Should Sex Be Prescribed Like Medicine? This Doctor Says Yes.

Credit: Photographs by Art Streiber

On a rainy January afternoon, Nicole Prause sits in a cozy apartment in Los Angeles’ Venice neighborhood with two laptops in front of her. The screens display graphs that constantly update a stream of information. In the bedroom next door, less-clinical data can be heard: “Uh, uh, uh.” Rhythmic moans rise, shifting in volume and pace. “Uuh! Uuh! Uuh!

As a sex psychophysiologist, Prause studies the mental and physical changes that happen during sex, and she’s made a career of dreaming up outlandish devices, protocols, and experiments to do so. “My goal is to identify the general health benefits of sexual stimulation,” says Prause. “There’s good reason to believe there’s a link.”

Today, that means hooking up Matt and Cara Brand to an EEG monitor to track brain activity, finger cuffs to measure heart rate, and an armband that monitors movement. The Brands are in the middle of something called orgasmic meditation, or OM. This relatively new practice requires a partner to stroke a woman’s clitoris to achieve “an optimal state of consciousness” but not necessarily orgasm — OM is not about getting off. Devotees claim that it can increase productivity, focus, and confidence. (“We OM twice a day, every day,” Cara says.) Prause is out to determine whether the method is legit.

“What Nicole’s doing — studying human sexual response in the lab and tying it to neuroscience — very few researchers in the country are doing,” says Justin Lehmiller, director of the social psychology graduate program at Ball State University.

That’s partly because sex research is a dying profession, at least in America. Stymied by persistent puritan convictions and a pullback in federal funding, even leading sex-research institutions have stopped studying actual sex. Researchers are forced to rely on rudimentary tools like surveys rather than studies involving actual genitals and orgasms. It’s why the majority of American sex researchers have lately decamped for Canada, Australia, and other countries with fewer hang-ups and funding challenges. Currently, only two U.S. labs studying sexual arousal have federal funding, and since Prause’s former mentor at the famed Kinsey Institute took a job in Belgium in 2014, Kinsey hasn’t had a full-time psychophysiologist on staff. Which means the iconic center is no longer actively studying how the body and mind interact during sex.

But Prause continues to tackle questions others are too gun-shy to address: How do you know when a woman is climaxing? What size penises do women really prefer? And perhaps most important, could sex be akin to medicine? Prause hopes to show how intercourse can help supplement or even replace certain prescription drugs and expensive therapies, similarly to medical marijuana.

Back in the Venice apartment, and after Matt and Cara complete their OM session and get their clothes back on, Prause instructs them to do a series of frustrating computer tasks. (The couple did the same tests before the session.) She wants to see if OM has improved their composure and resilience. Both claim they feel sharper, more confident, and less stressed than before OM-ing. Now Prause just needs an additional 150 or so couples to help create a clear conclusion.

As long as sex science has been around, a kind of squeamishness about the topic has hindered progress in the field. “I can measure your heart rate with 10,000 different things,” says Mark Cohen, a neuroscientist at the University of California, Los Angeles, who is one of Prause’s mentors, “but nobody has a tool out there that measures vaginal lubrication.”

Despite being one of the most integral parts of existence, our concept of sex is still riddled with misconceptions. “It wasn’t until 1998 that we realized we’d missed a part of the clitoris,” says Prause. “There are all kinds of big questions left.” For example, scientists don’t know why some people take sexual pleasure from pain; or what exactly makes sex most rewarding — the arousal or the climax; or even what triggers orgasm in the first place.

In addressing those questions, Prause has developed a reputation for rigor. “When it comes to her process, she holds herself to a higher standard,” says Ardy Rahman, a former UCLA research collaborator. “She overengineers her science.” For a study that measured whether condom use in porn impacted sexual arousal, Prause could have simply shown participants some scenes with condoms and some without. Instead, says Rahman, to create a more exact comparison, she used a single scene of unprotected sex and had a research assistant digitally add a condom to the male porn actor, frame by painstaking frame. “Poor thing,” Prause says with a laugh.

The cheery demeanor hides a defiant streak that’s spurred Prause to dabble in belly dancing and fire spinning, in which she twirls flaming staffs and batons. In 2014, she crashed while racing her motorcycle and suffered broken ribs and a shattered scapula. Three days later, she met up with her track club — where the 38-year-old is known as Danger Nikky — arm taped to her side and ready to run.

That tenacity transfers to her work, where Prause dreams up devices to help answer lingering questions about sex. In 2010, she was the first and only U.S. scientist to use genital vibrators and MRI machines to test brain response in the midst of stimulation. Two years later, she used a 3D printer to produce 33 erect penises of various sizes to deduce, for the first time, what length women actually prefer. Answer: big penises, but only 0.4 inches longer than what’s often considered typical — 6 inches long — and only for short-term flings. Women favor slightly shorter options — on average 6.3 inches, with a 4.8-inch circumference — for long-term partners.

For years, Prause struggled to obtain funding and approval for sex research involving actual sex. “Program officers at the National Institutes of Health instruct you not to include the word sexual in any of your grant applications,” she says. “Apparently, congressional aides run regular searches of funding databases to look for studies they can make examples of, and sexual is one of the words they search.”

Under the current administration, these problems could intensify. “I worry about this more now in the face of a government that is hostile to all forms of sexual discussion,” says Cohen at UCLA. “It is going to get worse for everybody.” It doesn’t help that the country has a history of sex-research witch hunts: In the early 2000s, Congress nearly defunded NIH-approved studies on sexuality and health. At the same time, a lobbying organization called the Traditional Values Coalition compiled a hit list of 157 sex researchers, many of whom were subsequently grilled by government staffers on the health benefits of their work.

In late 2014, when her UCLA contract was up and the university declined to accept the private-company funding she’d obtained to study orgasmic meditation, Prause decided it was time for a change. She launched her own research institution, Liberos, with the tagline “The freedom to desire.”

She’s using that freedom to explore the most mysterious sex organ of all: the brain. Prause is currently studying whether brain stimulation might prove to be a more promising treatment for female sexual disorders than Addyi, the “female Viagra” that’s become infamous for troubling side effects and limited effectiveness. And she’s hoping the OM trials will help her better understand unexpected shifts in galvanic skin response — a measure of emotional arousal — that she’s noticed in past studies. “When we showed people porn or turned vibrators on, galvanic skin response went up and up and up,” she says. “But when we said, ‘Now try to have an orgasm,’ all of a sudden the brain appeared to become disengaged and galvanic skin response dropped. We don’t know why that happens. Maybe to reach orgasm you have to reach a state of mind where you are no longer trying to control your environment.”

But what she’s most interested in learning is how sex can be used to make us healthier. She’s hoping the OM study will help her reveal a connection between genital stimulation and the positive benefits that people get when taking antidepressants. At the same time, she’s working on a grant proposal that would allow her to explore how sexual function could be used to understand depression; increased sexual activity is often a sign that people with the mood disorder are improving. She also wants to design a study that will ask people to masturbate in her lab, then try to fall asleep while she monitors their brain waves. The idea is to investigate whether orgasms could replace drugs as a treatment for insomnia.

All of this research fuels Prause’s belief that, one day soon, doctors will be prescribing good old-fashioned sex for what ails us — she just has to prove it works.

“People would care if there was evidence that orgasms can replace your antidepressant or sleep medication,” she says. Right now, though, science ignores the many beneficial changes that happen in the body when it’s sexually aroused. Says Prause: “We ignore them because it’s sex — and that’s stupid.”