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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.

2. 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.

3. 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.
4. Do the parts produce an effect that's different than each part on its own? Absolutely. There's an emotional and physical response.
5. 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."

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.

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

12. 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.

11. Buffers

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

10. The Flow of Stock

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

9. Delays

Number nine would be delays in the system.

8. 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.

11. & 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.

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