Ian Kerner: Sex Scripts & She Comes First

Ian Kerner is a licensed psychotherapist, sex and relationship specialist, and New York Times best-selling author who works with individuals and couples on a range of relational issues that often lead to distress.

Ian Kerner: Sex Scripts & She Comes First Introduction

Our programme, Unstress, is all about understanding and managing stress, and in life, I believe that our sexual lives have a particular impact on our lives in both positive and negative ways. from an early age all the way through life.

Today I spoke to Ian Kerner. Ian is a licensed psychotherapist who works individuals and couples on a range of relational issues that often lead to distress. He approaches psychotherapy from an integrative perspective, which seeks to explain human behavior by bringing together physiological, affective, cognitive-behavioral, neurobiological and systemic approaches as they apply to the natural stages of human development and the wide range of human functioning.

Ian endeavors to create an atmosphere of inquisitive reflection, along with a sense of emotional safety and commitment to the therapist-patient bond. Join us today as Ian shares his unique and indispensable methodology used to help thousands of couples get unstuck and into sexual sync.

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] Hello and welcome to Unstress. My name is Dr Ron Ehrlich. I’d like to acknowledge the traditional custodians of the land on which I’m recording this podcast, the Gadigal People of the Eora Nation, and pay my respects to their Elders – past, present, and emerging. 

Dr Ron Ehrlich: [00:00:20] Well, our programme Unstress is all about understanding stress, and in life, I think that part of our life, our sexual life, our sex life has a particular impact on our lives in a positive and a negative way. From a very young age, right through life. Well, my guest today is Ian Kerner. Now, Ian is a licenced psychotherapist, nationally recognised a less sexuality counsellor who specialises in sex therapies, couples therapies and working with individuals on a range of relational issues that often lead to distress. 

As Ian shares with us on this podcast, his own experience led him into this area, and he has written some amazing books, starting with a book called She Comes First, and he’s written, I think we have now about 12 or 13 books. And they are some they really are fantastic books. She comes first. He comes first. Date Scene Investigation, Passionist ,Sex Detox, Love in the Time of Colic, The New Parents Guide to Getting It On Again and his latest book. 

So tell me about the last time you had sex. It’s a wonderful conversation. I know that in my own life, in my own relationship, my wife and I have known each other for 42 years, have worked our way through a couple of these books. And it has been like having the psychotherapist in at home with us and then these framework for a wonderful conversations that have been extremely positive experience for us both. I hope you enjoy this conversation I had with Ian Kerner. Welcome to the show Ian.

Ian Kerner: [00:02:06] Hello, Dr. Ron. It’s nice to see you. 

Dr Ron Ehrlich: [00:02:10] Nice to see you, too, Ian. I have been and my wife huge fans of your books. Well, at least three of them. And the latest book you’ve written has a very catchy title. So tell me about the last time you had sex. That’s actually not my first question to you. Well, but you talk in the book about a sex script. What is the sex script? What are some of the components of a sex script? 

Ian Kerner: [00:02:37] Sure. So, you know, let me just back up a little bit, Ron, which is to say that the book and its title truly come from how I work with couples in the room and couples come in to see me. They often have a variety of different sexual problems, such as desire issues, arousal issues, sexual function issues. And it’s a little like having a toothache. By the time they arrive, they’re really in pain, and they just want to get the tooth and pain out of the way. So I’ve kind of developed, I guess, a kind of solutions oriented way of working where I really like to look at sex in action. 

Right. So that question really leads a patient or a couple to describe their most recent sexual event. And I really listen to it as though it were a script, as though I’m hearing a sequence of events that come together to create an event in my mind. And so a sex script is literally what unfolds during a sexual event. How did a couple initiate? When and where did it begin? Did it begin from a place of passion, from a percolating warmth? Did it kind of have a cold start? How did a couple generate arousal with their bodies, with their minds? What was off limits? Who had orgasms? Who didn’t? 

What happened in the moments following sex? What is life like in between sexual events? So, you know, I’m not just listening for the physical sequence of actions. I’m also listening to what’s happening emotionally and psychologically. So all of that sort of constitutes what I call the sex script. And once I have a sense of the sex script, I can really understand where issues might be coming up, how to rewrite or edit the sex script, so to speak, to kind of get on the other side of an issue. So it’s kind of just a lens in a way of working. 

Dr Ron Ehrlich: [00:04:42] So interesting because, well, listening to our patients is a message that I got to very early on in my career of chronic pain treatment. And my mentor said to me if you listen to your patients, they’ll often not only tell you what’s wrong with them, but they’ll tell you how to fix it. And I imagine you must see a lot of that as you as it unfolds. But you also introduce me now. We’ve heard about procreation, recreation, relational sex. But you’ve introduced this me to this term, at least about Rick relational sex. Could you explain that? Yeah.

Ian Kerner: [00:05:18] Yeah. Well, certainly, as you identified, I think there’s sort of three primary categories of sex. One is procreative. And sometimes my patients are coming in wanting to work on procreative sex, especially if they’re working on fertility issues or whatnot. But generally, the couples that I’m working with are kind of in what I’d call sort of just a relational pocket right there. They’re having sex. That’s hopefully connecting. 

Maybe they think of it as love may gain and that some sex usually is part of a monogamous, long term relationship. What’s often lacking when I’m talking to couples, what’s often lacking in their sex scripts, is a recreational element, right? Something that’s adventurous, new novel, fun, psychological. So their sex scripts have kind of become reduced to a series of events, a series of actions, a series of physical actions that, you know, usually get pretty quickly to intercourse. 

And so a lot of couples arrive, they’re bored, they’re feeling disconnected. The sex script isn’t working. And so, very often, what they need is more psychological arousal, more of the recreational. So that’s kind of where I’m looking at recreational sex, you know, holding on to the relational aspects and the connexion and what’s working, but really trying to layer on top some fun and the recreational.

Dr Ron Ehrlich: [00:06:50] Because I know one of the interesting things you talk about in the book is that in heterosexual couples, there’s something like 85 or 90% of interaction sexually in end in intercourse, but yet in gay couples. Also, that figure is something like 35%. And I think maybe we have a lot to learn from our gay friends. 

Ian Kerner: [00:07:14] Yeah. No, it’s absolutely fascinating. And it’s funny. Yesterday I was working with a couple, and their six sex script is literally just intercourse has a lot to do with dynamics and how she feels about sex and wanting to get it over with. But then, literally, he’s a suspected to arrive in a state of arousal, and the sex script is just a few different intercourse based positions. And you know, that’s an extreme example.

But yes, to your point, generally, heterosexual couples come in, and I ask them to tell me about the last time they had sex. I would say close to 100% will mention intercourse and will have gotten to intercourse quite quickly, within, within, often just a few minutes. And yeah, to your point in a study that looked at 25,000 gay and bisexual men in their most recent sexual event, only 35% had intercourse. 

So 65% were doing something completely different all together. And what they were actually doing was really building sex scripts that are outer core specs, right? All the things like kissing and touching and hugging and manual stimulation and oral stimulation and rubbing up against each other. And to me, what’s amazing is there were about ten outer course behaviours that were engaged in, but in this study, they were pulled together in 1300 different combinations. So that’s ten behaviours leading to 1300 different sex scripts, so to speak.

Dr Ron Ehrlich: [00:08:50] Yeah, yeah. Well, you know, I think most people are familiar with the terms foreplay and intercourse. You’ve just used the word outer course. And there’s another term you use called Coldplay, you know. Yeah. Tell us about Coldplay and out. Of course, you mentioned it quickly. People may have missed it. I want to come back to that.

Ian Kerner: [00:09:11] Yeah. And this really comes back to, you know, a little bit of a philosophical and even political point maybe, and goes back to my own roots and becoming a sex therapist, which is, you know, growing up as a young man really in the late 1970s, but mainly the 1980s and coming of age sexually, I had some pretty basic sexual problems. I suffered from early ejaculation. I suffered from erectile unpredictability as a result of my anxiety and nowhere was able to find any real guidance or help. So eventually, I kind of had to figure it out for myself and, you know, read folks like Masters and Johnson. And what I really learnt was that for my female partners who I really wanted to connect with and I was quite depressed and disconnected at the time. 

I really learnt about the role of the clitoris and female sexual function and that women really don’t experience that much pleasure from intercourse that most of the sensitive nerves that really contribute to the male pleasure and the orgasm are located on the surface of the vulva. And yes, the clitoris also has internal structures that do wrap around just the entrance to the vagina that can be stimulated via vibration. 

You know, but long story short, even if I could figure out my problem and last as long as I like and have whatever kind of erection I want to have, that didn’t mean that my partner would be experiencing pleasure. And so I really feel that we need to move out of what I call the intercourse discourse and thinking of sex purely through the lens of intercourse and all of the pressures and expectations that are wrapped up in intercourse, you know, for men, am I going to be erect enough? 

Am I going to last long enough? Is my penis the right size for women? Am I going to be able to have an orgasm? Am I going to be able to experience any arousal or pleasure? So I really think that if we shift from intercourse, I’m not saying forget about intercourse, but I’m saying really just think of intercourse as what it is, which is just one behaviour which is basically a penis in a vagina or in the case of a gay man, a penis in an anus, and to really consider all of the other behaviours that aren’t intercourse. 

So that’s, that’s really the term outer course. Now I guess traditionally, we would think of that as foreplay. Right. But then that is just by saying foreplay, it’s really privileging intercourse. Again, it’s everything that leads up to intercourse. I want a model where we can engage in everything and pull together sex scripts however we want. 

So that’s why I sort of think of foreplay more as a core play, especially since those are the activities that, at least for heterosexual couples and for gay couples, are most likely to generate mutual pleasure. You know, statistics show that with intercourse alone, 80% of women are not orgasmic, whereas with outer course and with foreplay and shifting that you really reduce that orgasm gap quite significantly. 

Dr Ron Ehrlich: [00:12:38] Hmm. Well, I mean, you know, you share your own personal experience, and I imagine it’s I can say it’s not an uncommon one. And I can relate, I can absolutely relate to. But you’ve gone off and done a PhD. You’re a psychotherapist. You’ve written eight, nine, ten and 11 books. 

I think there are, you know, you’ve really reacted to that in a very positive way. And, you know, as a reader of your book, I have to say thank you. But you also talk in your book she comes first about the difference between spontaneous and around and responsive arousal. And I think this comes to the core of what you’ve been talking, you know, what we started to talk about. Can you explain those differences?

Ian Kerner: [00:13:20] Sure. So, one, I think what you’re really getting at is that you know, one of the major problems that couples deal with is mismatched libidos and sort of falling into sex. Right. And if we’re looking at heterosexual couples, let’s just say very often, I’m not trying to stereotype, but very often you’ll have a male partner who experiences what would be called spontaneous desire, meaning that, you know, while I’m in a spontaneous desire framework, right. Like, I see my wife, and she looks cute coming out of the shower, and, you know, that single sexual cue kind of gets metabolised in my body. 

And I feel there’s a little bit of an urge for. Right. So that spontaneous desire. That’s why we say, oh, men are. Thinking about sex all the time or what have you. It’s sort of the way we’re wired to kind of gobble up these sexual cues very quickly and want to act on them in the beginning of a relationship. What’s interesting is very often that, spontaneous desire can be mirrored back to us by our female partners. And so it feels like we both have spontaneous desire in the beginning of a relationship. 

But as the relationship starts to unfold, what a lot of research points to is that women actually fall into a different desire framework, which would be called a responsive desire or framework, meaning that desire isn’t spontaneous. It’s not the first thing that you feel that sort of launches, launches you often. It’s more like the third or the fourth thing, and desire has to emerge. It’s responsive.

And what is it responding to? Well, it’s responding to a simmering a percolation of arousal. It’s not responding to just a single sexual cue. My wife might see me come out of the shower and say, well, you’re he’s not bad. He’s kind of sexy. But that isn’t necessarily going to lead her to want to have sex with me. When you’re in a responsive desire framework, you’re also much more vulnerable to external stressors and environmental stressors for a guy in a spontaneous desire framework. 

You know, his smoke alarm might be going off, and he may say to him so bad, don’t worry, it’s not going to be a fire. It’s just something a little smoke, right? Like we can totally like tune out the stressors. But I think that, you know, women tend to be in different desire frameworks and are much more sensitive to the stressors, and there is far fewer excitons.

 And so that’s where that sort of desire discrepancy starts to happen. It’s not that one partner’s just high desire and the other partners low desire, it’s that you’re actually in different desire frameworks, and you have to think about how to create an overlap. And that’s a lot of the work that I do with patients is creating a shared desire frame. 

Dr Ron Ehrlich: [00:16:25] And does that speak to just the difference between male and female sexuality? 

Ian Kerner: [00:16:30] How do you mean? Does that speak to well?

Dr Ron Ehrlich: [00:16:32] Well, males are more in tune to the spontaneous spontaneity of it. And, you know, particularly, you’ve mentioned heterosexual couples and 100% of the men in intercourse, whereas that doesn’t necessarily satisfy the woman. So our sexual asexuality is very different. Or is that uncommon?

Ian Kerner: [00:16:54] It’s interesting. What? No, no. I mean, I think, you know, I mean, part of the reason I love my work and I’ve been doing it for so long is that there’s such variability, and everything does happen across the spectrum. I can just as likely be working with a woman who may be the one who is experiencing spontaneous desire, and her male partner has low desire. 

I mean, sexuality is informed by so many different lenses that the biological and the physical, the medications we take, the lifestyles we lead psychologically, how we view ourselves and see ourselves psychologically, socially, how we view sex, whether we’re sex positive or sex negative, whether we experience shame relationally, how we feel about our partners, how we trust our partners, how we create safety and fun with our partners. So sex is so multi determined. 

But yes, if we were looking broadly if I had to, you know, wager on a couple sitting in front of me, a heterosexual company a couple, and they’re in a there’s a libido gap. If I had to wager, I would say, well, the guys in a spontaneous desire framework and the woman’s in a responsive desire framework. And what does that mean? This is just what I saw yesterday with a couple. He’s thinking to himself, I’m interested in sex. I’m a sexual partner. I see my wife, and I want sex. Why isn’t she interested in it? She must not be sex on him. 

Where? She must not be a sexual person. Why am I always the one that has to initiate? Why can’t I be desired? Right? When you’re in a spontaneous desire framework, and you’re partners in mirroring that back, there’s a whole set of expectations that come into play for a responsive desire partner. She might be saying to herself, You know, why is it always sex, sex, sex? Like, what’s his deal? Why isn’t there any environment or context or romance or, you know, why aren’t why isn’t he helping collaborate around reducing these stressors? Why does everything just come back to sex? Right. So there’s just all these internalised expectations that kind of get muddled up and kind of need to be kind of clear.

Dr Ron Ehrlich: [00:19:14] Hmm. I mean, you know, what fascinates me about this is we start as sexual beings, you know, at various points in our lives early. Early on, we discover our sexuality, and then we meet another person, and those two experiences come together, and they could be very different. I mean, discovering sexuality. I know in the book in your book, the latest book, you ask what was the sex model you grew up with? And that must inform so much of our journey.

Ian Kerner: [00:19:47] Sure. I mean, especially at least here in the United States, I imagine that’s somewhat similar in Australia. Sex is just something that doesn’t get talked about. It’s expected to be sort of just assumed and are expected to just sort of have this organic chemistry. I can’t think of any other aspect in relationships where you’re just supposed to be able to do it perfectly without any kind of communication, any other kind of activity. And so, why aren’t we talking about sex the way we might talk about putting together a shopping list? And I think that that has to do with just the shame that sex is shrouded by and how so many of us grew up in homes where we were getting sex negative messages. So, you know, don’t wear that. It’s too sexual. Don’t have sex before marriage. Don’t touch yourself. 

Don’t you know, don’t masturbate. There’s just so many don’ts and wrongs that we internalise that no wonder we’re completely anxious about sex and can’t talk about it. And I was that guy, so I know it. You know, I lived through that, you know, having a real problem that I probably could have really gotten on the other side of sooner if I just had the vulnerability and courage to talk about it with partners and figure out a solution together.

Dr Ron Ehrlich: [00:21:12] I mean, the question am I normal emerges very early on in a person’s life as they discover these things, particularly if they’re not talked about. What are some of the common myths, beliefs, beliefs or myths, beliefs that you confront in your practise? 

Ian Kerner: [00:21:28] Well, I think people have, you know, different beliefs about sex all the time. I mean, I think, you know, when I’m looking at male sexuality, there’s there is a belief, oh, men should be these spontaneous desire machines. Men should get erections immediately. Men should sustain those erections, you know. For women now, sex comes with some pain. Oh, sex. 

Some for women, partnered sex doesn’t always involve orgasm, so our orgasms aren’t as necessary to women as they are to men. I mean, I think you can start to look at almost, you know, any, any behaviour where engaging in and oral sex men don’t like giving that they don’t like the taste the smell they get bored. I mean, almost anything, if you’re not talking about it, leads to some kind of misunderstanding and belief, you know. 

A good example would be, you know, I’ve worked with heterosexual couples. They’ll come in, and they haven’t really had much sex in the last ten years. And he’ll be saying, well, it’s a desire thing, you know, and she feels undesired, unattractive, and he’s like, No, no, it’s not her. It’s like, I don’t know what it is work. My testosterone levels are just stress, my history, maybe some kind of trauma that I don’t remember. And you know what? In so many cases, that guy actually feels tremendous desire for his wife. 

That guy is turned on all the time, but he has anxiety around performing, and he’s so afraid of his inability to have an erection. That is, he’s hiding behind a desire issue, and he’s making her feel confused and unattractive, and they’re not sexually connecting, you know. So I just think that if we’re not talking about sex, if we’re not being honest about it, we just jump to all sorts of conclusions about what’s going on.

Dr Ron Ehrlich: [00:23:34] I mean, I think this is what I love about your book saying is it’s actually it’s like having a psychotherapist in the room with you, which is exactly what you are. And if one shares the experience of reading it together, it’s it provides a framework for those kind of discussions you mentioned. Well, what about porn? I mean, you know, you talk about performance anxiety and beliefs and disbelief and expectations. And porn has become so ubiquitous and available to young and old. What do you think the effect of porn has been?

Ian Kerner: [00:24:10] Well, I think, you know, we can talk about the positive benefits of porn, and we can talk about some of the negative effects of porn. You know, porn gets blamed for a lot of stuff. Right. And I have a number of guys who come in with a number of young guys, like 25, 30 year old guys who come in and they’re having erection issues. I keep talking about erection issues. I’m sorry.

Dr Ron Ehrlich: [00:24:34] Well, hey.

Ian Kerner: [00:24:35] Talk about, you know, and they point. They blame it immediately on porn. Oh, I screwed myself up. I rewired my brain because of all that horn I was watching. And now I can’t have more typical sex. I changed all the neurotransmitters in my brain. I saw that I Googled that, and that’s what I heard, you know. So meanwhile, there is no study that points to the idea that visual imagery would rewire your brain, that visual imagery would create addiction. 

It may trigger the reward system just like eating a good piece of chocolate might. But that doesn’t necessarily mean it’s going to lead to long term changes. So I’ll talk to guys. And, you know, what I discover is that it’s not that porn is addictive. It’s not that porn rewires the brain. It’s that porn is really easy and partnered. Sex is complicated, right? Porn is easy. There’s nobody looking over my there’s nobody watching me.

There’s nobody judging me. There’s nobody that I have to perform for. There’s nobody’s pleasure that I have to worry about. There’s nobody that I have to talk to. So, of course, when you’re watching porn, you’re going to have great sexual function. And when you go to have partnered sex, it’s more complicated. It’s also more pleasurable, I would maintain. But there’s another person there that you have to involve and think about, right?

So it’s not that porn is addictive. It’s that porn is easy in real life. Sex isn’t necessarily so easy. So that’s sort of one of the detriments. I think of porn on the plus side. As we said earlier, with recreational sex, psychological arousal is very important to sex. I mean, we know that there are women can fantasise their way to work as some without even touching themselves. Men can watch and look at something sexy and get really robust erections without even touching themselves.

So that’s the power of just our minds and psychological arousal. And that’s what we need to be like sharing, not just keeping to ourselves. We need to be creating, you know, psychological arousal with our partners. And so erotic media doesn’t have to be porn. It can be erotic literature, it can be erotica podcasts.

Dr Ron Ehrlich: [00:27:10] I do think there are all sorts of New York and the busy. I feel like I’m back in New York. This is just like being on TV, you know? I feel like I’m in New York y NYPD. Oh.

Ian Kerner: [00:27:25] Yeah, I can’t get past the sirens. So what I was going to say is that, you know, studies really show, and I don’t need a study to show it, that porn is really ubiquitous. Ubiquitous. It’s becoming normalised. And it’s a really it’s potentially a really nice way for couples to create a kind of what I call the arousal runway, you know, to get that arousal on that arousal runway and take off. 

Dr Ron Ehrlich: [00:27:55] Mm hmm. And, you know, I mean, coming back to children, though, with their access to it, and I was going to ask you about what role masturbation has to play in development for young and old. But porn would complicate somewhat the expectation of young people, wouldn’t it?

Ian Kerner: [00:28:15] I think it would. I think it would. I think that, you know when I talk about the positive benefits of porn and mainly talking about adults who have had some time to grow up and experience and think and reflect, and I think it can create certainly unrealistic expectations around sex. Porn isn’t the only thing that creates unrealistic expectations around sex. 

So it is not talking about so that creates unrealistic expectations just by being in a vacuum. Certain kinds of education that just focus on abstinence and don’t even talk about sex as being a source of pleasure or connexion. So there’s there’s a lot of ways in which we can have unrealistic expectations and develop shame. But, you know, certainly, I think that porn is a problem in terms of young people and their access. I mean, I think that we are born sexual creatures.

I think that masturbation as an entirely healthy activity cannot become problematic. And in certain circumstances, if it’s, you know, become becomes over, relied on as a coping mechanism for some kind of stress and anxiety or difficult emotions. Sure. But any. Coping mechanism can be unhealthy, from going to the gym to having a glass of wine. Sorry, I lost my train of thought.

Dr Ron Ehrlich: [00:29:46] Well, we’re talking about masturbation. Talking about masturbation and whether it was a problem or not.

Ian Kerner: [00:29:51] Yeah, so. So I think that masturbation is completely how healthy and at all ages. I think it’s really normal to want to masturbate and to want to fantasise. I think the problem sometimes with porn, though, it’s kind of like just like kids on their iPhone. Like, if you’re just getting everything from one screen, you’re closing off so much of the world, you know, you’re not allowing yourself to notice in the world erotically. 

You’re not using your own fantasies. You’re not using your own memories, you know. So I think that I think that that is one of the problems with porn. If we that’s the only you know, I think, you know, I work with a lot of men who are in their mid twenties, thirties. They have never had a masturbatory experience that wasn’t porn based unless it was just a spontaneous wet dream. Every single spirit and spirits has been linked to porn. Now, I don’t think that that’s the end of the world. I don’t think it’s like a national, you know, cause for alarm. But it’s a little sad to me. I’m going to make the value judgement. You know, it’s a little bit of a loss of the richness of all the ways in which sexuality manifests.

Dr Ron Ehrlich: [00:31:16] I mean, I think it speaks to a much bigger issue, which I can see is perhaps the biggest challenge to parents today with children is how to manage and advise about their interaction with technology in general, not just porn, but technology in general. Yeah,

Ian Kerner: [00:31:34] Think that’s very true. I mean, I have two boys and, you know, they spend most of their life embarrassed by what I did and embarrassed by my books on, you know, one of my sons were not able to, ah, to talk at all and really about this kind of stuff. He’s just very resistant and turns away. But my other son, you know, she grew up in a sex positive household. He saw my want, and I model healthy sexuality for him. He saw us be able to talk about different topics, and he is able to lean into the conversation and he is able to ask me question, how.

Dr Ron Ehrlich: [00:32:12] Old is he? How old are they?

Ian Kerner: [00:32:14] 19 and 16. Wow.

Dr Ron Ehrlich: [00:32:16] Very, very challenging ages. Yeah, yeah.

Ian Kerner: [00:32:20] Yeah. And so the 16 year old, I’m actually able to really be a dad to and to parent and to be a sex positive dad. And, you know, that’s really nice with my older son. I remember he had a girlfriend, and I wanted to talk to him about safer sex, and he’s like, Dad, I. I was having sex two years ago, you know?

Dr Ron Ehrlich: [00:32:41] Yeah, I know everything there is to know about. I don’t need your help. Yes. Well, you know, I think it’s interesting to how we should approach that with our kids in an age appropriate way. Is a challenge, isn’t it, as a parent?

Ian Kerner: [00:32:55] Yeah. Yeah, it really is. I mean, I always just look for teachable moments. You know, if I’m walking past, you know, a billboard of Kim Kardashian or somebody, you know, I might point out that’s might be sexy. It’s just not necessarily the most realistic version of all women’s bodies, you know? I mean, I think that there’s so much imagery coming at us that it’s not hard to begin to point out. Well, that’s an that’s how like a porn version of sex. That’s, you know, here’s something that might be a little more realistic to what you’re going to experience. You know that’s it’s definitely got to be clever. 

Dr Ron Ehrlich: [00:33:39] The other issue is trauma. You know, talk about how we develop. And I think the issue of child sexual abuse, domestic violence or all of this has become a lot more open and discussed. You must be. Do you see this a lot in your own practise? The impact of trauma on development, on a person’s sexuality?

Ian Kerner: [00:34:02] Well, I will absolutely say that I see the effects of all types of trauma on sexual right. It can lead to it can lead to a lot of anxiety. It could lead to a lot of damage to sexual function. It could lead to beliefs about sex and relationships. It could lead to hypersexual behaviour can lead to sexual withdrawal. I mean, trauma makes us feel unsafe, you know, trauma. Trauma. France. A seat of danger within us that keeps us on alert keeps us scanning for danger, and that includes and sexual situations. 

And the heart of sex is being able to get present and being able to be absorbed and being able to let go and let those defences down and really just be truly president. And so if you’ve experienced trauma, you know, and you’re very used to being on guard and being triggered and activated, it’s going to make it hard to become absorbed and present and connected. 

Dr Ron Ehrlich: [00:35:15] Mm hmm. What about as we get older, you know, sex positivity in old age? I mean, what are your observations about menopause, perimenopause, that kind of part of a person’s life as sexual desire go up or down or what? What is that? What is your observation?

Ian Kerner: [00:35:34] You know, again, it’s the beautiful thing about sex and desire is, you know, broadly, it goes up, it goes down like the stock market. But when you look really closely, there is a million little variables now. Now, is it true that there are lifecycle events that affect sexuality? Short birth, childbirth affect sexuality, illness affect sexuality, hormonal changes affect sexuality. And men and women medications affect sexuality. 

So sexuality is impacted across the life cycle. And I do not think it’s true to say that just because one is ageing, one is sort of opting out of sexuality now cannot become more difficult to become aroused for men and women. Sure. You know, you may be prone to, you know, some erectile unpredictability, or you may need some lubricant. But on the whole, I don’t know. I’m in my mid-fifties now, and I got myself in good shape during COVID.

I lost a ton of weight, and I gave up a lot of bad foods and bad habits. And, frankly, my libidos stronger than other stronger than ever. You know, I’m feeling more sexual, more confident than definitely, than I felt in my forties and even in my thirties. So I think a lot of it, again, sex is determined by many, many different variables and factors. And so, so is sexual health.

Dr Ron Ehrlich: [00:37:14] Mm hmm. No, I would agree with that, Ian. And I’m in my mid-sixties, so, you know, there we go. But it’s an interesting one. And the other one I’ve come to be aware of is prostate, you know, prostate problems for men and, in particular, prostatectomy which pose all sorts of challenges about sexual functions but also remind you of how penis centric sex can be. What’s your experience with him?

Ian Kerner: [00:37:45] So, you know, I would say it’s a little more limited, except what I’ve noticed is that in a lot of these procedures, you know, addressing the prostate is usually prioritised in a way that sexuality isn’t really considered very important. And so, whereas you can have nerve sparing surgery or there are alternative ways of thinking about preserving sexuality, it’s pretty much discounted as being a factor by the, you know, the medical community. And so I had seen a.

A lot of people on the other side of prostate problems who have had to, you know, change their sex scripts and different ways and become less generally centric or find different ways of developing arousal in their bodies, using medications, taking a longer path to regaining sexuality and not giving up with them. 

Dr Ron Ehrlich: [00:38:44] You know, I want to just finish up with one final question because we’re all on a health journey. You’ve just mentioned your response to the pandemic. But as individuals and ignoring the fact that you’re a psychotherapist, what do you think the biggest challenge is for an individual on that journey in this modern world? 

The Biggest Health Challenge

Ian Kerner: [00:39:03] On the journey to become a healthy, young, healthy, healthy sexually and just.

Dr Ron Ehrlich: [00:39:09] Just healthy, just putting aside your sexual or, you know, focus because there are other things besides sex.

Ian Kerner: [00:39:17] Well, I mean, you’re catching me on a day run where.

Dr Ron Ehrlich: [00:39:21] A lot of sirens going on. I can hear that.

Ian Kerner: [00:39:23] Or I would say that you know, between the Internet and between like the marketing machines of, you know, big corporations, I’m thinking specifically of like pharmaceutical companies who literally create the conditions to match up to the drugs that they’re developing. Yes. And completely applying. Blunt, blunt hammer. You know, kind of just try and blunt symptoms. I think so much of it is being discerning and finding alternatives to so much of the messaging network constantly subjected to.

Dr Ron Ehrlich: [00:40:04] Hmm. And I couldn’t have written a better script myself for you. Listen, I want to thank you so much. Thank you for your books. And thank you for joining us today and sharing your wisdom with us.

Ian Kerner: [00:40:15] Well, thank you. It’s a pleasure. I appreciate it. Thank you. 


Dr Ron Ehrlich: [00:40:18] Well, there it is. I mean, sex is a big part of everyone’s life, one way or another. And how we developed from the very early times in our lives right through our adult life and all the things that impact us along the way. It’s so easy in relationships just to get into a way of being with each other. 

And I would really recommend Ian’s books to you as individuals and as couples because and to enter and to discuss it together because it really is, as I mentioned in the introduction, like having the psychotherapist in your house, in your room, in your relationship with you. 

And I’ve always found psychotherapy to be an extremely positive experience in my life. In my life, I’ve had two or three instances of psychotherapy, which have always been a very positive experience, just the fact of being asked questions and to be having to articulate answers without having to listen to someone else’s problems is a very cathartic experience in itself. And if those questions are really well structured and you’re open and honest with your answers and discussions about them, I think it can lead to some really interesting and positive things. 

So his latest book. So tell me about the last time you had sex. I’d recommend it in his first book. She Comes First is also a wonderful read, as well as the others in between. And we’ll have links to Ian Turner’s website and his many books. I hope this find you will. Until next time. This is Dr Ron Ehrlich. 



This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.