Sexual health expert Dr. Goldstein from San Diego Sexual Medicine at Alvarado Hospital explains his current theory on sexual dysfunction.
We all, I think, know what a neurologic reflex is. Basically, you tap a tendon with a medical hammer and the sensory information goes to the spinal cord and out from the spinal cord comes a motor reflex causing the muscle to contract, pretty straightforward stuff.
The more complicated reflexes where the sensory information must travel not just to the spinal cord but go up to the brain, and let's put the sexual reflex into that sort of a concept. There are at least six, not an infinite number but at least six, very important places in the brain where integration happens in the sexual reflex but in the end it’s all about a gate, okay? The gate either opens or closes, depends on the appropriate inhibition forces versus the excitation forces. So if you sort of understand the gate theory of female sexual dysfunction, we actually have a group of women, albeit rare, whose gates are always open. They are 24/7/365 engorged, their clitorises are engorged, their labia engorged, they could have 30-40 orgasms a day.
It’s extremely distressing, but their sexual reflex fires without any inhibition and in the middle of the bell-shaped curve where people have normal sexual functions; their gates are appropriately opened and closed under circumstances that people would feel are appropriate. And then on the women with sexual dysfunction who, Jeez, they’re not interested, they don’t have arousal, they don’t have orgasm. For whatever reasons their gates are closed. The strategy is that we as researchers are employing our strategies that basically open the gates a tiny bit, make the inhibition less likely, make the excitation more likely to actually result in a sexual reflex.
And when you understand that, I think you can understand better what we’re all trying to achieve here using strategies that modify activity all the way down to therapies that involve drugs, even involving surgery. We have certainly some women who really need surgery, but in all cases the idea is to either open or shut the gate depending on the individual’s circumstances.
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