What Do Women Want?: Adventures in the Science of Female Desire (15 page)

But even for those who dismiss evidence like the twin study and who trust the lessons of the paralyzed and the truth of the internal orgasm, a primary mystery clouds everything. What is the exact anatomical origin, or blend of physiological sources, for this variety of bliss? Is the G-spot a spot or a diffuse and even slightly morphing province? Is it an entity of the vaginal wall itself or is it more about what lies behind the wall, the nerve-dense clitoral extensions, the wings, charted in the late nineties? If it’s about those extensions, and the stimulation they might receive through the wall during intercourse, are vaginal orgasms clitoral after all? Or is Komisaruk right in deducing, from his data with paraplegics, that this probably can’t be the case, because in these paralyzed women the nerve tracts from the extensions would be severed just like the paths from the glans?

And how should anyone grapple with understanding the mechanics and nerve routes of the proposed third type of rapture, the cervical climax, a late addition to the orgasm debate—and one with a possible reproductive relevance? As with rats, stimulation of a woman’s cervix facilitates a hormonal release that can, to an unknown degree, aid the fertilized egg. But finding out, scientifically, whether women can actually have a cervical climax may be impossible. It’s difficult to imagine how the experience could be isolated, difficult to imagine the dildo, kitchen-made or otherwise molded, that could completely bypass stimulation of the walls and touch only the back of the canal.

Setting themselves to unclouding the G-spot if not the cervical uncertainties, two French doctors lately positioned a woman, who said that she had vaginal orgasms, in gynecological stirrups. They had her lover slide himself inside her, and they put a sonogram’s scanner on her pelvis. This vision of intercourse revealed that a pair of the clitoris’ underlying projections might be the solution to the G-spot puzzle. These projections embrace the spongy, nerve-lush lining of the urethra. And on the sonogram, when the penis struck a particular zone on the front wall, the extensions were stirred into a scissoring motion, massaging the urethral lining. This, one new theory went, stoked the lining into an overload of neural activity—and the woman into climax. So the spot was the source of the scissoring, and the ultimate origin of the orgasm was the urethra’s cushiony outer layer.

Komisaruk and Whipple have released a guide for the general reader: “If one or two fingers are inserted into the vagina, with the palm up, using a
come here
motion,” the zone can be found. “Women have reported that they have difficulty locating and stimulating their G-spot by themselves (except with a dildo, a G-spot vibrator, or similar device), but they have no difficulty identifying the erotic sensation when the area is stimulated by a partner. To stimulate the G-spot during vaginal intercourse, the best positions are the woman on top or rear entry. The orgasm resulting from stimulation of the G-spot is felt deep inside the body.”

None of the efforts on either side has put an end to the vaginal versus external disputes. Nothing seems likely to. About half of all women believe they have a G-spot; half think they don’t. But Komisaruk and Whipple, using their finger pricker and pupillometer, have verified something that transcends anatomy, something that hasn’t brought much doubt: there are women who can think themselves to orgasm with no touching whatsoever. For reasons unclear, it’s a capacity much more common in women than in men. In Komisaruk’s and Whipple’s lab, imagining lovers or, for some, passages of music, women have sent themselves into ecstasy.

One afternoon I watched as Wise, Komisaruk’s associate on the fMRI study, lay back in the cylinder and demonstrated. It was all about breathing, she told me before she went into the machine, and about the strength of the pelvis and about “knowing how to circulate the energy.” She kept her preferred fantasies to herself.

I asked if it was truly an orgasm.

“There are all kinds of sneezes,” she said, “but there’s no question it’s a sneeze.”

Now she was motionless under the sheet. On the screen, the constellations of dots were getting thicker and thicker, more crazed. Five minutes and nineteen seconds after she began, she raised her hand.

Chapter Nine

Magic

M
artina Miller, the coordinator, counted out tablets. Wendy filled out a questionnaire. She prided herself on efficiency, and she was efficient at this. She sat at Miller’s desk, facing photos of Miller’s carefree dogs in magnetized frames on a file cabinet. She removed the paper clip that fastened the questionnaire’s many pages, swiftly read each query, quickly checked the boxes beside her answers, straightened the pages by tapping them sharply—
click-click
—against Miller’s white enamel clipboard when she was finished, reattached the fastener, and passed the document back to the coordinator.

In return, Miller handed Wendy a new supply of medication. Red slacks, a canary yellow scarf with orange trim—Wendy radiated bright hues and optimism. She said thank you, gave a split-second’s giggle, zipped the pill jar into her glossy shoulder bag. But there was a glitch. Checking her computer, Miller pointed out that Wendy had been missing some of her reports, that she hadn’t been making an entry in her online diary every time she put a tablet on her tongue.

“I know, I know,” Wendy confessed. “It’s a mess. I keep forgetting.” For two or three minutes, her upbeat armor cracked. There were no tears, only fear expressed in cheerful tones, as she stopped in here at a center for sexual medicine in a Maryland suburb. Soon she would be outside, in her car, in the sun, away. She would be driving through the May afternoon to her ten-year-old daughter’s lacrosse practice. But now she explained to Miller that she’d taken the drug, felt nothing, done nothing with her husband, fallen asleep and ignored her diary the next day, with only failure to record. She hoped her first round of pills had been placebos.

A
nswering ads on the radio, in newspapers, on Craigslist, the women had arrived to enroll in the trials all fall and winter. I’d watched that stage of the process at another clinic, near downtown Washington, DC. The tiny drug company, Emotional Brain, had enlisted centers all over the country, clinics run by psychologists and gynecologists and everyday physicians, some taking part just because medical trials were a facet of their practice, others because they believed that EB’s inventions, Lybrido and Lybridos, might prove distinct enough from the earlier chemicals of other companies, might be ingenious enough in their composition and precise enough in how they would be prescribed, to be the first aphrodisiacs to make it past the FDA, the first to give doctors something, something reliably successful and government approved, to offer women like Wendy.

“They use terms with real emphasis, words that are violent,” Andrew Goldstein, who ran the DC center, said about his patients. The light in his office was soft. A close-up photograph of a cherry tree hung opposite his diplomas. “This is like someone cut off my arm; this is not how I see myself; this is like something’s been ripped away from me. Stripped away. Stolen.” He was among the most prominent gynecologists in the country, the president of the International Society for the Study of Women’s Sexual Health. And he was all but exultant. He didn’t stand to profit financially if the data from the trials panned out, if the two drugs outperformed the placebo, if the side effects were mild, if the FDA gave its blessing. He’d signed on for trials of other medications, molecules aimed by pharmaceutical giants at the same despair, the feeling of desire’s vanishing, aimed at the same market, worth over four billion dollars a year in America alone. Then, for the past two years, he’d taken a hiatus, out of frustration. But Lybrido and Lybridos had rekindled his hope. He sensed solutions. And it wasn’t only that. EB’s diagnostic method, its gleanings of the genetic and the learned through blood work and interviews and its algorithm that compiled and processed these gleanings, would allow new glimpses into women’s sexual brains.

“The tools we’ve had up till now have been like flint knives.” His field’s wherewithal, for comprehending, for treating, had been blunt, crude; it had belonged to the Stone Age. As we talked between his screenings of possible subjects, he wore a blue and white pin-striped shirt, a white lab coat. His voice was scratchy and high. He had a cherubic face and full gray hair, so that he looked sometimes childlike, sometimes stately. The gray seemed to disappear when he spoke about EB’s algorithm, its pills. “God bless! This is fine-tuned!”

If EB turned out to be on target, he said, there would be fantastic changes, specific, vast. He would have a drug to help a subset of his patients, women whose antidepressants suffocated their desire. He would have a way to understand one of the conundrums of his field: why birth control pills snuffed out sexuality in some—but far from all—women. He would have something much more accurate than the current blurry grasp of testosterone’s effect on female libido. And more than anything, for all sorts of women, he would be able to restore what they felt had been torn away.

An African-American law student who, after five years with her boyfriend, couldn’t trick herself into the wanting she’d once felt, could only trick him. “I use a lubricant, so he doesn’t know,” she told Goldstein, as he interviewed her for EB’s pools. A divorced mother of three who sensed herself, with her lover, slipping into a sexual indifference that was familiar from the demise of her marriage. “When we split up,” she said about her ex-husband, “it was like going through a second puberty. So I attributed what had gone missing to who he was.” She gave some attribution as well to her children, the energy they drained away, the physical and occupational therapy appointments her disabled son needed each week. But with the indifference returning, she was starting to doubt those attributions, starting to wonder if it was something about herself. A bank officer who, answering Goldstein’s questions about her past, mentioned where she’d met her husband. “It was at Nashville International Airport.”

“How’d you meet him at an airport?” This sort of detail didn’t matter at all to EB in deciding who to enroll in its trials, but Goldstein was that kind of doctor. He liked to get to know the women who sat across from his desk, even if they weren’t his patients, even if they would only be in and out of his office a few times over several months, to pick up tablets and answer follow-up questions, even if they would be gone forever after that.

“I was a screener,” the bank officer remembered. “I was in college, and I was a part-time screener. I was coming back from lunch in my uniform, and he was looking at me, and I said, It’s not polite to stare at a woman without saying hello. I turned around, and he followed me.”

“Obviously he had something to say.”

“Obviously,” she said, and she and Goldstein laughed together.

“How long did you date?”

“It was extremely fast. June we met, March we married.”

And for years, even with young kids, she’d felt that speed, that sense of something predestined; she’d counted on the rush of their combined bodies. Now, in her late thirties, all happened slowly, all waited at a receding distance. Often she faked her orgasms.

“When he initiates sex, do you feel anxious?”

“I do.”

“Stress?”

“I try not to show it.”

For every woman who wanted to enroll, there were a range of reasons. There were the demands of law school, the disabled son, a self-consciousness about added weight, a fibroid surgery that seemed to have caused damage, though a neurologist could find no loss of sensation. “When he plays with me, when he tries to jump start me down there, I don’t feel it, I don’t understand,” the bank officer said. “That’s why I need to be in this study.” There were lots of factors, always, Goldstein told me. But as I listened, it sometimes seemed there was only one. There was no ripping away, no theft; nothing violent had occurred; there was only a leaving behind. Time had passed. Desire was back there. That was all. That was violent enough.

Lybrido, Lybridos, the pharmaceutical efforts that had come before them, the inestimable millions or billions that the industry had poured into research—the race was for a drug to cure monogamy. This was the main demand, the market with the biggest potential payoff.

“I just want to know,” one woman asked at the end of her interview, after describing the man she’d spent the past seven loving years with, “is this medicine going to work? Am I going to get my freak back?”

I
n her front yard, one May evening two years ago, Wendy sat with her neighbors on lawn chairs. Behind the women, their houses stood quiet, modest, in matching brick; beside them was a portable fire pit on iron legs, flames breathing heat into air on a cusp between spring and summer. Their upstairs windows were opened wide, letting that air transform the rooms. Their children swooped on a rope swing behind Wendy’s house; their husbands were at an Orioles game; the women sipped their wine.

A beeper went off, faint, then louder, more insistent, bleating into the suburban calm. Wendy’s next-door neighbor sprang up. The study Wendy and two of the others were in that year worked a bit differently than the EB trials; electronic diaries, logs of sexual acts and feelings, were to be updated every day, and Wendy’s friend sprinted inside to silence the company’s automated reminder before it began screaming across the neighborhood. They were taking Flibanserin. They tracked their responses for the company and talked with each other—and with their other friends at the fire pit, who were monitoring their progress—about whether the experimental pill was working. They wondered together what the odds were that two or all three of them had been given the placebo. They agreed, on evenings like this, or in the mornings, over coffee after putting their kids on the school bus, that whatever they’d been handed wasn’t having any effect, though one of them thought there might be a chance she was starting to feel something.

I
ntrinsa and Libigel, Flibanserin, Bremelanotide, these were among the defeated drugs that had come before Lybrido and Lybridos. Intrinsa and Libigel, a patch and an ointment, delivered infusions of testosterone—and within testosterone’s failure with the FDA were lessons about how little science had managed to sort out when it came to the biochemistry of women’s lust.

Somehow, by mechanisms still just broadly understood, testosterone primes the making and messengering of dopamine, the brain’s courier of urgent wanting. This priming happens within and right near the almond-sized hypothalamus, which sits down by the brain stem and helps govern our base drives and bodily states—hunger, thirst, lust, body temperature. Intrinsa and Libigel tried to influence the dopamine circuits that are devoted to sex by sending more testosterone through the blood to the brain.

Spiking dopamine directly, instead of using testosterone, can cause trouble. The techniques aren’t refined; the results can be a brain in overall overdrive, damage to the circuitry of motor control, severe nausea, a risk of addiction if you spike too often. And, Pfaus told me, testosterone might assist desire in ways that reach beyond dopamine by tweaking other crucial neurotransmitters. Given all this, a drug supplying extra testosterone seemed a promising approach. But there were baffling complications. They were known, to some extent, even before the testosterone aphrodisiacs went into development and into trials. Whether because testosterone isn’t the main primer after all, as some scientists argue, or because there is too much other biochemistry at play, the puzzle was this: add testosterone to a woman’s bloodstream, and you wouldn’t necessarily cause a rise in desire; deplete the hormone, and you wouldn’t dependably reduce libido.

Oral contraceptives, Goldstein said, launching into a lecture on hormonal confusion, could all but eradicate a woman’s blood-borne testosterone. “Birth control pill–takers have free testosterone levels one-tenth, one-twentieth of where they would normally be.” This situation hadn’t always been so drastic. Pharmaceutical companies had lately been fabricating contraceptives that pushed testosterone lower and lower to strengthen a sales-enhancing side effect—the elimination of acne. For plenty of women, the hormonal decimation didn’t seem to make any difference to desire. For some, the pill generated drive, probably, Goldstein went on, because women without worry of pregnancy, with lighter or less frequent bleeding, were more likely to seek out sex. But for others, oral contraceptives led to a crash in libido. Why were some women harmed by the bottoming out of testosterone, others unaffected?

Menopause added to the riddles surrounding the hormone. Middle-aged women and lots of their physicians tended to blame menopause for dissipating desire. Doctors gave out testosterone as a remedy—they gave it in a way known as “off-label,” unapproved by the FDA, semilegal. And some women reported successful results. Yet despite popular belief about the time of life when the hormone dropped, menopause didn’t actually bring a decrease in testosterone at all; instead, there was a slight rebound. In truth, a steady decline had taken place long before, when a woman was in her twenties and thirties. And the depth of the decline was no worse than what went unnoticed in uncountable women who took the pill.

Was there a way to make sense of any of this? Was there a way to draw tight links between the physiological—whether something as straightforward as a hormone count or as complex as menopause—and libido? With estrogen, possibly. Around menopause, loss of estrogen led, in some women, to dryness that could undermine desire—even though, if you hooked these women to a plethysmograph and played a pornographic movie, blood raced as it did in far younger subjects. The tissues just weren’t manufacturing as much fluid anymore when the blood flowed in. So the psychological pathways of desire were intact, but the chemical reactions responsible for wetness were impaired. And the tissues themselves could thin. This could lead to obvious problems: if intercourse was uncomfortable, you weren’t likely to want it; if it was downright painful, you would probably avoid it; either way, you might quit thinking about it; desire might be destroyed. Then again, something else was obvious, too: there were any number of other ways to have sex. But a deficit—immeasurable, maybe immense—was at work. Your mind wasn’t going to be hearing the messages of your genitals as well as it once had. And the communication could be tenuous to begin with. Chivers’s experiments had shown this; her subjects could seem deaf to what their genitals were saying. Lubrication was part of the language—with that diminished, the lustful messages might be more muted, the mind less prone to the awareness of desire, the brain and body much less easily caught up in a loop of yearning.