David Linden - Touch

So that kid Ralph was right: Merely having sexual thoughts can prepare the genitals for sexual activity. But that’s not the whole story. Penile erection and vaginal lubrication can result either from signals descending from the brain during sexual thoughts or from genital or perigenital touching. Most often, in either partnered or solo sex, sexual thoughts and genital touching go together, and both contribute to genital preparatory responses. But this is not always the case. If spinal cord injury interrupts the neural pathways from the brain to the genitals, then sexual thoughts will be unable to evoke erection or lubrication. However, if the sensory pathways from the genital or perigenital regions to the spinal cord are intact, reflex circuits in the spinal cord are sufficient for genital touching to evoke lubrication/erection. This is true even if those touches cannot be perceived due to damaged spinal cord fibers carrying touch information up to the brain. 17

Genital responses are one area where men and women differ considerably. For the most part, men get erections only when they are sexually aroused or when their genitals are directly stimulated (sometimes in a nonsexual way—by clothing, for example). However, when women are fitted with a tampon-sized probe that measures vaginal lubrication, it is revealed that they often lubricate in response to sensory stimuli that they report not to be sexually arousing. In one study, most of the straight women lubricated in response to videos of woman-woman or man-man sex (or even bonobo-bonobo sex), although they reported that they were not consciously aroused by these images. Likewise, most lesbians lubricated in response to male-female or male-male sex videos, even when they, too, reported not being aroused by them. 18Of course, I don’t mean to imply that there are no straight women who are aroused by male-male sex or female-female sex or even bonobo sex, and there are certainly plenty of lesbians who find male-female and male-male sex videos sexually exciting. The point is that, on average, males—gay, straight, or bi—tend to get erections only in response to stimuli (or thoughts) that they report as arousing while, on average, women—gay, straight, or bi—get wet in response to a much wider range of sexual stimuli, including those that they specifically report as not being arousing. Sex researchers Meredith Chivers and Ellen Laan have both proposed that reflexive vaginal lubrication in response to a broad array of sexual stimuli is an adaptive response to situations in which penis-vagina sex is rapid or nonconsensual: Lubrication would reduce the chance of vaginal injury or infection. They speculate that this might have been the case for much of human evolutionary history.

Both men and women can suffer from genital responses in the absence of sexual desire. In men, this condition, in which an erection lasts from hours to many days and is not relieved by orgasm, is called priapism. It can occur as a side effect of many different maladies, including leukemia, sickle-cell disease, and pelvic tumors. Many drugs, both therapeutic (certain antidepressants and blood thinners as well as drugs used to treat erectile dysfunction) and recreational (cocaine and amphetamines), have also been linked to priapism. While the persistent erection of priapism is painful, it is not typically associated with a strong urge to stimulate the penis to achieve orgasm.

Like priapism, persistent genital arousal disorder (PGAD) in women results in vasocongestion in the genital area and consequent vaginal lubrication and swelling of the labia and clitoris. Unlike priapism, it is associated with hypersensitivity to touch. Innocuous stimuli like the movement of clothing or vibrations from riding in a car can cause a pelvic tingling sensation sometimes leading to orgasm. Most distressingly, PGAD often involves a strong, unwanted urge to masturbate (or otherwise achieve orgasm). It is not associated with increased sexual desire but rather is like a terrible itch that won’t go away. An orgasm brings relief, but only briefly. PGAD sufferers do not enjoy their sexual sensations or compulsions and have reactions ranging from simple embarrassment (PGAD is almost certainly quite underreported) to deep distress about not being able to have normal social relationships, care for children, or hold down a job. In some extreme and tragic cases, women with PGAD have been effectively trapped in their homes, masturbating continually. Suicides are not unknown, like that of Gretchen Molannen, who killed herself at her home in Spring Hill, Florida, at the age of thirty-nine after suffering unrelenting PGAD for sixteen years. In an interview with the Tampa Bay Times a few months before her death, she described her daily life:

The arousal won’t let up. It will not subside. It will not relent. One O-R-G will lead you directly into the horrible intense urge, like you’re already next to having another one. So you just have to keep going. I mean, on my worst night I had 50 in a row. I can’t even stop to get a drink of water. And you’re in so much pain. You’re soaking in sweat. Every inch of your body hurts. Your heart is pounding so hard … You have to ignore it, Gretchen. YOU DON’T HAVE A CHOICE. STOP NOW. Just let your body calm down. Many times, I’ve tried that. I’d be as far as in the bathroom, going in for my reward shower. I’m done. Now it’s time to clean up and relax. And I’d look at myself in the mirror and there it is again. And I’d throw myself on the floor and cry. Men don’t understand it. They don’t care. They think it’s hot … When I describe it to men, I tell them, “Imagine having an erection that does not go down, that feeling of just before it comes out, all day, all night, no matter how many times, no matter how much you’ve destroyed the skin on your penis.” 19

There is no single, well-defined cause of PGAD. In some cases it can be the result of the entrapment of the pudendal or pelvic nerves (or one of their branches) and can be relieved by surgery. In others it has been associated with vascular problems related to the flow of blood in the pelvis. A type of cyst that forms on the dorsal root ganglia in middle age, called a Tarlov cyst, is much more common in women with PGAD, suggesting a causal relationship. Some neuropsychiatric medications have been suggested as PGAD triggers, while others have been reported to alleviate it, but the scientific literature on this topic is scattershot and confused. PGAD sometimes co-occurs with restless leg syndrome, which involves a similar itchlike compulsion to move one’s limbs, particularly the legs, and which is also poorly understood. To date we don’t know if PGAD is associated with changes in the nerve endings in the skin of the genital region, nor do we know what the pattern of brain activity looks like in women who are feeling the PGAD-driven compulsion to achieve orgasm. 20

Sometimes the most familiar things resist description. In this vein, let’s consider the question, What exactly is an orgasm? Physiologically speaking, orgasm in both men and women involves an increase in blood pressure, involuntary muscle contractions in the pelvis and elsewhere, a rising heart rate, and an intense feeling of pleasure, followed by satisfaction. But that’s a rather dry and clinical description, lacking in poetry. John Money, a Johns Hopkins psychiatrist who was a pioneer of sex research, writing with colleagues, did a good job of capturing both the transcendent and the biological in this definition of orgasm: 21“The zenith of sexuoerotic experience that men and women characterize subjectively as a voluptuous rapture or ecstasy. It occurs simultaneously in the brain/mind and the pelvic genitalia.” 22Money’s description highlights several key points. First, orgasm is a unique experience: It’s not merely a more intense form of touch sensation but a qualitatively different one. Second, the most reliable and typical way of achieving orgasm is when touch signals from genital stimulation are carried through sensory nerves to the spinal cord and the brain. Third, orgasm ultimately occurs in the brain, not the genitals.