Come As You Are: The Surprising New Science That Will Transform Your Sex Life

by Emily Nagoski

A woman can be perfectly normal and healthy and experience “arousal nonconcordance,” where the behavior of her genitals (being wet or dry) may not match her mental experience (feeling turned on or not).

A woman can be perfectly normal and healthy and never experience spontaneous sexual desire. Instead, she may experience “responsive” desire, in which her desire emerges only in a highly erotic context.

In the last decade of the twentieth century, researchers Erick Janssen and John Bancroft at the Kinsey Institute for Research in Sex, Gender, and Reproduction developed a model of human sexual response that provides an organizing principle for understanding the true story of sex. According to their “dual control model,” the sexual response mechanism in our brains consists of a pair of universal components—a sexual accelerator and sexual brakes—and those components respond to broad categories of sexual stimuli—including genital sensations, visual stimulation, and emotional context. And the sensitivity of each component varies from person to person. The result is that sexual arousal, desire, and orgasm are nearly universal experiences, but when and how we experience them depends largely on the sensitivities of our “brakes” and “accelerator” and on the kinds of stimulation they’re given.

If you look closely at a scrotum, you’ll notice a seam running up the center—the scrotal raphe. That’s where the scrotum would have split into labia if the chemistry or chromosomes had been a little bit different.

It is your Grand Central Station of erotic sensation. Averaging just one-eighth the size of a penis yet loaded with nearly double the nerve endings, it can range in size from a barely visible pea to a fair-sized gherkin, or anywhere in between, and it’s all normal, all beautiful. Unlike the penis, the clitoris’s only job is sensation.

The cultural understanding of clitoris is “the little nub at the top of the vulva.” But the biological understanding of clitoris is more like “far-ranging mostly internal anatomical structure with a head emerging at the top of the vulva.”

The clitoral hood covers the head of the clitoris, as its homologue, the foreskin, covers the head of the penis. And the male frenulum—the “Y-spot” near the glans, where the foreskin attaches to the shaft—is the homologue of the female fourchette (the French word for “fork”), the curve of tissue on the lower edge of the vagina. This is a highly sensitive and undervalued piece of real estate on all bodies.

You may or may not have a hymen—a thin membrane along the lower edge of your vaginal opening. Whether you have one or not, I guarantee that virtually everything you were taught about the hymen is wrong.5 The closest thing to true is that during intercourse the hymen can be painful if it’s not used to being stretched—that’s one of a number of potential causes of pain with penetration, but it is by no means the most common. (The most common is lack of lubrication.) But the hymen doesn’t break and stay broken forever, like some kind of freshness seal. If a hymen tears or bruises, it heals. And the size of a hymen doesn’t vary depending on whether the vagina has been penetrated.6 Also, it usually doesn’t bleed. Any blood with first penetration is more likely due to general vaginal tearing from lack of lubrication than to damage to the hymen. What does change when a woman begins having the hymen stretched regularly is that it grows more flexible. And as hormones change with the end of adolescence (around twenty-five years old), the hymen is likely to atrophy and become much less noticeable—if it was noticeable at all. The hymen is another example of the wide variability in female genitals. Some of us are born without hymens. Others have imperforate hymens (a thin but solid membrane covering all of the vaginal opening) or microperforate hymens (many tiny holes in an otherwise solid membrane). Some have septate hymens, which feel like a strand of skin stretching across the vagina...

One more thing about genitals: The name for the whole package of female external genitalia is “vulva.” “Vagina” refers to the internal reproductive canal that leads up to the uterus. People often use “vagina” to refer to the vulva, but now you know better. And if you are standing up naked in front of a mirror and you see the classic triangle? That’s your mons (“mound”), or mons pubis.

Why do we talk about penises “getting hard” and vaginas “getting wet,” when from a biological perspective both male and female genitals get both hard and wet? It’s a cultural thing again. Male “hardness” (erection) is a necessary prerequisite for intercourse, and “wetness” is taken to be an indication that a body is “ready” for intercourse (though in chapter 6, we’ll see how wrong this can be). Since intercourse is assumed to be the center of the sexual universe, we’ve metaphorized male hardness and female wetness as the Ultimate Indicators of Arousal.

Your genital secretions are probably different at different phases in your menstrual cycle, and they change as you age, and they change with your diet—women vary.

People whose genitals are “somewhere in between” experienced some slight variation in the hugely complex cascade of biochemical events involved in the growth of a fetus, from egg fertilization through embryonic development and gestation. This small change results in slightly different genitals in about one in sixty newborns.10 There’s nothing wrong with their genitals any more than there’s anything wrong with a person whose labia are uniquely large or small.11 It’s still all the same parts, just organized in a different way.

Get a hand mirror and look at your vulva, as I described earlier in the chapter. (Sometimes people use their cell phone with the camera in self-portrait mode. That works, too!) As you look, make note of all the things you like about what you see. Write them down. You’ll notice that your brain tries to list all the things you don’t like, but don’t include those. Do it again every week. Or twice a week. Or more. Each time, the things you like will become a little more salient and the noise will get a little quieter. Maybe even consider telling someone else about what you see and what you like. Better still, tell someone who also did the exercise! This activity gets labeled “cognitive dissonance” because it forces us to be aware of good things, when mostly we tend to be aware of the “negative” things. Try it.

If you’re having trouble with any phase of sexual response, is it because there’s not enough stimulation to the accelerator? Or is there too much stimulation to the brakes? Indeed, a common mistake made by people who are struggling with orgasm or desire is assuming that the problem is a lack of accelerator; it’s more likely that the problem is too much brakes (more on that in chapters 7 and 8). And once you know whether it’s a problem with the accelerator or the brakes, you can figure out how to create change.

Sensitive brakes, regardless of the accelerator, is the strongest predictor of sexual problems of all kinds.

Similarly, you learn the sexual language you’re surrounded by. Just as there are no innate words, there appear to be almost no innate sexual stimuli. What turns us on (or off) is learned from culture, in much the same way children learn vocabulary and accents from culture.

Now imagine you’re a sex educator, armed with the dual control model to help people understand how their sexuality works. People ask you frustrated questions, dissatisfied with their sexual response mechanism—it doesn’t behave the way they want or expect it to, and they want to change it. So can we change it? The answer has two parts, both equally important. First, accelerator and brakes are traits you’re born with that remain more or less stable over time, and so far the only variable that seems to impact either is partner characteristics (see chapter 3).15 In general, though, it seems there’s very little we can do to deliberately change the mechanism in your brain. And anyway, the sensitivities of most people’s accelerator and brakes are “medium”—neither overly sensitive nor problematically insensitive. Changing the accelerator and brakes if you’re medium isn’t even desirable. But then there’s the second part of the answer: You may not be able to change the mechanism itself, but you probably can change what the mechanism responds to. You can often change what your brakes consider a potential threat, and you can reduce those threats, like unwanted pregnancy, STIs, stress, etc. You also can change what your accelerator considers sex-related, and you can increase the sex-related things in your life. In other words, you can change the context—your external circumstances and your internal state. The why and how of these changes is the main topic of the next three chapters, bu...

In their survey research on “cues for sexual desire factors,” Katie McCall and Cindy Meston asked women what turned them on, and found that the results divided into four general categories.2

Love/Emotional Bonding Cues,

Explicit/Erotic Cues,

Visual/Proximity Cues,

And she added, “That, and grooming. A man with pristine white cuffs is a man whose skin will taste good.”

gotdamn

Romantic/Implicit Cues

In a series of nine focus groups with eighty women, Cynthia Graham, Stephanie Sanders, Robin Milhausen, and Kimberly McBride cataloged women’s thoughts on things that cause them to turn on or to “keep the brakes on.”3 These researchers found themes that have interesting parallels with McCall and Meston’s work. Here are the themes, with a quote from the research participants to illustrate each: Feelings About One’s Body. “It’s much easier for me to feel aroused when I’m feeling really comfortable with myself… it’s not as easy to feel aroused when I’m not feeling good about myself and my body.” Concerns About Reputation. “Being single and you know, wanting to be sexual with another person and thinking ‘okay, am I going to be too much?’ or ‘am I going to be not enough?’ or ‘what are they going to think of me because I’m doing these things?’…” Putting on the Brakes. “I think it’s like you might have some inclinations and then you’re like, ‘wait a minute, you can’t do that,’ you’re in a relationship or that guy’s a loser… and all of a sudden you just [think] ‘okay, fine, forget it, I can’t. That’s a bad idea,’ and just walk away from it.” Unwanted Pregnancy/Contraception. “Unwanted pregnancy is a big turn off and if you’re with a partner who seems unconcerned about that, then it really feels like a danger.” Feeling Desired Versus Feeling Used by Partner. “I like it when [men] caress not only, like, your body parts that get sexually aroused but just, like, your arms… it feels li...

Context is made of two things: the circumstances of the present moment—whom you’re with, where you are, whether the situation is novel or familiar, risky or safe, etc.—and your brain state in the present moment—whether you’re relaxed or stressed, trusting or not, loving or not, right now, in this moment. The evidence is mounting that women’s sexual response is more sensitive than men’s to context, including mood and relationship factors, and women vary more from each other in how much such factors influence their sexual response.6

Suppose you’re flirting with a certain special someone, and they start tickling you. You can imagine some situations where that’s fun, right? Flirtatious. Potentially leading to some nookie. Now imagine that you are feeling annoyed with that same special someone and they try to tickle you. It feels irritating, right? Like maybe you’d want to punch that person in the face. It’s the same sensation, but because the context is different, your perception of that sensation is different.

These changes in perception are not “just in your head.” People who are given a drug that will relax them and are told, “This is a drug that will relax you,” not only feel more relaxed compared to those who got the drug but not the information, they also have more of the drug in their blood plasma.11 Context changes more than how you feel; it can change your blood chemistry.

Learning to recognize the contexts that increase your brain’s perception of the world as a sexy place, and having skills to maximize the sexy contexts, is key to increasing your sexual satisfaction. At the end of this chapter, you’ll find worksheets to help you think through what aspects of context influence your perception of sensations. On those worksheets, you’ll recall three amazing sexual experiences you’ve had and three not-so-great sexual experiences, and think concretely and specifically about what made those experiences what they were, in terms of both external circumstances and your internal state. Do take the time to do this. Thinking through even just one amazing experience and one not-so-great experience can give you a sense of which contexts increase your brain’s tendency to interpret the world as sexy and which reduce that tendency.

Painful or Erotic? If your partner spanks your butt while you’re in the middle of tying your toddler’s shoes, it’s annoying. But if your partner spanks your butt in the middle of sex, it can feel very, very sexy indeed. Context can cause sensations that are typically perceived as painful, like spanking or whipping, to be erotic. Sexual “submission” requires relaxing into trust—turning off the offs—and allowing your partner to take control. In this explicitly erotic, highly trusting, and consensual context, your brain is open and receptive, ready to interpret any and all sensations as erotic. And in a culture where women have to spend so much time with the brakes on, saying no, it’s no wonder we have fantasies about abandoning all control, relaxing into absolute trust (turning off the brakes), and allowing ourselves to experience sensation.

“Context changes how your brain responds to sex” doesn’t just mean “Set the mood,” like with candles, corsets, and a locked bedroom door. It also means that when you’re in a great sex-positive context, almost everything can activate your curious “What’s this?” desirous approach to sex. And when you’re in a not-so-great context—either external circumstances or internal brain state—it doesn’t matter how sexy your partner is, how much you love them, or how fancy your underwear is, almost nothing will activate that curious, appreciative, desirous experience.

Exactly what context a woman experiences as sex positive varies both from woman to woman and also across a woman’s life span, but generally it’s a context that’s low stress high affection explicitly erotic

Your stress is the system of changes activated in your brain and body in response to those stressors. It’s an evolutionarily adaptive mechanism that allows you to respond to perceived threats. Or it was evolutionarily adaptive, back when our stressors had claws and teeth and could run thirty miles per hour. These days we are almost never chased by lions, and yet our body’s response to, say, an incompetent boss is largely the same as it would be to a lion. Your physiology doesn’t differentiate much.

Unrelated, but this could be an interesting idea for a story - a story about the burgeoning adoption of body modification technology that provides people with bodies that are optimally adapted to the experiences/challenges of the current day

Our culture is so uncomfortable with Feels that we may even sedate people who’ve just been in a car accident, preventing their bodies from moving through this natural process; this well-intentioned medical intervention has the unwanted consequence of holding survivors of traumatic injury in freeze, which is how PTSD gets a foothold in a survivor’s brain.5

Physical activity is the most efficient strategy for completing the stress response cycle and recalibrating your central nervous system into a calm state.

Here are some other things that science says can genuinely help us not only “feel better” but actually facilitate the completion of the stress response cycle: sleep; affection (more on that later in the chapter); any form of meditation, including mindfulness, yoga, tai chi, body scans, etc.; and allowing yourself a good old cry or primal scream—though you have to be careful with this one. Sometimes people just wallow in their stress when they cry, rather than allowing the tears to wash away the stress. If you’ve ever locked yourself in your room and sobbed for ten minutes, and then at the end heaved a great big sigh and felt tremendously relieved, you’ve felt how it can move you from “I am at risk” to “I am safe.” Art, used in the same way, can help. When mental health professionals suggest journaling or other expressive self-care, they don’t mean that the construction of sentences or the task of drawing is inherently therapeutic; rather, they’re encouraging you to find positive contexts to discharge your stress, through the creative process. I’m inclined to add grooming and other body self-care to the list. Though I’m not familiar with any specific research on it, I’ve talked with lots of women for whom showering and the rituals, part social, part meditative, of painting their nails or doing their hair or putting on makeup—generally “getting ready” to go out (or stay in)—fully transition them from a stressed-out state of mind to a warm, social state of mind. These anecdot...

Indeed, research has found that nearly everyone experiences some form of intrusive or unwanted thoughts sometimes, and about a third of people with OCD specifically have sexual intrusions. It’s anxiety manifesting as all the things we’ve been taught to fear about sex.9 And effective interventions exist. A quick internet search will offer a number of different approaches that generally involve gradually reducing the level of anxiety people feel in response to the thoughts, which in turn reduces the frequency, intensity, and perceived importance of those thoughts. If you have unwanted, intrusive, or obsessive sexual thoughts, know that you can disclose them to a qualified therapist and get evidence-based treatment.

Trauma results when a person has control over her body taken from her, she freezes, and then she can’t unlock. Whether the cause is a car accident or sexual violence, the survival mechanism kicks in: freeze, the petrified shutdown characterized by numbness and sometimes tonic immobility (paralysis) or a sense of disembodiment. Some people describe it as “going into shock.” This is the life-threat stress response, activated when your brain decides you can’t escape a stressor, nor can you fight it. It’s reserved for the most dangerous and violent contexts.

Sexual violence often doesn’t look like “violence” as we usually imagine it—only rarely is there a gun or knife; often there isn’t even “aggression” as we typically think of it. There is coercion and the removal of the targeted person’s choice about what will happen next. Survivors don’t “fight” because the threat is too immediate and inescapable; their bodies choose “freeze” because it’s the stress response that maximizes the chances of staying alive… or of dying without pain.

Each person’s experience of survival is unique, but it often includes a kind of disengaged unreality. And afterward, that illusion of unreality gradually degrades, disintegrating under the weight of physical existence and burdened memory. The tentative recognition that this thing has actually happened incrementally unlocks the panic and rage that couldn’t find their way to the surface before, buried as they were under the overmastering mandate to survive. But survival is not recovery; survival happens automatically, sometimes even against the survivor’s will. Recovery requires an environment of relative security and the ability to separate the physiology of freeze from the experience of fear, so that the panic and the rage can discharge, completing their cycles at last.

Relatively few men—the research indicates only about 5 percent—perpetrate the overwhelming majority of assaults,12

Sideways: Mindfulness. Perhaps the gentlest approach is the most indirect. Without ever addressing the trauma directly, you can simply begin practicing mindfulness, and gradually the trauma will work its way out, like shrapnel from an old wound. There are spectacular books on the practice of mindfulness. One of my favorites is The Mindful Way through Depression by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn. Don’t let the “through depression” part throw you; it’s a practical guide to managing any uncomfortable emotional experience. Here’s the short version of how to practice mindfulness: Start with two minutes. For two minutes a day, direct your attention to your breath: the way the air comes into your body and your chest and belly expand, and the way the breath leaves your body and your chest and belly deflate. The first thing that will happen is your mind will wander to something else. That’s normal. That’s healthy. That’s actually the point. Notice that your mind wandered, let those extraneous thoughts go—you can return to them as soon as the two minutes are up—and allow your attention to return to your breath. Noticing that your mind wandered and then returning your attention to your breath is the real work of mindfulness. It’s not so much about paying attention to your breath as it is about noticing what you’re paying attention to without judgment, and making a choice about whether you want to pay attention to it. What you’re “mindful” of is both yo...

The bad news is that, yes, most of us will find it easier to crave sex, for what that’s worth, when our relationships are unstable—either new or threatened, whether in reality or imagination. But the second good news is that there’s a bunch of spectacular research on people who have great sex over multiple decades. The key is to be “just safe enough.” I’ll talk about that research in chapter 7,

This sounds like 'mating in captivity' by esther perel

injury. You can’t choose for your broken heart not to hurt, any more than you can choose for a broken bone not to hurt. But you can recognize the pain as part of the healing, and you can trust your heart to heal, just as you trust your bones to heal, knowing that it will gradually hurt less and less as you recover.

Time heals all wounds

And, of course, this contradiction is more pronounced for women, who are the culturally sanctioned “managers of relationships.” When the going gets tough in a heterosexual relationship, it often falls to the woman to rein in her own stress response, in order to create space for the man to feel his Feels. In other words, if there is stress in a relationship, cultural rules make it likely to impact the woman more than the man, and it’s likely to impact her sexual interest and response. And because she has to hold on to her stress, so that her partner can let his go, she is more likely to become stuck in her stress, while he moves through his.

Students laugh like I made a joke when I ask, “What would happen if you met your friends at dinner and said, ‘I feel so beautiful today!’?” “Really, what would happen?” I insist. “No one would do that,” they tell me. “But… how often would someone meet friends at dinner and say, ‘I feel so fat today’?” “All the time,” they say. All the time.3 Women have cultural permission to criticize ourselves, but we are punished if we praise ourselves, if we dare to say that we like ourselves the way we are.4

I don’t think anyone will be surprised to hear that feeling good about your body improves your sex life. It’s obvious once you think about it, right? Just imagine having sex if you feel insecure and unattractive. How would it feel to have a person you care about touching you and looking at you, when the thought of your own body makes you uncomfortable? Would you pay attention to the sensations in your body and your partner’s—or would you pay attention to all the things you feel compelled to hide?

Self-criticism is associated with worse health outcomes, both mental and physical, and more loneliness.12 That’s right: Self-criticism is one of the best predictors of loneliness—so it’s not just “I am at risk,” it’s also “I am lost.”

But then, when women start to think concretely about it, they begin to discover a sense that they need their self-criticism in order to stay motivated. We believe it does us good to torture ourselves, at least a little bit. As in: “If I stop beating myself up for the ways I’m not perfect, that’s like admitting to the world—and to myself—that I’ll never be perfect, that I’m permanently inadequate! I need my self-criticism in order to maintain hope and to motivate myself to get better.”

Weight is just one of several things people (especially women) criticize themselves for, but it may be the most universal, with half of girls as young as three years old worrying that they might be “fat”13—and it’s certainly among the most dangerous and needless.

Self-compassion is the opposite of self-criticism and self-judgment. In her book Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind, researcher and educator Kristin Neff describes self-compassion’s three key elements: Self-kindness is our ability to treat ourselves gently and with caring. On the Self Compassion Scale (SCS), a survey used to assess self-compassion, self-kindness is described with items like “When I’m going through a very hard time, I give myself the caring and tenderness I need.” In contrast, its opposite, self-judgment, is assessed with “I’m intolerant and impatient towards those aspects of my personality I don’t like.” Common humanity is viewing our suffering as something that connects us with others, rather than separates us. It’s assessed on the SCS with items like “When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are shared by most people.” Its opposite, isolation, is assessed with “When I fail at something that’s important to me, I tend to feel alone in my failure.” Mindfulness is being nonjudgmental about whatever is happening in the present moment. I talked about mindfulness in chapter 4, and I’ll be talking about it again in chapter 9. Mindfulness is important. On the SCS it’s assessed with items like “When something painful happens I try to take a balanced view of the situation.” Its opposite is over-identification, as in over-identifying with your own failures and suffering, holding fast to...