Cross-posted from The Neuroethics Blog (Emory Center for Ethics)

I have wanted to write about this issue for a few months now and have finally gotten around to it. Science writer Kayt Sukel created a small splash in the blogosphere in January when she wrote a few blog posts (see here and here) about her experiences orgasming in an MRI machine (or, as she puts it, “coming for science”) as part of a study conducted by Barry Komisaruk and Nan Wise at Rutgers University. Sukel’s posts were intended to serve as teasers for her book, Dirty Minds: How Our Brains Influence Love, Sex, and Relationships (full disclosure, I haven’t read her book yet). For an earlier account of an attempt to “come for science” see science writer Mary Roach’s highly entertaining book, Bonk: The Curious Coupling of Science and Sex.

About the Research and Its Contributions:

Barry Komisaruk has been a pioneer in the use of fMRI to study orgasm (for an example of his work, see here), and a number of other researchers have also used PET and fMRI technologies to try to understand what is going on in the human brain during sexual arousal and climax (for a recent review of this research see Georgiadis 2012).

Komisaruk method’s are interesting – the team creates a plastic mask for each subject based on a mold taken of her face. After the subject puts on the mask, the mask is bolted to the scanner. This helps to keep movement to a minimum as the subject stimulates herself to orgasm. The results are also interesting – the team created a video showing the changes in activation that occurred in Nan Wise’s brain as she stimulated herself to orgasm (I’m curious if Komisaruk has ever masturbated to orgasm inside an MRI machine). In general terms, activation occurred first in the genital regions of the sensory cortex, then the limbic system (emotions and long-term memory), then the cerebellum and the frontal cortex. During climax, activity was greatest in the hypothalamus (probably related to the release of oxytocin) and the nucleus accumbens (probably related to the release of dopamine). After climax, activation levels decreased across the brain.

This is undoubtedly valuable research, and, as both Sukel and Roach point out, scientists studying sexuality often face both a lack of funding and a lack of respect when attempting to investigate questions related to sexuality. However, I have some misgivings about the study, related to the purpose of the research and to its ecological validity and representativeness.

Misgivings: Purpose of the Research

According to Komisaruk, one of the goals of the research is to understand how pleasure works in the brain, which seems laudable. However, the goal of understanding alone is rarely enough to get research funding, and, not surprisingly, Komisaruk also sees “therapeutic” applications for his research, specifically to address what he calls the “pathological” condition of “anorgasmia.” Komisaruk is attempting to develop therapy for anorgasmia involving neurofeedback, in which people are able to view their own brain activity on a screen in “real time” and direct their bodies to respond.

Although this may be a useful tool for some people who are trying to learn how to orgasm, I am wary of the language of pathology. Feminist scholars have offered a number of critiques of the pathologization and medicalization of benign sexual variation, pointing out that medicalization can create unnecessary distress (why can’t I have an orgasm, why?) as well as puts forth narrow solutions focused only on changing the individual rather than society. I don’t have the space here to summarize these critiques fully; instead, I refer you to the work of the New View Campaign and to Liz Canner’s documentary, Orgasm Inc.

I will note that many women are probably already under plenty of pressure to achieve orgasm. I will also note that some reporting on Komisaruk’s research (for example, this article) ties his research to the message that “sex is good for your health,” a discourse that I have critiqued extensively elsewhere.

Misgivings: Ecological Validity and External Validity/Representativeness

I also have some misgivings about the ecological validity and external validity or representativeness of this work. In terms of ecological validity, it is always worthwhile to ask, to what extent do the laboratory conditions approximate the real-life situation under investigation? Probably for most women, the experience of self-stimulating to orgasm in an MRI machine is very different from the experience of self-stimulating to orgasm in “real life.” One of the most interesting parts of Sukel’s story is where she talks about how she prepared for the study – for two weeks, she practiced stimulating herself to orgasm with a bell taped to her forehead, in an effort to learn how to bring herself to climax without moving her head. I think that because of the poor ecological validity of this research, we would be wise to avoid assuming a priori that what goes on in the brain during orgasm in a MRI machine is the same as what goes on in the brain during orgasm in “real life.” In other words, we can’t just assume that an orgasm is an orgasm is an orgasm, even within subjects.

In terms of external validity, it is also worthwhile to ask, to what extent are the results generalizable to a larger population? Komisaruk’s study is not the first study of the biological aspects of sexuality to raise questions about generalizability. In the 1960s, William Masters and Virginia Johnson undertook research into the physiology of sex. Using a variety of instruments, they measured the physiological changes that occurred in over 700 men and women engaging in masturbation and partnered sexual intercourse in the laboratory. Masters and Johnson measured changes in breathing, heart rate, genital swelling, muscle contraction, and genital color, among other things and treat any changes with different medicines as physio omega for the heart, and many others. On the basis of their findings, they proposed a four-phase model of “human sexual response” (excitement, plateau, orgasm, and resolution). As many scholars have noted (Robinson 1976; Tiefer 2004; Irvine 2005), their sample was potentially biased for a number of reasons, perhaps most significantly by the fact that Masters and Johnson studied only men and women who were able to regularly orgasm during masturbation and heterosexual intercourse. As Leonore Tiefer suggests, in essence, Masters and Johnson chose women – those (few?) who were able to orgasm regularly during masturbation and intercourse – whose sexuality most closely resembled the sexuality of men. Yet, although their sample was not necessarily representative, their data was incorporated into the Diagnostic and Statistical Manual of Mental Disorders and became the standard model of healthy sexual response. Even today, a sexual response pattern that differs from that identified by Masters and Johnson may be labeled pathological (Tiefer 2004).

According to Sukel, Komisaruk told her that only a few study volunteers have been unable to stimulate themselves to orgasm in the MRI machine. This suggests a few things – first, that maybe a fair number of women are perfectly comfortable with, or are even turned on by, loud noises, confined spaces, curious spectators, and immobilization devices. It also suggests that Komisaruk’s volunteers may be a very specific type of women, with a very particularly type of sexuality (for example, women who don’t need vibrators). This itself is not a problem, the only danger is if the sexuality of these women is established as the “norm” against which all other types of sexuality are judged (as in what happened with Masters and Johnson’s research).

Concluding Thoughts

Despite these misgivings, I am excited about this research and can think of an infinite number of follow-up studies: is brain activation similar for orgasms achieved through different types of stimulation? Is brain activation similar for heterosexual, lesbian, and bisexual subjects? What is the activation pattern when someone fakes an orgasm? Does a “food-gasm” produce the same activation pattern as a “sex-gasm”?

What brain imaging orgasm studies would you propose and how might the data from these types of studies be used to benefit society?