Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer, survivors and their partners, it can feel even more awkward. In fact, sex ranks among the top five unmet needs of survivors, and a new digital health startup, Will2Love, has been launched to help fill this void.
Sixty percent of cancer survivors — 9.3 million individuals in the United States alone — end up with long-term sexual problems, but fewer than 20 percent get professional help, according to Leslie R. Schover, PhD, Will2Love’s founder. Among the barriers she cites are overburdened oncology clinics, poor insurance coverage for services related to sexual health and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients and survivors about these issues.
Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for health care practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health.
“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” she adds.
The problem is twofold: how to encourage oncology teams to do a better job of assessing and managing sexual problems and how to help those impacted by cancer to discuss their sexual concerns.
Schover says that simple, open-ended questions such as: “This treatment will affect your sex life. Tell me a little about your sex life now,” can help to get the conversation started.
Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.
Sexual dysfunction after cancer can often lead to depression and poor quality of life for survivors and their partners.
Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, explains Schover. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.
“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stresses. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”
Schover hopes that Will2Love will bring much-needed attention to the topic by providing easily accessible resources for patients, survivors, their partners and health care providers. (Box)
Currently visitors to the website can subscribe to its e-newsletter and receive a free introductory five-part email course covering topics related to what your doctor may not be telling you about sex, fertility and cancer. After the fifth lesson, users will receive a link to the Will2Love “Sex and the Survivor” video series. “Sexual health is a right,” Schover stresses, and oncology professionals, patients and survivors need to be assertive to get the conversation started.
It’s not always clear if a woman is really having an orgasm, as Meg Ryan demonstrated in When Harry Met Sally.
In the nascent field of orgasm research, much of the data relies on subjects self-reporting, and in men, there’s some pretty clear physiological feedback in the form of ejaculation.
But how do women know for sure if they are climaxing? What if the sensation they have associated with climax is actually one of the the early foothills of arousal? And how does a woman know when if she has had an orgasm?
Neuroscientist Dr Nicole Prause set out to answer these questions by studying orgasms in her private laboratory. Through better understanding of what happens in the body and the brain during arousal and orgasm, she hopes to develop devices that can increase sex drive without the need for drugs.
Understanding orgasm begins with a butt plug. Prause uses the pressure-sensitive anal gauge to detect the contractions typically associated with orgasm in both men and women. Combined with EEG, which measures brain activity, this allows for a more accurate picture of a woman’s arousal and orgasm.
Dr Nicole Prause has founded Liberos to study brain stimulation and desire.
When Prause began studying women in this way she noticed something surprising. “Many of the women who reported having an orgasm were not having any of the physical signs – the contractions – of an orgasm.”
It’s not clear why that is, but it is clear that we don’t know an awful lot about orgasms and sexuality. “We don’t think they are faking,” she said. “My sense is that some women don’t know what an orgasm is. There are lots of pleasure peaks that happen during intercourse. If you haven’t had contractions you may not know there’s something different.”
Prause, an ultramarathon runner and keen motorcyclist in her free time, started her career at the Kinsey Institute in Indiana, where she was awarded a doctorate in 2007. Studying the sexual effects of a menopause drug, she first became aware of the prejudice against the scientific study of sexuality in the US.
When her high-profile research examining porn “addiction” found the condition didn’t fit the same neurological patterns as nicotine, cocaine or gambling, it was an unpopular conclusion among people who believe they do have a porn addiction.
The evolution of design of the anal pressure gauge used in Nicole Prause’s lab to detect orgasmic contractions.
“People started posting stories online that I had falsified my data and I received all kinds of sexist attacks,” she said. Soon anonymous emails of complaint were turning up at the office of the president of UCLA, where she worked from 2012 to 2014, demanding that Prause be fired.
Does orgasm benefit mental health?
Prause pushed on with her research, but repeatedly came up against challenges when seeking approval for studies involving orgasms. “I tried to do a study of orgasms while at UCLA to pilot a depression intervention. UCLA rejected it after a seven-month review,” she said. The ethics board told her that to proceed, she would need to remove the orgasm component – rendering the study pointless.
Undeterred, Prause left to set up her sexual biotech company Liberos, in Hollywood, Los Angeles, in 2015. The company has been working on a number of studies, including one exploring the benefits and effectiveness of “orgasmic meditation”, working with specialist company OneTaste.
Part of the “slow sex” movement, the practice involves a woman having her clitoris stimulated by a partner – often a stranger – for 15 minutes. “This orgasm state is different,” claims OneTaste’s website. “It is goalless, intuitive, and dynamic. It flows all over the place with no set direction. It may include climax, or it may not. In Orgasm 2.0, we learn to listen to what our body wants instead of what we think we ‘should’ want.”
Prause wants to determine whether arousal has any wider benefits for mental health. “The folks that practice this claim it helps with stress and improves your ability to deal with emotional situations even though as a scientist it seems pretty explicitly sexual to me,” she said.
Prause is examining orgasmic meditators in the laboratory, measuring finger movements of the partner, as well as brainwave activity, galvanic skin response and vaginal contractions of the recipient. Before and after measuring bodily changes, researchers run through questions to determine physical and mental states. Prause wants to determine whether achieving a level of arousal requires effort or a release in control. She then wants to observe how Orgasmic Meditation affects performance in cognitive tasks, how it changes reactivity to emotional images and how it compares with regular meditation.
Brain stimulation is ‘theoretically possible’
Another research project is focused on brain stimulation, which Prause believes could provide an alternative to drugs such as Addyi, the “female Viagra”. The drug had to be taken every day, couldn’t be mixed with alcohol and its side-effects can include sudden drops in blood pressure, fainting and sleepiness. “Many women would rather have a glass of wine than take a drug that’s not very effective every day,” said Prause.
Prause is studying whether these technologies can treat sexual desire problems. In one study, men and women receive two types of magnetic stimulation to the reward center of their brains. After each session, participants are asked to complete tasks to see how their responsiveness to monetary and sexual rewards (porn) has changed.
With DCS, Prause wants to stimulate people’s brains using direct currents and then fire up tiny cellphone vibrators that have been glued to the participants’ genitals. This provides sexual stimulation in a way that eliminates the subjectivity of preferences people have for pornography.
“We already have a basic functioning model,” said Prause. “The barrier is getting a device that a human can reliably apply themselves without harming their own skin.”
There is plenty of skepticism around the science of brain stimulation, a technology which has already spawned several devices including the headset Thync, which promises users an energy boost, and Foc.us, which claims to help with endurance.
Neurologist Steven Novella from the Yale School of Medicine uses brain stimulation devices in clinical trials to treat migraines, but he says there’s not enough clinical evidence to support these emerging consumer devices. “There’s potential for physical harm if you don’t know what you’re doing,” he said. “From a theoretical point of view these things are possible, but in terms of clinical claims they are way ahead of the curve here. It’s simultaneously really exciting science but also premature pseudoscience.”
Biomedical engineer Marom Bikson, who uses tDCS to treat depression at the City College of New York, agrees. “There’s a lot of snake oil.”
Sexual problems can be emotional and societal
Prause, also a licensed psychologist, is keen to avoid overselling brain stimulation. “The risk is that it will seem like an easy, quick fix,” she said. For some, it will be, but for others it will be a way to test whether brain stimulation can work – which Prause sees as a more balanced approach than using medication. “To me, it is much better to help provide it for people likely to benefit from it than to try to create fake problems to sell it to everyone.”
Sexual problems can be triggered by societal pressures that no device can fix. “There’s discomfort and anxiety and awkwardness and shame and lack of knowledge,” said psychologist Leonore Tiefer, who specializes in sexuality. Brain stimulation is just one of many physical interventions companies are trying to develop to make money, she says. “There’s a million drugs under development. Not just oral drugs but patches and creams and nasal sprays, but it’s not a medical problem,” she said.
Thinking about low sex drive as a medical condition requires defining what’s normal and what’s unhealthy. “Sex does not lend itself to that kind of line drawing. There is just too much variability both culturally and in terms of age, personality and individual differences. What’s normal for me is not normal for you, your mother or your grandmother.”
And Prause says that no device is going to solve a “Bob problem” – when a woman in a heterosexual couple isn’t getting aroused because her partner’s technique isn’t any good. “No pills or brain stimulation are going to fix that,” she said.
Same-sex couples are more likely to have a happy sex life in long-term relationships compared to straight couples.
And not only are gay people more likely to work on and try new things in their sex life, they are also less likely to believe they are ‘destined’ to be with a perfect partner.
According to new research by the University of Toronto, both same-sex and opposite-sex couples were happier when they were willing to work on their sex life and did not believe in a ‘perfect mate’.
Jessica Maxwell, a PhD candidate in the Department of Psychology in the Faculty of Arts & Science, used research involving 1,900 participants of both gay and straight couples.
‘Gay and lesbians have higher levels of sexual growth beliefs than heterosexuals, and have lower levels of sexual destiny beliefs than heterosexuals,’ she told Gay Star News.
‘This is encouraging because those with higher sexual growth beliefs had the best outcomes in our studies!’
The better outcome meant higher relationship and sexual satisfaction.
‘We know that disagreements in the sexual domain are somewhat inevitable over time,’ Maxwell added. ‘Your sex life is like a garden, and it needs to be watered and nurtured to maintain it.’
Maxwell scored gay and lesbian couples on average of 6.02 versus straight couples of 5.68 on the question of whether couples believed in working on sex in a relationship.
And on whether people believed in ‘sexual destiny’, opposite-sex couples were far more likely with a score of 3.17 compared to 2.69.
‘The fact that same-sex couples are higher in sexual growth beliefs does suggest they have a healthier view of sexual relationships which should in turn foster greater relationship and sexual satisfaction over time,’ Maxwell added to GSN.
The way Maxwell worded the question on sexual orientation, it did not allow her to easily differentiate if there was a difference between gay male couples and lesbian couples.
However, while she did see women were more likely to believe in soulmates and romantic destinies, the researcher found they are more likely than men to believe sex takes work in a long-term relationship.
Maxwell hoped to show that problems in the bedroom are normal, and it does not automatically mean the relationship is in trouble.
The study, How Implicit Theories of Sexuality Shape Sexual and Relationship Well-Being, was published in the November issue of Journal of Personality and Social Psychology. The research builds on the work of other researchers (Bohns, Scholer and Rehman, 2015) who examined the belief sexual attraction can be malleable.
Our inherent beliefs about sex can have a far-reaching impact on our relationships, finds new research published in the Journal of Personality and Social Psychology.
The way we think about sex may influence how satisfied we are with our relationships and sex lives, new research reveals.
University of Toronto researcher Jessica Maxwell, a PhD graduate, and her colleagues created a new scale to measure people’s general attitudes on sexual compatibility. They then tested their scale out across a variety of six different studies that involved nearly 2,000 participants. Overall, they found that people who strongly believe in sexual growth — a mindset that a fulfilling sex life takes effort and hard work from both partners — had better relationship and sexual satisfaction than those who didn’t. Meanwhile, people who believed in sexual destiny — that a good sex life is more a matter of finding the right person for you — had worse relationships when they started having disagreements about sex with their partner.
“People who believe in sexual destiny are using their sex life as a barometer for how well their relationship is doing, and they believe problems in the bedroom equal problems in the relationship as a whole,” explained Maxwell in a statement. “Whereas people who believe in sexual growth not only believe they can work on their sexual problems, but they are not letting it affect their relationship satisfaction.”
The differences between sexual destiny and growth aren’t easily apparent at first, Maxwell added, since many new relationships have their “honeymoon” phase when sexual desire is at its peak. It’s only later on in a long-term relationship that they begin to show up.
“We know that disagreements in the sexual domain are somewhat inevitable over time,” Maxwell said. “Your sex life is like a garden, and it needs to be watered and nurtured to maintain it.”
Interestingly enough, women were more likely to have a sexual growth mindset, which may reflect a reality about female pressure. Said Maxwell: “I think that this could be because there is some evidence that sexual satisfaction takes more work for women, so they rate higher on the sexual growth scale.”
Most people rarely belonged exclusively to one camp or the other, which is often the case in psychology research. For instance, some might be all for the concept of a sexual soulmate, while still believing that any good sex life requires communication. And even wholeheartedly believing in sexual growth doesn’t guarantee a successful relationship. But Maxwell believes their findings can be a source of relief to both the average person as well as therapists trying to reassure their clients that a flagging sex life isn’t necessarily the end of the road. And she does think believing in sexual destiny may be more trouble than it’s worth.
“Sexual-destiny beliefs have a lot of similarities with other dysfunctional beliefs about sex, and I think it’s important to recognize and address that,” she said.
Pleasure is personal, mostly because it has to be, and not least because female scientists continue to face grinding discrimination regardless of their area of research. And when it comes to sexual health, breakthroughs are few and far between: in spite of increasing documentation of associated health risks, birth control hasn’t really been reformulated since the 60s, and last year’s much-anticipated release of Addyi, a pill meant to fix female sexual dysfunction, only worked for ten percent of the women who tried it.
It’s clear that sexual emancipation has not yet been freed from the bedroom. In spite of its roots in scientific misogyny—the vibrator was developed in the 19th century to cure women of hysteria, after all—a swathe of new devices have people looking hopefully to sex tech (or sextech, as it is also known) as the answer to systemic gaps in sexual health. History, it seems, is coming full circle; where the 1960s saw the vibrator de-medicalized and uncoupled from science, today’s consumer market is beginning to see pleasure and health unified in the pursuit of wellness. Yet what we call “sex tech” is tied more to the lucrative sex toy industry—worth $15 billion this year—than it is to scientific institutions, with much of its promise linked to idea that personal pleasure makes for better health.
These days, more people than ever understand that a woman’s ability to understand what turns her on and why is a crucial step in developing a healthy perspective on her sexual life. So it makes sense that we’re seeking out masturbatory experiences that are more tailored than your average stand-in phallus. It’s the driving force behind the popularity of devices like Crescendo, the first-ever fully customizable vibrator, which raised £1.6 million in funding to date and shipped out over 1,000 pre-orders after a successful crowdfunding round.
Designed to cater to the inherent complexities of female arousal, the vibrator can be finely customized, equipped with six motors and the ability to be bent into any favorable shape. An accompanying app allows users to control each motor individually; it remembers favorite behaviors, provides pre-set vibration patterns, and responds to mood-setting music.
“We were inspired by the concept of tech designed for the human, rather than the human having to adapt their behaviour to tech,” says Stephanie Alys, the co-founder of Crescendo creators Mysteryvibe. “Human beings aren’t just unique in terms of our size and how we’re put together genetically, but also in terms of what we like. What turns us on can be different from what turns another person on.”
Mysteryvibe’s flagship product is the Crescendo, a customizable sex toy.
But in spite of the life-improving promises of consumer sex tech, the reality is that official, peer-reviewed studies remain crucial to reforming policy and education. Founded by Dr. Nicole Prause, Liberos Center is one of the few sex-centric research institutions in the United States. Much of its work investigates the relationship between psychology, physiology, and sex, with an emphasis on the hard data that is often lacking in sex tech.
Liberos presses on in a particularly antagonistic climate; the American government is famously skittish about sexual content. Sexual material is banned from government-funded computers, says Prause, making it difficult for researchers to, say, screen porn to test subjects as part of a study on arousal. She adds that congressional bodies actively seek to pull funding from research that addresses the topic head-on—four recent studies that had already been awarded funding were re-opened for assessment because of their sexual content.
“People report having certain types of experiences all the time,” says Prause. “But they’re often poor observers of their own behaviour, and don’t see anyone’s behaviour but their own. They don’t really have that external perspective, which is why I think it’s important to take both a psychological and laboratory approach. For example, in science, people haven’t been verifying that orgasm actually occurs. So we’ve been developing an objective way of measuring that, and of measuring the effects of clitoral stimulation—on how to best capture the contractions that occur through the orgasm.”
Liberos is also investigating the effect of transcranial magnetic stimulation (TMS) and direct current stimulation (tDCS) on sexual responsiveness. Both are non-invasive treatments, meaning anyone seeking a cure for low libido may not require anything more than the use of a headset. TMS holds potential for long-term changes to a person’s sex drive; the technique, which uses a magnetic field generator to produce small electrical currents in the brain, has already been used to treat neuropathic pain and otherwise stubborn cases of major depressive disorder. DCS, on the other hand, uses a headset to deliver a low-intensity electrical charge, stimulating the brain areas where activity spikes at the sight, or touch, of a turn-on.
If using the brain’s electrical signals to control the rest of the body sounds like a dystopian fantasy, the reality is that these medical treatments aren’t far off. Bioelectronic firms are now backed by the likes of Glaxosmithkline and Alphabet, Google’s parent company, and similar applications have already been established for hypertension and sleep apnea, while chronic conditions like asthma, diabetes, and arthritis are targeted for future development.
According to Dr. Karen E. Adams, clinical professor of OBGYN at Oregon Health and Science University, anywhere from 40 to 50 percent of women experience varying degrees of sexual dysfunction. Medication that targets neurotransmitters, like the SSRIs used to treat depression and anxiety, can fluctuate in efficacy depending on the unique makeup of the person using it.
Combined with the trickiness of locking down the nebulousness of desire (and lack thereof), it’s no wonder that Addyi, a failed antidepressant pursued because of its unexpected effect on serotonin levels in female mice, was a flop. Non-sex-specific studies have shown that electrical stimulation can be more adaptive to the brain’s constantly-shifting landscape than medication that interacts with its chemistry. For the 90 percent of women who found Addyi to be a sore disappointment, bioelectronic treatments could soon offer an alternative solution to low sexual responsivity.
“By giving women information about their bodies that they can decide what to do with, we’re enabling more female empowerment,” says Prause. “And by allowing women to decide which aspects of sex they want to be more responsive to, we’re giving people more control, and not with charlatan claims. We actually have good scientific reasons that we think are going to work, that are going to make a difference.”
Yet the field’s burgeoning successes are only as good as the social environment they take hold in. Sociopolitical hurdles notwithstanding, money remains a significant roadblock for developers, as the controversial nature of sex research has many investors shying away from backing new projects in spite of consumer interest. Whether they’re seeking government funding or VC investments, sex start-ups and labs alike are often forced to turn to crowdfunding to raise money for development.
“It’s pretty unsurprising that heavily female-oriented tech products do so well on crowdfunding sites; these are solutions to problems faced by half of the population, that are overlooked by a male-dominated industry where male entrepreneurs are 86 percent more likely to be VC funded than women,” says Katy Young, behavioral analyst at research firm Canvas8. “But the audience is clearly there—Livia, a device which targets nerves in order to stop period pains, raised over $1 million on Indiegogo.”
Outdated sex ed programs, which emphasize procreation and normalize straight male sexuality without addressing female sexual development, are ground zero for unhealthy social perspectives on sex. Acknowledging that change can’t just come from devices alone, New York’s Unbound, a luxury sex toy subscription service, is teaming up with “campus sexpert” app Tabù to bring both sex education and affordable masturbation tools to colleges across the country.
“There’s a national discussion right now surrounding consent, which is 100 percent needed and super important,” says Polly Rodriguez, CEO and co-founder of Unbound. “But for women to be able to engage in sex and address consent as equals, they need to learn about female pleasure—they should understand their own bodies so that when they are engaging in sexual activities with someone else, they know what feels good to them, they know how to communicate that, and they don’t feel uncomfortable about it.”
It’s tempting to buy into the idea of tech as freeing: that the increased presence of smart devices in our lives will help us form healthier habits and a better understanding of our ourselves, or that the availability of medically-approved tech will be a panacea in the intricately fraught landscape of female sexual dysfunction—which is as socially determined as it is biological, and as cultural as it is psychological.
But sex tech is still far from being paradigm-shifting. Its success will be dependent not only on consumer dollars but on government policies and public attitudes; at a level of engagement this intimate, tech is only any good if people feel free to use it.