Twenty-eight women have now participated in the sexual dysfunction research project here at the Department of Molecular Biology, University of Oxford. Our approach is empirical: that is to say, the treatment, a synthetic enzyme code-named KXC79, is adjusted in response to each set of results. All the participants are volunteers and are assessed by my colleague Dr. Susan Minstock, using a number of standard evaluations (the Derogatis Sexual Functioning Inventory, the Locke-Wallace Marital Adjustment Test, the Female Sexual Function Index, etc.), before a decision is made as to whether they are suitable for inclusion. It is always explained to the volunteers exactly what the study will involve; to date, thirty-one potential subjects have declined to take part after these initial conversations. Nevertheless, early results have been encouraging; see, for example, S. J. Fisher and S. Minstock, “KXC79 and Female Sexual Dysfunction: Some Encouraging Early Results” (2007).
Miss G. was slightly unusual in that she was a postgraduate student here at the university who heard about the project from one of our research assistants.1 Strictly speaking, this was a breach of our selection protocol. However, Miss G. worked in a completely different field, English literature, and in all other respects fulfilled our criteria: she was anorgasmic and had previously consulted a doctor “to make sure it wasn’t just a virus.” Notes were kept from initial and subsequent interviews. She had also experienced relationship problems:
It wasn’t just that I couldn’t have orgasms—it was the fact that sex was such a big part of his life, and I couldn’t share that. I simply had no interest in it. Almost as if I were going out with a football fan, but was bored by sports.
Based on this discussion and the questionnaires, Dr. Minstock made a tentative diagnosis of Hypoactive Arousal Disorder and accepted her onto the study.
I myself met Miss G. for the first time when she came to the lab for her induction. As this meeting, apparently so ordinary, was in some ways the beginning of the whole sorry fiasco, I suppose I should pause at this point to note my initial impressions of her—as a person, I mean. The truth, though, is that I did not really have any. If I may be allowed a small subjective observation, what I recall most is being somewhat annoyed that she was there at all: my understanding was that the data-collection phase of our study was completed, at least for the time being, whilst I prepared our latest findings for publication. It was work that required a great deal of concentration, and when Dr. Minstock showed someone into the lab I did not, at first, look up from my computer.
“This is where the hands-on part happens,” my colleague was saying. “Well, when I say hands-on, of course, I don’t necessarily mean that literally—we’ve got toys to suit every taste.”
Needless to say, I did not respond to this either. Dr. Minstock’s jocular manner, which she frequently assures me is simply a psychological stratagem to put test subjects and co-workers at their ease, on occasion strays—it seems to me—into flippancy. Great scientists from the past—men such as James Watson and Francis Crick, say, when they were engaged in their revolutionary work on DNA—never felt the need to be flippant. But Dr. Minstock, as a sexologist, does not always have quite the same regard for scientific method that I do.
“That’s Dr. Fisher, who’s in charge of the biochemical side,” she added in a deafening whisper. “Don’t worry, we won’t disturb him if we’re quiet. Over here’s the photoplethagraph: basically it’s like a little light we pop inside so we can see what’s going on—”
“Photoplethysmograph,” I said, still without raising my head.
“That is a photoplethysmograph, not a photoplethagraph. It calibrates reflected light. The darker the flush, the greater the vasodilation.”
“Oh, yes,” Dr. Minstock said brightly. “Photoplethysmograph. Of course.”
I did look up then. There was something about the voice that had just spoken—something wry, ironic even, as if the speaker were somehow mocking herself for not knowing the answer.
Or—it occurred to me a fraction of a second later—as if she were somehow mocking me for knowing it.
In short, I thought I had discerned in the way the visitor had spoken a spark of real intelligence, an impression only partially dispelled by her appearance. I did not at that point know Miss G. was an arts graduate, but I could probably have deduced it. She was attractive, strikingly so—I might as well make that clear at the outset. But she was striking, if this makes sense, in an entirely unremarkable way. A pleasant face, torn jeans, a cashmere pullover, a book bag, a knitted cap—and, spilling out from under the cap, a fine mass of chestnut-brown hair, as squeaky-clean and glossy as a freshly peeled conker. One could imagine that if one were to touch it, the hair would be expensive and soft, just like the sweater. Clearly, she was not part of the university I inhabit, bounded as it is by the Rutherford Laboratory on one side and the Science Park on the other. Hers was another Oxford entirely, a city of drama societies and college balls and open-top sports cars roaring off for meals in country pubs. In that Oxford, which overlaps mine whilst barely impinging upon it, girls like her are … I almost want to say “two-a-penny,” but of course they are considerably more expensive than that: their cashmere pullovers, their poise, and even their places at Oxford are the products of costly private educations.
So I glanced at Miss G. and immediately thought that I knew her type, a type which was both as familiar and as alien to me as if she were a member of another species.
In this, as it later turned out, I was quite wrong.
“Vasodilation,” I said, “relates to blood flow. Specifically, engorgement of the surface capillaries due to physiological stimulation.”
“Anything you want to know about the technical stuff, Steve’s your boy,” Dr. Minstock said, with a little roll of the eyes which was clearly meant to convey that knowing about the technical stuff was a long way down her own list of priorities.
“Actually,” Miss G. said, “there was one other thing—”
“I just need to check that file,” my colleague said quickly. “I’ll only be a few minutes.” As she left it seemed to me that she gave the other woman a pitying look, as if to say “I warned you.”
I sighed as I turned back to the visitor. “What did you want to know?”
“I was just wondering,” Miss G. said hesitantly, “if your treatment is something like Viagra.”
I regret to say that even before she had finished this sentence I was smiling slightly at its naiveté. “Not in the least, no. Viagra would be completely the wrong approach for any problem you might have.”
“Well, I can tell you if you like,” I said. “But I very much doubt you’ll be able to grasp the answer.”
She looked at me then in a rather level way, and I thought I detected a slight tightening of her jaw.
“Try me,” she said.
My explanation will undoubtedly seem rather simplistic to my present audience, but for the sake of establishing exactly what I said to Miss G., I will repeat it here. “The active ingredient in sildenafil citrate, or Viagra, is a specific inhibitor of phosphodiesterase 5,” I pointed out. “This cleaves the ring form of cyclic GMP, a cellular messenger very similar to cAMP. The inhibition of the phosphodiesterase thus allows for the persistence of cGMP, which in turn promotes the release of nitric oxide into the corpus cavernosa of the penis.”
She nodded slowly. “You’re quite right.”
“Of course. The mechanism is relatively well understood.” I turned back to my laptop.
“No, I meant you’re right that I didn’t understand. Not a word. Mind you,” she went on, almost to herself, “it’s got a sort of music to it, hasn’t it, and I don’t always understand a piece of Tennyson or Keats when I first hear it either. Sometimes you have to sort of … feel the meaning before you can work out the details. Let’s see … so what you’re saying is that once the phospho thingy, the phosphodiesterase, is taken out of the equation, and the cyclic GMP does its stuff, it’s basically a question of nitric oxide, which must be a gas, so it’s really just about hydraulics.”
I must admit, I was quite surprised that she had managed to work out the gist of what I was saying from so little actual knowledge. “Approximately, yes. Women’s sexual responses are rather more complicated.”
“Ah. Now there, perhaps, I can correct you. You mean ‘complex.’”
I frowned. “It’s the same thing, surely.”
She shook her head. “‘Complicated’ means something difficult but ultimately knowable. ‘Complex’ implies something which has so many variables and unknowns it can only be appreciated intuitively—something beyond the reach of rational analysis, like poetry or literature or love.” And then, somewhat to my surprise, she recited what I took to be some lines of verse:
“When two are stripped, long ere the course begin
We wish that one should lose, the other win.
And one especially do we affect
Of two gold ingots, like in each respect:
The reason, no man knows. Let it suffice,
What we behold is censured by our eyes.
Where both deliberate, the love is slight.
Who ever loved, that loved not at first sight?”
My confusion must have been evident, because she added “Marlowe, Christopher, 1564 to 1593.”
I bowed my head. “In that case, I stand corrected. But I still think I mean ‘complicated.’”
And then she asked the question that started the landslide.
I rarely get the opportunity to talk about my work. Or rather, I get opportunities, but they tend not to be ones where the other person is really interested in the answer. Because of the various irrational taboos surrounding the physiology of sexual response, and the even greater taboo surrounding scientific discourse, I find that when I try to explain to people what I do, either their eyes glaze over or they become embarrassed. So when someone asks me a straightforward question I take the view that the more I can dispel their ignorance, the better.
“What you call love,” I said, “by which I assume you actually mean romantic attraction, is a relatively simple phenomenon: cascades of a chemical called phenylethylamine gush through the central nervous system, inducing various emotional responses ranging from anxiety to a heightened need for touch. We know what it is, we know how it works, and, crucially, we know what it’s for. Evolutionary theory, Miss G., teaches us that everything in the human body has a purpose. Our feet are shaped the way they are so that we can walk upright on the grassy savannah. Our thumbs work the way they do so that we can shape simple tools. Our hair is sleek and smooth and glossy so that our sweat glands can work more effectively. The male orgasm is another case in point. It has one purpose, and one purpose only: the continuation of the human race. Any pleasure we feel is simply the bribe by which nature induces us to spread our genes more widely.
“If you hook a man up to an MRI scanner during climax, you see a localized, muscular spasm lasting about six seconds: highly functional, but with little variation. A woman, on the other hand, gets pulled into it gradually, building up her orgasm in a series
of waves.” At this point, I believe, I crossed to a whiteboard and sketched a brief illustration of the process, something along the lines of figures 1 and 2.
“First comes the excitement stage,” I explained. “Here. There’s a reddening of your chest, neck, and face, akin to a measles rash. A feeling of warmth pervades your pelvis. Your genitals engorge with blood; your pulse races, your limbs relax, you find it difficult to keep your mouth closed or control the sounds you make. A cocktail of stimulants, including dopamine and serotonin, are flooding your bloodstream, sensitizing your nerve endings and giving you a rushing sensation. Round about here”—I indicated the point with my dry marker—“your breathing becomes fast and shallow. Your capillaries dilate further, flushing your skin, which simultaneously becomes damp with perspiration. You are now at the stage scientists call the plateau, in which you feel as if you are being swept along on a rushing current of sensations. Synapses start firing in the right-hand side of your brain, the creative side, creating a flickering storm of electrical activity. Your nipples swell like berries. Here a chemical called oxytocin gushes from your pituitary gland, inducing an overwhelming feeling of euphoria. You gasp, you bite your lover’s neck, you shudder uncontrollably, and your lips contort.
“Yet all this has just been the curtain-raiser for the main event. Here your whole body stiffens. You have reached the point of no return, a feeling sometimes described as like being suspended at the top of a very high swing. You take a gulp of air and hold your breath, or grab your ankles and bellow. A pronounced frown—the so-called orgasm face—is a testament to the myotonic tension now building in your muscles.”
I glanced at Miss G.’s face. She was frowning with concentration as she tried to follow what I was saying, but I could see that she was more or less keeping up, so I continued. “At around this point, here, the long tissues of the arms and legs also contract in involuntary spasms. A shower of electrical signals twangs up and down the vagus nerve, like vibrations bouncing along a tightrope. A fiendishly intricate chain of biochemical reactions, only recently understood by science,2 lights up your brain like a switchboard. The central nervous system goes into overload; patterns dance behind your eyes; you feel yourself propelled, judderingly, as if traveling fast over rough ground in a flimsy vehicle.
“But only now, here, do you finally abandon yourself to what is happening. A cascade of muscular contractions—each one exactly 0.8 seconds long—pulses from your genitals, pushing outwards, until there is no part of your body, from the center of your hips to the tips of your fingers, that is not dancing to the same beat. And then at last, here, it lets you go, although you may find aftershocks occurring up to half an hour later. For around thirty seconds, Miss
G.—perhaps for as long as three whole minutes—you have been in the grip of a sensation more intense, more extraordinary, than any male has ever felt.”3
There was a brief silence. It occurred to me that the use of the word you might not be strictly accurate in this instance, since Miss G. would presumably not have been there in the first place unless she was having difficulty with some or all of this process.
“That is the how,” I continued. “But the interesting question, the question which has perplexed scientists ever since we started looking at this area, is the one you asked just now.”
“Exactly. What is it all for? The clitoris appears to be the only organ in the body which has no function other than pleasure; the female orgasm is the only physiological mechanism for which we can find no evolutionary purpose. It isn’t necessary for conception; it isn’t needed for eating, or sleeping, or raising young; it confers no advantage that can be passed on to the next generation. According to all the principles of natural selection, it shouldn’t exist. But it does. And even more fascinatingly, it sometimes goes wrong, for reasons we still cannot entirely fathom.
“That is the great mystery—and the great prize. In an age when we know almost everything there is to know about almost everything, the female orgasm is one of the few remaining puzzles. Your genitalia, Miss G., are the final frontier of scientific knowledge, the last unexplored territory. Indeed, I would go so far as to say scientists know more about the woolly mammoth than we do about your climaxes—and the mammoth is extinct! But all that’s changing now. Little by little, the bright light of research is illuminating the dark recesses of ignorance, and soon there will be no problem or glitch caused by nature for which science does not have a solution.”
I stopped, aware that I had spoken at rather greater length, and with rather more passion, than I had intended.
“Goodness,” Miss G. said, and once again I had the feeling that she might be mocking me, just a little. “You make it sound like so much fun, as well. So when do I start?”
I explained, of course, what the actual tests would involve—that she would be connected to instruments measuring blood flow, muscular activity, pH, and so on. So that she would fully understand what I was talking about, I even took her to the testing room and showed her the couch, with its hygienic paper cover, its lines of tiny plastic crocodile clips, and its electroconductive pads. It is at this point that many volunteers back out. Miss G., however, took it all in stride, asking several intelligent questions about the different pieces of equipment, such as the Schuster balloon and the Geer gauge, and—somewhat to my surprise—observing that the software which linked them was based not on Windows or Apple but on Linux.4
“I’m a part-time programmer for the Tennysonline project,” she explained. “The coding would be a nightmare if we didn’t use open-source.”
I noticed her looking rather anxiously, though, at the array of devices by means of which arousal is induced. These range from a small monitor, on which we can play video clips, to various kinds of transcutaneous electromechanical apparatus. The latter devices are necessarily rather more industrial in appearance than their High Street equivalents (figure 5), something which our subjects can find rather daunting. I tried to reassure her by explaining that the difference stemmed partly from the fact that we had to be able to vary the input from the control room next door.
“So basically you can change what’s happening to me just by pushing some buttons in there?”
“Exactly. Which in turn means that when we compare the measurements from one session with those from another, we can tell whether it’s taking more or less stimulation to produce the same result—in other words, whether the treatment is working.”
“And how many times will I have to do all this? Before I’m cured, I mean?”
“I don’t think you quite understand,” I said, a little stiffly. “This is a research project, not a doctor’s office. There are no guarantees of improvement.”
“But I thought you had seen some encouraging results? Or was that paper you published last year overstating?”
“Ah.” I had never before been confronted with a research subject who had actually read one of my own papers on the research in question, and for a moment I was at a loss as to the proper way to respond. “The paper was sound,” I said at last. “But the science is highly advanced. I very much doubt whether you understood it properly.”
This seemed to satisfy her—although she opened her mouth as if to comment further, she closed it again without speaking.
I turned to indicate Dr. Minstock, who was by now loitering ostentatiously. “Now, unless you have any more questions,” I said, “I will leave you in Susan’s capable hands. I should explain, by the way, that she is a sexologist, while I am a neurobiologist. But we get along perfectly well.” That, of course, is a joke, though admittedly not one which many people outside the fields of sexology or neurobiology would appreciate. As they left the room Susan said something to Miss G., something too low for me to catch. It was followed by a barely suppressed cackle of laughter. Generally I am immune to my colleague’s so-called empathy-building remarks at my expense, but on this occasion—I suppose because, somewhat unexpectedly, I had actually quite enjoyed talking to Miss G.—it annoyed me. I went into the control room and poured myself a beaker of water, staying there until I had regained my composure.
When I told Miss G. that Susan and I got along, that was true, generally speaking. When I was first given funding by Trock—really substantial funding, funding that transformed my little theory about primate populations into a full-scale human research project almost overnight—the firm imposed only one condition: that I was to bring a female sexologist on board. It wasn’t easy, at first, sharing my project. But eventually Susan and I got used to each other—one of our research assistants remarked that it was almost like a marriage, but with more sex—and in any case, excitement about what we were doing helped to smooth any difficulties between us.
I need hardly tell this paper’s audience that, in the great race to bring a successful treatment for female sexual dysfunction, or FSD, to market, a race currently taking place in clinics and laboratories all over the world, our little team is widely considered to be amongst the frontrunners. Oh, others may have reached the clinical phase before us; some may even have filed patents. By comparison, our progress has been slow but steady. While our rivals rushed to publish wild conjecture masquerading as research, we preferred to test and refine, test and refine; methodically exploring every avenue, no matter how unpromising; eliminating every false trail, no matter how seductive; checking and replicating every tiny success, in order that our method would eventually be seen to be as sound as our results. And now the prize was almost within our grasp. I do not mean money, although for our backers that must surely follow; I mean acclaim: the chance to have our names spoken in the same breath as those of the great scientific pioneers of the last century, people such as Chadwick, Townes, and Koch, or even—I may dare to believe—James Watson and Francis Crick. Under that sort of pressure, a few small personality clashes with one’s colleagues are almost inevitable.
But there have also been occasions when I have become aware that Susan—how can I put this?—thinks that I am a bit staid. I suppose this shouldn’t have come as a surprise: sexologists are by the nature of their profession a rather wilder bunch than we neurobiologists are. There was one occasion in particular, at last year’s Sexual Endocrinology conference, when I had to go to her hotel room to collect some papers I wanted to look at before the following morning’s session. I had already got ready for bed, and rather than get dressed again I simply put the hotel dressing gown on over my nightclothes. I thought as I knocked at her door I could hear voices, but if I assumed anything it was simply that she had the TV on. Then the door was pulled open. Susan was dressed in a loose toweling robe herself—but she, I couldn’t help but notice, was not wearing nightclothes underneath. In one hand she held a tumbler of drink. From inside the room drifted the herby odor of what I took to be marijuana. On the bed behind her I caught a sudden, shocking glimpse of writhing naked bodies, and I heard a woman’s voice—I am fairly sure it was that of Heather Jackson, a strikingly attractive research student who had recently started working for us—laugh throatily. A man’s voice, somewhat muffled, growled something in response.
Susan quickly stepped forward into the corridor so that my view was blocked. I explained what I wanted and she went to get me the papers, closing the door again until she returned.
She handed the papers over and I started to walk away. Then, as if on an impulse, she called after me, in a voice that slurred slightly, “Steve?”
“You know,” she said, “you should lighten up a bit.”
I said nothing. I took the papers back to my room, but for once my mind was incapable of processing the formulae in them. I found myself realizing, almost for the first time, that what I was reading—the complex interplay of neurotransmitters and secretions, hormones and platelets, desire and arousal, my life’s work—was all about sex: actual, flesh-and-blood bodies, writhing together like that knot of sexologists cavorting on Susan’s bed. It may sound odd, but it wasn’t something that had ever really occurred to me before—or at least, if I had acknowledged it, it had only been on an intellectual level. And I was disappointed too with Heather, whom I had believed to be a more serious academic than her behavior that evening had revealed her to be. That night I did not sleep well, and my paper next day on the climax of the female pygmy chimpanzee was one of the worst delivered I have ever given.5 I kept hearing that throaty female laugh coming from the bed, and the muffled deeper voice answering it.
Nevertheless, it was sensible of Trock to insist on my partner’s being a woman. Susan takes care of the difficult part, the interaction with our volunteers: attaching all the tiny plastic clips, explaining how to use the mechanical devices, carrying out psychological counseling, and so on. Now that I think about it, it is perhaps a good thing that the volunteers remained unaware of the omnivorous nature of her own tastes, as revealed by that glimpse into her hotel room. But whatever her other failings, I really cannot fault her manner with the subjects, with whom she never seemed less than totally professional.
1 The research assistant has since been terminated.
2 S. J. Fisher, “Neural Pathways in the Neurotransmitter Cascade During Climax of Human Females,” New Medical Chemistry 3 (2006).
3 I should probably clarify that I was referring here only to the male and female of our own species. Amongst other mammals, the picture is more complex. Coitus between minks lasts approximately eight hours, though it is unclear how much of that is taken up by orgasm, as minks are notoriously irritable when sexually aroused and prone to biting researchers. However, it is known that a pig’s orgasm lasts around thirty minutes, whilst the orgasms of the female bonobo ape are so frequent, and of such great duration, that two or more can sometimes overlap. S. J. Fisher, “Multiple Orgasm Amongst the Higher Primates,” Journal of Endocrinology 74 (June 2002): 91–121.
4 Miss G., quite unusually in my experience, even pronounced the name correctly, i.e., “Linnucks” not “Lie-nux.” See www.paul.sladen.org/pronunciation.
5 A pity, as it remains one of the very few studies of its kind.
© 2009 Anthony Strong