'Come As You Are': Book Explores Old Lies And New Science On Women And Sex

"You were taught to value and expect something from your sexuality that does not match what your sexuality actually is. You were told a story about what would happen in your sexual life, and that story was false. You were lied to. I am pissed, on your behalf, at the world for that lie. And I'm working to create a world that doesn't lie to women about their bodies anymore."

-- From: "Come As You Are: The Surprising New Science That Will Transform Your Sex Life."

I will be grateful forever to "The Hite Report." Ditto "The Happy Hooker." Certain books, at key moments, open our eyes to sexual reality — not the distorted reality of porn or bodice-buster novels, but the real-life reality of what our fellow humans do in private and how our own bodies and brains really respond.

I predict that for some, "Come As You Are" by Emily Nagoski — subtitled "The Surprising New Science That Will Transform Your Sex Life" — will be one of those books.

Nagoski, 37, is a sex educator, proud "sex nerd" with a PhD and past work at the Kinsey Institute, and director of wellness education at Smith College. (Also a blogger at thedirtynormal.com.) Her book focuses in part on a fine irony: Research over the last couple of decades in pursuit of a female version of Viagra — an effort that has failed — has nonetheless added new science to the study of women's sexuality, science that can be applied to improve sex lives without any little pink pills.

Our conversation, lightly edited:

You say that we were lied to. How?

From the beginning, the day we’re born, the model of sexuality that all of us are given is the one that comes from the expectation of how male bodies work — mostly because, for so long, men were the scientists and the medical providers, they just sort of assumed that the way a man works is how women are supposed to work. So the extent to which a person in a female body does not match a person in a male body is the extent to which they have 'failed' to be sexual people.

And what are the ways that women are likeliest not to match?

There are two ways in particular. The first is in what’s called 'arousal non-concordance.' Arousal is the activity of your central and peripheral nervous systems in response to sexually relevant stimuli. And it turns out, for men there’s about a 50 percent overlap between what his genitals are doing and how turned on he feels. Basically, if his genitals are responding he’s feeling pretty turned on. That’s not always true, but largely.

"Sex is most satisfying for most women when you’re in a context that is low stress, high trust, high affection and explicitly erotic."

Emily Nagoski

For women, there’s about a 10 percent overlap between what her genitals are doing and how aroused she feels. And most of the time, that's because women's genitals tend to respond to sort of anything, it's like a 'just in case' genital response. It doesn't mean that she likes or wants what's happening, it just means that it’s sexually relevant.

And we look at the way women's bodies respond to sort of anything and we think, 'Why don't they actually like or want all these things? What's going on with that?' And it doesn't mean anything is wrong. It just means the way female bodies work is not the way male bodies work. And that's OK.

So arousal non-concordance means, if you’re a woman and you're having genital response — wetness, blood flow — that doesn't mean that, in your head, you're necessarily turned on. And what’s another big one where men and women don’t match?

The other non-matching thing is in this idea of desire. The model we're given is that desire should be spontaneous. It occurs out of the blue. You have one stray sexy thought and suddenly your engine is revving and you're think to yourself, 'I would like to go find someone to hook up with.'

And that spontaneous desire, out-of-the-blue desire, totally is one way people experience desire. And there’s another way of experiencing desire called 'responsive desire': You're sort of in neutral, you're reading a magazine, you’re flipping through channels, and your partner comes over and starts kissing your neck or caressing your arm, and every cell in your body goes, 'Oh, right, that’s a really good idea!' But it doesn’t occur spot out of the blue. It emerges in response to arousal, instead of the desire coming before the arousal.

You also discuss these interesting, research-based concepts of having a sexual 'accelerator' and sexual 'brakes.' How does that work?

It’s called the 'dual control model.' When we think about how your body undergoes sexual response, it's really about what's happening in your brain. And there are two parts of it, not just one. We’re all used to the idea of sexual stimuli in your life, and that hits the accelerator, right? And that sends a signal that says, 'Go!'

And at the same time, happening in parallel, there is a brake, that notices all the very good reasons not to be turned on right now: You're in the middle of a business meeting, or you're not totally sure you trust your partner, or there’s risk of unwanted pregnancy or STI transmission, or you feel critical about your own body, or you have a history where sex was used as a weapon against you.

All of those things can keep the brakes hit, and they send a signal that says, 'Turn off!' And it almost doesn't matter how much you hit the gas pedal — if the brake is on, you're still not going to go anywhere. So most of the time when people experience sexual difficulties, it's not because of a lack of stimulation to the gas pedal, it's because there's too much stimulation to the brake.

That makes sense. In the last few weeks, you've waded into a public debate --

I don’t want to fight with anybody. All I want to do is help women have better sex lives. It’s not my goal to have public debates about anything. I just want to give women happier, better sex lives. But there are cultural forces that are really trying to make women feel bad. So I find myself having to kind of take them on.

In particular, you had a piece in the New York Times — Nothing Is Wrong With Your Sex Drive — that questioned the whole endeavor of trying to create a 'pink Viagra.' And of course we know this effort has failed, so you have a lot of strong arguments on your side. But then I saw pushback in the letters column, from people saying, 'No, no, we women who have sexual desire problems, we really need help, so why are you devaluing what we’re saying about what we want?' How do you respond, and wouldn't in fact a 'pink Viagra' be a good thing if any woman could feel desire whenever she wanted to?

Yes, sure. Wouldn't it be fun? Spontaneous desire is totally fun. But what the construction of a medication for it says is that if you're not experiencing spontaneous desire, you have a disease. You're broken. We have been brought up in this culture that taught us that that's true — that spontaneous desire is the one and only healthy way to experience desire. And one of the things that hits the brakes is the belief that you are sexually broken.

So if you notice yourself not experiencing spontaneous desire, you start to criticize yourself and feel bad. And is that going to hit the accelerator? It's going to hit the brakes. So all these women who are not experiencing spontaneous desire may be experiencing responsive desire.

"It should feel like the stars have exploded into rainbows, right? And that's not what sex necessarily is."

I want to tell this story: In the Cosmo article that covered this online — it was mostly a really great article — but like most of these stories it began with the story of a woman who was experiencing low desire, desire difficulties, and she even said, 'Once we get there, it's great, everything is fine,' and I was like, 'You have just defined responsive desire! You are healthy and normal. That is not a problem. It just needs a different set of skills, and a different expectation, and not criticizing yourself for not meeting the standard that you were taught — incorrectly — to expect.'

But mightn’t there be quite a few women who are having a problem beyond just responsive desire? Their brakes are stuck or they have a medical problem?

My best estimate is about 6 percent of women have a lack of both spontaneous and responsive desire, which is nowhere near the estimate Sprout Pharmaceuticals would like you to believe..

So your overarching message is that almost certainly, you are normal in what you're experiencing, and perhaps the biggest problem is, as you write, 'your feelings about your feelings...'

Right, because we've all been taught the wrong story. We were taught we're supposed to have spontaneous desire and concordant arousal and orgasms are supposed to happen in this very specific way and feel like a particular thing — it should feel like the stars have exploded into rainbows, right? And that's not what sex necessarily is.

We got taught the wrong thing. We have this template in our heads of what sex is supposed to be like and the template is wrong. And my goal with the book is to help women to create a template for their own sexuality that is a match for who they are. Which means there’s not a gap between where you are and where you want to be. You're already who you need to be to have a satisfying sex life.

That sounds like it needs to be a very individual template. But if you were going to generalize, what would it sound like?

Sex is most satisfying for most women when you’re in a context that is low stress, high trust, high affection and explicitly erotic.

Sounds good to me.

That’s what works for most women. It's not surprising. It's not rocket science. But when you point out to women, like, 'If you're not responding sexually, is your stress level high, is your trust level low, where’s the affection in your relationship, and is it sexy yet?' Then the problem isn't you, the problem is the context, and you can influence and change a lot of things about your context.

Women have gained so much more power in the last few decades — I'd have thought women would have been able to counteract the old messages better...

Right — why has all this not moved into the mainstream more? The early research I found on arousal non-concordance and responsive desire goes back to 1980. This is not brand new science. And the last 15 years, we've gotten a lot more research because of the hunt for the pink Viagra. Ironically, what that research has shown is that there's not going to be a pink Viagra. So we understand a lot more now than we did 15 years ago, but the ideas have been emerging for a full 30 years.

What science would you most highlight among the findings of those 30 years?

The dual control model, I think, changes everything, in particular the understanding that there's not just a gas pedal, there are brakes. That it is normal to experience ambivalence around sexual desire. Something can both hit the gas pedal and the brakes at the same time. So if you want something and are having trouble getting yourself there, that's normal and natural.

And identifying the stuff that hits your brakes, and learning to change your context so you can remove those things from hitting your brakes, is a completely different approach to changing your sexual functioning from what we were taught before — the usual advice was lingerie, role play, sexy stories...

...a glass of wine...

Actually, a glass of wine is a thing that lifts the brakes — one drink is disinhibiting — which is why people give the advice of having a glass of wine. But if people are having a high level of distress then one glass of wine isn't going to be enough to make a difference. So the dual control model is, for me, the foundation of where the understanding of the new science begins.

So to simplify massively, then, actually the answer to Viagra is figuring out your brakes. If you were to do one thing that would most help female sexuality, it’s to figure out your brakes and how to lift them.

Right. I will add that there’s a drug being developed whose job, at least in principal, is to reduce the sensitivity of the brake.

How’s that looking?

Not great. Several studies have been published on it so far. If you take women who have really sensitive brakes and give them the drug or a placebo, when they’re on the drug they’ll go from having 50-percent satisfaction with a given sexual experience to having 60-percent satisfaction with a given sexual event.

Pretty marginal.

And it's a drug that you take in two doses, beginning four hours before that sexual event. And you drop testosterone onto your tongue and a couple hours later you take a pill — it's complicated.

And if you think about it, what else could you do with that time that could increase your sexual satisfaction by 10 percentage points? What if you felt really comfortable with your body? What if you felt like you had permission to take all the time your body needed to become fully aroused? What if you knew for sure that your partner just loved everything about your body? I think that’s at least 10 percentage points of increased satisfaction for a lot of women...

I would imagine that now that young people grow up with Internet porn, that messes up sexual expectations possibly even worse than in past generations?

It’s been amazing to me how many students tell me that for them, watching porn is how they learned how sex works. Because they’re too young as teenagers to make the distinction between 'This is the sex that looks compelling on camera' versus 'This is the sex that people actually have in real life.' They end up behaving sexually according to what they see instead of according to what it feels like inside of their bodies. They're doing sex according to what they believe it’s supposed to be instead of how it feels to them, what gives them pleasure.

They're very entrenched in these two cultural dialogues that we have about how much we want sex or not and how much we have sex or not. Which leaves out the whole area in between, of how much we like the sex we’re having or not. And I think it’s when we add the pleasure — noticing the sensations inside our bodies and valuing that — that the pieces begin to come together and our sexuality makes a lot more sense in our lives.

But who is there who teaches that antidote?

Well, I do....

Further listening: Emily Nagoski also spoke with host Meghna Chakrabarti on Radio Boston: