BECOME THE MAN WOMEN WANT
5th of December 2014

Dr. Nicole Prause Interview (Part 2)

Introduction:

In part two of her interview, Dr. Nicole Prause, Tucker, and Geoff tell you what you need to know about orgasms, the g-spot, the clitoris, the current state of sex research, and what we don’t know about sexual physiology.

Podcast:


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Video:

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Key takeaways:

  • There’s a lot we don’t know about what an orgasm is exactly comprised of, what’s most common. We know a little more about men, but even about men, there are things we can’t characterize well, we don’t know what average variability is in some other anatomical features, much less the performance features, what’s normal, how long you can go, what the range is, and where we should consider something a problem or not.
  • The g-spot may or may not exist. There are various areas of different sensitivity in different women, it’s not consistent. And not all women have a point of enhanced sensitivity, it varies. Also, women who think they’ve identified it, it seems to vary wwith their mentrual cycle. So sometimes they say they have an area of sensitivity, whereas two weeks later, they might not feel anything different there.
  • When a lot of people say clitoris, what they’re thinking of is the tip of the clitoral glands. So, they want to go in and retract the clitoral hood and go straight after that thing, which you should not do, generally speaking. It’s super sensitive and it’s only a very small piece of the whole structure.
  • Sexual pleasure might be an effective intervention for things like depression, and even physical problems.
  • Sex reduces stress.
  • There are only four sexual physiology labs in the U.S.
  • Sex positive research is basically impossible to get funded.
  • “Porn addiction” does not seem like an actual addiction.
  • When a study about sex comes out, most media outlets don’t even try to get the facts right. Maybe 5% of them even read the study.

Dr. Nicole Prause’s Bio:

  • Dr. Prause received her PhD from Indiana University, Bloomington with joint supervision from The Kinsey Institute for Research in Sex, Gender, and Reproduction in 2007
  • Dr. Prause’s primary rotations were in neuropsychological assessment and behavioral medicine
  • Dr. Prause is currently a member of the research faculty at UCLA
  • Dr. Prause is Principal Investigator at Sexual Psychophysiology and Affective Neuroscience(SPAN) Laboratory
  • Dr. Prause’s research focuses on female and male neurological, physiological, and psychological issues relating to sex

Further reading on Dr. Nicole Prause:

Podcast Audio Transcription:

Geoff:
So, we’re here with Dr. Nicole Prause, who runs a sexual physiology lab at UCLA. I think one thing a lot of young guys don’t have a very clear idea about is what is sex research? Where does it happen? How does it happen? How does it get reported? Can we trust the stuff that we read in Maxim or Psychology Today or hear on the news?

Tucker:
Actually, even a step higher, most people don’t realize how little we know about our own bodies and our own sexual abilities and ranges and even anatomy. Most people think, “Yeah, scientists know blah blah blah.” No, they don’t. They don’t know anything, and the fact is there’s very little work being done on it and we’re hardly ahead of where Masters and Johnson and Kinsey were, and it’s shameful.

Geoff:
So, yeah, Nicky, here we are in 2014. It’s been more than sixty years since Kinsey books. It’s been forty years since Masters and Johnson. What do we still not know about human sexuality that’s important, that you, personally, would love to know?

Nicole:
We’ve been doing a lot of research lately to do with orgasm and there is a lot we don’t know about what an orgasm is exactly comprised of, what’s most common. We know a little more about men, but even about men, there are things we can’t characterize well, we don’t know what average variability is in some other anatomical features, much less the performance features, what’s normal, how long you can go, what the range is, where we should consider something a problem or not. There’s tremendous debate about all these things and not agreement at all, so it’s hard to say when someone comes in, “Is this normal? Is that normal?” Maybe.

Geoff:
So, to be specific, there’s a long-running debate, ever since Freud, about clitoral vs. vaginal orgasm. Are they the same? Are they different? Can they be interchanged reliably?

Tucker:
Does vaginal even exist?

Geoff:
Right. Does vaginal even exist? I’ve collaborated with a guy who is sort of one of your arch enemies who is like, Mr. Pro-Vaginal Orgasm, and you’re a little more skeptical about that work.

Tucker:
That’s pretty funny, a dude talking about, “Oh, yeah, let me tell you about vaginal orgasm.” Okay, buddy.

Nicole:
Well, it’s funny because we do have some activist scientists. Just like in any field, some people who have just decided that they figured it out. So, for example, we have some scientists who are convinced that the g-spot exists and they’re very vocal about it. Those of us that are a little more skeptical and want more data are a little surprised by how much time they spend in the media. So, if people really knew the data that they’re relying on to make some of their claims, it’s very weak. It’s extremely weak.

Tucker:
Well, let’s talk about the g-spot for a minute, ‘cause that’s a lot of what guys think, “Oh, yeah, you’ve got to find the g-spot.” I thought it exists. Why would it not? People talk about it all the time. And then, I forget who it was, I randomly came across a Dr. Ruth video, like old, Dr. Ruth Westheimer, and she’s like, “Oh, the g-spot is a myth!” I’m like, what is this kook talking about? Then, I did a little research and I was like, wow. This is nowhere near as settled as I thought it was, and there’s no doubt there are girls where I thought I was hitting it and they went crazy and other girls didn’t care or it didn’t work or whatever, so I was like maybe I’m just doing it wrong. No. It turns out; it may not actually exist at all, right? So, what is the state of the research? What’s your opinion? What should guys know about the g-spot?

Nicole:
So, there have been a few studies now looking at sensitivities, and they say the anterior wall – so, what that means, is if you reach into the vagina, that area towards your stomach – and there are various areas of different sensitivity in different women. It’s not consistent. So, there’s not a spot that if you can just find where it is, then you’ve hit it. And not all women have any point of enhanced sensitivity. It just varies. And, just to make it a little more complicated, women who, when they think they’ve identified it, it seems to vary with their menstrual cycle. So, sometimes, they say yes, that’s an area of sensitivity, whereas two weeks later, they don’t feel anything different there anymore. So, if you can find it, that’d be amazing, ‘because the women can’t find it consistently. Although, some women swear up and down, of course, “Yes, I have one and here it is.”

Tucker:
I’ve absolutely been with girls like that and others where it’s like “Stop pulling on the roof of my vagina and fuck me.” Totally both sides.

Nicole:
Yeah. So, I think a lot of concern about that is people want to hit the g-spot and they’re concerned with female ejaculation. They want to make that happen. And there’s a lot of debate in the field, are they just stimulating the urethra indirectly that causes some expulsion that’s not urine but something like that? Why would that happen? What function does that have? We don’t know. We’ve got no clue.

Geoff:
So, what are some other things we don’t know about? I was struck when I started researching the female preferences for penis size and trying to figure out how could women assess, how could they judge penis size? Why would it matter during copulation that what we know about female anatomy is pretty murky. Some crucial aspects of the deep clitoral structures, like the vestibular bulbs, we didn’t really understand until about ten or fifteen years ago, and it’s still hard. If you do a Google image search on female sexual anatomy, it’s still really hard to find a clear, accurate depiction of even what the structures are.

Nicole:
Yeah. I would say most medical textbooks are incorrect. If I flip through colleagues…

Tucker:
Like Gray’s Anatomy. Not the fucking TV show. The actual book.

Nicole:
Yeah. You pop the book open and you’re like, okay, half the stuff here is missing, and you can look at some diagram of the form and you’re like, well, that seems to have this, that and the other, but where’s the–? They’re just kind of not portraying this. They won’t label things and we’re going to physicians sometimes with problems or trying to problem-solve something, and they never saw it to begin with, so how would they be able to problem-solve?

Tucker:
These are OB/GYNs, no less, right?

Nicole:
No. Just general medical education. Maybe the OB/GYNS have better books, but it’s surprising to me that even what we do know takes a very long time to filter into medical education. There’s a lot of inaccurate – if you’re Googling and bringing stuff up, I wouldn’t be confident. It doesn’t matter if you’re on WebMD.

Tucker:
WebMD doesn’t have good shit about the flu. How’s it gonna have good shit about the vulva? Come on.

Nicole:
Right. There are lots of structures and there are relationships with those structures, like what Geoffrey was mentioning. This was a paper in 1998 that came out that was like, “The bulbs are oriented in a different way than we thought they were before.” Okay. That makes better sense. Glad we looked at that.

Geoff:
And this is important because these deep, clitoral structures, apparently some of them engorge with blood and they’re kind of erectile tissue and they might matter a lot in terms of female sensitivity during intercourse, and we talked a little bit about how a lot of women and men don’t really know how important it is to get parts of the vulva engorged before sex for female pleasure.

Tucker:
Alright. So, for the idiots out there, what do you mean, get the vulva engorged before sex?

Nicole:
Shall I?

Tucker:
Yes, please. You’re the only one in the room who has a vulva.

Nicole:
Right. When a lot of people say clitoris, what they’re thinking of is the tip of the clitoral glands. So, they want to go in and retract the clitoral hood and go straight after that thing, which you should not do, generally speaking.

Tucker:
Because it’s super sensitive, right?

Nicole:
Super sensitive and it’s only a very small piece of the whole structure, so the actual clitoris extends back into legs we call crura, back behind the labia in deep structure, and there are these bulbs at the end. All of these structures change with arousal. Their orientation changes and we’re not totally sure what role, for instance, the legs have in pleasure, but clearly, they are being expanded. You might think of them as a wishbone kind of shape. Maybe they’re very important. Maybe they’re important for some women and not others. We don’t know. But the bulbs, we think, probably support penetration so that if everything is engorged, it supports some of the rigidity around the opening of the vagina that allows you to penetrate. So, if the woman’s not aroused and those structures aren’t more firm and supporting the opening, allowing you in, that won’t work.

Tucker:
Yeah. That makes sense.

Geoff:
So, just to be clear, the point is that sort of simplistically, the whole clitoral structure is kind of like a wishbone shape. What most guys think of as the clitoris is just the tip of that wishbone in the middle. Then, the legs of it kind of wrap around the vaginal entrance and actually engorge with blood.

Nicole:
Yeah. They don’t go down quite that far, but yeah.

Geoff:
Okay. But we still don’t really know the anatomy or the physiology or exactly how it all works.

Nicole:
There’s a lot of questions about…so, we know where from the spinal cord we get innervation down in that area. We know that if you get various types of spinal cord injuries, generally, this might be affected. But there’s a debate, for instance, about how information gets from the vulva back up to the brain. A pretty major debate about is this huge nerve involved or not? Why are we having this discussion? What year is it, that we haven’t figured out what type of information travels at what speed and how some of this may be circumvented with spinal cord injuries or not? It’s really kind of a profound area of blindness in science.

Geoff:
So, apart from the stuff we just don’t know about yet because it hasn’t been researched, you can also get the casual impression from science journalism that there must be hundreds of labs in America actively researching sex. There’s all these sex bloggers and these self-appointed sex experts and people running around with PhDs from various places, some reputable, some not.

Tucker:
Unaccredited universities, most of them. Most of the sex research places, they’re diploma mills.

Geoff:
Right. But how much sex research is actually happening? How many labs in America are doing serious sexual physiology research right now?

Nicole:
Sexual physiology, I’d say there are, like, four.

Geoff:
Four. So, guys, there are four places—

Tucker:
So, we don’t know how the clitoris works and there’s only four places studying it.

Nicole:
We’re going as fast as we can.

Tucker:
I’m not blaming you. I’m saying that seems ridiculous to me. How much shit is more important than sex?

Nicole:
Yeah. I mean, there’s an incredible density of labs in Canada because the challenges to doing that work are so tremendous in the states that people have left for Canada.

Tucker:
So, how many are in Canada?

Nicole:
I would guess there’s probably more like eight or ten labs in Canada.

Tucker:
Those motherfuckers have 30 million people in Canada. We have 350 million, and they have double the number of labs.

Nicole:
Yeah.

Tucker:
That’s embarrassing. We’re letting the fucking Canadians out-research us on fucking. That’s terrible.

Geoff:
And you mentioned also, in Europe, there are active labs in the Netherlands and where else?

Nicole:
The Netherlands and Germany have some leading labs in this area, as you might expect, I guess.

Geoff:
So, basically, kind of tracks the sexual openness of the nation. And America, despite what we might think, is actually not very open to this and is—

Tucker:
Super regressive.

Geoff:
Sex researchers are actually leaving America to go to Canada because they can’t do the research here.

Nicole:
Yes. They definitely have, yes. I’ve been encouraged to leave for Canada many times.

Tucker:
By other people?

Nicole:
By my colleagues in Canada who say, “You’re having so many problems in the States. Just come up here. We’ll take care of you.”

Tucker:
So, generally speaking, though, it’s really difficult to get this stuff funded, right? Because most of the funding comes from government and they tend to be very – regressive’s not the right word, but extremely conservative. You were telling me another time that the only two times NSF grants have ever been revoked after they’ve been given is for sex research, right?

Nicole:
Yeah. The only grant that’s ever been rescinded in the history of the National Institute of Health was a sex grant. Then, it was like, eight years ago that four more were brought up for defending and they maintained their funding by one vote in Congress. So, it’s not stopped. It’s still there. There’s the funding challenge, the ethics board challenges – so, for example, we recently tried to do a study on the brains of so-called sex addicts and we’re prohibited from recruiting patients because it was seen as risking causing relapse. So, while we go and try to publish our study, the UK was allowed to recruit patients and now they have an MR study and we can’t do that work here.

Tucker:
Yeah. The results of the study have come out?

Nicole:
Yeah. They just came out a couple weeks ago.

Tucker:
Yeah. I remember and it was like, it looks like sex addiction is not really an addiction the way we think of other addictions, right?

Nicole:
So, they were saying that some of the brain activation is similar in people who are reporting this kind of mixed problem with either erotica or sexual behaviors. But what’s interesting, this is one of those media issues, is that the researchers were very careful to say this does not mean this is sex addiction. This is not sex addiction evidence. Does it look somewhat like it? Yes. It has overlap. It makes sense that it would have overlap. They’re both rewarding activities, substances. Media didn’t care. It became, “Look! They’ve proved sex addiction!”

Geoff:
You’ve been pretty active in this debate, right? And it sounds like you’re pretty skeptical about the concept of sex addiction.

Nicole:
Yeah. Absolutely. I think people have distinguished between porn addiction and sex addiction. We don’t know to what extent they’re really separable, but I think the evidence is exceptionally weak for the porn addiction. I really don’t see that we’re going to get to a point where we can support that. The sex addiction, we just know a lot less about it. So, I’m trying to be less bullish with respect to those because I can see where those might look more along the lines. But the brain studies, we talk about the brain studies of sex addiction, we’re talking about two structual studies, my EG and this one MR.

Geoff:
Okay. So, four papers that actually are relevant to that debate.

Nicole:
Yeah. And yet people think this is solved and we’ve got sex addiction and it’s in all these treatment centers, right? The title of the treatment center or one of their main things that they treat, and it doesn’t appear in the diagnostic and statistical manual, which is what we use to diagnose things. That’s not the be-all, end-all, but suffice to say; at least a big group of psychiatrists didn’t think there was evidence to include it. So, it is far from a done deal and there are a lot of us that are very skeptical about that idea.

Geoff:
So, also, porn addiction isn’t really a thing? Not in the same way that heroin addiction is, you think.

Nicole:
So, there is a very largely religious, although not entirely, group of people, bloggers who think that porn addiction is a real thing and you will be harassed if you disagree with them. So, for instance, you talk about some of the variates to doing the work, I’ve had to file police reports; I’ve had to lock down my lab and send out alerts to our staff.

Tucker:
Wait, what?

Nicole:
I’ve been threatened because of the work I do in sex addiction. Yeah.

Tucker:
But these are the fundamentalist ones who will actually blow shit up. Like, I get threatened all the time, but they’re just kooks, like, “I’ll kick your ass,” and I’m like, no you won’t. You won’t do anything. You’re talking about real—

Nicole:
I don’t know. That’s the problem, is you don’t know, so they do all this stuff online. It’s like you can’t go online anymore where they’re making claims that have no basis but it’s still, like, if you go into this area, you can plan on someone who’s going to try and besmirch your reputation. And you have to be beyond reproach. Your data have to be rock solid in a way that – you hope they are in every field, but…

Tucker:
Think about this for a minute. Who’s identity is so wrapped up in proving porn addiction? Think about what has to be going on in your head for you to be like, “Okay, if anyone says anything bad about porn addiction, I am so threatened that I have to go attack them and threaten them physically.” Think about that for a second. How fucking nuts is that? Porn addiction, right? That should tell you something about the awful sexual repression and probably the huge problems these people have with both porn and sex in their own lives, that someone who’s like, “No, this isn’t a real thing.” So, what’s going on? I’ll tell you exactly what’s going on. They believe some religious thing or whatever – it doesn’t necessarily have to be religious. Some sort of set of beliefs where they are ashamed of or denied their own sexuality, whether it’s straight, gay, whatever. And they probably use porn as a crazy outlet and they rationalize that it’s okay because I’m a porn addict, so it’s not my fault, which is the narrative of addiction. Now, someone’s coming along with real data saying, “No, this is not an addiction. This is a different thing going on. It doesn’t work in the brain like heroin, etc.” And that person freaks out because essentially, what your data is telling them is they have to actually be responsible for their own actions. That’s why they’re fucking pissed off.

Geoff:
So, we’ve worked together for three or four years on this penis size preferences thing and we come up with a lot of research ideas. We often realize, “Okay, that’s a cool idea. Can’t research it. Could never get funding. Couldn’t get it past ethics board.” What percent of research ideas that you come up with, Nicky, do you think, “I would love to know this. This would be important, but it cannot be researched”? Is it 10% couldn’t be or 80%?

Nicole:
I think I don’t even let my brain go there most of the time anymore.

Tucker:
You just stop it because it’s depressing.

Nicole:
Yeah. I’ve had an ethics board application rejected, which is really rare in the sciences. Normally, their responsibility is to help you get to a protocol that can be run, where you can study your area. But yeah, it’s been actually denied where they said, “We don’t care what you think you’re going to find for it. We’re just not going to allow you to do it here.”

Tucker:
Can you guys talk about some examples of ideas you came up with where it’s like, this would be a great study, would help people, would teach us a lot, and you’re like, let’s not even try because we know it won’t get funded?

Nicole:
I know the experience I had that actually was shut down, we were gonna look at orgasm in some of these guys who had many hours of viewing. So, we don’t doubt that some people have trouble regulating how much porn they view. Clearly, some people are watching more than they mean to. No doubt about it. So, we’re like, what’s with that? How do they have an orgasm? Is their brain doing something different from people, that the orgasm is not as satiating, it doesn’t please them as much? How can we characterize this as different? So, we tried to do an orgasm study of that, measuring their electroencephalography or EEG from their head at the time they were stimulated to orgasm. We were prohibited from doing it here, so we had to do it at another campus.

Tucker:
What’s – never mind. It doesn’t even make sense. What was the problem? The dude jacking off to porn?

Nicole:
So, all along, they said, “You haven’t justified the need to have someone orgasm in the lab.” We said, that’s the whole point.

Tucker:
For a study about orgasm.

Nicole:
For a study about orgasm. So, we said, “Well, that’s the whole point of the study. If we can’t do this, then we can’t…This is not a debatable component. This is the main part of the study.” The grounds they ultimately rejected it on actually had to do with checking boxes. It was completely different and very clear to me that they couldn’t say the reason they had actually rejected it, which is what they had communicated to us for months.

Geoff:
And these ethics boards are mostly middle-aged and older academics, scientists, doctors, whatever. It skews a little bit towards males rather than females, and my impression, having a lot of fights with them myself, is they just don’t appreciate the value of this. They don’t see a positive value, particularly for young people in knowing what the fuck’s going on sexually with humans.

Tucker:
Well, you said sex positive research is basically impossible to get funded. If you’re doing research into sex, the only thing that’s gonna get funded is if you’re showing positive and negative. The negative will get funded. Positive and negative, maybe. Sex positive, forget it.

Nicole:
Yeah. You will not get sexual enhancement research funded in this country.

Tucker:
You don’t mean penis enhancement. What do you mean about sexual enhancement?

Nicole:
Although, not penis enhancement either. So, you want to learn about what’s pleasurable or the role of the clitoral structures in orgasm? Not here. Canada. Not here.

Geoff:
So, I don’t know if you could talk about this, but it seems like the standard way a lot of sex researchers try to frame what they’re doing is they actually want to understand sex itself, but you have to frame it as, “We’re doing this in order to understand how to reduce sexually transmitted infections.”

Nicole:
Exactly. And I think all scientists have to do this to some extent, right? You can’t just study whatever the heck you want. You have to frame it in a way that the funder or the school will allow you to do it. So, I appreciate it’s not our unique problem. I just think it goes a lot farther in our field than any other, where there are barriers to doing things that are just basic science that shouldn’t exist.

Tucker:
Are there any other fields where you have to be in Canada because you can’t do the research in the richer country that has ten times more universities? Yeah. Maybe stem cell shit when Bush was President. I can’t think of anything where it’s not – you know?

Nicole:
Or maybe some drugs that are allowed in Europe, you can study a little more easily there.

Tucker:
Right. So, certain drugs because the FDA, stem cells because of crazy Republicans and religious fundamentals, and sex because of similar shit.

Geoff:
Well, another example is when we were doing the penis size preferences research, we were trying to get good data on what is the average penis size in America, and there are a few papers on it, but they’re not really very good. You mentioned one possible reason for that.

Nicole:
Right. So, we have a lot of data on flaccid size and there have been some good measurements in that domain and there’s a debate as to whether you should measure flaccid stretched or unstretched. So, they’ve gotten that far—

Geoff:
And also, like, how hard to stretch the penis to measure it.

Nicole:
I don’t know how you guys do this, but the erect is a problem because as soon as a guy has an erection, he’s in a sexual state and we can’t have a physician in the room because that’s inappropriate because he’s in a sexually aroused state. So, because of that, we end up with most of the measurements that are reported of erect sizes are of men measuring themselves.

Tucker:
Right. So, there’s at least a 20% marginal error.

Nicole:
Probably in one direction. Yeah.

Tucker:
Yeah. Exactly. Weirdly, only in one direction. Yeah. I don’t know why that would happen.

Geoff:
I think that’s extraordinary. In 2014, we don’t even know what the true average erect penis size is for American adults.

Tucker:
There’s a ton of studies about this, though. They’re just not good studies?

Nicole:
I think there are some smaller ones where physicians have taken the measurements themselves. They do exist, but by and large, these are all flaccid, and I think it’s largely because of that prohibition. They don’t feel it’s appropriate for them to be in the room, and when they are taking some of the erect measurements, these are when guys have gotten injections, so they’re looking at the repercussions not of a naturally achieved erection, so to speak.

Tucker:
Inject? What do you mean? They’re putting saline in the penis until it pumps up?

Nicole:
No. So, this is outside – you know what we used to do, pre-Viagra, or if you can’t take Viagra for some reason, you can get injections directly in the penis that work really well.

Tucker:
Why can’t you just get erect? Like jack off or bring your girlfriend in and you’re erect and you measure it?

Nicole:
There have been debates about what exactly causes that such that you can get it with an injection. In other words, things seem generally intact, and once you get it, you’re rigid and you’re fine and you can do what you want to do. As to whether that has to do with the brain causing inhibition and is it really the injection or is it something about the injection and giving you permission. It’s probably some interaction of psychological and physical factors.

Geoff:
So, even the measurements we have on erect penises are mostly chemically-induced erections rather than naturally arousal-induced erections.

Nicole:
Because that would be inappropriate because that’s sexual arousal.

Geoff:
Good lord. Okay. So, you talk to a fair number of science journalists, or at least, they asked to talk to you about stuff. What are the most typical misunderstandings or stupid, catastrophic mistakes that journalists tend to have that you have to keep correcting over and over?

Nicole:
There’s a lot of strong belief in brain science, where they think if we’ve seen it biologically, then we understand it. And there are many cases where I don’t think we’ve added anything with brain that we didn’t get from questionnaires. So, it’s funny to me that there’s often, “You actually measured it, but there was a sensor, right?” They kind of want verification. I was like, yeah, but you’ve got to ask what kind and was it really good for measuring, so for example, we have all these studies about female specificity, so how much women get aroused just to the thing they say they’re aroused by, and they think it was measured in the vagina, so that’s the god’s honest truth because that’s the vagina, and it’s like well… not exactly. There are a lot of problems with that instrument, and we have a lot of debates within our field about how accurate that thing is and is this really the best way to go about measuring that type of thing. So, even though I’m a psychophysiologist and those are my instruments, we’re the biggest skeptics of them. So, I think the journalists often want to talk to you because you have the god’s honest truth because you have the biology, and I don’t think that’s the case.

Tucker:
Welcome to media. All media is about trying to relieve the human condition of anxiety in a state of uncertainty with certainty. So, it used to be god. Now it’s science. Science is great, but people used to think god was all-powerful. Now, the bias is science is all-powerful, but it’s not. Science is a process that can help you find a better truth, but exactly like you said, there’s no measurement of, “This dial tells you everything you need to know.” That’s why they’re in media, because they’re selling certainty to people. They’re selling answers. I know why it drives you nuts and I’m not defending them, but understand, they’re always going to look for that forever because certainty is what they’re selling.

Nicole:
I definitely get the anxiety reduction function. People say constantly, “What’s normal?” With the penis size stuff, the first thing they’re asking is, “What’s average?” I was like, that has nothing to do with the study. Average almost doesn’t matter for the question we were trying to answer. “But, what’s average? Just tell me. Start there.” I couldn’t even remember. I had to go look it up.

Geoff:
And they get frustrated with you rather than frustrated with the politicians and ethics boards that are preventing people from finding out. That’s my personal opinion.

Tucker:
You should bring it up when you’re doing these sort of things. “Look, we don’t actually have good data on this because these things won’t get funded.” By the way, if you want to write a story that’ll get a lot of clicks, write it from the perspective of old white men are crippling research into women’s health, which is true. But frame it that way, and the whole debate on sex research changes, as opposed to the religious or conservative or whatever are seeing it as sex positive, sex is bad, frame it as a women’s health issue and frame it as old, white men restricting research into women’s health, which it really can be seen that way, very legitimately. Changes the entire debate. Gets you a whole, big set of allies who don’t care about sex research. They just want more ammunition to fight their enemies, which are whatever. It gets you an ally that can help you a lot.

Nicole:
Yeah. When these studies came out before Congress recently, it was kind of funny ‘cause we were trying to figure out, “Where do we go in DC? Who is it we’re supposed to talk to?” Because we’re academics. We weren’t trained to do this. We don’t know how to talk to these people.

Tucker:
You know the first place to start? The first place you need to start is with all the groups that back Planned Parenthood and then back pro-choice lobbyists. All the women political groups. Those people should be lining up to support your research. Lining up. Not all of them will because that’s a battle that not all of them want to fight. If you start that battle in the blogosphere and start with young women, most of these sites are awful, but places like Jezebel or Feministing or whatever, they’ll pick this up no problem. With a half-decent strategy, you can get a ton of younger – some of them will be crazy people and some of them will be really smart, but you get a ton of young, female writers to pick this up as a real cause, if it’s framed right, and it’s called trading up the chain. Then, bigger blogs will handle it and it becomes a story in mainstream media. You have to have one or two cool events where it’s like, some piece of research or study that’s clearly needed, saying we don’t know how orgasms work or something very clear, and it’s framed as both women’s sexual health and you don’t have to frame it as pleasure, but that’s the implied thing. This could be the sort of thing that could really become a hot-button issue.

Nicole:
We may have something in the pipeline like that that would be a good setup, but I’m trying to get my research done, too, and how many depression researchers are fighting this kind of fight? They’re just writing their grants and doing their work. What the hell am I doing, spending all this time trying to manufacture and structure this…

Tucker:
The depression researchers had to fight this 40 years ago, 30 years ago, before depression was seen as a thing. That was all just buck up and pull yourself up by your bootstraps. I don’t know if it was that easy or not, but especially once pharmaceutical companies started making money on depression, it was a very easy battle to fight. That’s the next step, is finding a way – look, pharmaceutical companies are the worst companies on earth, so I’m not saying to find a pill for female, Viagra for women or something, although that would really change the entire debate. That would absolutely change the debate. But what you need are allies, big political media allies who attach their identity to your cause, right? They exist. They absolutely do. This is one of the biggest debates in American media right now, is the relationship between men and women, how society is set up to either help or hurt women and men. It would be really easy to take sex research and sex positive research and slide it in as a women’s health issue, very easily. If you frame it the way it is, which is helping all people understand sex better, you’re not going to find a lot – even though that’s right and that’s better, it’s the perversion of media. You’re not going to find as many allies. But if you pick a side against another side, then the side you pick will use you as a tool to help them in their fight against the other side, which is fine because in twenty years, no one’s going to remember political battles, but they will know that sex research couldn’t be done in America and now it can, you know? That was very much how prohibition got started. It was basically the women’s suffrage leagues, after they got the right to vote, which was fantastic, they had nothing to do and didn’t want to disband, so they coalesced with a lot of the really radical, extreme religious group and picked alcohol as the demon. That became their thing. There’s a way to do this. It won’t be easy, but the cool thing is so many women are looking for causes – female writers, female media, and they’re kind of scrambling because so much of what they talk about is bullshit, like the wage gap and all of that stuff is actually not true. It’s made up. So, they have to keep the churn of…I don’t want to say deceit, but it is kind of deceitful. That’s the thing. This is a real issue, so you have a real issue that really impacts women.

Geoff:
Journalists need something to be morally outraged about, and to follow up on the big pharmaceutical company point, you mentioned you’d kind of overheard some commentary about how pharmaceutical companies think about women’s sexual health and the women Viagra issue. Do you want to comment on that?

Nicole:
Yeah. It’s a very strange situation, I would say, in pharmaceuticals. Certainly some people are still pursuing female drugs, but there have been so many negative trials now. It’s very little hope for a lot of things we were initially pursuing. But part of the challenge is, we certainly know from drugs of abuse, that there are sexually enhancing drugs. They exist. And we can build on those. We know that we can use them to improve desire, to motivate desire, that they should work in women just as well as they do in guys. But there are very explicit discussions in pharma that we talk about in our meetings that we can’t make women too desirous. We have to be careful. We can’t make drugs that are too strong.

Tucker:
They didn’t want to talk about that with male Viagra?

Nicole:
No.

Geoff:
So, the pharmaceutical company people are saying, “Here are some drugs. They could increase female desire, libido, maybe orgasm, but we can’t develop those because all hell would break loose if women actually had—“

Nicole:
Women would be out of control. It would be seen as not socially desirable. Now, how much that’s actually changed—

Tucker:
Hold on. When was this discussion? This sounds like shit from the fifties.

Nicole:
This is five years ago, and this is still…colleagues contacts that I have there say absolutely, this is still happening. That they worry not only about developing drugs and efficacy of the drugs, which is already a huge question, but if we do have a drug and it is effective, it can’t be too effective, because then…like the concerns with roofies. The roofies are not facilitating arousal. It’s a whole different kind of problem. But they see it along the same bane as guys will use this, they could use it to manipulate poor women who will be out of control.

Tucker:
They’re worried about bad press. They don’t care about women. They’re pharmaceutical companies, they don’t care about people. They’re worried about bad press. Let’s be fucking honest. Good or bad, that’s what they are. I wouldn’t make the debate about finding female enhancement drugs because that’s sort of like….you don’t find a lot of people really rousing for plastic surgery. Lifestyle type issues never raise the sort of ally stuff that a fundamentalist on female health is. Even though they’re all the same sort of thing.

Nicole:
Yeah. I don’t think it’s necessarily something people can get behind. I think Geoffrey’s getting more on how we got to where we are issue that is…it should be relatively easy, in some ways, to have some kind of a drug. Why is there not something that people have thrown at it that has some efficacy?

Geoff:
This is a major problem, so-called hypoactive sexual desire disorder, women not wanting sex enough, particularly married women in relationships not wanting sex, their boyfriends are frustrated, they’re looking for something to help.

Tucker:
Even the women, some of them. It varies, obviously, but some of them are like, “Yeah, I want to have sex more. I just don’t want to.”

Nicole:
It is the most common problem that women report to sexual health clinics and usually the way they report it is, “I want to want.” We do have Flibanserin has been around a bit. That’s the drug that some people, many in my field who have been financially reinforced for being interested in trying to put this drug forward, it’s been rejected now twice by the FDA.

Tucker:
Why? Efficacy issues?

Nicole:
It was a trade-off, so interestingly, it got classed as a lifestyle drug, which Viagra did not.

Tucker:
Right. Well, ‘cause it’s for men. It’s different.

Nicole:
Yes, and that must work. Must have penis. So, the female drug basically got held to a higher standard and my understanding of it is they had a couple of cardiovascular events that they said that because we have this higher standard for this drug, the side effects have to be truly minimal. This is not minimal enough to meet that requirement.

Tucker:
Can you get it in Europe or Canada? Flibanserin?

Nicole:
No. It’s not on market. It was one of these being originally developed as an antidepressant and they noticed that it had some side-effects that seemed to be positive sexually.

Tucker:
Women wanted to have more sex or they were more aroused around the people they were already having sex with?

Nicole:
So, this is lovely. So, the way drug companies study it is Satisfying Sexual Episodes, SSEs. Your acronym is Satisfying Sexual Episodes.

Geoff:
Meaning orgasms. Or who knows what they mean?

Nicole:
However they define it. It’s a very mushy concept that otherwise does not appear in science. It’s just the pharmaceuticals that have this weird endpoint.

Tucker:
So, hold on. It made women more likely to be aroused? It made sex better? What did it do?

Nicole:
It increased your SSEs in some cases.

Tucker:
Which doesn’t mean anything, apparently.

Nicole:
I don’t know what it means.

Geoff:
Well, I remember, I did some consulting work with a market researching company that was working with a Flibanserin pharmaceutical company, and they were very worried about “How do we frame this? Even if it works, even if it gets FDA approval, this female Viagra thing that’s supposed to increase sexual desire or arousal or orgasm rates, how do we sell it without freaking everybody out?”

Tucker:
The way you frame it is in relationships. You start very small. The way Cialis is framed is to show men and women together, the woman’s really wanting the man more, she’s enjoying sex more. You frame it that way and everyone can read everything else.

Nicole:
Then the guy finally gets the football through the tire swing.

Geoff:
The irony here is one of the most common female complaints, “I want to want. I don’t want. I want to have more sex in my relationship or my marriage.” It’s a big problem that causes massive, real, emotional suffering in real relationships. Tens of millions of marriages suffer, and the powers that be say, “Well, that’s a lifestyle drug. That’s an optional add-on. That’s not a serious medical problem, because all it does is result in affairs and divorce and misery.” It would never be covered by insurance, probably.

Tucker:
And all of this, Viagra doesn’t apply to. This is a tailor-made story for a lot of the mainstream women’s media. Tailor-made story. I’m telling you. If I was the editor of one of those blogs, I would want to sit with you for hours and know the whole field and do a six-part series about how…and I would frame it from my perspective, as click bait, how old white men are stopping women from being sexually healthy or something like that. We don’t understand orgasms. They won’t allow research on the clitoris. They won’t release drugs that are proven to work. If I’m thinking from that perspective, I’m gonna gin it up a little bit, but the ginned up version of this is very close to the truth and is probably even less than the truth because probably the extreme shit in this case is, you wouldn’t believe it. There’s huge stories here. It just has to be framed as a women’s sexual health issue and not as a lifestyle issue. If you do it that way and you start the discussion that way, I could see this becoming a big part of that movement. And it should. That, to me, seems obvious. This is a real fucking problem that real women have that is hurting everybody, men and women. As opposed to so much of this other shit, this made up crap.

Geoff:
So, we can have a media strategy session another time.

Tucker:
But that’s it right there. That’s the strategy session.

Geoff:
But another thing that you were mentioning yesterday that I thought was really intriguing was the idea that sexual pleasure and experience isn’t just an isolated part of life, but it might also be an effective intervention for things like depression or even physical problems, and how do you think, for example, women having more orgasms and sexual happiness in their life would compare to mindfulness meditation as a sort of intervention?

Nicole:
So, I’ll give you a sweet little story. Think about Parkinson’s treatments. We’re largely giving people dopaminergic drugs. Guess what another way is to get a good, big hit of dopamine.

Tucker:
Fucking. Truth.

Nicole:
But we can’t have that conversation because wait, you’re going to have Parkinson’s patients masturbate? Are you kidding? They can’t do that. So, a lot of people see sex as, okay that might reflect that you’re in good health because you’re having regular sex, but we can use it and we’re not currently being allowed to use it. So, we’re trying to publish some things demonstrating. It sounds ridiculous, but if you have more sex, guess what? You’re less stressed.

Tucker:
Who would ever believe that?

Nicole:
I know! Crazy, right? That’s nuts.

Tucker:
That’s kooky talk, you west coast liberals.

Nicole:
I know, right? But it’s like you have to do this step-by-step, kind of demonstrate that sex is useful for things, as well. People have talked about this broadly, but I don’t think we, as scientists, have done good jobs, partially because we have to maintain our jobs and get funding and all of that of really demonstrating that sex and orgasm is useful for a variety of potential things we haven’t really considered. Maybe Parkinson’s.

Geoff:
Yeah. I mean, the whole cause of direction of the Mate book and Mating Grounds is guys, here’s stuff you can change in your life to get better with women and have better relationships and more sex and all that, but also, there’s a feedback loop from having more sex to other aspects of your life can get better, too. And your girlfriend will be happier and less stressed if there’s good sex. We’re literally not allowed to research that.

Nicole:
Nope.

Tucker:
You just don’t get funded for it.

Nicole:
It’s all one-off, so the data we have showing some benefit of sexual activity was secondary analysis of somebody else’s where they weren’t looking at that. But yeah, you have to have the person who has the knowledge, then the connection. It all is being done backdoor and it shouldn’t be that way. That’s what’s frustrating about it, is to get that work done, you have to be crafty. You can’t just do it.

Tucker:
Another way this needs to be framed – I know it’s not part of the discussion, but I can’t help but think this way, is sex toy companies, porn companies, condom companies, framed the right way, would finance this research.

Nicole:
You know what’s amazing, Bill Gates’ Foundation actually has huge call-out and has funded some researchers to develop a more pleasurable condom. It took Bill Gates to finally say, “Oh my god, pleasure, sex, same thing. These two things are related. Maybe we should consider that in our interventions for HIV.”

Tucker:
Yeah. If people like the condoms, then they’ll use them and they won’t put them on bananas and they’ll put them on their penises. Yeah.

Geoff:
It actually takes being backed into a corner with a massive global epidemic of an STI to get people to go, “Oh, okay, as a last resort because men won’t use condoms unless they feel better. Okay. Then we’ll invent this.”

Nicole:
And even then, not federal government. This is an individual, right, who says, “I know the government can’t do it. I’m taking it on. I’m gonna do it.”

Geoff:
We should wrap up pretty soon, but in your experience, are there certain media outlets that tend to be better in terms of how they cover sex research and being more reliable and balanced and mature, where young guys can go there and be fairly confident they’re getting a good story? Are there others that seem to just keep getting it wrong again and again?

Tucker:
They all get it wrong. Does anyone get it right? That’s the question.

Nicole:
Yeah. I think it is the more entertainment-oriented the media outlet, the more likely they are to not have called. So, it’s like, when I have a study come out that gets a lot of coverage, most of them are just repeating. It’s one or two original sources. They just go with that and then they repeat the error over and over again. But there’ll be a few, someone from the Huffington Post often calls. If I have something going out, they’ll check in, say, “Hey, is this right? Is that right?” Sometimes, they’ll even have me read it beforehand, although that’s pretty rare. So, there are outlets who’ll check in with you, but it also varies. I don’t always get the call. Sometimes, they just run with what they’ve got.

Geoff:
So, what percent of journalists who are reporting on a sex study do you think have actually read the paper? The actual research?

Nicole:
Occasionally, they do write me and ask for the study. I don’t know how much of it they understand or what their science background always is, but I would say it’s rare. It’s maybe one out of twenty.

Tucker:
Yeah. If they can understand the abstract, that’s good. That’s a big…if they can get that, that’s good. Which, by the way, why don’t you guys write abstracts that are clear? I mean, I can understand most of them, the vast majority, but I’m pretty smart and most people can’t. The abstract might as well be in fucking Chinese.

Nicole:
Yeah. I mean, sometimes, we’re meeting the requirements of the journal, that you have two sentences about this, one sentence about that. It varies.

Geoff:
Yeah, but when I’m reviewing journal papers, that’s the first thing I do. It’s like, your title needs to be clear. Report what you found. Make the abstract so we can understand what you did. There’s amazing resistance on the part of scientists. They’re almost frightened to walk you through, clearly, what they did and what happened and what they found.

Tucker:
You know why, right? Because in academia, status is signaled by complexity and difficulty, not usefulness or clarity. It’s all status signaling, no doubt. That, or they don’t have shit to say and they’re trying to obfuscate that fact.

Nicole:
Excuse me, they’re trying to what?

Tucker:
They’re trying to confuse us.

Nicole:
Thank you.

Geoff:
Well, thanks a lot, Dr. Nicole Prause, for being on the show.

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