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Sex and Intimacy with Alyssa Pressman

Let’s talk about sex! It’s such a tricky subject even under the best of circumstances. And when someone has had a life altering experience like cancer, regaining sexual identity is a multifaceted physical and emotional process.

Brilliantly: It’s really amazing that people like you are focused on helping individuals understand the complexities of sexual and intimate wellness. I think many of us, myself included, don’t have doctors that typically address sex. We're not taught that our pleasure matters, so it’s hard to ask about it and advocate for it.

Alyssa: Most doctors don’t talk about sex nearly enough! There's sometimes conversations around the functioning and the mechanics, but he other pieces of it— like desire and pleasure— are just left out.

Often we’ve been taught that sex is private and that we shouldn’t talk about it. And anything that's kept secretive is layered in shame. And when there’s a problem or you’re entering a new chapter of your life, you can end up feeling disconnected and alone. That leads to people feeling too shy to address an issue with a medical professional. So if a practitioner that brings it up, that opens the door. I hope to see more of that in the future.

Brilliantly: By opening up the conversation, it gives the patient permission to ask questions. But, most doctors weren't trained to talk about sex. That’s why I think practitioners like you are so important.

Alyssa: I've been a sex and intimacy coach for the last year. In the beginning, I was also working as a therapist full-time. And I just decided to dedicate my full time to the coaching practice over the summer.

I work with women on a variety of issues. Even when they want to address desire or sexuality, we end up talking about so many facets of their life. Typically there is an event or experience that makes us feel disconnected from our bodies and it affects our relationships.

Brilliantly: Getting our intimate needs met is part of being human, and of course tied to the rest of our lives. We’ve been cultured to have rigid thinking and rules around what is sex, what is rewarding sex, what is okay or not okay, or moral, or amoral. And to heal in one area, sometimes we have to reframe our thinking about a number of things.

Alyssa: Exactly. Even though I'm a sex and intimacy coach, I really support people through all kinds of issues including cancer and chronic illness. If you've had an illness, you might start thinking about your needs differently, and getting them met can look nontraditional.

Brilliantly: Of course. I’m sure facing your mortality makes you reconsider things and not just accepted what everyone else is doing is right for you.

Alyssa: My training, but also my life experience, make me want to address those individual ways of being happy and whole.

For example, I believe that one person is not supposed to meet all of our needs. We used to live much more in community and we have gotten away from that. Most people are craving connection, and it is healthy to get the things that you want and need from multiple people. Whether that's sexual, emotional, professional, and that's okay. That’s good.

Brilliantly: My mastectomy was the opportunity for me to admit that I couldn't do everything on my own. I had to ask for help in ways that I’d never had to before. I now feel like having this village of people around had an enormous impact on me as a mother and as a woman.

Even more importantly, that experience helped me understand that I can’t do and be everything. Nor can anyone else. And at first, that was scary to admit.

Alyssa: Right! How do we even begin to say things out loud that are too scary to admit to ourselves? We aren't taught to think critically especially about relationships, or to question the narratives that we have been given about how they should work. And when you go through life, you might find that it is ridiculous to expect one person to be my best friend, and my comfort, and also my passionate lover. That's just not going to work all the time.

Brilliantly: I find that really difficult to say to another person. I don't want to make someone feel like they’re not enough. But I know I’m not going to be all the things a Hallmark card says I’m supposed to be, and I don’t expect that from someone else.

Alyssa: I often work with people on how to make space for nuance and complexity around marriage, relationships, and sex. It’s difficult because often we want things to be simple, and easy to understand so that we feel safe and comfortable.

But having regular, maybe uncomfortable, conversations with your partner/s helps people not reach a point in a relationship where they’re like "Wait, what the fuck? I'm miserable.” And that can look really different from one couple to the next, but it’s often about communicate and expectation.

Brilliantly: I feel really hopeful when I hear women asking and wanting to know about sex and how to feel better because we often have to change new ways to feel pleasure after something like cancer or mastectomy. But just starting to ask those questions is difficult. How do you suggest women start tackling sexual wellness? By talking to a therapist or a doctor?

Alyssa: If there's sexual dysfunction that's physical, going to a doctor is the first step. I recommend finding a doctor that is referred by someone you know or is trained to talk about sex. A good place to start that search is with nurses and admins at the doctor’s office— they know what goes on. You can call an office, tell them what you’re looking for and ask if a doctor in the practice would be a good fit.

On the other hand, if you know that what's happening is related to stress, anxiety, trauma that’s manifesting as a physical thing, that’s when a therapist, or a coach could be really helpful.

Brilliantly: Having a professional to talk to you about sexuality and intimacy is new for many of us. I didn’t grow up in a house where we talked about that, and am therefore sometimes more reserved talking about sex, with doctors especially.

Alyssa: Thankfully, my mom was pretty sex positive and I could ask her questions. I know that’s not everyone’s experience. When I was a kid, I would steal her Cosmo magazine and pour through it and then give advice to my friends. If there was something wrong with one of their vagina, or they had questions about sex, I was the go to. I've always loved talking about sex and sexual health.

I’m sure many of us learned about sex, sexuality and our bodies from our friends or magazines and weren’t really properly taught.

Brilliantly: That’s so true. I love that you have always been the one in the friend group who is the safe person to call and that you continue to be that.

Alyssa: I like it too! I’m very non-judgmental. I don’t want to be judged, so I don’t judge.

Brilliantly: It’s important to address sex and intimacy without judgement. Finding out what feels good after cancer, mastectomy or oophorectomy means you’re going to have to get creative to find pleasure. Being comfortable communicating what you want and need, is even more important after a big life change, because many times the issues we’re facing are invisible to a partner.

Alyssa: Since my surgery, my posture has gotten so much worse and I have pain in my shoulder. So certain sexual positions and acts that I used to like are uncomfortable. I hate the idea of suffering through discomfort when the other person doesn't even know it's happening. It's on me to speak up, I'm supposed to be enjoying it too.

Brilliantly: For me, being touched on my breasts was painful for years after my mastectomy. All of my sensation was really poor. My doctor said massage would help regenerate some nerves, but every time I touched them, I felt gross. It took years before I was ready to be on the other side of having everything feel painful. It’s really just in the last year that someone can touch me when we're being intimate and it feels good. Different than before, but at least not painful.

Alyssa: We often need to grieve the loss of how things used to be before healing. It's important for our partners to understand and be willing to work with us on finding what feels good and can ask what feels good in a particular moment- because that will change. For many women recovering from surgery and treatment, progress is probably going to be slow. And if certain areas just need to be completely touch avoidant, your partner needs to honor that. I think that's really important.

Brilliantly: Of course! We would do that for a friend, right? If I went to hug you and you said you were in pain and not to hug you, I’d say "Of course, let's high five." But, in an intimate relationship, it can be complicated with a whole different set of thought and expectation.

Alyssa: Yeah, in intimate relationships, we take it really personally. We need to take off that lens and just see the other person as their own separate entity experiencing their own shit, and that it’s our job to honor their experience. Otherwise we add more pressure and emotional unpleasantness.

Brilliantly: It's hard to zoom out when you have the expectations that naturally come along with intimacy.

Alyssa: Much of my job is examining expectations and figuring out where my client’s expectations come from, and if they actually feel aligned with their values. Then, the key is, helping them be honest about their needs and expectations with their partner or future partners.

Brilliantly: I think a huge part of having healthy sex with yourself or someone else — from communicating what you need, to understanding your expectations, to being in a relationship, to dating, to saying who you are, and what you need, and what feels good, and doesn't feel good— is about being honest.

Alyssa: Yes. Especially because we’re all trying to present ourselves as best as possible and often that means playing it cool or acting like you don’t need much. With my partner, I never pretended to be low maintenance. I have needs, and wants, and I'm very vocal. I think it's really important to simply be yourself, needs and all. It helps filter out the wrong people. That's good, we're not supposed to be for everyone. It's okay if you express your truth and someone is like, "Not for me!” Okay, then. Let them leave and move on!

Brilliantly: Letting someone leave is really difficult. Feeling judged is difficult, too. But I think you’re right. Do you find you often teach people about communication?

Alyssa: Yes, because we are not taught how to do it. But first I support people in getting clarity within themselves. You can’t communicate your intimate needs if you’re not properly in touch with your body. Dropping into your body and listening to all of the things happening in there helps us understand what we want and need. And then we work from there, because we have to get clarity around wants, pain, and what's happening internally before we can have a conversation with somebody else.

Brilliantly: Of course. I hadn’t thought about it that way before. Once you help someone understand what they want, what’s next.

Alyssa: Having regular relationship check-ins is part of maintaining that honest conversation with yourself and a partner. If you make time and space once a week to check in with yourself or have a short conversation with your partner about what made you feel loved, and what didn't feel good, and if there is a different way to approach something that happened, it keeps the conversation going.

Brilliantly: I bet sometimes those answers could be really affirming or tremendously difficult to hear.

Alyssa: The key part of these conversations is practicing not personalizing the response. If you're asking for feedback and then you freak out about the feedback, all that communicates to the other person is that it's not safe to be honest. Then it shuts down and that's it.

If we can practice learning to sit with ourselves through discomfort, it makes us much better partners. When someone is giving us feedback and we start feeling poorly, instead of reacting, we can instead just listen and take in the feedback. Even if it's really uncomfortable at first, the more you do it, the more it builds. This is a muscle that you're building and flexing. It’s important to create a space where both people feel safe expressing themselves, and having weekly check-in defines that time.

Brilliantly: That’s such a great idea and I think probably would make you better at any relationship- personal and professional. But I can see how this type of regular check in would be beneficial to a romantic relationship.

Do you typically work with couples? What about single people, or people who are dating?

Alyssa: I will often work with women without their partner, too. Through coaching I’m hoping to help people learn to self-regulate, and then they show up differently in their relationships. Just that can actually shift the communication dynamic in a partnership.

Brilliantly: I can see how that’s true. When I get angry, or upset I try to sit with it and explore why. That helps me get to the root of the thing that's bothering me, and then deal with that. I’ve learned that it rarely make sense for me to respond to deep emotional, triggering, trauma-inducing things in the exact moment I feel it.

Alyssa: I'm big on taking timeouts. I'll realize that I need to self-soothe in my room or to go outside until I calm down before having an emotional conversation or addressing something that felt bad.

Not everything needs to get resolved immediately. I hope we can normalize doing some self-regulating before hashing it out with another person, and also making sure they’re ready for the conversation. Just because I'm ready and want to have this conversation right now doesn't mean it's a good time for the other person.

Brilliantly: That’s why self-monitoring is so important, right? So we can figure out the underlying things that continuously come up and need to be addressed with our partners or with someone like you, and what is a momentary reaction.

Alyssa: Typically, we don't really talk about stuff a lot until it's a problem, and then every conversation about sex becomes charged or problematic. That’s why I encourage regular, positive conversations about what’s happening. A key part to the success of all of this is having those conversations outside of the bedroom and never when you’re getting ready to have sex.

Brilliantly: I was just thinking about how important this is for women who’ve just undergone surgery or treatment, and how important it is to have conversations or explore yourself the whole way through.

Alyssa: Yes, because it’s going to change all the time. You might feel sad that your libido is low, or feeling sexual even though you’ve just had surgery. If you’re in a relationship, it’s important that the other person knows what's going on and how you feel. Because what ends up happening is we make up a lot of stories in our head without having any idea what's actually happening for the other person. Having those conversations like: "I'm not getting wet the way that I used to and I don't really know what's going on. I don't know if it's hormonal, and I think I going to talk to my doctor." Versus being silent and just thinking, you have to figure this out alone because it's so embarrassing. Just talk about it!

Alyssa Pressman is a Licensed Clinical Therapist & Certified Sex + Relationship Coach. She specializes in supporting women in moving closer to themselves, to other people and to creating lives that feel in deep alignment with their unique desires, with an emphasis on cultivating more pleasure and joy.  She is a brca1

mutation carrier and a person living with chronic illness and pain. Reaching for joy and pleasure has been deeply healing for her. When not working, you can find her dancing, lounging, reading or cooking, usually scantily clad if not naked. She loves talking, learning and sharing on all things sex, love, relationships and healing.

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