I attended a lecture on sexual pharmacology at the recent American Association of Sex Educators, Counselors and Therapist conference. It was quite enlightening. One interesting tidbit: The sexual pharmacology revolution took a major shift in 1998 when Bob Dole became pitch man for Viagra.
When talking about sex, drugs and hormones, we often only think in estrogen for women and testosterone for men. The reality is that both sexes have both hormones, just different amounts, plus other hormones that affect our sexual functioning from a neurological level.
Compare it to traffic in Los Angeles – with all the lanes and roads crossing each other, when one is affected, many others change with it.
There are three stages of sexual response that we look at with neurological sexual functioning:
Estrogen and testosterone are big players here, but so are dopamine and prolactin.
Dopamine is the neurochemical that regulates pleasure and helps with attraction. We know that women need to feel some sort of reward or pleasure to have desire. This means different things for different women, but it does not mean orgasm. That comes later.
An increase in serotonin has been shown to decrease sexual desire, which is why “inhibiting sexual desire” is a side effect of so many antidepressants. Lastly is prolactin, which is mostly associated with lactation.
However, men will experience an increase in prolactin during relationship changes and the transition after his baby is born.
Here we look at Nitric Oxide and Acetylcholine, which play a role in genital tissue-functioning during sexual play. Both of these promote vascular responses, which we know are important for a woman's body's to become ready for penetrative sexual play. Serotonin also plays a role in inhibiting sexual arousal.
Here, we primarily look at endorphins and epinephrine. Norepinephrine facilitates orgasms, and again, our friend serotonin inhibits them. Oxytocin (the cuddle hormone) is also released for both men and women, which makes us feel a sort of high. The brain sometimes “misunderstands” during this stage, meaning it confuses pain and pleasure as they tend to travel on the same pathways.
As you can see, there are a lot of interactions between our neurological system and sexual response, but there's more to it. When we change one thing, we change another. When a drug enters our body, a domino effect takes place.
So I like to talk to patients about self and mental care before we start talking about hormones or medications.
A sex therapist from Florida was giving the sexual pharmacology lecture and mentioned he jokes around with his male patients when they want a pill to fix their erectile issues. His witty advice: Go to a strip club and get a lap dance. If you still can't get an erection, then you can look at hormones and medications.
I think that's genius. Now, I don't advocate strip clubs, but I am in favor of looking at relationship factors, family stress, overall self-care with eating habits, sleep and exercise before all else. For example, women that have young children are touched all day by needy kids. They often don't want to be touched when their husband comes home – and this isn't necessarily due to hormones.
All this said, I also support the use of hormone testing and replacement when needed.
I want to encourage couples to stop and think about their sex lives. What do you want and how do you get it?
There is not a test or machine that can determine an individual's level of arousal or desire the way self-reflection and open conversation can.