Result: The control group’s genital response and subjective arousal more than doubled when tested at home, compared to in the lab. Plus they reported feeling “less inhibited” and “more at ease” at home. The low- desire group’s genital response also doubled at home . . . but their subjective arousal did not, nor did they report feeling less inhibited or more at ease. Which is to say, they were less concordant because their brakes didn’t turn off. Just being at home wasn’t enough to turn off the low-desire women’s brakes.
The sexually satisfied women were more sensitive than women with low desire to the change in context from the lab to home. Which is exactly the result you’d expect if you assumed that women’s sexual satisfaction is more dependent on sensitivity to context than on sensitivity to genital 24response.
Let me make that extra clear: The big difference between women in the control group and women in the low-desire group was not what their genitals were doing or even how aware the women were of what their genitals were doing. The big difference was how sensitive their brakes were to context.
Context sensitivity causes both the low desire and the nonconcordance.
Nonconcordance is not the problem. Context hitting the brakes is the problem.
Context—external circumstances and internal brain state—is fundamental to most women’s sexual wellbeing; increasing sensitivity to context, rather than to genital response, is what makes the difference.
Context is the crux and the key. Context is the cause. medicating away the brakes I’ve spent my career teaching people how to change their external circumstances and heal their central nervous systems in order to maximize their sexual potential. In other words: how to change their contexts. And 25this kind of education is effective at improving people’s sexual wellbeing.
But boy, it would be easier to just take a pill, right? A pill that temporarily turns off your brake—the elusive “pink Viagra.”
One of the authors of that ambulatory lab paper is aiming to make just such a pill. Adriaan Tuiten is a lead investigator in developing new drugs for “female sexual dysfunction,” one of which is intended to turn off the 26brakes.
It’s a really smart idea, targeting medications to the brakes and to women whose brakes are most prone to getting stuck.
So can you turn off the offs with a drug? Research is under way and has 27been published, including a series of three papers in 2013.
The regimen for the brake-targeted intervention is described in the research this way: Four hours before having sex—or a “sexual event,” as the researchers call it—drop a testosterone solution under your tongue and swish it around for about a minute. Two and a half hours later, take a pill.
Then, an hour and a half after that, have some sex. Voilà!
Did it work? You decide: The women in the study rated their “sexual satisfaction” with “sexual events” both with a placebo and with the drug. Half of the women experienced no significant change. But half the women (the “high inhibitors” group) experienced a statistically significant difference in sexual satisfaction. With the placebo, they reported being 50.2 percent satisfied, on average, with a given sexual event. With the drug, 59.6 percent satisfied.
Would you schedule sex for a specific time, drop testosterone under your tongue four hours beforehand, and then take a pill two and a half hours after that in order to increase your satisfaction that night from 50 to 60 28percent?
And what else might increase your satisfaction with a “sexual event”
that much?
How about if you felt really beautiful?
Or if you felt profoundly, deeply trusting of your partner?
Or if you felt like you had 100 percent permission to take as long as you wanted to become fully aroused and your partner would love every second of it?
Or, if you have a history of trauma, as so many women do, if you felt you could more completely release that trauma and fully engage with pleasure in the present moment?
Would that increase your satisfaction by 10 percentage points? More
than 10? • • • The drug is designed to turn off your brakes by changing your brain, rather than by changing the context to which the brakes are responding. As the researchers write: “Ideally, sexual dysfunction in human subjects should be described in terms of a constellation of interacting mechanisms, both
biological and psychological, which at the same time should provide an adequate indication for treatment.”
This is an excellent example of medical model thinking, since it pays attention to biology and even psychology but ignores relationship and social factors—in other words, it ignores women’s actual lives. You can’t medically treat a whole life or a relationship, so why bother taking them into account when trying to figure out how to treat sexual problems?
The reason to bother is that life factors like relationship satisfaction and trauma history significantly impact sexual wellbeing—I’m thinking way more than 10 percent—and they can be changed. Kids can be baby-sat and parenting can be shared by multiple adults; relationships can be 29strengthened; trauma can be healed.
We don’t need to reduce nonconcordance. We need to improve the contexts—external circumstances and internal states such as stress, attachment, self-criticism, and disgust. It doesn’t take a pill to do that.
Here’s a thing that happens to me sometimes: A wife drags her husband over to me and says, “Tell him what you told me.”
Laurie did that with Johnny at a lunch buffet. “Tell him what you told me. The arousal thing. Tell him, please.”
“He didn’t believe you?”
“He thinks I ‘must have misunderstood.’ ”
So I told him: “Okay, Johnny. I know this is the opposite of everything you’ve ever learned about sex, but it’s true: The state of Laurie’s vagina doesn’t necessarily tell you anything about her state of mind.”
She thwacked him on the arm with the back of her hand and raised her eyebrows, as if to say, “See?”
He looked at me and he looked at her and he looked back at me and he opened his mouth to ask a question and then he closed it again.
Then he said to Laurie, “Go away, honey.”
She did—not before giving me a knowing glance.
In a confidential whisper, he said to me, “If I can’t go by her genitals, how do I know she really wants me? Because she could totally just be saying she wants me when really she’s just being nice.”
Johnny is a dude-bro, manly, fix-it kind of guy. I like him a lot, and often my role is to translate the science of women’s sexual well-