Dr. Lauren: And it's just so wildly different than your actual reality. Kimberley: Yeah. That's exactly what I was thinking about, is the expectation is getting higher and higher, especially as we're more accessible to pornography online, for the young folks as well, just what they expect themselves to do. Dr. Lauren: That's right. We have young people being exposed to that on the internet. We've got adults viewing that. With proper porn literacy and ethical porn consumption, that can be a really healthy way to enjoy erotic content and to engage in sexuality. The troubling thing is when we're not media literate, when we don't have some of the critical thinking to really remember and retain the idea that this entertainment, this is for arousal purposes, that it's really not giving an accurate or even close depiction of what really goes on between partners. I think it's easier for us to maintain that level of awareness when we're consuming general movies and television. But there's something about that sexuality when you see it depicted in the media that so many people are still grappling with trying to mimic what they see. I think that's because there's such an absence of a frame of reference other than those media depictions. SEXUAL ANXIETY IN MALES VS SEXUAL ANXIETY IN FEMALES Kimberley: Right. So good. Is there a difference between sexual anxiety in males and sexual anxiety in females? Dr. Lauren: I think it can show up differently, certainly depending on what role you play in the sexual dynamic, what positions you're looking to or what sexual acts you're looking to explore. There's a different level or a different flavor of anxiety, managing erection anxiety, managing anxiety around premature ejaculation. They're all similar, but there's some unique pieces to each one. All of the types of anxiety that I've seen related to sex have some common threads, which is getting up into our heads and dampening the experience of pleasure not being as present in the moment, not being as embodied in the moment, because we get too focused on what will or won't happen just moments from now. While that makes so much sense, you're trying to foretell whether it's going to be a positive experience, there is a-- I hate to say like a self-fulfilling prophecy, but there's a reaction in our bodies to some of those anxious thoughts. If I get into my head and I start thinking to myself, "This may not go well. This might hurt. I might lose my arousal. I might not be able to orgasm. My partner may not think I'm good in bed," whatever those anxious thoughts are, the thoughts themselves can become a trigger for a physical reaction. That physical reaction is that it can turn on our sympathetic nervous system, and that is the part of our body that says, "Hey, something in the environment might be dangerous here, and it's time to mobilize and get ready to run." What happens in those moments once our sympathetic system is online, a lot of that blood flow goes out of our genital region, out of our chest and into our extremities, to your arms, to your legs. Your body is acting as if there was a bear right there in front of you and your heart rate goes up and all of these things. Now, some of those can also be signs of arousal. That's where it can get really tricky because panting or increased heart rate or sweating can also be arousal. It's really confusing for some people because there can be a parallel process in your physiology. Is this arousal or is this anxiety? CAN ANXIETY IMPACT AROUSAL? CAN ANXIETY IMPACT SEX DRIVE? Kimberley: It's funny that you mentioned that because as I was researching and doing a little bit of Googling about these topics, one of the questions which I don't get asked very often is, can anxiety cause arousal? Because I know last time, we talked about how anxiety can reduce arousal. Is that something that people will often report to you that having anxiety causes them to have sexual arousal, not fight and flight arousal? Dr. Lauren: Yeah. I mean, what I see more than anything is that it links to desire, and here's how that tends to work for some people because then the desire links to the arousal and it becomes a chain. For many people out in the world, they engage in sexual activity to impart self-soothe and manage stress. It becomes a strategy or an activity that you might lean on when you're feeling increased stress or distress. That could be several different emotions that include anxiety. If over my lifetime or throughout the years as I've grown, maybe I turn to masturbation, maybe I turn to partnered sex when I'm feeling anxious, stressed, or distressed, over time, that's going to create a wiring of some of that emotion, and then my go-to strategy for decreasing that emotion or working through that emotion. That pairing over time can definitely work out so that as soon as I start feeling anxious, I might quickly come to feelings of arousal or a desire to be sexual. Kimberley: Very interesting. Thank you. That was not a question I had, but it was interesting that it came up when I was researching. Very, very cool. This is like a wild card question. Again, when I was researching here, one of the things that I got went down a little rabbit hole, a Google rabbit hole, how you go down those... Dr. Lauren: That's never happened to me. WHAT IS POST-SEX ANXIETY? Kimberley: ...is, what about post-sex anxiety? A lot of what we are talking about today, what I would assume is anticipatory anxiety or during-sex anxiety. What about post-sex anxiety? What is post-sex anxiety? Dr. Lauren: I've come across more-- I don't know if it's research or articles that have been written about something called postcoital dysphoria, which is like after-sex blues. Some people get tearful, some get sad, some feel like they want to pull away from their partner and they need a little bit of space. That's certainly a thing that people report. I think either coexisting with that or sometimes in its place can be maybe feelings of anxiety that ramp up. I think that can be for a variety of things. Some of it could be, again, getting into your head and then doing a replay like, was that good? Are they satisfied? We get into this thinking that it's like a good or bad experience and which one was it. Also, there's many people who look to sex, especially when we have more anxiety, and particularly if we have a more predominantly anxious attachment where we look to sex as a way to validate the relationship, to feel comforted, to feel secure, to feel steady. There's a process that happens where it's like seeking out sex for comfort and steadiness, having sex in the moment, feeling more grounded. And then some of that anxiety may just return right on the other end once sex is over, and then you're back to maybe feeling some insecurity or unsteadiness again. When that happens, that's usually a sign that it's not just about sex. It's not just a sexual thing. It's actually more of an attachment and an insecurity element that needs and warrants may be a greater conversation. The other thing is your hormones and chemicals change throughout the experience. You get this increase of bonding maybe with a partner, oxytocin, and feel-good chemicals, and then they can sometimes drop off after an orgasm, after the experience. For some people, they might just experience that as depressed mood anxiety, or just a feeling of being unsettled. Kimberley: That's so interesting. It makes total sense about the attachment piece and the relational piece, and that rumination, that more self-criticism that people may do once they've reviewed their performance per se. That's really helpful to hear. Actually, several people have mentioned to me when I do lives on Instagram the postcoital dysphoria. Maybe you could help me with the way to word it, but is that because of a hormone shift, or is that, again, because of a psychological shift that happens after orgasm? Dr. Lauren: My understanding is that we're still learning about it, that we've noticed that it's a phenomenon. We're aware of it, we have a name for it, but I don't know that we have enough research to fully understand it just yet. Right now, if I'm not misquoting the research, I believe our understanding is more anecdotal at this point. I would say, many different things could be possible, anything from chemical changes to attachment insecurities, and there's probably things that are beyond that I'm also missing in that equation. I think it's something we're still studying. HOW TO OVERCOME SEX ANXIETY, AND HOW CAN WE COPE WITH SEX ANXIETY? Kimberley: Very interesting. Let's talk now about solutions. When should someone reach out to either a medical professional, a mental health professional? What would you advise them to do if they're experiencing sexual anxiety or performance anxiety when it comes to sex? Dr. Lauren: That makes a lot of sense. That's a great question. What I like to tell people is I want you to think of your sexual experiences like a bell curve. For those who were not very science or math-minded like myself, just a quick refresher, a bell curve basically says that the majority of your experiences in sex are going to be good, or that's what we're hoping for and aiming for. And then there's going to be a few on one tail, there's going to be some of those, not the majority, that are amazing, that are excellent, that really stand out. Yes, mind-blowing, fabulous. And then there's the other side of that curve, that pole. The other end is going to be, something didn't work out, disappointing, frustrating. There is no 100% sexual function across a lifetime with zero hiccups. That's not going to be a realistic goal or expectation for us. I always like to start off by reminding people that you're going to have some variation and experience. What we'd like is for at least a good chunk of them to be what Barry McCarthy calls good enough sex. It doesn't have to be mind-blowing every time, but we want it to be satisfying, of good quality. If you find that once or twice you can't get aroused, you don't orgasm, you're not as into it, one of the liabilities for us anxious folks, and I consider myself one of them having generalized anxiety disorder my whole life—one of the things that we can do sometimes is get catastrophic with one or two events where it doesn't go well and start to jump to the conclusion that this is a really bad thing that's happening and it's going to happen again, and it's life-altering sort of thing. One thing is just keeping this in mind that sometimes that's going to happen, and that doesn't necessarily mean that the next time you go to be sexual that it'll happen again. But if you start to notice a pattern, a trend over several encounters, then you might consider reaching out to someone like a general therapist, a sex therapist to help you figure out what's going on. Sometimes there's a medical component to some of these concerns, like a pattern of difficulty with arousal. That's not a bad idea to get that checked out by a medical provider because sometimes there could be blood flow concerns or hormone concerns. Again, I think we're looking for patterns. If there's a pattern, if it's something that's happening more than a handful of times, and certainly if it's distressing to you, that might be a reason to reach out and see a professional. Kimberley: I think you're right. I love the bell curve idea and actually, that sounds very true because often I'll have clients who have never mentioned sex to me. We're working on their anxiety disorder, and then they have one time where they were unable to become aroused or have an erection or have an orgasm. And then like you said, that catastrophic thought of like, "What happens if this happens again? What if it keeps happening?" And then as you said, they start to ruminate and then they start to avoid and they seek reassurance and all those things. And then we're in that kind of, as you said, self-fulfilling, now we're in that pattern. That rings very, very true. What about, is there any piece of this? I know I'm disclosing and maybe from my listeners, you're probably thinking it's TMI, but I remember after having children that everything was different and it did require me to go and speak to a doctor and check that out. So, my concerns were valid in that point. Would it be go to the therapist first, go to the doctor first? What would you recommend? Dr. Lauren: Yeah. I mean, you're not alone in that. The concerns are always valid, whether they're medical, whether they're psychological, wherever it's stemming from. If after once or twice you get freaked out and you want to just go get checked out, I don't want to discourage anybody from doing that either. We're more than happy to see you, even if it's happened once or twice, just to help walk you through that so you're not alone. But the patterns are what we're looking for overall. I think it depends. Here's some of the signs that I look for. If sex is painful, particularly for people with vaginas, if it's painful and it's consistently painful, that's something that I would recommend seeing a sexual medicine specialist for. There are some websites you can go to to look up a sexual medicine specialist, someone in particular who has received specialized training to treat painful sex and pelvic pain. That would be an indicator. If your body is doing a lot of bracing and tensing with sex so your pelvic floor muscles are getting really tight, your thighs are clenching up, those might be some moments where maybe you want to see a medical provider because from there, they may or may not recommend, depending on whether it's a fit for you, something called pelvic floor therapy. That's something that people can do at various stages of life for various reasons but is doing some work specifically with the body. Other things would be for folks with penises. If you're waking up consistently over time where you're having difficulty getting erections for sexual activity and you're not waking up with erections anymore, that morning wood—if that's consistent over time, that could be an indicator to go get something checked out, maybe get some blood work, talk to your primary care just to make sure that there's nothing in addition to maybe if we think anxiety is a part of it, make sure there's nothing else that could be going on as well. HOW TO COPE WITH SEX ANXIETY Kimberley: Right. I love this. This is so good. Thank you again. Let's quickly just round it out with, how may we overcome this sex anxiety, or how could we cope with sex anxiety? Dr. Lauren: It's the million-dollar question, and I've got a pretty, I'll say, simple but not easy answer. It's a very basic answer. Kimberley: The good answers are always simple but hard to apply. Dr. Lauren: Simple, it's a simple theory or idea. It's very hard in practice. One of, I'd say, the main things I do as a sex therapist is help people really diversify what sex is. The more rigid of a definition we have for sex and the more rigidly we adhere to a very particular set of things that have to happen in a particular order, in a very specific way, the more trouble we're going to have throughout our lifetime making that specific thing happen. The work is really in broadening and expanding our definition of sex and having maybe a handful of different pathways to be sexual or to be intimate with a partner so that, hey, if today I have a little bit more anxiety and I'm not so sure that I get aroused that we can do path A or B. If penetration is not possible today because of whatever reason that we can take path C. When we have more energy or less energy, more time, less time, that the more flexibility we have and expansiveness we have to being intimate and sexual, the more sexual you'll be. Kimberley: Just because I want to make sure I can get what you're saying, when you say this inflexible idea of what this narrow you're talking about, I'm assuming, I'm putting words in your mouth and maybe what you're thinking because I'm sure everybody's different, but would I be right in assuming that the general population think that sex is just intercourse and what you're saying is that it's broader in terms of oral sex and other? Is that the A, B, and C you're talking about? Dr. Lauren: Yeah. There's this standard sexual script that most people follow. It's the one that we see in Hollywood, in erotic videos. It centers mostly heterosexual vaginal penetration, so penis and vagina sex. It centers sex as culminating in orgasm mainly for the man, and then nice if it happens for the woman as well in these heterosexual scenarios. It follows a very linear progression from start to finish. It looks something like—tell me if this doesn't sound familiar—a little bit of kissing and some light touching and then some heavier touching, groping, caressing, and then maybe oral sex and then penetration as the main event, orgasm as the finish line. That would be an example of when I say path A or B or C. I'm thinking like that in particular what I just described. Let's call that path A for not that it's the gold standard, but it's the one we draw on. Let's say that's one option for having a sexual encounter. But I also want people to think about there's going to be times where that is not on the table for a variety of reasons, because if you think about it, that requires a certain energy, time. There might be certain conditions that you feel need to be present in order for that to be possible. For some people, it automatically goes to the wayside the moment something happens like, "Well, I don't feel like I have enough time," or "I'm tired," or "I'm menstruating," or whatever it is. Something comes up as a barrier and then that goes out the door. That can include things like anxiety and feeling like we have to adhere to this progression in this particular way. Let's call that path A. Path B might be, we select a couple of things from that that we like. Let's say we do a little kissing and we do oral sex and we say goodnight. Let's say path C is we take a shower together and we kiss and we soap each other's backs and we hug. That's path C. Path D is massaging each other, full body. You've got all these different pathways to being erotic or sensual or intimate or sexual. The more that you have different pathways to being intimate, the more intimate you'll be. Kimberley: That is so relieving is the word I feel. I feel a sense of relief in terms of like, you're right. I think that that is a huge answer, as you said. Actually, I think it's a good answer. I don't think that's a hard answer. I like that. For me, it feels like this wonderful relief of pressure or change of story and narrative. I love that. I know in the last episode you did, you talked a lot about mindfulness and stuff like that, which I will have in this series. People can go and listen to it as well. I'm sure that's a piece of the pie. I want to be respectful of your time. Where can people hear more about you and the work that you're doing? I know that you have an exciting book coming out, so tell us a little bit about all that. Dr. Lauren: Thank you. I do. I co-authored a book called Desire . It's an inclusive guide to managing libido differences in relationships. I co-authored that with my colleague Dr. Jennifer Vencill. That comes out August 22nd, 2023 of this year. We'll be talking in that book mainly about desire. There are some chapters or some sections in the book that do intersect with things like anxiety. There's some particular instructions and exercises that help walk people through some things that they can do with a partner or on their own to work through anxiety. We've got an anxiety hierarchy in there where whatever your goal might be, how to break that up into smaller pieces. We're really excited about that. I think that might be helpful for some people in your audience. And then in general, I am most active on Instagram. My handle is my full name. It's @drlaurenfogelmersy . I'm also on Facebook and TikTok. My website is drlaurenfogel.com . Kimberley: Thank you. Once again, so much pleasure having you on the show. Thank you for your beautiful expertise. You bring a gentle, respectful warmth to these more difficult conversations, so thank you. Dr. Lauren: Oh, I appreciate it. Thanks for having me back.