Good Life Project - The Science of Sexual Desire (and how to change it) | Nicole Prause

Episode Date: August 7, 2023

Looking to unravel the mysteries of sexual desire and its impact on living a fulfilled life? In this eye-opening episode, renowned neuroscientist Nicole Prause dives deep into the science of sexual motivation and how it influences our relationships and overall well-being.Understanding Sexual Desire: What is it? Why is it essential to our lives, and how is it changeable?Myth-busting and Research Insights: Nicole shares why differences in sexual desire are normal and introduces groundbreaking work on brain stimulation to change individual desire.Impact on Health: Discover how the neuroscience of orgasm can enhance pleasure, relationships, and physical and mental health, affecting everything from inflammation to sleep.Don't miss this engaging conversation that's not just about sex but about embracing an essential and healthy part of life. You can find Nicole at: Website | Twitter | Episode TranscriptIf you LOVED this episode you’ll also love the conversations we had with Vanessa Marin about how to have open and honest about sex.Check out our offerings & partners: My New Book SparkedMy New Podcast SPARKED. To submit your “moment & question” for consideration to be on the show go to sparketype.com/submit. Visit Our Sponsor Page For Great Resources & Discount Codes Hosted on Acast. See acast.com/privacy for more information.

I actually think sexuality and sexual stimulation can be important for general health. I worked in health psych and did behavioral medicine practice. And all of those assessments for people who had sleep problems don't ask about sex, don't suggest sex. I was like, but why? Why would we not use sexuality in a way that enhances our general health? I think the more important argument is to say this is actually a part of improving health broadly. That might be sleep, that might be pain, that could be other mental disorders or concerns. And if we keep looking at it only in its own little box and say, well, we study sex to improve sex, fine goal to have in life, but maybe not

going to move us as far forward or making that argument for its importance in life broadly, if we don't think about it as integrated with these other health concerns, which I think it absolutely is and should be. So have you ever wondered what sexual drive or desire or what researchers call sexual motivation has to do with living a good life. What even is sexual desire anyway? And why should we care about it? And the question that tends to follow, is it changeable? Not in some smarmy, underhanded, or self-serving way, but in a validated, science-based, and genuinely relationship-building way. And if so, why would we want to change it and who is to benefit? My guest today, neuroscience longtime researcher and clinical practitioner

and founder of the Libros Research Center, Nicole Prowsey, she's been studying everything from sexual desire to the physiology of orgasm and how it can impact not just physical but also mental health for years now. And these are all universal experiences and topics that affect us both individually and in relationship. They tie into our ability to be healthier and build and sustain deeply rewarding personal relationships to help us live good lives. But we rarely if ever talk about them, let alone seek genuine science-guided advice on them, which is why we've been on a bit of a mission to normalize the conversation around topics like these that are truly essential, healthy, and universal elements of a life well-lived. In today's conversation, Nicole does

a lot of myth-busting around the topic of sexual desire or what she terms in more scientific language, sexual motivation. And she shares why different people can have wildly different levels of sexual desire, how that is actually completely normal and invites us to stop really pathologizing this discrepancy as a problem that must be solved or blaming or shaming any one person for being on the quote, wrong side of sexual desire. And she also shares some really fascinating cutting edge research that she has been leading on various forms of brain stimulation as a way to effectively change an individual sexual motivation or desire and where that research is headed and why we might want to say either yes or no to it. Nicole also shares some pretty groundbreaking work on the neuroscience of orgasm and its untapped potential for enhancing

not just pleasure and relationships, but also our physical and mental health through its potential impact on everything from inflammation to sleep to mood and so much more. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you eight hours of charge in just 15 minutes. The Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required,

charge time and actual results will vary. Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were going to be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're going to die. Don't shoot him! We need him!

Y'all need a pilot? Flight Risk. Really excited to dive in. The topic of human sexuality is something that in our culture, at least in Western culture, especially in U.S. culture, is something that in our culture, at least in Western culture, especially in US culture, is something that really spans the range from profoundly taboo to completely open, depending who you talk about it, where you are, what your family culture, your local culture, your faith-based culture is. And in no small part, that leads, I think, a lot of people to just completely ignore

the topic as if it has no role in our lives. So I'm curious, you end up earlier in life, you end up studying in Indiana, in part with Kinsey Institute. What happens in those early years for you that leads you to say, like, this is actually a really interesting topic for me to devote energy to? My interest is mainly out of the openness of the field. So I was training in an area called clinical science, which tests treatments to make sure that things that therapists are doing with people actually work. And I found, you know, I have colleagues who are working in depression, people working

on interpersonal violence, and I'd like learning about those things. I'm a curious person, but those fields are crowded. There are a bunch of people doing work in that space, lots of great stuff going on. But because of the stigma around sexuality, there were legitimate discoveries being made in the field. It's like, oh, there's a part of the clitoris we didn't know existed. It's oriented in this way. That's important. We should have known that. And I loved that kind of excitement in the field, that there were things that were truly new and discoverable and felt like there was a lot of space to do good work. So I always say I had more of a nerdy experience and interest coming in just because I loved that challenge of, well, how do we study something that's

never been studied or not been studied the way we think is right? And how do you dig into that to make those kinds of discoveries? And I love that about it. And I mean, part of the work was under the auspices of Kinsey Institute, which is, I guess it was a sort of like a part of the study for you, which is, you know, it's a legendary institute in a lot of different ways. A lot of people, you know, like hell the work that they've done over the years, a lot of people like the exact opposite. When you come out of that and you're making a decision about, okay, so like, where do I go from here? Like, this was really interesting. It was very cool for undergrad. What then tips the hand and says, this is actually something that I want to devote my full-time energy to. I really want to continue to study this. The first study I ever did at the Institute was

looking at older adult women's responses to a medication they were taking that we thought might have prosexual side effects. And I just remember being the research assistant first, and I was lab coordinator at the Institute for many years. And, you know, putting in VHS tapes with pornography, measuring their vaginal responses, and just thinking, like, you can do this. This is the thing you can study. You know, we don't have to just sit and read, like I think many of us do when we go to college, you know, you may start reading in a new space about sexuality, trying to understand your own feelings and preferences around it, or maybe a friend's. And everything you're reading is, I think this, my client said that.

And I was like, well, that's fine, but we can study this in some objective way. And that really, really appealed to try and be somewhat concrete about it. And not to say that experiences and reports aren't important. Of course they are. We collect those also. But I didn't even know that was a thing that you could do. So I got really lucky in landing there because I didn't go there for the Kinsey Institute. I didn't know it was there. It was an option for a lab credit that I needed for my undergrad program. And it was very easy to fall into because it was so much to do. There were so many questions. And I spent a lot of time, early graduate school in the basement of the psych department, working with the engineers to

craft new things. And I thought that was amazing. Everyone else was trying to figure out how to get enough money to buy the system they wanted. And I was like, my system doesn't exist. So we built it. And here's what we're doing. And it looks a little weird and the color's kind of strange. And sorry about the Christmas light looking thing. But that creativity was a lot of fun, building new things, getting help, learning about electronics, which I'd never had a reason to learn before. I just ate all that stuff up. I'm curious, what was the general state of research around sexuality just broadly at that time? Because you hear a lot about NIH and all sorts of grant funding and tons of labs at universities studying all these diseases and illnesses and

things all over the world that are well-funded. And was it the same for, more broadly, the study of sexuality, or was this something that really wasn't studied all that much? It was being studied by a number of folks, but even within the scientific community, we were definitely cleaved off from the rest of science. So I had experiences of talking to people at conferences who were clearly doing work that was related. I did a lot of work in affective neuroscience. And I would say, well, what about the pornographic stimuli? I saw they did this and they'd say, oh, I can't study that. My wife would kill me. I said, what? Who cares? This is science.

And still, I was hearing this, we don't do that. This is something that's outside of the realm of what other psychophysiologists or other affective neuroscientists thought as either a legitimate area of study or is too risky for their own careers. So there was some bias just to stay away from it. If you were a middle of the road, you know, doing some already recognized field, I think they didn't want to become involved often. And then the funding is unique from the National Institutes of Health in that you, number one, have to have a disease that you're treating. And so anything that would be funded for sexuality was usually related to HIV. So what's bad about sexual behavior? What naughty things do you do that we should stop you from doing?

What bad attitudes do you have that are causing you to engage in risky behaviors? And so everything that was funded to the extent it was, was framed in that way. And a lot of it focused on men who have sex with men. So that was where the overwhelming amount of funding went from these larger grants. And there was a small, you know, National Institutes of Health has made up a number of smaller groups. And so the National Institutes of Child Health Development, NICHD, should have been kind of our one to apply to. But even the program officers there would say,

don't put the word sexual in your grant. And if it requires it, I suggest you not apply because there were congressional aides that would regularly look through the CRISPR, like the database, looking for funding that had been awarded in this space to seek to rescind it. So there have been five grants that were brought up before Congress for defunding from the NIH. The only one that was successfully defunded was a sex grant. And four others that were brought up that were sex grants as well. One of them was part of my graduate funding. We were sweating that one when they brought that up. So there's very little funding. If you get it, they'll try and take it away. And by the way, if you are doing the work, we at the Institute had a number of safety procedures in place because we had physical protesters like marching placards and death threats in the form of bomb threats still at the Institute. work done, it's probably not going to find funding. If you do, you're probably not going to keep it. If you keep it, somebody is going to try and threaten it away from you. So it was maybe,

you know, I advise students now usually not to go straight into that route and say, you know, go learn severe mental illness and then apply, you know, in the domain of sexuality or learn about depression and then specialize in sexual disorders within major depressive disorder. Because going that route straight is very challenging academically. It's just something that's very, very high risk professionally, I think. I mean, that's really wild how political actually it is and how the politics then ripple down and affect the funding, which then affects our knowledge or lack of knowledge about this thing that is so central to human existence on a daily basis. So was that part

of the reason? I mean, you found a way to continue to study this for about a decade, part in school, and then about seven, eight years after that, and then 2015, end up effectively funding or launching your own institute, Liberos. Was that largely the reason behind you saying, I actually need to take control of this and just have my own thing? We had a very acute event that kind of made clear that needed to happen. We were trying to do a study of orgasm physiology and it was a multi-site study. So two universities that were involved. One university approved the protocol.

You know, we always have to go through ethics review. That's a federal process. Unquestionably have to go through it every time. One institute said protocol looks good. Go for it. The other institute said you can't do that here and shut it down. Not naming them, but I said, wow, I've never had that happen before. And that's really, really rare, actually, in ethics reviews, because usually they work with you to find something to allow that to move forward. And they hadn't raised any legitimate concern about it. There was nothing about confidentiality, nothing about safety. They just said, like, you can't do the orgasm part here. We could stimulate them, we could use vibrators, but they didn't want them having an orgasm on campus. And I said, well, this is the end. This is the limit of what can be done in academics right now. And that's when I chose to leave and not attempt to come back at that point. I had a grant that

had been awarded from a private foundation. And I said, you know, I'll take the grant. I'll do it myself. I don't need to be somewhere that's not going to support that work. And we still collaborate with universities because we want that federal oversight and everyone to know that what we're doing is safe and protected. But you really have to have institutions that are going to support the work of their faculty. And so that's where I ended up for a long time was doing this work through my institute, usually through smaller foundation grants to get the work done. And that was part of how we ended up with some of the first protocols of partnered sexual

interactions that have ever been published. That's how we ended up with some of the first data around orgasm physiology and genital manual stimulation and partners. It was worth it, but that was stressful to figure out how do you run a lab when you don't have a university anymore? You're not sitting in that institution that has all of those things built in. So I don't highly recommend it, but we were lucky enough to some foundation funding that supports you doing that. It can allow the institutes that are nervous to say, well, yes, we approved it, but it's not being done here. I think that was part of the selling point is like, it's not on our campus. Some other

places doing that part. And I actually think that really helped the university that was supporting, that had conducted the ethics overview to be supportive and to say, well, it's not going to come back on us. It's not even, it's a different lab. I'm excited to dive into some of your research because it's really fascinating. But even before we get there, as you're describing this sort of decade long journey you've taken, part of me is also wondering, what makes somebody stay in this for a decade when there's so much resistance, when literally everywhere you look, people are putting up roadblocks and barriers on every conceivable way.

And yet a decade in, instead of you saying, you know what, maybe this just isn't right. It's just too hard. You're like, no, I'm all in on this. In fact, I'm so all in it. I'm starting my own institute to I'm all in on this. In fact, I'm so all in it. I'm starting my own institute to keep going all in on this because that's not a response that I think, it's an unusual response. So I'm really curious what's underneath that. What keeps driving you so hard to say, I'm not stopping this? I think my dad would say stubbornness,

but I'm going to argue a bit and say my sense is there's some justice underlying that, like a justice principle, because if it stops me, it will stop everyone behind me. So if I allow an institute to say, you can't study this, then the next person who goes to ethics review now has a history where they're like, well, you know, somebody else wasn't allowed to do this either. And they have to disclose that. And their IRB may say, well, the institutional review board may say, well, if they didn't allow it, maybe we wasn't allowed to do this either. And they have to disclose that. And their IRB may say, well, the Institutional Review Board may say, well, if they didn't

allow it, maybe we shouldn't allow it. And, you know, if I get death threats for my research and I stop because of it, someone else may say, well, that worked. Let's threaten this new person too. So we can stop that work. And there it goes. So my sense was, to the extent that you allow yourself to be halted by processes that clearly shouldn't be stopping the research, I think you have to be open also to the possibility

like, am I doing something that shouldn't be done? I haven't run into that yet. I think everything we've done is very above board, but assuming that's not the case, I think if you fold, you also are folding on everyone behind you. All the students who are coming up now are going to have a harder time. All the scholars who want to come into that space are going to have a harder time. So for me, it was intentional trailblazing. I think, you know, I tell people that all the time in my talks with the couples research said, there's no reason you can't do this anymore. We hadn't approved protocol. They were published. The protocol is now widely known. Tell your IRBs, yes, you can. You know, there is a path now. So I really use that experience to try and advocate

for people going further in science and saying like, push, you know, do the work that needs to be done. Don't back off because you're nervous of being told no, because we got the yes. We did the work. Please use it, you know, move it forward. Yeah. For those who don't know, by the way, the IRB is basically a review board that looks at every study and basically determines whether it's safe and okay to move forward, you know, by whatever standards that they're using.

But it's interesting too, because in this context, you literally this morning on Twitter posted, one of my favorite parts of helping grad students in sexuality designing their projects is to ask, how might it be harmful? We often assume whatever we're investigating could only be helpful or benign, but it's so important to allow and assess that we could do harm. And so it's interesting that you kind of brought that up also that you're, it seems like you're constantly making that check on your own work too. Absolutely. I, part of what I sometimes lecture about are what we call

iatrogenic therapies or therapies that can cause harm. And that partly grew out of my clinical science background. We're supposed to be testing treatment claims. And I always hear this phrase, people say, well, at least they're getting help. You know, at least they're talking to someone. I say, well, are they though? Like who, who are they talking to? What are they doing with them? Because this is a known issue. They're a well-known iatrogenic therapies, like rebirthing therapy that inadvertently killed a youth sometime back. That was a more famous case. The conversion therapies, or sometimes known as pray the gay away, the colloquial that tried to do orientation change

are extraordinarily harmful. And I work on another treatment that also appears to be iatrogenic where people are claiming to treat erectile dysfunction using an abstinence approach and people are reporting becoming suicidal from that and shamed and all this. So it's extraordinarily important. I think not only that we look and see if we can do things that are beneficial, but that we aren't inadvertently

harming a subset of those folks we're trying to help. Even if it's some substantial minority, we need to know that's there so we can monitor for the harm and make sure no one goes down that path. And I do the same. I'm also a licensed psychologist and I have seen patients full-time. I don't see them now. But part of what we do is this systematic monitoring because we can deceive ourselves as a clinician because our patients say, oh, thanks, you're great. And they try and be flattering and pleasing as they sometimes do. You're like, right, but you're actually not getting better. And what do we need to do to actually move you forward? Or you seem to actually be getting worse. And maybe what we're doing is not effective. Maybe we got the wrong diagnosis. And it's really important to catch those things.

And I think too often clinicians, to a lesser extent, I'd argue scientists, because we're supposed to be trained to do that, don't catch those problems. And you really need to be open to that possibility that, is this the only thing that could be going on? We're not just looking for improvements, we're looking at all that variability and outcomes and what of this might not do well that we need to keep an eye out for. Yeah, no, that makes a lot of sense to me. As you're talking, I was remembering a scenario with a physical therapist, his friend of mine years ago, and he asked me to sort of like rate your level of pain from one to 10 before the treatment. And then he asked to rate it again after the treatment. And I was like, well, I think it's about a two degree difference, like a two point difference. And he kind of

chuckled and I said, what's going on? And he said, I pretty much like anything within like two or three points difference out of 10. He's like, I write off as basically the client just wanting me to feel better. Absolutely. That's a thing. Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were going to be fun. January 24th. Tell me how to fly this thing.

Mark Wahlberg. You know what the difference between me and you is? You're going to die. Don't shoot him. We need him. Y'all need a pilot. Flight risk.

The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, Flight risk. the Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone Xs are later required. Charge time and actual results will vary. So one of the fields of research that I think is fascinating that you've been really diving into is the field of basically sexual desire. I'm so curious about this. And I guess the first question is, when you talk about sexual desire, what are we actually talking about? What is it? Isn't that the million dollar question? So I have thought a lot, written a lot about this issue. And I think of that as a sexual incentive. So a lot of people refer to that as like a sex drive, our field included,

we're guilty. And I think that has been such a huge mistake because a drive is something like a sleep drive or a hunger drive, something that can be depleted that over time you're driven to do if you don't engage in it. And sexuality arousal does not work that way. If you don't engage in it for a long period, that drive tends to drop off. So I think that use of sex drive was a mistake on our part. Some people have talked about sexual arousal, sexual motivation as being an emotion, and it shares many, many, many features of that. So I would say there's not a sex area of the brain. People often have that mistake, like somewhere in here is an area that becomes active when you're sexually aroused. It's just the same places that get activated with emotions, same circuits. And that's why I do a lot of affective neuroscience research is because that's our field. You know, the sexuality field is not separate from that. one of the biggest picture sets used in emotion neuroscience has a whole segment of pornographic

images. So pornographic imagery has been studied in neuroscience for decades. You know, sometimes people say, oh, it's a new science, not new, been there forever. That's one way you could think about sex drive or whatever we want to call it is that it's some type of an emotion. But for me, I think there's not a lot of stability in the valence there. And what I mean by that is usually if we're happy, that's usually a positive thing. If we're sad, that's usually a negative thing. Being in a sexual state, kind of mixed. I feel like it's very often that it's a positive motivation for the most part, but a lot of people have traumatic experiences that are specific to sexuality that make that response a little more mixed.

So thinking of sexual arousal as a motivation is a very popular way of thinking about it, but I think there might be some challenges there. So the incentive model says more, what is it in the environment that's sparked this? And so we think now that sexual motivation, not as something that precedes, but that's actually a response and attention to the response. So I always say the difference is we used to think that, oh, we're just walking around during the day. And then like, bam, we get struck with the urge to engage in something sexual. And it doesn't seem to really happen that way. It's actually, we're walking around, it's like, oh, she's cute. Oh, she, you know, I had that memory of my girlfriend, boyfriend from back in the day. And oh, that was

really hot. So even if it's from an old fantasy, a memory, or from something in the environment, there's usually something that sparks that. It's not that we're just struck down by lightning out of nowhere to have this drive. So I like thinking of it as an incentive in the sense that we're responding to something. That's what is the sexual urge that we feel. So it's complicated. In summary. And part of the question is like, why do we even talk about this in the context of, you know, broadly? So this podcast, you know, Good Life Project, it's about like, what are the fundamental elements of a life well-lived? And when we talk about sexual desire,

first understanding like what is it and what isn't, I think is important, but also what is the role sexual desire or sex, sexuality or the desire for it in our well-being, in our physical well-being, in our mental well-being? I think a lot of my field argues for sexuality to be important as sex itself. And what I mean by that is they'll say, well, romantic relationships are more satisfying when you have orgasms more consistently. That's true. Lots of data showing that. Our life satisfaction is higher when we're having sex consistently with a connected partner. True.

Plenty of studies showing that. Don't doubt that. But I actually think sexuality and sexual stimulation can be important for general health. The example that's easiest for that is many people use masturbation to help themselves fall asleep at night, probably something mediated by vasopressin, although we don't know for sure in humans. And I say like, why don't we have that as a part of our sleep interventions? You know, I worked in health psych and did behavioral medicine practice and all of those assessments for people who had sleep problems don't ask about sex, don't suggest sex. I was like, but why? This is such an obvious, it's widely used. There are great animal models showing that this works, especially to decrease sleep latency. Those little rats knock right out after they ejaculate? And why would we not use sexuality in a way that enhances our general health?

So I think trying to argue for the importance of sexuality by saying, no, no, no, like it's part of these things. That's legitimate. It's there, but that's not going to sell some people on it. And I think the more important argument is to say, this is actually a part of improving health broadly. That might be sleep, that might be pain, that could be other mental disorders or concerns. And if we keep looking at it only in its own little box and say, well, we study sex to improve sex, we're going to close the orgasm gap. Fine goal to have in life, but maybe not going to move us as far forward or making that argument for its importance in life broadly, if we don't think about it as integrated with these other

health concerns, which I think it absolutely is and should be. Yeah. I mean, even if you take the domain you just talked about, sleep, what would be the potential effect if you actually study this and validate it and normalized it across that, given how many people now rely on a whole range of pharmaceutical or supplements and stuff like this on literally a daily basis for years or decades of their lives in order to fall and stay asleep. And if there was something that was non-substance that everybody had access to that was completely free for life. Yeah.

I mean, if you start to look at that in that lens, it's like, huh, like what would be the impact at scale? And that's just sleep. And you wonder then, well, how many other areas of life would this affect in a meaningful way? Absolutely. I think reducing reliance on medication is just one area it could clearly impact. So in the area of sleep, the sleep latency, that's difficulty falling asleep is the problem that most people have with sleep. Some people have trouble with early morning awakening. Some have poor quality sleep where they wake up throughout the night, but by far the most common problem is just falling asleep. And that is what this seems to impact most directly. So before you go on, you know, 12 milligram melatonin, before you go to the doc for

prescription sleep aids, I would love to be able to tell people to try this. But part of what we don't know is what the time course of some of these processes post ejaculation or orgasm are. So I don't know whether I should tell someone, you know, if you're going to do this, like you need to be in bed when you masturbate to have a sleep attempt. So it all sleep attempts, you know, you try to go to sleep, you should be in bed and like ready to conk out when you do this. Or should I tell them do this about 30 minutes before you go to bed, then brush your teeth and part of a routine, because then vasopressin is going to peak. I don't know when that happens. So because there's no basic science behind this very simple physiological process, highly accessible, very easy to identify, no funding to look into it, to say what is the

time course of this so that we can even advise people how to best integrate it to try it as an alternative to medications. But it's obvious. Absolutely. Yeah. I mean, it's so fascinating because I know researchers now who have tremendous funding around running labs around psychedelics. And one is studying very specifically what is set in setting because that's supposedly like the magic thing that makes psychedelics really be effective and safe and constructive rather than going off the rails. And kind of what you're talking about here is studying set and setting in this context. And in the psychedelic field, there's a ton of funding available now, but in yours, you're saying it's like, it just doesn't exist, which is fascinating to me.

Yeah. It's funny. The prime minister of Canada about five years ago actually announced the funding for a women's sexual health initiative. And I remember all of us in the US just going like, dang it, we're never going to get that. And so a lot of scientists who trained in the US have left for Canada. It's partially their funding is a lot more friendly for sexuality there. And they tend not to get death threats like we do here. So there's been definitely also a flight due to those kind of limitations that are really US specific. It's a shame that I think we've been kind of stuck in that box. But yeah, you have to fight just to do really basic work in this space. And a lot of it ends up foundation funded through folks that have a special interest for their group, their individual benefit, whatever elements of sexuality. And also the fact that yes, it is an enjoyable experience to climb actual orgasm. I think most people would

probably argue that yes, that's something that is enjoyable. But when we zoom the lens out and we start to look at the relational impact and the impact of sex on the quality and the depth of relationships, on intimacy, on just relational dynamics, especially over time. Talk to me more about that side of it. There are many researchers who are involved in looking at this idea of connection. So the extent to which two individuals kind of overlap or meld with one another, we often think about that most in romantic relationships, but that also could happen in friendships potentially, or other dyads. And what always cracks me up is a lot of that research concludes the way to increase closeness with another person is to engage in pleasurable,

novel activities. And they give examples like jet skiing, parachuting. And I say, or, or say it, come on, write it. And they never write it like sex, like have sex. How is this not something that's clearly novel and pleasurable? It's the most accessible of those. We can't all afford to go jet skiing all the time. So I think it's funny that this is clearly something, that sexuality, that should increase closeness between two people. Obviously, not always appropriate for the particular relationship or diet. But when it is, what a great way to do that. I think if it's something that, you know, you both consent to, you both want to do, that was one of our studies we were interested in seeing, does it require the presence of a romantic partner

if you're involved in some sexual stimulation with another person? So this is where issues like casual sex concerns come in because some people worry that if you're being intimate with being sexual with someone who's not your romantic partner, does that feel too risky to be beneficial or cause more harm than the pleasure it provides? And our data show for the first time that people who actually aren't romantic partners experienced a greater increase in connection with that person. Than people who were romantic partners and engaged in a genital stimulation practice for just for 15 minutes. And we wondered why. What is it about these two folks who actually aren't involved with one another that might cause that? And so our speculation was like, if you're not partnered, you may be single or your partner's away and they let you do this, whatever the situation may be,

you might be a little less connected to other people in general. You might be a little more lonely. You might be a little touch deficit. And if sex provides that, why are we saying not this? The other touches, the other connectors are fine, but when it's sex, that's gross. That you shouldn't do. See, Well, you have science now showing you could, and that it would increase the connection between people, maybe reducing loneliness, maybe increasing that connection that we worry so much about these days. So I really hope folks would be open to opening that box maybe to see how could we use sexual stimulation to decrease our loneliness in society broadly, to feel more connected in relationships where that might

be appropriate. Yeah. You just used the phrase touch deficit. Deconstruct that a little bit for me. Is this a very broad phenomenon? Touch deficit is often discussed in the case of older adults where they may have had the loss of a romantic partner through death or divorce. Maybe they're a little isolated because they're not working anymore. And there's a lot of research that goes into touch deficit in older adults who you may get a hug and say, gosh, no one's hugged me in three months. No one's even touched me in that time or only the nurse or whatever their particular situation may be. And the negative associations with that experience are many. There've been a number of studies showing the

negative outcomes of just not ever feeling someone touch you, not even in a sexual way, just in general touch deficit. So I always wonder, why know, why would we not, number one, expect that to happen in other folks? To what extent might they have that kind of a difficulty? You know, they just, no one's touching them at all. It's not the sexual thing even per se. It's, I don't feel anyone is close to me and wouldn't it be great if I did? So why would we not use sexuality to address a touch deficit? You know, to say like we can have a safe, intimate connection with someone and make sure that we know how to negotiate and consent to those kinds of things. Yeah. The Apple Watch Series 10 is here.

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Charge time and actual results will vary. We've been talking a lot about sex and sexual desire on the sort of like the benefit to humanity side. Let's kind of like look at the other side also, which is, I don't know if we want to label this dysfunction or not. I'll sort of like let you guide me here, but it's, and I think this is where a lot of the conversation goes, where you talk about sexual desire. My sense is a lot of times the conversation goes to the place of, well, I used to be really sexual attracted to this person or this person. Like my partner used to be really sexual attracted to me, but now it's sort of like we're roommates and I still love them.

I still want to be with them, but that desire is gone. And maybe it's okay for one person, but it's not okay for the other. And one person is really missing it and yearning it and craving it. And it's causing tension in a relationship. Talk to me a bit about this phenomenon and what you see going on there and also how prevalent it is and how much of a moral overlay we sometimes bring to that too. This issue is the number one brought before sexual therapy clinics. So couples most commonly present with an issue of, we call it desire discrepancy. And part of the motivation behind calling it desire discrepancy is to try not to label

one or the other to say, you know, you're low, bring it up. And no, you're a pervert, bring it down. So we think like, okay, you two aren't matched. What are we going to do about that? And early on, we thought the lower desire partner had a problem and the most likely they were sexually inhibited. And so we just needed to open them up and make them more positive about sex, Get them the right toy. Get them the right swingers convention, whatever it was that we thought might be helpful. But the data just don't support that. Most people who have low drive aren't especially sex negative.

It's kind of like you describe. It seems like maybe at one time it was there and it's just kind of gone and they don't even know why necessarily. So the lower desire partner typically describes that as I want to want, I wish it was there. Like I love this person and I don't know what to do. I don't know how to bring it back. So one thing we often will do early with couples with a desire discrepancy is we say, first of all, you know, we have to negotiate some things that will help reduce the tension as it is. So very often couples have rules around masturbation or pornography viewing or fantasy where they find the higher desire partner is masturbating

and they say, do you not want me anymore? And they say, whoa, that could mean that it's possible, but most likely not. Most likely they have a higher drive. They know you probably are gonna say no, they feel rejected, they don't wanna get turned down again, maybe they don want to pester you. And so they're like, I can handle this. I can take it off their plate. I'm going to take care of this myself. You know, I would prefer to have sex with them. They're not doing that. So we say, okay, first things first, we got to negotiate

that balance. Say, do you not want them to masturbate at all? If so, what's underlying that? Can you find times when that actually might be okay and that it doesn't mean that they don't love you and that it may actually be a good thing because it's reducing the pressure on that desire discrepancy? Or is there some other outlet that you feel is appropriate? Couples sometimes these days think,

oh, the answer is to try and open our relationship. That might work for some folks, but the problem is we have no data on who does that well. So we have data on people who are already doing that and kind of how they may be different from folks who have close relationships. But I can't advise someone to open their relationship to balance out that discrepancy because I don't know is going to do well with that. So we usually don't consider that. And the other issues are just trying to find areas of novelty potentially. And sometimes when a sex therapist says novelty, they think, am I swinging from the chandeliers?

Are we talking crazy activities? And we see novelty can actually be pretty simple. You know, it can be, we used to take five minutes. Well, now you're going to make yourself take an hour and find a way to fill the hour without going to penetration and try to find ways of integrating setting in an appropriate way that may be in an uncomfortable car, just because it's different, that may be outside. So I think sometimes people hear novelty and they think they have to shoot for the stars, that it has to be crazy novel. Not at all. I think sometimes looking for novelty and easier to access spaces, unchallenging areas is often something that can be helpful. But man, if I had the solution for that, I would open that clinic in a heartbeat.

There are a couple of medications that have come out recently to try and address low drive and bring that up potentially. The meds that are available have two different mechanisms at least. The first one that's already out doesn't seem to do much, doesn't look very promising. The effect sizes are tiny. So I don't generally recommend those. I think most of us don't. And the others that are coming forward might ultimately be helpful. I worry a lot about development that's being done on the other side that is to reduce high drive. I don't want to castrate anyone in any sense of the way.

Not neurally, not chemically. I think much better to find a way to negotiate those differences in a way that it honors both, if it's two, both members of the couple's values to balance that desire discrepancy. But it is such a painful thing to deal with because there's often a lot of hurt feelings and feeling rejected and love intertwined in that. And you have to, of course, navigate that and be aware of it. But there's certainly not a magic bullet. And I don't think it's that one or the other is pathologized, where somebody has a disease here and we got to label one. No, no, no.

Just different. I mean, it's interesting also because I wonder how much so many people are now on some sort of SSRI or variations of those SSRIs. And one of the known side effects of many of those is suppressed sexual desire. I wonder how many people are doing this balancing act of saying, okay, so this medication is actually really helping me, whether it's depression, anxiety, whatever it may be. This is making a real difference for me. And in theory, that would bring me back to a place where I would be more open to sexual

experience. But at the same time, the medication is actually suppressing my desire for any of that, which is a really tough place to be in, I would imagine. Absolutely. I always joke that antidepressant medications are more effective at causing an orgasm than treating depression. They will knock orgasm out quickly. We often talk about the delayed effects and that affect or emotion to kick in and say, oh, you got to wait a month on the meds. When you take the med about an hour later, you'll have more difficulty reaching desire. So you are allowed to choose to engage in sexual behavior without desire. So if you say, well, you know, my partner is feeling deprived, like we're not having sex as often as they want to, it is okay to say, I'm going to do oral sex with them. I'm going to use my hands with them. I'm going to hold them while they do something. Even though I don't personally desire to be sexual myself, I choose

to do that for my partner. And I think sometimes there may be a variety of historical reasons for us trying to say, no, no, like we don't engage in sex unless we personally want it. I say, well, sexual motivations are the reasons why you might engage in sex. So the joke often is, you know, take out the trash and, you know, there might be a treat for you. Okay. A little funny, but that is a thing you can do. It's not, it doesn't make you a bad person. There's nothing wrong with that. It doesn't mean you're not, if you're identified that you're not a feminist anymore, you know, if that's something of concern to you, you can absolutely choose behaviors that you may not be personally motivated to engage in at the time. Now that's always a

balance too. You know, it's like, how much do I do that before I start to feel like I've lost contact with my own desires? So as ever, not a simple answer there, but sometimes I think differentiating between like, you know, I can be sexually motivated and not have desire and it's still okay to engage sexually if I choose that. Got it. So one of the things that you've been studying also in this context is you've been doing a lot of work with, I guess there's a distinction between brain training and brain stimulation, right? Talk to me about like what the two are and what the distinction is. And then I'd love to know more about like the brain stem side of it. The brain training people often use to refer to things like biofeedback from electroencephalography

or EEG. So EEG is if you ever see the things that look like swim caps with a bunch of wires sprouting off of them, that measures electrical activity at the scalp that's generated by the brain. And you can do things like train yourself to increase your alpha response. That's by far the most common biofeedback that's used with EEG. And there are now a lot of headsets that allow you to do this to some extent at home. There are lots of clinics that have been set up to do this. It doesn't actually seem to be a lot more effective than other forms of biofeedback like electromyography or EMG that are with muscles that are much easier to do. The signal is much easier to read. So I don't know if there's anything

super special about the neuro biofeedback per se, but it seems to have some efficacy in a number of spaces. So that's measuring what's coming out and teaching yourself to have some control over what that electrical output is. Brain stimulation is putting activity in. And usually if people have heard of that, they're often familiar with it through electroconvulsive therapy or ECT. People do still use ECT for some things, but the problems with ECT is it's a fair amount of energy that's not very directed. So a lot is sent throughout the brain and we're not totally sure where it's having its

impact. Always makes you a little nervous when you don't know the mechanism. So there have been two major areas of brain stimulation and research. There are others as well, but the two main ones are transcranial magnetic stimulation or TMS and direct current stimulation or DCS. DCS is something that can be done at home. Right now, the FDA is still not regulating these for some reason. So you can get the parts and play scientist at home. But be careful. I have gotten a few calls about people being nervous about what they did to their head. So DCS is a less intense current that is supposed to be directed between two sensors that you

place strategically on the scalp to direct energy in a particular area. Transcranial magnetic stimulation, or the TMS, is done by a tech. These were initially approved to treat treatment resistant depression. And there's a big company out of Israel that sells almost all these devices in the US. And a ton of clinics have them now because they're FDA approved. They're often covered by insurance, which a lot of people don't know. There is some evidence from my lab and one other now that the TMS can alter sexual responsiveness. And the way that's often done is the TMS is very targeted. We're trying to get one particular area of the brain to alter its responsivity. And so we first apply the TMS to see how strong it should be. Everyone's

skull and dura matter are a little bit different in their thickness. And so we don't just plop it on the head of everyone and turn it on. We adjust it to make sure it's the appropriate strength for your particular physiology. And then we move it to the area that we're attempting to stimulate. And then the pattern of stimulation really makes a difference. So there are some studies showing you if you do pulses of this activity in one particular way, it's excitatory. It increases the activity in those brain areas. If you do the pattern of stimulation a different way, it suppresses activity in the brain areas stimulated. So there's a lot of work being done on, you done on which patterns optimize for this or that, how long are the effects? You're supposed to do it repetitively.

Well, what if you live in a small town and you're coming to a big town for treatment? Can I do two treatments in a day? They have to be every other day. How much can we mush these in together to get a full treatment session in to have the effects that we're trying to have? So there's a lot of methodological research being done on TMS, especially, and it's shown the most promise probably in depression, but I'm very optimistic for its application in sex as well. I mean, what are you seeing just in terms of early? Because I guess the Holy Grail is like, somebody's listening to this and saying like, you know, I'm this person you're talking about. Like, I love this other person,

my libido, my sexual drive, my sexual motivation just isn't there anymore. And I wish it was, but it's not. And like, is this a potential, is TMS, brain stimulation, a potential intervention that for that person could bring it back? Yes, it could be. So TMS can be prescribed of what's called off-label. So it's not currently approved for the purpose of altering sexual responsiveness, but because it is an FDA-approved device in general, if your physician decides that it may be useful for you in the sexual domain, they can prescribe it off-label. That's what that's called. for you in the sexual domain, they can prescribe it off label. That's what that's called. So you could go and say, you know, I hear there are a couple

of studies that have done this. I'd like to try it. I think it might be helpful for me. A lot of folks ask, well, like, how does this work exactly so that I can understand what you're doing to my brain? Because this is thought to be at least semi-permanent. That's the one reason I always say I do all my protocols. I run them on myself first to make sure everything feels safe and where it's supposed to be and everything's working. I don't do this one because I like my brain where it is. I don't want to do anything to permanently or even semi-permanently alter its responsiveness. And this is a treatment, the way we think TMS is working is primarily to add some noise within the neural network. So if you are someone who tends to be less sexually sensitive or responsive, maybe those connections between touch and understanding those

to be sexual have weakened over time. And maybe there's some inhibition that's been added because you're used to being rejected or you've had a lot of anxiety associated with your sexual response. Essentially, you're adding noise to both of those paths so that you can more easily condition them in the future. Another way of thinking about that is people have used TMS when they're doing physical therapy to speed the recovery of limb use. So you can think of it as the brain is getting used to not having sensitivity in my foot. And so my foot's not really working anymore. But if we apply TMS to that motor strip area and then do your physical therapy, you recover a lot more quickly. And that's because we're kind of adding some noise to your brain saying like, hey, maybe you should check that connection again. Like, are you sure it's still not there?

Oh, that's so interesting. And so it comes back online and becomes more effective more quickly. So I don't think you can just sit and like, oh, I'll stimulate my brain and then I'll be horny all the time. But I think if you do the stimulation in conjunction with sexual attempts and trying to heal that, maybe some new novelty as well, doesn't have to be crazy novelty, that those may be a great way of enhancing your response to come back. Yeah. I mean, it's so interesting. And especially if you're describing, this may actually be a very long-term outcome or result where you're like, you have a relatively short

series of treatments and if it sustains, well, I guess maybe that's part of what the research doesn't entirely know. What are we talking about when we're talking about long-term? Is it weeks? Is it months? Is it years? Is this like you've permanently rewired your brain this way? There's no real permanent rewiring, but that would probably be one of the big questions.

How long is it going to last and is it worth it to even try? Absolutely. And you can always condition it back. So even if you kind of were responding again, and then you have a sexual assault experience, goodness forbid, that could certainly cause a traumatic experience that would change that right back. But the research on depression has done a lot of long-term work now. And depending on the trial you look at, they're saying, you know, at least five or six years that they've looked out to. There are some the trial you look at, they're saying, you know, at least five or six years that they've looked out to. There are some that go longer than that, but they're very small

samples at that point. So I don't know these that are claiming 10 year efficacy. I was like, maybe, but the way that we're using insects is the same circuits that are being stimulated for depression treatments in the same way. So I think it's very reasonable to rely on the data from depression literature to inform how long the sex effects might last. So I think this is potentially at least semi-permanent, if not permanent so long as nothing else happens, experience. It may be worth trying. Yeah. I mean, it's pretty incredible. Does it work the other way around also? So we've been talking about, and again, we don't want to label a lack of sexual motivation

as like, well, you're the one who has the problem, right? Let's take that off the table. This is not a shame thing and there's no labeling. It's like you just said, there's a disparity and that's usually what causes the angst. What about looking at the other side of the spectrum? What about the person who actually has very high sexual motivation? And this person may be less motivated because ethically or morally they perceive themselves as like, I'm not the one with the problem. But if somebody is open to that and they really want a relationship to endure, does this technology work in the other direction too? That's exactly what we looked at in our study was we did some that were excitatory and some that were inhibitory. And we found evidence that we could modulate both directions. That's always

important in science. Like if you think you understand the mechanism, then you should be able to push it both ways, not just one or the other. So it looks like if you use inhibitory stimulation that you should be able to decrease the sensitivity potentially over time. But again, I think the main mechanism is through that kind of adding noise to the connections. So one way to think about it is if you're sexually hypersensitive, then if you go through TMS, it's probably going to weaken those connections. But if you continue to engage in whatever those sexual behaviors are at a high level over time, you're going to sensitize them right back. So I think, again, there's probably an interaction of if you have low drive and you're doing TMS,

it's going to benefit you to attempt to engage in some pleasurable sexual behaviors during that time. The opposite is probably also true, that if you do TMS, it's not a magic bullet. You probably also need to attempt some behavior change to not immediately resensitize. But the moral questions around that, absolutely. Like you would never want to- Yeah, big time, right? Yeah, to cause someone to lose that pleasure in their life either. Can you overdo it? I don't know. Maybe you should start. The other thing to keep in

mind with TMS is the effects are logarithmic. And what I mean by that is the sessions that cause the most change are the early ones. And then there's kind of less and less change over time. So often you'll have a series of 12 stimulations. So maybe you want to do one and see how it feels. One more, give it a month, see how it feels, that you may have some benefit in proceeding with caution if you want to try that. No, that makes a lot of sense. And part of what you're describing also, I'll loop this back to psychedelics. What's been described to me through some researchers is that it's not necessarily that the immediate intervention has changed, but it's sort of like it puts your brain into a state where there's a high level of neuroplasticity.

So whatever grooves you had, whatever neural connections you had coming into the experience, it's almost like it smooths the grooves a bit and has a high level of susceptibility for you to re-groove it in a way that feels more constructive to you. And it's kind of what it sounds like you're describing here, which is why in that world, they'll say, don't come out of an experience and go watch a whole bunch of violent movies and stuff like this. In the immediate window following, think about the things that you're saying yes to so that you can rewire it in a way,

which is really the way that you want to be. It sounds like it's a similar thing with this. Yeah. That description does sound pretty similar. Yeah. I mean, so fascinating. I'm excited to see where this research goes also in the next five years. When you look in the next five years. When you look forward, like next five years, like what's on the horizon for you? What are you looking at exploring from where you are now? I'm really interested in orgasm physiology. So the sexual psychophysiology is a tiny field. You know, our like flagship conference has all 150 of us all over the world. And so there are most folks in that

space working on sexual arousal in the first three to five minutes. We show them an erotic film. Maybe we use a vibrator if we're getting fancy with the hardware, but we know a lot about the early arousal response and very little about high arousal and climax in terms of physiology. And there's so much that changes with those states that we know nothing about. So I'm most excited about a study that we literally recruited the first person for the study the day the COVID shutdown happened. I was so heartbroken, but we're doing a funded study looking at orgasm and guys to start and their inflammatory cytokines before and after climax. So literally just saying, what does this do to inflammation? Cause we don't know. No one's looked, maybe we should look. We have lots of suspicions

about what might happen, but my goodness, like how many inflammatory diseases might be addressed by altering sexual activity one way or another, you know, depending on the particular difficulty you're having. So I'm really excited to get some very basic science information on Climax. The other pattern within Climax that we're interested in is if you took any human sexuality class, if you remember any human sexuality class, if you remember it, you probably got taught the Masters and Johnson's model of sexual response. And you're supposed to have a period of excitation and then plateau and then Climax. We have some data showing that plateau phase is not a plateau. Something entirely different

appears to be happening there that we didn't know was occurring. We've seen it enough now in our data that we think it's real. Like we're trusting it. Anytime you think you have a big discovery, you know, what is it? Big claims requiring big evidence, right? So we're trying to be conservative. But frankly, I'm very excited about what we've seen. I think that the sexual response model, we have some evidence that it's wrong in this way, that in high arousal states, there's actually a deactivation where people have to disconnect. And whereas in early phases, you have to focus, attempt to become aroused,

look at the sexual stimulus, elaborate on that cognitively to approach climax. We think you actually need to release some cognitive control. That makes sense for a lot of reasons, but we actually see evidence like sympathetic nervous system tone decreasing prior to climax. What? Like that's not supposed to happen. And man, the galvanic skin response, which is another measure of sympathetic nervous system activity just drops when you tell someone to attempt to climax. And so we're very excited to get those data in this large group of guys as well,

just to see, is our basic model wrong? Should we be correcting this? Because I think we probably should. Yeah, that's amazing. Well, I will be following along for sure because I think it's just fascinating in so many different ways and it can affect our lives in so many different ways, like from happiness to intimacy to like you're studying cytokines, which for those who don't know, cytokines are a major marker of inflammation in our body. And if literally, you know, a short intervention with no external substance and no cost, it can make a real difference and immediate difference in the level of information. I mean, how incredible would that be?

So I'm excited to follow along as you deepen into all of this research. It feels like a good place for us to come full circle in our conversation as well. So we'll loop around in this container of a good life project. Zooming the lens out, if I offer up the phrase to live a good life, what comes up? Oh, on the spot, off the top of my head, I would say a life of unshamed pleasures and connection is probably a good place. Thank you. Hey, before you leave, if you love this episode, say that you'll also love the conversation we had with Vanessa Marin about how to have open and honest conversations about Thank you. And if you found this conversation interesting or inspiring or valuable, and chances are you did since you're still listening here, would you do me a personal favor, a seven second favor and share it?

Maybe on social or by text or by email, even just with one person. Just copy the link from the app you're using and tell those you know, those you love, those you want to help navigate this thing called life a little better so we can all do it better together with more ease and more joy. Tell them to listen. Then even invite them to talk about what you've both discovered because when podcasts become conversations and conversations become action, that's how we all come alive together. Until next time, I'm Jonathan Fields signing off for Good Life Project. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist,

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