Question: What is the new frontier for sex?
Michael Perlman: I think the next big thing in sex will be a continuation of what really happened at the turn of this millennium, which it won’t be just for sex but will be for all areas, the biological revolution that is taking place, our ability to influence outcomes within the body to fight disease and really delay the consequences of aging. So whether we are talking about from a sexual point of view or even Alzheimer’s, a big thing is going to be, what is the use of sexually acting drugs in the mind? And by this I mean drugs that affect the brain the spinal cord. The current drugs that you see advertised on television, Viagra, Levitra and Cyalis, are part of a class of drugs called PD-5 inhibitors, and they all act at the periphery, they act at the end organ, they act on the penis; the drugs that will be developing in the next ten years will actually act on the brain. Now, we actually have a long history in psychiatry of using drugs that have an impact on the brain, but this is going to be much more multidisciplinary and focused because there will be work being done by biologists, psychiatrists, psychologists, urologists, gynecologists, primary care physicians, endocrinologists, neurologists, cardiologists, everybody who is involved in sex, which is very multidimensional, multidisciplinary from its scientific focus. Obviously the people who speak about this best are not people like myself, are the poets and playwrights and novelists because they’re the ones with much better words to express the range of human emotion. Having said that, these drugs will begin to impact your threshold for your sexual response. Now, why is that important? If you want to be able to have a sexual experience, a man, and you are using one of the drugs currently available today, that will facilitate your ability to obtain and maintain an erection. But we also know that erections in and of themselves aren’t enough; people have to be in the mood for sex. These drugs do not work particularly well for women, we can talk about what is going to be available for women later, but one of the things that is going to be making a difference for both men and women, are drugs that affect the threshold of their response. I believe in something called the sexual tipping point, and what that is is basically a very simple idea that sex is mental and physical. So what are ways that we can impact sex mentally? What are ways that impact us physically? So disease and illness impact sex physically in a very negative way. The sexual pharmaceuticals can impact sex positively and balance off some of these disease studies. Stress and pressures of modern society in general tend to negatively impact people’s sexuality. Some people are fortunate enough to be able to use sex as a relief from anxiety; most of us have to be somewhat anxiety free and depression free in order to function sexually, and stress free. So what if you got the average couple who is pretty tired at night, has a couple kids, they finally get them to bed, everybody is settled in for the evening, and during the course of the day they had some thought about having sex together, which they know would be good for their health, good for their feelings, good for their relationship, but basically, they are just like, you know, they’re done, they’re ready to go to sleep. And they are sort of in the mood and perhaps one rolls over and attempts to initiate it, and the other one sort of just is not quite there. What if there was a drug you could take earlier in the evening when you thought I would like to have a sexual experience, that would lower your threshold so you would be a little more responsive, and that’s a drug that would have to take place in the brain, not the periphery. It is not a question of increasing blood flow; it is a question of lowering your threshold. So it’s just like do I want to, don’t I want to, yeah, sure, why not? Now that is a very subtle thing because you do not want to develop a drug that just makes everybody hot and horny which is what everyone imagines, you know, people like myself must be involved with. We are not at all because, God forbid you had something like that on the market, it would a dangerous and hence criminal, it would be a date rape drug. So this is not what we want to do. So if we go back to the sexual tipping point idea, we want something that just slightly tips the balance, that allows people to do what they want to do anyway, and just do not have the same energy for or the same youthful vitality for, because, then, as we age, and we know with age, there is a diminishment in sexual response. You can compensate for that. Just like there will be drugs that will be developed that will help people remember better and will start minimizing the impact of the various diseases that affect the brain, that really actually are devastating to individuals and families, like Alzheimer’s, so there is work in that area. The other area that there is work in goes back to the peripheral, because even if you are sort of in the mood, we have fixed that in some way, both through a combination of counseling with people like myself or just people’s own natural good mental health, and the use of these pharmaceuticals, what if the end organs just don’t work so well? What if you have recently had a prostatectomy from prostate cancer and you are recovering nicely, but we know that the drugs we have available only work about half the time. What if there was something else that could be done to help these people or a woman who has gone through an early menopause secondary to hysterectomy and there has been some atrophy of the vagina? What else might you do? Well, as you’ve probably heard, there is a lot of experimentation with gene therapy, and while there is nothing available today, I think one of the things we will see in the future is our ability to use various vectors, that is the sort of term for it, how do you introduce some new genes into cells so that essentially you are growing new cells inside your penis or your vagina, so that your capacity to function has now been improved not by using a medication that facilitates blood flow, but instead, you are just kind of getting back to the way you were in a very, very real way. So I’m very optimistic for our future. I just think it is important that those of us involved in this maintain a very, very strong ethical standard and help maintain the basically competing pressures of pharmaceutical companies who have a profit motive, understandably, but that we’re able to help guide them more towards what is best for people’s health in general and yet keep ourselves cognizant of other people’s viewpoints that a better life is not necessarily coming from better chemistry.
Recorded on: 6/20/08