The Juicy Cuts: Nicole Prause, PhD, Part 1—On Recognizing Arousal

The Background:

Hey there, folks! Around this time last year, I was working on an article for a prominent sexuality publication which shall remain nameless. The article was going to be about the ways in which sex education, medicine, and pretty much everything else has failed to teach most of us about sex. And how female sex-tech founders in the private sector have been stepping up to the task.

I interviewed about a half dozen amazing women—company founders, scientists, medical experts, professors, and the like. It was amazing. And then they canned the article after I turned it in. I shopped it around to other publications, but nobody bit. So, now that it’s been a year, I’ve finally convinced myself to move on. And to give you, my amazing readers, access to the fascinating discussions that happened last year!

The Interview:

First up: Nicole Prause, PhD, the founder of Liberos, a sex-tech company that studies sexuality and on the brain. I’ve been a fan of her work for years, and even wrote about her over at YNOT a few weeks back. But this was the first time I was able to speak to her one on one, and, not gonna lie, I kind of fangirled at her. But after that passed, we had a very long chat about the science of pleasure. This is Part 1, in which we discuss the amazing lack of knowledge around the physiology of orgasm in people with vulvas.

nicole prause phd lynsey g juicy cutsLynsey G: I’ve read that you were a professor for 10 years before you started Liberos. Can you tell me about why you decided to leave academia?

Nicole Prause: Sure. Yeah. So, I didn’t decide to leave academia. It left me.

I got hired at UCLA. It was a contract position, but it could be extended. I just needed to get a grant to do that. And I did, but the school refused to accept the money because it was to have two people interacting sexually in the lab. 

So I always joke, [that] it’s the only time I’ve ever heard of a university refusing money. As have my colleagues. Everyone was just floored. There’s really no standard for how to respond to it when that happens. But before that I’d had some inkling there might be an issue, because my contract there was for three years, and I did complete it. I didn’t leave early. Initially I was trying to push through a study of orgasm because I was collaborating with someone studying depression. We were interested in reward processes in people who are depressed. And the ethics board at UCLA refused to allow it on campus.

So we had another project where we’d been stimulating the genitals with a vibrator on campus. They were fine with that. They would let that through, but as soon as we said they would have an orgasm, they said, “You can’t do that, you have to remove it.” But they wouldn’t cite any privacy or safety reason, which is the mandate of the ethics board. They’re supposed to be there to protect patients, to make sure that the science is going to provide information that’s meaningful if done properly. That their privacy is protected, they are able to consent, and all that good stuff. And they didn’t do that.

In our case, they just said, “You have to remove the orgasm component or we won’t approve the study.” And we said, “Well, we’re not removing it. That’s the point of the whole freaking study.” So they declined it and said, “You can’t do the work here.” And as far as I know, it became the second study in the history of the school to ever be rejected. 

LG: That’s wild. 

NP: It was wild. So I had like 20 sex-researcher colleagues that wrote emails to the ethics board and to UCLA, saying, “This person is a known scholar. What are you doing? This is a good scientific question.” They didn’t care. There was another IRB at Pittsburgh [that] approved the exact same with no problem. So we ended up running the study in Pittsburgh. 

LG: It sounds like there must have been someone sitting on that committee who just felt icky about it. 

NP: The chair said he was uncomfortable with it, and I said, “Well, if you’re uncomfortable, should you find someone else to review this?” I was very frank with him, and he wouldn’t step aside, so I sort of feel like he influenced that outcome. 

LG: Yeah, sounds like it. Was the study focused on anybody across genders, or was it specifically female oriented? 

NP: No. [In] that study we were going to be looking at normal functioning. So, before you can look at something as a pathology, you have to understand that basic physiology that underlies it [in order] to identify what’s aberrant or dysfunctional. We were going to do it kind of in two stages. That is, the first one is in people who didn’t have any kind of affective emotional issue and generally have good sexual functioning, to see what the brain looked like using electroencephalography—EEG—through that point. And then next step would be bringing in depressed people and seeing if we can identify abnormalities and their experiences of sexual reward. 

LG: That’s super interesting. In my understanding, the idea of normal sexual functionality is still pretty slippery from a research perspective. Or is that not your experience? 

NP: It really depends on what you mean by it. So, there’ve always been a lot of debates about categories for diagnosis—that is, what’s fair to call a disease. How much do we define that just by people’s distress when they’re distress might just be driven by social pressure or their partner, or you know, any number of things that really aren’t a disease, but are social issues that might need counseling. So that debate has always been there.

But there are some basic biological things that I would say are clear pathologies and differences. So for example, we know there’s good documentation in men that can orgasm separately from the ejaculation process. That is the sensation of the experience, but that almost always occurs when they’re taking a medication that causes those things to separate. So, I would argue that that’s dysfunctional, that if you’re having those—one and not the other—and you’re not trying to do that for some reason for pleasure, like a tantric something, that’s legitimately a problem that could cause fertility issues or distress in the person. And that’s something we should be able to inform and resolve.

So I think there are some we can make stronger claims on. But desire is by far the most slippery because it’s hard to quantify. 

LG: I’ve always understood that especially for women, orgasmic capacity and particularly the difference between mental desire and actual physiologically “turned on” can be very important. 

NP: There are some interesting points of that line of research. So, everyone else in science called it coherence research. And this is not unique to sex. For example, people study fear and look at how much your sympathetic nervous system matches or fails to match your reported fear to a spider, or something. And these processes are studied with respect to gender, extensively, outside of sexuality. There are lots of areas that contribute to our understanding of like, well, yes, in general, men tend to attend to internal perceptions more than women do.

So the sex thing isn’t so surprising because that’s kind of well-known across a variety of different areas, not just sexuality. But, yeah, you’re right that the overwhelming pattern in women is ][that] women tend to have lower coherence, but it’s almost always driven by a noticeable genital response that women don’t report experiencing. So it’s rare that you have women saying they feel sexually aroused and don’t find genital evidence for it. 

LG: That’s a good way of putting it. 

NP: And what’s interesting is we’re extending that to orgasm now and finding the same thing, which is a little mind-blowing to me. I thought this was one where they would probably agree pretty well, and they still don’t. So, part of what we’re seeing in some of these trials and pilots that we’re doing is women—so again, not guys. For guys, I would say when they have a orgasm, it almost always is accompanied by ejaculation. And so they tend to be tied very strongly to those contractions. They say, “I’m having an orgasm” when they have those contractions. That is their definition.

The women we have in [the lab] have this weird—don’t quote me on the prevalence, because these are kind of smaller samples—but of the people who come into our lab, somewhere between 25 and 50 percent of them will say they had an orgasm when we can’t find physical evidence for it. They don’t have the stereotyped contractions that men always have, or that the other women have. 

And when women have contractions, they are always defining their orgasm around those. So, we have them masturbate through a whole series of thinking about sex and then stop thinking about sex, think about sex again, stop thinking about sex. And then they shift up to starting to stimulate themselves and stop, and start to stimulate yourself and then stop. And then we have them actually try to experience an orgasm. We’d always tell them, “If you can’t, it’s no problem, we’ll still pay you.” We try and really make it clear that what we want is your honesty more than anything. And we ask them to indicate when they feel that their orgasm has started and when they feel like it stopped, and then we record anal contractions with a pneumatic device, so it measures air displacement and you know, keep it as small as possible so it’s not distracting or causing problems of them getting there in the first place. 

But that’s been really surprising to me. So, we have a number of cases where there’s a woman who has like one clench, basically at the time she says her orgasm is happening, another woman has that exact same physical profile, but reports she did not have an orgasm. We’re trying to figure out how to understand and interpret that still. And even my coauthor and I don’t agree right now.

So my sense is women largely just don’t know that that’s a thing that they should be looking for—contractions. Because as you’re looking at education, where would they ever learn that? It’s not represented in pornography, it’s not ever going to be represented in sex education in the US. I’ve never even seen it in the Dutch films that are more open and show genitals. You know, they still don’t show the whole process of [orgasmic] response. I think what’s happening is women might read in Cosmo [that] orgasm is a peak experience, and they’re like, “Well, that felt good. Maybe that was it.” 

I always say I don’t want to yuck anyone’s anyone’s yum, so I don’t want to say that they’re missing out, and isn’t that terrible for them. Because if they’re having a good time, just ignore us. But, you know, if you’re learning about your body and you want to know these things, and you want to see if your body does that… You should be able to find that information and know what that looks like and how to detect it in yourself. 

LG: Absolutely. That is mind-blowing to me. 

NP: I was floored when we saw that. We totally thought our instrument wasn’t working at first! We were like, “There’s no way this is happening.” We thought they were expelling it. Something must be wrong. But at this point I’m starting to believe my own data. 

LG: One of the big questions that I had going into his article was: What are some of the things that women don’t know they don’t know about their bodies and their sexuality? And, honestly, the idea of contractions during orgasm didn’t even occur to me. But you’re right nobody talks about this.  

NP: I think it’s in there somewhere, and when I directly asked, [I realized] we don’t have any study right now where we directly ask them about that. So, I’ve only done it with friends, in the way this often happens. I’ll say, “Well, what do you think? How do you know?” And some people will make that distinction. They’ll say, “Well, I have mental orgasms and I have physical orgasms.” And I’m like, “Oh God, don’t do that to me! Don’t make this complicated.” So I think some women are aware that sometimes they have those contractions and sometimes they don’t, but they don’t know what that means. They feel different to them.


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