Why does desire so often disappear after sex has become painful - and is there actually anything you can do about it?
In this episode, I sit down with Dr. Corey Babb, a board-certified gynecologist and one of my favorite voices in sexual medicine, whose Substack writing on desire and arousal is some of the clearest thinking on these topics out there. He returns to the podcast to set the record straight on two things we constantly confuse: desire and arousal.
We get into why these are two completely separate processes, and why - using Dr. Babb's "waterfall" model - desire is almost always the last thing you treat, after pain, arousal, and orgasm. We talk about the neuroscience underneath all of it: how the brain learns to associate sex with discomfort, what neuroplasticity has to do with desire returning, and why it can take time even after the pain itself is resolved. Dr. Babb also explains the two FDA-approved drugs for low desire in women, Addyi and Vyleesi, where they fit in, and why it's striking that these are the only two we have - more than thirty years after Viagra. We close on the most validating idea in the whole conversation: if you've had pain for a sustained period, low desire isn't a personal failing. It's expected, it's explainable, and there are people who know how to treat it.
Whether you're navigating pain and a desire that's changed, a partner trying to understand, or a clinician - I think you'll take a lot away from this one.
This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. (I earn a commission if you purchase through my link.)
In this episode:
The difference between desire and arousal, and why it matters
Dr. Babb's "waterfall" model: pain, arousal, orgasm, and why desire comes last
Spontaneous vs reactive desire, and where the idea of "spontaneous" desire came from
How the brain learns to associate sex with discomfort - and how it can relearn
What neuroplasticity has to do with desire returning after pain
The two FDA-approved drugs for low desire in women, and where they fit in
Why low desire after sustained pain is expected, not a personal flaw
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