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The Placebo Effect

By Dr. Pisaster | Pajiba Dirty Talk | September 21, 2010 |

By Dr. Pisaster | Pajiba Dirty Talk | September 21, 2010 |

A couple of months ago I reported on the trials for one of the many drugs intended to treat hypoactive sexual disorder in women. The study, unfortunately, indicated no significant improvement in women taking the drug over those taking a placebo, and the FDA ultimately did not approve the medication. It’s not that patients taking such drugs don’t experience improved sexual function - they do. But so do the groups taking nothing more than sugar pills, so the improvement is considered insignificant. Now a follow-up study to one of the many clinical trials of medication to help female sexual arousal disorder (FSAD) has analyzed the data for a placebo group in an attempt to determine what factors other than medication may explain the improvement among those patients receiving a placebo. If such factors can be identified, they may lead to development of ways to treat such disorders beyond just popping a pill.

In the study, the sexual response of 50 patients who had been given placebos during a FSAD drug trial was analyzed. The patients were between the ages of 35 and 55 and premenopausal. They came from different geographic regions of the US and consisted of 44 white women, 3 African American women, 1 East Asian woman, and 2 Hispanic women (so there’s obviously a bias towards white women in this trial, but hey, at least they’re up front about the racial make-up of the participants). All of the women who were analyzed were in stable relationships. The initial study followed 200 patients for a total of 16 weeks. The first 4 week period was a control period, during which patients were given no treatment but asked to attempt a sexual activity (either alone or with a partner) three times and answer questionnaires about their levels of desire, arousal, lubrication, orgasm, and satisfaction to establish a base-line for the actual trial. For the next twelve weeks the patients were given either a placebo or active drug and asked again to attempt sexual activity at least 3 times every 4 weeks and fill out questionnaires.

The follow-up study attempted to determine to what extent the sex lives of the placebo group improved and what factors correlated with improvement. Out of the 50 subjects, 26 had an improvement in sexual function (based on the above-mentioned measures) and 15 of those patients saw a clinically significant improvement. The average number of sexual events for the participants also increased during the trial period. Moreover, there was a significant improvement in reported satisfaction - subjects reported that 50.7% of their sexual encounters were satisfying by the end of the trial, versus 23% before the trial. So why did the placebo group experience an increase in sexual function while taking nothing but sugar pills? The placebo effect is generally considered to be psychological - patients think they are taking something that will make them feel better, so they get better, but in studies like this one which involve a change in behavior as part of the trial, the situation is a little trickier. It’s possible that simply being asked to engage in sexual activity with a certain level of frequency increased the amount of desire the subjects felt because they were thinking about sex more, or it may have created positive reinforcement when patients experienced satisfying sexual encounters that they would otherwise have avoided. It’s also possible that actively addressing the problem affected the patients’ stress level and aided in recovery of sexual desire. The researchers found that distress about sexual problems did not decrease with enrollment in the study, but that sexual function improved more dramatically for that fraction of the placebo group who did experience lower distress. Being encouraged to engage in behaviors they may have been avoiding may also have forced patients to address underlying issues. The authors also note that filling out questionnaires after sexual activity may have led patients to analyze their own reactions and identify problems. Patient-provider interaction might have also played a role, as such interactions are known to augment placebo effects, but the researchers concluded that this contribution was likely low, since the subjects also had interactions with the providers during the control period. Probably the strangest contribution they found was the fact that patients reported “increased genital stimulation” - not from masturbation, but from sexual activity with their partners. Maybe the subjects’ partners felt under pressure and tried harder to make encounters pleasurable for them during the study than during the control period, but that seems a little odd. I have enough faith in most men to assume that any such change was subconscious, at least, rather than a deliberate attempt to improve the way their performance was rated in the subjects’ questionnaires (by the way, there’s no information in the study as to whether homosexual women were included, but given the low number of subjects and the fact that most of these studies eliminate homosexual subjects, I’m guessing not).

The take-home from the study, then, seems to be that engaging in more sexual activity and deliberately thinking about the results of such activity may help women struggling with low sex drives improve their levels of desire and sexual satisfaction. That’s good news, since non-pharmaceutical methods for addressing such problems are ideal, given the chance of side effects with even the safest drug. Based on this study, interactions with a therapist, scheduling of a minimum level of sexual activity (masturbation counts!), and self-analysis of what one gets out of such activity and what’s lacking could go a long way to improving the sex lives of many women with low libidos. (I’d assume that these tactics would work just as well for men with low sex drives, by the way.) And more genital stimulation from partners. Apparently that’s very important.

Dr. Pisaster has a doctorate in biophysics, not actually anything sexy. She does however enjoy having sex, reading about sex, and talking about sex. Especially when she’s had a little whiskey.

Dustin is the founder and co-owner of Pajiba. You may email him here, follow him on Twitter, or listen to his weekly TV podcast, Podjiba.