Social Science

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contents

Introduction: Yes, You Are Normal The True Story of Sex The Organization of This Book A Couple of Caveats If You Feel Broken, or Know Someone Who Does

part 1 the (not-so-basic) basics 1. Anatomy: No Two Alike The Beginning The Clit, the Whole Clit, and Nothing but the Clit Meet Your Clitoris Lips, Both Great and Small Hymen Truths A Word on Words The Sticky Bits Intersex Parts Why It Matters Change How You See A Better Metaphor What It Is, Not What It Means 2. The Dual Control Model: Your Sexual Personality Turn On the Ons, Turn Off the Offs Arousability What “Medium” Means Different for Girls . . . but Not Necessarily What Turns You On? All the Same Parts, Organized in Different Ways Can You Change Your SIS or SES? 3. Context: And the “One Ring” (to Rule Them All) in Your Emotional Brain Sensation in Context Sex, Rats, and Rock ’n’ Roll Your Emotional One Ring You Can’t Make Them “Is Something Wrong with Me?” (Answer: Nope)

part 2 sex in context 4. Emotional Context: Sex in a Monkey Brain The Stress Response Cycle: Fight, Flight, and Freeze Stress and Sex Broken Culture  Broken Stress Response Cycles Complete the Cycle! When Sex Becomes the Lion Sex and the Survivor Origin of Love The Science of Falling in Love Attachment and Sex: The Dark Side Attachment and Sex: Sex That Advances the Plot Attachment Style Managing Attachment: Your Feels as a Sleepy Hedgehog Survival of the Social The Water of Life 5. Cultural Context: A Sex-Positive Life in a Sex-Negative World Three Messages You Are Beautiful Criticizing Yourself = Stress = Reduced Sexual Pleasure Health at Every Size

“Dirty” When Somebody “Yucks” Your “Yum” Maximizing Yum . . . with Science! Part 1: Self-Compassion Maximizing Yum . . . with Science! Part 2: Cognitive Dissonance Maximizing Yum . . . with Science! Part 3: Media Nutrition You Do You

part 3 sex in action 6. Arousal: Lubrication Is Not Causation Measuring and Defining Nonconcordance All the Same Parts, Organized in Different Ways: “This Is a Restaurant” Nonconcordance in Other Emotions Lubrication Error #1: Genital Response = “Turned On” Lubrication Error #2: Genital Response Is Enjoying Lubrication Error #3: Nonconcordance Is a Problem Medicating Away the Brakes “Honey . . . I’m Nonconcordant!” Ripe Fruit 7. Desire: Actually, It’s Not a Drive Desire = Arousal in Context Not a Drive. For Real. Why It Matters That It’s Not a Drive “But Emily, Sometimes It Feels Like a Drive!” Impatient Little Monitors Good News! It’s Probably Not Your Hormones More Good News! It’s Not Monogamy, Either “Isn’t It Just Culture?” It Might Be the Chasing Dynamic Maximizing Desire . . . with Science! Part 1: Arousing the One Ring Maximizing Desire . . . with Science! Part 2: Turning Off the Offs Maximizing Desire . . . with Science! Part 3: Desperate Measures Sharing Your Garden

part 4 ecstasy for everybody 8. Orgasm: The Fantastic Bonus Nonconcordance—Now with Orgasms! No Two Alike All the Same Parts . . . Your Vagina’s Okay, Either Way The Evolution of the Fantastic Bonus Difficulty with Orgasm Ecstatic Orgasm: You’re a Flock! How Do You Medicate a Flock? Flying Toward Ecstasy 9. Meta-Emotions: The Ultimate Sex-Positive Context Can’t Get No . . . The Map and the Terrain Positive Meta-Emotions Step 1: Trust the Terrain Positive Meta-Emotions Step 2: Let Go of the Map (the Hard Part) How to Let Go: Nonjudging Nonjudging = “Emotion Coaching” Nonjudging: Tips for Beginners “No Good Reason” Healing Trauma with Nonjudging When Partners Dismiss! Influencing the Little Monitor Part 1: Changing Your Criterion Velocity Influencing the Little Monitor Part 2: Changing the Kind of Effort Influencing the Little Monitor Part 3: Changing the Goal “To Feel Normal” “This Is It” Conclusion: You Are the Secret Ingredient Why I Wrote This Book Where to Look for More Answers

Acknowledgments Appendix 1: Therapeutic Masturbation Appendix 2: Extended Orgasm About the Author Notes References Index

For my students

introduction YES, YOU ARE NORMAL

To be a sex educator is to be asked questions. I’ve stood in college dining halls with a plate of food in my hands answering questions about orgasm. I’ve been stopped in hotel lobbies at professional conferences to answer questions about vibrators. I’ve sat on a park bench, checking social media on my phone, only to find questions from a stranger about her asymmetrical genitals. I’ve gotten emails from students, from friends, from their friends, from total strangers about sexual desire, sexual arousal, sexual pleasure, sexual pain, orgasm, fetishes, fantasies, bodily fluids, and more.

Questions like . . . • Once my partner initiates, I’m into it, but it seems like it never even occurs to me to be the one to start things. Why is

that? • My boyfriend was like, “You’re not ready, you’re still dry.” But I was so ready. So why wasn’t I wet? • I saw this thing about women who can’t enjoy sex because they worry about their bodies the whole time. That’s me.

How do I stop doing that? • I read something about women who stop wanting sex after a while in a relationship, even if they still love their

partner. That’s me. How do I start wanting sex with my partner again? • I think maybe I peed when I had an orgasm . . . ? • I think maybe I’ve never had an orgasm . . . ?

Under all these questions, there’s really just one question: Am I normal? (The answer is nearly always: Yes.) This book is a collection of answers. They’re answers that I’ve seen change women’s lives,

answers informed by the most current science and by the personal stories of women whose growing understanding of sex has transformed their relationships with their own bodies. These women are my heroines, and I hope that by telling their stories, I’ll empower you to follow your own path, to reach for and achieve your own profound and unique sexual potential.

the true story of sex After all the books that have been written about sex, all the blogs and TV shows and radio

Q&As, how can it be that we all still have so many questions? Well. The frustrating reality is we’ve been lied to—not deliberately, it’s no one’s fault, but

still. We were told the wrong story. For a long, long time in Western science and medicine, women’s sexuality was viewed as

Men’s Sexuality Lite—basically the same but not quite as good. For instance, it was just sort of assumed that since men have orgasms during penis-in-vagina

sex (intercourse), women should have orgasms with intercourse too, and if they don’t, it’s because they’re broken.

In reality, about 30 percent of women orgasm reliably with intercourse. The other 70 percent sometimes, rarely, or never orgasm with intercourse, and they’re all healthy and normal. A woman might orgasm lots of other ways—manual sex, oral sex, vibrators, breast stimulation, toe sucking, pretty much any way you can imagine—and still not orgasm during intercourse. That’s normal.

It was just assumed, too, that because a man’s genitals typically behave the way his mind is behaving—if his penis is erect, he’s feeling turned on—a woman’s genitals should also match her emotional experience.

And again, some women’s do, many don’t. 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).

And it was also assumed that because men experience spontaneous, out-of-the-blue desire for sex, women should also want sex spontaneously.

Again it turns out that’s true sometimes, but not necessarily. 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 reality, women and men are different. But wait. Women and men both experience orgasm, desire, and arousal, and men, too, can

experience responsive desire, arousal nonconcordance, and lack of orgasm with penetration. Women and men both can fall in love, fantasize, masturbate, feel puzzled about sex, and experience ecstatic pleasure. They both can ooze fluids, travel forbidden paths of sexual imagination, encounter the unexpected and startling ways that sex shows up in every domain of life—and confront the unexpected and startling ways that sex sometimes declines, politely or otherwise, to show up.

So . . . are women and men really that different? The problem here is that we’ve been taught to think about sex in terms of behavior, rather

than in terms of the biological, psychological, and social processes underlying the behavior. We think about our physiological behavior—blood flow and genital secretions and heart rate. We think about our social behavior—what we do in bed, whom we do it with, and how often. A lot of books about sex focus on those things; they tell you how many times per week the average couple has sex or they offer instructions on how to have an orgasm, and they can be helpful.

But if you really want to understand human sexuality, behavior alone won’t get you there. Trying to understand sex by looking at behavior is like trying to understand love by looking at a couple’s wedding portrait . . . and their divorce papers. Being able to describe what happened— two people got married and then got divorced—doesn’t get us very far. What we want to know is why and how it came to be. Did our couple fall out of love after they got married, and that’s why they divorced? Or were they never in love but were forced to marry, and finally became free when they divorced? Without better evidence, we’re mostly guessing.

Until very recently, that’s how it’s been for sex—mostly guessing. But we’re at a pivotal moment in sex science because, after decades of research describing what happens in human sexual response, we’re finally figuring out the why and how—the process underlying the behavior.

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 kind of stimulation they’re given.

This is the mechanism underlying the behavior—the why and the how. And it’s the rule that governs the story I’ll be telling in this book: We’re all made of the same parts, but in each of us, those parts are organized in a unique way that changes over our life span.

No organization is better or worse than any other, and no phase in our life span is better or worse than any other; they’re just different. An apple tree can be healthy no matter what variety

of apple it is—though one variety may need constant direct sunlight and another might enjoy some shade. And an apple tree can be healthy when it’s a seed, when it’s a seedling, as it’s growing, and as it fades at the end of the season, as well as when, in late summer, it is laden with fruit. But it has different needs at each of those phases in its life.

You, too, are healthy and normal at the start of your sexual development, as you grow, and as you bear the fruits of living with confidence and joy inside your body. You are healthy when you need lots of sun, and you’re healthy when you enjoy some shade. That’s the true story. We are all the same. We are all different. We are all normal.

the organization of this book The book is divided into four parts: (1) The (Not-So-Basic) Basics; (2) Sex in Context; (3)

Sex in Action; and (4) Ecstasy for Everybody. The three chapters in the first part describe the basic hardware you were born with—a body, a brain, and a world. In chapter 1, I talk about genitals—their parts, the meaning we impose on those parts, and the science that proves definitively that yes, your genitals are perfectly healthy and beautiful just as they are. Chapter 2 details the sexual response mechanism in the brain—the dual control model of inhibition and excitation, or brakes and accelerator. Then in chapter 3, I introduce the ways that your sexual brakes and accelerator interact with the many other systems in your brain and environment, to shape whether a particular sensation or person turns you on, right now, in this moment.

In the second part of the book, “Sex in Context,” we think about how all the basic hardware functions within the context of your actual life—your emotions, your relationship, your feelings about your body, and your attitudes toward sex. Chapter 4 focuses on two primary emotional systems, love and stress, and the surprising and contradictory ways they can influence your sexual responsiveness. Then chapter 5 describes the cultural forces that shape and constrain sexual functioning, and how you can maximize the good things about this process and overcome the destructive things. What we’ll learn is that context—your external circumstances and your present mental state—is as crucial to your sexual wellbeing as your body and brain. Master the content in these chapters and your sexual life will transform—along with, quite possibly, the rest of your life.

The third part of the book, “Sex in Action,” is about sexual response itself, and I bust two long-standing and dangerous myths. Chapter 6 lays out the evidence that sexual arousal may or may not have anything to do with what’s happening in your genitals. This is where we learn why arousal nonconcordance, which I mentioned earlier, is normal and healthy. And after you read chapter 7, you will never again hear someone say “sex drive” without thinking to yourself, Ah, but sex is not a drive. In this chapter I explain how “responsive desire” works. If you (or your partner) have ever experienced a change in your interest in sex—increase or decrease—this is an important chapter for you.

And the fourth part of the book, “Ecstasy for Everybody,” explains how to make sex entirely yours, which is how you create peak sexual ecstasy in your life. Chapter 8 is about orgasms— what they are, what they’re not, how to have them, and how to make them like the ones you read about, the ones that turn the stars into rainbows. And finally, in Chapter 9, I describe the single most important thing you can do to improve your sex life. But I’ll give it away right now: It turns out what matters most is not the parts you are made of or how they are organized, but how you feel about those parts. When you embrace your sexuality precisely as it is right now, that’s the context that creates the greatest potential for ecstatic pleasure.

Several chapters include worksheets or other interactive activities and exercises. A lot of these are fun—like in chapter 3, I ask you to think about times when you’ve had great sex and

identify what aspects of the context helped to make that sex great. All of them turn the science into something practical that can genuinely transform your sex life.

Throughout the book, you’ll follow the stories of four women—Olivia, Merritt, Camilla, and Laurie. These women don’t exist as individuals; they’re composites, integrating the real stories of the many women I’ve taught, talked with, emailed, and supported in my two decades as a sex educator. You can imagine each woman as a collage of snapshots—the face from one photograph, the arms from another, the feet from a third . . . each part represents someone real, and the collection hangs together meaningfully, but I’ve invented the relationships that the parts have to each other.

I’ve chosen to construct these composites rather than tell the stories of specific women for two reasons. First, people tell me their stories in confidence, and I want to protect their identities, so I’ve changed details in order to keep their story their story. And second, I believe I can describe the widest possible variety of women’s sexual experiences by focusing not on specific stories of one individual woman but on the larger narratives that contain the common themes I’ve seen in all these hundreds of women’s lives.

And finally, at the end of each chapter you’ll find a “tl;dr” list—“too long; didn’t read,” the blunt Internet abbreviation that means, “Just get to the point.” Each tl;dr list briefly summarizes the four most important messages in the chapter. If you find yourself thinking, “My friend Alice should totally read this chapter!” or “I really wish my partner knew this,” you might start by showing them the tl;dr list.I Or, if you’re like me and get too excited about these ideas to keep them to yourself, you can follow your partner around the house, reading the tl;dr list out loud and saying, “See, honey, arousal nonconcordance is a thing!” or “It turns out I have responsive desire!” or “You give me great context, sweetie!”

a couple of caveats First, most of the time when I say “women” in this book, I mean people who were born in

female bodies, were raised as girls, and now have the social role and psychological identity of “woman.” There are plenty of women who don’t fit one or more of those characteristics, but there’s too little research on trans* and genderqueer sexual functioning for me to say with certainty whether what’s true about cisgender women’s sexual wellbeing is also true for trans* folks. I think it probably is, and as more research emerges over the coming decade we’ll find out, but in the meantime I want to acknowledge that this is basically a book about cisgender women.

And if you don’t know what any of that means, don’t worry about it. Second, I am passionate about the role of science in promoting women’s sexual wellbeing,

and I have worked hard in this book to encapsulate the research in the service of teaching women to live with confidence and joy inside their bodies. But I’ve been very intentional about the empirical details I’ve included or excluded. I asked myself, “Does this fact help women have better sex lives, or is it just a totally fascinating and important empirical puzzle?”

And I cut the puzzles. I kept only the science that has the most immediate relevance in women’s everyday lives. So

what you’ll find in these pages isn’t the whole story of women’s sexuality—I’m not sure the whole story would actually fit in one book. Instead, I’ve included the parts of the story that I’ve found most powerful in my work as a sex educator, promoting women’s sexual wellbeing, autonomy, and pleasure.

The purpose of this book is to offer a new, science-based way of thinking about women’s sexual wellbeing. Like all new ways of thinking, it opens up a lot of questions and challenges much preexisting knowledge. If you want to dive deeper, you’ll find references in the notes,

along with details about my process for boiling down a complex and multifaceted body of research into something practical.

if you feel broken, or know someone who does One more thing before we get into chapter 1. Remember how I said we’ve all been lied to,

but it’s no one’s fault? I want to take a moment to recognize the damage done by that lie. So many women come to my blog or to my class or to my public talks convinced that they

are sexually broken. They feel dysfunctional. Abnormal. And on top of that, they feel anxious, frustrated, and hopeless about the lack of information and support they’ve received from medical professionals, therapists, partners, family, and friends.

“Just relax,” they’ve been told. “Have a glass of wine.” Or, “Women just don’t want sex that much. Get over it.” Or, “Sometimes sex hurts—can’t you just ignore it?” I understand the frustration these women experience, and the despair—and in the second half

of the book I talk about the neurological process that traps people in frustration and despair, shutting them off from hope and joy, and I describe science-based ways to get out of the trap.

Here’s what I need you to know right now: The information in this book will show you that whatever you’re experiencing in your sexuality—whether it’s challenges with arousal, desire, orgasm, pain, no sexual sensations—is the result of your sexual response mechanism functioning appropriately . . . in an inappropriate world. You are normal; it is the world around you that’s broken.

That’s actually the bad news. The good news is that when you understand how your sexual response mechanism works,

you can begin to take control of your environment and your brain in order to maximize your sexual potential, even in a broken world. And when you change your environment and your brain, you can change—and heal—your sexual functioning.

This book contains information that I have seen transform women’s sexual wellbeing. I’ve seen it transform men’s understanding of their women partners. I’ve seen same-sex couples look at each other and say, “Oh. So that’s what was going on.” Students, friends, blog readers, and even fellow sex educators have read a blog post or heard me give a talk and said, “Why didn’t anyone tell me this before? It explains everything!”

I know for sure that what I’ve written in this book can help you. It may not be enough to heal all the wounds inflicted on your sexuality by a culture in which it sometimes feels nearly impossible for a woman to “do” sexuality right, but it will provide powerful tools in support of your healing.

How do I know? Evidence, of course! At the end of one semester, I asked my 187 students to write down one really important thing

they learned in my class. Here’s a small sample of what they wrote: I am normal! I AM NORMAL I learned that everything is NORMAL, making it possible to go through the rest of my life with confidence and joy. I learned that I am normal! And I learned that some people have spontaneous desire and others have responsive desire

and this fact helped me really understand my personal life. Women vary! And just because I do not experience my sexuality in the same way as many other women, that does not

make me abnormal. Women’s sexual desire, arousal, response, etc., is incredibly varied. The one thing I can count on regarding sexuality is that people vary, a lot. That everyone is different and everything is normal; no two alike. No two alike!

And many more. More than half of them wrote some version of “I am normal.” I sat in my office and read those responses with tears in my eyes. There was something

urgently important to my students about feeling “normal,” and somehow my class had cleared a path to that feeling.

The science of women’s sexual wellbeing is young, and there is much still to be learned. But this young science has already discovered truths about women’s sexuality that have transformed my students’ relationships with their bodies—and it has certainly transformed mine. I wrote this book to share the science, stories, and sex-positive insights that prove to us that, despite our culture’s vested interest in making us feel broken, dysfunctional, unlovely, and unlovable, we are in fact fully capable of confident, joyful sex.

• • • The promise of Come as You Are is this: No matter where you are in your sexual journey

right now, whether you have an awesome sex life and want to expand the awesomeness, or you’re struggling and want to find solutions, you will learn something that will improve your sex life and transform the way you understand what it means to be a sexual being. And you’ll discover that, even if you don’t yet feel that way, you are already sexually whole and healthy.

The science says so. I can prove it.

I. I’ll use “they” as a singular pronoun, rather than “he or she” throughout the book. It’s simpler, as well as more inclusive of folks outside the gender binary.

part 1 the (not-so-basic) basics

one anatomy

NO TWO ALIKE

Olivia likes to watch herself in the mirror when she masturbates. Like many women, Olivia masturbates lying on her back and rubbing her clitoris with

her hand. Unlike many women, she props herself up on one elbow in front of a full-length mirror and watches her fingers moving in the folds of her vulva.

“I started when I was a teenager,” she told me. “I had seen porn on the Internet, and I was curious about what I looked like, so I got a mirror and started pulling apart my labia so I could see my clit, and what can I say? It felt good, so I started masturbating.”

It’s not the only way she masturbates. She also enjoys the “pulse” spray on her showerhead, she has a small army of vibrators at her command, and she spent several months teaching herself to have “breath” orgasms, coming without touching her body at all.

This is the kind of thing women tell you when you’re a sex educator. She also told me that looking at her vulva convinced her that her sexuality was more

like a man’s, because her clitoris is comparatively large—“like a baby carrot, almost”— which, she concluded, made her more masculine; it must be bigger because she had more testosterone, which in turn made her a horny lady.

I told her, “Actually there’s no evidence of a relationship between an adult woman’s hormone levels, genital shape or size, and sexual desire or response.”

“Are you sure about that?” she asked. “Well, some women have ‘testosterone-dependent’ desire,” I said, pondering, “which

means they need a certain very low minimum of T, but that’s not the same as ‘high testosterone.’ And the distance between the clitoris and the urethra predicts how reliably orgasmic a woman is during intercourse, but that’s a whole other thing. I’d be fascinated to see a study that directly asked the question, but the available evidence suggests that variation in women’s genital shapes, sizes, and colors doesn’t predict anything in particular about her level of sexual interest.”

“Oh,” she said. And that single syllable said to me: “Emily, you have missed the point.”

Olivia is a psychology grad student—a former student of mine, an activist around women’s reproductive health issues, and now doing her own research, which is how we got started on this conversation—so I got excited about the opportunity to talk about the science. But with that quiet, “Oh,” I realized that this wasn’t about the science for Olivia. It was about her struggle to embrace her body and her sexuality just as it is, when so much of her culture was trying to convince her there is something wrong with her.

So I said, “You know, your clitoris is totally normal. Everyone’s genitals are made of all the same parts, just organized in different ways. The differences don’t necessarily mean anything, they’re just varieties of beautiful and healthy. Actually,” I continued, “that could be the most important thing you’ll ever learn about human sexuality.”

“Really?” she asked. “Why?” This chapter is the answer to that question.

Medieval anatomists called women’s external genitals the “pudendum,” a word derived from the Latin pudere, meaning “to make ashamed.” Our genitalia were thus named “from the shamefacedness that is in women to have them seen.”1

Wait: what? The reasoning went like this: Women’s genitals are tucked away between their legs, as if

they wanted to be hidden, whereas male genitals face forward, for all to see. And why would men’s and women’s genitals be different in this way? If you’re a medieval anatomist, steeped in a sexual ethic of purity, it’s because: shame.

Now, if we assume “shame” isn’t really why women’s genitals are under the body—and I hope it’s eye-rollingly obvious that it’s not—why, biologically, are male genitals in front and female genitals underneath?

The answer is, they’re actually not! The female equivalent to the penis—the clitoris—is positioned right up front, in the equivalent location to the penis. It’s less obvious than the penis because it’s smaller—and it’s smaller not because it’s shy or ashamed, but because females don’t have to transport our DNA from inside our own bodies to inside someone else’s body. And the female equivalent of the scrotum—the outer labia—is also located in very much the same place as the scrotum, but because the female gonads (the ovaries) are internal, rather than external like the testicles, the labia don’t extend much past the body, so they’re less obvious. Again, the ovaries are not internal because of shame, but because we’re the ones who get pregnant.

In short, female genitals appear “hidden” only if you look at them through the lens of cultural assumptions rather than through the eyes of biology.

We’ll see this over and over again throughout the book: Culture adopts a random act of biology and tries to make it Meaningful, with a capital “Mmmh.” We metaphorize genitals, seeing what they are like rather than what they are, we superimpose cultural Meaning on them, as Olivia superimposed the meaning of “masculine” on her largish clitoris, to conclude that her anatomy had some grand meaning about her as sexually masculine.

When you can see your body as it is, rather than what culture proclaims it to Mean, then you experience how much easier it is to live with and love your genitals, along with the rest of your sexuality, precisely as they are.

So in this chapter, we’ll look at our genitals through biological eyes, cultural lenses off. First, I’ll walk you through the ways that male and female genitals are made of exactly the same parts, just organized in different ways. I’ll point out where the biology says one thing and culture says something else, and you can decide which makes more sense to you. I’ll illustrate how the idea of all the same parts, organized in different ways extends far beyond our anatomy to every aspect of human sexual response, and I’ll argue that this might be the most important thing you’ll ever learn about your sexuality.

In the end, I’ll offer a new central metaphor to replace all the wacky, biased, or nonsensical ones that culture has tried to impose on women’s bodies. My goal in this chapter is to introduce an alternative way of thinking about your body and your sexuality, so that you can relate to your body on its own terms, rather than on terms somebody else chose for you.

the beginning Imagine two fertilized eggs that have just implanted in a uterus. One is XX—genetically

female—and the other is XY—genetically male. Fraternal twins, a sister and a brother. Faces, fingers, and feet—the siblings will develop all the same body parts, but the parts will be organized differently, to give them the individual bodies that will be instantly distinguishable from each other as they grow up. And just as their faces will each have two eyes, one nose, and a

mouth, all arranged in more or less the same places, so their genitals will have all the same basic elements, organized in roughly the same way. But unlike their faces and fingers and feet, their genitals will develop before birth into configurations that their parents will automatically recognize as male or female.

All the same parts, organized in different ways. Every body’s genitals are the same until six weeks into gestation, when the universal genital hardware begins to organize itself into either the female configuration or the male configuration.

Here’s how it happens. About six weeks after the fertilized egg implants in the uterus, there is a wash of masculinizing hormones. The male blastocyst (a group of cells that will form the embryo) responds to this by developing its “prefab” universal genital hardware into the male configuration of penis, testicles, and scrotum. The female blastocyst does not respond to the hormone wash at all, and instead develops its prefab universal genital hardware into the default, female configuration of clitoris, ovaries, and labia.

Welcome to the wonderful world of biological homology. Homologues are traits that have the same biological origins, though they may have different

functions. Each part of the external genitalia has a homologue in the other sex. I’ve mentioned two of them already: Both male and female genitals have a round-ended, highly sensitive, multichambered organ to which blood flows during sexual arousal. On females, it’s the clitoris; on males, it’s the penis. And each has an organ that is soft, stretchy, and grows coarse hair after puberty. On females, it’s the outer lips (labia majora); on males, it’s the scrotum. These parts don’t just look superficially alike; they are developed from the equivalent fetal tissue. If you look closely at a scrotum, you’ll notice a seam running up the center—the scrotal raphe. That’s where his scrotum would have split into labia if he had developed female genitals instead.

Homology is also why both brother and sister will have nipples. Nipples on females are vital to the survival of almost all mammal species, including humans (though a handful of old mammals, such as the platypus, don’t have nipples, and instead just leak milk from their abdomens), so evolution built nipples in right at the very beginning of our fetal development. It takes less energy to just leave them there than to actively suppress them—and evolution is as lazy as it can get away with—so both males and females have nipples. Same biological origins— different functions.

the clit, the whole clit, and nothing but the clit The clitoris and penis are the external genital organs most densely packed with nerve

endings. The visible part of the clitoris, the glans clitoris, is located right up at the top of the genitals—some distance from the vagina, you’ll notice. (This fact will be crucial when I talk about orgasm, in chapter 8.) The clitoris is . . .

The hokey pokey—it’s what it’s all about. Two turntables and a microphone—it’s where it’s at. A Visa card—it’s everywhere you want to be. 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 penis has four jobs: sensation, penetration, ejaculation, and urination.

Two different ways of functioning, one shared biological origin. The visible part of the clitoris—the glans—is actually just the head of the clit, just as the

glans penis—the vaguely acorn-shaped cap at the end of the penile shaft—is just the head. There’s a lot more to it, though. The shaft of the penis is familiar to many. It is constructed of three chambers: a pair of cavernous bodies (corpora cavernosa) and a spongy body (corpus spongiosum), through which the urethra passes. All three of these chambers extend deep into the body. The corpus spongiosum ends in the bulb of the penis deep inside the pelvis. The corpora cavernosa taper away from each other and attach the pelvic bone.

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.” Like the penis, the clitoris is composed of three chambers: a pair of legs (crura) that extend deep within the tissue of the vulva, which are homologous to the corpora cavernosa, and the bulbs of the vestibule, homologous to the corpus spongiosum, including its bulb of the penis. The vestibule is the mouth of the vagina; the bulbs extend from the head of the clitoris, deep inside the tissue of the vulva, then split to straddle the urethra and the vagina. That’s right: The clitoris extends all the way to the vaginal opening.

The anatomy of the clitoris. The cultural meaning of “clitoris” is often limited to the external part, the glans. The biological meaning includes a vast range of internal erectile tissue that extends all the way to the vaginal opening.

The anatomy of the penis. As with the clitoris, the cultural meaning of “penis” is limited to the external part—the glans and shaft. And, like the clitoris, the penis has internal erectile tissue. All the same parts, organized in different ways.

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.

meet your clitoris If you’ve never met your clitoris “face-to-face,” now is the time. (Even if you’ve had some

good chats with your clitoris in the past, feel free to take this opportunity to get reacquainted.) You can find it visually or manually. After you’ve read the next two paragraphs, put down the book and try either method.

To find it visually, get a mirror, spread your labia (the soft, hairy outer lips of your vulva), and actually look at it. You’ll see a nub at the top of your vulva.

Or you can find it with your fingers. Start with the tip of your middle finger at the cleft where your labia divide. Press down gently, wiggle your finger back and forth, and scoot your fingertip slowly down between your labia until you feel a rubbery little cord under the skin. It might help to pull your skin taut by tugging upward on your mons with your other hand. It might also help to lubricate your finger with spit, commercial lube, some allergen-free hand cream, or even a little olive oil.

I have a specific reason for asking you to actually look at your clitoris: A student came up to me after class one night and told me that she had been Skyping with

her mom, talking about her classes that semester, including my class, “Women’s Sexuality.” The student mentioned to her mom that my lecture slides included actual photos of women’s vulvas, along with diagrams and illustrations. And her mom told her the most astonishing thing. She said, “I don’t know where the clitoris is.”

The mom was fifty-four. So my student emailed her mom my lecture slides. That story is why the first chapter in this book is about anatomy. That story makes me want

to print T-shirts with a drawing of a vulva and an arrow pointing to the clitoris, saying IT’S RIGHT HERE. It makes me want to hand out pamphlets on street corners with instructions for locating your own clitoris, both manually and visually. I want an animated GIF of a woman pointing to her clitoris to go viral on the Internet. I want a billboard in Times Square. I want everyone to know.

But even more, it makes me want every single woman reading this to stop right now and look directly at her clitoris. Knowing where the clitoris is is important, but knowing where your clitoris is . . . that’s power. Get a mirror and look at your clitoris, in honor of that student and her brave, amazing mom.

When I first looked at my clitoris, during my earliest training as a sex educator, I actually cried. I was eighteen and in a bad relationship and looking for answers. And my instructor had said, “When you go home tonight, get a mirror and find your clitoris.” So I did. And I was stunned to tears to find that there was nothing gross or weird about it, it was just . . . part of my body. It belonged to me.

That moment set the stage for a decade of discovering and rediscovering that my best source of knowledge about my sexuality was my own body.

So go look at your clitoris. And as long as you’re in the neighborhood, check out the rest of your vulva, too.

I love having nontraditional students in my class—those who aren’t in that eighteen-to-

twenty-two age range—and Merritt was as nontraditional as they come: a perimenopausal lesbian author of gay erotica, with a teenage daughter whom she was raising with her partner of nearly twenty years. I was uninformed enough when I first met her to be surprised when she told me that her Korean parents were Fundamentalist Christians and that she grew up with quintessential socially conservative values. Which made her outness as a lesbian, her writing, and her presence in my classroom all the more remarkable.

At forty-two, Merritt had never considered looking at her clitoris. It didn’t even cross her mind as a possibility until I suggested it during the first lecture, as I always do. She came up to me after class and said, “Is it really a good idea to suggest that kids this young look at their bodies? What if they just . . . shut down?”

“That’s a really important question,” I said. “No one has ever told me of an experience like that, but it’s not a requirement, so maybe the folks most likely to have that experience don’t try it. Still, it’s something I recommend, especially for students who plan to continue on in public health or medicine, but it’s entirely up to each person whether or not they want to look.”

Merritt didn’t do it. Instead, she had her partner, Carol, look—which in some ways is braver than looking

herself—and she looked at her partner’s. And they talked about what they saw and about how they had never before taken the time to deliberately look at and talk about their sexual bodies. And Merritt learned something remarkable, which she told me about the following week:

“Carol told me she’d looked at her vulva! She was part of a feminist consciousness- raising group in the ’80s, and they all got together in a circle with their hand mirrors.”

“Wow!” I said, and meant it. She held her hands out, palms up, weighing her feelings. “I don’t know why this kind

of thing is so much harder for me than it is for her. When it comes to sex, I always feel like I’m teetering at the edge of a cliff with my arms windmilling around me.”

The ambivalence Merritt experienced is absolutely normal for anyone whose family of origin taught them that sex should fit into a certain prescribed place in life and nowhere else. But it made sense for Merritt for other reasons, too, having to do with the way her brain is wired. I’ll talk about that in chapter 2.

lips, both great and small Female inner labia (labia minora or small lips) may not be very “inner” at all, but extend out

beyond the big lips—or they may tuck themselves away, hidden inside the vulva until you go looking for them. And the inner labia may be all one homogeneous color, or they may show a gradient of color, darkening toward the tips. All of that is normal and healthy and beautiful. Long, short, pink, beige, brown—all normal.

The male homologue of the inner labia is the inner foreskin. If a penis has been circumcised —that is, had its foreskin surgically removed—there is very often a color change midway down the shaft. That’s because the skin at the top of the shaft is actually the inner foreskin. (Because the color change is sometimes evident only after puberty, guys have asked me if something they did made the color change, but nope, that’s just how some penises look, bless them.)

The outer labia, too, vary from person to person. Some are densely hairy, with the hair extending out onto the thigh and around the anus, while others have very little hair. Some lips are quite puffy while others are relatively flush with the body. Some are the same color as the surrounding skin, and some are darker or lighter than the surrounding skin. All normal, all

beautiful. As with the clitoris, the cultural view of labia doesn’t match the biological reality. Vulvas in

soft-core porn are digitally edited to conform to a specific standard of “tucked-in” labia and homogeneous coloring, to be “less detailed.”2 This means that cultural representations of vulvas are limited to a pretty narrow range. In reality, there is a great deal of variety among genitals— and there is no medical condition associated with almost any of the variability. But such limited representations of women’s bodies may actually be changing women’s perceptions of what a “normal” vulva looks like.3

One example of a vulva.

So if you decide to have a look at other women’s vulvas—which I highly recommend, by the way, but only with their enthusiastic consent—you’ll notice how very, very different they all are from each other. Only rarely do you find the tidily tucked-in vulvas you see in Playboy.

Unless you’re experiencing pain (and if you are, check with your medical provider!), your genitals are perfect exactly as they are.

hymen truths 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.4

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.5 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 a woman’s hormones change as she approaches 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 women 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 women have septate hymens, which feel like a strand of skin stretching across the mouth of the vagina. Some women’s hymens are durable, others are fragile. Some disappear early in adolescence, and some are still in evidence past menopause.

Women’s hymens vary because, as far as science has been able to discover, the hymen was not selected for by evolution. It has no reproductive or any other function. It’s a byproduct, a little bonus left behind by the juggernaut of evolutionary selection pressure, like men’s nipples. It’s the homologue of the seminal colliculus, a crest in the wall of the urethra where it passes through the prostate and joins with the seminal ducts.

The hymen is a profound example of the way humans metaphorize anatomy. Here is an organ that has no biological function, and yet Western culture made up a powerful story about the hymen a long time ago. This story has nothing to do with biology and everything to do with controlling women. Culture saw a “barrier” at the mouth of the vagina and decided it was a marker of “virginity” (itself a biologically meaningless idea). Such a weird idea could have been invented only in a society where women were literally property, their vaginas their most valuable real estate—a gated community.

Even though the hymen performs no physical or biological function, many cultures have created myths around the hymen so profound that there are actually surgeries available to “reconstruct” the hymen, as if it were a medical necessity. (Where is the surgery to perfect men’s nipples?)

In a sense, the hymen can be relevant to women’s health: Some women are beaten or even killed for not having a hymen. Some women are told they “couldn’t have been raped” because their hymen is intact. For them, the hymen has real impact on their physical wellbeing, not because of their anatomy but because of what their culture believes about that anatomy.

a word on words One more thing about women’s external 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.

Got that? Vagina = reproductive canal Vulva = external genitalia Mons = area over the pubic bone where hair grows

I’m not suggesting that you go around correcting people who use the wrong words, or picket The Vagina Monologues with signs saying, “Actually, they’re The Vulva Monologues,” but now you know what words you should use. You wouldn’t call your face or your forehead your throat, right? So let’s not call the vulva or mons the vagina. Let’s make the world a better place for women’s genitals.

the sticky bits Woman have a set of glands at either side of the mouth of the vagina, called Bartholin’s

glands, which release fluid during sexual arousal—maybe to reduce the friction of vaginal penetration, maybe to create a scent that communicates health and fertility status. When women “get wet,” this is what’s happening. And it turns out, both women and men “get wet.” The male homologue, the Cowper’s gland, just below the prostate, produces preejaculate.

Why do we talk about men “getting hard” and women “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 woman 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. But like our anatomies, our physiologies are all made of the same components—changes in blood flow, production of genital secretions, etc.—organized in different ways. We put a spotlight on male hardness and a spotlight on female wetness, but male wetness is happening too, and so is female hardness.

Women also have a set of glands at the mouth of the urethra, the orifice we pee out of, called Skene’s glands. These are the homologue of the male prostate. The prostate has two jobs: It swells around the urethra so that it’s impossible for a man to urinate while he’s highly sexually aroused, and it produces about half of the seminal fluid in which sperm travels. In other words, it makes ejaculate. In women, the Skene’s glands also swell around the urethra, making it difficult to urinate when you’re very aroused. If you’ve ever tried to pee right after having an orgasm, you’ve confronted this directly—you have to take deep, cleansing breaths to give your genitals time to relax.

In some women, the Skene’s glands produce fluid, which is how some women ejaculate. Female ejaculation—“squirting”—has gotten some attention lately, in part because more science has been done and in part because it’s been featured in porn. As a result, I get asked about it pretty regularly. In fact, one day a couple of years ago I was visiting a student residence hall to answer anonymous questions out of a box, only to find that one student had put in the question, “How do I learn to squirt?” while another student had put in, “How do I stop squirting?”6

Needless to say, our culture sends mixed messages to women about their genital fluids . . . or their lack thereof. On the one hand, ejaculation is viewed as a quintessentially masculine event and women’s genitals are, ya know, shameful, so for a woman’s body to do something so

emphatic and wet is unacceptable. On the other hand, it’s a comparatively rare event, and the perpetual pursuit of novelty, coupled with basic supply-and-demand dynamics, means that the rare commodity of a woman who ejaculates is prized and put on display. So if they’re paying attention to cultural messages about ejaculation, women are understandably confused.

The biological message is simple: Female ejaculation is a byproduct, like male nipples and the hymen. No matter how big a deal culture makes of it, women vary. One woman I know never ejaculated in her life until shortly after menopause, when she got a new partner. All of a sudden she was ejaculating a quarter of a cup of fluid with every orgasm. Was it the change in partner? Was it the hormonal shift of menopause? None of the above? I have no idea.

But this brings me to an important point about genitals: They get wet sometimes, and they have a fragrance. A scent. A rich and earthy bouquet, redolent of grass and amber, with a hint of woody musk. Genitals are aromatic, sometimes, and sticky sometimes, too. 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.

If you don’t find the smell or sensation of genital wetness to be completely beautiful and entrancing, that’s unsurprising given how we teach people to feel about their genitals. But how you feel about your genitals and their secretions is learned, and loving your body just as it is will give you more intense arousal and desire and bigger, better orgasms. More on that in chapter 5.

intersex parts Intersex folks,7 whose genitals are not obviously male or female at birth, also have all the

same parts; theirs happen to be organized somewhere between the standard female and standard male configurations. The size of the phallus, the location of the urethral opening, or the split of the labioscrotal tissue may be anywhere in between.

Homology goes a long way in explaining how intersex genitals come to be. 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. There’s nothing wrong with their genitals, any more than there’s anything wrong with a person whose labia are uniquely large or small.8 It’s still all the same parts, just organized in a different way. For example, the male urethral opening may be anywhere on the head of the penis; rarely, it is somewhere along the shaft of the penis, but that too is just fine, as long as it doesn’t impede urination or cause chronic infection (which it usually does not). As long as the genitals don’t cause pain and aren’t prone to infection or other medical issues, they’re healthy and don’t require any kind of medical intervention. We’re all made of the same parts, just organized in different ways.

This is why I don’t need to see your genitals to tell you that they’re normal and healthy. You’ve got all the same parts, just organized in your own unique way.

Like many sex educators, I include photographs of a variety of vulvas in my anatomy lecture slides.

Where do I find these photographs? On the Internet, of course. My only difficulty is getting a diverse range—mostly I find images of the vulvas of

young, thin, white, completely shaved women. I have to search carefully to find great sex- positive images of the vulvas of older women, women of size, women of color, and women who’ve got all their pubic hair.

One day I was sitting around a busy comics convention talking about this challenge with Camilla, who, like me, is a nerd and a former college peer sex educator. Unlike me,

she has a degree in gender studies and studio art, is African American, and makes her living as an illustrator—all of which gave her insight into my little challenge.

She said, “Seriously, Emily? You’re googling, what, like, ‘black vulva’? At work?” I shrugged apologetically. “Sausages, laws, and sex education lectures. You don’t

want to know how any of them are made.” And Camilla said, “Let me guess: All you find is porny images, nothing artistic or

empowered or body positive?” “And graphic medical pictures,” I said. “I tried searching ‘feminist vulvas of color,’

but all I got was embroidery projects from Pinterest and Etsy.” Camilla laughed at that, but said, “Now think if you were a young woman trying to see

what a normal, healthy vulva looks like. If you’re white, you’re all set, Tumblr is full of those. But if you’re Black or Asian or Latina, what is there? Porn and medical pictures. What does that tell you?”

I said, “But I can’t say, ‘Hey, women of color, post more pictures of your vulvas on the web, so that other women will know they’re normal.’ ”

“No, but still,” Camilla said, “the images we see—or don’t see—matter. You know those Escher girls?”

“No, what’s an Escher girl?” “They’re the female characters in comics with abdomens so flat there’s no room for

their internal organs, and their spines are impossibly twisted so that you can see both boobs and both butt cheeks at the same time. Their poses are so anatomically absurd that they’re named after an artist famous for impossible illusions.”

“Sounds like some bad porn I’ve seen,” I said. “Right,” said Camilla. “I saw those as a teenager and I felt like that said everything

about what a ‘female’ was supposed to be, and because that wasn’t what being female felt like to me, I decided my first identity is ‘geek.’ Not woman, not Black: geek. Gamer. It took a long time to integrate the other parts of my identity, because I couldn’t see how they all fit together. Images matter. They tell us what’s possible, what things go together, what belongs and what doesn’t belong. And we’re all just trying to belong somewhere.”

This statement was such a gift to me. I go back to this idea over and over now, as I write my lectures. I spend hours searching the Internet for sex-positive images of a wide variety of vulvas, because my students vary—no two alike—and I want them to know that their bodies are normal and that they belong there in my classroom.

why it matters Why might the seemingly simple fact that all human genitals are made of the same parts,

organized in different ways be the most important thing you’ll ever learn about human sexuality? Two reasons: Because it means your genitals are normal—and not just normal, but amazing and beautiful

and captivating and delicious and enticing, on down the alphabet, all the way to zesty— regardless of what they look like. They are made of all the same parts as everyone else’s genitals, organized in a configuration utterly unique to you. The entire range is normal. Beautiful. Perfect. And because it is true for each and every facet of human sexual expression. As we’ll see in the chapters that follow, from genital response to spanking fetishes, our sexual physiology, psychology, and desires are all made of the same parts, just organized in different ways.

If we embrace this simple, profound idea—all the same parts, organized in different ways—it answers that ever-popular question: Are men’s and women’s sexualities the same, or are they

different? Answer: Yes. They’re made of the same parts, organized differently. While we can see obvious group differences when we look at populations—male and female

bodies—there’s at least as much variability within those groups as there is between those groups. I can illustrate with a nonsex example. The average height of an adult woman is five feet four

and the average height of an adult man is five feet ten, a six-inch difference between the two groups’ averages. But height varies more within each group than between the groups. If you measured the heights of a thousand random people—five hundred men and five hundred women —you’d find that nearly all the women would be between five feet and five feet eight—an eight- inch difference within the group—and nearly all the men would be between five feet four and six feet four—a twelve-inch difference. Notice three things: There’s more difference within each group (eight or twelve inches) than between the two groups (six inches); there are four inches of overlap between the groups; and one or two hundred people among the thousand would be outside even these wide ranges!9

The same goes for sex. Within each group we find a vast range of diversity—and I don’t mean just anatomically. I mean in sexual orientation, sexual preferences, gender identity and expression, and—the subject of the rest of this book—sexual functioning: arousal, desire, and orgasm. We also find overlap between the two groups, and we find folks who vary wildly from the “average” while still being perfectly normal and healthy.

Some authors argue that the differences between men and women are more important than the similarities. Others say that the similarities are more important than the differences. My view is that the basic fact of homology—all the same parts, organized in different ways—is more important than either.

And variety may be the one and only truly universal characteristic of human sexuality. From our bodies to our desires to our behaviors, there are as many “sexualities” as there are humans alive on Earth. No two alike.

Here’s the kind of conversation you have when you’re a sex educator out drinking with your friends:

Laurie: “This woman I know told me if she ever has kids, she’ll have plastic surgery on her ladybusiness right after she gives birth, because she thinks it won’t look good anymore.”

Camilla: “Did you tell her that the cosmetic medical-industrial complex paid a lot of money to make sure she felt that way about her body, so that they could profit from her needless self-criticism?”

Laurie: “No, I told her that once you have kids, your partner is just glad if they ever get to see your business, whatever it looks like.”

Emily: “Let’s invent a ritual where women celebrate the transition into their postpartum bodies. I mean, it’s not just its appearance that changes, it’s what your body means, to yourself and to the world.”

Laurie was the only mom in the group, and she was the only one who didn’t look at me like I was on drugs. She said, “I totally want a ritual. Anything to make it easier to live in a body that feels like a deflated balloon.”

“But you’re so beautiful!” everyone said instantly. The compliments to Laurie’s indisputable beauty flowed even faster than the wine, but

a few days later, Laurie told me that was the opposite of what she needed.

“What I need is to hear that it’s okay to feel sad that my body will never be what it used to be. I put a lot of effort into learning to love that body, and now I’ve got to start all over again learning to love this one.”

So I said, “It’s okay to feel sad that your body has permanently changed.” Laurie burst into tears—which is something she does a lot lately, sudden quiet little

storms that pass through her anytime she finds herself on the receiving end of the affection and attention she lavishes on others.

“It shouldn’t even be about whether I like my body or not,” she sniffed. “That’s really what changed after I had Trev. Now it should really be about whether or not it does what I need it to do.”

By “what she needs it to do,” Laurie means giving birth—at home, squatting in the tub, like a boss—breast-feeding for more than a year, and never sleeping more than four hours in a row for almost three years. The statement “Trevor is a bad sleeper” doesn’t even begin to cover the dark circles under Laurie’s eyes. Laurie’s body is amazing.

But she doesn’t feel that way. The notion of “all the same parts, organized in different ways” is as true for the ways

a woman’s body changes over the course of her life as it is for the ways people’s genitals vary. And just as everyone’s genitals are normal and beautiful, so all women’s bodies are normal and beautiful.

But mostly that’s not what women are taught. Mostly we’re taught that our bodies are supposed to be one specific shape, otherwise there’s something wrong with us. I’ll talk about that—and how to overcome it—in chapter 5.

change how you see10 I realize that just saying, “Your genitals are perfect and beautiful,” won’t change anything if

you feel uncomfortable with your genitals, but if seeing the beauty of your unique and healthy genitals is something you struggle with, there are two things I’d like you to do:

1. Get a hand mirror and look at your vulva, as I described earlier in the chapter. 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!

It’s an activity that 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.

2. Ask your partner, if you have one, to have a close look. Turn on the light, take off your clothes, get on your back, and let them look. Ask them what they see, how they feel about it, what memories they have of your vulva. Let your partner know what you’ve felt worried about, and ask for help to see what they see. Listen with your heart, not with your fear.

a better metaphor We started this chapter thinking about the ways we metaphorize anatomy, creating meaning

from random acts of biology in ways that end up making us feel uncomfortable with our bodies. To help undo all that, I like to use a different metaphor: a garden. It’s a metaphor I use a lot— remember the apple tree from the introduction?—because it offers a judgment-free way of thinking about how the sexual hardware we’re born with (our bodies and brains) and the families and culture we’re born into, interact to give rise to the individual sexual self that emerges in adulthood.

It goes like this: On the day you’re born, you’re given a little plot of rich and fertile soil, slightly different from everyone else’s. And right away, your family and your culture start to plant things and tend the garden for you, until you’re old enough to take over its care yourself. They plant language and attitudes and knowledge about love and safety and bodies and sex. And

they teach you how to tend your garden, because as you transition through adolescence into adulthood, you’ll take on full responsibility for its care.

And you didn’t choose any of that. You didn’t choose your plot of land, the seeds that were planted, or the way your garden was tended in the early years of your life.

As you reach adolescence, you begin to take care of the garden on your own. And you may find that your family and culture have planted some beautiful, healthy things that are thriving in a well-tended garden. And you may notice some things you want to change. Maybe the strategies you were taught for cultivating the garden are inefficient, so you need to find different ways of taking care of it so that it will thrive (that’s in chapter 3). Maybe the seeds that were planted were not the kind of thing that will thrive in your particular garden, so you need to find something that’s a better fit for you (that’s in chapters 4 and 5).

Some of us get lucky with our land and what gets planted. We have healthy and thriving gardens from the earliest moments of our awareness. And some of us get stuck with some pretty toxic crap in our gardens, and we’re left with the task of uprooting all the junk and replacing it with something healthier, something we choose for ourselves.

Your physical body—including your genitals—is one part of the basic hardware of your sexuality, the plot of land. Your brain and your environment are the rest of the hardware, and they’re the subject of chapters 2 and 3.

What It Is, Not What It Means

Olivia used her idea about her hormones, her “masculine” genitals, and her high sexual interest as a shield against the cultural criticisms that said she was . . . well, all kinds of things for which she “ought to be ashamed.” A slut. A nymphomaniac. Trying to “get attention,” “get a man,” or “control people” with her body—none of which were true, but all of which had been flung at her at various times in her life. The world had tried to convince her that her sexuality was toxic, dangerous to both herself and the people around her.

She had fought hard against these messages, in defense of her own sexual wellbeing. The shield of, “It’s my hormones, so it’s natural,” was an important part of that defense.

But as she absorbed the idea of “all the same parts, organized in different ways,” she didn’t need the shield anymore. She realized that the shield was actually blocking her off from other people, while “all the same parts” actively connected her with other people—it meant she wasn’t different or separate. She was the same—unique, but still connected in the continuum of human sexuality.

This is what science can do for us, if we let it. It offers us an opportunity to lower our defenses and experience the ways that we are all connected.

I know for a fact that Olivia was not born feeling uncomfortable with her genitals or her sexuality, and neither were you. When you were born, you were deeply, gloriously satisfied with each and every part of your body. But decades of sex-negative culture have let in weeds of dissatisfaction. Chapters 3 and 4 explain precisely how this can influence your sexual wellbeing, and chapter 5 describes how to undo that process and get back to living wholly inside your body, to return to that state you were born into, of deep, warm affection for and curiosity about your own body.

But before we get there, let’s spend a chapter talking about the biggest of all your sex organs and how it, too, is made of all the same parts as everyone else’s but organized in a unique way.

I refer, of course, to your brain.

tl;dr • Everyone’s genitals are made of the same parts, organized in different ways. No two alike. • Are you experiencing pain? If so, talk to a medical provider. If not, then your genitals are normal and healthy and

beautiful and perfect just as they are. • The genitals you see in soft-core porn images may have been digitally altered to appear more “tucked in”; don’t let

that fool you into believing that all vulvas look that way. • Find a mirror (or use the self-portrait camera on your phone) and actually look at your clitoris. Knowing where the

clitoris is, is important, but knowing where your clitoris is, is power.

two the dual control model

YOUR SEXUAL PERSONALITY

Laurie hadn’t actually wanted sex with her husband, Johnny—I mean, really craved it —since before their son Trev was born. At first she figured it was the pregnancy. Then she figured it was a postpartum thing.

Then she figured she was just tired. Or depressed. Or maybe she didn’t actually love her husband. Or maybe she was broken. Or maybe humans just aren’t meant to stay erotically connected after the months of

cleaning baby puke off each other’s shirts. They’d had a great run. Right up until she got pregnant, their sex life was the kind of

thing you find in romance novels—hot, hungry, passionate, sweet, loving, and just kinky enough to give them something wicked to think about as they locked eyes over his parents’ Thanksgiving dinner table.

So maybe that was all they got. Maybe the rest of their lives would be sexless. Still, they’d been trying. They’d bought some toys and massage oil. They’d tried tying

her up, tying him up, using flavored lube, videoing themselves, playing games . . . and sometimes it worked, all this exploration.

But mostly it didn’t. Mostly Laurie wound up feeling sad and lonely because she loved Johnny, loved him so much it hurt, yet she couldn’t make herself want him, not even with all the novelty and adventure available to them in a twenty-first-century world of technology, fantasy, and permissiveness.

One side benefit of this whole situation was that Laurie found she could have an orgasm in about five minutes with the vibrator, and that made falling asleep easier. So she’d go to bed early and buzz herself to sleep. But she hid it from Johnny, because she was pretty sure he’d be unhappy to learn that she was having orgasm on her own but not with him. It puzzled her, this interest in solo orgasm, when hardly anything could prompt her to want sex with her husband.

So she felt stuck and confused and crazy when she sat down to talk with me about it. Her perception of the situation—and her sense of hopelessness—changed completely

when she learned what’s in this chapter: Your sexual brain has an “accelerator” that responds to sexual stimulation, but it also has “brakes,” which respond to all the very good reasons not to be turned on right now.

Imagine it’s 1964 and you’re working in the laboratory of groundbreaking sex researchers William Masters and Virginia Johnson, at Washington University in St. Louis. You’re on the cutting edge of science, working to understand what has never been studied before, and you spend a lot of time posting want ads in the local paper. You’re looking for people, ordinary people, who are not only willing but also able to have orgasm in a laboratory (“research quarters”) while connected to machines that measure their heart rate, blood pressure, blood flow, and genital response, with you and the team of scientists in the room, observing.

When a woman responds to the ad, you invite her to the lab, where you take a detailed

medical and sexual history, you conduct a physical exam to check for any health issues, and you introduce her to the research quarters and its equipment. Next time she comes in, she practices having an orgasm in the research quarters, first on her own and then with the research team there in the room with her.

Now she’ll be observed, measured, and assessed as she stimulates herself with the equipment in the research quarters, all the way to orgasm. For science.

This is what you’ll observe: Excitement. As stimulation begins, her heart rate, blood pressure, and respiration rate

increase, and her labia minora and the clitoris darken and swell, separating the outer labia. The walls of the vagina begin to lubricate and then lengthen. Her breasts swell and the nipples become erect. Late in excitement, she may begin to sweat.

Plateau. Lubrication begins at the mouth of the vagina, from the Bartholin’s glands. Her breasts continue to swell, so much that the nipples seem to retract into the breasts. She may experience “sex flush,” a concentration of color over the chest. By now her inner labia have doubled in size from their resting state. The internal structures of the clitoris lift, drawing the external portion up and inward, so that it retracts from the surface of the body. The vagina itself “tents” around the cervix, open and wide deep inside the body. She experiences the involuntary muscle contraction known as myotonia, including carpopedal spasms (contraction of muscles in the hands and feet). She may begin to pant or hold her breath, as the thoracic and pelvic diaphragms contract in unison.

Orgasm. All the sphincters of her pelvic diaphragm (the “Kegel” muscle) contract in unison —urethra, vagina, and anus. She experiences rapid breathing, rapid heartbeat, and increased blood pressure. Her pelvis may rock, various muscle groups may tighten involuntarily. She experiences the sudden release of the tension that has accumulated in the muscles throughout her body.

Resolution. Breasts return to baseline, clitoris and labia return to baseline, heart rate, respiration rate, blood pressure all return to baseline.

This four-phase model of sexual response quickly became the foundation of sex therapists’, educators’, and researchers’ understanding of the human sexual response. As the first scientific description of the physiology of sexual response, it would become the basis for defining sexual health and also sexual problems.

Now imagine you’re a sex therapist in the 1970s, using the four-phase model to understand and treat clients with sexual dysfunction. Some of them you can help. Clients with anorgasmia (lack of orgasm) can learn to have orgasms, those with premature ejaculation can learn to control orgasm, those with vaginismus (vaginal spasms) can learn to relax those muscles. But there’s a group of clients who just don’t seem to respond to therapy informed by the four-phase model.

This is what happened to psychotherapist Helen Singer Kaplan. Reviewing treatment failures among her own and her colleagues’ patients, she found that the clients with the least successful outcomes were those who lacked interest in sex. Kaplan realized something important was entirely missing from the four-phase model: desire. The entire concept of sexual desire was utterly missing from the dominant theory of human sexual response.

It seems like a glaring oversight in retrospect, but of course it was missing—people who come to a laboratory to masturbate for science don’t have to want sex before they begin; they just have to get aroused for the purpose of the experiment.

So Kaplan took the four-phase model out of the laboratory and adapted it to the lived experience of her clients. Her “triphasic” model of the sexual response cycle begins with desire,

which she conceptualized as “interest in” or “appetite for” sex, much like hunger or thirst. The second phase is arousal, which combines excitement and plateau into one phase, and the third phase is orgasm.

For decades, Kaplan’s new triphasic model of sexual response served as the foundation for diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual. You could have normal or problematic desire, normal or problematic arousal, and normal or problematic orgasm. A number of these diagnoses now have effective treatments, including cognitive-behavioral therapy, mindfulness, sensorimotor therapies, and pharmaceuticals.

Fast-forward to 1998. Viagra: a pill that gives men erections. Now imagine you’re a researcher for a pharmaceutical company. Erectile dysfunction drugs

have hit it big and the pressure is on to find a “pink Viagra,” a drug that can do for women what Viagra does for men. You try giving Viagra to women—it doesn’t work. You test testosterone and estrogen—it works for only a small minority of women. You try antidepressants—nothing.

And today, nearly two decades later, pharmaceutical companies are still looking for this “pink Viagra.” If any drug worked for women, it would be a commercial bonanza—imagine being able to take a pill and just want sex, without effort, without hassle. It’s such a tantalizing idea that, despite lacking approval by the Food and Drug Administration (FDA), the pharmaceutical company Pfizer spent tons of money promoting off-label use of Viagra in women; the idea took off, with experts on Oprah and an entire story line (suspiciously similar to a product placement . . .) in Sex and the City, just for a start.1

But, as I said, these medications don’t work on women. Just as Kaplan looked at sex therapy treatment failures and found a missing piece—desire—

in the Masters and Johnson model, we can look at the failure of the pharmaceutical industry to find a medication for women’s sexual functioning and find a missing piece in the Kaplan model.

This chapter introduces that missing piece. In the first section of the chapter, I’ll describe the basic theory of the “dual control model” of

sexual response, which proposes a sexual “accelerator” and sexual “brakes.” The brake is the missing piece, the reason these drugs don’t work on women. And like desire, once someone points it out, it’s obvious . . . and it changes your entire understanding of how sex works.

In the second section of this chapter, I’ll talk about individual differences in the sensitivity of the brake and accelerator. This variation impacts how a person responds to the sexual world. We’ll find that while, yes, as you’d expect, men often have more sensitive accelerators and women have more sensitive brakes, there’s far more variation within those groups than between them. What’s more interesting than just how sensitive the mechanisms are is how these mechanisms relate to your mood and to your environment.

And that’s what the third section is about: what the brakes and accelerator respond to. What on earth is a “sexually relevant stimulus”? What kind of “potential threat” causes our brains to hit the brakes? How does our brain know what to respond to and what not to respond to? And can we change that?

I bet that before you picked up this book, you already knew that female genitals include a vagina and a clitoris, and you already knew that arousal, desire, and orgasm are things people generally experience as part of sexual response. Once you’ve read this chapter, I want you to feel that your accelerator and your brakes are as basic, as integral to your sexual functioning, as your clitoris and your desire. If I do my job in the next few pages, you’ll be telling everyone you know: “OMG, everybody, there’s a brake!”

The Power of Context Erectile dysfunction drugs don’t improve women’s sexual functioning, but they do have one of the strongest placebo effects observed in

medical research. Around 40 percent of participants in the placebo group of a clinical trial of sexual dysfunction medication report that the “drug”—actually a sugar pill—improved their sex lives; this is a response size so large that one particularly brilliant study reported only the effects of an eight-week “treatment” with a placebo.2 This is just one small hint at the power of context in shaping our sexual experience, which we’ll discuss in chapter 3.

turn on the ons, turn off the offs Allow me to introduce you to the dual control model. Developed in the late 1990s by Erick Janssen and John Bancroft at the Kinsey Institute, the

dual control model of sexual response goes far beyond earlier models of human sexuality, by describing not just “what happens” during arousal—erection, lubrication, etc.—but also the central mechanism that governs sexual arousal, which controls how and when you respond to sexually relevant sights, sounds, sensations, and ideas.3

The more I learned about the dual control model during my graduate education, the more I felt the lights come on in my understanding of human sexuality. I’ve been teaching it to my students for more than a decade now, and the more I teach it, the more I see how valuable it is in helping people to understand their own sexual functioning.

Here’s how it works: Your central nervous system (your brain and spinal cord) is made up of a series of

partnerships of accelerator and brakes—like the pairing of your sympathetic nervous system (“accelerator”) and your parasympathetic nervous system (“brake”). The core insight of the dual control model is that what’s true for other aspects of the nervous system must also be true for the brain system that coordinates sex: a sexual accelerator and sexual brake. (Daniel Kahneman wrote of his own Nobel Prize–winning research in economics, “You know you have made a theoretical advance when you can no longer reconstruct why you failed for so long to see the obvious.” So it was with Kahneman’s prospect theory, and so it is with the dual control model. I stand ready to send Erick and John large fruit baskets on the day the Nobel committee gets its act together and recognizes the importance of their insight.) So the dual control model of sexual response, as the name implies, consists of two parts:

Sexual Excitation System (SES). This is the accelerator of your sexual response. It receives information about sexually relevant stimuli in the environment—things you see, hear, smell, touch, taste, or imagine—and sends signals from the brain to the genitals to tell them, “Turn on!” SES is constantly scanning your context (including your own thoughts and feelings) for things that are sexually relevant. It is always at work, far below the level of consciousness. You aren’t aware that it’s there until you find yourself turned on and pursuing sexual pleasure.

Sexual Inhibition System (SIS). This is your sexual brake. “Inhibition” here doesn’t mean “shyness” but rather neurological “off” signals. Research has found that there are actually two brakes, reflecting the different functions of an inhibitory system. One brake works in much the same way as the accelerator. It notices all the potential threats in the environment—everything you see, hear, smell, touch, taste, or imagine—and sends signals saying, “Turn off!” It’s like the foot brake in a car, responding to stimuli in the moment. Just as the accelerator scans the environment for turn-ons, the brake scans for anything your brain interprets as a good reason not to be aroused right now—risk of STI transmission, unwanted pregnancy, social consequences, etc. And all day long it sends a steady stream of “Turn off!” messages. This brake is responsible for preventing us from getting inappropriately aroused in the middle of a business meeting or at dinner with our family. It’s also the system that throws the Off switch if, say, in the middle of some nookie, your grandmother walks in the room.

The second brake is a little different. It’s more like the hand brake in a car, a chronic, low- level “No thank you” signal. If you try to drive with the hand brake on, you might be able to get

where you want to go, but it’ll take longer and use a lot more gas. Where the foot brake is associated with “fear of performance consequences,” the hand brake is associated with “fear of performance failure,” like worry about not having an orgasm.

For the rest of the book, I’ll be referring to the brakes generally, without differentiating between the two kinds, because it turns out that, so far, effective strategies for turning off the brakes aren’t different depending on which brake is being hit. Over the next ten years we might develop behavioral strategies or even medications that target a specific system, but in the meantime, you don’t need to know for sure which brake is being hit in order to figure out how to stop hitting it.

• • • In essence, that’s all the dual control model is: the brakes and the accelerator. The details are

more complex, but the implications of even this basic idea are powerful, because you can immediately conceptualize all sexual functioning—and all sexual dysfunction—as a balance (or imbalance) between brakes and accelerator. 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 lack of accelerator; it’s more likely that the problem is too much brake (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.

When Olivia (the exuberant masturbator) answered my “excitors” questions [in the worksheets on this page] with, “I can feel turned on doing the dishes,” I had a pretty good idea what her sexual brain was like.

She told me, “I love sex. I love my partner. I love trying new things, new places, new positions, new toys, new porn, new everything. I’m One Big Yes.” And I could see it in her face: the joy, the confidence of a woman living fully inside her body.

I asked, “Have you sometimes done things and then thought, ‘Why did I do that?’ ” She winced and nodded. “That’s happened. Rarely, but . . . when I get super stressed,

I’ll just go out and be like, ‘Whatever. Go.’ I’ve done some stupid shit.” “And are there times when you feel like you need to masturbate several times a day?”

I asked, and she blinked at me like she wondered if I had a camera in her bedroom. “Usually I can ignore it,” she said. “But every once in a while it just makes me crazy.

It’s like having an itch that no amount of scratching will help. I have this out-of-control feeling.”

“Yeah,” I said. “A sensitive accelerator can make people more prone to risk taking and compulsivity—that ‘out-of-control’ feeling.”

“That’s why? A sensitive accelerator?” she said. “I’m not high testosterone, I’m high SES?”

“It would explain both your ‘One Big Yes’ and the occasional out-of-control feeling.” It’s easy to assume that having a sensitive accelerator is fun—and it can be, in the

right context. Olivia has a partner she delights in and a wide-open attitude that allows her to explore without worry or fear. She dives right in. And then sometimes, especially when she’s stressed or anxious, Olivia said, “It can feel like my sex drive is constantly demanding my attention and won’t leave me alone.”

There’s another level, too, to the risks that can accompany a sensitive accelerator. Because she sometimes feels like her own sexuality is bossing her around, Olivia finds herself worried that she, in turn, is bossing her partner around, being too pushy, too

demanding, too sexual, just plain too much. “I have to wield my powerful sexuality carefully, for the betterment of humanity,” she

announced—mostly kidding. Mostly.

arousability According to the dual control model, arousal is really two processes: activating the

accelerator and deactivating the brakes. So your level of sexual arousal at any given moment is the product of how much stimulation the accelerator is getting and how little stimulation the brakes are getting.

But it’s also a product of how sensitive your brakes and accelerator are to that stimulation. SIS and SES are traits. We all have them and they’re more or less stable over the life span,

but, like introversion/extroversion, they vary from individual to individual. Just as we all have phalluses and urethras (as we saw in chapter 1), we all have a sexual accelerator and sexual brakes in our central nervous systems (we’re all the same!). But we all have different sensitivities of SIS and SES (we’re all different!), which leads to different arousability—the potential to be aroused.

Some people are high on both SIS and SES, others are low on both, some have high SIS but low SES, and some have high SES but low SIS. And most of us are average. The variation is distributed on a nice bell curve; the majority of people are heaped up in the middle and a few people are at the extreme ends.

Let’s take a look at what happens if brake or accelerator is especially sensitive (or not). Suppose you’re high on SES and low on SIS—sensitive accelerator and hardly any brakes.

What kind of sexual response do you have? You respond readily to sexually relevant stimuli but not to potential threats, so you’re easily

aroused and have a difficult time preventing arousal. Which isn’t always as fun as it might sound, and it can, under some circumstances, lead to compulsive sexual behavior.

The sensitive accelerator plus not-so-sensitive brakes combination describes between 2 and 6 percent of women,4 and it’s associated with sexual risk taking and compulsivity. Because the brain mechanism responsible for noticing sexually relevant stimuli is very sensitive, you’re highly motivated to pursue sex, and because the brain mechanism responsible for stopping you from doing things you know you shouldn’t do is only minimally functional, you may sometimes feel out of control of your sexuality, especially when you’re stressed. You’re likely to have more partners, use less protection, and feel less in control. You might also be more likely to want sex when you are stressed (“redliners”), whereas other women are likely to find that their interest in sex plummets when they’re stressed (“flatliners”).

What if you have the opposite combination—sensitive brakes plus not-so-sensitive accelerator? This describes about 1 to 4 percent of women and is associated with difficulty getting aroused, lack of interest or desire, and problems with orgasm. If you have sensitive brakes, you’re very responsive to all the reasons not to be aroused, and if you have a relatively insensitive accelerator, it takes a lot of concentration and deliberate attention to tune in to sex.

A sensitive brake, regardless of the accelerator, is the strongest predictor of sexual problems of all kinds. In a 2008 survey of 226 women age eighteen to eighty-one, low interest in sex, arousal difficulties, and orgasm difficulty, were significantly correlated with inhibition factors, especially “arousal contingency” (“Unless things are ‘just right’ it is difficult for me to become sexually aroused”) and concerns about sexual function (“If I am worried about taking too long to become aroused or to orgasm, this can interfere with my arousal”).5

You can complete the Sexual Temperament Questionnaire that follows to get an idea of how sensitive your own brakes and accelerator are. Don’t mistake this for actual science. It’s intended to guide you in your understanding of how your internal sexual response mechanism may influence your response to sexual stimulation, but it is just an approximation.6 Recall, especially, that there are actually two different brakes—some people’s arousal is shut down more because of internal fears (e.g., taking too long to become aroused) and others are more affected by fears about external factors (e.g., getting an STI or getting caught having sex). Both can decrease your arousal, or prevent you from becoming aroused in the first place.

sexual temperament questionnaire Inhibitors (SIS) Circle the number of the answer that best describes you. Unless things are “just right,” it is difficult for me to become sexually aroused.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

When I am sexually aroused, the slightest thing can turn me off.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

I have to trust a partner to become fully aroused.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

If I am worried about taking too long to become aroused or to orgasm, this can interfere with my arousal.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

Sometimes I feel so “shy” or self-conscious during sex that I cannot become fully aroused.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

Total (out of 20) ____

Excitors (SES) Circle the number of the answer that best describes you. Often, just how someone smells can be a turn-on.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

Seeing my partner doing something that shows their talent or intelligence, or watching them interacting well with others can make me very sexually aroused.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

Having sex in a different setting than usual is a real turn-on for me.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

When I think about someone I find sexually attractive or when I fantasize about sex, I easily become sexually aroused.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

Certain hormonal changes (e.g., my menstrual cycle) definitely increase my sexual arousal.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

I get very turned on when someone wants me sexually.

0 1 2 3 4 Not at all like me Not much like me Somewhat like me A lot like me Exactly like me

Total (out of 24) ____

Scoring Low SIS (0–6)

You’re not so sensitive to all the reasons not to be sexually aroused. You tend not to worry about your own sexual functioning, and body image issues don’t interfere too much with your sexuality. When you’re sexually engaged, your attention is not very distractible, and you aren’t inclined to describe yourself as “sexually shy.” Most circumstances can be sexual for you. You may find that your main challenge around sexual functioning is holding yourself back, reining yourself in. Staying aware of potential consequences can help with this. Around 15 percent of the women I’ve asked are in this range.

Medium SIS (7–13) You’re right in the middle, along with more than half the women I’ve asked. This means that

whether your sexual brakes engage is largely dependent on context. Risky or novel situations, such as a new partner, might increase your concerns about your own sexual functioning, shyness, or distractibility from sex. Contexts that easily arouse you are likely to be low risk and more familiar, and anytime your stress levels—including anxiety, overwhelm, and exhaustion— escalate, your brakes will reduce your interest in and response to sexual signals.

High SIS (14–20) You’re pretty sensitive to all the reasons not to be sexually aroused. You need a setting of

trust and relaxation in order to be aroused, and it’s best if you don’t feel rushed or pressured in any way. You might be easily distracted from sex. High SIS, regardless of SES, is the most strongly correlated factor with sexual problems, so if this is you, pay close attention to the “sexy contexts” worksheets in the chapters that follow. About a quarter of the women I’ve asked fall into this range.

Low SES (0–7) You’re not so sensitive to sexually relevant stimuli and need to make a more deliberate effort

to tune your attention in that direction. Novel situations are less likely than familiar ones to be sexy to you. Your sexual functioning will benefit from increasing stimulation (for instance, using a vibrator) and daily practice of paying attention to sensations. Lower SES is also associated with asexuality, so if you’re very low SES, you might resonate with some components of the asexual identity. The women I ask are probably higher SES than the overall population—they’re interested enough in sex to take a class, attend a workshop, or read a sex blog—but still about 8 percent of those women fall into this range.

Medium SES (8–15) You’re right in the middle, so whether you’re sensitive to sexual stimuli probably depends on

the context. In situations of high romance or eroticism, you tune in readily to sexual stimuli; in

situations of low romance or eroticism, it may be pretty challenging to move your attention to sexual things. Recognize the role that context plays in your arousal and pleasure, and take steps to increase the sexiness of your life’s contexts. Seventy percent of the women I’ve asked fall into this range.

High SES (16–24) You’re pretty sensitive to sexually relevant stimuli, maybe even to things most of us aren’t

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