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Sexuality Matters

Mindfulness Training and Applications to Female Sexuality

Lori A. Brotto, PhD; Jane S. T. Woo, MA

A practice that promotes physical concentration without the overlay of emotion and judgment would seem to be an ideal strategy for women who have lost touch with their sexual responses.

Today’s culture views multitasking as praiseworthy, and perhaps even essential. However, many activities deserve to be the sole focus of concentration, such that multitasking may be a detriment.1 Specifically, thinking about the office or the grocery list while engaging in sexual activity can lead to distractions, impairing the ability to respond sexually—as can negative emotions and expectations.

Mindfulness is the practice of focusing attention on the current moment, of fully engaging in the present with alertness and awareness. The concept of mindfulness is rooted in Eastern spiritual traditions, and is described as the means by which dispersed thoughts are recalled to wholeness so that the mind can experience every moment.2 This principle has been applied to Western health care in the setting of stress reduction programs and the treatment of psychiatric conditions such as borderline personality disorder (BPD), depression, anxiety, and substance abuse.3 These efforts have shown that mindfulness can have positive effects on many elements of physical and emotional health.

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DIALECTICAL BEHAVIOR THERAPY

Mindfulness is a core component of dialectical behavior therapy (DBT), a treatment protocol developed for patients with BPD.4 Teaching mindfulness to patients with BPD helps them focus on the present moment without judging the experience or clouding it with emotions. Because individuals with BPD often take feelings literally—ie, confusing “I feel” with “I am”—mindfulness allows them to recognize feelings as feelings, to be aware of their presence, and then let them go.

Neuroimaging data confirm neural plasticity resulting from mindfulness practice. Brain scans show that when patients can label affect (as opposed to avoiding it), prefrontal cortex activity increases and bilateral amygdalar activation decreases.5 Also, there is reduced neural activation in long-term meditators of brain regions involved with discursive thoughts, and enhanced activation of circuits related to attention.6 Mindfulness practice also promotes activity in the anterior cingulate and dorsolateral prefrontal cortices.7

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SEXUAL FOCUS

Because women with sexual difficulties often report that coitus is associated with nonsexual thoughts and concerns over performance, body image, and/or partner-related issues, mindfulness practice can help them overcome these distractions and focus on their sexual responses.8 The literature on mindfulness and sexuality is limited. One study explored the association between mindfulness and marital satisfaction, concentrating on one partner’s ability to understand the other partner’s perspective.9 Here, mindfulness was associated with significantly greater marital satisfaction. Another study conducted qualitative interviews with 10 women who were regular practitioners of mindfulness meditation for a minimum of 5 years.10 Several subjects noted that integrating mindfulness into their sexual activity allowed them to be acutely aware and present during sexual encounters. Many cited a heightened awareness of genital arousal and a better understanding of their sexuality. Subjects also said that mindfulness helped them to “let go” of sexual expectations (eg, orgasm) during sexual activity.

The authors’ present research incorporated mindfulness practice into a group psycho-educational program aimed at women with loss of desire and sexual arousal. Other elements of therapy included cognitive behavioral therapy, education, and relationship exercises. Participants were told that they have the ability to be present in a nonjudgmental way in the context of sexual activity, but that this skill requires practice to develop. The group used in-session drills and listened to guided mindfulness exercises (www.mindfulnesstapes.com/series1.html).3 Between sessions, the women were given a series of mindfulness tasks to practice daily while driving, eating, or conversing. They were instructed to recognize any tendency to judge themselves and others, and to shift from this into an observational mode of simply noticing sensations, thoughts, and feelings. They also practiced nonjudgmental mindfulness of their bodies, beginning with noting what they see, feel, and sense during neutral activities. The women were then told to stimulate a low level of sexual arousal (eg, by fantasy, erotica, vibrators) while practicing mindfulness to appreciate the difference in sensations when the body is sexually primed.

Outcome data were obtained for approximately 100 women across 2 published and 2 ongoing studies. In general, these data show improvements in self-reported sexual desire, arousal, and satisfaction, and reduced levels of sexual distress and negative mood.11 There is also a trend toward significantly improved genital arousal as measured by vaginal photoplethysmography. Women with histories of major depression and/or sexual abuse benefited most.11

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CONCLUSION

There is much promise in the use of mindfulness techniques to improve low sexual desire and/or arousal in women. It may also prove beneficial as an adjunct therapy for women with provoked vestibulodynia who experience high levels of anxiety and fear.12 For the latter, the authors are currently conducting a randomized trial of mindfulness versus a control group for women with genital pain.

Neither author reports any actual or potential conflicts of interest in relation to this article.

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Lori A. Brotto, PhD, is Assistant Professor, Department of Obstetrics and Gynaecology; and Jane S. T. Woo, MA, is a graduate student in Clinical Psychology, Department of Pyschology, both at the University of British Columbia, Vancouver, Canada.

References

1. Rubinstein JS, Meyer DE, Evans JE. Executive control of cognitive processes in task switching. J Exp Psychol Hum Percept Perform. 2001;27(4):763–797.
2. Hanh TN. The Miracle of Mindfulness. Boston, MA: Beacon Press; 1976.
3. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Delacorte; 1990.
4. Linehan MM. Skills Training Manual for Treating Borderline Personality Disorder. New York, NY: Guilford Press; 1993.
5. Creswell JD, Way BM, Eisenberger NI, Lieberman, MD. Neural correlates of dispositional mindfulness during affect labeling. Psychosom Med. 2007;69(6):560–565.
6. Brefczynski-Lewis JA, Lutz A, Schaefer HS, Levinson DB, Davidson RJ. Neural correlates of attentional expertise in long-term meditation practitioners. Proc Natl Acad Sci USA. 2007;104(27):11483 –11488.
7. Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychol Bull. 2006;132(2): 180–211.
8. Dove NL, Wiederman MW. Cognitive distraction and women’s sexual functioning. J Sex Marital Ther. 2000; 26(1):67–78.
9. Burpee LC, Langer EJ. Mindfulness and marital satisfaction. J Adult Dev. 2005;12(1):43–51.
10. Mayland KA. The Impact of Practicing Mindfulness Meditation on Women’s Sexual Lives [dissertation]. San Diego, CA: California School of Professional Psychology; 2005.
11. Brotto LA, Basson R, Luria M. A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. J Sex Med. 2008;5(7):1646–1659.
12. Brotto LA, Basson R, Gehring D. Psychological profiles among women with vulvar vestibulitis syndrome: a chart review. J Psychosom Obstet Gynaecol. 2003;24(3):195–203.

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