Who Needs Genitals?
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arcalee Sipski is an expert in a field with few experts.
When I tell you what the field is, you will understand why the experts are scarce. Sipski, a professor at the University of Alabama School of Medicine, is an authority on sexuality among people with spinal cord injuries and diseases. Most people, even most M. D.s, are uncomfortable sitting down with a paraplegic and having a talk about, say, how to have intercourse with a catheter in your penis. Sipski is fine having that talk,* and she is fine with my coming to her lab while a subject is there.
Very little fazes Dr. Sipski. For her video Sexuality Reborn: Sexuality Following Spinal Cord Injury, she managed to recruit four couples to talk frankly (“. . . and there’s the *“The catheter can be folded back over the penis and both the penis and catheter covered with a condom.” stuffing method”) about how they have sex and even to demonstrate on-camera. They participated because they, like Sipski, were aware of the potentially ruinous effects of a spinal cord injury on a couple’s sex life and how hard it can be to find doctors willing to address the issue in a constructive, nuts-and-bolts manner.
Sex research is a relatively recent development in Sip — ski’s career. For years, she maintained a private practice in rehabilitation medicine. (Christopher Reeve was one of Sipski’s patients, as was Ben Vereen.)[75] Over time, she grew curious about the surprisingly high percentage of patients who said they were still able to have orgasms. For decades, the medical community—being for the most part able — bodied—had assumed that people with para — and quad — riplegias couldn’t have them. It was a logical assumption: If a person’s spinal cord is broken at a point higher than the point at which nerves from the genitals feed into the spine, then there should be no way for the nerve impulses to make their way past the injury and up to the brain. And thus, it was further assumed, no way for the person to reach orgasm.
Yet 40 to 50 percent of these men and women, according to several large surveys, do. Sipski decided to investigate. She recruited people with all different degrees and levels of spinal cord injuries for a series of studies, to see if she could find any patterns.
People with spinal cord injuries provide a unique window onto the workings of human orgasm. If you examine lots of people—some whose injuries are high on the spine, some down low, some in between—you can eventually isolate the segments of the nervous system that are crucial to orgasm. You can begin to define what exactly an orgasm is. (A recent review of the topic listed more than twenty competing definitions.) Once you have an accurate definition of what orgasm is and how it happens, then you will, hopefully, have some insight into why it sometimes doesn’t. Studying people with spinal cord injuries might benefit the able-bodied as well.
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t is a testament to Sipski’s reputation in the disabled community that more than a hundred men and women with spinal cord injuries have traveled to her lab to be part of a study. Unless you are extremely comfortable with your sexuality, masturbating to orgasm in a lab while hooked up to a heart-rate and blood-pressure monitor is, at best, an awkward proposition. It’s even more daunting when you have a spinal cord injury: Among those who can reach orgasm, it takes on average about twice as long to get there. Though Sipski’s subjects are alone behind a closed door, they can hear voices and sounds on the other side of the wall. They can tell that people are out there, timing them, monitoring them, waiting for them to finish.
The people out there this morning are uncommonly disruptive. This is because one of them is me, and because Sipski’s colleague Paula Spath said that by climbing up onto her desk and pressing my nose up to the one-way glass, I could get a peek at the experimental setup. I have on a skirt that does not lend itself to scaling office furniture. I lost my balance and crashed into Paula’s monitor, which slid across the computer it was standing on, knocking off a row of knickknacks and causing Paula to leap back and let out the sort of high-pitched exclamation that might more appropriately be heard on the yonder side of the wall. It’s a wonder anyone invites me anywhere.
A woman I’ll call Gwen is under the covers inside the lab. Aside from a caddy in the corner that holds the physiological-monitoring equipment, the lab resembles a scaled-down hotel room: there is a bed with a tasteful bedspread and extraneous throw pillows, a chair, a bedside table, a framed art print, and a TV for viewing erotic videos. Helping Gwen with her assignment is an Eroscillator 2 Plus, a vibrator endorsed by Dr. Ruth Westheimer and developed by Dr. Philippe Woog, the inventor of the first electric toothbrush.[76]
While Gwen eroscillates, Sipski explains what transpired before I arrived. All her subjects are given a physical examination to determine the extent and effects of their injury and its precise location in the spinal cord. One theory held that the people who could still have orgasms were those whose injuries were incomplete—meaning the spinal cord wasn’t completely severed and that some of the nerve impulses from the genitals were squeaking through and reaching the brain. Another possibility was that the orgasmic ones were those whose breaks were below the point where the genital nerves feed into the spinal cord.
It turned out that while both these things can make a difference, neither was an ironclad deciding factor for orgasmicity. People with high spinal cord injuries could have them, and so could some with complete spinal cord injuries. Based on Sipski’s data, only one thing definitively precludes orgasm: a complete injury to the sacral nerve roots at the base of the spine. Injuries here interfere with something called the sacral reflex arc, best known for its starring role in bowel and bladder function. The sacral reflex arc is part of the autonomic nervous system, the system that controls the workings of our internal organs. “Autonomic” means involuntary, beyond conscious control. The speed at which the heart beats, the peristaltic movements of the digestive system, breathing, and, to a certain extent, sexual responses, are all under autonomic control.
Sipski explains that when you damage your spinal cord, you primarily block the pathways of the somatic, not the autonomic, nervous system. Somatic nerves transmit skin sensations and willful movements of the muscles, and they travel in the spinal cord. But the nerves of the autonomic nervous system are more complicated, and not all of them run exclusively through the spinal column. The vagus nerve, for example, feeds directly from the viscera into the brain; Rutgers University researchers Barry Komisaruk and Beverly Whipple have posited that the vagus actually reaches as far down as the cervix, and that that may explain how people with spinal cord injuries feel orgasm. Either way, autonomic nerves seem to be the answer to why quadri — and paraplegics can often feel internal sensations— menstrual cramps, bowel activity, the pain of appendicitis. And orgasm.
“Think about it,” Sipski is saying. “Orgasm is a not a surface sensation, it’s an internal sensation.” Sipski routinely asks her spinal-cord-injured subjects where they stimulated themselves and where they felt the orgasm. Of nineteen women who stimulated themselves clitorally, only one reported that she’d felt the orgasm just in her clitoris. The rest ran an anatomical gamut: “bottom of stomach to toes,” “head,” “through vagina and legs,” “all over,” “from waist down,” “stomach first, breast tingle, then vaginally.”
It is strange to think of orgasm as a reflex, something dependably triggered, like a knee jerk. Sipski assures me that psychological factors also hold sway. Just as emotions affect heart rate and digestion, they also influence sexual response. Sipski defines orgasm as a reflex of the autonomic nervous system that can be either facilitated or inhibited by cerebral input (thoughts and feelings).
The sacral reflex definition fits nicely with something I stumbled upon in the United States Patent Office Web site: Patent 3,941,136, a method for “artificially inducing urination, defecation, or sexual excitation” by applying electrodes to “the sacral region on opposite sides of the spine.” The patent holder intended the method to help not only people with spinal cord injuries but those with erectile dysfunction or constipation.
Best be careful, though. The nervous system can’t always be trusted to keep things straight. BJU International tells the tale of a man who visited his doctor seeking advice about “defecation-induced orgasm.” For the first ten years, the paper explains, he had enjoyed his secret neurological quirk, but he was seventy now, and it was wearing him out. Horridly, the inverse condition also exists. Orgasm — induced defecation was noted by Alfred Kinsey to afflict “an occasional individual.”
The electronics term for circuitry mix-ups is crosstalk: a signal traveling along one circuit strays from its appointed route and creates an unexpected effect along a neighboring circuit. Crosstalk explains the faint voices from someone else’s conversation in the background of a telephone call. Crosstalk in the human nervous system explains not only the man who enjoyed his toilette, but also why heart attack pain is sometimes felt in the arm, and why the sensations of childbirth have been known to include orgasmic feelings or, rarely, an urge to defecate. Orgasms from nursing (or nipple foreplay) are another example of crosstalk. The same group of neurons in the brain receive sensory input both from the nipples and the genitals. They’re the feelgood neurons: the ones involved in the secretion of oxytocin, the “joy hormone.” (Oxytocin is involved in both orgasm and the milk-letdown reflex in nursing mothers.)
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ere is something eerie about spinal reflexes: You don’t need a brain. For proof of this, you need look no further than the chicken that sprints across the barnyard after its head is lopped off. Eerier still, you don’t even need to be alive. The spinal reflex known as the Lazarus sign has been spooking doctors for centuries. If you trigger the right spot on the spinal cord of a freshly dead body or a beating-heart cadaver—meaning someone brain-dead but breathing via a respirator, pending the removal of organs for transplant—it will stretch out its arms and then raise them up and cross them over its chest.
How often do the dead move? A research team in Turkey, experimenting on brain-dead patients at Akdeniz University Hospital over a span of three years, were able to trigger spinal movement reflexes in 13 percent of them. (In a Korean study two years later, the figure was 19 percent.) Most of the time, the dead just jerk their fingers and toes or stretch their arms or feet, but two of the Turkish cadavers were inspired to perform the Lazarus sign.
Reflexive movements can be extremely disquieting to the medical professionals in the OR during organ procurement surgery—so much so that there was a push in England, around 2000, to require that anesthesia be given to beating-heart cadavers. New York lawyer-physician Stephanie Mann, who publishes frequently on the ethics of brain death and vegetative states, told me that although beating-heart cadavers may appear to be in pain, they are not. “Certainly not in the way you and I perceive pain. I think the anesthesia is administered more for the doctors’ discomfort than for the cadaver’s.”
Mann said—because I asked her—that it might be possible for a beating-heart cadaver to have an orgasm. “If the spinal cord is being oxygenated, the sacral nerves are getting oxygen, and you apply a stimulus appropriately, is it conceivable? Yes. Though they wouldn’t feel it.”
I tell Sipski she should do a study.
“You get the human subjects committee approval for that one.”
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kay!” It’s Gwen’s voice over the intercom. “I’m finished.” She has a soft, swaying Alabama accent, “okay” pronounced UH-KAI. Paula tells Gwen to lie quietly for a few minutes and watches the monitor. She is looking for the abrupt drop-off in heart rate and blood pressure that signals that an orgasm has come and gone.
Gwen has agreed to talk with us for a few minutes before she leaves. She sits in a chair and looks at us calmly. If you did not know what she had been doing, you would not guess. Her hair is neat and her clothes are unrumpled.
Only her heart rate as the experiment began (117 beats per minute) betrayed her unease.
Gwen was diagnosed with multiple sclerosis in 1999. (Sipski began collecting orgasm and arousal data on MS patients earlier this year.) Her beauty and poise belie the seriousness of her condition. She says she is tired all the time, and her joints hurt. Her hands and feet sometimes tingle, sometimes go numb. She has trouble telling hot from cold and must have her husband check her baby’s bathwater. People with MS develop lesions along their spinal cord that affect their mobility and their skin sensations. Lesions also affect the pathways of their autonomic nervous system. Gwen’s illness has affected her bowel and bladder functions as well as her sexual responsiveness: the sacral triumvirate.
“I can’t feel inside,” she explains. “I can’t tell that I’m being penetrated I guess is what you’d say. And sometimes I can’t feel stimulation on my clitoris.”
Yet only six minutes had passed when she pressed the intercom button. The power of vibration to trigger orgasmic reflexes is a mystery and, as we have seen in chapter 10, an occasional boon. Sometimes you don’t even have to use it on the usual location. People with spinal cord injuries may develop a compensatory erogenous zone above the level of their injury. (Researchers call it “the hypersensitive area”—or, infrequently, “the oversensitive area.”) Applying a vibrator to these spots can have dramatic effects, as documented by Sipski, Barry Komisaruk, and Beverly Whipple, at the Kessler Institute for Rehabilitation in Miami, where all three used to work. “My whole body feels like it’s in my vagina,” said the subject, a quadriplegic woman who had just had an orgasm—evinced by changes in blood pressure and heart rate—while applying a vibrator to her neck and chest. Komisaruk and Whipple’s book The Science of Orgasm includes a description of a “knee orgasm” experienced by a young (able-bodied) man with a vibrator pressed to his leg. “The quadriceps muscle of the thigh increased in tension. … At the reported orgasmic moment, the leg gave an extensor kick. . . and a forceful grunt was emitted.” (In the interest of full disclosure, the young man was stoned.)
I ask Gwen how she made the decision to be part of Sipski’s study. “When I first heard about it from my neurologist,” she begins, “I thought, Yes, I want to do this. And then I started thinking what the situation was going to be like. And I thought, Well, I don’t know if I want to or not. But me and my husband talked it over, and we thought у’all could probably help me.” Gwen gets to take a vibrator home with her. The study for which she is a subject includes a treatment component comparing the two stars of the last chapter: the FertiCare (modified with a Woog head) and the Eros. The hope is that vibration (or suction/vibra — tion) therapy can help retrain the sacral reflex arc so that women with spinal issues can reach orgasm more easily.
Gwen retrieves her purse. She asks if we have any other questions for her.
I have one. “Did you hear a loud crash while you were in there?”
“Uh-huh. And talking.”
“Sorry about that.”
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ipski and I are eating at a suburban Birmingham restaurant where couples drink wine at lunch and seem to have nothing to say to each other. Or maybe they’re eavesdropping. I would be.
The lunch conversation has drifted to the topic of nongenital orgasms. The ones that wake you up from dreams.
The ones some epileptics[77] experience just before a seizure (and that occasionally motivate them to go off their meds). The “thought-orgasms” that ten women had in Beverly Whipple and Barry Komisaruk’s Rutgers lab. The individuals Alfred Kinsey interviewed who “have been brought to orgasm by having their eyebrows stroked, or by having the hairs on some other part of their bodies gently blown, or by having pressure applied on the teeth alone.” Though in the Kinsey cases, presumably other body parts had been stroked or blown just prior, and the eyebrow and tooth ministerings merely, as Kinsey put it, “provided the additional impetus which is necessary to carry the individual on to orgasm.”
I brought along a copy of a letter to the editors of the British Journal of Psychiatry entitled “Spontaneous Orgasms—Any Explanation?” The author was inquiring on behalf of a patient, a widowed forty-five-year-old Saudi mother of three, who had “complained bitterly of repeated uncontrolled orgasms.” They happened anywhere, at any time, up to thirty times a day, “without any sort of sexual contact.” Her social life had been ruined, and she had,
understandably, “stopped practicing her regular religious rituals and visiting the holy shrines.”
When I look up from the page, the waiter is standing with my gumbo, waiting for me to move my papers. Earlier he came over with the iced teas while Sipski was describing the bulbocavernosus reflex, which tells you whether the sacral reflex arc is intact. The test entails slipping a finger into the patient’s rectum and using the other hand to either squeeze the end of the penis or touch the clitoris. If the rectum finger gets squeezed, the reflex is working. The waiters are different in Birmingham than they are in San Francisco, where I eat out. This one said simply, “Who had the unsweetened?”
Sipski’s explanation for nongenital orgasms is this: You are triggering the same reflex, just doing it via different pathways. “There’s no reason why the impulses couldn’t travel down from the brain, rather than up from the genitals.” The input would be neurophysiological in the case of epilepsy patients and the Saudi woman, psychological in the case of the Kinsey folks.
Sexual arousal, not just orgasm, reflects this bidirectional split. Here again, spinal cord injuries have helped researchers tease apart the two systems: There is “reflex arousal” and there is “psychogenic arousal.” If you show erotic films to someone with a complete injury high up on the spinal cord, the person may say they find the images arousing, but that psychogenic input will be blocked from traveling down the spine, and thus no lubrication (or erection) will ensue. These people can, however, get erections or lubrication from physical, or “reflex,” stimulation of their genitals.
Very low spinal cord injuries create the opposite dichotomy: the person can only become lubricated from seeing (or reading or listening to) something
erotic. Physical “reflex” arousal is blocked by the injury. Able-bodied men and women respond to both kinds of input (though in women, as we’ll see in the next chapter, the head and the genitals are often at odds). Their orgasms can be triggered by a single type of input, or a combination. Barry Komisaruk calls the latter “blended orgasms.” This might explain why the single-malt orgasms—vaginal, clitoral, nongenital—all feel somewhat different.
There’s one more varietal orgasm I want to ask Sip — ski about: the kind some kids have climbing the ropes in gym class. Sipski wasn’t one of those kids. “I have never heard of this.” We both look at each other like we’re nuts. I explain that it isn’t from contact with the rope, but more from the lifting of your body. Sipski replies that this makes sense, as orgasms from squeezing the pelvic and/or buttock muscles are not unheard of. Kinsey mentions having interviewed some men and “not a few” women who use this technique to arouse themselves and who “may occasionally reach orgasm without the genitalia being touched.”
Sipski suspects that this might be how the handsfree orgasm women in the Rutgers lab were managing it. She doesn’t know that three weeks before I had lunch with her, I went out for sushi with one of those women. Kim Airs, whose contact information I got from Barry Komisaruk, happened to be in my city visiting friends and agreed to meet to talk about her unique skill set. Airs is a tall, ebullient woman in her forties whose past employers include porn production companies, an escort service, and Harvard University, where she worked with then president Lawrence Summers. Airs learned the “handsfree” technique in 1995, in a breath-and-energy orgasm workshop taught by sex-worker-turned-sex-educator
Annie Sprinkle A It took her two years to master the craft. Now she can do it easily and upon request, which she does in workshops and talks and, occasionally, on sidewalk benches outside sushi bars.
It was nothing like the When Harry Met Sally scene. The people walking past had no idea. She closed her eyes and took some long, slow breaths and after maybe a minute of this, her face flushed pink and she shuddered. If you weren’t watching closely, you’d think she was a runner who’d stopped on a bench to catch her wind.
Like the orgasms of Sipski’s subjects, those of Airs and Komisaruk’s other volunteers were verified by monitoring heart rate and blood pressure. Definitively verifying someone’s claim to an orgasm is more difficult than Masters and Johnson would have you believe. The duo described telltale muscle contractions, but Sipski found that not all women have these. t The steep rise and abrupt postorgasm [78]
drop-off in heart rate and systolic blood pressure are the closest there is to a reliable physiological marker. Airs made the grade.
Sipski is right that at least some of the thought orgasms were helped along by internal muscle flexing. At the end of their paper, Whipple and Komisaruk state that some of the women were making “vigorous muscular movements,” and concede that the others may have been doing so more subtly. A how-to Web article under Annie Sprinkle’s byline includes directions to squeeze the pelvic floor muscles in order to “stimulate the clitoris and G spot.” (Arnold Kegel years ago found that diligent Kegelers tend to have an easier time of orgasm.)
Airs herself, however, described a process involving chakras and waves of energy, but no interior calisthenics. She appeared to be taking herself into an altered state, which makes sense, because that seems to be where people go during an orgasm. Scans show that the brain’s higher faculties quiet down, and more primitive structures light up. As in most altered states, people tend to lose their grip on time. In 1985, sex physiologist Roy Levin brought twenty-eight women into his lab and timed their orgasms. After they’d finished, he asked them to estimate how long the orgasm had lasted. With only three exceptions, the estimates were well under the real duration—by an average of thirteen seconds. Orgasm appears to be a state not unlike that of the alien abductees one always hears about, coming to with messy hair and a chunk of time unaccounted for.
What is life like for someone who can discreetly trigger an orgasm with a few moments of mental effort? Airs insists she rarely undertakes it in public. “Sometimes on long plane flights,” she said. The last time was while riding the Disneyland tram.
Nor is it, in the privacy of her home, a nightly occurrence. “Usually when I get home I’m too tired.”
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