The Orgasm Researcher of My Most Beautiful Dreams - Dr. Nicole Prause Doin' Experimental Design Right

Okay, so I learned of a scientist yesterday that, upon some investigation, made me incredibly happy for the future of lady-gasm knowledge and the Orgasm Equality Movement. Her name is Dr. Nicole Prause. She just this month had an article called Clitorally Stimulated Orgasms Are Associated With Better Control of Sexual Desire, And Not Associated With Depression or Anxiety, Compared With Vaginally Stimulated Orgasms, which I've skimmed (and will do an SSL Journal Article Summary of soon), but already love because it seems to be a much needed, and more scientifically rigorous re-investigation of some research topic favorites of the prolific and seemingly Freud obsessed researcher Stuart Brody. She also has recently opened her own sexual biotechnology company funded by federal and private grants called Liberos.

The thing I really want to tell you about her, though, is encompassed in the quotes below. Dr. Nicole Prause is straight up on point about what needs to be done to make scientific investigation into female orgasm better. In the article The Big O by Maria Konnikova, I read words I have been waiting to hear a scientist whisper sweetly into my ears from the moment I started making this blog:
Much of the previous work on orgasm has relied on self-report: I am having an orgasm, or I’m not. One series of experiments led by Barry Komisaruk, for instance, depends on people pressing a button to signal they have experienced sexual release. In men, such self-report is fairly straightforward. It’s based on ejaculation. In women, however, it becomes trickier. How do you know you’re having an orgasm for sure? How do you know if what you’ve always thought of as orgasm is, in fact, that? The problem is not necessarily unique to women. One early study looked at what would happen if men were blocked from seeing their own erections: They became highly inaccurate in rating their physical arousal. For women, it doesn’t help that the popular press is rife with misinformation. Women cannot have an hourlong orgasm, Prause points out, despite what the latest magazine cover might have you believe. 
To “take away some of the mystery,” in Prause’s words, she relies on more precise measurements. An EEG headset is used to measure brain waves. (In another version, the EEG is replaced by fMRI.) Around the chest goes a respiration belt, and on the finger, a device to measure skin conductance. A tiny disc-shaped electrode that measures temperature — a thermistor — is placed on specific locations on the genitals. A modified butt plug fitted with a specialized pressure gauge is placed inside the anus to measure contractions. And then the “task” — “though it’s not really a task at this point,” Prause says — begins.
She had me at modified butt plug to measure contractions. And then as I was dropping to my knees to praise all the gods for sending us a female orgasm researcher who cares to actually know what's happening to a woman's pelvic muscles when she claims to orgasm, I read the transcript of an interview with her for Only Human in a segment called The Science of Turning Her On (MH = Mary Harris , the host, NP= Nicole Prause):
NP ...You do whatever you need to do to do the science right. And if that means an anal probe, then by god, we’re going to build it, we’re going to test it and we’re going to do it right.”
 MH: This probe - it’s called an anal pressure gauge - is a device of her own design. She uses it to measure the physical sign of orgasm, those vaginal contractions. At the same time she uses an EEG to understand what an orgasm looks like in the brain. Looking at her results, she’s noticed something strange.
 NP: We found that many women in our lab when they reported having an orgasm actually were not having any of the physical signs of an orgasm.
MH: What does that mean to you?
NP: I have no idea. (laughs) Clearly they’re having a good time. There’s some pleasure peak there, there’s something that causes them to say “I feel like that I am having some type of peak experience right now.” But that experience appears quite different for some number of women than it is for men.
MH: Here’s another problem. Most research into the female orgasm relies on women simply telling scientists whether or not they’ve climaxed. Nikky Prause thinks that’s far too vague of a measurement. Because if women don’t understand what’s happening in their own bodies - scientists won’t, either.
NP: Basically, any study that you’re seeing that claims to have an image of the brain at orgasm, does not have an image of the brain at orgasm, they don’t know what they’re getting. They’re getting an image of the brain when women think they’re having an orgasm. And that’s all it is. So, that sets us back.
MH: This is just an initial finding with a small sample of women. But for Nikky Prause, it shows just how profound the disconnect between women’s bodies and brains might be.
NP: So I’ve started at this point it goes personal, I started asking my friends - how do you know you’re having an orgasm? What exact criteria are we using? And you know this is complete non scientific reporting at this point, but you know “I feel goosebumps all over my body” and I was like “well that’s great but --”
MH: That’s not a thing.
 NP: It’s not what we would physiologically call an orgasm. Or I’ve had some women say I have two types of orgasms, and they didn’t mean clitoral and vaginal. They meant, I have one that’s a body orgasm and one that’s a mind orgasm. And I was like wait what? Because we’re not asking about that in our surveys. (laughs) This is off the charts. And I think it might partially be due to, where do we ever learn what an orgasm is? Do you talk to your mom? Your dad, certainly not. (laughter) Sisters? Uhhhhh, I didn’t.
I'm sorry, did you hear that beautiful music? That music of a scientist doing research on female orgasm who actually acknowledges that just because a woman says she orgasms in a study doesn't also mean she is exhibiting the physiological signs of orgasm? It's so deeply exciting and needed. Just last week I specifically directed the last section of my post to generic lady-gasm scientist persons and asked them to start doing more rigorous research that can help the world actually understand and make distinctions between what is happening with these women who do and don't have physiological orgasm responses when they claim they are orgasming. I didn't even know at the time that Dr. Prause was out there gettin' to doing the damn thing. I LOVE IT.

Seriously, I have never heard a scientist studying female orgasm so clearly state something that really should be obvious to that community by now. Women are not always describing the same physiological event when we say the word 'orgasm.'

This my friends, is why I'm so excited about Dr. Prause and her work. It is so incredibly important because she just might finally be the one to jump the scientific study of female orgasm forward after almost 40 years of relative stagnancy because she is going to give the question of female orgasm the care and scientific rigor it deserves.

Here are 3 reasons I think her approach is so revolutionary for the field right now.

1. Past research has largely not taken seriously the possibility that women might not give accurate accounts of their own orgasm, but Dr. Prause does.

In Science, Sex and the Ladies - the movie, we talk about how female orgasm is an incredibly stigmatizing subject, but scientists don't tend to approach it with that in mind.  Orgasm is clearly something women believe is important, something men take pride in 'providing' to women, something sexperts have been saying for decades is important to a woman's relationship health and her mental health - especially an orgasm during intercourse. At the same time, it's something that many women cannot have as often as they'd like - particularly when in a partnered sexual situation - and especially during intercourse. On top of all that, there is a lot of confusing misinformation about female orgasm and female anatomy.

So, there are lots of reasons a woman might say she orgasms when she in fact does not. You would think that scientists would see this as an issue to consider deeply when studying female orgasm. You would think there would be considerable effort to understand which answers given by women about their own orgasm are accurate, which are lies or half-truths, which come from a different use or meaning of the word 'orgasm,' or which are based in misinformation or confusion. Scientists do this with other 'stigmatized behaviors.' There is real effort to get more honest, accurate answers when asking people whether they engaged in male-male sexual behavior or had an abortion or use condoms consistently. Scientists understand people might not be giving them accurate information on those topics, and so they take pains to get better answers. Women's ability to orgasm should be treated with similar care, but it rarely if ever is.

2. Dr. Prause's work could help clear up our orgasm vocabulary. 

The word 'orgasm' is used indiscriminately for female orgasm in a way it is not for male orgasm - not only in our common language, but also by sexual educators, and often by orgasm researchers. How can there be top-notch research on female orgasm, when the word orgasm could mean a feeling, a tantric/spiritual event, an ejaculation, or an orgasm that exhibits a set of rhythmic pelvic muscular contractions. When a researcher is studying 'orgasm,' which are they actually studying? Are they lumping these different experiences in as one, and how do different studies about orgasm actually relate to one another? Lack of clarity means lack of thoughtful conclusions. Dr. Prause is advocating measuring for anal contractions (among other physiological measures) to discern whether the physiological aspects of orgasm were exhibited or not at the time a woman claims to orgasm. It seems so simple, and obvious, but it's not. It doesn't happen often in orgasm research, but doing so could eliminate a ton of confusion and mystery that has surrounded female orgasm for decades.

Now, it's not that there aren't studies that have looked at pelvic muscle contractions in relation to orgasm.These types of studies are the basis for our knowledge of the physiology of orgasm. It's just that these types of measurements are largely abandoned to rely solely on a woman saying she had an orgasm as a way to define when an orgasm happened. This is where all the confusion comes in because it is not sensible (and bad experimental design)  to always assume a woman is having those rhythmic pelvic muscle contractions when she says she orgasmed.

Besides the work Dr. Prause discusses above, I know of at least one other study that found women who said they experienced orgasm but did not show the physiological signs of orgasm. The authors did wonder if the women who did not exhibit the physiological response were actually orgasming, but ultimately decided to accept all claims of orgasm as orgasm.  I loved that this study reported this discrepancy, but I was sad that this 2008 study, had pretty much no previous data to help them account for what was happening with that discrepency. I know of another study that also recorded anal contraction data during orgasm but chose not to publish that part of their data. I always assumed it was because the contractions didn't always coincide with women's claims of orgasm, and was thus inconvenient. Largely, though, female orgasm studies forgo the physiological check of orgasm, and are worse off for it. The discrepancy between what women claim about orgasm and what their body is doing is a real thing that needs to be acknowledged and incorporated into experimental design of all orgasm studies.

This is particularly important because sexperts and even quite educated sexual educators use these confused studies to teach the public about female orgasm. So, for instance, there is not physical evidence that an orgasm (and as always, I'm speaking about the thing that includes the particular set of muscular contractions) has been achieved through cervical stimulation or through thought only - with no physical touch at all. However, there are some studies (for instance, this one) that claim there is evidence- because they base that soley on whether a woman says she reached orgasm or not - as opposed to whether she physiologically exhibited signs of orgasm. This kind of thing has led to tons of women, based on what they read from sex advisers and the like, thinking that there is science backed evidence that they could achieve orgasm from things like thinking or ramming things against their cervix - when that is simply not the case.

3. She is brave enough to say a thing that needs to be said.

I think there is real nervousness and fear in saying it is possible that sometimes women say they orgasm when they don't. I'm not talking about 'faking' in the most common of meanings. That's pretty clearly something that is found in both surveys and common cultural knowledge - women intentionally faking for some reason or another. No, what I'm talking about here is a fear from sexperts and sexual educators and sexual researchers of saying that it is quite possible that sometimes when a woman says and believes she orgasms - nay KNOWS she orgasms in a situation, she might be wrong. She might not actually be showing signs of physiological orgasm, and although she might be experiencing something - even something pleasurable and enjoyable, she is not experiencing the physiological part of orgasm. The data indicates that sometimes women do this, and it needs to be acknowledged to move forward with honest inquiry. Dr. Prause is doing that, and it's awesome.

There is fear in saying this for a variety of reasons...like that the established medical community has a misogynist history of not listening to female's experiences, and no one wants to be seen as a misogynist that says women's explanations of their own experiences are wrong...for instance. Another reason, is that people lose their shit in the comments section of the interwebs when you even allude to this topic. Believe me. I know this first hand. It's a deeply personal and sensitive topic, and people are passionate. Getting into the weeds about this is time-consuming and draining, and I think a lot of sexperts and sex education or research professionals would rather just avoid it altogether.

Prause - An Orgasm Equality Hero
So I'm so elated to see such thoughtful, honest discussion on this topic from an actual female orgasm researcher. I'm not saying all lady-gasm researchers are shit or anything. I mean there are a couple who are, but I am saying that she is bringing a particular perspective and a quality that will greatly improve the information coming out of this discipline - and for that I am grateful. So grateful in fact that I'm adding her prominently to the ever growing list of Orgasm Equality Allies because it is so, so absolutely true that more accurate information about female orgasm will help all us ladies better understand and more easily navigate our orgasms and our pleasure.

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