September 2019

Arts & Letters

Our largest sexual organ: Amee Baird’s ‘Sex in the Brain’

By Kate Cole-Adams
We know surprisingly little about how our brains orchestrate our sex lives

“Where am I?” A young woman is lying in bed with her partner. They have just had sex. “Why am I here?” At first, he thinks she is joking, then he sees there are tears running down her face. She seems to know who she is, she is alert, not in pain. But she has no idea where she is or what has just happened. He calls an ambulance.

The woman is experiencing a rare and perplexing state known as transient global amnesia: cause unknown but most commonly triggered by sex. Her story is among a multitude of strange tales that appear in Sex in the Brain: How Your Brain Controls Your Sex Life (NewSouth; $29.99) by Australian neuropsychologist Amee Baird. This story ends well – within 24 hours the woman is fine, and the couple can eventually joke about the episode – but many of the tales in this book do not. Which is one of the reasons Baird wants us to talk more about our largest sex organ.

It is astonishing how little we know about sex, or at least about how our brains orchestrate our sex lives. Sixty or so years after William Masters and Virginia Johnson hooked volunteers up to monitors to plot the physiological changes that happen during sex – and despite the advances in brain-imaging technology since then – we still don’t understand what happens in the brain during orgasm. This is partly because sex involves coordinating a lot of hugely complex brain regions. But it is also because of the strange ways in which we think, and refuse to think, about sex.

Baird tells us that despite a society steeped in sexual imagery, the stigma surrounding the topic is such that she knows of only one researcher in the world doing observational studies of the physiology of sex in healthy humans. Psychologist and neuroscientist Nicole Prause works out of the Los Angeles research lab she set up after having funding repeatedly denied or blocked by universities. Recently, she has been studying the changes in brainwave patterns in women as they orgasm, but she also pursues research with more immediately practical applications, such as the impact of orgasm on sleep, cognition and workplace productivity.

While there is apparently no shortage of volunteers for Prause’s studies (“People love them – the only exception is that they don’t like the anal probe”), she says funding is easier to find if she can demonstrate that her research has concrete health benefits. “Sex research is never going to be important for those people who think sex is only for procreation.”

As it stands, much of what science can tell us about the interplay between our sexual apparatus and the sexual centres in our brains has been gleaned indirectly. This is mainly through studying other animals, or interpreting the lurid swirls of brain-imaging read-outs – or by observing what happens to our sex drive when our brains are beaten, bashed or otherwise altered through injury, surgery, disease or drugs.

This is where Baird comes in.

As a neuropsychologist, she is interested in which bits of the brain can be shown to relate to which types of behaviour, and what this might mean for the bearer of the brain. Nearly two decades ago, working in a prestigious London neurology hospital, Baird met a man she calls Jack. His notes said he had fallen from a scaffold, hitting his head. “You’ll have fun with him,” the ward nurse told her. Jack was lying on his back in his bed staring at the ceiling. He glanced at her when she introduced herself. “Oh, thanks for coming to see me. Can you just give me a quick blow job?”

Baird tried distracting him, but he persisted. “Just a real quick one. I promise I haven’t been with any other women. I smell fine.” This continued for half an hour. Eventually, realising she wasn’t going to get through the questions or cognitive tasks she had planned (“Just make it real quick – no one will notice”), she gave up.

When he fell, Jack had damaged areas of his brain involved in what Baird describes as the “sexual neural network”. Central to this system are our frontal lobes, which shelter behind the forehead, and, crucially, the temporal lobes tucked behind our ears, each containing a smallish, almond-shaped nub called the amygdala (your “sexiest brain bit”, says Baird), which helps us process emotions.

Prior to her encounter with the sex-obsessed Jack, Baird had spent four years at the University of Melbourne doing a PhD on the impact of epilepsy surgery on people’s sexual and other behaviour. This surgery, an extreme measure to control seizures, may involve excising one of the temporal lobes. Scientists have known since an experiment on monkeys in the 1800s that removing both temporal lobes can cause dramatic changes in animals’ sexual appetites. “They engaged in indiscriminate mounting of animals of the same and opposite sex, and of inanimate objects,” writes Baird. “Males lifted up other males by their erect penises.” She reports that after surgeons did a similar operation in the 1950s to treat a young man with temporal lobe epilepsy, the changes included “sexual disinhibition, increased masturbation and out-of-character homosexual tendencies”, as well as memory loss.

Doctors no longer treat the condition by removing both temporal lobes. But surgery, including one-sided temporal lobectomy, remains a last resort for people with intractable seizures. As part of her research Baird carried out brain scans before and after such surgery, measured the sizes of patients’ amygdalae, and interviewed them at length about their experiences. Though she was initially shy about broaching the potentially awkward subject of sex, she found that most patients were more than willing to talk. While none seemed to suffer extreme reactions, she says more than half noticed changes in their sex drive. Most of these changes were subtle and welcome – they felt more sexual in a good way. But other patients reported more dramatic reactions, with some complaining that their partners could no longer keep up with them.

As well as epilepsy surgery, conditions such as stroke, brain tumours, some forms of dementia and diseases including Parkinson’s and multiple sclerosis can also reconfigure your sex life. Baird stresses that by far the most common change is a lack of sex drive. But it is when people become “hypersexual” that we’re more likely to hear about it. In the years since her encounter with Jack, Baird has continued to investigate and document the havoc that can engulf the lives of these patients and their families. As well as intense surges in sex drive, these changes can take the form of shifts in sexual orientation and the emergence of paraphilias – fetishes, voyeurism, exhibitionism and an array of sexual compulsions, sometimes including paedophilia.

Whether such changes are evidence of pre-existent, latent urges is unclear, as is the existence, or otherwise, of brain structures or processes that quarantine urges from action. Baird mentions some intriguing research showing differences between the brains of those who are sexually attracted to children and those who also act on that attraction. She interviews German psychiatrist Till Amelung about research showing that those who resist their urges tend to have bigger brains with more connections and stronger cognitive “brakes”, while those who act on their urges are more likely to have “reduced brain volumes”.

This modest but resolute book is testament to Baird’s persistence and her concern for the people she writes about. There is a fair bit of brain science in here, but she makes it clear this is not an academic or scholarly work. It is structured around a series of case studies and conversations, with other researchers, with herself and – most strikingly – with ordinary people who find themselves exiled, sometimes forever, from the people they once were and the lives they once led. The impact on the patients and on their families forms the heart of the book.

Along the way Baird ventures into at times divisive debates about what brain science can tell us about the existence or otherwise of “sex addiction”, the sex lives of people on the autism spectrum, and the impact of pornography (“There is much more research that needs to be done before it will be possible to answer the question ‘can porn change your brain?’”).

One of the most compelling sections explores the legal implications of paraphilias and the limits of free will. What do you do with the Australian politician who, after taking drugs prescribed for Parkinson’s disease, develops hypersexuality and is later found guilty of child sex offences and producing child pornography; or the woman, her brain dotted with the lesions of MS, who seduces her 14-year-old son’s 17-year-old girlfriend and tries to have sex with the family dog? How do you assign moral culpability? Who walks free? Who is put in prison?

It’s not all bleak. There’s a tender, funny account of Baird’s friendship with George, who had Asperger’s syndrome and whose special areas of interest included train timetables and hating former Victorian premier Jeff Kennett, and who liked to walk around with his hands down the front of his pants. (“But it feels so warm in there.”) We also meet the formerly morose Barry, whose unhappy marriage is transformed after he has a stroke. “He loves everything now,” his wife tells Baird. “He’s different – it’s a new version of the old Barry. He’s always saying how much he loves me, and ‘You’re beautiful.’ It’s wonderfully overwhelming.”

And there is some fascinating research into how falling in love appears to change the structure of our brains.

But some of the stories are immensely sad. These disorders may be rare, but Baird argues persuasively that we need to think – and talk – about them. “Doctors rarely discuss it and patients may hesitate to bring it up when changes in the brain mean that so many other things need medical attention. But wanting too little or too much sex, or changing sexual preference, can devastate relationships and in rare cases even lead to criminal behaviour. For this reason the sexual side effects of brain disorders need to be understood.”

Clearly there is a special urgency when changes in the brain contribute to the onset of a condition such as paedophilia. Research is critical. “We need to keep asking why and how, especially in the case of paedophilia, where the consequences for the person and their potential victims are so devastating. It is only by clarifying the nature of this condition, identifying its causes and understanding what leads to criminal behaviour, that we will be able to prevent the immense suffering it brings.”

Reading these stories, it’s tempting to view some of those we meet here as irretrievably “other”. Certainly, the damage several have inflicted is awful. But whether we like it or not, these damaged or disordered brains may tell us more about ourselves than we want to know. Not only about what can happen when things go wrong, but also about the nature of sex, intimacy and even about our capacity to love. This book reminds us that sexuality, like personality and self, is provisional. Life can change in an instant: some changes may involve joy; others can be worse than death. And the closest some people will ever get to a cure is information, understanding and compassion.

Kate Cole-Adams

Kate Cole-Adams is the author of Anaesthesia: The Gift of Oblivion and the Mystery of Consciousness.

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