A Way Beyond the Rainbow

#39 - On Marital Intimacy and Sex (Part II)

November 20, 2020 Dr. Rana Khaled and Waheed Jensen Season 3 Episode 13
A Way Beyond the Rainbow
#39 - On Marital Intimacy and Sex (Part II)
Episode Introduction
On Improving Quantity and Quality of Sexual Relations
On Increasing Emotional Intimacy
On Increasing Desire
On Managing Sexual Problems on the Long Run
On Unconsummated Marriages
On Treating the Causes of Sexual Problems
On Marriage Between a Man and Woman with SSA
On Sex Education
On Spouses Struggling with Pornography and/or Masturbation
On Delayed Orgasm
On Sexual Fantasies
On “Sexual Desire-Timing Asynchronization”
On Restoring a Long-Lost Sex Life
Ending Remarks
A Way Beyond the Rainbow
#39 - On Marital Intimacy and Sex (Part II)
Nov 20, 2020 Season 3 Episode 13
Dr. Rana Khaled and Waheed Jensen

*General trigger warning: Episode involves discussion of intimacy and sexual relations with graphic details. This episode is flagged for explicit content.*

This is part II of a 2-episode series on marital intimacy and sexual relations, answering frequently asked questions on these topics, with a focus on men and women experiencing same-sex attractions. Joining me in both episodes is sex therapist Dr. Rana Khaled, MD/PhD.

In this episode, we discuss ways to improve sexual relations between spouses in quantity and quality, and how to cultivate emotional intimacy with one's spouse. Special focus is given on enhancing sexual desire, intimacy and enjoyment through touch and bodily sensations. We also touch upon sex education, pornography and masturbation within marriage, as well as tips to restore a couple's sex life.

If my spouse feels that I do not desire him/her, what are some tips to cultivate desire? How do we solve sexual problems like erectile dysfunction, premature ejaculation, vaginismus or issues with sexual desire? What are the values and challenges of a marriage between a man and a woman where both of them experience SSA? If I struggle with masturbation and/or pornography use while married, how do I deal with this? How do I restore a long-lost sex life? These and other questions are explored in this episode.

Links to resources mentioned in the episode:
- No Fap website (English)
- Wa'ii/واعي website (Arabic)
- Sexaholics Anonymous

Show Notes Transcript Chapter Markers

*General trigger warning: Episode involves discussion of intimacy and sexual relations with graphic details. This episode is flagged for explicit content.*

This is part II of a 2-episode series on marital intimacy and sexual relations, answering frequently asked questions on these topics, with a focus on men and women experiencing same-sex attractions. Joining me in both episodes is sex therapist Dr. Rana Khaled, MD/PhD.

In this episode, we discuss ways to improve sexual relations between spouses in quantity and quality, and how to cultivate emotional intimacy with one's spouse. Special focus is given on enhancing sexual desire, intimacy and enjoyment through touch and bodily sensations. We also touch upon sex education, pornography and masturbation within marriage, as well as tips to restore a couple's sex life.

If my spouse feels that I do not desire him/her, what are some tips to cultivate desire? How do we solve sexual problems like erectile dysfunction, premature ejaculation, vaginismus or issues with sexual desire? What are the values and challenges of a marriage between a man and a woman where both of them experience SSA? If I struggle with masturbation and/or pornography use while married, how do I deal with this? How do I restore a long-lost sex life? These and other questions are explored in this episode.

Links to resources mentioned in the episode:
- No Fap website (English)
- Wa'ii/واعي website (Arabic)
- Sexaholics Anonymous

Waheed  00:38
Assalamu alaikom wa rahmatullahi ta’ala wa barakatuh, and welcome to a brand new episode of “A Way Beyond the Rainbow”, this podcast series dedicated to Muslims experiencing same-sex attractions who want to live a life true to Allah subhanahu wa ta’ala and Islam. I'm your host, Waheed Jensen, thank you so much for joining me in today's episode. Today's episode is part two of the discussion on marital intimacy and sex, it's the second half of the discussion that we started last week. And joining me again in today's episode is Dr. Rana Khaled, who was our guest speaker in the previous episode as well. So, let's get started, inshaAllah.

If we have someone who experiences same-sex attractions and he or she is married, what advice can you give this person on how to improve his or her sexual relationship in both, quantity and quality?

Dr. Rana  01:35
Okay, let's first agree that even in happy marriages there is no such thing as a perfect union. Some couples who said they were very satisfied with each other still had significant differences in temperaments, interests, family values, and conflicts were not infrequent. In a study of couples with young children, a high stress time in most marriages, they found that those whose sex life was good to great made sex a priority rather than considering it a last obligation on a long to-do list. These couples talked about their sex life, ensured they had one-on-one time together, and put their relationship first, despite the competing demands of work and children and daily life stressors. 

There is a way to make our sex life more romantic. The goal of sex in a long-term relationship is to have fun, heighten closeness and feel valued and accepted in a very tender area of our marriage. There are some tips I would like to mention. We have to redefine what we mean by sex. So, when sex becomes about technique rather than passion and communication, the result is sexual anxiety. So, instead of isolating sex from the rest of your relationship, try a change in attitude. For example, stop thinking about orgasm, as we talked before, and consider everything positive that happens between you and your partner as part of sex. This goal-oriented approach to love making can cause a great deal of sexual dysfunction, because if that objective isn't met, then there is a sense that something is wrong. So, consider all positive interactions to be sex, even kisses and hugs and cuddling. Consider all of these as foreplay, even during the day, so this kind of interaction and consideration is stretching our sexuality, and we don't have to always consider sex as just being intercourse. Even touching is sex. 

I would like to say that many partners with a lower sex drive end up avoiding any kind of touch or hugs or cuddling, because of the fear that it will be interpreted as an invitation to sex. Sometimes partners are exhausted, sleepy or just planning to go to bed with a book. They would enjoy physical closeness, but sex is the last thing on their mind. So, that's why sometimes the lower drive partner pulls away, avoiding the opportunity for physical closeness - cuddling on the sofa, for example, kissing or spooning in bed in the morning, or even creates additional distance, for example, by making critical comments to avoid any physical contact. Over time, the higher drive partner will make fewer gestures of closeness out of frustration and feelings of rejection. So, here, we must stop and be open to ourselves and just talk about when we need sexual contact, or let's say intercourse, and when we need this kind of extended sexual activity.

Waheed  05:55
So, it's very important to communicate from what I understand, that not necessarily every time we cuddle or we have a physical contact, it's going to end up in sex. These things can be separated, right? 

Dr. Rana  06:06
Exactly. But sometimes it could be considered indirect messages for some partners, so that's why we have to stop and talk and have open conversations, as we talked about before. 

Waheed  06:19
Of course, beautifully said, thank you. 

Dr. Rana  06:20
This is the first tip. The second one is, I'd like to say, learn how to talk about it. And sometimes we have to have the courage to discuss our sexual life together and to express ourselves without sounding critical or feeling embarrassed. We have to be gentle and positive, and we have to be gentle and patient with each other. We don't have to take things personally. Sex is so intimate, but what turns your partner on or off isn't about you; the goal of lovemaking is to explore what works for each of you. It is not a criticism of your attractiveness, sexual ability, lovemaking skill, or inner most being if your partner likes it harder, softer or differently. So, we have to think positively, and we don't have to take it personally. 

So, the third tip to enhance our relationship in quality and quantity is to chart our sexual love map. And here, in two ways: we have to question ourselves, “What felt good last time and what do you need to do to make sex better?” By discussing those things together and being open to each other about our differences in desire, about our differences in fantasy, what's acceptable, what's not acceptable for us, what can make things better, now we are really discussing our sexual life, and we can start enhancing it and improving it. 

The fourth tip, I can say, is have ongoing conversations about sexual intimacy. Keep your sexual maps up-to-date. And as I told you before, we talked about brain plasticity. So, our sexual preference can change from time to time. We have to update this map sometimes by asking or by observing what's going on through the two partners. And so, updating it is good also. The fifth tip is to learn how to initiate sex and sometimes how to refuse it, but gently.

Waheed  09:18
So what you mean is maintaining open communication, and kind of stretching the idea of sex to involve any acts of cuddling and hugging and foreplay to rekindle intimacy, right? 

Dr. Rana  09:31
Yes, exactly. Yeah.  

Waheed  09:33
And I really like the idea of the intimacy map that you mentioned, because it builds up and it creates a fluid dynamic between the couple, this is really wonderful. 

A lot of times, there are different things that men and women look for in terms of their sex lives, right? So, there is, of course, the sexual intimacy, which is important, but oftentimes, we also learn about the emotional intimacy, which is also very important for women in a relationship. You know, women need to be hugged, to be held, to be cuddled more frequently than men usually think. And, for example, because we are talking now to an audience of men and women who experience same-sex attractions, a lot of us have experienced traumas in our lives growing up. Many of us have been abused as kids, particularly sexually abused, and so on. So, these issues can be frightening for us. So, my question to you right now is, how do you recommend one would be able to create and increase emotional intimacy and bonding with one's wife or with one's husband?

Dr. Rana  10:48
OK, first of all, I’d like to say that emotional intimacy is a key component of a healthy marriage. So, when emotional intimacy is lacking, a marriage can suffer. Maintaining emotional intimacy requires work and attention, that restoring emotional intimacy after it is lost can be a lot tougher than working hard to preserve it along the way. So, when you are emotionally intimate with your spouse, you may feel as if you can see into the other’s soul, knowing their hopes, dreams, fears and understanding them at a deep level. Taking steps to strengthen emotional intimacy in marriage demonstrates your commitment to a long, strong and happy marriage. Sometimes, couples don't develop emotional intimacy in the first place, or they lose it after a while. Ideally, both partners will work to build this intimacy.

It's important to recognize your part in building emotional intimacy and being emotionally available. We don't have to rely on the other partner. We are both responsible. Relationships that lack emotional intimacy are often characterized by a lack of trust, poor communication, secrets and hidden emotions. So, if your marriage seems to be lacking in emotional intimacy, I would list a number of things that you and your partner can do to strengthen and deepen it. Let's start, especially these days, with electronics We have to silence the electronics, first of all. Electronic communication can be a barrier to real emotional intimacy, and now, a lot of homes are lacking this kind of emotional intimacy. So, work, email, social media and entertainment can be never ending and easily grow into distracting habits that interfere with your solid human one-on-one interaction. So, we have to give ourselves a break from those electronics and just try to communicate physically. 

The second piece of advice I can give is to be emotionally available. After a year together, a couple inevitably learns what might hurt the other partner. Kind and loving partners will, for example, avoid hurting each other, help each other feel loved, valued and safe. When we make the environment safe for our spouses, emotional intimacy finds its place. So, we have to just sit with ourselves and see what makes our partner emotionally stable and more comfortable. Unfortunately, many people have experienced hostility from those they trusted and felt unloved or learned bad relationship habits. If you have a habit of emotionally attacking those who are close to you, this habit will sabotage intimacy and create a wall in your marriage. So, when I talk about the “four horsemen” of the relationship: we emphasize criticism and defensiveness, feeling contempt and stonewalling. If you have a habit of emotionally attacking those who are close to you, for example, by criticizing them, by contempt or by being too defensive, these habits will sabotage intimacy, creating a wall in your marriage.

And another piece of advice, increase your time together. It can be hard to find time together as a couple. So, having children, especially in the home, can often magnify that difficulty. Consider having, for example, a cup of coffee together at a set time every weekend that can help you feel relaxed and able to engage in good conversation, maybe try weekly date nights or bi-weekly date nights, it doesn't matter, but we have to do something. Making time to focus on each other without kids or distraction, especially from our electronics, is critical to maintain our emotional intimacy. 

Also, I advise to read a book together, because by sharing information and talking about what we read, it can strengthen the trust and communication aspect of our emotional intimacy. I would also add, we have to seek a balance between self and couple. I consider this a very important point, because the strongest marriage relationships have two interdependent partners. Each one has rich hobbies, a professional life or a social life. Too much togetherness can be a bad thing, if it deprives the relationship of the energy and experiences that interdependence brings. So, make sure to engage in some good self-care as a husband and allow your spouse to do the same as well. And then, come together as a secure and trusting couple. 

And, at the end, put together a fun list. Spend time pursuing what you enjoy together can build shared memories and experiences whilst strengthening emotional intimacy. So, think about things you did when you were, for example, dating or engaged or newlyweds that made you enjoy time together, and consider putting them on your fun list. Explore activities that you have always wanted to try. Make sure that you are doing something on that fun list on a regular basis. And, if those don’t work, you may want to consider seeking help from a family therapist.

Waheed  18:08
I wanted to ask you about the touch needs, because they fall into this question, but then I'm going to kind of merge it with another question, which, you know, we get frequently. Let's say that a spouse doesn't feel desired, and, you know, typically the woman complains to the man that she's not feeling desired enough. And, you know, a man who has same-sex attractions usually might be having difficulty in that regard. So what are the recommendations that you can give us to kind of increase that level of desire towards our spouse? And feel free to talk about the touch needs that you wanted to include in the previous question.

Dr. Rana  18:55
OK. For a normal couple, two people rarely have the exact same sex drive. So, one person might be happy with daily sex, the other with monthly. Besides differences in basic libido, life events, job stress and childcare, sexual orientation can cause a desire discrepancy in couples. But, as I mentioned before, it's important to remember that intimacy doesn't necessarily mean sex. And in fact, non-sexual touch is vitally important, both, in itself and to improve sex life. And when I talk about non-sexual touch and physical intimacy to show your appreciation for your partner, it could include, for example, caressing your partner’s cheek, cuddling with one another, tickling the inside of your spouse’s arm, for example, walking with your arms around each other, sitting close enough so that you are physically touching, holding hands, briefly rubbing your partner’s back while watching TV or standing together at the kitchen counter, kissing or nibbling your partners’ ear. And this intimacy doesn't have to be through direct physical touch. Even eye contact is important, and many couples will go for days without looking directly into each other’s eyes. Humans, and especially females, and here I underline females, they are wired to be touched from birth until the day they die. The need for physical contact remains. 

All senses are a possible gateway to our sexual desire, and neurobiology has focused mostly on the way visual and olfactory stimuli excite sexual motivation and desire. But the skin as a proximal gateway to sexual desire has received little attention by people. The ability to perceive interpersonal touch as sexually stimulating and pleasurable could be a key component of our sexual behavior and sexual intimacy. So, there is a reported scientific evidence about the relationship between that tactile physical affection, relationship satisfaction and attachment bonds. So, here, we have to emphasize the importance of touch - I'm not talking here about the sexual touch, I'm talking about non-sexual touch. The touch information received through the skin has direct access to the brain's emotional and rewarding system. So, touch is suggested to be involved in the conduction of sexual stimulation, even if it’s not sexual touch, and that’s what we call arousing touch. One of the worst scenarios we experience in the clinic, unfortunately, it's high in prevalence, and that is skin hunger or touch deprivation for many reasons, because with time, the couple gets used to each other, they don't touch each other, even normal touch. 

As we mentioned before, our sexual response cycle, it's about our desire, arousability and satisfaction, and we can put between parentheses to include “orgasm”. Sometimes if we don't have desire, but we let ourselves go, by letting ourselves become aroused and don't put up boundaries about our relationships and our touching each other, here we can get aroused, and after that, we can enjoy our intimacy together, our emotional intimacy together, and with time, after increasing intimacy and sexual satisfaction, desire can come and rebuild itself. 

It's important to note that all relationships require time, effort and commitment from both parties to be successful. A healthy relationship is, therefore, not about having no difficulties, it's about having the skills, time and energy to work things out and grow together. And concerning people who have experienced sexual abuse previously, usually in their marriage, they can have some difficulty with trust, intimacy and sex. But we can say there is no prescribed way that an experience of sexual abuse will impact a man/woman or his/her marriage. Everyone is different, one of the ways that sexual assault could impact us in addition to, for example, avoidance of some people, places and situation, is trust. We have difficulties trusting people, even our spouses at times. When being hurt by a person we are supposed to be able to trust, it can be extremely difficult to trust in later relationships, even the spouse. As a result of this assault, there is closeness-distance dynamic in which you might experience a see-sawing in your relationship, both husband and wife might at times seek out reassurance and assistance, and at other times distance themselves from each other. In these cases, we always advise people to seek medical help if this problem persists, especially in avoiding some people, not feeling comfortable to be touched, physical closeness to each other, or even trusting the other partner.

Waheed  26:09
Let's say someone has been married for some time and things have been working out, or maybe there were some brick walls, eventually, and some sexual problems kept on emerging, let's say performance issues, whether it's the man or the woman, or both of them. And, as you know, this becomes very demoralizing to their sexual life and to their personal life. How do we manage this if these sexual problems keep on emerging? And we're talking here about the man and the woman, both of them together.

Dr. Rana  26:41
Every unsuccessful attempt could be interpreted by a person him/herself as a failure. So, the thoughts of failure torture the mind, and we go into the vicious cycle of frustration, embarrassment, fear, feeling incompetent, and, at the end, we cannot perform. So, my advice is stop trying to achieve intercourse as a goal and to stop and seek professional help. 

Waheed  27:17
Okay, this is very important, because at this point, it needs to have some sort of intervention to help the couple. 

Dr. Rana  27:24
Exactly, because, for them, they are in a vicious cycle, they cannot get out.

Waheed  27:31
And as you said earlier in the episode, you said that sometimes, the consummation may or may not actually happen, even after years, or even ever, right?  

Dr. Rana  27:40

Waheed  27:41
So, my question here is, if a man is not able to consummate his marriage at all, how frequently have you seen this?

Dr. Rana  27:49
Not so frequently, because usually they get divorced before they seek help. And, unfortunately, many of them, they cannot wait too long. But we have some cases, I saw a case of 11 years of unconsummated marriage. And, at the end, they come for treatment and, alhamdulilah, we succeeded. But what makes couples stay together is different from couple to couple, because, as I said before, every couple is unique, and every couple has their own reason to stay together or to leave.

Waheed  28:36
Okay. And in the case of not being able to consummate the marriage, obviously, your recommendation would be to seek therapy, right?

Dr. Rana  28:43
Yes, exactly. Because we have in the clinic a lot of cases of unconsummated marriage, and we work with them. And, alhamdulillah, we get a good result at the end. So, don't be ashamed of this problem. This problem is very common and could happen, nothing is wrong with you, and nothing is wrong with your spouse, but just seek out professional help and things will get better. 

I would like to mention here something, because, like I said before, unconsummated marriage is because either she has vaginismus or fear of having intercourse, or he has a sexual problem. Because every couple is a unit, when one of them has a sexual problem, with time, the other partner who has no sexual issue starts having some sexual problems as well. It's secondary to his/her partner’s sexual problem. And, instead of dealing with one spouse in our clinic, we now have to deal with both of them. So, seeking help at the right time is better than postponing things and being trapped in this vicious cycle of frustration, embarrassment, feeling incompetent and depression. 

Waheed  30:24
Of course, yes, this makes perfect sense. As you mentioned earlier, it's very important to keep communication open, to have the expectations laid out there, to focus on the touch needs and the things that you have described before. But when we talk about particular matters, like, let's say, in the man, erectile dysfunction or premature ejaculation, for example, these are very common issues. Or when we talk about the female, there's as you’ve been saying, vaginismus, or issues with desire or orgasm, which can apply to both male and female. How do you deal with these particular issues with couples that you see?

Dr. Rana  31:09
Usually, for these issues, we look at the cause, we try to treat the cause. For example, most of erectile dysfunction cases are due to performance anxiety. So, I need to deal with performance anxiety. Premature ejaculation sometimes is due to previous masturbatory habits. So, we have to deal with this issue, and we have to treat the man’s previous habits. So, sometimes we need medications, sometimes it's only psychological treatment. 

For the female vaginismus, we treat it with desensitization. And here, it's very important for us to take things slowly and step-by-step and not to rush the process of therapy. And we can also deal with, like you said, desire problems, orgasmic problems, and with everything, we always have to look at the roots of the issue and see what's causing the specific issue, if it's primary or secondary, if it's lifelong or situational, and how much distress it is causing someone. Because sometimes the man comes, and he complains about his wife, but when we ask her, she doesn't have any distress about the problem. So here, for example, we don't treat her. We try to treat him, because he's having the distress and she's not. It depends and is dealt on a case-by-case basis, and we always tailor the therapy. 

Waheed  33:04
So, in this case, it's very important to seek therapy, to seek professional help in these cases, whether individually or couple’s therapy is very important. 

Dr. Rana  33:15
Exactly, yes. 

Waheed  33:25
If I were to ask you about the idea of a marriage that involves both a man and a woman who both have same-sex attractions, and they both know about the attractions of their spouses, so they are 100% transparent with each other, and they get into this sort of an arrangement. Now, in previous episodes on the podcast, we actually talked about the idea that individuals with same-sex attractions come with emotional and mental baggage, and there needs to be support systems, there needs to be therapy, there has to be different areas in which they can overcome so many of the challenges that they have. And, hopefully, by the time that they decide to get married, then many of these problems would have been solved, or at least been dealt with, or the person is able to deal with them. Now, the first question that comes to mind about this kind of marriage, is such a marriage feasible? Is it stable? And if I were to ask you as a sexologist and therapist, have you ever seen such a marriage happen?

Dr. Rana  34:29
I saw it only once, to be honest. But we have to say that every couple is unique. And, so, we cannot generalize things. But here, we have to expect that they both have more explicit sexual desires and more sexual needs, but in different directions and sometimes they’re contradictory. So, this would be a challenge for both of them, so the couple has to find a balance between these two extremes. And I know, because you said they are open about this to each other, and this is a very important step, to be clear, to disclose our needs, to disclose our desires, to disclose our fears. Here, I think both of them, when they enter marriage, they have realistic expectations of what they would face. And because both of them, they know about each other, and they know that their common points aren’t sexual common points, or they are not as aligned (sexually) as the other types of marriages. So, it's a challenging marriage, but it could work. It depends on the spouses.

Waheed  36:08
Ok, this makes sense. Now, if we were to talk about this particular marriage, again, what are some of the things that can contribute to the success of this particular marriage? 

Dr. Rana  36:17
Bridging the differences. As I said, the differences are so big. Let's say we have three levels in the bridging process. We have to have real talking, as I said, by disclosing yourself and communicating in a good manner. When somebody discloses himself/herself, there ought to be real listening and real empathy for the inner world of the other. So, you need disclosure, and you need a good listener from the other side. The second step is, we need to reach truly common, shared feelings. And because feelings are the repercussions of what we do, we do not construct our feelings, right? We find them in ourselves. When I share and communicate my feelings, that doesn't mean that the partner has to feel the same way, bur rather that the partner is able to transport him or herself into the inner world of the other and see things as the other sees them.  

And the third step for me, I call it negotiating. First, they need to take the differences between them seriously. To start off by saying that “I want something different from what you want” is not easy in a loving marriage. But at the end of negotiating, most people promise too much - when we say “too much” we really mean too, too much. They just blow promises, but the result is that the agreement is not kept, and agreements that are not kept are agreements not well made. So, words alone here are not sufficient. The nonverbal expression through behavior by really doing something for the partner is the ultimate criterion by which a real relationship will be judged. So, commitment is evident in the behavior, the body and everything loving partners do for each other. Continuing to speak to each other after realizing differences are part of that commitment. And so, sex would be seen as an exercise of differentiation, and we have to bridge this differentiation.

Waheed  39:13
I see. So, what you're talking about is that we're trying to bridge the differences, and one of those aspects of the differences is obviously sex in this case, or the interests. So, we try to keep open communication and transparency, and you mentioned those things beautifully, and hopefully, this, inshaAllah, contributes to the success of this kind of marriage. Now, what are some of the unique challenges of such a marriage, and how can someone prepare for those kinds of challenges?

Dr. Rana  39:42
The most challenging thing here is sometimes low sexual desire, it can with time lead to sexual aversion, becoming an asexual marriage. We have to confront the problem and pay attention to it when it's closer to aversion. So, seeking professional help rather than denying things. When we don't communicate sexually, we are building a stonewall between us, but we don't need this. We need to communicate. We need this touch, the sexual touch, to bridge the differences.

Waheed  40:38
One question to you as a therapist and as a sexologist, what are the recommendations that you can give us on the topic of sex education, particularly when it comes to kids? What should they be taught? When should they be taught these things, and so on? 

Dr. Rana  40:53
Sex education is still a controversial issue all over the world. It is a source of a bitter ideological debate, because under the term “sex education” you can find programs and agendas with different goals, contents and methodologies, right? So, sex education for children and adolescents is widely regarded by some Muslims as “dangerous knowledge” that awakens premature sexuality and undermines Islamic identity. Just to mention, I'm not a sex educator, I'm a sex therapist, but just from my point of view, if we look at our Islamic curriculum, we find it's full of sex education and instruction for parents on how to raise their kids to have solid sexual wellbeing. 

The messages that children are taught about sex and gender roles plays an important part in how they will grow into their sexual selves and control. When we say “control”, this means to express or not to express their sexual motivation. Starting from the age of childhood, we have to help them to develop the characteristics of masculinity or femininity, and developing those differences until the child qualifies his/her role in family life, and guiding sex to the right approach in the field of sexuality. So, we need to teach them what is normal, what is normal in their body, saying that this desire is normal but we need to control it. We have to teach them the sexual differences and the right gender roles. And we have to preserve the child from sexual deviations by preventing them from looking at porn or engaging in early sexual experiences without marriage. When Islam forbade, for example, a man to imitate a woman or a woman to imitate a man, then, accordingly, it protects the man’s instincts and the woman’s instincts and nature, and eases each gender for its role in life. Nowadays, social media and the internet, in my opinion, have a problematic effect on people developing sexual attitudes and identities. From a clinical point of view, we find that Netflix, for example, has a big influence on preference. There is a study in the US that reported that the major source of sexual information for kids was their peers and the media, compared to only 10% who named their parents. And this illustrates how large a role society and internet play in shaping people's views when it comes to acceptable and unacceptable behavior and attitude towards sexuality. 

So, as Muslim parents, we have to know that sexual education should start at home, and we have to be courageous in addressing sexuality issues with our kids according to what they can be exposed to. And it’s important to know their milieu (environment) and what they can be exposed to, and teach them as a prevention before things happen, not after a while. It's important to mention that growing up with parents who express no warmth, who do not touch the child effectively and refuse to acknowledge his or her feelings can inhibit healthy intimate relationships as an adult, as well as undermine the child’s self-respect. So, a negative relationship in childhood may delay or inhibit healthy adult sexual development.

Waheed  45:17
So, I mean, the take home message here is that it should start at home, parents should be sitting with their kids telling them everything from a healthy perspective, explaining it to them age-appropriately, not shying away from these topics, because they're going to be exposed to it either at school or through the media anyway. So, it's better to be exposed to it at home in an appropriate way, so that they know how to deal with this, correct? 

Dr. Rana  45:42
Exactly, and not forgetting to show emotion to them. 

Waheed  45:45
Of course, of course, and not to shame them when we talk about these things, or to tell them “This is haram!” or “You should not be thinking about these things”, this kind of backfires. 

Dr. Rana  45:55
Not at all, because, you know, sometimes there are young boys struggling with masturbation. If you are open with them, you can help them overcome this struggle, instead of, for example, blaming them or not supporting them or shaming them; otherwise, they will stay in this vicious cycle. So, we have as parents a big responsibility to prevent our kids from any harmful influences on them, especially of sexual content. But if they are in, we have a responsibility to help them get out of their cycles. 

Waheed  46:37
Right, with a lot of understanding and compassion and not shaming them because they did something wrong. Yes. Hundred percent. 

Waheed  46:52
And, obviously, having a sexologist on board, we definitely have to talk about the taboo topics of pornography and masturbation, particularly during marriage. So, I would like to ask you, how do porn and masturbation lead to problems when being intimate with one's spouse? And do you have any tips on how to stop using pornography and masturbation, or any other forms of stimulation, like phone or webcam sex, and the like? 

Dr. Rana  47:20
The ideal is for our fantasy to be grounded in reality, at least with respect to whom we want to be with. But, unfortunately, watching pornography, watching such an exciting scene, produces a lot of adrenaline, dopamine, endorphins, a lot of neurochemistry in our brain, making us feel not only good, but so good! This chemistry flooding can lead easily to dependence, and this is not a joke, it's a devastating condition that is seeping through our society. And I see it a lot, a lot, a lot in my practice. There is a growing body of research that shows that compulsive pornography use impacts the brain in a very similar way to chemical dependence, and we call it “visual cocaine”.

Waheed  48:18

Dr. Rana  48:20
Yeah! So, they start first by pursuing the idea of sex, the fantasy of sex. Both men and women’s brains become bombarded by images of how sex should be and how our body should look. And the result is that when most people start having sex, their knowledge about it and about which sexual feelings and practices are normal tend to be very low, unfortunately. So, this is a problem that affects ordinary people, and the biggest barrier to getting help is the secrecy and shame that surrounds it. They feel that nobody can really understand them, so that's why they feel so desperately alone and isolated.

Waheed  49:12
And it also becomes like a coping mechanism, because they want to escape reality, any problems that they're going through, they want to escape from that, but it becomes a vicious cycle, because it's so addictive, correct?

Dr. Rana  49:22
Yeah, correct, exactly. This is case. There is advise that viewing pornography can help to overcome the problem, but many times, it has the opposite effect. It's well known that porn can induce sexual dysfunction, because watching too much porn can cause sensory overload in a man to the point where real sex just doesn't provide enough stimulation. It then becomes a problem. It's well known also that men respond more to visual stimulation than women. However, when it begins to affect sexual performance, it's more harmful. If we want to talk about how harmful watching porn is, we need hours and hours. Unfortunately, there are many published studies today claim that porn isn’t addictive or sex watching doesn't affect sexual performance, or other things..

Waheed  50:33
That's bullshit. 

Dr. Rana  50:36
Yes, this is not the reality. Many studies are paid for [by companies or individuals who have a vested interest in porn industry], so they are not reliable and, in my opinion, they are not totally objective, because what we see in the clinic is the total opposite. There are so many websites today, fortunately, that can help anyone who's struggling with pornography and webcam sex, and others. We can mention, for example, “No Fap”, and we have in the Arab world “Wa’ii/واعي” who are doing a great job in this regard.  

We have to understand ourselves, and we have to understand our triggers. When we need to help somebody to overcome his/her addiction, or compulsive sexual behavior let’s say (I don't like to call it addiction). We have to search for the triggers, because stopping compulsive sexual behavior is best done when you can recognize your own unique cycle of dependency. Everybody has his/her own cycle and the goal is to be able to personalize our cycle. First, we have to have a strong will, and we have to understand that stopping such things is not an easy journey. It's a journey full of ups and downs, it’s a journey full of challenges, and we need to be strong enough, and we need to know it is ok for us to have a relapse, or some lapse and then relapse. We have to understand this, and at the same time, we have to be strong enough to stay on this road. Change is sometimes painful, but at the end, if you can change it, it will affect all your life in a positive manner. So, a strong will at the beginning. Then, we have to search for the triggers. And triggers are an event, an opportunity, a body sensation, an emotion, a thought process that activates that behavior. Some triggers are, for example, mood disturbances, some triggers are about anger, some triggers are about our body. We have to understand what triggers we have, when the trigger can affect us, and when the trigger can trigger a sexual opportunity for us. So, we have to be prepared for the journey. 

Some people when they stop pornography, they count the days. But with time, they reach what's called a flatline. Flatline means they don't respond sexually to their wife. And here, they feel devastated, it would be a devastating event, because they think and feel “What's happening, why am I not feeling anything?” This is OK and it's normal to have this. Therefore, it’s important to prepare for this journey and understand and read about it and learn about what you can experience as you go through it. When you read what you can expect, and you face it, you won't get as many negative emotions or negative reactions.

Waheed  54:55
Interesting. And you actually mentioned “No Fap” and “Wa’ii” in Arabic, and I will add the links to their websites in the episode description. There's also “Purify Your Gaze”, which also helps with pornography addiction, and there are also 12-step programs like “Sexaholics Anonymous”, which can also help deal with these matters in a supportive environment. There are very common questions that we know, particularly about men with SSA, men more commonly than women with SSA, but let's say there's a man in a marriage, and he has same-sex attractions. He cannot be sexually satisfied without having gay fantasies, for example, or having a release, like he masturbates alone and has a release after these gay fantasies, or watches gay porn and needs to masturbate to get aroused, and he is married. And there is this argument that “This is the lesser of two evils. Instead of me going out of the marriage and hooking up with other men, this would be the lesser of two evils.” Now, we know that this is also not very helpful in the long run, and it comes with a lot of problems. What would you recommend in this particular case? If the man is not aroused unless he does all of these things, how would you deal with this? 

Dr. Rana  56:14
As I said before, that our porn viewing habits influence who and what we fantasize about. So, pornography consumption is related not only to the size and shape of the bodies and genitals that appear in our fantasy, but to our orientation too. So, the more gay porn that a man watches, the higher the chance his fantasies will be gay, and the more dissatisfying (things will be). So, many (people), when they appear in their own fantasy, they change themselves in some way, whether it's having a different body shape, genital appearance or even personality. So, this tendency to fantasize about changing one's physical or psychological characteristics sometimes reflects deep seated insecurity. And men who habitually look at pornography have a higher tolerance to increasing sexual permissiveness for abnormal sexual behaviors, sexual aggression, promiscuity or even rape. 

So, pornography affects people’s emotional lives. Married men who are involved in pornography, especially same-sex pornography, feel less satisfied with their marital sexual relationship and less emotionally attached to their wives. Women married to men with a pornography addiction report a feeling of betrayal, mistrust and anger. So, if you cannot stop watching pornography and masturbating by yourself, seek help, either by joining the groups that we mentioned before, or don't hesitate to seek medical and psychological help, if needed. Sometimes, in our clinic, for people who cannot resist their higher desire, we can start them with medication for a while. By the time we get to cognitive behavioral therapy, then we can taper the medication which can help them overcome this issue.

Waheed  58:28
Perfect. Okay, one very small question that one of the members wanted to ask is, is it true that with frequent masturbation over time, for example, there might be skin changes on the penis that affects the thickness, or like the nerve endings might be negatively affected? And like, when someone masturbates for a long period of time, like for years and years and years, having intercourse with a vagina will not feel as good? And if the answer is yes, is there a way for the damage to be reversed?

Dr. Rana  58:59
Unfortunately, sometimes the damage is irreversible, especially when the condition is chronic. I would like to explain something. Manual stimulation gives you too much excitement for your body. This excitement you cannot find it when you have vaginal intercourse. You cannot find this same intense stimulation that you can do with your hands. Here, we can say that, when you are doing masturbation, you are even destroying little by little the mutual stimulation that you want from your wife. You will enjoy only the “solo sex”, you won’t enjoy couple sex anymore.

Waheed  1:00:05
So, earlier, we talked about the idea if a man has premature ejaculation and how to deal with that, if it's a psychogenic cause, and a woman generally needs more time for her to reach orgasm, and how the man can actually satisfy himself and satisfy his wife in bed. Now, a question would be, if a man takes a long time to reach orgasm, or sometimes cannot reach it at all, what would be the recommendation in this case? And the same goes for a woman if she takes a longer time than usual, or she doesn't even reach orgasm, what would be the proper recommendation in this case?

Dr. Rana  1:00:49
Here, we turn back to a subjective assessment that lacks specificity, because how much of a delay in ejaculation or in orgasm is too much of a delay? In order to give an answer, we need to take a detailed history, we need to ask about specific conditions, if any, under which a male, for example, is able to ejaculate, with specific attention given to the variables that improve or worsen performance. So, specific questions about the man’s masturbation habits need to be asked about, including frequency, specific details of the man’s masturbatory style, simulation, and the differences between self-stimulation and partner stimulation are important. We need to know about his fantasies, use of pornography and the ability to communicate his preference to his partner. 

So, in addition, if ejaculation was previously attainable, a detailed exploration of life changes would be conducted, for example, the circumstances leading up to the development of the ejaculatory difficulty must be considered. Differential diagnosis must take into account the normal effect of aging, for example, on male ejaculation. Additionally, ejaculatory delay can be due to medication, for example, some medications like antidepressants, or medical conditions must also be ruled out. So, what to do all depends on the etiology. 

Waheed  1:02:33
Okay, so in this case, you would recommend seeking medical and professional help, correct?

Dr. Rana  1:02:37
Yes, exactly. 

Waheed  1:02:45
The next question would be; we know that each person has his/her own sexual fantasies, and let's say the person could only be aroused when the partner does particular things. So, what would, for example, a man do, if the wife does not enjoy or does not want to do these sexual fantasies, and vice versa? The same applies to a woman who enjoys certain things that the man doesn't want to do or doesn't enjoy. How would they deal with this?

Dr. Rana  1:03:17
Okay, we have to say that sexual fantasies are considered to be a marker sometimes of spontaneous desire, and their absence is one indicator of dysfunction. However, sexual fantasies are not proven to reflect a woman’s sexual desires. So, sexual fantasies start in childhood, so they are normal and okay, as long as they are consensual, and not harmful to the individual or his/her spouse. Here, we talk about sexual coercion if it were to happen.  

So, sex is also about communication. We need to learn how to communicate our needs and fantasies, how to share some content, without having the expectation of agreement, and without fearing criticism. Sometimes, in the clinic, we put a “10 and 10 sheet”, in which each partner reflects and then writes down their fantasy, and they share the result with each other. For example, I ask the female to write her plan, and for the man to write his own plan separately. In the table, we put three columns: either it's acceptable, unacceptable or a maybe. Maybe means we can think about it, or maybe we can do it with some little changes, for example. It's an indirect way to share our fantasy. Let's say, someone writes on their paper, “having sex in a car”, or “having sex outside the bedroom”. But for example, the wife, she has never thought about it, and the man is trying to mind read and assumes that she doesn't desire or want that. But sharing their results and teaching them not to judge the other, and just to say if it's possible, not possible or maybe, sometimes the spouse can be surprised about the answer of his/her spouse. This fantasy in their mind, or it's acceptable for them, or it's acceptable to some extent. So, sharing fantasies here is very important for us. Instead of us repressing our fantasy and incorrectly labelling things as “low libido”, we try to carry on with a normal sexual life. There’s nothing wrong with making some fantasies real, as long as they don’t hurt the other or it's not harmful. So, if the wife, for example, doesn't want to do this fantasy, let’s say, then we can go to the alternatives. So we have now a list of alternatives, and other choices that we have on the list, for example. All what we need is to break down the barriers to discuss sexual fantasies that exist in our life, so that we can allow those fantasies, the ones that are safe, legal and consensual, to become part of our sexual reality.

Waheed  1:07:14
Another question is, in the case of “sexual desire-timing asynchronization”, which means that, for example, a man might have a sexual desire for sex at the moment, but the woman doesn't desire that. Or let's say a woman has a desire for sexual intercourse at the moment, and the man doesn't desire it. There is asynchronization in timing, what should be done in this case, what would you recommend?

Dr. Rana  1:07:38
Let me explain, first, that sexual desire is the motivational state that may promote an individual to seek out to engage in sexual activity. It's the result of positive interplay among: internal cognitive processes like thought, fantasy, imagination; neurophysiological mechanisms, like sensory arousability; the affective component, like mood, stress, emotional state; and the biological basis. So, no one person’s desire is like the other, and this can affect relationship dynamics. For example, some men respond sexually to their stress, while for others, stress prohibits them from performing sexually. So, as I said, no one person is like the other, but we need to increase the awareness that partners have differences in desired frequency of sexual contact, and they have different attitudes towards sexual behavior and arousal. The conflict in view of sexual contact as a right to pleasure is always present. And we can have a struggle about power and control related to the initiation and type of sexual contact. Ineffective communication related to sexuality leads to desire discrepancy. 

But here also comes another issue, somebody told me that, in Islam, if a wife refuses to have sex with her husband, she would be cursed by the angels. Abu Hurairah, may Allah be pleased with him, said, “The Messenger of Allah, peace and blessings be upon him, said ‘If a man calls his wife to his bed and she refuses and does not come, and he spends the night angry with her, the angels will curse her until morning.’” So, we can see that the Islamic view of (the relation between) a husband and wife is to safeguard one another’s chastity, by providing one another a legitimate means of satisfying the sexual urge. This protection of chastity is essential for the preservation of the family unit. If we have some conflict about these two - as I said, there's differences in the desired frequency of sexual contact, and here, Islam comes to say that a woman has to respond to her husband’s desire – so, you know, where is the equality with regards to this issue?

Waheed  1:10:31
Right. So how do you balance this Islamic perspective with the scientific perspective? 

Dr. Rana  1:10:36
Amazingly, science gives us a very logical answer for this issue. According to them, for sexual response, we have many models, but a recent model is what we call the “circular model of sexual response”. A woman’s sexual activity may commence for a variety of reasons, not merely, but including spontaneous sexual desire. And sexual activities may lead to increasing levels of physical and subjective arousal, which may trigger responsive sexual desires later. This model allows phases to overlap and emerge. So, the sexual response is not necessarily initiated by intrinsic physical sexual desire. So, a woman's sexual response is more based on a willingness to find or to be receptive to sexual stimuli. Desire is part of arousal, and arousal can occur before recognition of desire. So, just let yourself go, try not to resist, and try to enjoy the moment by itself. 

Waheed  1:11:51
Okay, and that's very interesting what you said about the woman's sexual activity, it can happen for so many reasons, and not just sexual desire, correct?

Dr. Rana  1:12:00
Yeah, because, at the beginning, when they described the sexual response, they said, we have to have desire, then, after the desire, arousal comes, then we have orgasm, then we have resolution. But from this perspective, it means that the female has to have desire to get excited and to get aroused, right? But when the “circular model” came and explained that we don't need to have desire at the beginning, what you need is to let yourself go and allow yourself to be responsive to the stimuli. So, arousability can be built up, and when the positive feelings come, maybe you can reach or you don't reach orgasm, regardless, but you have this sexual satisfaction, then the desire will come. And, for the next time, you feel that you have more desire. So, we need to go into it many times, like the circular model suggests, then we can, from time to time, break the cycle and have desire, arousability then orgasm, and the like. So, for the female, my advice is not to say “I don't have desire”, just let yourself enjoy the moment and enjoy the simulation. And here, I have to say to the husband, “Please, please, please make a lot of foreplay, touching, a lot of caressing and loving, and don’t just make it a goal to target sexual intercourse.”

Waheed  1:13:54
And then the last question that we would like to ask is, and this is a very common question that applies to both, opposite-sex attracted couples or same-sex attracted, it's all across the board. If there is a sex life that has been long lost in one's marriage, either due to pregnancy of the wife, or because the couple has been busy with their own careers, bringing up kids, whatever that may be, or they may have lost the desire throughout the years, their sex life is virtually either nonexistent or very limited. How would you recommend the couple, or what would you recommend the couple to do in order to revive their long-lost sex life?

Dr. Rana  1:14:42
A stressor that can particularly challenge a relationship is the loss of sexual functioning and possible reduction in sexual intimacy for couples who had an active sex life before. The loss of sexual functioning, the loss of the ability to have spontaneous intercourse or a decrease in sexual interest on the part of the patient have implications on both spouses. So, spouses may have a number of different reactions, ranging from feeling rejected and unattractive, to feeling relieved due to their lack of personal sexual desire or ability to function. So, how a couple redefines the way that they express affection and sexual intimacy in their relationship can be a significant challenge. Emotional challenges, particularly the stress imposed by the loss of sexual functioning, can compromise a relationships quality, if not handled effectively. And so, we have to be so attentive here. Communication again and again and again between partners is critical, to manage the stressor and maintain or improve the relationship quality.

Empirical research has suggested that the amount and quality of communication that couples engage in can influence both partners’ emotional distress and quality of life. Just to mention that not all communication is viewed or intended to be supportive or constructive. Relationship communication can also play an important role in how much sexual dysfunction affects marital quality. The “four horsemen” of any relationship: the first one is criticism, when one criticizes the other. Contempt is the second horseman, and this is when we communicate in a state where we are truly mean, we treat each other with disrespect, mock them with sarcasm and call them names or mimic them, or use body language, such as eye rolling, and this can happen too much between couples, where one of them struggles with sexual dysfunction or a sexual problem, because the other is using contempt as a defense mechanism. The third horseman is defensiveness, and it's typically a response to criticism. So, we start to be defensive in response to criticism; when we feel unjustly accused, we fish for excuses and play the innocent victim so that our partner will back off. Unfortunately, this strategy is almost never successful, our excuses just tell our partner that we don't take their concerns seriously, and that we don't take responsibility for our mistakes. And the fourth horseman is stonewalling, which is usually a response to contempt. Stonewalling occurs when the listener withdraws from the interaction, shuts down and simply stops responding to their partner. Here, rather than confronting the issues with their partner, people who stonewall can make evasive maneuvers such as tuning out, turning away, acting busy or engaging in obsessive and destructive behaviors. It takes time for the negativity created by the first three horsemen to become overwhelming enough that stonewalling becomes an understandable “out”. But when it does, it frequently becomes a bad habit. And, unfortunately, stonewalling itself isn't easy to stop, it is a result of feeling physiologically flawed. And, with time, this touchless life can lead to sexual aversion. We have to be open and to communicate, communicate our needs. Sometimes, we have to search for reason and what's happened inside. Sometimes, it depends on one’s body image. Sometimes, it depends on a psychological problem. So, we have to search for the etiology, what's happened in between, and try to tailor this kind of therapy for them. But when such things happen, don't hesitate to seek a couple’s therapist or sex therapist, because, sometimes, these couples’ issues, daily life and stressors can affect your sexual life, and we enter here into a vicious cycle. We must break the vicious cycle in a manner that can save our life. And when we say our life or our marital life, part of it is our sexual life. 

Waheed  1:20:25
OK. So, if I understand correctly, what you advocate for is to try and find the etiology, or the main reason, why there is an aversion or a decrease in sex, and then to maintain open communication, to be transparent, and to try to find a common solution, and to seek couple’s therapy or professional help, because that will help in the process, correct? 

Dr. Rana  1:20:46
Correct. Exactly, because if we don't face the problem, we cannot solve it. 

Waheed  1:21:01
And with this, we have come to the end of these two episodes on marital sex and intimacy. Dr. Rana Khaled was my co-host for these two episodes. I'm very, very thankful for all of your efforts, this has been a pleasure. I have learned so much, and I'm sure a lot of the listeners have learned and benefited from these two episodes. Jazakom Allah khairan, I really appreciate all of your efforts. 

Dr. Rana  1:21:22
You’re welcome, thank you for having me, it’s been my pleasure. 

Waheed  1:21:25
Thank you. If you have any questions or if you'd like to reach out to Dr. Rana, she is available through her Gmail account: “[email protected]”, or through her Twitter account: @drranakhaled. I will add all of her contact information, in addition to her private online clinic number (+1-403-4741829) in the episode transcript, which you can check on our website: awaybeyondtherainbow.buzzsprout.com.  

And with this, we have wrapped up our series on marriage, celibacy, as well as sex and intimacy. The next episode is going to be our last episode of season three, and joining me as a guest speaker is going to be Alan who is going to be sharing with us his story. As always, you can reach out to me on [email protected], and I'd be happy to read all of your emails, suggestions and comments anytime. Until next episode, stay safe and healthy. This has been Waheed Jensen on “A Way Beyond the Rainbow”, assalamu alaikom wa rahmatullahi ta’ala wa barakatuh.

Episode Introduction
On Improving Quantity and Quality of Sexual Relations
On Increasing Emotional Intimacy
On Increasing Desire
On Managing Sexual Problems on the Long Run
On Unconsummated Marriages
On Treating the Causes of Sexual Problems
On Marriage Between a Man and Woman with SSA
On Sex Education
On Spouses Struggling with Pornography and/or Masturbation
On Delayed Orgasm
On Sexual Fantasies
On “Sexual Desire-Timing Asynchronization”
On Restoring a Long-Lost Sex Life
Ending Remarks