Internationally renowned, Dr. Michael Perelman is Co-Director, of the Human Sexuality Program, New York Presbyterian Hospital. He is a Clinical Professor of Psychiatry, Reproductive Medicine, and Urology at Weill Medical College, Cornell University. A National Institute of Health Fellow, he received his MS, M.Phil. and Ph.D. degrees in clinical psychology from Columbia University--where he wrote the first sex therapy doctoral dissertaion in Columbia's history in 1976.
Dr. Perelman's clients, experience common sense advice filtered through the wisdom of over 30 years of clinical practice. Dr. Perelman has been invited to present his Sexual Tipping Point model at professional meetings around the world and has published widely in the professional literature. He is frequently quoted and often featured by the media.
Besides private practice, Dr. Perelman serves on multiple professional society,editorial, and industry Advisory/Directors Boards. He is the Past-President of the Society for Sex Therapy and Research. His research interests are integrating the use of sexual pharmaceuticals with sex counseling to provide better risk/benefit for men and women suffering from sexual problems.
Question: What’s the biggest misconception about aging and sex?
Michael Perlman: That basically, you know, as you get older, you can’t have sex. While it is true there is deterioration in response, well, that does not mean you cannot have good sexual experiences. I play a little bit of tennis, but there is not a joint in my body that doesn’t ache when I play. If I could go back in a time machine, I could beat the 25-year-old me who was half my age, at tennis. Yet that man would be stronger than I am, he would be able to run faster, he would get to the ball more quickly, he would hit it much harder, but I would be able to win a match because I would play more strategically, that 25 years of additional experience would help me keep my emotions in check, keep my focus, and basically have this poor kid running back and forth to the net and eventually losing. In the same way, people, through good communication and technique and loving relationships continue to have a great sex life all their life as long as they are physically able and healthy to move.
Question: What can women do to improve their sexual health?
Michael Perlman: I think if we go back to when I first started doing this kind of work, which was a question you asked me, one of the most common problems at that time was women having the inability to reach orgasm. And that is something that has really changed dramatically over a generation. Where many women have learned to self-stimulate, so that they understand a little more what goes on in their body. So one of the major changes that has taken place statistically are in the last 25, 30 years, is that women have learned to self-stimulate in the same way that most boys always knew and did, and they have learned about their own bodies. That allows many women to be more naturally responsive when they are with a partner, and if he’s a little clumsy, to be able to give him some guidance as to what will help make things work better. So, in general, women have caught up a lot with men. Where I think things are lacking is science, because it has been male dominated, has focused more on helping men than helping women, and many of us are trying to change that. So there are a couple of areas are being looked upon, number one is hormonal; we know that testosterone is a hormone of desire in both men and women; women have less of it than men do, so how might we be able to provide women who are low in testosterone and needing testosterone, that hormone, without putting them at risk for other diseases which we know can come from messing around with people’s hormones. So there is concern about the consequences of that, but there is a tremendous amount of research going on right now to investigate it, and many physicians are carefully using these drugs on an off-label basis quite effectively with their patients. So that’s on a hormonal level. On the level of blood flow, just like men, the vagina engorges with blood that causes an internal sweating response which is lubrication, the clitoris swells, and her body becomes more physically sensitive. Now, in 35 years of practice, no woman has ever come to see me saying, you know, my clitoris is not big enough, is there something you can do about that. So it is not that these drugs will make somebody’s clit so much bigger and that that would be a big deal, that’s not the situation. But are there drugs that might help overcome a woman’s suffering from vaginal dryness because of a disease process or these could be used in conjunction with counseling for both her and her partner to help her be able to be more responsive, and that would be very important. And, then, going back to our earlier discussion of drugs that affect desire and arousal at a central level in the brain, this is a critical area of research right now for five or six different pharmaceutical companies worldwide looking into how can, in particular, the dopamine system, which is one of the neurotransmitters in the brain, be used to help facilitate sex without having any negative consequences physiologically to the rest of the body. One way of understanding this in fact is many of the drugs that people would be familiar with that are commonly used by psychiatrists to treat depression, SSRI’s which, Prozacs, these types of drugs, have an impact on serotonin, so by elevating serotonin, a neurotransmitter in the brain, something that helps signals move more rapidly and effectively in the brain, elevating that elevates mood. So for some people, these antidepressants actually are helpful sexually; but for many people, elevating serotonin actually makes it more difficult to reach orgasm and diminishes their desire. So the serotonergic system can act as a sort of stop on sex, an inhibitor, go back to the sexual tipping point model. That pharmaceutical can kind of depress a sexual response, and indeed, many people in my field, physicians will use that as an off-label treatment for premature ejaculation. I say off-label because it’s not approved by the FDA for use in that light; however, many physicians, because these drugs are legally available, will instruct a patient how they may use this to slow down their ejaculatory reflux. What does this have to do with women? Lots of women, for better or for, really, obviously, for worse, are stressed out, and for better, these drugs do help the mood for some people, but some of these women who are on antidepressants which are somewhat ubiquitous and perhaps even overused in our society, are suffering from the negative side effects of these drugs, and while they feel a little bit better and a little less stressed, their sexual response has been diminished. So if there was something that could be used that would improve mood without negatively affecting sexual function, that would be great, and has to do with probably the dopaminergic system, dopamine is a transmitter; Oxytocin is another hormone that functions in similar ways, and these are things that are under investigation right now which is really what’s going to be coming out I would imagine in the future we will be hearing more about this.