Female Orgasm System | Clitoris | Bulb and Root

Transcript

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Hello. Thank you, guys, for showing up again today. We took a couple of weeks off from our review of the female orgasm system. And now, we are ready to roll again.

Even Medical School Does Not Teach all of the Anatomy of the Female, and that Matters

When I was a kid, I remember wondering, "What the heck does the vagina look like?"

And then, as I got older and had girlfriends and then went to medical school and learned what the vagina is like, I was somewhat disappointed to realize that often it is thought about as if it were just a simple birth canal and a urinary tract and the elegance of the parts were not really discussed.

It turns out, my disappointment was not misplaced. An article that came out this year in the Journal of Sexual Medicine made a big point of the fact that not knowing about the female genital anatomy is not insignificant (Peters, 2023); if we don't think about the parts—all of the parts—then we do not know best how to treat dysfunction.

Another article demonstrated that, of seven medical schools in the Chicago area, only one was teaching all of the components of the clitoris (Codispoti, 2023). And the irony is that, in that article, they did not even test for all the parts. They left one of the components of the anatomy, the clitoral root, out of their evaluation of the curriculum.1

What is the “Female Orgasm System”?

There are two components of the female orgasm system that I think are most nebulous. Not only are they unseen, they are less discussed and more vaguely conceptualized by most physicians. Before we think about them, take 30 seconds to review what we were doing with this series of lessons: a systems analysis of the female orgasm.

Systems analysis first involves, "What's the purpose of all the parts working together?"

There is overlap; some parts work in both the respiratory and cardiovascular systems. Some parts of the urinary system are in the reproductive system or in the orgasm system. But, when you have a discreet set of parts that perform a specific function (in this case, sexual arousal in females, not reproduction, but sexual arousal, sometimes leading to orgasm)—then that is a separate system.

You can become more and more detailed by dividing each component, each subcomponent, and each sub-sub-component going on for infinity into the sub-particle level and eventually into ethics, philosophy, and mathematics (since everything is related to everything). But, clinically and practically, first-order components are most important to help women to better health and marriages.

You cannot really think about how all the parts work together if you do not even think about “What are all the parts?

Two Nebulous Parts of the Female Orgasm System

An article showed that (looking at medical schools) not all the parts are even being taught. I made a sketch (see the video) from a detailed article showing the suspensory ligament, prepuce (the hood), body, and glans. In the sketch, you will also see the root and the bulb; these two components of the female orgasm system seem nebulous to most people.

The Bulb of the Clitoris

At one time, the bulb was considered part of the labia, but it is contiguous with the body of the clitoris. And so, most people consider it, now, to be equivalent to the corpus spongiosum of a male and as just as much a part of the clitoris as the corpus spongiosum is to the penis.

More about the bulbs later.

The Root of the Clitoris

But the root is even more nebulous. Let me show you something that I did this morning. I think this will shock you: I went to the AI app that everybody's using now. When you search for the “root of the clitoris” in the new AI application, it says, "The clitoris is a complex organ, highly sensitive organ, female genitalia. It doesn't have a root like a plant does. Instead, it has a visible and internal components,"

I will show you how the root relates to the G-spot, the urethra, and sexual function. Before I do, consider the root from the lover’s perspective (including the woman who loves herself (I am only partly referring to masturbation).

Why the Root Matters in the Lover’s Mind

I have a friend, Anne Kent Rush, who co-authored and illustrated the first massage book published in the United States that was written for people other than physical therapists (Downing, 1972). I first read it when I was about 17, and I’m 63 right now.

Back in the '50s, massage therapists were thought to be people who gave you a happy ending, and their places of business were in the red-light districts. But, Ms. Rush, with her writing did much to change that.

In her book (co-authored with Downing), she gave what I think to be great advice for lovers or massage therapists. She said, "Let your hands talk to the other person about their own body."

So, if you are touching someone's back and you're just rubbing it absent-minded like their back is a piece of meat, that's one thing. But if you can actually see (in your mind’s eye) and say to the person, “Here are your splenius capitis; here are your paraspinal muscles; here is your trapezius; and here are the insertion sites, and here is the full length and beauty of this muscle,” and your hands are gently teaching the person, showing the person, the individual muscles and how miraculous their body-temple is constructed, then they are going to enjoy a beautiful massage.

How much more so if you do the same with the genitalia?

So, translate that idea over to lovemaking and imagine making love to your lover’s genitalia with full knowledge of all the seen and the unseen.

Now imagine the opposite: I have seen very bright physicians come to my workshops, and when we do the hands-on practice of how to do the O-Shot® procedure, and their wife is the model, I am often shocked to see the spouse fumble with the identification of the anatomy while doing a procedure on his own wife. And, I guess I shouldn't be shocked since we just discussed that female genital anatomy is not taught in medical school; so where was he to learn it? From the football coach who taught him sex education in high school?

If you are going to be the doctor to people with vaginas or you are going to be the lover of people with vaginas, even whether the vagina is yours or another person's, it might be helpful to know all the parts so you can love on them or treat them, whatever the case may be.

I acknowledge that, in the heat of passion with the woman you love, no one thinks about the intricacies of the clitoral anatomy. In the heat of passion, it is just sweat and sounds, and no one is speaking like the Oxford English Dictionary or thinking about the intricate connections of the prepuce or the suspensory ligament; that’s not happening.

But, on the other side of that, knowing every part could make you a better lover and it could certainly make you a better physician. Maybe I am overemphasizing the point, but I don't want you to think that I think it is necessary to know every part, to have good love-making, I think it can take things to another level if combined with the rest of your passion and intellect.

I sketched my version of it, a simplified version of the root (see the video). Part of the confusion for the confusion regarding the root is that the multiple planes of the crus and the bulbs make it difficult to illustrate. But, if you look at this dorsal view, you can see the glans, the body, and the clitoris. It comes down to this area, from which the corpus splits away. And it's been dissected, where you can see it on the patient's left, but not on the right (refer to the video).

And then, if you look at the transverse view, you can see one of the corpus cavernosi, coming towards you, and you can see the suspensory ligament. And, as you know, there's another corpus cavernosi going away from you.

So, let me draw it, in just about as simple as I could draw it, which would be like this. Here's glans, and here's corpus cavernosi. But what do you call that? That is not the glans, it's not the body, it's not the corpus cavernosi, it's the root.

In spite of what your artificial intelligence app says. The clitoris does have a root. It is talked about in the research; it is important; and you should know what it is and where it is.

Do we want to just go back to thinking of the introitus, labia, and clitoris as just a glob of tissue, or do we actually want to understand it?

Of course, you do because you're on this call!

Here’s a crucial point from one of my favorite papers regarding female anatomy (Pauls, 2015), discussing the clitoral root,

"It's positioned beneath the skin of the vestibule and forms the connection from the clitoral body to the crura, overlapping with the two bulbs of the vestibule. The root is considered of importance because of the sensation. The convergence of the clitoral erectile bodies may be the most responsive to direct stimulation, owing to its superficial location and its depth of erectile tissue."

Okay? Read that again and tell me the root is not important. I dare you.

Dr. G, the G-Spot, and the Clitoral Root

Now, think about where the root is:

The urethral orifice lies at the most posterior portion of the clitoral root. So, if you go back to this picture, the clitoris is angling down (caudal). And the urethral orifice is near the root.

Now, think about what the G-spot is:

Dr. Grafenberg's big idea was not really regarding a spot. His noticing was that pressure on the urethra, not a spot, the urethra, was the most stimulatory thing possible to a woman’s body. Pressure there resulted in the most amazing orgasms. And he documented or described female ejaculation from stimulating the urethra with pressure on the anterior vaginal wall (Grafenberg, 1950).

Pressure from the anterior vaginal wall against the urethra, the root is right there. The root is very responsive to stimulation (Oakley, 2013). It could be that part of what's happening when you stimulate the so-called G-spot2: pressure there is definitely going also to stimulate the clitoral root.

So, when Dr. Grafenberg described stimulation of the urethra, he was also stimulating the clitoral root.

Corollaries of Acknowledgment of the Clitoral Root

Considering the clitoral root, "What can go wrong?"

Vaginal delivery can tear the area. One of our gynecologists told me that when she delivers the babies of women who suffer genital mutilation, the whole clitoral body can be torn, including the root. It sometimes must be sutured back together postpartum.

Perhaps knowing about the root, should you wish for self-pleasure or pleasuring your lover, knowing that it's not just the vagina and the urethra that matters, but there's a root to the clitoris, from which the corpora and the body originate, like a root, branches coming off of a root. Then, that understanding could make things better.

When Bruce Lee discussed martial arts in his book on fighting (Lee, 2018), he said that after you study the book and learn it, you tear it up and throw it away. When fighting, the individual methods and specific learning go out the window the first time someone hits you in the nose. But, in the art and in instinct that guides the fists will be embedded, the learning from the book discarded. And so it is with lovemaking. You learn the anatomy and then forget the anatomy in the bedroom; still, things could be better with your eyes closed because of what you learned when they were open.

The sensitivity of the clitoral root also explains why size might matter—not big or little or loose or tight, but the best fit between one man and one woman will put pressure on the root—but not too much.

Moreover, assuming that there's something other than penis and vagina sex, knowing and understanding the clitoral root can make a difference to what one might be doing with hands and tongue; back to my analogy, with massage. If you know what's there, and you talk to your lover with your hands and tongue about what you are discovering, that can be much different than if you are only manipulating a big “glob of stuff” you don’t understand.

Disclaimer

Just to avoid as many arrows as possible, with every lesson, I like to remind you that I understand there is much more to a woman than her vagina—that’s the whole point of what we are doing: there is a system, there's the psychology, the sociology, the hormonal milieu, the circulation, so many other things, but why not understand all the parts? And back to the irony, this part (the root) was not included in the test of the medical school curriculum—the testers omitted one of the parts of the system about which they were testing.

To summarize the root:

The root is the intersection of the two corpus cavernosum, the body of the clitoris and the bulbs of the clitoris. It lies above the urethra. It's very responsive to stimulation. And we should know what it is and where it is.

More about the Bulbs

Now, back to the bulbs.

The bulbs are, let's go back to this picture (see the video); the bulbs are up to seven centimeters long. The bulb, look at it, it lies just along the edge of the labia minora and is contiguous with the body and the glans clitoris, and fills that space with tissue that is also both erectile and trabecular.

A lesson from the penis

Reconsider men for a moment. By the time a man reaches 65, he loses about 50% of the endothelium. With women, Delancey and others have documented that the nerves and muscles of the clitoris and urethra atrophy; in his cadaver studies (see multiple references listed below).

Further, we know that platelet-rich plasma causes neurogenesis and angiogenesis (see references). When we do our O-Shot® procedure, we're injecting the body of the clitoris, which is connected to the root, the crura, and the corpus spongiosum, or the bulb. As expected, after this injection, a woman’s sex can improve dramatically. (See representative references regarding the O-Shot® procedure here<—).

This cutaway view (see video), I think, is also very illuminating. I love this paper. And because you can see they're holding the body of the clitoris. They've cut away just along the edge of the labia minora. And you can see the bulb or the corpus spongiosum, right there, lying underneath the mound of the labia majora. Now, the tissue of the labia majora, so it's lying above.

Let's go back and look at this picture. Here is the introitus. So, it stops beneath the urethra, near Bartholin's gland, at the upper part of the introitus.

So, looking back here, it would go down, beneath the urethra, and it would come over, lying beneath the mound of the labia majora. And, remember, it's erectile and has sensation.

Now, when we do our O-Shot, we are injecting the body of the clitoris. When we do the Vampire Wing Lift® procedure, we inject PRP into the anterior half of the labia majora. And I don't propose that we are always accurately inserting that needle in the center of the corpus spongiosum. But there's enough volume there that there would definitely be a field effect that improves the function of the bulbs.

When you treat the hair, you don't have to cover every millimeter. If you're within a centimeter of an area, you are going to affect hair growth. And, oftentimes, you'll even see improvement in the skin of the forehead because there's a field effect. Platelet-rich plasma recruits pluripotent stem cells that migrate to the area and propagate regeneration of healthy tissue, collagen, nerve, and blood flow. And it's not just where the lumen of your needle happens to be exactly within a millimeter of the area intended.

So, I think I'm okay with being more lucky than smart. My original idea of doing the Vampire Wing Lift® procedure was injecting and restoring volume and rubor, like we do with the Vampire Facelift® procedure. I didn't really contemplate the idea that, in all likelihood, we're also improving the sensation and function and restoring some of the volume of the bulb or the corpus spongiosum.

So, the bulb lies in a triangular space of three to seven centimeters. It probably provides some structure that improves sensation with sexual intercourse.

"The bulb or homologous corpus spongiosum, they engorge during arousal, some lubrication function, but also conferring stability on the vaginal walls."

So by this explanation, the bulbs bring the clitoral tissue closer to the vaginal lumen during arousal.

Remember, we looked at a cross-section of the penis within the vagina, and we contemplated the following: “Without structure, there is no pressure."

The penis, without the structure supporting the vaginal walls, would have no pressure against the urethra, the root, the corpus cavernosi, the corpus spongiosum, or the bulb.

Conclusion

The more I read, the more I realize the vastness of what I don't know—even after reading all that I can read. There is much to know and even more to discover.

One year ago, I couldn't have given you a good explanation of what the root of the clitoris is. And now that I know, I have more questions than answers.

I say this to restate that what we're doing here is worth doing. Pointing out, if medical schools don't even teach all the parts of the clitoris, then, I think this project we're doing, defining the Female Orgasm System (it’s parts and how they work together) is worth doing.

I’m so very grateful that you're showing up for these webinars because it motivates me not to stop; it means that maybe at least somebody's interested. And there appears to be quite a few of you guys that are interested. Hope you'll spread the word. I'm not charging for any of this. I'm just putting it out, editing it some, before I put it out, with the mission that people realize that it's not just a glob of stuff down there.

And just knowing the parts doesn't fix anything.

I spoke with a very prominent gynecologist/pelvic reconstructive surgeon, and he proceeded to explain to me all the parts. And I was thinking, "Yep. Know it. Know it. Know it." But, knowing all the parts would be like lifting the hood of your car, but that doesn't mean you know how they're functioning together, as a system, to make your car go down the road."

So, we have, first, I think, to label all the components.

Then, there's this idea: “How are they working together?"

We haven't even gotten to the other parts, like the pelvic floor muscles. "How do they work together to help both with continence and improvement in sexual function?"

And, "How do they work together, with the clitoris and all the rest of the system, to create pleasure?"

But I think that's all I have today. Hopefully, that's helpful. And, hopefully, next time somebody asks you about the parts of the clitoris, you'll know exactly about the root and the bulb.

Have a great day. Goodbye.

References

  1. Codispoti N, Negris O, Myers MC, et al. Female sexual medicine: an assessment of medical school curricula in a major United States city. Sexual Medicine. 2023;11(4):qfad051. doi:10.1093/sexmed/qfad051
  2. DeLancey JOL, Trowbridge ER, Miller JM, et al. Stress Urinary Incontinence: Relative Importance of Urethral Support and Urethral Closure Pressure. J Urol. 2008;179(6):2286-2290. doi:10.1016/j.juro.2008.01.098
  3. DeLancey JO. Structural aspects of the extrinsic continence mechanism. Obstet Gynecol. 1988;72(3 Pt 1):296-301.
  4. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. 1994;170(6):1713-1720; discussion 1720-1723. doi:10.1016/s0002-9378(94)70346-9
  5. Downing G. The Massage Book. 25th anniversary ed. Random House : The Bookworks; 1998 (first published 1972)
  6. GRÄFENBERG, Ernest (1950) The role of urethra in female orgasm, in: The International Journal of Sexology vol. III, no. 3: 145-148.
  7. Lee B. Tao of Jeet Kune Do. Expanded ed. Black Belt Books; 2018.
  8. Oakley SH, Mutema GK, Crisp CC, et al. Innervation and Histology of the Clitoral–Urethal Complex: A Cross-Sectional Cadaver Study. The Journal of Sexual Medicine. 2013;10(9):2211-2218. doi:10.1111/jsm.12230
  9. PANDIT M, DELANCEY JOL, ASHTON-MILLER JA, IYENGAR J, BLAIVAS M, PERUCCHINI D. Quantification of Intramuscular Nerves Within the Female Striated Urogenital Sphincter Muscle. Obstet Gynecol. 2000;95(6 Pt 1):797-800. Accessed October 20, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192577/
  10. Perucchini D, DeLancey JO, Ashton-Miller JA, Peschers U, Kataria T. Age effects on urethral striated muscle I. changes in number and diameter of striated muscle fibers in the ventral urethra. American Journal of Obstetrics & Gynecology. 2002;186(3):351-355. doi:10.1067/mob.2002.121089
  11. Perucchini D, DeLancey JOL, Ashton-Miller JA, Galecki A, Schaer GN. Age effects on urethral striated muscle II. Anatomic location of muscle loss. American Journal of Obstetrics and Gynecology. 2002;186(3):356-360. doi:10.1067/mob.2002.121090
  12. Pauls RN. Anatomy of the clitoris and the female sexual response. Clinical Anatomy. 2015;28(3):376-384. doi:10.1002/ca.22524
  13. Peters B, Ndumele A, Uloko MI. Clinical implications of the historical, medical, and social neglect of the clitoris. J Sex Med. 2023;20(4):418-421. doi:10.1093/jsxmed/qdac044

References-PRP for Neurogenesis

  1. Wu YN, Liao CH, Chen KC, Chiang HS. Dual effect of chitosan activated platelet rich plasma (cPRP) improved erectile function after cavernous nerve injury. Journal of the Formosan Medical Association. Published online March 27, 2021. doi:10.1016/j.jfma.2021.01.019
  2. Yasak T, Özkaya Ö, Ergan Şahin A, Çolak Ö. Electromyographic and Clinical Investigation of the Effect of Platelet-Rich Plasma on Peripheral Nerve Regeneration in Patients with Diabetes after Surgery for Carpal Tunnel Syndrome. Arch Plast Surg. 2022;49(02):200-206. doi:10.1055/s-0042-1744410
  3. Foy CA, Micheo WF, Kuffler DP. Functional Recovery following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma. Plast Reconstr Surg Glob Open. 2021;9(9):e3831. doi:10.1097/GOX.0000000000003831
  4. Kuffler DP. Platelet-Rich Plasma and the Elimination of Neuropathic Pain. Mol Neurobiol. 2013;48(2):315-332. doi:10.1007/s12035-013-8494-7
  5. Sánchez M, Anitua E, Delgado D, et al. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opinion on Biological Therapy. 2017;17(2):197-212. doi:10.1080/14712598.2017.1259409
  6. Chung E. Regenerative technology to restore and preserve erectile function in men following prostate cancer treatment: evidence for penile rehabilitation in the context of prostate cancer survivorship. Therapeutic Advances in Urology. 2021;13:17562872211026421. doi:10.1177/17562872211026421
  7. Pandunugrahadi M, Irianto KA, Sindrawati O. The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study. Int J Biomater. 2022;2022:9601547. doi:10.1155/2022/9601547
  8. Abo El Naga HA, El Zaiat RS, Hamdan AM. The potential therapeutic effect of platelet-rich plasma in the treatment of post-COVID-19 parosmia. The Egyptian Journal of Otolaryngology. 2022;38(1):130. doi:10.1186/s43163-022-00320-z
  9. Aaraj MA, Boorinie M, Salfity L, Eweiss A. The use of Platelet rich Plasma in COVID-19 Induced Olfactory Dysfunction: Systematic Review. Indian J Otolaryngol Head Neck Surg. Published online June 10, 2023. doi:10.1007/s12070-023-03938-4

References PRP for Neovascularization

  1. Bindal P, Gnanasegaran N, Bindal U, et al. Angiogenic effect of platelet-rich concentrates on dental pulp stem cells in inflamed microenvironment. Clin Oral Investig. 2019;23(10):3821-3831. doi:10.1007/s00784-019-02811-5
  2. Miłek T, Nagraba Ł, Mitek T, et al. Autologous Platelet-Rich Plasma Reduces Healing Time of Chronic Venous Leg Ulcers: A Prospective Observational Study. In: Pokorski M, ed. Advances in Biomedicine. Advances in Experimental Medicine and Biology. Springer International Publishing; 2019:109-117. doi:10.1007/55842019388
  3. Norooznezhad AH. Decreased Pain in Patients Undergoing Pilonidal Sinus Surgery Treated with Platelet-Rich Plasma Therapy: The Role of Angiogenesis. Advances in Skin & Wound Care. 2020;33(1):8. doi:10.1097/01.ASW.0000615376.97232.0a
  4. Li Y, Mou S, Xiao P, et al. Delayed two steps PRP injection strategy for the improvement of fat graft survival with superior angiogenesis. Sci Rep. 2020;10:5231. doi:10.1038/s41598-020-61891-6
  5. Zhang XL, Shi KQ, Jia PT, et al. Effects of platelet-rich plasma on angiogenesis and osteogenesis-associated factors in rabbits with avascular necrosis of the femoral head. Eur Rev Med Pharmacol Sci. 2018;22(7):2143-2152. doi:10.26355/eurrev20180414748
  6. Nolan GS, Smith OJ, Heavey S, Jell G, Mosahebi A. Histological analysis of fat grafting with platelet‐rich plasma for diabetic foot ulcers—A randomised controlled trial. Int Wound J. 2021;19(2):389-398. doi:10.1111/iwj.13640
  7. Sclafani AP, McCormick SA. Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix. Arch Facial Plast Surg. 2012;14(2):132-136. doi:10.1001/archfacial.2011.784
  8. Araujo-Gutierrez R, Van Eps JL, Scherba JC, et al. Platelet rich plasma concentration improves biologic mesh incorporation and decreases multinucleated giant cells in a dose dependent fashion. Journal of Tissue Engineering and Regenerative Medicine. 2021;15(11):1037-1046. doi:10.1002/term.3247
  9. Fernandez-Moure JS, Van Eps JL, Scherba JC, et al. Platelet-rich plasma enhances mechanical strength of strattice in rat model of ventral hernia repair. Journal of Tissue Engineering and Regenerative Medicine. 2021;15(7):634-647. doi:10.1002/term.3200
  10. Saputro ID, Rizaliyana S, Noverta DA. The effect of allogenic freeze-dried platelet-rich plasma in increasing the number of fibroblasts and neovascularization in wound healing. Ann Med Surg (Lond). 2022;73:103217. doi:10.1016/j.amsu.2021.103217
  11. The clitoral root is thought by some anatomist to be very important to sexual arousal (Pauls,2015); but it is often not mentioned in anatomical descriptions of the vagina. The current author, asked his favorite AI app about the clitoral root, and the AI denied the existence of any such anatomical part. ↩︎
  12. which I always choke on that, because I think it's not really a specific unmovable spot. I think it's just that part of that area, that happens to be most sensitive, at that particular moment, for that woman on that day. It may be different five minutes from now. ↩︎

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Female Orgasm System: Clitoris

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Female Orgasm System | Systems Analysis: Why You Need It & How to Use It


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1. Systems Analysis: Why You Need It & How to Use It

Thank you for being on the webinar tonight. We are going to talk about the female orgasm system.

I think that we are creating a new paradigm regarding how to think about sexual medicine. Maybe not discovering any new parts, but we're talking about how the parts might work together. Although systems analysis has been applied to respiration, and to digestion, and circulation, I can't see where it's been applied to sexual response. Reproduction, as you know, could take place easily without any libido, orgasmic response, and vice versa. So it seems to me that it's worth talking about.

Most Helpful Reference Regarding Systems Analysis

Now, before we get too much into the details about what a system is, I'm leaning heavily on some references regarding systems analysis, which is becoming a whole new specialty in medicine. The one that has helped me the most, I'll give a shout-out to now by Donella Meadows, called Thinking In Systems: A Primer. I'll give you a copy of this. By the way, anyone who's on this call, you'll get access to a transcript and a video replay of this thing for free.

Call for Help

I feel like we're working together in creating this. I could just do this by myself and think that I got it right, possibly, but then I would be missing out on feedback from a lot of smart people. So I'm hoping that occasionally, as I go through this, I'll be able to stop, and you'll tell me some ideas about how you might correct or augment what I'm talking about. But I'll start with five characteristics. You might want to scratch these down.

How to Know if You Have a System or a Pile of Stuff

These are the five characteristics of how to know if you have a system versus just a pile of stuff.

  1. The first thing is, can you identify parts?

Let's just think about the respiratory system. There's lungs, there's alveoli, there's a trachea. Do the parts affect each other? The diaphragm expands the lungs, which pulls air down the trachea easy.

  1. Do the parts together produce an effect that is different than the effect of each part on its own? Easy, right? The parts together allow us to tag oxygen onto red blood cells, and to dispose of carbon dioxide. Then the last one is, does the effect or the behavior over time persist in a variety of circumstances? It's a little more nebulous, but what I think she's (Meadows,2008) getting at there is, systems tend to be self-preserving.

If you apply those rules to orgasm or sexual response, of course, they're there. There are parts, obviously. There's genitalia; there are hormones.

  1. Do the parts affect each other? Of course. The hormones affect the genitalia. The genitalia affects the brain. The brain affects the hormones and the genitalia.
  2. Do the parts produce an effect that's different than each part on its own? Absolutely. There's an emotional and physical response.
  3. Does the behavior over time persist in a variety of circumstances? We'd say yes to that. So, we have a system.

Do We Really Need Another System?

I think the reason I feel inclined to defend our whole discussion: if it is a system, why has there not been a poster, at least in medical school, if not on the wall of every grade school, explaining how the system works? Just like there's a poster explaining breathing, respiration, the respiratory system, the nervous system, and all that.

I think we could postulate the reasons why that isn't the case.

My best idea about why we're lagging and thinking about sex in terms of the system, like we have with reproduction, breathing, and every other part of the body, is that we haven't had... The past decade or two has produced two things, a greater understanding of how sexuality works, also, with the revolution socially in the idea that it's not just okay for women to have sex. We should help women have good sex.

That's the new sexual revolution, in the 60s it became okay for women to have sex.But since, really around the time of Fifty Shades of Grey, women are rightly demanding that they have access to new ways to improve their sex. There's still a great imbalance. There's over 20 different FDA-approved drugs and devices to help men with their sexuality and only two for women, both of which have come out in the past few years. So, there's an imbalance. I think perhaps, as you guys may know, the clitoris was not even drawn into Grey's Anatomy for a while. There's been a mismatch in interest.

That's why I'm starting with the female orgasm system. There's a male version as well, of course. But we're going to start with a female because I think, both from a scientific revolutionary standpoint and a social standpoint, it's time for this idea to come to fruition now.

Let's go first into some of the ideas about systems and why we should think about systems in general.

What's the Purpose of Thinking in Systems?

Even though we do this largely subconsciously when we practice medicine every day—just living your life every day—you think in terms of systems.

It helps to pull it out and think about the parts of the system. Then, as we go through the various lessons or ideas as we dig into the research over the next few weeks, we can pull out and see how to then tune up the system, either to help with disease or to help a functioning system function even better. So the idea of systems analysis is so embedded that we can take it for granted, and there are systems embedded in systems.

For example, if you have the system of the body that encloses the respiratory system and the circulatory system, which also includes the endocrine system, which has to help control all of that, and that body lives within a social system, which lives within a solar system, which lives within a galaxy.

Where do you draw the boundaries?

If you're considering a system, where do you draw all the boundaries?

To help with that, let's take a really simple system. So someone put a pile of wood in front of your home, and they soaked it with diesel fuel, and then they came to your door and said, "Hey, if you drop a match on this wood, you'll see a fire."

You didn't know about diesel fuel, but you drop the match on the wood, and you conclude that, really, all you need is a match and wood to make a fire. But once you see that you need all three to most ideally create the system of a fire, that's converting that wood into the things that chemical reaction does; then you can be more thoughtful in making a better fire.

I think what's happening, this is my opinion after doing sexual medicine now for a couple of decades, is that more than any other branch of medicine, there was a tendency to not do that—to not think in terms of systems. It doesn't mean we're bad people; it's just that sex was not taught in terms of systems analysis. For example, we know that testosterone can greatly increase the libido of women. That research has been done over and over for the past decade, which is part of the reason it's still astounding that we don't have an FDA-approved form of testosterone for women, and we're having to modify the dosage of medication approved for men.

That's beside the point, which is that you may know the helpfulness of testosterone and give it to a woman to help improve her sexuality, or libido, or orgasmic response. But if you didn't consider, perhaps she's depressed about her marriage, or maybe she's got a microadenoma producing prolactin, and her hyperprolactinemia is basically killing her sex drive, and what she needs is not testosterone, but Dostinex®. Or maybe she needs testosterone and Dostinex®. Without thinking about the whole system, you may give testosterone to that woman, and she may think, "Well, testosterone doesn't work."

Walt Disney used systems to think about how to sell Mickey Mouse; does a woman's orgasm deserve the same attention?

But, it really doesn't mean that testosterone doesn't work. It means it didn't work on that particular woman because there's another part of the system that needed attention. I see this happening a lot in sexual medicine—much more than in other branches of medicine. I'll see a therapist counseling a woman with great volition, much time involved, and much expertise involved about how to have wonderful sex without penis-in-vagina sexual intercourse because the woman might have dyspareunia and achieve great results, without knowing perhaps that we may have a way with our O-Shot® to make that dyspareunia go away. Maybe the therapist didn't consider the whole system in regards to the details of what might be going on with the pelvic floor, and inflammation, and how PRP might decrease inflammatory response.

It goes absolutely the other way, as I just mentioned. You may have someone who does some new radio frequency procedure on the vagina to help with sexual stimulation, and they never take the time to find out that the woman was abused, and she's still being abused by her husband, and she sees sexual stimulation, on her subconscious or maybe even conscious level, as a physical and emotional attack. So her instinct and what she's been conditioned to do is to recoil from it. So you can do testosterone and radiofrequency all day long, but until you consider the whole system...

Or, maybe she's got a spinal cord abnormality or a disc in her spinal column that's interfering with transmission of the nerve impulse. So until the whole system is considered, there's not going to be ideal treatment, and you'll have someone saying, "That didn't work." Another quick analogy is, suppose you gave a bronchodilator to someone with dyspnea, but their shortness of breath is due to profound anemia. If you did that, the person would [inaudible], "Oh, bronchodilators don't work for dyspnea." When really what they needed was a transfusion of two units of packed red blood cells.

It seems almost ridiculous to point that out in the circulatory system, but I see it happening every day in sexual medicine, which is why I'm wanting your help in developing this systems analysis. I think I've got a pretty clear view, but when you're alone with your books for years at a time, I think it definitely helps to rub brains with other smart people that I know. There's a lot of smart people on this call. So feel free to jump in and throw in some ideas, as we go along, into the chat box. I'll talk about them, and eventually they'll get integrated into the book and the poster that comes out of this.

Definition of a System

So a system is a set of parts that work together to accomplish a purpose or multiple purposes. You might be thinking, "When are we going to get to start talking about the clitoris or the hormone part?" Well, we'll start talking about the parts, but there are other parts to the system too. There's stock, there's flow, there's feedback. So for optimal discussion and effectiveness, we need to tease out the parts, and today's lesson was going to be primarily about that.

So, it's a collection of parts working together, accomplishing more than any of the parts separated from the system. They work at the same time. This is why those posters your 6th-grade science teachers showed you were so important. When you explain something in words, you're seeing a linear progression of ideas when what's really happening with the system, it's all working at the same time. Of course, it's helpful to think about each part separately, but to see it happening at the same time with one diagram is very, very helpful, and it emphasizes that it's all doing things and each part is affecting things at the same time.

More About Delineating the Boundary of the System

Now, more about the boundaries of the system. You could start with adrenals in a female making testosterone. Then you could go into the biochemistry of testosterone. The molecular structure of testosterone is chemical bonding, the cell receptors on the vaginal tissue or the brain that are receiving chemical messengers from the... You see what I'm saying? You could do a whole textbook just on the cell receptors. So you go on and on and on, because everything is related to everything, where do you draw the boundaries? And, because you have systems within systems.

If you use as a model of what other body system discussions have pivoted around, it becomes, at least in my opinion, that they've been defined. The borders of the system have been defined by thinking about, what are the first-order considerations that a clinician or a person who's trying to optimize their health. Wellbeing, what are the first order considerations that you would think about to make that better? For example, with the respiratory system, you might think about the alveoli.

But perhaps on your poster, in your first order of consideration, you wouldn't think about the chemical or the cellular makeup of the alveoli, and the ATP, and the mitochondria, and all the metabolism that's going on within the cells of the lining of the lung. You would stop and define it at the level that you would need to think about it when you're trying to get someone well. Of course, that would be different if you're doing research, and you would take it deeper and deeper, to infinity really, because there's no end to that.

Next you would consider not only what's the boundary that you would think of first order for healing, but also for accomplishment of optimal function. This gets to be more politically risky because, as physicians, we're not really supposed to do other than treat disease. You'll lose your license. For example, if you give testosterone to take a normal male and enhance his physical strength, that's considered to be malpractice because the possible detriment from that therapy is considered to be unnecessary and unacceptable to just make someone able to pick up a heavier weight.

But at least so far, the ideas of how to improve sexuality in normal function are less frowned upon because usually, this is important, whatever improved sex is improving overall health. Not always, of course there are drugs that get you thrown in jail and make you sell your refrigerator to buy more of them, and those are illegal. But for most of what we do as a physician, in the process of making sex better, we are usually making the body healthier. As long as we are doing that, I think it's perfectly acceptable. Both my philosophy and what I can see from the position statements of the powers that be, as long as you're doing that, it's okay to take good and make it better.

It's okay to take a person who's able to walk and instruct them to improve their VO2 max, and their anaerobic threshold, because we know that decreases their risk of myocardial infarction. In the same way, that same advice would most likely cause them to have better sex and stronger orgasms. Here's the risk of not using... Well, why not? Why can't I just think, "Well, I can try it, or I can think about it, and not get so deep into the systems analysis?" What happens without it is, people start to under... Not just physicians, but our patients. I think this is huge.

Why Patients Need to Know about the Female Orgasm System for Your Therapies to Work

It's important for us to talk with our patients, in terms of systems analysis, so that they know that we don't think our hammer also functions as a screwdriver and pliers. They need to know that we understand the whole system, and other parts of the system may require another visit to us, another test, or seeing two or three other consultants, a therapist, an endocrinologist, a surgeon, a physical therapist, you get the point.

So I put here, as a very basic example, and it's so basic it's almost insulting but it needs to be said, if you have the proverbial hammer and you're trying to progress the insertion of a screw, you break the screw, and you damage the wood.

You'd think, "Well, okay, that's so simple. Why do you even say that?"

Well, I'll give you an example. Someone did a study of our Priapus Shot®. In the study, they changed the way that they prepared the platelet-rich plasma. They used a saline placebo, which has been shown in multiple studies actually to have effects. So they changed the components, but what they really did was didn't consider the whole system. Metaphorically, it would be like you have the wood example, and you're going to change the diesel to lighter fluid, and then you're going to study that match and tell me whether the match works or not.

By considering the system, you neither underestimate or overestimate the effectiveness of your tool because you're thinking about how other systems might be affecting that part of the system you're studying. That's usually controlled by using inclusion and exclusion criterion when you do research. But I think by emphasizing it, as we do diagnosis and treatment of our patients, they'll be more cooperative because they see the benefits of thinking about everything. Both we and our patients will be less inclined to think that we think we have a magic bullet.

It also points out the fact that, because there may not be a magic bullet, unless you just have one system that's part of the system that's broken, then you fix that. Okay, that's the magic bullet. If you have wood piled up, soaked with diesel fuel, then a match is a magic bullet. But if you only have the wood and not the diesel fuel, and you throw a match on a pile of logs, not much is going to happen without some kindling. So there can become this misleading and overestimating because, as a clinician, you may do something that was great with someone, but maybe you nor the person understands that there was a part of the system that was ideal in that instance that may not be in the other. I bring this out because I want to think about just the system mindset, and why I think it's important.

Female Orgasm System: Problems with any one component changes the function of the whole system

You can see this is copyrighted in 1957. This was three years before I was born. Walt Disney apparently sketched out his idea about the whole system of Disney, and how it works. So if you look at it, you have a film, and magazines lead to the film. You have a comic book that leads to a film, which gives new material for the magazine, gets turned into a book, which plugs more film, raw materials for more books, you get more comic strips. All this gets pulled over into Disneyland where people come, it provides additional sales, merchandising. Then you get tied up in here in this thing and you're rotating through. They're selling music.

Everything is selling everything, and everything is pushing everything, and everything is developing everything. That's the Disney system on one piece of paper, and it's how Walt Disney drew it in 1957. Now, that is a different mindset than had he just been thinking, "Let's make a comic book about a mouse." He knew that the mouse was part of this huge system, and that was a huge reason for his success—he thought in systems. Now, let's think about some of the components. Maybe I'll stop here and see if there are any comments before we do go further. Let's see.

Do I have a female sexual questionnaire that you have your patients fill out. Yeah. We will get to that. There's lots of different questionnaires. There's female sexual distress scale and female sexual function index, are the two that I've used primarily. Female sexual distress gives you an overall view. Female sexual function index teases it out to give you an idea about which part of the system might be broken. But as we're talking now, you see that you really can't affect one part of the system without affecting others.

We'll take the endocrine system, for example. If you correct testosterone, you lower thyroid binding globulin, and you raise free thyroid levels if they're on thyroid oral medication without changing the dose. If you give them growth hormone, you raise testosterone levels. If you give them testosterone, you raise growth hormone. If you give them testosterone, you raise estrogen. So moving one thing moves the whole system, which leads to a lot of surprises because a lot of people are just focused on the one thing.

One of the surprises that happened with me is when I first did the study, our very first study we published regarding the O-Shot®, I had someone that only had a female sexual distress scale level of two, which is almost nothing. Basically, she was having great sex. Excuse me, it was one. So, basically no distress at all. But then it turned to a two after our O-Shot® and I found out... I said, "Well, what happened that made it worse?" She said, "My libido got so high my lover couldn't keep up, so I was less satisfied because I didn't have as much. Before, I was fairly satisfied. But then, when my libido went up and he couldn't keep up with me, I became more unsatisfied."

So there can be surprises, and that would be a surprise in the marriage or the family system that happened because we improved her orgasm system, and when he couldn't keep up, it actually made her less satisfied. By the way, that's one of the reasons that there are fewer drugs for women. Because with men, if you have a new drug, you just have to prove that the penis gets harder. For women, unless something's changed, for it to be approved, you have to show that they actually have improved satisfaction, which is different than just having more lubrication, or more blood flow to your clitoris.

Why Call it the ”Orgasm System”?

Just one quick other comment before we go to components. I thought about, what else could you call this thing if we're going to have a new system? Is it really just the reproductive system? We talked about that. You maybe could say it's a subcomponent or subsystem of reproduction because it promotes reproduction. But I think it's more overlap because, obviously, you can have reproduction with almost no libido and no orgasm at all.

So I thought maybe we call it the sexual response system, but to me it feels like orgasm system. You can have response without orgasm, but you're going to always get response when you get an orgasm. So it seems to me like orgasms more encompassing, and perhaps we think about orgasm as the fullest extent of sexual libido and response. So that's my reasoning behind it. But, maybe it winds up being called something else. That's why I'm thinking about that as the reason we call it that.

Now, a little bit more about mindsets, and let's go to components. Everything we think about, another way to think about a system as a model and part of the new specialty of medical systems, as a subspecialty of medicine, involves a lot of mathematical modeling. So you could almost substitute the word model. Everything we know about the world is a systems model, really everything. Our models, they have strong congruence or we'd throw them out. They have reliability, and predictability within the world.

Our Newtonian model of gravity works when it works, but then sometimes it doesn't, according to Einstein. So it works when it does, but then at some level it quits working. So you use a model for as long as it works, but you also have to... Whenever a model falls short of what's happening in the real world, then that's the time to reconsider, is your model correct or not? That's one of the places where systems or models fulfill one of their highest purposes or best purposes because, when you see your ability to not predict or, in our case, treat patients effectively...

Which, let's face it, when the stats are somewhere between 30% and 40% of women have sexual dysfunction even defined as... It doesn't even count unless you have some psychological distress from it, like you've got dyspareunia and you're not distressed by it, that doesn't even count as dysfunction. So when you consider, depending on how you define, count the numbers, what study you look at, somewhere between 20% and 40% of women have sexual dysfunction. Well, our models and our treatments need some rethinking. If we don't even have a diagram about how the whole thing's working, maybe it's time that we do.

Okay, I guess I beat that one to death. Let's talk about the categories or elements of the system because I think that is super important.

Elements of a System

Purpose

First, you have just your paradigm or your purpose of the system. If you're thinking about libido as just one part of the paradigm of reproduction, then it changes how you think about the whole system. As soon as you tease it out as libido and orgasm are a different system versus making a baby, then you're thinking about it changes. There's a beautiful book about scientific revolution that I list here in the references, that's been out now for 40 years. That's usually where the revolution happens. It's usually not an extension of what we already know. It's a change in the paradigm about what we're doing and what the purpose of the system might be.

Stock

Okay. The next part of the system is the stock. Let me show you what I mean by stock, change what you're looking at. I consider myself a student just like you guys, so I hope you'll tell me when there's something you think I should change or add.

But, let me pull up where you can see a diagram. This comes from that Meadows book and others about systems analysis. Just a minute. Okay, share something else. Here's a picture of stock. So, you have something that's coming into... An easy example is, this is your bank. You have money that's coming in from your salary, or whatever you're doing, and it goes into the bank.

Then this is information. In this case, the information is how much is there, and it also rules the flow of the information and the way the system is working, which brings up another important point.

The flow of Information & Watching the System Work

You can't understand a system just by knowing the parts. You have to watch it work. You have to watch the whole system work to understand it. You can't figure it out with it sitting still. Anyway, you put money in the bank. It turns out you're getting some amount of interest, so the interest then changes the amount of money that's flowing into your bank. That arrow, in this case, could probably better be represented by turning, pointing at the actual box of stock.

Feedback Loops: Self-Reinforcing and Balancing

But this would be a self-reinforcing feedback loop. Not a balancing, but a reinforcing feedback loop because the money flowing in grows even if you're not adding to it, because the more money that comes in, the more money is adding interest. So the old proverbial thing by Einstein about it being the greatest wonder of the world, because it just keeps growing, it's a self-enforcing loop. Versus the balancing loop, which would be a feedback loop, which would be... Well, let me just back up again.

So we have material or information that flows, that's stock you have. That's the stuff that's coming in. This could be a bathtub. Then you have the information that changes the flow, and then that flow of information becomes a feedback loop. So I just described a self-reinforcing positive feedback loop. You could have a negative feedback loop where, when left alone, it spirals down. So let's talk about a self-reinforcing and a negative feedback loop in the female sexuality. We'll get to this much more when we get to the actual details of the system.

But if a woman has a good sexual experience, then that memory makes it where she's more easily aroused in the next encounter. Because she's more easily aroused in the next encounter, she has an even better experience, which is thought to be different than how men respond. So, there's a self-reinforcing loop. The reverse could be happening, where she has sexual intercourse, she has pain. Now she associates sexual intercourse with pain, which makes her now have almost some form of vaginismus in her next encounter with her husband, which makes her have more pain because now she's having contraction of the pelvic floor and more dryness because she's not lubricating, because she's afraid, and now she has more pain, so the next time she's even less inclined to have sex.

So now she's in a negative self-enforcing or reinforcing feedback loop. So you've got positive reinforcing, negative reinforcing, and then you have balancing. A balancing feedback loop might be where you have the thyroid gland making thyroid that goes into the body. The hypothalamus, once it sees enough thyroid, turns down the amount that's being made. Where, if there becomes a need for more thyroid, then the hypothalamus turns up the flow of thyroid that's being made. So that would be a balancing loop that keeps the level about the same, versus reinforcing it or making it grow without any changing of anything else. The system itself propagates that way.

Examples

Okay, so what would be the stock in some of the systems we know about? In the respiratory system, the stock would be the oxygenation of red blood cells and the removal or the level of carbon dioxide. So you'd want the oxygenation optimal in the carbon dioxide. Then the information would be feeding back through the carotid sinus to change the respiratory rate. Let's say that you have a flight or fight response, and the sympathetic nervous system causes increased blood flow, and vassal dilatation, and bronchodilation, so you're able to oxygenate more. When you're sleeping, respirations go down and it doesn't take as much tachypnea to keep up.

So the stock and the respiratory system would be that. The stock in the gastrointestinal system would be the transfer of nutrients. Stock can be tangible and intangible. Stock could be affection for your lover, it could be your intellectual understanding of something. So it's not just information that can be intangible, stock can be intangible as well. I'm very open for suggestions here. But my best idea, after thinking about this for a few years, is the stock for the orgasm system would just be sexual desire and arousal. When that reaches some overflow state, then there becomes an orgasm.

At that point, the information would feed back and cause perhaps a decrease in the stock, as in decreased arousal, but there would be increased ability to have arousal on the next encounter. So there would be one negative feedback loop, and one self-enforcing or self-enforcing loop. All of this is functioning in all the systems. I think it's probably most visible when you think about the feedback loops and the endocrine system, but it's there in all of them. You have gastroparesis when you're overfed, so that would be a balancing feedback loop to cause decreased appetite when you have a full stomach, along with all the hormonal things that happen with that as well.

The Sermorelin, that's all the rage now, is just to play on the hormone that's made when you go jogging. You make it naturally every time you do aerobic exercise with the body saying, "Oh, if we're going to do this, we don't need to be carrying a bunch of food around, so let's just go to half a glass of juice and go on." Versus if you don't do the exercise, your appetite's up and you have a different level of caloric intake. So that's some of the ideas about feedback loops. When we're talking about the components of a system, you've got feedback loops, you've got stock, flow of information.

So then the goal of a feedback loop would be that it helps keep the stock at the level that best benefits the system, either replenishing it or depleting it, if that's the goal. Another important point is they can only affect future behavior of the system, so you can't go back in time. So let's say you have a certain amount of money here, then it changes what comes in tomorrow, but you can't change what you had in there yesterday. Which seems basic, but it's important when we start talking about sexual response. Maybe for a more formal definition, it's worth saying a feedback loop is a closed chain of causal relations where the level of stock changes the inflow and outflow due to the system.

Feedback loops can cause stability, but they can also be blockers of change. Reinforcing feedback loops can cause a logarithmic growth or a quick collapse of the system. When I say reinforcing, by their definition, in my mind from a layman's term, I would think reinforcing means growth. But reinforcing could also mean reinforcing negative. For example, libido's up, but then the two-year-old knocks in the door, well then the stock of libido is going to go down because now mama's worried about the two-year-old's fever. Or broken finger, or whatever's causing the two-year-old to scream at the door. So that would be a quick collapse because the information coming in would say, "No, this is not the time to have sex," and there'd be an instant collapse where you could think of a dozen things that might happen in the bedroom that might cause this logarithmically to increase to the point of orgasm.

So reinforcing with this terminology can be negative or positive. Here's something that happened a lot in the endocrine system, and it also happens in the sexual system. There could be long delays in the feedback loop. So, foresight is needed. This happened a lot with my hormone business back when I did more of this. I've treated thousands of women for hormone replacement. You'd give a woman some hormones. Let's say you give her testosterone, libido comes up gradually, but takes about 12 weeks for it to max out, and then she's having great sex.

The same thing happens if she stops the testosterone. So her prescription runs out, or she fails to make an appointment. It might be three months before she notices the drop in libido. Because of that lack of association in time, or close association, there may be confusion about... Frequently, I'm sure hundreds of times, I'd have women think, "I think that testosterone might've been actually helping me." It doesn't mean she wasn't brilliant, it just means the lack of time synchronization made it hard for her to determine.

The other thing that happened was, they would start my testosterone and then they're 12 weeks in, and they start some supplement they picked up at Walmart, and they stop my testosterone and they think the libido is still going on because of the new supplement. They brought some sort of toenail of a exotic plant or... I don't know, I'm making up something. But they bought something that's completely homeopathic bull, but they think they still have a libido because of that, and they didn't need the testosterone because it's six to 12 weeks before they lose the libido from the testosterone. So then they think, "Oh, I don't need that testosterone. I'm doing fine with this toenail of a bumblebee."

So that is important, super important, both as we think about our therapies and as we talk with our patients about what we're doing, so they are educated enough to associate what we're doing. A stock also works like a memory within the system. So there can be this inflow and outflow without that can work separately. So you can have an inflow into your bank, it's there, and then you can have an outflow that is not at the same time. That helps because, like the example I'll just mentioned, the woman stops her testosterone, but she's got this buffer because it's built up, and the metabolic effects and the proteins that were manufactured because of it continue. So, there's not a sudden drop-off because she missed something.

So the stocks might stay the same. If the in equals the out, then there's a dynamic equilibrium. If the in is greater than the out, then there's an increase in stock, and of course vice versa. So they can work independently. Knowing or thinking about stock, within our system of libido, will be important when we proceed to later parts of talking about actual physical parts of the sexual system. Let's see what I've left out here. Okay, two more things and then we'll call tonight, unless you guys have comments or instructions. Hopefully, you'll teach me something that I haven't thought about.

Influencing the System (Tuning It Up to Make Things Better)

System constraints, and ways to influence the system. Now we've talked about the basic parts of the system. We'll talk about principles of influencing the system, and then next week we'll get into the actual parts of the system in regards to sexuality, and start talking about how to influence them.

In a growing system, there must be one reinforcing positive feedback causing growth, and there has to be one constraining feedback to limit growth since no system can grow infinitely in a finite world. I'll say that one more time. If you've got a system, if it's going to grow, you have to have something to reinforce it. But because there's nothing infinite, there's always going to be something restraining it.

The closest I can think to something not restraining it is persistent genital arousal disorder, where there's this positive feedback loop that seems to not be restrained by anything other than just the person's ability to physically give themself an orgasm. The suicide rate in the people who suffer with that problem is higher than the suicide rate in people who have chronic pain, because they cannot... It's so demanding of their energy, and their thought, and their ability to constrain themselves, that they can't function. So, that's the closest I can think of to a positive feedback within the libido sexual orgasm system with the negative feedback being so limited that it's basically maddening for the person.

Of course, if we're going to help someone with their sexuality, we need to know all those restrainers and all those positive reinforcing influences so that we can more intelligently help people. Again, to grow there must be at least one positive feedback loop, to grow the system. There'll always be a negative feedback to limit it, because there's nothing infinite in this planet. Now let's talk about some of the ways to influence the system, and then we'll call it at night, unless you guys have questions. I'm going to list them.

The best description I saw of this was in that Meadows book. I'll go through it with some ideas about how we might apply it in the future. She listed a dozen.

Twelve Ways to Tune the System

  1. Numbers

You can have the numbers, which would be the simplest and the easiest to think about. You've got, so what is the testosterone level? What is the amount of time you're spending with your lover? You got the actual math of it.

  1. Buffers

You have buffers in the systems, which has to do with your stock relative to flows.

  1. The Flow of Stock

You've got the stock and flow structures. That would be 10, we're counting down from 12.

  1. Delays

Number nine would be delays in the system.

  1. Feedback Loops

Next is balancing or feedback loops, reinforcing feedback loops, information flows, rules, and self-organization goals.

And the most overlaying and most influential ways to intervene in the system are paradigms and transcending paradigms, which really gets out there. So a transcending paradigm would be to realize that there really is no always true paradigm. It's what we're doing now, that maybe we need a higher or a different paradigm than what's even being talked about. So letting go and being free to know that maybe what we know is not correct. But, that's a little bit nebulous.

  1. & 12. Paradigms and Transcending Paradigm

Bringing it down one is, what's the paradigm? What is the idea behind an orgasm system? What's the goal of it? How is it organized? What rules does it follow? How does the information flow? What are the feedback loops? What's the stock? What's the buffers? What's the numbers?

 

That's what you need to think about. More complicated than it appears. As I dive into this, I think, "Man, can we really do this?" But, I think we can pull it off.

The Poster

In the end, we just want a poster. It's just a picture. But still, by understanding that picture and slapping it on the wall, we now have this really nice way of thinking about sexuality. For everything we say to our patients, we have a deeper level of knowing that they will feel and they will understand when they get well, sometimes when no one else is able to help them.

You are Part of a Revolution

Okay. Last thing I'll mention here is just this whole idea behind scientific revolution, and then I'll stop unless you guys have questions. We'll call tonight, because it's almost an hour. This is a quote from the book I was recommending you read about, The Structure of Scientific Revolution. When the paradigm enters into a conversation, which it has to do... Right now, we're under the paradigm that sex is important. As arousal changes or increases, self-reinforcing, there's an orgasm, which causes people to bind together and sometimes make a baby, which spills them over into the reproductive system.

That's our paradigm. Within that paradigm, it's useful to recognize our logic will be circular because it will be confined to that paradigm. We come out of that paradigm and we talk to someone who says, "No, there's really no need for that. It's just wanting to have sex as part of reproduction. Get over it." There's no use really having a conversation with that person because their logic is also circular within their paradigm that arousal's just part of reproduction. So if we're going to encounter or embark upon this idea, last thing I'll say is the tips that came from that sex revolution thing, or from that scientific revolution book.

Five Tips for Leading a Scientific Revolution

Here are the five tips to leading a scientific revolution, which you're part of now on this call, and you're definitely part of if you're part of our Cellular Medicine Association. If you're on this call, you're probably an innovator and have your own other revolutions. Five things before I cough my head off, and then we'll stop. Number one, you keep pointing to the anomalies and failures of the old paradigm. In our case, the reproductive system really doesn't explain how to encourage people to make babies. It just explains how you fertilize an egg. But it doesn't fully explain how you encourage people to increase their chances of having a baby, for example.

But number one, you keep pointing to the anomalies of the current paradigm. In the case of our O-Shot®, for example, the anomaly in the paradigm is that all of the FDA-approved drugs at this account, all two of them, are psych drugs. They're affecting the brain and that is it. But sex has genitals involved in the system as well, and if you have something that's been used in dentistry and wound care for two decades and orthopedics for two decades, to improve the health of the tissue, why not use it to improve the health of the vagina since that is part of the sexual orgasm system. But to do that, we have to bring people in the idea of it being a system and not the proverbial hammer so everything's a nail. In other words, thinking about sex must involve the brain since that's where you think.

So that would be a new paradigm to bring up the idea of using tissue repair and tissue-improved health with callogenesis and neovascularization neurogenesis as part of your improvement of libido. That versus the other example would be in male sexuality. All the current drugs just make what tissues there work harder, if vasodilates or the arterial system that's already there, but does nothing for neovascularization or neurogenesis, but PRP does and shockwave does. So even if you have someone who's getting better on Viagra®, and they're satisfied, why would you not also offer them a therapy that improves blood flow and neurogenesis? Why wouldn't you? Why would you not even maybe offered as prophylactic to prevent ED? That's a different paradigm than just making disease tissue work harder versus creating new healthier tissue.

So one, you keep pointing to the anomalies and failures of the old system. Number two, you keep speaking and acting loudly with assurance from your new paradigm, based on the research always. Number three, you have people with the new paradigm in places of public visibility and power, and we have people on this call that are board certified in multiple specialties. I see names. We have people that are luminaries and professors in various universities, and those are the people... Of course we have the celebrity type patients who speak out for us too. Suzanne Somers did more than any probably one physician to improve the health of women by speaking out about the necessity to think in more finite, granular ways about the female endocrin system, and then women started demanding it.

So number three is, you have people with visibility and power to talk about the new paradigm. Number four is, you don't taste waste time with the reactionaries because, as we just talked about, they're in a different paradigm, you're not going to convince them. We may all be wrong, but we're definitely going to be wrong within their paradigm, as in they will seem not correct within ours, so you're wasting time to talk to a closed mind, closed off within their paradigm. Number five is, you work with the active change agents, which are the people on this call to speak to the open mind, middle ground, those who are not...

It was Max Planck that said, "Scientific revolutions happen one funeral at a time," because you've never really convinced the old school. You must wait for them to die out.

I'm not quite as pessimistic about it. I think there are people of every age that are open to the idea that, especially in the sexual arena, "Hey, what we're doing doesn't work all the time, so maybe we need new therapies and new ways of thinking," which is what we are going to do.

Okay, with that, I think I'm going to end it. It's two minutes away from being an hour. Let's see, a couple of questions. That one I've already answered. Let's see if there's another one. Yeah, think I answered that. What about Vyleesi®? I think we'll get to that when we get to the brain. I'm not discounting the drugs that we have. When we get to how the hormonal system and the brain work, that is definitely a way to help that part of the system. All I'm saying is that there's something other than a brain. In men, we seem to focus more on the genitalia. We have Viagra that makes the genitalia work better. And women, we don't have an FDA-approved drug that does that yet.

Okay. I think with that, I'll call it a night. I hope that piqued your interest in what's possible, and the level of thought that can happen within the system. As we plow into those 12 different ways to affect the system, and the different parts of the system, hopefully, when we're done, we have a beautiful poster that looks pretty enough and simple enough to slap on the wall of a 6th-grade science class, but yet we understand it in a level that allows us to be excellent clinicians. With that, I'll call it a night. I hope you found that helpful. Goodnight.

References

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Draghici S, Khatri P, Tarca AL, et al. A systems biology approach for pathway level analysis. Genome Research. 2007;17(10):1537-1545. doi:10.1101/gr.6202607
2.
Sayin U. Doors of Female Orgasmic Consciousness: New Theories on the Peak Experience and Mechanisms of Female Orgasm and Expanded Sexual Response. Neuroquantology. 2012;10(4). doi:10.14704/nq.2012.10.4.627
3.
Zi Z. Sensitivity analysis approaches applied to systems biology models. IET Systems Biology. 2011;5(6):336. doi:10.1049/iet-syb.2011.0015
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Furman D, Hejblum BP, Simon N, et al. Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination. Proceedings of the National Academy of Sciences of the United States of America. 2014;111(2):869-874. doi:10.1073/pnas.1321060111
5.
He JC, Chuang PY, Ma’ayan A, Iyengar R. Systems biology of kidney diseases. Kidney international. 2012;81(1):22-39. doi:10.1038/ki.2011.314
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Mardinoglu A, Nielsen J. Systems medicine and metabolic modelling. Journal of Internal Medicine. 2012;271(2):142-154. doi:10.1111/j.1365-2796.2011.02493.x
7.
Systems medicine: A new approach to clinical practice | Elsevier Enhanced Reader. doi:10.1016/j.arbr.2014.09.001
8.
Rutherford A. The Elements of Thinking in Systems: Use System Archetypes to Understand, Manage and Fix Complex Problems and Make Smarter Decisions. Kindle Direct Publishing; 2019.
9.
Pavličev M, Wagner G. The Evolutionary Origin of Female Orgasm. J Exp Zool B Mol Dev Evol. 2016;326(6):326-337. doi:10.1002/jez.b.22690
10.
Basanta S, Nuño de la Rosa L. The female orgasm and the homology concept in evolutionary biology. J Morphol. 2023;284(1):e21544. doi:10.1002/jmor.21544
11.
Rutheford A. The Systems Thinker, Essential Thinking Skills for Solving Problmes, Managing Chaos, and Creating Lasting Solutions in a Complex World.; 2018.
12.
Meadows DH, Wright D. Thinking in Systems: A Primer. Chelsea Green Pub; 2008.
13.
Kox M, Van Eijk LT, Zwaag J, et al. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proceedings of the National Academy of Sciences of the United States of America. 2014;111(20):7379-7384. doi:10.1073/pnas.1322174111
14.
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Wagner GP, Pavličev M. What the Evolution of Female Orgasm Teaches Us. Journal of Experimental Zoology Part B: Molecular and Developmental Evolution. 2016;326(6):325-325. doi:10.1002/jez.b.22694

Female Orgasm System

Hello,

A system is a group of components that work together to accomplish a purpose.  The Reproductive System produces offspring and propagates the race. The respiratory system removes carbon dioxide and provides oxygen to the cells. The Orgasm System provides pleasure to create deeper relationships and families and recurring sex (promoting the implementation of the Reproductive System).

Systems can share components and not be identical--there can be overlap.  The entire body could be thought of as a system with subsystems like the nervous, gastrointestinal, and endocrine systems.  The endocrine system makes up part of the Orgasm System. One might argue that the Orgasm System is the most complex since it does not work well if any other system malfunctions.

I first introduced the term "Orgasm System" to the medical literature more than a decade ago to promote a methodical, systems-analysis approach to diagnosing and treating sexual problems: exactly as is done with all other systems in the body.

Female Orgasm System: Problems with any one component change the function of the whole system

The following free course is for those who provide health care to women and for those who want to understand the beautiful complexity of women (women and those who love a woman).

Any one part of the system (for example, hormones) could fill a textbook, so intricate descriptions of every part of the system will not be part of the course. For this course, the components of the system will be identified, and the relation of the components to each other will be described (feedback loops). By doing that alone, physicians (and their extenders) and counselors  can more effectively take a systems approach to diagnosis and treatment and avoid the mindset that "I have a hammer, so everything looks like a nail."

Often, the counselor is not aware of the intricacies that can be done with hormones and regenerative therapies. And the physician who understands the endocrine system and the anatomy forgets the importance of knowing about past abuse and understanding the nuances of relationships.

Hopefully, by at least laying out the entire system for viewing on one page (as is done with every other body system), both women and those who care for women will facilitate more effective treatments and better sexual health.

I hope you find the course helpful. Feedback is welcome! The course will take place over ten weeks. The lessons will take place live but will be recorded and transcribed for viewing at the convenience of those who register (much will be password protected, even though free).

Register for free on the following form in ten seconds. Please, fill in all fields to help us know we are dealing with real people and not spam bots.

Thank you for your trust,

Charles Runels, MD

Charles Runels, MD
Runels.com
CellularMedicineAssociation.org

P.S. Those who complete the course and take the test successfully will receive a free certificate of completion from the Orgasm College™ certifying an understanding of the components of the Female Orgasm System.

Total Surrender Orgasm With Female Ejaculation

Total Surrender Orgasm with Female Ejaculation

Action Group for Men ONLY

What's the Real Problem with Most Love Relationships, and How Do You Fix It?

What if when you made love to a woman, you left her completely limp, exhausted, covered in tears of happiness, wet with her own ejaculate, and basking in the afterglow of a pleasure so amazing that she collapsed in happy bliss and in obedience to your wisdom and skill in helping her to pleasure and safety?

Yep--That's a mouth full; but it's possible.

When you look at all the courses on lovemaking, all the supplements and courses to improve connection, and sex, and appearance and even the size of the penis, when you study all the info on the best way to dress (even why people read the scriptures)--for what do most people search in the way of sex and love?

After talking with over 3,000 women about the intimate details of their health and their lives, after writing the best-selling sex manual that brought to me male patients and letters from readers around the world, after way too many lovers (on a personal basis), after studying the latest in sexual research and even doing my own research in the areas of sex and physiology---this is what I consider the problem that persists that most cannot even articulate: no matter how controlling on angry she may seem, most women want to rest in the love of a man who is on an adventure, she wants to be the beauty that motivates and inspires, and (now here's the politically incorrect part that may make you gasp)--she wants to feel so secure and loved and trusting that she relaxes and becomes--OBEDIENT.

I know there will be many angry people, just because I wrote the "O" word. But, ironically, the angriest, the most denying, are the most unhappy because they have not found a safe place to rest in the "O" word (and I don't mean "orgasm").

She wants to be obedient, but you must be worthy and able to accept her. Most women are unconsciously testing men to see if the man is strong enough to rule her (in a loving way) and become disrespectful and angry when the men come up short.

Scary word. "obedience", and most women would rather you ask them for anything other than obedience. But, in the right situation, they will gladly give it to the man: the right situation is--"Total Surrender Orgasm with Female Ejaculation."

Just for me to write the "O" word took much courage on my part because I know how much it's misunderstood and can even provoke more anger than most four-letter words.

But, wait, please let me explain the real secret of the "O" word...

What if she knew the man loved her enough to die for her with a completely unselfish love? What if she knew that he loved her so much he would never want anything for her except the very best, even if it brought him pain.

What if she trusted his judgment (because of his love); thought him strong and wise and connected to a higher power; what if she thought his soul connected to hers so that she knew that when she cut her finger that he would bleed--that when she had an orgasm, that he would feel ecstasy?

What if he really knew her body better than anyone--including herself?

Do you think that then, perhaps, she would know that whatever he asked would at least be the best for her, then, knowing that, could actually become eager to know what he wanted of her, and start living the "O" word even if her ladies magazines have taught her to deplore it?

If she knew that she would blossom with beauty and with happiness and with pleasure if obedient to him, would she want to be obedient?

It's pretty straight from most scriptures: The man loves the woman enough to die for her. The woman obeys the man with devoted surrender.

He gets respect. She gets love.

Sounds pretty cool, but how to pull that off?

More importantly, how do you relate to a woman emotionally and physically to find this very sweet surrender (and I mean sweet for her even more than for him).

Just being a "good lover" will not do it; she could have many "good" lovers who are mechanically adequate in bed, but she's looking for "something more."

Just listening will not do it; her friends listen.

Just being strong or rich or having large biceps or a large penis or a handsome face--none of these will do it.

She may think that when she meets the man with any combination of the above that she has found the man to whom she can surrender--but after a time, she realizes that none of these are enough and she will start to pull away, grow dissatisfied, and look elsewhere or settle into a tasteless routine.

An Experiment to Prove the True Nature of Men and Women

Show me a woman who is totally surrendered to a man who does not love her completely and I will show you a woman being abused by a man (physically, emotionally, or both).

Show me a woman who is not surrendered (and obedient) to a man who completely and unselfishly loves her, and I will show you a man who is broken physically and financially by the emotional (and yes sometimes physical) abuse of the woman he loves.

Here's the Experiment...

Stop now: Prove the truth of these words by thinking of couples who fit both categories.

  1. The surrender of the woman without the unselfish love of the man leads to the abuse of the woman.
  2. Unselfish love of the man without surrender of the woman leads to abuse of the man.

Could you think of examples of both cases? Women find it easier to think of cases of the first situation. Men find it easier to think of cases of the second example.

It takes both to have the perfect match. A wise, strong, loving man. A wise, strong, and surrendered woman.

Show me a woman who is totally surrendered to a completely loving man and I will show you a loving, excited, happy couple.

For this to work, the man's love must be greater than the woman's to earn the surrender of the woman. That is the way of the ancients and it's what's missing from the modern that results in the turbulence and the breakups of most marriages.

When the man puts on the suit, or lifts weights, or studies martial arts, or reads a book--he wants the surrender of a woman--but none of these will work.

When the woman puts on the dress, or gets the manicure, she wants the love of the man--but none of these will work.

Why the Problem Continues...

So, if this is the highest way between man and woman, and it's been spoken for at least 2,000 years, then why does the problem continue?

Here are several reasons:

  • Sometimes the man is fearful of the woman, when what the woman really wants is for the man to be man enough to stand up to her--to not be afraid. If he can't stand up to her, how can he be strong enough to stand up for her?
  • Sometimes the man loves the woman dearly but simply does not know how to communicate to the woman that he loves her enough for her to find rest with him (If he thinks his words or his money will do it, then he's in for some pain).
  • Sometimes the woman is so fearful of giving up control to a man (who might then abuse or neglect her) that she cannot find the courage to surrender (and he does not know how to help her find that courage).
  • Sometimes the man truly does not love the woman enough, nor is he strong enough, or wise enough to give her a place to rest--so she cannot surrender--it would be like stepping off a cliff to fall into an abyss.
  • Sometimes everything is in place (the man is able and loving, the woman is able and wanting) except for the man understanding a way to make it happen. Here the man struggles to find a better way to talk, or buys more things, or tries to have more sex, or less sex, spending more time, spending less time--until he's exhausted and she's confused. Until, with a deep feeling that everything could be perfect but with exhaustion from not being able to set it up, finally the couple splits to try to find bliss another way.
  • Or, without knowing what or how to find the total surrender to the perfect love, both parties settle into a place of mostly peaceful cohabitation. Never going deeper and never splitting apart. Never knowing the full bliss of a male and female union but living together to avoid the pain completely being alone.
  • Plainly this level of devotion and understanding is not easy, which is exactly why it cannot be found in the quick and meaningless encounters. This situation is the reward of those truly devoted to each other and is one way to define the heavenly bliss that should define a committed love. So, this situation only comes about with at least the idea of being together in some way forever (which ironically most people fear because they do not know what is possible).

How sad that some people think the only reason for a long-term relationship is either the rearing of children or the avoidance of sexually transmitted disease or to keep from being lonely. You can accomplish all of these ends fairly well and be reasonably promiscuous with only short-term relations.

But, to accomplish what I am describing demands that you go to the core of your being as a man

and find the core of her being as a woman.

And, the reward is the definition of love and of sexual bliss.

The Problem Continues Because Most Men are Learning Bed-Room Tricks and Lifting Weights and Buying Gifts Instead of Finding the Holy Pilgrimage to a Woman's Soul

The path to this blissful place cannot be explained in a 3-page article in Cosmo Magazine or in Men's Health Magazine. You won't find it exactly laid out in the scriptures or in the sex manuals or in the gym (though there are ingredients and clues in all of those places).

To really successfully follow this path requires a working knowledge of at least the following:

  • The psychology of a woman's surrender both emotionally and sexually (almost the same).
  • The different types of female orgasm and how to help a woman to each type.
  • The physiology and endocrinology of excellent female health and sexuality.
  • The detailed anatomy of the female body, especially how it relates to the different types of orgasm.
  • The sexual techniques of a man that allow him to have unlimited sex (not worrying about premature ejaculation).
  • The special techniques that best provide a deep, earth-shattering, ejaculating orgasm for the woman (one of these I developed and have seen in no other book).
  • The spiritual laws of sexuality that allow unbridled passion without boredom.
  • The how to find the courage to love her fearlessly (and why it's your own emotions that you should most fear). Why you won't take her to bliss and obedience without this because she will know your fear and hold back.
  • How to find the connection to a higher power from which she can draw strength through her connection to you. Are you really brave enough to become the "priest" of your house that sanctifies her sexuality and then fills it with exploding passion that show's her heaven on earth?
  • How to be loving without becoming wimpy. If you cater to her every need in a wimpy way, then she has castrated you and will look at you with disdain because you allowed that castration. If you love her unselfishly but with strength, then you have discovered the art of a manly love and she will surrender to you. Men who make idols of their lover will eventually know their lover's disdain.
  • According to ancient scriptures, the man who loves his woman in the wrong way will literally have his prayers "hindered" --eventually being cut off from both wife and God.

In summary, the reason the problem continues is that these are not easy skills and they are nether widely known nor widely taught. It took me until the age of 40, a few thousand patients, too many lovers, a study of scripture and physiology, sex manuals, anatomy, psychiatry, endocrinology, and a broken marriage to even start to become aware of the existence of these skills and laws.

The understanding of these laws and techniques is as deep and as profound and not far removed from the understanding of the Creator and discovering how to love the woman in your life can be a way to discover the face of that Creator.

A Powerful Tool for Finding Complete Surrender--What Is Possible with the Level 9 Orgasm

About a year ago, I discussed the idea of female ejaculation and offered a seminar to teach some very esoteric techniques.

I have closed that seminar for now; but I am offering a course that presents many of the techniques in audio and written materials. This is not a course to read and think about. This is an action group with home work assignments.

The goal of the group is that your lover will reach a place of more loving surrender and of female ejaculation. Before you get too excited, be sure to read this.

What This Action Group Cannot Fix:

  • If your woman has the personality to roam--borderline personality disorder, narcissistic personality disorder, and others--then she will roam no matter what. No man will ever satisfy her because she is unable to find satisfaction. But, she will still be obedient to you when she is with you.

  • If you do not do as instructed, then you will not see results. This is an action group, not a study course. You learn to do or else learning does not change your life.

  • If your relationship is damaged, it may take being away from your lover for a time or starting over with another person. Sometimes, you can't un break a glass. But, if you start over, you will increase your chances of a real connection.

The Tools to Teach You the Skills

Week 1: Total Surrender Orgasm with Female Ejaculation Part I (One hour MP3 audio recording).

Week 2: Anytime...for as Long as You Want: Strength, Genius, Libido, & Erection by Integrative Sex Transmutation 15-day course for men to improve sex and life.

Week 3: Total Surrender Orgasm Part II (One hour MP3 audio recording) Explains

Week 4: The Law of Health: 10 Essential Steps to Glorious Health & Miraculous Healing. A 10-Week course to find your best health and your best shot at rejuvenation and healing of your body-temple.

Week 5: Dr. Runels Recipe for Erection Enhancement. How to make your penis larger and healthier. What women really think about penis size. When size matters and when it does not.

Week 6: The #1 Health & Energy Secret Without this one you will have less energy to give.

Week 7: Total Surrender Orgasm with Female Ejaculation Part III (One hour MPE audio recording). Explains

Week 8: The Magic 9 techniques for extending lovemaking for as long as you want making ejaculation like a light switch that you turn on or off at will.

Week 9: Practical Application of Integrative Sex Transmutation: Advanced techniques for transmuting sexual energy into strength, energy, intelligence, creativity, spiritual enlightenment, and into the sexual and physical connection that makes two lovers become one.

For about the price of dinner and a movie, you can learn how to elevate your sex and love-making to a place of which few know exists and even less ever see.

I've been asked by some of my group to extend this price but after one more week, the price goes WAY up (haven't decided how much yet). Most offer discounts to get new clients. I'm offering a discount because you've been reading my stuff already.

Hope to hear from you. I'll be advertising the group and going up on the price in a few days.

(credit card will not show the name of the action group) 100% guaranteed results

Peace & Health,

sig

Charles Runels, MD

The Sex Energy Doctor™

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