as Medicine

Too hot for UCLA: Nicole Prause wants you to have more orgasms … so she can study them.

You won’t find the true address for Nicole Prause’s enterprise, Liberos, on the company website. She has carefully shielded it from the Internet, hoping to protect herself from the barrage of harassment and hate mail that tends to come her way. Some of it comes from anti-porn activists and sex-addiction therapists who are upset with Prause’s research that cast doubt on whether sex and porn addiction are real disorders.

Prause is a neuroscientist by training, but she’s chosen an unpopular specialty in her field. And it’s easy to see why so many scientists and doctors avoid research into sex. Prause recently gave up a research position in the psychiatry department at UCLA—in part because the experiments she proposed seemed to be too titillating for the university. She says that administrators didn’t want any orgasms in the lab, never mind the fact that her research has funding from, among other sources, the National Institutes of Health.

So Prause, who got her Ph.D. at the groundbreaking Kinsey Institute in Indiana, founded Liberos, “a sexual biotechnology company,” to continue her research into sex, sex drive, and the health benefits of orgasms. She also intends to create and sell a product that could finally — for real this time — be a “female Viagra.” In her tiny lab in Los Angeles, men and women are stimulated, or stimulate themselves, in one room while she and her research assistant monitor them from the other room.

Prause, a 38-year-old marathon runner, speaks quietly, smiles widely, and frequently laughs at her own statements, but it barely softens the intensity of her words. She is a woman on a mission. I sat down with her in her small office to find out more about what this mission is.

What exactly does your research focus on?

I basically study sex motivation. Which is kind of like sex drive — a lot of people use the terms interchangeably. But as a scientist, drive versus motivation are different things.

Some people think that sex is a drive, which means it can be depleted. And if you don’t have sex for a while, it just ups and ups and ups and like, “Oh, I’ve got to have it now, it’s been two months, I’m gonna die.” But there’s actually not good evidence for that. The longer people wait, they seem to just kind of forget about having sex.

That means it’s probably not really sex drive. It’s probably something else. Which is exactly one of our questions: How do you think about what this thing is that makes us want to have sex?

What originally drew you to the neuroscience of sex and sexual motivation?

I did genital physiology first. I used to run a cadaver lab where we would cut up the penis and look at the different parts, get the basic anatomy. You can do a lot with just the genitals and understanding what promotes blood flow to that area, how things are enervated. How does stuff get transmitted that causes us to have sexual sensations, whether unwanted, wanted, spontaneous, or not there even with great effort?

Photograph by Neal Preston

But eventually you’ve got to track back to the brain. Because we’ll see, “She’s reporting this, her vagina is doing that.” Why? Or, “There’s every reason to think this guy should have a hard-on right now. Where is it?” To make those connections between what’s going on in the mind and downstream, you have to actually assess both the physiology and the brain. There are very few labs that look at both ends; usually they pick one or the other and specialize. I wanted to look at both.

I think a lot of sex labs get very isolated, partly by design. That is, I think they don’t reach out as much as they should. But also a lot of people think we’re weird and don’t work with us because it’s super stigmatized work. So I always say my career has been to steal from the emotion researchers and put it in sex, or steal from the schizophrenia researchers and put it in sex.

What are some of the biggest questions you hope to answer about sex and the brain?

There’s one finding that’s been reported for a long time, where if you measure a woman’s genital response, and then ask her how sexually aroused she feels, these two things often don’t line up. There are lots of ideas as to why that might be, but we were the first lab that actually looked at the brain response and related it to the woman’s self-report and found that women actually had a stronger relationship between their physiology—when it was measured at the brain level—and their self-reported arousal than men did.

I think a big part of what’s going on is, we’re asking guys “How aroused are you?” and they can just look down, and say, “50 percent!” And then the scientists are like, “Yep, you’re 50 percent aroused,” because that’s exactly what we’re measuring — blood flow — and for men it’s something you can visually see.

So one of the big questions in neuroscience is: How do you measure sexual motivation in the brain?

“Right now there is a lot of technology in sex but not a lot of innovation.”

In addition to continuing your research that you couldn’t do at UCLA, you say Liberos is a “sexual biotech” company. What does that mean? Do you have products in the works?

Yes, there are some things we’re working for intellectual property. One is in the area of brain stimulation.

We’re working on brain stimulation technology that we want to use to push around sexual motivation. So that people who have low drive can potentially be able to stimulate their own brain at home.

The technology we’re working with is DCS, direct current stimulation. It’s like Viagra in the sense that you take it when you need it. But it’s more facilitating you to recognize something as sexual instead of just giving you a hard-on. Viagra depends on central activation, but it works at the periphery. And this essentially works on the brain directly. So you still have to have functioning pipes; we don’t fix that.

So what would be an example of how someone would use this? Is it like, “Okay, I’m going on a date. I should stimulate my brain first so I’ll be ready for a sexy situation”?

Yeah, if you want to increase your sexual response. Dean Sabatinelli, our collaborator at the University of Georgia, has been able to demonstrate that it works to increase sexual motivation. Typically what we’re testing is that you have it on for 20 minutes to do the stimulation, and then you should have a window of 30 minutes or so, peaking like an hour out. It’s like a shorter-acting Viagra and could be used in a similar way.

A potential application is like, “There’s this person, I really like them, but we’ve been together for 15 years and I’m kind of not feeling it so much anymore.” Or, “I’m kind of tired and the kid’s been hanging on me all day and I just don’t feel sexy so I could use a boost.” It’s not going to force you to be sexual, or feel sexually aroused, but it means if you encounter something that you think is sexual your brain is more likely to process it as a reward.

It sounds like one obvious advantage of this, over something like Viagra, is that women can use it.

I would say absolutely it makes more sense for women, because we have data published showing that their experience is more linked to their brain response than their genital response. Even though I hate that finding so much.

Why do you hate it?

It’s such a gender stereotype, like “Oh, women love with their head, men love with their penis.”

But is it true?

No, I think both men and women are primarily centrally driven. It’s just more guys have a higher sex drive that helps them overcome mental inhibitions. And I think women on average have a lower sex drive, so they just don’t overcome inhibitions [and become physically aroused] as easily. That’s why with first-time partners, men have about a 93 percent orgasm rate while women’s is about 65. It looks that way for a reason, and eventually over time, with each following sexual episode, the likelihood of orgasm increases.

It’s about comfort, skill. These things seem to matter a lot more for women than for guys.

“I have to take this pill every day for the rest of my life? Are you kidding me?!”

So at some point you hope to sell headsets that do the brain stimulation?

That’s the plan. Though I’m a terrible capitalist because I came out of academia where you’re not supposed to make money doing this stuff.

But you could potentially make money with these headsets.

I think so. Like if I wanted to be unscrupulous, I’d just sell them now. But I think it makes sense to wait and do more work.

When you do start selling them, who do you think your customers will be?

Low sex drive is still the number one complaint of women in sexual health clinics. That’s been the case for a long time. There are many of those people for whom this probably will not work. That is, I think some people just have discrepant desire with their partner: their partner’s [sexual desire is] really high and they’re quite normal. A lot of the women who have low-drive complaints, it’s because their partner is like “go fix yourself.” This will not help them. It will not fix Bob.

But it is a complaint for which we only had the first FDA medication last year, Flibanserin. And when it came out it was hysterical because it was touted as the first female sex drug and such a big deal and it FLOPPED.

Where do you think Flibanserin went wrong?

There were a few different things. The effect was tiny. You’re getting 0.8 more satisfying sexual episodes per month. It’s like, “I don’t even get sex one more time? And I have to take this pill every day for the rest of my life? Are you kidding me?!”

I’m not asking you to wake up and take a pill every day. And frankly I would rather sell you something that’s likely to work. So one of the things we’re doing is asking questions in our study about who benefits from this treatment. If I bring someone in and do a little assessment of EEG, can I predict who is going to show a sexual increase after a brain stimulation? I want to be able to say “this is most likely to work for this type of woman, having this type of difficulty, or this type of a guy who’s having low drive.”

I want to just be a lot more careful and truthful about what this thing is actually doing, and hope people will appreciate the honesty.

Research scientist Heather Cohen wears one of the headsets Liberos is developing. (Courtesy of Nicole Prause)

Are you more motivated to answer unanswered scientific questions than to try to liberate women to have more sex?

Yes. These are things we should know.

I love the example of insomnia problems. Generally speaking, if we ask people, “have you ever jacked off to help yourself sleep at night?” people go, “Well, yeah, I’ve got this sleep problem, and I’ve tried everything.” But I used to work in behavioral medicine, I saw all the assessments, I worked out of research-supported treatments, and none of them talked about orgasm and its function in sleep. So I was like, “Well, I should see what the science is and maybe I can write something about it. Then I looked and I was like, “Oh crap, there is no science on it.” There’s literally nothing on orgasm facilitating sleep in humans. That is a great example of low-hanging fruit. I don’t know how to tell you to use orgasm to facilitate sleep. I don’t know if you should masturbate in bed and immediately try to sleep, I don’t know if you should do it half an hour before you go to bed, I don’t know if you should actually have an orgasm; maybe you should just get aroused. I don’t know the mechanism of that response. If I could understand, then maybe I could say “You know, instead of taking the [sleeping] pill, the melatonin, or whatever half an hour before you go to bed, try to rub one out.”

You’ve talked about how the benefits of sex and orgasms are not as well understood as they should be. But what do we know about the benefits?

There are very few documented general health benefits. Most are very speculative, which is nuts. For example, ejaculation makes male rats very sleepy, but there is no proof that this occurs in humans. A paper last month suggested that inflammation is lower in older adults who continue to have sex, but this could just be that those who can continue to have sex are healthier. The idea that regular masturbation reduces prostate cancer risk remains a matter of scientific debate. Sexual arousal improves pain tolerance, but whether this could actually help a systemic pain problem, like fibromyalgia, is speculative. This is exactly why I am so excited to do work in this area.

Do we know anything about whether orgasms achieved solo have the same, more, or fewer benefits than orgasms achieved with a loving partner?

Yes, there are a couple of studies that report greater fluctuations in [physiological] indicators with partnered sex or orgasm than masturbation orgasm. However, there is a major problem with these data: there is no way to tell if it was the presence of the partner or merely having higher intensity sexual arousal with a partner present that made the difference. For example, masturbation often is used in a very functional way when people are asked, [did they do it] “to relax,” or “because my partner didn’t want sex.” If people extended masturbation as long as sex with a partner, those “differences” might disappear. We just don’t know at this point.

How might sex be better in the future?

Right now there is a lot of technology in sex, but not a lot of innovation. There are tons and tons of new sex aids coming out all the time. I look at these things and they’re pretty and they seem reasonably well developed, but I have no idea what they’re going to do for women. There’s no reason to think what they’re doing is responsive to what women actually need. They don’t do any of the science to find out if it’s what would actually be arousing. They might be fun party tricks, some people will try them, but they don’t advance us, they’re not innovative.

I’m hoping in the future we’re going to have the basic physiological knowledge and it’s going to help with sex education and that also we will get more innovation, and not just technology.

And what is the end goal of your research? Is it just for more people to have better sex?

I actually don’t care too much about how many orgasms somebody has or whether they had the hottest sex ever with their husband.

What I’m hoping is that some of this innovation is going to help us point to, say, if we understand direct manual genital simulation makes this happen in your brain, maybe can find out it works in some way to help depression. It might not have the same effect as the antidepressant medication, it might not be as strong, BUT maybe we’ve found that it’s been able to sustain people who had to come off of meds because Trumpcare goes through and they can’t pay for them anymore.

Or maybe they’re dealing with chronic pain disorders. One of the best things for chronic pain disorders is regular exercise. But that’s a very hard sell for someone who’s hurting. What if I could tell them to try regular masturbation?

Those are actually useful things to know, and I’m not convinced that having orgasms 94 percent of time with your partner is interesting.

So you think sexual pleasure could eventually be recommended to treat physical and mental disorders?

Absolutely. I mean there are so many things that change with that change in state. I don’t even know the extent of it because there’s not a lot of work in that area, but high arousal states, orgasm — there is the potential for a lot there. It’s very early stages, but we’re already getting a lot of pushback from the anti-sex, anti-porn crowd that doesn’t want people to engage sexually for pleasure. So we’re going to be fighting this the whole way.

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