For many neurodivergent people, sex becomes draining or disconnected over time, even when there’s desire and care underneath it all.

Sex can start to feel like something you’re being evaluated on — rather than something you get to enjoy.

In this episode, I talk with licensed counsellor Bowen Marshall about how ADHD, Autism, masking, and performance expectations affect our sex lives — and why so many people end up feeling like they need to "get sex right", instead of actually feeling pleasure.

We specifically talk about:

• Attachment patterns and sex
• Why sex can start to feel like performance rather than pleasure
• How masking and self-monitoring undermine sexual connection and pleasure
• The role dopamine plays in desire, arousal, and motivation
• Why many people don’t know what they enjoy — and why that’s not a failure
• How expectations around sex create pressure and anxiety
• What it can look like to shift focus from “doing it right” to what actually feels good

Chapters:

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“We used to have such great sex" is one of the most common things I hear from clients as a sex therapist and coach.

Along with this confession usually comes grief, shame, and worry that something important to them is lost forever.

In this episode, I explore the science of sexual nostalgia: why remembering past sexual connection can sometimes help rekindle desire — and why, in other cases, it can actually make things worse.

I also include a free exercise toward the end to help you revisit past positive sex memories and increase desire.

We talk about:

• Why remembering “how it used to be” can either ignite desire or shut it down
• When nostalgia becomes a resource — and when it turns into grief
• How sexual turn-ons can become turn-offs, and what to do if that happens for you
• A guided, free exercise to ignite desire by diving into sexual nostalgia

Chapters:

01:41 What is Sexual Nostalgia?

04:09 Study Overview: Sexual Nostalgia & Satisfaction

04:43 Attachment Styles & Nostalgia

05:33 When Nostalgia Helps vs. Hurts

08:41 Clinical Insights: Attachment & Desire

12:05 Using Nostalgia as a Tool, Not a Time Machine

12:39 How Turn-Ons Change Over Time & What To Do About It

17:41 Nostalgia vs. Fantasy

19:53 Guided Exercise: Access Desire Through Memory

21:21 Interpreting Your Response to the Exercise

24:27 Closing Thoughts & How to Get Support

The study discussed in this episode is Rose Colored Glasses: An Exploration of the Relationship between Sexual Nostalgia and Sexual Satisfaction by Thompson et al., published in The Journal of Sex Research.

Download the free exercise Access Desire Through Memory.

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Join my 1:1 online program Re:Desire here.

Do you want to submit a listener question for the podcast? Here's the link

If you want sex to feel good again and not have to think about whether you're hard or softening, or whether you're going to have an orgasm soon — this episode gives you clear, usable tools to start moving in that direction.

In part two of this series on sexual performance anxiety, I talk with health psychologist and clinical sexologist Dr Evie Kirana about how to deal with sexual performance anxiety. We break down the real mind–body connection (no woo here - just pure physiology!), why you can’t force your erection or orgasm to cooperate, and how to shift from performance pressure to meaningful connection.

You’ll learn:

• Why fighting or hiding your anxiety makes it stronger
• How to tolerate anxiety in the moment without shutting down
• The four practical steps to deal with sexual performance anxiety in a new clinical model
• How connection-focused goals (instead of "I-have-to-get-this-righ goals") help your body during sex
• How partners can support without becoming the “fixer” or the “nurse"

Timestamps:

01:24 Introducing Dr. Evie Kirana

03:50 Gender Differences in Seeking Treatment for Sexual Dysfunction

05:30 Understanding Sexual Performance Anxiety (SPA)

07:57 Shame and Its Role

10:05 Cognitive Reappraisal: Changing Unhelpful Thoughts

13:06 Why We Can’t Control Sexual Function (Much Like Other Bodily Functions)

15:53 Shifting from Performance Goals to Connection Goals

18:44 The 4 Phases of Managing Sexual Performance Anxiety (& How To Do It)

25:05 Partner Dynamics and Navigating Progress Together

28:08 Why Society Doesn’t Talk About Sexual Performance Anxiety

31:45 Key Takeaways from Dr. Evie Kirana's Research

34:14 When to Seek Professional Help for Anxiety

36:45 Resources: MindMyErection.com

38:30 My Sex-Therapist Reflections & Final Thoughts

48:17 Outro & Support Resources

You can find Dr. Kirana’s free video resources for men & people with penises (and their partners) at MindMyErection.com.

The study discussed in this episode is A theoretical model for sexual performance anxiety (SPA) and a clinical approach for its remediation (SPA-R) by Rowland & Kirana, published in Sexual Medicine Review.

Interested in my services? Check them out here

Join my 1:1 online program Re:Desire here.

Do you want to submit a listener question for the podcast? Here's the link

If you’ve ever felt your body shut down the moment sex begins (your arousal just disappears, or you become consumed with worries about your performance), this episode will help you understand why.

In part one of this series, I talk with researcher Dr David Rowland about what sexual performance anxiety actually is, how it develops, and what’s happening in your brain and body when anxiety takes over. We unpack why pills can help penises but not people, why avoidance keeps the cycle alive, and how cultural expectations fuel shame.

You’ll learn:

• The three ingredients of performance anxiety: expectation, evaluation, and consequence
• Why anxiety and sexual arousal can’t coexist in the body
• What happens when you avoid sex to “protect yourself” — and why it backfires
• Why thinking you're going to fail, increases the likelihood you will
• How and why the brain can sometimes create a preferred response toward anxiety

Timestamps:

00:23 – Introducing Dr. David Rowland

01:24 – Dr. Rowland’s Background

03:29 – The Need for Sex Education

05.25 – How Medication for Erectile Dysfunction Changed Our View On Performance Anxiety

06:14 – Pills vs. People: The Limits of Medication

06:34 – Why Sexual Anxiety Still Exists Despite Pills

06:57 – 3 Aspects of Sexual Performance Anxiety

09:14 – The Function of Anxiety

11:21 – The Brain and Anxiety Response

13:19 – How Anxiety Affects Sexual Response

15:00 – Anxiety, Masturbation, and Sexual Function

16:40 – How The Brain Can Develop A Preferred Response To Anxiety

20:01 – Avoidance as a Coping Mechanism

22:18 – Over-Preparation and Mindfulness

25:30 – The Role of Anxiety in Sexual Problems

31:00 – Cultural Ideals and Male Sexual Performance

33:33 – What to Do About Performance Anxiety

47:54 – My Sex-Therapist Take On The Impact of “Soft” Sexual Problems

48:18 – Pleasure, Productivity, and Underfunding

50:00 – The Brutal Cultural Ideals Surrounding "Performance"

51:33 – What to Do About It

52:19 – Closing Thoughts & Resources

The study discussed in this episode is A theoretical model for sexual performance anxiety (SPA) and a clinical approach for its remediation (SPA-R) by Rowland & Kirana, published in Sexual Medicine Review.

Interested in my services? Check them out here

Join my 1:1 online program Re:Desire here.

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A quick fix for low libido in women - sounds like a dream, right? Even for me as a sex therapist!

In this episode, I talk with researcher Dr. Glen Spielmans about bremelanotide — a medication approved in the US for low sexual desire in women. On paper, it’s designed to target brain receptors linked to desire. But when you look closely at the trials, the story gets a lot more complicated.

We get into:

• How the “statistically significant” results in the trials were actually very small, and why that matters for real-life change

• What happened when outcome measures were switched after the study was finished — and how that made the drug look more effective than it really was

• Why so many participants dropped out, and what those high dropout rates tell us about tolerability and side effects like nausea

• How measuring something as complex as desire with just two survey questions misses the bigger picture entirely

• And why solutions for low desire rarely come from quick fixes alone, especially when the underlying issues run deeper

The study discussed in this episode is Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder by Spielmans & Ellefson, published in The Journal of Sex Research.

Timestamps:

00:29 Meet Dr. Glenn Spielmans – The Truth-Seeker

01:47 The “Desire Drug”: What Is It Really Supposed to Do?

05:26 How Does This Drug Actually Work? (And Does It?)

08:12 Can You Trust the Science? A Peek Behind the Curtain

12:00 Does It Really Help? The Real-World Results

15:53 Why Did the FDA Approve This?

20:00 Measuring Desire: Why It’s So Much Harder Than You Think

24:21 Is Anyone Actually Using This Drug?

28:01 Controversy, Criticism, and Calling Out the Industry

41:33 A Sex Therapist Take: My Thoughts On What This All Means for You, Free Resources & Where to Get Help

Download the free Desire Test here.

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Join my 1:1 online program Re:Desire here.

Do you want to submit a listener question for the podcast? Here's the link

If the idea of planning sex makes you panic, this episode is for you.

And if you’re curious whether planning could help your sex life and relationship thrive - it’s for you too.

We often hear that spontaneous sex is the “real” kind of sex — and that if you have to plan it, something must be wrong in your relationship. But is that actually true?

In this episode, I unpack a new study on spontaneous vs planned sex and talk about how it plays out in real relationships.

I’ll share why planning can be a game changer for some couples, and why for others — especially if sex already feels pressured or stressful — it’s the last thing I’d recommend.

You’ll also hear what I do suggest instead if just the thought of sex makes your body tense up.

We dig into:

• Why holding on to the spontaneity ideal can backfire in long-term relationships
• How planning can increase satisfaction when sex is good but just not happening very often
• Why planning backfires when sex already feels like a chore, and what to focus on first instead
• How to rethink “planning” so it’s less about scheduling and more about creating space, anticipation, and safety

The study discussed in this episode is Is Spontaneous Sex Ideal? Beliefs and Perceptions of Spontaneous and Planned Sex and Sexual Satisfaction in Romantic Relationships by Kovačević et al., published in The Journal of Sex Research.

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Up to 40% of men experience low desire. But it's rarely talked about—in society or relationships.

In this episode, I talk with researcher Grace Wang about what really happens when a male partner is dealing with low sexual desire—and how the way we manage (or suppress) difficult emotions can make or break sexual communication in a relationship.

We unpack her study on emotion regulation and low sexual desire in men, including why “just regulating your emotions” is a lot harder than it sounds on social media, how societal norms make it even trickier for men to talk about low desire, and why hiding how you feel almost always backfires.

You’ll learn:

• Why suppressing emotions (“putting a mask on”) undermines sexual communication and connection
• How reappraising your emotions (instead of just “thinking positively”) actually helps—when you can do it
• Why emotion regulation is a skill that takes real practice (and most of us were never taught how)
• How our families and cultures shape the way we deal with sexual and emotional challenges as a couple
• Why suppressing “to protect your partner” is usually a recipe for disconnection, not safety

The study discussed in this episode is Regulate and Communicate: Associations between Emotion Regulation and Sexual Communication among Men with Hypoactive Sexual Desire Disorder and their Partners by Wang et al. and published in The Journal of Sex Research.

If you’d like to learn more about Grace Wang’s work, visit the Cash Lab at natalieorosen.com

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Join my 1:1 online program Re:Desire here.

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This episode is a bit of a departure from the regular stuff! A personal update and a few important reminders about sex, desire, and overall well-being.

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