What They Didn’t Tell You: From Core to Floor

Why Am I Only in the Mood at 2 A.M.? And Other Burning Sex Questions

• Millie • Season 1 • Episode 1

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Welcome to the first episode of What They Didn't Tell You: From Core to Floor! Dr. Millie Schweky (pelvic floor PT and your new favorite girlfriend in your earbuds) and sex coach Galya Falkson kick off the Sex Q&A season with real talk on things many of us wonder but few of us say out loud.

In this episode, we cover:

  • The two types of desire: spontaneous vs. responsive (and why knowing the difference is a game-changer)
  • What to do when partners have mismatched libidos
  • Is pain during sex ever normal? (Short answer: Nope!)
  • How birth control, antidepressants, and hormones play into your pleasure
  • The fear-tension-pain cycle and how to break it
  • Practical strategies for rekindling connection without pressure

Plus: how to rewire your brain and your relationship to sex.

Disclaimer: Not for little ears... grab your headphones.

Connect with Us:
 IG: @milliedpt | @galyafalkson
 Rate & review if you’re loving the vibe, it helps more women find this space.
 Stay tuned for Episode 2, we’re just getting warmed up!


[Dr. Millie Schweky]

Hey sis, welcome to What They Didn't Tell You: From Core to Floor. I'm your girl, Dr. Millie Schweky, your favorite pelvic floor physical therapist, and today on Season 1, Episode 1, our sex Q&A season, I have a sex coach, Galya Falkson, in here and she's going to introduce herself and we're going to answer some of your burning Q&A together. Just a disclaimer, this season is not for little ears, so if you're listening with your kids in the car or cooking in the kitchen, I recommend switching to headphones or putting this on later.

 In today's episode, we're going to talk about different types of desire, how to address pain during sex, we're going to talk about how antidepressants can affect your sexual function, including orgasm, and we're also going to talk about communication, so sit tight, this is a really good episode. So, Gaia, tell us about yourself.

 [Galya Falkson]

 Thank you for having me.

I'm Galya Falkson, I'm a sex and relationship coach and a Tarot Mishpache educator. I truly believe everyone deserves to feel confident and empowered in their relationships and sex lives. Working in this field for many years and helping so many people has been incredibly meaningful to me.

My job involves helping people break through barriers, whether it's misinformation, lack of information, breaking shame to booze, so that they can fully enjoy themselves, both in life and in the bedroom, and I believe that everyone has everything inside of them. In order to get there, I'm just there to help them unlock it. 

 [Dr. Millie Schweky]

Of course!

So, we have a lot of questions from patients, from clients, from the Instagram anonymous box, and today we're going to go through as many as we can in the next 15 to 20 minutes, and let's start with the first question that we got. Someone asked, I have no desire to sleep with my husband. I'm attracted to him and I'm so in love, but I only want to have sex if he starts coming on to me in the middle of the night.

So, as a sex coach, what do you want to say to this person? 

[Galya Falkson]

I want to say that you're totally normal. It makes so much sense, actually. Firstly, there's two types of desire.

 So, before I get into what those two types of desire is, you should also just know that oftentimes our body needs time to just relax and reset. So, the fact that you only want sex in the middle of the night sounds like your body needed time to just reset and relax into itself in order to be open to arousal, and that brings us to the different types of desires. We have a spontaneous desire, someone who just thinks about the idea of sex or even just spontaneously feels like having sex and they're ready to have sex, and then you have responsive desire, which means I respond to different types of arousal that then leads me to wanting and desiring sex.

 So, in other words, I don't think about sex or want sex unless specific things are done that I then respond to and then I am aroused enough to desire sex. So, it kind of really makes sense what this is going through, and I just want to validate that you're normal and that it's absolutely okay what you're experiencing and that it might be worth having a nap in the day in order to have energy to have a responsive desire to have sex early on in the evening, if that's something you want, or to think about maybe trying in the morning or looking at different windows of opportunities that work for both of you.

[Dr. Millie Schweky]

Right, and there's also so many other factors, right? There's hormones, brain chemistry, relationship dynamics, life stress, sleep deprivation, all these things totally factor in.

So, just to recap, the difference between spontaneous desire and responsive desire. So, you're saying spontaneous desire is like kind of what you see in movies, it's like a teenage crush, anyone who's like well-rested on vacation, like, oh, candy, let's eat candy. And the responsive is more like, oh, something's happening, that's getting me in the mood, right? That's kind of like the difference?

[Galya Falkson]

 Yes, but also responsive is a little bit more than that, in that you only respond to them being okay to be aroused and then desire turns on.

So, in other words, there's almost like a few steps that go into the desire and the want to actually have sex. You could be feeling somewhat aroused and not necessarily still desire actual sex. So, I think that's the difference where someone who has a responsive desire needs a few steps before they get to the point of, oh, I actually desire this, I want to have sex.

As opposed to someone who's spontaneous, they just want to have sex, they don't need anything to get them to a point of arousal, they don't need to desire, they're already aroused, they already have all those steps in place before, naturally, for them. And it's not unnatural for someone who's responsive, it's pretty normal. 

[Dr. Millie Schweky]

There's literally two types of people, it's not like, oh, sometimes I'm spontaneous and sometimes I'm responsive, it's like you're just a person, it's like more of like a personality type.

[Galya Falkson]

 Absolutely, there's literally two types of individuals.

[Dr. Millie Schweky]

 You do find more women who are responsive,

[Galya Falkson]

 but a lot of the time they see themselves as responsive, but actually they do desire sex already, they're just not aroused. There's a difference, they might already be spontaneously desiring sex, but they're just not aroused and they need more time to be aroused.

So there's arousal periods that women need more than men often, but again, that's a generalization, but it does usually skew more to the woman. 

 [Dr. Millie Schweky]

Interesting!

[Galya Falkson]

There are times when someone who is a responsive will randomly have a moment in their life where they spontaneously are in the mood, but usually that's because there's been factors that have lined up in order for them to get there.

So you are one or the other, but there can be random moments in your life where things have aligned and you're not necessarily putting in specific effort for it.

[Dr. Millie Schweky]

Okay, so if a husband and a wife have two different personality types, right, one's a responsive and one is spontaneous, what do you recommend to kind of like sync things up a little bit? 

[Galya Falkson]

Well, I like to tell people, imagine it, it's like, I know people always like joke about using this as an example, but food, if you feel like a five course meal and then you just go and get like a bowl of cereal, it's going to be pretty disappointing, right? So someone who has spontaneous desire, there's almost like a hunger, pang, and then it's sudden and obvious and they know they want food or whatever it is that they want. And someone who has responsive almost needs like an appetizer placed in front of them.

They then see the appetizer and are like, oh, this is very nice. Oh, I want this. And then I want to try other things.

So they're not actively hungry, but it looks good and they're willing to try it out. And then, okay, I actually want the rest. I want the full meal.

I want five course dinner. So that's the difference. So I always speak to like clients when they have this mismatched space that they're in.

And we say like, if you understand what your partner is and you expect them to be something else, you're constantly going to be disappointed. However, if you go in knowing that the only way this person gets hungry is if you put an appetizer in front of them and then they can make a decision, oh, do they want more or not? Then you know that that's who they are. That's what they need.

The same way that you know that if someone who needs to go for a run in order to feel good in their body or the head or their mind, because it's racing and going for a run helps release those endorphins, etc. You know that there's no point in having a conversation with that person or trying to get something out of them before they've gone for that run, because you're actually just fighting with literally a blank wall that can't actually give you what you need. But if you understand that and there's a level of understanding about your partner, so then you're willing to both put in that effort.

And then sometimes when it's really difficult for clients, I'll say to them, okay, then schedule sex. So then that way, because it's scheduled, you're planning around what you're going to do, what you're going to put in place, how you're going to get there, what appetizers are you actually making sure are available in order for the response of desire to then kick in? But I just want to preface and say that just because someone has responsive desire and someone puts an appetizer in front of them, it doesn't mean they have to now get hungry. You have a choice to see where your body's going to be and what your body feels like doing.

And you also have a choice to decide if you want that connection in this moment or not. And I think that often people think that sex is just this physical thing that people do in order to feel pleasure. And I want to question that and say, no, really, sex is a way of connecting on a very deep, vulnerable level with your partner.

And if you just make it about the physical, then yes, you're going to struggle with, oh, the person's not turned on when I want them to be turned on and I'm hungry now and you're not hungry. And then we're going to be annoyed with each other. As opposed to, well, I want to feel connected to this person and how does this person need connection? How do I need connection? So what middle ground can we find in order to be in a space that's beautiful together? When I say beautiful, I mean like full of understanding and connection as opposed to just expectations.

[Dr. Millie Schweky]

That's great. That's really such practical advice. I would even take it one step further and say something like, if middle of the night, getting turned on in the middle of the night is what works for you, why not try to even replicate that earlier? 

[Galya Falkson]

I think that creating that relaxed environment earlier is exactly what you can do if it's possible for you.

 But a lot of the time, sometimes it's not possible with kids or whatever else is going on. You can't take a nap in the middle of the day to recreate that environment. It's important then to start, if you are then a responsive desire, to start exploring non-sexual physical touch earlier on in the daytime.

 Flirty texts, connecting in different ways that lead you to a space of, oh, I'm actually aroused. I'm feeling desire. I'm feeling like I want something more.

 As opposed to only waiting for your body to completely relax before you can then start exploring these things. 

 [Dr. Millie Schweky]

Wow. Okay.

I think we definitely answered that question well. 

[Galya Falkson]

I wanted to ask you, from your perspective as a pelvic floor therapist, what is the difference between painful sex and normal discomfort? I think a lot of people often think that it's stupid to think that discomfort is normal. Is that coming from birth control? Is that coming from something else? Or is it actually just something that people should live with or not?

[Dr. Millie Schweky]

I feel like I really get this question a lot.

People also ask me, with this, is the pain normal? Am I being dramatic? Like, oh, my friends told me it was supposed to hurt. My mom told me. My sister told me.

I just want to clear this up in case you don't already know. Pain during sex is never normal, unless it's something that you're looking for and something that you want. But a little discomfort could happen, and that's something else.

That's completely different. I'll break it down for you. Discomfort is something that might show up if maybe there's not enough lubrication, or if you're trying a new position that kind of tests the limits of your flexibility, or if you're not fully aroused because there is a difference between it coming from yourself versus extra lube that you're using.

Even then, that kind of discomfort should be temporary and go away with little adjustments like slowing down, changing positions, adding lube, more foreplay. Pain, on the other hand, is something that's persistent, something that's sharp. People describe it to me as burning, stabbing, deep ache.

Some people say it feels like something's hitting a wall. It makes you tense up and dread sex altogether. That's your body's way of saying, hi, there's something off here.

If I just get nerdy for a second, painful sex, which is called officially dyspareunia, it can stem from a few different things. Obviously, one of the biggest things I see is pelvic floor dysfunction. If the walls around your vagina are too tight or overactive, penetration is going to feel like hitting a wall.

This comes along with certain diagnoses like vaginismus, which is basically like the body having a not conscious reaction and just closing up the muscles, tensing up the muscles, making any sort of penetration painful, whether that's a tampon, abidica, anything like that. It could also be hormonal changes. You're not crazy for thinking it's from birth control because some of them actually suppress estrogen, even the IUD, and it can cause vaginal dryness and even thinning of the tissue.

Less estrogen means less elasticity, which means less natural lubrication and more friction. That can be something leading to pain. Some other things I see are scar tissue or trauma.

If you've had a baby, if you had surgery or experienced any kind of trauma, scar tissue can make sex feel uncomfortable or painful. Then lastly, infections or medical conditions. Things like endometriosis, vulvodynia, vestibulodynia, which sounds complicated, but it really just means pain on the vulva or the vagina.

Those are things that can cause ongoing pain. To answer your question, no, it's not stupid to wonder if discomfort's normal. I think we've been conditioned to believe that women just have to push through pain, not only during sex, but just like during so many other things that we go through during our lifespan, but that's pretty outdated and wrong.

Pain during sex is your body asking for help. The good news is that there's so many ways to address it, whether it's switching birth control, using something like hyaluronic acid, which we can talk about to change the environment of the vagina, learning how to relax and strengthen the pelvic floor, or working with a specialist because sex is supposed to feel good. If it doesn't, we could figure out why.

[Galya Falkson]

Absolutely. I 100% agree with that. I think that the question of saying that, is it stupid to think that it's normal, is like, of course not, because we literally have grown up exactly like you said, that just push through, or someone telling you that it's normal that it hurts at first, but then how long does at first last? Is it going to be one time or is it going to be a year or three? I think that someone who doesn't understand this then starts to allow themselves to just go through these notions of having painful sex and waiting for it to end.

I think that an important thing that I see, especially within my practice and with my clients, is that when something hurts repeatedly, their brain literally starts to associate sex with pain, and they start to associate sex as this horrible thing instead of a pleasurable thing, and it's obviously the opposite of what we want, and then you land up having to recondition the brain over so many sessions and so many different angles of discussion and understanding of a person's experience in general, when it could have been avoided, and it makes me so sad because it is a normal thing that people are conditioned to believe this is normal, even though it's not a normal thing, if that makes sense.

[Dr. Millie Schweky]

It totally makes sense. So you know about the fear, tension, pain cycle? I mean, I could talk about it, but basically when we're exposed to a that's painful, right? Like our body's smart.

It wants to protect us. So the next time we're exposed to that stimulus, our body's going to want to go into protection mode. So what happens? You start to tighten up the muscles, and now you get put into the cycle of, oh, I know that the stimulus is coming.

Therefore, I will tense up. And then what happens is your muscles actually do tense up, and over time, you get stuck in this loop of pain. So I'm always telling my patients, you have to stop putting yourself in a situation where it's painful, and we need to work on getting your nervous system and your muscles and your breath to all be coordinated and on the same page so that we can avoid that.

And I just want to know from your perspective, like for a couple and the relationship, what do you recommend if someone's going through rehab, right, for painful sex, and they're stuck in this cycle? Do you say, like, oh, why don't you abstain for a little bit and try, you know, other things? Like, how would you guide someone?

[Galya Falkson]

Definitely. I think depending on the specific circumstance, but let's say someone is experiencing pain, the first thing I say is stop having sex that's painful. So if it's painful, then you're not having, I don't ever recommend having, continue having penetrative sex and having pain while you're going for treatment.

Once you start treatment, well, even before you start treatment, the minute it's painful, stop. But once you're in the space of treatment, the whole point of the treatment is to recondition our brain. So like you said, we have this cycle that we go through.

When you mentioned the pain cycle, I was actually just thinking about, like, how our brain works. So you have neurological pathways, and each time you do something over and over again, that neurological pathway becomes, like, pretty strong. And it will, therefore, when you want to do something, your brain automatically goes to that pathway.

However, when that pathway is now, oh, the minute I start kissing, I'm going to have pain in a half, like five minutes time. So therefore, my body tenses up and all those things happen. You can't work with that pathway.

You actually have to start creating a new neurological pathway with new experiences, with a new sensation, with pleasure and, like, excitement and all of the things, the connection that will then create that new pathway. And it has to look different to what you've done before, because if it looks the same as what you've done before, your brain's automatically going to go to that pathway. So the minute you start doing things differently, kiss but don't have penetrative sex, and then hug each other and do different things with each other's bodies, you start to create that new neurological pathway that gets stronger and stronger over time.

So yes, I would definitely tell a client to move away from penetrative sex and move into what can we do that doesn't involve anything that's painful? What are the things that we can explore with our bodies? And obviously, when it comes to my religious clients, they'll say to me, but no, like, you can't wear semen. And there's that whole discussion on that, which we can get to in another episode. But what I'll say is there is ways around all of that.

And I should speak to someone who understands the halakhah, because they can guide you. And this is something I then obviously will do for my clients, which is guide them through what it says and who they need to speak to if they need to speak to her or, you know, what the situation looks like for them.

[Dr. Millie Schweky]

This is great.

Just like watching you answer this question. I'm just so happy that this information is now going to be available for people to just like have and listen to. And I really think it's going to change people's lives.

[Dr. Millie Schweky]

All right, homies, thanks for listening. If you could do me a favor before you log out of this app and just quickly rate this podcast five stars and leave a review, that would be awesome. And it's going to help us continue to make more amazing episodes for you.

So don't forget to also share this with your friends and basically everyone, you know, this season's real juicy. And we're so excited to have you back for episode two. See ya!