Is Sex Really All in Your Head?

We have heard many times that sex is “all in your head” especially for women.  Could this be true?  For men, just one visual cue can stimulate arousal, but for women a series of emotional cues are required to elicit the same arousal.  What happens in the brain that can make or break this?

In our brain, there are substances called neurotransmitters that carry the signals.  Some carry signals that increase sexual thoughts and are “excitatory” and others can blunt or flatten sexual thoughts and are called “inhibitory”.  I will try not to get too complex with this, but the message is important for you to understand.

Let’s start with the good stuff.  One of the chemicals in your body that stimulates sexy thoughts/behaviors is norepinephrine.  This is responsible for increasing attention/focus, raising the heart rate as you get excited and increasing blood flow to the muscles. It increases the energy in the body.  Wellbutrin is a medication that increases norepinephrine and dopamine in the brain.  Amphetamines also have this action.

Next is dopamine.  This is the one that gets us into trouble!  Dopamine is involved in reward and motivation.  It is what makes you crave the feeling and when that feeling is rewarded with sex, it further increases that impulse.  I like to call dopamine the “stalking chemical” as it is responsible for drunken dialing, extramarital affairs and stalking your lover by driving by their home.  Dopamine causes the feeling of wanting and is what drives you to seek orgasm.  Things that increase dopamine are watching pornography, accumulating money, gaining power over others, gambling, compulsive shopping, and video games.  Medications such as buspirone can also moderately increase dopamine.

Oxytocin is a hot topic in sexuality currently.  Many are aware of the role of oxytocin in initiating labor and allowing milk to flow with breastfeeding.  Oxytocin is also elevated during orgasm in both men and women.  But the newer research reveals the bonding behaviors that are induced by oxytocin, especially in men.  It allows social recognition and is often called the “love” drug.  Very high levels of oxytocin have been shown to lower norepinephrine and dopamine levels.  This promotes the bonding of the relationship and reduces the sex seeking behaviors.  Stay tuned for more on oxytocin as the research continues.

Other stimulators of desire are the sex hormones estrogen and testosterone.  Sadly, our peak levels are in our 20’s and can be down fifty percent by our 40’s.  Supplementation as we age may be appropriate in many cases and improve sexy thoughts, energy and wellness.

Now let’s discuss the inhibitory substances in the brain.  Serotonin is probably one of the most studied inhibitors of sexual desire and arousal.  Serotonin medications are used worldwide to treat depression and other mood disorders.  The question always comes up, “is it the depression itself or the depression medication that is causing the patient’s problem?”  It is probably both.  Serotonin can blunt obsessive thinking and flatten the response to passion.  It can interfere with arousal in women and erection in men.  Do not stop your medication but rather seek a sexual health expert that can manipulate your medications to optimize your mood control while minimizing the effects on your sexuality.

Prolactin is another sex inhibitor.  Prolactin is found in both men and women and is the hormone present during breastfeeding.  This is required to produce the milk.  When prolactin is high the estrogen levels are low leading to fatigue, vaginal dryness and low sexual interest.  As though a new mother needed yet another reason not to have sex!

Another important inhibitor of sexual desire is opiates.  Yes, pain medications.  There seems to be an explosion of abuse of opiates these days and it is having a significant impact on the sex lives of those involved.  Not only does use/abuse of pain medications act as an inhibitor of sexual desire, it also interferes with our ability to appropriately treat depression.  These are often some of our most difficult patients because of their reluctance to give up the pain medications.

This is a summary of some of the common substances in our body that affect our brain and our sex drive.  Seek a sexual health expert to guide you toward those substances that will excite your passion!

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