Making Peace with Pleasure with Dr. Tom Murray

What happens when being responsible, disciplined, high functioning, and air quotes good begins to interfere with intimacy, pleasure, and connection? For many people, sexuality is not blocked by a lack of desire alone. It may be shaped by shame, perfectionism, fear of being judged, fear of losing control, religious or cultural messaging, trauma, pain, or

a lifetime of learning to stay composed and perform well. Today we’re talking about what it means to make peace with pleasure, soften over control, and reclaim intimacy without pressure, performance, or guilt.

Welcome back to the pelvic floor, where we are talking about this season, pelvic health as always, but also sexual wellness and whole body healing, where they finally get a voice. Today I’m joined by Dr. Tom Murray, author of Making Nice with Naughty. Love that title, by the way. ⁓ So welcome, welcome Tom to the podcast.

Tom (01:09)

So lovely to be here with you. Thank you, Ginger.

Dr. Ginger Garner PT, DPT (01:12)

Yeah, I’ve been waiting in this conversation for a while. So all of you, all listeners, you know what comes next. I need to do my little bragging moment here. So let me tell you a little bit about Dr. Murray. He is a 2023 Global E-book Silver Medal Award winner for Best in Relationships and Sexuality Nonfiction. Dr. Murray is a sex and relationship therapist.

clinical supervisor, educator, healthcare consultant, entrepreneur, and executive coach. He’s been featured in many outlets, including the Washington Post, HuffPost, the Daily Mail, and has appeared on radio, television, and podcasts, such as the Practice of Being Seen and ShrinkWrap Radio. He’s presented at local, regional, and national conferences and taught at institutions, including UNCG.

Greensboro. I said UNCG because we’re here in Greensboro. I’m to tell you all about that in just a second. Adler University and Northwestern University’s Family Institute. Now, he also has a clinical practice where he brings a direct integrative approach that blends conventional methods with Buddhist philosophy, inquiry-based practices to help people quiet that internal chatter. We all need that. And that really can interfere with happiness, intimacy, and fulfilling sexual relationships.

His work explores the impact of self-control, perfectionism, and over-control on sexuality, intimacy, and connection. So Tom, again, welcome. Welcome to the podcast.

Tom (02:43)

Yeah, I’m so delighted to be able to dive into this. This is going to be an exciting, exciting chance to speak to you and your audience about the impact of over control and sexuality.

Dr. Ginger Garner PT, DPT (02:54)

Yeah, you know, okay, so dear listener, many of you ⁓ may not know that we’re actually in the same town in Greensboro, North Carolina. ⁓ And there’s many, many shared connections there. But ⁓ yeah, that’s why I said, UNCG, as if everyone knows UNCG. So I had to clarify, we are in Greensboro. Yes, we are.

So I want to talk about your book first because A, I adore that title and also there’s a lot of weight in that title like socially, right? Of identifying the whole concept of sex and with naughty or calling it dirty talk and all of these things like that, right? There’s this whole connotation that I think holds people back. So before I dive in and I want to make sure I’m understanding like the heart of

that title in the book correctly. as I’m reading it, it’s not just about sex or sexual technique. It’s about what happens when the traits that help people function well in the world, self-control, discipline, my gosh, rule following, all those things, responsibility, and having superb executive functioning, like being well organized, begin to interfere with sexual health, essentially.

⁓ Does that and I have like on the wrong I get in the right message here

Tom (04:22)

You absolutely are. You really summed it up. What making nice with naughty is really getting at is that a lot of people who are particularly rule-oriented.

⁓ may have grown up in families where they got the message, don’t do that, color within the lines, don’t be naughty. And they were in essence told that ⁓ to be liked, to be likable, you have to follow the rules. And that gets people pretty far in life.

But when it comes to their sexuality, ⁓ it can become an impediment. And so making nice with naughty is really making nice, becoming friends with naughtiness again.

Dr. Ginger Garner PT, DPT (05:18)

I love that. I love that because it’s in the work that I do in the pelvic health side of things, seems like, I mean, sexuality is very much connected to the nervous system and we can get all nerdy about that, but it’s connected to those memories that we develop, the old beliefs, body image, shame, fear of being judged.

I have so many patients who already have a hard time even admitting that they have these issues so they can get the correct referrals. And I think that you would refer to that or call that like an over controlled like temperament.

Tom (05:55)

That’s right. That’s right. If you think about temperament as just stable ways of showing up in the world. And two of the most famous temperaments are introversion, extroversion. Right. These are not good or bad. They’re just, again, stable ways of showing up in the world. And similarly, there are people who tend to lean under controlled, which means that they’re much more mood oriented. And then there are people who are over controlled and those are more rule oriented.

Dr. Ginger Garner PT, DPT (06:26)

wow, okay. So explain the phrase of like naughty. So when you use the phrase making nice with naughty, what does that refer to? What does the naughty actually mean in the context of your book? Because it can be taken so many different ways.

Tom (06:41)

For sure, for sure. So when I’m talking about naughty, I’m talking about playfulness without a need for certainty. Over-controlled people, we love certainty. And I say we because I am certainly over-controlled. Anybody who goes to graduate school.

let alone get a doctorate, you have to be, you have to lean over control because ⁓ there are just these steps, these hoops that you have to jump through and be very methodical in that way. ⁓ And so ⁓ sex is really about

Dr. Ginger Garner PT, DPT (06:59)

Ha ha ha.

⁓

Tom (07:17)

playfulness, it’s about being in the moment, it’s about pleasure over performance, and that’s that naughtiness, almost that reclaiming, that which we innately gravitate towards, right, which is doing that which feels good. And, ⁓ but many people who are over controlled, they develop this sexual perfectionism. And then that becomes what shows up.

in my office to some degree. And if I may, there are four types of sexual perfectionism. There’s the, I have to be sexually perfect. There’s the, my partner has to be sexually perfect. Then there’s, I think my partner thinks I have to be sexually perfect. And then lastly, society expects me to be sexually perfect. So when I’m working with individuals or couples,

Dr. Ginger Garner PT, DPT (08:07)

Hmm.

Tom (08:16)

I’m often hearing one or more of those themes showing up and interfering with their ability to be present with their partners, or even when they’re present with themselves, just to reclaim that sense of sexual ⁓ identity.

Dr. Ginger Garner PT, DPT (08:32)

Yeah, that, there’s so much information in that. Okay, let’s unpack that a little bit. So.

How would a listener recognize themselves? Because sometimes, you know, maybe your partner recognizes things in you, but you can’t see those things in yourself or whatnot. So how might the listener recognize themselves in the color inside the lines person that you’re writing to?

Tom (09:00)

Well, ⁓ one example that gets a lot of chuckles when I do talks about it is if you have to go behind your partner to rearrange the dishwasher because it wasn’t quote done right, you probably are over controlled. Or if you’re someone who studies consumer report for three weeks before you buy that vacuum cleaner.

Dr. Ginger Garner PT, DPT (09:12)

Ha

Tom (09:21)

or ⁓ you’re constantly looking at the reviews on hotels or other excursions, trying to make your choice. And again, what is it all for? It’s to alleviate ⁓ the anticipation of regret. I don’t want to regret something in the future, so I’m going to strategize in the moment, ⁓ unfortunately, what

happens is that if your partner is on the receiving end of seeing you rearrange the dishwasher every time that they’ve ⁓ loaded it, you’re implying imperfection. It’s a subtle form of criticism. And it’s saying, my preferences are prioritized over the relationship.

And that is the slippery slope for a lot of over controlled people, that my preference to buy the perfect vacuum cleaner robs me of attention that might be better suited elsewhere. So again, over controlled people that rule orientation that there must be, that there’s a ⁓ particular way the world should be, must be, or has to be can be quite limiting.

Dr. Ginger Garner PT, DPT (10:39)

It sure is. And that’s what society praises, right? Being disciplined, being self-controlled, being responsible, being organized, those are all wonderful things, right? It’s what’s rewarded. ⁓ So how does someone… And the grad school degree, of course, we’re both sitting here with grad school degrees, and I’m laughing about that. That triggers, that brings up a lot of things for people is…

You write about that over controlled temperament and when it shows up in intimate relationships, what does that mean? What does that begin to look like? Obviously it becomes a barrier, right? But what do you see? What do you see as kind of a common presentation there?

Tom (11:27)

It can look often like criticism. So it’s giving a lot of unsolicited advice, for example, the strong sense of if you don’t do what I want you to do, then we’re going to have some kind of relational problem. Right. And in fact, there are are ⁓ two subtypes to the over controlled temperament.

Dr. Ginger Garner PT, DPT (11:30)

Hmm.

Tom (11:54)

And one of those is the overly agreeable subtype, right, which is a need to be liked, right? And often the overly agreeables have this subtext where they are communicating to their partner, ⁓ you don’t quite understand me and you’re hurting me, right? That might be a subtext.

There’s the overly disagreeable subtype, which is the subtype I have, ⁓ which is much more of the, I’m not going to tell you what to do, but you better do what I say. So where the overly agreeable have the need to be liked, the overly disagreeable have the need to be right.

Dr. Ginger Garner PT, DPT (12:42)

okay, liked versus right.

Tom (12:44)

you say,

liked versus right. And when that ⁓ is prominent in a relationship, it necessitates that the other person have to accommodate it in some way. ⁓ The other person may feel like, I have to walk on eggshells a little bit, or that I’m in a relationship with someone who’s not quite a self.

Dr. Ginger Garner PT, DPT (13:06)

Hmm.

Tom (13:10)

right, that they’re so afraid of offending that they don’t voice an opinion. ⁓ I think about ⁓ faking orgasms, for example, that is a common overly agreeable subtype tactic, right? ⁓ Or overly disagreeables may emphasize things like we should be having sex at least two times a week or three times a week, this kind of rule.

Dr. Ginger Garner PT, DPT (13:25)

Mm-hmm.

Tom (13:36)

⁓ orientation, but not so far as to be necessarily telling the person what they have to do, but there may be a ⁓ negative consequence for not doing it. Maybe moodiness, for example, the person, you know, you’re not giving me sex two or three times a week and now I’m going to walk around moody.

Dr. Ginger Garner PT, DPT (13:59)

Mm-hmm. Yeah. Yeah. my gosh. All right. So to go back over those subtypes, you’ve got the overly agreeable, which is what you mentioned, the need to be liked versus overly disagreeable or the need to be right. Okay, listeners, did you write that one down? Log that one in because that requires a lot of thought. so…

If someone identifies on either end of that spectrum, or maybe the better question is, how do they begin to identify which, because I’m sure it’s like everything else, a spectrum?

Tom (14:38)

It is an and certain relationships can bring out more of a strategy than others. Right. ⁓ I certainly over the course of my life have recognized my tendency to be differential if I’m communicating with someone who I think is an authority figure. But ⁓ I can also be very I’ve gotten feedback people can experience me as being intimidating.

Dr. Ginger Garner PT, DPT (14:44)

No, right.

you

Tom (15:06)

⁓ when we’re debating ideas, for example. ⁓ And so, and I’m sure we’ll get there, but I wanna preface this by saying there are ways to tone down the intensity of one’s over-controlledness so that they are more pro-relational. ⁓ And certainly that’s what my book represents.

Dr. Ginger Garner PT, DPT (15:10)

Mm-hmm.

Right.

And I guess for people listening this too, they’re going to have realized that they may not be able to identify it in such terms, which is going to be really enlightening for a lot of people for them to be able to say, okay, this is not some strange things. It actually can have a label, right? And they may be realized that that self-control has crossed from helpful in ways that it’s been rewarded into now it’s harmful. It’s a detriment. Yeah.

Tom (15:57)

That’s right, or maladaptive.

Right?

there’s this, it’s again, as you alluded to earlier, ⁓ being over controlled is seen as a superpower in most of the world. I mean, over controlled people are the ones that get things done. We show up on time. We’re reliable, accountable, responsible, we’re all of those qualities and that can be highly rewarded in the world out there. But if I find if it’s going to become a problem,

Where does it typically show up as a problem? in people’s sexual and intimate relationships.

Dr. Ginger Garner PT, DPT (16:35)

That’s the mic drop.

So do people even realize that they’re, as we kind of transition into kind of making, to doing something about it, like the mind-body connection, do people even realize that they’re carrying that over control or sexual shame, or does it just show up as avoidance, disconnection, anxiety, like conflict, loss of desire, like?

Tom (17:01)

For a lot of people, this is a new concept. Until I meet with them and I’m talking to them, and within a few minutes, I can have a sense of whether someone leans over controlled or under controlled. And then I can start describing their personality to them without ever having a full session. then that’s when the buy-in happens of, yeah.

you know, if Dr. Tom can identify this much about me, then maybe this isn’t original. You know, maybe it’s not that I invented this. And of course they didn’t, they didn’t invent it. And I have to remind them that they’re not that special, right? That they didn’t invent it.

Dr. Ginger Garner PT, DPT (17:34)

Yeah.

Yeah, well, I like to tell patients there are instances where being a unicorn can be great, but we don’t really want to be a unicorn in this situation.

Tom (17:55)

Yeah, and isn’t it nice to know that other people have had this experience, right? And that there’s a path forward.

Dr. Ginger Garner PT, DPT (18:00)

Yeah.

Yeah, yeah, yeah, it should be comforting to know that you’re not a unicorn in that way. ⁓ And that’s a really important reframing. mean, before someone ever talks about sex itself, we need to talk about all of the things that swirl around it that need to feel in control, what the nervous system does with that, which is a whole other issue. And so I wanna talk a little bit about the mind-body connection of that because so many people experience intimacy concerns

Tom (18:08)

Yeah.

Dr. Ginger Garner PT, DPT (18:32)

⁓ They’re not just thoughts or relationship struggles, but they’re like real body responses. And I think that’s where my entry point is to the whole sexual health realm is in pelvic health PT is seeing what’s happened to the body as a result of what’s going on. So one of the things I appreciate about talking about the framework is being able to move.

past this idea that it’s just, change your libido, or it’s just a technique problem. How do thoughts, memories, expectations, and shame shape the body’s threat response? Because I think that’s the nervous system. I tell patients this all the time. The nervous system is ultimately in control of so much about us. So what are some common ways that

people unknowingly bring this whole performance pressure into intimacy, like the thoughts, the memories, the expectations, the shame, how they respond to threat.

Tom (19:39)

Yeah, well, some people believe that over controlled people can ⁓ experience trauma differently than under controlled people in the sense that over controlled people, we work so hard to make life be predictable, to make life be certain, and yet life is inherently uncertain.

And so if we’re doing a lot of planning and we’re very hyper vigilant to threat, know, over controlled people tend to be threat sensitive, risk averse. And so if we’re doing all of that, we can hold a lot of tension in our body. Right. And of course, sex is a very vulnerable act for a lot of people, particularly if you have one or more of those sexual perfectionism.

Dr. Ginger Garner PT, DPT (20:22)

Mm-hmm. Mm-hmm.

Tom (20:33)

⁓ themes. And so ⁓ when you’re, ⁓ if you recognize that this is showing up as a problem in your sexual and intimate relationships, I think that that’s the first step is to look for opportunities for flexibility in how you’re thinking, in how you’re interacting, welcoming, here’s the big one, awkwardness.

Dr. Ginger Garner PT, DPT (21:01)

Hmm, yeah, that’s huge.

Tom (21:03)

It’s

a lot of over controlled people have an allergy to awkwardness. I need some EpiPens to pass out. You know, they have anaphylactic reaction to awkwardness. when we were children, young, young children, ⁓ the doing things that we didn’t know how to do was just that’s exactly how we navigated life. But for a lot of people, particularly if you were in a very ⁓ strict

morally punitive childhood, ⁓ you may have internalized that, ⁓ I gotta stay within this narrow definition. it doesn’t allow for the kind of flexibility that life inherently necessitates, you see. And so that ⁓ awkwardness,

Dr. Ginger Garner PT, DPT (21:55)

Yeah.

Tom (21:59)

is as adults, I think our best friend. So when we are, you know, I don’t want to reach out to my partner that I would feel awkward if I reached out and wanted to hold my hand, then reach out and hold your partner’s hand. Do the awkward thing over and over and over and over because that’s the playfulness that is making nice with naughty.

Dr. Ginger Garner PT, DPT (22:26)

I love that. I love that so much. ⁓ And that also shifts us away from the language that people often get entangled or ensnared in, and that’s all around the word performance. Where this performance turns into pressure, and then you can’t have, you can’t be focusing on that and actually have an ounce of playfulness in your body. And so that leads to things like, okay, so many of my listeners, just to like talk practically,

they are interested in, or they actually have active pelvic health problems, pain, trauma, they’ve lost that sense of being able to like somatically experience their body or embody what’s going on because that’s the way they survived. So what do you wish more clinicians understood about that relationship between, know, and it’s not just clinicians, it’s everyone, right?

Tom (23:13)

Yes.

Dr. Ginger Garner PT, DPT (23:25)

What do you wish people understood more about the relationship between sexual concerns and the nervous system when they have all of this noise going on in their head?

Tom (23:33)

Yes, think another way of thinking about personality is the sum of all of your best attempts to survive childhood.

Dr. Ginger Garner PT, DPT (23:44)

Hmm.

Tom (23:46)

So when a patient comes to your office, that person is bringing with them all of those echoes of a history. And they’re doing their level best to survive life. And yet we are also bringing in the…

negatives, if you will. ⁓ I had a couple where ⁓ the husband clearly has complex PTSD. And how he was showing up in the marriage over the course of about five years had really hurt the relationship.

Was he intentionally trying to hurt the, no, right? But it is recognizing that, if I let my anger ooze out because of ⁓ this trigger or that trigger, it’s not like it’s contained and it’s only happening in isolation, but it has an impact on other people, right? Well,

That’s true about the patients that you and I see, right? They have their life. They’ve had to interact with other people and other people’s stuff has impacted them. But of course, they too show up in ways that impact other people.

as well. And that appreciation for ⁓ your symptoms, whatever they may be, did not happen in a vacuum, but are a product of a particular context. I focus on the emotional, psychological. ⁓ You focus ⁓ more on the physical and the emotional.

And so it’s not a problem that only one person can solve. And that’s what collaborations, particularly as a sex therapist, having ⁓ collaborations with pelvic floor specialists who understand this dynamic process that involves all of these factors is really ⁓ important. And

Dr. Ginger Garner PT, DPT (25:46)

Yeah.

Tom (26:04)

the assumption is, of course, if a patient’s seeing you, they’re looking for some path forward.

Dr. Ginger Garner PT, DPT (26:12)

Yeah.

and they may feel, they may recognize that they’re being hypervigilant in some way, but can’t kind of break it down from there, or they have anxiety, ⁓ and that’s interfering with emotional closeness. Well, if you start from the beginning, desire, arousal, know, orgasm, emotional closeness. So how might, like from my perspective, ⁓ listeners have heard for several seasons now how that shows up, right, with pelvic floor dysfunction, and we talk about it all the time.

But then, how does this end up showing up beyond just, you know, the guarding and the bracing and the protecting that physically may happen, which creates dysfunction from the voice to the pelvic floor? How does that show up then emotionally, sexually, you know, when you’re working with people?

Tom (27:05)

I’m not sure I totally understand the question. you frame it differently?

Dr. Ginger Garner PT, DPT (27:09)

Yeah, sure.

⁓ I think that for, let’s just say we’re talking to people who, because lots and lots of people have back pain, over 86 % of the population, right? And I think many don’t consider that their multidisciplinary, like multi-system impacts. Back pain can turn into sexual dysfunction, right? Back pain may not be back pain, it actually might be.

sexual dysfunction or pelvic floor situation that’s going on. It could be other things too. So for the person who’s experienced that, and if the vast majority of the population has experienced that, how do they identify the emotional side of what may come up before it maybe becomes sexual function? Does that make sense? Like if we had a lab that we could, like a blood lab, right, that we could give someone and say, ⁓ here’s some precursors. The problem is coming.

Right? Like if someone’s pre-diabetic, instead of letting it become a full blown sexual dysfunction problem, what are we gonna identify in then that’s like a precursor to that? That might be emotional, psychological, spiritual. Like what are the things that are precursors there?

Tom (28:24)

The one that’s sticking out for me is ⁓ neuroticism. That the more that someone worries about life, if they identify with that worrier mentality, or again, that kind of rule orientation, things have to be a certain way, must be a certain way, should be a certain way. Think about it terms of psychological rigidity.

Dr. Ginger Garner PT, DPT (28:29)

Hmm.

yeah.

Tom (28:51)

right? The more psychologically rigid someone is, the more difficult ⁓ they’re going to experience the changing life situation. know, life is dynamic. The more flexible you are, the more accommodating you’re going to be, right? I mean, that’s the basic Buddhist practice of acceptance that

⁓ when we can be flexible ⁓ to life, then we suffer less. It’s in that rigidity that we’re suffering. And so neuroticism, that kind of in your mind, that worrying about what the next thing is going to be. When you see that a lot with vaginismus or even dyspareunia in general, it’s like I’m anticipating discomfort in the future. And that then

creates this physiological change in the body that the body now is preparing for discomfort and then becomes more rigid in the process.

Dr. Ginger Garner PT, DPT (30:03)

And that is where pain neuroscience comes in, pain neuroscience education of, end up explaining this a lot to patients to help them to get out of the self blame cycle, the self blame and the shame cycle of, your brain once it has experienced pain once or twice or 15 times will actually pull up that same memory, activate the same pathway and actually target the experience of real pain

with no stimulus at all because of the heavy anticipation that can be there. That’s all that’s needed to reactivate that same pain pathway. And then the point of that is to then break the cycle at where, at what point and how do you begin to break that cycle for people. And then that of course then easily overflows into you mentioned dyspareunia, which for our listeners just means, you know, painful intercourse, but that can mean a lot of different things.

depending on who you are and how you identify and what you define intercourse as. So that’s like a big bucket of stuff, right? If someone has experienced pain and then they have vulvadenia or vaginismus or in general, know, dyspareunia and they want sex, but the body will not cooperate, it’s definitely a multidisciplinary thing. Like it takes a village.

because we’d have to identify the psychological versus the biomechanical or the physical aspects of it. So when someone comes in and they’ve identified, they at least they’re pointed in the right direction. So they got to you, right? They picked up your book or they ⁓ found you somehow. Where do you begin? Because I know just to go back a couple of steps, we had talked about those subtypes of overly agreeable versus overly disagreeable.

Maybe that allows us to circle back to that for second. But where do you begin when someone sits down in the office? What does it look like? Because I think a lot of people might frankly be like, I don’t need that. Or I can handle this myself, right?

Tom (32:14)

Certainly, if someone is coming in to see me, ⁓ first, unfortunately, it’s unusual that women come to see a male sex therapist for these types of issues. ⁓ But when that does happen, I’m going to do a relational, psychological, emotional, and health history.

And I’m going to get them referred out as quickly as possible to see a pelvic floor specialist.

⁓ Typically, they’ve already have a relationship with a gynecologist because I, know, my license doesn’t allow me to touch patients. So I have to refer people to others who are able to do that and to make it an assessment and see is there something biomechanical at play that then can become also the source of treatment. And then the emotional psychological side is how do I navigate

the experiences that come up when I’m doing the exercises, for example. ⁓ Often, though, there is a relational component.

Dr. Ginger Garner PT, DPT (33:26)

Mm-hmm.

Tom (33:31)

that maybe this has come on so long that the other partner is just so sad or desperate or depressed or angry or resentful about that. And of course that impacts how that partner shows up in the relationship and then that impacts the patient and so forth. And so as a couple and family therapist, I’m really looking at it from a systems lens and how do these various elements interact.

Dr. Ginger Garner PT, DPT (34:00)

Yeah, and I think that, you you mentioned something that’s really important that it probably bears some repetition and expansion on because when people, and this is like a genderless conversation, because everyone has a pelvic floor, so at some point, you’re probably going to need help in that way across the lifespan, safe to say. ⁓ But when you go in and you talk to a practitioner, maybe you try to…

to talk to your general practitioner, your primary care, your PCP or GP. I find people don’t do that, right? They wait and they wait and they wait until they end up in the urology office or they end up in the gynecologist. And here’s the thing about that. Just like across the lifespan, most practitioners are not, let’s just say menopause literate, most don’t know what questions to ask, no one gets training in it. It’s like, it’s just, how do we talk about that?

No one gets training in screening for sexual health dysfunction or disorders or anything like that either. And so if you’re listening and you’ve had that experience, I just want to validate that for you that it’s unfortunately a common, commonly abnormal occurrence, right? To go into your gyno, to go into your urologist and say, I’m having these issues and they don’t even ask about sexual health at all.

It’s just major medical and that’s it. And then you’re out the door and you’re like, you know, the person, the patient, the person is like, now what do I do? Because they don’t even get a proper referral to end up in your office, right? They’re not even identifying biomechanical issues that might send them to my office, for example. So I just want to point that out because ⁓ our whole system is not identifying these issues well enough to get them to the right people.

Tom (35:54)

It’s true, and a lot of these medical providers will readily acknowledge that they get very little training in human sexuality. They get excellent training in human reproduction. It ends there. And so as we know, again, low sexual desire is one of the most common ⁓ symptoms that show up in any sex therapist’s office.

Dr. Ginger Garner PT, DPT (36:10)

And it ends there.

Tom (36:23)

Right. and but it doesn’t a low sexual desire is not just typically it’s not just something that is going on within the individual. ⁓ As Peggy Kleinplatz says, sometimes low sexual desire isn’t evidence of something wrong with you. It may be evidence of something right with you. That maybe you’re in a relational context that isn’t

Dr. Ginger Garner PT, DPT (36:50)

Yeah.

Tom (36:51)

facilitating sexual desire.

Dr. Ginger Garner PT, DPT (36:54)

That’s a really good point. I think that is a good segue to some next questions that I was thinking about, which is, so essentially I think what you’re saying is we have to differentiate between, well, A, make sure you get to the right provider who can actually ask you the right questions about sexual health and get you to the right person. That’s important. And there are previous podcasts in this season and a few coming up that tell you exactly how to do that. So you can ask the right questions and get to the right people.

But we’re talking about differentiating between a relationship problem, a sexual script problem, a shame problem, a body-based problem, a pain-related problem that may necessitate a referral to a different person. But what I appreciate, I think what we’ve been trying to say and what you’re trying to say so far is, you know, your people think, this is the phrase that I get a lot. There’s something just wrong with me.

Right? When in reality, their body might be protecting them, adapting, bracing, responding to old scripts, or like you said, a relational issue that they’re just not in the right situation. And that’s like a heavy thing for someone to realize, right?

Tom (38:15)

Yes, Of course, they’re coming to you when the symptom is so evident.

But again, most symptoms that we have, ⁓ certainly that I see, is months, if not years, in the making. And that ⁓

Dr. Ginger Garner PT, DPT (38:39)

Mm-hmm.

Tom (38:44)

understanding and appreciation is really important. Otherwise, we could focus on the wrong things. As a counselor educator, one of the common observations I have of new graduate students is they get sucked into the weeds. And they’re talking about the things that the couple is fighting about in that moment versus what

Dr. Ginger Garner PT, DPT (39:03)

Bye.

Tom (39:14)

is the meaning behind the position that each partner is taking. As Esther Perel says, it’s not about what couples are fighting about, it’s about what they’re fighting for.

Dr. Ginger Garner PT, DPT (39:19)

Mm-hmm.

Yeah. Yeah.

Tom (39:30)

And so

in sexuality, ⁓ there’s a subset of people who have been trained to believe that their sexuality is scary, that it’s bad, that it’s sinful, that it’s contaminated. ⁓ Working in the South, a significant of my…

Dr. Ginger Garner PT, DPT (39:49)

Mm.

Tom (39:55)

⁓ patient population are people who grew up in the purity movement, right? And we’re told over and over and over sex is a sin, sex is a sin, that boys only want one thing and this, that, and the other. And then on the day that they get married and they say, I do, it should be a switch where now sex is supposed to be enjoyable and that you would want it and that it’s sanctioned by God. And for a lot of people,

Dr. Ginger Garner PT, DPT (40:00)

yeah.

Tom (40:23)

particularly those who are over controlled, that is a very hard transition to make.

Dr. Ginger Garner PT, DPT (40:29)

Yeah.

That’s so true. mean, being born, raised in North Carolina in the South, I mean, that’s like the pervasive, that’s a pervasive thing that you hear that if you weren’t raised with that, it was all around you anyway, right? And as a clinician practicing in this, I’ve been, this is going on 30 years, you’re very immersed in what that rigidity looks like. So then how do, here’s the real question, right?

Now what? Right? So we have this cultural conditioning, this social script, religious conditioning, that kind of thing. But we want to move out of that rigidity and out of that body protection embracing and towards flexibility, towards play, towards vulnerability. And your book and your work invite people to do that, to soften that rigidity, to move towards that. So…

Why is that so flipping difficult for the over controlled person?

Tom (41:35)

It’s difficult because it’s so seductive to believe that life can be certain, that life can be predictable. And if you just plan enough, you’ll remove all uncertainty.

Dr. Ginger Garner PT, DPT (41:42)

Mm.

Tom (41:54)

and then you won’t regret anything and then you won’t feel bad in the future because of it. It’s very seductive that kind of, that line of thinking. And quite frankly, it somewhat reminds me of a time in my career when I was working with eating disorders, particularly anorexia. It is very seductive for the person with the eating disorder.

to believe that, if I just eat fewer calories and just fewer calories and fewer calories, I’ll lose weight, lose weight, lose weight, and then I’ll be more desirable. That’s very seductive. It is hard. It’s hard to convince somebody. Actually, you have to eat more calories. Like that is a ⁓ difficult.

Dr. Ginger Garner PT, DPT (42:39)

Yeah.

Tom (42:43)

transition. I think that that’s also true for a lot of over controlled people is that they can easily convince themselves in part because the world out there reinforces it. That intimate and sexual relationships do have a different set of needs, a different set of

of dare I say rules in order for it to be ⁓ enjoyable, in order for it to be meaningful, in order for it to be pleasurable. ⁓ For a lot of over controlled people, there’s this emphasis of I need to create a life worth having, which can be interpreted as with the least amount of unpredictability.

But what we really want to aim for is a life worth sharing, which does necessitate accommodation, flexibility, collaboration, coordination, consideration.

Dr. Ginger Garner PT, DPT (43:35)

Hmm.

Yeah.

And that whole idea of vulnerability to get to that point. So that what the person wants become insects and intimacy becomes possible. ⁓ And there’s things beyond the obvious, I’m sure, because it’s kind of like, here’s a phrase that I really hate hearing and a lot of patients come in and sit down and say, yeah, I I tried telling my urologist or my gynecologist that I

you know, whether it’s, you know, and men, might be erectile dysfunction or painful erections, et cetera, or in women like, oh yeah, sex hurts, only to get told, oh, you just need to relax. You just need to have a glass of wine and relax. And I’m like, oh, my head, my eyes roll back in my head. I’m like, And yet we hear it constantly, the superficial stuff, like, oh, well just relax then, just be playful, just be vulnerable.

What does that look like beyond the obvious if people feel silly, immature? Maybe it feels threatening to someone who survives by staying composed, competent, and in control.

Tom (45:04)

Yes, yeah. Well, ⁓ you bring up erectile dysfunction. ⁓ For a ⁓ lot of the men I see, ⁓ they ⁓ describe problematic erections only when they’re partnered. That when they’re by themselves and they’re masturbating, they have no difficulty getting and maintaining erections. So that’s

Dr. Ginger Garner PT, DPT (45:09)

Mm-hmm.

Hmm.

Tom (45:29)

evidence to me that what they have isn’t erectile dysfunction, they have erectile disappointment, that their their penis isn’t showing up. And in part, there’s this ⁓ emphasis on the penis being the star of the show. Right? So you remember sexual perfectionism, I have to be sexually perfect. I have to have an erection every time I want one. And I often say, well, dicks aren’t dildos.

Dr. Ginger Garner PT, DPT (45:35)

Hmm.

Mm-hmm.

Tom (45:57)

They’re not always erect just when you want it. But you also have the, partner ⁓ thinks I have to be sexually perfect. So you might get some feedback that you’re like, ⁓ no, I’m going to disappoint my partner if I don’t have an erection, or I’m going to disappoint my partner if I don’t have an orgasm.

Dr. Ginger Garner PT, DPT (46:00)

Yeah

Tom (46:20)

And sometimes the partner having their own sexual perfectionism does expect that their partner be sexually perfect. I do expect my partner to always have an erection. So ⁓ on occasion, I have suggested that in this transition from performance based sex to pleasure based sex, it is OK if you wear a strap on dildo.

If it means that you can have a good time with your partner, ⁓ you don’t ever have to worry about whether the erection is going to show up. In fact, you can even buy these ⁓ silicone molds on Amazon where you can go off on your own and get your erection and take a silicone mold. And it will be your penis in silicone. ⁓

Dr. Ginger Garner PT, DPT (46:50)

Yeah.

Yeah.

Mm-hmm.

Tom (47:17)

And what often happens is that when they wear the strap on, their natural erection shows up because there’s no pressure there.

Dr. Ginger Garner PT, DPT (47:24)

Yeah.

That’s such an important distinction because, I mean, even from a differential diagnosis, so like from the medical side of things, where we’re trying to figure out what is going on, right? Is it a biomechanical problem? Is this a systemic problem? Is this a cardiovascular problem, right? Is it a vascular issue? Or is this a psychological issue that can be worked out otherwise? That’s just really important to make that distinction. So I love that point.

Tom (47:48)

Yes.

Yeah, and I think a lot of therapists need to ⁓ rule out the medical. And I think too many of my colleagues are much, it reminds me years ago, I was with a patient who wanted me to do hypnosis for skin picking.

And I thought about it, you know, and I was, I certainly had a hypnosis script for that. But I said, you know, why don’t I refer you over to dermatology ⁓ first? And I made the referral, the patient was all dermatologists and the patient came back that they were diagnosed with psoriasis and that they only needed cream.

Dr. Ginger Garner PT, DPT (48:44)

Yeah.

Tom (48:45)

Right? Well,

I’m so delighted that I didn’t get, you know, stuck in my own ⁓ ego and be like, I can do this. I can do this. Yeah, it’s probably some kind of obsessive compulsive thing that’s going on. You know, rule out that those those medical things, those biomechanical things so that you have greater confidence that what you’re working on is really targeted.

Dr. Ginger Garner PT, DPT (49:00)

right.

Yeah, that is so important. I think it’s sad that in 2026, we have to be having that conversation too, that we need to properly screen for this, that we need to ask the right questions. But I just want to, again, listener to be encouraged to be validated that the system isn’t yet structured to be set up for you to ask these questions very easily.

But now, you know there are resources, okay? There are resources here, ⁓ certainly through the podcast, we’re going to obviously follow up with contact information and that kind of thing. But for now, we’re still operating in a system that might not be identifying all of the parts and pieces yet. So…

It’s not that it’s deliberate medical gaslighting, but it happens. It happens, yeah.

Tom (50:08)

It happens,

it does, and there’s an incentive to initiate the lowest cost intervention first, which is often about symptom relief versus problem resolution.

Dr. Ginger Garner PT, DPT (50:25)

So true, yeah. Our system is not aligned to look for root cause, unfortunately. Those values are not there. Yeah, it is set up to be symptom relieving and oftentimes that is just a simple bandaid or it is the wrong bandaid altogether. Yeah. So what are some small, as we move into kind of like expanding the conversation without pressure, teaching,

individuals and couples how to approach the issue without turning the other partner into the problem, right? To not make the other person feel rejected. ⁓ How does that conversation look? Like how do we just distinguish ways, small non-threatening ways that people could practice more openness, more play?

Tom (51:17)

Yeah, so inquiry is a process, right? It’s a ⁓ one of the more powerful questions one can ask themselves is what is it for me to learn here?

that am I approaching my growth edge and how am I going to lean just that little bit forward ⁓ and take some risks? I talk about this in my book that a common feature among over controlled people is this phenomenon I call psychological obesity, where they accumulate

⁓ ideas, research, they read books, listen to podcasts, they’re continuously taking in information, but not taking action. And so just like with caloric, if we eat too many calories, and more than we need energetically, then we’re going to gain weight. In a similar vein, if we’re taking in all of these ideas, but we’re not taking action,

Then it’s all it’s it’s perpetuating a problem if if not exacerbating it so taking action Asking yourself. What is it for me to learn here? I’ll give you an example my this is when my son was young and was playing soccer and and I kept on saying, you know, we’re gonna leave we’re leave to go to soccer and I’d give them a 30-minute window 15 10 5 and still

Dr. Ginger Garner PT, DPT (52:52)

Yeah

Tom (52:52)

This

his stuff wasn’t around. And I just blow my top. I get so upset. And then I reflected what was the rule that I was believing was being broken here.

And it came to me that what I was afraid of is how the coach would perceive me if I showed up late, as if the coach’s salary was dependent on my four-year-old showing up to the soccer field, right? Of course not. But that, for a lot of over-controlled people, we navigate life with what we call an invisible audience.

that other people have opinions about us. Well, when we can take a moment and register the frustration as evidence of an adherence to a rule that we’re afraid is going to be broken, frustration is evidence of a rule that we’re afraid is going to be broken, then we can question the validity of that. And is it pro-relational? Is it pro-relational for me to blow my top at my kids?

Is that cultivating a life worth sharing? Or is it, just want them to follow the rules so that I can have a life worth having.

Dr. Ginger Garner PT, DPT (54:08)

That’s so good.

That’s a hard question to excavate. ⁓ Very necessary. And I think that if we talk about how listeners may feel, so they’re thinking, okay, I clearly, like, I’m playing the listener here, clearly have some things that I could talk about or dig into that question deeper, but they want to…

just instead feel, walk away feeling like maybe embarrassed or shut down or disconnected from pleasure or afraid they’re just quote, know, like bad at sex. ⁓ What is the reflection that they can try to better understand their own like internal sexual script, so to speak?

Tom (55:01)

Why do you want to start a campfire?

Why would you want to start a campfire?

Dr. Ginger Garner PT, DPT (55:09)

I should answer it. Okay. ⁓

I want to be, it must be, well, it doesn’t have to be chilly. I love a good campfire. Cause it smells great. It’s warm. There’s a certain ambiance about it. It’s quite cozy. And one more thing. I can’t remember. That’s off of my head.

Tom (55:28)

Yeah, right. So you

have a vision about what you want in the future. And that’s what it starts with. What do I want in the future relative to a fire of desire? Do I want to have a sexual relationship that is meaningful, that is pleasurable? ⁓

Dr. Ginger Garner PT, DPT (55:35)

Yeah.

Tom (55:56)

Is that what I’m wanting to cultivate? And then once you have that vision, you can go to work with creating what in the book I use a metaphor, the fire desire, the rocks that go around the fire, the container are really the values. What are the things that you need to have in order to feel like, ⁓ I can let these flames build?

but feel safe enough within this space to allow that ⁓ out of control-ness, if you will, that is the fire, to happen, but within that perimeter of safety. And then…

The ⁓ fire, as you know, needs oxygen and fuel, right? So ⁓ oxygen is this identity, this sense of self as a sexual person that you’re breathing into the fire. I am a sexual person. I was born a sexual person. I am a sexual person today. And then the fuel, the wood, if you will, are those little things that you do on a daily basis that cultivates

⁓ a sense of eroticism, ⁓ either with yourself, maybe that is a particular type of clothing or a scent that you like to wear, ⁓ or it’s the ways in which you interact with your partner that facilitate that ⁓ eroticism.

the components of over control, ⁓ low risk, low anxiety, high predictability, comfort, familiarity are not ⁓ conducive to eroticism.

You see, so the very aspects of our personality, if you identify as over controlled, somewhat work against you when it comes to ⁓ experiencing the erotic. So that’s why having that sense of inquiry of what is the vision I want? Well, if I want to feel warm, if I want to feel the heat, if I want to feel the crackling of the wood, if I want to hear that, then I need

Dr. Ginger Garner PT, DPT (57:45)

Mm-hmm.

Tom (58:14)

to show up differently than I have been showing up.

Dr. Ginger Garner PT, DPT (58:19)

And how does that, what does that language look like for people? Because there’s such an inherent vulnerability in talking about it anyway that it’s easy for the other person or if it’s self-talk, right? If someone’s just on their own to turn into a shutdown or critique or performance review. And so what’s that like, how do they start to shift the language from out of blame or what may be perceived as blame into curiosity?

Tom (58:47)

You know, that’s a great question. There are some people who come to my office and I have penises and vulvas all over my office and that could be a little uncomfortable for them. But it also is an opportunity to have some exposure to it. So I would invite them to ⁓ seek out ways that they can begin exposing themselves to that kind of languaging, whether that’s through erotica.

whether it’s through ⁓ even more technical books like Come As You Are, where they’re just exposing themselves to that kind of language. The vital step will always be relational. How do you ⁓ broach these topics with your partner and then have a conversation around it?

Dr. Ginger Garner PT, DPT (59:23)

Mm-hmm.

Yeah, that’s true. I was working with someone last week and this person was in their 20s and just a ⁓

a great age to start being able to talk about this stuff, right? And I could tell when I initially started doing the screening that she wasn’t comfortable talking about it. And the shift for her to then be able to just give me all the details that I needed to be able to help her, came out of the anatomical. It came out of pulling the anatomy in three dimensions and single dimensions off the shelf and saying, okay, here it is. what point?

does this start to become not fun, right? At what part does, know, and point does this become painful and it shifts for you or you begin to feel that anxiety. And, you know, and that is one of the ways from a pelvic floor PT, you know, position that I might be able to get somebody to shift to that, but that’s a really good point.

Tom (1:00:26)

Yes.

Dr. Ginger Garner PT, DPT (1:00:44)

that you make too is that sometimes it may be in the technical aspect of picking up a different book or picking up an anatomy model and sometimes it might be in fiction.

Tom (1:00:57)

Yes,

and in that situation that you described with your patient, it can be helpful to say, I know that this can be awkward and are you willing to be awkward with me? It’s just ⁓ stating the obvious. know, you ⁓ know, even with men talking to me about masturbation and orgasms, that can be uncomfortable for a lot of men because that’s just not how men talk.

Dr. Ginger Garner PT, DPT (1:01:09)

Yeah.

Tom (1:01:24)

right? And so honoring, encouraging, being an example that the awkwardness again is really your friend here.

Dr. Ginger Garner PT, DPT (1:01:33)

Yeah, yes. That can be, I think, ⁓ one of the, sometimes it’s the simple things, right? It’s the little things that you just state, this is weird, and then you talk about it. Right?

Tom (1:01:47)

Yeah, that’s exactly

right. It’s almost as if you’re taking the wind out of the sails just by simply acknowledging it. That’s why my family hates when I come around for Thanksgiving and stuff, because I’m all about acknowledging the thing that nobody wants to talk about.

Dr. Ginger Garner PT, DPT (1:01:55)

Just us putting it out there.

I love it. my gosh. So what do you hope people feel like permission to explore or reclaim after reading Making Nice with Naughty?

Tom (1:02:14)

I hope that they have a better understanding of their personality, number one, that this aspect of their personality is not a flaw, it’s a superpower in many situations, and that if they are experiencing sexual and intimate problems, it may be tied back to this very superpower. I think about Superman with kryptonite. Superman.

⁓ away from kryptonite had all the had all of these great powers it’s when in a certain situation in a certain context that is in in proximity to the kryptonite that it became his weakness

Dr. Ginger Garner PT, DPT (1:02:55)

I love that because I guess, you if they could just remember that one thing as to ⁓ shifting away from, well, towards compassion, know, towards himself, towards self-compassion, towards away from self-blame and towards that. And so I just want to thank you so much for this conversation, Tom, because that is, it’s a vulnerable place for people to be. It’s a very loaded place. ⁓ It can be even be like scary for people. And

what I’m taking away from this conversation is that intimacy struggles is maybe just obviously more than about sex, but sometimes it can rarely be about sex itself and about so many other things that is brought into the conversation. So the underlying things under the surface that aren’t identified, the shame, the safety, the identity, the control, the nervous system, protection, pain, et cetera. Okay, so listeners, if you recognized.

If you recognize yourself in that today, the perfectionist, the rule follower, the person who always tries to be good and composed and responsible and easy to love, okay, there’s nothing wrong with you, right? You just might have learned strategies that are helping you survive or belong or feel safe. And I think that’s what I wanna draw out that you brought today. It’s like, given the right support.

given curiosity, compassion, and the right skill set too, right? Because there’s obviously strategies and skills that you’re teaching people every day that help them build the intimacy that they want. So just wanna thank you for bringing that to the conversation today. This has been really incredible. ⁓ And to the listener, if this helped you, please share it with someone who needs a more compassionate conversation around sexuality and intimacy and healing.

because your body has a voice, it has a story, and it matters, and you deserve that care that honors you.

Thank you again, Tom, for being here. ⁓ Can you tell people where they can find you in all the various places? Because I know you do a lot of different things.

Tom (1:05:06)

Yeah, certainly people can find me at my practice website, is – apathtowellness.com or they can find me at DrTomMurray.com

Dr. Ginger Garner PT, DPT (1:05:18)

Thank you so much.

Tom (1:05:19)

Great being with you, Dr. Ginger, and I look forward to continuing the conversation offline.

Dr. Ginger Garner PT, DPT (1:05:25)

Absolutely.