"Sexy Times Call For Sexy Measure" | CAS Inquire

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Tierney Lorenz of the Department of Psychology gave the talk for CAS Inquire Feb. 22.

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[00:00:02.240]Good evening, I'm Dr.
[00:00:03.800]Taylor Livingston,
[00:00:04.840]the director of the College of Arts and Sciences Inquire program.
[00:00:08.960]Thank you all for joining us tonight.
[00:00:12.080]We had the cozy comfort of Zoom or joining us in person
[00:00:16.840]and braving the blistering cold outside.
[00:00:21.080]Tonight's installment of the spring semester CAS Inquire
[00:00:24.560]lecture series is based upon the theme Pain and Pleasure.
[00:00:29.000]Although the topic for the series was chosen before the global pandemic,
[00:00:33.400]it's particularly apt given our current cultural moment
[00:00:37.400]and celebrating recently the anniversary of the second year of a global pandemic.
[00:00:44.160]The entire series is structured around these lectures,
[00:00:47.760]allowing students, faculty, staff and the wider public
[00:00:52.160]the opportunity to investigate how we, as individuals and society
[00:00:57.760]understand the concepts of pain and pleasure
[00:01:00.880]and how their perceptions shape and are reflected by human behavior.
[00:01:07.360]Additionally, it creates the opportunity to learn about the fascinating research
[00:01:12.280]the faculty members in the College of Arts and Sciences are conducting
[00:01:16.360]and enable students to see the necessity of multi trans
[00:01:21.160]and interdisciplinary insights to understand human phenomena and actions.
[00:01:27.600]Tonight's lecture by Dr.
[00:01:29.280]Tierney Lorenz, assistant professor of psychology
[00:01:32.280]in the Department of Psychology and also in the Center for Brain
[00:01:37.240]Biology and Behavior, explores the discom, the aspects of pleasure,
[00:01:43.440]sexual arousal and, while perhaps not openly discussed,
[00:01:48.520]is a vital aspect of women's, mental and physical health.
[00:01:53.520]Dr. Lorenz was a postdoctoral fellow at the Kinsey Institute
[00:01:58.120]for Research in Sex, Gender and Reproduction
[00:02:01.560]and here at Nebraska.
[00:02:04.360]She is the director of the Women Immunity and Sexual Health Lab, which investigates
[00:02:09.720]the connection between sexual behavior, women's immune system and hormone levels.
[00:02:16.240]In addition to this research, the lab also helps women with mental
[00:02:20.560]and physical health conditions lead sexually fulfilling lives.
[00:02:25.000]Please join me in welcoming Dr. Lorenz.
[00:02:51.120]OK, they told me that
[00:02:54.360]I still have to use a mic, even though I'm a New Yorker.
[00:02:58.360]OK, well, thank you all for braving the cold to be with us today.
[00:03:02.720]I'm absolutely thrilled to be here to get to close out
[00:03:04.920]what has been a really amazing lecture series on pleasure and pain.
[00:03:10.320]And thank you, Dr.
[00:03:11.080]Livingston, for that lovely introduction.
[00:03:13.920]As you mentioned, I am an assistant professor in the Department of Psychology
[00:03:17.280]and the Center for Brain Biology and Behavior, CB three
[00:03:20.280]and the Women Immunity and Sexual Health Lab,
[00:03:22.880]which has a couple of representatives here in the front row. Thanks for coming!
[00:03:26.880]Is within the clinical psychology and neuroscience and behavior areas.
[00:03:31.120]Today, I'm going to be talking a little bit about some of our recent work
[00:03:34.120]on sexual arousal, desire, pleasure
[00:03:36.920]and how that might influence women's, mental and physical health.
[00:03:41.280]So as a quick heads up, I'm guessing that if you are listening today
[00:03:47.400]that you know that we're going to be talking about sexuality.
[00:03:51.080]But I do want to warn folks that I am going to be using scientifically accurate
[00:03:55.720]but explicit language to describe sexual anatomy and sexual processes.
[00:04:00.760]So if you're listening at home
[00:04:02.000]and you have some little ones
[00:04:03.080]in the background, now's a great time to get those headphones.
[00:04:07.120]I also want to mention that I'm going to be talking
[00:04:09.720]about some of our work with survivors of sexual trauma
[00:04:12.840]and how their minds and bodies respond to sexual stimuli post assault.
[00:04:17.040]I recognize that that can be a really sensitive topic
[00:04:19.280]for some people, so I will give a heads up before we get into those sections.
[00:04:22.720]There will be two of them
[00:04:24.000]and each one is going to take about two, two and a half minutes or so.
[00:04:26.800]So if you want to tap out during the sessions, you will get fair warning.
[00:04:31.200]So let's start with the very broadest question, which is why study sex at all?
[00:04:37.200]Why study sexual pleasure and why specifically are we interested in the fun
[00:04:41.840]bits? I get this question a lot, usually right after the loading screen fail face.
[00:04:49.120]A you study what
[00:04:52.520]because people have a really hard time wrapping their heads around the idea
[00:04:57.080]that a scientist would want to take something
[00:04:59.880]that's so taboo and so personal and quantify and analyze it.
[00:05:04.240]But it's that tension that makes sexual pleasure so interesting to study.
[00:05:08.640]Some of the other talks in this series of really nicely
[00:05:11.200]highlighted the ways in which we think about pleasure and pain
[00:05:15.360]and how that in turn helps us to understand who we are as people
[00:05:20.520]and as a society now as a neuroscientist.
[00:05:23.800]I would argue that sexual pleasure is one of the most important aspects
[00:05:28.320]of pleasure to understand because it shaped the evolution
[00:05:33.040]of our sexual reward systems or of our reward processing systems more broadly.
[00:05:37.680]Sexual pleasure is considered one of the primary rewards, meaning that it's innate.
[00:05:41.880]It's sort of built into how our reward processing centers work.
[00:05:46.800]Primary rewards refer back to those rewards
[00:05:50.280]that we experience when engaging with our most basic needs, right?
[00:05:53.320]So the pleasure that we get from eating or from relief, from physical discomfort.
[00:05:58.480]But sex is really special among the primary rewards because
[00:06:04.240]although reproduction is necessary for the survival of the species,
[00:06:08.640]it's not necessary for the survival of any individual
[00:06:12.080]and in fact can come at really great cost.
[00:06:15.120]And so evolution has favored those individuals
[00:06:19.200]whose sexual motivation and reward processing is sensitive
[00:06:24.040]to the environmental context is sensitive to those times
[00:06:28.480]when resources are good and you can afford to invest
[00:06:32.320]in reproduction and in humans who are an incredibly social animal.
[00:06:38.160]That environment, when we talk about being sensitive
[00:06:41.000]to the environment, that environment includes the social environment.
[00:06:44.800]So understanding sexual pleasure
[00:06:48.680]gives us a really important key to understanding
[00:06:52.040]some of these evolutionary tradeoffs that we make between
[00:06:56.320]investing now in a current reproduction versus delaying later.
[00:07:00.760]And that, in turn, tells us a great deal about the mechanisms
[00:07:05.560]by which our minds, our bodies and our relationships
[00:07:09.960]are responsive to each other and to the environment .
[00:07:13.040]It provides a really excellent model of those broader systems.
[00:07:16.960]So for example, as we're going to see throughout the talk today,
[00:07:20.320]our bodies pay attention to our sexual activity
[00:07:23.440]and our sexual arousal levels in order to regulate the action of our hormones,
[00:07:28.200]of our autonomic nervous system and on of our immune system.
[00:07:33.480]And moreover, the ways that we experience sexual pleasure
[00:07:37.600]have also shaped the evolution
[00:07:39.160]of how we relate to each other in our most intimate relationships.
[00:07:43.440]There's been a lot of really great work that suggests that when it is shared,
[00:07:47.120]sexual pleasure is one of the most
[00:07:49.920]tight bonds that people can experience
[00:07:52.080]one of the strongest binding forces within a relationship.
[00:07:55.360]And evolution knows this and has used this to kind of shape the incredible
[00:07:59.680]diversity of different social systems that we see across the globe, right?
[00:08:05.640]Many different kinds of intimate relationships that vary in their structure
[00:08:10.240]and their form, but always come back to this sort of foundational
[00:08:15.120]framework of shared sexual pleasure.
[00:08:17.280]So if we don't understand how we experience sexual pleasure,
[00:08:21.280]why we experience that, the ways that people use it
[00:08:23.520]in their sexual relationships, then we're really missing out on this kind
[00:08:26.640]of key foundational piece to understanding the diversity of human relationships
[00:08:31.000]and the very nature of intimacy itself.
[00:08:34.480]As a real quick aside, here I do want to be mindful
[00:08:37.800]of the ace and Arrow folks who are listening in.
[00:08:41.080]I realize that it could sound like I'm dismissing people who don't experience
[00:08:45.360]sexual pleasure and don't particularly want to is somehow being unnatural.
[00:08:48.880]And I do recognize that historically there's been a lot of marginalization
[00:08:52.600]from science that has generally either excluded asexual folks or
[00:08:58.760]treated asexuality as some sort of pathology.
[00:09:01.720]But I think that there is incredible value in understanding
[00:09:04.760]your experiences, too, because it's a sexuality.
[00:09:09.040]And although sexuality evolved together and understanding both of these
[00:09:13.680]gives us a much better understanding of the broad range and spectrum
[00:09:17.640]of human sexual experience,
[00:09:20.080]and it helps us to understand these complex ways that sexual pleasure
[00:09:23.320]shapes our minds, bodies and relationships.
[00:09:26.560]So all of this is my pitch to you about why
[00:09:28.760]sexual pleasure is interesting from the perspective of a neuroscientist.
[00:09:31.840]But I'm also a clinical health psychologist, and from that perspective,
[00:09:36.000]I'm really interested in sexual pleasure and the ways in
[00:09:38.760]it's rooted in promoting well-being.
[00:09:41.840]So when we have good models of how the mind, the body and relationships work
[00:09:45.360]together, then we can act on those systems to promote. Well-Being.
[00:09:50.080]And when I talk about this, people are usually quick
[00:09:52.360]to think about reproductive health, and certainly sex
[00:09:56.040]is really important for understanding reproductive health.
[00:09:59.200]So for example, if we're really serious about understanding
[00:10:02.040]sexually transmitted infections,
[00:10:03.800]we have to understand the context in which people get
[00:10:07.200]sexually transmitted infections, which are sexual context, right?
[00:10:10.960]People don't engage in sex in order to expose themselves to risk.
[00:10:14.920]They engage in sex because it's fun.
[00:10:16.800]And so if we don't understand that fun, then we're really missing a key
[00:10:20.280]part of being able to help people to reduce their risks in a meaningful way.
[00:10:26.080]So if we're not serious about sexual pleasure,
[00:10:28.560]we're really not going to get very far when it comes to reproductive health.
[00:10:32.480]But as I just argued, sexual pleasure is really foundational
[00:10:36.480]to understanding how our minds and bodies work.
[00:10:39.720]So a lot of the work from my lab looks at sexual
[00:10:42.840]wellbeing in folks with mental or physical health conditions, as Dr.
[00:10:46.320]Livingston mentioned.
[00:10:47.840]But that's not just because we want to promote health
[00:10:50.600]in these populations, although we certainly do,
[00:10:53.120]but also because we see sex as a health behavior
[00:10:56.480]that can be used to promote well-being and reduce the risk of disease.
[00:11:01.200]So for example, today we're going to be talking
[00:11:03.640]about how sexual activity interacts with inflammation
[00:11:07.360]and how that in turn, could potentially influence people's risk for inflammatory
[00:11:11.880]inflammation related conditions such as depression or heart disease.
[00:11:17.280]And then finally, as a teacher and a mentor to the next generation
[00:11:21.520]of scientists and clinicians, I'm committed to training folks in the bio.
[00:11:25.320]Psychosocial model of health and sexual science is a really great way
[00:11:28.840]to get at this because sex is inherently a biological phenomenon,
[00:11:33.440]a psychological experience and a social context.
[00:11:37.480]So the science of sexuality really helps us to be able to train that mindset
[00:11:41.120]in the next generation, and I'm excited to see some of that next generation here.
[00:11:45.600]So that's my pitch for why we need to study
[00:11:49.320]sexual pleasure in the first place.
[00:11:51.240]But given that importance, how do we go about quantifying
[00:11:55.360]such a nebulous variable?
[00:11:57.880]So generally speaking, psychologists psychological scientists
[00:12:01.320]are interested in people's thoughts, feelings and behaviors.
[00:12:04.960]So this means that in the context of sexuality,
[00:12:07.200]we might be interested in studying people's behavior, such as their patterns
[00:12:10.840]of sexual activity, both partners and solitary.
[00:12:14.760]We might be interested in their sexual feelings, their subjective experiences
[00:12:18.280]of their own desire and pleasure, as well as their positive and negative emotions.
[00:12:23.160]When it comes to cognition, we might be interested in people's patterns
[00:12:26.560]of sexual motivation and interest, but also their attention to sexual cues
[00:12:31.440]or conversely, their distraction or dissociation from those cues,
[00:12:35.520]as well as the way that we think
[00:12:37.240]about our own sexuality that is our sexual self schema.
[00:12:41.280]Now, none of these broad categories are things that are particularly unique
[00:12:45.400]to sexuality scientists.
[00:12:46.640]There's lots of tools that psychologists use to measure schemas or attitudes or
[00:12:51.280]people's health behaviors.
[00:12:53.440]And certainly, we use all of these tools in my lab.
[00:12:55.640]But something that's unique to our lab and to sexual psycho physiology
[00:12:59.440]is also looking at the ways that people's minds influence
[00:13:02.880]what their bodies do during the sexual response and vice versa.
[00:13:06.240]That is what we call sexual arousal and orgasm psycho physiology.
[00:13:11.800]So thinking about what are the different aspects,
[00:13:16.440]what are the ways in which our minds influence what our bodies do during sex?
[00:13:21.080]first and foremost, we have to think about sexual arousal as an emotional response.
[00:13:27.040]So like all emotional responses,
[00:13:30.400]arousal is going to activate certain parts of the autonomic nervous system.
[00:13:35.440]So I'm going to take
[00:13:36.000]a little step back here and do some kind of psych 101 refreshing
[00:13:40.360]in our nervous system, right?
[00:13:42.120]We have different parts of the nervous system.
[00:13:43.720]We have the central nervous system. That's your brain, your spinal cord.
[00:13:46.840]And that's what most people think of when they think of the nervous system.
[00:13:49.360]But there's this whole other branch
[00:13:50.960]called the autonomic nervous system, and this is the part of your nervous system
[00:13:55.240]that helps to kind of coordinate action across different organ systems
[00:14:00.160]and communicate with your central nervous system in response to particular stimuli
[00:14:04.560]that you need to either activate or rest and relax.
[00:14:07.440]So the autonomic nervous system has the parasympathetic nervous system
[00:14:10.840]and the sympathetic nervous system as kind of buddies that operate together
[00:14:15.200]the parasympathetic nervous system. This is your rest and relax system.
[00:14:18.440]This is the system that's predominantly active
[00:14:20.360]most of the time when you're a healthy person, and the sympathetic
[00:14:23.400]nervous system is sometimes called the fight or flight system.
[00:14:27.200]It's a little bit of a misnomer, though, because it would be more accurate to say
[00:14:30.120]it's your activate
[00:14:31.320]and get energized system because with the sympathetic nervous system does is , it
[00:14:35.080]constantly scans the environment for cues that you need
[00:14:38.560]to react to a particular stimulus you need to activate.
[00:14:42.360]And when it notices those cues, it activates
[00:14:44.640]a whole bunch of different systems all across the body in.
[00:14:48.360]Order to be able to mobilize energy resources
[00:14:51.480]and get you ready to do something in response to that stimulus.
[00:14:55.120]So all emotions are going to generate some sympathetic activation.
[00:15:01.080]That's part of what makes
[00:15:03.600]emotional responses feel activating fuel energizing right now.
[00:15:08.960]That's true if you get turned on or if you're happy or you're angry, right
[00:15:12.960]that you're sympathetic, nervous system
[00:15:14.200]is going to kick on a little bit for any kind of emotional response.
[00:15:18.680]What's really interesting and unique about sexual arousal
[00:15:22.360]as an emotional response is the relationship that we have between
[00:15:27.800]this autonomic nervous system activation and the stress response.
[00:15:32.720]So when your sympathetic nervous system kicks in, right when that fight
[00:15:36.440]or flight system kicks in, when it gets to the higher levels
[00:15:39.440]of its activation, it can trigger a broader stress response.
[00:15:44.000]When we think about stress, we often think about the responsiveness
[00:15:46.920]of our hormonal stress responses like cortisol, right?
[00:15:50.680]And so when you feel really, really strong emotional responses,
[00:15:55.200]whether they're happy or not happy, whether they're good or bad,
[00:15:59.520]if they get to very high levels of sympathetic activation
[00:16:02.200]that can generate a stress response, that's part of why it feels so draining
[00:16:06.120]to have really strong emotions, even if those strong emotions are positive.
[00:16:11.560]But this is what's really unique about sexual response
[00:16:16.000]is that when sympathetic activation happens in the context of sexual arousal,
[00:16:21.240]we don't see that stress triggering
[00:16:23.720]right at very high levels of arousal and particularly at orgasm
[00:16:27.760]when we see really high levels of sympathetic activation.
[00:16:31.360]We see a significant drop in cortisol levels.
[00:16:35.000]Now, from a scientific perspective, this is really fascinating
[00:16:38.000]because it says that there's something unique about sexual arousal
[00:16:42.080]that allows the body to decouple this activation
[00:16:46.080]of the autonomic nervous system with a broader stress response.
[00:16:49.720]And if we can just understand that decoupling system,
[00:16:53.880]we might be able to harness that to be able to help
[00:16:57.320]to retrain the stress system in people whose bodies are particularly responsive
[00:17:02.720]to autonomic arousal, such as people with anxiety disorders.
[00:17:06.680]So as one example of this line of research
[00:17:10.320]from my lab, we've looked at sympathetic
[00:17:14.240]activation and various different measures of genital arousal.
[00:17:18.040]And here we're talking about vaginal genital arousal.
[00:17:20.720]So this vigorous from a large meta analysis that we conducted
[00:17:24.400]a meta analysis is when you take data from a bunch of different studies
[00:17:27.880]that study something similar and you put them all together
[00:17:30.040]into one big data set to try to come up with some stronger conclusions.
[00:17:33.720]So in this study, we looked at changes in heart rate variability,
[00:17:36.840]which is a measure of this autonomic balance, right?
[00:17:39.840]So in the kind of more blue side of the screen here,
[00:17:42.840]we're seeing more increasing parasympathetic activation.
[00:17:46.160]That means lower sympathetic activation.
[00:17:48.640]And on the red side of the screen, here
[00:17:50.240]we're seeing increasing sympathetic activation.
[00:17:52.920]This is in response to a sexual fell
[00:17:56.400]on the y axis. We have changes in genital arousal and in this particular case,
[00:18:00.280]we're looking at changes in vaginal blood flow in response to a sexual thing.
[00:18:03.760]I'll get into how we measure that in just a moment.
[00:18:06.440]But as you can see, there's this really interesting curvilinear
[00:18:09.080]response between autonomic arousal and subsequent genital arousal. Right?
[00:18:14.800]What's even more interesting is that when we get to these
[00:18:17.400]really high levels of sympathetic activation, even though
[00:18:21.200]there's maybe lower levels of absolute genital arousal,
[00:18:25.800]we're not seeing that same stress cascade.
[00:18:29.560]So really kind of interesting
[00:18:32.560]decoupling happening here and something that would be very difficult
[00:18:36.520]to look at if we weren't measuring genital arousal directly
[00:18:40.520]. As a heads up, I had mentioned that there were going to be a couple of moments
[00:18:43.600]when I was going to talk about sexual trauma, and this is one of those.
[00:18:46.160]So again, if you need to step out, now's the time to step out.
[00:18:48.680]We'll see you in about two and a half minutes.
[00:18:52.840]So one of the reasons that we're really interested
[00:18:54.840]in this kind of decoupling response is because we're really interested
[00:18:58.520]in the ways that this plays out in sexual trauma survivors.
[00:19:01.920]So in folks who have experienced sexual trauma, a sexual stimulus is
[00:19:08.120]has a kind of a push pull to it
[00:19:10.600]because on the one hand, a sexual stimulus still signals the possibility of reward.
[00:19:15.280]Right. Sex can still be quite pleasurable and fun for folks, even post assault.
[00:19:20.800]But at the same time, that exact same stimulus is now
[00:19:24.400]also being coded as a stressor.
[00:19:27.560]So you have this really interesting simultaneous activation
[00:19:31.160]of the sexual response and the stress response system at the same time.
[00:19:35.160]In parallel, that decoupling sort of breaks
[00:19:38.160]down in the context of sexual trauma survivorship.
[00:19:41.440]And that's also really interesting because it tells us a great deal more
[00:19:45.160]about the potential after effects of sexual trauma and the ways
[00:19:49.280]in which sexual trauma really uniquely activates the stress response system,
[00:19:53.720]even in the face of what would otherwise be a very pleasant, rewarding you.
[00:19:59.280]And so understanding that, too has some really powerful implications for therapy
[00:20:04.880]and for treating sexual trauma survivors
[00:20:07.160]and helping them to be able to experience reward again.
[00:20:10.800]So in a set of studies, we've looked at
[00:20:14.280]sexual trauma survivors and folks who don't have a trauma history.
[00:20:18.080]And what we found is that among women who have a sexual trauma history,
[00:20:22.400]particularly a history of childhood sexual abuse, we see
[00:20:25.840]we tend to see higher sympathetic activation.
[00:20:28.640]And it gets up to that level where we start to see the triggering
[00:20:31.440]of the stress response that we don't see in folks who don't have a trauma history .
[00:20:36.040]In fact, folks without a trauma history,
[00:20:38.040]we tend to see relatively lower sympathetic activation,
[00:20:41.200]but that's actually associated with higher arousal levels simply because it kind of
[00:20:44.800]puts them into this more moderate level of sympathetic activation.
[00:20:48.160]And then in folks
[00:20:48.880]who don't have a trauma history but who say that they have sexual problems,
[00:20:53.600]we actually see really low activation of sympathetic activity.
[00:20:57.640]And this kind of reflects the sort of broader issue
[00:21:00.800]with not feeling activated, not feeling energized, not feeling excited
[00:21:04.960]and engaged during sex.
[00:21:07.080]So it kind of nicely reflects that across the board. OK.
[00:21:10.960]Those of you who tapped out for the sexual trauma piece, welcome back.
[00:21:16.000]So coming back to that broader picture, right?
[00:21:18.000]So going beyond the idea that sexual arousal is an emotional response,
[00:21:23.240]there's 1,000,000 other things that happen to the body during sex that we could
[00:21:28.040]potentially measure and do measure in sexual psycho physiology.
[00:21:31.840]And I will note, not everything on this list
[00:21:33.520]I'm about to present is stuff that we do necessarily in our lab.
[00:21:37.040]But it is definitely things that we collaborate with, with other labs
[00:21:40.200]and is used in the broader field of sexual psycho physiology.
[00:21:43.840]So like I mentioned, we're really interested in autonomic arousal.
[00:21:48.400]At its core, sexual arousal is a
[00:21:51.280]a process of blood flow rate is a shift of blood flow
[00:21:55.160]to the genitals in response to a particular cue
[00:21:58.040]that the brain identifies as sexual or erotic.
[00:22:01.680]And so when we're studying blood flow,
[00:22:03.640]there's all different pieces to this that we can study.
[00:22:05.480]We can look at the direction of blood flow into the genitals,
[00:22:09.680]which we can measure directly using ultrasound or Photoshop.
[00:22:12.920]This mammography, both of which are tools that are going to measure the movement
[00:22:16.080]of blood flow or volume of of blood that pools into a tissue.
[00:22:22.240]So we can look at this
[00:22:23.080]directly, but we can also look at the after effects of that process.
[00:22:26.840]So if you think about the last time that you blushed,
[00:22:30.160]I'm going to call you out here
[00:22:31.120]because you were talking about how every time I talk,
[00:22:33.280]every time I give a talk, you always blush.
[00:22:35.000]So right now in Rick's cheeks, probably there's a little bit of blood
[00:22:39.280]that was circulating close to his core and is now coming up into his cheeks, right?
[00:22:45.680]And it's causing some change in color
[00:22:47.440]and it's causing some change, and he is giving me a thumbs up.
[00:22:50.000]That's what's happening. So, right,
[00:22:52.080]so when we move blood from the central part of the body
[00:22:56.320]into the periphery, it changes the heat and the color of those tissues.
[00:23:00.680]And those two we can measure directly using thermal graphic measurements.
[00:23:06.080]There is, of course, erection, which is probably
[00:23:08.200]what popped into most people's heads when I said measuring sexual arousal.
[00:23:12.240]So we can measure the physical firmness of the tissues.
[00:23:14.800]But more often we're changing.
[00:23:16.120]We're looking at changes in size or the rigidity of the tissue,
[00:23:20.320]and that's measured using this placement so we can put a displacement chamber
[00:23:23.680]over a tissue bed and that chamber will be filled with air.
[00:23:28.360]And as the tissue changes in shape or size
[00:23:31.640]that will push the air out of that chamber,
[00:23:33.640]and we can look at the amount of air
[00:23:34.920]that is being pushed out as a reflection of the degree of the erection,
[00:23:38.760]where similarly there are soft rings that are filled
[00:23:41.520]with liquid that you can place over or around a tissue.
[00:23:44.680]And again, as it becomes as it changes in shape, as it becomes more rigid,
[00:23:48.400]it will push against that soft ring and it will pull some of the liquid.
[00:23:52.280]Out of that ring, and we can measure just the amount of change in liquid
[00:23:56.040]in order to be a reflection of the degree of erection of that tissue.
[00:24:01.800]So in the uterus and vagina, during arousal,
[00:24:05.440]there are some really interesting protective mechanisms that occur
[00:24:09.600]to help protect the cervix and the internal organs from penetration.
[00:24:14.320]And so during arousal, as the body becomes more aroused,
[00:24:17.720]the vagina will actually stretch long and the uterus will kind of retreat up
[00:24:21.520]into the abdomen,
[00:24:22.800]and that both of those responses will increase the pressure
[00:24:25.640]within the vaginal canal.
[00:24:27.240]And so we're able to measure the change in the amount of pressure
[00:24:30.560]within the vaginal canal, either by using force plates
[00:24:34.760]or by looking at things in MRI.
[00:24:36.880]So by doing direct imaging, they're
[00:24:40.080]in a manner similar to how the uterus and vagina
[00:24:43.520]change their shape in order as a protective response for penetration.
[00:24:49.000]Similarly, the scrotum will also change its shape.
[00:24:52.440]And so this is essentially to kind of protect it from harm
[00:24:57.280]if it's being moved about or if it's being pressed up another body.
[00:25:01.320]So we can look at the changes in skin tension or elasticity
[00:25:05.080]as a function of the degree of arousal.
[00:25:10.080]Excuse me, something that we're really interested in in my lab is
[00:25:13.760]the way that arousal changes lubrication, vaginal lubrication in particular.
[00:25:18.400]So there's lubrication that occurs across genital types, not just in vaginas, but
[00:25:24.160]we can look at the amount of lubrication that's actually produced during arousal.
[00:25:29.120]So just the sheer amount of moisture.
[00:25:30.640]But what's even more interesting is that there are some
[00:25:32.480]pretty significant changes in the composition of that lubrication
[00:25:36.360]in terms of its acidity, its protein content, the presence of certain
[00:25:40.040]immune parameters or endocrine factors, hormones.
[00:25:43.880]So, for example, at baseline at rest,
[00:25:47.840]a healthy vagina is going to have a moderately acidic p h.
[00:25:52.400]It is precisely the age of a pinot noir wine.
[00:25:57.240]Good luck with trying to get that packed out of your mind
[00:26:00.040]the next time that you go to a wine bar. You're welcome.
[00:26:03.560]And as the process of arousal unfolds,
[00:26:06.920]that or that lubrication is going to become very slightly more basic.
[00:26:10.960]And so we're able to actually measure the changes in p h by
[00:26:14.000]just handing off a P H testing strip to be able to observe the ways
[00:26:18.880]in which arousal is changing that lubrication dynamic.
[00:26:23.400]So in addition to the changes in muscles and blood
[00:26:25.960]vessels and glands in the genitals,
[00:26:27.560]there's also changes in the nerve beds that generate sexual sensation.
[00:26:31.720]And we can measure this as well.
[00:26:33.440]So there's a really strong increase in sensitivity to fine touch and pressure.
[00:26:39.040]And at the same time, there's a significant decrease
[00:26:41.880]in pain sensitivity that is an increase in pain tolerance.
[00:26:45.760]What's really amazing is that the pain tolerance that we see in these nerve beds
[00:26:52.280]during orgasm is actually
[00:26:54.200]among the highest unmedicated pain tolerances that have been recorded.
[00:26:58.880]Now, from an evolutionary perspective, this makes a ton of sense because we are
[00:27:03.200]subjecting those tissues to extraordinary forces during sexual arousal, right?
[00:27:08.600]They are changing their shape, they're changing their structure,
[00:27:12.000]they're being moved about with great vigor.
[00:27:14.280]And so it would make a lot of sense that we would have evolved and adapted
[00:27:18.320]to have increased pain tolerance in those tissues during this time.
[00:27:22.720]But from a scientific perspective, this is really fascinating
[00:27:25.640]for understanding pain perception itself, right?
[00:27:28.920]Understanding the way that the brain processes pain
[00:27:31.760]and and interacts with other emotional sensations
[00:27:34.800]to be able to either increase or decrease our pain tolerance.
[00:27:38.360]So, for example, there's some really amazing work that's happening
[00:27:41.560]right now looking at people with chronic pain conditions
[00:27:46.160]and using orgasm therapies to retrain how the brain perceives pain
[00:27:51.840]in order to be able to help treat that chronic pain.
[00:27:55.160]I don't want to oversell that work.
[00:27:56.400]It is still definitely it's in its infancy,
[00:27:58.920]but I think it's really fascinating and kind of underscores
[00:28:01.240]the fact that understanding
[00:28:02.560]these processes tells us a great deal about how the brain works
[00:28:07.320]when it comes to orgasm.
[00:28:09.320]one of the things we're interested in is the not just the rhythmic contractions of
[00:28:15.840]that happen during orgasm,
[00:28:17.880]but the specific patterns of those rhythms, right?
[00:28:20.920]So during orgasm, there are contractions that occur within
[00:28:25.120]the genitals that kind of spread out into the pelvic floor.
[00:28:28.040]And there's some evidence that in people who are pregnant
[00:28:32.160]as they get closer and closer to their delivery date,
[00:28:36.760]that the pattern of rhythm that we see in during
[00:28:41.080]orgasm gets closer and closer to that which is coordinated during delivery.
[00:28:45.680]So there's this hypothesis that the body is using orgasm
[00:28:50.400]to train the pelvic floor not only in the extraordinary strength,
[00:28:54.560]but also the specific rhythms that are going to be necessary
[00:28:57.480]for a successful delivery. Really fascinating stuff.
[00:29:01.160]And then finally, there are these specific brain activation patterns
[00:29:05.160]that are associated with our subjective experience of our own sexual response
[00:29:09.920]and perhaps not surprisingly, sexual arousal and orgasm are associated
[00:29:13.800]with a significant decrease in brain activity,
[00:29:17.080]particularly in the higher order areas of the brain.
[00:29:20.920]This is often why I joke that I am a below the neck neuroscientist because if the
[00:29:24.960]brain's doing its job during orgasm, not a lot going on above the neck.
[00:29:31.920]So that was a lot.
[00:29:34.720]But hopefully it gives you an idea of some of the complexity of these measurements
[00:29:37.720]and the wealth of information that we can gather if we actively look
[00:29:41.480]for what happens during the sexual response.
[00:29:47.000]So what does that all get us?
[00:29:48.360]Let's dove into a little bit
[00:29:49.640]of our research on inflammation and women's sexual response.
[00:29:54.560]So a shout out here to my graduate student on a list
[00:29:58.080]who is in this picture showing off her amazing technical skills in the wet lab.
[00:30:01.440]But she's also a very talented graphic designer,
[00:30:03.640]and she designed this figure for one of our recent reviews.
[00:30:06.920]So in the whish lab, we're really interested in the ways
[00:30:09.600]that the immune system and in particular the inflammatory system
[00:30:12.800]interacts with women sexual desire, arousal pleasure.
[00:30:16.320]Inflammation is a really significant contributor to a lot of different
[00:30:20.000]chronic health conditions because it has interactions
[00:30:24.040]with a lot of different systems throughout the body.
[00:30:26.920]So, for example, the inflammatory system has communication
[00:30:30.160]with the endocrine system with hormones, and it regulates and is regulated
[00:30:35.120]by the expression of reproductive hormones and stress hormones.
[00:30:38.160]two things we're really interested in.
[00:30:40.080]It's also responsible for coordinating
[00:30:43.520]certain certain aspects of cardiovascular function, such as and can
[00:30:47.160]contribute to cardiovascular pathologies such as heart disease.
[00:30:51.280]So insofar as we're interested in arousal, right,
[00:30:54.560]we're really interested in blood flow.
[00:30:56.040]And so understanding inflammation is important there, too.
[00:30:59.200]And then there's also direct effects of inflammation on the brain,
[00:31:03.040]on the central nervous system, changing the way that the brain processes reward.
[00:31:07.880]So all of these things not surprisingly contribute to women's
[00:31:11.000]sexual arousal, desire and pleasure, and potentially vice versa.
[00:31:15.760]So I first got interested in this question of the interaction
[00:31:19.080]between sexuality and inflammation
[00:31:21.400]when I saw the results from the biological study about ten years ago.
[00:31:25.040]Now, it seems like yesterday.
[00:31:27.160]So this was a study that was conducted by the National Institutes of Child
[00:31:30.400]Health and Human Development.
[00:31:32.160]And in this study, they followed 259 women over the course
[00:31:36.520]of several menstrual cycles and measured multiple times throughout their menstrual
[00:31:40.600]cycles, a variety of different hormones and immune factors.
[00:31:44.240]And in this particular aspect of the study, they were really interested
[00:31:47.320]in this particular marker of inflammation called C-reactive protein, or CRP.
[00:31:52.280]A CRP is a really useful marker of the aspects of inflammation
[00:31:57.000]that can contribute to vascular pathology,
[00:32:00.080]which in turn can contribute to the risk for heart disease.
[00:32:03.280]So this is actually a test that your doctor can order
[00:32:06.520]to assess your risk for getting heart disease later on. Right?
[00:32:11.240]But the researchers were really interested in understanding
[00:32:14.800]how that measure might change over the course of the menstrual cycle.
[00:32:18.800]So here is being depicted in the dark circles that are filled in.
[00:32:23.960]And as you can see, there is a significant change in CRP
[00:32:27.520]over the course of the menstrual cycle in these healthy women.
[00:32:31.040]So we have the highest levels of CRP or highest levels
[00:32:33.960]of inflammation around menses.
[00:32:36.240]And then the lowest levels around the time of ovulation right around mid-cycle.
[00:32:40.840]What's more, these researchers found that if you took exactly the same woman
[00:32:45.880]and you took her values of CRP at menses,
[00:32:50.000]the same exact woman might be
[00:32:52.760]misdiagnosed as having heart disease if you measured her during menses.
[00:32:57.320]Then if you measured her two weeks later during her ovulation.
[00:33:01.480]So this has really profound implications for understanding
[00:33:04.760]the clinical utility of CRP as a marker of heart disease.
[00:33:08.640]But what intrigued me about this was the rationale that these authors offered
[00:33:12.560]for why there might be changes in CRP over the course of the cycle
[00:33:16.720]in the first place.
[00:33:17.960]So they hinted that it might be part of an evolutionary adaptation
[00:33:22.160]that by reducing the level of inflammation around mid-cycle,
[00:33:26.680]that is around the time of peak fertility that the body might be reducing
[00:33:31.640]the risk of interference of inflammation with the chance of conception.
[00:33:37.040]So this explanation struck me as logical, but a little bit incomplete,
[00:33:42.560]because if the body evolved to shift its immune function
[00:33:46.840]priorities over the course of a menstrual cycle
[00:33:49.880]in order to balance these offs between conception and
[00:33:55.360]defending against disease,
[00:33:57.200]then it would follow that those trade offs would only be relevant
[00:34:00.960]for people who could be reproducing that cycle. Right.
[00:34:04.320]So if a person is sexually active, then their chance of conceiving that cycle
[00:34:10.600]is it's possible they might get pregnant because they have been sexually active.
[00:34:14.800]And so it would make sense that for these people
[00:34:17.120]that you would see this shift in immune function over the course of the cycle.
[00:34:21.200]But in people who are sexually abstinent,
[00:34:23.600]then the chances of getting pregnant that cycle are.
[00:34:27.480]I mean, the pretty low rate, like the Virgin Mary is pretty much
[00:34:29.960]the only instance I can think of in which an absent person got pregnant.
[00:34:34.600]So barring that, it's real, pretty low.
[00:34:37.480]And so it really wouldn't make sense to be engaging with this tradeoff
[00:34:41.280]if somebody is sexually abstinent.
[00:34:44.200]So we first started to look at this hypothesis.
[00:34:47.600]We first tested this hypothesis in a sample of about
[00:34:51.480]30 healthy young college students here in the US.
[00:34:55.360]So women provided saliva samples at four time points throughout their cycle.
[00:34:59.680]So within the first three day of their menstrual cycle,
[00:35:02.720]about a week later during their follicular phase within 36 hours
[00:35:07.200]of their ovulation, which is what we call the Perry ovulatory phase.
[00:35:11.120]And then one week later, during their luteal phase,
[00:35:15.120]women collected their samples, their saliva samples at home,
[00:35:17.840]and they tested for ovulation using urine test strips for luteinizing hormone.
[00:35:21.960]So we were able to accurately pinpoint where within the cycle
[00:35:25.520]they actually ovulating so that we could match their saliva samples up to that.
[00:35:29.920]So about half of the sample was sexually abstinent,
[00:35:32.720]although I will note that this meant that they were not sexually partnered.
[00:35:36.400]This did not necessarily mean that they didn't engage in masturbation, because
[00:35:40.400]if you exclude women who masturbate from a young, healthy college sample
[00:35:45.200]pretty soon, you have no one left to study.
[00:35:47.280]So about half of the other women were sexually partnered, and of them,
[00:35:53.360]about half reported having partnered sexual activity once a week or less.
[00:35:57.640]That's our low frequency group, or twice a week or more.
[00:36:00.360]That's our high frequency group.
[00:36:02.680]These are not value judgments.
[00:36:04.120]These are just the median split of the data.
[00:36:07.560]So as predicted, the abstinent group
[00:36:10.040]showed very little change in inflammation over the course of the cycle.
[00:36:14.040]And similarly, the low
[00:36:15.640]frequency of sexual activity group also showed very little change.
[00:36:19.560]But among our folks who said that they had the most sexual activity,
[00:36:24.520]we saw really significant differences in inflammation over the course of the cycle.
[00:36:28.120]And this fits with our broader theory that this should only really matter
[00:36:31.320]for people who are more likely to potentially conceive.
[00:36:34.440]Right. So we saw much higher levels of inflammation in the in the menstrual phase
[00:36:39.400]and then a considerable decrease around the mid-cycle.
[00:36:43.120]So this is nice initial support for our evolutionary adaptation theory.
[00:36:47.680]But if this truly is an evolutionary adaptation,
[00:36:51.560]we should expect to see similar patterns across cultures and environments.
[00:36:57.640]And so we then sought to replicate these findings in a different population.
[00:37:02.360]And luckily, around this time I was working with an anthropologist colleague
[00:37:07.160]who was doing some research in Bolivia looking at rural Bolivian farmworkers,
[00:37:12.080]and she was really interested
[00:37:12.880]in understanding the dynamics of inflammation in that population
[00:37:15.880]so radically different from our UC College students.
[00:37:19.680]So here's what we found there.
[00:37:22.040]So in the graph that I'm about to show in a moment, the dotted lines reflect
[00:37:27.080]women who were sexually abstinent, were not sexually partnered, and then the
[00:37:30.280]solid lines are going to reflect the women who were sexually partners.
[00:37:34.200]And you can immediately see the extraordinary similarity
[00:37:37.280]to the findings that we had in the US population.
[00:37:40.640]So among the abstinent women,
[00:37:43.200]there's very little change in inflammation over the course of the cycle.
[00:37:47.000]And in the partnered women who are sexually active,
[00:37:50.120]we saw significantly elevated inflammation at the premenstrual menstrual
[00:37:56.360]luteal phase and a significant decrease around the time of population.
[00:37:59.600]So the fact that we saw such
[00:38:01.280]similar results across these two radically different populations of women
[00:38:05.200]really provides some additional support that this is an evolutionary adaptation.
[00:38:10.360]And what these studies suggest is that the body is using information
[00:38:14.320]about one's sexual behavior to direct the activity
[00:38:18.800]of the inflammatory system in really subtle but consistent ways.
[00:38:23.480]And that, in turn, got us thinking about some of the other ways
[00:38:26.640]that sexual activity both regulates and is regulated by the inflammatory system.
[00:38:32.520]So we were interested in understanding how the immune system might moderate
[00:38:35.840]inflammation to regulate reproductive investment, and that
[00:38:41.200]how this in turn could extend to sexual arousal to desire to pleasure.
[00:38:46.000]So in other words, the immune system in the reproductive system are coordinating
[00:38:50.080]their function in order to make sure that if sexual activity leads
[00:38:53.920]to an offspring, that that investment is really well spent,
[00:38:56.960]that conception is going to happen when the body is in this
[00:39:00.080]maximally receptive state a state of low, relatively low inflammation.
[00:39:07.600]Excuse me. So, for example, if a woman is really currently ill
[00:39:12.560]or engaging in a recovery response from an infection or an injury,
[00:39:17.760]and she's in a state of acutely inflamed and acutely inflamed state,
[00:39:22.880]that's not a great time for her to be investing a lot of energy
[00:39:26.400]in reproducing in producing an offspring.
[00:39:29.960]It would be better to delay her reproduction to when times are better,
[00:39:33.600]when resources are better and when her physical body
[00:39:35.520]is in a better condition to do so.
[00:39:37.400]And we certainly see this play out in the form of early
[00:39:40.240]pregnancy loss in folks who are experiencing acute illness.
[00:39:43.680]But as I mentioned at the beginning of the talk, evolution really favors
[00:39:46.840]these kind of subtle behavioral and psychological strategies
[00:39:50.320]because they allow us
[00:39:51.920]to dynamically respond to our environment in a much more flexible way.
[00:39:55.960]And so we started thinking of the ways that exposure to inflammation
[00:40:00.320]might also subtly change women's perceptions
[00:40:03.280]of their own desire and pleasure and their sexual reward.
[00:40:07.400]So in other words, inflammation might decrease a woman's sexual interest
[00:40:12.880]and decrease the amount of reward and pleasure that she experiences
[00:40:16.880]when she does engage in sex, and that if that happens on the balance,
[00:40:22.000]it's going to decrease her sexual frequency and delay her chance
[00:40:25.200]of conception to a time when her body is not in the state of active inflammation.
[00:40:30.440]And this would be a highly adaptive response in our evolutionary past.
[00:40:34.840]So we set out to investigate this new question by taking another
[00:40:38.480]look at the data from the study that I mentioned a moment ago
[00:40:40.680]where we were following women over the course of their cycle.
[00:40:43.400]So over that month, women reported on
[00:40:46.400]they did a daily diary measure
[00:40:48.120]on whether or not they had engaged in any kind of sexual activity that day,
[00:40:51.520]and if so, how aroused they became, how much pleasure they experienced and so on.
[00:40:56.520]And we also measured their CRP levels and kind of looked at how that mapped
[00:41:01.680]onto their self-reported sexual pleasure at different phases throughout the cycle.
[00:41:08.040]So indeed, we did see some significant effects here,
[00:41:11.200]so inflammation was not significantly related to women's self-reported
[00:41:15.480]sexual pleasure, either at menses or in the luteal phase, we didn't expect
[00:41:19.040]that those are not times when there's a very high chance of conception.
[00:41:23.120]It's not zero, but it's very unlikely.
[00:41:26.200]Surprisingly, there was actually a small but significant positive association
[00:41:30.600]between sirup and pleasure during the follicular phase,
[00:41:33.880]which is a little bit of a head scratcher, but might make sense in the context
[00:41:37.040]of the hormonal responses that are happening
[00:41:38.760]during this time as the body ramps up its estrogen
[00:41:42.840]during the follicular phase towards the ovulatory phase.
[00:41:46.640]It can actually have a slightly pro-inflammatory effect
[00:41:50.800]at the same time that other things are also driving sexual desire.
[00:41:55.760]But what was really kind of the kicker here is that we saw this
[00:41:58.320]really significant negative relationship between inflammation and pleasure
[00:42:03.760]during the ovulatory phase that is during the time of peak fertility.
[00:42:07.640]So in other words, if a woman experienced a higher level of inflammation,
[00:42:12.400]she reported much lower sexual pleasure for the sexual activity
[00:42:16.760]that happened during that ambulatory phase. Excuse me.
[00:42:22.800]So this fits this this fits really nicely with our original hypothesis
[00:42:27.360]that at the times when women were at peak fertility,
[00:42:30.080]that the negative effects of information on sexual reward were really amplified.
[00:42:35.080]But this analysis was limited by the fact that it's a really small group of women.
[00:42:39.040]It's only 30 women.
[00:42:40.760]So we thought to replicate these findings in a much larger, more diverse
[00:42:43.840]group of women and to examine a variety of different measures of inflammation
[00:42:47.400]and a variety of different ways of looking at sexual pleasure and desire.
[00:42:51.080]So for this next study, we recruited 91 women to come into the lab, and there
[00:42:55.480]they completed a really comprehensive battery of sexual functioning measures,
[00:43:00.360]as well as a comprehensive battery of measures of their inflammatory response.
[00:43:05.560]So we also measured their vaginal sexual
[00:43:07.600]arousal using about vaginal photocopies mcgruff, which indexes
[00:43:11.480]these really my new changes in blood flow in response to a sexual film.
[00:43:15.520]And they completed samples of saliva and blood and vaginal fluid.
[00:43:19.360]But to stay consistent here, I'm just going to be reporting
[00:43:22.600]on our findings with your so drumroll, please.
[00:43:26.200]We found a whole lot of nothing
[00:43:30.880]like seriously like impressively null results,
[00:43:34.000]and this was true if we looked at different measures of desire.
[00:43:37.720]So here I'm just showing off our results with our clinical index of desire,
[00:43:42.200]which comes from a really well validated clinical screener.
[00:43:45.080]But that was also true if we looked at self-reported desire
[00:43:48.040]to the sexual film or their desire that week.
[00:43:51.720]This was true. If we looked at zero p or we looked at other
[00:43:54.440]measures of inflammation like different kinds of cytokines.
[00:43:58.480]It was like really impressively null.
[00:44:00.600]And then we were talking about this with a group of researchers from Canada
[00:44:04.640]who had done a similar set of studies and we were like, we found all results.
[00:44:08.120]What did you find? And they said, Good question. Let's go look.
[00:44:10.720]And these sliced and diced their data 8 million ways.
[00:44:12.720]And they also found no results.
[00:44:15.280]So at least we were confident in the null myths of these results.
[00:44:21.120]Now, given the fact that this wasn't in lab study,
[00:44:25.480]it would be tremendously difficult
[00:44:27.240]to try to capture people during their ovulatory phase.
[00:44:30.040]It's a really narrow window of time.
[00:44:32.320]And so we were not actually in this study.
[00:44:34.440]We were not looking at people just within that narrow ovulation window.
[00:44:39.160]And so taken together, the results from our first study and the results
[00:44:42.880]from this impressively male study, what it suggests is that if there is an
[00:44:46.840]effect of inflammation on sexual desire, then it's really specific
[00:44:51.840]to the cycle phase, really specific to that ambulatory phase.
[00:44:56.760]But where we did see some significant effects
[00:44:59.400]of inflammation in this healthy sample is in sexual arousal
[00:45:03.880]and in particular with vaginal blood flow in response to sexual arousal.
[00:45:07.880]So our measure of national arousal is derived from the national photo.
[00:45:11.200]Put this in a graph I mentioned a moment ago.
[00:45:13.040]So here's a picture of the photo Put this in a graph.
[00:45:15.240]It's a small, tampon shaped device that participants
[00:45:18.360]insert themselves into their vagina in the privacy of a locked room,
[00:45:22.680]and it measures these really tiny minute changes in vaginal blood flow.
[00:45:26.640]The science writer Mary Roach once called this Cinderella's tampon,
[00:45:30.000]which I will treasure forever.
[00:45:32.960]So here I'm presenting on the
[00:45:34.320]degree of change in the amount of blood flow.
[00:45:38.120]But it's our findings are pretty similar here.
[00:45:40.080]If we look at how quickly the arousal response happened
[00:45:43.240]or how long women spent
[00:45:45.080]in their highest phase of arousal, that is the plateau phase.
[00:45:49.040]So following some of our prior work
[00:45:52.120]showing differences between women who are infrequently versus frequently
[00:45:55.600]sexually active, we looked at this interaction
[00:45:57.400]between degree of sexual activity and the effects of inflammation.
[00:46:02.120]So women who were regularly sexually active two or more times a week
[00:46:06.800]showed a really significant negative association between inflammation levels
[00:46:11.040]and the degree to which
[00:46:12.160]their vaginal blood flow increased in response to the sexual act.
[00:46:15.200]So nicely fitting in with our original theory.
[00:46:18.600]Surprisingly, we saw actually the opposite
[00:46:21.040]response in women who were more infrequently sexually active.
[00:46:24.480]Another head scratcher
[00:46:25.520]We don't have a great explanation for this,
[00:46:27.240]but one possibility is that women who are more infrequently sexually active
[00:46:31.400]have more variable patterns of sexual arousal,
[00:46:34.240]especially when they come into the lab.
[00:46:36.200]And so that may have kind of changed the way that we are able
[00:46:40.000]to detect these effects in the lab.
[00:46:43.120]So everything that I've been talking about up until this point has really kind
[00:46:47.200]of looked at inflammation and immune response across the whole body, right?
[00:46:51.200]Systemic levels.
[00:46:52.640]But we're also really interested in understanding the local effects
[00:46:56.360]within the reproductive tract because the effects of the immune system
[00:47:00.600]can be very different if you're looking in the general circulation
[00:47:04.120]versus if you're looking locally within a particular tissue bed.
[00:47:08.320]So here I'm going to do a
[00:47:11.080]little shout out to my graduate student, Kristen, who's also here in the front row,
[00:47:15.320]who is leading the next few set of studies that I'm going to be talking about here.
[00:47:19.680]So. In the same study that I described a moment ago, we also had
[00:47:22.520]women insert a menstrual cup into their vagina
[00:47:25.840]for ten minutes before and after the sexual film,
[00:47:29.080]and this collected samples of their vaginal and cervical fluid.
[00:47:31.800]So it allows us to be able to look at the composition
[00:47:33.920]of the lubrication that their body produced during sexual arousal.
[00:47:37.720]And not surprisingly, women had a greater expression of lubrication post arousal.
[00:47:43.280]So everything that I present here takes into account the difference
[00:47:46.280]in the total sample volume collected in the concentration
[00:47:49.360]of these findings are of these samples.
[00:47:52.880]So I'll also note here that I have shifted away from talking about inflammation,
[00:47:57.480]and here I'm looking at immunoglobulin
[00:48:00.400]A, which is a very important mucosal
[00:48:04.360]antibody that exists at the boundary points
[00:48:08.960]and is our first line of
[00:48:10.680]defense against diseases that occur within this mucosal environment.
[00:48:14.040]So is our first line of defense against sexually transmitted infections.
[00:48:18.240]We're really interested in kind of understanding the dynamics there.
[00:48:22.520]So we found no difference
[00:48:24.520]in the antibody production in women who had relatively low levels
[00:48:29.480]of vaginal sexual arousal from their pre to post arousal samples.
[00:48:34.400]There was really not a big difference.
[00:48:35.840]There was a slight decrease, but this was not significant.
[00:48:39.080]However, among women who had really high levels of national arousal,
[00:48:43.320]there was a significant increase in the production of these vaginal anti
[00:48:49.000]anti sexually transmitted infection antibodies.
[00:48:52.440]And because these antibodies are so important to the resistance
[00:48:55.360]disease, it's possible that this effect is part of a coordinated response
[00:49:00.320]of the body to use information about sexual arousal
[00:49:05.080]to predict the kinds of infection
[00:49:07.960]that it might encounter in the subsequent minutes,
[00:49:11.640]and to shift immune resources
[00:49:14.520]towards the kinds of immune resources, the kinds of antibodies
[00:49:18.320]that are going to be most important to reduce the possibility
[00:49:22.760]of having a transmitted infection in that context.
[00:49:27.560]So if that's the case, then it's another instance in which our body
[00:49:30.320]is using information about sexual arousal, about sexual pleasure
[00:49:34.560]in order to cue the activity of the immune system.
[00:49:39.040]This is heads up
[00:49:39.760]number two that I'm going to talk about sexual trauma for another moment.
[00:49:42.800]So again, those of you who are tapping out come back in about two minutes.
[00:49:47.640]So we're also really interested in the ways that sexual trauma,
[00:49:50.560]particularly childhood sexual abuse, or KASEI, can influence
[00:49:54.720]how a woman's immune response to sexual arousal might play out.
[00:49:58.800]Sadly, these experiences are incredibly common, and so a fair number of women
[00:50:03.600]in our sample reported having experienced childhood sexual abuse.
[00:50:07.960]So we saw a significantly increased concentration in vaginal IGA
[00:50:13.520]in the post arousal samples among women who did not have trauma histories.
[00:50:17.960]Unfortunately, in the women with the history of childhood sexual
[00:50:21.160]abuse, the level of vaginal antibodies significantly decreased.
[00:50:26.000]Now you're probably thinking as we were.
[00:50:28.240]Well, this is surely related to what
[00:50:29.720]you just showed me in the previous slide, right?
[00:50:31.400]Like this has to do with surely the women who have a history of childhood
[00:50:35.080]sexual abuse have lower levels of arousal and that that in turn,
[00:50:38.760]is explaining this decrease in their rational antibodies.
[00:50:42.600]But in this particular sample, that's actually not the case.
[00:50:45.520]There was no relationship between the history
[00:50:48.880]of childhood sexual assault and the degree of arousal.
[00:50:52.520]Some women had low arousal.
[00:50:53.920]Some women had high arousal in both groups.
[00:50:56.880]But the same kind of arousal, the same level of arousal,
[00:51:00.320]had very different outcomes, depending on the history of sexual trauma.
[00:51:05.080]And this, in turn, might start to explain why we see such
[00:51:08.240]dramatically different rates of sexually transmitted infections
[00:51:11.840]in survivors of childhood sexual abuse, even when we account for differences
[00:51:16.320]in sexual activity patterns and contraceptive barrier use.
[00:51:20.320]And again, a little
[00:51:21.400]shout out to sexuality science here, because I'll note that the pre
[00:51:25.240]arousal levels are pretty similar in women with and without trauma histories.
[00:51:29.920]And so we would not see this difference unless we studied women
[00:51:33.760]in the context of sexual arousal, right?
[00:51:36.560]And given that sexually transmitted infections happen,
[00:51:40.720]that they are transmitted during sex, it would seem really important for us
[00:51:45.400]to understand the dynamics of how the body responds during sex and how that in
[00:51:49.720]turn, might influence our risk for sexually transmitted infections.
[00:51:55.640]So welcome back to those of you who stepped out
[00:52:00.280]kind of transitioning again here.
[00:52:01.800]So our next direction for this line of work is trying
[00:52:06.400]to replicate the effects in a larger, more diverse sample
[00:52:09.560]and really digging into the mechanism of these effects.
[00:52:12.560]So does it change with people have different kinds of partnerships?
[00:52:15.240]Does it work in trans people? Does it?
[00:52:17.520]Do we have the same effect in?
[00:52:18.880]Queer relationships and people with multiple partnerships.
[00:52:21.800]Do we see it in older folks, do we see it in people
[00:52:23.680]using different kinds of contraception?
[00:52:25.200]These are all unanswered questions,
[00:52:26.640]and we're really excited to kind of delve into that.
[00:52:29.520]Another avenue that I'm really excited to follow up is applying these findings
[00:52:33.720]to understanding premenstrual dysphoric mood disorder or key MDT.
[00:52:38.520]So there's increasing evidence that inflammation and in particular
[00:52:42.080]the kind of chronic inflammation that we see in the modern western world
[00:52:46.520]is associated with depression and other mood symptoms
[00:52:51.480]like fatigue and loss of pleasure, which we call anhedonia.
[00:52:55.680]So some folks have suggested that premenstrual dysphoric mood disorder
[00:52:59.760]might reflect an increase in inflammation around the time of menses.
[00:53:05.920]But one of the things that makes this hypothesis really difficult to test
[00:53:10.360]is that there's extraordinary variability in individual relationships
[00:53:15.240]to their own menstrual cycle and individual differences
[00:53:19.720]in how the mood shifts over the course of the menstrual cycle.
[00:53:24.280]So just for example, in one study, we followed women for six months
[00:53:28.600]and we had them give us daily reports of their mood and other
[00:53:31.680]depressive symptoms for a total of 2534 daily reports.
[00:53:37.200]The study was a beast.
[00:53:39.520]And then we measured and modeled each person's
[00:53:42.120]individual level of variability, as well as cycle effects of variability.
[00:53:46.760]And this is a picture of the absolute mess that happens when you do that.
[00:53:51.800]So individual variation is absolutely overshadowing
[00:53:56.000]any of cycle that we can detect in a sample like this.
[00:54:00.280]But given what we now know about how sexual activity may interact
[00:54:05.280]with how inflammation changes over the course of the cycle and how
[00:54:09.080]sexual trauma in turn may further amplify these effects, it's possible
[00:54:13.600]that we may be able to better track mood changes that could lead to MDD
[00:54:18.640]if we account for sexual activity and trauma history.
[00:54:22.120]So we're currently conducting a follow up study that's measuring
[00:54:24.680]changes in cytokines and hormones over the course of the menstrual cycle
[00:54:28.720]in sexually active and abstinent women and women with and without a trauma history.
[00:54:32.240]So stay tuned for more results there.
[00:54:35.120]A great big shout out to the many people who make this work possible.
[00:54:38.880]first and foremost, a huge shout out to my graduate students
[00:54:42.600]without whom this work would simply not be possible.
[00:54:45.480]So right to left here we've got Katie and Alison.
[00:54:48.760]Tom Carper, Jones, Kirsten Clifton and Sophie Sanchez.
[00:54:51.520]Thank you guys so much for your work.
[00:54:53.800]It really would not be possible without you.
[00:54:55.440]Also, big thanks to our funders, without whose generous support.
[00:54:59.200]Again, this work would not be possible.
[00:55:01.920]And also a special little shout out
[00:55:04.200]thanks to the era of Zoom and the Zoom livestream.
[00:55:07.320]My parents are listening from the East Coast,
[00:55:12.040]so mom and dad, big shout out to you.
[00:55:14.680]Thank you for supporting me over the years, even when my crazy
[00:55:18.600]interests led to some pretty awkward dinner conversations.
[00:55:22.920]You've always been my biggest supporters, and I can't tell you how much
[00:55:25.920]that's meant to me over the years.
[00:55:27.840]So thank you all for your attention and I welcome any questions.
[00:55:37.840]Thank you so much to learn so much.
[00:55:40.440]It's wonderful if you have any questions
[00:55:44.040]and you were here in person, you're welcome to step up to the mikes.
[00:55:47.680]If you are via Zoom, you can put them in the chat.
[00:55:51.640]We do have one question. We have Zoom.
[00:55:55.960]There's a question about quantifying.
[00:56:00.360]Active and sexually active, so how active is sexually active?
[00:56:05.400]This is such a great question and I think really gets to the heart of
[00:56:09.680]the need for replication of these findings and really diving
[00:56:12.600]into the mechanisms of the effect because sexual activity
[00:56:17.040]has an enormous range of diversity of expression, right?
[00:56:20.920]And it's very difficult for us to even start to define what is sex like,
[00:56:26.880]what counts of sexual activity because of that immense diversity.
[00:56:31.000]And so one of the things that we really need to be doing
[00:56:33.920]moving forward with
[00:56:34.640]this work is kind of opening up and kind of looking at our right.
[00:56:37.680]Do we see this effect in queer folks?
[00:56:39.960]Do we see this in folks who are
[00:56:43.360]engaging in sex but with different kinds of contraception?
[00:56:47.320]Because that will help us to sort of tease apart
[00:56:49.680]what are the specific pieces of this that really that really matter?
[00:56:53.840]one of the things that we've sort of taken away from this,
[00:56:56.040]not from from the work that we've done, but from some other researchers
[00:56:59.680]who have looked at
[00:57:01.720]women who are in lesbian relationships versus women
[00:57:04.600]who are in hetero relationships versus abstinent women
[00:57:07.880]is that we do see very similar effects
[00:57:10.400]among queer and hetero folks, which suggests the possibility
[00:57:16.080]that it has to do more with some of the partnered aspects of sex
[00:57:20.560]or potentially the sexual arousal aspects of sex than it does
[00:57:24.960]the the pure kind of penetrative components.
[00:57:28.800]That said, queer women also engage in penetrative sex.
[00:57:31.520]That's not necessarily the case, and also
[00:57:33.720]we tend to see some of these effects in arousal to masturbation.
[00:57:37.720]So again, the broad answer to that question is, I don't know, and I'm
[00:57:41.480]excited to find out.
[00:57:53.120]I had a question about when your side that was talking about low grade
[00:57:57.000]chronic inflammation and how that relates to
[00:58:00.760]like lower vaginal arousal women who are sexually active.
[00:58:03.280]What is that inflammation that you're measuring and like?
[00:58:06.880]Like how does that how does that inflammation like present in the body?
[00:58:10.200]Great question. So there's a lot
[00:58:11.480]of different ways that you can measure inflammation.
[00:58:13.200]It's a it's a whole system.
[00:58:15.480]one of the ones that we typically measure is this protein called
[00:58:18.840]C-reactive protein, which is a it's a hepatic protein that is made on demand
[00:58:25.280]in response to a whole lot of different inflammatory systems across the body.
[00:58:29.480]So that is reflected in the general circulation.
[00:58:33.960]And then we can measure that either in the blood or in saliva.
[00:58:36.800]It's just a little bit easier to get in saliva because then
[00:58:38.600]we don't have to take blood from people and that can be a little stressful.
[00:58:42.360]But there's also different ways that we can look at
[00:58:45.520]the way that the immune system actually communicates with itself
[00:58:48.800]using particular signaling molecules called cytokines.
[00:58:51.960]And so one of the things that we're really interested in
[00:58:53.520]is understanding not just the byproducts of the inflammatory system, but
[00:58:58.080]also the signals that it sends to itself and also to other systems.
[00:59:02.960]There's also kind of functional ways that you can look at inflammation
[00:59:06.240]so you can look at things like wound healing
[00:59:09.040]or the ways that the inflammatory system actually changes the tissue.
[00:59:13.120]So things like actually causing
[00:59:15.920]changes in the vascular dynamics that's usually a little bit more of a
[00:59:19.960]kind of fine grained than what we get to in this research, just simply because
[00:59:24.960]we try to be as minimally invasive as possible with our work
[00:59:29.440]because we kind of recognize it's already asking a lot of the people to come
[00:59:32.280]into the lab and share their most intimate parts of themselves with us.
[00:59:36.240]But I think if we were to move forward, kind of that would be the next step
[00:59:39.480]of looking at some of those functional measures,
[00:59:41.280]because that's your question. Awesome.
[00:59:55.160]A great talk, thanks, Kim.
[00:59:57.520]Follow up on that just a little bit, so a lot.
[00:59:59.800]I mean, I guess I'm still trying to process how much the
[01:00:03.240]level of information reflected by the C-reactive protein,
[01:00:06.040]a sort of cause or which running in parallel.
[01:00:09.320]But we take we take lots of anti-inflammatories on a regular basis.
[01:00:15.000]Does that come in here?
[01:00:16.480]Is it does that influence your studies and does that influence
[01:00:20.040]how people feel arousal and when people have taken the toxin
[01:00:23.720]or ibuprofen or something like that that are really over-the-counter,
[01:00:28.000]pretty powerful, any
[01:00:28.720]inflammatory statement for the hundreds of milligram amounts? Yeah.
[01:00:31.960]So when we conduct these studies, we generally exclude people who are taking
[01:00:37.320]anti-inflammatory medications on a regular basis,
[01:00:40.920]and we ask people to avoid using those kinds
[01:00:43.960]of over-the-counter medications on the day that they come in.
[01:00:47.160]Essentially cause we want kind of a blank slate in that reflect.
[01:00:50.560]But I will say that is an active interest of mine
[01:00:54.160]because as I mentioned, some of the things that we're looking at in terms of
[01:00:58.480]understanding the interactions between inflammation
[01:01:01.080]and mood, particularly around this premenstrual dysphoric disorder.
[01:01:04.720]one of the implications of the findings of that study know, assuming that
[01:01:08.280]we find what we think we're going to find is that some of the prophylactic effect
[01:01:13.840]that people experience by taking these NSAIDs
[01:01:18.160]in that premenstrual phase could potentially extend beyond just
[01:01:23.320]regulating pain or regulating cramps, but
[01:01:26.640]potentially could also have an effect on mood as well.
[01:01:30.480]And if that's the case, that would be an immensely powerful tool
[01:01:33.600]for us to have as clinicians. OK, thanks.
[01:01:46.040]During lockdown,
[01:01:49.920]first, Tierney, thank you so much for a very thoughtful,
[01:01:53.800]interesting and inclusive talk, I really appreciated that tons.
[01:01:58.560]I'm going to ask you a question about the data you didn't
[01:02:00.680]talk about in your slide because it was just really interesting.
[01:02:03.720]I started scratching down notes because I was going to forget otherwise.
[01:02:06.920]So when you were showing the slide
[01:02:10.040]of the Bolivian women and the CERP measures,
[01:02:14.600]you replicated your effect, but you had another variable in there.
[01:02:17.280]You didn't talk about which was the poorer or better off.
[01:02:21.560]Yeah. Would you be willing to talk a little bit about that
[01:02:23.840]because you replicated the pattern in both?
[01:02:25.880]But just to remind people or no relationship was higher
[01:02:29.680]in both cases or the better off? Hmm.
[01:02:33.200]Yeah. And I I would love to unpack that further.
[01:02:36.120]So that piece of the project
[01:02:39.680]came out of trying to start to get at some of these mechanisms.
[01:02:44.080]And one of the things
[01:02:46.720]that I have a hunch about
[01:02:50.600]is that part of this effect of the way that sexual activity
[01:02:55.480]is having an effect on inflammation is through the stress system
[01:03:00.440]because of some of the things that we found around
[01:03:02.560]how sexual arousal kind of causes that decoupling with the stress
[01:03:06.280]response system, in particular with cortisol.
[01:03:09.440]So one of the things we were interested in, we had some women in that study
[01:03:14.080]who were really living under extreme
[01:03:18.000]conditions, extreme financial hardship.
[01:03:21.280]They were physically just moving their bodies all day,
[01:03:25.040]going through really difficult arm work, know low resource availability.
[01:03:31.520]And then some of the women lived kind of a little bit closer to town.
[01:03:35.240]They had a little bit more eat.
[01:03:36.600]They just had lighter, less stress overall.
[01:03:39.080]And so we were really interested in understanding the interaction between
[01:03:42.320]chronic stress that comes from socioeconomic status
[01:03:47.400]and its relationship to these kind of broader system of effects.
[01:03:51.800]Because we would expect that if it is really about stress,
[01:03:56.600]then we would see that amplified in the folks
[01:03:59.600]who are experiencing more chronic daily stressors.
[01:04:03.400]But what was kind of interesting is that we did see an ordinal effect
[01:04:08.120]like an intercept shift, but we didn't necessarily see the the interaction
[01:04:11.680]of the shape of the effects, the way that we had anticipated.
[01:04:23.800]I don't see any other questions,
[01:04:26.440]let's call it quickly.
[01:04:32.720]Thank you so much again,
[01:04:33.800]and I hope you all will join us on March 29th, which when
[01:04:37.600]all our speakers come back together and have a panel discussion.
[01:04:42.840]And thank you again to Dr. Lorenz.

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"Sexy Times Call For Sexy Measure" | CAS Inquire

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