When Your Gut Gets in the Bedroom: Exploring Sexual Health & Intimacy (with expert guest, Alyse Bedell, PhD, CST)

Part 3 of the Women's Health Series

Bloating, gas, urgency, abdominal pain, and that relentless “what if something happens?” loop can turn sex from a close connection into stress fast. 

Digestive symptoms can quietly impact some of the most vulnerable parts of our lives...including intimacy, relationships, and self-esteem. And often, the shame surrounding those experiences feels heavier than the symptoms themselves. If you’ve ever pulled away from connection because your gut felt unpredictable, this conversation is for you. In this episode, we’re opening up an honest and empowering discussion about gut health, confidence, and reclaiming intimacy without fear or embarrassment.

We dive into this topic with our expert guest, Dr. Alyse Bedell, GI psychologist and Certified Sex Therapist, covering: 
• Why digestive functions feel taboo in sexual relationships 
• How IBS and IBD symptoms can impact desire, relaxation, and satisfaction 
• Myth-busting the idea that sex must be spontaneous to be pleasurable 
• Scripts and “reset” strategies for handling symptoms in the moment 
• Redefining intimacy so closeness does not always imply intercourse 
• Flexible planning around meals, energy, triggers, and symptom patterns 
• Partner support that reassures without becoming patronizing 
• The circular sexual response cycle and starting from sexual neutrality 
• Rebuilding sexual self-esteem with stigma work and acting with "as if” confidence 

This episode has been sponsored by Ardelyx. 

References: 

Ballou S, McMahon C, Lee HN, et al. Effects of Irritable Bowel Syndrome on Daily Activities Vary Among Subtypes Based on Results From the IBS in America Survey. Clin Gastroenterol Hepatol. 2019 Nov;17(12):2471-2478.e3. 

Fretz KM, Hunker KE, Tripp DA. The Impact of Inflammatory Bowel Disease on Intimacy: A Multimethod Examination of Patients' Sexual Lives and Associated Healthcare Experiences. Inflamm Bowel Dis. 2024 Mar 1;30(3):382-394. doi: 10.1093/ibd/izad106. PMID: 38206426; PMCID: PMC10906359.

Wang J, Varma MG, Creasman JM, et al. Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome. Aliment Pharmacol Ther. 2010;31(3):424-431. doi:10.1111/j.1365-2036.2009.04180.x

Dubinsky MC, Potts Bleakman A, Schreiber S, et al.. Impact of moderate-to-severe ulcerative colitis and Crohn's disease on sexual activity: United States and European patient perspectives from the communicating needs and features of IBD experiences (CONFIDE) survey. Curr Med Res Opin. 2025 Jun;41(6):1017-1030. doi: 10.1080/03007995.2025.2530736. Epub 2025 Jul 17. PMID: 40635574.

Come As You Are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life by Emily Nagoski Ph.D.  

Becoming Cliterate: Why Orgasm Equality Matters--And How to Get It by Laurie Mintz

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) (great resources as well as a place to find a certified sex therapist)

Give us a follow us on social media @TheGutHealthPodcast, where we'd love for you to share your thoughts, questions, and experiences. 

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Transcript

Sponsor And Show Welcome

Kate Scarlata, MPH, RDN 0:00

This podcast has been sponsored by Ardelyx. Maintaining a healthy gut is key for overall physical and mental well-being. Whether you're a health conscious advocate, an individual navigating the complexities of living with GI issues, or a healthcare provider, you are in the right place. The Gut Health Podcast will empower you with a fascinating scientific connection between your brain, food, and the gut. Come join us.

When Gut Symptoms Meet Sex

Kate Scarlata, MPH, RDN 0:34

We welcome you.

Dr. Megan Riehl 0:37

Welcome to The Gut Health Podcast. I'm Dr. Megan Riehl, a GI psychologist, and today we're diving into a topic that does not get nearly enough airtime, but absolutely should. We are talking about what happens when your gut shows up in the bedroom.

Kate Scarlata, MPH, RDN 0:55

Yes, we have a saucy topic today. I'm Kate Scarlata, a GI dietitian, and let's just name it bloating, gas, urgency, abdominal pain. These are incredibly common. But when it comes to intimacy, they can feel isolating and really embarrassing. But the impact is real. In IBS, women report more difficulty relaxing during sex as well as lower satisfaction. Notably, patients with IBS C, constipation predominance, are more likely to avoid sex than those with IBS D. And in one survey, 40% of IBS patients said they would give up sex for one month in exchange for symptom relief.

Dr. Megan Riehl 1:38

Sad, hard. It is sad. And again, we don't talk about it enough. And it's not just happening in IBS. Our patients that are living with inflammatory bowel disease. When they were asked in a survey study as well, in a three-month period of time, 50 to almost 70% of these individuals reported avoiding or cutting back on sexual activity mostly because of bowel urgency or fear of stool leakage. Not great symptoms to experience, but you're gonna find, we're gonna get this opportunity to talk today about how that doesn't have to be an end-all be-all. It doesn't have to. And we hear this over and over that what's happening in the moment is really stressful. And quite honestly, this can happen with or without a GI diagnosis. So things like anticipation and unpredictability, there can be this constant mental loop of what if I'm not comfortable? What's gonna happen? Just holding this cognitive load. And we're gonna dispel some of the ways in which this can impact us with sex and intimacy, and also what to do about it.

Kate Scarlata, MPH, RDN 2:49

That's right. And you know, despite how common this is, most people are not talking about it. They're not talking with their partners, they're not talking with their providers, and we wanna break the stigma and open up the conversation.

Dr. Megan Riehl 3:02

And to guide us through all of this, we're going to be joined by Dr. Alyse Bedell, who is a GI psychologist and certified sex therapist who really sits on the intersection of gut health and sexual well-being. She is an assistant professor at the University of Chicago, where she directs the psychogastro enterology program. She specializes in stress, anxiety, and digestive health, working with patients across a range of GI conditions to help them better manage symptoms through a mind-gut approach. She also collaborates closely with medical providers and multidisciplinary teams to really personalize the care of each individual she comes in contact with. In addition, she is a nationally recognized expert in sexual health, providing therapy for individuals and couples navigating sexual concerns alongside medical or digestive conditions.

Kate Scarlata, MPH, RDN 3:56

All right. So if you've ever thought, is this just me or felt alone in this experience, or perhaps you're working with patients that have told you they're having challenges in their sexual relationship, this episode is for you.

Why Spontaneous Is Not Required

Kate Scarlata, MPH, RDN 4:10

Okay, so let's get into this with a myth. What myth would you like to bust pertaining to sexual wellness?

Dr. Alyse Bedell 4:17

The myth that I would like to bust is that sexual activity and sex needs to be spontaneous in order to be fun and pleasurable.

Dr. Megan Riehl 4:27

I like that. That's great news for all of the busy professionals, parents, really anybody out there listening. It's it's a great way to kick this off. Anyone that's not like a teenager or an early 20s person.

Dr. Alyse Bedell 4:40

Amazing. Basically.

Kate Scarlata, MPH, RDN 4:42

Perfect. So we're gonna get right into some questions for you. Why is digestive discomfort like bloating or gas treated as taboo and sexual relationships, even though we all fart, we all get bloated occasionally, but seems undesirable. So can you talk about that?

Dr. Alyse Bedell 5:01

Yeah, I think of course it is a complicated question. And it is one that I've thought about it a lot. I've thought about a lot, although I'm not sure that I have a perfect answer for it. I think it comes down to two things. One is that as you all know, and I'm sure anyone listening knows, I mean, digestive functions, period, are taboo in almost every context for starters. So not just sexual contexts or sexual relationships, which is probably a vestige from, you know, hundreds of years ago and we didn't have modern plumbing or good hygiene practices. It was wise to keep your distance from stool and other excrement, right? But then I also think that sexual activity and in sexual relationships, they are so socialized. And so we are so socialized, really, in almost every culture, to have this very pristine and unrealistic view of sexual activity, where really any type of human process is considered to be undesirable. And I think that that happens in really subtle ways, just by, you know, sort of like the images that we see on TV or in social media that are considered to be beautiful or sexy. But then I think, of course, it can also happen in more obvious or explicit ways, you know, in terms of people's exposure to pornography and sort of what is edited out and what isn't seen, or even just in movies, sort of what's seen and what's normalized and what isn't normalized. So I think that GI processes or GI symptoms kind of end up getting the brunt of all of that stigma and all of that taboo. And when they occur in a in a sexual context, even within, you know, even within a loving relationship, it can be unexpected for both parties because we just haven't been socialized to know how to deal with them in that context.

Dr. Megan Riehl 6:59

There's no intimacy coach in most of our bedrooms, and there's a lot of that in what we're socialized to. Yeah, it's absolutely what you're used to and what you're not used to. So it is a tough one. And I think talking about it is the thing we're trying to do here, right? To normalize that you're gonna be bloated. And that doesn't mean that you can't have sex or be intimate. And we'll probably talk a little bit about this that intimacy does not equal sex, and vice versa. That we'll talk a little bit about what intimacy can entail. And so what are some of the strategies that you give to patients or people that we just came from a large conference? So I'm sure among friends too, they're like, hey, you're the sex therapist. How do we communicate some of these unpredictable GI symptoms during sex without feeling like we're ruining the mood? How do we make this a normal thing?

Normalize The Talk With Partners

Dr. Alyse Bedell 7:51

It involves practicing talking about these symptoms both within a sexual context, so within actual sexual activity and outside of sexual activity. And by the way, you will notice that I'm probably not going to use the term sex all that often because there is kind of this implicit association of sex meaning intercourse. And what I'm really describing is like lots of different forms of sexual activity. So I usually just use that term to help people kind of keep their minds open to what that might entail. But I think outside of the bedroom is a great time to start talking about this. And I find that, you know, with most people that I work with that are in a relationship, they are actually more comfortable having sex, engaging in sexual activity than they are talking about it. So that's actually kind of the first type of exposure work that we're doing is just sitting down and talking to your partner about sexual activity. That can be very intimidating. But being able to just get used to talking about sexual activity first is very helpful. And then to actually talk about maybe some of the fears and anxieties about the GI symptoms that might occur or have occurred or you're fearful that they may occur is a really good step so that the partners are in a less pressured context, kind of a lower stake scenario where they can just have a conversation back and forth and communicate kind of about needs and wants and be able to offer support. Also, it is helpful to be able to practice how to talk about these things or at least cope with them in the moment, because symptoms are likely going to come up and you can't necessarily plan for or prevent everything by conversations that are happening outside of the bedroom. So I think being able to just again get comfortable with communicating with your partner and sort of recognizing that if a symptom comes up and that does sort of ends up resulting in some laughter or some embarrassment or a need to reset, it isn't the end of the world. And it actually doesn't have to be the end of the sexual interaction either. It can be okay to take a small time out or to sort of mindfully redirect attention back to the partner, back to the sensations, and to re-engage. But being able to talk about a strategy like that outside of the bedroom is going to make it a lot more effective.

Dr. Megan Riehl 10:18

Totally. Having that ability to say, like, okay, reset. And you already know what that means. That's a really great tip. And again, we'll talk a little bit about how somebody may find somebody like you if you're like, I don't even know where to start with this conversation outside of the bedroom. Yeah. Don't feel alone in that because a lot of people don't know where to start. And that, you know, that's again another way to kind of deepen your intimacy with your partner and have these uncomfortable, make them comfortable overtime conversations.

Kate Scarlata, MPH, RDN 10:48

So important. You should feel comfortable with your partner, right? To have these communications, but it is a little tricky, especially in the beginning of the relationship, I imagine. And I wonder if some of the, you know, being the older gal in the crowd here, I wonder just younger generations. I feel like, you know, talking about bowel habits, squatty potties, poop emojis, like things are opening up a little bit in this dialogue, you know. We're very much like, I got a poop, you know, in the house and it's not a big deal. We're like in our fam growing up, no one would say anything, you know? So I'm hopeful that we're destigmatizing these kinds of conversations a little bit, you know, just one talking about it today, but I think there is a greater awareness as well.

Dr. Alyse Bedell 11:34

I think you're right. I think I see a little bit of both sides of it. I think sometimes when I work with older patients, however you want to define that, sometimes, especially if they've been with their partner for a long time, then they've already gotten used to navigating some of these things. I think they may be a little bit more comfortable. They're probably the people that are leaving the bathroom door open, you know, when the other one is around. Whereas the younger patients who are in younger relationships, that may be a little bit too new. But Kate, I totally agree with you on the flip side. I think that younger generations are normalizing bowel function in general more. And also, I think are talking more about bowel issues more in a way that I think is just so helpful for this type of therapy or just helpful for maybe mitigating some of the problems that could arise.

Kate Scarlata, MPH, RDN 12:24

Like everyone farts. Hello, exactly, you know, exactly. And it is funny. I have a friend of mine, and her little son said, Mom, do you poop? Like he she like do girls poop? You know, and it was just so funny to me, but I it's you know, there's just so much cultural expectations, or you know, you're not pooping in front of your son, maybe, or I don't know. There's just so many factors that play a role in that.

Dr. Alyse Bedell 12:51

Yes. I remember being maybe three or four years old and asking my parents if Madonna pooped. Like I couldn't fathom it. Right. And I, yeah, I very specifically, and I just remembered. Madonna dad's dad is yeah, she does.

Dr. Megan Riehl 13:05

I feel like my family doesn't have to ask that question because they've all probably been in the bathroom at the same exact time while I'm trying to have a bowel movement. So I mean, like, there are parents out there that uh there's no private sacred space. But you know, the the other thing I'm thinking of, this episode is part of a women's health series that we're doing. And so we're talking about, you know, getting comfortable having these conversations, maybe earlier in relationships, as or maybe with a diagnosis of a GI condition. But one of the topics we're also talking about is endometriosis. We're also talking about perimenopause and menopause. And so, especially a woman's body can change in so many different ways. And so, also using this episode and some of these tips and tricks that we're gonna talk about, because what intimacy, sexual engagement may look like and feel like over the course of a lifespan can certainly change. And your needs around how to communicate those changes are also going to evolve. Absolutely.

Dr. Alyse Bedell 14:07

Yeah. And I think sex therapy is done from lots of different theoretical orientations. And certainly not every sex therapist is also a health psychologist like I am. But I think that sex therapy is so conducive to being done from a biopsychosocial lens. And in fact, that is one of the very first areas of education that I work through with a patient, is sort of creating their individual biopsychosocial model, where we spend some time actually talking about what are the more biomedical aspects, you know, of your life, medications, other conditions that you may have aside from your GI condition, any other relevant treatments, and how those intersect with, you know, your psychological factors, social factors, and interpersonal factors, particularly related to the relationship and the sexual relationship. And so it is actually, it's just very easy to integrate, you know, talking about things like endometriosis, perimenopause, menopause, where all of those things are and how they may intersect with the sexual function. And then I think also to kind of just go along with what you said, Megan, is that I think it's helpful to tell younger people who are in sex therapy who may, in a way, I think there can sometimes be this bit of a feeling of a failure, like how am I only in my 20s or 30s and 40s and I'm having these issues? These this should be so easy for me. But I think it's it's really helpful to be able to say, you know, that things that you are working on right now are things that almost everyone will be starting to be challenged by in their older age when it comes to still having a vibrant sex life. And so the skills that you are learning now are going to keep you having, they're going to support you having an active and vibrant sex life for decades to come. And I really believe that's true. And I do believe that that can be something helpful to leave a younger person with.

Kate Scarlata, MPH, RDN 16:04

Yeah, very validating and positive messaging, right? We talk about that when Megan talks about diaphragmatic breathing. It's like a tool you can use for the rest of your life in so many different situations. So, talking about tools and solutions, when we think about, you know, in GI with bloating and gas, distention, what are some diet changes, behavioral therapies, or other tips and tricks to really think about to help our patients with gut symptoms have a little ease in the bedroom?

Mind Gut Tools And Team Care

Dr. Alyse Bedell 16:39

Yeah, absolutely. I mean, I am working with patients in sex therapy within kind of a broader brain gut behavioral therapy context. So I'm working with them, you know, as a GI psychologist, helping them to manage their symptoms using, you know, things that have probably already been discussed here, right? Evidence-based therapies like gut-directed hypnotherapy and GI CBT. And so, you know, both helping to support them in addressing and reducing those GI symptoms while also helping them cope with maybe what's left and sort of build some acceptance around the fact that this is a chronic illness. And so those symptoms are likely going to wax and wane no matter how well you attempt to manage them. And then I do work in complement, you know, with my GI dietitian colleagues, my gastroenterology colleagues, and public floor physical therapists. And I would say that my GI patients that are working with me on sexual issues do tend to need a little bit of all of that. You know, there is sometimes a bit more complexity there. Also just working with my patient to help them kind of not be overwhelmed by that and think about how we might scaffold some of that treatment to make it feel more doable, that that can be helpful as well. So I guess I would say, coming to your question, there's this balance of yes, I want to support my patient and helping them reduce their symptoms as much as possible so that in every context, including in the bedroom, they don't have to deal with as many of those symptoms. But largely what we're doing is really working on helping them to not be so fearful of those symptoms occurring in the bedroom and sort of accepting that no matter how well managed your condition may be, uh, there's probably going to be some bloating. There's probably going to be some dissension. You cannot guarantee that you will never pass gas or have an episode of urgency where you have to get up. How can we sort of build the skills that you can work with your partner on that to feel supported and loved and desired, regardless of that, you know, reality that may be the case, and to sort of help you cope in the moment. And how can that not necessarily be the end of a sexual interaction? Or how can you have some flexibility around what sexual activity is on the menu that evening or that afternoon, depending on those symptoms and what you actually feel physically and emotionally comfortably comfortable doing?

Dr. Megan Riehl 18:59

That's a good practical strategy, right? A good tip that, you know, if you've been having diarrhea for the last 24 hours, that may not be the night for even if it's your anniversary or, you know, and meeting those expectations that just because you thought it was going to be that way, that's some of that cognitive flexibility, that it's not that.

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Intimacy Beyond Intercourse

Dr. Megan Riehl 20:42

Can you give us any other practical strategies around, again, maybe not penetration sex, other types of intimacy that somebody that might be gassy or bloaty or distended, how do you coach people to kind of even think outside of the box a little bit?

Dr. Alyse Bedell 20:59

Yeah, it's a great question. And I think it does go back to what you said about sort of like redefining intimacy. And it's another reason why I'm very cautious to not use intimacy as a euphemism for sexual activity, like so many people do, because we really want to preserve the meaning of that term, intimacy, which is so much broader than just sexual activity. And so, what can happen many times for people who are dealing with, you know, whatever combination of sexual difficulties and GI symptoms, that when the sexual activity becomes difficult, the overall intimacy also starts to become narrower and narrower as well. And there's so many reasons for that. But the I think the one that just seems to be the most obvious is that a person with a GI condition dealing with these symptoms or dealing with these sexual difficulties, sexual activity can feel so fraught and can feel so high pressure. That even sort of like a touch on the shoulder or a kiss on the cheek can start to feel like a threat. Because what might this lead to? If I act open to this little cuddle on the couch, that might imply that I'm feeling open for sexual activity. And by the time I'm meeting with many people, they're not open to sexual activity, or they're really very stressed about it when they are engaging in it. And so this kind of habit can form where, you know, you sort of like start sitting on opposite ends of the couch. And so even that sort of like coziness of even if you were just, you know, maybe to enjoy, like I'm not feeling great, I'm feeling bloated, I'm feeling oogie, but we could cuddle on the couch, like that reality may no longer even be existing because of the fear of what that could mean and what that could imply. So that is one thing. And that's where communication is important is to be able to have, you know, my patient talk with their partner and say, hey, I really want to get back to just us at least having intimacy, to have closeness, to be able to play board games and cuddle and go on dates. And I want to be really thoughtful about not necessarily assuming that sexual activity is going to come along with that. And so would it be okay? Could we plan on sort of re-engaging with each other in a more broad, intimate way, whether that is physical intimacy like cuddling and other types of emotional intimacy, but can we be really, really intentional and communicate really directly if we want that to actually move into something more sexual? So that then these things don't have to be completely linked together.

Kate Scarlata, MPH, RDN 23:44

Yeah. You're managing everyone's expectations, which absolutely is also really important.

Dr. Alyse Bedell 23:50

Yeah, and right. And these are expectations that are, you know, they've been rarely vocalized. Right. But both parties may be aware of them, sort of functioning in the background.

Kate Scarlata, MPH, RDN 24:00

You know, just thinking about dietary interventions for gas and bloating and bringing in the dietitian, you know, especially in this protein rage, everyone's like, protein is everything. And too much protein can really lead to hydrogen sulfide gas, which is like rotten eggs, smelly gas. And I'm not dissing protein because we need it. It's important for so many functions in the body. But sometimes subtle tweaks in the diet can make a difference if that's a problem. And so I think, you know, bringing in the dietician occasionally, and I know you mentioned that they are a key player, but just some of those small tweaks, no major diet eliminations, but just, you know, maybe don't eat the onion soup the night, you know, if onions are really gas forming for you and and that kind of thing. So diet can be manipulated a little bit. I do that sometimes, even when people are going on a long flight, you know, just the night before, trim down some of those fermentable carbohydrates so your belly doesn't blow up. So little subtle changes in the diet can play a role in some of that too. So I think, yeah, like you said, a team approach is really important.

Dr. Alyse Bedell 25:08

Yeah, absolutely. And I think, you know, even just some of the dietary or eating behaviors, like recognizing that, you know, for some people, if they really want to enjoy a nice dinner out, maybe the sexual activity could come first. You know, it doesn't have to be the last thing that happens before you go to bed. Right. And in fact, most grown adults are very tired by the time that kind of night come around. And so in reality, it's actually just not that great of a habit that people get into sexually, where the expectation is it's like right before sleep.

Kate Scarlata, MPH, RDN 25:44

Yeah.

Dr. Alyse Bedell 25:45

So that's another, it's kind of a no-brainer recommendation, but it's one that no one ever has thought about on their own, I think until they start strategizing around this, is like maybe it's better to do this when I'm feeling my best and I have the most energy, and that's rarely at 10:30 or later. Yeah, for all of them. Right.

Dr. Megan Riehl 26:03

That you know, you might have daycare until 6 p.m. And so, you know, that may be the best opportunity to plan, have a uh open conversation, get an early lunch with your partner, and then, you know, pick the kids up after and everybody's in a good mood. That is the kind of like pre-planning that, you know, when you're young and in love and have lots of time, maybe you're thinking, oh, we'll never be those people. It's okay to be those people. It's okay. Yeah.

Dr. Alyse Bedell 26:34

Yeah. It's it's amazing actually how much, how many practical tips. Sometimes it's not rocket science, right? Like sometimes it's just really some brainstorming in terms of sort of thinking about, thinking about a typical day, thinking about, you know, a typical sort of like what are the typical course of symptoms? What are the triggers? Kate, like you said, sort of recognizing that like, okay, maybe if it's really important that I engage in sexual activity, maybe I don't do the food or the like the large bowl of pasta that I know is really gonna make me feel bad. Let's like save that for a night where like we're just we know that we're gonna like watch a movie and cuddle, right? And that actually can be, I think it's surprising. Oftentimes the sort of identified patient and that situation feels like, oh, that's such an ask, and maybe I'm such a burden. Their partner doesn't care. Partners like it sort of oftentimes like to be able to plan as well. And so again, kind of going back to that like myth busting, it's actually very like both parties usually enjoy being able to plan for and look forward to a sexual interaction and being surprised by it can be nice every once in a while.

Food Timing And Symptom Planning

Dr. Alyse Bedell 27:42

But for most couples, especially in longer-term relationships, just being able to actually like savor and look forward to sexual activity is actually very satisfying and enjoyable.

Dr. Megan Riehl 27:52

So you mentioned the partner. Are there other ways that you coach partners or couples with how they can actively support someone that may be living with a GI condition without being like overly cautious or patronizing? How do you coach them with that?

Dr. Alyse Bedell 28:09

Yeah, I mean, I think a lot of it is just making sure that they were sort of at the table to receive the same type of psychoeducation as the patient was. And so even though in my my style would generally be that the majority of the work, especially in the first few sessions, are going to be with the patient alone, you know, if and when, and it's usually when, when we do bring the partner in for a visit, that visit involves the patient and I sort of recapping some of the major psychoeducation around the sexual response cycle and how that intersects with GI symptoms. That also gets repeated to the partner so that they are on the same page and the partner has a chance to ask questions. A lot of it is about facilitating, sort of giving the patient a place to talk about maybe some of their concerns, maybe some of the worries that they have a hard time vocalizing to their partner and to have the partner sort of be encouraged to be genuine in their responses, even maybe when the responses aren't ideal or aren't perfect, but to be able to kind of work through them together. And I think that, you know, you're bringing up a very good point, and it's one that we're watching for. There is sort of overly solicitous partner, is actually very well known to be not a helpful role to be playing when it comes to sexual function. And so that actually can just sort of like kill the sexual function. And what do you mean by that?

Dr. Megan Riehl 29:30

The over-solicitous partner.

Dr. Alyse Bedell 29:32

Oh, oh no, honey, oh, it's okay, honey. Oh, don't feel bad about that. Don't be embarrassed. I love you anyway. There's like get to like 50% of that and then back off because it's very desexualizing to be spoken to that way. And so just kind of like being a bit more like, yes, like reassurance is great, but a little reassurance goes a long way. You know, hey, I love you. We've planned for this. What do you need right now? Like, take a break, take all the time you need, and then get back to it. But like really still treating the partner as an adult is really the best way to go about it in almost all cases, because otherwise people do tend to feel, as you mentioned, Megan, the word, you know, being patronized, that can just be very desexualizing and make it harder to then kind of get back into the

Supportive Partners Without Babying

Dr. Alyse Bedell 30:21

swing of things.

Dr. Megan Riehl 30:21

And you mentioned the sexual response cycle. Can you tell us a little bit what do you mean by that?

Dr. Alyse Bedell 30:26

So the sexual response cycle, you know, was initially developed by Masters and Johnson like in the 1970s. And it was considered to be this very linear model that was really developed based on the sexual response cycle of men. And it starts with always having desire for sex, then followed by arousal, sexual arousal, then followed by having an orgasm, which happens, of course, on 100% of occasions, and then ending with resolution of that response. So hopefully you can hear this already in my voice. And so this is actually a little bit more commonly how it can work with men, particularly men who do not have any sexual difficulties. But especially for women, this actually is really not a very applicable cycle. We're both shaking our heads in the affirmative of no. Yes, thank you. And actually, I would say, in my experience working with men as well, it's also not typical of many men, in particular, any men who are dealing with anything that sort of makes it difficult for them to engage sexually. And so now we really teach more of this circular sexual response cycle where we educate that actually starting with desire for sex. Maybe this sounds strange, but it's actually not necessary for starting a sexual interaction. What's best and what's expected is that we start from a place of sexual neutrality where we feel some level of openness to engaging in a sexual activity. And the motivation for then proceeding into some type of sexual activity could be lots of things. It could be, you know what, I'm hoping for an orgasm, and that would be a really great tension release right now. Or it could be, you know, that sounds like such a nice emotional way to connect with my partner. Or it could be, you know, my partner's been asking for it and I feel like I want to give that to them. Or it could be sexual pleasure. That sounds lovely, right? But so whatever those reasons are, it allows the person to proceed into a sexual encounter and then to really sort of base what happens next or what happens next becomes based on the context. And so that might be the senses that start to get engaged, things that sort of are starting to work for that person, maybe a smell that's more of a turn on, or the conditions are just right, there's no like kids knocking on the door or dogs barking outside, you've got some alone time, and really an openness to then start to build arousal, and the desire starts to come later. And so the more that a person sort of starts to see that there are lots of reasons that they can sort of entertain the idea of a sexual encounter, and then it doesn't have to start with this spontaneous sexual desire that just occurs out of nowhere, people can then be a lot more responsive to their own bodies, their partners' bodies, and to the environment, and then can actually sort of build arousal and then desire for sexual activity actually comes from there. It's a lot easier to see visually, I will say. But it's a model that can be very easy to sort of put oneself in and see how there are many factors that are modifiable

The Sexual Response Cycle Reframed

Dr. Alyse Bedell 33:39

here. And that oftentimes actually forms the basis of the work that we're doing, is to sort of look at like what are the areas in this model that are working and what are the areas in this model where we can actually intervene on, both on your own and with your partner's support, to sort of get the context right for you to enjoy a sexual interaction more when you've decided to proceed.

Dr. Megan Riehl 33:59

I think that gives people certainly a mind-blowing change of shifting from like, huh? I don't have any desire and you know, or I my symptoms. And so beautiful illustration of opening the door for a very different way of thinking about this, but far more approachable and realistic for women and men as well.

Dr. Alyse Bedell 34:20

Yeah, absolutely.

Sexual Self Esteem With GI Symptoms

Kate Scarlata, MPH, RDN 34:22

So, how do you rebuild sexual self-esteem when your body feels unreliable or embarrassing because of GI symptoms? How do you help patients?

Dr. Alyse Bedell 34:32

Maybe interestingly, I think that first we sort of just put like the sexual aspect of it to the side. And we can just sort of like talk more broadly about what it's like to be experiencing these GI symptoms and to be someone that's struggling with a chronic illness like this, because it oftentimes does run so much deeper than just the sexual aspects of it. And so I think really just helping a person sort of explore like the ways in which the stigma has impacted their life, like what are some of the ways in which it's shaped the way that they feel about themselves and how they feel about themselves in relation to others is a very important first step. And I think that's the kind of work that, you know, most of us would be doing some of in a brain gut behavioral therapy anyway. And so it's why it is so nice when it can fit together in that way when you're working with someone who does have experience working with the GI conditions or chronic health conditions more broadly. But I think then being able to extend that into seeing how it relates to how they see themselves as a sexual being, like there is some nuance to that as well. And to help someone really, really sort of softly and gently, but challenge maybe some of those beliefs that they've inherited from society about why they feel like they can't sort of be seen as a sexual being or a sexy person because of their sexual issues. And I would say, you know, you can't be like as a therapist, you can't be forceful or pushy on that process. Like people have to sort of like you can you can guide them and you can sort of present different ways of thinking, but in a way they have to come to it on their own. And at the same time, I think, you know, in cognitive behavioral therapy, no, we know that one of the most powerful ways to shift the way that we think is to just shift the way that we behave. And so oftentimes it is about recognizing like that acting as if can be very powerful. And so even if you are, you know, in the sexual context and you are noticing that you have some distension and it's making you feel really unsexy, what would it be like and what would it look like if you just sort of like owned your body and you acted like a supermodel? And I've got air quotes on that. Like, what would that look like? What would that feel like? And when people are willing to sort of try that out, it can be pretty impressive, the results and what they notice can shift in their own behavior and actually how appealing and attractive partners find that. Right. To sort of just like be in your body with no apologies is actually like quite sexy, even if it's difficult for many people to truly feel that way. So again, I think just some balance of like really helping people to like sit with those uncomfortable thoughts and feelings and hopefully, you know, help them shift that, but also from a behavioral perspective to just kind of really doing that acting as if can help people, I think, shift those thoughts a lot faster.

Kate Scarlata, MPH, RDN 37:32

I love that. Acting as if, supermodel. That's great. Yeah, right. Yeah. I think people tend to be more critical of themselves than their partner is of them, you know. So that's just something that has to be broken down a little bit. Yeah. Yeah. Thankfully that is almost always true. Yeah. Really. Yeah.

Dr. Megan Riehl 37:54

Yeah.

Kate Scarlata, MPH, RDN 37:54

I'm sure there's cases

Resources Speed Round And Goodbye

Kate Scarlata, MPH, RDN 37:56

for sure.

Dr. Megan Riehl 37:56

You've given us some ideas of understanding what it might be like to work with a sex therapist. And my goodness, those of you in the U Chicago area with GI conditions, if you can get into the office of Dr. Bedell, you are a very lucky person. Any books or other resources that you might recommend to listeners that just want to learn a little bit more that you find to be good?

Speaker 38:22

I have two really top recommendations for books that I oftentimes do recommend my patients. It's just kind of a compliment to the work that we're doing. And they're intended to be used totally on their own, even if you're not in sex therapy. But the first recommendation is Come As You Are by Emily Nagoski, which I think is a really nice introduction to this circular sexual response system and all kinds of other very practical strategies that women can use to improve their sex life. And then the second is Becoming Cliterate, and that's by Laurie Mintz. And so that is a little bit more focused on sort of your own sexuality and being able to learn how to have orgasms for those women that maybe have never or haven't found them to be very pleasurable. These are really two excellent books. And then for folks who might actually be interested in finding a sex therapist or learning more about sex therapy in general, aasect.org is a great place to start for that. I'll spell it out. It's aa s ect.org. That website has a directory where you can find certified sex therapists by geographic region, and there's a lot of other really nice resources on that website as well.

Dr. Megan Riehl 39:37

Well, we will link those in the show notes so that people can find those resources. And gosh, thank you so much for all of this. We could talk, you know, I think for hours, but at least we're kind of kicking the door open on this conversation and, you know, hopefully more to come. But we're gonna keep you around for just a few more minutes for our speed round because it's a fun way to get to know you a little bit better. So you just let us know quickly what your answers are. You can just think about it right off the top of your head, and we'll go through these. So the first question is do you plan everything or are you a wing it girl? I'm a plan everything girl. Not surprising, right? No, you don't become a doctor by winging it too much. But you know, you know, it's good to embrace that. That's good. So do you have a big social circle or a tight inner circle? Tight inner circle, no question. Okay. And what matters more in a relationship? Chemistry or compatibility?

Dr. Alyse Bedell 40:39

Compatibility.

Kate Scarlata, MPH, RDN 40:41

Yeah, I like that one. Favorite morning beverage. Coffee with whole milk splashed in.

Dr. Megan Riehl 40:49

Perfect. All right. Sweet tooth or salty? Which one? Sweet tooth. Okay.

Kate Scarlata, MPH, RDN 40:56

Okay. One habit you do to help with your overall well-being.

Dr. Alyse Bedell 41:01

You know, seems minor. I feel like I have a ways to go on this one. But I I start my day with being 45 minutes phone-free. Oh, that seems a good one.

Kate Scarlata, MPH, RDN 41:10

We've had a few that have said that.

Dr. Alyse Bedell 41:13

Yes. Yeah. Yes. Not 45 minutes. Yeah, me and my coffee, and then, you know, I'm in a shower. Maybe that's kind of unfair, but I don't take my phone out. I don't look at anything. And I play with my cat and I stare at the wall.

Kate Scarlata, MPH, RDN 41:25

Yeah. Yeah. I think we all need to be doing a little less of that phone time. It's just amazing. Even walking through an airport, and I know people are idle, but you know, just recently traveling from DDW, and it's just like everyone's just like comatose looking at their phones. It's when you look at it, it's like enough is enough. Yeah, yeah.

Dr. Alyse Bedell 41:44

I feel a lot more clear-headed starting my day that way.

Kate Scarlata, MPH, RDN 41:47

Yeah, calm. Yeah, calm too. Well, thank you so much for joining. This was really amazing. And I know our listeners are really gonna learn a lot and probably gonna be checking out those books and getting those resources. So thank you so much.

Dr. Alyse Bedell 42:03

Thank you so much to both of you for having me.

Dr. Megan Riehl 42:05

This was a lot of fun. Yeah. Thank you so much, Dr. Bedell. You are a rock star. Thank you for joining us as we grow this gut health community. We hope you enjoyed this episode and don't forget to subscribe, rate, and leave us a comment. You can also follow us on social media @The GutHealth Podcast, where we'd love for you to share your thoughts, questions, and experiences. Thanks for tuning in, friends.