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The Fullness of Midlife

“Everything begins with communication.”

by Dr. Barb DePree MD

Mary Jo Rapini with Dr. Barb

Mary Jo RapiniMary Jo Rapini is a psychologist, author, and frequent communicator advocating for healthy relationships. In addition to her work with couples, families, and individuals, she’s a regular on Fox Houston 26 with a segment on healthy relationships and “Ask Mary Jo”; she’s also appeared on CNN’s Prime News, the Today Show, and Dateline. She’s co-authored three books, including one that supports mother/daughter conversations about sexuality, and one for couples seeking greater intimacy. Mary Jo was also an early advisor to MiddlesexMD, providing insight into the emotional aspects of intimacy and desire. (Find her guest blog posts or contributions to Dr. Barb’s here.)

Listen now.


Dr. Barb: We had Mary Jo Rapini as our guest recently. She is a psychotherapist and a friend to MiddlesexMD. We bring her back so she can talk about her recent book. Her book is called Recoupling: A Couple’s Four Step Guide to Greater Intimacy and Better Sex.

You can tell by the title that we share some interests. Welcome, Mary Jo.

Mary Jo: Hi, it’s good to be with you!

Dr. Barb: Thanks for spending time with us. I’m anxious for our listeners to hear more about what you have to offer through your recent book, Recoupling. But I’m curious myself as to what were the experiences or conversations or discussions that led you to think about this book.

Mary Jo: Well, I have a partner and his name is Dr. Mohit Khera; he’s a urologist that specializes in sexual dysfunction. He started—he sent me my first patient; this is how the relationship started, and after that we grew to be really close colleagues and friends. We always talked about writing a guide book because so many patients come in and, for whatever reason, they grew up in very religious homes, or they’re from countries where talking about sex is very taboo. We decided to just write a guide book, basically. It has a lot of information, and it’s practical.

The whole idea behind the book was, I wanted them to be able to read the book with their partner. And then there’s a little form on the back of the book that they can write out and complete on their own. Then basically, if they are too shy to talk to their doctor, they can take that form in, and the doctor will understand exactly what they need—and what they need more help with medically—as well as who to refer them to for more things that basically they don’t do, but other people do.

Dr. Barb: Well that’s an interesting concept, because I do think in the exam room, it is a difficult conversation sometimes to bring up. And I think, obviously patients have some hesitation bringing this up sometimes. And the data shows that providers are, unfortunately, not good at opening the door to have this type of conversation with them. I think the most recent statistic I read is that only about 17 percent of physicians and other primary care providers are opening the door to this type of conversation. So, it’s nice that there’s a pretty straightforward way to approach that.

And for all the things that you mentioned, whether it’s background or culture, previous experience—this can be a difficult conversation to have. On the other hand, this can be such a life-changing conversation to have, to begin to talk about what’s been going on. I think in my practice, those are the most appreciative patients who present with a sexual-related issue that is in most cases is successfully treatable, but they didn’t have the words or the courage to bring that topic up. So, it’s great to know that you’ve created, and that you’ve brought a somewhat straightforward approach to that.

When sex goes wrong... the underlying factor is their ability to communicate.Mary Jo: Right, well, what I really love in the book is it is medical, and has a lot of diagrams, so people can get in touch with their body parts. There’s a lot of miseducation in sexuality and in knowing your own body. I talk to women all the time who don’t—who aren’t sure where their body parts are. And so, it’s got very simple diagrams. But everything begins with communication because, what we found out is, sex does go wrong with couples. But the underlying factor that is always going wrong too—their ability to communicate. Because for many couples who have had a bad experience, and then they don’t have sex for a very long time, it’s awkward. It’s awkward to know how to go back to it. And it seems very out of place.

And because, most couples are very timid about talking about sex in their relationship, it just keeps building like a river in between them, keeps building and they may be angry and resentful, but they’re just not doing the things that are going to help them cross that.

Dr. Barb: I think you’re so right.The other thing I’ve observed is, sex tends to be an act of habit and repetition, and we know that with monotony, there’s often more boredom and so on. So many things go into that. But I find it’s hard for couples to understand how to recreate a conversation about that.

What are your suggestions for couples to begin a conversation acknowledging they want something different for their sexual relationship? How do you advise them to begin?

Mary Jo: Well, I think the important thing is, you know, I see a lot of couples who are already frustrated. One’s sexual desire is higher than the other’s. So basically, they keep thinking,  they’ll talk to the partner, and the partner listening to them will withdraw, or get angry, or just leave. I usually advise couples to take ten minutes a day and just begin to talk about sex. And not talking about what they aren’t getting, but talking more about the times when they were successful in the past.

Take ten minutes a day and talk about sex.When you rebuild what you used to have, you remind your partner that sex wasn’t always like this, that it used to be good. Watching movies can help with that, going to classes, going on retreats can help with that. But most couples, or many couples, are reluctant to do that, because they don’t want to admit that they have problems. If the couple can be strong enough to say, okay, ten minutes a day we’re going to start talking about sex.

Rather than talking out loud about it and thinking your partner isn’t listening because your partner can’t hear you, talk softly and make it a time when you’re not stressed out and you’re not preoccupied with other things.

Dr. Barb: Seeing both physical and psychological factors affecting engagement in intimacy, does your book really address both aspects of that?

Mary Jo: Yes, it really does, because a problem with, you know, many times, someone has a problem with libido. And so, Dr. Khera, my partner, will give them the necessary medications they need for that. But, the problem doesn’t go away. And the reason is because the problem wasn’t just medical. In fact, maybe it wasn’t medical at all, it was years of pent-up resentment or feeling unloved, feeling lonely, and basic anger.

Give your partner presence.And so, within that time those feelings that weren’t talked about, or where they felt abandoned or alone with, were basically storing up. And you cannot be sexual and feel sexual if you are full of resentment and anger. And it kills libido—probably faster than most things. I think the book is really good at that. I think the book explains that very well. I have little, within the book, there are pages that are highlighted, like “Pillow Talk,” “Ten Tips for Talking about Sex with Your Partner.”

The book is very easy; you could just print that out, and you could just keep it by your bed, or wherever you have your talks, and just kind of keep those things in mind.

Sometimes the very best way to talk with your partner or start the conversation is by touching them. Hold their hand and just give them presence. Nobody wants to open up and talk if their partner is on the phone or preoccupied with something else.

Dr. Barb: Is it critical that both partners agree and engage in working through the aspects of the book? Or could one partner who has an interest in restoring the relationship and the other a perceived disinterest from the other partner, or a true disinterest—is it possible to move that relationship forward with the primary engagement of one of the two persons?

Mary Jo: I believe so. As long as the partner reading the book didn’t use the book as ammunition or punishment of their partner. So, in other words, if you were to read the book alone, you’d have to go into it with the view that, “I’m going to learn what I can do better.”

Because if one person makes changes in their behavior, then their partner is going to have to change, because basically that's how change works. The reason any couple gets in a rut is because they both choose the same reactions. So if one of them takes a new reaction, everything has to change. Really, that’s empowering. It should help people feel more encouraged to actually take that step and try it. They have nothing to lose. And if nothing else, they are going to be a better version of a partner.

Dr. Barb: Which is really important. I think it’s encouraging to hear your words, because I do feel like when I speak with women, oftentimes I’m only hearing and seeing one side of that story. It’s always difficult to really get a full sense. But, I do feel like some women are somewhat dismayed that there isn’t an interest in their partner to engage in some of the repair work, so I wondered about the ability of a woman to start that journey on her own. And as you said, if she changes in some way, then a partner will have to change in response to that, so that’s encouraging to hear.

Mary Jo: Yeah, I think it’s hard to do because for most of us, when we get married we have the view that we’ll be supported. And If I see something good for the marriage and we discuss it, then we both will do it.  But when you’ve been married a long time, you realize, okay, I’m not going to expect that. I think this is what makes longer marriages both challenging and rewarding: the two individuals within it are very different.

They develop different styles to get where they are; they each have an interesting way of  knowing how to work the other person. When it comes to an issue of sex, you oftentimes lose that ability, because sex is very different. It’s tied into really, really deep vulnerability and intimacy issues that may have gone unexplored in the marriage.

Dr. Barb: The title of the book is A Couple’s Four-Step Guide to Greater Intimacy and Better Sex. So, just as a tickler for our listeners, four steps. Most people would say, “Four steps; I can do that; that sounds like it’s workable.” Could you talk to us about step one and how they would get started, or where you would have them initially direct their efforts?

Mary Jo: The book is written with a couple. We had a couple that Dr. Khera and I had both seen, but we changed their names. And we basically walked them through the program. We basically wrote it from their perspective of what exactly what they were doing, and how we helped. The very first part is improve communication. And I have numerous ways; the “Pillow Talk” is one of the big ones. It has ten points of how to basically start to talk about sex, to start thinking about creating a great sex life as a couple.

Then within that is also dealing with stress and dealing with feelings of anger. It’s more the emotional impact. And then the next one is: “Get Ready for Sex,” both physically and emotionally. People bring all sorts of medical issues to the table; like that’s where we cover the diabetes, the cancer, you know, having sex wtih cancer, having sex with Peyronie's Disease, anything, you know—erectile dysfunction, hypoactive sexual desire for women.

Sex is meant to be silly and fun and heartwarming and engaging and intimate.After that it’s “Re-establish Yourself with Intimacy” and re-energize your contact; that has more of the ideas of using vibrators—that’s where MiddlesexMD is really included in the chapter. Because I want the couples to be experimental. When you think about it, most adults, and especially couples who have been together for a long time, they are embarrassed to look silly in front of the other. But, sex is meant to be silly and fun and you know, heartwarming and engaging and intimate. All that stuff, and so I try to put a more playful, adventurous opportunity for couples, so we explain things, how it can work better, how to get comfortable with that.

And the last step is basically “Go for Better Sex.” And it’s role play: If this happens, this is what you should do. And at the end of the book is where the forms are. You can sit down and really do a true analysis of where you are struggling right now, and you can take that to your doctor with you.

I hope that answers your question.

Dr. Barb: That’s great! I appreciate your outline in that way. It strikes me that it doesn’t necessarily have to be a couple who finds themselves in a difficult situation. It may just be a couple who is seemingly having a successful sexual relationship, but could improve. I think we know that in every area of our life we can, with effort and intention, we can improve.

I think this is an area that suffers from inaction and inattentiveness. Even those who perceive their relationship as healthy could find some significant pearls of wisdom to further improve their intimate relationship.

Mary Jo: Absolutely! I tell my clients all the time, I know when you go to a sex therapist, that you think, wow, they probably have a great sex life! I’m human, I’m a person, and I get tired too and I even see little things that like, I should really do this. And I’m even worse, because I know what I should do, but, you know I get tired, and I’ve been married forever, and it’s easy to fall into that rut and to say, no, not tonight!

But, the book and my whole concept of sexuality is: It’s really a very sacred thing and it’s fun, it’s playful, it keeps you thinking young, it keeps you flexible with openness, and it’s so incredibly powerful for your relationship. It’s a way to connect, and everyone has a personal preference of how much they need sex. And, you know, I don’t have a problem with that. But, if you do have a different preference than your partner, then you need to talk about it. And maybe you can even negotiate a little bit.

I’m from Italy originally and the Italians have many, many ways to make love. Very rarely is it sexual intercourse. They use food and they use music and dancing, and those are all ways people can make love. It doesn’t have to be intercourse, all that making love—the real reason it’s so important is because it connects you on a deep emotional level.

And that’s what the body’s health and the emotional health of a human being really relies on. It’s a supplement if you will; I always think of it that way. Intimacy is, I mean, people die without intimacy, but nobody is going to die without sex.

Dr. Barb: I think those are great words. Yes, and I appreciate your wisdom in speaking into this important topic. I think what you have to offer our listeners is so critical, because we just understand the importance of intimacy in general health and emotional health and physical health.

And again, my frustration is that people minimize the impact that a strained intimate relationship will have on their future together. And I think that making it a priority and putting some work and effort into it will bring huge rewards. So, I’m so grateful for your resource you’ve made available and for the work that you’ve put into that. Thanks again, Mary Jo.

And thanks again for your time. Let our listeners know where they might find your book.

Mary Jo: You can get it on Amazon, but also, I really encourage them to go to my website, and that’s And if there’s any other thing I can help them with or they need more information, there’s a link there “contact Mary Jo” and it’s really easy and they can get in touch with me there; it comes in through email.

Dr. Barb: Thanks again Mary Jo.

Mary Jo: I love, love, love and I really love taking with you. You guys are really awesome. I can’t tell you, I’m just so grateful for you! You do such an incredible service for so many.

Dr. Barb: Well, thank you.



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