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Dr. Truth

A UVM prof probes the question: What turns women on?


Published February 24, 2010 at 6:32 a.m.

From an unassuming lab in the University of Vermont psychology building, Dr. Alessandra Rellini is unlocking the mystery of female sexual desire.

The Italian-born Rellini is director of UVM’s 2-and-a-half-year-old Sexual Health Research Clinic, which, to the casual observer, looks like a doctor’s waiting room.

Behind the Japanese-style changing screen, though, is a green leather lounge chair and a flat-screen TV. In the chair, female volunteers watch videos of couples having sex while lab techs in an adjacent room measure responses in their genitals, heart rate and hormone levels.

Rellini, a 34-year-old psychologist, is a rising star in the world of sex research. Her studies are probing the depths of women’s sexual fantasies, how hormones in birth control affect sex drive and how being in love affects sexual satisfaction.

Since 2001, Rellini has taken a particular interest in studying sexual dysfunction in women who have a history of childhood sexual abuse. Her groundbreaking research on the subject is leading therapists toward treatments that will help abuse survivors lead normal, enjoyable sex lives.

Childhood sexual abuse is stunningly common, affecting as many as one in four women, according to a 1998 U.S. Centers for Disease Control study. It is associated with a number of psychiatric problems, including post-traumatic stress disorder, eating disorders, major depression, borderline personality disorder and sexual dysfunction.

While pharmaceutical companies race to develop a “female Viagra” to treat female sexual dysfunction, Rellini is hunting for a different sort of cure. She hopes to develop a psychological treatment for sexual dysfunction, because she believes “changing behavior” is a powerful way to improve all disorders, sexual or otherwise.

“When you are able to help somebody with a sexual relationship, their whole life changes,” Rellini says.

In the UVM sex lab, study subjects answer a battery of questions about their personal background and sexual history. They submit to a “sexual self schema,” an image-association test that reveals how they feel about themselves and about sex.

Participants also take an “implicit sexual association” test, a computer-based exercise that shows them a rapid series of sexual images juxtaposed with mundane ones. Their responses indicate whether they view sex as relaxing and enjoyable, or as a stressor.

After that, the women sit in a lounge chair and watch erotic videos of couples having sex. They are hooked to devices that monitor heart rate, the amount of sweat on the skin and the degree of engorgement in the vaginal walls. They move a lever up and down to indicate how aroused they feel.

The results of Rellini’s studies have upended some of her expectations, especially concerning abuse survivors. Rellini anticipated that abuse victims would be less in tune with their own physical arousal because trauma often causes them to “disassociate” during sexual experiences.

“When you talk to ‘childhood-sexual-abuse women,’ they will tell you [that] during sex they may distract themselves; they may be bothered thinking about past sexual abuse,” Rellini says. “Some will actually tell you they remove themselves as if they’re floating above the bedroom looking down on themselves.”

What Rellini found, though, is that women of all sexual backgrounds are just as likely to be out of touch with the reality of their physical arousal. Most women report being turned on during the sex videos, but only a portion of them show physical signs of it.

A study Rellini conducted on “interoceptive awareness,” or how women vary in their awareness of bodily sensations, revealed a curious difference between men and women.

When men are shown erotic videos, their subjective arousal and physiological arousal are usually in sync, according to studies. With women, that has not been the case, and Rellini’s research aims to find out why. Some women become very sexually aroused in their genitals but report no feeling of sexual arousal, Rellini says. The opposite also occurs.

“For men, it’s very easy to figure out if they are sexually aroused: They just have to look down their pants,” Rellini adds. “For women, it’s a little more complicated.”

Research has also shown that men are more accurate when they estimate their heart rate and blood pressure. “So maybe men are just more in tune with what’s happening inside their body,” Rellini offers.

Some of Rellini’s findings on women’s sexuality might seem like conventional wisdom. But the dearth of hard data has made “conventional” assumptions just that — assumptions. What she’s doing is putting facts behind the theories.

Another of Rellini’s studies investigates the effect romantic love, and the hormones it triggers, have on sexual arousal.

Rellini has divided 40 female volunteers into two groups: those searching for a partner and those in early-stage “smitten” love. Her question: Do women in “smitten” love have better sexual experiences, and how, if at all, is that experience connected to hormones?

Her results are suggestive, but not conclusive. She found that women in early-stage love, who had spent less than six months with their partner, found sexual stimuli more arousing than women searching for love. She’s still awaiting results from hormone-level tests in those women, which will reveal even more, she says.

Born in northern Italy, Rellini came to UVM by way of the University of Texas at Austin, where she studied under renowned sex researcher Dr. Cindy Meston, author of the popular book Why Women Have Sex. Today Rellini is considered a trailblazer in her field.

“She has become the future of sexual medicine,” says Sheryl Kingsberg, a professor of reproductive biology at Case Western Reserve University and a past president of the International Society for the Study of Women’s Sexual Health. “She is working to develop strategies that will support treatment models, taking the science and moving it toward where we would use it for treatment. She’s one of a handful that is going to move the field forward.”

Rellini explains how she came to be a sex researcher: “A lot of women were coming to the clinic to talk about their sexual problems, and when I would turn to my supervisor and say, ‘What do we do?’ we would just treat the post-traumatic stress disorder or the depression.” But when it came to addressing the sexual dysfunction itself, “there was nothing,” she says.

Gale Golden, a clinical sexologist based in Burlington, picks up where Rellini’s research drops off: She offers therapies aimed at men and women with sexual problems. Golden says she is “delighted” Rellini has set up shop in Vermont. Rellini’s not the first person to study these problems, Golden says, but her approach is “a little more modern” — and that helps clinicians like Golden.

“Every clinician likes to have some guidelines, some road maps, some things to offer a client,” says Golden, who also teaches at UVM medical school.

Rellini provides whatever data she can. For example, one of her research assistants, Julia Camuso, conducted a sweeping study of female sexual fantasies. More than 500 women from across the country took part in an Internet survey aimed at determining how women fantasize about sex, again with an eye toward studying the effects of a history of sexual abuse. Rellini was particularly interested in whether abuse survivors had more violent fantasies — such as rape fantasies — than other women.

Participants were asked to write continuously for 20 minutes about a sexual fantasy, in as much detail as possible, then complete a battery of personality questions. Rellini’s team broke the fantasies down into three categories: so-called “vanilla” fantasies, such as a memory of sex with a partner; promiscuous fantasies, such as group sex; and violent fantasies, such as rape.

Of these groups, only the data for women with “vanilla” fantasies showed any correlation to sexual arousal functioning — it was easier for them to get aroused and stay aroused. Study of the women who had promiscuous and violent sex fantasies revealed no discernable correlation between those fantasies and their sexual health.

Violent sexual fantasies were relatively common among all types of women — sexually healthy ones and women who survived abuse. Sex abuse victims tend to have more sexual partners, become “sexualized” at an earlier age and engage in more risky sex, Rellini says.

“We expected to find more violent fantasies in sex abuse survivors than others,” Rellini says. Instead, “We found more promiscuous fantasies among sexual abuse survivors, but we didn’t find more violent fantasies.”

One of the keys to Rellini’s work, and to that of other sex researchers, is the vaginal photoplethysmograph, an instrument developed in the 1970s. Shaped like a tampon, the device is a tall, thin lightbulb inside a plastic tube that is inserted into a woman’s vagina and measures her sexual arousal.

The instrument’s light source illuminates an area of the capillary bed of the vagina. A detector senses how much light is being reflected from the vaginal walls. The more the woman becomes sexually aroused, the more blood flows to the genitals, which makes the capillary bed darken. The more light is absorbed by the capillary bed, the less will reflect onto the light sensor.

But just because there’s a tool for measuring female sexual response doesn’t mean there’s a will on the part of the science community to understand it.

Government research funding for female sexual dysfunction in women is scarce, to say the least, Rellini says. She and her colleagues receive virtually no funding from the National Institutes of Health or the National Science Foundation. The result, Rellini says, is that scientists know more about the sexual habits of certain insects than they do about those of women.

“You can make a very strong argument that erectile function is important to study because without erection, it is very difficult to have any procreation,” she says. “If you look at female sexual arousal, there is none of that. It is about the satisfied experience of the person. That is not a priority for our government to fund.”

The UVM Sexual Health Research Clinic is currently running eight studies on a shoestring budget of roughly $40,000. Rellini’s lab doesn’t currently accept funding from pharmaceutical companies, which are locked in a race to get first to market with a so-called “female Viagra” drug to treat female sexual dysfunction. But Rellini says partnering with big drug companies could be an attractive option.

Rellini doesn’t support the “medicalization” of female sexuality. But she doesn’t think the media’s criticism of pharmaceutical remedies has helped women much, either. “So we all nod our heads and agree when a documentary such as [local filmmaker Liz Canner’s] Orgasm Inc. shows us the dark side of things,” she says. But if the takeaway is that female sexual dysfunction doesn’t exist, or that it’s an invention of the drug companies, Rellini believes that does a profound disservice to women. “While a variety of psychotherapy and pharmacotherapy options exist for men,” she notes, “none exists for women.”

Rellini’s goal: To reverse that trend and do a better job understanding female sexual desire.

“Women want answers,” Rellini says. “They’ll call our lab and ask, ‘Do you have results? Do you have treatments?’ There is a strong need in the community for this.”