Mind over Vagina
Women Are Complicated
he human vagina is accustomed to visitors. Even the language of anatomy imbues the organ with an innlike hospitality, the entrance to the structure being named the “vaginal vestibule.” Take off your coat and stay awhile. Gynecologist Robert Latou Dickinson, circa 1910, documented its wondrously accommodating nature, using his fingers as a measuring tool. The volume of the virgin vagina is “one finger”; the married woman rates “two full fingers.” Once the babies start coming, it’s “three fingers” and up, all the way to Subject No. 163, whose vestibule (and parlor) appear in a pen-and-ink rendering in Dickinson’s Atlas of Human Sex Anatomy with the doctor’s entire hand submerged.
There is no reason why a visit from the acrylic probe of a vaginal photoplethysmograph should be cause for alarm. It’s small. It has no sharp edges. It doesn’t do anything in there except beam a ray of light onto the walls of the vagina. (It does this to measure arousal. The amount reflected back tells you how much blood is in the capillaries; the more light reflected, the more arousal.) There is no reason to say no to an invitation to participate in a photoplethysmograph study at the Female Sexual Psychophysiology Laboratory And so I have said yes. (Observing someone else who said yes was not an option, because of human subjects review board rules.)
The Female Sexual Psychophysiology Lab is part of the psychology department at the University of Texas at Austin. Its goal is simple but complicated: to untangle the complex, quixotic interplay of body and mind as they pertain to female sexuality. You have no idea what a perplexing mess is female arousal. When a woman is turned on by something or someone, her brain sends a signal to open up more of the capillaries in her womanly recesses. This ups the amount of blood in her vaginal walls, and some of the clear portion of it seeps through the capillaries and coats the vagina. Hello, lubrication. This much we know. But just because a woman is a little moist, that doesn’t mean she’s going to report feeling aroused. Unlike a man. If a man has an erection, or even half of one, as part of a sex study, he will almost always report that he’s aroused. Partly, this is because a boner is easier for its owner to detect than is a damp vestibule. It may also have to do with men’s greater skill at detecting subtle physical changes. A 1992 study showed that men were more accurate than women at picking up changes in their heart rate and blood pressure.
Conversely, when a woman isn’t damp, it needn’t mean she’s unaroused. To quote Dickinson on the topic of vaginal lubrication,* “Unwise stress has been laid on mucous flow as an adequate gauge of. . . readiness for the entry of ■^Dickinson’s descriptions of the female secretions read, in places, like a WD-40 advert: “It is clear as glass, tenacious and persistent, without being sticky. No other lubricant can compare with it in efficiency for a certain smooth and slippery quality. …”
the male. . . . For it must not be overlooked that there are women of strong passion, capable of vigorous orgasm, who show little or no mucous flow” In other words, there can be a puzzling disconnect between mind and body.
In women, the correlation between photoplethysmo – graphic measures of genital engorgement and their own assessment of how aroused they are is so low that some researchers have questioned whether the physical changes alone can be taken to mean anything at all about a woman’s state of arousal. Female sexual arousal disorder is rarely diagnosed by photoplethysmograph; it’s a conclusion typically reached solely on the basis of a woman having voiced a complaint. The equipment is used mainly for research.
The Female Sexual Psychophysiological Laboratory is run by Cindy Meston. For the past seventeen years, Meston has made a career out of figuring women out—and figuring out how to help them. Possibly longer, if you count the prepsychology era spent traveling rural Canada as a sewing machine sales rep. “I’d come to town and do sewing demonstrations and advice programs on the local radio stations. Ladies would call in and say, ‘Well, I’m sewing with Ultrasuede, and my stitches are skipping, what should I do?’ And I’d go, Well you need a Schmetz size-eight stretch needle with a leather tip. . . .’” Meston tried to tell me the name
of one of the programs, but was laughing so helplessly that it took a while. Finally, she came up for air: “Sewing and Serging with Cindy”
he Female Sexual Psychophysiology Laboratory is on the third floor of the even more time-consumingly named Sarah M. and Charles E. Seay Building. So enthusiastic is the university about its new structure that at one point during construction they set up a Seay Building Web cam, allowing interested parties to log on twenty-four hours a day and watch, literally, the paint dry.
The combination of the Seays’ generosity and Meston’s flair for interior decor has yielded a science lab not unlike the lobby of the W Hotel. Participant Room 1 (volunteers here are called participants, not subjects) is a small, serenely lit room with modish carpeting and a purple leather recliner. The walls hold framed prints of Modigliani nudes and a flat-screen TV for viewing the inevitable erotic video clips.
It was not always this nice. In the old lab, the erotic films were shown on an ancient TV set whose volume control was on the fritz. It occasionally happened that while Meston or one of her students was running an arousal study subject, department psychologists would be holding a parent-child session in the office next door. “The TV would just be blaring,” says Meston. “There’d be all this moaning and panting coming through the wall, and we couldn’t turn it down!”
The vaginal photoplethysmograph probe that I will be—holding? containing? wearing?—is, for the moment, hygienically sequestered in a Ziploc bag on a table beside the purple chair. The graduate student who is running today’s study explains how to insert the probe and directs my attention to a pretty ceramic bowl that in another lifetime might have held sugar packets but now holds little foil packets of “personal lubricant.” She doesn’t divulge the specifics of her study, because study subjects are always kept in the dark, lest their expectations taint their results. My assignment is simply to sit still and watch a series of video clips—the first batch neutral, the remainder, erotic—while the plethysmograph beams its light beam and measures my physical response to what I’m viewing. (I later learn that I was a control subject in a study about the impact of anxiety disorders upon sexual responsiveness.)
“Okay,” says the student. “See you in a bit.”
She leaves the room and shuts the door. I take the probe out of the bag. An LED and some wiring are encased in a round-tipped, bullet-shaped piece of clear acrylic. “Cinderella’s tampon,” I write in my notebook, a notation that I will, weeks later, stare at dumbly for several moments, having no clue what it means. Where the string would be, there is a stiff, plastic-coated cable that leads to a computer. I follow the instructions I was given, and now the cable is curling down the front of my chair. I feel like a bike lock.
On the table is a console similar to the shifter on an automatic transmission. When the video clips begin, I’m to move the indicator up and down according to how I feel. The device is called the arousometer, and Cindy Meston invented it. When the Viagra data started coming in and it appeared that the little blue pill wasn’t making women feel more aroused, Meston decided to rethink the methodology. A photoplethysmograph probe collects data sixty times a second. But the psychological data—the woman’s own assessment of how aroused she is—was taken only once per subject, at the end of the film footage. “You’d get a questionnaire after the fact, asking, How aroused were you? Did you detect this or this or that? But what, really, is a woman saying when she says, ‘I was a four’? Is she telling you what her highest level was? Or did she somehow compute an average of how she was feeling over the whole five minutes?” Meston devised the arousometer as a way for subjects to deliver an ongoing report as the footage rolls.
Using the new device, Meston discovered that there are indeed women who show a nice correlation between body and mind. She is finishing up a study of three groups of women: one with arousal disorder, one with orgasm disorder, and controls. While all three groups’ photople – thysmograph responses to the erotic clips were similar, the dysfunctional women differed in that they didn’t seem to be taking note of the physical changes taking place. And this occurred independent of the level of physical arousal. “Among the functional women, some had a very small change to the erotic film, but they were detecting it, they were paying attention to it. So with these women, if you could amplify the signal with a drug like Viagra, that could be a good thing. But for a woman who has a normal physical response but she’s not attending to it—and really for her the only thing that is arousing is when she feels emotionally bonded or loved or is doing a very specific sexual act—then Viagra is just not going to help.” Meston says that although Viagra has not been approved for use by women, doctors often prescribe it anyway—mainly because they don’t have anything else to prescribe.
Viagra isn’t the only drug being prescribed off-label for women with arousal problems. Los Angeles urologist Jennifer Berman told me some doctors are prescribing low doses of Ritalin. Drugs like Ritalin improve a person’s focus, so it stands to reason that it would make it easier to stay attuned to subtle changes taking place in one’s body. “It enables a woman to focus on the task at hand,” said Berman, managing, though surely not intending, to make sex sound like homework.
In the same category of anecdotal evidence regarding drugs that improve one’s focus and make sex more pleasurable and intense, there is pot. As Barry Komisaruk writes in The Science of Orgasm, “a substantial proportion of persons claim that marijuana enhances and enriches their sexual experience.” For obvious reasons, no one has done a controlled clinical trial of marijuana’s effects on arousal and overall sexual satisfaction. Too bad.
The importance of focus fits well with something that Masters and Johnson wrote about back in the 1970s. The team coined the term “spectatoring,” which refers to a tendency to observe oneself during sex. Not in an erotic, mirror-on-the-ceiling sort of way, but in a judgmental, critical way. Rather than focusing on the sensations of foreplay and sex, all the feel-good things happening in her body, a spectatoring woman worries about her performance or her appearance. A study by Natalie Dove and Michael Wiederman found that women who were more distracted during sex were—relative to less distracted, more sensation-focused women—less sexually satisfied. They had less consistent orgasms and more often faked them. The questionnaire alone was heartbreaking. Women had to rate how closely a set of statements was characteristic of themselves. Statements such as: “During sexual activity, I worry the whole time that my partner will get turned off by seeing my body without clothes.” “While engaged in sexual activity with a partner, I think too much about the way I am moving.”
One needn’t suffer these particular anxieties to be distracted during sex. A thousand things can play on a woman’s mind: work, kids, problems with Ultrasuede. One nonpharmaceutical solution is to teach women to redirect their focus and pay more attention to physical sensations—a practice called mindfulness. A pilot study—meaning it’s a preliminary investigation with no control group—by Lori Brotto and two colleagues at the University of British Columbia had promising results. Eighteen women with complaints about their ability to become aroused participated in mindfulness training. Afterward, there was a significant jump in their ratings of how aroused they’d been feeling during sexual encounters.
If it’s any solace, even female rats have trouble focusing. I give you a sentence, my favorite sentence in the entire oeuvre of Alfred Kinsey, from Sexual Behavior in the Human Female: “Cheese crumbs spread in front of a copulating pair of rats may distract the female, but not the male.”
he largest city of Russia’s Pacific coast is Vladivostock, and though it lies in Siberia, the southern location of the city allows it to enjoy ice-free waters year-round.” I’m spectatoring the neutral video clips now. There are those ice-free waters. Here’s a shot of a statue in the harbor. If the Seay Building Web cam continues to operate, and if one of the cameras is in this room, then someone, somewhere, is very confused. Looks like she’s watching the History Channel with no pants on.
Abruptly, the neutral footage ends. A snare drum has replaced the oboe and harpsichord music. A man with blonde highlights and a rub-on tan is standing by a desk, dressed in a uniform and a captain’s hat. On the desk is a large envelope. The camera, possibly out of habit, zooms in for a full-screen close-up. top secret, says the envelope. Now here comes more tacky hair and bottled skin, this time of the female variety. It would appear she’s going to seduce the captain and steal the envelope.
It is hard to imagine that I will be physically affected
by anything this pair might choose to do to each other. But science has its money on it. A series of studies by Meredith Chivers and colleagues at the Centre for Addiction and Mental Health in Toronto showed that men are more discriminating than women when it comes to how they respond to pornographic images. Women, both gay and straight, will show immediate genital arousal (as measured by a photoplethysmograph) in response to films of sexual activity, regardless of who is engaging in it—male, female, gay, straight, good hair or bad. Men, contrary to stereotype, tend to respond in a limited manner; they are aroused only by footage that fits their sexual orientation and interests. (Male arousal is usually measured with a “phallometric” device, which employs a strain gauge to detect changes in the circumference of the penis.) While straight women— and gay men—become physically aroused by footage of two men having sex, straight men generally do not. (A straight man will, however, respond to footage of women having sex, partly because he’s looking at two naked women.)
Chivers was struck by what seemed to be “fundamentally different processes” underlying the sexual arousal systems of women and men. To test the limits of the phenomenon, Chivers gamely ran a follow-up study in which men and women viewed, in addition to the usual gamut of human sexual scenarios, footage of bonobos mating. Here again, the women’s genitals responded—though not
as strongly as they did to images of human beings—and the men’s did not.
And it happens remarkably fast. “Automatic,” is how one researcher put it. Or, in Masters and Johnson’s cringe-worthy telling, “In a matter of seconds the sexually responding woman may develop sufficient lubrication for coital readiness.” The team actually witnessed this happening, using their penis-camera. They describe it in Human Sexual Response as “a sweating phenomenon. . . akin to that of a perspiration-beaded forehead.” Oddly, the illustration shows a cross-section of a vagina with tear-shaped droplets not beading up on the walls but appearing to rain down into the interior space, as though a summer shower were passing through.
Women’s genitals may respond indiscriminately to images of sex, but the women themselves will often report being totally unaffected by what they’ve viewed. Based upon how they feel, women are quite picky about pornography. Ever since a study by Dutch researcher Ellen Laan showed that women reported significantly higher levels of (subjective) arousal during women-centered porn, arousal researchers started going out of their way to use films made specifically for women.! The one I’ve been watching is an
example. As unappealing as the captain may be, he certainly is attentive. There was a full minute-long close-up of his tongue doing its thing while due south, his index finger moved in and out—albeit in an unerotic, Shmetz – like manner. The actress, for her part, did her best to seem transported, although every few seconds you’d see her halfopen her eyes, like someone cheating at hide-and-seek.
True to Chivers’s discoveries, the photoplethys – mograph readings for the women in Laan’s study were essentially the same during both types of film. Her subjects may have preferred the women-centered clips and perceived them as more stimulating, but their bodies told a different tale.
Be all that as it may, it is the mind that speaks a woman’s heart, not the vaginal walls. (Chivers is careful to point out that just because “women demonstrated a genital response to a nonhuman sexual stimulus does not suggest women have a latent preference for sex with animals.”) Rape offers a plangent illustration of this fact. I learned in a paper by Roy Levin that rape victims occasionally report having responded physically, even though their emotional state was a mixture of fear, anger, and revulsion. This harkens back to the last chapter, and what Marcalee Sipski learned about arousal from studying women with spinal cord injuries. Lubrication from “reflex arousal” (physical stimulation of the genitals) can occur with absolutely no subjective emotional arousal. Levin also points out that fear causes the release of adrenaline, and adrenaline increases blood flow to the genitals. Which, in turn, enhances lubrication (or erection in men).
Regardless of the mechanisms that may or may not explain a rape victim’s physical state, a rapist’s defense based upon evidence of arousal has, to quote Levin, “no intrinsic validity and should be disregarded.”
the Fruit Machine is a fine example of the perils of trying to make sexual conclusions about folks based solely on measurements of their bodily responses. In the 1950s and ’60s, in a laboratory in Canada’s National Defence Medical Centre, the government commenced a secret project to pinpoint a simple, trustworthy physical indicator of a man’s sexual preferences. John Sawatsky, author of Men in the Shadows: The RCMP Security Service, says the goal was to rout homosexuals from the Royal Canadian Mounted Police and other civil service positions—but to do it scientifically, so that no one was dismissed solely on the basis of hearsay. A bowl of poison with a cherry on top.
What they came up with was pupil response—and an elaborate chair-mounted contraption, nicknamed the Fruit Machine, to measure it. Experiments had shown that people’s pupils enlarge when they’re interested in what they’re looking at. The technique had been used in the past by food marketers to test the appeal of different types of packaging. Canada’s Security Service had heard about this and decided to apply it to sexual preferences. If a man’s pupils widen while he looks at a naked man, they figured, then that must indicate a preference for the male package.
Trouble set in almost immediately. The team couldn’t test the thing because the Department of Defence claimed it had no gays, and because Mounties were reluctant to volunteer as control subjects. Wisely enough, as it turned out: The scientists had forgotten to take into account differences in the brightness of the images on the screen. When the screen got darker, the viewer’s pupil would, naturally, enlarge to let more light in—regardless of who or what the image was. Meaning that if an RCMP recruit looked at an image of a dark brown horse, the Fruit Machine operator would have had to assume that the Mountie and his mount were engaging in something other than national security.
Years after the Fruit Machine project had been shelved, someone got the bright idea of measuring changes in the circumference of a man’s penis—rather than of his pupils— while he looked at naked people. Even phallometrics, as this technique is sometimes called, is not a reliable indicator of sexual preference. A strongly motivated man—for instance, an accused pedophile—can learn to control his genital response to an image that he finds erotic.
He can also, with a little training, develop a brand-new one. In 1968, researchers S. Rachman and R. J. Hodgson used classical, Pavlovian conditioning to create a fetish for women’s boots. Five men were outfitted with phallo – metric devices. Over and over, the team showed the men images of nude or provocatively dressed women, followed by images of a pair of knee-high, fur-lined boots. Eventually it worked: In three subjects, the boots by themselves plumped the men’s penises as much as the images of the women originally had. Two of the men were also aroused by high-heeled black shoes and by “golden sandals,” though no conditioning had been done to these images.
No man got an erection from looking at “brown string sandals.”
Many years ago, Cindy Meston, one of Rachman’s former students, decided to see if it would be possible to replicate the effect in female subjects. (The incidence of fetishism is far higher in men than in women.) This time the object of the fetish was the voice of the chairman of the psychology department at the University of British Columbia, one Tony Phillips. Meston had taken a snippet from a voiceover of an old student orientation film, and played it over and over as the women looked at erotic images: Welcome to the department of psychology. . . . Sadly, for Dr. Phillips anyway, the attempt was unsuccessful.
If you want to unlock the mysteries of female arousal— the kind the females actually notice and appreciate—the brain is probably the place to turn. After the costly failure of Viagra for women, pharmaceutical companies shifted their attention from drugs that affect genital blood flow to drugs that act directly on the brain. The showiest hopeful to date is bremelanotide, nicknamed “the Barbie drug” because it (a) stimulates the cells that make skin tan, (b) suppresses the appetite, and (c) ups libido. Like Viagra, bremelanotide’s sexual properties were discovered by accident—in this case, while the drug was being tested as a sunless tanning agent (under the name Melanotan). The tanning application didn’t pan out—“blotchy freckling” and “scrotal moles” are complaints posted by the trial subjects on www. melanotan. org—but some of the women in the study reported feeling randier than usual. And a drug that can make a woman with “black dots on face” feel sexy is a drug to look into further.
Michael Perelman, director of the Human Sexuality Program at New York’s Weill Medical College of Cornell University, ran the most recent bremelanotide trial. Twenty-seven postmenopausal volunteers with female sexual arousal disorder went in for treatment: once with a placebo, the other time with a nasal spritz of bremelanotide. Each time, not knowing what they’d been given, they filled out questionnaires—one shortly after the treatment, another a day later. The drug prompted statistically significant increases in the women’s perceptions of how aroused they were after receiving the drug, as well as increases in sexual activity and desire in the twenty-four hours that followed. Bremelanotide is expected to be in Phase III clinical trials (the final stage in the FDA approval process) by late 2008.
The other contender trotted out at the most recent
meeting of the International Society for the Study ofWom – en’s Sexual Health is a central nervous system drug called flibanserin. This one was originally being tested as an antidepressant. Because diminished libido is a common side effect of antidepressants, researchers were keeping an eye on subjects’ sexual feelings. They were surprised to find that flibanserin enhanced, rather than dampened, women’s libido. As of 2007, flibanserin is also in Phase III trials.
The FDA tends to be cautious with drugs that affect the brain—especially when they’re being used for what some in the medical community view as a lifestyle change. Because of this, and because no one yet understands the mechanism by which flibanserin works, approval may prove thorny.
The drugs come and go: pilot studies, high hopes, fanfare, silence. Apomorphine was the star a couple of conferences back; now you barely hear of it. I asked Cindy Meston whatever happened to it. She laughed. “It made you nauseous.”