Come as You Are (56 page)

28.
 Specifically: from an average rating of 2.51 without the drug to an average of 2.98 with the drug, on a scale of 1 to 5 (van Rooij et al., “Toward Personalized Sexual Medicine [Part 3]); note that this result is statistically significant. For a thorough critique of statistics in psychological research, see Simmons, Nelson, and Simonsohn, “False-Positive Psychology.”

29.
 I choose these three examples based on the treatment group in the study. Participants were divided into two groups: those who responded to testosterone plus a standard erectile dysfunction drug (the “control group”) and those who did not (the “treatment group”). The two groups were the same in terms of age, body mass index, race (it was almost exclusively white women), menopausal status, and birth control use. The treatment group was found to be significantly different from the control group in three ways: Women in the treatment group had more children, tended to be in longer relationships, and were more than twice as likely to report a history of negative sexual experiences. The only differences between the groups were these three factors—these three
contextual
factors—of children, relationship duration, and life history.

30.
 Jozkowski et al., “Women’s Perceptions about Lubricant Use.”

seven: desire

1.
 Basson, “The Female Sexual Response.”

2.
 These numbers are estimates, not to be taken too literally; what matters isn’t the specific proportion but the reliable difference in a wide range of sexual behaviors and thoughts assessed as “desire.” I offer these figures based on research results such as the following:

• Among 225 forty-year-old Danish women, 32.4 percent reported never experiencing “spontaneous libido” (Garde and Lunde, “Female Sexual Behavior”).

• 33 percent of 1,749 women in the United States reported lack of interest in or desire for sex (Michael et al.,
Sex in America
). In the same study, 16 percent of men reported the same lack of interest in sex.

• Among a mostly college-age sample, 28 percent of women and 5 percent of men reported desiring sex once per week or less; 7 percent of women and 52 percent of men reported desiring sex at least once a day (Beck, Bozman, and Qualtrough, “The Experience of Sexual Desire”).

• 29 percent of 853 American women reported “thinking about sex with interest or desire” less than once a week in the last month; 14 percent thought about sex with interest or desire daily (Bancroft, Loftus, and Long, “Distress About Sex”).

• In a multiethnic sample of 3,248 women age forty to fifty-five, 42 percent reported feeling a desire for sex two or fewer times in the last month (Cain et al., “Sexual Functioning”); 30 percent reported desiring sex between once a week and every day.

• 30.7 percent of 3,687 Portuguese women reported that they typically or always accessed desire only once they were aroused (Carvalheira, Brotto, and Leal, “Women’s Motivations for Sex”); in this study, about 12 percent of women “often” fantasized about sex and 12 percent “very often or always” initiated sex with their partners.

• Among Norwegian and Portuguese men age eighteen to seventy-five, 74 percent presented with spontaneous desire, 2.5 percent with responsive desire, and 24 percent with what the authors call “decreased” desire (Štulhofer, Carvalheira, and Træen, “Insights from a Two-Country Study”). The sole predictive difference among the groups was “proneness to relationship-related sexual boredom,” which I speculate may be associated with sensitive SES.

3.
 Laan and Both, “What Makes Women Experience Desire?”

4.
 Hendrickx, Gijs, and Enzlin, “Prevalence Rates of Sexual Difficulties.”

5.
 Dawson and Chivers, “Gender Differences and Similarities in Sexual Desire.”

6.
 Of course, it varies from individual to individual as well. Scenario 1 might feel spontaneous for a person with a brake that is less sensitive to stress, and Scenario 3 might feel responsive for a person with an accelerator that requires more stimulation before arousal stoked from a distance finally sparks into desire. But the general process is the same for everyone. Arousal plus the right context—the right external circumstances and internal state—equals desire.

7.
 Kaplan,
Sexual Desire Disorders.

8.
 Toates,
How Sexual Desire Works
, chap. 3.

9.
 Beach, “Characteristics of Masculine ‘Sex Drive.’ ” For a brief discussion of the history of the conceptualization of sex as a drive, see Heiman and Pfaff, “Sexual Arousal and Related Concepts.”

10.
 Williams, Teasdale, Segal, and Kabat-Zinn,
The Mindful Way through Depression.

11.
 Duffey,
The Relations of the Sexes
; Foster,
The Social Emergency.
Alas, this reasoning, offered in the laudable hope that it will protect women from the sexual entitlement of men, has often swayed to the opposite extreme, advocating absolute abstinence. This is why recognizing that it’s an incentive motivation system, as natural as exploration, play, and curiosity, is so important.

12.
 Fulu et al.,
Why Do Some Men Use Violence Against Women?

13.
 Bitzer, Giraldi, and Pfaus, “Sexual Desire and Hypoactive Sexual Desire.”

14.
 For a more precise and scientific description of the little monitor (for example, that there isn’t actually a little monitor), see Carver and Scheier, “Self-Regulation of Action and Affect.”

15.
 It could also be to avoid something—these are “antigoals” and they are the targets of discrepancy enlarging, rather than reducing, feedback loops (Carver and Scheier, “Cybernetic Control Processes”).

16.
 Schwarzer and Frensch,
Personality, Human Development, and Culture
, chap. 1.

17.
 Wrosch et al., “Importance of Goal Disengagement,” 370.

18.
 Toates,
Motivational Systems.

19.
 In comparative psychology, the phenomenon of curiosity is studied as “Exploration,” per Toates,
Biological Psychology
, 404–6, or “SEEKING,” per Panksepp and Bevin,
Archaeology of Mind
, chapter 3.

20.
 Toates,
Biological Psychology.

21.
 Three of sex therapist Jack Morin’s “Four Cornerstones of Eroticism” are about discrepancy-reducing feedback loop processes—the little monitor: “longing and anticipation,” “violating prohibitions,” and “overcoming ambivalence.” Only “searching for power” isn’t specifically and immediately about this process of “closing the gap” (
The Erotic Mind 
).

22.
 There are some cases when hormones might be involved in desire issues, mostly involving medical issues. For example, some women who have double oophorectomies (removal of the ovaries) before the age of forty-five may be more likely to experience low desire. And there may be a subgroup of women—about 15 percent—whose sexual arousability is testosterone dependent, primarily while taking hormonal contraception; specifically, their sexual response mechanism may have low sensitivity to testosterone, so they require more of it before their sexual interest kicks in (Bancroft and Graham, “Varied Nature of Women’s Sexuality”).

About a third of women experience a decrease in sexual interest when they’re on the birth control pill, about a fifth of women experience an increase in their interest in sex, and the remaining half experience no particular change (Sanders et al., “A Prospective Study”). So if your interest in sex went down when you started on hormonal contraception and you’d like it to go back up, switch to a different pill, or try the ring, IUD, implant, or any other hormonal birth control method. Every woman’s body responds differently to different hormone combinations.

It has also been found that the much-touted decrease in women’s interest in sex as they age is associated with
age
itself, not with hormones (Erekson et al., “Sexual Function in Older Women”). It’s complicated, and there are exceptions of course, but a good rule of thumb is that hormones can help with genital/peripheral issues—pain, dryness, sensation, etc.—but not with brain/central issues, and desire is a brain issue (Basson, “Hormones and Sexuality”).

23.
 Brotto et al., “Predictors of Sexual Desire Disorders.”

24.
 Perel, “The Secret to Desire in a Long-Term Relationship.”

25.
 Gottman,
The Science of Trust
, p. 257.

26.
 Charles Carver has suggested that pleasure could be a signal that we can stop paying attention to one thing and shift it to something more dissatisfying (“Pleasure as a Sign”).

27.
 This idea is actually the topic of my dissertation research, which modeled, in an artificial world, how the movement of a disease through a population changed based on the relative distribution (Nagoski et al., “Risk, Individual Differences, and Environment”).

28.
 Lewandowski and Aron, “Distinguishing Arousal from Novelty.”

29.
 Ibid.

30.
 Gollwitzer and Oettingen, “Implementation Intentions.”

31.
 MacPhee, Johnson, and van Der Veer, “Low Sexual Desire in Women”—cf. Ullery, Millner, and Willingham, “Emergent Care and Treatment of Women,” and Tiefer, “Sex Therapy as a Humanistic Enterprise.”

eight: orgasm

1.
 Kinsey and colleagues (1948, 158) defined orgasm as “a sudden release which produces local spasms or more extensive or all-consuming convulsions.” Masters and Johnson’s (1966, 6) “orgasmic phase” was “those few seconds during which the vasoconcentration [constriction of blood vessels] and myotonia [muscle constriction] developed from sexual stimuli are released. This involuntary climax is reached at any level that represents maximum sexual tension increment for the particular occasion.” You’ll notice these are more inclusive than the twenty-first-century “consensus that a woman’s orgasm involves a transient peak of intense sexual pleasure associated with rhythmic contractions of the pelvic circumvaginal musculature, often with concomitant uterine and anal contractions” (Bianchi-Demicheli and Ortigue, “Toward an Understanding of Cerebral Substrates,” 2646). This “consensus” definition contradicts the research on nonconcordance and on the contextual absence of pleasure with orgasm.

2.
 Levin and Wagner, “Orgasm in Women in the Laboratory.”

3.
 Bohlen et al., “The Female Orgasm.”

4.
 Alzate, Useche, and Villegas, “Heart Rate Change.”

5.
 And there is a
lot
happening in your brain. For a review, see Georgiadis et al., “Sweetest Taboo.”

6.
 Herbenick and Fortenberry, “Exercise-Induced Orgasm.”

7.
 Levin and van Berlo, “Sexual Arousal and Orgasm.”

8.
 Research has found that approximately 30 percent of women experience nocturnal orgasm (Mah and Binik, “The Nature of Human Orgasm”).

9.
 LoPiccolo and LoPiccolo,
Handbook of Sex Therapy.

10.
 It’s also true that different parts of the brain “light up” during vaginal stimulation compared to clitoral stimulation (Komisaruk et al., “Women’s Clitoris, Vagina, and Cervix”). Different parts of your brain map onto different parts of your body. But we don’t call them “vaginal somatosensory cortex orgasms” and “clitoral somatosensory cortex orgasms.” Women with spinal cord injuries may even bypass the spine altogether and generate orgasm through stimulation of a cranial nerve that travels directly between the cervix and the brain (Komisaruk et al., “Brain Activation”). And those aren’t “cranial nerve orgasms”; they’re orgasms, no qualifier necessary. Regardless of what body parts or which brain areas are stimulated, the process is the same: Orgasm is the sudden release of sexual tension.