Bonk (21 page)

Alas, though the Cushing doctors obtained
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semen from all eighteen men, only two of the wives became pregnant. (Partly because when the cremaster muscle is paralyzed, the testes can’t be lowered away from the body to cool, and the sperm overheat.)

In 1981, British sex researcher Giles Brindley set out to hone the craft of electroejaculation for fertility purposes. To figure out which nerve fibers were most expeditious, he first experimented on baboons and rhesus monkeys. As the electrotherapy fad had long ago faded, Brindley devised a homemade ejaculator, consisting of an electrode mounted on the tip of his gloved finger. Presently the baboons were excused and Brindley attempted some “experiments on myself.”
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Because Brindley’s spinal cord is intact, he could feel pain that paralyzed men could not, and he had to stop at less than a quarter of the voltage that would trigger ejaculation.
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Brindley made 256 attempts at electroejaculating 84 men with spinal cord injuries. Fourteen wives were inseminated, but, owing to the inferior quality of the sperm, only one conceived. Some of the wives soldiered on anyway. In Brindley’s paper, under the evocative heading “Domestic Electroejaculation,” he recounts that ten women had been taught to administer the voltage at home.

In the course of Brindley’s study, some of the subjects reported that for several hours afterward, their leg spasms had quieted. This information found its way to veterinarian and livestock electroejaculator designer Steve Seager. Not one to pass up an opportunity for lateral marketing, Seager got a grant to do a formal study of the efficacy of one of his Electrostimulation Units for reducing leg spasticity—in both men and women. It worked. And that is the story of how rectal probe electrostimulation came into use as a therapy for muscle spasticity in people with spinal cord injuries.

These days there is a cheaper, less intimidating alternative. The technique is called Transcutaneous Mechanical Nerve Stimulation, a.k.a. pressing a vibrator to the underside of your penis. Not just any vibrator, but a high-amplitude one made by FertiCare,
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called the Personal Penile Vibrator—or, should you happen to select the Spanish version of FertiCare’s Web site, El Vibrador del Pene.

Attentive readers may be thinking: If paraplegics can’t feel anything down there, how do they get aroused and have an orgasm? That is one of many mysteries being solved at the University of Alabama School of Medicine’s sexual physiology lab. The others are more universal: What exactly
is
an orgasm? Where in the body do you feel it? Can dead people have them too?

The Immaculate Orgasm

Who Needs Genitals?

m
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,
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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 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 Sipski’s career. For years, she maintained a private practice in rehabilitation medicine. (Christopher Reeve was one of Sipski’s patients, as was Ben Vereen.)
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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 quadriplegias 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.
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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 feel-good 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.”