When Is a Placebo More than a Placebo? (And What Can That Do for Sex?)

Let me kiss your “ouchie” and make it better.

How many times have we said this to our kids? Then, often as not, our wounded soldier scampered back to the playground, “all better” indeed. Maybe this was because she felt secure and loved, and because that magic kiss had activated her own natural painkillers and “feel-good” hormones, and that, in turn, enabled her to be distracted from pain enough for a turn down the slide with her pals.

We should do so well. Harnessing the power of the placebo effect (or Mama kisses) is fundamentally the practice of harnessing the power of our own minds.

I experience this process with my patients all the time—at least, I think I do. The placebo effect isn’t a mechanism that’s easy to quantify or observe. “Sometimes the mind can have a dramatic, immediate effect,” said Jo Marchant, author of Cure: the Science of Mind Over Body, in a recent interview on NPR. “Other times it's kind of one subtle effect among many. And other times, it has no effect at all.”

What I notice is that a patient may complain of mood swings, headache, and general irritability. I may ask if she thinks it’s hormonally related (because…duh). If the patient thinks that’s the cause, we pursue treatment based on her symptoms and her judgment, among other things. And very often, it works!

But I’m never sure… was the patient’s relief due to the treatment that I prescribed, or was it the feeling of being heard by an empathetic listener (which I am) along with the assurance that her trouble could be helped? Did those elements empower her to muster her own physical and emotional resources? Kind of like when a child is helped by kisses?

Both—medical treatment and psychological effect—are powerful and important.

Placebos are often looked down upon as nothing more than sugar pills aided by susceptibility. But research is uncovering a more complex and nuanced effect that, if better understood, could harness a natural, internal healing response that may be as effective as a drug for some conditions.

Taking a placebo for pain, for example, has been shown to cause the same chemical reaction—a release of endorphins—in the brain that the real painkilling opioid is supposed to mimic. In these studies, according to Marchant, our biological response to the sugar pill is almost the same as our biological response to the real drug. It isn’t just that we are tricked into believing something; our brain actually responds similarly.

Lots of factors come into play, of course. It could have to do with conditioning or our expectation of relief. It could have to do with stress—or lack thereof. If we feel anxious and vulnerable, we are more sensitive to pain and less resistant to illness. Conversely, if we feel secure and as though everything will be okay, we’re less sensitive to pain and more resistant to illness. Studies show, for example, that the placebo effect is enhanced when the caregiver is warm and empathetic.

So, ladies, can you see where this is going? Maybe we can use our minds to affect our reality: If we have a sense of well-being and security; if we feel that things will get better; if we believe that we are able to improve our lives, then maybe we can better change the course of chronic problems like pain or stress—or sexual troubles.

Don’t get me wrong. I believe in drugs. I’ve seen appropriate treatment regimens perform wonders. If you have an infection, you need an antibiotic. Topical estrogen for vaginal dryness just makes sense. But I also believe in using every option—every tool in the toolbelt—to improve our lives, sexual and otherwise.

This research may be an important tool as we grapple with the changes we’re going through now, at midlife, and that includes our sex lives. If we can mitigate the effect of stress, get a handle on discomfort, improve or stabilize our mood, or simply feel that we’re in the driver’s seat and life is, overall, really good, wouldn’t that be better than taking pills, sugar or otherwise?

The research on the placebo effect is fascinating and empowering. It will take time and more research to tease out the intricacies involved, but we don’t have to understand a mechanism thoroughly in order to incorporate the helpful bits into our lives. We’ll examine this in more detail in the next post.