The Brain in Love.

Daniel G. Amen.

ACKNOWLEDGMENTS.

The Brain Is the Largest s.e.x Organ.

(and Size Matters!).

As you walk by me, millions of nerve cells spark in my brain and I have to turn to look at you again.

You look back at me and a soft, brief smile forms on your lips. As you notice my eyes following you, your smile triggers an adrenaline release that causes my heart to leap with excitement.

Chemicals send increased blood flow to sensitive areas, as thoughts of you light the emotional fire centers of my mind.

For a brief moment you literally live in my skin.

As we connect, my mind works overtime obsessing on your smell and the color of your eyes.

You beat in my heart.

You pulse in my nervous system from the nerve pathways of my brain to the soles of my feet.

I start to become disoriented when we are apart.

Over time, your touch becomes essential.

I crave you.

Your body feels warm and rea.s.suring.

I need it next to me.

I sleep peacefully knowing you are near, and wake often in the dark to feel your skin.

I never want to get out of bed when I am lying next to you.

I look for you in my brain when you are away.

Your voice sweetens the vibrations in the air.

My mind beseeches me to make love to you, again and again.

Our bodies navigate s.p.a.ce together.

Your mind reads mine as you know how I want to be touched.

How does that happen?

You must have cells that mirror my desires.

The neurons of my eyes light up with sparks when you walk in a room, especially if you have been away for a while.

Songs, smells, places, and pictures never let me forget you as they trigger the memory centers in my brain where you live as if you were next to me.

The judgment part of my brain watches what I say when we are together so I can protect your feelings.

I watch how your eyes, face, and body move as you talk to me, to know if you are happy, desirous, or in need of a hug or understanding.

Even though it feels genital, the vast majority of love and s.e.x occurs in the brain. Your brain decides who is attractive to you, how to get a date, how well you do on the date, what to do with the feelings that develop, how long those feelings last, when to commit, and how well you do as a partner and a parent. Your brain helps you be enthusiastic in the bedroom or drains you of desire and pa.s.sion. Your brain helps you process and learn from a breakup or makes you vulnerable to depression or obsession. When the brain works right, it helps you be thoughtful, playful, romantic, intimate, committed, and loving with your partner. When the brain is dysfunctional, it causes you to be impulsive, distracted, addicted, unfaithful, angry, and even hateful, thus ruining chances for continued intimacy and love.

Your brain is also the seat of o.r.g.a.s.ms. Some research implicates the right hemisphere of the brain. In fact, certain forms of epilepsy, especially those found in the right temporal lobe, have been a.s.sociated with spontaneous o.r.g.a.s.ms. In one case from Taiwan, a forty-one-year-old woman had seizures that were induced only when she brushed her teeth. The seizure started with the feelings of being s.e.xually aroused, then she felt an o.r.g.a.s.mlike euphoria wash over her, which was followed by feelings of confusion. Her brain-imaging studies showed problems in the right temporal lobe, an area that has been a.s.sociated with both o.r.g.a.s.ms and religious experience. When someone has o.r.g.a.s.miclike feelings when brushing her teeth, odds are that she will have very clean pearly whites.

Scientists agree that the brain is the organ of behavior; as such, it really is the largest s.e.x organ in the body (about three pounds), and in this case size really does matter. Our brain becomes less and less active and decreases in overall size as we age. This is true for males and females and there appears to be an equal loss of gray matter (nerve cell bodies) and white matter (the connections between nerve cells). If you learn to take care of your brain, however, it can be active and healthy throughout your life. With targeted interventions, you can impact brain health, lose less brain tissue, and keep your brain healthy well into your elderly years.

Why does this matter to s.e.xual function? As the brain dims in activity over the decades, so, too, does many people"s s.e.xual function. The two go together. In men between the ages of forty and seventy studied over a nine-year period, there was a significant decline in s.e.xual function with age. This is consistent with past studies that have shown a decline in s.e.xual desire, intercourse, and erection frequency. Erectile dysfunction (ED) is very common and increases with age. Forty percent of men in their forties, and 70 percent in their seventies had problems. In women, aging and menopause often negatively affect s.e.xual interest and performance.

A major reason underlying both s.e.xual and brain dysfunction is decreased blood flow. Blood does so many important things. It brings oxygen, sugar, and nutrients to your cells and it takes away waste products. Anything that interferes with healthy blood flow will impair an organ"s functioning. Decreased blood flow to genitals from hypertension; vascular disease; diabetes; toxic exposure, such as drug abuse or smoking; physical trauma; and other causes impairs s.e.xual function. Increased blood flow, from targeted interventions including exercise, ginkgo, and compounds that increase nitric oxide, such as v.i.a.g.r.a and ginseng, improves function and reverses aging.

Likewise, decreased blood flow to your brain, from any cause, decreases brain function, which means you are likely to make impaired decisions and subsequently have less s.e.x. Few scientists have looked at the connection between brain health and s.e.xual behavior. That"s where I come in. My primary work is as a brain-imaging specialist. I have been doing imaging work for more than sixteen years and my clinics have the world"s largest database of scans related to behavior, more than 35,000. We look at the brain on a daily basis using a sophisticated study called SPECT imaging. SPECT stands for "single photon emission computed tomography," a nuclear medicine study that evaluates blood flow and activity patterns in the brain. We have looked at many healthy brains and brains in trouble. We have looked at the brains of children, teenagers, adults, and the elderly. We have looked at brains on medications, drug and alcohol abuse, supplements, prayer and meditation, grat.i.tude, and a wide variety of psychological and biological treatments. We have looked at the brain in love, l.u.s.t, commitment, divorce, domestic violence, s.e.xual abuse, and loss.

At our clinics, our primary work is to help maximize people"s brain function for the most satisfying and healthy life possible. We help healthy people who want to improve their own brain function, as well as treat attention deficit disorders (ADD), mood and anxiety disorders, obsessive-compulsive disorders, addictions, temper problems, and memory disturbances. We often help individuals and couples who struggle with relationship and s.e.xual problems of all kinds. It is really possible to dramatically improve brain function, whether your brain is troubled or not, and thus dramatically improve your life. Our guiding principle for the past sixteen years has been "Change your brain, change your life."

Since most people cannot see the brain, it is often left out of the equations of our lives. Yet, it is at the core of our personal universe. Connecting s.e.x and the brain through the lens of brain imaging has been one of the most fascinating journeys of my life, and I will share it with you in this book. I became much more effective in helping couples when I started looking at their relationships and s.e.xuality together with brain function. It is clear that healthy brain function is a.s.sociated with more loving and s.e.xual relationships, while poor brain function is a.s.sociated with more fighting, less s.e.x, and higher divorce rates. In committed relationships, s.e.x is a critical ingredient for health and longevity, but most people never connect the brain and s.e.x.

I start with a clear bias: s.e.x is best in the context of a committed, loving relationship. Anthropologist Helen Fisher writes, "Do not copulate with people you do not want to fall in love with, because you might do just that." s.e.x bonds you to others, and in some cases, if you are not careful and thoughtful, it can put you in bondage to others. Although this is my bias, it is not always the context of some of the research studies I will share with you on the s.e.xual benefits for health and longevity, which are based solely on s.e.xual frequency. Having acknowledged that fact, there are other studies that strongly suggest a happy marriage is also a.s.sociated with longevity, which usually means not sharing yourself s.e.xually outside your primary relationship. The discussion throughout the book is on heteros.e.xual relationships, but the same principles apply to all committed, loving relationships.

Based on my latest research, this book will share twelve practical neuroscience lessons to enhance your love and s.e.x life. Practical neuroscience is a term I coined for the study of applying the latest brain research to everyday life. I am the type of person, like many of you, who always wants to know why I should learn something. If it isn"t practical or helpful, then I don"t want to expend great amounts of neuronal effort on it. The reason to study neuroscience is that it is immensely practical. Here"s an example: On a recent faculty retreat with the University of California, Irvine Department of Psychiatry, where I teach psychiatric residents, I was walking back from dinner through a shopping district along the quaint cobblestone streets of Taormina, Sicily, with one of my colleagues and his wife. They were talking about buying shoes. The wife wanted her husband to go with her to the shoe boutique and he was balking a bit. I looked at him and said, "You want to go with her." He gave me a quizzical look which said, "Why?"

I replied, "In the brain, the sensory area of the foot is right next door to the sensory area for the c.l.i.toris. Unknowingly, women often feel that buying shoes is like foreplay. Feet are one of the best ways to a woman"s affections."

With my friend"s help, his wife bought three pairs of shoes the next day. He had a smile on his face for the rest of the trip.

METHUSELAH"S SECRET.

s.e.xuality, Longevity, Health, and Happiness.

"s.e.x ... what else is free, fun, low calorie, and exercise?"

-BARBARA WILSON, MD, neurologist and pain specialist.

In August 1982, during my internship year on the sterile surgical floor at the Walter Reed Army Medical Center in Washington, D.C., Jesse was discharged from the hospital. He had been admitted for an emergency hernia operation two weeks earlier and there had been some minor complications. I remember Jesse so vividly now because he was one hundred years old, but talked and acted like a man thirty years younger. Mentally, he seemed every bit as sharp as any patient I had talked to that year or since. He and I developed a special bond, because unlike the surgery interns who spent a maximum of five minutes in his room each day, I spent hours over the course of his hospitalization talking to him about his life. The other interns were excited to learn about the latest operating techniques. I was interested in Jesse"s story and I wanted to know about Jesse"s secrets for longevity and happiness. Jesse had his hundredth birthday in the hospital and it was quite an event. His wife, actually his second one, who was three decades younger, planned the event with the nursing staff. There was great love, playfulness, and physical affection between Jesse and his wife. Clearly, they still had the "hots" for each other.

Just before his discharge from the hospital, he saw me at the nurses" station writing notes. He enthusiastically waved me over to his room. His bags were packed and he was dressed in a brown suit, white shirt, and a blue beret. He looked deeply into my eyes as he quietly asked me, "How long, doc?"

"How long what?" I answered.

"How long before I can make love to my wife?"

I paused and he continued in a hushed voice, "You want to know the secret to live to a hundred, doc? Never miss an opportunity to make love to your wife. How long should I wait?"

A slow smile came over my face, "I think a week or so and you should be fine. Be gentle at first." Then I gave him a hug and said, "Thank you. You have given me hope for many years to come."

Science finally caught up to Jesse twenty-five years later. Now there is a wealth of research connecting healthy s.e.xual activity to longevity. The lesson from Jesse still rings true today. While there are many ingredients to a long life-good genes, a positive outlook, a curious mind, and exercise-frequent s.e.xual activity is one of them, too.

Like Jesse, Methuselah knew the secret, too. The oldest living Hebrew patriarch mentioned in the Bible, Methuselah was 187 years when his son Lamech was born. According to the author of the book of Genesis, he lived another 782 years, dying at the remarkable age of 969. Since then the name Methuselah has become a synonym for longevity; in this chapter I will ill.u.s.trate what I consider Methuselah"s Secret-the link between s.e.xual frequency, s.e.xual enjoyment, and longevity.

Can Ten Thousand Men Be Wrong?

Why do we have s.e.x on the brain? Why is it the topic of so many conversations? From a scientific perspective, the answer is simple. More than any other basic need, s.e.xual activity makes it possible for us to live beyond ourselves and for our species to survive. It is one of the most powerful drives motivating behavior. Yet, with the changing gender roles in our society and the constant mix of religious and cultural messages, s.e.x has become confusing and frustrating. Is s.e.x good? Is it bad? Is it important? Is it a luxury for pleasure or just a means of having children? New research shows that s.e.x is important, not only to the physical survival of the human race, but to the survival of individuals as well. s.e.x is a natural part of being alive, of being human; it is healthy to want to express yourself in that way. Having a healthy, satisfying s.e.x life is important for each person individually, but also to the health of romantic relationships.

s.e.xual interest, activity, and meaning change throughout the lifespan. Teenagers explore a new, exciting, confusing, and potentially risky (pregnancy and STDs) part of life. While young adults attempt to develop a sense of s.e.xual competency, older people strive more for a sense of meaning in their s.e.xual lives. Underlying most s.e.xual contact is a desire for pleasure, release, and emotional connection.

Toward the end of Chuck"s marriage, he was in bed reading Dean Ornish"s book Love and Survival. In the book Dr. Ornish wrote about a study where ten thousand men were asked one question: "Does your wife show you her love?" The men who answered no, in significant numbers, died earlier. "Oh my G.o.d," Chuck thought, "I"m doomed." He had been in a twenty-year marriage where their libidos were badly matched, and he was turned away nine times out of ten. At 3 A.M. that morning he awoke with crushing chest pain. His heart checked out okay the next day, but he knew that something had to change. His life might depend on it.

Withholding s.e.x, as a weapon of control or punishment, is common in relationships for both males and females. I have seen it in my practice for twenty-five years. Unfortunately, it is a deadly weapon and often kills relationships. After reading this chapter and understanding the research a.s.sociated with frequent s.e.xual activity and s.e.xual enjoyment, my hope is that you will honor s.e.x in your life. If you are someone who withholds s.e.x as a way to punish your partner, my hope is that you will realize two things: One, the act of withholding physical affection is actually bad for you, as you miss out on its many benefits; and two, it puts your partner"s health at risk. No kidding. I often joke in my lectures that if your partner knew the research, and you were withholding s.e.x, he or she could potentially sue you for attempted murder. There is a lot of nervous laughter at this point. Of course, there are other reasons besides their partner withholding s.e.x that people are not getting it, such as they are without a partner, there is an illness that affects s.e.xual desire or performance, or people may be uncomfortable with their bodies.

Most of the research discussed here on the health benefits of s.e.x involves s.e.xual activity with a partner. Some of the research, however, has to do with o.r.g.a.s.m frequency, which may also be due to masturbation. s.e.xual gratification or release through masturbation may be helpful for the brain. From a psychiatric standpoint, it is a complex issue. Masturbation can bring on a release of tension, but in some vulnerable people can also lead to excessive or addictive activity.

Healing: s.e.x Is the Best Medicine.

Many studies have investigated the relationship between s.e.xual activity and physical health. The potential dangers of s.e.xual activity, including s.e.xually transmitted diseases and unplanned pregnancies, have been widely reported, and rightly so. However, less publicized studies suggest that thoughtful s.e.xual activity with a committed partner improves well-being by enhancing longevity, immune system function, joy, pain management, and s.e.xual and reproductive health. These studies ill.u.s.trate that s.e.xual activity may be a preventive measure against the two leading causes of death in the United States, heart disease and cancer. Below are some of the aspects of your health that s.e.x can improve.

Longevity.

Learning how to enhance the largest s.e.x organ in the body (the brain) and using it well to intimately connect with others may add years to your life and is likely to make you much happier. Serious research on s.e.xuality began in the United States in the 1940s by Alfred Kinsey. He reported that s.e.x reduces stress, and that people who have fulfilling s.e.x lives are less anxious, less violent, and less hostile. Current research bears this out, as physical touch increases the hormone oxytocin, which boosts trust and lowers cortisol levels, the hormone of chronic stress. In a study done at Duke University, researchers followed 252 people over twenty-five years to determine the lifestyle factors important in influencing lifespan. s.e.xual frequency and past and present enjoyment of intercourse were three of the factors studied. For men, frequency of intercourse was a significant predictor of longevity. While frequency of intercourse was not predictive of longevity for women, those who reported past enjoyment of intercourse had greater longevity. This study suggested a positive a.s.sociation between s.e.xual intercourse, pleasure, and longevity.

A 1976 report in Psychosomatic Medicine concluded that an inability to reach o.r.g.a.s.m may have a negative impact on women"s hearts. Only 24 percent of women in the healthy control group reported s.e.xual dissatisfaction; while 65 percent of the women who had heart attacks reported trouble with s.e.x. In this study, the two most common causes of dissatisfaction in women were due to impotence and premature e.j.a.c.u.l.a.t.i.o.n on the part of their husbands. s.e.xual health is not just an individual issue. It affects both parties" satisfaction and overall health.

A Swedish study found increased risk of death in men who gave up s.e.xual intercourse earlier in life. The research was done on four hundred elderly men and women. At age seventy they were given a survey of their s.e.xual activity and then followed over time. Five years later the death rates were significantly higher among the men who ceased s.e.xual activity at earlier ages.

A daring group of researchers from Queen"s University in Belfast, Ireland, included in a long-term study of health a question about s.e.xual activity. The authors studied nearly one thousand men between the ages of forty-five to fifty-nine living in or near Caerphilly, Wales, and recorded the frequency of s.e.xual intercourse each week and month. The researchers then divided the men into three groups: high o.r.g.a.s.m frequency (those who had s.e.x twice or more a week), an intermediate group, and low o.r.g.a.s.m frequency (those who reported having s.e.x less than monthly). The men were monitored again ten years later. Researchers found that the death rate from all causes for the least s.e.xually active men was twice as high as that of the most active group. The death rate in the intermediate group was 1.6 times greater than for the active group.

Many questions come to mind with this type of study, such as "Is it the o.r.g.a.s.m that is healing? Or, the touch and physical and emotional connection that comes with intercourse? Does poor health decrease s.e.xual activity? Do other factors such as lack of exercise, alcohol, and depression cause both poor health and less s.e.xual activity?" The researchers found that the robustness of their findings persisted even after adjusting for differences in age, social cla.s.s, smoking, blood pressure, and evidence of existing coronary heart disease at the initial interview. This suggests a more likely protective role of s.e.xual activity.

The Irish researchers wrote, "The a.s.sociation between frequency of o.r.g.a.s.m and mortality in the present study is at least-if not more-convincing on epidemiological and biological grounds than many of the a.s.sociations reported in other studies and deserves further investigation to the same extent. Intervention programs could also be considered, perhaps based on the exciting, "At least five a day" campaign aimed at increasing fruit and vegetable consumption-although the numerical imperative may have to be adjusted."

In a 2001 follow-up study, this same research group found that having s.e.x three or more times a week reduced by half the risk in males of having a heart attack or stroke. If a drug company came up with a medicine that performed as well, their stock would soar through the roof of Wall Street. The coauthor of the study, Shah Ebrahim, PhD, underscored the results by saying, "The relationship found between frequency of s.e.xual intercourse and mortality is of considerable public interest." There is truth to the saying that an apple a day keeps the doctor away. It may also be true that an o.r.g.a.s.m a day keeps the coroner away.

Fewer Sick Days.

A study from the Inst.i.tute for Advanced Study of Human s.e.xuality conducted by Dr. Ted McIlvenna looked at the s.e.x lives of ninety thousand American adults. He found that s.e.xually active people take fewer sick leaves and enjoy life more.

Boosted Immunity.

According to gynecologist Dr. Dudley Chapman, o.r.g.a.s.ms boost infection-fighting cells up to 20 percent. Psychologists at Wilkes University in Pennsylvania found that students who had regular s.e.xual activity had a third higher levels of immunoglobulin A (IgA), an antibody that boosts the immune system and can help fight colds and flu.

Healthy s.e.xual and Reproductive Behavior Research done by Dr. Winnifred Cutler, a specialist in behavioral endocrinology, indicated that women who have intercourse with a male partner at least once a week are likely to have more regular menstrual cycles than women who are celibate or who have infrequent s.e.x. In same-s.e.x couples, women who engaged in s.e.xual activity at least three times per week also had more regular cycles. In her "White Paper for Planned Parenthood," Dr. Cutler reported that s.e.xual and reproductive health of both women and men is influenced by their s.e.xual activity. She reports that regular s.e.x can have positive effects also on reproductive health. Here are several examples: Fertility. Frequent s.e.xual activity may enhance fertility. Studies of menstrual cycle variability and frequency of intercourse have demonstrated that regular intimate s.e.xual activity with a partner promotes fertility by regulating menstrual patterns.

Menstrual Cycle Regularity. A series of studies found that women who engaged in intercourse at least once per week had cycle lengths that were more regular than women who had s.e.x sporadically or who were celibate.

Relief of Menstrual Cramps. Nine percent of nineteen hundred women stated that they m.a.s.t.u.r.b.a.t.ed in the previous three months to relieve menstrual cramps.

Pregnancy. A review of fifty-nine studies that were written between 1950 and 1996 concluded that s.e.xual activity during pregnancy does not harm the fetus, as long as there are no other risk factors, such as s.e.xually transmitted diseases, involved. In addition, some research has shown that s.e.xual activity throughout pregnancy may serve as a protection against early delivery, especially during the third trimester (between the twenty-ninth and thirty-sixth weeks). Of more than eighteen hundred women, excluding those who could not have s.e.x for medical reasons, preterm delivery was significantly reduced in the women who had intercourse late in their pregnancy.

Healthy Prostate. The prostate gland is responsible for producing some of the secretions in s.e.m.e.n. Sometimes the prostate becomes inflamed and painful (prostat.i.tis). In single men who had prostat.i.tis, more than 30 percent who m.a.s.t.u.r.b.a.t.ed more frequently reported marked or moderate improvement of their symptoms. In addition, there is a suggestion that frequent e.j.a.c.u.l.a.t.i.o.n may help prevent chronic nonbacterial infections of the prostate.

Higher Youth Hormone Levels.

(DHEA, Estrogen, and Testosterone).

Dr. Cutler also reported that women who enjoy regular s.e.x had significantly higher levels of estrogen in their blood than women experiencing either infrequent s.e.x or no s.e.x at all. The benefits of estrogen include a healthy cardiovascular system, lower bad cholesterol, higher good cholesterol, increased bone density, and smoother skin. There is also growing evidence that estrogen is beneficial to brain functioning.

Another important hormone that seems to be affected by s.e.xual activity is DHEA. Before o.r.g.a.s.m the level of DHEA spikes in the body to several times higher than normal. DHEA is believed to improve brain function, balance the immune system, help maintain and repair tissue, promote healthy skin, and possibly improve cardiovascular health.

Testosterone is increased through regular s.e.xual activity. Testosterone can help strengthen bones and muscles, and is also beneficial to a healthy heart and brain. The risk for Alzheimer"s disease is twice as high for people with lower testosterone levels. Low testosterone levels are also a.s.sociated with a low libido. From this connection one could infer that if you are not interested in s.e.x, your memory may be in jeopardy as well.

Potential Cancer Prevention.

A study conducted by Graham Giles from Australia concluded the more that men between the ages of twenty and fifty e.j.a.c.u.l.a.t.e, the less likely they are to develop prostate cancer. A study published by the British Journal of Urology International a.s.serted that men in their twenties can reduce by a third their chance of getting prostate cancer by e.j.a.c.u.l.a.t.i.n.g. more than five times a week.

Researchers have suggested that s.e.xual expression may lead to a decreased risk of cancer because of the increase in levels of oxytocin and DHEA, which are a.s.sociated with arousal and o.r.g.a.s.m in women and men. A 1989 study found increased frequency of s.e.xual activity was correlated with a reduced incidence of breast cancer among women who had never had a child. The study examined fifty-one French women who were diagnosed with breast cancer less than three months prior to the interview. They were matched with ninety-five controls. A higher risk of breast cancer also correlated with a lack of a s.e.x partner and rare s.e.xual intercourse, defined as less than once a month.

More Restful Sleep.

s.e.xual release can help people go to sleep. o.r.g.a.s.m causes a surge in oxytocin and endorphins that may act as a sedative. One study found that 32 percent of 1,866 U.S. women who reported masturbating in the previous three months did so to help go to sleep. As most women know, men often go to sleep shortly after having s.e.x.

Pain Relief.