Mary Harris: Hey everyone,

Just a heads up that this week’s episode is about sex. And it’s explicit, so maybe get the kids out of the room.

When Viagra came out almost 20 years ago, men couldn’t get enough of it.

<< Viagra commercial: Guys, it’s just the two of you. Curling up in bed with a favorite book is nice, but I think women would rather curl up with their favorite man. Viagra helps guys with ED, get and keep an erection. Viva Viagra[ promotional son]...Talk to your Doctor about Viagra, America’s most prescribed treatment for erectile dysfunction...>>

MH: The New York Times called it “Viagra madness.”

Last October, another new sex pill hit the market. This time, it was for women.

<< News clip: Well, there is now something called the little pink pill...>>

MH: It’s called Addyi, and it’s supposed to treat female desire.

<< News clip: The FDA had rejected the drug twice...Now to the big news about the so called female Viagra.>>

MH: Addyi was so highly anticipated, that the pharmaceutical company that developed it was bought out for $1 billion just weeks after the drug was approved.

But in doctors’ offices? The response has been really different.

Dr. David Gandell: I’ve talked to a number of patients about it, but when I explained to them the details of how they need to take it and what they need to give up i’ve had no takers at all

Dr. David Gandell is an OBGYN in Rochester, New York.   

MH: And --how many women have said no?

DG: I would say a couple dozen that I’ve discussed it with, but prior to talking to you today I called a major pharmacy chain in our area and I asked them if they'd had any prescriptions written for Addyi. And they said they had two prescriptions, and then they looked and said, well they’re actually for the same patient, um. And it looks like it would have been covered, and they looked and said she never picked it up…

 

It’s not that sexual desire isn’t a big problem for his patients.

 

DG: I would say my impression is about 20% of all couples who are together, and perhaps in what they feel is overall a satisfying relationship, are not having sexual intimacy.

MH: that’s so surprising to me, is that surprising to you?

DG: Well not anymore. (laughs)

MH: So why isn’t Addyi more popular?

The first problem - in clinical trials, Addyi was just a little bit more effective than a placebo. You have to take it every day, not just when you want to have sex. There’s also this long list of drugs you just can’t take while you’re on Addyi. Antibiotics. Birth Control pills. Anti-Depressants.

DG: But the biggest issue is that if you combine it with alcohol, there’s a significant risk of fainting and injuring yourself, so that to put a women on addyi we have to have them sign a contract that they will drink no alcohol whatsoever when they’re taking it.

MH: So the choice between a glass of wine and maybe having sex…I’ll go with the wine?

DG: I think that’s absolutely what happens, if a women has already gone through a time period where she's not having too much sex but she’s drinking her wine, she’s not going to give up her wine.

MH: In the first five months of Viagra’s release, doctors wrote nearly 4 million prescriptions for it. For Addyi? Barely over 3 thousand.

DG: it was too good to be true, and  this is why they had to go before the FDA committee for drug approval three different times before they finally got it approved. And I think the argument was well if you're going to approve viagra for men and for male sexual function why aren't you doing it for women?

MH: And this the question we’re going to try to answer: Why isn’t there a sex drug for women that works? I’m Mary Harris, and this is Only Human. We’ll also meet a researcher who is trying a completely different approach to stoke female desire.

MH: Why don’t we have a Viagra-like pill for women?

Nicole Prause: We do have a Viagra like pill for women; it’s called Viagra. (laughs)

MH: This is Nicole Prause. She researches sex.

She actually started working at the Kinsey Institute right around the time that Viagra was approved. She did research showing that the little blue pill that works so well on men? It works on women, too.

NP: If you give a woman one of these pills and you show her a sex film, stimulate her sexually in some way, you will see an enhanced or increased vaginal response and heat response when she is taking the drug as compared to when she’s not. The main difference is if you then ask her how sexually aroused do you feel, there’s no difference between the two conditions.

MH: Hold it, so you can feel aroused, but not have desire?

NP: They aren’t even feeling aroused. So their body is aroused, they’re having greater blood flow just like the boys do, to their genital area, but women do not generally use that to judge their sexual arousal.

MH: Why?

NP: We are working on that question. So-- there’s. there are lots of theories about how exactly that works. I think -- One most simple explanation is that for men there is direct visual feedback. That is if you ask a man how aroused he is, he looks down and sees how erect his penis is and then reports how aroused he feels.

MH: Well, I guess it’ s 7 out of 10.

NP: So, women even though we have physical signs of arousal and we also have tumescence and lubrication. There’s not this direct visual feedback. Whatever the case women don’t seem to integrate the information from their genitals very strongly when they are making judgments about how they feel sexually. And that’s -- very well replicated finding.

MH: Huh.

MH: So, if you’re looking to make a sex drug for women -- this is a big problem. Doctors can see that a woman’s body will respond physically to a drug like Viagra. But women don’t actually feel turned on when they take it.

This is true for men, too. We just don’t talk about it that much.

NP: The funny  thing about Viagra, I say Viagra won’t make her pretty. And what I mean by that is - a lot of people think you need an erection, you take Viagra, you get an erection, that’s not true. You take Viagra and if your brain is sufficiently  stimulated to start the cascade that would initiate an erection - then you will get an erection. So, if you take a Viagra and your partner is still very unattractive to you or being mean to you, the viagra will not be effective. So, I’d say for both men and women, we need to understand the central mechanism we would say, so the - how the brain affects the sexual response downstream.  

MH: Figuring out this central mechanism - what makes us want to have sex in the first place - is Nikky Prause’s mission.  At 37 years old, she just closed her lab at UCLA to form her own company, Liberos. Their tagline is “The Freedom to Desire.”

[Music]

MH: Prause is a neuroscientist by training. She calls science her religion. And she focuses on sex because there is so much still left to discover.  Especially for women.

MH: So, what made you want to make this work into your career?

NP: Oh, the second I was in the lab. (laughs) It was like this is a done deal, how do I make this my job. So-

MH: Why?

NP: It’s fascinating! And it spoke to the geek in me. Just, If you like to nerd out, this is your field. Because it’s so young. Unlike studying depression where there are already 200 PHD neuroscientist working in that area. Within sexuality? You can count on one hand how many neuroscientists are working in the area. So, there’s a tremendous opportunity for discovery, a lot of nerding out. It’s just the perfect field for me.

MH: And part of what’s interesting to me - You’re still doing this basic work to understand how arousal working in women. You actually bring people into the lab and sexually stimulate them and see what happens. Do you think of yourself as a modern day Masters and Johnson?

NP: Definitely. I think we’re as close to Masters in Johnston in the US these days as it gets.

MH: William Masters and Virginia Johnson were pioneering sex researchers who started their work in the 1950’s. You may know of them from the Showtime series “Masters of Sex.”

Masters and Johnson Sex Clip:

Johnson: Don’t you think we should start with one of our more dynamic findings? Like, vaginal contractions. Every woman, myself included, have experienced them, but nobody knows they exist.

Masters: And we will present that… how?  We know they exist because we’ve watched them. But you can’t wire up a vagina for graphical verification!

MH: Like Masters and Johnson, Nikky Prause is committed to studying sex in the lab. But doing that research at a university was challenging. She says getting approval for her work-- research that included inducing orgasms -- became difficult.

NP: Like Masters and Johnson one of the things they were of course famous for is their observational studies where they’d bring people in to have a full sexual response while they monitored with a variety of different pieces of equipment. And generally most labs in sexuality are still very hands off for the mostly conservative reason that oh “we should not be in the room if someone’s being sexually stimulated we need to be observing from a side space instead. And we shouldn’t be asking to put things on their butt to measure things because that’s dirty. You do whatever you need to do to do the science right. And if that means an annal probe, then by god, we’re going to build it, we’re going to test it and we’re going to do it right.”

MH: This probe - it’s called an anal pressure gauge - is a device of her own design. She uses it to measure the physical sign of orgasm, those vaginal contractions. At the same time she uses an EEG to understand what an orgasm looks like in the brain. Looking at her results, she’s noticed something strange.  

NP: We found that many women in our lab when they reported having an orgasm actually were not having any of the physical signs of an orgasm.

MH: What does that mean to you?

NP: I have no idea. (laughs)

Clearly they’re having a good time. There’s some pleasure peak there, there’s something that causes them to say “I feel like that I am having some type of peak experience right now.” But that experience appears quite different for some number of women than it is for men.

MH: Here’s another problem. Most research into the female orgasm relies on women simply telling scientists whether or not they’ve climaxed. Nikky Prause thinks that’s far too vague of a measurement. Because if women don’t understand what’s happening in their own bodies - scientists won’t, either.   

NP: Basically, any study that you’re seeing that claims to have an image of the brain at orgasm, does not have an image of the brain at orgasm, they don’t know what they’re getting. They’re getting an image of the brain when women think they’re having an orgasm. And that’s all it is. So, that sets us back.

MH: This is just an initial finding with a small sample of women. But for Nikky Prause, it shows just how profound the disconnect between women’s bodies and brains might be.

NP: So I’ve started at this point it goes personal, I started asking my friends - how do you know you’re having an orgasm? What exact criteria are we using? And you know this is complete non scientific reporting at this point, but you know “I feel goosebumps all over my body” and I was like “well that’s great but --”

MH: That’s not a thing.

NP: It’s not what we would physiologically call an orgasm. Or I’ve had some women say I have two types of orgasms, and they didn’t mean clitoral and vaginal. They meant, I have one that’s a body orgasm and one that’s a mind orgasm. And I was like wait what? Because we’re not asking  about that in our surveys. (laughs) This is off the charts.

And I think it might partially be due to, where do we ever learn what an orgasm is? Do you talk to your mom? Your dad, certainly not. (laughter) Sisters? Uhhhhh, I didn’t.   

MH: I think you might, now .

NP: Now yeah growing up certainly not.

MH: I’m Mary Harris, this is Only Human. When we come back: how Nikky Prause went from small-town Texas to the Kinsey Institute. And the experimental way she’s hoping to treat the problem of sexual desire. If it’s not a pill… what is it?  

 

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MIDROLL

While we were getting this episode together, we wanted to know what our female listeners thought their sex lives really needed. And would a pill really help?

Listener Call-in: My partner and I had really amazing sex for the first nine years of our relationship. Then we had kids and I was a dead zone for the better part of four years.

Listener Call-in: Although we were having sex, I was no able to have an orgasm. And I did a lot of researched and found that one of the off-label side effects of taking Wellbutrin is that it helps alleviate that. And all I can say is that it was sort of like a magic pill.

Listener Call-in: I would never take a pill. It’s just not for me. We made date night mandatory once a month and we did 30 days of oral sex. We worked on reigniting our sex lives and today we have a healthy sexual relationship.

Listener Call-in: I have endometriosis. One of the symptoms I have is just excruciating pain while having sex. I would definitely create a pill that could help women like me not have any pain or discomfort.

Listener Call-in: Two years ago, I made a New Year’s resolution to stop faking orgasms. At some point it just becomes easier to fake pleasure than to have to explain complex reasons why I sometimes don’t feel fulfilled. If I could take a pill that meant never having to fake it again, I would.

MH: Let’s keep the discussion going! Tell us what you think after you hear the rest of the episode. Leave a comment at OnlyHuman.org or give us a call and leave a message at 803-820-WNYC. That’s 803-820-9692.

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MH: This is Only Human, I’m Mary Harris.

And I’m talking to sex researcher Nikky Prause.

She got her start at the famed Kinsey Institute, but it was almost accidental. She grew up in small town Texas, a port city called Beaumont. She was the oldest of 6 kids, and the only daughter to refuse to have a debutante ball.

NP: I refused. I was asked and I told my parents no way! Even then I was a little progressive, so...But, I still went to my little sisters’ when they went through it. I saw them and clapped and kept my mouth shut.

MH: She followed a boyfriend to Indiana University, and she started working in the Kinsey sex laboratory for college credit.

MH: How did you explain your job to your parents?

NP: I didn’t explain my job to my parents. Every time I would start to go there a little bit it was usually my stepmom that was like: “not at the dinner table.”

MH: So, how did you learn about sex?

NP: The way everyone else learns. Through pain and misery! No, no -

MH: Was there like a talk?

NP: I definitely had the typical class that everyone has, taught by a coach. And reinforces waiting until marriage and shows scary pictures of STDs. That’s what I remember about my Texas sex education.

MH: So - it was  Abstinence?

NP: It was definitely an abstinence program. and I remember the images - they’re memorable.

MH: What images? What did they look like?

NP: They just put giant vulvas on the screen that were infected. With like really progressed cases of gonorrhea, saying basically, if you have sex this is what will happen to you.

MH: Nikky Prause thinks these scare tactics are part of the problem for researchers like her. Girls are told they can get pregnant, that they can get sick - but pleasure is rarely part of the conversation.

And she isn’t convinced pharmaceuticals will ever be the answer. Which is why she’s experimenting with something different: transcranial magnetic stimulation.

MH: when did you first get interested in the idea of using brain stimulation to stimulate desire?

NP: I got interested in brain stimulation back in 2006, I interviewed at an internship site that had a brain stimulation unit. And  I said if I come here I’m knocking on your door the first day I’m here. It was one of the very early labs.

MH: why did you think that? Why did you think oh this might work?

NP: Because they were using brain stimulation in depression, that was the first application. And there was every reason even then to think low sex drive was tied to low mood, depression.

MH: For the last decade, psychiatrists have been using transcranial magnetic stimulation -- TMS -- to treat depression that doesn’t respond to therapy or drugs. It’s a milder alternative to electroshock therapy, delivering magnetic pulses to the brain.

Nikky Prause wants to see if she can use the same technology to treat low desire.

In her Los Angeles lab, she’s recruiting research subjects on the casual encounters pages of Craigslist. For $150 they agree to have their brains stimulated.

NP: And it’s thought to last about 30 minutes. So we have a pretty quick window. So, once their brain has been stimulated, we walk them back to the sex lab and we hook them up!  

MH: So far, she’s tested it in about 20 people.

Her subjects watch pornography under physical observation, including that anal pressure gauge. She monitors their brain waves to see if someone who’s had their brain stimulated will get more excited when they know they are about to watch pornography. It’s her way to quantify … desire.

There can be side effects. Like headaches, even seizures.

MH: What does it feel like?

NP: TMS? I won’t do it. And I’ll tell you why. Because normally, I say I wouldn’t do anything to my subjects that I wouldn’t do to myself. But, TMS is therapeutic, it’s something that is thought to alter the brain in permanent ways. And I like my brain how it is. I don’t want to change it. So, one stimulation session, frankly, is probably is not going to do anything one way or the other, you really have to have a series to see permanent change. But, I don’t want to do TMS on myself.

MH: How did we get here? Where women are needing shock therapy to have better sex? I mean, how much of the problem is really cultural?

NP: I think TMS - shock therapy as you say - all these different approaches - are not going to work for the vast majority of women who have low drive. That stinks, but I think it’s because largely these are relational issues. So, you know - the fact that he or she won’t help with the house cleaning, and that really rubs you the wrong way and you don’t like them that much anymore and you don’t feel respected: it’s hard to get turned on in that circumstance and there is no amount of pills or brain stimulation that is going to improve your ability to respond to a partner you hate. (laughter)

NP: We joke sometimes too, and say it also could be a bob problem. What we mean by a bob problem - is if you have a heterosexul couple that’s in and the woman doesn’t seem to be aroused or not interested in her partner - sometimes you get the sense that the guy just either has no idea what he’s doing or -- That she’s not getting what she needs sexually, and he’s not responsive. And no amount of pills or TMS are going to fix that partner.

MH: Oh god that’s so sad for everyone.

[ Music]

MH: If you had one piece  of advice for women, what would it be?

Slower. We feel so much pressure to keep up with our partner. Especially, if you’re in heterosexual relationships, where guys can be much more responsive much more quickly, not only with their erections but also with their orgasm. And there’s lots of evidence now showing how much women sacrifice their own pleasure, interest, and desires because they feel the need to cater a bit more. And nothing wrong with catering once in awhile, treating your partner.

But. To continually kind of deny that we have an interest in sexuality and make those demands to say - you know you partner - you really need to slow down, I’m not there yet. They get that message from you and then the next woman and the next woman. They will slow down, and then we will have better partners. We’re all in this together.

MH: Ok ladies, we can do it. thank you Nikky Prause for doing this.

NP: Thanks so much, it was fun.

Nicole Prause works is the founder of Liberos.  You can find out more about her research at OnlyHuman.org.  

And while you’re there… tell us about your experiences with sex and desire… does your sex life need improvement?  Got any tricks to make things better?  Share your story with us.