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

This chapter opens with the narrative of a woman named Olivia who enjoys watching herself masturbate in the mirror. Olivia equates the larger size of her clitoris with a more masculine nature. She believes it is indicative of a higher level of testosterone. Dr. Nagoski responds that there is no correlation between the size and shape of genitals and hormone levels. Later, Dr. Nagoski realizes what was lurking beneath Olivia’s question: She wanted confirmation that her body was normal.

Historically, women’s genitals have always been thought of in a different way than men’s genitals. Since women’s genitals are less prominent than men’s, medieval scholars associated them with shame. Dr. Nagoski dispels the myth that male and female genitalia are differently situated. The clitoris has the same anatomical positioning as the penis. The assumption about their positioning reflects a cultural lens rather than a scientifically grounded reason. Male and female parts are the same but organized differently. The female labia majora is congruent with the male scrotum. The female clitoris is congruent with the male penis.

The clitoris is the epicenter for female erotic sensation. The clitoris has twice as many nerve endings as the male penis, all housed in an organ that is one-eighth of the size of its male counterpart. However, the clitoris has only one function: sensation. Dr. Nagoski recommends “meeting” one’s clitoris either visually or manually. She argues that knowing about one’s own clitoris and its location is a form of empowerment. Dr. Nagoski suggests using a hand mirror or asking a trusted partner to examine one’s own genitalia and to make a list of positives.

Like the clitoris, female inner and outer labia can come in many shapes and forms. Ideas about “tidy” and tucked-in labia are perpetuated by culture. Similarly, most of what people understand about the hymen is false. The most common cause of pain to the hymen during sexual intercourse is a lack of lubrication. Once a hymen has been broken, it may heal. Some women are born without hymens, and hymens—like all other parts of sexual anatomy—can come in various forms.

All female genitalia are packed together with the blanket term “vulva.” The term “vagina” refers only to the internal canal connected to the uterus. The “mons” is the area above the pubic bone where hair grows. Intersex individuals also have the same parts as male and female genitalia but organized differently.

Dr. Nagoski proposes that the fact that all genitalia are versions of the same thing—organized differently—proves that all genitalia are normal. The variations that naturally occur are a part of this normalcy. She also argues that all forms of sexual expression are normal within their wide range of variance.

Chapter 2 opens with the narrative of Laurie and Johnny. After giving birth to her son, Laurie found that she no longer wanted to have sex with her husband. She and Johnny tried mixing up their routine, but nothing seemed to work. However, Laurie did find comfort in using a vibrator before bed and found that she could orgasm after only a few minutes. She hid it from her husband because she did not want to make him feel insecure about her interest in solo orgasm. Dr. Nagoski explains that this story makes sense when individuals embrace an understanding of sex as encompassing “accelerators” and “brakes.”

Sex researchers William Masters and Virginia Johnson at Washington University in St. Louis conducted a study of human orgasm in 1964. Female orgasm was divided into four stages: excitement, plateau, orgasm, resolution. Each stage came with its own set of physiological symptoms. In the 1970s, Helen Singer Kaplan used this model to treat various sexual dysfunctions but struggled to help her patients who lacked interest in sex. She determined that the four-stage cycle needed two more stages: desire and arousal.

The part of the brain that controls sexual response functions as a “dual control model” containing “accelerators” and “brakes” (46). The dual control model was first constructed by researchers Erick Janssen and John Bancroft and reveals how the central nervous system contains two parts. The sexual excitation system (SE) takes in information about sex-related stimuli and functions as an accelerator. The sexual inhibition system (SI) represents the neurological signals that function as sexual brakes. While women are more likely to have more sensitive brakes than men and men are more likely to have more sensitive accelerators than women, there is a wide range of normal variances in sensitivity to each. Dr. Nagoski provides a quiz to help readers think about and understand their own personal system of brakes and accelerators.

Types of sexual accelerators can also vary widely. Dr. Nagoski describes this as a form of “sexual language” (61). All humans learn their sexual language through culture and experience. Just as verbal language has many adaptations, so too does sexual language come in myriad forms. As Dr. Nagoski addresses the question as to whether the brain can change regarding its accelerators and brakes, she explains that these sensitivities appear to be unchanging. However, most individuals have medium-level sensitivities. Rather than changing the level of accelerators and brakes, Dr. Nagoski suggests that what those systems respond to may be changed.

Contextual factors influence sexual desire and arousal. One research survey concluded that women have four “cues for sexual desire factors,” including “love/emotional bonding cues,” “explicit/erotic cues,” “visual/proximity cues,” and “romantic/implicit cues” (70). Each of these cues or a combination of cues press on the accelerator pedal. Researchers later found that women have specific inhibitors that may press the brakes. For example, how a woman feels about her body or concerns about unwanted pregnancy may limit arousal. Sexual cues may vary by person, but an individual may also have different sexual accelerators and brakes depending on a range of factors: A woman who normally has high excitation sensitivity may not experience that same level when she has the flu.

Many different conditions may impact sexual interest. The sample of described research participants may not represent the full spectrum of sexual desire and arousal. It is important to remember the role of context that encompasses both the external factors exerting influence on sexual desire and the brain state of the individual in the moment. Dr. Nagoski illustrates this point with the example of tickling. In one scenario, a man tickles his partner playfully, and the interaction is flirtatious. In another scenario, the woman is annoyed with her partner, who then begins to tickle her. In this instance, the interaction is irritating rather than stimulating. Context changes perception, and this answers why something may be an accelerator one day and a brake the next. In safe and comfortable environments, all stimuli have the potential to activate desire, but in a stressful or dangerous environment, all stimuli—even the innately positive—have the potential to inhibit desire.

The parts of the brain that are often mislabeled as “pleasure centers” are complex and control liking, wanting, and learning. Dr. Nagoski compares these portions of the brain to the One Ring in the Lord of the Rings series by J. R. R. Tolkien. Like the One Ring, these parts of the brain control all emotional and stress responses. Dr. Nagoski distinguishes between the three roles of the One Ring and shows how they may work together in different contexts. For example, a woman may experience the touch of her partner differently once she becomes pregnant because the context changes.

Although all women are different, Dr. Nagoski suggests that three contexts influence a woman’s ability to feel sexual interest, which she describes as “low stress, high affection, and explicitly erotic” (86). Context, accelerators, and brakes change frequently. Although these changes may not appear to make sense, changes in sexual desire and arousal are normal.