Tag: desire

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Why I Still Recommend Come As You Are in 2024

I first read Emily Nagoski’s Come As You Are in 2016, according to my Goodreads account. And I’ve been meaning to write a review ever since.

And there’s a reason for that.

You see, seven-plus years is a loooong time on the Internet, a little less so outside of it. However, I have continually recommended Come As You Are (CAYA), here (her name is even a tag on this blog!), in person, on Reddit, and to fellow classmates, among others. I’ve referenced it for work and school. It’s become something of a holy text for sexual desire, and I’m not the only person for whom this is true.

Emily Nagoski changed the landscape when she wrote this approachable book breaking down the ways that sexual desire works–and sometimes seems not to. That’s not hyperbole, either. This book brought the idea of responsive desire and the dual-control system of sexual desire from the white tower of academia to the hands of the people. You’ll find countless articles about this, sometimes by me, everywhere from NPR to Men’s Health. And it’s due in no small part to Nagoski’s work in translating the existing research into more accessible language, including plenty of helpful metaphors.

Come As You Are

That popularity is exactly why I never got around to writing a review. There is no lack of praise for CAYA. Researchers, therapists, book reviewers, bloggers–we all loved it. It became a New York Times Bestseller, after all. So I didn’t see a need to do more than rate it on Goodreads when others had already covered it by the time I got around to reading it 18 months after it came out (and after I wondered how it compared to a different book).

Most important, however, was how the book resonated with readers, the real people whose lives could be improved by the knowledge in those pages. Those people were mainly women because that is the audience Nagoski targeted because of how this information about libido impacts women.

Reading Come As You Are is like having a lightbulb moment simultaneously combined with a warm hug that says, “You are not broken. You are wonderful and loveable just the way you are.” Instead of understanding the natural sciences like you would in an experiment, you better understand your and/or your partner’s desire–or lack thereof. It was much needed.

For so long, people who couldn’t muster desire for their partners despite having great relationships and feeling attraction for them or those who just couldn’t get horny as quickly as society (and partners) expected were told they were broken (while using these so-called shortcomings to sell all sorts of potentially dangerous or unnecessary products). Women were seen as the problem. CAYA flipped the script. By providing information about the intricacies of desire and acceptance of different types of desire, Nagoski helped people understand what might be getting in the way of a more satisfying sex life. She pointed out that societal expectations made people miserable, even when they enjoyed themselves.

Emily Nagoski gave people a new approach to something that legitimately concerned them but had never been resolved by the age-old advice to try something new or spice up their sex life. She offered hope.

If any of this sounds like it might help you, then I wholeheartedly recommend Come As You Are. It’s not just for straight women in relationships with a desire discrepancy. Almost anyone can benefit from reading this book, regardless of gender, orientation, relationship status, or desire level. In fact, I think one of the biggest disservice some people do to this book is overlook how it applies to men, a demographic whose sexual desire is universally assumed to be automatic and, well, simple. If they read CAYA, they’d see otherwise.

And all of this is because the author took a journey to understand her own struggles with sexual desire and brought us all along with her (which certainly added to the book’s approachable nature).

In 2021, just six years after the initial printing, Nagoski revised CAYA. But the original remains as relevant and helpful in 2024 as it did in 2015. No revisions were necessary, even if they were appreciated. But you might as well buy the revised version if you think there’s something to learn. Keep it on your bookshelf or Kindle. Highlight passages or add bookmarks. Pass it around to friends. Read it for book club. It’s worth it still.

I write this shortly after reading Nagoski’s most recent book, Come Together. This newest work, while still aimed more at women readers, tackles sexuality issues as couples—and especially long-term couples—experience them. It starts with the premise that understanding how your desire works can change your life. But it may not always be enough to summit the mountain created by other issues. Instead, Come Together instructs readers to look past desire and focus on pleasure with some practical tips for doing exactly that.

Come Together is a natural sequel to Come As You Are in many ways, and if there were an instance where I wouldn’t recommend Nagoski’s first book, it would be if they already had but needed more. This book fills that need.

And, hey, maybe neither of these books meets any of the needs you’ll ever have (although I doubt it). In that case, I can’t recommend them to you. If so, you’re already doing better than most people, so consider yourself incredibly lucky. But if you ever find yourself joining the rest of humanity with at least occasional sexual issues, these books will be there for you.

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Books Reviews

What Do Women Want?: Adventures in the Science of Female Desire

What Do Women Want?: Adventures in the Science of Female Desire
$15.99 from Bookshop.org

 

Although I meant to sit down to write this review months ago, I’ve actually done it in far less time than it took to actually read this book since placing it on my to-read list (which badly needs and update). In fact, that delay contributes largely to my review as you’ll see when you keep reading…

The field of sex research is an interesting one. Because it was for so long viewed as inappropriate or unimportant, it has lagged behind other fields. This simultaneously means that we missed out on opportunities to learn about sexuality, and now that sex research is well underway, it’s happening at a rapid-fire pace. The downside of this frenzy of activity is that research or publications about research can quickly become dated, even painfully so. This doesn’t bode with for Daniel Bergner’s book What Do Women Want?

Published in 2013, this book isn’t quite a decade old. Yet, I was shocked at how unfamiliar I was with some of the researchers Bergner interviewed or cited aside from Lori Brotto. Some of the names I know indirectly because they’ve been cited by researchers with whom I am familiar. As I read this book, it almost seemed to focus on a different generation of researchers–and thus their research–than the articles, books, and podcasts I’ve consumed about sexuality over the last decade. Without more recent research, What Do Women Want? seems lacking.

Although I hesitate to say it, I think a project of this nature might have been overly ambitious, given the state of research in 2013. Of course, hindsight is 20/20, but Bergner’s book just doesn’t stand on its own two feet. Because the author’s ultimate point is that, yet, women do want to have sex and not necessarily in relationships. Yet that hardly seems groundbreaking or all that helpful, at least in 2022 2023.

After finishing the book, I was left wondering, “So what?” What are readers supposed to do with this argument, even if it’s the first time they’ve considered it (and I concede that this book might have been more revelatory when it was first published). There’s no thoughtful analysis about why we’ve come to a place where we believe women aren’t interested in sex, or women may not feel comfortable expressing that interest, let alone suggestions about what to do with this information. If women want to have sex, how do we get them there? Of course,  the answers to these questions are inextricably related.

Rest assured that plenty of researchers and sex educators, often women, have discussed both the causes and potential solutions. They’re written ad nauseam about how society slut-shames women, how sex education has failed us, and how we prioritize men’s pleasure over women’s to such an extent that we view women’s sexuality as lesser than men’s to the extent that we have pathologized it and normalized misogyny and rape culture.

And, you guessed it, all those things contribute to women’s inability to speak up about their desires and get what they want. Advocating for our sexuality can seem a losing battle when the sex we wind up having, the very sex that’s accepted as “normal,” is so subpar that we’d rather do literally anything else.

Of course, understanding these causes directly suggests what we need to do to improve the situation and both Emily Nagoski and Lori Brotto have written useful and timeless books that touch on ways women can improve their sex lives–from desire to orgasm. I’m talking about Come As You Are and Better Sex Through Mindfulness, respectively. Even Peggy Kleinpart’z Magnificent Sex, which is written less for the lay reader, offers more actionable advice.

But Bergner doesn’t touch on any of this. He only cherry-picks data that indicates women want more sex than they’re having or are willing to admit. While I think that’s ultimately true, it doesn’t make for a riveting book in the 2020s. It feels like I picked up a dusty relic, and I wouldn’t be surprised if it became forgotten as so many books do.

Perhaps that’s to be expected. Bergner, as both an author and journalist, doesn’t focus on sexuality–or even health. His choice of research and argument might reflect a base unfamiliarity with the topic, and this might still be true for many readers, even in 2023.

Emily Nagoski once replied to me on Twitter, saying that she and Bergner used much of the same research but came to different conclusions. I am not sure that’s entirely accurate. The two authors stopped their research at different points, which is why Bergner’s conclusion in this book is where the conversation should really begin, not end. It’s why this book didn’t knock my socks off and likely would be frustrating for anyone who wants to better understand their sexuality or that of their women partners.

Fortunately, other books have done both of those things, and there are many more options since this one hit the shelves. That leaves What Do Women Want? for those who are more interested in research that affirms women’s desire or learning about how sex research has changed through the ages, and an actual textbook (Justin Lehmiller’s Psychology of Human Sexuality comes to mind) inevitably does it better.

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Books

Not Always in the Mood: The New Science of Men, Sex, and Relationships

Not Always in the Mood: The New Science of Men, Sex, and Relationships
$15 from Amazon

Sex and science are my butter and bread. I think my readers know this already. Though, I have sadly fallen behind on Science of Sex posts.

Still, don’t fear! Because I’m here to talk to you about an entire book about science and sex, and one that aims to examine something that we take for granted: male sexual desire.

In Not Always in the Mood, author Sarah Hunter Murray relies on her experience as a couples’ sexual therapist to delve into the complexities of male sexual desire and bring a more nuanced look of the subject — mostly.

This is a caveat that I need to address and early on. In her work, Murray works with couples. She specifically mentions men in their 30s through 60s. While it’s a pretty wide range, these men are presumably in relationships, and she doesn’t mention men in their 20s at all. I think the title and tone of this book suggest all men, but there’s clearly a large swath of them who are left out. And while it can be reassuring to learn that, yes, men are human, too, and their desire reflects that, not explicitly stating who she talked to for this book may lead some readers astray. Men who are younger or prefer casual sex over relationships might differ from the men who Murray talked to. Namely, they may not be as invested in their partner’s emotional and physical satisfaction. If those partners think this information applies to those men, I can see them being let down.

In short? This book might better be subtitled “The New Science of Some Men, Sex, and Relationships.” I wish that were explicit.

In her book, Sarah Hunter Murray tackles common myths about men, sexuality, and desire. As the reader dives in, they’ll see that Murray’s research is qualitative and not quantitative. She crafts amalgamated stories from her past clients and sometimes uses quotes. It’s helpful to know when sentiment has been frequently expressed by her clients. For example, they want their partners to initiate sex more often or sometimes find their desire has waned for no discernible reason.

But I cannot help but wonder if it would often be even more useful to see some hard numbers along with this qualitative evidence. Murray’s research almost seems incomplete without that. Right now, Not Always in the Mood is interesting and helpful to a select group of people, but it doesn’t feel groundbreaking. It’s reassuring. It might spark some conversations. But it’s all sort of common sense.

With that said, we all know that common sense isn’t always that common. Maybe too many buy into the beliefs that men always want sex or measure masculinity by the strength of an erection. These reminders are useful. I can imagine scenarios where I would recommend this book. It’s certainly cheaper than therapy. And once people start viewing male desire with more nuance, they may spread that knowledge to others: partners, friends, even children.

Not Always In the Mood isn’t the perfect book for everyone, however. Despite a disclaimer that it can be useful to those who aren’t straight or cisgender in the beginning of the book, it’s really heternormative. I would hesitate to recommend it to anyone who isn’t straight or cis.

Furthermore, while the author mentions some sexual research, she never really uses scientific terminology, the type which I have discussed on this blog in the past, that might tie her research into existing research on sex and relationships. In several instances, it would have been worth mentioning and comprising spontaneous and responsive desire by name, yet Murray did not. The dual-control method would have fit right in, too. In fact, she did mention Emily Nagoski, whose book Come As you Are, discusses both topics. It would have been a great way to show the similarities, between men and women to hammer home the idea of men as being just as complex and human as women, but this book never reached that point. Perhaps Murray thought the concepts weren’t basic enough for her readers. Or maybe she wasn’t personally familiar with them.

I don’t feel like I am worse off for reading Not Always in the Mood, but it may not be the ideal book for me, a lover of science who has mostly casually sleep with men in their 20s. I would love to have seen some statements made that applied to men more generally, coupled up or not. Quantitative evidence would give this book an edge, too. On the other hand, maybe I just wish it had a different subtitle. For example..

Not Always in the Mood: The Truth About Men’s Desire in Relationships

Okay, so it’s a work in progress. But it’s a bit less misleading.

I know I’ve gone on about this at some length, but I think that these things matter. Had this book simply suggested it was about lessons on male desire from the POV of a couples’ therapist, I would have had different expectations.

Frankly, that angle is precisely what the reader gets, and it’s valuable. Sure, the idea that men want to be wanted, too, have hangups about their penis size or looks, or that their desire is impacted by stress might be common sense if you stop to think about it, but people don’t think about these things as much as they should. We can use another authoritative voice speaking on these things.

Sarah Hunter Murray might yet come to be that authority, but I don’t think she quite proves it in Not Always in the Mood: The New Science of Men, Sex, and Relationships. This may not prevent the book from helping some people, but it may not help as many people as it could if Murray had taken a different approach.

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Science of Sex

Science of Sex: Using Drugs to Raise Women’s Libido

Raising Women's Sex Drive with Medication

This month’s Science of Sex post comes on the heels of an announcement that the FDA has approved the second drug that intended’s to treat women with low libido, also known as hypoactive sexual desire disorder and which you might remember is one of several types of female sexual dysfunction.  The new medication, called Vyleesi, works differently than the previously-released Addyi. In both cases, however, the efficacy and methods of the drugs leave us with more questions than answers.

Vyleesi binds to melanocortin receptors in the brain. Although researchers aren’t sure why that would lead to increased libido because those receptors deal with pain and food intake among other functions. The current theory is that this helps to increase dopamine. Dopamine is a chemical that functions as a hormone in the body and a neurotransmitter in the brain, sending signals to other cells. Of the dopamine pathways in the brain, one is associated with the reward center. The association with pleasure is why dopamine plays a role in addition. It also helps to regular attention, emotional response, movement, and learning.

This drug may force the brain to process erotic stimulation as rewarding, which boosts libido. Because this happens immediately, Vyleesi only needs to be taken before sexual activity and not every day like Addyi, which has been around for several years but hasn’t performed well commercially.

Furthermore, Addyi works on another brain receptor to block serotonin, a neurotransmitter that contributes to feelings of happiness among many other functions. Serotonin plays a role in reward systems and too much can dampen libido as well as curb dopamine. Taken daily, Addyi can reduce serotonin

Both drugs have their risks. Because low serotonin levels are associated with depression, Addyi may be a poor fit with women who struggle from depression. It may be negated by SSRIs, which mitigate depression by boosting serotonin levels in the body but often reduce sex drive. The drug also comes with side effects such as dizziness and “sedation.” It shouldn’t be used with alcohol.

While Vyleesi isn’t taken daily and can be used with alcohol, which might mitigate some risks, users will face a tighter schedule. The drug can be used once daily, up to eight times a month. Boosting libido twice a week is better than the one additional sack session prompted by Addyi over placebo during clinical trials, but Vyleesi comes as an injection while Addyi is a pill. Furthermore, Vyleesi’s side effects include nausea, which affected 40% of women who took it, mostly after the first injection. A small number of participants experienced changes in skin color that remained even after they stopped the drug. Consider that 90% of participants remained in the trial, however.

Before Addyi was even approved, some sex educators were wary of the drug. I imagine Vyleesi will receive some of the same critiques. Vyleesi appears to be a better deal than Addyi in some ways, but neither drug increased the number of sexually satisfying events n a statistically significant way. The FDA no longer requires companies making these drugs to count sexual sessions, and critics point out that women may simply be having more sex that they don’t enjoy. 

And this leads us to one of the main complaints. Is it really beneficial to boost a woman’s sex drive just so it’ll be closer to her partner’s? Should we make women to feel bad for having less desire than men (apparently)? It is a win to force women to sit through more bad sex? Certainly there are women who would feel just fine having less sex if society allowed them to.

The CEO of the drug company has stated “It’s not just about low sexual desire, but about how it impacts patients’ relationships and quality of life. These women are really suffering.” However, this drug doesn’t examine why women are suffering. Dr. Adriane Fugh-Berman, a professor in the department of pharmacology and physiology at Georgetown University Medical Center who studies pharmaceutical marketing has.

I think it’s worth noting what’s an acceptable level of libido is socially influenced. Making women care less about the bad sex that they’re having is a dubious goal.

And for those women who want to want more sex? There are non-drug options that are more effective than both of these options and present fewer risks. Mindfulness can increase libido and sexual satisfaction. Sex education can ensure that women know and ask for what they want in bed, that their partners are better lovers, and that people understand that responsive desire does not necessarily mean low desire. On top of this, education explains concepts such as the dual-control model, which helps explain how external factors play into libido and enables people to ditch the shackles placed on them by society in the form of (useless) sexual scripts.

Can we even diagnose low libido before tackling those issues?

Reading a book or experimenting doesn’t require a prescription, abstinence from alcohol, or perfect health to produce results that are more statistically significant than Addyi and Vyleesi have shown.

Further Reading

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Science of Sex

Science of Sex: Mindfulness as a Treatment for Sexual Dysfunction

This month’s Science of Sex post is directly inspired by the book that I reviewed by Dr. Lori Brotto and, in fact, will draw from several of her studies. Mindfulness at first times to be new agey– more hype that hypothesis. But multiple studies have shown that mindfulness can have a positive impact on many facets of life, sex among them. So this month’s Science of Sex post focuses on that.

Check out previous Science of Sex posts here.

Mindfulness as a Treatment for Sexual Dysfunction

Dr. Brotto does a good job of explaining what mindfulness is in her book: it’s an awareness of your thoughts, feelings, and sensations, that allows you to create a distance with them, which can reduce the impact of pain, for example. But mindfulness also helps you remain more in the moment to focus on sensation. We’ll start with Brotto’s work since she’s done so much.

In one study, Brotto and her team found that while mindfulness didn’t necessarily increase arousal, it does increase women’s’ awareness of their physical/genital arousal, in turn increasing arousal concordance (symmetry between observed physical and genital arousal).

Another study by Brotto et al found that a group of 31 endometrial cancer survivors experienced improvements in multiple aspects of sexual functioning — desire, arousal, lubrication, orgasm,  and satisfaction — after participating in three sessions of mindfulness-based cognitive behavior therapy. And the improvements remained six months later.

Yet another study by Brotto found four sessions of a “mindfulness-based therapy significantly improved sexual desire, arousal, lubrication, satisfaction, and overall sexual functioning”. Continued sessions resulted in further improvements in genital and mental excitement. Any immediate improvements continued to a 6-month followup.

Finally, a 2008 study found similar improvements in women’s’ sexual function when exposed to mindfulness training. Furthermore, women who had previously experienced sexual abuse benefited the most from mindfulness compared to all participants.

Clearly, Dr. Brotto has done a lot of research on mindfulness and sexual function and talks about a 60% increase in sexual function after mindfulness in one of her studies. I think we can expect that to continue. But she’s not the only one. Time and again, studies suggest that mindfulness could be key to an improved sex life.

One such study compared how long it took men and women to register their physical arousal, finding that men did it significantly quicker than women. Mindfulness meditation enabled women to require less time to notice bodily responses, putting them on par with men. Additionally, women who practiced mindfulness were less judgmental toward themselves. Others found that mindfulness may be helpful to people who experienced sexual abuse as children.

Yet another study posited that people with more disproportional mindfulness would be less likely to engage in sexually compulsive behaviors or use drugs and found this to be true. Finally, a survey of women who completed mindfulness-based therapy online only found improvements in sexual function.

Studies on mindfulness have focuses on women, perhaps because they’re more likely to experience certain sorts of sexual dysfunction (low desire, difficulty with arousal, impaired pleasure, etc), but it’s reasonable that men could improve their sex lives by learning and practicing mindfulness, too. Some sources even state that mindfulness could help people with ED and at least one study focuses on sensate touch, a type of mindfulness program originally developed by Masters and Johnson, as a possible aid here. I’d like to see mindfulness applied to men. Otherwise, the science is promising.

Further Reading

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Books Reviews

Better Sex Through Mindfulness: How Women Can Cultivate Desire

Better Sex Through Mindfulness: How Women Can Cultivate Desire
$13.86 from Amazon

Some of you may not read as many educational books about sex as I do, so you may not realize that this year has been pretty active with releases (this does not actually include my last book review, Becoming Cliterate, which was released last year). It’s why I’ve been reading about sex non-stop for the past several months. It’s been a few years since this has been the case; although, the break from reading about astrophysics certainly was welcome.

Check out all my book reviews before you leave.

Even though Better Sex Through Mindfulness was just published a couple months ago and I was able to get my hands on a digital copy immediately, the author came across my radar last year. You see, Lori Brotto, a psychologist, is one of the women I wrote about in my post about women who study sex.  Let me refresh with the description of her work because it leads us directly to the theme of Brotto’s book:

Lori Brotto has studied the disconnect that women often experience between mental and physical arousal. Brotto’s research suggests that the way that women multitask and tend to be detached from their bodies contributes to this. Brotto suggests mindfulness as one possible solution

So her work and research have led her to write a book directly about how mindfulness can help women overcome their sexual issues. Brotto is one of many who are adamant that the solution to low sexual desire cannot be fixed simply by a little pink pill (Emily Nagoski, who wrote the foreword, shares similar views). And while the tagline of this book focuses on desire. Better Sex Through Mindfulness goes beyond how mindfulness can be helpful with sex drive and focuses on topics such as heightening pleasure and reducing the impact from pain as well.

As a researcher, Brotto has worked with women to help them solve and alleviate the symptoms of their sexual issues, and she draws heavily from her own research when she makes conclusions in Better Sex Through Mindfulness. When she tells you that women have increased sex drive as well as pleasure from sex due to a something as small as mindfulness, you believe her and wonder if we’ve been treating sexual complications wrong all along. At one point, Brotto mentions how “mood, sense of well-being, body image, self-esteem, and how a woman feels about her partner turned out to be far stronger predictors of her level of sexual desire than a single hormone,” which really drives this point home (later she highlights how opinions about sexuality can also be more significant than hormones). Not only may some treatment options for sexual dysfunction be misguided, but the focus of hormones as cause and treatment for sexual dysfunction after menopause may also overestimate the function of hormones in sexual function.

But let me back up because by calling mindfulness ‘small,’ I am being quite reductionist. Really, mindfulness can be life-changing, and Dr. Brotto takes time to explore the definition and use of mindfulness as well as its history (the word wasn’t using when Masters and Johnson were teaching about sex, for example, but their sensate practices were certainly mindful!). She compares and contrasts mindfulness with cognitive behavioral therapy, with which I was familiar from my own experiences.

Furthermore, mindfulness can be difficult for some people, and Dr. Brotto emphasizes that willingness to try and practice mindfulness as key to its effectiveness. As someone who has struggled with meditation and mindfulness in the past, I think this is especially pertinent. It struck me that getting help to master mindfulness might be the catalyst to success in people who similarly struggle. Indeed, Dr. Brotto points out how trying to force yourself to relax is a misunderstanding of mindfulness and can be counterproductive.

Brotto often points to others’ research as well. In her book, she talks about studies that have highlighted differences in the brains of women who have healthy versus low sexual desire. One difference may be smaller amounts of grey matter in the brains of women who have low sexual desire. Brotto explains how women with low sexual desire spend more time monitoring their sexual performances rather than enjoying sex — and research backs it up!

Better Sex Through Mindfulness isn’t all about the argument that mindfulness can be helpful, however. Scattered through the books are practices that readers can use to (try to) improve their own sex lives. Admittedly, I am not currently struggling with sexual issues, but I found the reminder to be mindful during my everyday life useful. Of course, this book also offered something to sate my appetite for sexual science. Of particular note was how mindfulness can assist women who suffer from pain during sex due to various conditions. While mindfulness does not lessen the pain (and in some instances, medical professionals are not sure how to do this), it does enable women to enjoy sex and intimacy by reducing the intensity of their perception of pain and by encouraging a wider variety of intimacy.

I also highlighted a blurb regarding how sexual concordance differs between men and women. Women experience a lower level of +.26 than men’s level of +.66 (with 1.0 being perfect concordance between mental and physical arousal). This book was full of interesting tidbits like that.

In Better Sex Through Mindfulness, Brotto makes the case for her mindfulness programs by revealing the results of surveys filled out by the participants. She states that “sexual satisfaction increases by 60 percent” from prior to the program. She also illustrates how learning mindfulness can equate to long-term sexual improvement and not just improvement in the present. Even women who were dubious about the effects of mindfulness found it to be helpful. Certain groups of women (those who were the most distresses prior) even benefited the most.

In the end, Dr. Brotto’s book shows that not only is there hope when it comes to sexual dysfunctions such as low desire or pain but that the solution might be easier and more accessible than people realize, all without needing pharmaceutical intervention. Although geared toward women, I can imagine men would benefit from this book, too.

Better Sex Through Mindfulness ends with an appendix full of resources, either for women to get help to improve sexual function. This book is ideal for any woman (or man) who wants to get more out of her sex life, but some professionals might also benefit from reading it and incorporating mindfulness into their treatment and coping strategies.

If you think you might benefit, you can buy it at any number of retailers. A hard copy might be especially useful for partaking in activities, but I usually prefer Kindle versions for highlighting and taking notes. Get the digital version for less than $10. It’s only a couple bucks more for physical!

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Science of Sex

Science of Sex: Female Sexual Dysfunction

Welcome to my latest installment of Science of Sex. I’ve officially be doing these for more than a year and have more planned! If you want to check out my archives, click here. Otherwise, enjoy this month’s post!science of sex - female sexual dysfunction

Today we’re venturing into the realm of female sexual dysfunction, just what it is, and why that title might not actually be helpful.

At its heart, female sexual dysfunction is an issue with sexual functioning in a woman. This can include a number of conditions and concerns, but four of the main ones are:

  • Desire : Many women and sometimes their partners describe their lack of spontaneous desire as a dysfunction. However, studies show that women are more likely to have responsive desire than men. This is not a dysfunction as much as it is a difference in sexual function. Furthermore, some have suggested that the traditional stages of arousal may not apply as well to women whose arousal process is more cyclical. It’s also important to understand that a woman’s sexual brakes are often quite touchy (learn more about this). Finally, low desire often corresponds to relationship issues, so it’s not so much a sign of sexual dysfunction as it is one of relationship dysfunction.
  • Arousal: Female sexual dysfunction can also present as a lack of physical arousal. This highlights further incorrect assumptions or beliefs about female sexuality. First, it doesn’t take into consideration that women are much less likely to experience concordance – an alignment between mental desire and physical arousal – than men and, secondly, it ignores the variance in a woman’s natural lubrication.
  • Orgasm: Some women may describe their inability to orgasm through sexual intercourse as dysfunction, but multiple surveys have found that the majority of women need clitoral stimulation to orgasm and very few achieving orgasm solely through penetration. At least one study reports a group of women who prefer penetration/sex with their clit stim as a way to get off.
  • Pain: Too many women experience pain during intercourse (in fact, at least one study has found that the bar for good sex for women is so low that they simply describe it as sex that is not painful). This is often remedied by increasing foreplay to encourage arousal, using lube and improved sexual communication. While conditions such as vaginismus and endometriosis can lead to pain during sex, painful sex can also be a symptom of poor technique and can often be ameliorated by changing the script.

Of course, there are other types of dysfunction, including those that center on physical issues and are not rooted in psychological or romantic distress. But the solution or treatment to any one of these “dysfunctions” may not be at all alike to the treatment for any other dysfunction.

The problem is that the term sexual dysfunction itself is not well-defined, and female sexual dysfunction is even more poorly defined because the umbrella term lumps together so many potential issues, including those that may be easily rectified by a better understanding of female sexuality. Furthermore, having a stronger grasp on female sexuality would show that some so-called dysfunctions are simply functions of sexuality in women that do not need to be pathologized. Of course, it’s not like men don’t suffer from this. It’s not a dysfunction if men ejaculate within ten minutes — it’s the norm — but the deep-seated misunderstanding of female sexual function had led to a lot of suffering.

Fortunately, doctors have devised questionnaires such as the aptly-named Sexual Function Questionnaire, and other tools to more readily diagnose sexual dysfunctions and focus on the root of the problem, whether it may be physical, relational, or a combination of factors. Sex therapists and educators are also making great strides in adjusting public and personal views of normal and healthy sexual function. For example, Dr. Emily Nagoski has written about desire and arousal in her book Come As You Are, Dr. Laurie Mintz shed light on clitoral stimulation in her own book Becoming Cliterate, and Dr. Lori Brotto helps women experience greater sexual function in her recently-released book Better Sex Through Mindfulness.

It should come as no surprise that women working on sexual research and providing sex therapy offer unique insight into female sexuality and what truly is dysfunction. If you’re interested in that topic, check out my post on  about the Women of Sexology

Further Reading