Nicole (Nikki) Prause, Ph.D is an impressive neuroscientist working mostly in the field of sex research. I see her name pop up all the time, as an author on interesting journal articles, and as an expert voice in newspaper articles most often on the topic of sex and porn addiction. I was lucky enough to get Nikki on the phone to ask her some of my questions about her research.
I wanted to know what drew Prause to the field of sex research. She told me it wasn’t actually a very exciting story. She was doing a clinical science degree at Indiana University, which is also home to the Kinsey Institute; a private research facility for the study of human sexuality. She could get her required lab class credit at the institute, and to her it seemed like a no-brainer because sex is, of course, a fascinating topic. The first study she ever did was measuring the vaginal responses of older women, looking at the sexual effects of a drug that at the time was commonly taken by post-menopausal women.
After this, she was hooked. “There was just so much complexity and unknowns in that field that it seemed like there was a lot left to do!” She was right of course, and in the time since has contributed a lot to the field. And although there is still a lot left to do, she's still working at it!
For a decade Nikki worked as a faculty member doing her research at SPAN Lab, UCLA. Yet last year when trying to put together a study in which orgasms would be provoked in the lab, UCLA refused to approve it. Not for any safety or ethical reasons, they just didn’t want it done on their campus. Shocked at having a study disapproved, she told me it was only the second one in the history of UCLA that had ever been disapproved. At the same time a colleague of hers at Pittsburgh had the same study approved by his ethics board.
I know that it’s sometimes difficult to get funding for and carry out sex research, so I was actually surprised that this wasn’t more of a common occurrence. But Prause explains that, “definitely with sexuality they always have extra questions. There’s always a bit of a delay. You have to answer their concerns. [E.g.] That you’re not exposing someone to porn for their first time ever, or that you’re not going to infect people with HIV with your genital instruments (which is a very reasonable concern). So yeah, it usually takes a bit longer to get sex studies through but I had never heard of one that was just blocked.”
Liberos: THE FREEDOM TO DESIRE
In light of this situation she decided to “jump ship and just try and make go of a business”. That business is Liberos LLC. Her own brain research company, where she is currently carrying out studies of brain stimulation and brain training in relation to sexual response and orgasm. The company is in its early stages having only been founded last year, but Prause told me that it has been an amazing experience. Although it has taken longer for things to get up and running than she had initially expected, there are already some very exciting projects in the pipeline now that she has the freedom to study what she likes without needing UCLAs approval.
At our time of speaking she was finishing up a contract to do partnered genital stimulation as part of an orgasmic meditation study. Something she can’t imagine UCLA would ever have allowed her to do.
Liberos is also partnered with a clinic that houses some very expensive brain stimulation devices, so she is also able to carry out research on brain stimulation. One paper of which is under third review at the journal, and she believes will be helpful for women who have low desire problems and may also have applications for people with the reverse issue of high drive problems.
I wanted to know how and why she was working on an orgasmic meditation study, as it’s an area that seems quite distant from the rest of her body of work. Orgasmic meditation is a specific practice that I’ll just briefly describe. It’s partnered stimulation, but always a female that is being stimulated. The stimulation is basically soft and gentle touch just around the clitoris for 15 minutes. I’m not sure why it’s “meditation” because it looks a lot like just being masturbated while focusing on breathing.
When she was introduced to the orgasmic meditation people around three years ago Nikki said she thought it sounded “pretty goofy”. But when during an early conversation she asked, “are you open to the possibility that all of these benefits that you’re proposing are just due to sexual arousal, not anything religious or spiritual?” and they answered “of course”, she was happy with the response and so got on board with the study. She explains, “sexual arousal by itself has good health effects, so that’s kind of how we’re treating it”. Whilst the orgasmic meditation people are of course interested in some of the holistic benefits also, Nikki is especially focused on and interested in looking at partnered stimulation.
Sex & Porn Addiction
During Nikki’s decade at UCLA the idea of sex and porn addiction has blown up, caused much panic, and solidified in the mainstream as fact. Much of Nikki’s research has been focused around this, and she is a prominent counter-voice in the media where she has been attempting to communicate the reality of the data and what it means.
She told me that whilst there are certainly people who have problems with sex and pornography, the real question is “how do we best understand what that problem is, because the model that we apply determines what kind of treatment is likely to be helpful”. Nikki’s main issue with the categorisation of sex and pornography as being “addicting” is that it leads to us not providing the correct solutions.
Addiction is not the only model that can be used to explain people’s issues with sex and pornography. Other models could be applied; she suggests compulsivity, or the social context of shaming.
Nikki says her own research finds that there are many pieces of the addiction model that simply don’t fit. She explains that in the media her research is often presented as “there is no such thing as a problem with sex or porn”. But assures me this is never what she has said. More to the point her work is to say that the evidence shows the problem is probably not an addiction. So how do we best think of it? And then how can we treat it?
She explains, “If it’s something that’s primarily due to shame (or at least for some sub-set of people) that is causing them to feel like what is actually normal, is abusive or shameful or problematic, then that suggests more of an educational approach in therapy.” Alternatively “if it’s something that looks more compulsive, we have OCD treatments that could be generalised to sexual behaviour”.
Both these approaches are a far cry from the addiction model. And the treatments employed would be very different than that of addiction treatment. By categorising peoples’ problems with sex and porn as “addiction”, we may be missing a huge opportunity to provide the most effective treatment and support. And as Prause put it “just sticking to the addiction model, with not much evidence to it, could actually be harming people”.
With addiction, the overwhelming treatment model used is abstinence. Even with regard to substance abuse, there is much debate within the addiction field as to the effectiveness of abstinence-based treatment. There is a growing body of work, Nikki tells me, “trying to sub-type and identify people who would do okay with moderation”. So already the abstinence model may be flawed, but when applied to sexuality, the flaws appear to be amplified.
Nikki gave an example of one of these flaws in action. When she used to see couples in therapy, sometimes one partner had a sex addiction diagnosis and they’d been told not to have sex with their partner. Which Nikki says "is a huge problem if you’re trying to do couples therapy. [Because sex] is usually the one unique way that partners can connect. And would usually signal that they’re going in the right direction, that they had some benefits from the therapy. And yet in their case it’s considered a failure if they have sex”. She adds “getting that kind of a label, and being treated that way, causes other problems”.
Interestingly Nikki tells me it’s been found that people who do adopt the label of ‘sex addict’ or ‘porn addict’, and who like to apply the label to themselves, tend to have a more conservative, religious background, and tend to feel that any doing (any wanking, any viewing of porn) is immoral. For these people, it seems the problem is very closely tied to feelings of shame around sexuality, something that the addiction model can’t account for, and something that abstinence will not solve.
Beyond these feelings of shame is the basic issue of lack of understanding and education around sexuality. If we don’t have an accurate understanding of what’s ‘normal’ and healthy, then ANY behaviour can be perceived as unusual and unhealthy.
Nikki mentions the online communities of discussion and support groups for abstinence. She's concerned by the fact that it appears that a lot of the conversation in the groups are between very young men who “by and large don’t understand relationships, don’t understand sexuality and might benefit from just understanding what’s normal, what’s common, how masturbation works” and so on. She also notes that very young guys are probably in their peak sexual responsiveness, “so it makes sense that they might experience that urge as feeling very powerful and feeling overwhelmed by it,” but that it’s a better idea to teach them that they’re not actually overwhelmed by it, and they can actually control it. i.e. Empower young men to understand and harness their sexuality rather than feel ashamed or not in control of it.
In my experience of running a sex advice page I’ve found an alarmingly high rate of young guys who feel like they have a problem with pornography and masturbation. It seems unlikely that all these guys actually have a problem. And more likely that it’s their own feelings, and messages they receive from our culture, that lead them to perceive their behaviour as troublesome.
A lot of men worry that they are masturbating too often, or watching too much porn, or watching the wrong kind of porn. And a lot of men attribute these things to any issues they might be having with erectile or ejaculatory problems. Nikki thinks that the introduction of Viagra in 1998 could have something to do with this.
Over the past decade or so there has been a lot of panic about an increase in the prevalence of erectile dysfunction (ED) in young men. And the growth of easily accessible Internet pornography has been blamed as the cause. But the problem is, Nikki points out, is that the Internet is not the only thing that has changed over the years. A lot has changed, including the introduction of magical boner pills.
Nikki reckons that Viagra and its various cousin drugs, and the messages communicated in their advertising, has altered the expectations that we have of erections. That is, that we now have an expectation that men (and especially young men) should always be able to get hard and stay hard, and if they don’t there’s a problem. But the reality is, is that there are a hundred and one factors that can influence erectile function, and it’s absolutely normal, and common to have difficulties with your erections that come and go. In fact, just like me, Nikki isn’t convinced there even is an increase in ED among young men, just that changing expectations have led to more men seeking medical advice for totally normal erectile experiences.
Again this isn’t to say there aren’t real issues. There absolutely are people for whom porn has become a problem, or at least where their porn use is a symptom of another problem. And there are people who do engage in compulsive and risky sexual behaviours that could be harmful to themselves and others. But these issues need to be explored without us jumping to condemn porn as a whole, and without us jumping to conclusions with no basis in science. In order for us to best understand, and best provide help those who are suffering, we need to move away from the addiction model, and porn-panic, and explore some alternatives.
As many of my conversations with experts end up doing, this talk really highlighted the desperate need for fact-based sex education, and more accurate discussions about sex and sex research in the press. But we can only have these evidence-based, honest dialogues because of the amazing research that is being done by people like Nicole Prause, working hard to uncover the complexities of human sexuality.