Forget female Viagra: This new book dismantles stubborn myths about women and sexual desire

Salon talks to Emily Nagoski about "Come As You Are: The Surprising New Science That Will Transform Your Sex Life"

Published March 6, 2015 12:00AM (EST)

Just a few weeks ago, Sprout Pharmaceuticals submitted flibanserin to the FDA for review. The so-called female desire drug had been rejected twice before, which has led some to charge sexism. Terry O'Neill of the National Organization for Women said of the FDA's repeated rejections: "I fear that it's that cultural attitude that men's sexual health is extremely important, but women's sexual health is not so important." But in an Op-Ed recently published in the New York Times, sex educator Emily Nagoski made a different argument: "The biggest problem with the drug — and with the F.D.A.’s consideration of it — is that its backers are attempting to treat something that isn’t a disease."

She wasn't just referring to the fact that hypoactive sexual desire was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders two years ago, although that is certainly of note. Nagoski was also pointing to misconceptions about what constitutes normal desire, especially in women. That misconception is that it is necessarily spontaneous, arising like a boner out of the blue. But the truth is that for many women, desire is responsive. First comes kissing or touching, and then comes sexual desire -- and that is perfectly normal. "I can’t count the number of women I’ve talked with who assume that because their desire is responsive, rather than spontaneous, they have 'low desire,'" she wrote in the Times. "That their ability to enjoy sex with their partner is meaningless if they don’t also feel a persistent urge for it; in short, that they are broken, because their desire isn’t what it’s 'supposed' to be."

The cure for that isn't a pill; it's, as Nagoski put it, "a thoughtful exploration of what creates desire between them and their partners." Luckily, Nagoski has written an entire book on that very topic, "Come as You Are: The Surprising New Science That Will Transform Your Sex Life." Lots of books -- and articles and experts -- claim to have the keys to transform your sex life. This one actually has it. It isn't as fast as taking a pill, but it will last a whole lot longer. You will find no hot new bedroom moves -- it's that deeper-level soul stuff. You know, the stuff that actually works.

I spoke with Nagoski about women's biggest sexual insecurities, generation porn and that Idaho lawmaker who doesn't know how the vagina works.

You start the book by talking about how almost all sex questions boil down to “Am I normal?” Why is that?

It took me a long time to figure what an answer to that question might be, and I don't know that I'm right, but I think when people ask, "Am I normal?" what they really want to know is, "Do I belong here? Am I doing it right? Do I get to be a part of this experience we're all having here as humans?" With a lot of other behaviors we get to see what other people are doing and we talk in much more open and trustworthy ways about what we experience, but sex is so hidden. When you finally find someone whom you can ask the question, it's just one opportunity to hear something you can trust. Am I doing this the way we're all doing it? Am I part of the herd?

I'm from the generation right before Internet porn and my students, the way they see sex happening, where they see it, is in porn. I have learned that they are doing the stuff they see in porn because that's what they see and so that's what they think you do.

What specifically are women’s biggest concerns when it comes to not being normal?

Desire, orgasm and genital response or what their genitals look like. Maybe even in that order. Desire is all over the news these days because of the whole filbaserin thing. I've been told over and over again that the most important idea in the book and my blog is the concept of "responsive desire." The science has shown increasingly for the last 20 years that spontaneous out-of-the-blue desire is totally a normal way to experience desire, but it's not the only way to experience desire. Responsive desire, which comes after arousal has begun, is also 100 percent normal. That sets lots of women free from beating themselves up for not experiencing spontaneous desire.

How common is responsive desire in women?

It's hard to know. The best estimate I can find is about a third of women experience responsive desire primarily. Almost everyone will experience both depending on the context. The traditional narrative would be you experience spontaneous desire when you're in the hot and heavy falling in love phase of your relationship because the attachment fire burning in your emotional brain is also lighting the sex fire. As you settle into a secure base of attachment that fire isn't burning as hot, so you shift into a more responsive style of experiencing desire.

In the book you talk about how for so long we've looked at female sexuality as "Men's Sexuality Lite," as you put it. Is expecting women to have spontaneous desire a result of that?

I think so. I think because the majority of men experience desire as spontaneous that's why we have the expectation to begin with that desire is supposed to come before arousal. The notion that women are supposed to just matches this entire pattern of believing that the way men work is the way women are supposed to work. One of the emails I got in response to my recent New York TImes Op-Ed was from a man who experienced responsive desire and it was just as liberating for him as it was for all the women that I've heard from.

It seems like such an uphill battle to normalize that because the idea of spontaneous desire is so engrained. If you're not feeling spontaneous desire for your partner they will feel wounded because it must mean you don't want them. How do you fight that?

Very slowly. Culture change is always slow and culture change around sex is even slower. We could have begun really creating change in the '70s when the Hite Report was published. I don't know how recently you've read "The Hite Report," but there's a lot of stuff in there that points in the direction of responsive desire. In my class, I read the definitions of normal sex from "The Hite Report" and then another from van de Velde's "Ideal Marriage" from 1926. So, one 40 years ago and one 90 years ago, and I asked them which one sounded like what they grew up learning, and hands down no contest it was the 90-year-old definition of what normal sex was. That is despite the fact that all of the science since "The Hite Report" has just increasingly reinforced what Hite's definition was. But the culture hasn't changed. I asked them how could the science be in such a different place from where the culture is and they were like, "[Sigh.] The patriarchy." The necessity of practicing social control in particular over women's sexual bodies, the imperative of that is so powerful that it keeps the brakes on social progress in a very powerful way.

While reading the book’s section on basic anatomy, I couldn’t help but think of the Idaho lawmaker who recently demonstrated his belief that women had a direct route from their mouths to their vaginas. How common are these kinds of misconceptions?

Alarmingly common. I don't actually know a number, but I teach some of the best prepared, most priveleged women who have ever walked the earth and even they during my anatomy lecture sit there with their jaws in their laps about all the things they didn't know -- not so serious as thinking that there's a link between their digestive tract and their reproductive tract. The internal stuff about the clitoris, all the stuff we have been taught about the hymen, things that should be common knowledge and taught in high school that nobody knows.

What specifically about the hymen?

Literally everything. At the end of my very first teaching at Smith, a student raised her hand and said, "What's the evolutionary origin of the hymen?" It has never even occurred to me. I looked it up -- it's just a byproduct, by the way, a leftover, it doesn't serve any reproductive purpose -- and in the process I also found that everything that I had been taught, even after 15 years as a sex educator, was wrong. The hymen doesn't break, it stretches -- and if it does break it heals. Some people have hymens, some don't. There are half a dozen kinds of hymens that you can have, all of them are normal. You can have a hymen fully intact, there is no relationship between whether or not your vagina has been penetrated and whether or not you still have a hymen.

You have something called the “dual control model” when it comes to arousal. Can you explain that?

You can tell from the name, it has two parts. If I tell you the first part is the sexual accelerator or gas pedal, what does that mean the second part is?

The brake.

Gotta be a brake, yeah. The sexual gas pedal responds to all the sexually relevant information around you -- everything you see, hear, smell, touch, taste or imagine, it interprets all that information and sends a signal that says, "Turn on." This is happening right now at a very low level in everybody's brains. At the same time that that's happening, in parallel, the brake is noticing all the reasons not to be turned on right now -- everything you see hear, smell, touch, taste or imagine, everything from you're in public sitting on the bus and it's not appropriate, to "I'm not sure I can trust my partner," to "I feel self-conscious about my body," to "I don't want to get pregnant." All those things hit the brake and send a signal that says, "Turn off." Your level of arousal at any given moment is a balance of this on and off. The process of becoming aroused is both turning on the ons and turning off the offs. For a long time, we've tried to treat sexual difficulties by trying to increase stimulation to the gas pedal, so all the advice to get a sex toy, watch some porn, put on sexy underwear. More often, sexual difficulties are caused by too much stimulation to the brake and you're better off not so much focusing on the gas pedal, which is fully functional, but taking stuff away from the brakes so that the gas pedal can do its job.

While we're talking about sexual difficulties, you wrote this Op-Ed in the New York Times about the recent flibanserin re-application and you said that the reason this continues to fail is that they're trying to treat something that isn't a problem. Is there a subset of women who do need something like "female Viagra"?

Well, not a female Viagra, not technically. Viagra is an arousal drug, which is to say it's a genital response drug. Unfortunately there's not much of a relationship between what's happening with female genitals and how aroused she feels. Whereas there's a strong relationship between what male genitals are doing and how aroused he feels. It's hard to know what the estimate is, it's probably in the 5 percent vicinity, of women who experience both lack of spontaneous desire and lack of responsive desire. If they're interested in having desire, then it'd be great if we had effective treatments. There are some: mindfulness and sex education in combination can be effective. Body-based somatic therapies can be effective. Plain old sex education is often effective, and probably therapy.

Do you think women who are interested in the idea of "female Viagra" or a female desire pill are basically not willing to accept that their sexuality is normal as it is?

Most of the women who email me, it's revelatory to understand responsive desire as a normal variation on desire. They love that they're not sick or broken and all they need to do is think through how to create a great context that allows desire to emerge. I do hear from some women who can acknowledge that responsive desire is the thing they're experiencing but cannot bring themselves to believe that what they're experiencing is a normal, healthy thing that is worth experiencing. They just are totally invested in the idea that spontaneous desire is the only way that they can feel normal. That's a cultural belief that is deeply entrenched.

If you try on the possibility that responsive desire is normal and healthy and you don't need to be experiencing spontaneous desire, if you could just for a second try it on, what would it be like? What would happen next? What would it be like for you to be a sexual person, who would you be? You would not be the sexual person that you imagine yourself being, this sort of phantom sexual self that you have in mind and that you want a drug to help you achieve, you'd be a different sexual person. You would be the sexual person that you actually are. I say over and over in the book: confidence and joy, confidence and joy. I never really get specific, but for me, confidence comes from knowing what's true about your body, which might be responsive desire, and joy comes from loving what's true. I think the loving is actually more difficult for some people, recognizing that your sexuality may never be the thing you were taught it was supposed to be and believing that what your body actually is is totally acceptable and is in fact better than the lie you were told.

What is your best sex advice for women?

Enjoy the sex you are having. As a culture we talk about how much sex you desire or not and how much sex you have or not. We don't talk about how much sex you're enjoying. What does it feel like? Pleasure is not simple. It's about creating a context that allows pleasure to emerge. When pleasure is your focus instead of specific behaviors, the other pieces begin to assemble themselves on their own.

By Tracy Clark-Flory

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Books Emily Nagoski Fda Female Sexual Dysfunction Sex