Episode 110: Ergoerotics, Sex and Mobility

Suzanne Noble: I'm very excited to welcome our new sponsor, Higher Nature, who have created Rekindle, which I'm currently trying out and is working a treat. A 100% natural libido-enhancing supplement for women, which contains clinically backed ingredients to give your sex life a boost. And who doesn't want that? Hi, I'm Suzanne Noble, and you're listening to Sex Advice for Seniors. This week, I'm actually going to be talking about something that, believe it or not, we've never spoken about before on this podcast, which is the challenge that some people face— doesn't have to be older, but often I suspect is when they may have mobility issues that impact on how they are able to experience sex. And of course, I have to find the person that's the most expert in this, who's a woman called Heather Howard. She's a clinical sexologist. She's got her own company called Ergo Erotics, which basically says what it does on the tin, doesn't it? I love names like that. Welcome, Heather, to the program.

Thanks so much for having me, Suzanne, and it's a pleasure to meet you too.

And you. And so to explain to you a bit about what you do and how you do it.

Yes. Well, so I'll talk a little bit about Ergorotix, which, which you introduced right off the bat. And you mentioned when we were speaking, you know, prior to the conversation that it is a website, actually. So ergoerotix.com is a website and it's, it's intended for people to find pleasurable comfort.. And I have found— I was finding in my clinical work that there weren't great resources for adjustment. I couldn't find good models to show people. It didn't really seem appropriate for me to like get on the floor, get on the sofa in my practice and be doing positions with my clients. I've heard the same with, you know, from the physical therapy colleagues that I have too. And so I, I realized this was a missing area in the field and I wanted to create resources for people to use in their practices to demonstrate positions, positional adjustments, and also some educational courses, some video courses, because for people to be able to see how to do adjustments for themselves, and you know what, it really is a good jumping off point for conversations with partners and with medical providers. Many times, I know you and I were also talking about the fact that medical providers often don't bring up the topic of sexuality. So if we don't tell them it's important to them, then they may not know it's something we need help with, or we would like to discuss. So, I, I really wanted some good materials that would be excellent, you know, beginning conversations for people that they could take to their providers or use to talk to, to their partners as well, to figure out how they might be able to adjust and continue having pleasurable comfort throughout their lives.

And Typically, are your— I suspect there's no typical, but I'm just going to ask the question anyway. Are— what types of mobility issues are kind of the most common? And is it things that just suddenly happen or these are things that develop over time?

Really good question. So I actually targeted my video courses to the most common medical challenges, which are, you know, hip and knee pain, you know, which people might have if they've been athletes or, you know, just as we're getting older and we're wearing and tearing our joints. So hip and knee pain and surgery, also spine pain or back pain and surgery. I mean, those are, these are the most common issues that will affect the most people in the world and throughout their lives. And also I did a course on pelvic pain. Because that's an area that's, you know, it is incredibly common as well. It's not talked about enough, and there really aren't that many resources on adjusting sexually with pelvic pain too. So, so those are the things that I focused on because I figured they would reach the majority of people, will have one of those things, and that people really need accessible resources that are affordable too.

Yeah, absolutely. I mean, even people I know who are, as you say, they're, they're still mobile, but every once in a while something happens like they hurt their shoulder or, you know, or they get tennis elbow or something. And suddenly, like, getting on all fours isn't so much fun anymore for them. And that's right. You're a man and you're having to do that wonderful push-up position. And I don't even know how most guys actually do that for anything.

But Tom, at a certain age anyway, it's— these are muscles someone has to develop, you know, through their lives and keep conditioned for sure. Yeah, it's, it's, it is definitely a challenge. And yes, you're right, you know, sex, sex can be a cause of repetitive stress. So, this is why I was looking for how can people do the activities that they enjoy but without adding more stress to their joints. So, yeah, I really did focus on, on joint issues like hip and knee and back and as well as pelvic pain, which is not a joint issue. Person. But, but it is, it's just, again, it's just not addressed enough. And you're right, most people at some point in their lives will have an injury, be it temporary injury, they'll break something and they'll notice that, uh-oh, now I can't do the things I used to be able to do. I was rehabbing an ankle injury just over a year ago, and I have to say, I couldn't believe how many things it affected. It was my driving ankle. So You know, I was, I was really limited. Um, but, you know, people may take for granted— those of us who have good health may take that for granted. Um, and when something changes, it, it actually can be really debilitating psychologically. Um, so having— knowing that there are options can give people hope and give them— people may need like a path for the adjustment, just an idea of how to do it. And so even if someone doesn't have one of these particular health problems. Also, this information can be useful for getting a model for adjusting and again talking about sexuality.

Yeah, and I suspect the other thing, you know, that I've certainly seen is that if you've got health issues like MS, for instance, there's just stuff around your energy levels, right? So certain positions are much more active than other positions, and that's right, there's ways of, of maintaining your energy level without becoming completely exhausted. And I know that in a prior relationship, that was something that you said it would be like, oh, I'm too tired. I'm so tired. Or I've just got so hot all of a sudden.

I gotta stop. I gotta stop.

Right?

Right. Right. I mean, these are all such good points. You know, as you say, like people have a hard time sustaining energy, especially when they're sick or when they have a health condition that may affect energy. I have a lot of like chronic COVID. Clients who are like living with Long COVID that find that their energy levels fluctuate. And so, giving people options for when they might still be interested, but it feels like way too big a threshold to be sexual if they did it in the way they used to, or they're used to doing it. So, having some modifications can be helpful. And I also want to add— oh, sorry. I wanted to add also that it's often, I'm not just seeing one person in a partnership having a health problem. You know, typically what the fun puzzles for me are when, You know, people come in with their list of health problems for each partner involved. And, you know, and I guess this is for partnered people, certainly. But, you know, it's like, well, I've had, you know, knee surgery on this side and then hip surgery on this side, and then I have a back injury, and my partner, you know, has erectile difficulty and has like, you know, so I get the list. So my partner also had knee surgery, but on the other side. And so that's the fun part, is dealing with real people and real challenges and trying to figure out how do How do we get all the information, not just what's happening with your body, but what do you prefer? You know, because it may be that it's physiologically possible to do something, but I may not like that. Or I might find that, and this is what I learned from a lot of people, it really doing things as a workshop where we're collaborative is important because a lot of people feel like, okay, well, you've given me this position, but I prefer face-to-face with my partner, for instance, because I want to see them and that's part of my intimacy. And so even though my, it might be better for my body to do a facing away position, that's not, you know, that misses the whole point of this activity for me. Or, you know, I prefer the pleasure from facing away. So you might have given me like a face-to-face or a side position, but I'm not getting stimulated in the same place, the same way. So it's really fun to work with real humans and figure out all of those factors.

Yeah, I mean, that was the thing that sprung to mind is that we were, we're creatures of habit. And, you know, I suspect for most of us, you find what feels good and you just keep doing it. And then, you know, as you get older, maybe you switch it up a little bit because you need to do something different because what felt good before doesn't feel so good anymore or, or whatever. But if you've been indoctrinated into a certain way of doing things and suddenly that's taken away from you, I can appreciate that not only is this a physical issue, this is also a real psychological issue. I mean, how many people come to you and just are like, I don't even know, can we do this anymore? You know, what's, what's possible? Because as you said, if they come with a long list of problems, that, that feels like a significant hurdle to try and overcome.

Yes. And, and someone may feel like they'd have to have a lot of desire and a lot of motivation to be willing to overcome the roadblocks or the challenges. So, really, when I'm working with couples, it's figuring out where does your motivation come from too. And that is a psychological factor. You know, where's the psychological motivation coming from? Also, what are the medications you're taking that might affect motivation? Or, you know, so we're looking at all of those variables and figuring out how do we, if this is something that you still want in your life, or your partner still wants, and you're on the fence, right? How do we, how do we help you to tip those scales scales so that— this may be something you talked about in other shows, right? But really looking at the scales of desire of the gas pedal and the brake pedal, how do we get you to the point where the brakes don't feel like they're, you know, there's so many brake pedals being pressed all the time that you can actually access the gas pedal or, you know, that it's effective when you press the gas pedal and you're not over— right, you're not overwhelmed by the brakes. But it is a challenge for sure.

Yeah, I mean, look, I know someone who was recent— well, he had a massive heart attack and unfortunately he wasn't able to be seen in time. And as a result of that, he's now a paraplegic, right? In his 50s. And I, you know, I can appreciate that that must be I mean, I've never spoken to him about this because honestly, it feels really too sensitive a topic for even as a good friend for me to bring up with him because having that kind of being, being a virile man with all the equipment working and then suddenly nothing. How do you deal with that?

Well, when you say suddenly nothing, you know, I think it would— without talking to that individual, it's hard to know what is functioning. Yeah, but one of the things that I, I have found in my career and learned also when I've talked to people who have had that kind of, uh, that kind of physical debilitation is that sexual function is typically going to be a function of the agility of the mind. You know, I have found people who are perfectly able-bodied and who can't— who do not have flexibility in their minds. There's only one way that sex can look. There's only one way they can interact with partners, and they are— they can be the most debilitated. Whereas I've had clients, and I have known people as well, who may have much less physical capacity, but they're mentally flexible. And often when someone does have an injury, they have to learn to, they have to relearn everything and they may actually become more mentally flexible. And they may be able to find new ways to do things where their minds are what are going to enable the possibilities. That's not to discount what someone's living with physiologically or physically. I would never discount that. But I think it is important to recognize that You know, sometimes when we're faced with the biggest limitations or the biggest challenges is when we have to learn to rethink all of the things we took for granted before. And we may actually have more flexibility of our minds then. And this is where, you know, something like, you know, erotic hypnosis could be effective. You know, someone could really turn a partner on or be turned on by what goes on in their minds. The mind is the most— the mind and the skin are the most powerful sex organs, you know. And so typically, if we have sensation anywhere in our bodies and we have a mind that works, it's amazing what can happen. But I do understand that it can be a sensitive topic, especially with a friend. We don't know what's an appropriate question to ask, even though this is your area of interest, right?

Yeah, yeah, yeah. And I think, you know, I've spoken— it's interesting when I look at the differences in how genders seem to approach the topic. And I don't know if you agree with this, but I You know, I meet a lot of women that, that during the menopause, their libido's dropped off a cliff. They don't— they find it very difficult to get aroused. And they, as a result of that, they just kind of park the idea of having sex, right?

They're just—

or as you've discussed, they have pelvic pain, they have some sort of pain. So they start associating sex with pain. And honestly, nobody wants painful sex, right?

And that is a really common, you know, symptom of the genital urinary syndrome of menopause. You know, that's what happens. You know, our bodies change. Yep, go on.

But then on the flip side of that, you know, I, I, I see men who are also struggling with, you know, some form of erectile dysfunction. And, you know, and for them, my experience has been that, you know, firstly, they go off and get the blue pill, right? Because it's seen as kind of quite an acceptable thing to do. And the second thing is that they may get really good at oral sex, or so But it seems like from the men that I've known and spoken to, that sex is so much more important for them that the whole idea of parking it feels pretty humongous. Whereas for a lot of women I know, it's— it doesn't have the same degree of, of like, you know, urgency or It's, it's not necessarily a requirement in their lives. Whereas, you know, for me, when men— when things happen to men, whether it's a terrible accident and they suddenly lose the ability to feel anything below their waist, or they have their prostate removed and they're no longer able to get an erection or something, it seems like they, they still want to try something. It's just that they're on this journey of like I'm, I'm not sure what to do here with this.

I mean, I think it will depend on the individual where their motivation is coming from. You know, for some people, they still have interest, they still, you know, they're, they still want to connect with either, you know, and it depends on what they're interested to do, right? Is it to connect with someone? Is it to be close? Is it to feel desirable? And but for a lot of people, sex is tied in with their identity. And so, you know, it may be difficult to think of oneself as a whole person. And, you know, I'm putting air quotes here for those who can't see me. You know, this, this idea of like what it means to be complete or, you know, or a healthy person, for some people that, that seems inseparable from sexuality. You know, we're all, we're all sexual beings, we all have that capacity. But But I think it will depend on the individual where their motivation comes from. And it can be really debilitating for people for whom, you know, sex is such an important component to their identity, and they have a very narrow view of what sex is. And, you know, so that, that where— that's where a lot of the work may be done in the psychosocial, you know, on the psychosocial side. Um, I would, you know, certainly people, you know, uh, people have ovaries. Will have so much of their, so much of their changes in life will be dependent on biological changes. And so the major, major landmarks in life will be, you know, really clear because of the changes. Whereas for people who don't have ovaries, the changes are not quite as distinct, you know, with, you know, they don't have necessarily that drop-off, the way that someone, you know, with estrogen levels, the way that someone with ovaries will. So, um, so it is— you're right that you'll really see some major changes. And, and you're right, I do see people coming to me who have had that change. And again, with the genitourinary syndrome of menopause, they will have physiological changes where their tissue changes. They may be more susceptible to infections because, you know, they don't their hormones have changed and their entire environment's changed in the vagina and around the urethra. You know, the tissue is thinning, they don't have as much protection from infection. So, I'll notice those on the physiological side, but also, yes, hormones change the way we experience everything in our lives, right? The sensation changes, our arousal changes, our— what we're motivated to do changes. And often I'll, I'll find people who have had those changes, and they come to me because they want to want, you know, so there are a lot of people that are very suited for, you know, whose identities might be again tied into sex. I see myself as someone who has sex in my life, even though I don't feel that motivation anymore. And that's not to say everyone's that way. You know, quite often, people in menopause feel much freer to be sexual and not worry about things like conception. And, but, but yes, I will see, you know, I will see differences, often, you know, general differences in genders. And an identity is a big part of it. But I will also say that in my practice, I do have a lot of heterosexual couples, whereas actually the person, the vulva owner, who has a much higher drive than the penis owner. So it is interesting how that happens too. Um, yeah, yeah. You know, because again, the way that a sexual relationship will work out and the way desire works will be a function of the relative difference of the partners. So, you know, if the person's the one with the higher drive, regardless of their gender, um, you know, they may find themselves feeling frustrated and thinking about sex way more because they're, they're feeling unmet., and then the partner with a relatively lower drive will be feeling, you know, not great about themselves. They'll be pressuring themselves or feeling pressure, and that of course will lower their drive even further. And it doesn't actually matter. The gender doesn't matter there. It's really a— it's a function of dynamic.

Yeah, I think absolutely. You're— and what I'm hearing, and I agree with you, is how much your identity is tied up with sex, right? How, how much you consider yourself to be a sexual person and how important that is to you. And, you know, I've said before, in this that I definitely experienced my libido going off a cliff, and I made a very intentional decision to remain sexually active and to figure out what that was going to look like at this stage of my life, having not had the same libido, the same desire, and just went, but I just really like it. I remember, like, you know, I've always really liked it. So, and it's always been something that I find really fun and relaxing and all of that, and I just didn't want to let it go. So I had to reevaluate how I went about, you know, being this older woman with a different kind of sex drive. And I'm curious to know, just on, on a very practical level, what are some of the positions if, for instance, you have a hip replacement, as I know a friend of mine's partner recently had? So if she's listening, this one's for you. What are some of the positions for someone who's recently had a hip replacement?

Yes, so it will depend on the approach of the hip replacement and what restrictions the surgeon would give. But typically one of the things that we'll avoid would be bringing the knee too close to the chest. So beyond, less than 90 degrees from the chest, and rotation. So, um, I'm, I, I'm just like, in this moment, I'm not even envisioning, uh, what, what I would say. So facing away positions can be really helpful for someone in that case, um, because they wouldn't, um— so let me just think. One of the easiest ones might be if someone's lying on their stomach with a nice cushion under, under the stomach, um, so so they're not moving too much and having the partner come in from behind. So a facing away position can be a really helpful one. Also, it might be a standing position with— I mean, I'm trying to figure out how to best describe it. So like a standing position leaning on a high kitchen counter, like, right? So they're— so someone's not bending over beyond 90 degrees, but leaning on a high kitchen counter And so that could be a good one also with someone coming from behind. Again, these are some of the easiest ones to describe, and the partner with the longer legs might actually have the wider stance. So if the partner from behind— so, and this is penetrative sex only, by the way, you know, and I will just say, one of the things that I think is really important to normalize is that sex doesn't have to be penetrative at all, and it doesn't even have to include genitals. But for those people who are trying to do penetrative sex, you know, certainly the partner with the vulva is going to have way more restrictions, you know, when it comes to trying to achieve penetrative sex as the receptive partner, I should say. Well, I would say the receptive partner, they— it could be also anal sex, you know, but so certainly, often there's more of a crouching position, more of a bending position for that partner. And so figuring out how to not crouch or bend in that way is going to be important. So this is where facing away can give someone a lot more ability to protect that bend.

So what about spooning?

Spooning certainly can work. And you know, when we think of transfer techniques as well, getting into that spooning position, often they will have been taught that already by their physical therapist.

Yeah.

The challenge with the spooning is again, to achieve the penetration for the receptive partner, they may find that they want to bring their knees up to their chest a bit more or crouch in order to, in order to have that penetration. So that's one thing to really watch out for. A way to achieve a lying down position could be that the partner with the penis, if this is again a heterosexual couple, or an, or even if it's just a partner, even if it's a homosexual couple with a receptive anal partner, Yeah, you would be thinking about the person with the appendage or penis. Think of them as being on this, lying on their side.

Yeah.

And the partner who's receptive can roll onto their back. So it's a perpendicular position.

Oh, yes.

With their legs over their, their partner. And so that can give them some good support. The challenge there again is not bringing the knees too close to the chest. So, um, it, it would depend on how far after the surgery they're, you know, they're trying this. Also how much they've stabilized in physical therapy. Um, but I— so, you know, and also how comfortable they are with even being sexual. Um, you know, but, but the body heals over time, but there may still be some restrictions. That they would need to keep in mind over time. Yeah, but, but so spooning can work, but it will really depend on, um, you know, again, being able to insert in that position, um, because often people would want to move into more of a couch. That's why the side and the leg over thing makes sense, because, yeah, um, right, so rolling onto one's back with knees over the partner, the legs can be a little bit straighter, but again, there may be a tendency to Bend the knees up. So, yeah, I mean, it's funny, even though I do this all the time, I use, I use my Ergorotics, you know, I have a video library that I created because I can't remember everything at all times. And actually, when I go through the positions with partners, we do this collaboratively so that we're looking together. How would you feel about that? So here's one that I think could work for your body. But I don't know if it will work for you and what you enjoy. So we do this all together. So I'm really just thinking like individual by individual, how do we put this, you know, you're going to give me all of your preferences, all of your limitations, what you're hoping to achieve, and then I'm going to like put it through my computer of my brain and then come out with, you know, what I kick out may not be something you'll like. So let's talk it through. But so I'll give usually a number of suggestions until we figure it out.

But, you know, quite fun and quite—

it is fun. And, you know, it's been really great since, since I do everything online now over video chat, I can work with people anywhere in the world. And, you know, I use education, I'm not a therapist, I'm a— I use education for my work, my, you know, my PhD is in human sexuality, not psychology. So the great thing is I can work with people anywhere. So I get to work with them in their space. So they can take me into their living room or into their bedroom or wherever they like to be sexual, into their special playroom. And I can see the ergonomics of that space and even do dress rehearsals with them to figure out, well, how will we make this work? And let's bring that cushion over there and let's see if you can get aligned better in that way. And so it's really fun because I get to see them in their environment. And that was like a— like this breakthrough aha moment I had with some clients that I saw in my clinic. And, you know, in, um, prior to the pandemic, um, they did a video chat session because they couldn't make it to my office that day. And we were doing ergonomics that day, and I got to their space, which changed everything because they had this— they were sexual on a futon. That was their playroom. And what they realized is something wasn't working for them, and the futon was leaning a little bit in one direction. So I looked, I saw that, I'm like, why don't you just rotate, you know, 180 degrees? Let's see how that works. And it changed everything. They could move it better. So it was just a really fun puzzle and such an easy tweak. And what people will find when they're traveling in their hotel rooms too, if they're on the different side of the bed or it's a different movement to the bed or the bed height's different, it may change things. And so they're going to need to be creative and figure out what they can do to modify. But these are the fun things. Yeah.

Yeah, super fun. And also I wondered about bringing in— I bought myself this little kind of blow-up wedge cushion. Which is quite a useful thing to have. Just raise it.

They're wonderful.

Actually, it's, you know, it was like $10, really cheap, really just kind of just a useful thing to have. I've seen lots of furniture that has got wedges and does all sorts of stuff like that. And of course there's always toys, which, you know, can fill in the blanks when you can't, when you can't reach the areas that you need to reach. Do you include all of that?

Or if it just feels better too.

Or it just feels better.

Absolutely right. So ergonomics is, is the adjustment of the environment to fit the needs of the people involved, you know. And I think the goal of that for sexual ergonomics is for sustainable pleasure. And so it would mean adjusting the location, it could mean adjusting the environment by, by cushions, by furniture, you know, it could also mean changing the type of stimulation that we're doing. You know, or changing the activity altogether. So you named it. I mean, it's adjusting any and all of those things to figure out what's best for these people involved.

Awesome. It sounds amazing. Yeah.

Well, it's fun because Ergorotics assessments often— for some couples, I'll be seeing them a little bit longer, right? They're working for a challenge that could take a while. When it's focused on ergonomics, you know, I can do an Ergorotics assessment, which is of course my name for erotic ergonomics, in you know, in a couple sessions. I can do one session and maybe a follow-up to see how it works, see if we have to do any tweaks. So those are kind of fun because they're just puzzles to solve. Some people will want to work with me a little longer if other challenges come up, or, um, but you know, sometimes really it will be a one session or one session and a follow-up kind of thing where it's just like I got to do a puzzle for the day and it was an amazing fun puzzle, and people leave and they have like 2 or 3 options to go and they're excited. Yeah. So, but sometimes that's all that someone needs. Other times, there's more complexity where they also need to address, as you say, like the mental adjustment or the first option doesn't work for them.

Yeah.

You know, it's a suggestion but doesn't always work out the first time.

Makes sense.

Yeah.

How can people find you then? Where are you based?

Well, I'm based in the US, in, in the Bay Area near San Francisco. My office is in San Francisco, but I'm totally online now, so I'm wherever I am. And so people can contact me, the Ergoerotix website, ergoerotix.com, and you'll probably put that on your information. Or they can just find me through heatherhoward.com. And that is my clinical website. And they're welcome to contact me and let me know what time zone they're in. That's helpful. You know, what their time zone is. And then, we'll try to work on scheduling a session. But it's, you know, and letting me know what they envision. So, they don't have to give me too much information, but basically, I wanted to work just on ergonomics or if there's a different challenge where, we may be looking for more time slots. But typically, we'll just get someone in for a first session, see how we can help and clarify goals. Everything is— with sex counseling, everything is goal-oriented. You know, it's intended to help people get to function, giving them practical strategies and skills training. So, you know, again, I don't, I don't see that many people for a long period of time. Although for some people, the psychosocial aspects are more of a factor, and I might see them for longer.

Anyway, it's been delightful to speak with you.

Delightful to speak with you too.

And have a lovely, lovely day out in the Bay Area. It's great.

Have a wonderful evening in the UK.

It's great here.

Bye. Thank you so much for having me, Suzanne Noble. Thanks. Bye.