#97 Better Orgasms Using the Brain with Barry Komisaruk

[Angel Donovan]: Barry, thank you so much for joining us today.

[Barry Komisaruk]: My pleasure.

[Angel Donovan]: So, just to get a bit of background on what you do, Barry, you're working in a lot of scans, and I think a lot of our audience aren't very scientific, so in layman's terms, could you explain how you go about exploring orgasms and investigating them?

[Barry Komisaruk]: We record the activity in the brain using functional magnetic resonance imaging or functional MRI. And we have men or women do self-stimulation in the scanner and we map the genital sensory input to the brain and then we ask them to self-stimulate to orgasm. We've also done partner stimulation to orgasm under various conditions. And so that's the basic situation.

One of the big problems with doing brain imaging is head movement, so I spent a lot of time and effort in developing a system that immobilizes the hand. So we have been able to reduce the head movement to less than 2 millimeters, which can be compensated for by the computer program.

[Angel Donovan]: That must be fun for the people in the scanner having orgasms while they can't move their heads.

[Barry Komisaruk]: Right. It takes special kind of people, but they say it's comfortable. It's basically a whiplash neck brace combined with a thermoplastic mesh over the back of the head and the front of the face.

[Angel Donovan]: Sounds like a fetish, almost.

[Barry Komisaruk]: We heat it up in warm water and mold it to the head, the face, and to the neck brace and cut out holes for the eyes and the nose and then we clamp it down into the scanner. So it really holds the head very immobile, but it's comfortable. I've done it myself and nobody's complained about it.

[Angel Donovan]: Well, that's a good sign. That's a good sign.

So, in terms of what the fMRI is actually looking at, what is it, is it blood flow or how are you getting at the brain activity?

[Barry Komisaruk]: It's more than blood flow. It's related to blood flow, but what happens in the fMRI is that when neurons in the brain are more active, they take in more oxygen from the blood and the iron in the blood carries the oxygen. So as soon as the oxygen is taken out of the blood, it changes the magnetic property of the iron in the blood and that perturbation is what is picked up in three dimensions in a magnetic field and that's what creates the image.

So it's really the activity of the brain in a local region taking the oxygen out of the blood and that change is what is measured as the brain activation. That local activation is superimposed on the anatomical image of the person's own brain so we know exactly where it's located.

[Angel Donovan]: Great. And we hear a lot about functional MRI in the press these days, pretty much all of the studies are using it; why is it the most popular for tracking things like brain activity? Is it the best thing we have right now?

[Barry Komisaruk]: It's the best thing we have. The advantage is that you can see activity in the brain in three dimensions throughout the brain in all regions of the brain. The difference between that and EEG that people are familiar with is that EEG is really just basically, surface activity; you can't localize the activity deep in the brain. But with a functional MRI, you can see very small regions of activation in all places in the brain and even in the spinal cord.

The other major advantage of a functional MRI is that it's just a software modification of MRI. So all hospitals have MRIs to do anatomical images of the body, but functional MRI uses a special software to add the ability to see brain activation. So there are many such instruments throughout the world, and basically, most major hospitals have an MRI instrument so it's possible to have functional MRI.

So there's been an explosion in the use of functional MRI since it was started in the 1990s; tens of thousands of studies using functional MRI because it's relatively cheap compared to positron emission tomography, or PET, which is the other major imaging method. That requires making radioactive substance and when I've done it, it was about $7,000.00 per scan as opposed to functional MRI which is several Hundred Dollars per hour.

The other advantage of an fMRI is that it's completely noninvasive, as opposed to PET where you have to inject radioactive material into the person in the scanner; there's nothing like that in the functional MRI, they just lie in the scanner and we take the pictures.

[Angel Donovan]: Yes, much safer probably for the long term, especially if you're going to be doing quite a lot of them as it seems you do in your studies.

Have you been working on orgasms for 30 years?

[Barry Komisaruk]: Scientifically speaking?

[Angel Donovan]: Scientifically speaking or however you want to speak.

[Barry Komisaruk]: Scientifically speaking, I've been studying orgasm for about 35 years, but I've been studying reproductive behavior with laboratory animals for about 45, 50 years.

[Angel Donovan]: Great.

[Barry Komisaruk]: [Unclear 11:29].

[Angel Donovan]: You did and you must be one of the world's experts, at this point.

So if you were to walk us through the 35 years, what were the big highlights, in terms of your work? Has it all been functional MRI looking at how the brain responds to orgasms? Is that the most fascinating thing to you, the brain and how it's related to orgasms?

Because a lot of things we think about today are physical, when we're talking about orgasms. Some of the things we have on this show is hitting the G-spot and stimulating the clitoris and these are the kinds of things that everyone talks about a lot, but of course, you've focused a lot of your energy on looking at the brain. Now have there been other things that you've looked at over time?

[Barry Komisaruk]: Yeah, sure. I've looked at the nerve pathways getting to the brain and those have been very interesting. The way I got into this whole area was through studies in laboratory animals in which the mating stimulus stimulates the hormones of pregnancy. I was interested in how the brain controls the hormone system and how the hormones influence the brain; that was how I got started. And in my post-doc at UCLA in the Brain Research Institute, they were studying this reflex of how vaginal stimulation stimulates the hormones of pregnancy and when I tried it in my own lab, I saw that the animals seemed to first become immobilized with the vaginal stimulation. I tested whether the immobilization would inhibit their response to painful stimulation and it completely blocked the response to painful stimulation. And I did a series of studies to confirm that the pain is really blocked by the vaginal stimulation. And then I said the only way to know for sure is by studying women and asking women what happens; that was the most scientific approach to it, just ask women what happens to their pain response when they have vaginal stimulation. So I did that and recruited Beverly Whipple as my doctoral student and we did that study.

We found that in fact, the vaginal self-stimulation has a very powerful pain blocking action; that's really how I got started. Then to find out what sensory nerves carry the pain blocking signal, I identified in the animal studies by doing differential surgery, cutting different nerves. I identified that the pelvic nerve carries the pain blocking signal.

And then to test that in women, the only way to test that in women would be to study women who have spinal cord injury at different levels that would block the access of the various nerves to the brain. So when I did that, my most severe case condition was to be women who have a complete severed spinal cord high up that would block all the possible nerve pathways to the brain and that should block the ability of the vaginal stimulation to block pain. And what I found, to my surprise, was that those women still felt their vaginal stimulation.

[Angel Donovan]: So someone could be in a wheelchair and be paralyzed and not be able to feel their legs, and if she's a woman, she could still have an orgasm and feel stimulation there?

[Barry Komisaruk]: And this was a shock to everybody. It was hard to believe because they had no sensation below the injury and no voluntary control of the movement, but they did have menstrual cramps and they could feel the vaginal stimulation of all things.

[Angel Donovan]: That's great news for them.

[Barry Komisaruk]: Well, it was great news for them and it was a shock to them because they had been told by their doctors that their sex life is over, that they have no sensation, and they never tried for years and years. They came into the lab and they tried the stimulation and they said, "I can feel this."

[Angel Donovan]: That's great. And for guys, a guy in a wheelchair because he's a physiological response, can it work for him or is it just for women?

[Barry Komisaruk]: Well, this is a big question that I'm very interested in right now. I think there's a possibility anecdotally, I have contacted some men with complete spinal cord injury like that and they say that they have no genital sensation at all, but they can feel their prostate.

Let me just get to the bottom line with the women because I identified the mechanism by which they can feel the vagina is via the vagus nerves and I did that by doing brain imaging, functional MRI of the brain looking at the region of the brain to which the vagus nerves project. The vagus nerves are the cranial nerve X. They go outside the spinal cord. They go directly from the brain to various organs in the body and from various organs in the body bypassing the spinal cord completely.

So they are intact with these women with the severed spinal cord and I saw that with the functional MRI that when they applied the vaginal self-stimulation. The region of the brain that the vagus nerves projects to is activated and those women had orgasms and that's how I got the first data on where in the brain orgasms occur and that was the first evidence in women of where orgasms occur in the brain, it was in those women.

[Angel Donovan]: All right. So it's kind of like you were looking at other things and you stumbled across the whole subject of orgasms?

[Barry Komisaruk]: Right. Exactly. So in men, because the prostate gland has the same embryonic origin as the cervix in women, that there's a possibility the vagus nerve carries sensation from the prostate in men and we're looking into that possibility. So that may account for why men with a complete severed spinal cord say they can feel nothing else, but they can feel their prostate; this is possibly a route for them to have orgasms, but we have to look into that.

[Angel Donovan]: Great. So you've been doing all this work on orgasms; how would you describe an orgasm? Because I think it's something that's not very well defined today and we don't really know where it comes from. What is an orgasm for you? How would you describe it?

[Barry Komisaruk]: Well, in terms of the bodily physiology, what's common in women and men is that the heart rate approximately doubles, the blood pressure approximately doubles, the pupils dilate, they become insensitive to pain. Of course, men, there's the ejaculation and some women also ejaculate and the evidence is that there is a prostate in women that's called the stains gland and that releases a small amount fluid in many women, maybe a teaspoonful, and that has the chemical constituents of male seminal fluid. So there is ejaculation in many women, and of course, in men, so those are some of the physiological responses.

And then in the brain, there's activation throughout the brain. I think the closest function that's shared by orgasm is epileptic seizure where there's also a very widespread activation throughout the brain. And many people with epileptic seizures describe them as being orgasmic.

[Angel Donovan]: That's interesting because when we describe orgasm, it's kind of this rush. A lot of people talk about this build and it's kind of like an explosion in your head or it's this rush in your head and it kind of does feel like it's all throughout your head.

Is it the same for men and women? Because a lot of people talk about the women these days, that they're more orgasmic than men, that's one of the common things we say. But is it true, based on your scientific research, are men and women different or are we experiencing the same thing?

[Barry Komisaruk]: We've looked at the brain activity in men and women and what I can say is that during orgasm, the similarities in brain activity are greater than any differences that we see. So the only major difference is after orgasm when there's a refractory period in men. That is when genital stimulation no longer can produce another orgasm until some time passes, it's called the refractory period, as opposed to women who can have multiple orgasms continuing one after the other, so that is a major difference.

In terms of a qualitative description of orgasms, there was an interesting study by Vance Wagner some years ago in which they asked college men and women to describe their orgasms in writing and then they edited out any reference to any specific body parts. They then gave the descriptions to sex therapists, psychiatrists and gynecologists to ask them to tell which description was written by a man versus which description was written by a woman. And they gave them something like 50 descriptions and the experts were not able to discriminate the descriptions produced by men and women versus women.

So, in other words, the descriptions of intense pleasure, intense arousal, activation and excitement, those kinds of descriptions were equivalent in men and women, indistinguishable.

[Angel Donovan]: That's actually good to hear because a lot of the communication differences between men and women are kind of said to be about we feel things differently, we experience things differently. Even in stereotypes in arguments and things, I think that comes up a lot so it's kind of good to hear that there's some common ground so we can actually have a pretty good understanding of what women are going through when they're having an orgasm.

I was wondering as you were talking about that, the quality of orgasms can be very different depending on the time, the person. The actual experience of it can be extremely varied and I was wondering if that's something that showed up in your research. Basically, are people different so two women are different? Or a woman at a different time, is it going to be a completely different experience each time just depending on it or is it pretty standard, in terms of how it shows up scientifically?

[Barry Komisaruk]: Well, there are a lot of questions in what you just asked me.

[Angel Donovan]: If we say it's one specific situation, it's not like they're varying the situation or the partners or anything. If it's just like self-stimulation say in the MRI, if she followed the same woman through several different functional MRIs and she was self-stimulating each time in the same [unclear 21:50] or however you asked her to do it, would it actually show up quite differently each time?

[Barry Komisaruk]: I would say that the similarities are greater than the differences, really in general. The intensities can change with physical condition. When I've been exercising a lot, my muscles are strong, my muscles contract more forcefully during orgasm and it feels more pleasurable; certainly, that factor. Also, depending on who you're with. I mean, there's sex and orgasm and then there's love and sex and orgasm and when love and passion are combined, that's a much more intense orgasm. When I have an orgasm with the woman I love, that's the most intense experience.

So there are certainly factors that can modulate the intensity of orgasm. Who you're with, certainly, that has a factor.

[Angel Donovan]: That strikes me as pretty difficult to research.

[Barry Komisaruk]: No, I haven't tried to ask people to come in with different individuals.

[Angel Donovan]: Come with this person you don't like. You can go in with them today. Tomorrow you'll come in with a person you really like. I'm not sure that's ever going to happen.

[Barry Komisaruk]: That one's a little hard to get through the ethics committee. I haven't tried that one. The University Ethics Committee might have something to say about that.

I haven't studied it, but there are reports that the likelihood and the intensity of orgasm can change over the menstrual cycle with hormone treatment. Certainly, testosterone in women and in men have been described as increasing desire and intensity of pleasure.

[Angel Donovan]: So higher testosterone levels?

[Barry Komisaruk]: Yes.

[Angel Donovan]: Does it have to be supplementation?

[Barry Komisaruk]: Higher testosterone level, only if there's an insufficiency of testosterone. In other words, if testosterone levels are normal, then adding testosterone doesn't do anything.

[Angel Donovan]: Do you know what that normal ratio would be? Because we've spoken about testosterone before and I don't know if you're aware, but there's been a decline in men. The normal standard over time is going downwards.

For instance, we talk about a level, I like to have mine at 800 to 1,000 nanograms per deciliter. We've tested some people in our coaching programs that would be like 200, 250, it was pretty low, and so we get them on some diets that will raise it and they tend to feel a lot better. I have a better sexual life like this stuff you're talking about, so I was just wondering if you had any ideas about the norms.

[Barry Komisaruk]: No, I don't know what the norms are. I know that in general, studies that have been done in women correlating testosterone levels with their desire, it doesn't show any significant correlation. In men, it is known that if there is insufficiency, then the testosterone will give them a boost, but if they're at normal levels, and different people have different normal levels.

[Angel Donovan]: So this would show up in the test, they'd be having a more intense orgasm? You'd see more activity?

[Barry Komisaruk]: Well, I wouldn't want to speculate because you're asking whether there would be a correlation between the perceived intensity of orgasm and any perceived change in brain activity or level of brain activity and that's a very difficult study and we haven't done it. We do ask the women to give us a rating of their orgasmic intensity from 1 to 10, we always do ask that, but the individual differences, with the variability, with that kind of analysis, that's just very difficult to do technically; it's very difficult to do because there's so many complexities.

[Angel Donovan]: It's hard to connect to the scans?

[Barry Komisaruk]: Well, what I can say is that when we analyze the change. We record continuously as the women and men are doing the self-stimulation and then having an orgasm and then afterwards. We ask them to press a button when their orgasm starts, and then we take the 10 seconds immediately after the button press and compare it to the 10 seconds immediately before the button press.

So in other words, they are highly aroused, just on the verge of orgasm, and then they go over into orgasm and we compare the activity in those two 10-second epochs and group all the activity, and what we see is that there is an overall increase going over into orgasm. So even though they're highly aroused, but not having an orgasm, their activity is lower throughout the brain than when they go over into orgasm. So in that sense, we can correlate the perceived intensity. We haven't looked at the perceived intensity of orgasm, per se, but the brain activity is lower immediately prior to orgasm and then immediately after or immediately at onset of orgasm. So we do see that kind of difference in brain activity.

[Angel Donovan]: Great. Great. One of the other things, I think this is maybe going to move a little bit outside of the MRI area, I'm not absolutely sure, it might all connect up, but one of the things I was looking for from your work was the fact that it seems like there's quite a bit of flexibility, in terms of where orgasms come from for different people, and this can vary from the genitals and even other areas; could you talk about some of the most common areas where you see this kind of activity and some of the rarer types of stimulation people get? So we can get a feel for the sensory stimulation people, it's kind of like different people can experience it through different ways and I think a lot of people don't understand the variety of that.

[Barry Komisaruk]: Well, one of the surprising things that we saw is that when we map where the genital system projects to in the brain, that was an initial study to see where the clitoris, the vagina and the cervix project to in the brain, in the penis, in the testicles, scrotum, prostate, rectum; we've done all that kind of mapping of the genital sensory responses, one of the big surprises to me, at least, was that when we asked the men and the women to do self-stimulation of other parts of the body like the hand, the face and the nipple, we got activation.

First of all, with the genital mapping we found that all the genital regions in men and women project to the same region of the sensory cortex. There's a region of the sensory cortex. The body is mapped onto the cortex in a point-to-point representation. So the hands, the face and the feet are all in slightly different locations on the brain in a very systematic pattern. Wilder Penfield was the one who did the mapping originally, and he called it the homunculus, so the little person, because the body is mapped onto the sensory cortex.

So that we see that all the genital regions project to the same general region of the sensory cortex, in men and in women. And that's very consistent with what Penfield mapped actually, deep in the midline between the two hemispheres of the cortex, right next to where the feet are represented, actually.

[Angel Donovan]: Well, some people have feet fetishes, right?

[Barry Komisaruk]: Exactly. And foot orgasms and so that could be a basis for some of the foot fetishes, it's just adjacent to the genital region.

[Angel Donovan]: How is that possible? Why is it the fact that they're next to each other in the brain that could maybe create some transfer or [unclear 29:54].

[Barry Komisaruk]: Spread of activation. Ramachandran is a physiologist in California and he reported in his book The Phantoms in the Brain that a man and a woman, each of whom had an amputated foot, and they said that after the amputation, they now feel like the orgasms are in their phantom foot as well as in their genitals. Because there's a sprouting, there's a spread of activation when a part of the cortex that responds to a particular body region, when that's vacated, when the neurons projecting to it die out, then the adjacent neurons sprout into that region, so that's an established neurophysiological phenomenon.

So when the foot is gone, the genital nerves, the pathways from the genital system project spread out into the vacated region that's adjacent to it on the cortex. So when the genitals are stimulated, it feels like the genitals are stimulated, but it feels like the feet are also stimulated, and now the amputee said that their orgasms feel larger now. They feel it in their phantom foot as well as in their genitals.

[Angel Donovan]: It sounds like there because it's taking up more space, the genital's area, that's what is potentially giving them that greater experience.

I don't know if you've looked into, and this is just something I was thinking about as you were talking about that, is if you've looked into things like brain training. We have things about when you're training to learn a sport or you're training to learn the skill, if you repeat that activity, the myelin, the brain develops around that. We've kind of accepted that the brain can change and adapt to that.

So you think it would be possible for someone who is more sexually experienced, who basically practices sex more to develop a larger area of the brain dedicated to sex because they're spending more time in it?

[Barry Komisaruk]: Well, it's possible. As you were talking, I thought of three different themes so let me see if I can respond. The reason I mentioned the foot was that in answer to your question about the other regions, that when we map the nipple for context, what we found was that the nipple self-stimulation projected exactly to the genital sensory cortex in women as well as in men.

First we saw it in women and I said, "This is really strange because the nipple stimulation should go to the chest area, if anything, rather than the genital region." And I said, "Now we have to reconsider the classical map." And when I mentioned that to my male neurophysiological colleagues they all say, "Yeah, we have to expand the map." And when I tell my women neuroscience colleagues they say, "Yeah."

[Angel Donovan]: Of course.

[Barry Komisaruk]: So it's nothing new to the women that nipple stimulation feels erotic. We see it exactly overlapping with the genital projection region so it activates the same area. That could be why nipple stimulation feels erotic. Now we see the same thing in men. We see that the nipple stimulation projects through exactly the same area as the genital, the penis, the testicles, the prostate, the rectum, it all projects to the same region as in women. So that genital sensory cortex responds not only to the genitals, but it responds to at least nipple stimulation.

Here's another surprise that we had, and this is in answer to another point you raised about the mental activity. As a control, we asked the women and the men, "Just think about stimulating clitoris or vagina or cervix or nipple. Just think about it, don't do it. As a control, we want to see the difference." And what we found was that just thinking about the stimulation activated the same area of the genital sensory cortex.

Just thinking about nipple or clitoral or vaginal stimulation activates the same region, but there is a difference, and there is the prefrontal cortex does become very active when they're thinking about the stimulation much more than when they're really actually applying the stimulation. In other words, doing clitoral self-stimulation activates the genital sensory cortex, but not much is happening in the prefrontal cortex. But when they think about stimulating the clitoris, then the same genital sensory cortex region gets active, and in addition, the prefrontal cortex becomes tremendously active.

[Angel Donovan]: So for people who are not so scientific, what does it mean that the prefrontal cortex... [check 34:59]

[Barry Komisaruk]: The prefrontal cortex is the so-called executive part of the brain. That's the part that was cut off in frontal lobotomies before there were tranquilizers. That's the part of the brain that's the very front of the brain, front of the cortex that is supposed to be what makes us human. It's executive function, thinking, caring and feeling.

[Angel Donovan]: Can you say it's the conscious brain, the more controlled aspects of what we do or self-discipline?

[Barry Komisaruk]: Well, it could be the planning brain, the discipline. When you say conscious, we're conscious of light, sound and touch and those are in different parts of the brain, but the planning and the thinking and the ethics. All that kind of processes that we think make us human compared to the animals, although there are questions about that if we kill each other. Which animals don't tend to kill their own species and we're unique in that; I'd say advanced with air quotes around it. I'm not so sure that that's advancement, but it is complex thinking, there's no question about that and that's all a function of the prefrontal cortex.

So thinking about the stimulation activates that part of the brain much more than the actual stimulation does.

[Angel Donovan]: Much more?

[Barry Komisaruk]: Much more, yes.

[Angel Donovan]: So would you say, because this is obviously one of the arguments that comes a long time, is sex more about the physical aspect or is it more about the mental aspect?

[Barry Komisaruk]: Really, we studied women who claimed that they can think off. They claim that they can have orgasms just by thinking, without any physical stimulation, and I was very skeptical. I did this with Gina Ogden who is a sex therapist who says she has many women who say they can have orgasms just by thinking. I did it with Gina and Beverly Whipple to test whether they're really having orgasms.

We measured their heart rate, blood pressure, pupil diameter and pain thresholds. We asked 10 women who said they could think off, we asked them each to have an orgasm by physical self-stimulation and then have an orgasm by thinking. We took all the physiological measures and we found that the increases in the physiological measures were equivalent when they had orgasms by physical stimulation or by thinking.

So they really did have thought induced orgasms and now we've been studying some of the women in the scanner and we see when they say they have orgasms, they're activating not all, but many of the same brain regions that are activated when they have orgasm by physical self-stimulation.

[Angel Donovan]: Right. That kind of fits in, in terms of practical take home advice, we often talk about how if the woman's not relaxed and she's not in the right mental state, she's not comfortable and she finds it difficult to orgasm. We talk about things like distractions. How would you relate the research to these kind of things that we say?

[Barry Komisaruk]: What we find is that women can have orgasms by stimulating clitoris or vagina or cervix, and each of those regions have different nerves that carry sensation to the brain. The clitoris has the pudendal nerve and the vagina has the pelvic nerve and the cervix has the hypogastric nerve. They all project to the same general region of the sensory cortex, but in slightly different places.

The qualities of the orgasms elicited by stimulating clitoris are different from those that they describe from stimulating vagina and different from those stimulating the cervix. They say the clitoral stimulation is more external and more localized. When they have an orgasm it feels more localized to the clitoral region, but when they have an orgasm from vaginal stimulation, it feels much deeper in the body, much more whole body involving. And cervical stimulation is described as very intense. One woman said a shower of stars when she had a cervical orgasm.

Now what we see is that because they each have different nerves carrying sensation to different parts of the sensory cortex, and if the women stimulate these different regions simultaneously or concurrently, they describe their orgasms as more intense and more complex and more enjoyable. So what I would suggest is that adding stimulation of clitoris plus vagina plus cervix plus nipple can intensity the orgasm because it's activating more neurons in the brain.

They're all going to slightly different regions like in a cluster of grapes. It's stimulating all the grapes in a cluster at the same time. You can have an orgasm from stimulating one grape, but if you stimulate all the grapes in the cluster, then there's more neurons that are all going to the orgasm mechanism and the whole thing is going to be more complex, more intense.

So that would be a way of the more erotic stimulation that can be applied concurrently, the more pleasurable, more intense and more complex. So that would be one implication of our research. Thinking about or having fantasies at the same time, since thinking really does have orgasm inducing potency, adding that, the more stimuli that can be added, the more intense it's going to be.

[Angel Donovan]: So mental is like another big layer to the physical stimuli you may be giving and more tends to be better. I'm sure it's not the same for every woman in everything, but overall, it tends to be more stimuli is better?

[Barry Komisaruk]: Yes. Another aspect of that is that some women say that it's easier to induce an orgasm from clitoral stimulation than from vaginal stimulation. I use a metaphor of a manual transmission car and a lot of people in the United States don't know what I'm talking about because everybody drives an automatic except me. There are very few manual transmission cars left in the United States, but I guess they're much more popular in England and Europe.

I used the metaphor of for many women, vaginal or cervical stimulation is like 5th gear as opposed to clitoral stimulation which is 1st gear. So it's possible to start the car going if you're just in 5th gear. You can do it, if you can do it carefully, but it's much easier to start in first and then shift through the gears.

In other words, rather than just starting with vaginal stimulation, wham-bam-thank-you-ma'am, maybe in a woman who finds that clitoral stimulation more easily induces orgasm than vaginal or cervical stimulation, start with clitoral stimulation, get the arousal increased and then do the vaginal and cervical stimulation. It's like then shifting into 5th gear. Once you're going, you shift into 5th gear and there's more momentum so it actually intensifies the response.

But it has to get started so you have to start slow and then build up the excitation and then go to the higher momentum, higher inertia systems of the vagina and cervix. That doesn't apply to everybody, but many women do say that's the case.

[Angel Donovan]: It sounds also like you start with one source of stimulation, say the clitoris, which is also the area that women are most used to. If they're masturbating, they've had more practice with that, obviously, just because it's the one that they can really play with the most.

[Barry Komisaruk]: And nipple stimulation also...

[Angel Donovan]: Absolutely.

[Barry Komisaruk]: ...at the outset.

[Angel Donovan]: Yes. But my point about experiencing and practice, like if a girl has been practicing since she was in her teenage years and she's been self-stimulating her clitoris and nipples, they're going to be better developed than her vagina, at first, just because they've been used more and the neurons are being developed more in that area kind of like as if we're training anything else in our lives.

[Barry Komisaruk]: Well, it's possible. I don't know of any study that actually demonstrated that, but it's logical.

[Angel Donovan]: I guess I'm taking from an anecdotal. I've been with women who are not interested in the clitoral stimulation at all versus some that are completely the opposite. Sometimes it tends to fit with their stories. Some girls just never practiced masturbation, for whatever reason, or they had been already focused on that. It seems to kind of fit with their comfort level and what they're used to more than anything else.

[Barry Komisaruk]: Right. Certainly, I've spoken to sex therapists and they say that one of the most effective treatments for women who claim that they are anorgasmic is to encourage the women to start masturbating. They haven't been doing that, so start masturbating and see what kinds of stimulation do it and learn from their own self-stimulation. Learn about their own bodies by exploration and then that's effective in reducing the incidents of anorgasmic, overcoming the anorgasmia and then they can start becoming orgasmic. So that kind of practice is certainly effective, clinically effective.

You were asking about practice and self-stimulation and one of the things that we're developing is a neurofeedback system where the people in the scanner can see their own brain activity in real time. The question there is if we can see our brain activity in real time, to what extent can we control it voluntarily? And can we make it activate or deactivate, as necessary, specific parts of the brain?

[Angel Donovan]: Giving us more control. It's like learning to have more control like in the examples of the women that are thinking off, they seem to have a lot of control over that. They've learned how to do it. I look at it in the same way as we learn how to meditate. It takes quite a while to do that as well, it's like a skill.

[Barry Komisaruk]: Right.

[Angel Donovan]: Okay. There was one thing I wanted to talk about [unclear 45:12] stimulation is, is the rectum, the rectal/anal area. We talk a lot about anal orgasms and I think that's something that a lot of people say there's no such thing as anal orgasms.

[Barry Komisaruk]: No, that's not true. Many people describe anal orgasms. And I mentioned that the pelvic nerve carries sensation from the vagina, another branch of the pelvic nerve carries sensation from the rectum; it's not surprising. In fact, it's very common for women when they're giving birth and the baby is coming through the birth canal, they describe it as they have an urge to defecate because they're confusing the true source of the stimulation.

So if stimulation of the pelvic nerve via the vagina can activate orgasms, then stimulation of the pelvic nerve via the rectum can also stimulate orgasms. And if people say they have orgasms from rectal stimulation, who's going to deny it? And there's a neuroanatomical basis for it.

[Angel Donovan]: So I'd like to get your opinion on this, this is like a technique that's talked about for someone who doesn't yet have orgasms and maybe are not really into that much. People talk about associating anal penetration with an orgasm in order to learn to have it be pleasurable. To have orgasms that way because the idea is that when you're linking having a vaginal orgasm with the penetration at the same time, those senses start to get more linked together, and thus, the pleasure from the orgasm stops transferring to the anal penetration at the same time; there's actually quite a perspective on that.

[Barry Komisaruk]: Well, it makes sense, but I don't have any evidence one way or the other, but it's logical that could occur.

[Angel Donovan]: I guess the other tangent to look at is the big differences in how dominant and supplicant. I don't know if any of your work relates to this. I did notice it in some of your papers so I'm just wondering your ideas around it. Some people prefer dominant sex. They prefer to be the dominant person; some people prefer to be the supp, [check 47:11] as we call them, who doesn't really do anything. They just kind of relax and they prefer to get things done to them. Have you seen anything in your research relating to that or maybe the prefrontal cortex or anything like that which could indicate why that happens?

[Barry Komisaruk]: No. I haven't seen any research on that and I haven't done anything on that. There's so much that we don't know about sexuality and there's so much pressure against research. It's so difficult to get funding for research. I mean, these are all questions that people are very interested in, but to actually do research on it, that's a whole other problem. The answer is, I don't know. I just don't know.

[Angel Donovan]: It sounds like you'd love to know all the answers.

[Barry Komisaruk]: Well, it would be interesting. A related question is BDSM, a group, who have very interesting neurophysiological questions. Are they insensitive to pain? Is the pain somehow converted into arousal without being aversive because they have control over the intensity of the pain? If they can stop the pain when it gets too intense, then it can be arousing without being aversive.

Or is there some kind of cross wiring in those people who prefer painful stimulation; does it really activate the erotic regions of the brain? Which is a whole other very interesting question that we don't know yet. What is the difference? And this is something that we're studying now, what is the difference between genital stimulation that feels just prosaic, like when you sit down where there's genital stimulation as opposed to when the genital stimulation feels erotic? What is the difference in the brain regions? Where is the erotic sense perceived in the brain?

That's something that I think is a very interesting question and we have some insights about it. We're following up on it, but some ideas of what's different between prosaic genital stimulation and erotic genital stimulation, in terms of the brain.

So different people for different preferences, if we can identify where the erotic region of the brain is, if there is such a thing, then maybe people who have specific preferences, they just happen to be able to activate that part of the brain. And what if we could learn to activate that part of the brain, what would that do to depression or anxiety if we can learn how to activate the parts of the brain that give us pleasure, what would that do to all the problems that we have? So there's much more that we don't know, that we do know, and it's a wide open area for research.

[Angel Donovan]: So you're talking about pain, and I don't know if you've seen this website, it's called beautifulagony.com?

[Barry Komisaruk]: Yes. Yes. In fact, the pictures I have in my book I took from, I think, it's sweet agony or something like that. Yes, the facial expressions during orgasm almost indistinguishable from facial expressions of pain.

And one of the interesting things is that there was just a very interesting seminar at our University from a Nicholas Palkovich from Hungary who was studying brain activation during pain and every region that he identified, with the exception of maybe the nucleus accumbens, every region that he said is activated by pain we see activated by orgasm. So since we see that orgasm inhibits pain, maybe in all those regions there are inhibitory neurons that we can't detect with a functional MRI; that we're turning on the orgasm neurons and they turn on inhibitory neurons to pain. We can't see where the inhibition is; fMRI just doesn't have that ability.

But it's remarkable that so many of the same regions are activated. The anterior commissure and the insula, those are two pain regions that are strongly activated during orgasm. And then the amygdala, the hippocampus, the periaqueductal gray, those areas activated by pain, activated during orgasm.

[Angel Donovan]: I guess it could also explain the BDSM, the whole thing. If these areas are close together, as you said for an analogy, you just tell me if this is not correct, if there are just slight movements in these areas in the brain they could just overlap and then you've got combined senses. You're liking pain more because now it's linked to this pleasure.

[Barry Komisaruk]: It's very possible. That is really a very strong possibility, we just have to do the research to find out.

[Angel Donovan]: Excellent. Excellent. So there was one piece of interest, I was just curious how you did it, you said cervical orgasms; in my experience for the cervix, quite a few women find that a little bit painful when you hit it.

[Barry Komisaruk]: Yes, it's true. It's painful, but if it's stimulated at the time when the pain is being blocked by high level sexual activity and high arousal, the aversive edge might be taken off and it may be converted into just the pleasure.

[Angel Donovan]: That definitely fits my experience.

[Barry Komisaruk]: Intense arousal, without the aversion, because the pain blocking mechanism has taken over, but if you do it too early, then it could be aversive.

[Angel Donovan]: And that's actually very practical. Stay away from the cervix early on in the sexual intercourse. You want to start banging and a bit later, actually, it could be very pleasurable for the woman if you're [unclear 53:03] quite hard at times.

But I was actually wondering how you did the science of only stimulating the cervix.

[Barry Komisaruk]: The way I came to that conclusion is that when we did the study of the effect of vaginal stimulation versus cervical stimulation on elevating pain thresholds, blocking pain, I had two separate devices, two separate stimulators. And for the cervical stimulator, I used the diaphragm with a Velcro disc on it and that was attached to a rod that the women had a handle so they could push directly on the diaphragm. It was a plastic rod with a modified tampon on it.

And so they could push directly against the cervix back and forth, push and pull against the cervix without stimulating the clitoris. It was very, very minimal stimulation of the vagina, so some of the women who had the spinal cord transection, none of them could feel the clitoris, so clitoral stimulation was out. There could be some vaginal stimulation, but they were mainly stimulating the cervix and some of them had orgasms from that stimulation.

And as a matter of fact, one of the women said the diaphragm was over the cervix, protecting the cervix and centering the stimulator on the cervix. When she pulled back on the rod, it created a suction on the cervix. She would push and pull on the diaphragm. She said when she pulled on the rod and it was attached to the diaphragm, it created a suction on the cervix and that was extremely pleasurable. She said she never felt that before.

[Angel Donovan]: Well, you could patent that for some kind of new device, potentially. I'm not kidding either.

[Barry Komisaruk]: Yes, well maybe. Yes. And also, the area of activation by the cervical stimulation was different from the area of activation from the vagina or the clitoris.

There was a study by Winnifred Cutler where she asked women, "The clitoris, the vagina and the cervix, do they contribute to orgasms?" And 95% of the women said that clitoral stimulation contributes to orgasm; 66% percent of the women said that vaginal stimulation contributes to orgasm; and 35% of the women said that cervical stimulation contributes to orgasm. So it's a small percentage, a third of those women. There was 128 women in her study, so there's a substantial number of women saying that they can feel the cervix and it contributes to orgasm.

[Angel Donovan]: That's great. Those are very useful statistics as well, to give people a bit more perspective on this. Everyone's different, so a lot of this depends on communication. That's why we always have to come back to communication.

[Barry Komisaruk]: Communication is critical. Communication between partners, it takes courage for the partner to tell the other partner what feels good, what doesn't feel good. In the heat of passion, maybe it would be a little bit too stultifying to have a conversation like that, but there are various ways of indicating that or communicating it verbally, nonverbally, at various times, but that communication is crucial.

[Angel Donovan]: Yes. Your work is very useful from this kind of perspective because basically, you're kind of legitimizing a lot of things that people have, right? So I have no orgasms and I feel weird about it because I grew up in a conservative background and it's not the kind of thing I think is correct. But when you explain it in these terms where you can explain, "Well, there's an association between the two areas of the brain. It's the same place. It's kind of normal that sometimes there's some overlap." I think people can be a lot more accepting of themselves and the way they are and be freer to communicate it and also to explore their own sexuality like it's not a big deal.

So nipple stimulation stimulates me, that's a bonus, it's not a downside to your sexuality. I think your work is great for that for clarifying a lot of these points.

I was wondering, are there any other lifestyle factors that you would say have significant impacts on our orgasms, in terms of negative or positive? We spoke about a couple of things.

[Barry Komisaruk]: Certainly, recreational drugs, they do have effects on orgasm, especially cocaine. A cocaine rush, people describe it as feeling orgasmic and one of the major effects of cocaine is to release dopamine and there's a lot of evidence that dopamine plays a stimulatory role in orgasm.

[Angel Donovan]: Right. I guess we're saying there potentially, you could take cocaine and have sexual intercourse and it would give you a bigger orgasm, not that we're advising it or anything crazy like that.

[Barry Komisaruk]: I'm not advising it, but I mean, this is just based on the literature that that's what cocaine does and that's what people describe; I mean, that's a lifestyle using recreational drugs.

[Angel Donovan]: As I understand it, after cocaine abuse for a while, you kind of burn out your dopamine receptors.

[Barry Komisaruk]: Yes.

[Angel Donovan]: So then it would be more difficult... [check 58:21]

[Barry Komisaruk]: You down regulate it. You don't burn them out, but it's reduced, the numbers, with the sensitivity, yes. Another negative lifestyle is with opiate use like heroin. Morphine and heroin have an inhibitory effect on orgasm, and actually, people have stronger orgasms when they come off the opiate drugs.

[Angel Donovan]: Is that compared to before they started morphine in the first place?

[Barry Komisaruk]: Yes. Yes. The opiates have an inhibitory effect and when people come off it, they get nervous and shaky and that's when they say that their orgasms are more intense, is a disinhibition.

[Angel Donovan]: It's like positive feedback for quitting. If you're in a rehab for heroin abuse then that's potentially something you can put in front of you as a positive.

[Barry Komisaruk]: You can look forward to it, yes.

[Angel Donovan]: Yes, look forward to it. Now I've quit morphine, now I'm going to get some benefits from quitting.

[Barry Komisaruk]: A benefit of quitting. Yes, it's probably true, but I don't know if anybody has recommended that.

[Angel Donovan]: How about psychedelics, psilocybins or LSD or anything like that?

[Barry Komisaruk]: Yes, I mean, they're changing levels of consciousness and awareness of sensory stimuli. Any drugs like that, marijuana or psychedelics can change the quality of stimulation.

I remember speaking to one woman actually related to cervical stimulation, she said that she finds cervical stimulation to be extremely aversive, very, very irritating and very strong and aversive stimulation, but when she tried marijuana, it took the edge off it and it became intensely pleasurable. So again, that's changing the aversive quality and you may not change the arousing quality, and that could convert it into a pleasurable stimulus.

Well, as far as lifestyle, exercise. I mentioned at the beginning that when my muscle tone is relatively high, my orgasms are more intense. One of the big effects of orgasm is muscle tension. The cerebellum, which controls muscle tone, is very strongly activated in men and women during orgasm, very reliable.

[Angel Donovan]: So just being more physically fit, having more muscle?

[Barry Komisaruk]: Yes. It makes the orgasms more intense and pleasurable. The muscles contract all over the body and when it's strong, it feels really good.

I don't know about different dietary supplements, I don't know if there's any really good evidence on that.

[Angel Donovan]: One of the things we just kind of connected with, but not really looked at is nature versus nurture. If I'm born with a certain orgasmic capacity is that how I am or is it something I can learn to get better at over time? We've kind of been talking around the subject, but it'd be good to hear your opinion.

[Barry Komisaruk]: There's really, virtually, nothing known about what causes anorgasmia, people who can't have orgasms; it's something very interesting. Actually, I'm studying the refractory period in men to see what does not get activated in response to genital stimulation during the refractory period as opposed to before the refractory period? What gets blocked? Certainly, during the refractory period, you can feel the genital stimulation. It just doesn't feel erotic. It doesn't get to the orgasmic process.

[Angel Donovan]: It could even feel like pain if someone was stimulating during that period. It's uncomfortable.

[Barry Komisaruk]: It can be. Some people describe it as being uncomfortable, but other people say it's not uncomfortable. I'm aware of it, it's not numb.

[Angel Donovan]: It's not interesting.

[Barry Komisaruk]: It's not interesting. It doesn't get anywhere. So I think that could be a useful model if we can understand what fails to get activated during the refractory period, then maybe that's what fails to get activated in people with anorgasmia. And with the neurofeedback system that we're developing, maybe it's possible to get around the blockage. If we can see what gets blocked, maybe we can learn to overcome the block voluntarily, if we can see our own brain activity, so that could be an approach.

And the fact that women who claim that they're anorgasmic can learn to become orgasmic by masturbating and getting permission to masturbate. What it means to me is that there must be very many psychological factors that intervene and that can influence the ability or inability to have orgasms. I'm so surprised that just thinking about stimulation will activate the sensory areas of the brain, the parts of the brain that are supposed to be classically described as responding to physical stimulation, we can activate them by just thinking about it. God knows what we can do.

[Angel Donovan]: It's kind of like if we learn to visualize, fantasize more these kind of things that people talk about, you can kind of learn to enhance your experience of sex if you get more immersed.

We talk on this show, [unclear 1:03:46] is we talk about getting more immersed in sex because some people tend to be in their heads, a lot especially today, the way the modern world is. We're looking at computers a lot, we're not really interacting with other people as much, in a lot of cases, depending on your job.

Maybe if you're in IT, work tends to be worse when we tend to have more guys in IT are listening to the show due to that, I think, just because they're getting less human interaction. And the way the world works today is we're looking at our phones and all this other stuff, we're not present looking at people, and I think that transfers to the bedroom as well. We're just not being as present as we should be, we're kind of in our heads thinking about stuff.

[Barry Komisaruk]: I think that's very true. The loss of contingent response. We're on Skype and we're seeing each other and we're responding to each other, but with email, I mean, there's such delays. We're losing the ability to understand body language. There's less face-to-face interaction.

So yes, I think that's a major factor and it could be a major factor in a loss of ability to communicate, especially when it comes to something like sexuality where it's overloaded with so many different factors and so many inhibitions. I think to facilitate communication is really crucial in sexuality; that's probably a major factor in anorgasmia.

I remember I started studying anorgasmia and this woman said she was anorgasmic and we scheduled her to come in and have a scan so we could get an idea of what's going on. And she called me up the day before and she says, "I can't do it." I said, "What happened?" She said she got a new boyfriend and she had the first orgasm of her life, so bummer, you know.

[Angel Donovan]: Dang, you lost your scientific study.

[Barry Komisaruk]: Yes.

[Angel Donovan]: That's good news. That's nice to hear. I believe everyone can, it's just you have to find out what the problem is. I'm sure there are some people who are genetically, for whatever reason, [unclear 1:06:02].

[Barry Komisaruk]: It could be problems like in diabetes where there's really nerve damage and compromised sensation.

[Angel Donovan]: I was going to ask you about lifestyle, like diet. Someone who is very overweight, you've brought up diabetes; are there any lifestyle factors like that where they could damage [unclear 1:06:18] or lessen their ability to have good orgasms? Is there anything you know of?

[Barry Komisaruk]: I don't know.

[Angel Donovan]: Okay. Just health conditions like diabetes or something like that.

[Barry Komisaruk]: Well, diabetes is nerve damage so that really is compromising the sensory input. I just published a review article on brain damage and multiple sclerosis and Parkinson's, those can have deleterious effects on orgasm, certainly. Many diseases can interfere, but in people who are otherwise healthy and anorgasmic, there really is nothing, other than taking drugs like SSRIs, the selective serotonin re-uptake inhibitors, the antidepressants, those are notorious for increasing serotonin and blocking orgasm. They're notorious for inhibiting sexual response. Actually, they're used off label to treat premature ejaculation in men because of their inhibitory effect where it's desirable to slow down.

[Angel Donovan]: Okay, so I don't want all of you guys running out trying to get prescriptions for SSRIs now; be careful with that kind of stuff, there's other ways to deal with premature ejaculation.

All of us thank you so much for your time today. It's been a really good chat, and obviously, you've got a wealth of information, just so many decades of looking at this subject.

Which would be the best way for people to follow more of your work and get to know you? I know you've got a few books and other things.

[Barry Komisaruk]: I have a book The Science of Orgasm and The Orgasm Answer Guide. I have a website. My students keep trying to get me to keep it active so I'll try to do that. I'm at Rutgers University, they can find me that way. I have a website.

[Angel Donovan]: We'll put all of these links in the [unclear 1:08:10] notes.

[Barry Komisaruk]: And they can send me an email; [email protected]. I'd be happy to respond to emails.

[Angel Donovan]: Great. Thank you for that. That's really great.

Is there anyone besides yourself you'd recommend for advice or ideas in this area for good research in the area of orgasms or sexuality, that you've kind of followed their work and it's people you respect? People that would be interesting for the audience to check out and follow as well?

[Barry Komisaruk]: Well, Beverly Whipple, W-h-i-p-p-l-e. She's retired now, but we did a lot of work together. We're continuing to work together. And for peripheral changes in your genital system, I guess, Ken Maravilla in Seattle. M-a-r-a-v-i-l-l-a. In Europe, Odile Buisson, B-u-i-s-s-o-n, is doing imaging during intercourse, vaginal and penile imaging with ultrasound.

Those are some, but if you want further contacts, feel free to contact me and I can refer people to clinicians.

Irwin Goldstein in San Diego is a urologist who does a lot of clinical sex research.

[Angel Donovan]: Great. Thank you. I really appreciate those.

So the last quick question for you. What would be your top three recommendations to guys who want to improve their orgasms or they want to improve the orgasms of their partners? Based on everything you know, what would be your top tips?

[Barry Komisaruk]: The top tips would be take it slow with your partner. Start with nipple, breast and clitoral stimulation and wait until the woman gets more and more aroused and then penile/vaginal stimulation and cervical stimulation later on. Sort of build-up gradually, but with communication with your partner to get the timing right and the patterning, the timing, the force, the relative force. That kind of communication is crucial because the profile of force over time, what to apply stimulation to, how forceful to apply it, when and in what pattern and what combination, those are all crucial.

I think of two metaphors, one is a metaphor of pushing somebody on a swing, that if you want to get the swing going higher and higher, you have to get the force and the time, when you apply the force, you have to get that right. You have to get the rhythm right. If you push at the wrong time, you can stop the whole thing. So it's the timing and the force over time that's crucial.

And another metaphor is let's say you have a bathtub half full of water and your objective is to get the water to splash over the top of the rim of the bathtub and you can only use your hands to get the water going, then you have to heed the rhythm of the water in the system to know when to apply the force and to get the rhythm going and get it sloshing higher and higher until it sloshes over the top, which is the orgasm.

So it's a question of force over time and the timing with another human. I mean, you can do that with yourself, but with another human, there's the issue of communication because that person's rhythm, force, timing and preferences are different from yours. So you have to find a way to communicate back and forth to optimize the interaction and optimize the likelihood of getting higher and higher to an orgasm, so that's the basic hint.

Take advantage of the fact that there are multiple erotic inputs. And also, ask your partner what does it for her. There are people who describe having orgasms from toe stimulation, from ear stimulation, neck stimulation, lip stimulation, nose stimulation, hand stimulation; essentially, any part of the body. People have described that any part of the body can stimulate orgasms when it's done by the right person in the right way.

People with spinal cord injury, men and women, it's very common they say that at the level of the injury, there's an area of hypersensitive skin that if it's accidentally brushed it is excruciatingly painful, but if the right person stimulates it in the right way, it produces orgasms, from that skin region. It has nothing to do with the genitals. They can have orgasms from stimulating this hypersensitive skin region.

So everybody has different erotogenic regions. Find them and stimulate them in the right way, but that all requires communication.

[Angel Donovan]: Yes. So some great points there, Barry. Thank you very much. And thank you for your time today. I really appreciate it.

[Barry Komisaruk]: My pleasure.