~By Justin Lehmiller
What is a day in the life of a sex researcher like? In this interview series, I talk to some of the world’s foremost authorities on sex in order to answer this question, but also to provide a glimpse into what they’re currently working on, what the media tends to get wrong about sex, and what they think about some of the most pressing issues facing the field of sex research today.
For this interview, I spoke with Dr. Nicole Prause, a sexual psychophysiologist and neuroscientist who founded the independent research institute Liberos. Prause, a former Kinsey Institute trainee, has an extensive body of research that addresses topics including orgasm, pornography use, penis size preferences, and more. Below is the transcript of our email conversation.
Lehmiller: Please tell us the story behind how you became a sex researcher. What is it that initially inspired you or drew you to this field of study?
Prause: My career in sex research is a story of the success of liberal arts education. I had no idea “sex research” existed, but found the Kinsey Institute lab was an option for my degree requirements while I was a student at Indiana University-Bloomington. My first study used vaginal photoplethysmography and sex films with older adult women to test the potential sexual effects of a drug. Finding that these supposedly ephemeral feelings could be quantified and observed—and that they offered great scientific puzzles—hooked me.
Lehmiller: What is your primary area of research and what methods do you typically use to answer your research questions?
Prause: I primarily study approach motivation, and sexual motivation is a type of approach motivation. Approach motivation is commonly studied in emotion neuroscience and describes an urge to engage. That urge can be unpleasant—like anger—or pleasant—like love. My research in sex is unique because I am rarely interested in sexual endpoints. Put another way, I do not really care how many orgasms you have. Rather, I view sexual stimulation as behaviors that can improve “non-sexual” health endpoints. If you struggle with sleep, depression, or inflammatory diseases, you should be interested in what we study.
We use physiological methods in our research. Many of these measures are instruments that we create. Some instruments we adapt from what are called “maker” kits, such as Arduino and Seeed boards. Other instruments we 3D print. Three examples would be:
- We record sympathetic nervous system responsiveness from the feet, because it is the only place with high-density eccrine glands other than the hands. Our participants’ hands are very busy masturbating, so recording from the hands would mean bad signals and a potential biohazard from ejaculates.
- We record the highly stereotyped contractions of orgasm using an anal device. It has a 3D-printed base and is wrapped in a compressed air tube linked to a Seeed board. When the air is displaced, we record these as anal movements. When these are a very specific pattern, we know that they are rhythmic contractions that only occur at orgasm.
- We record brainwaves with Bluetooth equipped electroencephalography (EEG), because typical EEG does not tolerate head movements well. Masturbation is a relatively high movement exercise for sensitive EEG, so we have developed a number of unique algorithms to make these data useful (i.e., to denoise them).
Questionnaires, clinical interviews, and daily diaries are also part of our skill set to capture the experience of the participants.
Lehmiller: Please tell us a bit about one study you’re working on at the moment. For example, what research project are you most excited about right now?
Prause: Dr. Tierney Lorenz and I received a grant from the National Organization of Rare Diseases to study Post Orgasmic Illness Syndrome (POIS), which is thought to primarily affect men. This enabled us to collect blood and saliva biomarkers before and after orgasm, providing the first robust glimpse into the inflammatory effects of physiological orgasm. We hope this not only clarifies the nature of the POIS disorder, but the unaffected, control participants also will provide extremely unique data. I believe this is this first standardized protocol of climax collecting biomarkers of inflammation before and after climax. We also are capturing brain and peripheral physiological measures to further characterize male orgasm. I already have those data in women and expect they might challenge aspects of Masters and Johnson’s “Sexual response model” that has remained largely untested, despite its popularity. There are so many unique pieces of data that will come from this project, we cannot wait to see the results ourselves!
Lehmiller: You are one of a handful of sexual psychophysiologists in the United States. Why is there so little work going on in this area, and why is it vital to our understanding of human sexuality?
Prause: There are many challenges to working in the field of sexual psychophysiology in the USA. If you have to do any development of tools, like we do in my lab, this research requires a collection of strong skills not only in sexuality, psychometrics, and self-report, but also in computer programming and scripting, hardware engineering, time series statistics, biohazards, and novel ethics issues. These are a relatively rare constellation of skills bridging multiple areas of expertise, so this field requires fairly aggressive training plans.
While many areas of physiology struggle to reach full funding, this problem is especially pronounced in sexuality. The USA is fairly unique in that special interest religious groups are well-funded, aggressive, and are not adequately separated from the interests of the state. It is not uncommon for scientists in this field to receive death threats, have our physical addresses doxed, and pictures of our families circulated to intimidate us. They have successfully scared some scientists into relocating, including out of the country. Our European colleagues are often confused by the aggression we face here. Unfortunately, this aggression in the USA also sometimes gets exported to our colleagues. The USA might be the worst place in the world to do sexual psychophysiological research due to the religious and political climate here.
Sexual psychophysiology is essential to our understanding of emotion and motivation generally. There is no “sex area” of the brain. Rather, sexual motivation and sexual response rely on existing emotion circuitry. This makes sex a powerful tool for understanding emotions. In particular, sexual physiology is characterized by (1) high specificity, (2) large effect sizes, (3) biphasic sympathetic response profiles, and (4) a clear satiety state. Without going into detail on each of these issues, suffice it to say sexuality offers features that emotion researchers absolutely need to open new interventions for disorders of emotion and motivation (e.g., depression, schizophrenia, etc.).
Lehmiller: So much of our knowledge of the sexual response cycle comes from the research of Masters and Johnson in the 1960s. Their work was important and groundbreaking, but so many of their conclusions have gone unchallenged for more than a half century. At the same time, technology has advanced far beyond the tools they had available. Should we be revisiting what we think we know about the sexual response cycle?
Prause: I am determined to force us to revisit that model. The Masters and Johnson response cycle was a fine place to start, but it has not been explicitly tested (for the most part). The Masters and Johnson model is widely used as a heuristic in clinical practice, so we should know whether or not it is accurate!
Lehmiller: Your research on the psychological effects of pornography has generated a lot of controversy because it challenges the concept of “pornography addiction.” There’s a lively debate about this going on both in the field and in the popular media. So how does porn really affect us? What do people really need to know?
Prause: Pornography has been widely studied in emotion neuroscience for about 40 years. Emotion scientists use it to provoke pleasant, high arousal emotional states. To neuroscientists, sexual arousal is most similar to emotions like “triumphant”, “adventurous”, “elated” and “delighted.” Like those emotions, sexual arousal is excellent at capturing attention (which also means being a distraction), priming pleasure-seeking (which also means impulsive behaviors), and motivating us to connect with others (which also means deciding not to use barrier protection during sex). The literature focused on pornography is exceptionally poor, because it largely ignores the entire field of emotion neuroscience.
Pornography does not “hijack” anything in the brain, it does not “flood” the brain with dopamine, it is not a “superstimulus,” and it absolutely is not “more addictive than cocaine.” This common panic language shows a basic lack of education in neuroscience that is very difficult to provide in the 280 characters of a tweet. Of course, objecting to someone having insufficient background to understand these issues brings accusations of elitism. It is a lose/lose situation when the public approaches scientists with aggression. I, and I think most of my colleagues, are actually very interested in engaging in public dialogue, but we are worn down by daily insults and threats.
Porn is a positive influence, on average, for the vast majority of adults who choose to view it. The best predictor of distress about your own porn viewing is having a conservative or religious upbringing, and this distress appears to disappear on its own without intervention in longitudinal studies (i.e., people tend to grow out of their worry naturally as they understand sexuality better). Pornography is overwhelmingly used as a masturbation aid, which is surprisingly often ignored in research. That is important, because any time two behaviors co-occur nearly 100% of the time, it becomes essential to disentangle which behavior actually is responsible for any observed effects.
While women also are most likely to view pornography as a part of masturbation, women also are more likely than men to use it for the purpose of increasing their sex drive to engage in sexual behaviors with their partner. This also may be why the associations of pornography viewing for women are consistently positive, while the associations with men’s sexuality are more variable. In the next 10 years, I suspect we will conclude that men are simply choosing to masturbate (with porn) when they cannot have their preferred sex with a desirous partner, which is “reverse causality.”
Lehmiller: Last question: In your experience as a sex researcher, what are some of the biggest misconceptions you’ve encountered about sex? In other words, what are some things that are widely believed, but that aren’t supported by the science?
Prause: Here are a few:
1. Myth: Men are “more visual” than women.
Science: Anyone with a higher sex drive, male or female, is more responsive to a whole range of sexual stimulation, including visual stimulation.
2. Myth: Women’s orgasms are reached by many different paths and have greater potential to be multiple.
Science: Women define their orgasms very differently than men. Men tend to only report orgasm when they have contractions. When you require that contractions occur to define orgasm, men and women are not looking very different at all in terms of orgasm characteristics in my lab. For example, the contraction patterns are indistinguishable by gender. This makes sense, because orgasm is a reflex.
3. Myth: Sex is an overpowering part of our reptilian brain, which forces us to engage sexually.
Science: Sex is no more compelling in the brain than other pleasurable emotions.
4. Myth: Vibrators/porn/robots will blow out my dopamine receptors, so I cannot respond to a real person.
Science: Interacting sexually with an actual person is very unique physiologically from non-human stimulation, including C-afferent fibers, preferential processing in brain areas associated with social connection, and having high complexity in multiple stimulus modalities. There is no evidence that these can be “rewired” to make you dependent on sexual technology.
5. Myth: Sex without orgasm is not satisfying.
Science: High states of sexual arousal that occur before orgasm appear unique and highly rewarding in their own right. Sure, vasopressin increases after orgasm (yeah, sleep!), but dopamine does not.
6. Myth: Nothing can help my sexual problem.
Science: I was shocked recently to hear a prominent marital therapist claim that there are no empirically-supported interventions for sexual disorders. There are numerous highly-effective interventions for sexual difficulties at this point. In general, we do really well treating rapid ejaculation and sexual aversion issues, whereas our interventions to increase sexual desire have smaller effects.
7. Myth: I have erectile dysfunction.
Science: Okay, you might have erectile dysfunction, it does exist, but the incredible over-identification of normal erectile variability as erectile “dysfunction” is staggering. While sex therapists fought for years to help the public understand that erections are commonly variable, such as when someone is tired, it feels like PDE-5 inhibitors (like Viagra) undid all our education progress. We are back to everyone thinking being nervous with a new partner is unacceptable, and that certainly benefits the pockets of pharmaceutical companies.
Dr. Justin Lehmiller is an award winning educator and a prolific researcher and scholar. He has published articles in some of the leading journals on sex and relationships, written two textbooks, and produces the popular blog, Sex & Psychology. Dr. Lehmiller’s research topics include casual sex, sexual fantasy, sexual health, and friends with benefits. His latest book is Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life. Follow him on Twitter @JustinLehmiller.