Why people struggle to talk about sex — even when the silence is damaging their relationships

Thank you for joining me today. I want to start by asking you about something that most people in your position rarely get asked — not the professional achievements, but the internal work that made them possible. Can you take me back to the moment when you understood what you were really building here?

Andrea Koh works at the intersection of sexuality and therapy, and in this conversation she is direct about what she finds: the problems most couples present with are almost universally underreported, misunderstood, and easily addressable — if the shame architecture can be dismantled first. She maps how Malaysian culture constructs sexual silence, and why most relationship distress has a physical dimension that nobody in the room will name.

On the challenge that defines this work

When you say that, I notice something — there's a particular kind of pressure in what you're describing. Not just operational pressure, but something more existential. The sense that what you're building matters in a way that doesn't allow for half-measures. How do you hold that?

That's exactly it. And I think what most people don't see from the outside is that the pressure doesn't come from external expectations — it comes from your own clarity about what the work is for. Once you understand that, everything else is just problem-solving. The hard part is reaching that clarity in the first place. Most leaders never do.

On what the work demands of the person doing it

I'm interested in the personal cost of what you're describing. Not in a deficit framing — I mean the way this kind of leadership shapes the person who does it. What has this work made you?

It has made me specific. I don't mean narrow — I mean I have a much clearer understanding of what I am and am not built for. That kind of specificity is often mistaken for rigidity from the outside. It's not. It's just the result of years of learning what works and what doesn't — at a level of resolution that most professional development frameworks don't reach.

Full transcript continues on published episode page · Sexologist and licensed counsellor Andrea Koh on shame, sexual anxiety, and why the most common relationship problems are also the least talked about.