TODAY'S GUEST: Dr. Nicole Prause

I'm extremely happy to welcome Dr. Nicole Prause to Hard Conversations!

Dr. Nicole Prause, Ph.D. is an American neuroscientist researching human sexual behaviour, addiction, and the physiology of sexual response. She is also the founder of Liberos LLC, an independent research institute.

Prause obtained her doctorate in 2007 at Indiana University Bloomington, with joint supervision by the Kinsey Institute for Research in Sex, Gender, and Reproduction. Her areas of concentration were neuroscience and statistics. Her clinical internship, in neuropsychological assessment and behavioural medicine, was with the VA Boston Healthcare System's Psychology Internship Training Program. Her research fellowship was in couples' treatment for alcoholism with Timothy O'Farrell at Harvard University.

Prause became a tenure track faculty member at Idaho State University at the age of 29. After three years there, she accepted a position as a Research Scientist at the Mind Research Network, a neuroimaging facility in Albuquerque, New Mexico. In 2012, Prause was elected a full member of the International Academy of Sex Research and accepted a position as a Research Scientist on faculty at the University of California, Los Angeles in the David Geffen School of Medicine. While there, she was promoted to Associate Research Scientist in 2014. Institutional attitudes towards sex research and ongoing safety threats from anti-porn organizations prompted her to found Liberos LLC in 2015. This private research institute and biotechnology company is funded entirely by grants from the federal government and undisclosed private organisations. She is also a licensed psychologist in California.

• WEBSITE:

  https://www.liberoscenter.com/

• Twitter

• @NicoleRPrause

YOU'LL LEARN

• The relationship between erectile variance and testosterone

• The body is not just being driven by testosterone, it’s driving testosterone

• How anxiety inhibits erections

• A little bit of anxiety is good - the Yerkes Dodson Law

• Get your brain in a sexual set

• What neuroscience knows about sex and erections

• That the brain responds very differently to sexual imagery than it does real-life people

• Thousands of studies involving the International Affective Picture System have been conducted over several decades

• Masturbation is prohibited in most sex labs

• There are more sex labs in Canada

• How neuroscience validates sensate focus techniques

• The negative effects of porn

• Insights on sexuality

• There are many layers to how we interact with porn that determine how porn effects us

• How we study chemicals in the brain

• THAT WE’VE NEVER SEEN OXYTOCIN IN THE BRAIN (as of 2018)

• And more!

THANK YOU FOR LISTENING to my male sexuality and sex therapy podcast!

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About the Show

Introducing Hard Conversations, a podcast about male sexuality, and all things erectile, from the latest natural erectile dysfunction treatment to the best ed medical treatment. Therapist Tim Norton expands the conversation about male sexuality, adds context to why we struggle as a society to have hard conversations and breaks down how in a sex-positive environment there really is no room for taboos, judgment, or shame when it comes to penises.

YOUR online sex therapy and couple’s therapy HOST:

Tim Norton is a sex positive sex therapist working in private practice. He offers online therapy, online sex therapy, online sex coaching, and therapy and coaching for somatic symptom disorder.

Tim obtained his bachelor’s and master’s degrees from the University of Southern California. Tim is a proud member of American Association of Sex Counselors, Educators, and Therapists (AASECT), the Los Angeles Sexological Association, and works part-time with the Pain Psychology Center in Beverly Hills.

Hard Conversations podcast transcript

Tim Norton: Hello, and welcome to Hard Conversations. My guest today, Dr. Nicole Prause is a neuroscientist researching human sexual behavior addiction and the physiology of sexual response in Los Angeles, California. Her resume mentions among other things, a doctorate degree from Indiana university Bloomington research at the Kinsey Institute, a clinical internship at the VA Boston healthcare system, psychology internship training program, tenure track faculty member at Idaho state university research scientist at the mind research network, full member of the international [00:01:00] Academy of sex research and research scientist on faculty at the UCLA school of medicine.

She is also the founder of Liberos, LLC. Did I pronounce that correctly? Sure. Okay. And independent research Institute where she currently oversees ongoing sex research. Hi, and welcome to Hard Conversations

Dr. Nicole Prause: Well done. Thank you. 

Tim Norton: So today we're going to basically talk about. The neuroscience of erections.

I was speaking with a urologist the other day on the podcast, and he was talking about how, you know, there's usually three areas of,  of the body that affect erections has going to be hormonal blood flow and neurological. And so if you could sum up everything we need to know about the brain. And how it affects erections, 30 seconds, 30 seconds or less, our guests would really appreciate it.

So,  can you just speak [00:02:00] broadly about how the brain determines erections or is that just a ridiculous question? 

Dr. Nicole Prause: No, we can kind of dive in and see what happens. So, so the first thing the brain has to do is recognize,  stimulus,  or a cue, something that it encounters as being sexual. And that turns out to be a little more complicated than you might think.

So,  one of my favorite studies, they,  put some vibrators on guys' penises,  in the Netherlands of course, This is decades ago and they turned the vibrators on them and they watched their erections and they really weren't getting erect. And they said, wow, this stimulus is directly on their penis and they're not getting an erection.

That's bizarre. So they turned on some porn and then turned on the vibrator. Full erections. No problem. So what that suggested was that the vibrator itself, even though it's direct, tactile stimulation to the penis, does not necessarily do anything. Your brain has to recognize that it's being presented with something [00:03:00] that it needs to respond to, that it needs to activate that sexual system for.

And,  it doesn't have to be porn per se. Of course. It's just something that you recognize and the, you know, your penis vibrating alone is not a common form for most guys. So,  basically you have to, you know, see this kind of competent queue and then have,  networks of the brain activated that. Caused you to become motivated to act.

So,  with one exception, there's really no sex center in the brain. There's no area of the brain that becomes active and says, okay, you know, we're getting a wreck now.  we need to activate that, but. The centers that are most relevant,  are probably the salience network. So nowadays we don't really talk about areas of the brain as much as networks, because it's a recognition that these things don't operate independently.

They're all interconnected and salients,  links. Some of the areas that are really responsible for motivation. So just as,  like someone who's depressed, [00:04:00] these areas tend to be really under reactive.  someone who's manic, they tend to be very overreactive. And so the sexual response then kind of activates these networks that are associated with motivating us to go do something, to get off our butts, which is important for sex.

Then the only part that's really kind of specific to the erection is in somatosensory cortex. So just across the brain, you know, the you've maybe seen these body maps. Before where it says, Oh, your lips are here and your arms are here, you know, across the,  top on the outside. And there's an area for the penis too.

And it also becomes active when you watch the,  things being done to a penis on a screen. So there's some mirroring that occurs there, although we don't know a lot about those. So,  that's broadly kind of how things work that is, you certainly can sense things from the genitals going up to the central nervous system to the brain.

 but. You really have to have that central activation or you're not going to get anything downstream. 

Tim Norton: Okay. And that sounds like kind of a lot to stay on top [00:05:00] of, in terms of you've mentioned one area that we don't know a lot about. And it just seems like what's something as complicated as brain that there's really a lot of things that are operating at the same time.

Dr. Nicole Prause: There's a lot going on. Yes. 

Tim Norton: So one thing that I've always kind of struggled with is. I do get really excited about neuroimaging studies, but I, I sit and think about it and I say, well, that's just. One picture of one second of the brain at one point in time, isn't it kind of hard to make a huge generalization about that?

How do 

Dr. Nicole Prause: we, yeah, it really depends what you're trying to comment on. So there are some things I wouldn't want to step as far as like. I don't know if this stuff we're measuring in the lab really applies to partnered sex in a lot of cases. And there's some reason to think now that I have data on 250 people having sex in my lab, that I do,  I don't think that it does apply.

And I think we're about to change a lot of that literature. [00:06:00]  and so, you know, trying to,  Step and think like how generalizable is this, you know, as a laboratory. And so on the other hand, if you're trying to study something, like, I always say a vagina is a vagina is a vagina at some point, you know, if you're just trying to study,  blood flow dynamics in the vulva,  you basically just need someone who has a functioning full VA and.

Then you can comment broadly on when blood does go in this area. However, I got it there.  this is what that looks like in terms of temperature change, for example. So,  the things that are more kind of physiological, I think are very reasonable to look at in the lab and kind of the further and further we get from that, then we have to worry about like, eh, you know, is this really going to generalize to a partner setting, which is usually what people care the most about.

Right. And 

Tim Norton: usually how we hear the data reported. Like, it'll be a study that. Did some FRM FMR I technology. And then they'll say this means you want to have sex every 30 seconds. 

[00:07:00] Dr. Nicole Prause: Please, please. Your partner by doing this new XYZ move. 

Tim Norton: According to neuroscientists around the world. 

Dr. Nicole Prause: Yeah, we didn't say that.

Tim Norton: Right. And I bet a lot of times when you see anecdotal presentations of neurological neuro neuroscience research, you're saying she didn't actually, he didn't actually say that 

Dr. Nicole Prause: it does vary. I think,  like I've had to learn that I have to be comfortable sometimes telling media the brain responds more.

And what I mean is there was enhanced late positive potential at the time. Yo positive 500 millisecond Mark for the stimulus, comparing the neutral and this to that substance. I'm like, okay, the brain responds more. And so there has to be compromises made and it's like, the more you do that kind of work, you recognize hopefully when your colleagues are doing that, you know, that they're really more careful than that, but you have to be able to communicate.

Tim Norton: Okay. And so one of the areas that,  Gets a lot of publicity. These days is [00:08:00] porn.  porn is, you know, obviously being watched by hundreds of millions of people every day. And,  porn hub puts out as statistics every year of just how many people are. And it's, it's massive. And so I do see these headlines every now and then about neuroception scientific findings about porn, but when I.

Really thumb through the research. I'm not really finding a ton of it outside of you, not a ton of it, where they actually got the approval for the funding for the study, where they actually in a laboratory at ways actually masturbating. They were actually looking at their brain. Like I see generalized,  video games studies and, and internet studies and other things, but not is there you tell me, you tell us about how much data there actually is on good data.

Dr. Nicole Prause: Yeah, I think it does depend kind of how you're slicing it. So I sometimes see people say, Oh, you know, there's so little known about porn in the brain. And I say, you've [00:09:00] gotta be kidding me. They're 40 years old. So there's a, one of the most widely used emotions. Stimulus sets in all of neuroscience is something called the international effective picture system.

Or I apps. And this stimulus set contains pornography. It's been used all over the world.  there are thousands of studies with it. So if you say, do we know how porn affects the brain? I was like, yes. I'm like, we have a lot of data looking at erotic cues.  they're visual.  Now films of course have been more recent, but even in that respect, you know, this is,  most commonly how psychophysiology is provoke a response to the lab?

 I would say 95% of sex labs use porn to provoke sexual response. So really, really common stimulus.  what's maybe atypical is usually that stimulus doesn't last, like max five minutes. You know, we might hit three minutes,  most commonly. And so you can ask again, like, well, how generalizable is that?

And so what I am trying to do in my work is [00:10:00] exactly to take the next step and say, we need to be looking at the full response to really understand.  how people are interacting with and viewing porn to understand what is sitting down and viewing a film versus what most people are doing through it, which is masturbating versus then transferring that to something with a partner there.

Tim Norton: So a lot of that old. I app's research people probably wouldn't have been masturbating in a lot of those studies. Well, getting the visual acuity 

Dr. Nicole Prause: masturbation is almost always prohibited in our lab studies. We explicitly tell people don't do that. Okay. 

Tim Norton: Right. And so, which is, is that part of the reason why you have your own research thing?

Now? It 

Dr. Nicole Prause: is. So we had two things happen while I was at UCLA. I'd applied to do a study, looking at orgasm response in the lab. And they were okay with me vibrating genitals, but I had to promise that I would never have anyone have an orgasm. And usually an ethics board is required to give [00:11:00] you a safety or privacy concern that you can respond to, to, you know, get your study adjusted and approved.

So it's something you can do. And they refused to give us any, they just said, you have to remove the orgasm component. And I said, I'm not going to do that. It's about orgasm and. So, you know, we had like a letter writing campaign, a bunch of my colleagues wrote in and said like, this is real science. I don't know, like, what's going on.

 the chair personally said, like, he was really uncomfortable with the topic. Well, then we need another chair on this board, but we couldn't get it through. And so that's just dead in the water. If you can't get your stuff through ethics board, you can't do the study. And then we got a grant that was supposed to be two years to fund my work.

And typically if you're on a.  position like the one I had, you get grant funding, the school accepts the money. Like no question, you know, they, they always take money. Universities don't turn down cash, but this was to have partners come into the lab and interact sexually. The school refused the money.

So at that point I kind of realized this is not going to be able to happen here. And it [00:12:00] really is,  I, the nature of the work. And when I was initially at Kinsey as a student, I always said, I thought if the work was good enough, it wouldn't matter. I said, you know, we're going to get over this. This is a puritanical thing that the us is like moving through.

And I don't say that anymore because I ran into it myself. 

Tim Norton: Would you say that that was particular? So I went to USC and there's a huge green and I want to bash UCLA any chance I get, let me help you. But was that, would you say that was. Particular to UCLA, like, are there other institutions that are more liberal with the kinds of research that they allow?

Dr. Nicole Prause: Definitely European universities are. So for example, with the pornography research that I've done, I've been prohibited from recruiting patients in the U S because they say,  if these people are porn addicts and you show them porn, you're going to cause them to relapse. For some reason, the Europeans don't think that way.

So they don't,  they allow them to test patients there. So that's been a challenge and trying to generalize some of my [00:13:00] work,  And the labs of course vary some from place to place. But I will also say, I don't think I had any protocols that were that challenging when I was at those other institutions.

I was doing stuff that was a little more standard. I mean, I had a, at the mind research network, you mentioned I had a pneumatic vibrator in the FMRI,  that the, they tolerated. So what kind of vibrator?  pneumatics. So when you take things into that Fri they can't have anything Ferris. Metal in them.

Cause you'll hurt people. It's a large magnet. And so pneumatic is just air driven. So we had a giant compressed air tank in the control room that we just ran tubes through,  to the genital. So somebody else had done this work,  making a vibrator for the forearm. And I said, well, we're just gonna move it down.

We're just gonna move it. Fan blades and put it on the genitals. So,  we were doing some of that kind of work, but it wasn't partnered, it wasn't to orgasm. It was really just kind of swapping films for vibrators at that 

Tim Norton: time. Okay. So [00:14:00] you're mentioning all kinds of research that I guess I don't see very often.

It sounds like it always seems like it's hard to get this kind of research funded, as we're saying. And, but you also mentioned other research sex labs. Are there a lot of. What you have a lot of these kinds of places, 

Dr. Nicole Prause: not in the U S so most of them have moved to Canada. So,  the Canadian federal government actually has money set aside at, for sexuality like female sexuality studies.

 here we have been advised by program officers at our funding agencies, not to use the word sexual in our grant applications.  that makes it impossible to dream about,  seeking some of these larger grants.  that are federally sponsored. So,  sometimes they can kind of repackage them, you know, and try and put them,  as something that might be useful for depression.

Something might be useful for,  sleep disorders, for example, but it just, the funding climate is already so tight. You know, about 8% of [00:15:00] grants are funded, depending what agency you look at.  so you already have a very, very high bar. And now you're going to say, if you climb that bar, there's a very good chance.

Just the content,  will prohibit it from being funded. 

Tim Norton: Okay. Man. All right, well, so I'm back to erections. So when we talk about,  regardless of where the research stands, why, what did you find? So you w when I Googled porn addiction and erectile dysfunction and Google scholar,  you come up, you come up pretty much near the top.

So what did you find? 

Dr. Nicole Prause: So we,  There were kind of two studies, I think that are relevant for that. And one was a study I did with Jim Fouse, where I scraped together. My 10 years of testing people doing random sexual things in my lab and said, who in these studies do I have measures ever tell functioning with a partner?

And do I have some indication of their,  [00:16:00] sexual response? And so I.  tried to link those two things in, I forgot exactly what the sample slides ended up being, but a couple of hundred guys and found kind of two pieces. That is one that,  to the sexual films that we showed them in the lab, which are very,  very vanilla.

So we have one man, one woman consensual vaginal intercourse. That's the definition of a sex film that 99% of is use in the lab.  and so you could argue if someone, you know, has been viewing a lot and you're making the argument that someone should escalate their use, that the nature of porn is such that,  you have to continue to see things that are more extreme or it doesn't work.

Then you would expect that someone who thinks they're struggling in this area, Or has a lot of porn exposure is then not going to be responsive to these kinds of lower levels stimulating. And we didn't find that. In fact, we found the opposite that was guys who'd had kind of more exposure to the films actually, [00:17:00]  reported feeling more sexually aroused.

And for guys, this is not the case for women, but for guys,  their self-reported sexual arousal in their erectile responses,  are highly correlated. Most commonly.  so it could be that, that wasn't the case in this study. We didn't record erectile responses, but there's good reason to think that they should be.

And there was another,  lab that did that work,  with PNL measurements.  but the other piece of ours before I get to that is,  then we looked at just the porn viewing with their erectile functioning, using the international index work, tell functioning questionnaire. And there was no relationship there.

And when you see no relationship, the main thing you have to be worried about is,  is it possible that there was a small relationship and I just didn't have enough people to see it. That is, was this statistical power sufficient to see an effect, had it been there. And,  it was sufficient to have seen a small effect size, and we still saw no evidence for it.

So that was my paper. That was probably the [00:18:00] closest to that topic. 

Tim Norton: Okay, let's whittle that down a little bit. So being the first one, you know, in addiction terms is tolerance. Really what we find with people who are technically addicted is that more and more, they need more and more stimulation in order to get the same desired effect.

And that's what a lot of. The anti-porn advocates were talking about. And then you didn't find that you found the opposite of that. Yes. Yeah. Okay. And then with the other one, how would you tell it to the media? Like in when like one sentence 

Dr. Nicole Prause: we've found no relationship between the amount of porn viewing and erectile difficulties with a real partner.

Tim Norton: Has there been a lot of studies like that 

Dr. Nicole Prause: there've been a number of them. It hit around that. So kind of,  different pieces of that. So just by chance, when our study came out, literally a week later,  Alex Sanders,  still Hoffer's laboratory in Croatia. I had a study that did this. Same kind of thing.

Almost like he used the same freaking questionnaire. I was like, Sasha, where you been? [00:19:00] So we just,  we easily could have been his replication and it turned out in his study as well. Like they just didn't find relationships between porn viewing and this international index, worst health function.  so that was probably the closest, but,  Jason winter's work.

Is,  someone that also had guys trying to like self-regulate,  looking at whether or not they felt like they had problems in the laboratory to films and found very similar to what we found that is,  people who thought they had problems actually were more responsive. They don't seem to have done down-regulated or not be responsive to these kinds of vanilla milk toast.

Similarly,  And another one is like the Kinsey tested a group that had some reasonable criteria for,  what was, what would have been sexual compulsion at the time. And,  we're measuring erectile response and found no relationship,  with the erectile response in the laboratory. And there, [00:20:00]  felt.

Difficulty in the real world. So there are a few streams like that. Then there's some broader ones. Like there's a study out of Netherlands just last year. That was the first that had a nationally representative sample. So part of what we always work with with laboratory is we have to be aware, you know, who is it?

This walking in our door. Yeah, who's willing to come to these studies. And the most common bias by far is they tend to have higher sex drive on average. And they actually don't differ that much in terms of like religiosity or things you might guess, but the nationally representative studies kind of make sure that that didn't happen.

That is they make sure they got a good kind of cut of society. And so at the Dutch study found was there was no relationship between sexual dysfunction defined very, very broadly. So their measure was not as detailed.  And,  port and belief that you were addicted to porn. So,  that was nice to see just because we had some confidence that it wasn't just the weirdos.

We got to come do our stuff. Right. 

Tim Norton: Okay. And [00:21:00] there's so many different dimensions, but one thing that you keep touching on is, you know, how we define addiction or a sexual compulsion, I think varies. Throughout the literature. And so I think that's, that's one part of this. And then the other part,  that I see people debate a lot is, is the idea of withdrawal.

And when we're talking about, you know, heroin addiction or alcohol addiction people, when they stop drinking alcohol, they literally shake. Like, I never really want to define alcohol addiction when I'm working on that with somebody, right. But if they say they're shaking us. Okay. We've we've got problems.

So I need a medical detox where he'd read me something. Yeah.  there no shakes and porn addiction. And in that, I think, you know, if you go on to like different websites where guys are talking about the things that they're going through while quote unquote, withdrawing from porn, they re report all kinds of things for [00:22:00] sure.

But has that, has any of that been shown in a lab? 

Dr. Nicole Prause: Not that I know of. So,  I was curious about this as well, at one point, cause I said, well, what, what are they saying? Withdrawal is because as soon as I know what the claims are, then I can test them. And it turns out of the published literature, at least, I don't know, website wise.

 the most of the effects seem to be claimed to be physical. That is, they are saying, you know, sleepiness changes,  alertness, concentration. And I was like, those are all things I can measure. So we, we have some data around some of those now, certainly not all of them.  and so I don't know. I don't think the claims are as narrow as,  you know, just, I feel sad and that's going to make it hard, harder to quantify.

We can measure sad, but, but it's a little harder to quantify. So,  I think there are clear enough claims there that withdraw claims can be easily tested, but I have not seen them [00:23:00] tested well, certainly by questionnaires. Totally people report them. But as we've seen people often report things that aren't really 

Tim Norton: there.

Right. Yeah. And that's, you know, that's why we want the neuroscientific data is, is we're, we're tired of just the questionnaires. And so, and you're, so you're saying neuroscientific evidence of withdrawal as it has to do with porn. Doesn't it just yet? 

Dr. Nicole Prause: I haven't seen anything convincing. No. Okay. 

Tim Norton: Yeah. And then the other aspects of addiction that we normally talk about, I can't imagine how.

 you would study, like I also say, I don't want to want to even use the word unless you've had some ramifications. If you're drinking two bottles of wine every night and your partner's not upset and your physical looks fine and you're not missing work, then why did you even call me? I don't want to, it sounds like a lie, but you know, if you're fine, then my I'm not going to slap you and tell you to go to an AA meeting.

And so I don't know how. You know, neuroscientists could quantify or [00:24:00] look at something like that.  and all the behaviorals have an isolating. And,  

Dr. Nicole Prause: yeah, so,  we're trying there's  so one of the criteria I would say of most addictions is negative consequences and there is a questionnaire that was made a long time ago that I like to use because it kind of divides the concept into where one is kind of.

Feel bad feelings. And the other one is negative behavioral consequences. And that's part of why I like it is it's like, okay, but really have you been fired? You know, like what is something really happened to you? You know, not to, it's terrible that you feel bad and I I'll try and help you with that too, but there's anything really happened behaviourally that I can document.

 and so erection problems have been a good one because that is something that's so easy to quantify. Like if you're saying the negative effect for me is I can no longer have sex with my partner. That's a good one. We can test that.  another potential negative effect is just feelings of disconnection from the partner that is,  [00:25:00] you know, maybe I have some.

 type of,  avoidance or anxiety connection rather than a secure connection. If we didn't want to go all attachment theory,  with folks and maybe the pornography viewing is either a symptom of me for having those feelings or it's driving me having those feelings. And so I'm no longer able to kind of relate and feel intimate,  in some sense.

And that is what we currently have under review at a journal. So I can't tell you the results. Okay. But we're trying,  So that was part of our, a couple of studies. We had folks where we assessed their kind of attachment status and looked at its relationship with pornography and felt compulsivity okay.

Tim Norton: Oh, fascinating, please.  let me know how that whole I'm sure. I'll see it. Hopefully maimed and blogged everywhere. And then yeah, 

Dr. Nicole Prause: I see. Yeah. Fingers crossed. He's always takes so long, but yeah. Okay. 

Tim Norton: When I'm in, in psychological communities and therapy communities, we use a lot of [00:26:00] neuroscience language in our, you know, mental health write-ups even at some times.

And there's a handful of parts of the brain that I hear a lot of therapists talk about.  And in it, I think it's really makes them sound more convincing to clients. And it's good too, to know those areas, but it's another thing that I also worry that gets oversimplified sometimes. So one thing that I always see with porn and erections and then sex and everything is dopamine.

Hmm. And so there's listeners out there couldn't see her face. And I said that, but it looked a little exasperated at it. Never 

Dr. Nicole Prause: too old to roll your eyes. 

Tim Norton: So if someone's understanding, if they just looked at the headlines was, you know, look at porn, get dopamine, get addicted to dopamine, and eventually you don't get any dopamine.

From porn and you're depressed and you don't get erections. So I get this terrible. I get the sense that this problem will be a [00:27:00] thousand times bigger than what we're talking about. Because when I look at the numbers on PornHub,  a but B I I've also have seen some headlines around how we do oversimplify dopamine, and that it's, it's actually a little more nuanced than just this.

Pleasure chemicals, so to speak. 

Dr. Nicole Prause: So there, yeah, there are a few things with dopamine that I would love to never see again, in that what you just mentioned is probably the biggest one that is,  there was some really Seminole important work done by Schultz years ago, showing that dopamine is not responsible for pleasure.

That is not a pleasure chemical period, do not call it pleasure. Dopamine is not pleasure, dopamine,  surrounds it's around pleasure. It happens also when pleasure happens often, but not all the time. And so what I'm trying to get at as the main function, well, okay. WWII has multiple functions, but in this context,  its main purpose is to help us learn.

And so. When you see something that's novel,  your brain tags it by saying dopamine [00:28:00] salience network come online. We need to remember what just happened. We didn't know that this was a thing. So pay attention brain, and it helps us learn in that way. And then again, you know, some people,  will say yes, and these, these neuroplasticity changes as like, you mean learning.

That's learning. So neuroplasticity is like this big word people like to throw in with dopamine.  and there's really,  there's nothing super stimulus about porn. That is, it does not.  So one of the challenges like with cocaine is it is driving the system, using its natural,  centers harder than it can drive itself.

So the exoticness substance comes into the body and can occupy more of the dopamine receptors than,  we would be able to by doing anything,  running or masturbating,  porn can't do that. Masturbation can't do that.  it can't occupy more of the dopamine receptors than our. Naturally able to be [00:29:00] occupied.

 they are an indogenous function. And so they use indogenous systems to generate their feelings of pleasure. 

Tim Norton: I'm going to go out on a limb with endo and XO, the Dodgers as an exemption is so exogenous, being external stimulus, stimuli 

Dr. Nicole Prause: coming in and stuff. Yeah. 

Tim Norton: And endogenous being things that happen inside of your body.

Dr. Nicole Prause: Yep. Exactly. Okay. And so it's,  to some extent like the, your body self limits, you know, it's like, you can only drive the system so hard. And so sometimes I see people describe porn as having like some incredible, like it's driving the system. I said, Porn isn't gonna do anything that you were not doing with it.

So by paying attention to it, by engaging in a fantasy with the material that you're encountering in the same way that I can,  turn a vibrator on, on your penis and not have you have an RXL response, I can show you a porn film and ask you, watch this film as a director. [00:30:00] Critique the appearance of the actresses,  pay attention to the lighting.

 think about how awful the dialogue is. If there is any dialogue and blammo, you still got all the content of the sexual stimulus, but you don't,  have a sexual response to it. And that's a particular type of emotion regulation.  That,  we often refer to as reframing. So it's,  an alternative strategy is like distraction.

So just, you know, taking your brain somewhere else while you're watching the thing. And so that's kind of another piece is that, you know, it's just by having this. Thing presented to you that is these images coming in.  you can only drive the system so hard and it's not done automatically. And that is, you know, this dopamine is not, I see bathing the brain, it's not bathing the brain.

So there was no bath.  there's nothing super stimulus about it. That is it's not driving the receptors harder [00:31:00] than they're able to endogenously drive themselves. So I would say it's the. Maybe two key things with dopamine are it's not responsible for pleasure.  and that it's,  not flooding the system in any sense.

You know, there's really not,  a pouring in of the closest thing I would say to like, if you what's the highest dopamine change you could possibly get might be an orgasm and it doesn't modulate with orgasm. Okay. Okay. So increases with sexual arousal, but not an orgasm. Which is weird 

Tim Norton: dopamine doesn't ModuLite with 

Dr. Nicole Prause: sarcasm.

Yeah. So we,  there's increases up until that point. And there's a little bit of debate about like how well we can capture that exact moment because it's so fleeting and only happens one time. And that's the science is about, there's a, yeah, some of that,  So, yeah, there's still some questions there, but in general, the data we have so far, it looks like it doesn't especially spike with orgasm per se.

It's like [00:32:00] dopamine increases an earlier section. So 

Tim Norton: then, then what's the pleasure chemical during orgasm. 

Dr. Nicole Prause: So we think,  opioid based, but I don't know. Because other challenges, we don't have good orgasm models and a lot of animals where we could do some of that basic work. And so like, Jim Bause has done some work recently trying to argue that female rodents have vocalizations that are consistent with orgasmic response in his rats.

 there's some arguments to be made there.  I'm not sure I'm convinced because there aren't kind of other physical.  correlates there that I would expect to see with guys, we can make a little bit more of an argument for animal models cause they have ejaculation and usually that's accompanied by orgasmic sensations in humans, but there again, like how do you decide an animal had an organism?

Tim Norton: So how would we even study that? Provably in humans. Like if we were the, some shady fascist, underground rogue [00:33:00] lab, like what would you literally have to do to see what chemical was happening during an orgasm? 

Dr. Nicole Prause:  so probably the closest way. Is to do something to speed up a positron emission tomography.

So pet,  or positron emission tomography. He is,  you can use radio ligans to tag stuff in the brain, which just means I inject you with something that will,  get on a particular chemical that I'm interested in. And there are some really good ones for,  dopamine.  There aren't any for oxytocin.

And then they vary for other things oxytocin. So we've never seen oxytocin active in the brain. So if you ever heard oxytocins, they'll love chemical in the brain for bondings. They'll say it's in the periphery, but it's not, we don't know what's happening in the brain. We can make some guesses based on animal work, but yeah, 

Tim Norton: we haven't even seen it.

Dr. Nicole Prause: We can't working on that tag right now, but,  I. I haven't seen it published yet. [00:34:00] So just 

Tim Norton: ruining everybody's understanding 

Dr. Nicole Prause: of my science. I know for, and,  yeah. Helen Fisher is a little aggressive in her interpretation of oxytocin. Yeah.  because there, there are changes in the periphery with sex.  and there are reasons to think it might be the case, but there's no direct evidence.

So I would love to see as a pet. Sampling continues to kind of speed up. And some of the things we can tag are going to continue to advance. I think that's the most likely place we would see evidence with dopamine is, you know, once we're able to get it kind of quick enough that we can be confident that what we just got was actual orgasm and there are other issues with that with women, especially.

So I'm trying to, what do you define as the onset? You know, what's the offset,  we're doing work on that right now and. So I think that's probably where it's going to come from. Our best information is just as that technology continues to develop. 

Tim Norton: And so how do we [00:35:00] transition this into erections? So I think one might guess he, if, if,  my dopamine levels are low, then I won't be able to get erections.

Dr. Nicole Prause:  They would have to be damn low in a sense. So,  We get this with testosterone a lot too. Like guys, if they have some erectile Fe failures, I shouldn't even call them failure. Rochelle variants, they have a new name for it.  you know, they often will make, you know, I think I need to go on T my team must be low and,  there is not a good documented relationship between testosterone as long as it's in physiological range.

 that is, if you happen to be a quote unquote high testosterone,  versus on the lower end of normal,  your erections are probably fine. It's once you end up getting on the very low end to where, you know, you actually have a hypogonadal problem in the [00:36:00] case of testosterone, that you start to see an impact in that area.

So,  I don't see. And if you need to increase your dopamine one way to do it is to masturbate because,  you know, maybe this is a good bar trick. I don't know, but.  often when guys seem to want to brag about their testosterone level. Oh, I got tested the other day and my range is high. I was like, yeah, it means you're masturbating a lot.

Cause you're single. So they don't realize what they're saying,  because you should never do that to a sex researcher.  cause we know, but it's  so you know, the body is not just being driven by testosterone. It's also driving testosterone. So if you're very sexually active, even by yourself, You can increase your own testosterone, dopamine levels by doing that.

And,  we think that may be therapeutic and helpful in some, with some difficulties. So,  still trying to understand some of it.  but the, the system is a lot [00:37:00] more kind of cyclical. I would say. It's not like, Oh, you know, my dopamine is low. And so if I go take cocaine, no, my erections will be good. Don't do that.

Tim Norton: Okay. So masturbate more. Is the lesson taking away from there, but we still, we just don't know. Cause people talk about, there was actually not a, a great link between testosterone and erectile dysfunction or erectile issues.  but I only see that about 10% of the time, I'd say 90% of the time. I see, you know, that's the first thing you should look at.

Dr. Nicole Prause: If it's, hypogonadal sure like in that maybe, and they never say that I've never, never, yeah. Like an MD might reasonably suggest that because if that's the case, that's an easy solution.  we have very straightforward and if it's not that. Now, what are we going to do? So we used to,  give you a device to take home, to wear on your leg, that you would then loop around your penis and it [00:38:00] would measure your erections during sleep.

For two nights, nephew got erections at night, we said, then your erection problem is psychogenic. And if you didn't get them, we said it was organic. We now know that's not true. So we stopped doing those tests.  well, Most of us and 

Tim Norton: she's gone some people out today. 

Dr. Nicole Prause: So,  yeah, there,  and because I think Viagra is now so available and so cheap in most cases, I think there's very little interest in looking at etiology.

If you're a physician and somebody comes in and says, my is bothering me, you just give them a prescription for a PD, five inhibitor,  whatever that class is. And so. I don't know that people are doing that work anymore, you know, to really think through like, where is this coming from? Why? And the doctors don't really need to, in the sense that,  you know, unless it's, hypogonadal like really kind of severe problem that has clear medications to address, [00:39:00]  then they're not going to go through testing anymore because it really doesn't differentiate.

And here we have this pill that's super effective. 

Tim Norton: Yeah. Okay. So it's not just dopamine and oxytocin and testosterone. I also hear about serotonin and endorphins or any of these other things, something where I can eat like a nice brain food for, and then I'll get better erections. 

Dr. Nicole Prause: Yeah. A lot of those things are really hard to disentangle in humans.

So one of the ones that we. Maybe know more about is if you are taking an antidepressant and you were taking a SSRI, selective serotonin re-uptake inhibitor, chances are very good. You no longer have orgasms. And that may later affect your erections as well, just because why do I bother? I'm never going to have an orgasm and then it's just going to know me,  which you shouldn't think that, but whatever.

So I, you know, there.  [00:40:00] like in the case of serotonin. So if you're taking something like that, to be helpful, we have kind of a natural experiment and I'm like, okay, well, if we put a bunch of serotonin in the system, you know, that alone is not enough. You need an intact sympathetic, nervous system functioning to support interaction and orgasm and you know, all of those things.

So,  it's not enough, certainly just to have those things intact or to have them high or, or working in general. But I would say that one of the best,  well-documented causes of erectile problems is anxiety. So to the extent that these chemicals are associated with you having better mood and being less anxious with your partner,  whether that's for,  we'd say threat of performance, failure, theater, performance consequences.

So kind of two classes of anxiety are very common. That is,  I'm not going to get hard. And my partner's going to laugh at me or think I'm less of a. Dude or,  leave me whatever,  or,  you know, I'm going [00:41:00] to have this sex and this person is going to get pregnant by me. I don't want to deal with this person being around, you know, this is supposed to be a short term, whatever the kind of,  wherever the anxiety comes from it, that is it.

Dang good inhibitor for erection. And so, you know, to the extent those we can modulate those systems, kind of whether it's search synergic,  or dopaminergic to kind of support people, having less anxiety, that's probably what's going to be most helpful. So rather than worrying about being happy, I worry more about reducing anxiety per se.

Tim Norton: And so how does that work? So let's say I'm worried that I'm going to get her pregnant. How do I get from that thought to,  flacid penis? That won't 

Dr. Nicole Prause: right. So Mike is, so I work more and the functional space, and so I don't want to step on molecular toes. This is a little more Jim's world, but a fast world, but,  [00:42:00] So from my perspective, kind of what happens is there when you're having a full arousal response, there's an early stage when you're trying to get sexually aroused.

So you have high evidence of high effort and cognitive engagement in the brain. And you're saying, come on, buddy, let's go. Let's do this. Let's go. And then later on in the response you say, okay, I'm sufficiently aroused, whatever that is. We're still working on that. Now I'm going to have an orgasm at some point and let myself go there.

So I'm going to reduce cognitive control. And now we see hypofrontality like decreased activity,  less engagement, more,  cortical idling, you might say,  in the brain. So. To me, the main problem with erections then is most likely to happen in that early phase. That is when like I'm supposed to be expending efforts and really engaging.

And so if I get a little bit of anxiety, it can actually help me. Yeah. That is that's the rollercoaster study. You know, you come off a roller coaster, your [00:43:00] heart's beating a little faster and you attribute it to that cute person. You know, you see the rollercoaster and so you respond a little bit more than you might otherwise, but then you tip over that scale and now.

 you're no longer able to engage that sexual excitatory system because you're just looking for danger everywhere and,  worried about the pregnancy. And so to me, it's that kind of delicate balance of like, you need. In the early stage to develop an erection, to be able to,  focus on and expend effort to get your brain and a sexual set.

So that is,  I am now in a sexual situation. And that's what I'm thinking about. I'm not thinking about pregnancy situation, 

Tim Norton:  but you are a little. Riled up. You're a little, 

Dr. Nicole Prause: there's some, yeah, there's some Yerkes Dodson curve there. So that's the optimal arousal idea that is,  and this exists in many systems, of course, that it's, you need a little bit of activation, but I would say in [00:44:00] this case, like the activation has to be of a type, you know, that's,  those motivational systems.

That's not a strong frontal inhibitory activity. That's going to shut that down. 

Tim Norton: Okay. So would it, would it be like a little bit of cortisol? In the beginning that, 

Dr. Nicole Prause: yes, that's fair. I feel okay with 

Tim Norton: that. And then, but we, and I doubt we could study this live. But then we'd want us to it, but then we'd want it to drop.

 so we could, it sounded like you were saying, so we could be more present in the sex. So, so the, some of the frontal lobe activity would slow it down. 

Dr. Nicole Prause: Yeah. Part of what I love is this stuff feeds, I think right into sensate focus. It's like maybe they didn't think of it as doing that, but I do,  I think,  maybe part of what the mechanism is for that.

Exercise working is partially like I'm just going to be touched and I'm just going to feel it. And I'm not going to, you know, like I'm just going to concentrate on getting my head in this thing and feeling everything as much as I can [00:45:00] feel it. And I'm not worrying about where it's going or you're having these other inhibitory things come on.

And I'm not worried about trying to have an orgasm that's, you know, Week eight or whatever, sensate focus. So,  I think it might be getting at some of those things,  which always love when you find like afterwards. Oh, that's probably the mechanism. 

Tim Norton: Yeah. And then thousands of old time sex therapists would be saying, yeah, yeah.

You can tell me anything new, but so neurologically. You, you say sensate focus and maybe I should talk about how, what that basically is, is,  hallmark that your sex therapist gives you where you very gradually touch each other in a very mindful way. And initially in a non-sexual way, like a non penetrative sexual way.

And then you gradually increase that touch and mindfulness over time until your, your back.  Firing on all cylinders. And so from your understanding of the brain and what happens to the [00:46:00] brain during sexual sexual arousal?  that seems like a good model. 

Dr. Nicole Prause:  yeah, I like it a lot for that. Okay. 

Tim Norton: And name drop some of the chemicals that would be happening at the same time as those sensate focus exercises or regions or 

Dr. Nicole Prause: so, yeah, I've never seen.

Anyone trying to sensei focus and record anything at the same time.   there has been some work done by Yana coach Jedis,  who is in Europe with guys being masturbated by their female partners with their head in the scanner and their case.  Yeah, they, he again is focused on some of these motivational salience networks.

And so you, you don't see,  the strong engagement of, again, like frontal systems that are going to be monitoring and doing what I associate with them. Spectator ring. So that other kind of concept that is I'm not [00:47:00] engaged in the sexual act itself. I'm kind of looking in from the outside, evaluating how fat I look or how much my partner is going to leave me rather than just feeling the sensations.

And so his people are all functional, you know, they're screened to not have issues,  significant sexual issues. And so that's largely what he's documented with the partners is just this increase in,  kind of motivational.  stance and salience network. So kind of nucleus, nucleus, accumbens, ventral striatum are classic.

In this respect. He's also looked at women,  tagging dopamine while they masturbate to orgasm. Awesome. So without a partner,  there is evidence, he was specifically, so with pet, you have to pick what you're looking at and who specifically picked a dopamine. So there were increases during sexual arousal, orgasm.

Maybe, maybe not,  some debate, so those kinds of changes are happening.  [00:48:00] but we don't have great evidence for them with partnered acts are really, really thin.  and then this stuff that we do have that's partnered is mainly like FSRI kinds of work and sometimes it's not well characterized exactly what the partners were doing.

So that's part of what, again, like with our.  the 250 people we had through,  we're trying to get away from porn models and really use partnered stimulation to see if this is really the same thing. So,  if I can go a little aside, if I haven't been going aside the whole time,  there is, there are big distinctions between porn in the brain and partner touch and the brain.

And this is part of why I don't expect there to be erectile problems due to porn use is because. They really seem to be completely different processes. So if you're just watching a film,  we'd say that's a secondary reinforcer because you're watching it and saying, [00:49:00]  wow. Normally I would be masturbating right now.

This is kind of weird to sit in a lab and watch porn, or, you know, I would be getting my partner in here because I'm like ready to go.  and I would like to start having sex now, please.  whereas the, the partner situation is the primary reward. So this is actual, you know, touch. And social touches really cool.

There's a lot of really neat work done on social touch that we're now expanding with.  Jim Cohen, who has done a lot of work in this area with handholding. I say, we've got to move, move the hands down, Jim. And so these look very different. Another way you could think of it as like,  when somebody followed people after we show them porn in the lab.

 a lab in the Netherlands and it turns out people are much more likely to have sex with their partner when they get home from one of our studies. So clearly the porn was not satisfying.  that is,  porn is not a primary reward,  and primary [00:50:00] and secondary rewards are represented very differently in the brain.

So it's really important that we don't try and make generalizations about how sex works. Based on porn studies, because I think we're studying very different things. And,  I really want to see a lot of work done in with couples and if not with couples, at least with vibrators, so that we're doing direct genital stimulation and can really talk about how that might generalize,  to situations people care more about.

Hmm. 

Tim Norton: Yeah, it does sound like that's work. That's really necessary.  But unfortunately probably, probably not going to take place in an American university. 

Dr. Nicole Prause: That's why I am where I am. 

Tim Norton: Yeah. And how long have you had this setup and 

Dr. Nicole Prause: five years?  three years now. Three years. So pretty young? 

Tim Norton: Yeah. Okay. Okay.

And right now you do have data from 250 people who had sex somewhere and not in this room that I'm in right now. [00:51:00] No, that's down the hall, somewhere down the hall. And I just wonder, do you, do you get, is there a lot of,  like a lot of people who.  think of themselves as exhibitionists who come for these studies.

Is that 

Dr. Nicole Prause: something? Yeah. People ask a lot of course, about who volunteers for these things. Oh my God. And there is some of that. I think that people,  You know, once you to know as the experimenter, just how open they are and like, you don't really need to tell me it was like, I get it.  so there is some aspect of that with some people I think who come in, but a lot of folks, especially like the orgasm setting I'm working on now, the woman are like, We need to know this about women's bodies.

You know, this is a very much a feminist agendas they're being paid to be here. And they're like the money's great. And that is helping me with parking, but I'm here because we need to know this stuff. So I think some of the motivation is altruistic as well.  [00:52:00] and we get by coming into the community, I've gotten a lot more diverse sample now.

So like the study that I was doing, I was shocked. Like we have a majority African-American women, it's like. We've never had, you know, normally we have a really young white sample usually and,  mostly queer women,  which I don't know how that happened, but that's great. And they don't need to be straight anymore because I don't show them porn.

So, you know, as long as you can masturbate in my lab,  so we're making, I think a lot of strides and figuring out.  you how to do this in a different settings, I'm going to try and make more people do it. And. And it's,  some of the benefits are there. I think in terms of like the diversity of folks that we get in.

And,  and it's not all folks who are just,  extreme and again, it really depends what we're studying. So if I just need to see the brain at orgasm, all I need is an orgasm. I don't really care how you got [00:53:00] there.  that is they should look very similar.  the contractions that are associated with orgasm are highly stereotyped.

They're very easy to see. So,  physiologically speaking. So that's,  I really love that kind of about having a different lab experience where folks can come in, who are not necessarily the frankly, mostly sorority girls in psychology, one Oh one classes getting credit. 

Tim Norton: Yeah. I think I participated in like 50 of those as an undergrad.

I really

okay. So, wow. This is all. Well, some of it's kind of a bummer because, you know, I think as clinicians, we feel like we know something about oxytocin and dope domain and how those things interact with the brain and affect behavior. And you're kind of, I don't know if you're saying that it's all wrong, but I feel like you're saying, dang, maybe [00:54:00] we're over-generalizing  with, with some of our, our.

Broad statements. 

Dr. Nicole Prause:  I mean, I think it's, there are of course elements of truth to all of this. It's like, none of that would be sticky if it was just off the wall. So the dopamine modulates with sex, it does, we're working on exactly how and under what circumstances and at what time exactly that's happening.

And,  we know it's not pleasure. So what is generating the pleasure and,  for example, When people have an orgasm, they have all kinds of different reports about it. And I was like, dude, it is the same physical thing, you know, from a physiologist perspective, I was like, it happened, it didn't happen. It was like, so why are you saying that when sucked?

And I was like, you had 14 contractions and you're telling me, you know, that was amazing. And this person was,  not satisfied with 20.  and so, yeah. Like that variance, I think [00:55:00] is really important to keep capturing for us as well, because the that's, the psychophysiology list is psychology and physiology.

And if you just get the physiology without kind of being able to translate into what the patient says, when they walk in the door, then we're not helping you very much.  and so I guess maybe that's part of,   what I would love to see is. You know, we use a lot of skepticism when people come in and report something,  which is not to say we're,  saying they're lying to us or being jerks, but it's like, we want to understand how that report got generated.

And if there was more curiosity around like, okay, this person is reporting, having this experience,  Do we want to just take their word for it?  or can we help them more by understanding etiology of what might be going on? So like in the case of pornography,  Marty Klein has a book that talks to him about his clinical cases that I [00:56:00] really like.

Cause he talks about, you know, a lot of the kind of back and forth. And the couple is being an insecurity of one that. You know, why does usually he, sorry, pick on the guys, but you know, why does he need that stuff? And he was thinking. I just like it. So if I can find, you know, some of these things in the brain that said he, he does just like it.

Like, it's just a thing he does. And is there some compromise we can have here so that he can do the thing that he likes? And it has nothing to do with the fact that he occasionally has erectile problems with you. You know, that he's not finding you unattractive, but this is kind of how they're managing,  their sexual life together.

 so that's why I really liked the psychophysiology approach is I think. You know, hopefully what we're finding in the lab can map on Maura to,  help a clinician say, you know, this, person's having this report. I know that when tested, you know, that they're not. Actually likely to be having erectile problems due to the pornography [00:57:00] viewing,  itself.

So it could be right. I,  a bellwether of something else, you know, I'm, if I'm dissatisfied with sex for my partner, maybe I am an attracted to them, a weight gain being the classic here. I used to be a couples therapist and Oh my God, that was a terrible want to have to deal with. Right.  So, you know, he's not watching the porn potentially because,  you know, he's addicted to it, but it's like, I just don't know how to have that conversation with my partner.

Maybe I shouldn't have that conversation because how do you tell your life partner that I don't want to have sex with you anymore? That's a horrible conversation to have to have,  And maybe you shouldn't, I don't know.  so those conversations are really more complex than hard, I think as a clinician to have than just saying, yeah, you need to stop watching porn.

Porn is bad for your brain. They probably just have a higher sex drive and you know, and they're using this to manage whatever relationship [00:58:00] conflict they're having. So,  you know, if something that we're doing can help kind of inform that that would be ideal is to have the.  communication to say, like in the brain stimulation study I did, I was like, okay.

 you know, we have some sense now that people who have a lot of sex partners, we can do brain stimulation with them and it helps them gain control of their sexual response in the lab. Well that stuff's already available through FDA. You know, you could potentially get your brain stimulator. I'm not advocating that you immediately send your sex addiction clients to,  get their brain stimulated.

But it is an option. And I don't see discussion about that because I think that is viewing it as more of a sexual desire or urge problem.  you know, where there's not that evidence, what can people do?  so we did a trial with transcranial magnetic stimulation or TMS,  with people who specifically had had a lot of sexual partners and,  were reporting some distress [00:59:00] around there.

 Sexual activities. So they'd say yes, I had fun. Yes, it was consensual. But you know, I didn't plan to do that when I went out that night, that was a bit much. And so we looked at if the, so these folks tend to be very reactive to sexual accused. So if you show there, show them,  one of these sexual images, their brain is a very reactive to even like the hint of sex.

So something romantic that's shadowing, doesn't show penetration. They're still brain very responsive to it. And,  whereas people who have lower drive and don't get as much trouble,  aren't D their brain doesn't respond to those cues until the cues are pretty explicit. Like you have to have. Oh, wait, that's definitely sex.

No doubt about it. This, these are not just,  hugging kissing people. And so we kind of took that principle and said, so we know these people are likely responding very strongly to the sexual cues. So can I stimulate their brain using this TMS [01:00:00] device in a way that decreases their brains responsiveness to these cues?

Because we know that their responsiveness predicts their sexual behavior in the near future. So,  we were able to modulate their brains, reactive newness responsiveness in the lab. And so that's the reason to think, you know, the next step could be trying that,  to help you kind of manage the sexual urge, but no one ever talks about these, which drives me nuts.

I was like, it's a very, you know, it's already FDA approved for all these other applications. And,  yeah, that means it could potentially be talked about,  off-label use if an MD were to agree to that, you know, and think it was a useful thing to try. So, you know, we do that work, but sometimes I think it's so mechanistic and really,  testing thing that I don't write it in the way that necessarily translates as,  Easily.

Cause I, I don't want to make claims that are too strong, you know? Cause I don't want to go and say, Oh, here's the next [01:01:00] treatment? You know, don't give them Naloxone, send them to TMS treatment. And I was like, I actually don't. I would say don't go send people all to TMS treatment right away, but it could be an option.

You know, there's already some data suggesting that that could help people manage their sexual urges. Hmm. 

Tim Norton: Okay. And is it stuff that, I mean, would. Would the TMS provider have to know the kind of work that you guys did or is it actually pretty easy for them to, is there like a patches or an app? 

Dr. Nicole Prause: Yeah. TMS is funny because of the,  depression and approval.

There are now a ton of centers, especially in LA. I get calls all the time to do this stuff. And so the centers usually have a tech and an MD. And the MD is present because,  there is a risk of seizures. If you have a personal history or family history,  we do a really good job of screening out now. So it's very, very rare for someone to have a seizure, but [01:02:00] you still need someone nearby just in case that were to happen.

 and sometimes the centers will require that the MD also meet with the patient.  sometimes they're okay. Taking referrals. I've just seen it vary the tech themself. It doesn't necessarily know. They may just see, okay. Stimulate dorsolateral, prefrontal cortex at this frequency with this device, you know, using data burst stimulation.

You know, the stimulation itself is five minutes.  and for depression treatments, it's done, you know, somewhere around like 12 to 16 times.  and the response to it is logarithmic in the sense that the biggest effects occur earliest in treatment. And then the,  it kind of Peters off towards the end in terms of effect size.

So, and this is not direct current stimulation. So there are lots of different types of brain stimulation and. Direct current is one that's,  there's a lot of debate as to whether it's even getting through the cranium. And,  is it really having the effects we think TMS [01:03:00] is getting in? It's definitely getting it.

 but there's more debate about,  how targeted we are. Exactly. You know, and when we'd stimulate this area, what network is it propagating through primarily?  but it is not your mama's.  electroconvulsive therapy. We are not doing any CT anymore,  with the TMS. And I think it's a really fascinating option.

 if it's something that makes sense for that patient and that the MD agrees is safe. 

Tim Norton: Maybe give it a shot. Okay. And I actually had a, it's actually gone over an hour. I just wanted to see if there was anything you were excited about for the future of like, Neuroscience research and,  

Dr. Nicole Prause: yeah, as you might imagine, it's all partners for me.

So,  there is so little work being done kind of on the high end of stimulation. So we have people doing their first, like five minutes of sexual arousal [01:04:00] alone without touching anything. And that's fine.  and there's a lot of that. So, you know, I wouldn't say porn studies are in their infancy. I'd say they're mature.

 and now we need to stop doing that and go to some better models that better resemble actual sexual behaviors to see if porn actually has anything to do,  with how the brain is responding under conditions of erotic touch. 

Tim Norton: Right. So there's probably never been. The study of what we think of as the quote unquote porn addict, who's sitting there masturbating for five hours,  going from thing to thing that too much.

So nobody's done that. Yeah. 

Dr. Nicole Prause: That's another good,  Like, I've always been curious when I hear someone, like I looked at porn for five hours and I want to sit them down and say, okay, like, so when you start, tell me about starting and tell me, so were you masturbating the whole time or you wreck the whole time?

Did that change? How many [01:05:00] orgasms did you have? Were they all ejaculatory? I've never seen a study that asked those simple, like questions in detail and it really matters. Stuff, I'm testing. I need to know, you know, is it that you're having three orgasms in that time because that's a very different model of what the porn effects are.

Then just, I watched a movie and it wasn't touching myself and I just find porn movies more interesting than Hollywood movies. I doubt that's the case, but we don't know why don't we know. And 

Tim Norton: it does hap well, according to self-report anyways, and I had to learn this. And doing sex therapy. Intakes is, do you watch porn?

And that's a different question then, do you masturbate to the porn men? Some, some people every once in a while, they'll say no. And I'm always caught off guard. Why? But sometimes yeah. And 

Dr. Nicole Prause: even more that, yeah, like when you master it, w how, how are you masturbating? Like what does that pattern look like?  Because I just exactly like, that's what I'm always confused about is like, [01:06:00] what are you, what are you doing for five hours?

You know, I need to,  somewhat tongue in cheek, but I also need to understand that process. So am I talking about multiple orgasms to where I need to think about.  really quantifying refractory periods in a more sophisticated way than they have been before, because those are almost all self-report too.

 or is that not possible because they're generally only having the one orgasm at the end. And that's the big,  event when you find the perfect film? I don't know. I don't know if anybody knows. 

Tim Norton: But you want to find out and you are putting a lot of time and effort and energy into this work. And I want to thank you for doing that.

 because I know it is hard to come by this kind of data. And then I know, you know, As a sex therapist, I want to have it. I want to be able to share it with clients and, you know, let them know that I'm not just making this stuff up. So your work is really important and I hope all whoever's funding all [01:07:00] of this that they, they triple and quadruple that you'd see thousands of couples in here.

Cause it's, it's really 

Dr. Nicole Prause: important. I appreciate it. Yeah. I hope,  that I keep having nice people who are willing to come in and do the studies as well. I think,  as a scientist, we sometimes. Forget how lucky we are, that people are willing to trust us and that we're going to protect their privacy and safety and all that good stuff.

So thank goodness for the research subjects. 

Tim Norton: Yeah. Okay. So yeah, that's a call for people to sign up for sex studies and I'll say it,  cause we, we need to know this stuff. Well, thank you so much for your time. And,  Like any last thing or how can people find you out on the internet and everything?

Dr. Nicole Prause: Libero center.com, L I B E R O S center. All one word.com and I tweet sometimes about motorcycles.  Nicole R Prause. 

Tim Norton: Thank you so much. Thanks.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sexual podcasters, sex [01:09:00] surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard conversations. Bye-bye.