#123 What Sexually Arouses Women with Cindy M. Meston

[Angel Donovan]: Cindy, thank you so much for joining the show.

[Cindy Meston]: Yeah, my pleasure.

[Angel Donovan]: So, I wanted to first... you've explored a number of interesting topics. So, what I'm first interested in is what has triggered your interest in these topics? Where do you get started with them and develop your interest in these areas?

[Cindy Meston]: Yeah, I actually became interested in the field as an undergraduate. I was working in a bio site lab for a professor who studied serotonin and rat's sexual behavior. So, I started studying rat's sexual behavior as an undergrad and wrote a review for an honor's paper looking at the role of serotonin and human sexual behavior. In the process of doing the research, I came to realize that there had very little conducted on human sexuality period but particularly, women's sexuality since Masters and Johnson in the 1970s.

[Angel Donovan]: Yeah.

[Cindy Meston]: It seemed like, "Wow, this is a really under studied and important area that seems to be neglected in the field of psychology. So for that reason, I decided this is an area that I want to explore further.

[Angel Donovan]: Great, great because Masters and Johnson, we haven't really spoken a lot about their work but, to give it context, how far did their work go and where did it kind of stop?

[Cindy Meston]: They were the first to really take sexuality into the laboratory and study it from a psycho-physiological perspective. Meaning that they actually created equipment to be able to measure physiological changes during sexual arousal and orgasm. So, they mapped out the sexual response cycle in terms of desire beseech arousal, beseech orgasm, resolution and really contributed an enormous amount towards understanding what happens during the sexual response.

But since that very basic mapping of the response, there hasn't been anything that looked at, "Well, that's what happens but, what leads that? What causes that and are there significant differences between men and women?" There so happens that we explain that and of course, the important role that all of this plays in the treatment of sexual problems for women with various concerns.

[Angel Donovan]: Great, great, thank you. So, there's a lot of interesting areas in your research that I noticed around the hormones topic and also neurotransmitters which is a similar topic. Once of the topics that people listening to this podcast have probably come up a few times before is testosterone and talking about things like how... many men these days seem to have lower testosterone and what could be the possible effect. I know that you've looked into testosterone and how that effect women's sexual physiology and behavior. Could you talk a little bit about that and what you've looked into?

[Cindy Meston]: Yes, definitely. We've always kind of attributed testosterone to male sexuality and playing an important in men's sexuality. Initially, it was thought, "Well, that's kind of the male hormone and estrogen and progesterone are the female. " But really over the last decade, there's been an enormous amount of research and clinical reports suggesting that in terms of sex drive, (the desire to have sex) it's actually testosterone that plays a key role and it plays a facility role as it does in men. Meaning the testosterone, it facilitates sex drive in women as it does in men.

Now having said that, there are huge differences in the amounts of testosterone needed by men and women. Men produce so much more testosterone than women but, we do know that as women age, testosterone declines as it does in men. When women hit pre-menopause, menopause and beyond, there is a significant reduction in testosterone that researchers now have reason to believe that that could be link for some women to a decrease in sex drive that occurs as they age.

Now one thing that listeners really need to realize is that, it's not simply the case that more is better. It's not the case that if you take testosterone or testosterone supplements that it's necessarily going to increase sex drive but, it only does so for women that are truly below normal levels of testosterone and this is not widely recognized out there. There's a lot of physician, a lot of naturopathic doctors who prescribe testosterone. Off label, it's not approved in North America to be administered by a physician. Like there are no pills or drugs that you can order but, it's off label in the sense that there are many pharmacies who are compounding testosterone creams.

So that the danger is taking too much really can be detrimental to a woman. Well, for a man as well but for women, it causes acne. It causes facial hair growth. It causes hair loss and it could lead to some other cardiovascular serious risk factors if they take too much. So, the important thing to keep in mind is testosterone plays a role but, it's not simply the case that if you have low drive, take testosterone because, women have low sex drive for a lot of... a variety of different reasons and only some women can you attribute that to a lack of testosterone. If it's not a lack of testosterone, then you have to really be careful with taking too much.

[Angel Donovan]: Yeah, it's getting that ideal U curve, the spot in the U curve. Trying to get it right in the middle on the reference rage. Have you heard... I don't know if you've heard of this term. I've heard of it before as scream cream.

[Cindy Meston]: No, no.

[Angel Donovan]: Okay, I didn't think so but you know, it's something come up a little bit recently. So, I thought I'd just bring it up. With the testosterone creams, some people have been using it to say that it gives women greater orgasms. So, giving the girl a little bit of the testosterone cream prior to sex or something like that. Do you think there's any evidence in that? Does that sound like something appropriate or not appropriate?

[Cindy Meston]: Well here is the thing, I mean, I doubt that putting on the topical cream would have that immediate an effect from a physiological standpoint however, we do know that there is an enormous placebo effect on sexuality in women. I mean you know, placebo effect is out there for all drugs and for men and women but, I do not believe that there has ever been higher reported placebo rate than there is for drug treatment for women. In the initial Viagra studies... you know in 1998, Viagra was approved as you probably know by the FDA for the treatment of erectile dysfunction in males.

[Angel Donovan]: Yeah.

[Cindy Meston]: That enormously effective drug... that drug absolutely works and has revolutionized sex therapy for me. Well, all the pharmaceutical companies were trying to develop the first pink Viagra for women, right? What did we find? I was involved in some of the initial drug trials and we found that, "Yeah, Viagra works for women but, the placebo effect was so enormous." Up to 40% of women taking the placebo cream showed a significant enhancement in their sexual functioning.

[Angel Donovan]: So, the take away is all you have to do is give your girlfriend some placebo cream and tell her it's scream cream?

[Cindy Meston]: Well, for some women, yes that will have an effect because, they will... if they really believe it and they believe it's going to work then, they have this attribution that, "Wow, this is going to work." When you put anything on your genitals or where ever you're rubbing this cream in, if you think it's going to work then, you're attending to sexual sensations more readily. That's one explanation.

If you think you've been given something that's going to increase your genital response. Well, guess what? You pay attention to your genitals more and you notice things more and you notice the sensations and that in of itself facilitates further arousal and drive. It's an interesting concept because, the placebo is not nothing. Taking a placebo that you really believe will work, leads you to act differently and experience different things during sexual situations.

[Angel Donovan]: Yeah, absolutely. Have you looked at how different women have different levels of testosterone and oxytocin and things like this and does it change their behavior or do they exhibit different behaviors based on the levels of these hormones?

[Cindy Meston]: Oh, you bring up a really, really good point. So, there has not been a lot of research done on that. We have very poor norms for understanding hormone levels in women by age and by menopausal status and we just don't know what are the averages for all these different women.

Now having said that, there have been studies where they've taken women who have low drive, problems with feeling like they have a lack of interest and drive versus women who have a normal sex drive. Strangely, there are not significant differences in testosterone levels. It would be actually great if there were because, then we could say, "Ah ha! Wonderful! Women with low drive, just take a little testosterone, bring you up to a normal level and you'll be fine," but that's not the case. So, that's where it gets really complicated and the reason that there are probably no differences between women with and without low drive is that so many women with low drive have perfectly normal testosterone levels but, have other reasons for having lack of desires.

[Angel Donovan]: And do we have ideas on what those other reasons may be?

[Cindy Meston]: Yeah, there's about a million relational reasons.

[Angel Donovan]: Okay, right, right. That could be it.

[Cindy Meston]: Women are much more contextual in their sexual experience than a man. Meaning that, men are very good at attending to genital cues and genital sensations. I mean when a man becomes aroused, he has an erection. It's a very visible response. He's used to attending to his penis. From the the time he's a child because, you use your penis to urinate. They touch their... Men touch their genitals. Like they have this for... as strange as this may sound, they have a close relationship with their genitals and certainly, an erection is very visible, noticeable. When a man has an erection, it rubs against his clothes. He right away knows he's aroused and attends to those sensations.

Women on the other hand, you know whole sexual arousal response is more subtle. It doesn't grab their attention as much and many women... I mean, this is changing among younger women but, many women are raised or socialized to kind of not pay attention to their genitals. So just from a developmental perspective even, women aren't used to attending to genital cues and their follower.

What happens is, added to that, women are socialized to pay attention to their surroundings, to people, to their environment. So as adults, if you bring that into a sexual situation, what it means is, women kind of have to have everything right to be able to focus on sex most of the time, unless there's a real... you know, they're in the heat of passion and they're able to tune out extraneous cues. Things like if they've had a bad day, if they the children haven't been fed, if the dog's barking, if the house is a mess, all of those sort of things distract them from being able to better focus on sexually arousing cue.

Relationally, it's certainly not the case for all women and the book that I wrote with my co-author, Dr. David Buss showed that women have sex for all sorts of reasons, not just love and emotional attachment. But that said, for a lot of women, sex can't be taken in isolation. They need to feel good about their partner, good about their relationship. They need to feel connected and emotionally bonded in order to really want to have sex and experience sex. Whereas men are better able to enjoy the sexual experience in the absence of some of those factors.

[Angel Donovan]: Yeah, thank you for that. A great resume there. Another thing I picked out from some of your work is that you've looked at nicotine and possibly you have some ideas about other popular drugs and how they effect sexual arousal. I was quite surprised to see nicotine in there.

[Cindy Meston]: Well, we were surprised as well to see that it had such a dramatic effect and at an acute level. I mean, certainly we've heard for a long time that smoking is bad for all sorts of health reasons and for the erectile response in men but, we really assume that that's a long-term, chronic effect.

So, we brought it into the laboratory and we did two studies, one in men's, one is women's and these were young, healthy men and women with no sexual problems who were non-smokers. We simply wanted to look at the effects of nicotine, a single dose of nicotine on the actual physiological sexual response. In men, we looked at the erectile response. In women, we looked at blood flow into the vagina. We found that... and we used nicotine gum and we used a placebo gum that we could easily match in the flavor and smell and their texture and what have you the best we could.

We found that quite surprisingly, nicotine had a deleterious effect on the sexual response in men and women. So when we showed them a sexual film... this is how we measured sexual arousal in a laboratory. We show the people a... the participants a non-sexual film to get a baseline of just the blood in the genitals and then, we showed them the sexual film. We looked at change in blood flow. When someone's aroused, within a few seconds of presentation of the erotic film, there's a dramatic increase blood flow to the genitals.

We found when they had received nicotine prior to doing these films, there was a much smaller blood flow response to the erotic films when they'd taken the nicotine. So really, it's having an effect on not allowing blood to go into the genitals. If that's done time after time after time, many times a day for many years, what happens is it actually begins break down the musculature in the penial... in the penis, called erectile tissue which is the network of little blood vessels surrounded by a muscular network that opens and closes to allow blood to go in and out of the genitals. It breaks down the ability for the muscles to do that and that's what in long-term chronic smokers, what happens.

[Angel Donovan]: So, does that contribute to erectile dysfunction?

[Cindy Meston]: Oh absolutely! It's a huge cause of erectile dysfunction, yeah. If you look at long-term smokers versus non-smokers, there's a much higher incidence of erectile failure.

[Angel Donovan]: Yeah, what other raises erectile dysfunction, do you know? Have you looked at it because, you know we're always talking... like it seems like the media and everything else around us is telling that erectile dysfunction is a lot more present today?

[Cindy Meston]: Yeah, I mean a real rough average is about a quarter of men. I mean, it certainly increases with age.

[Angel Donovan]: Yeah.

[Cindy Meston]: But, probably about 25% of men and I'm not talking incidental erectile failure. I mean... one thing that I would like to get out also to your listeners is that occasional erectile problem is the norm, not the exception. Many men have experiences where they will experience erectile failure and we know from the literature that for most men, they recognize that. They say, "Oh yeah, well. You know, I'm tired or I'm stressed out about something or I'm particularly nervous about this sexual interaction." Sometimes, if a man has a new partner and they're very excited about their partner, they're so worried about being a good lover that it has the opposite effect of causing erectile problems because, they're so worried that they're not focused on the sexual cues.

So, it really is the case that is normal. Don't worry about it and so by talking about erectile dysfunction, we're talking longer-term, chronic, over time, really repeated inability to obtain and maintain and erection. The best to know if you really have a problem versus "Is this just that I'm anxious during sex," is if the man, they look to attain an erection during masturbation, then he doesn't have a physiological problem. It's just as simple as that.

[Angel Donovan]: Right, it's physiological.

[Cindy Meston]: Exactly, yep.

[Angel Donovan]: Okay great, thanks for straightening that out because, I know it's something that a lot of guys are concerned about. So, we've been talking about a variety of physiological factures. When it comes to women, how do you think about how these... the physiological sexual arousal aspects relate to psychology for them, how they think, how they behave and so on?

[Cindy Meston]: Yeah well, you ask the key question that I've been trying to understand for 45 years, actually. It's really complicated because, what we find as I sort of alluded to early, for men there's a much closer connection between the erectile response and how aroused they say they are or they experience psychologically. Whereas as women, it's not as close a connection. We don't have, even in the laboratory when we measure psychologically aroused they are and what their body is doing. It's not as close a connection.

So, this isn't to say that genital cues are not important but for women, some women aren't attending, some women aren't maybe able to detect them easily enough or for some women, they aren't experiencing those genital cue as sexually arousing. There may be other cues are more important to them. It's to say that the physiology isn't important because, it is and many women say, "I used to experience these genital sensations. Now, I don't. It's making me feel less sexually satisfied but for other women, it's not as close a relationship, if that makes sense.

[Angel Donovan]: Okay, it sounds like it varies. How do you look at this whole space of women's sexual behavior? Do you have a kind of working model in your head or ways you think about it more broadly?

[Cindy Meston]: Well, I think that for women, you have to the right... a certain level of physiology working properly. You need to have hormones intact. You need to have... we know that some of the neuro-transmitters like dopamine, noracaneferone. We don't know a lot about oxytocin in humans yet but, we believe that that link may play a bounding role in sexual attachment in humans to some degree like it does in animals.

So, the underlining physiology needs to be functioning but, there needs to be more than that and if I had to sit here... but, I would say it's probably more so for women than men is that the role of just the contextual factors, the relational factors, the many reasons that they want to have sex or they feel sexually satisfied, it probably plays a slightly more important role for women then it does for me. It isn't to say that men are just all about becoming sexually aroused and having an orgasm. That's not true and some of my research with Dr. Buss has shown that but, I do think that women are more easily distracted from their sexual response and that so many more things in their relationships play a key role in allowing them to become sexually aroused.

[Angel Donovan]: Thank you, thank you. It's always interesting. Someone with 25 years of work to understand how they of it today. It's quite...

[Cindy Meston]: Yeah, yeah and we still don't have all the answers but, we're learning.

[Angel Donovan]: Yeah, it's a work on progress.

[Cindy Meston]: Yes.

[Angel Donovan]: I was going to ask this to you later but, seeing as we were just talking about this. Have you got any big things you'd like to get answered in the next five, ten years, questions that you think could get answered about women's sexuality?

[Cindy Meston]: Well, I guess two different lines of research. One is really understanding more about the physiology of sexual arousal and this is something that I've been very interested in for a long time. In fact, my dissertation research focused on this and that is for a very long time, it was believed that in women, sexual arousal you want to get them into kind of a non-anxious state.

Our nervous system has two branches, the sympathetic and the parasympathetic and the sympathetic is what prepares for what you for what you probably heard of the fight or flight response. So, your heart and all these changes that get you ready to run basically. The parasympathetic is kind of an opposing of the nervous system that kind of calms you down. It brings you back to resting equilibrium.

It was believed forever that the thing to do for women if you want to facilitate sexual arousal is to get them into a calm state. You get them to relax, get a bubble bath, listen to some calming music. That this would help facilitate arousal and with the caveat that, that indeed would be helpful for women who are particularly anxious about sex but, for women who have a normal level of nervous system or arousal and as the approach sexual situations have a normal level, the actual opposite I have shown to be true.

You actually want to get them aroused from a nervous system perspective. They'd be much better to go for... show them exercise and afederen, all of these things facilitate arousal in women. So to do an activity that is more activating as opposed to calming before sex, it seems to jumpstart sexual arousal in women.

[Angel Donovan]: Right, so it seems to be the opposite of what we thought, apart from if someone is anxious, it doesnÕt... it tends to interrupt the process?

[Cindy Meston]: Yes.

[Angel Donovan]: So...

[Cindy Meston]: That's what I believe, yes.

[Angel Donovan]: Yeah, so it sounds like in absence of anxiety for whatever reason. It could be work, stress or it could be stress about the relationship and so on, then being more excited in terms of like having their nervous system more excited is going to beneficial to sexual arousal?

[Cindy Meston]: Yes.

[Angel Donovan]: Is that correct?

[Cindy Meston]: Yes, you have it.

[Angel Donovan]: Yeah, so I noticed that you'd also explored some of these methods. You've explored exercise. Efedrine, you said. Is that a drug?

[Cindy Meston]: It is. Efedrine is what they put in a lot of diet medications. I would not suggest taking that at all. It's dangerous actually. I give it just to really get at the narapenafin response but, yes exercise. You know, go run around the block or even better, get your partner to chase you around the block. Something like that.

[Angel Donovan]: Right, just anecdotally, I would the exercise, I think definitely works. I used to go training with my girlfriend and there seemed to be a correlation the post activity there. Another thing I saw was gingcobaloba you were looking into?

[Cindy Meston]: Huh uh, yes.

[Angel Donovan]: So, eferin is like something that you probably donÕt want everyone to start taking, as you said. Why did you look at gingcobaloba?

[Cindy Meston]: Well, gingcobaloba has been shown to increase blood flow all over the body and it's a safe herbal extract. So, I wanted to see whether is kind of had a similar effect to Viagra which is increasing blood into the genitals particularly among women who are on antidepressants. What we know, there are a lot... well, men and women... all of people are on antidepressants these days. It's selective serotonin reuptake inhibitors.

You know, like Prozac and Wellbutrin and all these drugs, a lot of people are taking them and unfortunately, they have negative side effects on sexual function for a lot of people which is one of the main reasons that a lot people stop taking them. Which is too bad because, they're very beneficial for depression. One of the problems with the side effects is you can't really figure out how to resolve them as a physician. They don't seem to respond to traditional therapy.

So, I wanted to see whether something like ginkgo biloba that increase blood into the genital could counteract those effects. We found modest effects, nothing that I would say, "Oh, this is so fabulous. Run out and buy it right away. "

[Angel Donovan]: Right, right.

[Cindy Meston]: More recently, just a few years ago, we looked at an exercise program for women who were on antidepressants and who were suffering from sexual side effects and found that the women who... we had several different conditions. One is they exercised within a half hour before having sex and in a different condition, they just exercised but, at a time period unrelated to sex activity. So, you're kind of looking at the chronic beneficial effects of exercise which we know are huge versus the immediate effects of exercise on the sexual response.

We found it was beneficial in both conditions but really, the exercise within 30 minutes of having sex actually helped these women who were on antidepressants and having problems becoming sexually aroused and having an orgasm that it actually counteracted some of those effects. So, I was really delighted with that finding because, this is a large group of women who you know are perfectly sexually functional then they go on antidepressants and it impairs their sexual response. So, this is something that would be great to get at and get the word out. It doesn't cost anything. It's good for you sex life and it's good for all sorts of other things as well.

[Angel Donovan]: Yeah, as you were talking about that... I mean, I've been into exercise for a very long time and I tried a lot of different methodologies. I've looked at thing thing like cardio in my early years. I did a lot of jogging and I went into resistance training but, kind of high-volume resistance training. So, I would be in the gym most days.

[Cindy Meston]: Mmm-hmm.

[Angel Donovan]: Pushing some weights. Then, I did some things like high-intensity training. So, that's more like once a week weights in a kind of different specific protocol and I push at the high-intensity training protocols, interval training rather where people are like doing sprints, stops, sprints, stops and any of the cross fits. I've had all of these different types which people are into. I wonder if they'd have different patterns of impact on arousal. What kind of exercise specifically did you look at or do you just kind of put it all into one box?

[Cindy Meston]: No, I looked cycling on a stationary bicycle and running on a treadmill. So, you're right. There's so many different theories of exercise and I don't by any means pretend that I'm an exercise physiology. An expert, I'm not. My understanding is that the type of exercise program you chose depends to some degree on your desired outcome, right?

If you're trying to lose weight or you're trying to build flexibility or you're trying to gain muscle mass, whatever and I was specifically looking for ways to increase sympathetic nervous system activity. So, relying on the exercise physiological literature, I learned that 20 minutes of intense cardiovascular exercise at somewhere between 70 80% of your volume of oxygen uptake. So, it's a pretty good workout.

[Angel Donovan]: Right.

[Cindy Meston]: But, as little as 20 minutes has a really beneficial effect.

[Angel Donovan]: Yeah so, that's not a really the kind of jogging. That's more intense than that. That's probably more similar to the HIIT except there's intervals there.

[Cindy Meston]: Yeah.

[Angel Donovan]: Yeah, yeah, cool.

[Cindy Meston]: Yeah.

[Angel Donovan]: Alright.

[Cindy Meston]: Yeah.

[Angel Donovan]: Yeah, that's also interesting because I'm sure a lot of people are doing different things at home.

[Cindy Meston]: Oh well, I was just going to add one kind of interesting tid bit about the exercise studies and that is... and I replicated this finding many, many times right now. So, I'm very confident that's it a real finding is that what's interesting. When you do all of that exercise or that 20 minutes of exercise and put into a sexual situation, we found that when the women are viewing a non-sexual films, their blood flow to the genitals doesn't change with exercise.

So, it's only when they're viewing a sexual film. So, they're thinking sexual thoughts. So, what's interesting about that is, it's not simply that exercise is just putting blood into your genitals. That's not the case. It's actually preparing the body for sexual arousal. So, that when they are put into sexual situation, they respond more intensely and also more quickly.

[Angel Donovan]: Right. Is this... because, it's kind of like your body's more aroused overall. That's what you're saying with the sympathetic system but, it's not...?

[Cindy Meston]: Well, it's like prepared to become... it's aroused and it's prepared to become sexually aroused. So, it's like a more efficient system.

[Angel Donovan]: So, it sounds like exercise is one of the best findings for improving a couple's a sex life. You know, start going to the gym together or something like that?

[Cindy Meston]: Absolutely! I believe so, yes.

[Angel Donovan]: Yeah, as I said, you know it's been something I've just noticed over time which is good. One of the more, how would you say, challenging topics you've looked at is child or sexual abuse and women's sexual behavior in adulthood. I just know that there's a lot of popular myths or popular ideas out there about how sexual abuse translates into adulthood and so on. So, I wanted to look into this topic with you. What is the background of sexual abuse? How common is it?

[Cindy Meston]: Sadly, it's very common. About a third of North American women experience... have experienced in their lifetime some type of sexual abuse. Now, the prevalence rates change dramatically depending the way you're defining sexual abuse of course. In the literature, it's even confusing because, some people define it as any sort of let's just say childhood sexual abuse. Some people define it as any sort of unwanted sexual contact. So, this could be someone exposing themselves, their genitals to a child but, not actually ever touching the child. To the very far end of the continuum which would be a penetration of the child.

So, to try to get exact numbers is hard because, it's how someone defines it and also the age. Some researchers say, "Well, it's prepubertal." Some say 12 years. Some say 15 years. So, it's hard to get... put exact numbers on it but, bottom line there are... it's a high rate which ever way you want to look at it and it has deleterious effects on sexuality in adulthood for not everybody but, for a large proportion of women who have had these experiences.

[Angel Donovan]: Right. So, I think of the popularized ideas about sexual abuse victims is that they tend to become more sexualized and kinky in adulthood as a result. Are these myths or does your research support that? `

[Cindy Meston]: Well to some extent, research does support that. So, here is what we know. With women who have been sexually, particularly in childhood. Sorry to be so vague but, there's so many factors...

[Angel Donovan]: Right.

[Cindy Meston]: ... that will determine if they experience negative effects on sexuality. It depends on how early the experience, if it was repeated, if it involves penetration, if it was a family, all of these things do play a role in the degree to which it impacts one's sexuality but, we know that any unwanted sexual activity, especially in children and even in adolescence or adults, if it was their very first sexual experience. So, if they don't have kind of a repertoire of normal sexual experiences that comes first, then it has a negative impact.

By negative we say, "Well, it's different from normal." We find that some women do tend to engage in a lot of what's referred to as unrestricted sexual behavior. So, they're very sexualized. They have a lot of sexual partners. They have a lot of uncommitted sex. Then on the other side, it kinds of falls into these two camps are the women who really have a lack of desire for sex.

So, where is that coming from? The unrestricted or the... as some people have labeled oversexualized behavior may be coming from... doesn't mean attachment, doesn't mean commitment, doesn't mean love. Sex, you do it because, you have no choice. Your boundaries have been violated many times and so, a sexual boundary doesn't really mean that much like it does to someone who's not experienced those things. It's just crossing out a personal boundary that isn't that different from other personal boundaries being crossed. So, it's not really sex in some ways. It's just an act. It doesn't have the same meaning to some of those women.

Then for others, they even allude it to a lack of desire for sex because early on, their experiences, their first experiences, sex wasn't enjoyable. I mean, it happened in childhood, they didn't even label it as sex. This is just painful. It's scary. It hurt and especially if it's something that they knew and trusted then, sex... the whole issue of lack of trust and, "This is someone that I trusted and who I thought loved me and now, they're hurting me."

So if that becomes the sexual experience, you can imagine the kind of thoughts that are created and formed and then, you... all of sudden you jump into adulthood and you're supposed too... you love this person. You care for them greatly and then, you're supposed to make sex feel like it's love and attachment and all the good things when that's not what you've learned. So, it's hard to do that kind of mental shift for some women. It's complicated but...

[Angel Donovan]: It's a complicated matter.

[Cindy Meston]: Yeah.

[Angel Donovan]: Yeah, it's definitely a complicated matter. Are there healthy and unhealthy ways that they're dealing with it. I mean, when you look at the unrestricted sex, I bet some times it's a healthy outlet for them in terms of... I don't know if you've crossed over and looked at the relationship impacts and stuff like that?

[Cindy Meston]: Well, I think it's so individual. You know, it just all depends on the individual woman. Bottom line, it's pleasurable for her, if she's doing it willingly and it is pleasurable then, one could argue then it's not harmful. If she's doing it because, she's not getting sexual pleasure but, she's getting something else out of it. She's getting money or gifts or favors or has taught... has kind of learned early on that she needs to do that for reasons that have nothing to do with sexual pleasure then, it maybe not the best thing for her.

[Angel Donovan]: Has your research uncovered any potential healthy or beneficial approaches men could take towards women. Say a guy discovers that his new girlfriend has suffered sexual abuse in the past. So, is there anything he could do which would potentially be a beneficial approach either towards sex or towards relationship.

[Cindy Meston]: That's a very good question and a hard question to answer. I guess I would say a couple of things. More just to know that number one, not all women who have had these experience, it doesn't impact their sexuality. So, don't make the broad assumption that, "Oh wow, you've had this abuse history. You must be kind of messed up sexuality," and make these false attributions which could be simply for many other reason.

If the woman has disclosed this, it would be probably beneficial and meaningful if the male asks her, "Do you think that this has effected your sexuality or your enjoyment of sex?" She may not know but, I think even asking that opens the communications or, "Let's figure out ways that sex can be enjoyable to you." It may be that certain position, activities sexually are what really are the negative triggers and that you could find a sexual repertoire devoid of those specifics that lead to better outcome. So kind of offering to open up communications about it and to try to find ways of having a good sex life that don't involve those negative triggers that she may be experiencing is one thing.

I would like to say, when you started to ask this question, I thought you were going to ask, "Are there any treatments that I've found can work for women with these sexual problems," because I'm very excited about this. This is possibly the finding that I'm most happy about in my whole career and that is, I was funded to do a six-year long study of women who had a severe history of childhood sexual abuse and we experiencing sexual problems in adulthood.

We have a large group of women. It's a very hard population to study because, some of these women, (and again, I'm certainly not generalizing) there's a portion of these women who just don't function that well and there's a higher proportion who don't have jobs, people who are below the national income level who don't fair. So, we really try to get the worse effected population of women into the laboratory and to try to help them. It was a hard study to run because, just to keep them in a study for six months and longer is difficult for them.

With that said, we have this group of women. We did a very, very simple treatment and this is, we got them to write. It was an expressive writing treatment. We know from the literature that writing about your feelings on a certain topic has beneficial effects for people who suffer from depression and anxiety. That's been shown before. It has not been applied to women with sexual abuse.

We had these women come in and they were assigned to write. They cam into our laboratory and they wrote for 30 minutes, several times a week for several weeks, like five weeks and we had three groups of women. One group was assigned to simply write about their day. So, they just came in, a couple times a weeks and they wrote about their day and that was the control group.

Then, we had another group of women come in and they wrote about their abuse experiences. So, they actually wrote about the trauma. Then, we had a third group of women who came in and I got them to write about how they viewed themselves as a sexual person, how they think that they became that person and how it effects them in their adulthood, in their current life and their path sexually.

So, they wrote for several period of time and what we did is we measured their sexual functioning. We also measured things like depression and post-traumatic stress disorder symptoms, all those things that we know occur at a very high prevalence rate among with a history of childhood sexual abuse. We measured them at the beginning of the study, at the end of the study. So after a month and then, we also followed them afterwards for three months and six months after they'd been through this very simple treatment.

Honestly, I never expected and I hope this isn't imagination that we have such significant findings. I was hoping for a small and promising effect and we got a hugely significant finding where the women who wrote about their trauma and who wrote about their sexuality, how they viewed themselves as a sexual person. At the end of treatment, they had lower levels of depression, fewer post-trauma stress disorder symptoms, so the nightmare, the reoccurring thoughts, the flashbacks, things like that significantly decreased compared to women who just came in and wrote about their day. That was maintained at six months. That's the longest follow-up for any sort of treatment among this group of women.

So that in and of itself was super exciting but, what also made me just so pleased to see is the women who wrote about how they viewed themselves as sexual beings, they showed significant improvements in sexual functioning. Measured with interviews, measured with really well constructed validated questionnaires. Over half of the women no longer met criteria for a sexual dysfunction after being in this very simple treatment. It's just really mind blowing that it was so effective.

[Angel Donovan]: Yeah, yeah, it is. I guess... I was just thinking of what people might have been doing before they found out about this, if they'd been keeping diaries or journals. That could have been serving the same purpose.

[Cindy Meston]: Mmm-hmm.

[Angel Donovan]: So, some of the women out there may have self medicated or self treated. I know...

[Cindy Meston]: Yeah.

[Angel Donovan]: ... keeping journals and diaries are relatively popular.

[Cindy Meston]: Yes.

[Angel Donovan]: I don't know what the percentage of the population it is.

[Cindy Meston]: Yes, absolutely. I think that that's very beneficial, very therapeutic. I think that there was something about having them really think about who they are as a sexual person kind of put it all together for them. Like a lot of times when someone has experienced a trauma be it sexual or anything, they think about the events and it's like this reverberating circuit. They have the thought and then, they stop it and then, they have it again and they stop it. It never really goes any where. There's no closure and when you're forced to write it, then you put it into a narrative.

So, there's a beginning, the middle and an end and I think something about that helps the brain almost to stop the reverberating circuit. You then have a beginning a middle and an end. It was one possibility and then also, just kind of really thinking about how it's effected me sexuality is therapeutic. I don't all the mechanisms for it but, it seems to change the individual self, being about how they view themselves as a sexual person changes with this writing intervention. What's so beautiful about it is it doesn't cost anything and for some women, they don't want to seek therapy. They can't afford it for some of them but, even those who can don't always want to seek therapy because, it's too painful or they feel shame about it. They don't want to relive with a professional. So, this is a great option.

[Angel Donovan]: Yeah it is and as you say, it's very accessible to everyone. So, thanks for bringing that up. It's great. Rounding off because, I know we're running out of time here but, I do want to know. What are the best ways for people to connect with you and learn more about you and your work?

[Cindy Meston]: Well, I have a website which is http://www.MestonLab.com and on the website, I have all of my publication and some information about some broad topics of sexuality and many links to other professional organizations that people can learn more specific about and certain aspects of sexuality. I'm not able to do individual therapy over the internet, both for ethical reasons and just...

[Angel Donovan]: Yeah.

[Cindy Meston]: It's not a good way to get therapy but, there's a lot of good information.

[Angel Donovan]: Great, thank you. Who besides yourself would you recommend for high quality like knowledge, research in this area of dating, sex or relationships?

[Cindy Meston]: Boy, well for women's sexuality, there are a number of good researchers in our field. The Kinsey Institute is doing some good research on women's sexuality. For men with erectile problems, possibility the world's leading expert is a Dr. Erwin Goldstein who's at San Diego University. He heads a sexual medicine clinic there. My good friend and colleague, Dr. David Buss has written a number of very interesting books on the evolutionary aspect of sexuality which I think are very interesting and informative. More and more, sexual medicine is becoming a well known field and more good researchers are entering the field all the time. So, I think there's good promise for learning a lot more in the next five years or so.

[Angel Donovan]: Thank you very much for those recommendations. Very interesting. What are your top three recommendations to guys who want to improve their dating life as fast as possible? Have you got top three recommendations? It might be a bit tricky given your focus of research but, if you have some that would be helpful.

[Cindy Meston]: Yeah, I think that's something that David Buss could answer better than me. No, I don't study dating, relationship per se. So, I how about I give one good piece of advice. Keep in mind that women are vey different in their sexual needs, their sexual desires, their sexual expressions, what turns them on and I think a lot of men made the mistake of kind of entering into a new relationship with some background of, "Hey, I was really good. Like my past lovers thought I was really good. They really like this. That just really turned them on." They apply the very same template to next woman and the next woman and it may not always work.

Keep in mind that women are different. To not expect just because it worked with one woman that it's necessarily going to work with the next and to not be offended if it doesn't work. Keep it open to communication. To be a good lover, you have to be willing to listen, to ask and to learn something new and not just to go on your past experiences.

[Angel Donovan]: I think that's a great takeaway, not to use templates or cookie cutter approach to sexual experience.

[Cindy Meston]: Exactly, women are complicated.

[Angel Donovan]: Which has been said before.

[Cindy Meston]: Yes, it's not a novel statement.

[Angel Donovan]: Well Cindy, thank you so much for your time today. I really enjoyed a look into your research and what you've been up and all of your discoveries.

[Cindy Meston]: Well, thank you for inviting me. It's been very enjoyable chatting with you.