In Your Pants with Dr. Susie G - Science of Sexual Arousal with Dr. Nicole Prause, PhD

Starting point is 00:00:00 on this episode men on the other hand when they view more pornography and report lower relationship satisfaction lower sexual satisfaction and so this was a puzzle it's like what you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below on today's show we have guest dr nicole prowsey a neuroscientist and licensed psychologist who studies human motivation especially the physiology of orgasm on the brain and the health effects of pornography we discuss the workings of our brains and genitals during arousal and orgasm highlighting the surprising similarities between genders and challenging long-held myths how

Starting point is 00:00:58 arousal challenges differ from orgasm challenges and strategies to overcome them dr prowsey helps us better understand the sexual response cycle contrasting the traditional linear model proposed by masters and johnson with more contemporary perspectives we have a conversation about the effects of porn on sexual health with dr prowsey challenging the use of terminology in mainstream media like pornography addiction and the beliefs posed by anti-masturbation groups for pornography related problems. Lastly, we discuss a rare condition that occurs mostly in men called post-orgasmic illness syndrome. Dr. Prousey sheds light on theories and her upcoming study that may support individuals experiencing illness-like symptoms post-orgasm.

Starting point is 00:01:44 So let's dive into the world of intimate conversations right here on In Your Pants. Dr. Prousey, welcome to the show. Thanks so much for having me on. Yes. So can you explain the science behind arousal and orgasm, specifically what happens in our brains and genitals, as well as any unique distinctions between genders? Okay, I'll hit all of it. Let's see. Generally speaking, when you start to get aroused initially, it means you have to notice that something is sexual. So that may be more automatic for some things and more effortful or specific to you for others. You have to pay attention to it. You have to elaborate on it. What we say cognitively, that is not just see that it's there, but actually

Starting point is 00:02:31 think about it, start to think about it as a sexual stimulus. And so your brain is engaged in a very effortful process. And at that point, the genital or peripheral arousal typically starts also when everything's working. As we get to higher and higher levels of arousal, there's to some extent it's just more of the same you know we get more and more activation but at some point there seems to be a switch that we're currently calling a periorgasmic period where the effort actually starts to decrease so where we had sympathetic nervous system activation so increased breathing rate increased heart rate increased galvanic skin response which is a sweating response now that stuff starts to reverse so this is not orgasm itself this is just before

Starting point is 00:03:13 the things become less effortful this may be where people describe edging or a flow state in those kind of states and climax we don't actually know how it's triggered still a bit of a mystery but climax itself is a reflex so kind of once it starts you can't really stop it and it's actually really well physiologically defined although people obviously report experiencing it a lot of different ways awesome and are there any unique distinctions between genders that you're aware of in your research? There are some surprising similarities and some differences. So people often think, oh, you know, women have all these multi-orgasmic capacities, men don't have. Orgasm between the genders is actually very similar. Like if we look at the

Starting point is 00:03:53 traces of contractions, we cannot tell genders apart. They have the same kind, same number, all of that good stuff. And when you actually have those contractions with Climax, where they seem to have similar prolactin changes for example where they're quite different is when you ask men or women to judge their arousal most commonly men look down at their penis and so they report what they see you say i am this much aroused and women are judging a lot more things typically and kind of integrating information not only from what their genitals are doing but also the context they're in if it's safe you know they think more about those kind of cues so if anything we often see women will have some genital response that we can document but they don't report feeling aroused

Starting point is 00:04:39 so some people call that a lack of coherence or a discordant response between women but i don't see it as necessarily anything wrong it's just kind of how it is okay well and that so what i'm hearing is that physiologically, there's a lot of similarities, but subjectively there, there are these differences between how we're weighing the, the experience, our sexual experience and what contexts are important. Although I would, I would say that context is important for everybody. Of course, as the rule, there's more overlap than difference, but if you ask for difference, I can find them. That's fair. Awesome. Well, this brings me to my next question because I've heard you and other sexuality researchers challenged the traditional linear sexual response model that was

Starting point is 00:05:30 first proposed by the researchers William Masters and Virginia Johnson in the 1950s. Can you contrast this with the contemporary perspective derived from yours and other research? And how does this contrast similarly or differently to the male sexual response cycle? it's funny almost anyone who takes a human sexuality class even in college today is still taught this masters and johnson thing and literally has not been tested like that plateau phase no one's made sure there's a plateau phase seems it's important so that was one of our kind of recent contributions as we said we should probably see if that's a thing that exists and if we can document it or what exactly that that piece is but before that uh so obviously there

Starting point is 00:06:17 is this longstanding model, very linear, or it's like this needs to happen, then that needs to happen. This is the order of things. And Helen Singer Kaplan came in and added a desire phase that was unique to her model. But that still was a long time ago. And more recently, Rosemary Besson has suggested a model of female sexual response. If you look at it, it has a lot of arrows going everywhere and lots of different ideas and constructs. The good thing that came out of that is she talked about the differences in responsive versus kind of initiating desire. So that's the extent to which somebody has spontaneous urges to be sexual. And she said, this is something men have a lot more of and women's desire tends to be more responsive.

Starting point is 00:07:01 And so there's a lot of research around that now, but the model itself is almost untestable. Like the way that it's kind of made, it's very complex and there are kind of feedback loops that really can't be easily taken apart so it's useful kind of to think about those concepts but from a science perspective it's very difficult to support her model because it's not really testable aspects of it are but not the kind of whole thing so now we're kind of in this limbo you know we're in between we've got linear models that we're like we want the good stuff out of those but we don't want is like to have good sex you must have this then you must have then this thing must occur we really want to try and help people get away from that framework while still saying that there

Starting point is 00:07:44 is some physiological basis like these things do have some linearity like generally to have climax you know with some very unique exceptions it doesn't just happen you know it's like there's a process generally that needs to occur before that to help potentiate the likelihood of it happening so it's still very much a balance you know we're trying to work on with these models So if you had to summarize the potential or new proposed updated model, like how would you describe that to someone who's new or just newly learning these concepts or models? I think the most important thing we're starting to modify from the Masters and Johnson model is when you start to get more and more and more aroused, we always kind of thought, well,

Starting point is 00:08:27 you just need more of whatever that is to get to climax. And we seem to see now that that is not the case. Like there's a unique, distinct brain body state that occurs between high arousal and the initiation of orgasm that can be easily seen physiologically. And we're not sure exactly what the function is. We have some ideas, but that suggests if you're having trouble with arousal, but not orgasm, if you're having trouble with orgasm, but not arousal, there may be reasons for that. These seem to be very different kind of processes.

Starting point is 00:08:58 And so it makes sense that you may struggle in one area and not the other. and what might some of those reasons be if you compare the both like or having difficult orgasming but not with arousal and then vice versa so if this periorgasmic state thing is real which we think it is obviously i wouldn't mention it but um if you had trouble with arousal i may think uh but orgasm was fine like once you get turned on you can usually get there then i would think this person is someone i want to help uh their focus to be able to notice when things are sexual to elaborate and think about those fantasize about them become engaged with them i i suspect they struggle more in that space if you don't have trouble getting turned on but you

Starting point is 00:09:40 can't get over the hump you know you're like where is my climax you know what's happening then i would think this person they're getting aroused just fine but they're having trouble reducing the cognitive control that we think allows the climax to occur so we may have this person try and hyperventilate in a safe way where they're not going to fall uh we may have them do things to try and alter their perception of their space. So trying to get to these very high arousal states. You can even now, some of the tools we use in the lab called galvanic skin response, you can buy these pretty cheaply for your iPhone if you have that and monitor your own galvanic skin response and see, you know, it's going up, but it needs to be coming back down before you

Starting point is 00:10:21 can expect a climax. So you can even do biofeedback potentially to see what is my body doing? Like, am I getting there? Am I seeing that pattern that should help potentiate the climax? So that person who's struggling with climax, I'm not going to worry as much about like, oh, let's get you just, we used to say, oh, you just need a stronger vibrator. Probably not. I mean, that may be the case for some folks, but probably not. You know, it really seems to be a really unique state that we have to figure out a way to get people to almost disconnect a little bit from the stimulus they're experiencing once it's sufficient and we don't know what sufficient is yet we're working on it but um but they're they seem to be really distinct problems for a good reason oh that's

Starting point is 00:11:05 interesting so it sounds to me like the second piece the difficulty getting to the climax right so what i'm what i'm hearing you say is there's this and if i'm understanding correctly so this is me just processing as well but so there's this space between you know that you know getting to the climax where it's, it's not just, it doesn't end at the peak. What you're saying is there has to be some coming down from that heightened state of, of stimulation is, and I'm getting that correctly. There's a space in between that, that before the climax. So it's actually like, yeah, for several minutes. And so it's not just like, sometimes people have heard the phrase ejaculatory inevitability, and that basically means the climax has started. I mean, that's, that's not what we're

Starting point is 00:11:50 talking about this is uh in women we see this state can go on for many minutes so it's uh we came across it by accident because of the way we'd set up our protocol we wanted to see an arousal process and then see them trying to have an orgasm and so we had women like get aroused in the lab and they said okay try have a climax if you can press the button when your climax either starts you want to tap out uh so they would start to try and we're like whoa did the sensor fall out like the crazy shift in response. And we're like, this is actually really distinct and unique, and we need to understand what this is. And now we see it's really replicable. It's a really large effect as far as we can tell, but it lasts for quite a long time. And so that's why I think this

Starting point is 00:12:34 might be what people are talking about when they say edging, you know, that's having a very high kind of altered feeling of the space that it may be that brain state, whatever that is that we're still working on characterizing. Right. I was just going to ask you that, like, what are some of the qualities and characteristics of being in this state that people have described or that you've observed? The clearest one is a shift in alpha response. So alpha in electroencephalography, so EEG is brainwave data. And the rule of thumb is EEG is very good at things in time. Functional magnetic resonance imaging, or fMRI, is really good at things in space. So both measures do. The other thing also, you know, fMRI goes over time and EEG can model things and where it's happening in the brain, but they're better at their respective things. So EEG is very good at time. And when we look at the different frequencies within the EEG brainwaves, there's some between eight and 13 hertz or cycles per second that is commonly referred to as alpha, nothing special to somebody, stick that label on there a long time ago.

Starting point is 00:13:40 and it's very easy to manipulate so for example to make sure that the thing is recording properly we may have people close their eyes and open their eyes when you close your eyes your alpha goes up open your eyes your alpha goes down so alpha broadly is thought of as an index of almost cortical idling so when you're watching television you kind of space out you don't remember what was on the last couple of minutes the alpha was probably high so it's not that exact state but that is typical of a high alpha state. So when you start to get aroused, your alpha is strongly suppressed because you're focusing, you're engaging in effortful attention to make this thing happen for your genitals. And later on in this periorgasmic state, the alpha starts to rise

Starting point is 00:14:24 noticeably. So it seems like you're actually reducing the control a little bit and saying, you know, I don't need to engage in this effort. Now I'm riding the sensation. it's writing that so that's what you're talking about this flow state of i think so that's our suspicion yeah that's and this is similar between genders we have seen it in men but we have far fewer data in men we were recruiting for a male study of orgasm in march uh right as covid started and our lab closed so we now have all this uh great grant funding and we are trying to get restarted. We are so close. So hopefully we'll have better data. We have just a few men right now where we've observed it in men, but because their latency is so much shorter. So when we ask

Starting point is 00:15:11 them to climax, they can do so pretty quickly. We have a much shorter time window to kind of see that state in men. So we have a protocol now that we think is going to allow us to see that a little more if it exists, but we do think it's there for guys also, but our suspicion is it's just much shorter. Yeah. Okay. And so you mentioned hyperventilating, like safely hyperventilating and stimulate the state. Are there any other strategies that would be helpful as well to kind of get into this state that someone could do? I mean, literally closing your eyes increases alpha. So it's the things that you may think of that kind of help you check out and focus on sensation so for example i suspect that some of these mindfulness exercises that are becoming

Starting point is 00:16:00 more popular and to the extent that they help you just feel the sensation and kind of ride more than like trying to force something or get it to go somewhere is like to just experience just feel you have to go out those kind of intentions or instructions those should help increase alpha as well so the hyperventilation is kind of a hack more so than anything of what can we do for someone who may struggle with that so the hyperventilation is more bottom up whereas the mindfulness or focus shift is more of a top down okay that reminds me of like have you heard of the wim hof breathing methods that use you know cold therapy but also this very fast breathing but then slow breathing you're kind of playing with your breath, uh, stress response states. I'm not sure if you've

Starting point is 00:16:51 ever heard of, no, we do a lot of like stress breathing, square breathing and a stuffing therapy. So I don't know that one. Yeah. Okay. It sounds very, it sounds very similar or one way to train in the ways that you're, you're describing, uh, with the physiological stress response mechanism general. So that's cool. Awesome. That's really cool. So this is a great segue into the next question I have around pornography, which I, we all know is a very controversial topic these days, but what this is triggering for me in my mind is that, you know, when you close your eyes, you can ride your sensations and be within and kind of go with the flow. This, this reminds me of those that have difficulty reaching climax. And I'm speaking particularly

Starting point is 00:17:35 for men. Maybe they have difficulty, you know, getting to orgasm, but they're, they're, they're they're using pornography and they're you know visually that's very stimulating they're very aroused if closing their eyes like could well I have many questions about pornography but could pornography be a distraction in that moment if if they're having difficulty reaching climax and also would love to get your your opinion about the effects of pornography in general on sexual health and well-being so the first part you're saying like if they're actually having sex with someone and trying to view porn at the same time or you mean that during individual during masturbation so i don't know pornography can have interesting different effects

Starting point is 00:18:22 depending how it's used and this is some of our questions is we when someone's viewing pornography they could be doing a lot of different things with it they could be imagining themselves as one of the characters in what's going on imagining that person being touched that way as you being touched that way that kind of identification appears to facilitate sexual arousal when you're doing pornography um or you could be using it as a springboard for recall so i see them doing that i remember when i did that with this partner who i really cared about and that reminds me of all these other things so we really don't know to what extent people are engaged in the image that they're seeing and identifying with characters versus using that as a springboard for fantasy

Starting point is 00:19:02 and it probably varies you know some people probably use it more one way than another So from that, you know, one is the pornography is probably not that distracting because they're not really engaging with the stimulus itself. Whereas I could imagine if you're putting yourself in that space, then it's quite consuming and may make that more difficult. So I could see, you know, if you're having difficulty experiencing climax while you're watching pornography, it may be worth playing with the experience, kind of how you're engaged with it. as you mentioned closing eyes like using that as audio erotica so some people that object to the content of pornography will still enjoy the audio sometimes just by using the sounds and imagining something that is appealing to them occurring rather than the specifics of what you know like if they feel like they see pain on women's faces for example they may not want to see that and say

Starting point is 00:19:58 i'm just going to close my eyes and imagine her face as i would love it to be so there may be strategies for uh kind of using it in a more effective way um so yeah i'm not sure exactly because we're not totally sure how porn is used in the moment i would love to know more about that myself um for science the the general question how pornography affects sexual health in general uh it's varied and it depends on the person so for example i when youth watch people often have a knee jerk like oh oh that's terrible like kids are watching it is illegal here uh youth cannot watch they're not supposed to uh when they do it's a bit of a mixed bag so in the sense that the youth who watch do tend to have more accurate genital knowledge they know more about where

Starting point is 00:20:52 clitoris is um people who view clitoral stimulation and erotica tend to also be more likely to do it themselves which is important for women's arousal so you could say well that's probably good for them to learn to do that and to attend to that however there is also a lot portrayed that they may not understand the context for or know how to ask for consent to do those acts and so of course you know when youth view uh overwhelmingly we just don't know what the effects are because we can't do the experimental work that would be necessary to show that because we'd have to experimentally show children pornography, super illegal, very much in jail after doing that. So for the most part, there's a lot of panic, but we just don't know. We don't have data around that.

Starting point is 00:21:38 Otherwise, there's a huge gender effect. So when women view more pornography, whether they're in a relationship context or not, it seems to be largely beneficial. They report more sexual satisfaction, more relationship satisfaction, even when they personally view more pornography. It also matters if they're disclosing. So if they're keeping it a secret from their partner, it's more likely to be a negative correlation. If they're disclosing to their partner, it's more likely to be positive. If they're co-watching, very likely to be positive. Men, on the other hand, when they view more pornography, tend to report lower relationship satisfaction, lower sexual satisfaction. And so this was a puzzle. It's like, well, what is

Starting point is 00:22:18 happening like they have the same brain that's interesting very yeah so the best explanation I've seen for it so far is really porn is primarily for masturbation sometimes used for education sometimes used to co-view overwhelmingly used for masturbation and the genders use masturbation very differently and so I think it's just reflecting that so men tend to use masturbation And when I say tend, I mean, again, huge overlap. We're talking very average. You may not fit this. In general, men tend to use masturbation in a compensatory way and women tend to use it

Starting point is 00:22:55 in enhancing way. So in a relationship, men may view pornography because their partner turned them down for sex because they had a fight with their partner because their drive is higher than their partner and they don't know any other way to balance it and don't have an open relationship and don't have anything else that might permit those kind of outfits. and they are more likely to hide it from their partner to hide their use. Whereas women tend to use masturbation in this enhancing way. So they're using it to get excited so that they will have sex with their partner or so that they're better able to bring themselves to

Starting point is 00:23:32 climax more easily. So that makes the sex itself more reinforcing and enhancing. So my guess is it's not really a pornography effect. It's probably more due to just how men women use masturbation differently. But I always think it's interesting when they say all these negative effects. I was like, sure, if you only talk to men, you may have that impression, but you need to think about the context of how it's being used, right? That really matters. So we did a study, for example, people worry, if you view a lot of pornography, you're not going to be responsive to your partner anymore. That is definitely not true. We have studied that in the brain. We have studied it with real partners. We have studied it with erections. We have done

Starting point is 00:24:11 the laboratory work i am not worried about that um by and large people who view more pornography do so because they have a higher sex drive so if they could have sex with you they would generally speaking um so that's one thing it doesn't you know blow out your dopamine receptors is something common i've heard or yes yeah yeah yeah cause a dopamine flood there's actually no increase in dopamine at climax, FYI. So there's just lots and lots of myths around pornography and all the trouble it could cause. But I think it really matters a lot, the context, you know, like does your partner approve of your use? Are you open about your use? In what way are you using it? Is it your use due to conflict? Does my partner want to have sex with me because we're

Starting point is 00:24:57 fighting? Yeah, then you're going to have a lower relationship satisfaction and be masturbating more. So, um, so I really want to see that context brought into research and we just don't see a lot of that yet. And what are your thoughts around, and you kind of mentioned this a little bit about like dopamine reward centers, you know, tapping into this conversation around pornography addiction, like a physiological perspective, you know, what does the research say about that? And I, and I'm already gathering like intent and engagement and the context around use

Starting point is 00:25:29 really matters and and the effect on your overall you know relationship and and the rest of your life really um to to make that determination but i'd love to hear more about your thoughts the pornography is not recognized as an addiction currently by any diagnostic nomenclature in the u.s or elsewhere that's a common myth but people do recognize pornography problems and it occurs in all kinds of contexts so some people who are depressed use pornography more than it's healthy for them and use it to isolate themselves, to not go out, to not date because they kind of find that an outlet instead. And that's probably not great for the way it's sometimes used. Other folks may have obsessive compulsive disorder, OCD, may use it compulsively in the

Starting point is 00:26:16 context of OCD. So the way I think about it is for something to be called an addiction scientifically, it actually is a really high bar. It has to meet all these different criteria and there are things that it cannot be that have to be excluded and so almost all the work around pornography has been kind of replicating stuff we already knew 40 years ago frankly that just shows like oh porn activates the reward center right okay no like that's the same thing cocaine does like right and other rewards like spending time with friends and other rewards like seeing pictures of puppies and like so is it does need to be there to call something an addiction um but it is not sufficiently specific to offer much evidence so we say well then what what is this

Starting point is 00:27:03 like how do we think about this if somebody says i feel like i'm watching too much um first of all we can absolutely help with just that behavior there are interventions to help people decrease their television viewing and guess what viewing a lot of television is also associated with obesity you know it has other negative associations where someone might just want to decrease their viewing just because they want to decrease their viewing and that's totally fine we don't need to pathologize it or give it a label just to be helpful and intervene there but my suspicion is really there's uh really really poor what we call discriminant validity with pornography problems so that is to show that something is a new diagnosis or needs to have its own label

Starting point is 00:27:45 you have to show that it is not something that we already know about And when we look at people who have pornography problems, they overwhelmingly have a lifetime history of depression or a current history with depression. So that's the most common overlap by far. Another one is alcohol abuse problems. So people, when they're abusing alcohol, often will engage in these types of sexual behaviors also and understand and label them in that way. But I think that's probably better understood in the context of their alcohol use. So that's where I have been pushing back a lot and get pushed back is to say, like, I don't think this is really a new entity. I think we're trying to make something into a newfangled thing that we want to, you know, think we've got the lock on this sexy new topic. And really, it's just a manifestation of things we already know, and it would be more helpful if we kind of understood it in that context and treated it in the ways of these interventions. Like for depression, we have so many good interventions, so many research-supported interventions.

Starting point is 00:28:53 I would so much rather see these folks helped with depression interventions that I think are likely to be helpful. In fact, there already was one trial that took in people who said they had these sexually compulsive behavior and just gave them a depression treatment, and they all improved. And I was like, okay, so can we? It doesn't have to be that complex, right? Yeah, obviously not everyone is just depressed instead, but I think a lot of them are, is my suspicion. Where do you think that this, and thank you so much for educating me

Starting point is 00:29:24 on pornography problems rather than pornography addiction, because that's something you don't hear in social media and mainstream language, even in educational curriculum, to be honest. even around sexuality curriculum it's not defined in the in quite the elegant way that you have really and logical way that says hey this is really what we're dealing with and let's not pathologize something that isn't a pathology there are other things contributing to a particular behavior and intent of use and I love that so I really appreciate that so thank you and and my

Starting point is 00:29:59 site my question to that is where do you why do you think where do you think this came from or stemmed from as far as this whole controversy around, you know, addiction around pornography and et cetera? There seem to be kind of three bodies that are pushing this right now, none of which are scientific. So there were some early papers written about a coalition between religious groups and feminists, which is pretty unusual. They don't normally get along, but in this context, they do. So in general, there are lots of religious groups that are still anti-masturbation. You know, they don't think you should be self-pleasuring and certainly not looking at pornography. So they're anti-pornography and they really want to co-opt the health language

Starting point is 00:30:37 and say, no, no, no, no. It's not that we're moral judges. It's that it's bad for you. You know, we're just here for your health. And we're like, no, no, no. We know where you're from. We know how this works. We've seen this before. And then the feminists, you know, there's a huge split in the feminist groups. There always has been some that find pornography empowering for women and others that find it degrading. And so those feminists that believe that it's degrading to women have partnered with the religious groups now and around this particular issue and so I said there's three groups the third that's coming in the last 10 years is guys looking to make money so they come in and they say you have a pornography addiction and I alone can fix it if you give me

Starting point is 00:31:16 money and so they've come up with all of these like online tests that have no scientific basis and these abstinence treatments where you have to abstain from masturbation porn and orgasm for 90 days and that'll reset your brain back they literally say back to factory settings which is not possible by the way so don't do that um but they they're often coaches it's how they describe themselves and usually their only qualifications is that they claim they experienced it themselves so now they these three groups work together it's like the religious groups and these anti-porn feminists and these profiting coaches are all saying porn porn addiction is real porn addiction is real because they make money off of it like crazy in the most recent case. So it's

Starting point is 00:32:01 very difficult to fight right now. The most popular male sexual health topic on both Instagram and TikTok is semen retention or nofap. Yes. You just read my mind. I was going to ask you about that. And that's why they're selling a product. So these guys have just taken over social media and we do research on these groups we scrape their forums and one of the problems we have because you know we're regulated in terms of the research we do we have to meet ethical requirements is they don't want us to study kids but these are anonymous online accounts and so it's difficult for us to know if they're children and so we do our best to get them out but that's part of the trouble is when we started scraping these forums we're like this is overwhelmingly children

Starting point is 00:32:45 like this we couldn't use so much of the data we had to throw quite a lot out and be careful you know kind of who and how we were getting our information our data so my read is a lot of these are really young guys who are just learning about their sexuality having their first sexual partnered sexual experiences and they have very typical anxiety around this and these guys are very happy to lie to them and say oh you have erectile dysfunction because they you know had trouble getting hard with their first ever partner. I was like, no, no, no, no, that's not ED. That's, that's anxiety. It's very common. It's fine. It's going to be okay. You do not need a coach. You should not pay anyone. So, so we see all these posts that just break my heart. You know,

Starting point is 00:33:30 it's these folks that are really being misled in kind of their developing sexuality to think they have a problem that they need help with, that their brain has been forever scarred. And I just think guys I know it's tough out there it's embarrassing sometimes and you don't always know what's going on but most likely you're going to be fine and I wish I could just get them to some good education when I see those posts but we are fighting a very well-funded highly motivated group that with between the three of them are really really active in legislative efforts and all kinds of things to try and, you know, sway the public in ways that scientists don't often engage. You know, we're publishing papers and maybe helping one-on-one in the clinic.

Starting point is 00:34:18 Exactly. Exactly. Wow. Oh my goodness. That is so enlightening and also scary at the same time. Like really sad for these. Yeah, it is. And the advice you just, just gave is practical. It's free. It's biologically sensible. It's, you know, I mean, but that doesn't sell, like you said, it's not you you can't sell you can't sell that you know yeah everything i always joke i say i feel like most of my career is like everything's fine stop it it's fine on a t-shirt yeah everything's fine stop it on the on the back i love it i love it i love it dr prowsey well that Okay, so we're going to segue here a little bit to a different topic, if I may, because you have an upcoming study, a little birdie told me about an upcoming study about post

Starting point is 00:35:15 orgasmic illness syndrome. And I'd love for you to just share with us what that is and a little teaser about this study. We were interested in post orgasmic illness syndrome or POIS because there seems to be a small group of primarily, but not only men who experienced this, where every time they have an ejaculation and orgasm by any means, it doesn't matter if it's partnered or solo, they have flu like symptoms for two to seven days afterwards. Now, these guys are highly motivated and that does not stop them. They usually are still sexually active or they have partners who want

Starting point is 00:35:51 to be intimate. And so they're struggling and trying to figure out what is happening with me. and because this is so rare it's not a well-funded area of study so we were thrilled to get funding from the National Organization of Rare Disorders or NORD and also sent from the Fulton Family Foundation to do this work and we're funded to look at over 100 men in the laboratory some of which have this condition POIS and some of which are what we call controls that is they don't have any known POIS or other sexual dysfunction. And to compare, especially their inflammatory cytokines before and after climax. So that means we have to provoke climax in the lab. So we're having them masturbate in the lab. We take blood samples. We take saliva. We're getting their EEG. We're

Starting point is 00:36:37 getting anal contractions. We are getting all the things. So you can imagine this is a psychophysiologist dream to get all of these data. And some of them, we really don't have any information on the inflammatory markers we're getting have never been recorded being post-climax before. So some of this is really basic science. It's stuff we should know by now that we can't wait to get and see how that turns out. And of course, the main hope is to help these guys to figure out what might be going on that's it was a long-standing theory that it may be an auto ejaculate autoimmune response to the ejaculate content so there was something in their ejaculate that they're having an allergic response to and in that vein some of the treatments were

Starting point is 00:37:24 doing like auto inoculation where they would inject their ejaculate back into themselves and that turns out probably not to be the case um and the auto inoculations don't seem like a great idea So I wouldn't do that as first line if you're having that struggle, but we're really trying to figure out what is it exactly that's going on. And so some of that earlier research I mentioned, looking at like the periorgasmic period is part of that puzzle and saying, is it something dysregulated in the sympathetic nervous system? Is it something like, what is it that's different about these guys that when they get over that hump their body thinks they're sick and starts launching all of these things to to try and help

Starting point is 00:38:05 them get better so it's clearly something is misfiring and we're trying to figure out what that is do we know if there are any overlapping other health comorbidities or conditions that correlate with you know post-orgasmic illness syndrome there have been a number of studies that have found a bunch of different overlapping symptoms, syndromes, and none stand out. So it does seem like something where, you know, to be fair, you always have to rule out the potential for psychosomatic concerns. That is something that they've worried themselves sick is one way of colloquially putting that. We don't think that's the case or we wouldn't be collecting the measures we are, but we always have to rule that out. And so some of the syndromes may be

Starting point is 00:38:53 related to some of that. So it may be that some guys are having that kind of a issue or concern, but the others are having, you know, a really different kind of physical response. So we are looking for those kinds of things just to be sure. So we can rule them out, but I don't know what like another prominent kind of comorbidity is that really stands out to me. I've seen a number reported in different kind of case reports. These, these are all usually also very typically small samples because rare disorder. Exactly. And I'm imagining that even just diagnostic criteria are very slim of how to even recognize what those would be other than subjective symptoms. That was exactly, we had to go through the literature and see what is being used and

Starting point is 00:39:39 what seems most reliable and what do we think people can accurately report. And that is one nice thing at least is flu-like symptoms are pretty stark. And some guys will say right after I climax, I start sneezing. It's the weirdest thing. It's a, I don't have, you know, change about normally or within 24 hours, I'm going to be sniffling and I know it. So one thing that is nice about it is the symptoms are high, seem highly specific. Like if you're having them, you know, and you're not wondering they, they seem to usually be pretty profound in the guys who are struggling with this. Right. Oh, it'll be so interesting to see what the data says as far the markers that you're going to collect. I am extra mad at COVID because it closed our study

Starting point is 00:40:22 right as we started. It's back on the table. It's back on the table, guys. We're going to get it. We're going to get it. Thank you so much, Dr. Prousey. Yes. And your research team, of course. I'm sure there's many others who are part of this venture and all the work that you do. Thank you so much. And really, I really do appreciate you being on the show today with us. For our viewers and our listeners out there, how can I connect with you? Our website is LibrosCenter, L-I-B-E-R-O-S center.com. Or I have what's known as a ResearchGate account. If you're curious about scientific papers, I'm always happy to share those with anyone who likes them, to grab them from ResearchGate, no problem. Thank you so much. Again, really appreciate you being on the show. And to all

Starting point is 00:41:11 of our viewers and listeners there loving wellness for your pelvis this is dr suzy until next time thanks for listening to today's episode be sure to visit my website drsuzyg.com for show notes and related resources on today's topic if you like what you're hearing head on over to youtube and subscribe to my channel on my youtube channel you'll find content related to sex pelvic health and expert interviews for men if you got a question or a topic that you'd like me to answer on my channel be sure to type it in the comment box below

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