By Emine Saner

So there you are, in bed with your partner, having perfectly pleasant if serviceable sex, when your mind starts to wander: what was it you meant to put on your shopping list? Why didn’t your boss reply to your email? Don’t forget it’s bin day tomorrow.

Many of us feel disconnected during sex some or most of the time. At the more extreme end, sexual dysfunction – erectile problems, vaginal pain, zero libido – can severely hamper our quality of life and our relationships. In many cases, there could be a relatively simple, if not easily achieved, fix: mindfulness.

In essence, mindfulness involves paying attention to what is happening in the present moment and noticing, without judgment, your thoughts and feelings. It can reconnect us with our bodies – stopping us spending so much time in our heads – and reduce stress. It has been used by the NHS as a treatment for recurrent depression and popular books and apps have made it part of many people’s everyday lives. After mindful eating, drinking, parenting and working, mindful lovemaking is starting to be recognised more widely as a way to improve one’s sex life. (Earlier this year, the couples therapist Diana Richardson gave a TEDx talk on mindfulness in sex, which has been viewed 170,000 times on YouTube.)

A survey published in June by Public Health England found that 49% of 25- to 34-year-old women complained of a lack of sexual enjoyment; across all ages, 42% of women were dissatisfied. The most recent National Survey of Sexual Attitudes and Lifestyles, published in 2013, found that people in Britain were having less sex than they once did, with low sexual function affecting about 15% of men and 30% of women. Difficulty achieving orgasm was reported by 16% of women, while 15% of men suffered premature ejaculation and 13% experienced erectile dysfunction. Problems with sexual response were common, affecting 42% of men and 51% of women who reported one or more problems in the last year.

At the time, the researchers said modern life could be affecting our sex drives.
 
“People are worried about their jobs, worried about money. They are not in the mood for sex,” said Cath Mercer from University College London. “But we also think modern technologies are behind the trend, too. People have tablets and smartphones and they are taking them into the bedroom, using Twitter and Facebook, answering emails.”

Mindfulness is one of the tools that can help people focus in a world full of distractions. Kate Moyle, a psychosexual and couples therapist, says mindfulness is a recognised part of therapeutic work, even if it has not always been given that name. “When people have sexual problems, a lot of the time it’s anxiety-related and they’re not really in their bodies, or in the moment. Mindfulness brings them back into the moment. When people say they’ve had the best sex and you ask them what they were thinking about, they can’t tell you, because they weren’t thinking about anything, they were just enjoying the moment. That’s mindfulness.” Moyle says the techniques involve “encouraging people to focus on their sensations, explore their senses, hone in on what is happening in their body and how they’re experiencing it”.

A simple exercise Moyle recommends is “getting in touch with the senses in the shower – listen to the noise, the sensation of the water on your skin, notice any smells, see what the water tastes like, look around you. You’re really encouraging people to try to stay in their bodies, rather than be in their heads. It’s about refocusing their attention on what they can feel right now.”

Ammanda Major, the head of clinical practice at the relationship support organisation Relate, says mindful sex “is about focusing in the moment on what’s going on for you and making sure all the extraneous things get left behind. For example, if you’re being touched by your partner, it’s really focusing on those sensations. People may find themselves very distracted during sex, so this is a way of bringing themselves into their body and being totally aware of themselves in that moment.” It is now part of the standard advice and support Relate offers to clients, she says. “It can feel clunky to start with, but with practice people realise they’re able to engage in mindfulness without realising they’re doing it.” In short, it becomes a way of life. Other than focusing on sensations, people can bring into sex an awareness of “how nice your partner feels, or how nice they smell, or the sound of their voice – something that will bring you right back into the moment. When you have thoughts that distract you, one of the key issues is not to blame yourself, but just to acknowledge it and cast them adrift.”

At the Jane Wadsworth sexual function clinic at St Mary’s hospital in London, mindfulness is used in almost all sexual problems, says David Goldmeier, a clinical lead and consultant in sexual medicine. These approaches have been used in sex therapy since the 50s, but they were not known as mindfulness at the time. The American researchers William Masters and Virginia Johnson used a technique called “sensate focus”, emphasising the exploration of physical sensations rather than focusing on the goal of orgasm.

A mindful approach can help men with erectile dysfunction and premature ejaculation. “If you have a man who has an erection problem and is stressed by it, a lot of his mind [during sex] will be worrying: ‘Have I got an erection or not?’” says Goldmeier. It is also used to help men and women who find it hard to orgasm or have low desire, as well as in sexual problems relating to abuse. “In our clinic, we see an awful lot of people with historical sexual abuse and [mindfulness is] a foundation for the trauma therapy they have. It is useful in sexual problems that are based in large part on past sexual abuse,” he says.

Lori Brotto, one of the leading researchers in this area, agrees. In her book Better Sex Through Mindfulness, she wrote of a study she published in 2012, which noted that “teaching sexual abuse survivors to mindfully pay attention to the present moment, to notice their genital sensations and to observe ‘thoughts’ simply as events of the mind, led to marked reductions in their levels of distress during sex”.

Brotto is a professor of psychology at the University of British Columbia and the executive director of the Women’s Health Research Institute in Canada. Having started sex research during her graduate degree, she began studying mindfulness in 2002. Mindfulness-based treatments had been used effectively for people with suicidal tendencies – these ancient techniques started to be used widely in western medicine in the 70s – and Brotto realised they could also be helpful for addressing the sexual concerns of women who had survived cancer. “What struck me was … how the patients I was seeing with suicidal tendencies, who would talk about feeling disconnected from themselves and having a real lack of awareness of their internal sensations, were very similar to the women with sexual concerns,” she says. “At that time, I thought: ‘If mindfulness could be an effective way of staying in the present and helping them manage these out-of-control behaviours, I wonder if it could also be a tool to help women reconnect with their sexual selves and improve their sexual functioning.’”

Sexual problems can be caused by a huge range of factors. Depression and stress can be triggers, as can the side-effects of antidepressants. Over time, these side-effects can become a psychological factor, as people worry that they are no longer sexually responsive. Problems can also be caused by physical conditions such as vaginal pain, or inhibitions and shame about sexual desire, particularly for some women and people in same-sex relationships. Survivors of sexual abuse, who learned to dissociate during an assault, can also experience distressing sexual problems in a later consensual and otherwise happy relationship. “Mindfulness is such a simple practice, but it really addresses many of the reasons why people have sexual concerns,” says Brotto.

At its most basic, she explains, mindfulness is defined as “present-moment nonjudgmental awareness. Each of those three components are critical for healthy sexual function. For a lot of women who report low desire, lack of response and low arousal in particular, all three of those domains are problematic.” Being “present” is critical. “Then there is the nonjudgmental part – countless studies have shown that people who have sexual difficulties tend also to have very negative and catastrophic thoughts: ‘If I don’t respond, my partner will leave me,’ or: ‘If I don’t have an adequate level of desire, I’m broken.’ Mindfulness and paying attention nonjudgmentally is about evoking compassion for yourself.”

Body image issues come up consistently, she says. “Women will often say they prefer to have the lights off, or they’ll redirect their partner’s hands away from the areas of their body they’re not happy with, or they may be worrying that a partner is perceiving their body in a negative way. All of those things serve to remove them from the present moment.”

As for awareness, Brotto says, “lots of data shows us that women, more so than men, tend to be somewhat disconnected from what’s happening in their bodies”. Her experiments have shown that women can experience physical arousal, such as increased blood flow to their vagina, but it barely registers mentally. “There may be a strong physiological response, [but] there’s no awareness in their mind of that response. We know that healthy sexual response requires the integration of the brain and body, so when the mind is elsewhere – whether it’s distracted or consumed with catastrophic thoughts – all of that serves to interrupt that really important feedback loop.”

It can be the same for some men, she says, but “there tends to be more concordance between the body’s arousal and the mind’s arousal. When men have a physical response, they’re also much more likely to have a mental sexual arousal response.”

While working with a group or a sex therapist can be helpful for people with sexual concerns, others can teach themselves mindfulness techniques using books or any number of apps. In her book, Brotto says mindfulness practice can be as simple as focusing on your breath. An exercise she uses involves focusing on a raisin (this is a well-established practice and there are many tutorials online). First, scrutinise it – its shape, size, smell, feel, its ridges and valleys – then put it to your lips and notice your anticipation and salivary response; finally, bite into it and observe, in detail, the taste and texture. This can teach us to focus on sensations and the moment, rather than mindlessly eating a handful of raisins. The same sort of attention can be applied to sex.

In Brotto’s eight-week group programme, people practice mindfulness techniques for 30 minutes each day, followed by a maintenance plan of between 10 and 15 minutes a day. For someone doing it on their own, she recommends starting with 10 minutes a day and trying to include a few 30-minute sessions. “The benefit of a longer practice is you get to deal with things such as boredom and frustration, and physical discomfort in the body, all of which you want to be able to work through,” she says. “A body scan is one of our favourites within the sexuality realm – that involves closing your eyes and really tuning in to the different sensations in different parts of your body and not trying to change anything, just observing. If people can start to do that in their life generally, on a regular basis, they strengthen that mindfulness ‘muscle’ and start to become more aware generally and they can take that newfound awareness into their sexuality.”

When we have better sex, we tend to want more of it, so it becomes a satisfying circle. “Desire is not a fixed level that each one of us has, but rather is adaptive and responsive to our situation,” says Brotto. “When sex is not satisfying, it makes sense that the brain adjusts itself and creates less [desire].”

Mindful sex does not have to be an intense, time-consuming session. “It can be very everyday; it doesn’t have to be a different type of sex,” says Moyle. “You might have sex the same way, in the same position, but you’re in a different headspace, so you’re experiencing it differently. People can think: ‘I’m not into mindfulness,’ or: ‘It’s a bit spiritual and I’m not,’ but it doesn’t have to be that. It can just be really straightforward – focusing your attention and fully experiencing sensations.”

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