Sexual Issues Are Way More
Common Than People Think —
People Just Don't Talk About Them

Andrea, you are a sexologist. First question: how glamorous is the job actually?

Not as glamorous as people imagine. It is still essentially therapeutic work — sitting with clients, listening, working through their concerns. The title is just different. I have a Master of Sexology from Curtin University in Australia, and also a Master of Professional Counselling from Monash University Malaysia. So my full title is Sexologist and Counsellor. I practice at Rekindle Center for Systemic Therapy — though we usually just call it Rekindle Therapy Center.

What I genuinely enjoy is that every client brings a different story, a completely different experience. That variety is what keeps the work interesting. As for glamour — the glamorous part, I suppose, is when people realise I am currently the only person in Malaysia with the registered sexologist title. So when they find out, there is that moment of: you're the only one? Yes. I am the only one using this specific title, though there are other professionals who do have training in sex therapy — they may call themselves psychologists or counsellors — but the sexologist title is mine alone at this point.

Let us start with the female side of things. Vaginismus. Is it purely psychological? Is it a physical manifestation of shame or trauma? Why does it happen?

Perhaps first — for those not familiar — vaginismus is a condition where a person with a vagina experiences difficulty with penetration. This includes sexual intercourse, gynecological examination, even finger penetration. It is not only a sexual issue. It affects medical care too.

The causes are multiple. It can be physiological, psychological, or both — and which one comes first depends entirely on the individual. Some clients come in with a genuinely positive view of sex — they want to experience it — but their first sexual encounter was painful, and the body developed what we call muscle memory of that pain. Fear builds. The muscles respond protectively. That is one version.

Another version: the person has never experienced pain at all, but they have heard so many fearful stories about first nights — that it will hurt, that they will bleed, that the pain is inevitable — that when the moment arrives, the anticipatory fear creates the exact outcome they feared. The body responds to the expectation of harm.

There is also secondary vaginismus — women who have had perfectly comfortable sex, who have given birth, and then develop vaginismus following a later uncomfortable experience: pain during a subsequent childbirth, dryness, discomfort. It can develop at any stage of life.

But here is what is significant for the Malaysian and broader Asian context. Based on my clinical experience and the research I have read, psychological and cultural factors play a disproportionately large role in what I see. How we view sex in Malaysia — the silence around it, the shame embedded in how it is discussed, the absence of honest sexual education — all of this shapes women's sexual experience in ways that pure physiology does not account for.

And the treatment approach?

We begin by assessing which factors are driving the condition for this specific person. If there is a physiological component, I provide exercises — and if those feel too overwhelming, I refer to a women's health physiotherapist. This is quite a niche specialty in Malaysia. Most people think physiotherapy is for musculoskeletal injuries. But there is a smaller group of physiotherapists who specialise in women's pelvic health — they can work hands-on with a client to ease muscle tension, teach calming techniques, and guide the body toward a different relationship with penetration.

The combination of physical therapy and psychological therapy accelerates recovery significantly. But — and this is important — the work does not end in the clinical setting. The client has to go home and practice with their partner. And sometimes a person can do everything well in the clinical context — even progress to larger dilator sizes without difficulty — but still cannot manage penetration with their husband at home. The relational dynamic is doing something the clinical environment cannot replicate. That is its own layer of work.

Let us talk about orgasm. There is clearly a gap between what women experience and what men assume they experience. Where does it come from and what does it cost?

The clitoris has approximately eight thousand nerve endings — and it is the only organ in the human body whose sole function is arousal. There is no other biological purpose. And yet it receives very little attention in most sexual encounters in Malaysia, because the dominant model is focused on penetration. Get ready, penetrate, done. And for many women, especially in Asian cultural contexts, they do not even know whether they have reached orgasm — they are uncertain what it feels like, they do not know their own bodies well enough to say.

For many women, clitoral stimulation is not supplementary — it is necessary. The penetration alone will not produce orgasm for most women. Some women can orgasm through penetration, and that is because of anatomical positioning — the clitoral nerve network extends inside the vaginal wall, and for some people the friction during intercourse stimulates those internal nerve endings. But that varies enormously between individuals. A lot of women need clitoral stimulation alongside or instead of penetration to actually experience orgasm. And most have not been told this. And most have not told their partners.

What I advise clients is: be present in your body in that moment. Do not focus on chasing the specific sensation you have learned to produce for yourself, or that you experienced with a previous partner. Allow yourself to notice what this body, with this partner, in this moment, finds arousing. Sometimes the orgasm gap closes when women give themselves permission to be fully in the experience rather than searching for something familiar.

The good girl syndrome — we have been taught to be compliant, to not have needs, to follow. Do you still see this playing out in the generations coming to you? And is religious guilt still a significant factor?

Yes, very much so. Particularly among women from more traditional or religious backgrounds, and those not living urban-centred lifestyles. I see women who have been holding the "good girl" image their entire lives — modest, compliant, non-sexual in self-presentation — and then they get married, and they are now in a context where they are supposed to be sexual. And they genuinely do not know how to make the transition. The identity they have spent years constructing sits in direct conflict with what their husband is now asking of them. Being naked comfortably, engaging with their own desire, dressing or behaving in ways that feel overtly sexual — all of this collides with the self-concept they have been taught to protect.

Even when it is legally and religiously sanctioned within marriage, many of these women still feel it is somehow wrong. The body and the mind have internalised the prohibition so thoroughly that explicit permission — a marriage certificate, a religious blessing — does not automatically dissolve it. Therapy in these cases involves helping the person understand that they are now in a different context, that the rules they learned were for one environment, and that they can create different rules for this intimate space. But it takes time. It takes significantly more patience than either the client or often her husband expected.

And this creates its own relational pressure. The woman feels guilty for how long it is taking. The husband may be frustrated, wondering how much longer he has to wait. Both of them are in a difficult position. The work is about holding that difficulty with compassion for both people, without shame, without blame.

Sex is becoming increasingly commodified — OnlyFans, subscription intimacy, people marrying AI companions. Do you see sex going back to something intimate or is it simply going to be transactional from here?

I think what we are seeing is a symptom of something deeper, which is a loneliness epidemic. Technology was supposed to connect us — and in some ways it has. But it has also created a particular kind of surface connection that does not satisfy the deeper need. People feel more lonely than before. And platforms like OnlyFans, or the trend of forming emotional attachments to AI, are providing a temporary feeling of connection. They are not solving the loneliness. They are managing it.

What people actually need is real connection — felt, present, embodied. And I think what gives me some optimism is the growing appetite for in-person social activity. People are looking for it again. The pandemic showed us very starkly what the absence of physical presence costs us. We need to build more of that back. If we want to reduce the demand for substitutes, we have to make real connection more available and less frightening to pursue. And that begins with being honest — with ourselves, with our partners — about what we actually need.

One final question — if you had one wish to make the planet a better place, what would it be?

My wish — as a sexologist — is that every person feels sexually empowered. That they understand what their needs are, and that they feel safe expressing those needs without fear of judgment, without fear of being treated badly for simply knowing what they want.

Sexual empowerment is not about performance. It is not about frequency or variety. It is about having access to your own experience — understanding your own body, feeling entitled to pleasure, being able to communicate honestly with your partner. That is what I am working toward with every client. And if I could wish it for the whole planet, I would.

Thank you so much, Andrea. We have barely scratched the surface — I have so many more questions. We will have you back. And that is a wrap on Episode Seven of The Centered Edge.