The Skinny on Psychostimulants,Part 2:Methylphenidate Stimulants

The Skinny on Psychostimulants, Part 2: Methylphenidate Stimulants

Last week I introduced a class of drugs called psychostimulants, or central nervous system (CNS) stimulants. As the name states, psychostimulants are “uppers” that stimulate the central nervous system when consumed in varying ways. This class includes the illicit drugs cocaine, ecstasy, and crystal meth, nicotine found in tobacco, and the most commonly consumed drug in the world, caffeine, which is a highly addictive compound that occurs naturally in more than 60 plant species, including the various beans brewed to make the most widely consumed beverage in the world, coffee. Other recognizable sources of caffeine include cocoa beans, tea leaves, and kola nuts. Caffeine is also chemically synthesized for handy inclusion in energy drinks, sodas, and various medications. This class also includes two types of stimulant medications, amphetamines and methylphenidate, which can be found as the bases in a myriad of pharmaceutical products.

In last week’s blog I introduced amphetamines; this week I’ll discuss methylphenidate stimulants. Like amphetamines, methylphenidate stimulants are tightly controlled Schedule II central nervous system (CNS) stimulants that work by stimulating the chemical messengers dopamine and norepinephrine, the neurotransmitters associated with control, attention, fight or flight response, and the pleasure/ reward system in the brain.

While these two types of drugs induce similar effects when taken, the way that they induce those responses, their mechanisms of action, are actually different. Both work to increase levels of dopamine and norepinephrine in the synapses between neurons, which helps messages move from one neuron to the next. Recall from last week that amphetamines have three mechanisms for increasing these levels: 1) they reverse the direction of the transporter pumps that would normally divert dopamine and norepinephrine away from the synaptic cleft, 2) they disrupt cellular vesicles, thereby preventing the storage of excess dopamine and norepinephrine, which frees them up for use in the cleft, and 3) they also promote the release of dopamine and norepinephrine at nerve cell terminals, making them more readily available in the synaptic cleft. Amphetamines’ three mechanisms combined ensure that there are very high concentrations of dopamine and norepinephrine in the synapses of the central nervous system and result in the very strong psychostimulant effects that amphetamines produce. 

In contrast, methylphenidate affects the levels of dopamine and norepinephrine in the synaptic cleft through a single mechanism: by shutting down the transporter pumps that would usually take up excess neurotransmitters. It does not reverse these pumps to cause a flood of neurotransmitters to be released, and does not work to increase neurotransmitter levels through any other actions the way that amphetamines do. As a result, amphetamines are slightly more stimulating than methylphenidate-based stimulants. For this reason, I typically use methylphenidate-based stimulants for children and adolescents and generally reserve amphetamines for use in adults. 

Both amphetamines and methylphenidate are used to treat and control symptoms of narcolepsy, obesity, binge eating disorders, and most commonly, attention deficit hyperactivity disorder (ADHD). Off-label indications, meaning potential uses that are not strictly approved by the FDA, include using either to treat major depressive disorder and in cancer patients to treat weakness, fatigue, and depression. There are also some relatively recent studies that indicate success in using psychostimulants off-label to decrease pain levels as part of a regimen in treating chronic pain patients. 

All stimulants can be prone to misuse, and may be used recreationally in certain populations via oral route, smoking, injecting, or snorting, to get high and/ or to stay awake for long periods of time. And their ability to improve concentration means some people use them to boost cognitive ability, to improve focus, and to study for and/ or take exams. This is a relatively common practice among some college students. 

The two types of medications are available as short-acting medications and in longer acting preparations. Both are essentially equally effective, and have the same benefits, risk(s), and side effect profiles, only varying mainly in their severity, with the profiles associated with amphetamines sometimes being slightly stronger than with methylphenidate. And while I’ve found that most patients respond equally well to either medication, adults to amphetamines and children to methylphenidate, some may respond better to one versus the other. But that’s certainly not a unique feature; that’s always the case with medications, as different bodies respond differently to varying formulations. 

Methylphenidate is most commonly used for treating ADHD, and is FDA approved first line therapy for ADHD patients age 6 and up. While it may seem counterintuitive to treat hyperactivity with a stimulant, this class of drugs have been shown to be the most effective treatment for reducing the symptoms of ADHD. This is because CNS neurotransmitter concentrations are lower in the ADHD brain, sometimes markedly so, and the addition of a stimulant raises the neurotransmitter levels to equal those comparable to the “normal” levels found in the non-ADHD brain. 

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, and is associated with impaired functioning and negative developmental outcomes. Children with ADHD find it unusually difficult to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. They generally have more difficulty focusing, controlling actions, and remaining still or quiet, as compared to classmates or other people the same age. The American Academy of Pediatrics (AAP) recommends behavior therapy and medication for children 6 years of age and older, preferably both together. The end result in up to 90 percent of cases is that methylphenidate-based stimulant medication helps children with ADHD become more focused, improve their approach to schoolwork, get better organized, think before acting, get along better with others, conform better to societal norms, and break fewer rules. They do better socially, academically, and in terms of self esteem. As a result, they, and their other family members, are happier. In my experience, as the chaos in the patient’s mind is decreased, the chaos that usually follows and surrounds them is also decreased, and that makes for better harmony in the home as well. To put the success of methylphenidate in treating ADHD into perspective, there is no other medication for a psychiatric condition that has such a high response rate. 

In contrast, children with untreated ADHD don’t do as well comparatively speaking. Generally, if the symptoms of ADHD are negatively impacting any area of their life, they are impacting every area of their life, because ADHD is not just an academic problem, it’s a neurobehavioral problem that permeates every aspect of life and affects them academically, emotionally, and socially. Studies have shown that unchecked ADHD symptoms hinder childhood progress, causing a tendency to suffer in school and in social relationships. This negatively affects self-esteem, which causes feelings of anxiety and depression, not only at the time, but as lifelong consequences. The long term implications of low self esteem are well documented and extensive, and nearly always include fairly pervasive anxiety and depression. Low self esteem and all of its many consequences is common in adults with undiagnosed childhood ADHD, as well as from other sources, and it’s a common source of issues that I treat on a daily basis. 

So the lesson is that when weighing risks of treating ADHD with methylphenidate stimulants, recognize that making the decision not to medicate a child with notable ADHD symptoms has its own risks that must be considered. When you take into account that childhood is meant to be a building block and a time to learn, not just math and grammar, but how to make friends and function in the world, what the decision encompasses is a whole person and a whole life, and all that entails. As a psychiatrist, my opinion might be biased, but I might never understand why the decision to treat disorders affecting mental health are made so differently from ones that affect physical health, as if good mental health isn’t as important, or as necessary, as good physical health. I wonder, if a child had diabetes that was negatively impacting their life, would you suggest that child be treated for it, or would you withhold medication from them? Why is mental health treated so differently?

While it has been used safely and effectively for decades, there’s still a great deal of angst and controversy surrounding using stimulants in children with ADHD, one that begs further discussion. I’ll start with some fast facts on ADHD.

ADHD: By the Numbers

Incidence and prevalence statistics always vary according to sources and sampling methods, but the following are the 2020 numbers quoted by the Centers for Disease Control and Prevention.

The number of children ever diagnosed with ADHD is 6.1 million, or 9.4 percent. 

This includes: 

388,000 (2.4 percent) young children, aged 2 to 5 

2.4 million (9.6 percent) of school-age children, aged 6 to 11

3.3 million (13.6 percent) of adolescents, aged 12 to 17

Symptoms of ADHD typically first appear between the ages of 3 and 6.

The average age of ADHD diagnosis is 7 years old.

Males are more than twice as likely to be diagnosed with ADHD than females (12.9% compared to 5.6%).

Despite that fact, the incidence of ADHD diagnosis in girls has increased in recent years. Historically, diagnosis and incidence reporting had been low in girls, but new research indicates how ADHD symptoms manifest differently in boys and girls, leading to better recognition in girls.

ADHD isn’t just a childhood disorder. About 60 percent of children with ADHD in the United States become adults with ADHD, which is about 4 percent of the adult population. 

ADHD severity is generally based on the age at diagnosis:

Mild: Average age of diagnosis is 8

Moderate: Average age of diagnosis is 7

Severe: Average age of diagnosis is 5

Roughly two-thirds of children with ADHD diagnosis have/ have had/ will have at least one other mental, emotional, or learning disorder: most common are depression and/ or anxiety and other behavioral or conduct disorders, but other conditions such as autism spectrum disorder and Tourette syndrome/ tic disorder may also affect children with ADHD.

ADHD On the Rise

Cases and diagnoses of ADHD have been increasing dramatically in the past few years. The American Psychiatric Association (APA) says that roughly 8.4 percent of American children have ADHD, which differs significantly from the statistic quoted by the Centers for Disease Control and Prevention. The numbers vary depending on sampling methods and reference, but they all do indicate one thing: that ADHD diagnoses are on the rise. 

To account for the differences in statistics, there may be an implication that ADHD is being commonly mis-diagnosed, that children are being diagnosed with ADHD when they don’t actually have it. In reality, while ADHD isn’t a fast, easy diagnosis to make, there are strict and clear cut guidelines for diagnosis that make mis-diagnosis fairly rare. There must be a comprehensive evaluation using multiple collaborative sources (including interviews with the child, the parent(s), and typically the teacher), established symptom rating scales, observation by a physician, and cognitive and/ or academic assessments. A valid diagnostic appraisal takes time, so while mis-diagnosis certainly occurs in a very small percentage, it is certainly not responsible for the rise in numbers. 

What is responsible? The answer is multi-faceted, and includes: the increase in research and development in making the diagnosis, the decrease in the stigma associated with seeking help and/ or being evaluated for and/ or potentially having the diagnosis, and the increase in public awareness of ADHD. Many of today’s ADHD patients would have been yesterday’s “problem children.” In other words, we simply know better now, so we do better. Physicians are better trained in how ADHD manifests itself, especially in girls, since it’s stereotypically been a “boy disorder,” and everyone involved, including physicians, parents, and teachers, are more alert and pay closer attention to the disruption that behavioral issues cause in the classroom to everyone, not just the student with ADHD. 

The question then may be asked if more kids are actually experiencing ADHD today than they were before, and if so, why? We now know that ADHD is caused by a mix of genetic and environmental factors, and current best estimates indicate that about 70 to 80 percent of the risk for ADHD is genetic. But it’s not very clear cut or simple, where you either have an “ADHD gene” or you don’t, and there’s no single marker to look for or confirm a diagnosis. Instead, each gene involved in the condition contributes a certain amount of risk for developing it. The genetic component is complicated, but we really know even less about the environmental component, which makes up the other 20 to 30 percent of the risk of developing ADHD. The environmental risk factors we are fairly sure of- the ones we have the strongest and clearest evidence for- appear to be preterm birth and low birth weight. We also know that it is likely that if in fact we are seeing a true rise in ADHD cases over the last 20 years or so, as we believe we are, environmental factors must play an important role in it, simply because genetics don’t change that quickly. Some studies have suggested that exposure to toxins (ie lead exposure, smoking during pregnancy) may play a role, and that traumatic brain injuries may also play a role in increasing risk of developing ADHD. In the end, the rise in the number of cases is most likely to be a combination or interaction of all of the above factors, and that some environmental factors interact with certain genetics to increase a child’s risk of developing ADHD. What else do we know about increasing numbers of ADHD cases? That we always need and want to know more. 

Methylphenidate Medications

There are several methylphenidate product formulations, including oral tablets and capsules in immediate release/ short-acting, extended release/ long acting, chewables, liquid, and patches to be applied to the skin. There’s even a formulation called Jornay PM, which is taken at night, but only becomes active in the morning. All are derived from essentially the same basic methylphenidate compound. Immediate release or short-acting formulations typically begin to work about 30-45 minutes after ingestion and last about 3-4 hours, while extended release generally last about 6-8 hours, though there are of course exceptions that may release even more slowly and last longer.

Ritalin is a short-acting formulation of methylphenidate that lasts about 3-4 hours. Focalin is another form of methylphenidate that also lasts about 4 hours. Both of these medications begin to work about 30-45 minutes after taking them. For children who have trouble swallowing pills, this medication can be crushed and mixed with foods. There is also a liquid and a chewable tablet form of the short-acting methylphenidate.

Other preparations of methylphenidate have been created to release the medication over a greater period of time, extending the duration of the effect of the medication. This is of great benefit when trying to provide a response that lasts through a school day, typically 6-8 hours. Some of these compounds take effect as quickly as the short-acting forms of these medications. 

Concerta is one of the longest-acting methylphenidate medications on the market, lasting 8-12 hours. Concerta can’t be chewed or opened. It has to be swallowed whole in order for it to work the way it was designed. This can be a problem for some kids.

Ritalin-LA and Metadate CD are capsules that are filled with medication. These medications are very similar in that they both last about 6-8 hours. These are better for kids who can’t swallow pills, because you can open up the capsule and sprinkle it on foods like yogurt, applesauce, peanut butter, etc.

Aptensio XR and Focalin XR are also capsules filled with medication that can be opened and mixed with food. They typically work longer than Ritalin LA or Metadate CD.

Quillivant XR is a long-acting formulation of methylphenidate in liquid form, which makes it a good alternative for kids who have trouble swallowing capsules and can’t tolerate beads on food items either.

Quillichew ER is a chewable long–acting formulation of methylphenidate that can last up to 8 hours.

Daytrana is a methylphenidate patch. It’s another good option for kids who can’t swallow pills. You can wear the patch for up to 9 hours, and often get another hour’s worth of response after the patch is removed. But if using the patch, understand that it can often take 1-2 hours from application to the skin to start working.

Potential Benefits of Methylphenidate

In truth, the benefits of treating ADHD with stimulants are too vast to really list when you consider long term implications, but for our purposes, I’m only dealing with direct observed benefits when treating ADHD with methylphenidate stimulants here. 

Methylphenidate based medications have been proven to reduce the disruptive and troublesome symptoms of ADHD, making kids less hyperactive, less impulsive, more focused, and less distractible, with few side effects, if any, when the medications work properly. However, it’s important to note that these medications cannot treat or correct learned behaviors or other types of learning disorders.

The Benefits of Methylphenidate on ADHD Brains: What Science Says

Much of the controversy that surrounds treating childhood ADHD with  methylphenidate stimulants has to do with concerns about long term implications, mainly regarding brain development. Recent research on the neurobiological and anatomical underpinnings of ADHD has shed some light on this subject. 

Several years ago, neuroimaging work confirmed that there are neuroanatomic, or structural differences, in the brains of people with ADHD versus those without ADHD, especially in the frontal cortex, which is involved with attention, organization, abstract thinking, and keeping track of things. It was also confirmed that total brain volume, made up of gray and white matter, also differs.

Regarding anatomical brain differences, specifically, children with ADHD had overall smaller brain volumes, by about 3 percent, than children without ADHD, though it is important to note that intelligence is not linked to or affected by brain size. In addition, five of the regional areas in the deep brain that pertain to regulating emotion, motivation, and emotional problems- the caudate nucleus, putamen, nucleus accumbens, amygdala, and hippocampus- were smaller in people with ADHD; and some showed structural deformations as well. The brains of children with ADHD showed decreased cortical thickness in the prefrontal cortex, and less white and gray matter. 

White matter affects learning and brain functions, and acts as a relay to coordinate communication between different brain regions. White matter consists of axons, or nerve fibers, which have a myelin sheath whose color gives the area its name. Think of these myelinated nerve fibers of the white matter as the wiring of the brain- where information is carried from one point to the next- and these are insulated, so that the information is conserved, ie doesn’t “leak out” as it’s carried. Grey matter is the more outward layer of the brain that serves to process information in the brain and directs sensory stimuli to nerve cells in the central nervous system where the synapses induce the response to that stimuli. The grey matter has more connections than white matter, but isn’t as insulated as myelinated white matter; so this area relates more to memories and facts which are used every day to help a person function optimally.

In fact, further studies have shown that the structural differences in ADHD brains tended to be most observed in the brains of children with ADHD and not as much in ADHD adult brains. This is likely an indication that childhood is an important time to treat ADHD, which seems to be confirmed by further research. All in all, the findings led researchers to state that ADHD is a function of atypical brain structure and atypical chemical development. A few years ago, a research group took these findings a step further. Given the success of methylphenidate in treating the symptoms of ADHD, which is basically correcting the atypical chemical differences in neurotransmitter levels, they looked at the effects of methylphenidate on brain structure. 

The study found that childhood psychostimulant medication (methylphenidate) led to volume normalizations in several areas where volume levels were known to be reduced in the ADHD brain. Normalization means that where they were previously reduced prior to treatment with methylphenidate psychostimulant medication, they were increased to the point of reaching levels found in “normal” non-ADHD brains after being treated with the psychostimulant methylphenidate.

These studies found that specifically, overall white matter volume and grey matter volume normalized, or “resolved” after childhood treatment with psychostimulant, as did anterior cingulate cortex (ACC) volume, which is implicated in several complex cognitive functions, such as empathy, impulse control, emotion, and decision-making. When they looked at the largest part of the brain, the cerebral cortex, which is the ultimate control and information processing center, responsible for higher-order brain functions of sensation, perception, memory, association, thought, and voluntary physical action, they found that the ADHD-related thinning that had been present, was moderated by childhood psychostimulant treatment. The ADHD-related size reduction of the deep brain structures, which are key to learning, memory, reward, motivation, and emotion, normalized after psychostimulant treatment, as did deformations of the caudate nuclei, when present. 

One hypothesis that they had looked to prove or disprove was that methylphenidate treatment of ADHD during childhood and adolescence, but not during adulthood, would stimulate white matter, striatal, and frontal cortical development, resulting in more adult-like values. And in fact, their findings did prove this. This is important, because it is an age-related treatment response. It essentially means that when you treat childhood ADHD with methylphenidate in childhood, the methylphenidate stimulates a response that normalizes most of the abnormalities found in the brain of the child with ADHD such that they are comparable to normal adult values later. That’s a good thing.

Another study looked at behavioral changes associated with using methylphenidate, and found that, relative to periods off medication, ADHD patients on medication have fewer motor vehicle accidents, have a lower risk of traumatic brain injury, are less likely to engage in criminal activity, have lower rates of suicidal behavior, and have lower rates of substance abuse. Why? Because it seems that when neurotransmitter levels are normalized, behavior is normalized as well, which makes behavior when on medication safer, more risk averse, ie less risky. The authors end the report of their findings with this: “Thus the answer to the question ‘Is there long-term benefit from stimulant treatment for ADHD” is a definite “Yes!'”

Potential Negative Side Effects of ADHD Stimulant Medications/ Methylphenidate

Most side effects associated with methylphenidate are very mild and temporary, but if they exist, are likely to be dose or formulation related, as it can take some time to find the appropriate medication and dose. If you find that any side effects are intolerable or persist, it’s important that you inform the prescribing physician. In addition, the dose should be re-evaluated each year, even if there are no issues, as the medication needs can change over time, especially in growing children. 

Decreased Appetite

This is the most common side effect of stimulant medications. The loss of appetite may happen just while the medication is effective, and then wear off, as the benefits of the medication do. Children may be very hungry once the medication wears off, and if they haven’t eaten, they may also be irritable, aka hangry. This is typically a manageable problem, but the issue should be discussed with the physician who prescribes the medication if it persists or is intolerable.

Insomnia/ Sleep Problems

There may be issues with falling asleep associated with methylphenidate. This is usually fairly mild, and it tends to occur more in younger children who might have already had issues with falling asleep before they started the medication. There are many things that can interfere with falling asleep or manifest as sleep issues, so it’s important to determine if any external causes (other than medication) may be present. These can include poor or irregular sleep schedule, excess screen time/ blue light exposure right before bed, academic concerns/ worrying about school tests, or social issues with friends. Again, problems falling asleep are likely to improve over time, but may also be overcome by changing either the time or type of the medication that is given. For example, if a second or third dose of a short-acting formula is taken too late in the day, it may not have worn off by bedtime, which could cause the issue. This can be addressed by the physician with formula or dosing changes.

Mood Changes

There is a small subset of children with ADHD who may seem moody and irritable when they take stimulant medications, even if they are taking the best possible dose. If this is going to happen, it usually happens right away, as soon as they start taking the medication, and goes away immediately when they stop taking it. If this happens, it may help to switch to a different formulation or dose, so inform the prescribing physician right away to discuss potential alterations. Sometimes when a stimulant dose is too high, especially in children, they may begin to look tired or experience irritation. If this happens, the prescribing physician may opt to adjust the dose until the right dose is found: one in which the child gets the most benefit from the medication with the least possible side effects.

“Wear-Off” Effects

While this isn’t technically a side effect, a very small minority of children experience behavioral changes as their ADHD medication wears off, which typically occurs at the end of the school day. Some parents call it “rebound” but that term can be a bit misleading. They can seem more irritable or emotional, but it is usually a mild transient finding. Sometimes it’s related to being hangry or overtired, but it can be connected to the medication level dropping, and strategies that create a more gradual decrease in the medication level may help relieve it. Obviously, discuss with the prescribing physician if you notice it and believe it’s due to the medication levels. 

Tics

About 10% of kids with ADHD will have concomitant tics, whether or not they take methylphenidate, so that translates to a fair number of children. Tics usually start between 6 and 8 years of age, which is often when kids also first start taking a medication for ADHD. Tics may also be transient, and may come and go over time. The best we know from a series of studies, is that stimulants don’t cause tics, but if tics are present, sometimes methylphenidate can aggravate them. Despite this, methylphenidate may possibly still be used, but treatment should be more closely monitored if this is the case. If tics increase significantly during treatment, there may be an option to use a non-stimulant medication that affects the brain in a different way. 

Non-Stimulant Medications for ADHD

There are two types of non-stimulant medications that can help to alleviate some symptoms of ADHD. While they don’t have the efficacy that stimulants do, and they have very different side effect profiles, they may be an option worth trying if stimulants aren’t a viable option due to concomitant disorders like tics. Just as with stimulants, it may take several attempts to find the right medication and dosage, with the least side effects.

Clonidine (Catapres, Kapvay) and guanfacine (Tenex, Intuniv) are called alpha-adrenergic agonists, and these medications were developed to lower high blood pressure in patients with hypertension. But they are also prescribed in adjusted doses for children with ADHD who don’t tolerate stimulants well, and are sometimes also used to treat tics. These medications can cause fatigue related to low blood pressure, so blood pressure and heart rate must be regularly monitored while taking these medications. These are typically short-acting medications that require several doses each day, but they come in longer acting versions, Kapvay and Intuniv.

Atomoxetine (Strattera) is in a class of drugs called norepinephrine reuptake inhibitors. Norepinephrine is one of the CNS neurotransmitters needed to control behavior.

Unlike stimulants, Atomoxetine can take 4-6 weeks to take effect and has to be taken daily.

Busting Myth-information

There’s a great deal of false information out there on ADHD and stimulants. 

Does using stimulants stunt growth?

In spite of concerns that have been voiced regarding growth and stimulants, a recent well-validated clinical study showed that neither ADHD, nor treatment with stimulants, was associated with a decrease in growth rate during the maximum growth period in childhood, or a change in final adult height. Combined with other studies, it is clear that treatment with stimulants has no impact on growth rate or final adult height.

Are psychostimulants addicting?

Provided they are taken via the prescribed route, at the level they are prescribed for ADHD, methylphenidate medications do not raise the dopamine level high enough to produce euphoria, and they are not considered addictive.

Does using stimulants make children prone to addiction later in life?

Observational studies conclude that stimulant medication to treat young children with ADHD does not affect- neither in an increasing nor decreasing way- the risk for substance abuse in adulthood.

Does using stimulants change a child’s personality?

ADHD medications should not change a child’s personality. If a child taking a stimulant seems sedated or zombie-like, or tearful and irritable, it usually means that the dose is too high and the clinician needs to adjust the prescription to find the right dose.

Does using stimulants have negative long term effects?

In over 50 years of using stimulant medications to counteract the symptoms of ADHD, and hundreds of studies, no negative effects of taking the medication over a period of years have been observed. On the contrary, using methylphenidate to treat childhood ADHD especially, is associated with the positive effects and benefits of normalization of neurotransmitter levels and structural brain differences.

Using Methylphenidate for ADHD in Children:

Parental Considerations

As a parent, making a decision to place a child on a stimulant for ADHD isn’t to be taken lightly. As a physician, it’s certainly one I take very seriously. The following are things to keep in mind when weighing the decision.

All research studies indicate that stimulants are the most effective treatment for symptom reduction in ADHD. 

Methylphenidate has been used for decades, and is considered safe and generally well tolerated by most people, including children and adolescents, with low side effect profiles. 

Do a risk/ benefit analysis. You have to weigh the risks associated with treating ADHD with a safe and effective stimulant with a good track record versus not treating the ADHD, and all of the areas of the person’s life that decision impacts, including the well documented academic and social implications. In the total analysis, the risks associated with living with untreated ADHD are generally greater than treating with a methylphenidate stimulant that has an excellent safety profile and actually has the benefits of normalization of neurobiological and structural brain anomalies associated with ADHD. 

When the symptoms of ADHD are negatively affecting every aspect of a child’s life, medication is a better and safer alternative than allowing that negative impact to persist throughout school age years and beyond.

Methylphenidate, like all medications, may cause some side effects, but most are mild, temporary, and/ or can be relieved by a change in formulation or dosing. It may take some trial and error to find the prescription and dosage that works well with the least side effects. While this may take time and patience, it’s time well spent. 

Deficiencies in neurotransmitters such as those in ADHD also underlie many common disorders, including anxiety, mood disorders, anger-control problems, and OCD, obsessive-compulsive disorder. As a result, ADHD often occurs concomitantly with other disorders. In other words, ADHD may not be the only thing going on with an ADHD brain. At least two-thirds of people diagnosed with ADHD are also diagnosed with at least one other mental health or learning disorder in their lifetime, according to the American Academy of Child and Adolescent Psychiatry. Some of the more common accompaniments, especially in children, include anxiety disorders, depression, and learning and language disorders. As a parent, you may find you’re looking for the right mix of medications or treatments for multiple issues.

Granted, there are a lot of issues to consider, but hopefully I’ve managed to cover most of them here. My opinion is clear, and it is that overall, given the high efficacy, the track record, the safety, and the many well proven benefits of its use, methylphenidate treatment for ADHD far outweigh the risks associated with not treating it. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

Learn More

The Skinny On Psychostimulants

The Skinny on Psychostimulants

Happy 2021 people! Are you as happy as I am that 2020 is finally in the rearview?! Weirdest. Longest. Year. Ever. 

That actually makes me think of a new and hilarious commercial I just saw for a big online dating site. It starts out with Satan bored out of his mind in hell, and then he gets a text message from the site saying he’s been matched with a girl, and he’s very intrigued. When they meet, it’s obvious that they’re both instantly smitten. Then the starry-eyed girl introduces herself as 2020. They fall in love. And they live happily (?) ever after… apparently in hell. Unless they stay at her place I guess. Anyway, 2020 is over, even though unfortunately, we’re still schlepping some of its covid baggage, but hopefully not for much longer. 

Considering the euphoria surrounding the new year and the stimulation of resolutions, I thought it very fitting that I start with a three part blog series on pharmacological central nervous system stimulants, aka psychostimulants. One of the main compounds in this class of drugs are the amphetamines, and that will be today’s blog topic. 

As psychostimulants go, amphetamines are very strong ones; they are a group of very tightly controlled and well monitored schedule II drugs. Add a little carbon atom, bind some hydrogens to it, and you’ve got a methyl group; and that makes it methamphetamine, which everyone’s heard of. When prescription methamphetamine is (very) illegally altered…tah-dah…you’ve got crystal meth, aka speed, ice, crank, etc. Other examples of psychostimulants include caffeine, nicotine, cocaine, and other prescription compounds that I’ll cover next week. 

Because of their stimulant activity within the central nervous system, prescription amphetamines are used in the treatment of several disorders, including narcolepsy, obesity, binge eating disorders, and very commonly, ADHD, or attention deficit hyperactivity disorder. They can also be used recreationally in certain populations to get high, to stay awake for long periods of time, and/ or to improve focus and study for exams. In fact, it’s those last two that make amphetamines very popular party favors among college students.

Structurally speaking, amphetamines are drugs that are related to catecholamines, which are chemical messengers that help transmit a message or signal across neural synapses in the central nervous system, from the terminal end of a transmitting nerve cell to the receiving end of a target nerve cell. In an over-simplified explanation, when a signal gets to the end of one neuron, catecholamines help the signal jump to the beginning of the next neuron, hence the name “neurotransmitter.” That message is repeated billions upon billions of times, as there are billions upon billions of neurons in the central nervous system. These neural signals activate emotional responses in the amygdala of the brain, such as fear in a “fight or flight” situation. At the same time, catecholamines also have effects on attention and other cognitive brain functions. Examples of catecholamines include the neurotransmitters dopamine, epinephrine, and norepinephrine. Pharmacologically speaking, amphetamines increase levels of the specific neurotransmitters dopamine and norepinephrine in the neural synapses, which helps the message to make the jump from one neuron to the next. In a way of thinking, amphetamines “speed” the transmission of the message by increasing the levels of these neurotransmitters. Amphetamines increase these dopamine and norepinephrine levels through three different mechanisms of action, at least that we know of: 1) they reverse the direction of the transporter pumps that would normally divert dopamine and norepinephrine away, 2) they disrupt cellular vesicles, thereby preventing the storage of excess dopamine and norepinephrine, which frees them up, and 3) they also promote the release of dopamine and norepinephrine at nerve cell terminals, making them readily available in the synaptic cleft. These three mechanisms combined ensure that there are very high concentrations of dopamine and norepinephrine in the synapses of the central nervous system. The “catecholaminergic” (try that one next time you play scrabble) actions of increasing the levels of dopamine and norepinephrine result in the very strong psychostimulant effects that amphetamines produce.

You’ll notice that I keep saying amphetamines, plural. Why? Because like the neurotransmitters dopamine and norepinephrine it effects, amphetamines are chiral molecules; this is a fancy way of saying that in their three dimensional world, they can exist in different forms called enantomers (more scrabble points!) that are mirror images of each other. I know this sounds complicated, but it’s really not. Think of it as “handedness.” Your left and right hands are mirror images of one another: they look similar, except the placement of the fingers and thumbs are mirror images, and they can do pretty much the same things, like hold a fork or a pencil, but the way they do so differs slightly. The same is true of amphetamines. The two enantiomers of amphetamines are usually referred to as dextroamphetamine (also denoted as d-amphetamine) and levoamphetamine (also denoted as l-amphetamine). All prescription amphetamines boil down to four variations of the amphetamine molecule, which have markedly similar, but potentially slightly variable effects: dextroamphetamine, aka dexadrine; lisdexamphetamine, which is a precursor or pro-drug of dextroamphetamine; methamphetamine, aka methamphetamine HCL, which has that methyl group I mentioned before; and mixed amphetamine, which is essentially a mixture of dextroamphetamine and levoamphetamine at a specific ratio. 

Of those four active forms of amphetamines, there are several brand name drugs on the market, some of which have generic forms available. They are all oral formulations that may be immediate-release, which are typically taken twice a day, or extended-release, which are obviously released more slowly and taken once a day. 

Adderall XR (generic available)

Dexedrine (generic available)

Dyanavel XR

Evekeo

ProCentra (generic available)

Vyvanse

Methamphetamine (Desoxyn)

The desired effects of amphetamines include: stimulation (thank you Captain Obvious), increased alertness, cognitive enhancement, euphoria, and mood lift. Amphetamines have been around for a long time and when taken as prescribed, they’re fairly safe, but there are potential negative side effects. These can include insomnia, hyperfocus, GI irritation, headache, anxiety, slight increase in heart rate and blood pressure, and anorexia. There is addiction potential associated with amphetamines, and there is a short and fairly mild associated withdrawal period where one might feel some fatigue, sleep a lot, and experience strange dreams. 

When taken as directed, and by mouth, usually 20mg – 40mg per day, amphetamines are fairly safe. However, when smoked, injected, or snorted, they are decidedly UNsafe; especially in large doses. I’ve seen people take up to 1000mg per day… though not for long. Why? Because they usually end up dead of overdose. What happens if you choose to use amphetamines in large quantities and/ or via routes other than oral? Hallucinations, delusions, psychosis, seizures, cardiovascular collapse/ arrest, stroke… the bottom line is it ain’t pretty, people, so don’t do it. 

Because amphetamines have multiple mechanisms of action and thereby are very strong psychostimulants, I generally restrict their use to adults only, and choose to use another type of psychostimulant in children called methylphenidate. And that will be the topic next week in psychostimulants part 2 of 3. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Kratom:Panecea or poison?

Kratom: Panacea or Poison?

What is Kratom?

Kratom (scientific name: Mitragyna speciosa) is a tropical evergreen tree in the coffee family that is native to the jungles of Southeast Asia; specifically found in Thailand, Myanmar, and Malaysia. It is also found in Papua New Guinea. Other names for kratom include thang, kakuam, thom, ketum, and biak. Whatever it’s called and wherever it may be found, this tree, or at least the leaves on it, has been causing quite a commotion in recent years.

The Scientific Scoop

Mitragyna speciosa leaves contain multiple active components, referred to as alkaloids, with properties ranging from stimulant-like energizing and uplifting to opiate-like drowsiness and euphoria, so this makes it difficult to characterize kratom as one particular type of drug, i.e. as “stimulant” or “opiate.” Kratom’s two main alkaloids are mitragynine and its active metabolite, 7-hydroxymitragynine, which has strong activity at the µ-opioid receptors (where µ is pronounced like ‘you’ but with an m: mu). This is the main opioid receptor, the same one that is the primary binding target of opioids like heroin and oxycodone. Why is this so important? Why do we need to know exactly where kratom binds and what effect that has? Well, so we know how it may be used. Here in America, the government isn’t so good with just accepting that this ancient Asian secret does xyz just because they said so. Because kratom binds to µ-opioid receptors just like heroin etc, opponents say that it must be categorized as a narcotic and therefore, it must be addictive just like heroin etc. But Narcan/ naloxone is also categorized the same way, and obviously it’s not addictive; in fact, it’s used to save people in cases of opioid overdose. 

There is a great deal of supportive scientific evidence from many independent laboratory studies using mouse models and multiple human cell lines that confirms that kratom’s alkaloid metabolite 7-Hydroxymitragynine is in fact a key mediator of the analgesic effects of kratom, through its agonistic binding to the µ-opioid receptor. This has also been confirmed by the finding that in the presence of the opioid receptor antagonist naloxone, the pharmacological blockade of the analgesic effect will occur. In plain language: they’ve clearly shown that kratom binds specifically to the µ-opioid receptor in human cell lines, and demonstrated that this binding produces analgesic effects by giving it to a specific type of live mouse that essentially models the human system. So after the mice were given kratom, they exhibited analgesic effects from it– through previously established and accepted behaviors that I’m totally not going into here– just trust people. And then, as if that’s not enough, to further prove that this analgesic effect the mice were having was definitely the result of kratom’s binding to the µ-opioid receptor, they then gave the kratom-dosed mice Narcan, aka naloxone, which is a µ-opioid receptor antagonist. What does that mean? Think of it this way: the Narcan “antagonizes” the µ-opioid receptor; it basically bullies anything already bound to that µ-opioid receptor, pushes it off, and then it binds to it and blocks it so that as long as it’s parked there, nothing’s getting by it to bind to those µ-opioid receptors. That’s how and why Narcan saves people from overdose: it pushes all the opioids off all of the µ-opioid receptors and then sits on them, and hopefully that happens soon enough that the person survives the overdose. If they do, and if they then ingest more opioids for several hours after being given the Narcan, they won’t feel the effects of the drugs for as long as the Narcan is present there on those receptors, because the drug’s opioids won’t be able to bind to the µ-opioid receptors, as the Narcan will be sitting there. So there’s been a lot of work done in various labs all over the globe to elucidate kratom’s form and function. But despite all of this work, there’s much more to be done! I’ll talk more about that later.

None of kratom’s uses are clinically proven, as it has not been studied in the human clinical trials that the FDA requires to allow a drug compound to be legally available on the open market. Clinical studies are very important for the development of new drugs, as they help to identify consistently harmful effects, harmful interactions with other drugs, and dosages that are effective, yet not dangerous. That said, there have been many legitimate published laboratory studies with clear demonstrable findings in mouse models and human cell lines that do allow us to at least extrapolate the effects of kratom in humans with some accuracy and relative safety. Most findings have been positive, and there is a large vocal community of kratom supporters with numerous anecdotal testimonials of kratom’s effectiveness in treating various conditions. But despite this, because treatment practices using kratom have not been rigorously studied as either safe or effective, the DEA staunchly maintains that it has no valid medical uses or benefits. In fact, several years ago, the FDA threatened to make kratom a Schedule 1 narcotic, meaning it would be grouped with marijuana, LSD, and ecstasy, among others, and this elicited a huge backlash… tens of thousands of kratom proponents complained vociferously, signed endless petitions and all that yada yada, and the FDA caved, dropping the issue, at least for the time being. But that’s not going to be the end of that story people… not when the government’s involved. So for now, kratom’s status should be listed as “to be continued.”

What is Kratom Used For?

In its native regions of Southeast Asia, kratom has been known to be used as a traditional medicine for more than a century, but has likely been used for multiple centuries. There in Southeast Asia, the leaves of the kratom tree are typically chewed directly from the tree or consumed as a tea, and they induce stimulant and opioid-like analgesic effects, depending on the amount used. This is because the effects felt from ingesting kratom have been found to be dose-dependent: at low doses, which is generally considered 1 to 5 grams, kratom has been reported to work like a stimulant, imparting feelings of being more energetic, more alert, and more sociable. At higher doses, considered to be 10 to 15 grams, kratom has been reported as being more sedating, dulling emotions and sensations while producing euphoric effects. Anything over 15 grams is considered risky.

The stimulant type effects have traditionally made kratom popular among Southeast Asian agricultural workers especially, who use it to aid them in their long hours of hard labor. But for generations there, kratom has also been used successfully in its native regions for several other purposes: as an aphrodisiac to increase sexual desire, as an energy booster, to ameliorate withdrawal symptoms following cessation of opioid use, and for treating cough, diarrhea, and chronic pain. More recently, here in the US, there has been an uptick in the use of kratom by people who are self-treating chronic pain and managing acute withdrawal from opiates, while seeking alternatives to prescription medications. While some people claim to have success using kratom to treat depression and anxiety, and others say that kratom can also be used to treat muscle aches, fatigue, high blood pressure, diarrhea, and post-traumatic stress disorder (PTSD). Some studies report that kratom possesses anti-inflammatory, immunity-enhancing, and appetite-suppressing properties, but obviously more research is needed to confirm these benefits.

Kratom: Processing and Forms

The psychoactive compound referred to as kratom is found in the leaves of Mitragyna speciosa, and the processing seems pretty straightforward: after the plant’s large dark green leaves are harvested, they can be prepared in several ways: fresh leaf, dried leaf that is pulverized and powdered, dried leaf that is simply crushed, and concentrated liquid leaf extract. Kratom can typically be purchased in multiple forms, including paste, capsule, tablet, gum, tincture, and extract. In certain forms it is often combined with added sweetener to overcome its harsh bitterness. Kratom can be brewed into a tea as well, a form that is offered in kratom tea houses present in a few US states. Kratom can also be smoked or vaporized, though this is not very common.

While the use of Mitragyna speciosa is certainly not new, the alkaloid extraction and refinement methods to turn the alkaloids from the plant into kratom has certainly evolved, and now purity is said to be higher. I’ve read that now there are also fortified kratom powders available, and these contain extracts from other plants in a nod to the nutraceutical angle. In the United States, kratom is usually marketed as an alternative medicine, and often found in stores that sell supplements. Kratom can also be found in gas stations and paraphernalia shops in most parts of the US, except in the handful of states and cities that have banned it. Many people purchase kratom over the Internet, where it may be sold for “soap-making and aromatherapy,” a lot like what happened with synthetic marijuana or spice; that’s in an effort to circumvent the FDA’s 2014 ruling that made it illegal to import or manufacture kratom as a dietary supplement in the US.

Is Kratom Legal?

Although kratom is technically legal at the federal level, some US states and municipalities have chosen to ban it, making it illegal to sell, possess, grow, or use it. Other states have imposed age restrictions. In the states of Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin, kratom is illegal to buy, sell, possess or use. There are special cases in some states: while kratom is legal in California, it is banned in San Diego. While it’s legal in Colorado, in Denver it’s considered illegal for human consumption. Kratom is legal in Florida, except for Sarasota Country, where it’s banned. Kratom is legal in Illinois for those over the age of 18, except in the city of Jerseyville, where it is banned. Kratom is legal to use in Mississippi, except in Union County, where it’s banned. In New Hampshire, kratom is only legal for those over the age of 18. Please don’t quote me on these people- make sure to double check if you’re wanting to purchase- not that I’m encouraging that or even saying it’s acceptable btw. 

As far as countries around the globe go, kratom is illegal in: Australia, Denmark, Finland, Israel, Japan, Latvia, Lithuania, Myanmar, Malaysia, New Zealand (unless prescribed by a doctor), Poland, Romania, Russia, Singapore, South Korea, Sweden, Thailand, and Vietnam. Note that most places where native Mitragyna speciosa grows, it’s illegal… funny! Speaking of that, the country of Thailand has recently reconsidered the status of some illegal substances, so kratom might not remain illegal there.

In countries like Ireland, Italy, and the United Kingdom, the rules may vary from one city to the next. It’s also important to note that the status of kratom legality isn’t widely known for some countries. For example, it isn’t clear whether it is legal in China, or in many of the African nations. However, as the drug kratom becomes more widely known, countries, counties, and cities that don’t currently ban kratom may choose to do so at any point.

Is Kratom Safe?

Proponents say kratom is an amazing compound, a game-changer and lifesaver. Opponents, like the FDA, say it has no viable medicinal properties. How the US DEA, medical professionals, and millions of regular kratom users can have such divergent views of the same plant is hard to fathom. The overarching “company line” seems to answer this question “No!!” They state that kratom is considered addictive, that people can develop a physical dependence on it, and that in and of itself indicates that it’s not safe. There are some anecdotal reports of people becoming dependent on kratom, but there are more reports of people successfully using it to recover from opioid addiction; not to mention successfully treating chronic pain, fibromyalgia, anxiety, depression, on and on. So in my book, the jury’s out people. 

The question of kratom’s safety comes down to two factors: the lack of regulation and the interactions with other drugs or substances, whether endogenous or exogenous. 

Lack of Regulation

Any time a substance, including herbal supplements, isn’t regulated by the FDA, there are potential safety hazards. This is because there is no standardization when a substance isn’t regulated. That means that companies, particularly if they’re operating online, can market the product however they want. There are no official drug warning labels for kratom, and people may take it without knowing what other substances it contains. A buyer never knows what level of potency a kratom product could have or whether it’s pure. In addition, the active ingredient in kratom varies widely by plant species. As with marijuana strains, different kratom strains have slightly different effects; there are multiple species of the tree, so this makes kratom’s effects unpredictable. This unpredictable nature leads to a risk of overdose and other serious side-effects, including seizures, hallucinations, chills, vomiting, liver damage, or even death.

Kratom Interactions

Because there is little research currently available on how kratom interacts with other substances, the breadth and severity of effects are yet unknown. This unpredictability adds to the dangers of using kratom in combination with something else, because you’ll have little idea what it could do to you. Potentially negative effects can be even more severe when kratom is combined with other drugs and prescription medicines. Some of the kratom chemicals have been shown to interact with how the liver metabolizes other drugs, which can lead to dangerous interactions. Another risk is presented when people buy commercial versions of kratom that have been combined with other drugs or substances, especially if they too work on the same opioid receptors. The potential consequences of many drug interactions can range from seizures to liver damage.

Various Points on the Kratom Controversy

Depending on what you read and who you believe, kratom is a dangerous, addictive drug with no medical utility and severely deleterious side effects that include overdose and death, or it is an accessible pathway out of undertreated chronic pain and opiate withdrawal, as well as being useful in treating many other health issues. There are great physicians and impressive institutions with interesting facts on both sides of this issue.

Recent increased kratom use in the United States, combined with concerns that kratom represents an uncontrolled drug with abuse potential, has highlighted the need for more careful study of its pharmacological activity. The major active alkaloid found in kratom, mitragynine, has been reported to have opioid agonist and analgesic activity in vitro and in animal models that are consistent with the purported effects of kratom leaf in humans. However, preliminary research has provided some evidence that mitragynine and related compounds may act as atypical opioid agonists, meaning they induce their therapeutic effects like analgesia, while also limiting the negative side effects that often accompany classical opioids. One such side effect that is absent in kratom is constipation. A chronic pain medication like kratom that doesn’t cause constipation like current opioids all do sounds like a good thing, but as I said before, it’s a long way from here to there, especially considering the FDA’s current opinion. And something tells me they won’t be changing their collective mind any time soon. 

As it stands now, there is little to no control or reliable information on growth, processing, packaging, and/ or labeling of the kratom currently sold in the US; and all of this adds to the already considerable uncertainty of its health risks. In 2018, the FDA instituted a mandatory recall of all kratom containing compounds over concerns about Salmonella contamination in these products. More recently, the DEA placed kratom on its “Drugs and Chemicals of Concern” list, but as I mentioned before, it has not yet labeled it as a controlled substance, though not for lack of trying. Time will tell how long that lasts.

Kratom can be addictive due to its opiate-like qualities, and a small minority of users may end up requiring addiction treatment. The CDC claims that between 2016 and 2017, there were 91 deaths due to kratom; but this claim should be met with healthy skepticism, as all but seven of these casualties had other drugs in their system at the time of their deaths, and that makes it totally impossible to uniquely implicate kratom.

A patient wishing to use kratom to treat chronic pain or to mitigate opioid withdrawal symptoms could expect to encounter several problems with doing so, not all of which even have anything to do with the intrinsic properties of the kratom itself.

A patient that wants to use kratom to treat a legitimate illness or condition will likely face four problems for the foreseeable future:

-The first problem is that the DEA still occasionally threatens to make it a Schedule 1 controlled substance, along with drugs like heroin and ecstasy. This would make kratom very difficult to access, and would likely make the supply as a whole even more dangerous than it is now. Generally, it’s not a good idea to use something to treat chronic pain or addiction that may soon become less available and less safe: you want to know it’s going to be readily available, and that as a cure, it won’t cause more problems than the illness it’s being used to treat!

-The second problem is that the complete lack of oversight and quality control in the production and sale of kratom makes its use potentially dangerous.

-The third problem is that kratom has not been well studied for any of the uses its proponents claim it has an affinity in treating! Maybe the FDA hasn’t heard the saying that goes, “Absence of evidence of benefit isn’t evidence of absence of benefit.”

-The fourth and final problem is that kratom doesn’t show up on drug screens. I like kratom’s potential, but I can argue that adding another potentially addictive opiate-like substance while an opiate epidemic is already going on may not be the best course of action. 

Is there a sensible path forward with kratom?

I’m not sure that anyone has the answer to that question, but at a bare minimum, the safety of kratom could be improved through:

-Regulation: it would be safer if people knew the exact dosage of kratom they were truly consuming, and that it was totally free of contamination.

-Education: educated consumers who know all of the potential benefits and dangers of the compound they are consuming are far less vulnerable to misleading claims.

-Research: if kratom does in fact have the benefits that have been demonstrated in the laboratory for treating either addiction or chronic pain, we should absolutely know it and make it known: accurately defining the risks of using kratom is critical, as is making all medical personnel and laypersons informed.

If all four of these points could somehow be accomplished by scientists and public health specialists, without: overdue distortion from corporate interests, anti-drug ideology, and romanticism by kratom enthusiasts, then we should have enough clarity to answer the basic questions about kratom, including the most important question of all…is it harmful or helpful?

Effects of Kratom: Good, Bad, Ugly

The Good

Recall that the expected effects from kratom are dose-dependent: that smaller doses will produce a stimulant-like effect, while larger doses will produce sedative or opioid-like effects. 

A small dose of kratom to produce stimulant effects would be up to just a few grams, and these effects would be felt within 10 minutes after ingestion and can last up to 90 minutes. These expected stimulant effects include increased energy, alertness, and sociability, increased sex drive, decreased appetite, and giddiness.

A larger dose of kratom, between 10 and 25 grams, can have a sedative effect, imparting feelings of sedation, calmness, euphoria, pain reduction, and cough suppression, which last for much longer periods of time, potentially up to six hours.

The Bad

Potential unsafe and negative effects of regular kratom use, even at low doses, can include: agitation, tachycardia, drowsiness, vomiting, confusion, anxiety, tremors, itching, sweating, insomnia, lack of appetite, tremor, coordination problems, and withdrawal symptoms.

There can also be negative effects of high dose kratom, including: addiction, nausea, itching, constipation, and withdrawal symptoms of tremor and sweating.

There can be negative side effects of taking any dose of kratom at irregular times or random intervals as well. Many users of kratom have reported something called “The Kratom Hangover” the day after taking it, the symptoms of which can include irritability, anxiety, nausea, and headaches.

Because kratom can cause problems with coordination and sleepiness, it’s dangerous to drive or operate machinery while using it. For this same reason, pregnant women are also advised never to use kratom. 

The Ugly

There can be grave side effects from taking kratom, which can include seizures and respiratory and/ or cardiac arrest.

If a person takes a high dose of kratom and falls asleep, they may vomit and choke while asleep.

Kratom Overdose

There are numerous calls into the CDC poison centers for kratom overdose every year.

The risk of overdose increases when kratom is taken with another substance, especially opioids.

Recent studies have found evidence of fatal kratom-only overdoses involving severe and negative side effects that can occur when someone takes too much. Some of the symptoms of taking too much kratom can include: impaired motor skills, lethargy, slurred speech, either shallow or very heavy breathing, tremors, listlessness, aggression, delusions, and hallucinations.

Long-term and heavy use of kratom can lead to liver problems, as kratom tends to make it more difficult for the liver and kidneys to process and filter toxins out, contributing to the potential for this type of organ damage.

Signs of liver damage include dark-colored urine and yellow skin and eyes.

Kratom: Necessary Evil or Just Plain Evil?

Kratom is currently considered a dietary supplement, as it is not approved nor regulated by the US FDA. That said, there are anecdotal reports of beneficial effects of kratom use, though there is no clinical evidence yet to support them. In the future, with the proper supporting research, kratom may indeed have proven potential. 

But without this research, there are a lot of unknowns with kratom, such as effective and safe dosage, possible interactions, and possible harmful effects, including death. These are all things that you should weigh before taking any drug, but for kratom, they’re all question marks. In the final analysis, going by laboratory findings, kratom holds great potential. But if you’re thinking about using kratom to treat chronic pain or opioid addiction, or anything else… exercise extreme caution people.

I hope you enjoyed this blog and found it to be interesting and educational. Sharing means caring, so please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Sadomasochism

Since it’s pretty clear you people really like reading about all things tangential to sex, I don’t mind indulging your secret freaky sides every once in a while. Hey, far be it from me to deny you! So in that spirit, this week’s topic is…. 

wait for it….

Sadomasochism. 

The Oxford Dictionary has this to say:

[sey-doh-mas-uh-kiz-uhm]

noun

interaction, especially in sexual activity, in which a person enjoys or derives pleasure from inflicting or receiving physical or mental suffering upon or from another person.

Abbreviation: S&M, S and M

The shrinky dink version from the American Psychological Association Dictionary version:

1. sexual activity between consenting partners in which one partner enjoys inflicting pain (see sexual sadism) and the other enjoys experiencing pain (see sexual masochism).

2. a paraphilia in which a person is both sadistic and masochistic, deriving sexual arousal from both giving and receiving pain. —sadomasochist n. —sadomasochistic adj.

The Mark G. Agresti version:

deriving pleasure or gratification from inflicting or experiencing pain.

It’s important to note that both the pain and pleasure given and/ or received in sadomasochism can be physical, emotional, or both. In addition, when it exists in the strictest definition, it is considered a mental illness, but there are all sorts of conditions and considerations- and controversy- that go along with that. I’ll elaborate a little on that later. No matter who you listen to or what you believe, sadomasochism tends to be a rather delicate topic, and strictly speaking, not exactly one you’d discuss in “polite society.” Whatevs. I’m all about taking deep dives into that kind of stuff- it’s actually one of my missions in life- and in fact, my entire profession centers on helping people with delicate issues that aren’t talked about in “polite society.” Despite not being coffee talk, there’s a lot to be said about sadomasochism… including the fact that many people exhibit sadomasochistic tendencies, which is not to say they regularly wear black leather gear or want to tie their partners up and beat them btw. I’d even venture to say that most people, eapecially when in romantic love relationships, exhibit characteristics of sadomasochists. How does that grab you? If you’re thinking Ineed my head examined right about now, then keep reading about the psychology of sadomasochism. 

But first, I have to get into where the term sadomasochism comes from, break it down (pun intended), look at its nominal derivation, and how it’s been viewed and analyzed throughout the ages. Let’s just say that shrinky dinks have had a lot to say on the subject. 

Captain Obvious says that sadomasochism is the mashup of sadism and masochism, terms coined in the late 1800’s by an Austrian psychiatrist dude named Richard von Krafft-Ebing, who believed that the natural tendency of the male was toward sadism, while the natural tendency of the female bent toward masochism. What!Everrr! In reality, studies show that sadistic fantasies are just as likely to occur in females as they are males, though the masochistic bend definitely develop earlier in males. We now know that, like many things, sadomasochism knows no gender. When you break it down, sadism is defined as pleasure or gratification gained from the infliction of pain and suffering upon another person, while the counterpart, masochism, is the pleasure or gratification of having pain or suffering inflicted upon the self. At the simplest, most basic level, you could say that sadists get off on dishing it out and masochists on taking it. Now, how often are things that simple? Like never, people. And believe me, that’s the case here. But this generalization works just in terms of remembering which is which. That said, there are no clear lines dividing the two, and in practice, they’re often interchangeable and may even coexist in the same individual at different times.

Krafft-Ebing named sadism after the 18th century Marquis de Sade, a French nobleman, revolutionary politician, philosopher, and writer. He is most famous for his libertine sexuality, and he ‘graced the world’ with novels, short stories, plays, and dialogues, including Justine, which is basically about a woman with the same name who travels around the world getting the crap beaten out of her as she goes, and Les prospérités du vice, which roughly translates to something like the pleasures of vice, in which he said: 

How delightful are the pleasures of the imagination! In those delectable moments, the whole world is ours; not a single creature resists us, we devastate the world, we repopulate it with new objects which, in turn, we immolate. The means to every crime is ours, and we employ them all, we multiply the horror a hundredfold. 

Two of his most commonly annotated quotes:

“It is always by way of pain one arrives at pleasure.“

“I’ve already told you: the only way to a woman’s heart is along the path of torment. I know none other as sure.“

Sounds like a great guy, right? Evidently, his current day ancestors have been very busy trying to rehabilitate their great great great whatever’s image by creating a line of gourmand treats: wine, pâté, cheeses and such; and supposedly had pitched a Sade line of lingerie to Victoria’s Secret. Another fun fact, the film Quills, starring Geoffrey Rush, Kate Winslet, and Michael Caine, is inspired by the story of Sade.

Krafft-Ebing was a busy guy, naming masochism for a contemporary of his, 19th century Austrian nobleman, writer, and journalist Leopold von Sacher-Masoch, who gained renown for his romantic stories of Galician life. He also authored Venus in Furs, in which he wrote:

Man is the one who desires, woman the one who is desired. This is woman’s entire but decisive advantage. Through man’s passions, nature has given man into woman’s hands, and the woman who does not know how to make him her subject, her slave, her toy, and how to betray him with a smile in the end is not wise.

Interestingly, evidently Masoch did not approve of this use of his name. Bummer that somebody names something after you and you don’t approve of it. My suspicion is that it’s more likely that he didn’t approve what it was used for, as Krafft-Ebing essentially outed the guy as a masochist. Sadly, no word on a lingerie line for Sacher-Masoch, but I’ll keep you posted. 

Sadomasochism as a mashup term was actually coined by none other than Freud, the mother-loving, father-hating Austrian neurologist and psychologist who is widely regarded as the father of psychoanalysis, a therapeutic process designed to make the subconscious conscious by releasing repressed emotions and experiences. 

Even The Kama Sutra, which dates back to second century India, includes an entire chapter devoted to “blows and cries.” According to the Hindu text, “sexual relations can be conceived as a kind of combat… For successful intercourse, a show of cruelty is essential.” Seriously? 

Now that you’re good to go for the daily double on historical literary references to sadomasochism…

Most of the time, for obvious reasons, we think of sadomasochism and it’s nominal components in terms of sexual behavior only, but they can have broader applications, and this is especially the case in sadism. The quality of being sadistic is most applicable to some notable autocrats of the past and present, and these are actually the first thing that comes to mind when I hear the word. When no other single word could possibly encompass the horror of their being, sadist just works. Think Stalin, Pol Pot, Hitler, Saddam Hussein, and the Kims. I was surprised to even see our 45th President’s name included while looking up a statistic. Hmmm… wonder who submitted that? (Dr. Mark Agresti is not making a statement about any person’s sexual inclination or mental status and is not claiming any political affiliation; this advertisement is brought to you by the equal opportunity offender party.) 

Okay, I have no clue how that dude got in here, but you get the idea about sadism. On the other hand, masochists enjoy receiving pain, which, again, may or may not be sexual. Strangely (?) I couldn’t find much in terms of famous or known masochists. The best I could do was a British artist I actually remember from some required art “appreciation” class freshman year, a painter named Keith Vaughan. Evidently, he purpose built some kind of gizmo contraption to electrocute his own genitals. They definitely didn’t cover that part in my class though, I’m pretty sure I’d remember that. 

Sexual sadism and masochism can actually be considered to be psychological disorders, as each are categorized by the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as paraphilias, which are sexual disorders that are characterized by socially unacceptable preoccupations or behaviors. Some other examples of paraphilias include voyeurism, exhibitionism, and fetishism, to name just a few. There’s a great deal of controversy on this topic, and at first glance, I generally think of sexual sadism and masochism as quasi-disorders at best. Proponents of the ‘disorder theory’ claim that because sadism involves causing physical or psychological pain or suffering to another human being, anyone who enjoys it is mentally ill. Opponents say that it doesn’t involve pain or suffering in the ‘classic sense,’ (say whaaat??) and that as long as it occurs with a consenting partner, it should be argued that it is not a psychological disorder. 

I say that there are many factors to take into account, but that it should definitely be considered a psychological disorder in certain cases: if and/ or when it causes anxiety or depression to that individual, causes problems that interfere with work, social setting, or family, and obviously when it poses, or is likely to pose, a potential danger to another individual person or group. And in fact, more recent versions of the DSM back me up, asserting that it must “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” in order for sexual sadism or masochism to be considered a disorder. I’ll spare you the markers that must be considered to establish that distinction. And you’re welcome for that. 

When applied to sexual relationships, sadomasochism is generally termed BDSM, or Bondage and Discipline, Dominance and Submission, and Sadism and Masochism. BDSM is generally considered to be an “alternate” sexual preference that includes a variety of sexual identities and activities. Mainstream culture often represents it as reckless, dangerous, and unhealthy; a dark, non-normal kind of sexual preference which typically forces its players to retreat into carefully curated communities alienated from the majority of society. If you actually paid attention to Fifty Shades of Grey, you might have understood that Christian Grey’s reasons for enjoying kink stem from a childhood filled with abuse. Television crime dramas often portray fetishists as seedy, unethical lawbreakers, and that’s probably as a result of the psychological disorder theory more than anything else. Participants or “kinks” often make the argument that dominance and submission are more a power dynamic than a punisher-punishee relationship; and they usually identify themselves in one of three main ways: dominant, submissive, and switch, though the identities are fluid and continuous, and can change depending on the participants’ mood or partner. But if you consider the fact that the terms sadism, masochism, and sadomasochism were coined in the late 1800’s, pop culture wasn’t responsible for making kink the latest fad… it seems some humans have long had a penchant for adventurous sex. Even way back in 1956, when the ​Kinsey Institute was in its heyday, a study revealed that 50% of men and 55% of women enjoyed erotic biting, evidently as racy as they got when describing kinky sex. Considering all of the historical evidence taken together, I can only surmise that we’re not necessarily having more kinky sex than we always were, but we’re just talking about it- or admitting it- more than before. 

BDSM Components

Bondage: A form of restricting a sexual player’s movement, ie by ropes or handcuffs, to increase pleasure.

Discipline: A series of rules and punishments typically used by a dominant partner to exert control over their submissive partner.

Dominance: The act of dominating a sexual partner, during or outside of sex. This can include dictating sexual behavior, food habits, and even sleep patterns.

Submission: The act of a submissive partner following a dominant’s actions or dictates. 

Consensual sadomasochism should not be confused with acts of sexual aggression. While sadomasochists do seek out pain in the context of love and sex, they do not do so in other situations, and typically abhor uninvited aggression or abuse as much as the next person. Generally speaking, sadomasochists are not psychopaths, and thankfully, the opposite is usually true as well. Also contrary to popular belief, evidently submissives have just as much control over deciding what happens to them as their dominant partner does, and sometimes even more so. Communication between the dominant and submissive is of utmost importance, as that’s where boundaries are set, desires are shared, and permission is given. Consent, in the form of a formal contract, a verbal agreement, or a casual conversation, is the key to healthy expression of BDSM and sadomasochism. There is typically an understanding between all partners that activity could stop at any moment should they be uncomfortable with the intensity of play; this can be done through the use of previously agreed upon safe words that signal others to stop when uttered. I’ve seen references to layers of safe words that are like a traffic light: green means good to go, yellow means proceed with caution, and red means get the hell away from me. That’s sure different than the “red light-green light” we played as kids. 

Speaking of games….

Maybe you think that this sort of stuff only applies to a small number of “deviants,” but the truth is that many people, if not most, do actually harbor sadomasochistic tendencies. For example, many casual, “normal” behaviors, like infantilizing, tickling, and love-biting, could be considered as containing traces and elements of sadomasochism. In addition, sadomasochism can play out on a more psychological level- sadomasochism on the DL if you will. Consider the fact that in almost every relationship, one partner is more attached than the other. This phenomenon is just accepted as fact without much discourse, so commonly that it has even been the subject of poetry and philosophy, with the more attached partner being referred to as “the one who waits.”

In 1977, A Lover’s Discourse: Fragments philosopher Roland Barthes writes:

Am I in love? —yes, since I am waiting. The other one never waits. Sometimes I want to play the part of the one who doesn’t wait; I try to busy myself elsewhere, to arrive late; but I always lose at this game. Whatever I do, I find myself there, with nothing to do, punctual, even ahead of time. The lover’s fatal identity is precisely this: I am the one who waits.

When this asymmetry is examined, the less attached partner (A) grows dominant, while the more attached partner (B) becomes infantilized and submissive in a bid to please, coax, and seduce them. Sooner or later, (A) feels stifled and distances themselves, but if he or she moves too far away, (B) feels threatened and may go cold or give up. That in turn prompts (A) to flip and, for a while, to become the more enthusiastic of the two. But the original dynamic soon re-establishes itself, until it is upset again, and so on, ad nauseum. Domination and submission are elements of every relationship (or nearly so) but that does not mean that they are not tedious, sterile, and immature, as Freud points out…endlessly I might add.

Rather than playing cat and mouse, couples need to have the confidence and the courage to rise above the game playing. True love is about trusting, respecting, nurturing, and (healthy) enabling, but not everyone has the capacity and maturity for this kind of love. I see this domination-submission phenoma nd game playing a lot…like a lot a lot, and it can be quite the mess to rectify, as people get comfortable in their roles, whetjer they’re conscious of them or not. 

Sadomasochism, BDSM, kink…they aren’t really my thing. Then again, neither is sociopathy, but I can still effectively diagnose and treat patients with it. That said, sadomasochism as a practice is definitely harder to understand than just grasping it as a general concept. I classify it as one of those great mysteries of the human condition that give me a headache when I try to completely untangle them. I’ve of course had patients into all kinds of kink and BDSM, and then again, I’ve also had some who are more “classic” practicing sadomasochists, who can be more challenging to treat. Everybody’s got a backstory that I may or may not be privy to, so I don’t judge and I think I do a pretty good job of treating everybody fairly. I figure that understanding, or at least the most earnest attempt at it, is the best way to deal with anything we may not ascribe to, even as we wish to respect the person who does. Along that same vein, if you’re curious about BDSM and kink, there are websites galore with tips and tricks, even online “academies” where you can learn to be a dom or a sub, or BDSM groups for the over 50 set…you name it, it’s there for your perusal. If you do decide to partake, I can only suggest to communicate, communicate, communicate; be safe, establish a safe word and safe boundaries, and have fun people. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too! 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and remember… sharing means caring! Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them. As always, my book, Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Migraines;Strategies to Treat It and Bear It

Migraine: Strategies to Treat It and Beat It

Last week, I talked all about migraine. What do I hope were the takeaways? Well, there are roughly 10,000 known human diseases under the sun… of allll those diseases, I hope you learned that migraine is a very unique beast, thanks to a very unusual constellation of facts surrounding it: its striking capacity to debilitate (ranked first in neuro and sixth overall) and staggering prevalence (ranked third overall) despite a frighteningly high (60%-70%) rate of misdiagnosis really make it a beast of a neurological disease. 

This week, the focus will be on how to manage and/ or prevent migraine. I’m going to cover some basic suggestions and nonprescription ways to avoid or prevent migraine, and I’m also going to discuss some prescription medications and procedures to treat migraine when it occurs. Spoiler alert: one of the very new migraine meds has been like a miracle in my life people. So read on to find out how you might be able to avoid getting a migraine as well as some ways to deal with it once it rears its ugly head. 

First, a few more takeaways from part 1: 

– Migraine is more than a bad headache. 

– Proper and early diagnosis by a specialist physician with specific neuro symptoms is very important. 

– Episodic migraine occurs once or twice a month while chronic daily migraine is minimum 15 days per month. 

– There are several migraine types classified mainly by presence or absence of neurological aura. 

– Migraineurs often have identified triggers that will cause attack. 

– All migraines suck, but some more so than others (hello cluster, rebound, and status migrainosus) because of the extreme pain, but also because of the extreme neurological disturbances that come along for the ride. 

– Exact cause of migraines still unknown, but thought related to a combination of genetics, neurotransmitters, and/ or hormones. 

– There are medications to prevent, abort, and rescue from migraine.

Why isn’t there an obvious known way to prevent and treat migraine?

When people find out I have cluster headaches or when I’m asked by a fellow migraineur or a patient why we don’t already have a foolproof way to prevent and treat migraine, the answer is intensely unsatisfying, especially considering that migraine affects zillions of people, and has done so for a looong time. For the love of Pete, why haven’t we figured it all out by now? Well, even though it is the world’s most common cause of neurological disability, researchers are only just beginning to understand what really causes migraine. I say ‘really’ because unfortunately, the common and long accepted vascular explanation for migraine had to be thrown out relatively recently. The vascular theory was proposed in 1938 and claimed that pressure changes in the vascular system near the brain, and in the brain, caused migraine. More specifically, that vasospasm and vasoconstriction narrowed the blood vessels, slowing and restricting blood supply in and around the brain and causing visual aura and other neuro symptoms; then vasodilation occurred, and those vessels rebounded and widened, allowing too much blood to course through too quickly and causing pain. Eventually, the vessels came back to their normal size and state and the migraine ended…until the next time. This vascular explanation had considerable intuitive appeal because alteration in blood flow seemed to fit the pulsating pain quality that migraine headaches often possess. But now after extensive testing, this theory no longer has any validity. We now know for sure that migraine is a gene-related neurological disease, not a vascular one. So we lost a lot of valuable time looking at the wrong culprit and screwing around with the vascular theory.  

Current research shows that a variety of genetic mutations are at least partly responsible for migraine, with the TRESK gene being identified as one such genetic mutation site. The TRESK gene provides the blueprints for a potassium ion pump channel that is believed to help nerve cells rest. When mutations occur in this gene, they may cause nerve cells to become overexcited, making them more responsive to a smaller pain stimulus or less pain. Personally, I would call that over-reactive rather than overexcited, but that’s just me. Either way you get the idea. Even though genetic mutations tell part of the story, migraine initiation is enormously complicated. It relies on several processes which either result in a visibly changed brain structure or are caused by these changes in structure. In fact, it seems that most scientists believe as I do, that there isn’t just a single cause. In my thinking, there can’t be- there are so many different systems and senses affected that there have to be multiple causes in play. Obviously, lots of research is still needed before we know the whole story. 

Treating Migraine: Natural Remedies

When a migraine does strike, you’ll do almost anything to make it go away. There are ten natural remedies and at-home treatments that may help prevent migraines, or at least help reduce their severity and duration. 

1. Know and avoid triggers, esp in diet

Diet plays a vital role in preventing migraines. Many foods and beverages are known migraine triggers, such as:

-Foods with nitrates, including hot

dogs, deli meats, bacon, and sausage

-Chocolate

-Naturally-occurring tyramine compound, such as blue, feta, cheddar, Parmesan,

and Swiss cheese

-Alcohol, especially red wine

-Foods that contain the flavor enhancer monosodium glutamate (MSG) 

-Foods that are very cold such as ice

cream or iced drinks

-Processed foods

-Pickled foods

-Beans

-Dried fruits

-Cultured dairy products such as

-Buttermilk, sour cream, and yogurt

-Caffeine: a small amount of caffeine may ease migraine pain in some people, and a small amount of caffeine is found in some migraine medications. But too much caffeine may also cause a migraine and/ or may also lead to a severe caffeine withdrawal headache.

**Track yourself! As Migraine Warriors, we tend to think of the occasions when attacks occur and the major symptoms that go along with them. Always keep a diary or list of things that act as warning signs or triggers of an oncoming migraine, including foods or environmental triggers, how much sleep have you had, what the weather is like, what you ate and when, etc.  To figure out for the first time which foods or beverages may trigger your migraines, keep a daily food diary. Record everything you eat and note how you feel afterward. All information may be very important and will likely help you to avoid future attacks.

2. Apply lavender oil

Inhaling lavender essential oil may ease migraine pain. According to a 2012 study, people who inhaled lavender oil for 15 minutes during a migraine attack experienced faster relief than those who inhaled a placebo. Lavender oil may be inhaled directly or diluted and applied to the temples.

3. Try acupressure or acupuncture

Acupressure is the practice of applying pressure with the fingers and hands to specific points on the body to relieve pain and other symptoms. While there are no recent scientific studies, according to some sources, acupressure is a credible alternative therapy for people in pain from chronic migraine and other conditions, and may also help relieve migraine-associated nausea. And although there may not be any definitive  scientific studies on acupuncture, some migraines may respond well to acupuncture, the Chinese method of inserting needles into specific body locations to reduce or stop pain. Because the results are so variable, some doctors do not recommend this treatment. But because some patients report headache relief, it is another treatment method to consider.

4. Look for feverfew

Feverfew is a flowering herb that looks like a daisy, and according to some, is a folk remedy for migraines. According to some sources, there’s not enough evidence that feverfew prevents migraines, but many people still claim it helps their migraine symptoms without side effects.

5. Apply peppermint oil

The menthol in peppermint oil may stop a migraine from coming on. A 2010 study found that applying a menthol solution to the forehead and temples was more effective than placebo for the pain, nausea, and light sensitivity associated with migraine. 

6. Go for ginger

Ginger is known to ease nausea caused by many conditions, including migraines, and it may also have other migraine benefits. One study claimed that ginger powder decreased migraine severity and duration as well as the prescription drug sumatriptan, and with fewer side effects.

7. Sign up for yoga

Yoga uses breathing, meditation, and body postures to promote health and well-being and may relieve the frequency, duration, and intensity of migraines. It’s thought to improve anxiety, release tension in migraine-trigger areas, and improve vascular health. Although researchers conclude it’s too soon to recommend yoga as a primary treatment for migraines, they believe yoga supports overall health and may be beneficial as a complementary therapy.

8. Try biofeedback

Biofeedback is a relaxation method that teaches you to control autonomic reactions to stress. Biofeedback may be helpful for reducing migraine triggers like stress and early migraine symptoms such as muscle tension.

9. Take vitamins and supplements

Some vitamins and supplements (collectively known as nutraceuticals) may be useful therapies. One of the nutraceuticals that has shown some evidence of relief in preliminary testing is magnesium. Magnesium deficiency is known to be linked to headaches and migraines and studies show magnesium oxide supplementation helps prevent migraines with aura, and may also prevent menstrual-related migraines. Adding magnesium to your diet may be helpful. You get magnesium from foods like nuts and nut products, including almonds, sesame seeds, sunflower seeds, Brazil nuts, cashews, peanut butter, eggs, oatmeal, and milk.

10. Book a massage

A weekly massage may reduce migraine frequency and improve sleep quality, according to a 2006 study. The research suggests massage improves perceived stress and coping skills and also helps decrease heart rate, anxiety, and cortisol levels.

The Takeaway

If you get migraines, you know the symptoms can be challenging to cope with. You might miss work or not be able to participate in activities you love. Try the above remedies to possibly find some relief… they can’t make it much worse!

It might also be helpful to talk to others who understand exactly what you’re going through. There are lots of websites, support groups, and apps to connect you with real people who also experience migraines. You can ask treatment-related questions and seek advice from other people who totally “get it.” So do some googling for migraine support. 

Calculate your Headache Burden

Another good idea… Some doctors like to estimate how much migraine disrupts your normal activities before establishing a treatment regimen. A questionnaire may be given to the patient to estimate how often they miss various functions (school, work, family activities) because of their attacks. You can also commonly find other surveys and tools online meant to be filled out, printed, and brought to a primary care physician to broach the subject of headache and/ or to discuss migraine types with specialist physicians to help define headache/ migraine type and zero in on the best treatment regime.

Treating Migraine: Medications

There are many types of medications for people with migraine headaches. Some help to reduce symptoms of acute migraine as they occur, while others prevent episodes from occurring. Captain Obvious says that taking any drug can have side effects, and that some are safer than others.

Two primary ways that medications treat migraine headaches: Acute medications aim to treat symptoms of migraine headaches as they occur. Preventive medications aim to reduce the risk of migraine headaches occurring in the first place by reducing migraine frequency and severity.

Over-the-Counter (OTC) Medications

-Acute medication to treat migraine

-A range of migraine medications are available without a physician’s prescription. 

-These include analgesic medications like aspirin, acetaminophen, naproxen, or ibuprofen, may help to reduce pain. 

-Many of these analgesic medications are nonsteroidal anti-inflammatory drugs (NSAIDs). This means that similar to steroids, they reduce inflammation which may help with migraine symptoms. 

-It is best to take these medications when the first signs of an episode occur. The medicines will take time to enter the bloodstream, and taking them too late means that the headache will likely last longer and possibly won’t be susceptible to the medication; in other words it may not help. 

-The risks associated with using OTC analgesics are relatively low. 

-May cause mild side effects in some people, such as rashes.

When over-the-counter (OTC) medications do not work, a doctor may recommend stronger prescription drugs. There are several different types of prescribed migraine medications.

Prescription Medications: Treat Migraine

As opposed to preventing migraine

Ergot Alkaloids: Treat Migraine

-Medication to treat acute migraine

-I want to point out that ergot drugs are really old school. The American Migraine Foundation wants to point out that doctors don’t commonly prescribe them any longer, but they may recommend them in severe cases if someone doesn’t respond to other analgesics.

-Two main types are dihydroergotamine (DHE)  and ergotamine (Ergomar)

-Ergot alkaloids may cause blood vessels to narrow, which can have serious side effects for people with cardiovascular disease issues.

-Other potentially serious side effects: nausea, dizziness, muscle pain, unusual or bad taste in the mouth, vision problems, confusion, unconsciousness, in addition to many drug interactions.

-These side effects and the drug’s interactions are so problematic that physicians typically severely restrict use of ergotamines except in very rare cases.

-Fun fact: many scholars claim that the behavior of Salem’s “witches” was actually due to a fungal infection in the grain used at the time; ergotamines are essentially a mimic of this grain infection. So maybe don’t take it unless you look good in black and like the pointy hat look. Yikes people! Because of the side effect profiles and lack of efficacy, this class is definitely not as commonly used as newer and more effective triptans and more novel compounds.

Triptans: Treat Migraine

-Acute medication to treat migraine

-Approved to treat moderate to severe migraines: headaches where the symptoms interfere with the ability to perform daily tasks.

-Triptans act on the symptoms of a migraine headache in its early stages. -They will not stop the migraine headache, but they can help with some symptoms, such as nausea, pain, and light sensitivity. 

-Several triptan medications exist:

sumatriptan (Imitrex)

zolmitriptan (Zomig)

rizatriptan (Maxalt)

-A person should take these drugs as soon as migraine symptoms start. 

-They may not work if taken during a migraine aura. 

-They are available in several forms: pill, orally disintegrating tablet, nasal spray, or injection.

-Triptans can cause side effects: dizziness, fatigue, nausea and vomiting, pain in the throat, chest, or head, numbness, dry mouth, burning or prickly feeling on the skin, indigestion, hot flashes, chills.

Antiemetics/Antinausea: Treat Migraine

-Acute medication for migraine symptoms

-Also known as antiemetic drugs, these can help people with migraine, even if they don’t feel nauseous. 

-Don’t reduce pain, so some people take them alongside pain relief medication.

-Examples of antiemetic drugs:

chlorpromazine (Thorazine)

metoclopramide (Reglan)

prochlorperazine (Compazine)

promethazine (Phenergan)

CGRPReceptor Antagonist: Treat Migraine

-The FDA has recently approved several drugs that block calcitonin gene-related peptide (CGRP) receptors for the immediate treatment of migraine.

-CGRP is a molecule typically involved in migraine episodes.

-Examples of recently approved CGRP receptor antagonists include ubrogepant (Ubrelvy) and rimegepant (NURTEC).

Ubrogepant (Ubrelvy): Treat Migraine

-First drug in the class of oral CGRP (calcitonin gene-related peptide) receptor antagonists approved for the acute treatment of migraine with or without aura in adults

-Similar to Rimegepant (Nurtec ODT)

-Most common side effects that patients in the clinical trials reported were nausea, tiredness, and dry mouth. 

-Contraindicated for co-administration with strong CYP3A4 inhibitors such as ketoconazole, clarithromycin, and itraconazole.

-Your doctor may change your treatment plan if you also use: nefazodone; an antibiotic – clarithromycin, telithromycin; antifungal medicine – itraconazole, ketoconazole; or antiviral medicine to treat HIV/AIDS – indinavir, nelfinavir, ritonavir, and saquinavir.

Rimegepant (Nurtec ODT): Treat Migraine

-CGRP receptor antagonist used for acute treatment of migraine with or without aura in adults. 

-Similar to ubrogepant (Ubrelvy)

-Orally Disintegrating Tablets (ODT) for sublingual or oral use.

-Side effects include: nausea and

hypersensitivity, including shortness of breath and severe rash

-Important: like Ubrelvy, Nurtec will interact with other medicines such as: strong CYP3A4 inhibitors and moderate CYP3A4 inhibitors such as ketoconazole, clarithromycin, and itraconazole. Will also interact with inhibitors of P-gp or BCRP.

**This is the new medication for treating migraine that works like a miracle for moi people!

Lasmiditan (Reyvow): Treat Migraine

-First in a brand-new class of drugs (Ditans) that stimulate the serotonin 1F receptor found in different brain regions and believed involved in causing migraine

-Slows body’s pain pathways

-Used for acute treatment of migraine with or without aura in adults. 

-Not useful for migraine prevention. 

-Taken by mouth 

-Common side effects: sleepiness, dizziness, tiredness, numbness

-Reduces inflammation that arises in the nervous system. 

Prescription Medications: Preventing Migraine

-For people who get migraine headaches regularly, some medications can help to reduce the number and severity of episodes, ie prevent migraine.

-Most drugs for preventing migraine headaches are relatively low risk.

-May cause side effects such as constipation, muscle spasms, and cramps.

-Several categories of preventative medications:

Antihypertensives

-Antihypertensive drugs lower blood pressure, usually in people with high blood pressure. 

-There are many different types of antihypertensive drugs that might help to prevent migraine headaches, such as: beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors

Anticonvulsants

-Anticonvulsant drugs treat seizures in people with epilepsy by reducing activity in the brain- and this can also reduce the risk of a migraine headache.

-Examples of anticonvulsants for treating migraines include topiramate (Topamax) or valproic acid (Depakene).

Antidepressants

-Antidepressants often work to increase the availability of serotonin in the brain. -Because of this mechanism, some of these drugs could also help to prevent migraine headaches, such as amitriptyline (Elavil).

CGRP inhibitors

-Calcitonin Gene-Related Peptide

-CGRP inhibitors are preventive migraine treatments that disrupt a protein called CGRP, which is particularly active in people with migraines.

-They block the flow of CGRP to the brain, disrupting signals that cause migraines.

-Unlike traditional migraine meds, such as sumatriptan (Imitrex), CGRP inhibitors don’t constrict blood vessels, so they’re safe for people who’ve had a stroke, heart attack, or vascular disease.

-Three new CGRP inhibitors are injected once a month to prevent migraines:

erenumab (Aimovig) 

fremanezumab (Ajovy) galcanezumab-gnlm (Emgality)

-So new: may cause unknown side effects, and consequences of long-term use are still unknown. 

Eeptinezumab-jjmr (VYEPTI)

-FDA 2020 approval, migraine prevention in adults

-First drug for migraine prevention via IV infusion.

-Treatment involves doctor administering this drug intravenously for 30 minutes every 3 months.

Devices: Treat/ Prevent Migraine

-There are three new noninvasive medical devices currently available:

Cefaly

-Placed on the forehead to stimulate a nerve that impedes migraine pathways. 

-Used as prevention or for treating when a migraine strikes.

-SpringTMS

-Magnetic stimulator placed on the back of the head to disrupt migraine signals in the brain.

-Used as prevention or for treating when a migraine strikes.

gammaCore

-Third device

-Used for treating when a migraine occurs, cannot prevent migraine

-Placed at front of the neck to stimulate the vagus nerve. 

Procedures: Preventing Migraine 

There are two profedures used in an attempt to prevent migraine by reducing frequency and severity.

SPG Nerve Block

The sphenopalatine ganglion (SPG) is a group of nerve cells linked to the trigeminal nerve. 

-Applying local anesthetics to this group of nerve cells can reduce sensations of pain related to migraines.

-Doctors can apply medication to this area through the use of small tubes called catheters. They can place these tubes inside the person’s nose, then insert numbing medication through the tube using a syringe.

Botox Injections

-OnabotulinumtoxinA (Botox) injections for people with chronic migraine headaches. 

-Doctor might prescribe Botox if a person has experienced at least 15 headaches per month for 3 months, eight of which must have included migraine symptoms.

-Doctors tend to recommend two or three other types of medication before trying Botox injections.

-Comes as injection only, can have many side effects.

-Progress carefully monitored, treatment may be stopped if there is no response after 8–12 weeks or if migraine episodes fall to less than 10 per month for 3 months.

-Can also have many possible side effects, including numbness or mild nausea. -Some other side effects are more serious, such as gallbladder dysfunction, visual problems, and bleeding.

Your Migraine Treatment: Is it Working?

-Sometimes initial treatments for migraine either do not reduce the symptoms or only marginally reduce them. 

-If, after trying prescribed treatment(s) about two or three times and getting little or no relief, you should ask your doctor to change the treatment.

-Patients are strongly urged to treat migraine attacks early: some references indicated to take it within about 2 hours of the start of headache to get full benefit of treatments.

-Taking it earlier is better: as early as possible.

Migraine Treatment: Medication Limits

-Some chronic headaches are due to overuse of medicine

-Avoid using migraine-prescribed medicines more than twice per week. -Using and tapering medicine for migraine should proceed under your doctor’s supervision. 

-Narcotics are a bad idea except used only as a last resort for migraine because they are addictive and very easily cause rebound headache pain. For example, only in an emergent situation, an ER visit.

Migraine: When to Seek Emergent Care

Most people know the pattern of their attacks (triggers, auras, and headache pain intensity). However, new headaches, in people with or without a migraine history, that last two or more days should be checked by a doctor. However, if a headache develops with symptoms such as fever, stiff neck, confusion, or paralysis, the person should be examined emergently and should be taken to an Emergency Medicine Department for scans and thorough evaluation.

Okay people, now you know pretty much everything about migraine… I hope it’s information you don’t need for yourself, and that you can tuck it away in your brain for the who knows when future. If you learned something, great! If you’re interested in a blog about a specific topic, please feel free to leave that in this comments section and I’ll see what I can do. And don’t forget about the sex and orgasm survey people! We need people to agree to be contacted once we finish it, so leave that in the comments too if you’re willing to takw it. Please pass this blog on to friends and fam. And definitely check out my YouTube channel for all of my videos and please like, comment, and share those too. As always, my book Tales From the Couch is available on Amazon and in the office. 

Thanks people!

MGA

Learn More

Migraines,Part 1

Migraines, Part I

This is a very personal topic for me, as I have had cluster headaches and migraines my entire life. While I was double checking a statistic for this blog, I came across a term that I’d never heard before: migraineur. Such a romantic sounding word to define a person with migraines. But when in Rome… As a migraineur, at times my headaches dictated my entire life, what I did and when I did it; or more accurately, if I did it. My cluster headaches are horribly disabling, like fireworks going off in one side of my head; bunches of them exploding at random intervals- in clusters- hence the name. Best medical intel indicates this barrage lasts 4 to 72 hours, though mine have always been a helluva lot closer to the latter than the former. And I swear that migraines and clusters somehow alter the spacetime continuum, tearing a hole in the fabric of time such that every minute lasts an hour. In any event, suffice it to say that every minute of a cluster or migraine is the Longest! Minute! Of! Your! Life! If you’re having difficulty imagining what that pain might feel like, consider yourself lucky. Most people (physicians included) don’t realize how consequential and life altering migraine can be. Migraine is the 3rd most prevalent illness on the planet and the 6th most debilitating illness on the planet, yet also the most misunderstood, underestimated, mis-/un-diagnosed, and mis-/under-treated neurological disorder, especially in relation to its symptoms and ability to incapacitate afflicted people, people. While most migraineurs have “attacks” or episodes once or twice a month, more than 4 million adults experience chronic daily migraine, which is defined as having at least 15 migraine days each month. Though it’s usually unintentional, medication overuse in treating episodic migraine is one of the most common reasons why episodic migraine becomes chronic daily migraine. 

Migraine Fast Stats

-Affects 12% of the US population = 39 million people in US, 1 billion globally.

-Affects 18% of all American women, 6% of all men, and 10% of all children.

-Onset can occur at any time, but most commonly falls between ages 18 and 44.

-Approximately 90% of migraine sufferers have a family history of migraine.

Migraine and Gender

-Migraine disproportionately affects women, as 85% of chronic migraine sufferers are female, affecting 28 million women in the US.

-Fluctuations in estrogen levels are often responsible for increased severity and frequency of migraines.

-Before puberty, boys are more affected by migraine than girls, but adolescence sees an increase in the risk and severity of migraine in girls such that by adulthood, three times more women suffer from migraine than men.

Pediatric Migraine

-Very often undiagnosed or misdiagnosed

-Evidence suggests association with infant colic, possibly an early form of migraine.

-Occurs in kids as young as 18 months.

-50% of first migraine attacks occur before age 12.

-Occurs in 10% of school-age children 7-14 and 28% of adolescents 15-19.

-Migraines are hereditary: studies have shown that a child with one parent who suffers from migraines has about a 50% risk of developing migraines, but if both parents have a migraine diagnosis, a child’s risk of developing migraines jumps to 75%. If just a distant, non-parent relative suffers from migraine headaches, the risk for any genetically related offspring to also develop migraine is 20%. 

-Childhood aged boys suffer from migraine more often than girls, but as adolescence approaches, the incidence rate increases faster in girls than in boys, and by adulthood, females with migraine outnumber males by three to one.

Costs of Migraine

-Migraine is a public health issue with major social and economic consequences.

-More than 157 million workdays are lost each year in the US due to migraine.

-US industry loses $36 billion per year due to absenteeism, lost productivity, and medical expenses caused by migraine.

-US headache sufferers receive $1 billion worth of brain scans each year.

-Over 90% of sufferers are unable to work or function normally during migraine, claiming at least a 50% reduction in overall productivity.

-24% of people living with migraine disease report headaches so severe that they have sought emergency room care.

-Medical costs of treating chronic migraine itself equal approximately $6 billion annually, but sufferers spend nearly seven times that treating the conditions often associated with it including depression, anxiety, and sleep disturbances. 

-Healthcare costs are 70% higher for a family with a migraine sufferer than a non-migraine affected family.

Headaches vs Migraines: Who’s Who?

Headache refers to any pain within the head, face, or neck. This pain may be centralized to one focus or area, or it may be diffuse and emanating throughout all areas. While many people consider all “bad” headaches to be migraines and/ or use the two terms interchangeably, this is inaccurate. As I’ll explain next, migraines are a type of primary headache, so that means that all migraines are headaches. But the reverse, that all headaches are (or can be) migraines, is not true. 

Headaches: Three Main Categories

Category 1) Primary Headache

Category 2) Secondary Headache

Category 3) Painful cranial neuropathies and other (facial) pain

Primary Headache: Refers to a headache that occurs on its own. The three major types of primary headaches are migraine, tension, and cluster.

Secondary Headache: Refers to a headache that is caused by something else, such as ‘medication overuse headache’ which is caused by using migraine medication over a long period of time. This is also known as rebound headache, a very disabling headache that is basically the result of taking meds for frequent migraines over an extended time period, even when taken as directed. I have a chronic daily migraine patient that at one time had 22-plus migraine days per month, and she got locked into a gnarly rebound headache. They’re super painful and the only way to treat them is to discontinue the causal migraine med… and that’s a problem if that’s the only thing that’s ever helped. Thankfully, these days we have more options for both preventing migraine and treating it when it rears its ugly head. But I’ll tackle all of that next week. For now, continuing on with migraines.

Painful Cranial Neuropathies and Other Facial Pain: Refers to headaches/ pain arising from, or related to, nerve abnormalities in the upper part of the head and neck. For example: a whiplash injury or disk injury with nerve damage (ie neuropathy) leading to inflammation and pain.

As opposed to “bad” headache, migraine is a neurological disorder whose accurate diagnosis requires the presence of specific symptoms and certain qualities.

Requisite Migraine Symptoms

Migraine attacks are accompanied by one or more of the following disabling symptoms: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch, and smell, and/ or numbness/ tingling in extremities or face.

Migraine Qualities

-(Mostly) occuring on one side of head

-Pulsating pain quality

-Moderate to severe pain intensity

-Made worse with physical activity

-Nausea and/ or vomiting

-Sensitivity to light (photophobia)

-Sensitivity to sound (phonophobia)

Migraine: Ancillary Symptoms

The presence of one or more disabling symptoms (listed above) are required for diagnosis of migraine, but many other ancillary symptoms can be (but aren’t required to be) associated with migraine. These can include abdominal pain, fever, dizziness, and fatigue.

Migraine: Triggers

Many things under the sun can trigger a migraine. Triggers are very individualized, they’re not the same for everyone; what’s more, what causes or triggers a migraine in one person could relieve it in another. 

Migraines are commonly triggered by environmental factors, and these can be external factors like eating certain foods or taking certain medications, or internal factors like stress or blood sugar changes. 

Triggers may be hormonal, behavioral, physical, emotional…they vary, but there are common themes. Below are some of the usual suspects, along with ways to avoid them. 

Certain light patterns, loud sounds or strong smells

Alcohol: Red wine is a common and well recognized migraine trigger, but other alcoholic drinks can also cause migraine.

Weather changes: Even small changes in barometric pressure can cause migraine, especially those associated with storms and hurricanes. If weather is a trigger for you, ask your doctor about the possibility of taking medication at the first sign of atmospheric change.

Bright light: It’s believed that light “turns on” certain cells that can trigger pain. Wearing sunglasses indoors can increase your eyes’ sensitivity to light, so save your shades for outside. You can also try wearing FL-41 boysenberry-tinted lenses, which have been shown to minimize the triggering effect of light.

Caffeine: Caffeine is unusual in that both its presence, and its withdrawal, can trigger a migraine; and it is a common component of prescription and over the counter migraine remedies. If you have migraine, your best bet is to not vary your regular coffee/ tea routine and caffeine intake, even on weekends.

Processed meats and cheeses: Some people may be sensitive to tyramine, a substance found naturally in some foods: especially aged and fermented foods like some cheeses, kimchi, smoked fish, soy sauce, caviar, cured meats, and some types of beer. 

Computers: Poor ergonomics and the screen’s bright light can combine to trigger a migraine. Practice good posture and take frequent stretch breaks.

Dehydration: Not consuming enough liquids causes blood volume to drop and decreases blood flow to the brain, which can trigger migraine. Low electrolyte levels and/ or the loss of electrolytes are also common culprits. Aim to drink at least eight 8-ounce glasses of water a day.

Hormonal changes: Migraines affect women disproportionately, which could be partly due to fluctuations in estrogen levels. Talk to your doctor about whether you should take NSAIDs a few days before menstruation.

Hotter temperatures: The risk of migraine jumps almost 8% for every 9-degree Fahrenheit increase in temperature. Stay hydrated and consider avoiding outdoor activities during the hottest seasons and/ or times of the day if you’re sensitive. 

Anatomical Migraine Triggers

Rather than an environmental trigger, these are four distinct external sensory nerve regions in the neck and face that can act as anatomical migraine triggers. Patients who are subject to one or more of these triggers will feel as if migraines are emanating from these specific areas.  The common trigger areas are 1) the area above the eye/ forehead, 2) the neck, 3) the nose (felt behind the eye), and 4) the temple(s).

Two long term treatment options act against these trigger points: 

-Botox injections will relax all of these trigger sites except for the nose. 

-Trigger point surgery will physically release these nerves. 

More on these next week.

Migraines: Diagnosis

Nearly one in four American households includes someone with migraine. This exceptionately high incidence rate means that every American knows someone who suffers from migraine (whether they’re aware of it or not) or they themselves struggle with it. Despite this high incidence rate, migraine is misdiagnosed more frequently than it is accurately diagnosed, most often as tension headache or sinus headache. Seriously? Misdiagnosed as often as it’s accurately diagnosed?! Scary, no? Blows my mind… but check out this this cute little factlet: 60% of women and 70% of men with migraine are misdiagnosed… period, end of story. But getting an accurate diagnosis is critical for arranging the right treatment, as some medications indicated for specific migraine types can actually be dangerous to people with other migraine types. 

The science behind migraines can get complex people… we are dealing with the brain after all. But understanding exactly what’s occuring during a migraine can help in receiving the proper diagnosis and treatment options, as when it comes to migraine, it’s always better to err on the side of caution. Why? Aside from the fact I mentioned above, about how certain type-specific medications can be dangerous if utilized incorrectly… Well, if a migraine is not properly diagnosed and treated, an individual will typically experience recurrent and increasingly severe symptoms, including extreme head pain, fatigue, nausea, vomiting, and increased sensitivity to light and sound. Not only do the symptoms of the migraine become more severe when left untreated, the migraine tends to become more difficult to treat as it becomes more prolonged. In addition, the neurological disorder as a whole tends toward the progressive, such that subsequent instances of migraine and associated symptoms generally become more severe with time. But even setting aside the health and medical implications, there’s simply no reason to suffer pain needlessly and allow your life to be totally disrupted in the (horrifyingly) special way that only migraines can. Primary care physicians are often responsible for a preliminary diagnosis of migraine headaches, but it is strongly suggested that patients suspected of having migraines see a neurologist for a full workup, including a neuro evaluation and imaging studies if/ when indicated. Knowing exactly which type of migraine you have is essential to finding the safest and most effective treatment for you.

What’s Up with the Migraine Brain?

What’s happening in the brain to create such an excruciating storm? A migraine typically starts with a trigger, which is often incoming sensory information that wouldn’t bother most people… maybe opening the door to a bright sunny day or walking into Starbucks with the intense smell of coffee beans roasting. But a migraine brain is essentially damaged, so it doesn’t respond to stimuli the way a “normal” non-migraine brain does. So during a migraine, these incoming stimuli feel like an all-out assault.

Simple mechanistic view of a migraine brain: upon presentation of a trigger, the migraine prone brain produces an oversize reaction to that trigger, and its electrical system immediately starts (mis)firing on all cylinders. All of this electrical activity causes a change in blood flow to the brain, which in turn affects the brain’s nerves, causing pain and other associated symptoms. About 25% of migraine sufferers have an associated visual disturbance called an aura, which usually lasts less than an hour. In 15-20% of migraine attacks, other disabling neurological symptoms occur before the actual head pain, while in some other cases of migraine, these neurological symptoms occur without any actual head pain. More on these specific phenomena to come. 

Migraine: Progression of Stages

Migraine attacks can progress through four distinct stages: prodrome, aura, attack, and post-drome. It’s important to note that not everyone with migraine goes through any or all of these stages.1) Prodrome Stage

Beginning one to two days before a migraine, some subtle changes that may warn of an impending migraine include:

-Constipation

-Mood swings, depression to euphoria

-Food cravings

-Neck stiffness

-Increased thirst and urination

-Frequent yawning2) Aura Stage

Reversible symptoms or sensations of the nervous system that might occur before or during migraines or other neurological events. They’re usually visual symptoms, but they can also include other types of disturbances as well. Each symptom usually begins gradually, builds up over several minutes, and lasts for 20 to 60 minutes before fading away.

Examples of migraine aura include: 

-Visual phenomena, ie bright spots, flashing lights, and zigzag lines

-Vision loss

-Pins & needles sensations in extremities

-Weakness or numbness in face or single side of the body

-Difficulty speaking

-Auditory symptoms: noises/ music

-Uncontrollable movement,shakes/jerking3) Attack Stage

A migraine usually lasts from 4 to 72 hours, depending on its severity and if/ how it’s treated. Migraine frequency varies from person to person; may occur rarely or strike many times each month.

During a migraine, you will likely have:

-Pain on one side of your head, but can occur on both sides.

-Pain that throbs or pulses

-Sensitivity to light, sound, smell, touch to varying degrees.

-Nausea and vomiting4) Postdrome Stage

After a migraine attack, you might feel drained, confused, hung over, and moody for up to two days. Some people report mood swings from elation to despair. Sudden head movement may briefly bring on pain once again.

Migraine: Treatment

Traditional migraine treatment involves a combination of medications, lifestyle changes, and potentially, alternative therapies like acupuncture. Migraine medications are usually divided into three groups: preventative, abortive, and rescue. 

Preventative medications: Captain Obvious says that preventative meds are generally taken daily in an effort to avoid getting (aka prevent) a migraine, as they are intended to reduce the frequency and severity of migraine attacks.

Abortive medications: Abortive meds are generally the first-line, acute medications meant to be taken when someone gets a migraine. Unlike pain medications that only mask the pain for a few hours, abortive medications work to stop the migrainous process itself and end the associated symptoms, and they are most effective when taken as early as possible in a migraine attack. 

Rescue medications: Rescue meds are often pain medications, and are intended to be used if and when abortive meds fail, or when abortive meds might be contraindicated due to allergy, side effects, or pregnancy in some cases. Other types of rescue meds can be used to help people relax and get through a migraine by reducing nausea for example. Rescue meds don’t have the ability to abort a migraine, but the idea is they may mask the pain for a few hours while the migraine runs its course. 

While most migraineurs experience “attacks” or episodes once or twice a month, more than 4 million adults experience chronic daily migraine, which is defined as having at least 15 migraine days each month. Though it’s usually unintentional, medication overuse in treating episodic migraine is the most common reason why episodic migraine becomes chronic daily migraine. About 25% of migraine sufferers have an associated visual disturbance called an aura, which usually lasts less than an hour. In 15-20% of migraine attacks, other disabling neurological symptoms occur before the actual head pain, while in some other cases of migraine, these neurological symptoms occur without any actual head pain. More on these specific phenomena to come. 

Migraine Types

Migraines are like ice cream… they come in a variety of different ‘flavors’ that ‘taste’ different to each of us. The basic ingredients may be the same, but the symptoms and severity vary widely by person, age at time of attack, and length of time they’ve been experienced. It’s always possible to have multiple migraine types, so talk to your doctor about your symptoms if you’re uncertain.

According to the ICHD-3 the International Classification of Headache Disorders, there are seven types of migraine, with diagnostic criteria based on scientific evidence. It should be clear by now that not everyone will have ‘typical’ migraine, so please view this information as a guide only, and not as a replacement for physician evaluation. Note that some references created different divisions.

ICHD-3 Seven Migraine Types:

1. Migraine without Aura

-Formerly called common migraine

-First & most widespread type of migraine 

-Main symptoms: throbbing pain that starts on one side of your head (as opposed to starting behind the left eye where most migraines tend to start), moving around tends to make the pain worse, and it’s normal to feel nauseous, dizzy, and sensitive to light and sound.

-Duration 4 to 72 hours

-Prodrome brings: difficulty speaking or reading, increased urination, irritability and depression, food cravings, frequent yawning, muscle fatigue or tight or stiff muscles in the neck and shoulders, nausea, constipation, or diarrhea, poor concentration, sensitivity to light, sound, touch, and smell, and trouble sleeping.

-After the 4 to 72-hour headache attack,  hits, postdrome with “migraine hangover” can make you: feel moody, feel sensitive to touch, especially in areas where the headache was focused, feel tired, have stomach issues

Here’s some more info about how the common migraine progresses.

2. Migraine with Aura

-Formerly called classic migraine, focal migraine, complicated migraine, aphasic migraine, migraine accompagnee.

-Main symptoms: visual disturbances before migraine begins, followed by common migraine symptoms

-Duration of visual disturbances: ranges from a few minutes to a full hour, usually before the actual migraine attack starts.

-Duration of migraine: 4 to 72 hours.

-25% of people with migraines also experience aura. 

-Aura can cause visual disturbances, neurological symptoms, and unpleasant feelings like a numb face or tongue, or pins and needles that spread across body.

-ICHD3 breaks these down even further into four types: typical aura, brainstem aura, retinal aura, and hemiplegic aura.- ICHD-3 Subtype 1: Typical Aura

-Typical aura brings visual symptoms, inc temporary blind spots, geometric patterns, zigzag lines, stars or shimmering spots, and flashes of light. – ICHD-3 Subtype 2: Brainstem Aura

-Brainstem aura involves symptoms that seem to originate in the brainstem, like difficulty speaking, double vision, ringing ears, or vertigo.- ICHD-3 Subtype 3: Retinal Aura

-Retinal migraine (a.k.a. ocular migraine and optical migraine) differs from a typical migraine with aura in that you typically only have visual disturbances in one eye. Because they cause visual issues, they’re sometimes called “ocular migraines” or “optical migraines.”- ICHD-3 Subtype 4: Hemiplegic Aura

-Hemiplegic migraine involves symptoms like motor weakness or a loss in the strength of your muscles, usually on one side of your body; you may also struggle with language and feel confused or tired.

-Like with typical aura migraines, these symptoms usually last only minutes, and usually for no more than an hour, though may be longer for some; but memory loss and problems with your attention span can linger for weeks or even months. -Sometimes, hemiplegic migraines can cause more serious issues, like seizures, coma, and long-term problems with brain function and body movement. 

-These facts might be frightening to read, but these types of migraines are rare and the extreme side effects are uncommon.

3. Menstrual Migraine

-Also called “hormonal migraines.”  

-Pretty much as they sound: migraines in women triggered by hormonal changes.

-Duration: 4 to 72 hours

-ICHD-3 notes that menstrual migraines can happen with aura or without, and usually strike just before or at the beginning of your period. 

-If you experience migraines during this time in two out of three periods, they are likely to be menstrual migraines.

-According to the US Office on Women’s Health, menstrual migraines might be triggered by the quick drop in the hormones estrogen and progesterone that happens before your period starts. -Affect about 7% to 19% of women 

-Most women who usually get menstrual migraines also have other migraine types at other times.

-Frustrating but good-to-know: menstrual migraines tend to last longer than your average non-menstrual migraines, and might be more painful.

4. Vestibular Migraine

-Main symptoms: vertigo, dizziness, and trouble with balance

-Duration: ranges from a few seconds to a few days

-Surprisingly common, affecting 30%-50% of migraine sufferers. 

-Vestibular migraines can give you sudden bouts of vertigo, where you see the world spinning or feel like you’re moving when you’re not. 

-These bouts of vertigo might not always occur like aura symptoms, ie right before a headache sets in…

-These vertigo bouts may happen for just a few random seconds or may even happen intermittently for a few days.

-Sometimes this occurs when you move your head too quickly or when you see something particularly stimulating. 

5. Migraine without Headache

-Main symptom: no actual headache pain, thank you Captain Obvious.

-Duration: each aura symptom can last 1 hour or less

-If you get aura symptoms but never get the telltale splitting pain in your head, you might have a migraine without a headache, sometimes known as a “silent migraine,” “painless migraine,” or “acephalgic migraine.”  

-ICHD-3 simply calls them a “typical migraine with aura without a headache”

Whatever!

-An acelphagic migraine, or a migraine with no pain, can have all the same symptoms of migraines with aura, except the headache just never shows up!

-Interestingly, migraines without headaches become more likely as you get older. Something to look forward to!

6. Abdominal Migraine

-Main symptom: stomach pain instead of a headache

-Duration: 1 to 72 hours

-Migraine can cause extreme pain in your abdomen rather than your head; this is an abdominal migraine.

-Causes pain near the belly button, can make you feel nauseous, give you no appetite, cause vomiting, and make you look pale.

-This is more common in children than adults, but 2/3 of the children with a history of abdominal migraine actually end up developing migraine headaches as adolescents.

-Just like common migraines, abdominal migraines can be triggered by things like stress, bright lights, and food additives like monosodium glutamate (MSG). -Typically treated using the same medications as standard migraines with headaches.

7. Status Migrainosus

Main symptoms: a migraine that that lasts more than 72 hours

Duration: 72+ hours

-Basically a migraine (with or without aura) that lasts longer than the standard max of 72 hours. 

-ICHD-3 recognizes status migrainosus, and points out that overusing migraine medications could be a likely cause

-Other triggers can bring on Status Migrainosus, like: changes in food and sleep habits, changes in medication, changes in weather, head and neck traumas, hormones, illnesses like the flu or a sinus infection, sinus, tooth, or jaw surgeries, and stress.

-Status migrainosus can be extremely frustrating; called a “trick candle on a birthday cake,” because the headache might briefly respond to medication, just to flood back randomly after a break.

Next week I’ll get into more specifics on these seven migraine types, along with the various medications used to treat the specific types and why they’re used. Also lots of intel on non-pharma methods of managing migraine, including devices. 

That’s all for today folks. Please make sure to share my blogs and YouTube vids with friends and fam, and like, subscribe, and comment people! As always you can find my book Tales from the Couch on Amazon.com.

And don’t forget that Dawn and I are going to need everyone’s help to take a simple, anonymous, sex and orgasm survey coming up here before too long. The more people that take it, the more meaningful the data, and the better the book will be! And you want it to be good, right people?  

Thanks and be well!

MGA

Learn More

Blog Part 3:The Future Of Sex Toys

Hey people!

MGA here. I’m writing this closing after finishing today’s blog, but it’s weird that I’m sticking it at the top of it, but there’s a method to my madness. I’m switching things up today and talking to you first because I might just have an announcement! And maybe even a favor to ask of all of you. So please read on. 

I think you guys have liked these sex toy blogs, no? Well, I have to tell you, this series has been a lot of work, but really great fun, too. So even though today’s sex toy blog is the last in the series (wahn waaahnn waaahhhhnnnnn) I don’t want you to be sad. 

Months ago, when I stumbled across some health benefits of orgasms that I didn’t know or hadn’t thought about, I started thinking that if I didn’t know or think about these things, maybe some of you didn’t either. Once I started looking at all the material online about orgasms, that led me directly to the point (underlined in bold letters) that they’re not the automatic foregone conclusion to any and every sexual event that all the movies and all the… propaganda is really the only accurate word… makes them out to be. In fact, nothing could be further from the truth. Especially for women. This singular fact- that there is more bs and shame shrouding the real reality of sex and orgasm- made me want to expose it. And of course do so in my very own unique (maybe slightly weird and slightly more irreverent) way. My shrinky senses were on alert, and the rest of it, the sex toys and all, was just a natural progression. I had a mission. Present all of it in an approachable way, no shame, no bs, no flinching. 

There’s sooo much material on the great interwebs on all things sex, orgasm, toys, and sex psych… it’s actually overwhelming. I knew that I couldn’t possibly do the subject any justice in one blog, so I decided to do the series. And while I was researching and reading, I saw so much evidence that made it crystal clear that sex, orgasm, and sexual health and wellness are such huge and integral components of the human condition, yet… Shhhh!Keep your voice down! What is wrong with you?! Why do you have to talk about this stuff anyway? Helll-ooo… such huge and integral components of the human condition, yet WE DON’T TALK ABOUT THEM!!

Because the fact that we don’t talk about it is just patently dumb. Look, I’m all for discretion, though you couldn’t be blamed if you’re having a hard time believing that, rolling your eyes right about now and thinking “seriously?” Yep. Seriously. I understand that it’s not an easy topic, but the fact that there’s so much shame and confusion and bs obscuring the topic of sex, all things that do real damage to real people in real life, I knew that propagating those things by continuing to not talk about it just wasn’t going to happen. 

Once I had put up the first sex toy blog, a patient asked me what the hell was I… ‘a psychiatrist of all people, doing writing about sex (very quietly) and dildos (almost whispered, as though she was concerned that the morality police were hiding behind my desk waiting to bust her) and how some people can and some people… can’t… be… satisfied?‘ she almost spit it out, she was so happy to have found the word, any word. Then she quickly added, ‘It’s just too… too personal!‘ she said with a shake of her head and a tsk tsk expression. For any of you that are thinking ‘Yeah, riiight? Exactly!’ right now, my answer to why is pretty simple: I am a psychiatrist, so people come to me seeking help for their problems. Right? I’m dealing with their minds and all the things that happen in them and to them. So any and every “thing” that creates a barrier to their happiness- to the point that they’re sitting in my office- is fair game. And many times, the tallest, widest, and strongest barrier I see in that office is shame. And shame is shame, no matter what it arises from, and so it is my sworn enemy, and I like to make it a point to wipe it out where it lives at every opportunity. And the fact that this patient who wanted to know why I was doing these blogs had to barely whisper the word dildos as it stuck in her throat, and because I could literally see her search frantically for any word to say butorgasm is exactly why I was doing them. How’s that for irony? 

I don’t claim to be a sex therapist, so it doesn’t fall to me to cleanly and concisely educate about it in an academic way, every impact that sexual health and wellness has on people’s lives. That’s not why I wanted to do it. Do I want you to learn something? Definitely. By the time you’ve read these blogs, do I want you to be able to recite the six principles of sexual health and explain the genesis of their inclusion? No. In fact, I don’t even go over all of that technical stuff, because that’s not what this is about. What this is all about is just getting the real deal info out there. Relax the stigma. Show that the subject is not too taboo, which was why I made that the subtitle of the first sex toy blog. 

So during the countless hours I spent putting these last three blogs together, I had an epiphany. Okay, maybe it was part epiphany, part hallucination brought on by a lack of sleep, but the end result remained the same: with all of the things that have to be brought to the light, these were going to be some really. long. blogs. people. In fact, I could totally fill an entire book with this stuff. So I’m going to. That’s the announcement: I’m doing another book…my third. But it’s going to be very different from my first two, and not just because of the subject matter. It’s going to be different because I’m writing with a co-author, something I’ve never done. Her name is Dawn, and she’s kind of got degrees like a thermometer: biology, molecular biology, chemistry, microbio… there could be more, but my point is that she’s not a moron at all, yet despite that, she doesn’t take herself too seriously, and I think you’ll like her writing style, because I do… and it’s a lot like mine to be honest. I think that having both the male and female perspectives will make it a better, more balanced book. It’s going to be good, people!

Which brings me to my next point. Actually, my next question. And it’s for you. Yes… you. And you. All of you! I need a favor. Well, we- Dawn and I- need one. We need you to help us. Will you help us write this book? I promise it’ll be super easy. Here’s the scoop: given the general topic of sex and orgasm, we’re going to be doing a simple, anonymous sex survey in the not-too-distant future, and we’re hoping that you’ll agree to participate in it. And in order to get a statistically significant sample size (say that five times fast) and draw conclusions from the survey, it’s got to get into the hands of a lot of people. So I’m asking everyone to please share this blog with at least five people, but if you can share it with more than that, even better! So I guess that’s two favors I’m asking: one, that all of you will agree to be contacted to take the survey, and two: that each of you will share this blog to pass that same request on to at least five others. I really appreciate it people! 

For you to agree to be contacted to take the survey, you just have to leave a comment on the blog saying so. If you’re familiar with the site, at the end of each blog there’s a little blue link that says “LEARN MORE” Click on that and it’ll take you directly to a reply box. Type in “Contact me to take the survey” fill in your info, check save my info for future, check if you wish to get notifications and submit. Voila!

If you’re like me, you like to ‘copy paste edit’ to save time, so here’s a message you can do that with to send along with the blog to explain everything to your people, people! FYI: I assumed that the people you send to won’t be familiar with the blog, so the instructions on how to leave a comment that I give in the following pre-fab message are different than those I gave you above- they’re faster, as they don’t require they read the whole blog to see the “learn more” link located at the end of each blog. They can just click on the small grey comment link just before the blog. 

Feel free to ‘copy paste edit’ this paragraph to send when you share the blog. Thanks!

Dr. Mark Agresti, a psychiatrist I know, has a weekly blog https://dragresti.com/blog/ and he just mentioned that he will be doing a simple anonymous sex survey sometime in the not-too-distant future, and in order to get a statistically significant sample size of completed surveys to draw conclusions from, he’s requesting that people agree to be contacted to take the survey, and that we please pass that same request on to at least five other people. So great news… you’re one of my people! So please click on the link https://dragresti.com/blog/ and you’ll be able to see and read all of his weekly blogs anytime. To agree to be contacted to take the survey, you have to leave a comment saying so. There are lots of places to do that, but the fastest is to look where it announces that week’s blog title and in small grey letters you’ll see the authorship, date, category and a [> 1 comment] link. Click on that little comment link and it’ll take you directly to a reply box. Please type in “contact for survey” then fill in your details, check the box that says ‘Save my name, etc for next time’ and if you wish to receive future notifications and submit. Voila! And please feel free to pass the request along to as many people as you’d like. Dr. Agresti appreciates it and so do I! 

Housekeeping is almost done here people. 

I hope you’ll enjoy this final blog in the three part sex toy series: The Future of Sex Toys 

Please don’t forget to leave a “Contact for survey” comment and share the blog to pass it along to as many people as possible. The more people that take the survey, the more meaningful the data gathered from it will be- and the better the book based on that will be! 

I really appreciate it.

And if you have other comments about any of my blogs, if you like what you’re reading or you have suggestions, please leave those too. I’m always down for comments! 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, share, and comment on those vids too! And my book Tales from the Couchhas more educational topics and patient stories, and it’s available in the office and on Amazon. 

Thank you and be well people!

MGA

Now without further ado, this week’s blog…

Part Trois du Trois: 

The Future of Sex Toys

Throughout the course of history, humans have experimented with numerous ways to derive sexual satisfaction: ancient dildos, Ben Wa Balls, Cleopatra’s bee vibrator… We’ve already explored how our ancestors got off in the history of sex toys, so now we’ll look ahead. What does the future of sex toys hold?

Imagine a world where you can strap on your VR headset, crank up your smart bodysuit, and have virtual sex with someone on the other side of the globe. It sounds like the setting for a sci-fi porn flick, but fully remote VR sex is closer than you think.

Sex Tech

The marriage of sex and innovative technologies is known today as “sex tech.” And just like every innovative business linked to sex, it’s BIG business: the sex tech industry is currently valued at more than $30 billion dollars. But unlike some businesses linked to sex, the sex tech market specifically is set to explode, and this value is predicted to climax at over $124 billion by 2024… quadruple in four years people! I can’t think of another industry that has, or ever could, accomplish this growth rate expectation. 

Remember that total geek that sat in front of you in eighth grade math class? The guy with the pocket protector and ultra thick glasses that couldn’t get a human date so he was really into robots? Yeah, him. This is what he grew up to do: sex tech. And just fyi… he’s a billionaire now.

From Sex Industry to Sex Tech

While sex toys in their primitive form have existed for literally ages, the last few decades have allowed civilization to explore an unprecedented level of freedom in the sexual health and wellness arena, and this has led to a proliferation of sophisticated technology and innovation in sex tech. A perfect example of this is the novel intersection of sex and Artificial Intelligence (AI), a pairing that was once thought to be inconceivable, but now holds great promise for the most immersive sex experiences ever possible.

Sex Tech Defined

As defined by FutureofSex.net: “Sex tech is technology and technology-driven ventures designed to enhance, innovate, and disrupt in every area of human sexuality and human sexual experience. Sex tech is important because sex and sexuality lie at the heart of everything we are and everything we do.”

Now that we’ve cleared that up…

What Will Sex Toys Look Like In The Future?

Where do you currently keep your sex toys? In the sock drawer? A dedicated goodie box? 

Let’s explore some data:

The world’s largest masturbation study (yup, that’s a real thing) published that 78 percent of adults in the world masturbate, including: 96 percent of British men, 93 percent of German men, and 92 percent of American men; and 78 percent of British women, 76 percent of German women, and 76 percent of American women.

A survey from UK sex toy creator Lovehoney found that three in four Americans own at least one dildo. That means roughly 70 percent of Americans have a dildo in their homes (or cars, or cubicles… no judgement) While the majority, 78 percent, are women, 64 percent of men that answered also said they own a “phallic sex toy;” guess they couldn’t say d i l – d o… dildo.

One safe conclusion we can draw from this data is that there are a lot of dildos floating around out there people. If we round down the current US population to 328 million, and assume that each respondent has just one dildo (which would be highly unusual- most people that use them definitely have more) that means there are more than 229 million dildos in the US. And given that number, as compared to the number of people that freely talk about using them or admit to it, we can also see clear evidence that many people still feel embarrassment and/ or shame to admit to masturbating, much less using toys. So even though the tech has advanced, it’s pretty clear that society’s acceptance has not come nearly far enough. It’s especially true in the non-male founded sex tech companies. There is a definitive double standard, so read on for details on that.

In 2017, one sex tech company self-named by its founder, Lora DiCarlo introduced the Osé, a dual massager for blended orgasms that introduced the world to “sex tech inspired by human movement.” For the very first time, a “smart toy” employed very complex mechanics and robotics that spoke to actual female anatomy and vaginal physiology. This founder and her company actually did a ton of work to develop this. They took countless measurements and made molds of thousands of vaginas to create a natural feeling toy with robotics that perfectly mimicked human movement, specifically a “come hither” motion for G-spot massage. The end result was apparently worth it- it was so unique and the movement so human and life-like that it actually won a highly coveted robotics innovation award from the Consumer Technology Association (CTA) in that same year. 

But then, when the CTA considered that the company was founded by a woman, they actually rescinded the award! Apparently because in their estimation, a female engineer/ founder creating robotic tech ‘inspired by human movement’ for the purposes of creating ‘a dual massager with come hither G-spot massage and clitoral stimulation’ for the specific purpose of ‘achieving a blended orgasm’ was lewd, and as such, the CTA could not be associated with the device in any way; which btw in their policies, that made it comparable to hard core pornography. That means they were actually saying that a woman creating robotic tech to theoretically pleasure herself and other women is pornographic. Saaay whaaat?! I’m a guy, so I don’t even have a horse in this race, but I’m still offended! They made it quite evident that if it had been developed by a man, it would have been a different story. A male founder of the product would have kept the award. Can you believe that bullshit, people? And PS, they also refused to let her company, and all other female founded sex tech companies, to even attend the event in the future! 

As you can imagine, Lora DiCarlo was mad as hell, but not surprised at all. She and all of the other female sex techies were used to having Facebook and other social media platforms censor them, PayPal refuse to offer their payment platform for their websites, or to be associated with them in any way. They got nothing but doors slammed in their collective faces. Just another Tuesday.

Well, Captain Obvious says that Ms. Lora DiCarlo had some things to say to the CTA about that. She started a critical public conversation about gender equity in tech, demanded that CTA issue a public apology and re-award her the award that she earned, and publicly demanded that any and all female-founded sex tech companies be invited to all future CTA events. And CTA in fact got smart and capitulated to her demands. Since that time, Lora DiCarlo and her company have continued to champion the cause of women’s sexual health in as open and public a way as possible. In addition, she and her fellow female techies have also formed Women of Sex Tech, which the New York Times said is “a tech-savvy and female-led women’s sexuality movement that has made its home in New York, instead of, say, Silicon Valley. Women, many of them under 40, are updating sex toys and related products with their own needs in mind, and leading the companies that sell them.”

And in fact, there are many more female founded sex tech co’s than male- it’s not even close, and Facebook and some other social platforms still censor them, so some specifically create vanilla campaigns to slip past the censors to be allowed on them. I don’t know about PayPal, but any person or company with three brain cells to spark off each other should be rolling out the red carpet to welcome these previously wrongly censored companies. I can feel her pain with Facebook… they refuse to boost my blog ever since I said that social media was problematic because devotees spent too much time in their artificial, anti-social social media platform. They need to get with the times and realize that just because they don’t appreciate a product or comment or statement, that doesn’t automatically invalidate it. 

Anyway, the moral of that story is that today, women are kicking butt and leading the charge in the women’s sexual wellness arena and the robotics and AI that go with it…a fact that offends the nerdy guys in their Silicone (Valley) Prisms. 

Back to the Future… of Sex Toys

We all know what yesterday’s dildos look like- mostly veiny, flesh-toned, realistic penis replicas (designed by men- I can believe that) or brightly colored carnival-prize-looking things that apparently didn’t excel in form or function. Both of those are relegated to under the bed to gather dust and dog hair (eeeww) or under the socks in the top drawer. 

Now contrast that to an insta-worthy living room with a coffee table proudly displaying an artsy magazine, a glass succulent cactus terrarium, and a beautiful, artisanal, teal-colored dildo…

According to sexperts, advances in sex tech will continue to be accompanied by a more open and accepting attitude towards sexuality. As a result, sex toy designs are moving away from products that need to be hidden away under a bed or in a drawer like a dirty secret. Now designers are embracing sleek and aesthetically pleasing designs that are meant to be noticed and begging to be on display in (almost) every home in the country. Ornamental dildos? Sure, why not?!

More Options, More Orgasms

As society becomes more open-minded and accepting of trans, non-binary people, and just all people, we can expect to see more gender neutral toys in a range of sizes, colors, and designs. In fact, as you’ll read later, this is already the case. 

Alexa… Oh Yeah, Right There Alexa!

The future isn’t just about high tech gadgets, it’s about having greater control over them. Imagine a vibrator with a range of personalized settings: slow and sensual or a hit it and quit it quickie for lunch breaks. Voice recognition and AI technology will play an increasing role in realizing this future. Voice activated toys that respond when asked to change strength, speed, or force will make Alexa look like a boring prude by comparison. And in fact, this is another example of ‘the future is now’ deal, as Vibease, the company that introduced the world’s first app controlled vibrator has now developed the world’s first AI integrated, voice activated vibrator. And it actually looks like a designer lipstick, so they clearly created it with an eye toward it going with when the user heads out to work or play. As Vibease says, their “goal is simple: bring out your inner glow…” Pretty catchy, huh people? Right now, I believe the AI enabled voice activated lipstick vibrator (say that four times fast) is actually available on Kickstarter for half price; they’re evidently selling it at a discount as a means of funding future techie toys. If anybody maybe needs a handy excuse for buying and trying…

Integration Innovation

How about sex toys that become integrated into our bodies? The founder of media and research company Future of Sex believes that in 30 years we might not even see sex toys as separate entities. I don’t know about that exactly, but it’s quite a concept, and as you’ll read later, Elon Musk is already working on what I might categorize as similar tech. A male sex techie named Rich Lee has developed the LoveTron9000. How stereotypical does that sound? I can hear some dulcet baritone celeb like Morgan Freeman or James Earl Jones, or best yet, Barry White, voicing the commercial… “The LoooveTronnn9thouusaaannd… Oh yeaaahhh, you neeeeddd thiiss, mennn.” So what is it? It’s an implant that’s embedded behind the pubic bone, and it vibrates so that it makes the penis vibrate. If you’re into that, then the good news is that innovation in bio-hacking and body modification means that similar tech innovations will become more common. Just had a thought: is Barry White dead? If he is, sorry and may he RIP, baaabbbyyyy.

If vibrating penises aren’t your thing, how about a smart bed that can hug you, whisper sweet nothings in your ear, and stimulate your nether regions… all at the same time. That tech is on the not-too-distant horizon too, people. 

VR and LDR

If you’re in a long distance relationship and/ or living in The Time of Corona, futuristic sex toys could bring you closer together, even if you’re social distancing. VR, sex robots, and teledildonics (sex toys controlled remotely over an internet connection via apps) are combined to allow your sex doll to be controlled remotely by your partner while you’re wearing a VR headset, with… say, Fiji as the 3D backdrop. The tech is coming soon, people. Teledildonics has already been around long enough to be slightly goosed by the newer competition. While it’s not obsolete by any means, there have been tech advancements that necessitated a new and equally advanced term: cyberdildonics. While some references seem to mistakenly use the two terms interchangeably, cyberdildonics is actually distinctively different. Both are technologies for participants to have remote sex via electronic data link and/ or smart applications, but cyberdildonics is tech in which tactile sensations (which is also called haptic tech) specifically are also able to be communicated between the participants via a data link and/ or smart applications.

Here’s how cyberdildonics work. The dildo lover/ female/ pronoun of your choosing/ yourself/ them: they have a high-tech dildo embedded with touch sensors. The person who enjoys penis attention has an advanced penis sleeve that’s capable of pulsating and contracting. First step: the two lovers connect their sex toys to the interfacing app. Second step: both then connect to a video call, which can be through the same toy interface app (some companies have this ability included) or through another exogenous app like FaceTime, What’s App, or Duo. Third step: have some fun! When they stroke or suck or insert the dildo into themselves, the other sees it on the video call screen and in response, their sleeve pulses and squeezes, delivering sensations that are said to be remarkably close to actual sex.

And/ or… switch ’em up! For the person who would usually be enjoying the sleeve’s pulsations on their penis, give them a smart vagina, replete with vulva and clitoris and embedded with touch sensors. Then give their lover an app-enabled vibrator. As one strokes or licks the smart vagina, their lover’s vibrator will react so they can feel their touch with every move made. With tech advances, new smart toy types have been, and will be continued to be, released. So if variety is the spice of life, get the vibrating cock ring, butt plug, vibrator egg, or whatever strikes your fancy and eat it up!

Teledildonics, Cyberdildonics, Digisexuality… Oh My!

Here’s a neologism for ya: digisexuality. What is it? A digisexual is a person who is sexually attracted to robots or other forms of sexuality that are technologically-mediated. Like the geek in my eighth grade math class with his thick glasses and pocket protector… the one who’s bound to be a billionaire by now. He’s a digisexual for sure. But whatever floats your boats people. No judgement, just saying.

No Partner? No Problem! 

According to sexperts, it’s just a matter of time before celebrities hop on the digisexual and cyberdildonic bandwagon and license the use of their faces for sex dolls or VR scenes, so one day soon, you’ll be able to have a simulated sexperience with your favorite celebrity! Honestly, this one rates kinda high on my creep-o-meter people.

Sick of People? Date a Robot!

Wouldn’t it be great if you could program your boyfriend and/ or girlfriend to do and say whatever you wanted? Well, sex robots are not a sci-fi fantasy anymore: they’re already among us. Harmony 3.0 (and by now maybe even 4.0 and 5.0) is a lifesize doll which can be programmed via the Realbotix app. And of course it comes with 18 personality types, 42 nipple designs, and 14 dishwasher-friendly labias to choose from, don’tcha know. These AI drive sex toys are transforming the way people view- and feel- sex. One benefit associated with them would be that if you wish to fulfill any sexual fetish that a regular human partner might not want to engage in, you can access various quick sex scenarios on your bot partner and indulge in the experience that way. And Captain Obvious says that another benefit of utilizing this technology is that the risk of STD is completely eliminated. Remember Ryan Gosling in the movie Lars and the Real Girl? I mentioned it in a previous blog. If you’re into this, dolls and bots can be programmed to tell jokes and recite poetry, whatever you’re willing to teach them, they’re willing to learn. Just think: she will always remember your birthday. And never bitch when you leave the toilet seat up. Now that is technology I can get behind people!

If bionic penises are more your speed, sexbot company RealDoll also has a fully customizable male doll… Though it looks like they literally have one, while the rest of their site is absolutely overrun with different female versions: classic, petite, and wicked, in dizzying arrays of features, along with interchangeable heads and toros too, for the Jeffrey Dahmer set I suppose. And if you like penises but could care less what it’s attached to… or if it’s actually attached to anything, they also sell the RealPenis, which at first glance is shockingly realistic. And it may also be at second glance too, but I couldn’t look again.

The Future of Sex Toy Tech is Coming… Are You?

The expiration of the original teledildonics patent a few years ago is the driving force behind the rapid expansion in the field of smart sex toys. That’s why we’ve come so far in such a short period of time and have an array of smart toys. It’s been a wild ride, but we haven’t even hit the loop de loops yet! Where there once were only app controlled panty vibes where you turned control over to your partner so they could zing you out of the clear blue sky just to say hi, now there are teledildonic couple toy sets: an app controlled toy for vaginal/ G-spot/ clitoral stimulation is sold in a set with a vibrating penis sleeve, or vibrating butt plug, or vibrating cock ring. They’re meant to be used simultaneously via app control by your partner. 

There are a few really unique smart app controlled vibrating toys that are worth an honorable mention. If you can’t sleep unless you can hear and/ or feel the beat of your partner’s heart, Little Riot’s Pillow Talk might be the ticket. It lets you hear the heartbeat of your loved one in real time via a mobile app, wristband, and speaker, as if you have laid your head on their chest, even when they’re on the other side of the world. And haptic touch advancements in combination with VR have also made smart toy prototypes that make virtual hugs and even remote kissing possible. Now I don’t know about you, but I’m going to have to see that to believe people.

What could possibly go wrong? Well, since you asked… as anyone who’s argued helplessly with Alexa or Siri about just turning on a damn light has discovered, the reality of an ‘Internet of Things’ is sometimes closer to an ‘Internet of Shit.’ If you think it’s irritating when your own doorbell decides you’re an intruder because you’re wearing your favorite Batman shirt, wait until tech companies start using your genitals to beta-test their cutting edge tech. And the quality of your sexual experience in using these is based on the quality of internet connections and the app/ software interface between the devices. But I imagine the up-side is that time will only lead to better connectivity. Regardless, this tech is not without risk. In reality, it’s possible that people can be hurt, technologically and maybe even physically by this tech. Companies could possibly leak data that identifies users, even without malicious intent mind you. Remember the Ashley Madison hack in 2015? When “The Impact Team” stole the user data of Ashley Madison, the commercial website that billed itself as an enabler of extramarital affairs? At least two suicides are directly attributed to having been identified in that data breach. 

Breaches of that order happen all the time. I got a letter from an e-commerce, or “shopping cart” company about a year ago. They’re basically responsible for presenting you an online store’s stuff, enabling you to select the stuff you want and put it in your cart, write reviews, seek faq’s, make modifications, and eventually pay for your crap in order to receive it. Well, the letter informed me that this gigantic e-commerce site had a security breach, and that my card information was among the data that was extracted. The kicker? The breach had taken place like 16 months before! Yet this was the first I’d heard of it. I don’t know if they dragged their feet during an investigation and that’s why they didn’t inform me sooner, or if maybe they didn’t even know about the breach until long after it was done. Frankly both are disturbing. They say that cyber thieves or their network rings usually just hold on to the data they steal for a while, lulling you into believing that your info must be safe, because surely they would’ve robbed me blind by now, right? Right? Anyway, you see the issue. If you’re employing an app to facilitate intimacy, use protection… and I don’t mean condoms.

Poor security could also allow malicious hackers to view the GPS coordinates of users, or take control of devices remotely. We’ve known for years that cars can be hacked, as can heart implants and webcams. Similar invasions could possibly be coming soon to your erogenous zones, too. But I have noted that some sex techs are very serious about security, as Bluetooth can also be hacked. And the almighty cloud. In an attempt to thwart this, I know that sex tech co Vibease allows only one linked device to control the toy at any given time so that any hacker will just be impotent. You set it up with your partner with a password and they also suggest a fingerprint-required complete phone lock to keep pick-pocketing smartphone thieves from availing themselves of your partner’s pleasure. Maybe the sex toy app itself should require a penis or nipple print as a unique identifier to access it too. 

While there are always cons against pretty much anything in life, the same goes for pros. In addition to providing a viable outlet for sexual intimacy in long distance relationships, as well as the same during A Time of Corona, there are some other fascinating opportunities. For example, sex tech can provide people with an anonymized and untraceable alternative to a physical encounter in countries where gay sex is against the law. In a situation like that, teledildonics could provide physical pleasure with far less risk than what would be involved with an actual encounter. And as we’re already seeing with cyberdildonics, as sex tech advances, it will continue to incorporate other emerging technologies. Combining VR is on the not-too-distant horizon, so in combining VR and toys, you’re more fully immersed in the sexual experience, since you can see it, hear it, feel it, and get physical stimulation based on what you’re seeing in the chosen scene. Morning sex in Maui, a nooner floating along on the Nile, and for delicious dessert, go to Dubai.

Another cool thing about sex tech is the definitive opportunities to create hardware for disabled people to have sex. Historically, most toy controllers have been touch-based. There hasn’t been a lot of time and/ or effort dedicated to voice interfaces or eye tracking capabilities that would allow people who can’t reliably manipulate a phone to control toys. Through hands free utilization, tactile capabilities, and voice recognition AI, sex tech can be developed as a more sexually gratifying experience for people with disabilities. Also, for those people, or any people who may find it difficult to reach orgasm, many tech toys already can, or will be able to “learn” what gets their user off, so that the patterns and combinations that are the E ticket ride can be recalled, accessed, and re-played anytime.   

Whether you consider yourself to be a visionary on the cutting edge or a total dinosaur in technology adoption, one thing is for sure… sex tech literally moves at cyberspeed. A report from Future of Sex offers insightful information and predictions on technological transformation in 5 areas:

#1: Remote Long Distance Sex

Internet of thing (IoT) system that enables the safe connection of device(s) to the Internet. Obvi this technology of teledildonics and cyberdildonics is already here and expanding, and there doesn’t seem to be an end in sight. 

#2: Virtual Sex, Cybersex

Virtual sex or cybersex would entail the electronic transmission of sexually explicit or obscene messages via text, voice, or video. Historically, cybersex has utilized chatroom(s) and/ or online games, but believe it or not, good old fashioned phone sex and sexting are some of the most common forms of virtual sex. 

Virtual sex via online games allow fantasies to run wild. Online multiplayer virtual games allow users to adopt different roles to see what they like best. The game Red Light Center allows you to design your own avatar to experience virtual interactions and even sex with other players in real time. The role playing, customization of avatars, and the virtual environment allows fantasies that are erotic and outrageous, and everything in-between. Some 3D sex games even support virtual reality headsets and interactive sex toys, all of which can deeply intensify the immersive cybersex experience.

#3: Robot Sex

Robots aid humans in various tasks; robotics are actually integrated into so many everyday objects that we take them for granted… we don’t even think about them. But sex tech robots are designed to be noticed; and many “online adult forums” utilize erotic chatbots to help moderate and facilitate racey group chats or private room activities. So it should come as no surprise that sex robots have been a popular sex tech trend, and they’re getting better all the time, as I mentioned near the beginning of this blog. Sexbots are basically very expensive and very lifelike, fully customizable silicone dolls. Tech advancements give them increasingly sophisticated movement and features to make them look, feel, and act like real girls. As they do closely mimic human movement and behavior, when you consider the potential to learn constantly, get smarter in communication on every topic (humor, speech, friend’s preferences/ likes/ dislikes) and with every interaction their human friend has with them, they offer very realistic and responsive experiences when it comes to sex and intimacy. Different doll techies/ creators offer multiple dolls with varying levels of virtual reality, artificial intelligence, physical characteristics, capabilities, and external feature realism, such as skin qualities: how it feels to the touch, it’s warmth, and the presence of responsive touch sensors. 

#4: Immersive Entertainment

In order to have an immersive experience and heighten the end user’s intimacy, it is common to see many adult entertainment providers embrace and incorporate virtual reality (VR) technology with teledildonics and cyberdildonics. For example, CAM4VR offers live streaming with a VR sex camera and voice capability, so users can engage directly with adult performers. Put it all together and it makes for a very up-close and personal experience. Meanwhile, CamSoda includes 3D holograms to explore and even incorporates a release of various scents through a sensory mask in order to provide a multi-sensory play.

Aside from the adult industry, VR is utilized in  an immersive sex education experience in an effort to create a safer environment for people to learn about their sexuality. Emory University and Georgia Tech plan to develop a high-engagement VR sex education program focusing on safer sex practices for young women to minimize instances of STD infection and transmission, HIV infection and transmission, and unintended pregnancy. VR is also utilized in therapeutic applications as well. BaDoinkVR is one example of such a program; their complementary VR tool is provided to singles and couples to help them discover their own sexual pleasure preferences and those of their partner, as well as methods to enhance both sexual pleasure and performance in real world sexual intimacy. And what’s coming soon may have you doing the same… on the not too distant horizon, VR will be applied to haptic (touch sensation) tech for users to indulge in thoroughly immersive acts of sexual intimacy.

#5: Augmentation

Human augmentation typically refers to the notion of improving on or building upon the capabilities of the human body. But being human, we’re constantly wanting more and better, so augmentation also refers to theoretical methodologies to push the envelope on the human body’s capabilities and use methods that could, would, or will (!) include augmented reality through implantables or wearables. 

The future is now, and many recent medical breakthroughs have demonstrated marked success in human augmentation; these have opened our eyes to many possibilities we once believed impossible. 

Some success stories include: the first US penis transplant in 2016. A penile cancer patient required an amputation of his penis in order to have a chance of survival. Following this at a later date, his surgeons at Massachusetts General Hospital successfully completed the 15 hour transplant operation using a complete organ taken from a deceased donor. The operation was ultimately deemed a success after the 64-year-old man regained sexual function and the ability to urinate normally once again. This procedure has been adapted and procedure time significantly decreased to apply the surgical technology to US soldiers who sustained severe bodily damage and amputations from bombs and IED explosions during overseas wars, and thus far with great success, as they have regained sexual function and the ability to urinate normally post-operatively.  

Another example of augmentation success as Swedish doctor Mats Brannstrom completed the world’s first “womb” transplant, which I assume they mean is a uterine or total vaginal transplant. Since then, many procedures involving varying iterations of vaginal transplants have been successful in countries around the globe, some of which were reproductively successful with patients carrying pregnancies to full term and delivering normally with the transplanted organs. 

Yet another example of successful human augmentation was made possible by doctors at Wake Forest Baptist Medical Center when they succeeded in building and implanting a lab-grown vagina derived from the patient’s own cells, ultimately allowing her to resume normal vaginal function. The same group was also responsible for bio-engineering penile erectile tissue followed by successful implantation on laboratory rabbits. 

Augmentation methodology has been used to overcome sexual dysfunction and/ or injury through the re-engineering of human tissues and organs which are then transplanted to help restore normal function. Moreover, this technology offers the potential for future body modification and customization in an effort for humans to enhance their individual sexual aesthetic and increase their enjoyment of sexual intimacy.

Clearly, augmentation is yet another technology where the future is now, as it has already been successfully employed numerous times around the world to repair the body and its organs after the ravages of disease and war. But what if feelings of orgasmic pleasure or heroin-like bliss were accessible through augmentation and made available to you as easily as you could push a button? Would you push it?

Elon Musk is betting you will. His company Neuralink has recently made quite a stir with the claim that their products can directly stimulate the pleasure centers in the brain. The company is dedicated to creating “Brain Computer Interfaces” (BCIs) which are devices that communicate directly with the brain at the synapse level. Basically, they want to put microchips inside people’s skulls, people… microchips that would elicit a chemical release as a response to their communication with the brain.

Musk has introduced a pig named Gertrude to the world, and she has a coin-sized chip implanted in her brain. Interesting timing, as the BBC states that Neuralink applied for approval to begin human testing on their BCI microchips last year.

So what is this brain chip anyway? Musk calls it a “digital superintelligence layer” that mediates communication between the limbic system and the brain’s cortex. The limbic system mainly deals with emotions, how we feel about things, while the cortex is more involved with the experiences of consciousness, perception, and thought which are far more important to human homeostasis.

Musk has stated that the initial use of BCIs will be aimed at brain-related diseases, claiming that neurological conditions like Obsessive Compulsive Disorder (OCD), Amyotrophic Lateral Sclerosis (ALS), and autism could all potentially be “solved’ or cured with Neuralink’s microchip. Basically, brain signals release chemicals, and those chemicals make us feel the way we do about things. So if Musk’s chip can tap into our sexual pleasure centers, it can cause a release of chemicals that make us feel an orgasm without the physical actions and scenarios that we would usually undertake in order to reach it. In a nutshell, he says that the chip will allow the wearer to bypass the requisite physical activity and get straight to the reward. I’m going to use the example of Tourette Syndrome, which is a disorder whereby affected people are compelled to make repetitive disruptive noises and sudden movements called tics. Like OCD, Tourette Syndrome is a neurological disorder that is totally out of a person’s conscious control; if they make attempts to deny the tics or hold them back for any length of time, eventually they will literally explode with tics, to the point where they are unable to function until the tics are expressed, which then sort of puts them back at baseline, almost like they’ve been reset. Affected people say that the mental feeling of needing to tic is like the need to scratch an itch, and that the feeling will build and multiply until they must finally “scratch it,” meaning they express the tics. This causes them to expel the tics that have built up in a sort of fit, after which the “itch” is vanquished… for a short time. It will build again and the whole cycle starts over. This feeling of being purged of tics must be mediated by the release of a chemical in the brain…. Just as the all-encompassing feeling of ‘I need to tic, I must tic’ is mediated by a chemical released by the brain when affected people resist their tics. That bit is basic science people, it’s like a for-sure deal that different chemicals released by the brain are what tells the person’s nervous system ‘hey, you haven’t tic’d, you can’t deny me, you must tic now now now…’ And also after having tics, then ‘hey, it’s okay, chill out, you’re good… for now.’

Musk didn’t mention my example, but I think it’s the perfect model for explaining the potential of a chip with this technology, assuming it actually does interface with the brain in the way it’s described and that it does elicit the chemical response as it’s described to do. But please understand that those are big assumptions for now.

If this BCI chip causes the release of chemicals in the brain that mediate how we feel about something without having to physically enact the behavior(s) that would usually cause their release, then it should work well in Tourette Syndrome or tic disorder, along with other neurological disorders with the same sort of altered or skewed reward system, where you could get the chemical release without acting out the potentially maladaptive or undesirable behavior of tics or checking and re-checking the locks in OCD, or self-injurious behaviors (like head baging) often exhibited in autism. I can also see the potential for use in psych patients who are cutters: they have an irresistible need or urge to deeply incise the skin and/ or release blood and/ or feel pain. If they could have that insatiable desire quenched chemically in the brain without having to act out the physical cutting action, that’s it… problem solved, cutting cured. That’s pretty incredible to imagine. The potential benefit in ALS patients is a little more complex, so I won’t bother with that here, but on first glance, Musk’s BCI chip has the potential to be a total game changer in treating some of the most difficult neurological and neuropsych disorders on the face of the planet in my opinion. It could hold great promise for disorders where the reward system is somehow perverted or held for ransom by the brain.

Musk says that the advent of his BCI chip will not necessitate the automatic elimination of physical activity, and that the chip’s presence would not override independent human thoughts of performing physical activities as we’re all used to doing now. And dare I add the single qualifier “before…” to the end of that statement? Because when you’re monkeying around with the reward center, the release of chemicals, and the brain, bad things can happen from the jump or they can develop over time. The brain is a powerful organ people, just ask an addict. That said, to me, Musk’s pre-qualifying comment at this very early stage of the game sort of smacks of his intentionally plugging a pacifier into our collective mouths before we even start whimpering about its absence. In any case, Neuralink’s human studies could prove to be an interesting bit of theater. But Musk generally gets what he wants, and he wants this technology- at least the ownership of it. Because I’m pretty dang sure he won’t be getting one of those chips in his skull anytime soon. Still lots to be determined. Stay tuned. 

I do see benefits of the chip in the sexual wellness category. For people who are unable to physically engage in sexual activity due to illness and/ or injury, people who are simply anorgasmic, or people that can perform acts of sexual intimacy, but not to a point of orgasmic release, I see great potential. These are all genuine issues with real life implications. The chip could allow for the stimulation of pleasure centers to heighten arousal and increase the potential for an orgasmic sexual response. Then it could essentially capture and record the pleasure responses of one person and those can be read by some technology within the chip or even some of the independent biofeedback type sex tech devices, and then transmitted (for lack of a better word) to that person’s partner, which would let that partner know what the first person’s sexual pleasure feels like, and that could integrate that desire into their partner’s intimate experience. And also, if there is a specific set of circumstances that arouses someone and makes them more likely to achieve the end goal of reaching orgasm, they could share that feeling with their partner. Say if they like the excitement from the risk of being caught having sex in a public place, or they like the completed idea of getting away with it, the chip could capture what that risky feeling feels like to them and those feelings could then be overlaid onto the partner’s chip or through some other type of independent sex tech, so that the partner also feels the rush or excitement from that risk, and therefore automatically incorporates it into their feelings during the sexual experience. Almost like dimming the lights to set a mood, except this would be setting a mental mood, so that the sexual experience would have a specific mental context that may make both halves of the couple more likely to reach orgasm. That’s a win – win scenario.

Sounds interesting, right? Well, need I say there are risks? Actually, there are RISKS people. I mean, Captain Obvious reminds us that we are talking about having a chip implanted in or near the brain… an electronic component interfacing directly with brain tissue, or at least interacting with another electrical system, which the human brain is. But even if we throw those trivial matters aside, hell, I’ve had my computer hacked- what happens if some homicidal freak hijacks people’s chips? Would they be able to remotely control someone to do their dirty work? Yikes, people! And what about all the data collected from chips? All the random thoughts and/ or feelings, the ‘side data’ if you will. If a private interest group got access and/ or control over everyone’s data and used it to advance a candidate in an election, or influence the government, or squash or advance legislation or alter bill introduction or the passing of laws or affect the governing actions of all of the above? Any group that had access to all that information would basically rule the world- they could control everyone and everything with relative impunity.

But this I know: people could potentially be seriously harmed by overstimulating the brain globally, and overstimulating the pleasure centers of the brain specifically. Helll-ooo… aaa-ddic-cc-tion! If people can have “orgasmic pleasure” or “heroin-like bliss” freely available to them as easily as pushing a button, will they be able to continue functioning everyday without constantly pushing that button? They would be bombarding their neurons with pleasure chemicals… and usually, too much of a good thing… is a really bad thing. 

We’ve all seen sci-fi movies where AI (artificial intelligence) enslaves the entire human race. But Musk has an answer for that too. Sort of. He claims that Neuralink’s devices are actually the very things that will protect us humans from this situation, should it ever arise: that BCIs would give us virtually instant access to information in a way analogous to completely automated systems, which intimates that we would somehow “know” or “understand” everything, even when we’re being tampered with or manipulated. Not so sure about that.

Generally speaking, I like Elon Musk. And admittedly, some of this sounds cool. But I don’t trust his abilities over mine to be certain of potential medical, psychological, and behavioral ramifications of brain neurochemistry. But I assume he’s put the right people in the right places. I have to say that as a psychiatrist, if there was a cure for some of the most destructive and currently incurable neuropsych disorders in existence, that would be amazing. But… in my experience, where Mother Nature or God or a higher power or whatever you believe in puts a check…there’s a balance somewhere, usually in a place you don’t see until it’s too late. Couple that with the potential for addiction issues, the possibility of chip hijacking, and honestly, Musk’s (kinda lame) assertion/ pseudo explanation not to worry, that we would know and/ or anticipate everything would keep us safe, that feels a little too tenuous for moi to step out on… So let’s just say that I won’t be beta testing these BCIs. But, I will follow this issue and read with great interest all about the people who do. 

Embracing Sex Tech: Problems & Solutions

As far as existing sex tech and products coming in the relatively near future, most fall squarely into the “adult entertainment” and “sexual health and wellness” arenas, and I think the latter have been, and will continue to be, better received. It seems that innovations in teledildonics and cyberdildonics aim to improve intimacy and sexual pleasure, and they hold great potential to resolve the age-old problems that revolve around physical, emotional, and geographical constraints of romantic love relationships. I know that with coronavirus, some couples that had to temporarily split for months at a time had difficulty doing so successfully. Long distance relationships are another excellent example. If you’re a young newlywed bride from Great Grits Georgia and your soldier husband is called to serve in some hellhole on the other side of the globe for a year, that’s a real problem- the kind that breeds misery, introversion, distrust, communication issues, and physical/ emotional intimacy problems in both partners- problems that can potentially pave a road to divorce where one never existed before. So if sex tech and couple toys or similar interactive devices allow couples to continue- or even advance- their sexual intimacy, while forging ahead with a difficult situation, then only good healthy things are likely to come of it. 

…Very Different from Embracing Sexbots!

AI-driven sex tech robots are relatively new and their aim is to apply advanced concepts of machine learning to transforming our sexual experience. Thanks to the sensors in the defined “sensitive” zones of the bots’ bodies, these sex robots can experience pleasure and, in turn, reciprocate the favor. Also, they can learn from previous experiences. For example, your habits and moods or what turns you on. 

I was surprised to read a recent survey that said that 1 out of 5 men said they are open to the idea of having sex with a doll. This number is likely to increase when sex dolls become more humanlike and way less expensive. In fact, human/doll (or bot) sexual intercourse might overtake human/human sexual intercourse way faster than we think.

Issues: Sex Dolls and Bots

However, major concerns are arising, not the least of which involve the concept of men having sex with child type sex dolls. With sex dolls, the romance and chit-chat typical of a normal relationship are eliminated, and maybe more importantly, these relationships happen in a strictly private environment. It’s not like you bring your bot ball and chain with you when you go to a buddy’s house to watch the game. So really we’re left to just speculate about the psychological ramifications of a continual and purposeful romantic love relationship with a non-human entity. And boy do we speculate…

Monetary Costs of Sex Dolls and Bots

Currently, these things are freaking E for expensive people. A Realbotix head alone costs about $10,000, but you’ll shell out another $25,000 to $65,000 if you want a body to put it on. And speaking of that body, features such as skin-like materials, self-warming orifices, full-body detailing, and a texturized canal with internal pulsations are only the tip of the iceberg. If a human tells their doll/ bot what they enjoy sexually, they can evidently learn from it; then when it’s applied during physical intimacy, the patterns can be recorded or “remembered” by the doll or bot; I can only assume that they can then be recalled, essentially repeating the exact same experience. This would only be in the most advanced models I’m sure. Doll/ Bot companies claim that today’s most futuristic dolls can learn whatever names you give them, when your birthday is, how to read poetry, and even hold their own during erotic conversations. Plus, they don’t require cab fare when you’re done or a romantic dinner before you even get started. 

In comparison, the “busted up bargain bots” as I lovingly call them only range from $4,000 to $12,000. But with continued advances in technology, the price across the bot board is certain to drop, making this tech more accessible to the average person, which will undoubtedly lead to more dolls and bots, but probably the same scant amount of information about the psychological ramifications of a purposeful romantic love relationship with a non-human entity.

And this was a new one on moi…

Enter the Slutbot Sexting Tutors

Supposedly, these were developed in response to the controversy that has obviously sprung up around the invention of such high-functioning sex bots, with people arguing that such machines will make interpersonal interactions a thing of the past. But the world’s first Slutbot Sexting Tutor has entered the scene and it’s definitely making the conversation more interesting- in more ways than one. This intuitive robot helps users express their sexy, seductive side in a more efficient and flirty way, which serves as not only a relationship booster, but also a terrific add-on to any interactive sex toy you might already own and utilize. So its reason for existence is basically to transform lonely -cis men into slutbox sexters? Alllrrrightyyy thennn…

The True Future of Sex Toys Is Non-Binary

When sex toys became popular in the ‘70s, they were made “by men” and “for women” so it’s no great wonder that they looked like giant towering examples of realistic penises, complete with veins and perfectly sculpted heads, often with an attached set of perfectly sculpted balls, neatly placed where they would be in an anatomy schematic but never in real life. They were typically flesh toned and the focus was placed on the penetrative aspect as opposed to being concerned with stimulation. In short, they missed the mark, and that really set them up to continue to miss it for a very long time. Why? Because that’s what the industry execs assumed women wanted to use. And so began a long enduring disconnect. But fast forward to today, when the sex tech industry is finally focused on inclusion, and actually does include some non-binary-led companies amongst the many powerful female-led companies, all of them seeing that the future of sex tech is truly and unapologetically non-binary. 

Gone are the days of “one size dildo fits all vulvas.” Gone are the days when hot pink phallic contraptions had to be appreciated, just because it was amazing to even have a choice. It’s a good thing that those days are in the rearview mirror. But let’s face it, there’s still a huge amount of phobia surrounding sex in general, no matter the labels or qualifiers. But it’s magnified and multiplied when it’s non-cis, non-hetero sex. Thankfully, more and more companies are working hard to do away with that phobia.

When it comes to sex toys, we now recognize that sexual interests and tastes can be as unique and singular as the bodies that contain them. While there’s nothing wrong with wanting a rainbow glitter dick, lipstick vibrator, or hyper-realistic flesh-colored dildo, many of these products can be alienating to individuals who may identify as gender nonbinary, or people who feel put off by the gender essentialism of toys created “for men” or “for women.” So, in light of the increased cultural awareness of non-binary gender identities, innovative sex toy designs are making pleasure more accessible for everyone. One company striving to make the sex toy industry more inclusive is Wild Flower, a nonbinary sex toy retailer and digital community dedicated to providing sex education to those who have been overlooked by the adult industry. 

What makes purchasing a sex toy so difficult for some individuals are the ideas and labels that automatically come attached to them like baggage. Gender, sex, and bodies are complex topics… acknowledge this and counter it by totally eliminating gender in marketing. While this might make things like search engine optimization difficult, the upside is that newly unlabeled and unlimited genderfluid-friendly toys can open minds and new worlds of sexual expression for everyone, regardless of how they identify, or if they even do at all.  Free the toys!

A Victorian Take on Remote Sex

Today’s blog has been all about the future of sex tech, which at its heart centers around smart sex toys designed for remote sex in one of many forms. But really, remote sex is nothing new. Ever since the dawn of literacy, lovers separated by distance or circumstance have touched each other remotely through erotic letters held and read in one hand… while doing something else with the other. If you’ve got some time, there are many examples of “Victorian sexting” during the civil war era online. Some of it is hilarious and some is pretty mind blowing… but let’s take a quick “wow break” to check out a couple of excerpts from letters between none other than General George Armstrong Custer and his wife Elizabeth “Libbie” Bacon Custer, who was said to be “hotter than a $2 pistol.” We’ll see how they implemented remote sex.

Far from the prudish stereotype of the Victorian woman, Libbie clearly delighted in creative euphemism and double-entendre. In one letter to her husband, she wrote of “a soft place upon somebody’s carpet” and of her desire to “sit Tomboy” (as in astride) for “just one… ride” as they were fond of asking for “just one” which appears to be a reference to an orgasm. Scandalous.

Custer wrote in reply “Oh, I do want one so badly. I know where I would kiss somebody if I was with her tonight.” Shocking.

Nothing could dampen Custer’s ardor for Libbie. During one of his campaigns, he sent her the 19th Century equivalent of a dick pic:

“Good morning my Rosebud. ‘John’ has been making constant and earnest inquiries for his bunkey for a long time, and this morning he seems more persistent than ever, probably due to the fact that he knows he is homeward bound.”

And in one letter to her BFF, Libby told her that she and Custer had had a threesome, and it seems like she wants her to stay! 

She said “Custer, as I, devoted most of our attention … to the selection of a pretty girl… This pretty girl … was held by both of us, and would do more toward furnishing and beautifying our army quarters than any amount of speechless bric-abrac.” 

That Libby was really freaky. And the great General Custer was into it. Who knew?

Now moving away from the Victorian age and through the 20th century, remote sex migrated to the telephone, when even Dear Abby approved of- and even recommended- phone sex for long distance lovers. Of course, any form of remote sex is not the “real thing,” but the body’s sexiest organ is the mind, and remote sex talk excites it just as much now as it did in years past. Teledildonics and cyberdildonics basically combine these excited and sexy thoughts, and therefore the minds, of each half of a couple that are separated, bringing them together virtually, and that extends the potential excitement more than ever before.

Potential Real World Ramifications of Sex Tech

Teledildonics Biggest Winners: Sex Workers

No doubt some long-distance lovers will embrace teledildonics and have big juicy fun. But the largest market for Web-enabled sex devices appears to be sex work. The Web already contains a surfeit of sites whose female (and gay male) employees show their assets, touch themselves, and exhort remote users to masturbate, all in an effort to earn a buck.

Teledildonics not only makes remote sex work more lifelike, it’s also more personal. The phone-Web interface is more one on one, allowing consumers to feel closer to providers. In addition, teledildonics allows sex workers to earn extra money by fulfilling requests. Men can tip to see the sex worker fellate a dildo while they physically feel it by utilizing a device. Tipping is almost too easy: just tap your phone, and voila… the fee is charged to your credit card. No fuss, no muss, no exchange of fluids.

Many sex workers prefer remote sex to the real thing. And why not? The hours are flexible. They can work in the privacy of their homes. And compared to the alternatives: street-walking, massage parlors, hotel calls, and brothels, remote sex is safer… no violent customers, poor hygiene, or sexually transmitted diseases, and no risk of arrest. Police generally focus on street level sex work; they really couldn’t care less what people do on the phone behind closed doors. Teledildonics is also safer for men who regularly pay for sex as well, and for all the same reasons.

Teledildonics’ Biggest Losers: Women Who Abhor Porn and Snoops

While teledildonics may be a boon to long distance lovers, it’s bound to cause consternation among women who feel threatened by their men masturbating to porn. Except instead of the man stroking himself to some random video image, now teledildonics allows him to look at a real live woman who’s stroking, licking, and using a Web-enabled sex toy. Many men are likely to find that more compelling than porn. And I suspect that their wives will not exactly be thrilled about all that. 

By some estimates, as many as 25 percent of coupled individuals have peeked into their partners’ devices looking for evidence of porn use or affairs. I hear about this from patients all the time. They complain that their partner tracks them, or steals their phone to snoop. Some put a screen lock on, but their partners know that sometimes the photos they might be looking for would be on the micro card, so they snag it and plug it into their phone to snoop. Anyway, the evolution of sex tech means that from now until who knows when, jealous and insecure partners will continue to snoop and should now be expected to check for teledildonics apps- after scouring the phone for texts and calls with random women, and tossing the closets and drawers looking for web-enabled sex toys.

As teledildonics and cyberdildonics become more established, I think the news media will treat it breathlessly, with sympathetic profiles of long distance couples who “really enjoy it” followed by hand-wringing from those who consider it a threat. Personally, I find that sex sells… people love to read about it and speculate on it, and app-enabled sex toys are a fascinating new wrinkle in the oldest quest of all time: the search for erotic satisfaction. Especially in my profession, where that search is often tied into self worth. I’m not terribly concerned with what it all means for civilization, since it’s not like commercial phone sex services have led us to the ruins of Sodom and Gomorrah in previous years. We’ll survive. Necessity may be the mother of invention, but lust is often the father of necessity… because don’t forget that a hard prick has no conscience.

Sex Tech Psychology

The End of the World as We Know It?

If the sexbots are already here, what’s next? Will everyone start marrying dolls and sever connections with other human beings? If we get used to programming our partner, how could we ever go back to human beings with free choice? Panic rules the streets!

I’ve read articles and comments online that point to concerns that sexbots and VR pornography could dehumanize sex and warp our perception of consensual relationships, but I’m not convinced of that at all. Even if that’s a possibility in the future, it’s certainly not the case yet, because I think sex robots have yet to seem ‘real’ enough to appeal to a large audience. Until the last couple of years, designers have been very bad at making human-like robots, as technology hasn’t been all that well suited to it, and our brains can easily pick out points where human-like things don’t look like humans, and that’s a buzzkill in every way imaginable. And until recently, after advancements in skin technology to add warmth and feel and the addition of more realistic facial features and movements, sex robots have really just been immobile sex dolls glorified with some animatronics and chat capabilities built in, and I think it’s going to stay niche as long as that’s the case, and that makes it a non-starter in the problem department. I don’t think they treat these dolls like real people.

But some vehemently disagree, claiming that owners become deeply bonded to bots, but also add that even if their use of sex dolls appears to dehumanize real (meaning actually human) women or promotes misogyny, that in reality, bot-owners actually “cherish” their dolls and treat them with respect. That’s a ‘Hmmm maybe’ for moi people. I’m sure that for some people that find it hard to make connections and sustain romantic relationships, sex dolls could be an incredibly useful way to combat loneliness. But I can’t imagine a way that any man could ever convince himself that he is in a real relationship with a doll. Just doesn’t compute for me. But I guess the fact is that it doesn’t have to! In the meantime, it’s an interesting theoretical, but I don’t think I’ll be spending much time worrying about it.

The Future of Sex Toys: For Better or Worse? Utopia or Dystopia?

Should we be excited about all this new technology, or terrified of what the future holds? Are sex robots a threat to human relationships, or a niche invention which can help the lonely without affecting anyone else?

With all of the questions swirling around the future of sex, I think that the answers have everything to do with being human, and little to nothing to do with technology. No matter what “toys” you add, it still comes down to a person’s brain, as that’s what’s ultimately in control. As for the future, I’m just hoping for one that is more open, with less judgement and shame, and more acceptance and equality. I think that’s something we can all get behind. However it goes, the future of sex tech promises to be exciting, and all we can do is wait for it to be revealed and see what it’s about.

Thanks- be well, people!

MGA

Learn More

Sex Toys, Part 2 of 3

Sex Toys: Much Ado About Something

I hope everybody enjoyed last week’s marathon blog on sex toys and learned something new. I know I definitely learned a few things in researching it. So now that we know all about the categories of sex toys and their illustrious histories, today we’ll move on to who’s using sex toys and why, and go over some important things you should take into consideration if you’re thinking of joining them. So once again, open your minds, set aside your preconceived notions and biases, and read more about sex toys, people… 

Part deux sur trois!

Out of the Closet… and the Nightstand

Sex toys are so much more mainstream and accepted- appreciated, even- more now than in previous generations, and the proof of that is in studies being published in notable medical journals. These studies on sex toy use are important for the contributions they make to an understanding of the sexual health and sexual behaviors of adults in today’s society.

Indiana University conducted survey studies on the use of sex toys among nationally representative samples of adult American men and women. I looked at surveys on vibrator use where they sought responses specifically from 2,056 women and 1,047 men, ages 18 – 60, and the results were published in the Journal of Sexual Medicine, a leading peer-reviewed journal in the area of urology and sexual health. These are the first studies to document many insights into sexual health, including: how and why people use vibrators, the side effects of use, and how use is associated with sexual health behaviors, sexual enjoyment, and quality of life. The results showed that vibrator use is in fact fairly common, with approximately 53% of women and 45% of men responding positively, indicating vibrator use. Among the men included in the survey, there was no statistical difference between the rates of vibrator use among men who identified as heterosexual and those who identified as homosexual or bisexual.

Of the 53% of women that reported using vibrators, 70% of those indicated that they never experienced any side effects associated with use. Those side effects that were reported were typically rare and of a short duration, and included mild genital numbness, irritation, or inflammation. 

Vibrator users were significantly more likely to perform genital self-examination and have regular gynecological exams as well. In addition, the 53% that reported using vibrators also reported better sex- including increased sexual desire, arousal, and orgasm- though there was no significant difference in general sexual satisfaction between the female vibrator users and the non-users.

The 45% of men (which included heterosexual, homosexual, and bisexual men) that reported using vibrators were more likely to record participation in sexual health promoting behaviors like testicular self-exam, and also scored themselves higher on four of the five factors used to measure sexual function, including erectile function, intercourse satisfaction, orgasmic function, and sexual desire. Of the 45% of men that reported using vibrators, approximately 17% said they did so for solo masturbation. Of the heterosexual constituent of the 45% of men that reported using vibrators, 91% of those reported most commonly doing so during foreplay or intercourse with a female partner. 

Though often thought to be covered in dust and dog/ cat hair, hidden under beds, or buried deep in sock drawers, these studies demonstrate that vibrator use is actually more common than most think. In addition, these groundbreaking results demonstrate that the use of vibrators is associated with a fulfilling sex life, positive sexual function, and being more proactive in caring for one’s sexual health. This affirms what many doctors and therapists have known for decades- that using sex toys is common, linked to positive sexual functions of desire and ease of orgasm, and rarely associated with any side effects of note.

Who’s Using Sex Toys and Why?

I hope you’re getting the point that sex toys aren’t just for sluts and freaks and ridiculous shades o’ grey. All kinds of people may choose to use sex toys, and for any of many different reasons. For some people, using sex toys is the easiest- or only- way they can have an orgasm, especially in vulva owning (female) people. Sometimes people use sex toys to help them masturbate Han Solo, or during sex with their partner(s). 

For transgender, nonbinary, or gender nonconforming people, using certain sex toys may help positively affirm their gender identity or help relieve gender dysphoria.

Some people with disabilities or limited mobility use sex toys to make it easier to masturbate, have sex, or perform certain sexual activities using positions that would otherwise be difficult- or impossible- for them. 

Sex toys can also help treat the symptoms of certain disorders, like erectile dysfunction, genital arousal disorder, hypoactive sexual disorder, and orgasm disorder/ anorgasmia. And some people find that sex toys help them deal with the sexual side effects of certain medications, health conditions, or menopause, ie low sex drive or decreased genital sensation.

Put simply, it’s not only totally normal and acceptable for any/ every consenting adult to use sex toys, but it’s also often a component of a fulfilling sex life and a sign of positive sexual health. Having said that, it’s also totally normal to not want to use sex toys. It’s a personal decision… everyone’s different and therefore entitled to their own opinion. As long as you’re using sex toys safely, there’s nothing harmful in it and no big down side. How do do you use sex toys safely? I’m glad you asked. I’ll tell you…

Safe Sex (Toys) People

Sex toys are big business- serious business- and big money. Yes, they should be for fun; and yes, they can be fun, but if you’re a newbie considering exploring the great sex toy universe, you need to seriously consider some things. Let me ask, would you eat something poisonous? What about something that smelled wrong- like chemicals- or looked off- like maybe it had little black dots on it or was discolored? How about something you’re allergic to- would you eat it? You probably answered ‘no, no, and no.’ We’ll assume you did. But why? Why no? ‘Well, Dr. Agresti, because those things are bad for the body… if it smells bad or it’s growing stuff, I don’t want to eat it. I don’t put bad things in my body.’ Okay, great. Does that apply to sex toys? Because in some situations, those go in the body too, right? 

Exactly. 

Sharing sex toys with other people can spread STD’s- Sexually Transmitted Diseases. If someone with an STD uses a sex toy, the bodily fluids on that toy can spread the infection to the next person who uses it. So if you’re using a sex toy with a partner, unless and until you exchange clean test reports, it’s important to take steps to help prevent STD’s, essentially by behaving as if they have one. How? Read on. 

Wash sex toys thoroughly with antibacterial soap and hot water after you use them if it’s a single user situation. It’s always better to sanitize toys, and you must sanitize toys that are shared, before you share them. Always sanitize before they touch another person’s genitals. In addition, if you put a condom on the sex toy, that will help keep them clean and prevent the spread of STD’s, but just make sure you change condoms before the toy touches another person’s genitals. It’s best to sterilize your sex toys whenever possible, and washing doesn’t equal sterilization. If your toy is heat stable, you can wash it in the top rack of your automatic dishwasher on the sterilize setting. It’s an important feature, so consider putting the ability to sterilize on your sex toy wish list.

Throwing back to last week again, remember that if you enjoy “backyard” play, make sure you use lots of lube. That area doesn’t lubricate itself the way other areas do, so putting something in your butt without adding lube can be painful and medically unsafe. And never put a sex toy that’s been in the anus directly into the vagina without sanitizing it and changing the condom first. If germs from the anus get into the vagina, it will most likely lead to a serious case of vaginitis. Basically, when referring to single person orifice swapping, the rule of thumb is this: toys are fine to go from vagina to anus, but never the reverse- never anus to vagina- that’s a no go people. And if you’re dealing with a multiple player situation, the toy should always be sanitized and the condom changed when toys pass from one person’s parts to another’s.  

Another throw back, remember that if you are a penis owner into the back door, it’s important to make sure that any sex toy you use in your anus has a wide base to keep it from going all the way up and in the backside. If a sex toy goes so far into your anus that you can’t reach it to pull it out, you’ll need to see a doc to get it out. By the way, if you’re wondering… a sex toy cannot be lost in the vagina because the cervix stands in the way, blocking the end. So vulva owners are off the hook for that bit.

Don’t use silicone lube with silicone sex toys-  unless you put condoms on them- because silicone lube can react with the solid silicone of your toy and damage it. Some people disagree- it seems to be a grey area- but the safe play is usually the best one. Water-based lube is a safe bet to use with any sex toy, and any condom for that matter. So just make it a point to keep only water based lube around so that if you’re a little too deep in the heat of the moment, you don’t accidentally reach and grab for the wrong tube. 

Toxic Toy = No Joy

It wasn’t all that long ago that most people didn’t care about what their sex toy was made of, or even ever thought it could pose an issue. It’s only been in the last 15-ish years or so that people have realized the toxicity issues and the market has offered more access to all-silicone sex toys.

I hate to be a killjoy, but knowledge is power people, so let’s get down to brass- more accurately, plastic- tacks. 

There are body safe toys and “non-toxic but not body-safe” toys…. There are shades of tres grey when it comes to the dangers of sex toys. Some people seem to experience no obvious side effects, no problemo. Some people break out and get very sick, and it’s a nightmare. For those people, there can be very specific materials that they cannot be exposed to, but it’s not like sex toys come with a list of ingredients. So if you’re one of those people that are prone to sensitivities, how do you make sure you’re not using something that can make you sick? Read on. 

The first sex toy tests after people started becoming aware (at least publicly) of important issues, reactions, and infections from the use of sex toys were run by the Danish EPA in 2006. Do you understand the implications of that, people? The EPA monitors threats to the environment first and foremost, not people’s health. Evidently, after people became aware of reactions and infections and such, I can only speculate that some concerned Danish person (environmentalist?) must’ve looked into what might be in these toys to cause these illnesses, and that they were possibly so alarmed by the components- more accurately, the making of said components- they ultimately made enough noise and garnered enough backing that the Danish EPA ran material safety testing. That’s a big deal. And the results weren’t good… By September 2014, figuring the sex toy industry had come a long way in eight years, Smitten Kitten and Badvibes.org did another round of testing, and the results were better, but there was still some room for improvement. I imagine that will always be the case, and not just for the sex toy industry. But why does this industry seem so fraught with problems? The biggest reason is the total lack of oversight and regulation. Nobody’s minding the store, and it’s all about the bottom line… pun intended. I believe I read that up to 80% of toys are manufactured in China, and we know there’s not much tlc involved. Hey, we run out of component xyz, we’ll add more of abc, of course. No time to halt production. Besides, who’s gonna know? 

So I want to make sure you have information on toxic toys and “non-toxic but not body-safe” (say whaaaat?) toys. There are so many shades of grey when it comes to the issues here, and admittedly of course, some people will experience no obvious side effects. But others surely will, and that’s an important issue that I’d like to attempt to change. A sex blogger and toy reviewer named Dangerous Lilly is all about DIY home sex toy “tests” that aim to ferret out toxic toys, expose blatant material lies, and dispel some myths about silicone sex toys. She’s even done these jar tests to prove that toys made of compromised garbage materials are dangerous. You’ll have to check it out at http://dangerouslilly.com/ and go near the top, under the header where it says in little letters “New? Start Here!” and then click on Toxic Toys. There’s also a search site option and it’s very easy to navigate. It seems that she hasn’t posted in maybe a year, but her very extensive blog is still available, and it’s an excellent resource. These details are also in the references at the end of this blog. 

Anyway, she did these jar tests where she took two giant glass jars; one was filled with a bunch of toys of questionable materials, and the other was filled with a bunch of 100% silicone toys. She sealed both and documented what happened over the course of a couple of years. Suffice it to say that it absolutely demonstrated that cheap garbage toys off-gas, leaking chemicals and softeners and all the crap they’re made from, they get tons of little black dots which are spores, and these lead to fuzzyold/ mildew growth and yuck and all the pieces deform and glop up (technical term) onto each other, all swimming in five inches of toxic goo and chemicals- and almost all of it actually happens in the first three months. In jar two, with the 100% silicone toys touching each other, there was nothing doing. No oozing, no melting, no spores, nada. And that does demonstrate that silicone can be stored safely with silicone, although experts still say that after use, proper care dictates that toys must be sterilized and thoroughly dry before being placed in individual baggies. And you should always inspect your toys before using them: look for little black spots and examine any ‘things that make you go hmm.’ Better safe than sorry people.

There are still sex toys on the market that contain gnarly stuff, like phthalates (pronounced phay-lates) Have you heard of phthalates? A tidal wave of research has documented the wide-ranging negative health impacts of phthalates on pets and people, so they’ve been demonized and (theoretically) excluded from children’s toys, then dog toys, and now sex toys, among many other things: cosmetics, personal care products, hair combs, even earring backs. Basically manufacturers use them to make anything that’s made of plastic less breakable, really. For this reason, they’re referred to as plasticizers, ie, substances added to various plastics to increase their flexibility, transparency, durability, and longevity. And they’re often used primarily to soften PVC (polyvinyl chloride) and other plastics to make them less brittle and less likely to break with use… sounds like it would be great to use in sex toys, right? Maybe in theory. But manufacturer’s want ’em to be tough, so bring on the phthalates! Not.

Clearly, it’s a good idea to limit your exposure to phthalates, as studies are demonstrating that exposure can lead to organ failure and possibly cause cancer. Phthalates are present in lots of sex toy materials, but they’re not found in pure silicone toys, which is why it’s ideal to buy 100% silicone toys. 

But phthalates aren’t the only harmful chemical being used; other chemicals have been found, stuff like latex- helll-ooo- so many people find they’re allergic to latex… how’d you like to learn that way, with itchy fire orifices? No thank you. Another issue is that companies can (and do) lie about their material claims. Often, “phthalates-free” is more like a wishful tagline that doesn’t mean jack. So ultimately, we’re left totally in the dark about the safety of a sex toy unless you buy only from a company that’s demonstrated a history of honesty. Like many sex bloggers and toy reviewers, Dangerous Lilly still has a list of approved manufacturers and retailers, and it’s worth going over. To help you out, I’ve included it in the references section at the end of this blog. I’m a giver.

Another issue is that there are sex toy materials that have not been proven toxic yet, but they’re still softened with mystery oils (grades and types unknown), the materials are very unstable, they break down quickly, and are so porous that they harbor a lot of bacteria and mold. So even if (and that’s a big if) the material is ‘non-toxic’ when you first buy it, that changes as you expose it to air and lube chemicals and… other stuff. As you use it over time, even if you take exemplary care of it, it breaks down. That’s a simple fact people. Chemical changes will occur and oils will release, along with new volatile compounds VOCs, and who knows what else. Yet another issue revolves around the colorants and paints that tint and/ or paint these toys. Materials are especially questionable when derived from other countries… like China. Where maybe 80% of these toys come from. Ya think they care about what’s going into them? That there’s any oversight or quality control? Ah haeelll no! Especially to be sent to us! It’s about producing the cheapest possible junk they can possibly squeak by with… and if they can use garbage that shaves off an eighth of a cent per piece- even way less than that- that translates to more money for them, and that’s the name of the game. 

One particular group of offenders are the Jelly toys. Sometimes spelled jelly, or gelle, or gels. Whatever it’s called and however they spell it, it’s cheap garbage. Dangerous cheap garbage. Using Jelly products for oral, vaginal, or anal stimulation is going to introduce phthalates and other toxic solvents to be absorbed into the mucous membranes of the body. That bit happens quickly, but you may or may not know immediately. But you will know. Headaches, cramping, and nausea are just some of the proven side effects that result from exposure at the levels found in the study… normal levels from normal use. Regardless of whether you sheath the thing in condoms every time you take it out of its box, it’s still going to off-gas, degrade, begin to dissolve, release a greasy oil stain, fuse to its packaging, and stink like old tires. Is any part of that sexy? Doesn’t do it for me people.

Again, I can’t stress enough that a company can and will have the Chinese manufacturing plants put anything on the box and/ or label- any tagline or buzzword you might be looking for when buying a toy. “Phthalates Free!” “All Silicone!” More like All Crap. Nothing and no one can stop them. Nothing dictating that their packaging has to hold a grain of truth. No regulation, people.

A Magic Word

Now I think we’ve established that you can’t always trust the manufacturers. So only buy from a reputable source, and if you have any doubts about it- any smells, strange changes in the finish, development of little black dots- do not use it. Note that manufacturer’s name and you can research their reputation, maybe consider asking someone in the know about it, and don’t buy from them again. 

But how do these manufacturers get away with it? Aside from everything I mentioned before about how it’s a penny pinching free for all in China, even if you could complain, they’ve got you beat anyway… First, you really can’t complain because there’s the ‘lost in translation’ feature. They no speaky de englees don’tcha know. But regardless, the magic word comes into play: for Novelty use only. Yep. That 9 inch flesh toned realistic dildo that’s falsely stamped ‘All Silicone!’ that you bought from us is a novelty (betchur bippy they know that word…) we didn’t think you were going to use it there! Yeah. Riiighhht. So there’s that. 

We’ve discussed some sex toy lab tests over the years and things have changed for the better. In the mid-2000’s the Danish EPA tested many sex toys, and found very poor toxicity results. And while the sex toy industry has come a long way since then, and more recent tests were actually found to be improved, the big issue remains: better results still fail to explain why so many people still get chemical burns, allergic reactions, and/ or chronic infections and related issues from using certain sex toys, lubes, and accoutrements. Here’s a for instance that I want to serve as a word of warning, people…

Doc Johnson ‘Sil-a-Gel’ Products: 

Burn, Baby, Burn!

One brand to avoid that I’ve read about in several places with multiple references is Doc Johnson ‘Sil-a-Gel’ products. Don’t know what Doc Johnson is doing with these specific products made with this specific stuff, but I don’t want to find out the way some people have had to. Sil-a-Gel isn’t actually a material, it’s an additive. They claim it is an antibacterial agent that is mixed in with very porous PVC to inhibit bacterial growth in the pores of the material. Sounds pretty harmless… but note that they’re using PVC in these toys, and that’s not all silicone. The extreme reactions people have reported are cause for great concern, and many folks in the know recommend a complete boycott of any Doc Johnson products containing this ‘Sil-a-Gel’ additive. It’s worth noting that I’ve seen plenty of good reviews on other Doc Johnson’s toys, so if you just buy 100% silicone you should be safe. But ‘Sil-a-Gel’ boycott… That’s what’s up Doc!

There are so many sex toys out there… I mean, I know they say variety is the spice of life, but that’s a spicy meataballa! Navigating the sex toy universe to choose the right toy is a potential minefield, especially the first time! It’s not like you can google “world’s best sex toy” and come up with a reasonable list of safe quality toys to look at. So, what to do? Thankfully, there are plenty of people in the know, so I’ll pass along their advice. 

Choosing Sex Toys: It’s a Material World

Clearly the first thing you should consider when choosing a sex toy is material. The material the toy is made of dictates everything about how you can safely use it and how you care for and clean it. 

When you’re talking about the best sex toy materials, you want to consider material safety, durability, and hygienic properties. The best sex toys are nonporous and phthalates free. You want a toy to be nonporous because that means you can sanitize it. Nonporous materials literally have no pores, meaning no microscopic holes in them for bacteria to get into- or, at the very least, the pores are so small that nothing can get in there. To repeat: porous material= bad, invite bacteria to accumulate, reproduce, and spread. Nonporous material= good, no pores or pores too small for bugaboos to get in and colonize. 

This means that toys made of nonporous materials can be safely shared, only after being sanitized between users. It also means the toy can be used vaginally and anally, but only in a specific order if not sanitized between orifices. Going from vagina to butt in the same person is okay without sanitizing, but the opposite direction, from butt to vagina is a no go people. If you go from butt to vagina, you’re ass-king for an infection if you don’t sanitize the toy. You can also use a condom on the toy in lieu of sanitizing, but if you’re in a multi-player scenario, you must change the condom and/ or sanitize the toy whenever it goes from the first person’s genitals to the other person’s. Remember, vagina to butt is OK in a solo situation. Butt to vagina is not- ever. Also, no matter the material, a new sex toy needs to be thoroughly washed with antibacterial soap and warm water prior to its first use. If it were me, sanitize sanitize sanitize people!

That said, I’ll start with the best choices for sex toy materials first, based on everything:

Silicone: All Silicone.

If you want a more pliable toy, then 100% silicone (not a blend) would be the best choice. Silicone actually comes in a wide range of firmness and finishes. For high quality silicone sex toys, I understand from lots of sex bloggers that you can’t go wrong with the company Tantus. As mentioned before, silicone is phthalates free and nonporous. 

Being nonporous and heat resistant, you can sterilize silicone toys in a number of ways, including: boiling for a few minutes (making sure that the toy never touches the sides or bottom of the pot), washing in a 10% bleach solution, or washing in the top rack of your dishwasher set on sanitize cycle. I saw where some said you could simply lather it up really well in antibacterial soap and rinse it clean, but I’m not totally sold on that, especially if you share it. That’s not sterilizing it. And Captain Obvious says if your silicone toy has an electronic vibrator inside then don’t boil it or put it in the dishwasher.

Usually manufacturers and most sex toy reviewers will tell you to only use water-based lube with silicone toys. This is because some silicone lubes can damage some silicone toys. As I mentioned before, there are some differences in opinion on this, but better safe than sorry. So it’s best that if you’re going to keep lube around, make sure it’s water-based, especially if you’re sort of in the heat of the moment, you don’t want to worry about grabbing the wrong lube. 

Many people believe that you can’t store silicone toys where they are touching each other, but again, this is another grey area. Some people say you can and some say you can’t. From what I’ve read, many sex toy reviewers have stored their high quality silicone toys piled together in drawers without any issues, but a good rule of thumb is to have some kind of individual ziplock storage bag for each of your silicone toys. Then you can put all of them in some sort of storage box and put that by your bed or wherever. A lot of toys evidently come with their own pouches and it seems fine to store them in there. Just make sure that after using your toys that you thoroughly wash and sanitize them and make sure they’re totally dry before you seal them up in plastic bags. Any moisture left in there can lead to mold growth.

Stainless Steel

If ever there was a durable sex toy material, stainless steel would definitely be it. Seems like it would be bullet-proof. The polished finish on these toys makes it so you can use any type of lube you like, and you can also disinfect steel toys really easily by boiling or on the top rack of the dishwasher on the sanitize cycle. For routine cleaning, an antibacterial soap is good to use. About the only way you can harm steel toys is if you use something abrasive to clean them that will mar the polished finish.

Glass

Understandably, many people are skeptical of using glass sex toys, but evidently it’s considered a great material to make toys out of. Glass toys are nonporous, phthalates free, and are compatible with any type of lube, so no worries there. It’s cleaned in all the same ways you would clean steel or silicone, but if you decide to boil a glass toy,  you might want to put a hand towel in the pot to cushion it and keep it from hitting against the sides and possibly chipping. But if it does get chipped, you must stop using it. Be sure to thoroughly inspect the glass toy for chips or cracks prior to every use. I did read about annealed glass toys vs not, and annealed seems to be better, as it’s evidently stronger. There is a DIY test to suss that out. The only other issue may lie with any tinting in the glass or painting on the glass, so awareness is key. If it’s painted here in the US, say by an artist, chances are good it’s safe, but everywhere says to use a condom over it anyway. 

Wood

Wood sex toys are sealed with a finish that is nonporous and body safe, and wood itself is a nonporous and phthalates free material. A company called Nobessence is a reputable manufacturer of wood toys. You should not put wood toys in the dishwasher or boil them, but antibacterial soap and a 10% bleach solution can be used to sterilize. Solvents of any kind should not be used on wood sex toys, as they will damage the finish, but all types of lube are compatible with wood toys.

Aluminum

Aluminum is nonporous, body safe, and phthalates free. It can be cared for just like stainless steel, and any lube can be used with it. An advantage it has over steel is its lighter weight.

If you choose a sex toy made of quality materials from a reputable retailer, take proper care of it, and observe safe sex toy practices, toys should be expected to last a long time. I would emphasize staying away from cheap novelty stuff of questionable origin and dubious materials- we don’t often consider the non-monetary cost of things we purchase, even though those are usually the highest priced items in life. I’m reminded of a fitting saying I heard ages ago, don’t even remember where; but a variation on it just popped into my head. It’s a little crude, but it says “a hard prick has no conscience.” I would argue “neither do the toy companies that make ’em that way.”  

Some toys might be okay if the labeling on the box is honest and accurate and if you adhere to proper hygiene. But there’s just too much uncertainty with these materials- too many cases of reactions and infections. It’s so insidious, because the people most affected with these things almost never even consider that the root of the issue could lie in their sex life, so when they finally go to a physician and begin the long road to eatablishing cause, they don’t think ‘oh yeah, I introduced a new toy’ and the doctor doesn’t think to ask them ‘have you used a new lube or introduced a new toy?’ Definitely keep that in mind if you should ever have a reaction or issue. But fingers crossed, you won’t.

If you know you have sensitivities or allergies in your life, just don’t mess around with cheap mystery toys- or lube- same thing. Remember the potential non-monetary costs, so research, research, research… and go with quality 100% silicone. 

Perusing the Great Sex Toy Universe

There’s a lot of information out there on how to choose a first toy- be it a dildo, vibrator, butt plug, cock ring- you name it. Clearly I don’t have the time to go over all of it for every single thing, but I’ve included a list of resources at the end of this blog, and all or most are fully searchable. If you’re interested in entering the great universe of sex toys, I really encourage you to do a lot of research and ask questions; a lot of bloggers seem happy to help people with it if you send a question. Dangerous Lilly is one; even though she hasn’t posted recently, you might still want to ask since that was kind of one of her specialties and she is super detailed. But there are many sex bloggers out there… Google ‘sex toy reviewer’ or ‘blogger’  and see what I mean. Again, I’ll list some in the resources section at the end of the blog. If you’re a newbie interested in a toy, research, research, research. Absolutely ask a blogger- one of the people I’ll list at the end. Don’t be embarrassed, they’re into this stuff and are in the know. But once you’ve done some serious due diligence, I’d say take a field trip or a research expedition: go, see, and touch things; you’ll be more able to compare what’s what and make a better decision. If you’re planning on using it in a couple situation, make it a good time!

Buying for Others: Gift Trip

Now if you want to buy something for a lover, spouse, committed partner, or nebulous ‘I hope I get to use this with (insert name here)’ it makes the process of choosing sex toys even more complicated, especially if it’s the first one! Dangerous Lilly has a set of several questions that she says the buy-er must know about the buy-ee before buy-ing a toy, people. They entail accurately measuring members, maybe some comparisons to vegetables… and some deep introspection. One thing I definitely can say that’s frowned on is “Surprise!!” sex toys, especially if they’re a new introductory type deal to one or more partners. They’re fraught with potential pitfalls from the jump. So I’d suggest no “Surprise!!” sex toys. If you want to introduce the topic, or you’ve talked about it but nothing further, try a “Surprise, this is a gift certificate for us to go to (wherever) to do some shopping, baby/ honey/ sweetie pie, I thought it would be better to shop together” gift; it’ll be much better received. You can make the shopping excursion into an experience to bring you closer together and make some serious sparks fly, people. 

What else have I learned? When you’re talking about dildos, size does matter. As patients, I have seen lots of men and penis owners feel threatened by the introduction and/ or use of dildos, where they feel absolutely in competition with them, especially if it’s “bigger” than they are. This is a very real and potentially serious issue that can undermine an otherwise amazing relationship, especially because people don’t find it easy to open up about it. Any problem is a problem as it is, but a problem wrapped in shiny shame is a monster. That said, it seems an unspoken agreement that a ‘mere’ ¼ inch increase in the width of a dildo is enough to make some ladies leave a room… and others to run screaming from it. Well, you must understand one big factor: it’s not living human flesh, so evidently it equals a lot more in the fullness aspect. Because they’re not living human flesh, toys don’t have any give at all. Whereas living human flesh can be compacted in certain areas, causing it to be more expanded in others, a dildo is going to be what it is, everywhere it is. And I can imagine how that could be uncomfortable when you’re dealing with a sensitive area in the center of a body. To give you an idea: I’ve even read accounts of dildo ‘aficionados’ (unclaimed by them, just my estimation only) that refuse to use anything wider in girth than 1.25 inches, which by the way is considered a size small. They do come smaller though… and larger… up to porn starlet size. I’m just saying that there’s no reason to remain insecure about allowing a partner to explore the use of any toy, whether a dildo or anything else. Note I said remain insecure. I said that because people are allowed to feel whatever they feel; but I have seen patients that have felt that way, and they tell their partner, get assurances, and let it go. Or, they internalize it, build resentment, get miserable, stay miserable, distance themselves, then end up in my office with some major issues. With all the patients I’ve seen, I’ve never come across a situation where the person asking for and/ or using the dildo is actually doing so to cause their partner to shape up or engender a sense of competition. And by the way, there is a size designation for dildos: length and girth. The easiest one to follow was on a blog called Betty’s Toy Box. The direct link to it is here:

https://www.bettystoybox.com/blogs/bettys-buzz/betty-s-guide-to-dildo-size-how-to-get-the-right-length-and-width-for-you

Hopefully that will stay active after I post this, and I’ll include it in the references section at the end as well. If all else fails, just Google Betty’s Toy Box Dildo Size Guide.

Another note on a first dildo that I noted was on several sites… if you’re a vulva virgin and haven’t experienced any penetration; or if you have a vulva and maybe you’re built on the smaller side and have difficulty or pain on penetration; or you have medical issues that prevent penetration or make it too painful, all the cool kids say to ease into things, and get a silicone dilator set before you consider anything else. And get a lot of lube. As a physician, I definitely second that. You can actually do some damage, so medically speaking, lube and very gradual dilation would be the way to go. I saw two references to a Sinclair Institute dilator set on SheVibe I believe. Link is below in the references section. Gotta walk before you run, people.  

Don’t Go Here… or There

I’ve never seen so many ridiculous material and product names in my life! So many -skins and -gels and -luxes, -future this and that. It’s ridiculous! And they do it on purpose! They figure you won’t take the time to Google what it is if it sounds interesting enough. Also remember you usually get what you pay for, and that a bad decision may cost you more than money. So for the love of all that is holy, avoid some things like the plague people! 

Just say ‘NO!’ to: 

-Jelly, Gelle, Jels, Gelz or anything like that 

-Rubber anything (helll-ooo latex!)

-PVC

-Cyberskin

-UR3

-Futorotic

-Any ultra-realistic dildos, especially when painted, and if they smell funny. They’re guaranteed to have phthalates in them, and they’re porous so they can’t ever be fully sanitized, so they also can’t be shared. 

Some Takeaways

-You get what you pay for…

-But if something is waaay crazy overpriced, it’s likely to be a rip off, because 100% silicone is 100% silicone. A toy can’t be siliconi-er people.

-If you stick with brands that reviewers trust, you’re much more likely to make the best purchase and be happy with whatever you bought. Some reviewers actually offer discount codes as well, so look for those while you’re researching. 

-Your best bet is all silicone, but it is more expensive, so it may be out of your range. If you decide you absolutely can’t get silicone right now, go for glass, but not cheap, un-annealed glass; and/ or cover it with a polyurethane condom. Other cheaper options that are (usually) non-toxic include TPR / TPE / Elastomer, but it’s porous so it’s hard to sanitize, and it’s softened with mineral oil-based ingredients most of the time. Oil isn’t compatible with latex, as in latex condoms, so you can’t use that type of condom with it. So that’s a minor little detail to keep in the forefront of your mind.

-If you do choose a porous material, please examine it very carefully before each use; look for any discoloration, odd odors, and black dots anywhere on it. And it is recommended that you toss it after six months to be safe, even if it’s not growing crap like a petri dish… yet.

It seems sex bloggers generally advise  avoiding buying sex toys from Amazon and Ebay. Counterfeit sex toys are definitely a major problem as bullshit seems to reign in this industry. You can easily get ripped off and pay for something that you think is silicone but actually isn’t. Some people have reported good experiences buying from Amazon, but the risk of getting a fake sex toy is high enough that people in the know advise against it. Stick with well-known sex toy retailers like Shevibe, Early to Bed, and Smitten Kitten. They say in Canada, use Come As You Are, but I’m sure they’re online and these days they must ship. I also saw the name Tantus mentioned several times on different sites when talking about good quality all-silicone stuff, but then they specify that they’re a manufacturer. I still think you could find a way to buy directly from them. I haven’t tried personally, but I’m betting you can… 

References

Unsure that links will remain active people!

Dangerous Lilly

https://dangerouslilly.com/

-Hasn’t posted since 2019, but all previous posts available with excellent information

-Very interested in toy safety and materials

-Former sex toy retailer 

-Very good with instructing in “Surprise!!” sex toy gifts. But just don’t do it- a certificate if you must, but no “Surprise!!” sex toys. Take your partner shopping and make it fun people!

Betty’s Toy Box

https://www.bettystoybox.com/blogs/bettys-buzz/betty-s-guide-to-dildo-size-how-to-get-the-right-length-and-width-for-you

-This is the direct link to the Dildo Size Guide on Betty’s blog, which is another great resource.

Toy Meets Girl

https://toymeetsgirlreviews.com/about-me

-A no bull middle-aged woman started a blog due to problems with hyposexual drive secondary to medical/ medication issues

-Lots of great info on everything, including toxic toys, tells it like it is. 

The Smitten Kitten

https://www.smittenkittenonline.com/blogs/news

-Blog and a trusted retailer 

-If you do a Google search, be aware there are crazy cat lady blogs and cat retail stores and boarding services as well, very different!

-Also interested in toxic toys- talks the talk

Bad Vibes

BADVIBES.ORG

-This is an organization est in 2005

“Creating radical change in sex toy manufacturing and consumer awareness around sex toy material and usage.”

-Tons of resources

-Worked with Smitten Kitten to do second round of sex toy material safety testing

Sexational!

http://www.sex-ational.com/blog-1

-Any semi sex-related topic you can imagine

-They describe it best

-As their home sign-in page says: 

“Keep Abreast”

It’s “Whatever I feel like, once a week–and at least one breast.”

Then: “GET ON IT” and “I’m not kidding about the breast.”

Trusted Suppliers

SheVibe   

https://shevibe.com/

“The most competitive prices for the highest quality products available.”

Early to Bed   

https://www.early2bed.com/

“Chicago’s feminist sex shop. Helping all kinds of folks have great sex since 2001. We ship discreetly and quickly!”

Smitten Kitten

https://www.smittenkittenonline.com/

“Non-Toxic and Body-Safe Sex Toys”

Also have guides to sex with disabilities

Come As You Are Co-op (Oh Canada)

https://www.comeasyouare.com/

“World’s only worker-owned co-operative sex shop … a fundamentally anti-capitalist and feminist approach to sexual pleasure, health, and education.”

I’m not absolutely positive if they ship outside of Canada, eh?

Tantus

https://www.tantusinc.com/?rfsn=3563776.b20e70

“Founded on the belief that each person has the right to a healthy sex life. We believe that our products should be driven by passion and integrity, and inclusive to everybody.”

-They highlight their “Ultra-Premium Silicone”

-And yes, you can definitely buy direct!

AND…

Next week… Last of Sex Toy Blog Series

Smart and App’d Couple Toys- For long distance love… or love in the time of Covid!

Sex Toys of the Future

The last sex/ toy blog- for now- so stay tuned!

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Sex Toys:Not Too taboo

Sex Toys: Not Too Taboo

Usually I write my blogs and record my vids right off the top of my head with basically zero preparation required. Today’s topic is a little outside my usual scope, but I’m man enough to admit that I did some research- and believe me when I tell you that there is a freaking metric ton of info on sex toys out there! As a physician, I’ve seen more than my fair share of kink and way-out-there sex practices in hospital ER’s all over this great country, but I found that toys these days go from “wow…now that sounds interesting” to “they want you to put that there?” to “dammit, why the hell didn’t I think of that??” Some of it is totally blush-worthy, but set aside your hang-ups and preconceived notions, open your minds, and get ready to get really up close and personal here, people! And fair warning: prepare for plenty of innuendo and double entendre – and any time you read something and think to yourself ‘oh wow, did Dr. Agresti realize what he wrote there, what that word choice kinda sounds like in a blog about sex?’ The answer is yes and yes…I did and I do. So I hope you like it and share it.

Sex toys are clearly no longer the taboo subject of generations past, as ever increasing numbers of men and women, cis and trans, L, G, B, and Q, individually, and in couples and fill-in-the-blank-somes, are incorporating toys into their sex lives. As a result, it’s no surprise that the sex toy business is banging. Not a shock if you recall my wildly popular orgasm blog and some of the not-so-fun facts I had to reveal: 

-10% to 15% of all women are anorgasmic, meaning they cannot or do not orgasm…like at all. Bummer days people.

-75% of women will never (Hey, you hear that? Never…ever…ever…ver…ver…err…errr) reach orgasm from straight up intercourse alone, without a toy. Like wow people. 

-Captain Obvious says that means that only 25% of women will reach orgasm from vanilla sexual intercourse alone, ie without a toy.

-Only 29% of women regularly reach orgasm with their partner, while 75% of men will always reach orgasm with their partner (“yeah, or a hole in the wall” as added by someone who will remain nameless that’s giving me the stink eye at this very moment because for some reason she thinks that when I’m typing on my laptop I somehow magically become blind to everything else.) Anyway, the moral of this story is that women are far more likely to orgasm when they’re all by themselves than when they’re with a partner. Ouch people.

So…why should you care, you ask? Well, numero uno is that you might have a vagina. Duh. And if you’re an owner of said vagina, you are statistically much more likely to be among that 75% that can’t orgasm from vanilla intercourse, or the 71% that don’t orgasm with your partner at all! Or you could even be both. Or, maybe you have a penis, but you care about someone that has a vagina…like you really care, to the point where you want to have sex with them and please them…both at the same time I mean. This would be good intel then, no? Because then you could even introduce a sex toy (surprise, honey!) and explain that you got it just because you’re so concerned that she may be a member of the “no orgasm club.” But don’t call it that- use big words and quote the statistics in an effort to make yourself sound smart- they’ll appreciate that. Oh, and because you’re a giver. Throw that one in there too. No… really, in all seriousness, emotional intimacy and pleasure from physical intimacy are truly very important parts of a love relationship. And emotional intimacy is at its best when everybody involved derives pleasure from engaging in physical intimacy. To simplify: make your partner’s orgasm at least as important as yours. They’ll be much more inclined to like you and give you more opportunities to make their orgasm at least as important as yours… it’s a positive feedback loop.

There are a lot of myths surrounding sex toys, and one of the most ridiculous is that they’re unnatural and unhealthy. In reality, that couldn’t be farther from the truth. Sex is one of the most natural things a body does; it’s a gross comparison, but sex is right up there with peeing and pooping. Anything that promotes sex and pleasure is absolutely natural and completely healthy! In fact, people who abstain tend to have more instances of anxiety and depression. Facts people. Women that use sex toys report greatly increased levels of sexual desire, much more frequent orgasms, far greater sexual satisfaction, and happer, better, and more complete intimate relationships. I can’t find a negative in any of that. 

Why are sex toy sales on the rise?

While they were once seen as depraved and belonging to a certain line of work, these days they are totally socially acceptable. Now there are even more sex toy parties than Tupperware parties, and women enthusiastically compare notes about the latest sex toys in their collection. The hype surrounding the film Fifty Shades of Grey has played a part in this, along with the fact that today’s women are no longer ashamed about satisfying themselves. On the contrary, self-assured modern women are open about their sexuality, and this includes the fact that they don’t necessarily need a man to be sexually satisfied. That said, couples are also incorporating sex toys into their activities at an ever increasing rate. In particular, couples in long-term relationships are using sex toys to spice up their love lives, allowing them to explore new sexual experiences together. I’ll be talking all about this in part three of this sex toy series, and you don’t want to miss it- it is hot stuff people!

But before we get that deep, today I’m going to start with the basics on sex toys: what they are, how they started, and what they’re all about. Then next week in part two, I’ll talk about who’s using sex toys and what you should consider if you decide to join them. As I said before, part three will be about partner toys and ways to spice up long-term relationships. And at the end, I’m going to paste some links to articles and sites where you can find more information about different types of toys, how to choose a first toy, and where you can find and purchase any and every toy you could ever want. Look, if you’re into playing fingerpuppet five-on-one or downstairs DJ and it works for you, I certainly have no objections your honor, but some new toys could put a new smile on your face; so keep reading my blogs and if anything strikes your fancy… be adventurous and go for it!

What are sex toys?

As if you don’t know… Sex toys, aka adult toys, aka “marital aids”… all are terms for objects that people use to have more pleasure during partner sex or masturbation. Sometimes sex toys can also have medical uses, as in cases of sexual dysfunction, although that seems to be something of a point of contention. There are many different types of sex toys, and people use them for any of many different reasons, but the general idea and end goal is basically the same for everyone across the board: to get off. I’m pretty sure that’s the technical term.

Here’s a quick overview of some of the most common categories of sex toys:

Vibrators

AKA vibes or buzzers

AKA “personal massagers” (yeah…riiiight) 

-Objects that vibrate or buzz to stimulate internal and/ or external genitals.

-Most commonly used on the clitoris and/ or other parts of the vulva and vagina, especially the G-spot.

-Can also stimulate the penis, scrotum, testicles, nipples, anus, and the male P-spot. 

-Come in endless shapes and sizes, waterproof or not, for inside the body and/ or out, and for all genders.

Dildos

-Objects that go inside a vagina, anus, or mouth. 

-Come in many shapes and sizes, but they’re often shaped similarly to a penis. 

-Some look realistic, others more abstract.

-Can be slightly curved to help stimulate G-spot or prostate,  the P-spot.

-Can be made out of lots of different materials: silicone, rubber, plastic, metal, or

glass (freaking yikes – not for butterfingers!)

-Dildo Fun Fact #1: Ever wonder where the term dildo came from? Constantly, right? Let’s get in the Wayback Machine to find out!

-Turns out, like so many words, dildo is thought to be a bastardization of terms taken from other languages.

-IMO, the winner is diletto, taken from the Italian which means ‘a woman’s delight.’ This seems a very likely place where the word we know and love today got its start, however there are a couple of other contenders. 

-My next personal choice would be dill-doll, which is the ye olde English translation for the old Norse word ‘dilla,’ a verb meaning ‘to soothe.’ So literally, a dill-doll would be a soothing doll, as in…a penis! Of course! Or an intimidating giant rubbery effigy of one, anyway. 

-Dildo Fun fact #2: Did you know that there’s an actual place called Dildo? I heard that’s where Waldo was… Waldo in Dildo. But seriously, there’s a town in the maritime province of Canada called Dildo, and Dildo Island is located just offshore don’tcha know. The tourism marketing folks there are fighting one hell of an uphill battle. Check out these tags that I came up with: 

‘Dildo~ The Weather is Here…Wish You Were Beautiful!’ 

‘Come to Dildo…See the Sights!’ 

‘The Isle of Dildo…Get On It!’

Anal Toys

-Captain Obvious says these are toys made specifically to stimulate the anus. 

-Includes plugs (aka butt plugs), anal beads, prostate massagers, and wide base/ flared dildos. Yeah people…pay special attention to that wide base/ flared part- if you don’t, these suckers are prone to take an accidental detour waaay up the hershey highway, and then you’ve got to go to an ER to have it pulled out, and that’s not embarassing at all. I’ve seen this all up-close-and-personal-like more times in the ER than my poor brain can block people.

-You must use lube to use anal toys (especially anal toys) safely. An overarching theme on these toy sites is basically this: lube is cheap, so use lots and lots of lube when you play with toys.

Sleeves

-AKA masturbation sleeves

-AKA penis sleeves 

-AKA strokers

-Soft tubes designed to put the penis into.

-Come in all shapes and sizes, and with different textures on the inside for more sensation. 

-Some feature vibration or suction. 

-These are cool because there are strokers specially designed for a larger clitoris or smaller penis, particularly for intersex or trans people.

Penis Rings

AKA cock rings 

AKA erectile dysfunction rings

AKA constriction rings  

-Shockingly, these are rings that go around your scrotum and/ or penis (must be prior to arousal people!)

-Work by slowing the blood flow out of the penis once it’s erect, thereby increasing sensation and/ or making the erection harder and longer-lasting. 

-The safest penis rings are made from soft, flexible materials that can be easily removed in case of emergency: silicone, rubber, or leather with snaps for the biker set. 

-Some penis rings have little vibrators on them to stimulate the wearer and/ or their partner during intercourse. 

-Penis rings restrict blood flow, so don’t wear one for longer than 10 to 30 minutes, and take it off right away if it becomes even slightly painful: kind of defeats the purpose. 

-Talk to a nurse or doctor before using penis rings if you have a bleeding disorder or are on blood-thinning medicine. See, just the fact that they mention that leads me to believe that there could be blood shed associated with using this toy…so for me, this is a pass and a no freaking way, people!

Pumps

AKA penis pumps

AKA vacuum pumps

AKA vacuum erection pumps

-Vacuum-like devices that use a hand or battery-powered pump to create suction around the penis, clitoris, vulva, or nipples. -Pumps drive blood flow to the area, which helps increase sensitivity and sensation. -Penis pumps can help you get an erection, but they won’t make your penis permanently bigger. Sorry people.

-Some pumps are designed to help treat erectile dysfunction, genital arousal disorder, and orgasm disorder. 

-For more information about these pumps, contact a nurse or doctor. You can also go to your local Planned Parenthood health center. -Most of the pumps you buy in sex stores or adult shops are not medical devices, they’re just meant to enhance pleasure during sex and masturbation. 

-Make sure to follow the instructions on the packaging, and don’t pump for longer than the instructions dictate.

-Once again, talk to your doctor before using a pump if you have a blood disorder, or are on blood-thinning medication.

Ben Wa Balls

AKA Kegel balls

AKA Kegel trainers 

AKA Vagina balls

AKA Orgasm balls

-I’m sure you’ll all be shocked to learn this first part: that these are round objects; but maybe a little more surprised by the second part: that they’re designed to be inserted inside the vagina, and definitely shocked by the last part: some women keep them in for an entire day. Like on purpose. Whoa people. Don’t mind me, I’ll just be crying in the fetal position over in the corner. 

-They can assist in exercises that tone and strengthen the Kegel muscles. 

-Kegel balls are usually weighted so that the vagina must be squeezed to keep them inside the body, strengthening the pelvic floor muscles. 

-You don’t need these balls to do Kegel exercises, and not everyone uses them for that purpose; many women just like the way they feel inside the vagina.

-Fun Ben Wa Balls fact: female prisoners could use these to enlarge their “God purse,” which is what they call their vaginal cavities, especially when they hide illegal items from cops and/ or smuggle contraband into jails and prisons. Wonder if a female inmate came up with them… after all, necessity is the mother of invention.

-Some are hollow with smaller balls inside that roll and bounce when you move, making a jiggling sensation. And probably a jingling noise too, right? Can you imagine that? I’ll do it for you: you’re a man in an elevator, you’ve just pushed the button for eleven, and just as the doors are about to close, you hear the familiar sound of jingle bells getting louder as you see a woman is running to catch the elevator, and as she jumps inside at the last second and lands in her spot, there’s one final loud jingle as she smiles and says “five please,” then silence. Internal thoughts as you push five: Hmmm, those were bells. Like jingle bells? Huh. But kind of… quiet-ish… almost muffled (? you ponder this as you clean your right ear with a pinky finger). Funny, it’s May, not December. I don’t see any bells tied to her stilettos. Odd. Well, maybe she’s one of those people that keep that holiday spirit all year long. Freaks. Ugh so annoying! Or, she’s got ’em in that purse. It’s really small; didn’t see that on her other shoulder before. That’s it. They’re in that purse. Gotta be. Mystery solved. Good job. 

Meanwhile, her internal thoughts after you pushed five: Sheese…this ass monkey moron heard my bell balls. Ha! He’s trying to figure it out right now…I can see the gears working overtime in his pea brain. Can practically smell the burning as he’s inspecting me. No moron, they’re not tied to my Manolo’s…what am I, four? Doesn’t he- oh, he just saw my purse. Yep, he thinks I’ve got them in there. Oh yeah, he thinks he’s got it all figured out…he looks so proud of himself. Little does he know this silly little purse won’t even hold my bell balls! But my God purse does…juuust fine. Later loser.

Right after his mental pat on the back, the elevator stops, the door opens, and she’s gone… jingle all the way.

Harnesses

-AKA straps 

-AKA strap-ons

-These are garment systems that hold a packer, dildo, or other sex toy against the body. 

-Some can be worn like underwear or jock straps, while others can go around other parts of the body, such as the thigh.

People still have a hard time talking about sex and orgasm, but make no mistake: these are integral components of life, and even the ancients knew it. The desire for a good, satisfying, old-fashioned orgasm is timeless. Our ancestors, while they were making hair combs out of bone and forming and firing clay pots, they didn’t neglect their sexual needs… quite the opposite actually. Need proof? To date, the oldest dildo recovered is a big curved stone phallus found in Germany. How old was it? 28,000 years old people!

Turns out, historical men (and women, maybe even more so) were light-years ahead of us in the pleasure department; we have proof positive of this, thanks to their inventions, all of which are still used today. Here are the backstories on some of the most recognized sex toys and paraphernalia that’s still out there in one form or another. 

Blow-up Dolls

-Invented in 1904

-“Lady substitutes” are recorded as far back as the seventeenth century, when French sailors devised the Dame de Voyage: a collection of curvaceous rags (say whaaat?) that could only ever resemble a woman to a very homesick and horny Frenchman. But it wasn’t until some time after vulcanized rubber was patented that the more familiar model came about, which was in 1904. Boy, that must’ve been a Goodyear… and a good year! At that time, they marketed them as  “inflatable dolls for discerning gentlemen.” Would’ve been a hell of a lot easier than marketing tourism to Dildo.

-Less than four years later, German sexologist Iwan Bloch was marvelling over mass-manufactured versions that could ‘imitate ejaculation’ for sale in Parisian catalogues. Rating super creepy was a firm that offered a custom doll resembling “Any actual person, living or dead,” which has to be the single most disturbing tagline in the history of marketing and advertising. Except maybe of course for ‘The Isle of Dildo…Get On It!’ 

-Now they make those “real life girls” which are waaay too (sur)real for me, but devotees talk to them, eat with them, and live with them like they’re real humans. Some medical show I saw followed these men that preferred these dolls, and one guy had four of them, and he actually detailed conversations between himself and the “girls,” including arguments between them about how they would get jealous when he chose to “spend time” with someone other than them. And I’ll never forget when they filmed him opening a door with a smile and saying something like “Yeah, the girls hate to be put in the closet,” and the camera focuses on the closet and there are his three other girls all sprawled out haphazardly. Here he was explaining how he loved each of them, combed and styled their hair, shopped for hot outfits for them, and here they were, all crumpled up in some dingy little closet, waiting for their next date with him or whatever. It was patently ridiculous while absolutely hilarious! There was a movie on this same storyline, I think it was called Lars and the Real Girl. I’m sure you could find it if you were so motivated. 

Butt Plugs

-Invented in 1892

-An English dude named Frank E. Young was a man with a vision, and that vision evidently involved things being inserted up other people’s rectums. Because that happens everyday, right? 

-Developed in 1892, but not marketed until the turn of the century, his ‘Rectal Dilator’ was a terrifying 4 1/2-inches of pain, designed to go not just where the sun don’t shine, but where the sun can’t, and won’t ever, shine. At the time, it was billed as a cure for piles, a gussied-up term for hemorrhoids. 

-The devices were hawked to doctors and even advertised in respected journals. And people might well have gone on believing they were medical devices too, were it not for the ridiculously suggestive instruction manual included with each order. 

-For forty years, these Victorian butt plugs managed to jump the pond to be sold all across the US of A, before they fell afoul of the 1938 Federal Food, Drugs, and Cosmetics Act, which banned them for “false advertising.” Given that it looks like it does, I don’t see how that’s possible, but we are talking about our federal government here. 

Vibrators

-Invented in 1869

-That date is the officially accepted one, but legend has it that Cleopatra actually developed the first version of a vibrator. She was said to keep a jar of live bees on her bedside table, and when she was needing some personal attention, she had her servants fill a hollowed-out gourd with them. She then pressed that against her lower Mesopotamia, using the angry vibrations emanating through the gourd to pleasure herself.  

-She had to stimulate her own self after all four of her husbands died… I guess a girl’s gotta do what a girl’s gotta do. And evidently she did, quite regularly.

-Back to the Victorian vibrators of 1869… this period was a different time… a time when “robots” were steam-powered and doctors treated hysterical women by masturbating them to climax. Of course. I also covered this in my orgasm blog.

-Female hysteria was supposedly a genuine illness, and its treatment involved a qualified medical professional rubbing the female patient’s private parts until orgasm was achieved. Because nothing about this practice could be logical, doctors often complained of boredom and pain-in-the-wrist, probably the very first cases of repetitive motion injury. 

-One of said qualified medical professionals, George Taylor, came to the rescue and invented the first steam-powered vibrator. Because what could possibly go wrong with that… a metal device powered by steam… which is hella hot people!

-Although (shock of shocks) that version failed to catch on, J. Granville’s 1880 ‘electrochemical’ design really did, much to the delight of housewives everywhere, as they went bonkers for them. 

-Even Good Housekeeping magazine started running monthly reviews of these marvelous wonders. So what happened? Well, society accepted the ‘massager’ as long as devotees could tell themselves that it was a medical device, rather than a sexual aid. Yeah, riiight…whatever gets ‘ya through the night people. 

-Now, I should note something I learned while doing research for this blog: that supposedly, while this practice of medical professionals using a vibrator to bring women to climax was common, it was not done for a female hysteria diagnosis, as there supposedly was no such animal. So there ‘ya go, now ‘ya know.

-After these vibrators made their debut in the earliest porn films, husbands soon realized what their wives were up to all the time, and they put a stop to it. Of course they did! Because as every man of that era knew, the last thing you wanted was a sexually satisfied wife… total bullshit. 

-Trust me people, I’m a doctor: a partner that’s satisfied in every aspect of life is actually the thing you should want more than anything else in the history of things in the whole wide world. If you’re wondering why, (re-)read my orgasm blog. 

Condoms

-Depends on whose history books you read, but the accepted invention date was around 1560-ish.

-Going by a strictly modern definition, the first reliable record of condom use doesn’t appear until 1564.

-Regardless, in Japan and China, ‘condoms’ made from various animal membranes were in use before the 15th century. I use ‘quotes’ because there’s really no telling what they were called.

-Japan favored tortoiseshell, but then later thin leather, to make them. In China they were made out of oiled paper or lamb intestines. Neither differed much from condoms in later centuries that were made out of linen or animal intestine.

-They were typically one-size-fits-all – sorry “Magnum” men – and they had to be dipped in water before use to make them pliable. Hmmm… pleasure fit.

-In the 16th century, condoms were used primarily to prevent STD’s like syphilis, as it was typically fatal. So whatever they called them, they may have saved some lives. That is until…  Duhn Dun Duuuhhhnnn!!!

-The discovery of spermatozoa in the 17th century changed everything forevermore. -The Church became outraged over the use of any barrier that could impede the progress of men’s little swimmers as they attempted to reach and fertilize a golden egg. 

-As a result, by the 18th century, the condom’s reputation amongst medical professionals had been firmly cemented as a tool for philanderers, prostitutes, and the immoral.

-Despite this condom condemnation, they actually proved to be quite popular among the upper and middle classes of the day. The beleaguered working classes finally gained access to them after the vulcanization of rubber, round about 1839… another Goodyear and good year. And also what undoubtedly led to the ubiquitous term recognized ’round the world… ‘rubbers.’

Penis (Cock) Rings

-Invented in China in about 1200 A.D.

-These have undergone few changes or innovations in their history. If it ain’t broke…

-Evidently, being ancient Chinese nobility was not an easy job. Not only did you have to put up with assassination plots and Mongol invaders, you were also expected to service your wife, mistresses, and concubines… all on a regular basis. 

-While it sounds like fun and games, there was an urgent reason behind it: if you didn’t produce an heir, you could be pretty sure some obscure prince was going to step up to take his shot at a coup. 

-In stressful circumstances, performing can become… well… difficult, people!

-But have no fear – penis rings are here! -First made from the upper and lower eyelid rings of a goat, with the eyelashes still attached (freaking ouch!) it helped the wearer get on with the business of impregnation for hours on end, even if he was secretly crying on the inside. And I’ll bet he was.

-While primarily made for purposes of sexual enhancement, they were later made from carved ivory and jade to also be worn for aesthetic adornment. No matter how pretty it is, I betcha they still hurt like hell.

-For a brief period inspired by sexual repression, these rings were also designed specifically for the purpose of preventingerections and sexual exploits by inflicting pain with constriction or spikes. 

-This is interesting, because it really demonstrates the clear link between pleasure and pain, even waaay back in dynastic China… tres 50 Shades. Interesting though it may be, I’ll take a hard pass on the pain part of that equation, thank you very much people. Debbie and I have no Christian and Anastasia tendencies at all.

-In reality, the basic form and function of these rings have remained quite unchanged, though they are now made in softer, less painful materials and in adjustable models as well. 

Geisha Balls

-AKAs: Ben Wa Balls, Burmese Balls

-Origins are uncertain and incomplete

-What we know: they appeared in the Orient sometime around A.D. 500 and were originally used to pleasure men. 

-Women soon (somehow) caught on to the benefits (?) of the device, and the balls went supernova. 

-Recorded across most Asian cultures, Geisha Balls were the “Rabbit” of their day: a toy that could heighten pleasure during sex, or simply facilitate some good old-fashioned self-pleasure.

Penis Enlargement

-Popularized in Third Century A.D.

-The Kamasutra was many things: a manual for living, a treatise on sex, and likely the earliest recorded scam. Why? I’m glad you asked: because in it, they describe a method for making a penis larger. How? I’m glad you asked: by catching wasps, and- stingers and all- rubbing them all over the penis, being very careful not to crush and kill them before they angrily sting the entire shaft and head of the penis. Or, some people say you could also simply grasp each wasp and apply its stinger to the skin of the penis- and then repeat that action until you’ve managed to cover it completely. Does it work? I’m glad you asked: technically, yes… but the enlargement you get would only be courtesy of the swelling caused by the poison stinger, and I’m quite sure that using the penis for intercourse in that condition would be painful as hell, certainly sufficient enough to prevent you from doing so. In reality, the efficacy of this “treatment” in making the penis larger is questionable at best, and lethal at worst, if that’s how one discovers they happen to have a severe anaphylactic reaction to wasp stings, and would be very temporary in any case… So it would only work about as well as the tub o’ enlargement cream that Junior High boys buy online after sneaking dad’s credit card. 

-There is an alternative of sorts, to increase the girth of a penis. What is it? I’m glad you asked: Apadravyas. What the hell are those? I’m glad you asked: apadravyas are a type of deep penis shaft piercing. *Warning: cross your legs, penis people!* These piercings pass through the penile shaft at certain specific points and apparently function to make the penis feel larger as it enters the vagina – or so devotees claim. 

-These girth piercings come in other forms based on where they are placed through the shaft.

-In addition to apadravyas, other forms of these piercings are called ‘deeply placed ampallangs’ and ‘reverse shaft Prince Alberts.’ Well hell, that clears it right up… not!

-These deep penis shaft piercings are fairly rare piercings due to (helll-ooo!!) their associated pain, difficulty, bleeding, and long healing times. 

-Common placement is directly behind the head of the penis, but they can be placed farther back if the (completely batshit crazy) man so desires.

-In the interest of research (heh heh) I had to ask Debbie if she would have intercourse with a dude with an apadravyas. I can’t describe the look she gave me, because words just can’t go there, and I can’t tell you exactly what she said… but it sounded a lot like “what the muck is a applegravys and what does it have to do with mucking some dude?!” After I enlightened her, I repeated my question: “…so would you have intercourse with a dude with an apadravyas?” I can’t tell you what she said, because she didn’t say anything… she just set her face in an ‘ewww, what the hell stinks?’ expression and shivered… an impressive, full body-length shiver, starting from the blonde hairs on the very top of her pretty head and carrying down to the very tips of her perfectly manicured pink toenails. After this shiver response, she started to turn and walk away, but then turned back to add “Just to be clear… I would never (word that sounds like muck) a dude with an applegravys in his (word that sounds like lick) – not even after a tetanus shot! I love my wife, so it’s my duty to keep her on her toes, however I find it fit to do so. That’s how I see it anyway… can I get an amen?! Anyway, so it was for her own good that I asked (read: yelled after her as she left) in my very best Austin Powers voice “…so you’re saying it really turns you on, huh baby?” And what did I get for all of my concern? A Debbie triple: an eye roll-tongue tisk-whut-everrr! As you can imagine, it’s a classic at my house. 

‘Lube

-Sometime and somewhere – evidently, actually everywhere in Ancient Greece.

-Given their reputed penchant for orifices that don’t naturally lubricate, it should come as no surprise that the Greeks were into lube. 

-While no record exists of its earliest use, we do know that by 350 B.C., olive oil was big business… and it wasn’t just for salads, o-kaaay? 

-Aristotle makes a passing reference to this olive oil love in his History of the Animals, implying that smoother sex was best because it made pregnancy less likely. Suurre…

-Two centuries later, physician Soranus echoed Aristotle’s views on olive oil as lube. Seriously?! A Greek dude named Sore-anusthat’s into olive oil lube? Duh! This has got to be a joke. Albeit a hilarious one!

-Sore-anus’ friends- Herodotus, Plutarch, and Ovid- evidently agreed wholeheartedly, and all maintained that Athens got its name because the goddess Athena herself gifted its founders with an olive tree… that’s how much they loved olive oil.

-Greeks were clearly keen on material innovations. In an effort to upgrade from hard (not to mention dangerous and so very uncomfortable) materials like stone, dried tar, and wood, the Greeks developed olisbokollikes- these were essentially dildos baked out of bread. They basically made breadsticks, people. Breadstick dildos…a whole new take on “food porn.” 

-I don’t know why, but whenever I think about Greeks, I automatically think Romans, so I don’t want to leave them out… the Romans were innovators as well during this time. They’re actually known for creating the double-ended dildo, which was regularly used between partners and friends, but was also even used during certain public ceremonies. Roman exhibitionists… that’s amore, people!

….And speaking of dildos

-Archaeologists discovered an eight inch stone behemoth in Germany, dated at 28,000 years old, people!

-The dildo may well be humanity’s most durable invention, as only fire, weapons, clothing, and beads appear to have been around longer. 

-Evidently, archaeologists find dildos on digs all the time: it’s almost as if people in the prehistoric era found sex to be a natural and enjoyable thing that they didn’t have to be ashamed of. No shame in their game people. 

…And speaking of no shame: Pornography

-Years ago, archaeologists uncovered a decidedly pervy prehistoric statue carved from a mammoth tusk. Who knew that archeology could be so titillating?

-It was basically a female torso with… hmmm- how to put this… ‘exaggerated’ sexual parts on top and bottom. 

-It was a toy- a sex toy- and it was also functional pornography! A two-fer people!

-The exact age of it is uncertain, but the best guess places it at over 35,000 years old. 

-That means it may even pre-date religion. That’s big, people. 

-Obviously, the history of religion is essentially educated guesswork, so lots of eggheads argue about it, but if you assume it’s true- that this pervy porno sex toy pre-dates religion- can you understand the implication of that?

-In case you can’t, I’ll help you out: that would mean that before humans bothered with their ‘trivial’ thoughts on the meaning and creation of life, they had already figured out all the things that turned them on and got them off, and were producing toys and paraphernalia to make it easier and more gratifying to do so. Talk about priorities, people. 

Clearly, human beings have been exploring sexuality since the dawn of time, and as it turns out, sex toys and sex paraphernalia have been around for just as long. The above glimpse at their design histories offers a strange and often hilarious look at humans’ constant quest for innovation and better…. connection, let’s say. 

Okay people, this blog has been a long one, but you hung in there (hahaha I’m on a roll here!!) and I like to reward good behavior. So, speaking of hilarious, I found a page from a UK-based global sex toy company called Lovehoney (Lovehoney.co.uk) where they sell stuff that might blow your mind…but the following will sooner bust your gut: it’s their list of the 101 funniest Lovehoney site searches (look for occasional commentary from me, MGA people!)

101 Funniest Searches on our Sex Toy Site

https://www.lovehoney.com/blog/2018/03/08/101-funny-sex-toys-searches-lovehoney/

Quoted from Lovehoney page:

There have been 6.9 million unique searches on Lovehoney.co.uk in the year to date. Most of the words that are typed into the search box at the top of our site are pretty straightforward: cock rings, vibrators, and all the other types of sex toys we sell. And when customers type in a phrase, we try to present them with the product or page they’re looking for. Simple. But!!! Some of the searches are not quite what you’d expect…

“Anal cockroach”???

Ummm… Sorry, no page for that!

Or any of the below, which are just 101 of the funniest, weirdest, and ‘whoops you’re on the wrong website’ searches we’ve found!

Typos and epic auto-correct fails…

1. make your duck longer

2. election enhancer (MGA: we’ll all need this come November people!)

3. cockfosters extension

4. pension extender (MGA: where can I sign up for this?)

5. masterbakers for male

6. master storyteller sleeves

7. prostate lasagne (MGA: not what your Italian grandma serves for Sunday supper, thank you God) 

8. blowtorch stroker

9. extra quiet clitoris

10. quiet rabbi

11. g spotify

12. large g snot rabbit

13. vibe eating butt plug

14. king clock dildo

15. breaded dildo (MGA: ditto last comment)

16. jelly bilbaos

17. rubber dodos (MGA: and scientists claim they went extinct)

18. nipped pasty

19. nipple gardening cream

20. or gasman creams

21. pies for woman to get horny (MGA: we need to introduce this lady to Mr. 5 ^)

22. parents ribbed and dotted

23. bondage ape (MGA: our ASPCA would never allow those here)

24. lego restraints (MGA: I remember looking for that set. People really snapped ’em up at Christmas time!)

25. clint clamp

26. sexist enhancer (MGA: ‘Ah-hem, I’m afraid I couldn’t purchase these again for you, Mr. President’)

27. £3 sex tits (MGA: that’s only $3.75 USD…can’t be very BIGsex tits)

Somebody’s got the sex toy blues…

28. argue dildo

29. be warned balls

30. begging set

31. bitterly kiss

32. bleak lace lingerie

33. blue worthless knickers

34. fifty shades of greed

35. cock extinction

36. fleshlight insults

37. handcoffins

38. hate based lubricant

39. male sick vibrator

40. male wasterbators (MGA: masturbating stoner guys)

41. vaginal fighting cream

42. ben war balls

43. very berating pants

44. misery bundle

45. pensive sleeve

46. performance kills

47. remorse egg

48. repent rabbit

49. undead wear

50. ruthless panties

51. sorry panties

52. worthless dispenser panties

We do NOT sell these…

53. bishop vibrator

54. barman vibrator

55. cricket vibe

56. turnip vibrator (MGA: for the very strict vegan)

57. parsnip vibrator (MGA: okay, somebody clearly thinks they’re a comedian. I make the jokes here, people!)

58. vibrators with noodles

59. bike saddle dildo

60. pogo stick dildo

61. glasses with testicals snaped to them

62. Darth vader condom

63. extra sting condoms

64. pickled onion condoms

65. chicken tikka masala condoms (MGA: it’s past somebody’s dinnertime)

66. lovehoney wine

67. extra wine vibrator

68. make-up sperm coconut

69. paperami lube

70. Love twiglets

71. family guy sex doll

72. Japanese dancing pants

73. loyal pyjamas

74. machine guns

Going somewhere? You’re on the wrong site… (MGA: if I had captioned this, it would’ve been: “Sorry – we’re all about coming, not going…”)

75. gloucestershire bus timetables

76. london to whitehaven train times

77. meeting point in bangkok airport

78. walking trails in east falmouth

79. bike rack inside caravan

80. staying in a hotel in alton towers

81. is drinking allowed on coaches

82. parrot sale in india

83. North Korea (MGA: there’s a Kim dynasty joke in there somewhere)

Nope, we’re not a grocery store…

84. andrex supreme quilted toilet roll tissue paper

85. fairy non bio pods sensitive skin washing capsules

86. gaviscon double action mint tablets

87. roasted cauliflower with parmesan cheese

88. serrano ham

89. Ragu

90. Absinthe

Just plain weird…

91. Peter from gravesend – timewaster

92. hide your drink in bra

93. mild penis

94. mild vagina

95. outpouring vegan

96. room of priests

97. scrotal parachute (MGA: I know they stretch as we age, but wow…that’s gotta be impressive)

98. the loo of love (MGA: must’ve missed that position in the Kamasutra)

99. Wednesday

100. Dave

And finally this person, who clearly knows exactly what they want…

101. a silicone butt plug for beginer one my wife can leave in her ass n get on with housework shaped without risk of it falling out

(MGA: alert the media people… I’m speechless!!)

   _______________________________

That’s some of the history and background on sex toys. In the next couple of weeks, I’ll be covering more interesting details and specifics on sex toys that you won’t want to miss, so be sure to come on back for more, people. 

I hope you really enjoyed this blog and maybe even found it to be slightly more titillating than the usual fare. If so, please feel free to spread the love and share it with family and friends…. and lovers of course! And be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more fabulously educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Opiate Addiction and Detox: Buprenorphine vs Methadone

Opioid Addiction and Detox: Buprenorphine vs Methadone

Last week, I went over the history of opioids, and it really highlighted the trend of addiction that has always been linked with them. According to the World Health Organization, more than 15 million people are suffering from opioid dependence today. It’s clear that the opioid epidemic isn’t a new phenomenon; for as long as the opium poppy has been in existence, so has addiction. Historically speaking, what is relatively new is that physicians and pharma companies are recognizing the need for more effective ways to combat this epidemic, whether through prevention or treatment. As a result, we have some novel compounds that present different options for people who are addicted to these drugs; these include non-narcotic options for pain relief to prevent addiction, as well as medications to help addicted people on their road to recovery from opioid dependence. In a future blog, I’ll talk about a non-narcotic compound currently in patient trials that is showing a great deal of promise in the chronic pain arena. If you’re interested now, I posted a video on it on my YouTube channel, so check it out. But for today, I’m going to talk about the latter: two drugs, one relatively new and one not so much, that are being used to detox opioid addicts and give them a shot at a clean life. These two drugs are buprenorphine and methadone, and one of these is definitely not like the other. I’m going to compare and contrast them: the good, bad, and the ugly. By the end, you’ll not only know my opinion on the matter, but why I’m passionate about it. 

What is Buprenorphine?

On the market for nearly twenty years, buprenorphine is a Schedule III drug used to help treat the physical ramifications of opioid withdrawal. Given as a simple medicine that dissolves under the tongue, buprenorphine satiates the opioid receptors that cause dependent people to crave opioids. It can be prescribed in its solo form, or as a branded compound product with naloxone, which is the familiar ‘resurrection’ drug Narcan. It is the most strictly regulated drug by DEA, and available only from physicians that have been specially certified in its use, a fact that has been the nexus of some controversy. Why? Some physicians and policy makers feel that the hoops that physicians must jump through in order to receive the ‘X Waiver’ required to prescribe it present a barrier to its use; that if certification requirements were relaxed or eliminated, more opioid-dependent people would have access to this option for detox. The objective of someone taking buprenorphine is to help them remain safe and comfortable as they go through detox from opioids so that they can focus on treatment and recovery. While some data claims that buprenorphine may create some feelings of well-being when a person takes it, it does not cause a euphoric high. It’s also worth noting that while it can be used safely long term, the duration of use of buprenorphine tends to be more short-term, which clearly verifies the absence of a high and it’s low potential for addiction. Buprenorphine’s binding action to opioid receptors in the brain blocks the narcotic effects of traditional opioids, so if a drug-dependent person takes buprenorphine and an opioid together, there’s still no “high,” thus eliminating the reason for taking said opioid. And, buprenorphine also has a ceiling effect, meaning that beyond a specific dose, its effects remain unchanged. This essentially does away with the “if one is good, four are better” phenomenon, so overdose is very rare. 

What is Methadone?

Methadone is a drug that some physicians believe can be used to “help” opioid-dependent people as they try to stop using drugs. But that’s about where the similarities end. Old as the hills, methadone is a Schedule II opioid medication that’s been used for detox for 60 years. Methadone has a similar chemical structure to morphine; as such, methadone can, and does, make someone feel high. In theory, methadone doesn’t make people “as high” as some other opioids, and it can take longer for that high to occur, which proponents say translates into less potential for abuse. I say this is total bullshit. Why? Because we’re talking about drug-dependent people here, people! We’re dealing with people that, despite any good intentions they may have, their brains and bodies tell them they must get high. Remember that “if one is good, four are better” phenomenon I mentioned? Yeah. Bottom line is that methadone is a very strong opiate, so when a dependent person takes it, their addicted brain gets a taste of that high, and it’s like a tease…it tends to make them want more. Helllooo! There’s almost nothing that will stop a drug addicted brain from getting what it wants. There’s no blocking action and no ceiling with methadone, so overdoses are not unusual. Regardless, for over sixty years, methadone has been given as a “short-term” treatment to help people stop using opioids. That’s bad enough, but what’s worse is that it’s even more often used as a long-term maintenance drug for the “management” of opioid addiction. In reality, it’s replacing one bad drug with an even worse one. In fact, methadone is also known as “liquid handcuffs” by the people who have managed to successfully get off of their methadone “management” programs. 

While the general objectives of buprenorphine and methadone use may be similar to one another, there are clearly many significant differences.

Methadone is almost exclusively dispensed by clinics on a per diem basis, meaning that people have to head to the clinic every day and line up to get their “medicine.” In contrast, a physician with an X waiver can write for a 30-day supply of buprenorphine. It is less problematic than methadone, largely because it’s less dangerous and less addictive than methadone, thanks to the ceiling effect precluding overdose, and the fact that it doesn’t cause a high. That said, people must keep in mind that buprenorphine is a powerful drug, and not one to be taken (or prescribed) lightly. Saying that it’s less dangerous than methadone, while absolutely true, is sort of like saying that rattlesnake bites are less dangerous than cobra bites. Me personally, I’d just rather not be bitten…but if I have to be bitten, bring on the freaking rattlesnake. 

Buprenorphine vs. Methadone

It’s Science, People!

Both humans and animals have opioid receptors in the brain and spinal cord. Biologically speaking, these receptors facilitate the binding and effect of naturally produced pain-relieving chemicals. Externally sourced opioids like methadone belong to the opioid agonist class of drugs. They work by binding to these specific receptors in the brain and mimicking the effects of those naturally produced pain-relieving chemicals. As a result, the perception of pain is blocked, producing feelings of well-being and euphoria, but also side effects such as nausea, confusion, and drowsiness. While opioid drugs are often very effective in treating pain, people can eventually develop a tolerance, so they require higher doses to achieve the same effects. It’s a vicious cycle, so people become dependent, and will experience symptoms of withdrawal if they decrease or stop opioid dosing. That means that when it comes time to taper off of methadone, it’s intrinsically difficult, and withdrawal is unavoidable. Symptoms of opioid withdrawal can include anxiety, muscle aches, irritability, insomnia, runny nose, nausea, vomiting, and abdominal cramping. It’s seriously un-fun at best.

Buprenorphine belongs to the opioid agonist-antagonist class of drugs, and it is a partial opioid agonist. As such, it activates only a portion of an opioid receptor, so it only causes a portion of the effects of an opioid, specifically eliminating the euphoric effects of opioids like methadone. It has lower potential for causing respiratory depression than methadone, and that translates to little potential for overdose death. And it also effectively blocks the effects of other opioids, including heroin and prescription pain medications like fentanyl and oxycodone, so it’s much more likely to discourage relapse in recovering patients. Buprenorphine prescriptions can be filled and taken home, eliminating the need to go line up at a nasty clinic every single day. And because it’s much longer acting than methadone, buprenorphine doesn’t need to be taken every single day anyway, so patients aren’t tied to it; they have the freedom to spend more time doing activities that are more positive for their recovery. When it comes down to tapering off of buprenorphine, it’s far easier than methadone, with essentially zero physical withdrawal symptoms. All of these factors make a big difference, people.  

Buprenorphine Pros vs Methadone

Newer, safer, more effective 

Long acting, easy taper

Safe for use during pregnancy

Low overdose potential

Prevents opioid usage- blocks euphoria

Covered by most insurance carriers

Typically excluded from employment drug screening

Buprenorphine Cons vs Methadone

Can be more expensive out of pocket

Unpleasant taste sometimes reported

Requires specialized physician

In my practice, I treat a fair number of opioid addicted people, and I do not and will not ever use methadone to treat them…it makes zero sense, when there’s an alternative that is more effective, safer, and easier to use. Methadone doesn’t solve a problem, it creates a bigger one. If I have a new patient that is on methadone, I switch them to buprenorphine as a matter of course. It’s not easy on them, but I use every weapon available in my arsenal. 

Methadone to Buprenorphine

In order to start taking buprenorphine, a patient must be in withdrawal, another un-fun fact. This is because buprenorphine is a bully. When you take it, it preferentially binds to those opioid receptors we talked about before. That means it kicks the true opioid off the receptor and replaces it. Doesn’t sound so horrible in theory, but it’s a very different thing in practice. The opioid addicted brain without its favorite thing- opioids- leads to a brain in withdrawal, which leads to a body in physical withdrawal…shakes, sweats, nausea, vomiting, diarrhea, muscle aches, and joint pain, just to name a few of the symptoms to be expected. 

The patient must be in a state of withdrawal for a proscribed amount of time before you can dose them with buprenorphine, because it can be dangerous to give it sooner. The longer they can tolerate that withdrawal prior to dosing buprenorphine, the better the buprenorphine will work and the easier the process will be. The length of the ideal withdrawal time is based on the half-life of the opioid the patient is addicted to. The half-life of a drug is roughly the amount of time it takes for half of the drug to be metabolized by the body, ie that 50% of it is left. For most opioids, 24 to 36 hours is the ideal withdrawal time. But methadone’s half-life is crazy long; in some people, it can be between 88 and 59 hours. But wait…it gets worse. That’s just for half of the drug to be metabolized. It generally takes six or seven half-lives to fully metabolize out a drug so it is no longer biologically active, so in methadone you need to have ten days off before you can safely introduce buprenorphine. Again, this is because that buprenorphine is a bully, and if you introduce it too soon, when methadone is still parked on the opioid receptors, it’s going to kick that buprenorphine off and throw the person into instant, severe withdrawal, which is not only dangerous, but intolerable to patients. Coming off of methadone requires high doses of buprenorphine for the first 24 to 48 hours, even after waiting for it to metabolize out. Otherwise, you can precipitate major withdrawal where that person starts kicking their legs uncontrollably, sweating, flinging sheets off the bed, and having terrible muscle spasms and cramping- it’s a horror to watch, let alone experience. I had a new patient that had become addicted to strong opioids secondary to chronic, severe pelvic pain and a series of several consecutive pelvic surgeries for ovarian tumors. The whole thing lasted for years and culminated in a hysterectomy. Immediately upon release from the hospital after the hysterectomy, she checked herself in to rehab to detox, and they put her on buprenorphine way too soon. Her withdrawals were very severe, to the point where she vomited so hard that she tore 19 of her abdominal sutures open and had to be taken back to the operating room emergently. Needless to say, she wasn’t too keen on the possibility of that ever happening again.  

So what’s a guy like me to do when a methadone-addicted patient comes in? If they’re committed, there are a couple of ways to handle it. Neither is fun nor risk free. One, you can step down from methadone to another opioid substitute like oxycodone in an incremental ratio for three days or so, stop the substitute for 24 hours, and then start buprenorphine. Or two, stop the methadone, wait as long as you can, which is usually two days, three max, of total misery, while using ancillary drugs like clonidine, benzodiazepines (like Klonopin, Ativan, and Xanax), muscle relaxants like Robaxin, and Mirtazapine to sleep. Basically using every drug possible to make the patient more comfortable, hold off on the methadone for as long as possible, and let the methadone metabolize out. Then put them on high dose buprenorphine for 48 hours, then drop to moderate dose for whatever time period is required. 

In addition, there are some dietary type changes that are helpful. Taking high-dose vitamin C acidifies the urine, enhancing the secretion of methadone out of the system. Taking 1000 mg of vitamin C twice a day, drinking slightly less water if possible, and eating a lot of protein will help further acidify the body and constipate the system, which sounds like hell, but is actually a good thing for withdrawal. 

The best way to deal with the situation is not to, meaning avoid becoming addicted in the first place. But, if you do find yourself addicted, do not choose a methadone detox, and definitely do not choose a methadone maintenance program. There’s just zero reason to do that when we have buprenorphine fairly readily available. 

The clear consensus is that buprenorphine is the gold standard treatment for patients suffering from opioid addiction. As a provider, I’ve had the privilege of seeing patients reclaim their lives with the help of a buprenorphine detox regimen; it allows them to focus on their jobs, their families, and their own well-being, instead of physically, mentally, and emotionally battling their addiction every minute of every day, to the exclusion of all happiness.

So boys and girls, the moral of the story is…

Coming off methadone is not fun, and I have had patients who are still depressed, anxious, and unable to sleep- six months, eight months, even a year- after transitioning from methadone to buprenorphine, to the point where they still require medications to deal with it. Xanax and methadone are my two least favorite pharmaceuticals in the entire world, each for their own specific reasons. Clearly, for patients looking to switch from methadone to buprenorphine, it’s a tough row to hoe; the symptoms can be excruciating, especially if mismanaged, but don’t let that stop you from making the switch. My first and best advice is to avoid becoming an addict, but if you do become one, never go on methadone, for any length of time, ever. It’s a trap, pure and simple. 

I hope you enjoyed this blog and found it educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Opiates:History,Use,Abuse,Addiction

Opioids: History, Use, Abuse, Addiction

How Did We Get Here?

Anchored in the history, culture, religion, mythology, biology, genetics, and psychology of the earliest civilizations to the societies of present day, humans have long tried to balance the positive medicinal properties of opioids with the euphoric effects that have so often led to their use and abuse.

Before we get into their history, first a quick fyi lesson in the semantics of the terms opiates vs opioids vs narcotics. While the terms are often used interchangeably, they are technically different things. 

The term opiate refers to any drug that is derived from a naturally occurring substance, ie from opium alkaloid compounds found in the poppy plant. Types of opiate drugs include opium, codeine, and morphine. The term opioid is broader, and refers to any synthetic or partially synthetic drug created from an opiate. Examples of opioid drugs include heroin, methadone, oxycodone, and hydrocodone. Narcotics is an older term that originally referred to any mind altering compound with sleep-inducing properties.

For the general public, only the term opioid is really necessary, as it includes all opi- substances. In my practice and in my blogs, I sometimes make a distiction between the terms, but if you’re looking for a safe bet, or maybe a trivia win, the term opioid is the best and most accurate choice. Regardless of the word used, one is not any safer than the other; any opiate or opioid has the potential to treat pain, to be abused, and to cause dependence.

Following are some of the most common opioids and their generic names, listed in order of increasing strength.

Codeine

Hydrocodone (Vicodin, Hycodan)

Morphine (MS Contin, Kadian)

Oxycodone (Oxycontin, Percocet)

Hydromorphone (Dilaudid)

Fentanyl (Duragesic)

Carfentanyl (Wildnyl)

History of Opiates

A long, long time ago, opiate use began with Papaver somniferum, otherwise known as the opium poppy. Native to the Mediterranean, it grew well in subtropical and tropical regions fairly easily, a fact that contributed to its historical popularity. Unripe poppy seed pods were cut, and the milky fluid that seeped from the cuts was scraped off, air-dried, and treated to produce opium. 

In case you’re wondering… today, legal growing of opium poppies for medicinal use primarily takes place in India, Turkey, and Australia. Two thousand tons of opium are produced annually, and this supplies the entire world with the raw material needed to make the medicinal components. Papaver somniferum plants grow from the very same legal and widely available poppy seeds found in today’s many seed catalogues. But, planting these seeds is less legal, with the DEA classifying them as a Schedule II drug, meaning that technically, they can press charges against anyone growing this poppy variety in their backyard. You can ask this one dude in North Carolina about it, as he was busted for having one acre of these big blooming beauties behind his house. At about 9 feet tall and topped with big red blooms, they’re not exactly inconspicuous. Another grow was discovered after an Oregon state patrol officer stopped to look at a field of beautiful “wildflowers,” wanting to cut a bouquet for his wife… a story that I personally find totally hilarious. Evidently, when he cut the first one, he was surprised by the sap that got all over his hands, so instead of taking some home to his wife, he took one to a fellow cop friend that was big on horticulture, and she enlightened him on what it was. Good thing too, because he had even thought about how cool it would be to dry the “wildflowers” to seed and plant them in his side yard! You just can’t make this stuff up.

Archaeologists have found 8,000 year-old Sumerian clay tablets that were really the earliest “prescriptions” for opium. The Sumerians called the opium poppy “Hul Gil,” meaning the “Joy Plant,” which was regularly smoked in opium dens. Around 460-357 B.C. Hippocrates, known as the “Father of Medicine” acknowledged opium’s usefulness as a narcotic, and prescribed drinking the juice of the poppy mixed with nettle seed. Alexander the Great took opium with him as he expanded his empire- it’s surprising that he was so great, because some accounts seem to suggest that he was a raging addict. Arabs, Greeks, and Romans commonly used opium as a sedative, presumably for treating psychiatric disorders. In the 15th and 16th centuries, Arabic traders brought opium to the Far East. From there, opium made its way to Europe, where it was used as a panacea for every malady under the sun, from physical ailments to a wide variety of psych issues. Biblical and literary references, and opium’s use by known and respected writers, leaders, and thinkers throughout history, including Homer, Franklin, Napoleon, Coleridge, Poe, Shelly, Quincy, and many more, made opium use perfectly acceptable, even fashionable. 

19th Century Opiates to Opioids

There was a lot of unrest and violence around the globe throughout the 1800’s. Wounded soldiers from the American Civil War, British Crimean War, and the Prussian French War were basically allowed to abuse opium. And sure enough, beginning in the 1830’s, one-third of all lethal poisoning cases were due to opium and its opiate derivatives, and this really marked the first time that a “medicinal” substance was recognized as a social evil. Yet, most places around the world still really turned a blind eye to opium and opiate use. But, so many soldiers developed a dependency on opiates that the post-war addiction state was commonly known as “soldier’s disease.”

In 1806, German alkaloid chemist Friedrich Wilhelm Adam Sertürner isolated a substance from opium that he named “morphine,” after the god of dreams, Morpheus. The prevailing wisdom for creating morphine was to maintain the useful medicinal properties of opium while also reducing its addictive properties. Uh huh, sure. In the United States, morphine soon became the mainstay of doctors for treating pain, anxiety, and respiratory problems, as well as consumption and “female ailments,” 

(that’s old-timey for tuberculosis and menstrual moodiness/ cramps) In 1853, the hypodermic needle was invented, upon which point morphine began to be used in minor surgical procedures to treat neuralgia (old timey for nerve pain). The combination of morphine and hypodermic needles gave rise to the medicalization of opiates.

Well, morphine turned out to be more addictive than opium, wouldn’t ya know it. So, as with the opium before it, the morphine problem was “solved” by a novel “non-addictive” substitute. Of course… I mean, what could possibly go wrong? Your first clue is that this novel compound was the first opioid, and was called heroin. See where this is going? First manufactured in 1898 by the Bayer Pharmaceutical Company of Germany, heroin was marketed as a cough suppressant, a treatment for tuberculosis, and a remedy for morphine addiction. Well, as you can probably guess, that worked great, until heroin proved to be far more addictive than morphine ever thought of being. So what to do? Hmmm… what…to…do… I know! Let’s make a “non-addictive” substitute for the heroin! That’s the best plan, definitely. 

20th Century: Opiates to Opioids

By the dawning of the 20th century, the United States focused on ending the non-medicinal use of opium. In 1909, Congress finally passed the “Opium Exclusion Act” which barred the importation of opium for purposes of smoking. This legislation is considered by many to be the original and official start of the war on drugs in the United States. Take that, Nancy Reagan! In a similar manner, the “Harrison Narcotics Tax Act of 1914” placed a nominal tax on opiates and required physician and pharmacist registration for its distribution. Effectively, this was a de-facto prohibition of the drug, the first of its kind.

In 1916, a few years after Bayer stopped the mass production of heroin due to the dependence it created, German scientists at the University of Frankfurt developed oxycodone with the hope that it would retain the analgesic effects of morphine and heroin, but with less physical dependence. Of course they did, because this worked out so swimmingly before. What could possibly go wrong? 

Well, we know how this story turns out.

First developed in 1937 by German scientists searching for a surgical painkiller, what we know today as methadone was exported to the U.S. and given the trade name “Dolophine” in 1947. Later renamed methadone, the drug was soon being widely used as a treatment for heroin addiction. But shocker… unfortunately, it too proved to be even more addictive than its predecessor heroin. Captain Obvious says he’s sensing a trend here.  

In the 1990’s, pharmaceutical companies developed some new and especially powerful prescription opioid pain relievers. They then created some equally powerful marketing campaigns that assured the medical community that patients would not become addicted to these drugs. Gleefully, docs started writing for them, and as a result, this class of medications quickly became the most prescribed class in the United States- even exceeding antibiotics and heart medications- an astounding statistic. Well, we now know that the pharma co’s were full of crap: opioids were (and still are) the most addictive class of pharmaceuticals on the planet… and so in the late 90’s, the opioid crisis was born. 

Opioids: True and Freaky Facts

The real fact is that 20% to 30% of all patients who were/ are prescribed opioids for chronic pain will misuse them. Further, studies on heroin addicts report that 80% of them actually began their addiction by first misusing prescription opioids. That’s a big number people, but I think it’s actually higher. Food for thought for all the pill poppers out there saying ‘I’ll never use a street drug like heroin.’ And speaking of that, by the turn of the 21st century, the mortality rate of heroin addicts was estimated to be as high as twenty times greater than the rest of the population. Twenty times, people.

Opioid Addiction and Overdose

Opioids produce a sense of wellbeing or euphoria that can be addictive to some people. Opioids are often regularly and legitimately prescribed by excellent, well-meaning physicians when treating patients for severe pain. The problem is that even when taken properly, many people develop tolerance to these opioids, meaning they need more and more to get the same effect and relieve their pain. That’s just one factor that makes them so insidious. In addition, we cannot predict who will go down this tolerance and potential addiction path, because it can happen to anyone who takes opioids. However, there are some factors that make people more susceptible to addiction, such as the presence/ prevalence of mood disorder(s) and especially a genetic/ familial history of addiction, which contributes to nearly 50% of abuse cases.

When people become addicted to opioids, they begin to obsessively think about ways they can obtain more, and in some cases they engage in illegal activities, such as doctor shopping, stealing prescriptions from friends and family, and/ or procuring them on the street. 

Another insidious facet of tolerance is that the tolerance to the euphoric effect of opioids develops faster than the tolerance to the dangerous physical effects of taking them. This often leads people to accidentally overdose as they chase the high they once felt. In this attempt to get high, they take too much and overdose, dying of cardiac or respiratory arrest. Drug overdose is the leading cause of accidental death in the United States, and there are more drug overdose deaths in America every year than deaths due to guns and car accidents combined. According to the CDC, 2019 drug overdose deaths in the United States went up 4.6% from the previous year, with a total of 70,980 overdose deaths, 50,042 of which were due to opioids. 

There’s a kahuna in Opioidland that’s so big and so bad that it bears a special mention… fentanyl. Referencing the above statistics, of the more than 50,000 opioid overdoses, fentanyl is specifically indicated in more than 20,000 of those fatalities. Again, I think it’s way higher than that. Regardless, I think we can all agree that it’s deadly. Fentanyl is so crazy dangerous because it is 50 to 100 times more potent than morphine, so it takes the teeny tiniest amount to overdose. A lethal dose of fentanyl for adults is about two milligrams- that’s the equivalent of six or seven grains of salt people! 

Obvi, there are tons of chilling statistics about fentanyl, but here’s another one for you: in one-third of fentanyl overdoses, the individual died within seconds of taking it. Get this- they died so quickly that their body didn’t have enough time to even begin to metabolize the drug, so no metabolites of fentanyl were found on toxicology screens at the time of autopsy. The moment you ingest or inject any drug/ pharmaceutical, the body immediately begins to break it down into components called metabolites. After a certain period of time (which varies according to many different factors) the drug is completely metabolized by the body, so a toxicology screen will pick up those metabolites rather than the complete molecule(s) of the drug. Every drug has a known rate of metabolism, so tox tests can tell how long ago a drug was used or ingested. This data is saying that in one-third (33%) of fentanyl overdose deaths, tox screens pick up zero metabolites, because the body had no time to even begin to start the process of making them. The screens detected the presence of the full complete molecule(s), but no breakdown products. It’s a very significant and scary hallmark of fentanyl use/ abuse/ overdose: the fact that you may not live long enough to regret using it.  

How did fentanyl become such a big part of the opioid epidemic? Around 2010, docs were getting smart to the use and abuse of opioids and the ensuing crisis, and many stopped prescribing them. This left a lot of addicted people, including many who legitimately required relief from pain, unable to get prescriptions and SOL. At the same time, buying prescription drugs on the street was crazy expensive due to increased demand and decreased supply. But also, heroin had became so abundant that it suddenly became cheaper than most other drugs, so addicts started to switch to heroin. In one survey, 94% of people in treatment for opioid addiction said they used heroin only because prescription opioids became much more expensive and harder to obtain. 

Next, to make things exponentially worse, drug cartels discovered how to make fentanyl very cheaply, so huge quantities of fentanyl started flooding the market. Because fentanyl is easier to make, more powerful, and more addictive than heroin, drug dealers recognized the opportunity, and began to lace their heroin with fentanyl. People taking fentanyl-laced heroin are more likely to overdose, because they often don’t know they’re taking a much more powerful drug. Fentanyl can be manufactured in powder or liquid forms, and it can be found in many illicit drugs, including cocaine, crack, and methamphetamine. And let’s face it folks, the people making this garbage aren’t exactly rocket scientists, so all of these drugs can (and usually do) contain toxic contaminants and/ or have different levels of fentanyl in each batch, or even varying levels within the same batch. These facts just add to the lethal potential of this stuff. 

Now fentanyl has found its way onto the street in yet another form: pills. When fentanyl pills are created for the street, they’re pressed and dyed to look like oxycodone. Talk about insidious! If you go looking to buy oxy’s on the street and the dealer is selling them dirt cheap because they don’t know any better, or care is probably more accurate, you’ll probably think ‘Wow- these oxy’s are cheap! Let me get those!’ If your body is accustomed to using real oxy’s and you unknowingly take fentanyl, you will absolutely overdose. Like see ya later, bye overdose.

But believe it or not, it gets worse… A new variation of fentanyl is finding its way into the drug trade. Carfentanil is 100 times stronger than fenatanyl, which makes it 10,000 times more potent than morphine. While it was originally developed as an elephant tranquilizer (hel-looo??!!) the powdered form of carfentanil is now commonly used as a cutting agent in illicit drugs like heroin, cocaine, and methamphetamine.

Opioid Withdrawal

Opioid withdrawal can be extremely uncomfortable. But an important thing to remember is that opioid withdrawal is not generally life threatening if you are withdrawing only from opioids and not a combination of drugs. This is because each drug class is pharmacologically different, so withdrawal is different for each one. FYI, the most dangerous withdrawls are from benzodiazepines (Valium, Xanax, etc) and alcohol, even though alcohol isn’t technically a drug, it reacts, is metabolized, and physically withdraws from the body like any drug. Individually, either can be lethal in withdrawl and require medical supervision. 

Opioid Withdrawal Symptoms

Withdrawal typically includes the following symptoms to varying degrees:

Low energy

Irritability

Anxiety

Agitation

Insomnia

Runny nose

Teary eyes

Hot and cold sweats 

Goose bumps

Yawning

Muscle aches and pains

Abdominal cramping

Nausea

Vomiting

Diarrhea

Stages of Opioid Withdrawal

-The first phase (called acute withdrawal) begins about 12 hours after the last opioid use. It peaks at around 3 – 5 days, and lasts for approximately 1 – 4 weeks. This acute stage has mostly physical symptoms.

-The second phase (post-acute withdrawal) can last for a long time, with some references documenting up to two years. The symptoms during this phase are mostly emotional, and while they are considered less severe, they last longer.

Symptoms include mood swings, anxiety, variable energy, low enthusiasm, variable concentration, and disturbed sleep.

But, don’t let concern over withdrawl symptoms keep you from getting off of opioids. There are medications that can significantly decrease all of these. Two of the most common are methadone and buprenorphine. Being that drug detox is one of my specialties, in next week’s blog, I’ll outline both of these and tell you my reccommendations.

Until then…

Now that we’ve covered the history and background on opioids, if you think you might have an opioid addiction, I have a separate quiz that will bring some clarity to you on that question. I will upload a more detailed assessment as a separate blog, but for now, here’s a short generalized screen to take first. 

Do You Have an Opioid Addiction?

Answer yes or no to each of the following questions. If you answer yes to at least three of these questions, then you are likely addicted to opioids and should definitely take the detailed addiction self-assessment test which follows. I also suggest that you print the assessment and answers and take them with you for a professional evaluation.

Addiction: Basic Screen1) Has your use of opioids increased over time?2) Do you experience withdrawal symptoms when you stop using?3) Do you use more than you would like, or more than is prescribed?4) Have you experienced negative consequences to your using?5) Have you put off doing things because of your drug use?6) Do you find yourself thinking obsessively about getting or using your drug?7) Have you made unsuccessful attempts at cutting down your drug use?

Again, if you answered yes to at least three of these questions, then you are likely addicted to opioids and should take the detailed addiction self-assessment test which follows as a separate blog. Be sure to print both with you for a professional evaluation. 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Drug Abuse Screening Test – DAST-10

To determine if you may have an addiction to drugs, please answer the following questions regarding the last 12 month period with a yes or no. An answer of yes is scored as 1 point. An answer of no is scored as zero. Once completed, add the number of points together and follow the corresponding recommendations listed at the bottom. Be sure to print this to take with you for a professional evaluation when indicated. 

In the past 12 months…

No (0)

Yes (1)

1. Have you used drugs other than those required for medical reasons?

2. Do you abuse more than one drug at a time?

3. Are you unable to stop abusing drugs when you want to?

4. Have you ever had blackouts or flashbacks as a result of drug use?

5. Do you ever feel badly or guilty about your drug use?

6. Do your spouse/ parents/ friends ever complain about your involvement with drugs?

7. Have you neglected your family because of your use of drugs?

8. Have you engaged in illegal activities in order to obtain drugs?

9. Have you ever experienced withdrawal symptoms or felt sick when you stopped taking drugs?

10. Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding)?

Your Score & Recommendation

3 ‐ 5 = Probable drug problem/ addiction; see professional for evaluation. The quality and length of your life likely depend on it. 

6 ‐ 8 = Substantial drug problem/ addiction; see professional for evaluation at earliest convenience.The quality and length of your life depend on it. 

9 ‐ 10 = Severe drug problem/ addiction; see professional for evaluation ASAP. The quality and length of your life seriously depend on it. 

No single test is completely accurate. You should always consult your physician when making decisions about your health.

Learn More

Edinburgh Postnatal Depression Scale

This 10-question self-rating scale has proven to be an efficient way of identifying patients at risk for “perinatal” or postpartum depression. While this test was specifically designed to be administered by a medical professional, to a woman who is pregnant or has just had a baby, it can be used as an effective at-home guide to determine if you or someone you care about has postpartum depression. Just make sure to follow all of your score’s corresponding action(s).

For each of the 10 questions, please check mark the answer that comes closest to how you have felt in the past 7 days. Scoring is explained after the questions.1) I have been able to laugh and see the funny side of things.

____  As much as I always could

____  Not quite so much now

____  Definitely not so much now

____  Not at all2) I have looked forward with enjoyment to things.

____  As much as I ever did

____  Rather less than I used to

____  Definitely less than I used to

____  Hardly at all3) I have blamed myself unnecessarily when things went wrong.

____  Yes, most of the time

____  Yes, some of the time

____  Not very often

____  No, never4) I have been anxious or worried for no good reason.

____  No not at all

____  Hardly ever

____  Yes, sometimes

____  Yes, very often5) I have felt scared or panicky for no very good reason.

____  Yes, quite a lot

____  Yes, sometimes

____  No, not much

____  No, not at all6) Things have been getting on top of me.

____  Yes, most of the time I haven’t been able to cope at all

____  Yes, sometimes I haven’t been coping as well as usual

____  No, most of the time I have coped quite well

____  No, I have been coping as well as ever7) I have been so unhappy that I have had difficulty sleeping.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all8) I have felt sad or miserable.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all9) I have been so unhappy that I have been crying.

____  Yes, most of the time

____  Yes, quite often

____  Only occasionally

____  No, never10) The thought of harming myself has occurred to me.

____  Yes, quite often

____  Sometimes

____  Hardly ever

____  Never

SCORING VALUES AND GUIDE

Grade each of your checked answers with the specifically stated score, then add the scores together. Take that sum and apply to the interpretation/ action scale and follow the stated suggestion.1) I have been able to laugh and see the funny side of things

0 As much as I always could

1 Not quite so much now 

2 Definitely not so much now 

3 Not at all 2) I have looked forward with enjoyment to things

0 As much as I ever did 

1 Rather less than I used to 

2 Definitely less than I used to 

3 Hardly at all 3) I have blamed myself unnecessarily when things went wrong

3 Yes, most of the time 

2 Yes, some of the time 

1 Not very often 

0 No, never 4) I have been anxious or worried for no good reason

0 No, not at all 

1 Hardly ever 

2 Yes, sometimes 

3 Yes, very often 5) I have felt scared or panicky for no very good reason

3 Yes, quite a lot 

2 Yes, sometimes 

1 No, not much 

0 No, not at all 6) Things have been getting on top of me

3 Yes, most of the time I haven’t been able to cope 

2 Yes, sometimes I haven’t been coping as well as usual 

1 No, most of the time I have coped quite well 

0 No, I have been coping as well as ever 7) I have been so unhappy that I have had difficulty sleeping

3 Yes, most of the time 

2 Yes, sometimes 

1 Not very often 

0 No, not at all8) I have felt sad or miserable

3 Yes, most of the time 

2 Yes, quite often 

1 Not very often 

0 No, not at all 9) I have been so unhappy that I have been crying

3 Yes, most of the time 

2 Yes, quite often 

1 Only occasionally 

0 No, never 10) The thought of harming myself has occurred to me 

3 Yes, quite often 

2 Sometimes 

1 Hardly ever 

0 Never 

EPDS Score Interpretation/ Action

Score of 8 or less: depression not likely, but continue to seek support.

Score of 9 to 11: depression is possible, continue seeking support and re-screen in 2 to 4 weeks. Seriously consider appointment with primary care provider or established mental health professional.

Score of 12 to 13: fairly high possibility 

of depression. Continue to monitor and seek support. Make appointment to see primary care provider or established mental health professional.

Score of 14 and higher: this is a positive screen for probable postpartum depression. Diagnostic assessment is required to determine appropriate treatment. See mental health specialist or primary care provider for referral to same. 

Note: if there is any positive score (a rating of 1, 2, or 3) on question 10 (suicidality risk) definite immediate discussion and possible emergency management is required. Refer to primary care provider, mental health specialist, or emergency resource for further assessment and intervention as appropriate. The urgency of the referral will depend on several factors, including: whether suicidal ideation is accompanied by a plan, whether there has been a history of suicide attempt(s), whether symptoms of a psychotic disorder are present, and/ or if there is concern about harm to the baby.

Learn More

Postpartum Depression,Signs,Symptoms,and Treatment

Postpartum Depression: o

Signs, Symptoms, New Treatment?

Last week, we talked about sex and orgasms, so it seems only fitting that this week, I talk about the potential ‘homework’ that may come after the sex and orgasms: pregnancy… and the postpartum depression that may accompany it. 

It is one of life’s greatest joys, and for me personally, the proudest moment of my entire life: the birth of a child. But no matter how much you love that baby or how you’ve looked forward to its arrival, having a baby is stressful on both parents for many reasons. However, there are specific reasons that make it more physically and emotionally taxing on mom. Captain Obvious says that there are many physical, emotional, and chemical changes in a woman’s body that allow them to (help) create, carry, and birth these little miracles. And add to that the onset of new responsibilities, sleep deprivation, and lack of time for any personal care, it’s not a big shock that lots of new moms get overwhelmed and feel like they’re on an emotional rollercoaster from hell. In fact, the mild depression and mood swings that are so common in new mothers have earned them a name, “the baby blues.” But how do you know if what mom is feeling goes beyond the blues? What should you look for, and when should you seek help? 

The majority of women experience at least some symptoms of the baby blues immediately after childbirth. Why? It’s all down to female hormones: specifically, progesterone and estrogen, the big kahunas in the female hormone universe.

Progesterone’s role in pregnancy is so vital that it’s referred to as the “pregnancy hormone.” Actually, progesterone comes into play long before pregnancy, as it is one of the hormones secreted by the ovaries that governs ovulation and menstruation in post-pubescent women. Then upon conception, it gets the uterus ready to accept, implant, and maintain a fertilized egg, and it also prevents the uterine muscle contractions that would otherwise cause a woman’s body to reject it. During fetal gestation, it helps create an environment that nurtures the developing baby. It makes it sound like progesterone is in there painting, hanging curtains, and fluffing pillows, but its role goes way beyond that. The placenta, which is the structure inside the uterus that provides oxygen and nutrients to a developing baby, will itself begin to produce progesterone after about 8 to 10 weeks of pregnancy. At this point, the placenta increases progesterone production to a much higher rate than the ovaries ever thought about making. Those high levels of progesterone throughout the pregnancy cause the mom’s body to stop producing more eggs, as well as prepare her breasts to produce milk. 

Also produced by the ovaries when not pregnant, and then later by the placenta during pregnancy, estrogen helps the uterus grow, maintains the uterine lining where the budding baby is nestled, steps up blood circulation, and activates and regulates the production of other key hormones. In early pregnancy, it also helps mom develop her milk-making machinery. And baby benefits too, as estrogen triggers the development of those teeny tiny organs and regulates bone density in those cute little developing arms that wave and legs that kick. 

The increased levels of progesterone and estrogen during pregnancy actually make mom feel good and feel bonded to baby, even though she may be crying her eyes out for virtually no reason (sorry ladies) in the beginning. Levels of both hormones continue to increase as the pregnancy advances, and mom’s body actually gets used to these high levels. Then when the baby is born, there’s no more placenta, so mom’s progesterone and estrogen levels drop suddenly and precipitously, in a matter of hours. So mom goes essentially cold turkey from high hormone levels to comparatively no hormone levels. Sudden hormonal change + stress + isolation + sleep deprivation + fatigue = tearful + overwhelmed + emotionally fragile mom. Generally, these feelings can start within just the first day or so after delivery, peak at around one week, and taper off by the end of the second, third, or maybe up to the fourth week postpartum; that’s if it’s the baby blues. 

These baby blues are perfectly normal, but if symptoms are extreme, don’t go away after a month, or get worse, mom may be suffering from postpartum depression and likely needs help.

Postpartum Signs & Symptoms

Though they share some symptoms, postpartum depression is a much more serious problem than the baby blues, and should never be ignored. Shared symptoms of the two include mood swings, crying jags, sadness, insomnia, and irritability.      

Postpartum depression is the most common complication of childbearing, and it occurs in 10% to 20% of all moms after delivery. It is different from the baby blues in that the symptoms are more severe and longer lasting. It is an issue that can’t be blown off or underestimated, because it begins at a critical time, when mom is caring for a helpless infant and needs to be bonding with them. 

Symptoms of postpartum depression can include suicidal thoughts, an inability to care for the newborn child, and in extreme cases, even thoughts of harming the baby. Postpartum can be extremely debilitating, and certain signs can put the lives of mom and/ or baby in jeopardy.

Beyond the Blues

Common Red Flags for Postpartum:

-Mom withdraws from partner

-Mom’s unable to bond well with baby

-Mom’s anxiety gets out of control, preventing ability to sleep and/ or eat

-Mom feels guilty, worthless, useless, overwhelmed

-Mom seems preoccupied with death or wishing she were no longer alive

There’s no single reason why some new moms develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are generally at play.

Postpartum Causes/ Triggers

Hormonal changes after childbirth cause fatigue and depression:

 -Progesterone/ estrogen levels drop

 -Thyroid levels can drop

 -Changes in blood pressure, immune system functioning, metabolism

Numerous physical/ emotional changes after delivery: 

 -Physical delivery pain

 -Difficulty losing baby weight

 -Insecurity, especially in physical/ sexual attractiveness

Significant stress of caring for a newborn:

 -Mom is sleep deprived

 -Mom is overwhelmed/ anxious about her abilities to properly care for baby

 -Mom has difficulty adjusting

All of the above factors are especially true in first time moms, as they must also get used to an entirely new identity at the same time. 

Postpartum Risk Factors

Several factors can predispose a mom to suffer from postpartum depression:

  -History of postpartum depression

A prior episode can increase the chances of a repeat episode by 30% to 50%.

  -History of non-pregnancy related depression and/ or family history of mood disturbances

  -Social stressors, including lack of emotional support, abusive relationship, and/ or financial uncertainty 

  -Significantly increased risk in women who discontinue medications abruptly for purposes of pregnancy.

Postpartum Psychosis

Postpartum psychosis is an even more rare, and more extremely serious disorder that can also develop after childbirth. Characterized by a loss of contact with reality, postpartum psychosis poses an extremely high risk for suicide or infanticide, and hospitalization is nearly always required to keep both mom and baby safe. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within a matter of 48 hours. 

Postpartum Psychosis Symptoms

Postpartum psychosis is considered a medical emergency requiring immediate medical attention.

  -Hallucinations: seeing things and/ or hearing voices that aren’t real 

  -Delusions: paranoid, irrational beliefs

  -Extreme agitation and anxiety

  -Suicidal thoughts or actions

  -Confusion and disorientation

  -Rapid mood swings

  -Bizarre behavior

  -Inability or refusal to eat or sleep

  -Thoughts of harming or killing baby

There is a screening tool that can be used to detect postpartum depression, called the Edinburgh Postnatal Depression Scale. I will put the questions and explain the scoring of this scale at the conclusion of this blog. It can be helpful if mom or partner isn’t quite sure if symptoms are the baby blues or true postpartum depression. 

Coping with Postpartum Depression

Four Tips for Moms:

1) Create a secure attachment with baby.

The emotional bonding process between mom and child, known as attachment, is the most important task of infancy. The success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how he or she will interact, communicate, and form relationships throughout their entire lives.

A secure attachment is formed when moms respond warmly and consistently to baby’s physical and emotional needs. When baby cries, quickly soothe them. If baby laughs or smiles, respond in kind. In essence, the goal is for mom and baby to be in synch, and to be able to recognize and respond to each other’s emotional signals.

Postpartum depression can interrupt this bonding. Depressed moms can be loving and attentive at times, but at other times may react negatively or not respond at all. Moms with postpartum depression are generally inconsistent in their care, and tend to interact less with their babies; they are also less likely to breastfeed, play with, and read to them. Postpartum is sinister in this way, as learning to bond with baby not only benefits the child, it also benefits mom by releasing endorphins that make mom feel happier and more confident. By its very presence, postpartum makes the bonding process difficult, and therefore mom is less likely to produce those endorphins that would make her feel better. It’s a vicious cycle.

If mom didn’t experience a secure attachment as an infant, she may not know how to create a secure attachment as a mom. However, this can be learned, as human brains are definitively primed for this kind of nonverbal emotional connection that creates so much pleasure for both mom and baby.

2) Lean on others for help and support.

Human beings are social creatures. Positive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically, and from an evolutionary perspective, new moms have typically received help from those around them after childbirth. In today’s world, new moms often find themselves alone, exhausted, and lonely for supportive adult contact. 

Ideas to better connect with others:

 -Make relationships a priority. When feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friends, even if you’d rather be alone. Isolating will only make the situation feel even bleaker, so make adult relationships a priority. Let loved ones know your needs and how you wish to be supported.

 -Don’t hide feelings. In addition to the practical help that friends and family can provide, they can also serve as a much-needed emotional outlet. Share experiences- good, bad, and ugly- with at least one other person, and preferably face to face. It doesn’t matter who mom talks to, so long as that person is willing to listen without judgment and offer reassurance and support.

 -Be a joiner. Even if mom has supportive friends, she may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear other mothers share the same worries, insecurities, and feelings. Good places to meet other new moms include support groups for new parents or organizations such as ‘Mommy and Me.’ Pediatricians can also be excellent neighborhood resources.

3) Take care of yourself. One of the best things moms can do to relieve or avoid postpartum depression is to take care of themselves. The more moms care for their mental and physical well-being, the better they’ll feel. 

Simple lifestyle changes can go a long way toward helping moms feel more like themselves again.

 -Skip the housework. Make yourself and baby the priority, and give yourself the permission to concentrate on just that. Remember that being a 24/7 mom is far more work than holding down a traditional full-time job.

 -Ease back into exercise. Studies show that exercise may be just as effective as medication when it comes to treating depression, so the sooner moms get back up and moving, the better. No need to overdo it: a 30-minute walk each day will work wonders. Stretching exercises, like those found in yoga, have shown to be especially effective.

 -Practice mindfulness meditation. Research supports the effectiveness of mindfulness for making moms feel calmer and more energized. It can also help moms become more aware of what they feel and need.  

 -Don’t skimp on sleep. A full eight hours may seem like an unattainable luxury when dealing with a newborn, but poor sleep makes depression worse. Moms must do whatever they can to get plenty of rest- from enlisting the help of the partner or family members, to catching naps at every opportunity.

 -Set aside quality time for yourself to relax and take a break from mom duties. Find small ways to pamper yourself, like taking a bubble bath, savoring a hot cup of tea, lighting scented candles, or getting a massage at a day spa, or even calling a masseuse to come to you.

 -Make meals a priority. Nutrition often suffers during depression. What mom eats has an impact on her mood, and also the quality of breast milk the baby requires, so always make the best effort to establish and maintain healthy eating habits, for yourself and baby.

 -Get out in the sunshine. Sunlight lifts the mood, so try to get at least 10 to 15 minutes of sun each day.

4) Make time for your relationship with your partner. More than half of all divorces take place after the birth of a child. For many men and women, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship, unless couples put time, energy, and thought into preserving their bond.

 -Don’t scapegoat. The stress from nights of no sleep and new or expanded responsibilities can leave parents feeling overwhelmed and exhausted. It’s all too easy to play the blame game and turn frustrations onto your partner. Instead of finger pointing, remember that you’re in this together. If you tackle parenting challenges as a team, you’ll find that you’ll become an even stronger unit.

 -Keep the lines of communication open. Many things change following the birth of a baby, including roles and expectations. For many couples, a key source of strain is the post-baby division of household and childcare responsibilities. It’s important to talk about these issues, rather than letting them fester. Don’t assume your partner has a crystal ball or knows how you feel or what you need, because you’re bound to feel perpetually disappointed and frustrated if you do. 

 -Carve out couple time. It’s essential to make time for just the two of you when you can reconnect. But don’t put pressure on yourself to be romantic or adventurous, unless you’ve discussed it and found you’re both game. And you don’t need to go out on a date to enjoy each other’s company. Just spending even 15 or 20 minutes together, undistracted and focused on each other, can make a big difference in how close you feel to each other.  

Treatment for Postpartum Depression

If, despite self-help and the support of family, mom is still struggling with postpartum depression, it’s best to seek professional treatment.

 -Individual therapy/ marriage counseling A good therapist can help moms deal better with the adjustments of motherhood. If moms or partners are experiencing marital difficulties or are feeling unsupported at home, marriage counseling can also be very beneficial.

 -Antidepressants. In postpartum cases where mom’s ability to function adequately for herself or baby is compromised, antidepressants may be an option, though they are more effective when accompanied with psychotherapy. Obviously, medication must be closely monitored by a physician.

 -Hormone therapy: Estrogen replacement therapy can sometimes be helpful in combating postpartum depression, and is often used in combination with an antidepressant. There are risks that go along with hormone therapy, so moms must be sure to talk to their doctor about what may be best, and safest, for them.

Helping New Moms with Postpartum

If your loved one is a mom experiencing postpartum depression, the best thing you can do is to offer support, give her a break from her childcare duties, provide a listening ear, and always be patient and understanding. But, be sure to take care of yourself too. Dealing with the needs of a new baby is hard for the partner as well as mom. And if your significant other is depressed, that means you are dealing with two major stressors.

Tips for Partners:

 -Encourage mom to talk about her feelings. Listen without judgement and without making demands. Instead of trying to ‘just fix’ things, simply be there for mom to lean on.

 -Offer help around the house. Chip in with the housework and childcare responsibilities, and don’t wait for mom to ask… trust me on this one!

 -Make sure mom takes time for herself. Rest and relaxation are even more important after a new edition. Encourage her to take breaks, hire a babysitter, or schedule some date nights.

 -Be patient if she’s not ready for sex. Depression affects sex drive, so it may be a while before mom’s in the mood. Offer her physical affection, but don’t push it if she’s not up for anything beyond that.

 -Getting exercise can make a big dent in depression, but it’s hard for moms to get motivated when they’re feeling low. So do something simple, like going going for a walk with mom. Better yet, make walks a daily ritual for just the two of you, or for the whole family.  

There is a fairly new breakthrough drug called Zulresso (brexanolone). Approved in 2019, Zulresso is a neuropathic drug, and first in its class. So what is it? Basically, it’s an aqueous (water-based) solution of progesterone products. They have taken the component product of progesterone and put it into solution; it is then administered to a new mom with postpartum depression. And then a miracle happens… seriously! This lifts postpartum depression like a kid does candy. It is a scientific breakthrough; never before have we had a drug that treats postpartum depression faster than any drug for any type of depression, ever. That’s the good news, but guess what comes next… the bad. While we know it works, very well and very quickly, there are some major disadvantages of this drug. The first one is that it can only be administered by IV infusion. So that means that you have to place an IV map into mom’s vein and drip the drug in with IV fluid. That brings me to the next big disadvantage: it can only be administered in a hospital setting. Why is that? Well, studies show that during administration, which takes place over about 60 hours, two and a half days, some moms can become very dizzy and faint, can lose consciousness, and can even stop breathing. For all of these reasons, moms must be medically monitored with an oximeter and telemetry for two and a half days, during which time they must be checked on every two hours. And they cannot be in charge of baby during this hospital stay, because they may be in and out of consciousness and/ or have severe respiratory issues. While that’s no bueno, the last disadvantage is muy loco, people. Are you ready? The drug costs $34,000. Yep. But wait, it gets better, which in this case, actually means worse. That little $34K is just for the drug! The hospitalization and monitoring costs more… a lot more. And to add insult to injury, you have to shell out the cash to pay for a sitter to watch baby, as mom could potentially be very busy losing consciousness and going into respiratory distress.  

Needless to say, Zulresso is not used very much, even though it is an amazing breakthrough product, essentially curing the notoriously difficult-to-treat postpartum depression in a mere 60 hours. There are some other anti-depressants that work pretty well. Effexor (venlafaxine, desvenlafaxine) and Wellbutrin (bupropion) with antipsychotics like Abilify help to speed up the treatment process generally show some progress in about a week. 

So while I’m very impressed with Zulresso as a novel, first-in-class drug, you can see my practical issues with it. Although, I suppose that everything is relative: if my wife were suffering from serious postpartum depression, to the point that she was suicidal, or the baby’s life was in danger, and it was refractory, meaning all other treatment options had been tried and failed, I would find a way to get the Zulresso treatment; I’d make it happen, by contacting the manufacturer for patient support options. Or maybe by selling a kidney. Whatever it took.

Edinburgh Postnatal Depression Scale

This 10-question self-rating scale has proven to be an efficient way of identifying patients at risk for “perinatal” or postpartum depression. While this test was specifically designed to be administered by a medical professional, to a woman who is pregnant or has just had a baby, it can be used as an effective at-home guide to determine if you or someone you care about has postpartum depression. Just make sure to follow all of your score’s corresponding action(s).

For each of the 10 questions, please check mark the answer that comes closest to how you have felt in the past 7 days. Scoring is explained after the questions.1) I have been able to laugh and see the funny side of things.

____  As much as I always could

____  Not quite so much now

____  Definitely not so much now

____  Not at all2) I have looked forward with enjoyment to things.

____  As much as I ever did

____  Rather less than I used to

____  Definitely less than I used to

____  Hardly at all3) I have blamed myself unnecessarily when things went wrong.

____  Yes, most of the time

____  Yes, some of the time

____  Not very often

____  No, never4) I have been anxious or worried for no good reason.

____  No not at all

____  Hardly ever

____  Yes, sometimes

____  Yes, very often5) I have felt scared or panicky for no very good reason.

____  Yes, quite a lot

____  Yes, sometimes

____  No, not much

____  No, not at all6) Things have been getting on top of me.

____  Yes, most of the time I haven’t been able to cope at all

____  Yes, sometimes I haven’t been coping as well as usual

____  No, most of the time I have coped quite well

____  No, I have been coping as well as ever7) I have been so unhappy that I have had difficulty sleeping.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all8) I have felt sad or miserable.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all9) I have been so unhappy that I have been crying.

____  Yes, most of the time

____  Yes, quite often

____  Only occasionally

____  No, never10) The thought of harming myself has occurred to me.

____  Yes, quite often

____  Sometimes

____  Hardly ever

____  Never

SCORING VALUES AND GUIDE

Grade each of your checked answers with the specifically stated score, then add the scores together. Take that sum and apply to the interpretation/ action scale and follow the stated suggestion.1) I have been able to laugh and see the funny side of things

0 As much as I always could

1 Not quite so much now 

2 Definitely not so much now 

3 Not at all 2) I have looked forward with enjoyment to things

0 As much as I ever did 

1 Rather less than I used to 

2 Definitely less than I used to 

3 Hardly at all 3) I have blamed myself unnecessarily when things went wrong

3 Yes, most of the time 

2 Yes, some of the time 

1 Not very often 

0 No, never 4) I have been anxious or worried for no good reason

0 No, not at all 

1 Hardly ever 

2 Yes, sometimes 

3 Yes, very often 5) I have felt scared or panicky for no very good reason

3 Yes, quite a lot 

2 Yes, sometimes 

1 No, not much 

0 No, not at all 6) Things have been getting on top of me

3 Yes, most of the time I haven’t been able to cope 

2 Yes, sometimes I haven’t been coping as well as usual 

1 No, most of the time I have coped quite well 

0 No, I have been coping as well as ever 7) I have been so unhappy that I have had difficulty sleeping

3 Yes, most of the time 

2 Yes, sometimes 

1 Not very often 

0 No, not at all8) I have felt sad or miserable

3 Yes, most of the time 

2 Yes, quite often 

1 Not very often 

0 No, not at all 9) I have been so unhappy that I have been crying

3 Yes, most of the time 

2 Yes, quite often 

1 Only occasionally 

0 No, never 10) The thought of harming myself has occurred to me 

3 Yes, quite often 

2 Sometimes 

1 Hardly ever 

0 Never 

EPDS Score Interpretation/ Action

Score of 8 or less: depression not likely, but continue to seek support.

Score of 9 to 11: depression is possible, continue seeking support and re-screen in 2 to 4 weeks. Seriously consider appointment with primary care provider or established mental health professional.

Score of 12 to 13: fairly high possibility 

of depression. Continue to monitor and seek support. Make appointment to see primary care provider or established mental health professional.

Score of 14 and higher: this is a positive screen for probable postpartum depression. Diagnostic assessment is required to determine appropriate treatment. See mental health specialist or primary care provider for referral to same. 

Note: if there is any positive score (a rating of 1, 2, or 3) on question 10 (suicidality risk) definite immediate discussion and possible emergency management is required. Refer to primary care provider, mental health specialist, or emergency resource for further assessment and intervention as appropriate. The urgency of the referral will depend on several factors, including: whether suicidal ideation is accompanied by a plan, whether there has been a history of suicide attempt(s), whether symptoms of a psychotic disorder are present, and/ or if there is concern about harm to the baby.

So that’s all the news on postpartum depression. If you liked this, please share with friends and family. Look for new blogs here every Monday, and check out my book, Tales from the Couch, for more education and patient stories, available on Amazon.com. See my YouTube channel for new lectures- I post them all the time. And I’d appreciate it if you hit that subscribe button, people! Thanks everybody, be well. 

MGA

Learn More

Double your Pleasure:the Health Benefits of the Magical Mystical Orgasm

Double your Pleasure: the Health Benefits of the Magical Mystical Orgasm

Once a topic strictly relegated to hushed conversations, research has taken the orgasm from bedroom to clinic, elucidating the many positive benefits of these happy endings. Great news, right? But before I get into that, I want to talk about the definition and history of the orgasm. What you don’t know might surprise you. 

Because it’s hilarious, my favorite clinical description of orgasm is ‘a temporary state of neuromuscular euphoria and paroxysmal climax, often accompanied by vocalization, and generally with the ejaculation of semen in the male and vaginal contractions in the female.’ 

If you’ve ever wondered, the sensation of an orgasm is basically the same for men and women. This is because the penis and clitoris are homologous organs, meaning they arise from the same tissue in a developing embryo. Whichever part you have is connected to the spinal cord, and hence the brain, through a pair of nerves called the pudendal nerves. It’s a horrible name for the same nerves in males and females, so it makes perfect sense that we have the same perfect sensations of pleasure.

From fascination to repulsion and everything in between, orgasm has been the subject of speculation and debate since the Big Bang. Aristotle actually wrote about orgasm and female ejaculation in the first-century BC… and you thought he was just into philosophy! By the way, that’s not a typo: women can ejaculate, though research estimates that only 10% to 50% of women do; actually a small number considering that the woman must reach orgasm in the first place in order to ejaculate. The moral of that story? Don’t let the pornos fool you- it’s a pretty rare event whose presence or absence says nothing of a male’s or female’s sexual prowess. 

In ancient times in Western Europe, women could be medically diagnosed with a disorder called “female hysteria,” during which they exhibited symptoms of nervousness, insomnia, irritability, loss of appetite for food/ sex, and “a tendency to cause trouble.” (this elicited a what-ever! and an eye roll from my wife Debbie) Women diagnosed with the condition would sometimes undergo the proscribed treatment of “pelvic massage” by a medical professional until they experienced “hysterical paroxysm,” which immediately, but not permanently, “cured” them. Captain Obvious says that this diagnosis is no longer recognized as a medical condition. In the early 1900’s, the first electric vibrators hit the market- a decade before vacuum cleaners and electric clothes irons! Evidently, women had gotten their priorities straight. And the rest, as they say, is history. 

Thankfully, we’ve clearly come a long way in narrowing the orgasm perception gap. But questions persist: how long does it last, does a woman need one to get pregnant, can all women have them, can men/ women have multiples, what’s the G-spot, where’s the G-spot, do women fake it and how to tell??? Time for answers.

I’ll just get the less pleasant news out of the way first. 10% to 15% of all women are anorgasmic, meaning they cannot orgasm… at all. It can be global, meaning there is no means by which she can orgasm, or it can be situational, meaning she can only orgasm under certain circumstances. In some cases, age and circumstance are factors in the ability to orgasm for both women and men. (Un)Fun fact: Marilyn Monroe was actually anorgasmic until the age of 36, when she reported to her psychiatrist that she had finally had her first orgasm. A sadly ironic circumstance for America’s biggest sex symbol was that her first orgasm, and possibly last, had been just months before her death. In men, anorgasmia typically manifests in an inability to ejaculate, called anejaculation, and usually occurs as part of erectile dysfunction, which can be organic or a side effect of medication.

Fast facts from peer-reviewed studies:

-75% of women never reach orgasm from intercourse alone. 

-75% of men and 29% of women always reach orgasm with their partner. 

-Women are far more likely to orgasm alone than with a partner. Ouch.

Are orgasms like potato chips? Experts say that if women can have one, they can have more than one. In fact, studies have shown that most women are not only capable of multiples, but they are actually capable of two different types of multiples: sequential and serial multiples. Sequential multiples are a series of orgasms that come fairly close together. Usually from 2 to 10 minutes apart, sequential orgasms have a drop-off in arousal in between; they’re like a roller coaster, with a dip after the first hill before a climb back up the next. According to studies, women report that the most common scenario for sequential multiples is an oral sex orgasm followed by another orgasm during intercourse. In contrast, serial multiples are orgasms that come one after another and are separated by just seconds; with no interruption in arousal, serial orgasms are more like a set of waves breaking on a beach. It’s a different story for men, who have what’s called a refractory period. This is the time needed for a break- and sometimes a nap- between orgasms, but given the right amount of time, male multiples aren’t entirely unusual.

The average length of a man’s orgasm is approximately 10 seconds, though it is possible for them to last up to 30 seconds. A woman’s orgasm may last slightly longer or much longer than a man’s, with an average length of 20 seconds, but possibly up to 30 seconds or more. There is a very rare and misunderstood disorder called Persistent Genital Arousal Disorder (PGAD) found in women. PGAD is spontaneous, persistent, unwanted, and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire, and which is typically not relieved by orgasm. Women with this disorder report feeling constantly and uncomfortably on the brink of orgasm for weeks or months at a time. If you’re thinking that would be cool, you’re wrong; for the sufferer, it is a very debilitating and embarrassing disorder with no cure and little potential for future therapeutic intervention. There is concern that the word ‘arousal’ in the title may be misleading, because it connotes pleasure, and having PGAD is the polar opposite of pleasure. Though vastly more common in women, PGAD is considered an analogous version of priapism, and is called such; this is when men have persistent and often painful erections for various reasons, the most well known being a side effect of the ‘little purple pill’ Viagra.

According to a published study, straight women only have orgasms 62% of the time they have sex, while lesbians orgasm 75% of the time they have sex. I guess there’s something to be said about being familiar with the tools you’re working with.  

G-whiz! There’s much ado about the female G-spot, and most people don’t even have a clue what the G in G-spot stands for. The Gräfenberg Spot was named for German gynecologist Ernst Gräfenberg, who unknowingly started a furor when he characterized an erogenous area of the vagina that, when stimulated, can lead to strong sexual arousal, powerful orgasms, and potential female ejaculation. While some people think the G-spot is as real as a unicorn, most say that every woman has one, but that it’s not necessarily the magical button of fable and lore. So for reals, what is it? The G-spot is a quarter-sized area in the vagina that swells with blood when women are aroused, and some “experts” say it is directly connected to the ‘orgasm center’ in the brain. For the record, I call bullshit on this ‘orgasm center’ stuff- it sounds like it comes from a Cosmo article. Being board certified in psychiatry and neurology, I know a few things about the brain, and there isn’t an ‘orgasm center.’ In reality, orgasms are not localized, discrete events. Researchers have used PET-scans and functional-MRI’s to show that up to 30 major brain systems are activated during orgasm, so it’s more like a wave that washes over the brain in a global manner. There is an analogous male G-spot called the P-spot, where P stands for prostate. This organ is located internally, between the base of the penis and the rectum, and produces pleasant sensations on stimulation.  

Though an orgasm isn’t strictly necessary to feel pleasure, most people will admit that reaching the big “O” with a partner or ‘Han Solo’ is a great added bonus. But beyond just feeling great, an orgasm also brings with it a host of unexpected health benefits, from lowering stress levels and heart attack risk to giving skin a fabulous natural glow. Read on to learn all the good stuff that comes from the fun stuff.

Several hormones are released during orgasm in both males and females, including oxytocin and DHEA. Studies suggest that these hormones could have protective qualities against cancers and heart disease. Oxytocin and other endorphins released during male and female orgasm have also been found to work as relaxants, in both a physical sense and psychological sense, as a mood elevator. Oxytocin is the bonding and cuddling chemical, aka the ‘tend and befriend’ chemical, and makes both sexes feel a desire to be closer to their partner during and after sex. Women actually release four times the normal amount of oxytocin on orgasm. In fact, evidence shows that the bonding and cuddling mechanism is so reliable and predictable that if a woman doesn’t feel cuddly after sex, it is strongly suggestive that she faked her orgasm. Whoa, people.

Orgasms can help lower the risk of prostate cancer in older men. Ward off prostate cancer by having sex? True story! A decade-long and well-reviewed study demonstrated that regular and frequent ejaculation (defined as at least four times per week) in men over age 50 can lower the risk for prostate cancer by up to 30%. One of the authors of the study said, “We know that having sex and orgasms is beneficial for every aspect of male health. The male reproductive system fares best with regular use, and the prostate belongs to that system. The more ejaculations, the better off he’ll be.” Hey, no argument here. 

Orgasms can help regulate the female menstrual cycle, even during times when women are not actively on their periods. According to a published and peer-reviewed scientific journal, the mechanism is linked to the apparent circadian rhythm of ovaries and their response to inflammation. Regular orgasms in females lower inflammation, improving immune health, mental health, and circadian health, which fosters regular cycles.

Orgasms can also help boost female fertility.

Regular sexual activity triggers physiological changes in the body that increase a woman’s chances of getting pregnant, even outside the window of ovulation, meaning that orgasms bring benefits at any and all points in the fertility cycle.

An associated concept is that female orgasm appears to improve the odds of conception. Now, I’ve been surprised and frightened by the prevailing ignorance on this topic, so let me be clear here: a female orgasm is not required for a woman to get pregnant; all that is required is the male’s sperm (part of the ejaculate) to meet the female’s egg(s), which is/ are released automatically and independently each month during ovulation. The basic premise of orgasm improving the odds of conception centers on the vaginal and cervical contractions during orgasm. It is believed that the ligaments involved in the muscular pulsations and contractions from the female orgasm cause the cervix to dip down and pull in any semen pooled in the vagina. That brings in more sperm, and more sperm means it’s more likely for one or more of those wiley guys to win the race to any unsuspecting egg that may be hanging out up there. This is all borne out by findings in women who have had intercourse with orgasm having more sperm in their cervical mucus than women who have had intercourse without orgasm. The moral of this story is that orgasmic pulsations are some next-level shit, and those baby-making parts have minds of their own, grabbing around in the dark to continue the genetic line. Science, people! 

Orgasms as the next homeopathic treatment for colds and flu? Consider going to the bedroom instead of the drugstore. Orgasms are killer for your immune system, no pun intended. A small German study found that immediately after sexual arousal and masturbation to climax, men showed increased levels of leukocytes, which are the white blood cells that help protect the body from illness and infectious disease. But the ladies haven’t been left out here. Another study demonstrated a correlation between female sexual activity, and therefore female orgasm, and levels of Helper T cells, which help to activate the cells the body needs to fight off foreign invaders that cause disease and illness. In addition, orgasm in both males and females releases those feel-good hormones called endorphins, and these are known to reduce general inflammation, the arch enemy of the immune system and other biological pathways. Reduction of inflammation, wherever it may be, does a body good. 

In both men and women, orgasm is shown to help alleviate pain and increase one’s threshold for pain. This is also due to the release of those feel-good endorphins and their ability to reduce inflammation. Studies have shown a direct link between sexual activity and migraines, with 60% of participants reporting some improvement of their migraine attack, and 70% reporting moderate to complete relief. It is believed that orgasm impacts perceived pain through the down-regulation of pain sensitization pathways and by modulating the immune system to reduce levels of inflammation, thus reducing pain levels. Orgasm as an anti-inflammatory once again… O-lieve?

Evidently, orgasm is also useful for relieving the pain of menstrual cramps. In addition to the reduction of inflammation for general pain relief, the pleasurable muscular pulsations and contractions of the female orgasm also use up specific lipid compounds called prostaglandins, which are the cause of menstrual cramps. Lower concentrations of free prostaglandins translates to less cramping-type muscle pain, which is a very good thing.   

Orgasms can help keep your brain sharp. The flood of hormones released in both male and female orgasm sends a ton of messages throughout the body, increasing brain activity. This is particularly true in women. An imaging study of brain function and orgasm showed that while masturbating and upon orgasm, women’s brains light up with activity in the cortical, subcortical, and brainstem regions. The researchers stated that these benefits are more powerful than doing challenging crossword puzzles. Hmmm… Sunday New York Times puzzle, roll in the hay; New York Times, roll in the hay… Frustration, satiation… Duh- this one’s what you call a no-brainer. At least, that’s the technical term.

Orgasm reduces levels of stress and anxiety in males and females. Though an orgasm initially releases a flood of stress hormones, studies have shown that the end-game effect is stress reduction. Experts have long agreed that the post-coital payoff in terms of anxiety reduction is also major, as during an orgasm, the parts of the brain that process fear shut down. All of this is thanks to our friend oxytocin, the bonding, snuggling, tend and befriend chemical.  

What makes for a happy heart can also make for a healthy heart. Since any sort of physical activity helps your heart pump more efficiently, it’s no surprise that sex can too. But published studies indicate that regular sexual activity seriously benefits heart health, helping to lower cardiovascular risk in older men and women. More specifically, they demonstrated that frequent sex and orgasms reduced instances of cardiovascular disease, hypertension, and rapid heart rate among those over age 65, especially in comparison to those that don’t have frequent sex and orgasms. This study didn’t define “frequent,” so take away from that what you will. Or what you can get away with.

Orgasm as the mystical fountain of youth? That radiant flushed look is post-coital glow; it’s for reals, and all thanks to the increased blood flow from your orgasm. The skin is the body’s largest organ, and also the biggest tell. If you’re under stress, it shows by way of a sallow, stressed out complexion. But when men and women climax, blood vessels throughout the body open up, allowing them to carry greater quantities of blood, which is the source of the flushed and blushed look. The increased blood flow also helps to stimulate the production of collagen, a protein that keeps skin looking plumped and youthful, which is why orgasms may be the quickest- and cheapest- way to gorgeous skin. Some British shrink did a survey of 3,500 people, including both men and women, and determined that regular orgasms were the second most common factor/ cause for people looking younger, the first being regular exercise. Nobody called me, so I don’t know who appointed this guy the chief judge of orgasm and youngness, but it is what it is. 

Orgasms can help boost your self-esteem and well-being. When your desires are being satiated, it makes sense that you would feel better about yourself, but it turns out that there’s a proven and demonstrable link between sexual health and self-esteem. So say researchers at Johns Hopkins (well…la tee da) as they found that sexual pleasure among young adults (ages 18-26, both male and female) is linked to healthy psychological and social development. They specifically looked at measures of self-esteem, autonomy, and empathy, and found that sexual pleasure increased all three of these measures in both males and females. However, they also found that the level of increase was not uniform: measures of self-esteem increased the most in young women particularly, while young men showed higher levels of empathy. The explanatory hypotheses for these findings are similar: that the effect of a female’s orgasm on self-esteem is circular, so the ability to easily achieve orgasm increases a woman’s self-esteem, which, in turn, better facilitates her achieving orgasm, which again feeds her self-esteem, and so on. In an analogous way, empathetic males are more responsive to their partner’s needs, and this initiates a positive feedback cycle: being more responsive to their partner’s needs increases the male partner’s ability to reach orgasm, which feeds the male’s empathetic nature and makes them more responsive to their partner’s needs, and so on… Now, I can’t say that I’m calling bullshit on this, but it seems to me that this is back-asswards: while I totally buy that orgasm in both men and women would lead to increases in all three measures, I would think that levels of self-esteem would be more increased in men, resulting from a sort of evolutionary caveman pride ‘look what I can do’ kind of thing. And I would think that greater empathy levels would be higher in women, because of the super intensive release of oxytocin that results in the huggy cuddly ‘oh how I love this person’ feelings. Then again, maybe it’s that women have a higher increase in self-esteem because their orgasm assures them that they are sexually attractive, and men have a higher increase in empathy because their partner has had a simultaneous orgasm? I’m not sure, and you probably don’t care, so we’ll just step away from this one for now.

Orgasms can help you live longer, so say some experts. Additionally, the health benefits of orgasm increase with age, and extend throughout a person’s life. Some Brits studied men between the ages of 45 and 59, and found that those with “high orgasmic frequency” lowered their mortality risk by as much as 50%. The men that had two or more orgasms a week died at a rate that was half the rate of the men who had orgasms less than once a month; in other (less confusing) words, the men that had fewer than one orgasm per month died twice as fast as the men that had eight or more orgasms per month. Like wow, people! These findings prove that sexual activity and orgasm have a protective effect on men’s health. As for the ladies: over the course of an eight-decade study on married, heterosexual couples, researchers found a demonstrable link between orgasms, health, and longevity: specifically, results indicated that women who orgasmed frequently lived longer than their female counterparts who didn’t, though they did not disclose a longevity estimation or definitive ratio of the number of orgasms required to attain greater longevity. 

Orgasms aren’t exactly a miraculous method for weight loss, but getting there might be a different story. Sex is an aerobic activity; it gets your heart rate up, and there’s no better way to burn calories than when your heart is pumping. Beats a treadmill, stairclimber, or pilates any day of the week. Researchers have attempted to measure the number of calories burned during sex for many years and on numerous occasions, but the results have varied wildly. Accepted averages indicate that most people burn about 150 to 200 calories each time they have sex, but there are some really fun ways to set that number on fi’ya… a heated make-out session can burn as many as 85 calories per hour in a 150-pound person, while 15 minutes of heavy foreplay will burn about 25 calories. So, figure you make-out for 15 minutes, then another 15 minutes of foreplay, followed by intercourse, will burn about 250 calories- that’s the same number burned in a 30-minute run, but it’s way more fun than a run. If that’s not enough burn for you, add in a sensual and arousing massage at a burn rate of 80 calories per hour. Or, employ the magic of multiples: reaching a second orgasm can burn an additional 60 to 100 calories, depending on the amount of work required to get there; and since it’s a bonus score, why stop after just one? The ultimate formula for burning more calories during sex is fairly simple: just pour on more heat and more passion for a longer period of time. 

You have probably always known that orgasms are awesome, but now you know the why and how of everything orgasmic, and are all set to impress and amaze your friends with your dazzling sexual intellect at the next cocktail party.

And even though I wrote this blog on the benefits of orgasm, I don’t want to contribute to society’s historical relationship with sex and orgasm: typically seen as goal-based, a skill to be practiced and reward to be achieved, rather than something to explore, experience and enjoy. So go forth, explore, experience, enjoy, orgasm, and spread the word, people! 

But first, google ‘Dr. Mark Agresti YouTube’ to check out my videos, leave comments, like, and subscribe to my YouTube channel. As always, you can find tons of content and patient stories in my book, Tales from the Couch, available in office or on Amazon. Thanks people.

Learn More

steroids:Seductive Today,Sinister Tomorrow

Steroids: Seductive Today, Sinister Tomorrow

An Appointment and Cautionary Tale

I got a new patient who came into my office- we’ll call him Rocky- and he said to me, “Ya know, I’m here because I’ve been having trouble with rage.” And then he just looks at me expectantly. After eleven words, he’s waiting for me to open my desk drawer and take out my magic wand. Bing! You’re cured! He’s clearly never been to a shrink. We talk here. 

In all honesty, I didn’t even need a magic wand at that point, because between those eleven words and my eyes, I had already diagnosed him. I should’ve waved my pen at him like a wand and said “Stop using steroids. You’re cured.” Instead, I said, “Let’s explore this a bit.”  

He says “I’m worried, I might be bipolar….” How did I just know he was going to say that? It is so typical. At 32 years of age, Rocky’s a big boy, unnaturally bulky, looks like he’s been lifting a lot of weights. Compared to his trunk, his head looks like somebody washed it in hot water. His face is oily, pock-marked with acne and scars. I’m noting all these things, jotting them down on my pad, jot jot, as he goes on. “…and I like to go to the gym to blow off some steam…” Rages jot. Acne jot. Oily skin jot jot. Bacne jot. Receding hairline jot jot. “…and lately everybody just pisses me off and I can’t…” Angry jot jot.“…I mean, I can bench a lot. So the other day, I was with my buddy and I finally figured it out; I realized that he’s jealous; that’s his problem with me…” Paranoia jot jot. “…and I know I’m his competition. I undercut him all the time. He would love to see me fail and close up shop, but…” Ah ha. Psychotic? jot jot. All of this is very typical with steroid use and abuse. “…so anyway, I can push harder, lift more, ya know? I work at it! The steroids help, but the work is all me.” Bingo! Finally! Now we’re getting somewhere. 

So tell me about that…the steroids. Who’s prescribing? “Oh no, I am buying it at the gym.” Well, how much are you using? “I’m doing 200mg every two days.” Injecting testosterone cypionate, 200mg Q 2 days jot jot jot jot jot. Buys at gym jot jot. And how long have you been using them? “Uhh, maybe about three years?” Times 3+ years jot jot jot. Do you think maybe you have a problem? “Oh, no. No.” Denies problem jot jot. I explain that he’s at a max dose for someone who has virtually no gonad function. Confusion jot. I explain that means someone who produces no natural testosterone. I spell it out. You’re taking the max dose that a person with no gonad function, zero testosterone would take, and that’s on top of your normal testosterone levels. Or I should say your natural testosterone levels. So you would be way above normal- ten times normal levels or more. And you’re wondering why you’ve been having these rages? Losing control? Loses control jot jot. Banging on s÷=%t at home jot jot jot. Screaming at wife jot jot. Have you ever hit her? “No. I haven’t hit her. But I’ve wanted to hit something. My fists are clenched and I want to tear something apart with my bare hands.” Denies hitting wife jot jot. Clenched fists jot jot jot. Believes he’s bipolar jot jot. I tell him that he’s not bipolar. Steroids are the problem here. He says, “No, it’s not. Can’t be.” No. It’s the steroids, I’m sure. Rocky says, “Ya know, I’ve been reading, and I’m saying it’s probably bipolar.” He’s just holding on to the bipolar excuse. Addicted jot jot. I mean, he would rather be bipolar- actually fight to be bipolar- than admit that his precious steroids are the sole root of his many issues. Denial jot. Steroids don’t cause a typical high, it’s more of an exhilarating positive feeling, an energized, almost super power feeling. For dudes like Rocky, with his temperment, he is all about that musclebound feeling of power. 

Have you noticed your hairline is receding. “Oh. You can tell?” Umm, yeah, I can tell- it’s like three inches back from where it should be- that’s why I mentioned it. That’s what steroids do. “Really?” Really. Bipolar doesn’t do that. Have you noticed your oily skin and acne on your back? “Yeah, I have.” Yeah. Bipolar doesn’t do that either. Guess what does. You get really argumentative and pissy. Some people actually become psychotic. “Oh, I’m not psychotic, man.” Really?  But, you know, in our conversation, you said you’re always worried about people at the gym being jealous and giving you side eye and you said people are trying to destroy your business. You know, maybe you’re getting a little paranoid. “Oh, I am not paranoid.” Uh huh, yeah. I tried to explain. When you’re getting paranoid, you don’t know you’re getting paranoid. He saw all these deep meanings and he was making these deep connections, why people would be tracking him and why government agencies would be interested in monitoring his business. Rocky is in the nursing home business. He’s not even actually running a nursing home, he just provides services to nursing homes. It’s not like he’s involved with any government agencies. He’s contracted to bring in ancillary services to nursing homes. It’s a fairly big business and he’s been pretty successful financially, but there was no root in reality for the paranoia he was demonstrating. 

I asked him if he noticed anything else, like maybe breast enlargement? “Ahh, maybe a little bit, but no big deal.” Mmm hmm. + breast development jot jot jot. He says, “You know, my muscles got bigger, I got leaner, and my endurance increased. I felt trimmer, more energetic.”   You said your endurance went up, how much cardio do you do, Rocky? He says, “Well, I used to do more, but man, I’ve gotten so much bigger that it’s hard to breathe when I do heavy cardio, you know?” No, I don’t know, because I don’t abuse steroids. Androgenic erythrocytosis jot jot jot. That means that you have increased the number of red blood cells in your blood, so your blood becomes thick and viscous like oil. You have so many red blood cells, it’s tough for your heart to beat, it’s tough for your lungs to get oxygen, because there’s drag from the increased viscosity, so when you do cardio, you can’t breathe. “Yeah, yeah. I can barely run. I used to do triathlons. I can’t do them anymore, but I can lift way more weight.” Yeah, because not only are the steroids making your blood thick like oil with RBCs, the thick blood makes the left heart ventricle- the one that does most of the pumping of the blood- thick. It’s a muscle, so the thick viscous blood overworks it as it tries to pump that thick gross blood through, so it makes that left ventricle wall thick, really thick. So instead of having a thin elastic pump that pumps blood in and out easily, you get this thick, wide left ventricle wall that cannot pump effectively. It enlarges the left ventricle wall, so you can’t pump good oxygen rich blood through. It’s called hypertrophy. With all those factors going on, it’ll cause hypertension. “Oh, yeah, I take medicine for that.” Like no, big deal. Aah, I just take medicine for the damage that I’m causing myself. Duh! + hypertension jot jot jot. + medication jot jot. And did you tell the doctor that prescribes that med that you’re using steroids? “No.” Nice. Prescribing Dr. unaware of illicit steroid use jot jot jot jot jot. Do you know that hypertension leads to kidney disease? “Really? My kidneys work good I think.” I’m thinking ‘maybe for now’ to myself. You think you look good on the outside, although you’re balding, your skin is oily, you have pitted acne scars on your face and acne on your back and you’re growing boobs like a teenage girl and your testicles are microscopic and you have low to no sperm and your penis doesn’t work… and you can’t breathe with any amount of exertion because your blood is thick and gross so your heart is all enlarged and your blood pressure is so high you have to take medication like a man more than twice your age. And you’re causing all of it! Through your steroid addiction. And as if the physical side isn’t bad enough, now it’s affecting you mentally. You’re paranoid, on the verge of psychosis…really you’ve got a toe or two over that line if you want the truth. So no matter how big your muscles are, no matter how good you think you look (and my raised eyebrows were clearly saying that was debatable) you are destroying your body. “Um, like what? How?” Now he’s really listening. I continued. Do you understand what hypertension actually is and does? Cause and effect? How about atherosclerotic plaques. What are those? What do they mean? The arteries in your heart become lined with plaques that are basically made of fat. These fat plaques are sticky, so as your thick gross blood slogs through the arteries, the fat plaques gather and narrow the arteries, so you cannot push blood through the arteries. Eventually, they clog off. It’s like a tunnel being filled with more and more muck, so there’s not enough room for blood to flow through and you get a heart attack and die. But before that happens, you’re incapacitated with high blood pressure because your thick oversized left ventricle is trying to push your thick gross blood through arteries that are filled with fatty muck, athersclerotic plaque filled arteries. “I didn’t know all that.” I’m sure you don’t, but I’m not done educating you yet. It gets better. Well, actually worse. 

Education jot. Steroids decrease HDL, which is the good cholesterol that helps keep your arteries open. And it also raises the LDL, which is the bad cholesterol that causes the fatty plaque to build up. So lowers the good while raising the bad. Got that? “Yep. Got it.” So that causes hypertension, and makes you prone to heart attacks and strokes. Did you know that hypertension also makes your kidneys malfunction? I didn’t think so. Right now, your kidneys are trying to pump under hypertension, and that kills them. The gross viscous blood thick with red blood cells kills them. So your kidneys shut down. Do you like to be able to take a piss? To be able to clean your thick slaggy blood of all the toxins you make? He nodded that yes, he rather liked to be able to take a piss and clear his thick slaggy blood of all the toxins he makes. I thought so. Enjoy it while it lasts. Before long, a machine will do that for you: four hour sessions, three times a week…if you’re lucky enough to live that long. If the massive heart attack doesn’t kill you first. Honestly, Rocky looked like he was about to have a heart attack right now. I know I’m hitting him pretty hard with all of this at once, but this guy was in a romantic relationship with his precious steroids, and I need him to break it off, clean and quick like. But wait, there’s more!

Now, with all this bad stuff going on, the little vessels throughout your body do not pump blood as well because they are clogged and they are hypertensive. So all those tissues, joints, and bones are starved of nutrients and oxygen. You get something called avascular necrosis. Avascular means without vasculature- blood vessels- and necrosis means death. It’s everywhere, but especially in the hips, with the ball and socket joint. The little vessels that feed the balls of your hip joints, where the femur meets your hip? Hello, the blood supply gets occluded- it gets starved- and then it gets dead. So you can recognize all the steroid abusers out there: they’re the 40 year olds using wheelchairs and walkers, whining about the pain in their hips. Balding, acne, boobs, erectile dysfunction, heart problems, kidney issues, disability, chronic pain. On and on. Oh yeah, it’s pretty bad, but it gets worse. His face fell. I couldn’t let up now. You enjoy being able to lift weights? You enjoy being physically capable? Like a zombie, he mumbled on a sigh “Yes…” I’m glad you do. But don’t get too used to it. Because if you keep this crap up, keep injecting that garbage, you’ll build your muscles up beyond what your body can handle. You’ll build them up- your muscles will get bigger- but your ligaments and tendons can’t be built up, and they can’t support these unnaturally large muscles. Do you know what muscles without ligaments and tendons do? Not much. Without healthy ligaments and tendons, big muscles are useless for anything but causing pain, debilitating pain. When you’re pumping iron, lifting really heavy weights, your ligaments and tendons get damaged. In no time, the muscle size supercedes the ability of the damaged ligaments and tendons, so you get irreversible chronic muscle pain. Sounds great, right Rocky? Oh, wait, and to top it all off, now you’re having psychological effects. You’re having rages. You want to tear something apart with your bare hands. You said that. What’s scary is that right now, at this moment, you have the physical ability to do that. If somebody pushed you too far on a bad day, you might go there. You could kill someone. I’ve seen it happen to a patient. A guy a lot like you. He came in here young and dumb and I explained everything to him, just like I’ve done with you. For several years, I begged him to stop. He refused to listen; didn’t believe me. Ultimate in denial. He’s in prison now for the next 30 years; that equals a life sentence for him. It’s scary. What’s even scarier is that if you keep this crap up, keep sticking yourself with that needle, you won’t be able to tear somebody apart for long. You might want to, but you’ll be too debilitated. That guy in prison? He’s in a wheelchair now 90% of the time. He uses a walker sometimes- when he can stand the pain- which isn’t often. 

I’ll make this very plain. You are addicted to steroids. They are physically wrecking your body, the body you seem to worship. Oily skin, acne, bacne, boobs, receding hairline, balding, teeny tiny testicles, a penis that you can’t get up…and no sperm to come out of it anyway. And that’s just the stuff on the outside that people can see! Your insides get wrecked too. Thick slaggy gross blood, hypertension, atherosclerosis, heart attack, stroke, kidney dysfunction, erectile dysfunction, avascular necrosis, chronic pain. And now you’re raging, scaring the crap out of your wife, you’re paranoid, becoming psychotic. You have nothing positive happening in your life. So it’s your call, Rocky. I can help get you off the train here before it runs your ass over. He was nodding very slowly, but clearly shell-shocked. Look, how about this. Don’t use for two weeks and see me again. You’ll have some time to digest all of this. Can you do it? If you can’t- if you feel like you’re gonna hit that needle- I’ll see you sooner. Here’s my cell number. Call me anytime, but especially if and when you’re tempted to use. Deal? “Deal.” We shook on it.  

Dx: steroid addiction, assoc features jot jot jot jot

Pt agrees to d/c use jot jot jot

F/up 2 weeks, will call/ see sooner prn jot jot jot jot jot

Here’s the bottom line on steroids people. Your body just does not like these drugs in excess. There may be some use for them in people with anemia, in people who have wound healing problems, a temporary use in people with HIV or cancer who do not want to eat, and in muscle wasting diseases for short periods of time and in very regulated doses, okay…fine.  

But, for my Olympic athlete patients, my professional athlete patients: you all know who you are. All of my Rocky’s out there: cut it out! You’re sterile, can’t get it up, scared everyone’s gonna see your breasts, hello, they are! I know you’re saying ‘but I cycle them on and off, doc!’ I say bullshit. No, it causes permanent damage to heart, kidneys, tendons, and ligaments. Not to mention the cosmetic aspects: the oily skin, the acne on your face and back, the balding, receding hairline… and you say ‘oh, but to minimize the breasts I use an estradiol’ (an anti-estrogen, because testosterone breaks down to estrogen, so if you use an anti-estrogen in someone who is abusing testosterone or testosterone-like drugs, you will not get the breast enlargement) Yes, that’s true. I’ll give you that. But, you still get all that other crap, guys! Hellllo!! All my elite athletes, you all whine like ‘No, no, no, I need it to stay competitive, because everybody else is doping!’ Whatever! You are addicted to the high, the performance, and the cosmetic enhancement. You get big muscles, tiny balls, and tinier brains. You also get limp and sterile, permanent damage to the ventricles, the heart, and the kidneys, hypertension, and its host of other problems. You are predisposing yourself to coronary disease, heart attack, and stroke. You become delusional, and you fly into rages when the wind blows.  

As you are my patients, I’ve probably told you about other patient stories. For those that haven’t heard them: one steroid abuser was very paranoid and psychotic, but of course didn’t know it, because you will not see yourself becoming psychotic. He was stopped at red light. I don’t know what he was doing, but when the light changed green, he didn’t go right away. So the car behind him honked. He started ticking like a time bomb, and the car kept honking, but for whatever reason, he still didn’t go. Instead, with the light still green, he got out of his car. With a golf club. He went off, banging on the guy’s car with the golf club, and he just didn’t stop. Eventually, they called the police.  The police came and they had to subdue him with a tazer because he was out of control. When he was transported to the emergency room, he continued there, even continuing to spit and scream, even after being put in four-point restraints. Finally, he had to be pharmacologically restrained with a freaking rhino dart. Unbelievable. I mean, he was all black and blue, like he had been beaten, but he did it by thrashing, all by himself. His whole affect was totally inappropriate. I know that some people are beaten by police for no reason; they don’t deserve it, but this maniac was taking every opportunity to hit the police officers for absolutely no reason. In the hospital, he was arguing with nurses, disturbing the entire emergency department for no reason. His wife finally came in, but even she couldn’t calm him. He just lost it, in every sense. He was (or had been) on the road to being Mr. Olympia or some such title. He was 190 pounds, and bench pressing over 450 pounds. It was just crazy. Eventually, but not long after, he went into kidney failure. But it wasn’t from the steroids. Yeah, right. Denial!! jot jot

You know, it also causes immune suppression, so you don’t fight off pathogens like viruses, like COVID-19, like any bacteria. I had someone who had a heart attack and died. He was 25. Another stroked out in his late 30’s. These patients are Olympians, professional athletes, and really elite level people. They’re so hyper-disciplined about their diets and their training and supplements and sleep patterns and all of that. But they’re abusing steroids. It’s a crazy dichotomy. Some have made it. Big success stories that stopped and then did it the right way. But many don’t. Right now I have a 45-year-old man who is just going into kidney failure. And the one with psychosis that killed the guy that set him off. He’ll die in prison. Now I have Rocky. I hope I opened his eyes. 

Remember, people… just because you cannot see what’s going on doesn’t mean the steroids aren’t destroying you. They are. But you can get there without them. And PS, for those that are wondering, there is a steroid withdrawal: headaches, drowsiness, decreased appetite, weight loss, fatigue, depression, dizziness. It’s a mess when I get them off, especially when they do high dose. It takes two to four weeks, and they are miserable, cranky, irritable, and obnoxious people to deal with when they are in withdrawal. I use benzodiazepines, things to help them sleep; I sometimes add anti-psychotics because they can’t see themselves drifting to the psychotic lane, sometimes hearing voices and seeing things. It’s a spectrum. And lots of misreading events in reality… “Those people are talking about me. They’re plotting against me. Those police officers are here to get me, or that group of people talking over there are planning something against me or these workers are not working because they are all in a grand plot against me. They are very faint signs and forms of psychosis. Hearing voices and seeing things, disorganized speech and behavior is the extreme. But there can be the unextreme, the misreading, the over-emotional abnormal response to normal events, thinking people are plotting.  

Probably from age 10 to 30 is when most people started and abused the steroids. And too often, it’s a one way trip, once they start, they get lost in it. You know, “I am superman now” and they don’t stop, and then they stroll into my office and then I deal with them when they are 45 to 50 and that’s when their kidneys shut down, when they get a heart attack, when they are debilitated with degenerative disk disease from lifting too heavy weights, their ligaments and tendons go, they become sterile, they cannot have kids, they’re in constant horrible chronic pain. They have heart problems and kidney problems, and that’s what gets them. If they have heart and kidney failure, to the point where the organs have just given up, that’s what kills them.

Hopefully not Rocky jot jot jot

Learn More

Sociopath or A-hole How To Tell The Difference

Sociopath or A-hole?

How to Tell the Difference

When you think of a sociopath, you probably picture someone like Dr. Hannibal Lecter in Silence of the Lambs, or Annie Wilkes in Stephen King’s Misery. But like most mental health conditions, sociopathy- otherwise known as antisocial personality disorder, or ASPD for short- exists on a spectrum. And clearly, kidnapping and hobbling your favorite author or enjoying a cannibalistic dinner with a nice chianti would be pretty out there on that spectrum. 

Before I get started on the details of recognizing sociopathy, I want to quickly remind you about last week’s blog topic, the differences between sociopathy and psychopathy. Both disorders are considered ASPD’s, but people tend to use the terms sociopath and psychopath interchangeably, though they mean different things. Typically, sociopaths are a product of their childhood environment or upbringing. Disturbed and unhinged, they’re not always big planners, so they’re more prone to impulsive behavior. They’re very likely to break rules and/ or laws without thinking twice, but as for going on a murderous rampage? Not so much. On the other hand, psychopaths are essentially born, and have an innate disdain for others coupled with a compulsive need for violence. They are cold and calculating, and can even be charming when it suits their purposes, a la Ted Bundy. Psychopaths are at the most extreme end of the antisocial personality disorder spectrum, and while all psychopaths are antisocial, not all antisocials are psychopaths. 

There are many people with difficult personalities out there, all of which can impact your life to varying degrees. These are your garden variety a-holes, and they’re usually pretty simple-minded and relatively harmless if you don’t pay them much attention. But sociopaths have one of the most hidden personality disorders, as well as one of the most dangerous. They often slip under the radar because they put so much energy into deceiving people. In my vast experience with sociopaths, most people don’t know what to watch out for, and they’re generally shocked at how easily they can be manipulated. In truth, anyone can be a target. The point of this week’s blog is to explain sociopathic behavior, help you identify potential sociopaths in your life, and share how to deal with them once you do. 

Sociopathy occurs in nearly 4 percent of the U.S. population, which works out to about one in 20-ish people. There is a clear link between ASPD and sex. You are 3 to 5 times more likely to be a sociopath if you own a Y chromosome; and only 25% of sociopaths are female. Obvi not all men are sociopaths, but being male can be one clue in identifying them.

Whether someone has intentionally deceived you for their own perverse pleasure, or you’ve had a college roommate eat the last of your mom’s famous homemade lasagna without asking before or apologizing after, you’ve experienced sociopathic behavior. Fortunately, your selfish roommate’s sociopathic behavior probably doesn’t make him an actual sociopath… it just makes him rude AF. 

So that begs the question: how can you differentiate between an a-hole and a sociopath? It’s not always as easy as it seems, because sociopaths can be masters of deception, and some traits might be hidden by their frequent lies. Remember too that they can be intelligent and good at manipulating people into doing what they want, so they may come across as friendly and outgoing when it’s really all a ruse.

That said, here are some of the general themes to be on the lookout for:

Sociopaths can be highly effective at getting you to overlook any warning signs you see or sense. That’s why they’re called con artists: they take you into their confidence, and you trust them. You will doubt yourself before you doubt them. They are narcissistic, believing they are better, smarter, cuter, funnier, and more interesting than anyone else. 

In a dating relationship, a sociopath may be the most loving, charming, affectionate, and giving person you have ever met. But, if it seems too good to be true, it usually is. They are likely to be secretly dating several other people. They can be very promiscuous and are loyal to no one. They’re also very quick to anger. If you dare to question them, their anger response is totally outside the scope of what would be considered ‘normal’.

They can be fast talkers and bull$#&t artists. They’ll say anything to cover up their secret activities, no matter how ridiculous it sounds. I have a patient that was actually living with 3 different women in 3 different houses, at the same time- and the women were happy and had no clue about his deception. I actually had him bring each of them (in separate appointments, of course) for a couple’s session, because I had to see it for myself. Get this…he would tell them that he did contract work for the CIA, so he couldn’t give them any details about it. When he would leave a woman to be with one of the others, he’d just say that he’d be gone all the next week on a secret mission. And then he would lament about how much he wished he could tell them all about it, but he just couldn’t, so they must never askhim about it. And they bought it, hook, line, and sinker! 

They quickly lose interest in a girl-/ boy- friend, but they’ll keep them hanging on with a few words of love, so that they can still have sex with them, borrow money from them (which is never returned) and maintain access to their house or car. They have no empathy, so they’ll use them until they’re not useful anymore, and then leave, feeling no remorse for any damage they’ve left in their wake.

They are secretive. They may pretend they are going to work at the office everyday, when they’re actually going out to deal drugs. Or gambling away their paycheck, then saying they were robbed. They’re often impulsive and irresponsible, and unable to maintain a job, so they don’t have money and need to find a reason to cover that up. They like to see how far they can control a situation, what they can get away with. Everything is done for their personal gain, and they have a greatly exaggerated sense of self-worth.  

Sociopaths love to play the victim. They’ll tell you a story about how someone else took advantage of them, or how life circumstances treated them very badly. This is a calculated tactic to get you to feel sorry for them, so that you’ll want to help them. This ploy works, because normal, healthy people naturally care about others, even strangers. Ted Bundy tore a page out of the sociopath’s play book and used to put a fake cast on his arm or leg, then drop a bunch of books near an isolated young woman on a college campus. Then he would ask her to help him carry his books back to his car, and when they leaned into his car to put the books in the back seat, he would shove them inside. And the rest was history.

I’ve seen firsthand how all of these kinds of activities have gone on under the radar for so many people in relationships with sociopaths. The targets are always shocked, because the sociopath was so good at living a lie. But as I tell the victims, that’s what they do. 

Officially diagnosing someone as a sociopath using the DSM-IV isn’t always as simple as you might think. But, if someone has three or more of the tendencies listed below, as Jeff Foxworthy would say, they might be a sociopath:

-Failure to conform to social norms (i.e, they break the law)

-Repeatedly lie or con others for profit or pleasure

-Fail to plan ahead or exhibit impulsive behavior

-Repeated irritability or aggression (i.e, they always get into fights)

-Reckless disregard for the safety of themselves or others

-Consistent irresponsibility (i.e, they can’t hold down a job or meet financial obligations)

-Lack remorse (i.e., they rationalize their actions or are indifferent to other people’s feelings)

Following is more information on some of the red flag symptoms of sociopaths to watch out for, based on criteria listed in the DSM-IV.

Symptom: Lack of empathy

Perhaps one of the most well-known signs of a sociopath is a lack of empathy, particularly an inability to feel remorse for their actions. When you don’t experience remorse, you’re basically free to do any horrible thing that comes to your sick mind. That’s a problem. 

Symptom: Difficult relationships

Sociopaths find it hard to form emotional bonds, so their relationships are often unstable and chaotic. Rather than forge connections with the people in their lives, they might try to exploit them for their own benefit through deceit, coercion, and intimidation.

Symptom: Manipulativeness

Sociopaths tend to try to seduce people and ingratiate themselves with the people around them for their own gain, or just for sheer entertainment. While some are charming, this doesn’t mean they’re all exceptionally charismatic. I’ve seen plenty that I would not call charming in any way, shape, or form. But they think they are of course; this can be an important distinction. 

Symptom: Deceitfulness

Sociopaths have a reputation for being dishonest and deceitful. They often feel comfortable lying to get their own way, or to get themselves out of trouble, whatever motivation they may come up with. They also have a tendency to embellish the truth when it suits them. 

Symptom: Callousness

Some sociopaths can be openly violent and aggressive. Others will cut people down verbally. Either way, they tend to show a cruel disregard for other people’s feelings.

Symptom: Hostility

Sociopaths are not only hostile themselves, but they’re more likely to interpret others’ behavior as hostile, which drives them to seek revenge. Revenge is a primary goal when a sociopath feels wronged.

Symptom: Irresponsibility

Sociopaths often have a deep disregard for financial and social obligations. Ignoring responsibilities is extremely common, which can include not paying child support when it’s due, allowing bills to pile up, and regularly taking time off work. Their needs and wants supersede everyone else’s, no matter who they are, even including their children. 

Symptom: Impulsivity

We all have our impulsive moments: a last minute road trip, a drastic new hairstyle, or a new pair of shoes you just have to have. But for sociopaths, making spur of the moment decisions with no thought for the consequences is part of everyday life. They find it extremely difficult to even make a plan, much less stick to it.

Symptom: Risky behavior

Combine irresponsibility, impulsivity, and a need for instant gratification, and you get risky behavior. It’s not surprising that sociopaths get involved in risky behavior, because they tend to have little concern for themselves, let alone the safety of others. This means that excessive alcohol consumption, drug abuse, compulsive gambling, unsafe sex, dangerous hobbies, and criminal activities are all on the sociopath’s to-do list.

Can sociopathy be cured or treated?

There’s no cure for sociopathy, and there isn’t a lot of evidence that it can be successfully treated. Typically, the main issue in treating it is that it’s unusual for a sociopath to seek professional help. One of the curious things about this disorder is a general lack of insight on the sociopath’s part. They may recognize that they have problems, might notice that they get into trouble on the job, and may recognize that their spouses are not happy with them. But they tend to blame other people, and other circumstances, for the trouble; this is part and parcel of the diagnosis. The good news is that symptoms of sociopathy and other ASPD’s seem to recede with age, especially among milder cases and in people that don’t do drugs or drink to excess. Cognitive behavioral therapy isn’t very helpful for treating the disorder itself, but it can help people to stop certain devious behaviors. Sociopaths might not really develop actual empathy or learn to feel badly about their actions, but they could possibly learn to stop eating their roommate’s lasagna.

So now you know the symptoms of sociopathy to look for and you’re better prepared to recognize a sociopath. But if you suspect that you’re dealing with a sociopath, what should you do?

The best and simplest answer is to get far away from them, to permanently extricate them from your life. If you don’t, they will seriously complicate that life. Unfortunately, that isn’t always possible. If it’s your boss or a relative, you might not be able to just cut ties and bolt, but you can learn how to deal with their sociopathic behavior and still remain true to yourself and your own mental health.

First, trust your instincts. A person doesn’t need a DSM diagnosis to be a manipulative a-hole who’s causing you harm. If they don’t care about your feelings, repeatedly lie to you, and manipulate your emotions for their pleasure, they aren’t someone you should be around, sociopath or not.

Secondly, remember that you cannot change this person. They may not realize that what they’re doing is abnormal, and they definitely don’t give a flip if it hurts you. You must let go of any illusions that you can fix them or get them to be a better person.

As you distance yourself from them, the sociopath might try to make deals with you. Do not go along with it! They don’t care about your feelings and they don’t obey any rules, so they will never honor any deal they offer. And even worse, when it fails (because it will) they will say that you were the one that ruined the deal; they’ll try anything to put any and all blame on you. So your best bet is to just avoid that crap all together.

If you’re not sure how to distance yourself from this person, or you need other tools to deal with them, talk to a therapist. They’re far better able to spot the true tendencies of a sociopath, and they can help you learn how to set boundaries or remove yourself from the situation. They can also help you cope with the harm the sociopath inflicted and the damage they left in their wake.

If the person seems like they’ll cause extreme harm to themselves or others, you can call an emergency mental health line. SAMHSA (Substance Abuse and Mental Health Services Administration 1-800-662-4357) is a good one. And If you are, or anyone else is, ever in any physical danger, call 911 immediately.

Now you know all the hallmark behaviors of a sociopath and what to do when you realize there’s one squirming around in your life. There are a bunch of sociopaths out there, so by all means, share the knowledge with your friends and family. 

For more information and patient stories on sociopathy and other personality disorders, you can read my book, Tales from the Couch, available on Amazon. And you can also check out my lectures and subscribe to my YouTube channel by searching under Mark Agresti. 

Learn More

Psychopaths and sociopaths Tomato Tomato or Tomato Potato

That dude in the little blue speedster flying down I-95 and using all three lanes to cut everyone off and pass them… what a total psycho! The captain of the high school cheerleading squad who’s demanding that her boyfriend work extra hours to pay for her hair and nails to get done every week… that chick is such a self-centered sociopath! We pin these labels on people easily, and often jokingly, but psychopathy and sociopathy are pretty serious states of being, sometimes far from a joking matter. 

Do you know someone who seems to have no understanding of what it means to show empathy or concern for others, someone who has no regard for right or wrong, or someone who actually seems to derive pleasure from hurting others? To you, this behavior and personality seem calloused and unreal, maybe even impossible to believe; but believe it…if the above characteristics sound familiar to you, you’ve probably crossed paths with a psychopath or sociopath. 

A lot of people use the labels psychopath and sociopath interchangeably when referring to a person who exhibits a wide array of creepy, odd, or dangerous behaviors. But while the two do share some common traits, there are other points that separate them as well. Both sociopaths and psychopaths have a patent disregard for the safety and rights of others, and manipulation and deceit are central features to both personalities. Contrary to popular belief and what you see in the movies, psychopaths and sociopaths are not necessarily bloodthirsty or violent. Surprised? Violence is actually not a necessary requirement for a diagnosis of psychopathy— but it is often present. In this blog, I’ll shed some light on sociopathic and psychopathic traits, go over why they’re grouped together, and also what sets them apart from one another.  

In actuality, neither psychopathy and sociopathy are official diagnoses on their own, but The Diagnostic and Statistical Manual of Mental Illness puts them under the heading of antisocial personality disorders, meaning that people with psychopathy and sociopathy have a diagnosis of antisocial personality disorder, hereafter ASPD. 

ASPD is a mental health diagnosis characterized by a lack of empathy, ie an inability to care about the needs or feelings of others. Approximately 3 percent of the US population qualifies for a diagnosis of antisocial personality disorder. It is more common among males and more often seen in people with an alcohol or substance abuse problem, or in forensic settings such as prisons. People with antisocial personality disorder are usually master manipulators and absent of moral conscience. The exact cause of ASPD is not currently known, but environmental factors, genetics, and possible changes in the function and structure of the brain are believed to be factors that contribute to its development. Other contributing factors may include having a family history of mental health disorders or a history of living in an unstable or violent family in an abusive or neglectful environment. In both cases, some signs or symptoms are nearly always present in a person before the age of 15, so that by the time that person is an adult, they are well on their way to becoming a full fledged psychopath or sociopath.

The common features of a psychopath and sociopath lie in their shared diagnosis and key characteristics of ASPD:

Lack of empathy toward others

Constant deceitful or manipulative behavior

Little regard for the safety of others

Difficulty with all relationship types

Aggression or irritability

Criminal history

Lack of remorse or guilt for actions

Reckless and/or dangerous behavior

Laws/ Rules don’t apply to them

Regularly breaks or flouts the law

Impulsive and doesn’t plan ahead

Prone to fighting and aggression

Irresponsible, can’t meet financial obligations

As with many things in life, there are different levels of both psychopaths and sociopaths.

Some might be thieves or cheaters, while others could be actual killers. The most concerning difference between psychopaths and sociopaths is that when someone is a psychopath, you’ll probably never know it, never have the faintest idea… which is what makes them even more dangerous.

You’re probably familiar with some famous fictional psychopaths and sociopaths. How about psychopath Hannibal Lecter from Silence of the Lambs, or the psychopathic detective Dexter from the primetime crime drama of the same name. Or sociopathic pop culture hero, King Joffrey from Game of Thrones, and the sociopathic Joker in The Dark Knight. These characters all had ASPD and lacked empathy, broke laws and disregarded rules, ignored others’ rights, exhibited violent tendencies, and never felt an iota of guilt for their behavior, if they even knew they behaved badly and hurt people in the first place. Which they probably didn’t.

Traits of a Psychopath

Psychology researchers generally believe that people are born psychopaths, as it’s likely associated with genetic predisposition. The flip side is that sociopaths tend to be a product of their environment, perhaps as a result of abuse. But that’s not to say that psychopaths may not also suffer from some sort of childhood trauma. 

Research has shown that psychopathy might be related to physiological brain differences, as psychopaths often have underdeveloped areas of the brain in regions that are responsible for emotion regulation and impulse control.

Generally speaking, psychopaths are superficial, egocentric, and emotionally shallow. They’re practiced and smooth operators, and they will compliment you, make you feel good, and say all of the right things, until you find out later they’ve been playing you for their own purposes, using you, stealing money from you, or plotting some kind of crime…like your murder. 

They’re extremely manipulative and pros at gaining others’ trust. They have a hard time forming real emotional attachments with others, so they intentionally form shallow, artificial relationships designed to be manipulated in a way that most benefits them. They see people as pawns to be used to forward their own goals and agendas, and rarely, if ever, feel any guilt regarding how they treat others or how much they hurt them. 

Psychopaths can often be seen by others as being charming and trustworthy, as they hold steady, normal jobs. They tend to be very successful and well liked, much like master con artists. They may even have families and seemingly-loving relationships with a partner. And while they tend to be well-educated, they may also have learned a great deal on their own, living in and experiencing the real world. They are the princes most charming of all…until they aren’t anymore. Legendary psychopath Ted Bundy comes to mind here. Women found him smart and attractive, and they took him at face value; and that was their undoing.

When a psychopath engages in criminal behavior, they tend to do so in a way that minimizes risk to themselves. If that means they must implicate an innocent party in the behavior, so be it. They will carefully, and even obsessively, plan criminal activity to ensure they don’t get caught, having contingency plans in place for any and every possibility.

While psychopaths are like chameleons, seamlessly blending into their environment, sociopaths are easier to spot. The cool, calm psycho attitude is replaced by the hot-headed sociopathic one. They are rage-prone, and if things don’t go their way, they’ll get angry and aggressive, with emotional outbursts.

Traits of a Sociopath

Researchers tend to believe that sociopathy is the result of environmental factors, such as a child or teen’s upbringing in a very negative household; or in any situation that resulted in physical abuse, emotional abuse, or childhood trauma.

In general, sociopaths tend to be more impulsive and erratic in their behavior than their psychopath counterparts. While they also have difficulties forming attachments to others, some sociopaths may find it easier to form an attachment to a like-minded group. Unlike psychopaths, most sociopaths have a difficult time holding down a long-term job, fitting in properly with some social situations, and presenting a normal family life to the outside world.   

When a sociopath engages in criminal behavior, they may do so in an impulsive and largely unplanned manner, with little regard for the risks or consequences of their actions. They may become agitated and angered easily, sometimes resulting in violent outbursts. These kinds of behaviors increase a sociopath’s chances of being apprehended.

Who is More Dangerous?

As with many things in life, there are different degrees of severity in psychopaths and sociopaths. In reality, both pose risks to society, because they must constantly, 24/7-365, find ways to cope with a way of thinking and a way of life that is different from society’s accepted norm, and this can make them edgy. But, that said, psychopathy is the more dangerous disorder, because people with it experience far less guilt connected to their actions. Also, a psychopath is better able to dissociate from their actions, meaning they can easily separate emotional feelings from any actions they undertake. Without this emotional involvement, any pain that other people suffer is completely meaningless to a psychopath. All of the most famous serial killers have been psychopaths.

Psychopath v Sociopath: Childhood Clues

Clues indicative of later psychopathy and sociopathy are usually available in childhood. Most people who are diagnosed with sociopathy or psychopathy have had a previous pattern of behavior in which they violated the basic rights of others or endangered their safety. They also often have a childhood history of breaking rules and laws, as well as societal norms too. These kinds of childhood behaviors are recognized as a conduct disorder. 

Conduct Disorders:

Four categories of problem behavior

Aggression to people and animals

Destruction of property

Deceitfulness or theft

Serious violations of rules or laws

If you recognize any of the above four symptoms or any of the specific childhood clues of conduct in a child or young teen, they’re at much greater risk for having antisocial personality disorder. We’ll talk about what to do with that next week. Also next week, we’ll get deeper into how to spot a sociopath. 

Check out my website for more blogs at dragresti.com/blog/ and pass them around to friends. Search my name on YouTube to see all of my lectures there and subscribe to my channel, people. And share with your friends! Also, as always, my book Tales from the Couch is available on Amazon.com.

Learn More

Pedophilia:Predators in Your Back Yard

*Sensitive Content*

*Reader Discretion/ Age Advisory*

Pedophilia: Predators in Your Back Yard

Pedophilia has become a topic of increased interest, awareness, and concern for both the medical community and the public at large. In my nearly thirty years of practice, I am sad to say that I have treated far too many victims of pedophilia and sexual predation of every unimaginably horrific kind; those narratives are indelibly etched into my memory. In the last decade or so, increased media exposure, new sexual offender disclosure laws, web sites listing the names and addresses of convicted sexual offenders, and increased investigations of sexual acts with children have increased public awareness about pedophilia. That’s definitely a good thing. The passing of laws, like Megan’s Law in 1996, authorizes local law enforcement agencies to notify the public about convicted sex offenders living, working, or visiting their communities, and has helped expose pedophiles living amongst us, and this allows parents to better protect their children.

But in the age of the internet, cyber predators can stalk their victims from a safe distance before ever suggesting they meet. They can be very cunning, and they often lie about their age/ gender/ status/ likes/ dislikes; they play online team video games to attract children, and they make up customized stories, tailor made to lure specific victims. Because of these realities, it’s important for everyone to understand pedophilia, its rate of occurrence, and the characteristics of both pedophiles and sexually abused children. 

In recent years, the law has taken a tougher stance on dealing with pedophiles and sexual predators, and exposure is often the order of the day for the media, as these cases play out in the wide open. You need only note the allegations of sexual predation in the priesthood or in the Boy Scouts to realize that predators are everywhere, even in some unlikely places. Who can forget Jared Fogle, the smiley faced Subway spokesman who lost 200-plus pounds, supposedly by eating only sub sandwiches? Who would’ve ever guessed that he was actually a predator, targeting children of middle school age, a demographic he often found himself in the company of during his well paid and nation wide lectures about healthy eating habits. That age group was his preference, but he wasn’t discriminatory by any stretch of the imagination. He made that quite clear in the surreptitiously taped conversations he had with a “friend” who was actually working undercover for the FBI. I was physically repulsed when I heard those recordings, and even as I remember them now, I can actually taste and feel the bile rising in my throat. Ultimately, in 2015, Fogle was adjudicated as guilty of charges of child pornography and having sex with minors, and was sentenced to more than 15 years in prison. He apparently passes the time by filing frivolous lawsuits against the Feds and Donald Trump, all without the aid of his attorney. 

A name synonymous with sexual predation since the millennium, especially here in Palm Beach County, is of course Jeffrey Epstein. This multimillionaire financier dirtbag was a predator incarnate, who, over a period of at least 15 years, lured a procession of girls as young as 14 to his Palm Beach mansion to perform nude bedroom massages for money; massages that often ended with Epstein groping or sexually assaulting the girls. All told, investigators found evidence that Epstein preyed on at least 80 girls total, here and in New York. 

One of my patients, I’ll call her Dominique, was one of at least 15 girls from Royal Palm Beach High School alone, who Epstein sexually exploited in that aforementioned bedroom 15 years ago, and she will live with those memories forever. At the time, it was a not-so-well-kept secret among RPBHS students, teachers, and administrators that girls were being sexually exploited in return for gifts of cash, expensive cars, trips, and shopping sprees courtesy of their Sugar Daddy; but nobody reported their concerns to authorities at the time. Epstein masterminded an underage sexual assault scheme, paying girls $200 for each new victim they recruited, instructing them to target vulnerable girls, often on the verge of homelessness and desperately needing money, and “the younger the better.” 

Dominique drove a convertible Mercedes, courtesy of Epstein, flew in his jet to travel on trips with him to Mexico and the US Virgin Islands, and met some very famous and influential people, including a former POTUS, a ridiculously wealthy computer nerd, and one particularly slimy smarmy one that calls Britain’s monarch “Mummy.” Dominique told me that she and the other girls would skip school, hang out at his house, float around in the pool, go out on the boat, or head to Worth Ave for lunch, followed by black card shopping. The girls also drank alcohol and did drugs, made available by Epstein, of course. Consumption of alcohol and drugs is a way that predators groom their targets, to seduce them, make them more comfortable and less inhibited, and hamper their ability to resist. 

The girls traded sexual favors in exchange for all of the cash and material gifts he gave them, and Dominique said that oral sex and intercourse were just an acceptable part of the deal; it was very much a simple transaction. The better the girls were, the more they pleased him, the more money and gifts he would give them. It was a calculated and infinitely alluring arrangement, all by Epstein’s diabolical design, and before she knew it, Dominique was in over her head, but yet unable to cut ties. Thankfully, the law intervened and cut those ties for her, for once and for all. Now she’s moving on with her life and looking forward to the future, all while still dealing with the extreme damage done in the past.

When any of his girls became nervous or ever questioned activities, Epstein had a remedy for those circumstances as well. He used his “assistant” Ghislaine Maxwell as a beard to make the girls feel more comfortable; sort of an older sister vibe, a figure for them to look up to and emulate. She played a key role in the scheme, and she’s currently awaiting trial on sex trafficking charges and who knows what else. In his first two charges here in Palm Beach County (soliciting a minor for prostitution and procuring minors for prostitution) Epstein made a sweetheart deal with the Florida DA’s office, spending 13 months (of an 18 month sentence) in a private wing of the Palm Beach County Jail on Gun Club Road, but he was still allowed to go to “work” on Palm Beach Island six days a week for twelve hours each day. I consider that incomprehensible. Then after he served his tiny time here, he was facing more charges in New York for sex trafficking of girls as young as 14 and conspiracy to commit sex trafficking. Apparently, the Feds also had a lot more charges up their sleeves, and were investigating every single thing in his life. At his arraignment in New York, Epstein pleaded not guilty to all charges. If convicted, he would have faced up to 45 years in prison. But, evidently, he couldn’t take the heat. He was found hanging in his cell by the guard that may have been too busy sleeping to guard him. The coroner’s manner of death was listed as suicide, but his family and other conspiracy theorists say he was murdered. Either way, he’s gone, as is the opportunity for his victims to face him in open court and tell their truths. 

Below, I define pedophilia and associated terms, and discuss a generalized profile of a typical pedophile or sexual predator, and go over what you can do to protect children from such predators. 

Pedophile, Hebephile, Ephebophile, Predator, or Child Molester?

I want to clarify some terms related to pedophilia. A pedophile is a person who is primarily attracted to prepubescent children, usually defined as under the age of 12. A common mistake is to define a pedophile as anyone attracted to another person that is below the age of majority; but this definition would include people attracted to teens, which is incorrect. Even a late adolescent (like 15 or 16 years old) can be a pedophile, if they have sexual interest in prepubescent children. A hebephile is a person who is primarily attracted to others in their young to mid-teens, while an ephebophile is a person who is primarily attracted to others in their mid-to-late adolescence. Captain Obvious says that a child molester is anyone who molests a child, but without regard to their sexual attractions or preferences. Their act of molestation is not typically linked to sexual desire or interest. In the interest of time for this blog, I will not divide or differentiate the term predator into hebephile or ephebophile, and the terms pedophile, predator, and molester will be used interchangeably.  

Pedophilia is a psychiatric disorder in which an adult or an older adolescent is sexually attracted to young children. Pedophiles can be anyone: rich or poor, young or old, of any race/ creed/ color, educated or not, and professional or not. Despite this wide array of potentially inclusive characteristics, pedophiles do often demonstrate similar attributes. Please note that these are just possible indicators, and you should never automatically assume that individuals with these indicators or characteristics are pedophiles. But noticing these characteristics in a person, in combination with questionable behavior, could be a red flag that someone may be a pedophile or sexual predator.

All parents want to protect their children from predators, but how do you do that when you don’t know how to spot one? Anyone can be a pedophile/ predator/ child molester, so identifying one can be difficult, especially because most of them are initially trusted by the children they abuse. Below, I’ll go over which behaviors and traits are red flags, what situations to avoid, and how to deter predators from targeting your child.

Understand that there is no one physical characteristic, appearance, profession, or personality type that all child predators share. They may appear to be charming, loving, and totally good-natured, while also adept at harboring predatory thoughts. That means that you can’t just dismiss out of hand the idea that someone you know could be a child predator. Anyone can turn out to be a pedophile or predator.

Most pedophiles are known to the children they abuse. Thirty percent of children who have been sexually abused were abused by a family member; that can include mother, father, grandmother, grandfather, aunts, uncles, cousins, stepparents, and so on. Sixty percent of children who have been sexually abused were abused by an adult that they knew, but who was not a family member. That means that only ten percent of sexually abused children were targeted by a total stranger. In most cases, the child predator turns out to be someone known to the child through school or some other common everyday activity, such as a neighbor, teacher, coach, clergy member, tutor, music instructor, or babysitter.

Traits of Pedophiles or Sexual Predators

-Majority are men over 30 years of age, regardless if victims are male or female

-Heterosexual and homosexual men are equally likely to be child molesters

-Notion that homosexual men are more likely to be child molesters is completely false

-Female child predators are more likely to abuse boys than girls

-Often single and/ or with few friends 

-Some have mental illness, such as a mood or personality disorder

-Many have a history of physical and/ or sexual abuse in their own past

Behaviors of Pedophiles or Sexual Predators

-Display more interest in children than adults -May have a job or volunteer in a position allowing them unsupervised access to a child 

-Will contrive other ways to spend time with children (act as helpful neighbor or coach)

-Tend to talk about or treat children as though they are adults 

-May refer to a child as they would refer to an adult friend or lover

-Often say they love all children or feel as though they are still children

-May prefer children nearing puberty who are curious about sex but sexually inexperienced

-Common for the pedophile to be developing a long list of potential victims at any one time

-Many believe their proclivities aren’t wrong: it’s healthy for the child to have sex with them

-Almost all pedophiles have a pornography collection, which they protect at all costs

-Many predators also collect “souvenirs” from their victims, which are also very cherished 

Other Noteworthy Characteristics

Look for signs of grooming. The term “grooming” refers to the process that the child predator undertakes in order to gain a child’s trust, and sometimes the parents’ trust as well. Over the course of months, or even years, a pedophile will become an increasingly trusted friend of the family; they will likely offer to babysit, take the child shopping or on trips, or spend time with the child in any number of ways. Many child predators won’t actually begin abusing a child until full trust has been gained; this exhibition of patience and restraint is unnerving in the grand scheme of things. 

Child predators look for children who are most vulnerable to their tactics, whether they are shy, withdrawn, handicapped, lacking emotional support, come from a broken, dysfunctional, and/ or underprivileged home, come from a single parent home lacking supervision, or just aren’t getting enough attention at home. Pedophiles work to master their manipulative skills and unleash them on these vulnerable children by first becoming their friend; this quickly builds the child’s sense of self-esteem and brings them closer to the predator. The pedophile may refer to the child as special or mature, which appeals to their need to be heard and understood. They basically strive to give the child whatever is lacking in their home. This sounds altruistic, but in reality, it’s just another empty ploy, used by the predator to distance the victim from their family and draw them nearer to them. Often, the next step is to entice them with adult activities, like looking at sexually explicit pictures and magazines and watching x-rated movies. 

Pedophiles and predators don’t only need to earn the trust of their mark; they must also work very hard to convince parents that they are a nice, responsible person and capable of supervising their child or children in their absence. They may make it seem like they’re doing the parent(s) a favor by watching them or taking them out, “Oh, I don’t mind taking little Johnny to get an ice cream cone and then to the park, that way you can just relax and put your feet up for awhile.” This is how a child predator manipulates parents, instills a false sense of security, and gains their trust. Pedophiles will foster a close relationship, and even forge a friendship, with the parent(s) of a mark in order to get close to that child. That friendship with the parent(s) is just the ticket to get the predator through that front door. Once inside the home, they have many opportunities to manipulate the children and use guilt, fear, and love to confuse them. If the child’s parent(s) works, they may offer after school babysitting or tutoring, and this gives them the private time needed to abuse the child.

Pedophiles often refer to children in angelic terms; they use descriptive words like innocent, heavenly, divine, angel, pure, and other words that may describe children, but seem inappropriate and/ or exaggerated. They may also fixate on a specific feature on a child’s face or body, and talk incessantly about it, making unusual and age inappropriate comments like, “Oh, that baby girl has the prettiest lips I’ve ever seen, they look so soft, and they’re the perfect shade of pink,” or “Wow…she’s going to be really hot when she grows up and fills out,” or “I’ll bet she’s going to grow up to be a real tease, ya know what I mean?” These are examples of how pedophiles and predators sexually objectify children, by speaking to or about them in a way that is not age appropriate and is not acceptable. 

A pedophile will often use a range of games, tricks, and activities to gain the trust of and/ or deceive a child. One of the predator’s main goals is to make sure the child won’t tell anyone about the inappropriate contact. What they do or say to ensure this silence depends on the age of the victim. For younger children, they may suggest a pact of secrecy; secrets are valuable to most kids, because they’re seen as something very “grown up” or “adult” and a source of power as well. For older children, the predator may threaten their victim, warning them that nobody would believe them if they told, and that people would make fun of them, and that they would lose all their friends if they told. In rare cases, the predator may even threaten bodily harm. Some predators just don’t care if the world knows what they’re doing; they feel above everyone else, like nobody and nothing can touch them, a la Jeffrey Epstein. As the relationship progresses, they incorporate some sexually explicit games and activities like tickling, fondling, kissing, and touching. The predator will behave in a sexually suggestive way, and have no issue exposing a child to pornographic material, bribing the target child, flattering them, and then worst of all, showing them affection and love. Be aware that all of these tactics are ultimately used to confuse your child and isolate them from you. 

Now that you know some general traits of pedophiles and predators as well as some behaviors to be aware of and look out for, let’s move on to protecting your child from predators.

How to Protect your Child(ren)

One of the first things you can and should do is find out if, and how many, sex offenders live in your neighborhood. There are subscription services that show you everything about the offenders and then send you updates with alerts when new sex offenders are released from jail and/ or if a registered sex offender moves near you. But, unless you need all the bells and whistles for some reason, you can always go to one of several free sites that will allow you to search a sex offender database by zip code, neighborhood, and by offender name if you suspect someone specific of being a sex offender. Here is my disclaimer: while it’s good to be aware of potential predators, realize that it is illegal to endeavor to take any kind of action against registered sex offenders.

Dru Sjodin National Sex Offender Website

https://www.nsopw.gov/

The Florida Department of Law Enforcement Sexual Offenders and Predators Search https://offender.fdle.state.fl.us/offender/sops/home.jsf

Another way to protect your child is to supervise their extracurricular activities. Being as involved as possible in your child’s life is the best way to guard against child predators. They will look for a child who is vulnerable and who isn’t getting a lot of attention from his or her parents, and they will cozy up to them, and then will do everything in their power to convince the parents that they are of no danger to their child. Show up at sporting games, practices and rehearsals, chaperone field trips and all other trips out, and spend time getting to know the adults in your child’s life. Make it obvious to everyone that you’re an involved and present parent. If for some reason you can’t be there for a trip or other outing, make sure that at least two adults you know well will be chaperoning the trip. Don’t ever leave your child alone with adults that you don’t know well. Remember that rule even goes for relatives too, as they can also pose a threat. The key here is to be as present as possible.

Set up a nanny cam if you hire a babysitter. Obviously, there will be times when you won’t be able to be present, so use other tools to make sure your child is safe. Set up hidden cameras in your home so that inappropriate activity will be detected. No matter how well you think you know someone, you always need to take precautions for your child’s safety.

Teach your child about staying safe online. Make sure your child knows that predators often pose as children or teenagers in order to lure children in. Monitor your child’s use of the internet, keeping rules in place to limit their “chat” time. Have regular discussions with your child about whom he or she is communicating with online. Be sure your child knows to never ever give out your address or phone number, or send any pictures to a person they met online; and that they must not ever meet someone in real life that they’ve only communicated online with. As a parent, you must know that children are often very sneaky and secretive about online behavior, especially when encouraged by others to keep secrets, so you’ll need to be vigilant about staying involved in your child’s online activity.

Make sure your child is feeling emotionally supported. Since children who don’t get a lot of attention are especially vulnerable to predators, make sure you are spending a lot of time with your child and that he or she feels supported. Take the time to talk to your child every day and work toward building an open, trusting relationship. Child predators will always ask, or demand, that their marks keep their secrets from their parents. Ensure that your children understand that if a person has asked them to keep a secret from you, it’s because they know what they’re doing is wrong. Express ongoing interest in all of your child’s activities, including schoolwork, extracurriculars, and hobbies; and let your child know that he or she can tell you anything, and that you’re always willing to talk.

Teach your child to recognize inappropriate touching. Many parents use the “good touch, bad touch, secret touch” method. It involves teaching your child that there are some appropriate touches, like pats on the back or high fives; there are some unwelcome or “bad’ touches, like hits or kicks; and there are also secret touches, which are touches that the child is told to keep a secret. Use this method to teach your child that two types of touches aren’t good, and if and when these touches happen, he or she should tell you immediately, even if the person touching them tells them that they can’t or shouldn’t tell. Teach your child that no one is allowed to touch him or her in private areas, and that they are not to touch anyone in their private areas. Many parents define private areas as those that would be covered by a bathing suit. Children also need to know that an adult should never ask a child to touch their own private areas or to touch anyone else’s private areas, and if someone tries to touch them or tells them to touch someone else, tell your child to say “no” and walk away. And again, reinforce the directive of telling them to come to you immediately if someone touches them the wrong way.

Recognize when something is out of sync with your child. If you notice that your child is acting differently for no obvious reason, pursue the issue to find out what’s wrong. Regularly asking your child questions about their day, including asking whether any “good,” “bad,” or “secret” touches happened that day, will help open the lines of communication and create an important daily dialog. If your child tells you that he or she was touched inappropriately or doesn’t trust an adult, never summarily dismiss it. Always trust your child first. Along those same lines, never dismiss a child’s claims just because the adult in question is a valued member of society or appears incapable of such things. That’s exactly what a predator or pedophile wants, it’s their stock in trade. They’re counting on adults not listening to child victims so that they can continue to get away with molesting them. 

By age 12, kids should already have gotten basic sex education explained by their parents, including what everything is called, what it does, and how it works. Parents explaining it all to their kids themselves will prevent a predatory teacher or friend from misleading them about sex for their own nefarious purposes. Make sure your child already knows everything they need to know about what’s what and what is and isn’t acceptable behavior, before they are taught very different lessons and definitions through rumor and innuendo discussed on the monkey bars or over ham and cheese sandwiches in the cafeteria. 

A child aged 14 and under may not recognize that there’s a difference between a grumpy teacher giving extra homework and a strange acting teacher that insists on kissing them on the cheek before leaving the room. They can’t really differentiate, because at this age, they simply file both of these things in their brain under ‘annoying.’ So if your child tells you vague stories about the teacher making sex jokes or touching them, or being ‘annoying’ and asking all kinds of ‘private stuff,’ you must consider the possibility that there might be something hinky going on. When and if a child mentions that their teacher is acting strangely, asking about their family and siblings, making them uncomfortable by grilling them for private information, and/ or is pushing for pictures, you must guide that child, and tell them how to react to, and deal with, these ‘annoying’ things. 

But I cannot stress enough that you must be realistic in your approach! Telling your kids to run away screaming bloody murder if the teacher touches their back, or telling them to yell ‘no!!’ and smack the teacher’s hand away if an innocent touch grazes a shoulder as the teacher walks down the rows of desks in the classroom. Those reactions will not help the situation for several reasons. First of all, chances are that they won’t hit a teacher under any circumstances, but they surely won’t do so if that teacher is actually and truly grooming them, all while filling their head with smooth assurances that they’re a good guy, on their side, and only there to help them. 

So, what’s a parent to do if they suspect something’s hinky, but have no concrete proof? If the child is age 14 and under, there are a couple of possibilities to consider. The first one is to instruct the child that if this person touches them, or asks questions or makes suggestions that makes them feel uncomfortable, that they should tell this person that they have told their parents about this issue (of inappropriate touching or making them uncomfortable with questions or whatever the case may be) and that their parents weren’t happy to hear about it. This would definitely take some serious chutzpah on the child’s part, but I think it would also empower them, and that’s never a bad thing. The second option would be to have the child deliver a message to the person that touches them, or asks questions and makes suggestions that makes them feel uncomfortable. One of the parents would create the message by getting a piece of paper and jotting a quick note on it; it should simply say ‘Stop touching my son/ daughter, Johnny Smith/ Jenny Smith’ or ‘Please stop asking my son/ daughter, Johnny Smith/ Jenny Smith so many questions, as they make him/ her very uncomfortable’ or whatever the issue may be. Then finish the note with the date and the parent’s autograph. Then the parent can put the signed note in an envelope and give it to their child, and instruct them that they are to give the envelope to the person who is touching them inappropriately, at the time they are touching them inappropriately, despite being asked to stop; or give the envelope to the person who is asking them questions and making suggestions that make them uncomfortable, at the time they are making them uncomfortable, despite being asked to stop. It is important to make sure the child gives the note to this person when they are red handedly doing what they have asked them to stop doing. This can be a very tricky situation, so make sure to give this a lot of thought. Keep in mind that employing one of these two tactics will only have a positive effect if you are absolutely sure that this person is ignoring a child’s personal boundaries and going too far with touching inappropriately or asking questions and making suggestions that make the child uncomfortable, all despite being asked to stop. You must be sure that this is a deliberate act of a magnitude that is unacceptable. One impulsive hand on the shoulder doesn’t meet the criteria to qualify here. 

Remember that the most important thing you can do to protect your child is to pay attention to them and really listen when they speak. Keep the lines of communication open, let them know you’re on their side, assess their needs and desires, talk to them, and basically, just be the best parent you can possibly be. The bottom line is that if you don’t pay attention to your child, someone else will.

These days, it seems like pedophiles and predators really have the odds stacked in their favor; they get away too easily due to lack of evidence, and even when they are caught and jailed, they get out early for good behavior. One factor that works against the pedophile is that eventually, the children they molested will grow up and recall the events that occurred, and hopefully they will report them. Often, pedophiles and predators are not brought to justice until such time occurs, and even then, they get off far too lightly. That makes victims even angrier, as they feel like they are victimized twice- first by the predator, and then again by the justice system. More than anything, victims of pedophiles and sexual predators want to protect other children from the same fate that befell them. 

Don’t forget to check out my YouTube channel for tons of interesting lectures, and be sure to hit that subscribe button. If you liked this blog and found it insightful, please pass it along to family and friends, especially if they care for children. And as always, my book, Tales from the Couch has lots of patient stories and great information; you can find it on Amazon.com.

Learn More

The 15 Scariest Mental Disorders of All Time

The 15 Scariest Mental Disorders of All Time

Imagine having a mental disorder that makes you believe that you are a cow; or another that you’ve somehow become the walking dead. Pretty freaking scary, eh? Well, while relatively rare, these disorders are all too real.

Worldwide, 450 million people suffer from mental illness, with one in four families affected in the United States alone. While some mental disorders, like depression and anxiety, can occur organically, others are the result of brain trauma or other degenerative neurological or mental processes. Look, having any mental illness can be scary, but there are some disorders that are especially terrifying. Below, I’ve described the 15 scariest mental disorders of all time.

‘Alice in Wonderland’ Syndrome

In 1865, English author Lewis Carroll wrote the novel Alice’s Adventures in Wonderland, commonly shortened to ‘Alice in Wonderland.’ Considered to be one of the best examples of the literary nonsense genre, (seriously, who knew they even had a nonsense genre?) it is the tale of an unfortunate young girl named Alice, who falls through a rabbit hole into a subterranean fantasy world populated by odd, anthropomorphic creatures. That’s your vocabulary word for the week… anthropormorphic. Popular belief is that Carroll was tripping when he penned it. Regardless if that’s true or not, what is true is that one of Alice’s more bizarre experiences shares its characteristics with a very scary mental disorder. Also known as Todd Syndrome, ‘Alice in Wonderland’ Syndrome causes one’s surroundings to appear distorted. Remember when Alice suddenly grows taller and then finds she’s too tall for the house she’s standing in? In an eerily similar fashion, people with ‘Alice in Wonderland’ Syndrome will hear sounds either quieter or louder than they actually are, see objects larger or smaller than what they are in reality, and even lose sense of accurate velocity or textures they touch. Described as an LSD trip without the euphoria, this terrifying disorder alters one’s perception of their own body image and proportions. Fortunately, this syndrome is extremely rare, and in most cases affects people in their 20’s who have a brain tumor or history of drug use. If you need yet another reason to not do drugs… well, there ya go. 

Alien Hand Syndrome

While most likely familiar from cheesy horror flicks, Alien Hand Syndrome isn’t limited to the fictional world of drive-in B movies. Those with this very scary, but equally rare mental disorder experience a complete loss of control of a hand or limb. The uncontrollable body part takes on a mind and will of its own, causing sufferers’ “alien” limbs to choke themselves or others, rip clothing off, or to viciously scratch themselves, to the point of drawing blood. Alien Hand Syndrome most often appears in patients suffering from Alzheimer’s Disease or Creutzfeldt-Jakob Disease, a degenerative brain disorder that leads to dementia and death, or as a result of brain surgery separating the brain’s two hemispheres. Unfortunately, no cure exists for Alien Hand Syndrome, and those affected by it are often left to keep their hands constantly occupied or use their other hand to control the alien hand. That last one actually sounds even worse- one unaffected arm fighting against the affected arm that’s trying to tear into the person’s own flesh. Yikes. 

Apotemnophilia

Also known as Body Integrity Disorder and Amputee Identity Disorder, Apotemnophilia is a neurological disorder characterized by the overwhelming desire to amputate or damage healthy parts of the body. I recall a woman with Apotemnophilia making worldwide news ages ago when she fought with her HMO to cover the amputation of one of her otherwise healthy legs. Good luck; they don’t even cover flu shots. I remember I was pretty shocked that she found a surgeon to agree to do the amputation in the first place, as it seemed to me that might violate that little thing called the Hippocratic Oath us docs took when we got our medical degrees, specifically that part about ‘do no harm’… and sparked a debate about the ethical dilemma of treating or “curing” a psychiatric disorder by creating what is essentially a physical disability. Though not a whole heck of a lot is known about this strangely terrifying disorder, it is believed to be associated with damage to the right parietal lobe of the brain. Because the vast majority of surgeons will not amputate healthy limbs based purely upon patient request, some sufferers of Apotemnophilia feel forced to amputate on their own, which of course is a horrifying scenario. Of those who have convinced a surgeon to amputate the affected limb, most say they are quite happy with their decision even after the fact.

Boanthropy

Those who suffer from the very rare- but very scary- mental disorder Boanthropy believe they are cows, and usually even go so far as to behave as such. Sometimes people with Boanthropy are even found in fields with cows, walking on all fours and chewing grass as if they were a true member of the herd. When found in the company of real cows, and doing what real cows do, people with Boanthropy don’t seem to know what they’re doing when they’re doing it. This apparently universal finding has led researchers in the know to believe that this odd mental disorder is brought on by possible post-hypnotic suggestion, or that it is a consequence of dreaming or a sleep disturbance, sort of kin to somnambulism, aka sleepwalking. I can buy the sleepwalking thing. I have a patient that is a lifelong sleepwalker who sleep-eats, sleep-cleans, sleep-cooks, sleep-destroys, sleep-online-shops, sleep-everythings. Some mornings she wakes up to very unpleasant findings of the house in total disarray, electronics dismantled and improperly and ridiculously fashioned together, every piece of furniture moved or a sink full of dishes and pots and pans with dried up food in them. Before setting up prevention measures, she even had single episodes of adult sleep-driving, and even sleep-biking at (eek!) age 9. In the middle of the night, her mother awoke to what she thought was the big garage door opening, and when she went to check, she saw her coasting out of the driveway on her bright yellow bike, heading right toward a very busy highway. She always has zero recall of the events afterwards. If she can do all of that while essentially sleeping, it would be comparatively easy to wander out to a pasture on all fours and stick around to munch on some grass. Curiously, it is believed that Boanthropy is even referred to in the Bible, as King Nebuchadnezzar is described as being “driven from men and did eat grass as oxen.” Or was it King Nemoochadnezzar? No? Okay, moooving on…

Capgras Delusion

Named after Joseph Capgras, a French psychiatrist who was fascinated by the effective illusion of doubles, Capras Delusion is a debilitating mental disorder in which a person believes that the people around them have been replaced by imposters. As if that’s not bad enough, these imposters are usually thought to be planning to harm the sufferer. It really sounds like a bad Tom Cruise movie. Oh, wait; that’s redundant. Anyhoo, in one case, a 74-year-old woman with Capgras Delusion began to believe that her husband had been replaced with an identical looking imposter who was out to hurt her. Fortunately, Capgras Delusion is relatively rare, and is most often seen after trauma to the brain, or in those who have been diagnosed with dementia, schizophrenia, or severe epilepsy.

Clinical Lycanthropy

Like people with Boanthropy, people suffering from Clinical Lycanthropy also believe they are able to turn into animals; but in this case, cows are typically replaced with wolves and werewolves, though occasionally other types of animals are also included. Along with the belief that they can become wolves and werewolves, people with Clinical Lycanthropy also begin to act like the animal, and are often found living or hiding in forests and other wooded areas. Didn’t Tom Cruise play a werewolf in one of his many (vapid) movies? Or was it a vampire? Werewolf, vampire – tomato, potato.

Cotard Delusion

In a case of life imitating art, or life inspiring art, we have Cotard Delusion. In this case, the ‘art’ is zombies, a la The Walking Dead. Oooh, scary! For ages, people have been fascinated by the walking dead. Cotard Delusion is a frightening mental disorder that causes the sufferer to believe that they are literally the walking dead, or in some cases, that they are a ghost, and that their body is decaying and/or they’ve lost all of their internal organs and blood. The feeling of having a rotting body is generally the most prevalent part of the delusion, so it doesn’t come as much of a surprise that most patients with Cotard Delusion also experience severe depression. In some cases, the delusion actually causes sufferers to starve themselves to death. This terrifying disorder was first described in 1880 by neurologist Jules Cotard, but fortunately, Cotard’s Delusion, like good zombie movies, has proven to be extremely rare. The most well-known case of Cotard Delusion actually occurred in Haiti, circa 1980’s, where a man was absolutely convinced that he had previously died of AIDS and was actually sent to hell, and was then damned to forever walk the earth as a zombie in a sort of pennance to atone for his sins. 

Diogenes Syndrome

Diogenes Syndrome is a very exotic name for the mental disorder commonly referred to as simply “hoarding,” and it is one of the most misunderstood mental disorders. Named after the Greek philosopher Diogenes of Sinope (who was, ironically, a minimalist), this syndrome is usually characterized by the overwhelming desire to collect seemingly random items, to which an emotional attachment is rapidly formed. In addition to uncontrollable hoarding, those with Diogenes Syndrome often exhibit extreme self neglect, apathy towards themselves or others, social withdrawal, and no shame for their habits. It is very common among the elderly, those with dementia, and people who have at some point in their lives been abandoned or who have lacked a stable home environment. This is likely because ‘stuff’ never hurts you or leaves you, though most people with the disorder are unlikely to be able to make that connection. Fortunately or unfortunately, depending on how you look at it, this disorder is much more common than some of the others I’ve mentioned here.

Dissociative Identity Disorder

Dissociative Identity Disorder (DID), is the mental disorder that used to be called Multiple Personality Disorder. Another disorder that has inspired a myriad of novels, movies, and television shows, DID is extremely misunderstood. Generally, people who suffer from DID often have 2-3 different identities, but there are more extreme cases where they have double digit numbers of identities. There was a “reality” show a few years ago that centered on a young mother of two that supposedly had like 32 distinct personalities. All of them had names and ranged from a five-year-old child to an old grandpa; and according to her, a few of them were homosexual while the rest were not, so she was required to be bisexual. She claimed that many of the personalities knew everything about all of the others, and they would get mad at or make fun of the others at various times. What’s more, she would “ask” other personalities to come forward so that producers could ask them questions for the camera’s sake, and her voice and mannerisms changed, depending on the different characteristics of the personalities. It was all pretty difficult to buy to be honest, because I’ve seen a lot of people with DID, and none seemed like they were having as much fun with their illness as she did. In true DID cases, sufferers routinely cycle through their personalities, and can remain as one identity for a matter of hours or for as long as multiple years at a time. They can switch identities at any time and without warning, and it’s often nearly impossible to convince someone with DID that they actually have the disorder, and that they need to take medications for it. For all of these reasons, people with Dissociative Identity Disorder are often unable to function appropriately in society or live typical lives, and therefore, many commonly live in psychiatric institutions, where their condition and their requisite medications can be closely monitored. 

Factitious Disorder

Most people cringe at the first sniffle indicating a potential cold or illness, especially these days, but not those with Factitious Disorder. This scary mental disorder is characterized by an obsession with being sick. In fact, most people with Factitious Disorder intentionally make themselves ill in order to receive treatment; and this is what makes it different than hypochondria, a condition where people blow mild symptoms into something they aren’t, kind of like if you cough once and automatically think you have covid-19. Sometimes in Factitious Disorder, people will simply pretend to be ill, a ruse which includes elaborate stories, long lists of symptoms, doctor shopping, and jumping from hospital to hospital. Such an obsession with sickness often stems from past trauma or a previous genuinely serious illness. It affects less than .5% of the general population, and while there’s no cure, psychotherapy is often helpful in limiting the disorder. 

Kluver-Bucy Syndrome

Imagine craving the taste of a book or wanting to have sex with a car. That’s reality for those affected by Kluver-Bucy Syndrome, a mental disorder typically characterized by memory loss, the desire to eat inedible objects, and sexual attraction to inanimate objects such as automobiles. I’ve seen a television documentary that featured people with strange fetishes, and they had two British guys that were sexually attracted to their cars. They gave them names and described their curves in the same manner that some men describe women. While one guy (supposedly) limited it to “just” caressing his car, the other actually also made out with his car; I’m talking about tongue and everything. Talk about different strokes! Because of the memory loss, not surprisingly, people with Kluver-Bucy Syndrome often have trouble recognizing objects or people that should be familiar. They also exhibit symptoms of Pica, which is the compulsion to eat inedible objects. The same wierd fetish documentary featured two young women that were “addicted” to eating weird stuff; one routinely ate her sofa cushions. She actually pulled the foam apart into bite sized pieces and ate them, many times a day. She became so used to doing so that she would get anxious if she went too long without eating it, so she started having to bring pieces of her sofa with her to work. I’m guessing she didn’t have to worry about co-workers stealing her food. She had started eating the cusions so long ago that she was actually on her second couch. Her family was so concerned about the potential medical ramifications of eating couch cushions that they made her see a gastro doc, who thought he was being punked when he asked why she was there. After imaging studies, she was in fact diagnosed with some intestinal issues and told to stop eating couch cushions, but the desire was too great for her to cease. She’s probably on her fourth couch by now. The other girl actually loved eating powder laundry detergent. She described the taste in the same dreamily excited way a foodie describes a chef’s special dish du jour. This terrifyingly odd mental disorder is difficult to diagnose, and seems to be the result of severe injury to the brain’s temporal lobe. Unfortunately, there is not a cure for Kluver-Bucy Syndrome and sufferers are typically affected for the rest of their lives.

Obsessive Compulsive Disorder

Though it’s widely heard of and often mocked, Obsessive Compulsive Disorder (OCD) is rarely well understood. OCD manifests itself in a variety of ways, but is most often characterized by immense fear and anxiety, which is accompanied by recurring thoughts of worry. It’s only through the repetition of tasks, including the well-known obsession with cleanliness, that sufferers of OCD are able to find relief from such overwhelming feelings. To make matters worse, those with OCD are often entirely aware that their fears are irrational, but that realization alone actually brings about a new cycle of anxiety. OCD affects approximately 1% of the population, and though scientists are unsure of the exact cause, it is thought that chemicals in the brain are a major contributing factor. I’ve discussed OCD and recounted OCD patient stories many times in this blog and in my book, Tales from the Couch.

Paris Syndrome

Paris Syndrome is an extremely odd but temporary mental disorder that causes one to become completely overwhelmed while visiting the city of Paris. Stranger still, it seems to be most common among Japanese travelers. Of the approximately 6 million Japanese visitors to Paris each year, one to two dozen of them experience the overwhelming anxiety, depersonalization, derealization, persecutory ideas, hallucinations, and acute delusions that characterize Paris Syndrome. Despite the seriousness of the symptoms, doctors can only guess as to what causes this rare and temporary affliction. Because most people who experience Paris Syndrome do not have a history of mental illness, the leading thought is that this scary neurological disorder is triggered by the language barrier, physical and mental exhaustion, and the reality of Paris as compared to the idealized version. Slam! I’ll bet the Paris Tourism Board hates to hear about this one! Huh houn, wee wee monsieur.

Reduplicative Amnesia

The Reduplicative Amnesia diagnosis was first used in 1903 by neurologist Arnold Pick, when he described a patient with a diagnosis of what we know today as Alzheimer’s Disease. It is actually very similar to Capgras Syndrome, in that it involves duplicates, but instead of believing that people are duplicates, people with Reduplicative Amnesia believe that a location has been duplicated. This belief manifests itself in many ways, but always includes the sufferer being convinced that a location exists in two places at the same time. Today, it is most often seen in patients with tumors, dementia, brain injury, or other psychiatric disorders.

Stendahl Syndrome

Stendahl Syndrome is a very unusual psychosomatic illness; but fortunately, it appears to be only temporary. The syndrome occurs when the sufferer is exposed to a large amount of art in one place, or is spending time immersed in another environment characterized by extreme beauty; probably one of those places that “takes your breath away.” Those who experience this scarily weird mental disorder report sudden onset of rapid heartbeat, overwhelming anxiety, confusion, dizziness, and even hallucinations. It actually sounds a lot like a panic attack to moi. Stendahl Syndrome is named after the 19th century French author who described in detail his experience after an 1817 trip to Florence, which is evidently a beautiful place. I have it on good authority that Stendahl Syndrome has never happened to any visitor to Paris, which, oddly enough is Stendahl’s country of origin. 

So, we’ve learned a lot today: that there is a nonsense literary genre, that there are a bunch of freaky and frightening mental disorders out there, that some people might need to look up the word anthropormorphic, that illicit drugs are bad for yet another reason, that a lot of terrible B movies are actually based on some pretty obscure mental disorders, that people with Boanthropy probably get a lot of fiber in their diet, that the lives of people with Capras Delusion sound a lot like a bad Tom Cruise movie, that the term “bad Tom Cruise movie” is redundant, that Tom Cruise probably has Clinical Lycanthropy, that Tom Cruise is a tool, oops, sorry, everyone already knew that. We also learned that there is no longer such thing as Multiple Personality Disorder; it is now called Dissociative Identity Disorder, that Kluver-Bucy Syndrome is threatening to couches, and that if you have Kluver-Bucy Syndrome, co-workers will never steal your lunch. We learned that Japanese tourists hate Paris, and that Stendahl Syndrome never happens there. And we learned lots of other cool stuff, but that if you have so much stuff that you can’t walk through your house you likely have Diogenes Syndrome, probably because you have a deep seated knowledge that stuff never hurts you or leaves you. 

Please check out my videos on YouTube- better yet, hit that subscribe button, and share them with folks. And as always, my book, Tales from the Couch has lots more information and patient stories on various psychiatric diagnoses and is available on Amazon and in the office. Be well, everyone!

Learn More