Sunday, January 25, 2015

The Chemistry of Sex

Sex is one of the most intimate and privately held aspects of our lives, yet it is expressed openly in the media. There are certainly conflicting viewpoints and opinions on this subject, and because of this polarity, talking to your doctor can bring about anxiety, embarrassment, and awkwardness. This is why choosing the right doctor is paramount. After all, sex is part of Maslow's hierarchy of needs. It is one of the most basic biological and physiological needs along with air, food and drink, shelter, warmth, and sleep. A doctor with a holistic approach considers all aspects that influence sexuality. They look at mind, body and spirit.

Benefits of Sex
Sex does a body good. A study in Biological Psychology found frequent intercourse was associated with lower blood pressure and lower overall stress. Sex is a form of exercise and can improve your strength, flexibility, balance, and your emotional health. Having sex is an aerobic workout and burns calories. Thirty minutes of sex burns 85 calories on average.

Sex enhances immunity. Scientists at Wilkes University found those who had sex once or twice a week had higher levels of an antibody called immunoglobulin A, or IgA. IgA antibodies protect body surfaces that are exposed to outside foreign substances and are found in areas of the body such the nose, breathing passages, digestive tract, ears, eyes, and vagina.

Having sex and orgasms increases levels of oxytocin, a hormone that increases levels of contentment and a sense of bonding and closeness with a partner. Researchers from the University of Pittsburgh and the University of North Carolina evaluated 59 premenopausal women before and after warm contact with their husbands and partners. They found that levels of oxytocin increased with increased contact. This hormone is also responsible for decreased pain levels after sex. As oxytocin surges, endorphins increase and pain declines. A study published in the Bulletin of Experimental Biology and Medicine had participants inhale oxytocin vapor and then had their fingers pricked. Those who had inhaled oxytocin raised their pain threshold by more than half.[i] The oxytocin released during orgasm also promotes sleep. Getting enough sleep has been linked to a healthy weight and blood pressure.

In the British Journal of Urology International, Australian researchers found that frequent ejaculations in 20-something men may reduce the risk of prostate cancer later in life. Another study in the Journal of the American Medical Association found that frequent ejaculations -- 21 or more a month -- were linked to lower prostate cancer risk in older men.

Obstacles to Sex
Many people do not enjoy sex; others don’t perform well when having sex. Forty-three percent of women experience sexual dysfunction. Of those women, 40% do not seek help from a physician. As women grow older this percentage increases. Additionally, 31% of men also experience sexual dysfunction.

The ability to enjoy sexual relations can be affected by many factors. Psychological factors can influence our ability to enjoy sex. Events from the past, especially our childhood, and social, religious, and moral beliefs can all intrude upon or warp our attitudes toward sex. Mind, body and spirit are connected and intertwined. Depression, low libido, not feeling sexy, low self-worth, and inability to focus on pleasurable feelings are all factors that influence our sexuality. Hormonal imbalances associated with perimenopause, menopause, postpartum, and andropause are well-known influences of changes in sexual function. Also physical injury, diabetes, kidney disease, vascular disease, nerve damage, toxins, and medications influence how we feel, respond, and function with respect to sexuality. The physical issues affect the mental state and this can affect the spirit.

Women’s sexual dysfunctions have been virtually ignored partly because there is no pharmaceutical wonder drug to treat it. While a man’s impotence is obvious and is psychologically linked to his “manhood,” if a woman becomes less interested in sex or has difficulty achieving orgasm, she is still physically able to participate in sex. As a result, sexual dysfunction in women rarely gets reported to physicians, and it is unusual for such reports to be entered into drug company databases or forwarded on to the FDA.

Medications may play a large roll in sexual dysfunction. Sex seems simple, but it is actually very complex. There are a number of ways in which medicines can interfere with sexual satisfaction. Many medications affect libido; others may cause erectile dysfunction (ED), vaginal dryness, and difficulty achieving an orgasm. See Graedon’s Guide to Drugs That Affect Sexuality, made available by The People’s Pharmacy®. While not directly associated with sex, drowsiness, fatigue, depression, confusion, decreased focus, and weight gain can all affect the ability of people to feel good about themselves, just relax and enjoy sex.

Poor adherence to a medication regimen is often due to the side effects of medications, especially when it comes to sex. Physicians must be pro-active and inform their patients ahead of time of possible side effects and work with them to minimize these side effects. This is imperative for compliance and wellbeing. Some of the most widely-prescribed medications have sexual side effects. Anti-depressants such as SSRIs can cause ED, anorgasmia (inability to have an orgasm), premature ejaculation, and decreased sexual desire. Blood pressure medications – especially beta blockers – may cause ED. There are alternatives to treatment; talk to your physician about alternative medications, supplements, herbs and essential oils. They can help develop a regimen designed especially for you.

Some drugs have a direct impact on neurotransmitters, the chemical messengers of the brain which allow nerve cells to communicate with other cells. They are critical for sexual health and overall health. As stated above, sex is complicated. Dopamine, Acetylcholine, GABA, and Serotonin are the neurotransmitters responsible for the four components of human sexuality: desire, arousal, orgasm, and resolution.

Dopamine is the neurotransmitter that affects brain processes that control movement, emotional response, and the ability to experience pleasure, desire, empowerment and pain. Dopamine is released when we experience pleasure. Eating certain foods, participating in sexual activity, and using certain drugs can stimulate the pleasure centers in the brain. This reinforces and motivates us to do or continue doing those activities causing the stimulation. This is seen with addictive drugs like cocaine and amphetamines because they elicit a pleasurable response. Also, the treatments for restless leg syndrome and Parkinson’s disease utilize a drug that is a dopamine agonist (acts like dopamine). Working in the ICU, critical care nurses use dopamine at low doses for kidney support by increasing and promoting urinary output. At higher levels it is used for blood pressure (BP) support by increasing the BP and heart rate. When levels of dopamine are too low in the body, it causes low sexual arousal, low libido, and reduced interest in sex. In a study done at Florida State University, mice with low dopamine levels had abnormal genital reflexes and copulatory patterns.

Acetylcholine helps with focus, creativity, and concentration. Acetylcholine also influences sexual arousal and desire, and moisture levels reflected in men’s semen volume and women’s vaginal lubrication.

GABA (gamma-amino butyric acid) is responsible for evoking a feeling of calm and tranquility. When GABA levels are low, it is hard to relax; it’s impossible to trust and to let go of fear and anxious thoughts. Increasing GABA levels can have a positive effect on dopamine levels, too. Not only will adequate levels of GABA help one reach an orgasm, but desire also increases.

Serotonin makes us feel relaxed, happy, content, and emotionally balanced. These are the feelings many equate to the “afterglow” after having sex. The hormone oxytocin also plays an important role in “afterglow”. On the other hand, low serotonin levels can result in a lack of joy and decreased feelings of intimacy.

How do you know if you have low levels of neurotransmitters, and what can be done for low levels? First, there are neurotransmitter lab tests that can identify deficits in neurotransmitters. There are also neurotransmitter questionnaires that can help identify which neurotransmitters are low.

Dopamine can be increased by chromium, rhodiola rosea, ginkgo biloba, testosterone, estrogen, DHEA, thyroid hormones, human growth hormone (HGH), mucuna pruriens, panax ginseng, tyrosine and maca.

Acetylcholine can be increased by choline, DMAE, acetyl-L-carnitine, phosphatidylserine, lecithin, omega-3 fatty acids, manganese, huperzine A, alpha lipoic acid, and gingko biloba.

GABA-enhancing compounds include inositol, B vitamins, magnesium glycinate, kava kava, l-theanine, leucine, isoleucine, and valine. GABA is also available in supplemental form.

Serotonin can be increased by tryptophan, 5-HTP, saffron extract, omega-3 fatty acids and magnesium.

Real laughter releases some very powerful dopamine boosters, such as serotonin, endorphins, and oxytocin, into your bloodstream. So, laugh a lot.

Sex Hormones
Testosterone has been equated to a man’s sex drive. It is also plays a part in a woman’s sex drive. Testosterone increases libido, arousal response, and the frequency of sexual thoughts. Men can apply creams or gels, or take injections or injected pellets. Women generally use topical or vaginal products. Compounded bio-identical creams are available; these may be applied vaginally or to the genitalia. She may also apply the cream on the inner thighs or arms for hormonal support.

Hormone levels have to be checked regularly to make sure that the testosterone levels are within normal range, and that testosterone is not being converted to estrogen too quickly. Men’s testosterone levels range from 500 to over 1000, depending on height and muscle mass. Generally, tall men need more testosterone than shorter men; muscular men also need more than their slender counterparts. Women, like men, also vary in their need of testosterone. Women who are larger and more muscular need higher levels than their slender counterparts. Normal ranges are from 30 to over 80.

Estrogen is also prescribed for women for sexual health and wellbeing. As women age, their estrogen levels decrease causing the vaginal tissues to thin and be less lubricated. Estrogen cream applied topically to the vagina increases new epithelial tissue growth and lubrication. Again, this may be a bio-identical cream compounded by a pharmacist or topical estradiol (Estrace). It is not taken orally because of the side effects related to oral estrogens. Once the tissue in the vagina is thicker and younger, the cream may be applied less frequently for maintenance. This type of hormone replacement therapy allows sex to be more pleasurable without the discomfort associated with thin, dry vaginal tissue. Vitamin E can also be inserted vaginally to help lubricate vaginal tissues.

Enhancing Sex Naturally
DHEA is a supplement that can be taken orally by both men and women to increase testosterone levels. It also will increase energy and stamina.

Progesterone raises GABA in men and women. It provides a natural way to get calm instead of using other drugs.

Tyrosine is made from phenylalanine and is needed to make dopamine. Tyrosine is found in many high-protein foods such as chicken, turkey, fish, peanuts, almonds, avocados, milk, lima beans, and seeds. Consuming adequate amounts of folic acid and thiamine helps to ensure that the body makes the dopamine it needs.

Vitamin B12 also helps regulate the levels of dopamine. Adequate levels of vitamin B6 are also needed for the body to make and use serotonin and dopamine.

L-Theanine crosses the blood-brain barrier and increases dopamine and GABA levels in the brain.

Rhodiola, historically, has been used for anxiety, fatigue, impotence, and depression related to stress. People also have used it to increase physical endurance, work and performance.

Ashwagandha has been used in India to boost women’s sex drive and is known as India’s most potent sex-enhancing plant.

Maca is a plant that grows in Peru and its extract is prescribed by physicians for low libido and ED. Researchers found that this plant improves sexual stamina and helps both men and women obtain more frequent and more powerful orgasms.[ii]

Horney Goat Weed stimulates desire and has been used for over 2 thousand years restoring sexual passion. This plant also is used for treating ED and low semen production. [iii]

is Nature’s Viagra. It has also been used in folk medicine as an aphrodisiac. The bark of this plant stimulates engorged vessels in the penis and nerves of the lower spine.

Panax ginseng enhances libido, sexual vitality, and erectile function.

L-Arginine is an amino acid that causes vasodilation by producing nitric oxide (NO). It is used for ED but also for the production of vaginal fluid. NO is responsible for genital engorgement. 

Pycnogenol from a bark extract also activates NO production. One of the best ways to increase NO levels is to exercise. Exercise causes the red blood cells to bump up against the epithelial walls of the vascular system and this produces NO. Viagra, Levitra and Cialis work by blocking the chemical phosphodiesterase type 5 (PDE5) which breaks down NO, so levels of NO stay higher longer. Icariin, another herb used for ED, also deactivates PDE5.

Pelvic floor muscles are some of the muscles that contract during orgasm. Strengthening and toning the pelvic floor will help maintain the integrity of these muscles and tendons, and keep the tissue vital by increasing the blood flow to the pelvic area. One of these muscles, the pubococcygeus, controls urine flow and rhythmically contracts during orgasm. When it tightens, it reduces the diameter of the opening of the vagina. [iv] This also enhances vaginal sensations, making it easier to reach climax. 

Kegel exercises focus on the pubococcygeus muscle and are often prescribed for urinary incontinence. The exercises are performed by contracting muscles as if trying to stop the flow of urine. Can we deduce that having frequent orgasms also helps with urinary incontinence? Definitely, a fun way to prevent urinary incontinence! Kegel exercises are also prescribed for men to help control premature ejaculation.

Aromatherapy has been used in sexual practices and rituals in many cultures for over 5000 years. We are influenced by the scents around us and by the scents of others; especially those of our lovers. Many scents are known for their amorous properties and have been used (and are used) to attract lovers and to help heal broken relationships. Reportedly, Cleopatra used fragrant oils to seduce Mark Anthony. She used a special blend of cinnamon, rose, and cardamom. Roman women used basil, while Tantric disciples used sandalwood. The book, Essence of Love, by Maggie Tisserand, has many romantic ideas for a fun and romantic Valentine’s Day. She incorporates poetry, massage, aromatherapy and reflexology into fun ideas for lovers.

There are different ways to use essential oils. One can anoint the body with essential oils blended with a carrier oil like jojoba, olive oil, vegetable glycerin, almond oil, or coconut oil. Soaking in a bath with essential oils and leaving the lingering smell on the skin can increase partner’s desire for one another. A diffuser in the room allows for the air to be filled with a choice of sensual smells.

The best oils to use are the ones that you and your significant other like. Patchouli, sandalwood, cedarwood and basil are good choices for sensuality. To decrease anxiety, use lavender, clary sage, or bergamot. Ylang ylang is euphoric, anti-depressive, sedating, and is considered an erotic scent that acts as a powerful aphrodisiac (but be advised: it can also cause headaches and nausea). Neroli, rose, clary sage, patchouli, and ginger are also passion- and desire-invoking essential oils.

Cypress oil blended with a carrier oil and rubbed on the bottom of the feet increases circulation, which is good for increasing blood flow to the genitals. Rosemary and carrier oil is also great for circulation and ED, but use with caution if you have high blood pressure. Most oils should be used with a carrier oil to prevent irritation of the skin. MOST essential oils should NOT be used on infants, young children, and pregnant women.

Reflexology is a therapy that applies pressure to reflex areas of the hands, feet, and ears in order to bring the body back into balance and function. The eyes, feet, hands, and ears have reflex points that represent a corresponding body part and system. Applying pressure with the thumb to the Solar Plexus reflex point in the middle of the hand or foot for 20 seconds releases endorphins and gives the feeling of euphoria. There are reflex points on the feet at various points around the ankle. The reflexes on the male and female sexual organs are found across the top of the foot. The uterus and prostate reflex points are located on the medial side of the foot and hand. The reproductive reflex points are on the lateral side of the foot. Using various reflexology techniques on these areas can improve function. There are many reflexologists who can help with all aspects of function, including sexual function, through reflexology. 

Sex should and can be fun. Remember, your biggest sex organ is your brain. So don’t take fatigue, resentment, or anger to bed with you. Intimacy will be blocked and sex may not work as well. Practice being present and focused while enjoying the sights, sounds, smells, touch and taste of your partner. Employ visualization and meditation techniques to enhance your experience. By using a holistic approach you can improve, enhance, maintain and balance your sexual health and overall wellness for years into the future.

[i] Uryvaev, Y.V. & Petrov, G.A. (1996, November). Extremely low doses of oxytocin reduce pain sensitivity in men. Bulletin of Experimental Biology and Medicine, 122(5), 1071-1073.
[ii] Zheng BL, He K, Kim CH, et al Effect of a lipidic extract from meyennii on sexual behavior in mice and rats. Urology. 2000;55:598-602
[iii] Wu H, Lien EJ, Lien LL. Chemical and pharmacology investigations of Epimedium species: a survey.
Prog Drug Res. 2003;60:1-57
[iv] John Archer, Barbara Lloyd (2002). Sex and Gender. Cambridge University Press. pp. 85–88. ISBN 0521635330. Retrieved August 25, 2012.

Content created by Elizabeth R. Vaughan, MD, and Tina Arey, BSN, RN

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