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 Copyright © 2020 Dr Karen Gurney

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Contents

Title Page
About the Author

Introduction

One: Common Misconceptions and How They are Holding Us Back

1 A brief history of sex, science and gender politics

How did we get here?
Sex and sinning
Sex and madness
Sex and subjugation
The creation of sexual dysfunctions
Sex and neuroses
Sex and drugs – the medicalization of women and sex
Sex, power and feminism

2 Mind The Gap – Statistics around sex and desire

How much sex are people having?
Who decides what’s normal?
A national barometer of sex
Sexual satisfaction and problems
The impact of sex on relationships
What are we distressed about?
How does desire change within a relationship over time?
Men are not from Mars
What’s the right amount of desire?

3 Gaps in our foundations

Gaps in our knowledge
How sex positive was your sex ed?
Anatomy and pleasure
The orgasm gap
‘Change me, not my sex life’
The Orgasm Olympics
Gaps in our language
What is sex?
Understanding what makes sex good for us
‘Conditions for good sex’ and maintaining desire
Exercise: Reflection – Understanding your own ‘conditions for good sex’ triangle
Trying it out – sharing this with a partner

Two: The Truth About Sex and Desire

4 Sex in our society

The role of social norms in shaping our sex lives
How we learn about sex
Penis-in-vagina sex is ‘real sex’ – the ultimate unhelpful heterosexual script
The influence of the media on how we see sex
Porn and sexual scripts
So why is this important?
Inequality and the curse of the heterosexual sexual script
Faking orgasms and sexual scripts
Reciprocity and oral sex in heterosexual scripts
Women’s bodies and society
Mind your language
How we are our own worst enemy – the perpetuation of unhelpful societal beliefs
The ease of spontaneous sex
The three-times-a-week myth
Expect the worst for your sex life
Monogamy reigns supreme
Our intersectional identities and sex
Take home messages from this chapter
Exercise: Reflection: Your sexual biography

5 Sex in our relationships

‘We want it to be like it was in the beginning’
Is it possible to have good sex for ever?
Why does sex matter?
Communication and initiation
Why we have sex
Desire discrepancy between people in a relationship
Relationship dynamics and sex
Bad sex equals bad relationship, right?
Intimacy – too little or too much?
The paradox of security
It’s not the time you have but what you do with it that counts
Priorities, practicalities and time together
Technology and our sex lives
Having children
Sexual currency
Take-home messages from this chapter
Exercises: Reflection – Understanding your motivations for sex
Trying it out – sexual currency overload

6 Sex in our brains

‘Sex drive’
Arousal
The role of attention in sex
A word on psychological wellbeing and its impact on sex
Where do we want our thoughts to be?
Understanding the role of learning
A word on the impact of sexual trauma
How can we get our brains working for us, not against us?
How the way we use language influences our thoughts
Take-home messages from this chapter
Exercise>: Reflection – What kinds of thoughts interfere with your enjoyment of sex?
Trying it out – mindfulness and sex

7 Gaps in our understanding of desire

Desire facts to blow your mind
The history of sexology and our current understanding
A new understanding
Being receptive
Sexual stimuli
Psychological barriers
Circumstantial barriers
Physical barriers
Arousal and desire
Emotional and physical satisfaction
Emotional intimacy
How does your desire work?
Bringing this all together – Amy and Mark
Moving forward
Take-home messages from this chapter
Exercise: Reflection – sexual stimuli, hot or not?
Trying it out – an experiment in kickstarting desire

Three: How to Futureproof Your Sex Life, for Life

8 What next?
How does change happen?
Getting partners on board
What do you stand to lose or gain?
Working on your own sexuality
Maximizing success – where do you want to go?
Picking your moment
How to have this conversation
Take-home messages from this chapter
Futureproof your sex life, for life
What do we mean by a good sex life?
What does the science say about what makes sex good in the long term?
Responsiveness
Conscientiousness
Self-expanding activities
How to deal with being thrown off course
How to deal with changing needs
Is sex a priority?

Conclusion
Acknowledgements
Notes
Further Reading
Index

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Dr Karen Gurney is a highly specialized clinical psychologist and certified
psychosexologist, and a recognized national expert in the theory and
practice of therapy around all aspects of sexual well-being and function.
She is currently Lead Psychosexual Therapist at 56 Dean Street (Chelsea
and Westminster Hospital NHS Foundation Trust), as well as Director of the
Havelock Clinic, an independent sexual problems service based in Harley
Street and in the City of London. Dr Gurney has written for and been
featured in publications such as Marie Claire , Cosmopolitan and
Refinery29 . She has appeared on BBC2’s Victoria Derbyshire show and is
the expert attached to Cherry Healey, Lisa Williams and Anniki
Sommerville’s podcast, The Hotbed Collective (@thehotbedcollective
[URL inactive]), regularly appearing in their live shows and podcasts. She
is also an ambassador for www.thepornconversation.org – a not-for-profit
initiative set up by Erika Lust designed to help parents and carers talk to
young people about porn use. Dr Gurney is on Instagram as @thesexdoctor
[URL inactive]. Mind The Gap is her first book.

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Introduction

What if I told you that everything you’ve been led to believe about your
own sexuality wasn’t true? That the standards you’ve been judging yourself
and your sex life by, and often feeling you’re failing at, are unrealistic for
most of us and cannot be realized? That it’s possible to simultaneously feel
little or no spontaneous desire in your sexual relationship, but also have a
happy and mutually satisfying sex life long term?

It might well be hard to believe.

There aren’t many areas of science where we have got it so wrong for so
long that gross inaccuracy has seeped into our collective psyche, but sex is
one of them. Sex is an area where so much of our understanding comes
from culture, folklore, religion, hearsay and magazines that we have lost
track of the facts. We are too blinded by the pervasive and all-encompassing
impact of this cultural and social story to see clearly.

My professional life as a clinical psychologist and psychosexologist in this

field has been spent unlearning everything I thought I knew about people
and sex in order to be able to help the people who come to see me in
therapy. I spend a great deal of time working with women and their partners
in therapy sessions around the issue of dissatisfaction with a sex life that, to
them (or their partners), isn’t quite hitting the mark. A sex life where the
desire they should feel for one another is not as present as they feel it should
be , and this seems like a looming, impending disaster in their lives.

The reality is that they – us, we – have been sold a lie. Sex science has
made some surprising discoveries in the last few decades, since it first
brought forward ideas about how human desire worked, ideas that came to
dominate popular opinion and society and shape how we understand our
own sex lives. What came later were new understandings and ideas that
have revolutionized the field of sex therapy even further, but this
knowledge has not yet trickled its way down from academia or therapists to
the mainstream, so the old ideas remain and hang over our sex lives like a
sword of Damocles of impossible standards.

But why? Surely, if it’s that important, people would be talking about it?
Well, sadly, the evidence of history shows ‘real’ facts about sex and
sexuality often struggle to cut through the thick fog of moral, social and
cultural opinion. You only have to look at other areas of sex science to see
it. Ideas about masturbation making you go blind, which were prevalent in
the early nineteenth century, are still brought to the therapy room to this
day. The belief that monogamy ‘works’, despite evidence that, for many
humans, it can be challenging, is rooted in the institutions of culture and
religion, rather than any scientific evidence demonstrating that humans
were made to stick with one partner for life. And, lastly (and possibly, to
you, most importantly), that you should feel sexual desire randomly and
frequently for your long-term sexual partner, that good sex should ‘just
happen’, and that this desire should prompt you to have sex whenever the
whim takes you.

Take a second to reflect on this. At this current moment in time, do you

believe these ideas? Ideas such as, in your sexual relationships, you should
frequently and spontaneously desire sex with your partner? It would
surprise me if you don’t believe it strongly (even if it’s not happening for
you). Everything we have been led to believe speaks to this idea. Films, TV
and music perpetuate it. Everyone is worried about how much sex they are
having (and that it’s not enough), and a relationship that can stand the test
of time and still be passionate is the holy grail for most people. But,
ironically, there’s another discourse that sits alongside all this. A warning
bound up with jokes and innuendo (especially related to marriage), that it’s
impossible to have a happy sex life in a long-term relationship. That
couples who commit to each other basically throw away any hope of ever
having good sex for the long term, but that, somehow, long-term
companionship should make up for this.

So which is it? Should we be expecting passion that lasts a lifetime or sex

only on birthdays after the honeymoon period?

There are problems inherent in both of these ideas. In the first, an

impossible ideal of everlasting passion that can somehow endure all manner
of relationship dissatisfaction, life events and changes to our bodies and our
identities, without any conscious effort. In the second, a sense of hopeless
inevitability that sex is doomed and that it can never be resolved, no matter
how hard you try: a kind of passion black hole.

The truth is that great sex is cultivated, not ever present, but we need to
understand how desire works and develop knowledge and skills regarding
how to cultivate it. And those tropes we mentioned? Of everlasting
unwavering passion with little effort? Or of long-term relationships
inevitably moving forward to total sexlessness? Neither of them help us one
bit.

The title of this book, Mind The Gap , makes reference to the differences
between how we think our sex lives should be (often based on unhelpful
comparisons) and how our sex lives actually are, as well as the difference
between what we need to know about sex and desire to have great sex and
what most of us actually know. There are also other gaps which influence
our sex lives negatively and which will feature in this book. Some of which
you will probably be familiar with already, such as gaps in gender equality
(yes, inequality affects our sex lives too), and others which you may have
heard of, such as the orgasm gap (where women, particularly straight
women, have less pleasure during sexual encounters with men than the men
they are having sex with). My hope is that reading this book will help you
close these gaps in your own life and relationships.

Couples who come to see me for therapy in regards to desire often hint in
the first session that they expect the work that we will need to do to be long
and arduous. As I hope you will learn from this book, the reality is far from
this, and the process can even be as quick as a realization that might happen
in a single session (or on one page), or a few sessions (chapters). The harder
work, in fact – if there is any – can sometimes be the unravelling of patterns
that have formed, which then also need to be addressed, so as not to
undermine this new way of seeing things. In this book this aspect will be
addressed with useful exercises I’ve set out at the end of each relevant
chapter for you to try.

I’m hoping that you picked up this book because you can see the potential
for a more satisfying sex life. The truth is, all of us can, and should, strive
for our sex life to get better and better over time. If you find this hard to
believe, you have fallen for the societal myth we talked about earlier – that
sex declines in a relationship over time.

This book is for all women (or female identifying people) of any age. This
doesn’t mean that this information isn’t also of use to those identifying as
men or non-binary (in fact, much of the content will be equally relatable),
but rather that we’ll be focusing on the enormous influence of gender on
sexuality, and so the content might speak more to those whose gender
identity is female. When I refer to women throughout this book, I mean all
women, no matter what sex they were assigned at birth. That said, there are
key differences in the experience of sex for trans and non-binary people,
related to society, culture, transitioning, being on gender-affirming
hormones or having had lower surgery, which I will not be addressing here.

If you are in a sexual relationship with a woman, this book is for you too, as
you will learn information about your partner’s desire that will change the
way you understand your sex life. This book is relevant for women of all
sexualities, and you will find information related to the key differences in
how the gender identity of your partner(s) might influence your current sex
life as the book continues. There are many similarities between the sex lives
of women who have sex with women and women who have sex with men,
but also some key differences, which provide key insights for all of us about
how we can better understand our sex lives.

When I refer to sex, what I have in mind is not a narrow definition of one
sexual act, such as penetrative vaginal sex, as is often the meaning of ‘sex’
in our society. In fact, I’m not assuming what sex means to you at all. This
is partly the journey, understanding what ‘sex’ is about for us, which is in
constant flux, and then basing our current sexual lives on this
understanding, not someone else’s blueprint. I also do not see ‘good sex’ as
just the absence of a sexual problem. Let’s aspire to more than that, shall
we?

My hope is that it will give you a new sense of what’s ‘normal’. It may lead
you to the conclusion that you were expecting something impossible of
yourself and your sex life in every long-term relationship that you’ve been
in so far, but it will also give you a comprehensive understanding of how
desire really works, so that you can be in the driving seat of how you’d like
desire to feature in your sex life over the course of the rest of your life. No
longer a passive recipient, but in control of the direction you want it to go
and the destination you are aspiring to.

Part One will give you a brief overview of the social, cultural and political
history to where we find ourselves right now. Chapter 1 will cover how
institutions such as science, religion, psychology, psychiatry and the media
have authored different bits of this story, each with their own objectives and
biases. This is an important backdrop to many of the subsequent chapters.
In Chapter 2 we’ll learn the real facts about what’s happening in the sex
lives of the UK population and across the world – how much sex are people
really having? What kind of sex? How many of those people are dissatisfied
or worried about desire? Then, in Chapter 3, we’ll talk anatomy, orgasms,
sex education and understanding what your individual ‘conditions for good
sex’ are. Part One is about understanding the forces that have led to the way
you think and feel about your sex life right now.

In Part Two we’ll be opening up and exploring some of the key aspects of
how sex and desire work. This will include the impact of society on how we
understand and act sexually, how the context of our relationships help or
hinder our sex lives, and how our brains process and facilitate sex and
desire. I’ll also be introducing you to more recent understandings of how
desire actually works. This new understanding will give you a clearer idea
of the changes you can make in your own relationship to have better sex
and nurture desire.

In the final section, Part Three, we’ll take all of this forward and build on it.
How can we put all we’ve learned into practice and make the changes we
now realize we need to make with a partner? What other aspects of our
relationships should we work on if we want to keep the sex hot? How do we
keep a sex life on track despite the sudden onslaught of new life challenges,
or over time? Put simply, how do we futureproof our sex life, for life?

I wrote this book for two reasons. One is to disseminate information about
sex that I feel all women should know. The second reason is because I have
seen first-hand the difference that this kind of perspective can make to
people’s sex lives and relationship satisfaction. I hope it’s the change you’re
looking for right now.

Ready?

Let’s start a revolution.

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One
Common Misconceptions and How
They are Holding Us Back
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1
A brief history of sex, science and gender
politics

How did we get here?

It would be impossible to write a book on women’s sexuality and desire
without outlining some of the key social, political and scientific influences
that led us to where we are today. As you read through this book, you will
discover that desire exists within a constraining framework of gender
politics, and that beliefs about desire have been influenced by key advances
(as well as key retreats) in science, feminism, psychology and sexology.

This first chapter is not intended to give a comprehensive and complete

review of this history, as this would be an enormous feat, outside of my
expertise and also, probably, not the reason you picked up this book.
Nonetheless, these historical influences leave such a legacy it would be
remiss of me not to mention how influential they still are for our sex lives
today.

In this chapter I will give a brief, non-linear and selective historical

overview in order to provide you with a foundation that will help you to
make sense of later chapters and look at things you previously believed to
be truths about sex with new eyes. I wish to demonstrate that how we view
sex is almost entirely influenced by the prevailing culture, language and
politics of the time, and attitudes to sex vary enormously across continents,
communities and cultures because of this.

For the purpose of this book, I will focus on some of the key institutions
that have dominated society in the UK as well as Western science over the
last few centuries, which is not to say that there weren’t other influences, or
that there weren’t other communities with different views and experiences
at that time – there most definitely were. Dominant institutions and
movements during this time, such as Christianity and monogamy, have had
a tremendous impact on our views about sex and women’s sexuality.
Similarly, cultural shifts, such as the women’s movement, had a significant
impact on women’s rights, sexuality and autonomy. And, in the twentieth
century, the evolution of modern science and the birth of psychotherapy and
sexology each played a significant and prevailing part in how society saw
women and sex, all of which has laid the foundations for how we
understand sex today.

To sum up, how we see sex, including what is ‘normal’ and how women are
expected to relate to sex, is a moveable feast, depending on the cultural
context and dominant views of the time. Although it may not seem like it,
these key points in history are still hugely relevant to your sex life in this
present moment.

Sex and sinning

We start this timeline in the seventeenth century, mainly because we have to
start somewhere and the dawn of time would take us far too long. In many
parts of the Western world, monogamy was the norm at that time, mainly
due to the influence of religion and the importance given to the institution
of marriage. Marriage had importance as it was connected to ownership of
land and, therefore, finance, but most women’s partners were chosen by
their fathers, not by the women themselves. Christianity was the dominant
influence on moral values, but the Protestant Reformation was gradually
changing the image of marriage to something that was more about personal
choice, and included desire, rather than almost exclusively being about
procreation. 1 Interestingly, prior to this point in history, women had been
considered to be the more lustful sex, but this was soon to change and be
replaced by the idea that men’s sexuality was more powerful and women
were naturally less sexual. Sex outside of marriage and for anything other
than procreation was seen as sinful, and this was evident in the laws of the
time, with adultery and homosexuality being considered illegal and even
punishable by death.

In contrast, it has been suggested that the eighteenth and nineteenth

centuries brought with them a shift in sexual values. 2 It was no longer
illegal to have sex outside of a relationship (though still frowned upon),
although women’s sexuality was viewed as less powerful than men’s, and
women were positioned as ‘gatekeepers’ regarding sex, with the onus on
men needing to control their urges. There was also an assumption that
women’s orgasms were important, as the woman’s orgasm (and, in fact, a
simultaneous orgasm) was believed to be crucial to getting pregnant. Sex
was seen as an important part of marriage, but fears about the dangers of
masturbation for one’s physical and psychological health were prevalent.
This was evident from the invention and dissemination of devices to
prevent ‘self-touch’ and the lengths that people went to dampen sexual
impulses, especially in women, for whom a perception of a ‘naturally’
lower interest in sex meant that any evidence of sexuality was particularly
problematic.

You could be forgiven for thinking that some of these more sex negative
aspects of history were just representative of the times, represented across
the world, and that we’ve moved on a lot since then. Not so. Many of these
historical views of sex contrast greatly to more liberal attitudes to sex in the
UK before this period, and also across the globe. Sex positivity is evident in
numerous historical texts, such as the ancient Hindu Kama Sutra (compiled
between 400 BCE and 200 CE ) and the Encyclopaedia of Pleasure from
tenth-century Baghdad. 3 In both of these, sex is represented as being
primarily for pleasure, without shame and with relaxed attitudes to gender
and sexual diversity. In many parts of the world it was, in fact, colonization
by the British which imported more restrictive sexual values and brought
with it new, more conservative perspectives. We also know that the sex =
shame rhetoric is (and was) absent in many other non-Western cultures.
Women living in certain matriarchal communities, such as those of the
indigenous people of Papua New Guinea, were free to enjoy sexual
expression with a variety of men for pleasure. What we can deduce from
this is that, here in the UK and in other parts of the West, the roots of our
recent sexual past are related to a conservative ancestry with views of sex
related to religion, gender inequality, a fixation on monogamy, and with a
distinct fear of sexual urges as the backdrop.

Sex and madness

Sex then moved from something that was policed by religion – ‘your
desires are a sin’ – to something that was policed by medical science (at this
time, psychiatry) – ‘your desires are a sign of madness’. ‘Hysteria’ was
defined as an illness connected to sexuality in women, with masturbation
being one of the symptoms, while the term ‘nymphomania’, which was
coined in the eighteenth century and rapidly gained popularity, was used to
describe women who masturbated, wanted sex more than their husbands
did, who fantasized about sex or who had sex with other women. The use of
these terms as explanations for a range of women’s experiences neatly
aligned women’s sexual urges with madness. Interestingly, at the turn of the
nineteenth century, many more women were committed to psychiatric
institutions than men for concerns regarding their sexual behaviour, a
pattern and a narrative of female sexuality being seen as more dangerous
than men’s that we have not seen replicated since. Women were locked in
psychiatric institutions, forced to have hysterectomies or lobotomies, had
leeches applied to their genitals, were forced to take freezing cold baths,
had their clitorises removed or caustic chemicals inserted into their vaginas.
These diagnoses and treatments have been hypothesized to be a form of
social control over women, with sexual desire as the mobilizing factor.

Sex and subjugation

In the second decade of the twentieth century, Britain was about to go to
war. This devastating event marked a significant change in women’s
opportunities and position in society. Women were, for the first time, taking
on roles that had typically been held by men in our historically patriarchal
culture, shifting the view of what women were capable of. By the end of the
Great War, significantly more women were in employment than had ever
been before. Women, empowered by this experience, continued to push for
rights that were justifiably theirs and, as a result of the efforts of the
women’s movement, some women were granted the right to vote in 1918. It
has been suggested, however, that this small but significant shift in gender
equality was met with a cultural backlash, as it was seen as potentially
threatening to the institution of marriage, ‘family values’ and, therefore,
society.

At the same time, modern science and medicine as we now know it was an
evolving field, as was the means to carry out scientific enquiry. In the
eighteenth and nineteenth centuries, a cultural shift from religion as a
dominant world view to science as a dominant world view started to gain
traction. This was not without challenge, as advocates of these two
opposing views battled for who was right. A key feature of this era was that,
until this time, it was dangerous to hold a view that represented something
other than the dominant view of the church. Pretty soon, however, science
became the more dominant voice (alongside religion and social convention)
as an authority on people’s lives, and this started to play out in sex,
medicine and the control of women’s sexuality by these means.

The creation of sexual dysfunctions

Psychiatry, it can be argued, created sexual dysfunction. The American
Psychiatric Association’s Diagnostic and Statistical Manual (DSM) was
created in 1952, with the aim of being a complete list of all the possible
diagnoses available regarding mental ‘disorders’. Essentially, if it’s not in
there, it doesn’t exist. But, equally, the inclusion of supposed disorders in
DSM gives them credibility. The DSM first included sex as something
which could be ‘disordered’ in the third edition, which came out in 1980. 4
Before this, people had concerns about sex, of course, but DSM-III marked
the first time that specific terms for sexual problems (such as ‘Inhibited
sexual desire’) were coined, a historical moment of which the aftermath
influences our sex lives even now. Before this date, ‘sexual dysfunctions’
didn’t have labels, weren’t medicalized, and decisions about what aspects of
sex to prioritize and therefore name ‘dysfunctions’ weren’t decided upon on
the basis of what constituted ‘normal sex’ at the time.

Sex and neuroses

In the late nineteenth and early twentieth centuries, a few determined voices
started to suggest that religion and science had got it wrong when it came to
sexual expression. Sexologists were few and far between, but those that
were about, such as Havelock Ellis, were presenting very unpopular ideas,
such as the thought that homosexuality was, in fact, not an illness but a
normal representation of sexual preference found in humans. 5 Sex between
men wasn’t decriminalized until 1967 in the UK (and then not in all
circumstances), however, and ‘homosexuality’ was only removed from
DSM in 1973 (and so declassified as a ‘mental disorder’). Sex between
people of the same sex has been present in humanity since records began,
and it hasn’t always been seen as a problem by various cultures and
communities through various points in history. And yet negative opinions
about LGBTQ people are still painfully evident today when we look at the
recent protests by parents in the UK against the inclusion of teaching
around LGBT identities in schools.

When Sigmund Freud, the Austrian neurologist and psychiatrist, later

dubbed the ‘father of psychoanalysis’, came along in the late nineteenth
century, he was happy to talk about sex. So happy, in fact, that it seemed
that everything was suddenly about sex in one way or another. Freud’s own
version of therapy came along before therapy began to utilize scientific
methods, and his personal observations or reflections on his cases were
postulated as theories that continued to dominate the world of
psychotherapy for the next century. Much of Freud’s theories about sex and
sexuality we now know not to be true; for example, the idea that a clitoral
orgasm is an ‘immature’ version of a vaginal orgasm, or that homosexuality
is an immature version of heterosexuality. Despite unknowingly and
unhelpfully pathologizing large sections of the population, at least Freud
promoted a narrative about sex as something that people like to do, and an
urge that people have, rather than the old narrative of sex being something
to create life only (unless you’re mad).

One of the most pivotal moments in sex science came with the ground-
breaking work of Alfred Kinsey in the 1940s. Kinsey was an American
entomologist (i.e. his field was the scientific study of insects) who decided
to study human sexuality in a laboratory setting to learn more about it. Here
we have the intersection of several key moments in time coming together in
historical union. The view that sex is not a sin, but just something people do
(and enjoy!) and also the view that everything can be observed and studied
by science, just like you might study insects. And finally the concept that
this is how we can come to know better what sex is or how people do it, not
through opinion, the views of the church or the views of the state.

Through his interviews, Kinsey discovered that sexual orientation wasn’t

binary and that most people were somewhere in the middle, not on either
end of a straight-or-gay scale. He discovered that people enjoyed sex, went
about it in all sorts of different ways, and that most people masturbated. He
suggested that all types of sexual expression were acceptable. Kinsey’s
work and discoveries were seen as so challenging to American family
values that his funding was pulled, and his ground-breaking research was
stopped in its tracks. If Freud was the father of psychotherapy, Kinsey was
certainly the father of sexology.

Virginia Johnson and William Masters came next, and wanted to build on
Kinsey’s discoveries of what people do and find out more about how sex
actually worked. Masters was a gynaecologist and Johnson was initially his
research assistant and then became his partner – in both senses of the word.
Throughout the 60s and 70s they applied science and process to their
laboratory studies, making observations and collecting data on sex. Masters
and Johnson came up with the first real model of what happens to humans
during sex – the human sexual response cycle. This model was added to by
Helen Singer Kaplan and others shortly after, and became the model to
explain humans and sex for decades to come. 6

The Masters and Johnson/Kaplan model (which you will learn more about
in Chapter 7) not only formed the basis of all of the sexual dysfunctions that
were first named in DSM and stayed there until very recently, but seeped
into the fabric of society, from the echelons of science down to popular
culture, and added to our idea of what sex is and how it should look.
Masters and Johnson were quite keen on using the media to disseminate
their discoveries to the masses and appeared regularly on TV, which was
quite unusual for scientists of their time. I like to think of them as the
original sex influencers and think that, if they were around right now,
they’d have a massive Instagram following.

Masters and Johnson’s understandings have formed the basis of how we as

a society view ‘normal’ sex – even up until this day, and until now you may
not have even realized that their work has been responsible for how you
understand sex. This, of course, is what happens with science and law: if
something is illegal, we presume it must be wrong, and if something is
found in science, we presume it must be right. Without question we absorb
these things to be truths and they form part of our cultural narrative. One of
the key understandings from Masters, Johnson and Kaplan was the idea that
desire is the first part of human sexual response. These days, a large body of
evidence suggests that this is not the case and that desire operates
differently to how it was first understood in the 60s. This knowledge has not
yet trickled down into mainstream understandings, but by the end of this
book I hope you will have changed how you see desire completely, in line
with these new views.
The potential for sex to be seen as a learnt skill is also perhaps a hangover
from how sex was reported by the media around the time of the Masters and
Johnson era, and an attitude which prevails even now. The question ‘Are
they good in bed?’ suggests that we believe that sex is something we can be
good at, as if having sex was like playing the piano or some other
acquirable skill. In fact, sex is more like creating a piece of music and
playing it in synchronicity with another musician, who has created their
own piece, which yours must harmonize with. The skill is in listening and
harmonizing, not simply playing the instrument.

Masters and Johnson are also credited with being the original founders of
sex therapy, and so they should be. They published one of the first books on
working with sexual problems and developed a new form of behavioural
sex therapy. So much of their work is relevant now, and although sex
science has moved on in leaps and bounds since then, their work still
remains pivotal. What is fascinating about the work of Masters and Johnson
is that, similar to Kinsey, their work also came at an important intersection
in history.

At the time they were studying sex in the 1960s, behavioural and cognitive
therapy paradigms were starting to take shape, and the dominant view of
other models of therapy, descending from Freud, were making room for
new ways of understanding how people think and how problems are
formed. Much of Masters and Johnson’s work was based on these
behavioural and cognitive concepts. For example, they described how, if
you have a thought that you will lose your erection, it causes anxiety in
your body, which creates physical changes in the body, which in turn make
sexual arousal (and therefore erections) impossible. The thought itself can
cause the sexual problem, and the prediction of the same thing happening in
the next sexual situation you find yourself in will mean that this cycle
continues, building up momentum over time. These realisations were
pivotal for sex therapy, as they moved us away from ideas of neuroses
leading to sexual problems to the concept that sexual problems can happen
to all of us, and can be overcome by creating a different experience or
understanding. The continued influence of this approach will be evident as
you read this book.

Sex and drugs – the medicalization of women and sex

Sex therapy as a field grew from the work of Masters and Johnson, gaining
popularity, acceptability and kudos. But the advent of the pill in the 1960s
brought with it a fresh panic about women’s sexuality and what would
happen to women’s sexual behaviour without the restrictions of the fear of
getting pregnant. Sadly, the ongoing policing of women’s bodily autonomy
is still a massive worldwide issue in relation to abortion rights, and there are
strong parallels to be drawn around such restrictions and women’s sexual
lives in the world around us today.

In 1996, after the accidental discovery of Viagra by Pfizer, the field of

sexology took a temporary medical diversion. Viagra had been designed to
treat angina, but it was discovered that, as a side effect, it could produce
rock-hard erections and drug companies immediately started to see pound
signs (dollar signs, really, as it happened in the United States, but you know
what I mean). There was suddenly much talk about creating a similar
product for women. After all, it was ‘well known’ that women were not that
keen on sex, compared to men, and that men supposedly needed more sex
than women, so a fix to this problem seemed ideal (these things aren’t
actually true, of course, but bear with me). Drug companies raced to be the
first to come up with a solution to the ‘problem’ of women’s desire. In the
background, a bunch of feminist scientists and sex therapists started to
question the status quo about how women’s sex lives (especially desire)
were being talked about in the scientific and medical arena, with an absence
of context about other forces that shaped women’s sexuality.

Since 2015, two drugs have been approved by the Food and Drug
Administration in the US for the treatment of low desire in women. The
first was Flibanserin (Addyi) and, in 2019, Bremelanotide (Vyleesi). Both
are associated with significant side effects reported in studies of their early
use and there has been a great deal of controversy and debate about these
drugs in the field of sexual medicine. Addyi brought a (rather unimpressive)
increase of one extra satisfying sexual experience roughly every two
months for the women taking it daily, with some challenging side effects
and contraindications. 7 Controversy about such treatments is focused on the
potential for further over-medicalizing women’s sexual functioning and
concern that situating women’s desire in a purely medical context is
reductive because it does not take into account the socio-political context
women’s relationships exist within. Despite the availability of Flibanserin
and Bremelanotide in other parts of the world, medications specifically
aimed at women with ‘low desire’ are not available in the UK currently, but
this might change in the next decade, with several new drugs in
development set to launch in Europe.

Sex, power and feminism

Until the 1960s, sex science (in fact, most science) was dominated by men,
and we now know that this made a difference to the information that was
gathered, the questions that were asked and the models that were put
forward. Masters and Johnson studied sexual response in both men and
women, and documented differences between the sexes – for example,
making the discovery that women did not need the refractory period (the
period of delay between orgasming and getting sexually aroused again that
we see in men) and could be multi-orgasmic. But Masters and Johnson still
landed on a final one-size-fits-all model of human sexual response that was
predominantly based on a male experience (i.e. with a refractory period).
This was a reflection of science as a patriarchal institution.

As such, we did not question whether the categories of sexual dysfunction

that had been included in DSM since the 80s were perhaps better suited to
heterosexual cis gendered male sexuality and maybe privileged penis-in-
vagina sex over all else. Or that this bias didn’t adequately represent anyone
or anything else. For example, ‘premature ejaculation’ was defined in DSM-
IV as ‘coming before or just after vaginal penetration’. There was no
equivalent category of coming too soon for women (even though we now
know that a small proportion of women feel they do) or for coming too
soon before another type of sex, such as mutual masturbation or anal
penetration. The reason for this, as suggested by many sex scholars and
academics, is that the only sexual dysfunctions included in DSM were ones
which prevented the successful completion of wider society’s current idea
of what constitutes ‘normal’ sex, with men’s experience taking centre stage.
It doesn’t matter when women come, as sex can continue, right? It also
doesn’t matter what happens for LGBTQ people, as straight cis sex is the
normal one.

Feminist sex scientists and clinicians rejected these ideas of women’s

sexual difficulties based on this male model and patriarchal view of what
sex is or who sex is for and formed a working group to address their
concerns. In the early 2000s, ‘The New View’ of women’s sexuality was
proposed, as an alternative system for women, to move away from the
perceived inequality and gender bias of DSM and the medical model. 8 This
system allowed greater emphasis to be placed on the social, economic and
political influences on women’s sexuality. Leonore Tiefer, a vital member
of this working party, used the analogy that ‘sex is more like dancing than
digestion’, referencing the cultural, political, social and learned aspect of
sex as more important than the historical importance placed on biology. You
will see the influence of this view in this book, as I will talk very little about
the biology of sex and desire, favouring instead the influence of society,
gender politics, psychology and relationship dynamics.

Women started to play a more pivotal role in sex science and there was an
explosion in the numbers of female sex researchers who, through their
research and writing, have changed the way we see sex for ever. The work
of many of them, such as Cynthia Graham, Rosemary Basson, Amy Muise,
Sarah Murray, Robin Milhausen, Emily Impett, Lori Brotto, Meredith
Chivers, Debbie Herbenick, Kristen Mark, Karen Blair, Caroline Pukall,
Julia Heiman, Ellen Laan, Marta Meana, Sari Van Anders, Lisa Diamond
and many equally important others, are represented in much of the scientific
content referenced in this book. They have made discoveries and developed
theories about sex and desire that will have a direct impact on how you
understand your own. Remember their names, as they will go down in
history, just as Kinsey or Masters and Johnson have, for the impact they
have made to sex science. They are feminism, sex science and power in
action.

In the last twenty years, perhaps the largest advances in sex science have
been made with regards to how we understand women’s desire. New
models of sexual response were proposed to rival Masters and Johnsons,
and, for the first time ever, they were based on women’s sexuality, which
I’ll tell you more about in Part Two. Sex researchers started to learn more
about women’s desire, pleasure and orgasms and began to directly
challenge the way women’s sexual problems were represented in DSM,
suggesting that, based on new science, the current classification system was
pathologizing the normal expression of sexual functioning in women. New
advances were made in understanding how attention and sex were closely
linked, as well as the impact of our thoughts and how we experience
relationships.

In the late 2000s, a team of sex scientists aimed to change the way women’s
desire was represented in DSM, based on new evidence, and they succeeded
in creating a new category, ‘Female sexual interest/arousal disorder’, in the
latest version of DSM, DSM-V. 9 The old category of Hypoactive (low)
sexual desire disorder was removed, reflecting new research regarding how
women find it hard to separate desire and arousal and placing much more
emphasis on the subjective and relational aspects of arousal and desire.
Such changes represent great strides forward in sex science, as opinions of
what constitutes normal or dysfunctional in the scientific or medical
community influences what we all believe of ourselves.
It is no longer seen as a problem if women don’t feel like sex
spontaneously. It is no longer seen as a problem if women don’t feel like
sex without ‘adequate sexual stimuli’ (for the record, for most people,
saying ‘It’s been a while, how about a shag?’ doesn’t constitute ‘adequate
stimuli’). Women’s sexuality, pleasure and capacity to respond to sex is
being given the credit and attention it deserves, and the situations that
amplify it, and extinguish it, are now understood in greater detail. Women
are being armed with the information they need to know that their bodies
work just fine.
OceanofPDF.com
2
Mind The Gap – Statistics around sex and
desire

How much sex are people having?

I don’t meet many people who aren’t concerned about the amount of sex
that they want or are having, or how their sex life is going more generally.
You might feel that this is connected to the job that I do, but, in actual fact,
this is what I hear both from my clients and the people I meet outside my
job. Admittedly, once people find out what I do, they tend to share more
with me about the details of their private life than they probably share with
most. If we’re ever at the same dinner party, I recommend sitting next to
me, as inevitably the conversation in the immediate vicinity will turn to sex
in some way, shape or form. The good thing about this for me is a) I love
my job and never get tired of it, and b) sex is ridiculously fascinating and
never gets boring, even when you talk about it all day.

People mainly start to worry because they are mapping out what’s
happening for them against a standard that they believe is the ‘average’.
But, generally speaking, people are drastically wrong when it comes to this
estimation of other people’s sex lives, and they are also often mistaken
when it comes to the assumption that frequency is a good indicator of a
good sex life (more on this later on). Still, I feel it’s useful at this point to
talk more about what’s ‘normal’, so that you can feel reassured about what’s
happening for you. This is what this chapter is all about: a snapshot of our
sex lives and what we know about what is really happening. A yardstick for
you against which you can breathe a sigh of relief, but also an indicator of
how inaccurately we understand and judge ‘sex’ as a society.

In this chapter I will lay out some of what we know from large-scale sex
studies about how often people are having sex, the difficulties that we are
having in our sex lives, and the consequences people report in relation to
their lives and relationships generally when their sex lives aren’t going to
plan. I’ll give you a sense of how common sexual dissatisfaction is and all
the ways it can feel difficult, and (hopefully) begin to reassure you that, if
you are struggling with these things, or would just like your sex life to be a
bit better than it is now, it’s not just about you or even your relationship, but
rather something you share with a significant number of other women in the
UK and the rest of the world.

Who decides what’s normal?

One of the problems with sex is that, if you don’t make the study or practice
of working with it scientific, all you are really left with is bias, opinion, and
the skewed impact of cultural values and assumptions. This is more the case
with sex than it is with almost any other subject, as it is both something we
don’t talk about that often in public and (as we learned in the last chapter) it
has been heavily dictated to by ideas of shame, religion, culture, medicine
and politics at different points in history, giving a bias to which stories are
privileged over others.

Not looking at sex scientifically (and by this I mean finding out what people
do, and understanding how and why, by looking closely at the evidence
rather than what you think) does not make for a good sex therapist. It also
stops us learning more about sex as a society. As a clinical psychologist, the
ethos of my training is about being an evidence-based practitioner. This
means doing therapy based on what science says, not my intuition or
assumptions. Of course, this doesn’t mean I can’t use my intuition at all,
just that I should be careful to test my intuition as a hypothesis, rather than
following it blindly. I use the learnings of science heavily in my therapy
sessions, and my hope is that you will also value this aspect when reading
this book.

It is for this reason that, the first time I heard about the Natsal study
(National Survey of Sexual Attitudes and Lifestyles) 1 venturing into the
realm of sexual functioning many years ago, I nearly fell off my seat in
excitement. My joy was not just based on the fact that I knew it would
provide us with solid facts about the sex life of the UK that we had never
had on such a large scale before, but also because I’m a total sex-research
geek. I feel we should be immensely proud of the fact that this study
happens in our small country, especially as it is currently the biggest and
most rigorous undertaking regarding sex research, on a population level,
anywhere in the world. Natsal is a collaboration between several big
research bodies and institutions and aims to look at how adults in the UK of
all ages, backgrounds, ethnicities and sexual orientations experience sex,
sexual health and, more recently, sexual function and satisfaction. It’s one
of the best markers we have about what actually happens in peoples sex
lives, and without it we (as clinicians, but also as people having sexual
relationships) are left completely in the dark about what’s ‘normal’, * or
how other people feel about or experience sex. Without this kind of research
we are left only with societal opinions, based on skewed assumptions and
biases, plus the dominant forces of the time in question, and you’ve already
learned what a mess relying on that got us into historically in Chapter 1.
* Although I’ve used the word ‘normal’ in this context, I do not mean that if you do something
differently, or at a different frequency to the majority of the population, you are not ‘normal’. Rather,
there are things that are common sexually, and if these things happen to you or feature in your sex
life, you can rest assured that you are not alone in this.

A national barometer of sex

One of the most crucial of the ‘gaps’ in our sex lives that the title of this
book refers to lies between our perception of how our sex lives should be in
comparison to others versus our lived experience of our actual sex lives.
Frequency of sex is often a barometer that we use to judge this, possibly as
it’s easier to ‘count’ than some other aspects of sex. And, of course, we’ve
been sold the myth that frequency is the most important thing (one of a
whole host of myths, actually).
Over the last few decades, Natsal data tells us that the frequency that we’re
having sex has dropped in the UK, and a recent Natsal publication 2 tells us
that, in the UK, the average person has sex a little less than once per week,
or about three times per month (although this is more like twice a month for
women between the ages of 35–44). This most recent analysis of the data
also shows us that a higher proportion of adults under forty-four are
reporting no sex at all in the last month, which is more than in previous
Natsals (29% having no sex in the last month in Natsal 3, compared with
23% in Natsal 2).

This same Natsal publication also highlights general declines in sexual

frequency in other countries around the world, such as Japan, Australia,
Finland and the US, albeit showing slightly different trends in these
declines. Now, firstly, don’t panic if you’re having sex a lot less than twice
or three times a month, even if it’s much less than this. What you will learn
as we go on is that the frequency with which you have sex is almost
meaningless. Do be reassured by these numbers, though, if you (or your
partner) have been feeling abnormal based on your assumption that you
should be having sex much more than this up until now. There’s also
nothing wrong with wanting more sex than you’re having at the moment or
more than is reported as the UK average. This Natsal data also picked up
that over 50% of women (and even more men) wanted to be having more
sex than they were currently having, but whether this is about people
feeling their sexual frequency is not measuring up to a perceived norm, or
whether people are genuinely dissatisfied with the amount of sex they are
having we just don’t know.

How frequently you want sex and how frequently you have sex are
certainly not the same thing, and as we will learn over the course of this
book, there any many factors that influence whether we invest in and act on
our desires using the behaviour of ‘sex’. Similarly, frequency of sex and
quality of sex are not the same thing, and quality of sex has huge
implications for desire. Often social chat about sex tends to be focused on
how much sex people are having, or whether they went all the way
(penetration), and very rarely how mutually pleasurable or even life-
expanding it was. This is important, as alongside making people who have
infrequent but life-affirming sex feel like their sex life isn’t up to scratch,
we know that frequent but unsatisfying sex is generally bad for desire and
not actually a useful goal to aspire to anyway.

Sexual satisfaction and problems

Natsal was pioneered by a team of female scientists with expertise across
public health, social science and epidemiology. It was conceived as a
response to the beginning of the HIV epidemic in the UK in the late 1980s,
when it became clear that the fight to combat HIV by reducing transmission
would be impossible without a clear idea of the types of sex the population
of the UK was having. The Natsal team have undertaken this enormous task
every ten years since then, with data first coming out in 1990–91, then
1999–2001, and the latest in 2010–12. Natsal 4 is in the pipeline at the time
of going to press. Over the years, Natsal’s data gathering has intelligently
evolved to include sexual function, as well as Sexually Transmitted
Infections (STIs) and sexual behaviour.

Natsal 3 uncovered some key information about the sex lives of the UK,
specifically that we have a high percentage of people reporting sexual
problems. 3 Just over half of women (51%) and 42% of men reported a
sexual problem, such as lack of interest in sex, lack of enjoyment in sex,
difficulty reaching orgasm or erectile problems, lasting three months or
more in the last year. Sexual problems were experienced across the age
ranges. To put this into perspective, there were 15,000 adults surveyed
across the country between the ages of 16–74, selected to represent a range
of geographical locations and other demographics, and roughly half of these
reported that something wasn’t going as they felt it should in their sex life.
This is an awfully large number, but does map on to similar studies done in
the US, Australia and Europe (rates in non-Western countries are higher
still), so it’s both surprising and unsurprising in equal measure.

In Natsal 3, people were asked about how their body worked sexually, how
they felt about their sex life, and how their sexual relationship was
functioning. They found that difficulties with sex were associated with
depression and poor physical health, relationship difficulties and finding it
hard to talk about sex with a partner. When asked whether they had
experienced sexual problems lasting three months or more in the past year,
34% of women in the UK reported a lack of interest in sex, 16% reported
difficulties with orgasms, 13% an uncomfortably dry vagina and a further
12% reported a lack of enjoyment in sex. This book is not focused on men’s
sexual experience, but you may also be surprised to hear that lack of
interest in sex was the most commonly reported concern for men too, at just
under 15%, quashing some ever-present myths that men are always wanting
or ready for sex. Early ejaculation for men and anxiety during sex for
women were two of the sexual concerns that decreased with age for men
and women, reflecting perhaps the impact of growing sexual confidence
over an individual’s lifespan.

Consider these statistics for a second. Fifty-one percent of women reporting

a sexual problem. A third of women feeling that they lacked interest in sex
for a significant period of the previous year. This statistic is not surprising
to me, as my clinic is full of women concerned about their desire, and
feeling a lack of interest in sex is well known to be the most common
reason that people seek sex therapy, but what do you make of this statistic?
Consider your friendship group, your team at work or the people sitting
around you on the bus/tube/train just now. Half of these women are
dissatisfied with sex, and for just over 3 in 10 of them, this is connected to
how much they feel like sex. This is where our sex lives are at in the UK.
It’s no wonder that drugs like Flibanserin have been developed, promising a
‘quick solution’ to this issue. And no wonder the therapy rooms of people
like me are filled with couples desperate to fix this ‘problem’ in their
relationship.
It’s important to note, however, that there’s a difference between having a
sexual problem and feeling distressed by it. Of women reporting lack of
interest in sex, pain or difficulty with orgasms, only 29% found their
problem distressing. 4 This may tell us that a significant number of women
with a sexual problem are coping with it okay, and don’t interpret this issue
around sexual functioning as a problem for them, or perhaps they have
found a way around it.

The impact of sex on relationships

You might be wondering why it matters. I mean sex is just sex, right? A
frivolous activity that we do in private for fun, not a life-or-death matter.
Well, not exactly. Sex is more important to us as humans than we often give
it credit for. In fact, research has found that people rate a happy sex life as
more important than an adequate income or shared interests with a partner. 5
I would argue that part of the reason we don’t give it credit for being as
important as it is is that we don’t understand the function it serves in our
lives and relationships. But, for now, let’s look at the evidence. What do we
know about the impact of sexual dissatisfaction on peoples’ lives? Does it
make a difference to our overall happiness if our sex lives are going well?

Studies have shown that, when couples have sex, they are more likely to
report a better mood and relationship satisfaction on that day and the next
day or two afterwards. 6 , 7 In fact, there’s evidence to suggest that sexual
satisfaction might be more important to relationship satisfaction than
relationship satisfaction is in having good sex. 8 I see this a great deal in my
clinical practice. Yes, there is a link between relationship dissatisfaction and
difficulties with sex 9 – it can obviously be difficult to have good sex if you
are feeling angry, disconnected or disrespected by a partner. But I see many
couples where it’s the other way around. They describe a wonderful
relationship, with sex the only part of it that is not working well for them. It
may be that, for a while, they didn’t mind this so much, and accepted that
sex is the one part of their relationship that doesn’t run as smoothly as the
rest. But, over time, this became a concern for one or both of them, and they
come to see me, wondering if it’s possible for a great relationship and great
sex to co-exist, or whether they need to accept that sex is the one area that
isn’t going to be so great. I’ve certainly worked with couples where all else
in their relationship is good, but what’s happening with sex has impacted on
their relationship satisfaction or security over time.

The evidence is strong that having a good sex life is associated with
relationship satisfaction and relationship stability, 10 and that maintaining
desire has a positive effect on relationship satisfaction. 11 so, as much as we
might like to think of sex as a frivolous recreational pursuit, there are some
clear reasons why we might want to prioritize it if we want to maintain a
happy relationship long term. There are numerous studies detailing the
psychological and relationship consequences of an unhappy sex life. We
know that, among other things, sexual problems are associated with
decreased relationship quality, thoughts of infidelity 12 and lower personal
well-being. When they have worries about their sexual desire, women
typically describe a negative impact on their emotional health, self-esteem
and their relationships, 13 with fears of consequences on the impact on their
partner or relationship if it’s not resolved. 14 Essentially, sex (when it’s
good) benefits our mood and is good for our sexual relationships all round.
Not being happy with sex in a relationship can lead to resentment and
feeling disconnected, or can leave one or both partners vulnerable to the
idea of meeting their sexual needs elsewhere.

There are two obvious exceptions to this. The first is asexuality, a sexual
orientation where you do not feel the need to have sex with another person.
Asexuality is not the same as not feeling like sex much or only from time to
time and being worried about it. People who identify as asexual feel no
distress about their desire and their preferences about sex are fairly
consistent over time (as with all sexual orientations, there can be some
fluidity). A lack of sex in this case would not lead to the same personal or
relational consequences, unless that person was in a relationship with
someone who did wish to have sex and this caused a problem between
them.

Secondly, these negative effects related to sexual dissatisfaction should not

be extrapolated to situations of mutual agreed celibacy or consensual non-
monogamy (CNM). In CNM relationships, one or both partners might have
other sexual partners or sexual relationships, which might add to their
overall sexual and relational happiness. In their 2016 paper, 15 Amy Muise
and Emily Impett make the crucial point that ‘no other relationship domain
involves more dependence between partners than the domain of sexuality,
given that the majority of long-term couples are monogamous and therefore
cannot – or are not allowed to – get their sexual needs met outside of their
current relationship’. They go on to discuss how, if there are other areas of
relationship dissatisfaction, for example not feeling able to easily discuss
work dilemmas with a partner, or not sharing the same interests, these needs
can be met by others in our social or family circles, but not sex, if you are
monogamous. It’s important to note that consensual non-monogamy is a
valid and healthy relationship structure, and allows people to make choices
around sex and relationships which don’t place all the responsibility upon
one significant other to meet all an individual’s needs. However, due to the
social conventions and historical context I mentioned in Chapter 1, we often
find ourselves being monogamous, without any real sense of having
intentionally chosen it as the best fit for us; rather, we are monogamous by
default, as it’s what people do . It’s worth considering this for yourself at
this point. Did you choose to be monogamous as it feels like the best fit for
you? Are there any drawbacks for you, such as those mentioned above? If
you felt CNM was just as popular and it was celebrated by our society,
would you be more likely to give it a try?

What are we distressed about?

Several research studies have demonstrated that women with sexual
problems, such as concerns about low desire or difficulties with orgasm,
feel more concerned about the impact of these issues on their partner than
they do about the impact on themselves. This is particularly fascinating
when you consider this in relation to the political context of gender equality
that we discussed in Chapter 1. Why are we defining a good sex life based
on someone else’s satisfaction if we’re not afforded the same concern in
reverse?

We also know that women tend to worry more about a sexual difficulty the
more ‘severe’ they think it is (as opposed to how severe it might objectively
be) 16 and this, of course, is connected with what we think should be
happening with our sex lives, which is especially relevant in the case of
desire.

To sum up, we’re concerned about the impact of how we are sexually, as it
often doesn’t match up to our ideas of what’s ‘normal’ and we’re concerned
about the impact on a partner of how we are sexually more often than we
are about the impact on ourselves.

How does desire change within a relationship over time?

How we feel in sexual relationships develops in different stages, beginning
with a phase of infatuation and passion. This stage is characterized by the
desire to be near each other constantly, lust, and obsessive thoughts. It is
followed by a stage of greater emotional closeness and companionate love ,
where distance from the person is more easily tolerated. It’s important to
note that, typically, people experience higher levels of desire to have sex in
the early stages of a relationship. After some time, when they enter more of
a companionate love phase (roughly one to two years in), their levels of
desire will typically reduce. 17

It’s extremely common for women to come to see me and blame this change
in desire on themselves. Anna was a typical example, and described this as
many other women have before her, saying ‘It’s fine at the beginning, I feel
like sex a lot, but then, after some time, it just goes. It must be me that has
the problem, as it happens in every long-term relationship I’ve been in.’ If I
had a pound for every woman who has consulted with me who compares
her current sex life unfavourably with this unsustainable early sex life, and
blames her faulty sex drive for it, I’d be quite well off. Wouldn’t it be great
if we knew that this was normal, rather than a problem with us or our
relationships?

There are two important things to consider about this pattern of a change
over time. The first is that, although a drop in desire from the first few
months or year is common for many couples, it is certainly not the case that
this drop in desire should lead to sexual or relationship dissatisfaction. The
second is that desire declining over the course of a relationship doesn’t
happen for everyone, 18 and even though it’s associated with the length of
the relationship, this does not mean that time is the key factor which causes
the decline. In fact, there are many other relational factors which might pick
up speed over the duration of a relationship, such as predictability,
equity/division of labour, amount of time spent connecting, the impact of
having children, and too much or too little intimacy, all of which are more
likely culprits. You’ll be hearing all about these in Chapter 5, and the good
news is that these are all areas you can nurture and create positive change
in, should you wish to. It’s likely that the couples who maintain desire over
time are the ones who either know how, or instinctively nurture, these
aspects of their relationship, and you can do the same. There is an important
distinction here between knowing what’s normal but at the same time not
believing that this change should result in a worse sex life and an inevitable
decline, so that we just give up aspiring to great sex. A decline in sexual
satisfaction in a long-term relationship is not a given.

It’s useful to note at this stage that physical attraction is important to desire,
19
and that there is research to suggest that being more physically attracted
to a partner at the start of a relationship is a protective factor for desire later
down the line. 20 However, I would also like to point out that changes in
relationship dynamics can lead to a change in attraction (in either direction)
as can a re-emergence of seeing each other as sexual beings again, both of
which we will cover in Chapter 5. In my sex therapy work I notice that it
can be hard for people to evaluate whether they still feel attracted to their
partner when sex isn’t going as well as they’d like, and it’s not necessarily
the case that they are not attracted to their partner, rather that they have
stopped looking at their partner in that way . In my experience it can be
useful to revisit the question of attraction again later on, when changes are
in place which have shifted the sexual relationship to new territory.

It’s also to be expected that our sex lives and desire will face challenges
over time, and that this happens at different rates for each partner, so that
there will frequently be times of mismatch that will need to be negotiated.
Natsal 3’s data showed that differences in sexual desire within couples are
common, with about 1 in 4 people reporting a difference in their want for
sex and their partner’s, and other researchers have suggested that desire
discrepancy should be thought of as inevitable in the context of a sexual
relationship. 21 Similarly, what people desire will change over the course of
a relationship too, and it’s common for couples to have to navigate
differences in the things they like sexually, and how often they do them.
The key thing here is that having a good sex life is not about always
needing to be on the same page, or wanting as much sex as your partner, but
the success with which you navigate these differences.

Men are not from Mars

We have long believed that men want more sex than women. This is not
consistently backed up by research, as it depends on how desire is
measured, and we are starting to see more similarities than differences
between men and women when we measure certain types of desire. 22 Also,
expectations that we have for men, women and desire are learnt by the
process of absorbing societal messages. Therefore, when men do report
higher levels of desire than women, it’s likely that this is, in part, related to
the expression of gendered norms that they should, in the same way that
women are socialized not to express high desire. Men are negatively
impacted by the expectation that they should spontaneously feel like sex
often, and that they should always be up for sex. Plenty of men have
concerns that they don’t feel like sex enough (if you remember, Natsal data
reported it was just under 15%). The truth is that the force is strong when it
comes to gendered expectations of behaviour for men and women and we
are not as different as we are led to believe in many ways. Yes, androgens
such as testosterone play an important role in sexual desire, and, yes, men
generally have higher levels of androgens than women (though there’s not
as big a difference as you might think, and men and women show
considerable overlap). But there is no clear difference in the levels of
testosterone in women with high and low desire, 23 so we can’t just look to
hormones as the reason. As you will learn later on, although desire is
dependent on biological processes in part, it is largely a psychological event
underpinned by physical factors, not the other way around.

The other important factor, while we’re on the subject of gender, is that
gender is a social construct, and the key aspects of how biological sex and
gender manifest in humans (such as hormones, neuroscience, chromosomes,
genitalia and the social expression of gender) do not always show clear
indications of a distinct gender binary (for example, in the case of people
who are intersex). 24 This means that clear distinctions of the categories of
‘male’ and ‘female’ cannot be easily observed in science. As hard as it can
be to get your head around this, our social categories of ‘men’ and ‘women’
are more of a convenient societal shorthand than a scientific fact. This
means that there’s plenty of variation between people who consider
themselves to be male and female and therefore much crossover when it
comes to the expression of sex and desire on many levels. One of the
problems, though, is that our social convention of using binary gender is so
entrenched that most research about sex is done with ‘men’ or ‘women’,
hence my having to talk in this book as though gender is more binary than
we now know that it is.
One of the interesting differences between desire in long-term relationships
over time for men and women is connected to the length of the relationship,
as mentioned earlier. Women’s desire is more likely to decline for the same
partner whereas men are more likely to maintain a sense of desire for the
same partner over many years. 25 The challenge of the demands of
monogamy for women has been written about eloquently by Wednesday
Martin. 26 Martin brings together data from anthropology, history and sex
science to understand female desire as not naturally monogamous and
constrained in Western culture by the socio-political climate women find
themselves in. The concept of long-term sexual exclusivity dampening
female sexual desire has been researched and written about by others too,
and it’s certainly the case that the struggle many women have in
maintaining desire in long-term monogamous relationships is accepted in
sex science.

Another interesting fact about sexual satisfaction and gender from The
Global Survey of Attitudes and Behaviours in 2005 27 is that differences in
sexual satisfaction between men and women are more significant in
countries with less gender equality, highlighting the important notion of
women’s political and social context being taken into account when it
comes to sex, as proposed by The New View Campaign. It’s perhaps an
obvious thing to say, but without safety, agency, autonomy and equality of
pleasure, women’s desire suffers.

What’s the right amount of desire?

I mentioned earlier that frequency of sex is not the same as frequency of
desire. People often have sex when they don’t feel like it, and don’t get to
have sex sometimes when they do. So, what do we know from research
about how often women report feeling like sex? Studies have found that,
when asked about their levels of sexual desire, a large proportion of women
commonly say something between ‘never’ or ‘once or twice a month’. 28
Studies such as these are vital in understanding that it is normal for many
women to not feel like sex often out of the blue, and data such as this has
also underpinned some of the new understandings of women’s sexual desire
in long-term relationships that you will learn about later on in this book.

But here’s a fascinating fact: there are several conceptual problems with
how we measure desire, which make it difficult for us to know for sure
what is ‘normal’. 29 The first is that we have moved away from an
understanding of sex as a drive – something that we all have within us that
is a fixed part of who we are. Now we understand that our desire is never
static, and we have to remember that we are only really measuring desire in
that exact moment. The second is that our new understandings of desire tell
us that it is dependent on context, and so, when we ask about it, we are not
learning about the levels of desire within that person but their current desire
in that exact moment in that particular context . Their desire might show
itself differently the week after, if their circumstances change. The third
problem is that women’s desire is now known to work best when triggered,
rather than just occurring out of the blue, and therefore many of the old
studies of gendered differences in desire asking ‘how often do you think
about/feel like/initiate sex?’ were measuring the ‘wrong type’ of desire for
women. With this new understanding, it’s hard to measure women’s desire
without triggering it first. This means that a large proportion of women
might say that they think about or feel like sex never, or once or twice a
month, but if you transported these same women to a remote paradise,
removed their daily stress and orchestrated an intimate and flirtatious week
with a very touchy-feely Idris Elba, they might report thinking about and
desiring sex several times a day . . .

So, despite us knowing that, when asked, women report never or rarely
thinking about sex, there is no norm in sexual medicine for what our levels
of sexual desire should be. Amazing, right? Where else in science is there
no norm? We have norms for height, norms for intelligence, norms for how
long it takes men to come etc, etc. These can all easily be displayed on a
bell-shaped curve with an average in the middle and a range that we expect
most people to fall within. Not desire. It’s impossible to give a definitive, as
the variance is too wide even within individuals, and desire is too situation
specific. Desire is too dependent on everything else that is going on, in
essence. It has the potential to vary significantly person to person,
relationship to relationship, day to day.

In the much-improved definition of Female Sexual Interest/Arousal

disorder, which replaced Hypoactive (low) Desire in DSM-V, as mentioned
earlier, there are no criteria for frequency of desire for this very reason.
Also, it is suggested that sexual interest should be assessed as a response to
‘adequate triggers’ to desire. One of the criteria for FSIAD is being
distressed about it, which is important, as who cares if you have no interest
in sex if you don’t? Plus, this also usefully avoids asexual people being
pathologized. This change to the diagnostic criteria is important. But there’s
a bit of a Catch-22 still in how we view desire until we as a society
understand desire more thoroughly. We are upset that our desire isn’t
‘normal’ (in the absence of there being a known normal), and we’re likely
basing this idea of normal on an unrealistic belief of spontaneous desire (we
don’t yet talk much about ‘adequate triggers’ or responsive desire when
talking in our society, about ‘low sex drive’). So, in some ways, we can
meet the criteria of distress, at least, by not really knowing how desire
operates.

My perspective is that, until popular culture catches up with the scientific

understanding of how women’s desire works, and how we might expect to
feel, how women report their desire and the distress women experience in
relation to it is entirely driven by unrealistic expectations, not necessarily a
problem with their desire itself. This was one of the motivators for me to
write this book, as I believe that helping women to understand how their
desire works, what they can expect of it, and how to maintain desire in their
relationships, could make a difference to the large numbers of women who
are concerned that their desire isn’t working the way it should.
There are two things I want you to take away from this chapter. The first is
that the sexual life of the UK, on paper at least, would not pass its own
MOT and there are huge potential psychological- and relationship-level
consequences for such widespread levels of dissatisfaction and concern.
The second is that these difficulties are so common and happen on such a
widespread level that they are more likely a problem of how we understand
and think about sex as a society rather than a problem with us or our
relationships. We might think of the problem more as how we think of and
understand sex, and the gap between how we expect our sex lives to
be/work and how they actually are. The rest of this book is designed to help
you spot how, as a society, we’ve got ourselves into this position, and
crucially, how we can get ourselves out of it.
OceanofPDF.com
3
Gaps in our foundations

Gaps in our knowledge

Unless your sex education was startlingly different to mine, the key features
of it were probably something like this: don’t get pregnant, don’t get an
STI, and, actually, try not to have sex at all, okay?. Even better, if you went
to a very religious school, like I did, you probably took away some other
unhelpful nuggets, such as ‘abortion makes you a bad person’ and
‘contraception is a sin’. Good luck navigating a straightforward road to
sexual pleasure with those foundations.

Essentially, for many of us our early sex education was a mish-mash of

scaremongering, finger-pointing and threats of impending disaster. Not only
was there very little sex positive talk, of the myriad good outcomes that
might come from sex, but for many of us there was also very little sex
neutral talk, of sex being okay, really, all things considered. Sex negativity
was the name of the game, and this message may have been amplified by
the absence of talk about sex at home too. TVs switched over or slightly
awkward faces, say, and not even the slightest hint of information about sex
from our parents. For lots of us, this unhelpful experience has scarred our
sexual lives from the get go, as we embarked upon our journey far too
focused on avoiding all that could go wrong, and without the slightest
regard for how it could go right. For girls and women especially, some of
the first things we learned about sex were ‘it’s dangerous’, ‘you shouldn’t
really be doing it’, ‘nice girls don’t’, and ‘you’ll get yourself a reputation.’
If you didn’t identify as straight as a teenager or young adult, you will have
had the added bonus of ‘you and your sexual thoughts are not normal’.
The way we learn about sex shapes our perception of it. Many women are
still psychologically imprisoned by the way in which the concept of sex was
presented to them, as something shameful, dirty and not to be celebrated.
We were programmed to pay attention during sex to all that can go wrong,
not the things that can go right. There was a total disregard for our pleasure,
as a barometer of how good it was: instead we were encouraged to look for
signs that ‘nothing went wrong’ and ‘they thought I was okay’ as an
indication that it qualified as ‘good sex’. You will see in Part Two how
much this early learning has disseminated throughout society, our
relationships and our minds, to influence our sex lives in the here and now.
This is something I will be encouraging you to move away from as a key
part of navigating your way to your best sexual life.

Perhaps you had a slightly different experience than this and sex was talked
about freely and easily in your house, bodies were celebrated and your
parents happily took you to get the pill once you talked about being
sexually active? I do hope this was the case. Research has demonstrated that
young people who are more ‘sexually competent’ tend to have more
positive sexual experiences and delay their first sexual experience.
Crucially, early positive experiences in relation to sex education are
associated with better sex lives later on. 1 ‘Sexual competence’ is a term that
was first put forward in a paper by Kaye Wellings and team in 2001, in
order to move away from the idea of age as an appropriate marker of
readiness for first sexual experience, given that age is both arbitrary (two
sixteen-year-olds can be quite different) and the societal definitions of the
age of consent are based on opinion and have changed over time. 2 Wellings
and her colleagues proposed that it might be useful to move away from
definitions and studies of ‘early sex’ based on age alone and move towards
definitions of timings of sexual debut that were more aligned with holistic
concepts of sexual health and wellbeing. For this reason, they defined
‘sexual competence’ as making decisions to have sex which are autonomous
(i.e. because you want to rather than as a result of peer pressure), where
there is mutual consent, where the time felt ‘right’ and where there is
adequate protection from STIs and unwanted pregnancy.

How sex positive was your sex ed?

We now know that it’s not just sex neutral messages that we should be
aspiring to as a society and as parents or carers of young people, but
messages that are more clearly sex positive. It’s great not to have any strong
negative reactions to a young person telling you that they are sexually
active, and to help them think through their options with regards to their
sexual health; heck, it’s better than the sex negative experience that many of
us had. But it is even better to have frank and open conversations about
celebrating pleasure, celebrating sex, and how we can work with our bodies
and relationships to get the best out of them. Imagine for a minute what
your relationship to sex now might have been like had you had a different
introduction to it as a child/teen? If you were told about masturbation being
a great thing, about sex being something wonderful when the time feels
right, about the role of the clitoris in your pleasure, about the importance of
respect and consent? If the focus had been about sex being something
wonderful for you to look forward to, rather than something dangerous or
morally wrong?

Many of us are working hard to reverse the damage that this sex negativity
has done to our sex lives. We can choose to reject these sex negative ideas
as adults, and to move towards representations of ourselves as sexual, as not
only entitled to good sex but with the belief that it is good for us and our
lives. We might need to surround ourselves with sex positive messages to
do this, or to be able to notice the sex negative thoughts and reactions
creeping in automatically and choose to reject them. But it is possible and,
later on, I’ll be telling you how. We also have a huge opportunity in front of
us, as many of us are parents, caregivers, significant family members or role
models for young people, and so we have a chance to change this for the
next generation. As we learned in the last chapter, the benefits of good sex
for people’s life and relationship satisfaction is without question, but good
sex can be harder to come by easily when there is a foundation of sex
negativity. If you have any influence or contribution to the sex education of
a child or young person, I urge you to consider the impact that the following
might have on their sex lives as adults:

Knowing the right words for their genitals and saying them without
shame from as early as possible

Knowing that (and how) their bodies can give pleasure and that this is
wonderful

Having a sense that their body is theirs, and they can do with it what they
please, including saying no to others (i.e. not being forced to give Uncle
Bob a hug just because he wants one)

Understanding that variety in sexual and gender expression are perfectly

okay and not presuming their gender identity as cis (aligned with their
sex assigned at birth) or their sexuality as ‘straight’

Knowing what sex is, what it isn’t, and what can be amazing about it (but
not suggesting that sex has to be all about love or commitment)

Understanding the difference between porn and real-life sex

Understanding the choices available to them about avoiding pregnancy

and STIs, but also that, once this is taken care of, sex does not need to be
something to fear

It’s important that good sex and relationship education happens in schools,
of course, and we have made great strides with this in the last year alone in
the UK. But I’m a firm believer that the responsibility belongs to parents
and caregivers too, not solely with schools. This is because good sex
education is a lifelong pursuit, and is just as much taught in attitudes to
bodies, gender, consent and boundaries from early childhood as it is with
talk of porn and contraception later on. It’s something that is best done in a
holistic, consistent and meaningful way by modelling and continuous
conversation. There are some exceptional social media/web sites, such as
the ‘sex positive families’ Instagram feed and website, * which provide
guidance and resources to help parents and caregivers who didn’t have this
kind of education themselves, who struggle to know what it acceptable,
how to do it and what to cover. If it’s something you want to learn more
about, do look into it and think of the impact that you could be having on a
young person’s future sex and relationship satisfaction by laying solid
foundations of sex positivity.
* https://sexpositivefamilies.com/

Anatomy and pleasure

For women (as well as trans and non-binary people with clitorises), the
clitoris is really the source of our sexual pleasure; it contains corresponding
structures and nerve pathways to the penis. It’s often not a part of our
anatomy that we are particularly familiar with, or learn about when we are
younger and are taught about at school, so it can come as a bit of a surprise
to know that the tip of the clitoris (the glans, which is the pea-sized bit of it
you can often see under the clitoral hood) is just the tip of the iceberg when
it comes to its full function and structure. In fact, the clitoris extends about
9cm in length and 6cm in width underneath the skin, and the full structure
looks a bit like this:
The clitoris is equivalent in structure and function for pleasure to the penis,
in that it fills with blood on arousal, and it is a key source of sexual pleasure
when stimulated. Its sole job is to give pleasure.

Many people find it shocking that the full structure of the clitoris was only
supposedly discovered and publicised in 2005, after we had already
discovered life-saving HIV medications and had identified and mapped all
of the genes of the human genome, but the real disappointment is that the
full structure of the clitoris was actually first discovered in 1844, by the
German anatomist Georg Ludwig Kobel; it’s just that the scientific
community decided not to include this discovery in most anatomical
diagrams, anatomy texts or models of the female pelvis for the following
century and a half. Mark Bletchner wrote a great paper about this, and how
it’s possible that the clitoris has been repeatedly discovered and then
forgotten about again over the course of more than a century. 3 He also talks
about the fact that it’s perhaps no coincidence that most anatomists were
men, a point which corresponds with our discussion of male bias in sex
science from Chapter 1.

The full structure of the clitoris, however, resurfaced again in 2005, after
surgeon Helen O. Connell and her team presented an MRI view of it 4 and
it’s received a fair amount more airtime since then, with people producing
3D models, jewellery, art, animations and fancy-dress costumes (brilliant!),
but it’s still often a surprise for many women and their partners to see it.
Given the power for pleasure that the clitoris has, it’s an enormous travesty
that it is so often left out of discussions about women’s genital anatomy in
favour of other parts of our anatomy, such as the vagina, the uterus and the
ovaries. Talk about women’s sexual anatomy essentially privileges the parts
that can make the woman useful to someone else and those that are
problematized. The foundations of our knowledge are all wrong.

Perhaps if we talked about masturbation more we might feel more confident

in understanding the clitoris in all its glory, and the key role that it must
play in sex if we want pleasure to feature? For example, we know that most
women who masturbate do so by stimulating the clitoris (with fingers, sex
toys, an object) and that this is the most reliable route to orgasm for most,
as it stimulates the glans of the clitoris directly, as well as the other internal
structures behind it. It’s common, also, for a smaller proportion of women
to use vaginal penetration as an adjunct to this, to enjoy a different
sensation, and given that the bulbs and legs (called crura) of the clitoris are
either side of the vaginal walls, this sensation is also stimulating the clitoris,
albeit less directly. What is uncommon is women using penetration as the
sole act of masturbation, with no additional clitoral stimulation (it happens,
but in less than 5% of women 5 ). The statistics about what women do
sexually when left to their own devices speaks volumes about what
women’s bodies need and respond to.

The orgasm gap

Nowhere are the gaps in the foundations of gender inequality and its impact
on the sex lives of women more evident than in the orgasm gap between
men and women when they have sex together. If you haven’t heard of the
orgasm gap already, it’s basically the sex equivalent to when we found out
that the BBC were paying men more than women to be on the same show.
The orgasm gap situates the disadvantaged sex lives of heterosexual women
as a feminist issue. It references several pieces of key research published in
the last two decades, which tell us that:

Despite what we’ve been led to believe, women’s bodies are not ‘trickier’
than men’s. Women and men can orgasm at roughly the same rate from
masturbation (over 95% of men and women can reliably orgasm this way
in just a few minutes 6 )

When women and men have sex with each other, the rate of men usually
or always orgasming stays at 95%, and for women it drops to 65%, 7 with
much lower rates reported by women for casual sex (only a depressing
18% of women usually or often orgasming during casual sex 8 )

Women who have sex with other women do not see such a significant
drop in orgasms when they have sex with each other (orgasm rates of
85%)

The rates of how often women have orgasms alone or with other women
tell us that women have a similar orgasmic capacity as men

From this we can deduce that it’s not women’s sexuality, capacity for
pleasure or anatomy that is responsible for women coming less than men
when women and men have sex together, but, rather, how sex happens
and whose pleasure is prioritized

To make sense of the orgasm gap, we need to understand which types of sex
are most associated with sexual pleasure and orgasm for women and how
these fit with the types of sex that heterosexual women usually have.

I mentioned that the number one sexual activity for reaching orgasm is
masturbation. Although a small proportion of women struggle to orgasm
alone, most women reliably orgasm from masturbation even if they don’t
orgasm from other types of sex. Following masturbation, the second 9 is a
partner using their hands to stimulate the clitoris, the third receiving oral
sex and, lastly (very faint drum roll), penetrative vaginal sex. 10

What’s interesting is that, for heterosexual men, the activities resulting in

‘usually or always’ experiencing orgasm follow a different order.
Penetrative sex is high up on the list, alongside masturbation, and, on
average, men prefer penetrative sex to any other sexual act, such as
receiving oral sex or manual stimulation by a partner’s hand. 11 Despite this
gendered difference in pleasure resulting from penetrative sex, it features
much more highly in the sexual scripts of heterosexual sex than in same-sex
experiences, 12 occurring at a much more frequent rate when men and
women have sex together. One of the key differences in the sex lives of
women who have sex with women is that they typically report a greater
variety and frequency of sexual acts, such as receiving oral sex and clitoral
stimulation, alongside penetrative sex. This shows itself in more orgasms
(as well as more general sexual satisfaction) than women who have sex
with men. Women who have sex together are also three times as likely as
heterosexual women to have an orgasm with a partner, along with a greater
frequency of multiple orgasms. 13

Women’s drop in orgasm frequency when having sex with men is a result of
the type of sex men and women most frequently have together, not a result
of women’s ability to orgasm, but what’s disheartening about this is that we
know that women who have fewer orgasms tend to blame themselves rather
than external factors, such as the types of sex they are having, or societal
influences, for not coming. 14 But why? Well, it’s the influence of society on
what we believe to be ‘normal’ and how this plays out in the sexual scripts
we feel we should enact.

‘Sexual scripts’ are pre-conceived, societally dictated norms about how we

should behave during sex and, amongst other unhelpful ideas, lead us to
believe that women’s orgasms are elusive and should not be expected, that
men’s sexual pleasure is more important (especially when it comes to casual
sex), and that the type of sex which equates to ‘real sex’ is vaginal
penetration (suiting men’s anatomy and their most reliable route to orgasm,
not women’s).

Although it’s certainly the case that not all people know the significance of
the clitoris for female sexual pleasure, or the fact that orgasms from vaginal
penetration alone are rare for women, when women do know this
information, it’s associated with higher rates of orgasm from masturbation,
yet does not translate into sex with a male partner. 15 So there’s more to the
orgasm gap than a lack of knowledge regarding what women like sexually;
there’s a whole host of other pressures, not to be ‘too assertive’, not to put
our pleasure first if it impacts on someone else’s, not to go against what we
believe is expected of us sexually. We’ll be revisiting sexual scripts and
their influence on us in Chapter 4, but the acceptance of both the orgasm
gap and men’s pleasure taking precedence in heterosexual sex are certainly
a stark indicator of patriarchy in action.

But it’s also important to say that, if we remove the gender inequality of
women not coming at the same rate as men, orgasms are not the be all and
end all of good sex. There’s plenty of other emotional, relational and
physical rewards that sex can bring that we should be aiming for as part of
our sexual experiences. Yet research tells us that women report more
satisfaction with their sex life and relationships more generally when they
have more orgasms, 16 so while we shouldn’t see orgasms as the only goal
of sex, we certainly shouldn’t discount their role in overall sexual
satisfaction either – especially when there is such a sizeable gap between
men and women and the impact that sexual pleasure has on desire.

‘Change me, not my sex life’

In my clinical work, I often have women come to see me because they are
concerned about not being able to have orgasms. Once we get talking and I
find out more, it’s not unusual to find out that they do, in fact, have
orgasms, just not from penetrative vaginal sex. They explain that they can
orgasm from masturbation, and/or from receiving oral sex from a partner,
for example, but that this doesn’t feel good enough for them or their partner.
Sometimes they are at first shocked, then usually reassured, to hear that this
is normal for women and that most women can’t come from vaginal
penetration. In fact, the majority of women are not able to come from
vaginal stimulation without any additional direct or indirect stimulation of
the clitoris. 17

Frequently women accept this, but then ask me how I can help them change
this so that they can start having orgasms from vaginal sex. I explain to
them that expecting a woman to orgasm from no stimulation to the clitoris
is equivalent to expecting a man to orgasm from sex that includes no touch
or stimulation to his penis. I sometimes ask them how open to that idea they
think most men would be? They might laugh a bit at this point at the
ridiculousness of the question, but underlying this is an important political
point about women’s sexual pleasure. As a society we still do not see
women’s sexual pleasure as being as worthy as men’s. We are happy to
achieve it, but only if the route to achieving it doesn’t disrupt the experience
for someone else (‘someone else’ usually being male, as women having sex
with women are not as focused on this idea of having to change their body
to create vaginal orgasms, in my experience). In 2020, women are still
coming to people like me to find a way to circumvent their own anatomical
needs to prioritize a man’s.

The Orgasm Olympics

As a psychologist who works with people to help them get the sex life that
they want, I’m totally uninterested in the current media focus on striving to
achieve an almost tick-box-like holy grail of women’s pleasure, as per
articles such as ‘The 14 Different Types of Orgasm’, or ‘The Quest for
Female Ejaculation’. Sex is not a competition in which your body needs to
be trained to do more and more. Pleasure is pleasure, orgasms are orgasms,
and who cares how each of us get there as long as we have the knowledge
about ourselves to get there. When it comes to sexual satisfaction, pressure
on having to come in different ways or learn how to enjoy ‘G spot’
stimulation are missing the point entirely. Yes, explore your body in any
way you like, and learn new things about yourself as you do it. That is
certainly important. But good sex is about so much more than a technique,
is so much more than a physical act. For this reason, you will see no ‘how
to’ guides in this book, as tips, tricks and titillating techniques miss the
point of what really matters: how you relate to your body, your gender, your
relationship and yourself sexually, and how this helps or hinders how sex
unfolds for you. It’s these things that make sex worthwhile and sexual
desire and satisfaction long-lasting.

Gaps in our language

The other problem we have with the foundations of our sexual
understanding is the inaccuracy of language that we use to describe
women’s genitals. We are not only raised with huge gaps in our vocabulary
in relation to our genitals but also with an absence of awareness that some
parts of our body exist or what they exist for. A recent campaign by the Eve
appeal, as part of their Gynaecological Cancer Awareness Month, revealed
that 44% of women were unable to identify their vagina on an anatomical
diagram, and 60% were unable to identify a vulva. My guess is that this
percentage is significantly higher when it comes to the full anatomy of the
clitoris.

For decades we’ve been using the word ‘vagina’ when we actually mean
‘vulva’, incorrectly locating the important parts of women’s sexual anatomy
in completely the wrong place. The widespread use of the word vagina
suggests that the vagina (the canal leading up to the cervix and uterus) is
what sex is all about for women, an inaccurate use of language which has
reinforced untrue ideas of what women prefer sexually.

I feel passionately that there would be a huge shift in sexual satisfaction if

we could just get this right. Knowledge is a crucial basis for our sexual
satisfaction learning journey, and it helps us to navigate creating a
foundation with someone else within which sexual satisfaction can thrive.

What is sex?
An important gap in the foundations of our knowledge about sex is what we
actually see sex as being in the first place. My guess is that, if we asked 100
people on the street what ‘sex’ is, they would describe it as a physical act.
Sex is, of course, physical, as it’s often (but not always!) about something
we are doing with our bodies, and the sensations this produces. Less often
do people think of sex as psychological, i.e. about what’s going on in our
minds, or relational – how we are connecting with another person. Even
more rare, I imagine, would be the proportion of this 100 people who would
guess that sex is something we do that is an enactment of society/culture.
The truth is, it is all of these things. Sex is widely known in sex science to
be a biopsychosocial phenomenon. What this means is that you can’t
separate what goes on in your body from what goes on in your head or from
the relationship between you, other people and society. The crucial
consequence of this in regards to having a ‘good’ sex life long term,
especially when it comes to maintaining desire, is that each of these aspects
are essential to the picture. Another reason why learning to ‘orgasm from
having your feet touched’ is not going to salvage your sex life or protect
desire from dwindling.

Understanding what makes sex good for us

Part of knowing yourself sexually and getting the most out of your sexual
experiences is understanding what I call your ‘conditions for good sex’. You
can think of these conditions as an inter-related triangle, of which all three
points are crucial to your sexual experience.

The three points of the triangle are:

Psychological arousal – this refers to how much of what is

happening involves experiences or contexts that you find erotic, and
how much the connection you have with that person meets these
needs also. It involves things like the environment, trust, safety, love,
power play, how exciting you find different sexual acts, visual
stimuli, the dynamic or connection between you and your partner,
talking, attraction, passion, props, sensuality, closeness, eye contact,
the role you take and much more. This part of the triangle can be
thought of as how close this sexual situation matches up to the kind
of sexual situation you would create in a fantasy, for example, or
which would create maximum arousal.

Physical touch – this refers to how close the physical stimulation is

to the type of physical stimulation that makes your body feel good.
This can be anything from the type of kiss that you like to whether
you like penetration or not (and if so, where), the pressure of touch
you like to your skin, and the speed and location of touch to your
genitals. It could be around restraint, fabrics, the feel of body hair,
the feel of someone’s body. There is some overlap here with the
psychological, as a sexual position you enjoy could be both about
physical touch (you feel the most pleasure in that position due to the
contact between your bodies) but also psychologically arousing (as
you find that position hot).

How present you are – this refers to how ‘in the moment’ you are,
versus being away with your own thoughts or distractions. This can
be anything from feeling worried, self-conscious and anxious, to
being distracted by something innocuous in the background. There is
a continuum here, with being totally in the moment or totally present
at one end and being totally distracted by what’s going on in your
mind at the other. The reality is that we might be somewhere
between those two points, but the closer we are to being present, the
better.
In a 2007 paper investigating the key components of great sex, the authors
Klienplatz and Menard state ‘this quality of being entirely alive in their
bodies with no mental interference was the hallmark of great sex’.
Participants in the study described being present as ‘Reaching the point
where arousal overcomes thinking’, and ‘I stop the running commentary in
my head . . . I don’t have to think about where to place my hand – it just
goes there.’ 18 The opposite of this, of course, is a constant running
commentary in your mind during the encounter, covering everything from
‘Oh no, they will see that I’ve not shaved my legs!’ to ‘I don’t think I’m
ever going to come . . . should I tell them?’ to ‘Is that next door’s cat I can
hear?’

We want each of these three factors to be as close to our ideal conditions as

they can be, so maximum eroticism through high levels of psychological
arousal, the most pleasurable physical touch based on what we like, and
being as present as we can be. The content of each of these three aspects
will be different for all of us, and it’s this reason that it’s impossible to be
‘good at’ sex, as you can never really know what someone else’s conditions
will be without asking or being told. In this case, you might be good at
talking about sex, or responding to feedback – both of which are great skills
for sex, as we will learn later – but the phrase ‘good at sex’ is a societal
term which implies that there is a ‘right’ way to do sex that works for most
people, and this is simply not the case.

If we feel really turned on (high psychological arousal), are receiving

pleasurable physical touch and have a low level of distraction or worry, we
are meeting our ‘conditions for good sex’ and it’s more likely that this sex
will be pleasurable for us. Our ‘conditions for good sex’ do not exist in
isolation, of course, and there are additional external contexts which impact
upon it, such as understanding what needs sex is meeting for us at any given
time, negotiating and communicating what we want with someone else, and
how much our conditions feel accepted or frowned upon by society. These
further aspects will all be explored later on in this book. However, without
knowing what these primary conditions for each of us are in the first place,
we are starting from a huge disadvantage when it comes to negotiating good
sex with others.

‘Conditions for good sex’ and maintaining desire

Later on in this book you will learn about the processes that make us want
to repeat behaviour that has been rewarding, and how relevant this is to
desire. You will also learn about the latest developments in sex science that
keep sexual satisfaction and desire alive over the course of your life. An
important aspect of understanding your own sexuality is recognizing that
‘sex’ is not just one thing, and the types of sex, the way you have sex, the
pleasure you get from it and how it makes you feel about yourself and your
relationship are all crucial factors in sexual satisfaction and desire. ‘Sex’
can mean any number of experiences day to day, year to year, or
relationship to relationship, and it’s important to understand what types of
‘sex’ are good for you and in what contexts. You can see this reflection as
looking inwards at your own sexuality before we can consider how your
sexuality fits with anyone else’s, as it’s essential to have a clear
understanding of how your own sexuality operates before you can expect it
to dovetail optimally with a partner’s.

Often I use this ‘conditions for good sex’ triangle as a starting point in
therapy, to help people get a basic understanding of which elements of their
sex life are going well and which need further attention. We spend some
time on each of the three aspects, writing the conditions that the person
feels are important for them for psychological arousal and physical touch,
and rating them according to how close they are to where they would like
them to be in their most recent sexual encounters. We then spend some time
considering indicators that they are in the moment, such as a feeling of
transcendence or being completely absorbed in sensation or a partner’s
body to the exclusion of all else, or the types of thoughts or distractions that
they find themselves plagued by.
We then move on to understanding the ways in which elements of the
triangle impact on each other, and you’ll learn exactly how these processes
happen later on in this book. For example, distraction reduces our ability to
experience sexual sensation. Being more turned on makes it more likely
that we are absorbed in the moment. High levels of psychological arousal
are great, but not if the touch is unpleasant, as then it will decline. High
levels of psychological arousal and our preferred physical touch will have
no impact if all we can focus on is what our thighs look like or whether the
other person is thinking of their ex.

I might use the ‘conditions’ triangle to help people reflect and make sense
of their sex life currently. Sometimes we discover that their physical needs
aren’t being met, as their partner doesn’t know what they like (or does
know, but just doesn’t do it). Sometimes they don’t feel safe to let
themselves go with the person they are with. Other times the environment
they are mostly having sex in is deeply unerotic or distracting. Often, their
mind is elsewhere, and without your brain involved, sex can feel like you’re
going through the motions. Mapping out this ‘conditions’ triangle once for
partnered sex, and once for masturbation, can also be really eye-opening, as
it becomes apparent how much having difficulty being in the moment, or
getting the touch that works best for you, may be with partners only. This
might be, for example, because sex with someone else is full of distracting
thoughts about being judged. Or perhaps psychological arousal is at its
highest with a partner as opposed to masturbation, as you struggle to
generate fantasy or recall hot memories alone and feel you need the
presence of someone else to be really turned on?

There are no rights and wrongs with the preferences that people have, and
all (consensual) sexual preferences and expression are valid. Also, this
‘conditions for good sex’ triangle must be seen as a snapshot in time, rather
than a template for life, as our sexual preferences, wants, needs and
confidence are in constant flux. For this reason, if you would like to have a
go at mapping this out for yourself, I would suggest you repeat the exercise
periodically, as your needs and wants will change. You can use it to reflect
on how much of the time your conditions for good sex are met both when
you’re alone (solo sex) and when you are with a partner. At the end of this
chapter you’ll find a guide to getting started mapping this out for yourself.

LUCY’S CONDITIONS FOR GOOD SEX WITH A

PARTNER
Physical touch – likes kissing, starting off sensual and moving to
deep, passionate kissing, soft gentle touch to the body but not
squeezing or grabbing, likes indirect touch to the clitoris through her
underwear or by pressing down on the pubic mound, dislikes direct
touch, especially if the clitoris is exposed. Likes being on top of her
partner due to the indirect clitoral stimulation it offers.

Psychological arousal – likes casual sex, where she gets to explore

new bodies and be completely herself with someone who doesn’t
know her, likes novelty of a new partner and prefers sex where there
is power play involved somehow. Finds looking at chests/shoulders a
turn on, likes sex in luxurious surroundings, enjoys risk, likes to see
desire on their faces, enjoys talk during sex about what’s
happening/what they want, likes sex that makes her feel ‘free’ to ask
for what she wants, likes to feel in control.
 Being present – mostly feels completely absorbed in the moment
but is sometimes distracted by thoughts about the environment, how
into it they are, how her stomach looks and whether this is what the
other person wants.

Learning about sex, in terms of the sex positive, neutral or sex negative
messages we have received, as well as our understandings about our own
anatomy and sexual response are crucial foundations for a lifetime of sexual
satisfaction. Also, for many of us, there is a gap in our knowledge about
anatomy, pleasure and other factors which define and make sex feel good
for us. This gap in knowledge is perpetuated by gender inequality and is
demonstrated by the way women who have sex with men often enjoy less
pleasure in the form of orgasms from sex than anyone else. Having a strong
understanding of the psychological and physical aspects of what makes sex
good for us and being able to be in the moment during sex are the starting
points for having good sex with someone else. These conditions for good
sex reflect the fact that sex is not just a physical experience that we do with
our bodies, and that we all hold individual (and changing) preferences.
Becoming more aware of this is an important precursor to being able to
influence the sex we are having in a way that creates meaningful
experiences and satisfaction. For many of us, there is a gap that has
emerged between the sex neutral or sex positive starting point we need to
enter into a sexual experience with, and the reality of our feelings about sex.
Closing the gap by filling in these foundations is the first part of the
journey.
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Exercise :
Reflection – Understanding your own ‘conditions
for good sex’ triangle
Draw a triangle on a large piece of paper and write the three headers
‘psychological arousal’, ‘physical touch’ and ‘being present’ on each point.
Think back to the three best and three worst sexual experiences you have
had with another person, and try to recall everything about these
experiences that made them great (or not) for you in order to help you fill in
each section.

After you have done this, add to the triangle anything you have not
experienced in real life but feel you would like, as well as anything which
works for you during masturbation, but less so with a partner. Try to make
sure you have a good number of points under each. Below is a series of
prompts which may help, though there is so much variety in ‘conditions for
good sex’ that you should not be constrained by this list when coming up
with your own.

Feeling in sync with the other person

Being able to ask for what you want

Tension/build-up/erotic charge/suspense

Making/hearing noise

Sexual talk

Visual cues like watching hips thrusting, seeing biceps rhythmically

moving, seeing wetness, seeing body parts that are attractive

Eye contact

Environmental factors: lighting, music, surroundings, textures

Body confidence

Intimacy

Having sex with more than one person

Playing with power

Playing with restraint or pain

Biting

Pushing boundaries

Types of touch: gentle, firm, grabbing, slapping, stroking,

Types of kissing and places you like to be kissed

Taking control /relinquishing control

Positions (not just sexual positions – positions you like to be in for

kissing, for example)

Sex acts (giving or receiving oral sex, fingers inside vagina/anus,

rimming, penetrative vaginal/anal sex, rubbing bodies up close together,
etc)

How you like to feel about yourself/see yourself during sex

How you like to experience the other person and how they act during sex

Attraction to the person

Animalistic/passionate sex

Feeling free/alive/spiritual
Trying it out – sharing this with a partner
If you’ve been able to complete this for yourself and are in a relationship, a
great next step is to be able to share it with a partner. In an ideal world, you
would get them to read this section of the book and complete theirs too.
Then, when you have the time and energy to sit down together and discuss
them, do so, using the principles of:

Listening well and asking probing questions, i.e. ‘What do you mean by
this one?’

Not ridiculing or judging each other’s conditions

Making an attempt not to get defensive or into an argument

Being careful with the words you use to discuss them: go gently

Once you have compared these (and remember that they are a snapshot in
time, not a definite map for your lifelong sexuality), discuss the following:

1) Is there anything on your partner’s ‘conditions’ triangle that you didn’t

know before? Ask them more about it. Is this something you might agree
to try out/build on?

2) For the things that you did know, how often do these things feature in
your sex life? If they’re infrequent, what gets in the way?

3) There will be differences between your ‘conditions’ triangle and theirs.

This is normal and not a sign of sexual incompatibility. There will be
some total ‘no-no’s, which neither of you feels you want to incorporate,
and this is fine. But are there any that, with some modification, you’d be
prepared to look at further? For example, you might not be into kissing
with tongues but your partner might be. Try asking them what it is that
they like about this. Perhaps it’s that this type of physical contact
represents passion to them? If so, is there another type of kiss, such as
rough or deep kissing, that would work instead? Or you might decide
that, although tongues is not your thing, you’d be happy to do it from
time to time, especially if it’s a big deal for them? I’ll introduce you to
the concept of ‘sexual giving’, in terms of the impact of being generous
in this way has for long-term sexual satisfaction later on in this book.
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Two
The Truth About Sex and Desire
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4
Sex in our society

I mentioned in the last chapter that often, when we think about sex, we
think of it as a biological or, perhaps, relational phenomenon – that sex
happens in our bodies and/or between us and other people . In my
experience of talking with thousands of people about their sex lives and
what is working or not working for them, I notice that it is much harder for
us to recognize the impact of family, culture, society and language on our
sex lives. The impact of these factors is almost so large that the boundaries
are outside of our field of vision and so it’s difficult for us to spot the
weight they carry.

Let’s take Cara, for example. Cara came to see me and described some
unsatisfactory sexual experiences, as well as a history of painful sex,
difficulty with orgasms and an experience of being able to take or leave sex,
which was showing itself in very little sense of desire. She was a twenty-
something white heterosexual woman, originally from the UK, and she’d
started having sex at university, initially delaying having penetrative sex
because she felt it was the right thing, for her, to preserve her virginity. This
was all connected to growing up in a family where sex was not talked
about, and pleasure-giving body parts, such as the clitoris, were not named.
When sex was referenced, the subtext was that it was something that ‘good
girls don’t do’ or should be frightened to do, as ‘so much can go wrong’.

To delay losing her virginity, Cara felt she needed to avoid all sexual
encounters with men, as she told me that ‘it’s unfair to lead men on’, ‘they
get carried away’ and ‘it’s not right to expect to do some things but not
penetrative sex’. Because of this, and also her negative view of
masturbation, she went into her first sexual experience, aged twenty, armed
with very little knowledge of her own anatomy and sexual needs, and a
sense of ‘giving away’ her virginity in a sexual act that she felt was overdue
and was all about what men needed. Cara described finding her experiences
of sex to date unarousing, uncomfortable and, on occasion, wanting her
partners to stop but having a strong sense of ‘we’ve started so I’ll let them
finish’. Her sexual encounters so far had been mostly negative or neutral,
and were based on the following internalized beliefs:

wanting or enjoying sexual pleasure is shameful, especially for women

sex is about men’s needs more than women’s

women are the gatekeepers but not the drivers of sexual activity

women’s sexual pleasure is less important than men’s, especially when it

comes to casual sex

for women, looking good and a partner’s satisfaction are more important
than personal satisfaction

it’s not desirable for women to direct the sexual experience in relation to
their wants and needs

once you’ve started down a particular route, it would be impolite to stop

For Cara, none of these beliefs (which are entirely rooted in social norms
and scripts around sex, gender politics and British values) were
immediately obvious to her as contributors to her current difficulties.
Instead, she had come to see me as she felt she was a woman who had
difficulties with having orgasms, painful sex and low desire. But these
sexual problems are not located within Cara. Cara would have not had these
same sexual difficulties in another context (for example, if she had been
male, or if she identified as a lesbian) because these difficulties are mostly
rooted in heterosexual scripts and the playing out of these scripts in real
life. This doesn’t mean that Cara wouldn’t have had any difficulties with
sex, just that it’s unlikely that they would have been the same ones. Re-read
the bullet points above, imagining that Cara was male, and see where you
think she’d be at with her experience of pleasure or desire.

But where have these internalized beliefs about sex come from? And why
would Cara then attribute these sexual problems to there being something
wrong with her, rather than reject these unhelpful societal ideas and refuse
to settle for this kind of sex?

The role of social norms in shaping our sex lives

Social psychologists explain how we behave in relation to others and why.
They use cornerstone psychological theories, such as conformity,
compliance, social learning and identification theory, to explain, on a social
level, why we do what we do. These theories basically translate to a human
desire to fit in, belong, learn from what we see, make classifications of
ourselves and others, outline the characteristic of certain groups (such as
‘female’, ‘Western’, ‘Muslim’, ‘young’) and the efforts we then make to
adopt the characteristics of groups we identify with, to ‘toe the line’. None
of us exist in a vacuum and, whether we like it or not, we experience a
gravitational pull to do what’s expected of us, adhere to social norms and
behave in a certain way.

Social psychology theories explain the dynamics between groups and how
these dynamics can result in discrimination, stereotypes and injustice, and
how we can risk exclusion or disapproval from other group members if we
don’t respect these social rules and scripts. They also explain how the world
around us teaches us how we should be through how others behave and
what we see in the media. Essentially, we learn by what we see and what we
understand is deemed acceptable for our identity.

Consider masculinity as an example. Being ‘one of the lads’ or being told to

‘man up’ in response to displaying emotion or sensitivity is one way some
members of the social group of ‘male’ might respond to another member
acting in a way they feel threatens the status or integrity of that group, as
the group has historically had a core perceived characteristic of ‘being
tough’. The social group ‘male’ also has a historically elevated and
privileged social status based on a belief that ‘masculinity (which =
toughness) is superior’ that it doesn’t want to risk losing.

Concepts of social psychology are crucial when it comes to understanding

sex and why we do the things we do. This is because, firstly, even though
the ideas we get from the world around us about sex are not ‘truths’, they
are so strongly socially enforced that they feel like they are, so we don’t
often question them or notice their impact. Secondly, given we learn how to
‘be’ sexual from our family of origin and from the world around us, we
develop a perception of how sex should look and boundaries for behaviour
deemed acceptable for our age, gender expression, race, sexuality, religion
and cultural group. All of this learning filters down into the nuts and bolts
of how we are sexual with others, helping or hindering us, mostly without
us even realizing. This is what we’ll unpick in this chapter. My aim is to
raise your awareness of the impact of societal messages or norms on your
sex life, with the aim of encouraging you to take action in rejecting the pull
of any influences you are not happy with.

How we learn about sex

Within families, learning about sex starts as soon as we are born. In Chapter
3, we touched upon how we learn from the way our caregivers talk (or
crucially, don’t talk) about pleasure, genital anatomy and sex. For example,
we learn about how much power we have over our right to bodily autonomy
by not being always able to say no, even when we don’t want to do to
something we’re being asked to do with our bodies, such as kissing a
relative, or finishing all the food on our plate. This kind of learning teaches
us that the social rules of politeness and convention outweigh our personal
physical or psychological discomfort in favour of someone else’s needs.
Through consistent positive or negative comments about our appearance we
learn from family members how important it is for girls to ‘look nice’, and
how this is often prioritized over values, interests or worldviews. From the
use of often gender-specific language, such as ‘bossy’, for example, we
learn that it’s not seen as desirable for people identifying as female to be
assertive, which is a real disadvantage when it comes to sex. Social learning
theory (learning through seeing and imitating) shows us how what we are
exposed to about how adults ‘do’ relationships and sexuality, and what we
absorb from this, makes a significant difference to how we ourselves ‘do’
sex and relationships as we grow.

We also know that, by primary school age, children have strongly held ideas
about gender, with girls falsely perceiving themselves as physically weaker,
less destined for success and having more responsibility to ‘look pretty’
than boys. 1 This might, at first, sound like it’s relatively unconnected to our
sex lives, but it is most definitely not, as this concept of women as ‘less
than’ paves the way for the patriarchal society we live in that disadvantages
women’s sex lives in later years.

It doesn’t take a great leap to see how early learning such as this can play
out unhelpfully in sexual situations later on. In these early years, we may
learn that sex equals shame, that sex is wrong or that our role in sex is to
please others, look good and manage our inner discomfort silently. The
impact of this kind of learning, especially on women, is why a commitment
to lifelong sex positive education is so crucial.

Understanding the powerful role of social leaning and norms with regards
to sex and how this intersects with gender (plus other contexts, such as
race) is crucial to understanding our relationship with desire. Let me
explain how.

Sexual Script Theory 2 describes the way in which societal and cultural
expectations around sex shape our behaviour and interactions by providing
us with clear expectations and boundaries to adhere to. These expectations
are heavily gendered and shaped by the media, language, and interactions
we have with others. Sexual Script Theory is the playing out of social
psychology in our sex lives. Although the word ‘script’ implies that these
ideas are explicit – and they can be at times, in the language we use – they
are just as often implicit, alluded to by stories in the media, folklore and
social convention.

The pervasiveness and impact of sexual scripts have been heavily

researched, both in terms of how much they are replicated in the media and
cultural messages and how people of all genders subscribe to them. Here
are a few of the dominant sexual scripts in Western societies that have been
identified as widespread and impacting on people’s behaviour: 3

Men are sexual subjects with desires to be acted on and women are sexual
objects who gain gratification from being desired

Men have higher levels of sexual desire and ‘uncontrollable’ sexual

impulses

It’s more important that men orgasm in heterosexual sex

Penetrative vaginal sex is the most important sexual act in heterosexual

sex

Motherhood and getting older mean a woman should be less sexual

Men show masculinity through high desire and many partners and women
show femininity by sexual restraint

Women should be less sexually assertive and initiate sex less

Women feel that they should perform during sex in a way that increases
men’s sexual attraction to them and prioritizes men’s sexual pleasure

Heterosexual sex ends when men come

 Women are more motivated by relationship intimacy and closeness in sex
than pleasure

Women have an obligation to comply with their partner’s need for sex to
maintain relationship satisfaction

Women’s orgasms are more challenging to achieve than men’s

And there are many more, including some particularly interesting ones
relating to reciprocity in regards to oral sex, and also some specific ones for
women who have sex with women, which we’ll come to.

Sexual Script Theory proposes that, if we choose to go against these

implicit social ‘rules’, there are sanctions which manifest as disapproval
from others and which risk the individual who transgresses being labelled
as problematic and less desirable. This is borne out in research when people
are given scenarios related to the scripts above and then asked to judge
people who deviate from them. People displaying behaviour outside of
these scripts are judged more harshly and labelled less desirable – for
example, women who are sexually assertive. There is evidence to suggest
that these scripts might hold more weight in casual sexual encounters or at
the start of relationships than they do in longer-term relationships, but the
influence of them for all of us remains on some level, whether we feel
constrained by them at this present moment or not.

You might feel as though you are aware of these scripts but do not believe
in them or go along with them in your sex life. Great! Being aware of such
influences is crucial to being aware of the contribution they have and
making attempts to resist what’s unhelpful, but it’s often not as simple as
this. As I mentioned, social norms make it very difficult for us to break free
of the ‘rules’ that we are led to believe we should all adhere to, by creating
sanctions which kick in as a result of perceived transgressions. We only
need to look at the #MeToo movement to see the widespread prevalence of
women being treated as objects for another person’s gratification. We hear
the atrocious stories of women accused of ‘leading men on’ when they
dressed in a certain way and then changed their minds about a sexual
encounter or stopped showing enthusiastic consent. There is still too much
injustice related to the people who perpetrate these crimes not being held to
account because of constructs such as ‘boys will be boys’ or it being ‘just
locker-room talk’. The ramifications of these sexual scripts are dominant,
widespread, dangerous and, sadly, affect many of us whether we like
them/believe in them or not.

The impact of the privilege and personal agency that women have is
crucially relevant here. Not all women have equal agency, privilege and
resources and we mustn’t presume that they do. Race, religion, culture and
economics play a part in how women are seen sexually as well as how able
and safe women feel to overtly reject the impact of these scripts or not.
Sexual scripts might be highly gendered, but the impact of them between
women is partially connected to the intersection of other contexts.

Sexual scripts for women who have sex with women, in some ways,
provide more sexual freedom. There is not, for example, a typical script for
what lesbian sex should look like in terms of who does what and in what
order. This is in contrast to women who have sex with men, who will often
give a set description of how sex should typically look in formulaic order.
Although this is partially why women who have sex with women typically
have higher levels of sexual satisfaction, if you’re about to have sex with
another woman for the first time, the absence of a script can be confusing
and scary. While largely unhelpful, one of the theories behind why we have
societal scripts is that they reduce anxiety by providing us with information
about how we should behave in social situations.

Also, living in a heteronormative world (heteronormative meaning

everyone is presumed straight, and language, institutions and culture are
geared towards this) means that, however you identify your sexual
orientation, it doesn’t stop you being continually exposed to heterosexual
sexual scripts. The impact of this for women who have sex with women
shows itself in a different way. Firstly, by leading to a sense of your sex life
not ‘fitting in’, being afraid to hold hands in public or being asked
inappropriate questions about how your sex life can possibly work.
Secondly, how you make sense of how to ‘be’ in a sexual relationship with
another woman when our sexual scripts position men as the initiators and
performers of sex, with high levels of desire, and women as passive
recipients.

The impact of these scripts was never more evident than during the ‘lesbian
bed death’ era. ‘Lesbian bed death’ was a term used colloquially and in the
scientific community in the 80s to refer to the fact that is was presumed
(based on scripts that women were inherently less sexual, low in desire and
passive sexually) that women who have sex with women would eventually
stop having sex after a certain period of time together.

Of course, we now know that this isn’t true. The desire of women in same-
sex relationships works in the same way as with women who have sex with
men, meaning that many women in long-term relationships might report
low spontaneous desire, if you ask them how often they think and feel about
sex out of the blue, and this in itself is not problematic. Recent studies
comparing the sex lives of women in same-sex and mixed-sex relationships
have once and for all put the ‘lesbian bed death’ myth, well, ‘to bed’ 4 . But,
despite ‘lesbian bed death’ being discredited as a phenomenon, it still
lingers as a sexual script for women in same-sex relationships and, sadly,
can sometimes stop women who have sex with women making changes to
their sexual relationship if they start to feel unhappy with how sex is going,
as they (incorrectly) fear it is just the start of an inevitable decline.

One of the things we do know is that for women in same-sex relationships

their desire is negatively affected by how impacted they are by
heterosexism in society and the ‘minority stress’ it causes. 5 ‘Minority
stress’ refers to being part of a marginalized group and the fear of coming
out or being visible in relation to this, along with the psychological toll it
takes at times to hide who you are. This means that, for women who
identify as lesbian or bi, connecting with the wider LGBT community,
coming out to trusted others and finding places to socialize and feel safe are
key not just to mental health but to sexual satisfaction and desire too.

Our heteronormative society is also responsible for the script that ‘being
straight is normal and best’, and this is conveyed in everyday language,
social conventions and institutions. Despite increasing ‘minority stress’ for
non-hetero people, this script is also damaging to a much larger body of
people than those who currently identify as LGBT. The reason being that
science tells us that sexual orientation in humans is unlikely to be binary
(that is, straight or gay) and that most people will fall somewhere in the
middle (remember Kinsey?). It’s the sexual script that ‘straight = best’, plus
the influence of homophobia (often stemming from a fear of transgressing
this purported norm), that stops more people from exploring this side of
their sexual self, exploration that could lead to higher levels of sexual
authenticity, satisfaction and desire. How might living in a society that isn’t
largely homo/bi-phobic change how you consider your sexual experiences
or expression? A percentage of you reading this might feel more
comfortable (even in a small way) to explore a side of yourself that you
currently don’t feel able to, as it transgresses social convention and risks
your membership of the social group of heterosexual. It’s important to
remember what we explored in Chapter 1: that the marginalization of same-
sex activities has not always been problematic in the UK, and certainly isn’t
in all cultures and communities across the world, but is an unfortunate
example of our historical classification of ‘homosexuality’ as a mental
disorder and illegal, amongst other things.

Penis-in-vagina sex is ‘real sex’ – the ultimate unhelpful heterosexual

script
If I were to ask Cara why she opted to have penetrative sex as part of her
sex life, given that she didn’t feel she got anything from it and she found it
uncomfortable, I guarantee she would look at me as if I had just arrived
from Mars. Heterosexual sex has such a set script of penis-in-vagina sex
being ‘real sex’ that couples feel they can’t imagine a sexual relationship
without it, or imagine their partners would leave them if they insisted on
dropping it. I’m not for one second suggesting we should abandon PIV sex
altogether, just wanting to demonstrate that some of our sexual scripts are
so pervasive and dominant that even the thought of deviating from them
seems absurd, and it’s this feeling that pulls us back in line with the
‘shoulds’ of social convention.

The influence of the media on how we see sex

In the UK, we typically spend around nine hours a day interacting with
digital media, roughly half of which is TV, and the other half online digital
content and social media. 6 It’s a known and well-proven fact that what we
see, and read about, in the media influences our beliefs, attitudes and
behaviours (including sexual scripts). There are a multitude of media
messages out there for us to pick up on, such as how our bodies should look
or that periods are something that shouldn’t be talked about openly, the
judgement that comes down on people who are unfaithful in monogamous
relationships or that penis size is important, how much sex we should be
having, etc., etc.

All of these messages impact on our attitudes and behaviour, causing us to

fear the judgement of our social group and identity if we transgress them.
This happens with all dominant messages that we are exposed to through
the media – for example, messages around food. But there is something
unique about sex. With food and diet, it’s likely that you are constantly
exposed to adverts showing tasty food, say, pizza or ice cream, on TV, as
well as conflicting messages about body image dictating what your body
must look like to be ‘good enough’. With food, you will be able to balance
any conflicting messages you are exposed to with first-hand knowledge of
seeing how and what your family eat, talking with them openly about what
they eat and why, or even hearing them talk about their relationship to food.

Sex is so different because there’s often such an absence of sex-related

conversation in our lives. The consequence of this can be that, when it’s not
talked about openly and honestly, when we see it on TV it’s often the first
time we’ve seen it, and the most times we’ll ever see people other than
ourselves do it. So, in the absence of open conversation elsewhere, we grab
hold of that information and absorb those messages in what we see about
how sex is as absolute fact. The absence of talking about the truth of sex in
our families, schools and society in general makes the media
representations of how sex happens and how sex should be even more
powerful.

Think about the last sex scene you saw on TV or in a film. It was probably
between a (cis) man and woman, it probably involved sexual acts based on
this predefined sexual script (mainly kissing and penetrative vaginal sex)
and it would have included very little of anything else.

The scene would also likely have included a sex scene that was high in
spontaneous passion, where both partners felt a sudden urge to connect
sexually at the same moment and in the same way. This representation of
desire is what we are used to seeing on TV and in films: spontaneous,
mutual, synchronized passion. It’s no wonder we feel despondent when our
own sex lives don’t match up. Where is the TV/film representation of a
couple who negotiate sex, as one of them feels like it and the other doesn’t?
Who start off not feeling that into it and passion builds as their arousal
does? Who look at each other and say, ‘Will we regret it if we don’t do the
housework and just have sex instead?’ I have seen these representations on
TV at times, but they often act as an indicator of sexual problems to the
viewer rather than being represented for what they are: a normal, well-
functioning long-term sexual relationship.
Of course, there are many couples who have been together a very long time
who still look at each other with desperate lust, and have moments of
perfectly synchronized spontaneous passion – and I wouldn’t want to
perpetuate the myth that this is not possible in long-term relationships as it
most definitely is . But this same couple may also have moments where sex
is less erotic, more negotiated, less sparky, and the point here is that they
could be forgiven for worrying that there is something wrong with this type
of sex, given the lack of exposure we have to it. We don’t have a script for
this.

As I mentioned, the type of sex we usually see on TV often consists of a bit

of kissing, quickly followed by vaginal penetration and quick mutual
orgasm in positions where any kind of clitoral stimulation is unlikely. This
repetitive exposure to ‘how sex looks’ is one of our forms of sex ed and one
of the important ways our sexual scripts are perpetuated. One consequence
of this is that we start to see what is represented on screen as the norm, and
view our inability to reach orgasm in this quick and easy way as a failing in
comparison (hence faking it, as an obvious and common solution). I
mentioned earlier that I have women come to see me with problems with
orgasm who, it turns out, can orgasm just fine from oral sex or masturbation
but not from penetrative sex. This near-constant representation of an
impossible goal of women orgasming from two minutes of penetrative sex
with virtually no build-up has created a sense that women’s bodies are
faulty when they don’t oblige in the same way, especially when you
consider that most women can’t orgasm like this to begin with.

Porn and sexual scripts

When it comes to porn, I feel strongly about two things. Firstly, the idea
that porn is harmful, wrong or always degrading to women is untrue. Porn
as an industry is as large as the television industry and, just as you see the
full range, from poor quality, unethical or degrading TV shows to high
quality, ethically produced and empowering TV on mainstream television,
you see the same range in porn. The problem is that when we think or talk
about porn, we are often talking about mainstream/free porn, which is just
one section of the porn market. It is certainly true that there are some parts
of the industry which use terminology, practices or storylines which are
degrading to women, perpetuate unhelpful ideas about how sex should look
and are of dubious ethics. But there are also many porn producers making
ethical content which privileges things like diversity, autonomy, equal
pleasure and consent.

Despite the variety in porn, it’s certainly the case that mainstream free porn
is easily accessible, heavily viewed by people of all genders, and that the
adult entertainment industry is one of the fastest growing sectors. 7 We also
know that a large proportion of young people in the UK have seen porn by
their early teens and that this is most likely to be mainstream porn. As we
have already discussed, in the absence of good sex education, TV in general
and porn in particular can be ways young people learn about sex. But how
has increasing access to porn shaped our sexual scripts? And is this
something to worry about?

One of the changes in sexual behaviour picked up by Natsal 3 was a rising

trend for younger generations of heterosexuals to include anal sex as part of
their sexual practice, in comparison to older generations (17% of 16–24-
year-old women have had anal sex in the last year, compared with 8% of
45–55-year-olds). 8 One possible explanation for this increased trend is that
younger Brits are more open and liberal about sex, meaning that they are
more likely to try a sexual practice that has historically been more taboo
during heterosexual sex. It’s also possible that our sexual scripts are shifting
as a result of the impact of mainstream porn, where there is a growing trend
for showing anal penetration as a standard part of heterosexual sex. Our
choice to have anal sex might therefore be our version of doing what we
think society and our partners expect of us as part of ‘normal’ sex. There’s
nothing wrong with anal sex, of course, but what is important is that how
we see sex shifts depending on what we are exposed to, whether that’s the
more relaxed attitude of our peers, or exposure to new sexual scripts in
porn.

One of the other concerning trends with mainstream porn is its lack of
attentiveness to female sexual pleasure. Research published in The Journal
of Sex Research by Seguin and colleagues in 2017 reviewed the fifty most
viewed Pornhub videos of all time and analysed them for orgasm-inducing
sexual acts (such as clitoral stimulation) as well as how often they
contained visual and verbal representations of women’s sexual pleasure. Of
them, only 18% showed visual or verbal cues suggesting women’s orgasm,
compared to 78% showing men’s. 9 In these videos, the presence of
dominant sexual scripts was noted in the (incorrect) portrayal of most
women orgasming from penetration, the presentation of sexual acts based
on female sexual pleasure as ‘added extras’, and the focus on male orgasm
as both more important and signifying the end of sex.

Porn is not the source of our sexual dissatisfaction, but unless we become
more porn literate (and teach our children to be so also), or until ethical
porn becomes more mainstream, porn will continue to take an ill-placed
spot centre stage in our sex education and potentially contribute to the
evolution of our sexual scripts over time.

So why is this important?

The recognition that social and cultural factors shape our sex lives as much
as (and perhaps more than) what happens in our bodies and relationships
opens up huge possibilities for our enjoyment of sex and our experience of
desire. Widening our field of vision and spotting the influence of society in
this way also changes the location of a problem with desire. Remember that
34% of women in the UK have experienced a lack of interest in sex in the
last year, that pleasure from sex is often missing for women (as evidenced
by the orgasm gap) and that women have been raised not to be assertive
sexually, not to put their own needs first and to make sure they look nice
above all else. How can we overlook the influence of this on desire? Desire
is difficult to cultivate and maintain in these contexts. How can we not
locate at least part of any problems we might have with sex here?

I should say, by the way, that men are also hugely disadvantaged by the
pervasiveness of these dominant sexual scripts, as they create perceptions of
masculinity which suggest that men are sex-crazed, intimacy-averse, bold
sexual initiators, low in self-control, which (as well as not being factually
correct) causes its own problems for men’s sex lives. But that’s not the
focus of this book and, when it comes to sex, women, particularly straight
women, get the roughest end of the deal from society by far.

Let’s revisit Cara for a second. What might Cara’s experience of sex have
been like if she had known more about her own pleasure? If she had
understood that she was entitled to enjoy any type of sex she wanted on her
own terms? If she felt she never had to have penetrative sex again and that
this was perfectly fair on her sexual partners? If she felt her desire and need
for sexual release were just as powerful, or more powerful, than a man’s? If
she dominated the sexual experience and therefore made it entirely focused
on her wants? I can tell you the answer to this, if you’re not there already.
Cara would not have been sitting opposite me, seeking my help.

Imagine Cara was raised in a family culture where she was encouraged to
seek pleasure, enjoy her body and have no shame in either of these things.
She might have enjoyed masturbation as part of her early sexual
experiences and, as a result, learned exactly how she liked to be touched.
Her lack of shame in talking about sex and the messages in her culture that
women should ask for what they want sexually, might have led her to seek
out sexual experiences where she could explore what she liked with
someone else. In these experiences she would have been clear, direct and
assertive, saying things like ‘I’d like you to go down on me then penetrate
me with your fingers just before I come’, and she wouldn’t feel self-
conscious about the lack of penetrative sex for them, the ‘sidelining’ of their
pleasure for hers, or what they would think about her asking so directly. If
she did have penetrative sex, it’s likely that she would feel no pain, as she
would be turned on (a direct result of being able to be sexually assertive and
communicate one’s needs) and she would feel confident and in control of
the pace and speed of penetration. However, you can be sure that she would
feel able to say ‘I’d like to stop now please’ at the point at which she got
bored of, or felt discomfort with, penetrative sex, and she would not worry
about the impact of this on her partner, or that it would jeopardize the future
of the relationship. She might not feel constrained to stop at one orgasm
either, even after her partner had come.

So . . . Here’s the challenge. We know from research that sexual

assertiveness and autonomy are associated with higher levels of sexual
satisfaction in relationships and sexual wellbeing. 10 In contrast, we also
know that sexual submission and over-focus on a partner’s pleasure to the
exclusion of your own results in lower levels of sexual satisfaction and
sexual functioning. But I have rarely met a heterosexual couple whose sex
life has not been negatively affected by the scripts we have discussed in this
chapter. I’ve also rarely met a heterosexual couple who have come to a first
session with me having really reflected on the nuts and bolts of how sex
happens and, crucially, which partner’s needs are currently being served
best as the backdrop to their sexual problems. Usually, there has been a lot
of talk about sex, but mainly focused on the female partner’s ‘low’ desire
and how it can be fixed. The impact of society and culture on one partner’s
sexual needs being disadvantaged over another’s is almost too large for
them to be able to spot.

Dan and Vanessa had been together eleven years and came to see me as they
both felt Vanessa’s desire had dwindled to the point that it had become non-
existent. When we talked about their sexual preferences and sexual history,
I discovered that (like most women) Vanessa mostly enjoyed clitoral
stimulation as her main source of sexual pleasure. In fact, when she
masturbated, she did this using her hand, or a suction-type vibrator to
stimulate her clitoris, and penetrating herself as part of masturbation simply
never crossed her mind. Although it wasn’t something she did often, she
experienced high arousal and high pleasure from masturbating. When Dan
and Vanessa had sex together, they had got into a habit of this being a
couple of minutes of kissing, then Vanessa giving Dan oral sex, then him
penetrating her, which lasted until he orgasmed. This sexual encounter is
largely based on societal scripts we’ve discussed here – of what
heterosexual sex should look like – and is mainly focused on Dan’s sexual
pleasure and experience. It’s not that Dan is intentionally orchestrating sex
which limits Vanessa’s pleasure, or that Vanessa has even thought about the
fact that this habit of sex is way off the mark when it comes to her pleasure.
After all, they are both just recreating an image of sex that is societally
constructed and looks like sex to them . They have seen it happening on TV
this way a million times. It’s what sex looks like to them. But when we look
at what Vanessa is expected to get from this encounter in terms of physical
reward, it is unsurprising that her arousal, enjoyment and desire have
dwindled over time, and they’re unlikely to flourish without this being
addressed.

Inequality and the curse of the heterosexual sexual script

In my experience, it’s really common for heterosexual couples like Vanessa
and Dan to fall into a ‘set menu’ when it comes to sex. This generally looks
like a starter that’s of a bit of a quick fumble, then a main course of
penetrative sex. I often say it’s better to think of sex as a buffet. You can
have whatever you want in any order. It doesn’t need to include the same
things every time, or end with the same dish. Imagine how much more
novel and exciting that would be.

LGBT couples often do this as standard and report much less predictable
sexual encounters than their straight counterparts. If you were to adopt this
idea in your own sex life, for example, sex could be kissing for a long time
then ending in both of you giving and receiving oral sex. Sex could be both
of you being sexual together with no penetration and no orgasms, or
entirely focused on one of you with no touch at all to the other.

Sex can be whatever you want.

The Natsal data we reviewed in Chapter 2 tells us that there is a correlation

between having genital contact without penetrative sex and better sexual
function. It’s possible that having very ‘samey’ sex every time you have sex
lowers your sexual functioning by being so predictable, and/or couples with
lower levels of sexual functioning have less of other types of sex, as things
haven’t been going so well. Either way, it’s important to pay attention to the
dangers of always ‘ordering the set menu’ if we want sexual satisfaction
long term. Especially if you’re planning on eating in the same restaurant
every night for the rest of your life.

We live in a society where we are constantly striving for equal rights for
women in all kinds of areas, but we are massively lagging behind when it
comes to sex. Heterosexual women are often having the types of sex that
are not the ultimate fit for their anatomy, then feeling shame and guilt for
not experiencing the ‘right amount’ of pleasure or orgasms from those
experiences, or experiencing a knock-on effect on their desire for sex with
their partner, without even realizing these limiting and dissatisfying scripts
are to blame.

This is why Cara is sitting in my room.

Faking orgasms and sexual scripts

We know that women fake orgasms frequently (roughly 50–65% of women
report having faked or regularly fake orgasms) and for a variety of reasons
11
such as:

wanting to look like a ‘good sexual partner’

wanting sex to end

to protect a partner’s feelings

 an attempt to enhance sex for them or their partner

to avoid conflict or explanation

wanting to prevent a partner from leaving

to avoid shame, as they feel they should have come

Faking orgasms reinforces the sexual scripts we currently have available to

us by creating the illusion that women are just as satisfied by the way sex is
happening as men are. Faking it also affirms the false belief held by society
that most women can come from penetrative sex. Faking it also does men a
disservice, as it provides unhelpful feedback about the things that add to
sexual pleasure and leads to unrealistic expectations – in fact, studies have
found that men consistently overestimate the amount of women who reach
orgasm and underestimate the amount of women who don’t. 12 Faking
orgasms is a key ingredient in the orgasm gap. But the frequency with
which women are faking orgasms also tells us several important things
about our current sexual scripts: women feel pressure to prioritize their
partner’s needs in such a way that it prevents communication about what
they really want; women’s pleasure is seen as an added bonus, not an
expected essential; women find it hard to communicate that they want sex
to stop in case they disappoint someone else. Faking orgasms is essentially
a symptom of our current sexual scripts in action.

Reciprocity and oral sex in heterosexual scripts

In Chapter 2 we learned that certain sexual acts, like receiving oral sex, are
often associated with pleasure and orgasms for women. So how does this
fact show itself in social scripts around how (heterosexual) sex should look?

Fascinatingly, but frustratingly, we know that attitudes towards giving and

receiving oral sex tend to see giving men oral sex as part of a duty that
women should partake in, whether they enjoy doing it or not, whereas
giving oral sex to women is seen as something that requires too much
‘work’ for men, is too much to ask for or asks for close up contact with our
genitals in a way that we feel they (and perhaps we) won’t feel comfortable
with.

Research in the UK found that more than twice as many young people aged
16–18 expected men to receive oral sex as part of a sexual encounter as
opposed to women (42% vs 20%), 13 and this disparity plays out in other
countries, across sexual experiences and across the lifespan of partners.
There is no doubt that pervasive societal negativity about the smell,
appearance and taste of vulvas, combined with male sexual pleasure being
seen as more important than women’s, contributes to the sidelining of oral
sex focused on women in heterosexual sex, and this has been described in
research.

The widely held belief that giving oral sex is unpleasant for men combined
with women’s anxieties about the appearance, smell and taste of their vulva
influences women to such an extent that we almost convince ourselves that
we don’t like it, don’t mind not having it or don’t need it as part of our sex
lives . This, of course, is in contrast with the data that tells us it’s one of the
most pleasurable sexual acts for women. Feminist sex scientists and writers
have long argued that holding on to these beliefs that it’s just not our cup of
tea , rather than a sexual double standard around inequity in relation to
giving and receiving pleasure, acts as a smokescreen for a hard-to-swallow
reality. Holding on to an idea that ‘we just don’t like it that much’ allows us
to maintain a sense that our sex lives are defined by equality and reciprocity
in how sex happens when, in fact, they are not.

Perhaps you’re wondering if another explanation for this inequity in

receiving oral sex is that women just enjoy giving oral sex to men more
than they do receiving it themselves? Afraid not. Many women report not
liking or enjoying the sensation of giving oral sex or the taste of semen, but
when asked why they do it, describe a strong social script that ‘it’s just what
you have to do’. Incidentally, men report enjoying giving oral sex more
than women report enjoying giving oral sex, which is another confusing
piece of the puzzle when you consider that women do it at a rate of twice
that of men AND that it’s a more reliable route to orgasm for women than
for men.

Sadly, it’s more likely that the elevated importance of men’s preferences
and pleasure in our sexual scripts, our communal discomfort with women’s
genitals, and women’s socialization to please, leads women to overlook
these factors and perform oral sex much more frequently than men. If you
are someone who avoids receiving oral sex but are not completely sure that
you don’t like it, rather you find it hard to feel entitled or be able to relax
and enjoy it, perhaps it would be beneficial to experiment with this a bit? As
with anything in life, the more we do something, the more comfortable we
generally feel doing it, so whether it’s about you changing your relationship
with your vulva, getting reassurance from a partner about whether they
enjoy giving oral sex and why, or just seeing if you can get more
comfortable by doing it more, this could be a good thing for your sex life.

Women’s bodies and society

Body image has a particularly important role to play in women’s sexual
confidence and experience of desire, and there have been many important
studies that have demonstrated a strong relationship between the two.
Whether it’s our weight, shape, size, amount and location of body hair, how
our vulva looks/smells/tastes or the size of our labia, we are plagued with
worries about what sexual partners will think of our naked bodies. 14
Although body image concerns such as these are not unique to women, and
more and more men are feeling insecure about their body image too,
concerns about body image disproportionately affect women. 15

The process by which we are so impacted by concerns about how we look

sexually is argued to be a byproduct of ‘objectification theory’. 16
Objectification theory proposes that we have internalized the (very
gendered) social scripts that self-worth is highly dependent on how we
look. Therefore, when we feel we have to be naked in front of another
person, we are overly focused on seeing our body from that other person’s
perspective and, in comparison to unrealistic societal expectations, we fear
the judgement they may make of us. Being overly focused on body image
in this way leads to us being distracted from sex, and we’ll talk more about
why this is crucial to enjoyment and desire in Chapter 6. For now, it’s
useful (though depressing) to know that poor body image is associated with
lower sexual satisfaction, avoiding sex, struggling to have orgasms and
having less desire to masturbate or have sex with a partner. 17

There is no doubt whatsoever that how we feel about our bodies is one of
the key culprits in regard to how we experience desire. The good news,
though, is that the effects of body image concerns reduce for some women
with length of relationship and age, meaning that, as time goes by in life
generally or in a relationship, we may be less affected by such concerns. 18 ,
19
The other good news is that, if this is the case for you, being aware of this
and taking a position on it, as I will invite you to do at the end of this
chapter, is a way of reducing the impact that it might be having on your sex
life.

Mind your language

Language is both a key feature of society and a way in which our reality is
created. When it comes to sex, the language we use has the opportunity to
perpetuate unhelpful ideas and sexual dissatisfaction or, alternatively, set us
and our desires free. Let’s have a look at some of the ways language has
been serving our sex lives badly so far.

I can’t remember the last time I used the word virginity . Instead, I ask
people about their first (consensual) sexual experience alone or with
someone else as one of many key moments in their sexual history. Framing
the start of our sex lives as an emerging sexual debut is also more inclusive
of LGBT people, who may not have, or value, vaginal penetration as part of
their sex lives in the same way. It also gets away from that horrible idea that
we are giving away – instead of gaining – something precious that marks us
out as ruined (women more than men) by someone else. I find throwing the
word virginity in the metaphorical bin also very useful as a therapeutic
intervention in its own right in sessions with clients. This is because, just by
my choice of language, I can shift the value of penis-in-vagina sex from its
pedestal of ‘ultimate essential sex act’ to just one of the things you might
value in your sexual relationship, or even something which might be deeply
unfulfilling to you that you are doing for someone else or because you think
you should. The reason the word virginity is rated so highly as a construct
in our society is because we have fallen into the trap of favouring penis-in-
vagina sex as our ‘definitive sex act’ over all other types of sex, regardless
of what we know to the contrary. For many women, other types of sex
(including masturbation) feel more pleasurable, or more intimate, and are
therefore arguably a better definition of sexual debut, but these sexual
experiences are invisible in the language we have available to us in our
society.

The same assumption behind the term virginity is also the reason that so
many women in same-sex relationships get asked ‘who’s the man’ or ‘how
on earth do you have sex’? The assumption is, if a penis doesn’t go in a
vagina, it isn’t ‘real sex’. It’s an example of how narrow our sexual scripts
can be and how they threaten to exclude a group who are perceived not to
have access to this ultimate act (they, of course, do, but are not so foolish as
to revere it over all else).

There’s other language we use that adds to and fuels some of our less
helpful social scripts. The concept of ‘blue balls’ – schoolyard slang for the
idea that men’s desire is so powerful that once they’ve started on the
journey of arousal there will be health consequences if the destination of
orgasm isn’t reached – might be teenage talk, but it’s fuel to those sexual
scripts and is evident in my clinical work, where women frequently tell me
that they feel that arousing their male partner and their partner not having
an orgasm at the end of it is equivalent to their partner being hanged, drawn
and quartered. You’ll see the negative influence of this belief in Chapter 7,
when we examine the impact of pressure on how women’s desire works.
What’s often of interest, and reflects our scripts around women’s desire, is
that women very rarely have this same perception of their own arousal.
They see it as entirely acceptable and expected that they should have to
manage feelings of arousal that are left to dwindle away as their pleasure is
sidelined. Nowhere is this more evident than the orgasm gap in casual sex,
where, if you remember, women orgasm around 18% of the time with male
partners. Women report that this is what they expect and accept. They don’t
worry about having ‘blue labia’, or that their genitals will combust or
explode as a result of being turned on and not having a physical release.
Our sexual scripts tell us that male sexuality and desire is more powerful
and needs to be satiated, when, in fact, it is not.

Finally, the one word in our language I despise the most, which restricts our
sexual pleasure and expression by its mere existence, is ‘foreplay’. ‘Sex’ is
any physical or psychological act that uses your body or mind for sexual
pleasure or expression. I never use the word foreplay, as, to me, it
represents the creation of a hierarchy through language that elevates some
types of sex as ‘better’ or ‘more like proper sex’. There are at least three
main problems with the word foreplay:

1. It marks out one type of sex (PIV) as superior to all others and the ‘main
event’, even though this type of sex benefits people with penises more
than people with vaginas (see ‘Orgasm Gap’)

2. It suggests sex that follows a set formula, and predictability and lack of
novelty are generally less exciting for sex for most people

3. It is not LGBT inclusive, as it suggests that much of the type of sex that
LGBT people have is not ‘real sex’
Please let’s ditch ‘foreplay’ from our vocabulary and stop using it from this
point on. Sex is so much more than that one act, and we’d all be better off if
we started seeing and talking about it as such.

How we are our own worst enemy – the perpetuation of

unhelpful societal beliefs
One of the many ironies of society is that we continue to support and
perpetuate ideas about sex that cause us great misery, and we do so without
questioning this. There are so many unhelpful ideas about sex that float
around unchallenged that I could probably have written a whole other book
full of them. I’ve picked a selection here that are some of my favourites to
dismantle in sex therapy, as they are crucial to how we experience sex and
desire in relationships.

The ease of spontaneous sex

We are led to believe that sex should happen spontaneously and easily
without any considerable effort from anyone involved, and this is also
linked with how we see sex happening on TV. It strikes me as odd that we
often hear lots about the effort and investment people put into other areas of
their life, such as to maintain a healthy diet or to stay fit, or when they want
to create change or keep something to a certain standard, yet we often
maintain a belief that sex should work just fine with zero effort or
investment.

Connected to this is the idea that scheduling physical intimacy is unsexy.

It’s probably also related to the idea that ‘good sex’ should be spontaneous.
I find this idea about planning being the antithesis of a good time really
interesting, as it raises the question: what other enjoyable aspects of our life
does planning lead to a lack of excitement or enjoyment? When you think
about where you want to go on holiday, spend time considering where you
want to go, imagine what it will be like, picture yourself there having a
great time, imagining the sun on your skin, or how relaxed you’ll feel, does
that make the holiday less exciting or enjoyable? Would it be better if you
didn’t know you were going on holiday and you were ushered on to the
plane at the last minute, not really sure where you are going, having not
packed, not knowing whether you even feel like going on holiday or are
ready for one at that moment?

I feel what people are really referring to when they recoil at the concept of
scheduling is the idea that ‘sex’ being expected is off-putting, and in some
ways this can certainly be true, as pressure and expectation can be real
desire killers (more about this in Chapter 7). But there is a difference
between carving out time for physical connection and pre-emptively
consenting to sex you aren’t even sure you want or will feel like, and it’s a
crucial one. Knowing that there is a no-pressure, enjoyment-filled,
intimacy-fuelled fest planned that evening, which may lead to wanting more
but also might not, can be really sexy. Also, knowing that this time is
planned not only allows both of you to anticipate and fantasize about it
(which are both important triggers for arousal and desire) but also allows
you to put things in place which help with the practicalities of making it
happen. This might be making sure you switch your phone off or resisting
checking your stressful work emails, making an effort to be home from
work on time, or not answering that call from your aunt which might take
an hour. It might also lead you to take steps to connect with your own
sexuality and do what you need to do to feel confident in your body. This
might be having a shower, wearing something that makes you feel
confident, or creating the right environment using music or temperature. If
you reflect back to your ‘conditions for good sex’ triangle, there will be
some clues here about what would help set the tone for you.

The other advantage of scheduled versus spontaneous physical intimacy is

that it sets a tone of expectation between the two of you which allows you
to flirt and build up anticipation throughout the day, amplifying each other’s
excitement (for example, sending a text ‘How’s your day?’ ‘A bit stressful
TBH! Only thing getting me through is looking forward to chilling with you
later ’. When it comes to sex, and the fact that it requires (at least) two
people to be on the same page at the same time in this hectic modern age,
why wouldn’t we give ourselves the advantage of having the heads up that
we are invested in creating a space for physical intimacy in which desire
can flourish? Isn’t this one of the most obvious way of helping each other
and our sex lives along?

The three-times-a-week myth

One of my absolute favourite societal myths about sex and desire is that we
should be having sex three times a week. I love this one mainly as a) it’s so
pervasive (it’s what couples usually tell me they want their sex life to be),
b) it’s really far from how often we know couples are actually having sex
(as you learned in Chapter 2), and c) it bears no relation to sexual
satisfaction, desire or pleasure (the idea of frequency as a marker tells us
nothing about our actual experience of sex). Nevertheless, it persists! I’m
totally stumped about where this one comes from (tell me if you know!),
but I do know it’s quite resistant to extinction and it’s the cause of an
enormous amount of stress for a lot of people who feel their neighbours are
beating them at meeting this magical number of three times a week.

Expect the worst for your sex life

Another unhelpful societal belief that I feel hinders sex in long-term
relationships a great deal is the idea that there will be an inevitable decline
in sexual satisfaction or passion. This saddens me, as once we subscribe to
it, it can serve as a self-fulfilling hypothesis. Yes, for some couples, sex
might start to lose its charm after a few years, due to normal changes in
desire, or connected to changes in habits of how people relate as they get to
know each other more, or linked with a change of circumstances, such as
living together or having a child. But, sadly, the belief that this is the start of
an inevitable decline is often the thing that stops couples doing something
to rectify the situation. With knowledge and investment, desire can be
sustained over many decades 20 and sexual satisfaction doesn’t need to
decline, even as a consequence of normal changes in desire over the course
of a relationship. The secret to a good sex life in the long term is being able
to discuss and adapt to the inevitable ebb and flow of desire and sex in a
relationship. In Part Three we’ll learn all about what makes sex good in the
long term and how we can adopt these ideas and watch our sex lives
flourish, even when life conspires against us. The problem is, as soon as we
believe we are on an inevitable downward trajectory, with no escape and no
hope, we stop making any attempt to adapt. How we evaluate our sex lives
and what we believe about desire is crucial to how our sex lives then play
out over time.

Monogamy reigns supreme

Monogamy is possibly one of the best examples of a societal construct that
influences our behaviour to such an extent that we find it hard to see it’s
there, instead imagining that being monogamous is just what humans do,
and not a product of the influence of the religious, economic and political
forces at work in our society, as mentioned in Chapter 1. What is
fascinating about our (Western cultural) belief in the construct of
monogamy is that not only does seeing humans as essentially monogamous
lead us to expect that fidelity and satisfaction should come easily to us
without effort, but we also end up with a great deal of societal disapproval
of those who are seen to contravene it, whether they are content in their
sexual relationships or not. I often feel that our acceptance of monogamy as
inevitable and lifelong can be damaging to our sex lives, as it removes our
sense of freedom to leave a relationship and can lead us to take a partner’s
long-term sexual interest and enthusiasm for granted, rather than seeing it
as something to nourish. I’m certainly not anti-monogamy (or anti any
relationship structure), but I am suggesting that it’s useful to reflect on how
we made the choice to be monogamous (did we, or are we just doing what’s
expected?). I’m also interested in how the social construct of monogamy
being ‘normal’, or even ‘easy if you love each other’, helps or hinders our
sex lives in terms of the effort we make to nurture it. For example, an
expectation that monogamy is easy, natural and to be expected, even in the
absence of a good sex life together, can be a dangerous assumption in a
relationship, in my clinical experience. How might it impact on our
investment in our sex lives if we saw monogamy as something which is not
necessarily easy and, for many people, something that is dependent on
relationship and sexual satisfaction?

Our intersectional identities and sex

In this chapter so far, I’ve spoken a great deal about the context of gender
and the enormous impact of gender identity on how we think and behave in
relation to sex. Gender is a hugely important construct, as not only is it one
of the core constructs which shape how we see ourselves, but the social
construction of gender in our society dictates how we are supposed to look,
act, dress, behave, desire and ‘do’ sex. Similarly, the impact of gender
politics on the act of sex itself is crucial to how we understand our sexual
satisfaction and desire, as women’s pleasure and desire are negatively
impacted by restrictions on bodily autonomy, self-knowledge, assertion,
pleasure, reciprocity and expectations to please.

I’ve also spoken about the context of sexuality, mainly as there is a large
disparity between women who have sex with men and women who have
sex with women regarding their experience of pleasure and satisfaction,
which illustrates the huge impact of the context of gender and gender
politics. But I have also referenced how the experience of having sex with
men or having sex with women brings with it new opportunities and
challenges for women in certain aspects of sex, such as the experience of
pleasure, the pervasiveness of sexual scripts, gendered expectations about
desire and the impact of living with
heteronormativity/homophobia/biphobia/transphobia can have on how you
feel or how you are treated with regards to your sexual expression.

But we mustn’t assume that the contexts which make up our unique sexual
history, understanding and experience stop at gender and sexuality, and it’s
crucial that we reflect on the other aspects of our identities that shape our
lives and experience of the world, in turn making a difference to our
experience of sex. For many of us, some of these contexts might feel even
more influential to our relationship with sex and desire than sexuality or
gender.

Earlier in this chapter we talked about the influence of the media and how
our consumption of media impacts women’s adherence to ‘sexual scripts’.
Much of this research (as with much of science) has been biased and
focused on predominantly white women, and therefore doesn’t take into
account the different social and cultural factors or scripts that may be at
play with the experience of race more widely. Recently, there have been
some important attempts to redress this balance, and some newer studies
have reported on key differences in the media impact on the sexual scripts
available to women as they intersect with race.

We know that gendered sexual scripts are constraining and may be barriers
to all women’s sexual well-being, and it is argued that adhering to these
sexual roles diminishes women’s sexual entitlement and empowerment.
However, we mustn’t assume that women of colour are exposed to the same
gendered scripts around sexuality as white women. There are key socio-
historical differences informing how women of colour are judged,
stereotyped and treated differently to white women around issues of sex and
sexuality, due to the impact of racism in our society.

One example of this is a study which found that black women reported
feeling concerned about asserting themselves and advocating for their own
needs sexually for fear of reinforcing (harmful) negative stereotypes of
black women as ‘being overly sexual or animalistic’. 21 We can also see the
influence of racism, oppression and violence with regard to women of
colour in mainstream porn, where videos featuring a woman of colour are
regularly titled with a reference to the fetishization of her race, or with a
reference to the dynamics of her submitting to or being humiliated by a
white man. It’s these damaging ideas which lead to a society where sexual
assaults on women of colour are tragically too common and are less likely
to result in convictions. 22

What’s important here is that culture, society and our unique contexts have
a far bigger influence on our individual experience of sex and desire than
we might recognize. If we want to have a good relationship with sex and
desire, we must pay attention to how who we are has shaped our social
learning about the intersection of sex and race, culture, age, physical ability,
body size/shape, class and religion.

The potential positive and negative impacts of all of these other contexts of
our identities on sex are so large that they warrant a whole book (and there
are many books devoted to each of them), so they are outside the scope of
this chapter. Despite this, it can be really important to examine the role of
the different contexts that make up who you are to work out which of the
social messages about sex coming from these contexts you agree with or
reject, which of them are in congruence and which clash, and which of them
are helping or hindering your current sexual expression, including desire. At
the end of this chapter there is an exercise to take you through this and
make these implicit messages explicit, so that you can ‘name the game’ and
feel more power over these messages than they currently have over you.

Given society has such a negative impact on our sex lives and desire, why
don’t we speak out about it more? Firstly, there are several things that we as
a society simply do not talk about, and we therefore do not know about our
own sexuality. We are not told much about how our bodies work, or that it’s
okay to ask for non-penetrative sex, or that other women feel the same way,
that it’s still ‘sex’ if you don’t have penetration, that we’re not unusual and
that the odds are stacked against us to come in the way we’re expected to,
particularly if TV is anything to go by.

Secondly, we care too much. We care about being perceived as unusual,

about moving too far from the norm, about a partner’s pleasure or
disappointment being more important than ours, and about rocking the boat.
This is all understandable, as it’s rooted in us as being social animals, with a
desire to conform and fit in, as well as in persistent and detrimental gender
politics at an institutional and linguistic level.

What’s great about sex, though, is that, given I’ve just shared with you all
the ways by which sex is a socially determined concept, it’s also, therefore,
something that can see shifts over time. These movements come with
changes in dominant ideas, changes in how we use language, and as other
cultural values (like alternative relationship structures, like feminism) shift
with it. Despite the limits that our current societal beliefs place on our sex
lives, we also know that these narratives and scripts have shifted in the last
100 years. Even in the last fifty. So, we can choose to rebel, choose not to
conform, choose to speak up about what does or doesn’t work for us. We
can decide to reject the scripts and the constraining language that doesn’t
serve us. We can experiment with asking to do things differently and
noticing the effects, on us, on our partners, on our mutual satisfaction and
on our desire over time. We can add to the rewriting of these scripts.

Perhaps it’s time we brought our politics to the bedroom?

Take home messages from this chapter

Our society, culture and the interaction of this with our individual contexts
(gender, race, sexuality, age) have a huge impact on our sex lives, often
more powerfully than we are aware

These sexual scripts and cultural norms can have both a direct and indirect
impact on desire, by creating the illusion that desire is less powerful for
women, by defining sex as something which doesn’t always produce
pleasure for us, or taking away our ability to be assertive

Language is a key vehicle for sexual norms and maintains frameworks for
sex that limit positive sexual experience and pleasure and create a narrow
perception of ‘sex’
The media and porn have a large part to play in the maintenance of sexual
scripts, and this becomes even more relevant in communities with poor
sex education at home or in school

Societal beliefs about sex for women are not uniform, and being black,
gay, older or disabled will change the nature of the ideas about sex we are
exposed to

Despite not believing some of these ideas about sex or how we should
behave in our society, we will be affected by them and might find
ourselves going along with them more at certain stages of life (for
example, accepting orgasm gaps in hook-up sex) or experiencing
negative consequences for rebelling against them (for example, being
called a ‘slut’)

Understanding the impact of these dominant societal beliefs and how they
might personally impact on our own sexual experiences can be key to
changing our relationship with desire. This might include not feeling able
to ask for what we like, feeling our pleasure is unimportant in comparison
to someone else’s, or being overly focused on the importance of how we
look
OceanofPDF.com
Exercise :
Reflection: Your sexual biography
Reflect on your sexual history from as early in your life as you can
remember and write a story of your emerging sexuality from:

Your early memories of your body and self-touch and any reactions you
remember the family having towards this

How body parts were named when you were growing up

Consent around your bodily autonomy

Any unwanted sexual experiences, no matter how ‘minor’ you feel

they\were

How your sexuality started to emerge with puberty, and the pride or
shame you felt about this

How sex was talked about, and what was implicit in those conversations

How the significant adults in your life demonstrated their sexuality and
what you took from this.

How you have felt about your body since you were young. What can you
remember thinking and feeling about your body, including body hair,
your vulva, your weight, your breasts? What messages were around about
what you ‘should’ look like?

What was your experience of starting your periods, having early lustful
feelings, your first sexual experiences and what part you learned to play
in sex from an early age?

What you learned about what was important that you do or not do in sex,
and why? Whose pleasure was prioritized, and how did you feel about
 this at the time?

Who did you talk to about masturbation? Sex?

What was the contribution of race, culture, ability, religion or age to this
journey?

What were the messages you received from TV, magazines or porn, and
how did this make a difference?

What messages about sex did you internalize that were entirely due to
gender?

How did what you knew (or didn’t know) about your own body make a
difference to your sexual journey?

After you’ve written the story of your sexuality for yourself, think about:

1. The legacy of this story for any parts of your sex life in this present day
(positive and negative)

2. Whether you continue to be influenced by ideas about sex or your body

that you don’t actually agree with and want to consciously try to move
away from

3. Reflect on how you might do this. For example, are any of your current
cultural and social contexts reinforcing these ideas? A good example of
this is body image – it’s rare to meet a woman who feels happy with her
body or genitals when naked. This is mainly due to the constant barrage
of media images representing ‘perfect’ bodies. A good way to start to
tackle this is to change what you’re exposed to – for example, by curating
your social media feeds. Being exposed to feeds with images of normal
women, a variety of vulvas and body positivity will, over time, make a
difference to how you feel about your own body

4. Being aware of these influences is one important step in taking away

some of their power, but you can also make changes to the way that you
act in relation to them. For example, if you have always believed that
talking about sex is vulgar, talk about it more with friends or a partner. If
you have always faked orgasms, see what happens if you don’t. If you
only ever have sex that ends with a penis in a vagina, experiment with
changing this. At times, you may have to take yourself out of your
comfort zone, but the impact of rejecting these scripts actively is key to
changing the weight of their influence on your sex life
OceanofPDF.com
5
Sex in our relationships

‘We want it to be like it was in the beginning’

In an era where lust and passion dominate our perspective of a good sexual
connection and is often how a ‘good sex life’ is represented to us on screen,
a sex life where passion can last the distance of time appears to be one of
the holy grails of popular culture. In therapy sessions, I see many couples
who come to see me because they want it ‘to be like it was in the
beginning’. Although sex therapy can create huge shifts in people’s sex
lives if people are committed to the process, it’s often important to know
that the feelings we might have in the early stages of a relationship – where
we are driven to distraction by wanting, lust and obsessive thoughts – can’t
really last. Something else takes their place – an opportunity for knowing
another person intimately (both physically, sexually and emotionally), and
the foundations of a relationship (of whatever type and structure) that can
lead to personal, sexual and emotional growth.

Is it possible to have good sex for ever?

It is absolutely possible to maintain high levels of sexual satisfaction and
desire whilst having sex with the same person time and time again, but it
requires some investment and, for most, some effort. The early stages of
sexual relationships tend to be high in lust and desire, and this time is
characteristically different from more established stages of our sex lives,
when we get to know our partners on a deeper level. One of the great
cruelties of this is that, for many couples, the things that they value about a
longer-term relationship (security, knowing another person completely) can
bring with them an overfamiliarity and predictability that isn’t always great
for our sex lives. If we add to this unhelpful and inaccurate societal
messages that you should desire sex with a partner in a relationship often,
without having to do any work on triggering that desire, then we can start to
understand why sexual dissatisfaction within relationships is a very
common experience.

It might be obvious to state it, but sex happens in a context of other

relationship dynamics. This means that levels of contentment, irritation,
power play and connection/disconnection in the relationship influence how
we feel we can be (and want to be) in relation to sex. Sex with casual
partners or even strangers is also not immune to the impact of the
relationship (even if it’s a relationship of only an hour) influencing how we
act sexually – but there’s an obvious difference in us being less known to
them and also knowing them less. During sex we might find ourselves
wanting to be passionate, creative, assertive, subservient, quiet, aggressive,
shy, serious, sensual, dominant, playful – all kinds of things. For some of
us, some of these ways of expressing ourselves sexually are easier with a
stranger, as being a ‘blank slate’ in their eyes can allow us to feel less self-
conscious about showing a wider variety of these contrasting versions of
our sexual selves. We can feel freed from fearing that they will pick up on
this as unusual and say, ‘Whoa! What’s going on with you? You’re not
usually like this!’ This freedom can allow a greater variety in expressing our
sexual selves that, for some people, can feel constraining in long-term
relationships.

For others, taking a risk to show different sides of our sexual selves is easier
to do in the safety and security of a relationship, where we feel safe to try
new things, express ourselves fully and be totally free. At this point, it’s
worth considering your ‘conditions for good sex’ that you started to put
together in Chapter 3. What kinds of ways of being do you have written
down under psychological arousal? How many of these do you feel able to
bring in to your sex life at the moment? Are there any types of sexual
expression that feel out of bounds for whatever reason? Are there sides of
your preferred sexual self, such as showing aggression or totally
relinquishing control, that are easier with someone you trust or with a
complete stranger?

I’ve met many people in my clinical work in long-term relationships who

crave sex with a stranger, not entirely for the novelty of the stranger but for
the novelty of being able to be a different person themselves. As well as the
physical act of sex being vulnerable to becoming predictable over time, so
can we as the players in that act. We risk becoming typecast, and the sides
of ourselves that we show sexually can become narrow and predictable.
Before we know it, we feel restricted in what parts we can play or who we
can be, in a way that takes away variety in our expression of ourselves
sexually.

Before Tom, Jess had enjoyed diversity in who she felt she was
sexually and had enjoyed being both dominant and submissive in
subtle ways, as well as having passionate sex, which felt frenzied,
and sex which felt slow, intimate and sensual. When she met Tom,
she enjoyed the fact that they had lots of intimate, sensual sex, and it
fitted with the fact that she fell in love with him and the intensity of
their emotional connection was high. Several years later, they were
still in love, but Jess felt stifled by the dynamic between them
sexually. It wasn’t that she didn’t enjoy the slow, sensual intimate
sex that they had – she still did. But she missed a part of herself
sexually that she had previously valued, the variety of expression
that allowed sex, and crucially her own sexual expression, to be
much more diverse.

You might be wondering what this has got to do with their relationship?
After all, this is about Jess and what Jess wants, not Tom. But Jess sees
herself and her way of being in the relationship through the lens of Tom’s
eyes. Their sexual personas have been defined by the sex they have been
having and so Tom sees Jess as a sensual, intimate person sexually. Picking
up on this, Jess feels self-conscious about acting outside of this role, so she
does not try to show the sides of herself that she is finding herself missing.
She also finds it hard to articulate the part that she’d quite like Tom to play
sexually sometimes, which is to be assertive, dominant, selfish and
impulsive. The limits that Tom and Jess’s relationship dynamics place on
their expression of sexuality place them at risk – not only of sexual
boredom, but also of Jess feeling motivated to seek this interaction
elsewhere. We’re all capable of having non-negotiated sex outside of a
monogamous relationship, for a huge variety of reasons, but sometimes
these reasons are connected to parts of our sexuality that are stifled rather
than our feelings about our sexual partners.

We shouldn’t be fooled into thinking that monogamy is easy for most

people, especially if we are clipping the wings of the full expression of our
sexual personas or those of our partners, as it most definitely isn’t. In fact, it
has been suggested that it might be harder for women than for men, due to
the impact of long-term monogamy on desire. 1 As the UK largely has been
a monogamous society for the last few centuries (despite plenty of evidence
that it doesn’t work for many people), there is an assumption that
monogamy is ‘natural’, easy, how humans work or without effort. This can
be a dangerous place to be if we want to sustain monogamy, as it implies
that monogamy will work for our relationship under any strain,
circumstance or conditions. It also implies that there are people who are
‘good and faithful’ and people who are not, which is equally unhelpful. The
truth is that choosing monogamy as a relationship structure might be just as
‘challenging’ as choosing a different relationship structure and should be
approached as such.

It might be worth stopping here and reflecting on whether there are any
sides of your sexual self that you’d like to show but currently feel restricted
in showing or expressing. Fantasies are not necessarily indicative of what
we want in real life, but there are some interesting parallels with how we
see ourselves being in our fantasies (in control, passionate, devoured, taken,
powerful) and what we might enjoy more of in our sexual expression in real
life. Some fascinating research by Justin Lehmiller in 2018 into some of the
most common fantasies and what they mean to people suggests that
fantasies can be a window into our own sexual preferences when we don’t
feel restricted by what society dictates for our sex lives. 2

Why does sex matter?

When a couple consults me around problems with desire, or frequency of
sex in the relationship, it is almost never about the amount of desire or
frequency of sex in the relationship. One of the tasks involved in making a
meaningful change in the lives of a couple struggling with this is
understanding what the real problem is.

What I mean by this is that the key to getting to the bottom of how we feel
about our sex lives is understanding the meaning of sex for us as
individuals, and for our relationships. Only then can we know what it is we
feel we are missing out on if it’s not happening as much as one or both of us
would like, or in the way that we would like. Only once we know this can
we understand the cost to that couple and why it might be troubling them
right now. For Jess, her concerns about sex were that the relationship
dynamic or sexual habits she and Tom had got into were, she felt, stifling
her own sexual expression. But what beliefs and assumptions were behind
how their sex life did or didn’t play out?

When we talked further, it was clear that Tom’s preference around how they
had sex was not just about his ‘conditions for good sex’, but was connected
to his perception of their relationship identity. Tom explained that he was
desperately in love with Jess and that he wanted their sex life to represent
that. Jess tentatively and nervously explained that sometimes she craved
more ‘animalistic sex’ and had fantasies of being ‘taken’ by Tom in a way
that was about his desire for her being about his physical wants, not their
emotional connection. Tom was, at first, shocked and upset, as he felt this
change signified a change in their relationship and one for the worse. He
felt that the animalistic sex Jess was referring to represented a way men
were with women when they were not respecting them. We talked more
about it and started to understand this change in Jess’s preference as being
both about her wanting to revisit and express all sides of herself sexually, as
she always had, as well as wanting some variety in the parts they played
sexually, for the sake of novelty within their sex life. But we also
understood it as being about the impact of having been together seven
years, as Jess explained that she knew Tom loved her intensely, and she was
very grateful for this, but that, after all this time, she craved feeling desired
by him, and that this was one of the reasons this particular fantasy was a
favourite of hers.

It’s also important to notice here that Tom’s assumption that sensual sex =
love and animalistic sex = disrespect are an important aspect of the picture,
as these societal and heavily gendered messages of how men should treat
women influence the sex that Tom feels inclined to have. These beliefs
might be Tom’s individual ‘conditions for good sex’, but, for Tom (as with
all of us), his conditions for good sex are heavily influenced by the role of
society, gender politics and his learning about sex so far. It’s interesting to
note that it’s also possible that there are sides of Tom’s sexual self that he is
restricting for fear of seeming disrespectful or trivializing their love, based
on his assumptions about how sex should be, or his feminist views.
Relationship dynamics, habits, communication and miscommunication are
crucial to good sex, and are the focus of this chapter, but each person in the
relationship brings with them their own beliefs, attitudes and past
experience, which shapes the relationship dynamics. The interaction of the
two plays out in the subtle and often unspoken dance between us.

For Jess and Tom, their sex life was hampered by the limitations, routine
and habits their relationship had got into as these were restricting their
sexual expression. This was heavily connected to the meanings they read
into doing it differently. But the meanings we form about sex in our
relationship are not always connected to how we or our partners are
sexually, but sometimes more in relation to how much we want sex, or the
importance we perceive our partners place on it.

Lucy was worried that Gina seemed to want sex much less now than
she did when they first got together. She started to worry that this
was about Gina not finding her attractive any more, but she didn’t
voice this concern outright, instead letting her dissatisfaction about
their lack of sex come out in sarcastic comments during rows. Lucy
was desperately worried about Gina no longer finding her attractive,
as that was what had prompted the end of her last relationship and
her confidence had been knocked so badly by it.

Lucy’s concerns appear to be about the quantity of sex that they are having
in their relationship, but there is a strong chance that this is just a surface-
level concern. Lucy interpreted the change in frequency of sex as a signal
that something else, something alarming, was wrong. For Lucy, Gina not
wanting sex as much as she did signalled that she just wasn’t good enough,
wasn’t attractive enough. Lucy internalized the problem as being about her
(though, in actual fact, Gina had no idea Lucy had done this, as Gina was
used to Lucy making jokes that she was the problem). For other people,
differences in desire for sex can prompt fears of a fundamental lack of
compatibility, and worries about the future of the relationship. Our
individual beliefs about the meaning of sex are important in relationships,
but we can also see the impact of beliefs about sex in society trickling down
into our beliefs and creating a problem where there isn’t necessarily one.
Lucy was perhaps dialling into the strongly held societal belief that a
woman’s worth and sexual role are heavily based on her appearance, or
maybe a fear about the myth of ‘lesbian bed death’. Other beliefs affecting
the personal meaning we make of a change in our sex lives can be ‘you
shouldn’t have to work at sex, it just happens’ and ‘relationships must have
a lot of sex to survive’. The impact of society, outlined in the previous
chapter, is crucial here but, importantly, it’s generally something in the
relationship that has allowed this to take root and become a problem. It’s
likely that, if Lucy had voiced her concerns earlier, she may have got the
reassurance she needed and the change in their sex life might not have felt
like an issue. Talking about sex might sound easy but, as we all probably
know, in reality it can feel like anything but.

Communication and initiation

Much has been written about the importance of communication for a good
sex life. We know from research that people who are more able to talk about
sex with partners enjoy their sex lives more, 3 and that communicating
about sex acts as a buffer to a drop in desire. 4 This includes being able to
talk about what you like, don’t like, your fantasies and desires, and your
evolving wants, need and preferences. Sounds simple, right? Well, it might
be if we didn’t have all the gaps in our foundations that we talked about in
Chapter 2. Being out of practice, not having the right words, feeling shame
or being raised with the belief that talking about sex is crass can all get in
the way. Getting the words out can make us feel incredibly vulnerable and
anxious – I see this all the time in sex therapy, even in the most confident
and outspoken of people. No matter how good we are at talking generally,
we’re all still up against it, as we live in a world where it’s not okay to talk
about sex.

This matters for several reasons. Firstly, because our sexuality (our wants,
needs and preferences) changes over our lifetime, and we and our partners
need to be able to know about and talk about this, so that we can adapt to it.
For example, ‘Since I’ve been pregnant, I actually really like penetrative
sex in a way I wasn’t that fussed about before, can we start doing more of
it?’
Secondly, the very nature of sex is negotiation. On a broad level this might
be ‘what kind of sex life do we want to have as a couple?’; week by week it
might be ‘I want sex now, do you?’; and, in the moment, negotiations like ‘I
want to do X to you but I’m not sure if you want that or not.’ Negotiation is
difficult without communication. Imagine trying to get anything else in life
done in partnership with someone else without being able to talk about it?
Talking about sex is essential for negotiation, and negotiation is crucial to
good sex. At the start of a relationship, or when things are going well, it
may appear that sex just happens and doesn’t need negotiation. This is not
strictly true, but it can be more easily masked during this early stage, when
desire and lust are high. But the challenge comes when we want something
different, when problems crop up or when life gets in the way. By then we
can be out of practice with negotiating about sex, but getting back into
practice can be especially hard if we find talking and listening to each other
already challenging, even outside of sex. It can also be difficult if we have
both grown a little defensive about our sexual relationship or generally find
it hard to assert our wants and needs.

Lastly, communication in sex is important because we are heavily

influenced by the world we live in and, unless we are able to explicitly state
otherwise, we risk being shoehorned into a model of what society tells us
sex should be like. This can be what we think we should be doing based on
sexual scripts rather than what we actually want . For example, we might
need to actively say, ‘I actually could take or leave penetrative sex, to be
honest. Can we not always do it? In fact, I’d be happy if only 10% of our
sex ended this way,’ or else penetrative sex will be assumed to be our main
event and this will affect our satisfaction and desire in the long term if it’s
not our favourite thing.

I could share a million examples with you from the couples I’ve worked
with. Everything from difficulty in asking to use lube (‘they’ll see it as a
sign that I’m not turned on enough’), to asking for oral sex (‘I’m pretty sure
he doesn’t like it as he doesn’t often do it’) to how sex is initiated (‘she
thinks I like it when she bites my ear but I find it cringey’). Quite often one
of the key turning points in therapy comes when something that has never
previously been spoken about is talked about in detail, and we discover that
neither person was right about what they thought the other person thought
about it. In therapy, sometimes we call this ‘the difference which makes a
difference’ (a phrase coined by systemic therapist Gregory Bateson). 5
These turning points in therapy demonstrate the power of ‘not talking’ in
keeping us stuck in old patterns that are not helpful. Sex, in my opinion, is
the area of our lives and relationships which is most ripe for
miscommunication. To keep sex good and to benefit our desire in the long
term, talking about sex is crucial.

As I mentioned earlier, it sounds simple, but we all know that being

socialized not to talk about it, not having the words for it or not feeling
comfortable saying the words out loud can make it hard. Imagine trying to
order some new books you’ve been wanting to read in a bookshop that
you’ve been raised to feel ashamed to shop in. The titles of the books you
want contain words you’ve never spoken out loud before and also words
you associate with embarrassment. There’s the added impact of being
socialized to feel shame about ordering these books, as people might take
one look at you and expect you to want totally different books (or no books
at all).

In some ways, when I’m doing sex therapy, I’m the person working in the
bookshop. I try to make customers feel that it’s perfectly okay for them to
be shopping here, or to help out by first offering a few titles of books they
might be interested in, without any prejudice about what they might like
(also, being the first person to say the words can be hard, so it’s easier if I
start things off). I might make some suggestions for good titles if they’re
really struggling, encouraging them to try not to be influenced by what they
think others might read. Even with someone facilitating, talking about sex
can be hard, but without good communication our sex lives and our desire
will suffer.
You will know yourself how easy or difficult you find talking about
anything tricky generally in your relationship, and this might be a good
barometer for considering how communication might be helping or
hindering your sex life, given sex is usually harder to discuss than most
things. How well do you feel you and your partner currently communicate?
Do you feel listened to? Taken seriously? Are difficult topics easy or hard to
bring up? Do they get quickly sidelined when they get tough, or can you
both stick with it and find a way to delve in even if it’s uncomfortable?
Does one of you use humour in a way that the other finds dismissive? Does
one of you wish the other would use humour a bit more to lighten the tone?
Does one (or both) of you interpret any difficult conversation as criticism,
or feel frightened and get defensive? Do you feel able to take responsibility
for whatever you are talking about in equal measure, or does one of you
always seem to bear the brunt of blame? Do you struggle not to be ‘right’,
are you both able to really, intently listen and hear not just the words but the
feelings behind them? Are you able to admit you were wrong and say sorry?

There’s plenty of help out there for improving your communication as a

couple generally, and if reading this segment has got you thinking that you
could do with making some changes in this regard, I’d recommend you first
find a way to work on communication outside of your sex life, so that the
changes you make benefit what happens inside your sex life too. Later on,
in Part Three, we’ll revisit the idea of how to talk about making changes in
your sex life in a way that works, and I’ll be recommending some strategies
on how to do this. These strategies will be useful only if there aren’t
fundamental issues in your communication already that could do with
addressing, however, so take action now if needed.

Of course, we could be forgiven for thinking that communication about sex

is mainly talking about it. In fact, there is a whole host of complex non-
verbal or indirect communications that we use to communicate in the
absence of, or in addition to, words, and these can be just as useful and just
as problematic. Take Axa and Jack as an example:
 Axa had been thinking about Jack during the day at work and was
generally feeling content and lucky to be in a relationship with him.
She decided it would be great to have sex tonight, mainly as she
wanted to demonstrate her love to him, but also as it made her feel
on cloud nine to connect with him that way. Axa sends a text to Jack
saying, ‘Let’s have a cosy night in tonight ’, hoping that Jack will
understand what she means. When they get home, Axa dresses in an
outfit she knows Jack likes and puts some music on that she finds
sensual. Jack comes in and is clearly pleased to see her, but seems
distracted about his day and the relentless sound of an album he
finds annoying. They sit on the sofa together, and Axa asks about his
day, all the while stroking the back of his neck with her fingers and
looking him in the eye. She kisses him, and he kisses back but pulls
away to tell her about another thing that happened which he forgot to
mention. Axa asks him if he wants dinner, or to take a bath together.
He replies that he’s quite hungry, so dinner would be good. When it’s
time for bed, Axa takes off her clothes in front of Jack, looks him
straight in the eye and places his hand on her naked body. She sees
the glimmer of recognition in his face.

How many indirect or non-verbal communications did you notice Axa

making before Jack understood what she was getting at? We might call this
initiation. Initiation of sex (and by ‘sex’, I of course mean any sexual act) is
simply a communication that says, ‘shall we . . . ?’ It can be tricky,
particularly as it can be direct (‘I’m horny and I’d like to go down on you?
Can I?’) or indirect, such as the strategies Axa tries above. Initiation is an
important part of sex with someone else, but it also depends, crucially, on
communication and, as with any communication, it’s ripe for
misunderstanding and misinterpretation. This is something that many
couples struggle with. One person has the thought or motivation to be
sexual, but the other doesn’t notice the initiation as the communication is
too indirect, or they have misinterpreted it as non-sexual, or it comes at a
time when they are too absorbed in something else. The opposite can also
happen – our sexual communication can feel blunt and too much for our
partner, and they experience it as pressure to feel something that they
currently don’t. More about how initiation fits in with desire and an
opportunity to spot how this happens in your own relationships, helping or
hindering desire, can be found in Chapter 7.

In the meantime, a few fascinating facts about initiation of sex: it’s heavily
linked with sexual scripts, and research over the last few decades has shown
that women in relationships with men are initiating sex more than they used
to, reflecting a change in the (outdated but still somewhat influential)
scripts that ‘men should initiate sex more than women’ and ‘men are the
drivers and women are the gatekeepers of sex’. This is a positive change for
women’s sexuality, as we know that being the person who initiates sex is
also associated with higher levels of sexual satisfaction in the sexual
encounter that follows.

Although women in relationships with men initiate sex roughly equally as

often as men, research tells us that they tend to initiate sex more directly
than men. 6 This means that women in relationships with men are more
likely to say, ‘I’m feeling horny, let’s have sex’ than to start kissing a
partner gently and hope they know what this means. There have been some
ideas put forward as to why this is the case, especially given that we know
women who have sex with women (who, incidentally, report initiating sex
more than women in relationships with men) tend to use more indirect
strategies. Sex researchers suggest that the script that ‘men are always up
for sex’ (which, as you now know, is also not true) is still very much alive
and kicking, and responsible for women who have sex with men feeling
more able to take a risk with direct communication. In contrast, women
who have sex with other women, and men having sex with women, might
do the opposite and assume that women are more likely not to feel like sex,
and so ‘test the waters’ of initiation more gently.

A final word on initiation. It’s normal and common to often not feel like sex
at the same time as someone else, but how we convey that to a partner can
have an important consequence on our sexual satisfaction long term. For
example, research tells us that ‘rejecting’ a partner in a reassuring way (‘I’d
really like to and I am really attracted to you but I just have all this work to
do’) leads to higher levels of couple satisfaction long term than a critical
way (‘Why are you so sex mad all the time? I wish you’d stop nagging me
about it.) 7

Why we have sex

Why is sex important to us, our partners and our relationship and why does
it matter if we don’t have it? Well, partly, the answer to this is linked with
the reasons we have sex in the first place. Representations in the media will
have you believe that sexual activity happens as a response to feeling sexual
desire, but, that is not necessarily the case, especially in a long-term
relationship. Of course we want arousal and desire to be present at some
point in the sexual encounter, and sex will be pretty rubbish without it
making an appearance, but it’s often not there in the beginning – it grows
over time, so there’s another need being met at the beginning that it’s
important we are paying attention to. It’s these needs which, without sex,
we or our partners feel we are missing out on and can cause us distress.

In 2007 sex researchers Cindy Meston and David Buss did some research
into the reasons people engaged in sex. Before their study, a few other
studies had reported a handful of motivations, such as ‘I felt horny’, ‘to
relieve sexual tension’ or ‘to be emotionally close’. Meston and Buss found
there was much more to it than this – 237 distinct reasons, in fact, linked
with other aspects of psychological functioning, whether it was with casual,
regular or relationship partners. 8 Gender played a big part in the reported
reasons, with some themes of emotion as a driver rated highly for women
and physical sensation rated highly for men. This is unsurprising, due to the
social conditioning of how messages around gender play into our learning
about sex over the years.

Some of these needs or motivations relate to pleasure, some to protecting

the relationship, some to expressing or feeling attractive; some are about
placating and some are about obligation, boredom, stress relief or self-
expression. Take a minute to consider how these drivers or motivations are
represented in society and the media. Sexual desire is almost always
portrayed as uncontainable passion or lust. We rarely see representations of
sex that start as one person going along with another’s initiation but end up
being passionate and hot, but this is a lived experience for many people and
is perfectly good sex. What I’d like you to take away from this is that the
desperate I-want-to-tear-your-clothes-off-now desire is not always the
driver for many people. It is also not very realistic in long-term
relationships.

Sometimes not having sex or not having enough sex is what is named as a
problem by one or both people. However, in my experience, after some
detailed enquiry into this, people will say that, actually, there’s something
else behind this that’s bothering them. Things like the conflict it causes,
feeling abnormal, worrying about infidelity as a result of not ‘satisfying’
their partner, feeling rejected, missing the excitement it brings, missing
expressing that part of themselves, feeling disconnected, etc., etc.

What this means is that concerns about what is happening in your sex life
might not necessarily be linked with how much sex you are having, but
rather that one or both of you are losing the opportunity to meet other needs
in that particular way. A sexual partner will have their own key drivers or
motivations for sex, things they really value, reasons why they are inclined
to want sex. Do you know what they are? How do we know why they feel
the way they do about the amount or type of sex you are currently having if
we do not know what function sex serves for them?
Understanding this about ourselves and our relationships can be the first
step in getting to the bottom of the problem of what’s missing for us and our
partners when we’re not having the greatest sexual connection or
experiencing a discrepancy in desire (both of which are inevitable for all of
us, at times). Understanding this also gives us some useful clues about how
we can address these needs in other ways – either while we work on sex,
instead of sex or in addition to it.

Let’s go back to Axa and Jack for a second. Re-read this description of them
from earlier, and see what you make of Axa’s motivations to initiate being
sexual with Jack.

Axa had been thinking about Jack during the day at work and was
generally feeling content and lucky to be in a relationship with him.
She decided it would be great to have sex tonight, mainly as she
wanted to demonstrate her love to him, but also as it made her feel
on cloud nine to connect with him that way. Axa sends a text to Jack
saying, ‘Let’s have a cosy night in tonight J ’, hoping that Jack will
understand what she means. When they get home, Axa dresses in an
outfit she knows Jack likes and puts some music on that she finds
sensual. Jack comes in and is clearly pleased to see her, but seems
distracted about his day and the relentless sound of an album he
finds annoying. They sit on the sofa together, and Axa asks about his
day, all the while stroking the back of his neck with her fingers and
looking him in the eye. She kisses him, and he kisses back but pulls
away to tell her about another thing that happened that he forgot to
mention. Axa asks him if he wants dinner, or to take a bath together.
He replies that he’s quite hungry, so dinner would be good. When it’s
time for bed, Axa takes off her clothes in front of Jack, looks him
straight in the eye and places his hand on her naked body. She sees
the glimmer of recognition in his face.
What did you notice?

Axa is not feeling desire. Axa is wanting to have sex because it meets her
need to express her love for Jack, allowing her to feel close and connected
with him. This is an important difference. If Jack had decided that he didn’t
want to be sexual with Axa this evening, the consequence for Axa is not one
of sexual frustration, but of missing out on an opportunity to connect and
show love for Jack. This motivation can be met in ways other than sex, but
if neither Axa nor Jack recognizes that this is what Axa is wanting, the sex
(or lack of it) might be incorrectly assumed to be the problem between
them. Sex may well be the vehicle for another need.

There are many reasons why understanding your and your partner’s
motivations for sex are important. An easy trap to fall into if your partner is
the one who initiates sex more than you is to assume that their initiation is
solely motivated by a need to release sexual tension, or to express a ‘sex
drive’ unconnected to you. This might well be the case (and certainly will
be for all of us on certain occasions), but this is where some of our sexual
scripts can trip us up. If you’re trying to negotiate a difference in desire
with a male partner, scripts that ‘men always want sex’ and talk of men
thinking of sex every seven seconds can reduce the entirety of men’s sexual
behaviour to nothing more than scratching an itch. The truth is that men are
much more complex, as are women. We all have complex reasons for
wanting sex, which if we were more aware of, might lead us to be more
empathetic when we are turning each other down, or to find other ways to
meet that need.

Since Meston and Buss’s original research into people’s motivations to be

sexual, other researchers have started to investigate whether the type of
motivation a person has for having sex matters. 9 They investigated what
difference it made to people’s sex lives when they were motivated to have
sex by a positive outcome, such as giving or receiving pleasure or to
experience intimacy (termed ‘approach’ reasons), as compared to those who
were motivated to have sex to avoid negative outcomes, such as conflict, a
partner’s disappointment, or to prevent a partner leaving (termed
‘avoidance’ reasons). The results were fascinating. It turns out that having
sex for avoidance reasons is more likely to result in a decline in sexual
satisfaction over time. On the other hand, having sex for approach reasons
is associated with increased sexual satisfaction as well as the person holding
a more positive view of sex. What’s useful to know from a desire
perspective is that not only is having sex for approach reasons associated
with better sex, but it has also been shown to buffer against sexual desire
dropping over time. 10

In my work I often meet couples who are having sex because one person
wants to (and is annoyed if they don’t ‘get it’) and another person is feeling
little desire to but is having sex to ‘keep the peace’. This is likely to further
reduce desire over time for the person going along with it. In addition to
this, this same crucial research into the impact of approach or avoidance
reasons on a partner has found that, despite people often having this type of
avoidance sex to please a partner, it doesn’t actually achieve this result, as
sexual partners of people having sex for avoidance goals report less
satisfaction also. What this means is that it might feel like it’s helping to
have sex to placate someone else, but it is not actually helping anyone.
Instead, it’s possibly making the situation worse over time for both of you.
If this is the case for you, then it is important to address it by stopping
having sex for these reasons. Instead, studies have shown that if you ask
people to focus more on approach reasons (for example, thinking about and
noting down positive reasons why they might want to be sexual), they
experience higher levels of sexual satisfaction and desire than people who
have not been instructed to do this. 11 This is a wonderful piece of sex
science, as it shows us that we can modify our motivations (and therefore
our satisfaction and desire) simply by intentionally focusing on all the good
things that we or our relationships stand to gain from sex.
At the end of this chapter you’ll find a more detailed exercise to help you
consider your motivations for yourself and encourage your partner to do so
also. You can then start to consider the pattern of this in your relationship
and work out what function sex serves for the two of you. Is it mainly to
connect? Is it to feel and express attraction? Is it to experience another level
of sensation/experience together that marks you out as a sexual couple? Is it
to keep each other satisfied as a strategy to protect the relationship from
infidelity? Is it to escape from the mundane and feel alive? Are your
motivations for sex largely approach or avoidance based? Once you have
done this, I’d like you to use this information to reduce or stop having sex
for avoidance reasons (explaining to your partner why this is important, as
well as understanding what their motivations are and how they can be met
in other ways) in addition to spending more time investing in and thinking
about approach goals.

Whatever the function that sex serves for you, your partner and the
relationship, understanding this allows the two of you to know what
difference it would make if you invested in it more, what you stand to lose
if you don’t and how your motivations might affect your desire over time.

Desire discrepancy between people in a relationship

In Chapter 3 we talked about data from the most recent Natsal study, which
told us that about a quarter of UK adults feel like they have a different level
of desire to their partner. So the issue of trying to negotiate a difference in
desire is not solely the problem of couples seeking sex therapy, but rather
an experience common to many of us, and it is likely to be a challenge that
most of us will need to negotiate in our sex lives. The problem comes when
we don’t know how to manage this difference between us, or when it starts
to feel loaded, hurtful or frustrating. How it feels when we feel like having
sex less frequently than our partner depends on the meaning we make of
sex, and why it’s important to us. So let’s try to understand this in a little
more detail.
One of the first things I do when a couple comes to see me, telling me that
one of them has ‘low sexual desire’ that is causing them both distress, is to
explain to couples that I prefer to talk about it not as one person’s problem
with low desire , but as a problem of discrepancy of desire in their
relationship, which is standing in the way of one (or both) of them getting
something they need. Or I might explain it as a problem of a mismatch
between how they feel and an unrealistic standard set for them by society
around the myth of spontaneous sexual desire for women in their long-term
relationship. Or that it’s a problem of how the comfort or pattern of their
relationship over time has unwittingly turned into a barrier to desire
flourishing. This subtle change in seeing a problem of desire as not one
person’s problem and using language which shows that it’s dependent on
other things and amenable to change is where the hope builds (and the work
starts).

Relationship dynamics and sex

The impact that relationships with significant people, such as early
caregivers, have on our lives is known as our ‘attachment style’.
Attachment theory, initially reported by the child psychoanalyst John
Bowlby, is a way of acknowledging that humans have a natural propensity
to seek out closeness with others, and that our ability to trust and feel secure
with another person or feel loved is something we learn from the world
around us in the first few years of life. This learning happens through our
interactions with our attachment figures, who, when we are babies and
young children, are our primary caregivers. We can develop a ‘secure
attachment style’ when we feel that we are (more often than not) responded
to, our needs are met and our caregiver is available and responsive. This
leads us to develop a positive sense of ourselves and others that we take
with us throughout life, influencing our expectations (and therefore our
behaviour) in all future relationships.

On the other hand, if we experience our caregiver as mostly rejecting,

unavailable or to be feared, we can develop an ‘anxious’ or ‘avoidant’
attachment style. This means that our early learning is that other people
cannot be trusted, don’t meet our needs, or will not come back when we
need them. Again, this will influence our relationships as we move through
life, leading us to be hypervigilant to rejection, or fearful or uncomfortable
getting close to, or relying on others.

In adulthood our attachment figures are typically the people or person we

reach out to if we are upset, or need care or support, which is often a
romantic/sexual partner. It’s good to know that even if we’ve had a difficult
early start and developed an anxious attachment style (for example, being
prone to regular fear that our partner will leave, and showing a lot of
hypervigilance or reassurance seeking around this), our attachment style
can change with new experiences of someone who offers security. This
means that, if someone who has an anxious attachment style is with
someone who is consistently reassuring and dependable, a more secure
attachment can emerge, and worry about being abandoned can start to
diminish.

The interaction between our attachment style and that of our partner is
relevant to desire and the approach /avoidance motivations for sex we
covered a few pages ago. For example, it can be harder not to have sex for
avoidance reasons (i.e. to prevent a partner from leaving you for not ‘giving
them sex’) if you are someone who finds it difficult to trust that people will
stay, or that you are worthy of people staying. 12 This can make it
challenging not to have sex for avoidance reasons, and, in this case, it’s
useful to consider how you can start to feel more secure in the relationship,
so that you can feel confident in asserting yourself in this way now you
know the effect that sex for avoidance reasons could have on desire.

For some people, therapy can be a useful way of figuring out whether they
have a way of relating to others that’s affecting their sex life
problematically in the here and now. Not everyone needs therapy, however,
and for some people, understanding what’s going on in their sex life in this
way (by questioning the function sex serves and whether their reasons are
approach or avoidance), in combination with having a reassuring partner,
can be a way of bringing added security to the picture.

Bad sex equals bad relationship, right?

No, not necessarily. It can be easy to assume that, if things aren’t working
perfectly when it comes to sex, there must be something wrong, but it’s
often not the case. It’s certainly true that there’s a direct relationship
between how content we are in our relationship and our sexual satisfaction,
and how content we are with our sexual relationship and relationship
satisfaction, and it’s perhaps common sense to recognize why. But it doesn’t
follow like this for all couples. For some couples, the relationship couldn’t
be any better, but good sex, or even any sex, feels hard to achieve. This can
happen for so many reasons, but can include things like getting out of the
habit of relating to each other sexually and starting to feel more like friends
than partners, waiting for desire to come spontaneously but not creating the
context for it, or being so intimate that it’s hard to position the other as
sexual. So let’s discuss some of the relationship dynamics or habits we can
fall into which might get in the way of desire, even in the most solid
relationship.

Intimacy – too little or too much?

Intimacy (which may mean something different to you than to the next
person) is also an interesting concept when it comes to the success of a
sexual relationship. When people use the word ‘intimacy’ they often mean
emotional closeness or connection, trust, security or familiarity. This might
show itself in everything from how much time they spend apart, how much
they share of their personal thoughts and feelings, or the personal
boundaries they feel comfortable to cross, such as how comfortable they
feel about going to the toilet in front of each other. There are no rights or
wrongs when it comes to levels of intimacy, in that we all have our own
preferences regarding what feels good to us, and what works. But despite
much advice around spending more time together or ramping up intimacy
being good for your sex life, it’s possible that this is not always the best
advice, at least not for all couples. There are certainly some relationships
where an increase in intimacy could lead to a better sexual connection,
perhaps as it brings with it an opportunity to really connect, to feel safe, or
to trust enough to let go of inhibitions. For other relationships, intimacy can
do the opposite. Intimacy that prevents individuality, space, time to yearn
for the other, the opportunity to see the other person as separate from
yourself, or enough difference to create a feeling of novelty can be
challenging for desire, 13 and having distance from a partner can buffer
against this. 14 One of the things I’m often looking for when a couple first
meets with me is how much physical separation there is between them, and
how this helps or hinders their relationship. Only you will know whether
intimacy is something you might benefit from fostering, or whether you
might benefit from more distance in a metaphorical rather than a literal
sense. There is also evidence that creating changes in intimacy is more
important in boosting desire than striving for either extreme. 15 If you’re
interested in seeing the difference this may make in your relationship,
perhaps experimenting by trying things differently for a few weeks might
give you the information you need.

The paradox of security

‘We do not own our partner. At best they are on loan to us, with a
chance to renew.’

The above quote from Esther Perel (who has written extensively and
eloquently about relationship dynamics, intimacy and desire) 16 is a
wondrous challenge to our tendency to feel that our relationship and our
partners are a given. It’s provocative, as it is at odds with our societal
expectations of monogamy as something that is easy and expected, as
outlined in the previous chapter. It suggests that our partner could leave us
at any time and that we should treat them and the relationship as if this were
the case. How does reading this quote make you feel? Worried? Shocked?
There are some remarkable benefits that can come of treating your
relationship, no matter how long it has stood the test of time, as if it’s
something delicate and precious that needs to be nurtured to survive. I’m
not suggesting for a second that we should not plan that cinema night out
next week, or that holiday in three months, for fear that our partner might
get up and leave tomorrow. But rather, if we take them too much for
granted, due to a (mistaken) belief in the infallibility of monogamy or the
institute of marriage, we might not see how crucial it is to nurture them and
the relationship.

In therapy, I sometimes talk about the concept of what I call ‘giving each
other the scraps’. This is a relationship habit that can be easy to fall into,
and is basically when we present the most exciting, dynamic, interested,
interesting, attentive and caring sides of ourselves to our job, our friends,
our work colleagues, our neighbours (or even the barista at Pret), but when
we get home and see our partners we give one-word answers, lie on the sofa
and barely make eye contact. Giving each other the scraps could also be
positively construed as the joy of having a committed other who you don’t
always have to be presenting the best version of yourself to, someone you
can completely relax around and just ‘be’. This in itself is a wonderful
thing. But there’s also a risk that you and your partner could start to forget
those sides of each other (that were so present and abundant in the early
days) of making each other laugh, really listening to each other like no one
else matters, of connecting over your hopes, dreams, knowledge and world
view. This is where desire can suffer.

It’s not the time you have but what you do with it that counts
A recent paper by Dr Amy Muise and her colleagues in Canada has added
to what we know about how we spend time with our partners and the
impact of this on sex. 17 We already know that couples who engage in
activities that excite and inspire them with a partner revisit some of those
much sought-after early relationship feelings towards one another, and
Muise and her colleagues wanted to look at the impact of these same
behaviours on sexual desire. Their recently published study suggests that an
injection of novelty and ‘self-expansion’ in ourselves or our relationship
outside the bedroom can affect what happens within it, and that couples
who spend more time doing novel, interesting and challenging activities
individually or together see an improvement in their sex life as a result.
Self-expansion might include learning a new language, visiting a new place,
taking on a physical challenge, or having a new experience.

Basically, they found that couples who spent time on these ‘self-expansion’
activities (as opposed to just time together as usual) were more likely to
experience sexual desire, and more likely to have sex. What’s important
here is that it was not the amount of time couples spent together but how
they spent it that resulted in higher reported desire and sexual activity.
Couples who found ways to ‘excite, inspire and connect’ with each other in
this way are thought to make space to learn new things about themselves or
each other, and create conditions of novelty, distance and newness, akin to
those in the early months and years together, fanning the flames of desire. A
crucial finding of this study was that the longer sexual partners had been
together, or the more pressed for time they were (think new parents), the
more impact self-expansion activities such as these had on their sex lives.
Our experiences of desire and sexual satisfaction are complex and there are
many elements adding to this picture (what’s going on in our bodies, our
personal relationship with sex, our relationship with our cultural and social
contexts), but there is a huge and tangible real-life value in studies such as
this, which demystify how nurturing the seemingly non-sexual parts of our
relationships can make a difference.

For our long-term sexual relationships, this means that, if we want to keep
our sex lives hot, perhaps it’s time to prioritize making time to really
connect, by having explorative and meaningful conversations with the
intention of discovering new things about each other – not just about what
we ate for lunch or who said what at the photocopier. For some of us it
might be as simple as looking at each other through another person’s eyes,
or in a different environment, such as watching our partners charm the new
neighbours at a party. For others it might be planning an adventure together,
trying something new and exhilarating, or learning how to dance. The
bottom line is: the challenge of creating time together which involves
something novel and exciting might take a bit of thought and planning, but
it could seriously benefit our sex lives.

Consider some of these ideas around relationship dynamics and sex in your
own life for a second. Do you feel that you spend so much time together
that you know what your partner is about to say even before they do? Do
you notice that you feel more desire when you’ve spent time apart? Do you
feel that the more time you spend together, the more emotionally connected
and sexual you feel? Do you sometimes wish you could live a more
separate life and develop more of your own separate interests? Can you
remember the last time you really laughed, felt excited or exhilarated
together?

You probably have a natural reaction to reading this and know instinctively
what camp you fall into. Would your relationship benefit from more or less
emotional intimacy? Would it benefit from less time together, but for more
of the time you spend together to be not just giving each other the scraps?
Perhaps you don’t feel that emotionally connected at all, and more time
investing in your relationship is what’s needed. Whichever it is, don’t be
fooled into thinking that spending time in the same room, house or flat
constitutes this time. The opposite of giving each other the scraps is what’s
needed. Really connecting, listening and valuing each other’s thoughts or
opinions, without your TV or phone competing for your attention, is key.
It’s great to do this over dinner, or whenever you see each other, but if you
can find time for self-expanding activities, such as doing something new
together, having an adventure or engaging in a fun task together, then this
kind of time together is probably the best type of all.

Priorities, practicalities and time together

In the last chapter we talked about the sexual script that ‘sex should happen
spontaneously and easily, without effort’. In my opinion, this is one of the
fundamental challenges to good sex within modern-day relationships. We
live in a society where we are told that to have a healthy body we must pay
attention to our diet, to be fit and strong we must make time for a regular
exercise routine, and to be happy we must find time to practise self-care and
gratitude. It is less common to hear about the importance of prioritizing our
sex life, or the benefits of doing so in this way. It’s also common for
practicalities and time together to be a bigger problem for desire than
anything else, such as in the case of Alexandra and Gregory.

Alexandra and Gregory came to see me about the lack of sex in their
relationship of three years. They explained that they wanted to have
more of a sex life, but since about eight months after they’d been
together, the frequency of sex between them had dwindled to once
every month or two. Neither of them felt happy with this
arrangement and both felt they were missing out on a connection
unique to them, and feared what they had was turning into a sexless
relationship, which would make their relationship more vulnerable to
failure [hopefully you can spot here their motivations for sex, the
function sex serves in their relationship, as well as the influence of
societal beliefs and how crucial these are]. Once we’d established
why this was important to them, and that there were clear benefits in
making changes (instead of just accepting that once every two
months was fine for them), we set to work on understanding how sex
happened in their relationship. One of the key factors, they
explained, was that they had no time for sex. I asked more about
their commitments in other areas of their life and how they spent
 their time and they told me that they were on special diets to
maintain their physiques, which required several hours of menu
planning, shopping and meal prep every day. It became clear that it
was not the case that they did not have time for sex, but rather that
they did not prioritise sex in the way that they prioritized other
elements of their life (their diet and fitness, which they put
tremendous effort into). We wondered together what difference it
would make if they spent several hours a day prioritizing their
emotional and physical connection. I asked them, ‘What if sex had
the same priority as your diet?’.

Alexandra and Gregory admitted that they had never considered that they
needed to prioritize sex before, as they thought it should just happen. But
when they actually looked at their week and thought about it, there was not
a single bit of free time or an obvious time of the day or week that gave
them an opportunity to be sexual together. Understanding this meant that
they then had two choices moving forward. The first was recognizing that
sex is not happening as it’s not a priority and changing the meaning of it so
it’s no longer seen as a problem (‘We are not broken sexually. It’s just that
sex doesn’t often happen spontaneously when you’re busy doing other
things and we have other priorities that are currently more important to us,
and that is fine.’). The other choice is to decide what priority they want sex
to take and treat it accordingly. This might mean relegating something else
and making sacrifices in other areas, to devote the time to sex that it needs.

Even if it were true that sex happens spontaneously and easily without
effort (which it mostly isn’t), how would this spontaneity and ease happen
if you aren’t physically in the same room alone together? Think about your
week with your partner for a second. Discount any time that you have with
kids, family or other people in close proximity, discount any time you are at
work, exercising or seeing friends. Discount any time you are getting
dressed, cooking, cleaning or doing essential life admin. Discount the time
you are asleep. How much time is left? By the time you’ve totted it all up,
you might feel like all you want to do is watch Netflix and scroll through
Instagram. You’d be normal in this regard. But if this is the case, how much
of a challenge is it to expect sex to happen spontaneously and easily in this
narrow window? Then add into the mix the need for your partner to be on
the same page in terms of also feeling like sex spontaneously at exactly the
same moment and we start to see what a challenge this is.

So what do you do if you only have late evenings alone together? What do
you do if you feel most receptive to sex in the early morning, when things
are hectic and you’re both always rushing? Or perhaps in the middle of the
day, when you are at work? What if you and your partner are on completely
different time clocks with sex and you have a huge daily ‘to do’ list? This
will undoubtedly affect your desire and is really common. In this case (and
like Alexandra and Gregory), you have two options. One is to find more
time together, that’s uninterrupted and about connection on an emotional
and physical level. The second is to change the meaning of what’s
happening with sex to be about the stage or pace of your lives rather than a
problem between you. This might be enough to make it acceptable, or it
might be that a sacrifice is needed. That’s for you to decide.

For us to improve our sexual lives or keep them good over time, we must
find a way for sex to feature in our priority list, or else we risk it becoming
extinct. As much as we might not want to hear it, we have a choice in how
we spend our (potentially small amount of) free time, but the choices we
make inevitably side-line one activity over another (Netflix vs Sex) or by
nature of how these impact our mood and therefore also impact on sex. For
example, if we scroll social media and see a range of pictures and posts that
make us feel low and feel self-critical, as opposed to spending time talking
about our day whilst looking into our partner’s eyes, leading to an increase
in emotional intimacy. It might sound obvious when presented this way, but
we don’t always make the choices that match up best to our life or
relationship goals.

Technology and our sex lives

Whilst we’re on the subject of scrolling, smartphones are not always the
greatest thing for sex when it comes to how we prioritize our time. Large-
scale research studies both in the UK and the US has shown that couples are
having less sex than ever before, and we can only guess that the key factor
that has changed in the last ten years is the rise in smartphones to manage
our day-to-day lives. The average Brit checks their phone every twelve
minutes and spends about three hours a day using it to go online for things
like social media, surfing the web or checking emails. 18 We look them more
in the eye than we do our partners.

Our phones can sometimes take us away from the people we are with, into
another world. They can also add another element of a life task into our day,
as we feel the need to answer those work emails at home or catch up on
Twitter, Facebook and Instagram every day. How much time do they take
out of your day? Getting used to a constant level of stimulation from
scrolling social media, watching TV and streaming online doesn’t just take
up a great deal of our time which we could be using to connect with others,
though; they also make it harder for us to tolerate just being in the moment
without being stimulated by them (how long can you sit in a restaurant
when the person has gone to the toilet without getting out your phone?).
Have a think about whether the time you spend on your phone or the power
it has to distract you takes you away from your partner.

Of course, it’s not technology per se that can have a negative impact on our
sex lives, but the way in which we relate to it. Spending an hour a day on
WhatsApp might be great for you if you’re spending it flirting and sending
images and promises of things to come. Scrolling Instagram for three hours
per week, however, might be sapping time you could devote to emotionally
connecting with your partner, or it could be your way of connecting with
your sexuality, or working on your body positivity, by interacting with
accounts focused on sex-positive messages, erotica, or images of body
diversity. Technology isn’t the problem, but not spending time reflecting on
how it is helping or hindering your sex life might be.

Having children
There are a multitude of ways in which having a family can impact on our
or our partner’s desire for sex. On a biological level, breastfeeding can
reduce desire due to the impact of the rise in the desire-sapping hormone
prolactin, as can recovery from birth or the effects of birth trauma. But one
of the biological factors that is perhaps most long-lasting after the birth is
sleep deprivation. Whether you have children or not (but it will be ten times
more applicable to you if you do), tiredness is a well-known desire killer. In
fact, tiredness is so influential for all of us in terms of our sex life that one
study into women’s desire, orgasm and arousal showed that getting enough
sleep increases your chances of having sex the next day by 14%! 19

There’s a well-documented and significant negative impact that having

children has on our sex lives. Studies into the sex lives of new parents make
for fairly depressing reading, mainly as sex tends to take such a hit in the
first five years of having kids, and this can show itself in dissatisfaction or
sexual problems at higher levels than those of the general population. 20 The
important thing here is that it’s not kids per se that impact on our sex lives
and desire, but the changes that they bring with them. Having little people
manhandling your body all the time or the loss of time to invest in activities
that previously may have increased our confidence, desire or a sense of
connection with our partner is the issue. Changes to our bodies post
pregnancy, affecting body confidence, or an increased life admin or stress
impacting on relationship dynamics are a factor too, as in the case of Sandra
and Mike.

Having kids and the maternity leave that followed had kick-started
 more of a ‘traditional’ family structure, in terms of gender roles, than
Sandra and Mike had ever intended, but they had become entrenched
in these roles over the years. Sandra, previously attracted to Mike for
his independence and egalitarian attitude towards their relationship,
had started to be resentful of having taken over all of the
responsibility for the household since going on maternity leave. She
not only felt less desire for Mike as a result of this, but the position
she found herself in of cooking, cleaning and making Mike’s packed
lunches was also a role she found deeply unsexy. At first Mike didn’t
understand how this could be influencing Sandra’s desire for sex,
mainly as he believed that sex was a drive that should happen
spontaneously, regardless of what was going on in their lives.

In part, this is why not understanding how desire works can stop us finding
solutions. Sandra and Mike are not alone in this aspect of the practical side
of their relationship, i.e. division of labour impacting on their sex life.
Studies have found that the more equitable the division of household tasks
in relationships, the greater relationship and sexual satisfaction the couple
usually report. 21 Sadly, even in 2020, unequal gender politics translate to
women in relationships with men carrying out the lion’s share of the
emotional and practical burden of the household tasks. It may feel
unconnected to sex, but it most definitely is not and can impact on our time
for sex, our ability to prioritize sex, our feelings about our partner, the
relationship, or our feelings about ourselves, as it did for Sandra. As we will
learn as we move through the next few chapters, committing to more equity
in this regard can be one way that partners can create the foundations
women might need in order to cultivate and maintain desire.

The good news about all of this is that the effects of having young children
don’t affect every couple negatively and won’t last for ever. In my opinion,
the most important thing is knowing that this kind of change in your sex life
is very common. This is crucial, as it stops you worrying that it’s a problem
with you, your partner or your desire. Hopefully, what you’ve picked up
from this book so far about desire not being a drive, and being responsive to
context and needing to be triggered, explains the impact of kids on your sex
life to a T. Saying that, it’s worth doing what you can to keep sex as good as
it can be for now, and putting some effort into making it a priority – as you
are by reading this book – so that you don’t find yourselves in a place
where sex has gone so far off the agenda that it’s hard to come back from in
a few years’ time. This does not have to take a great deal of time and
investment, which you’ll be pleased to hear if you are currently running on
empty and juggling thirty things at once. It can be as simple as a few
seconds throughout the day or week where you relate to each other as
sexual partners rather than as housemates or co-parents. I call this ‘sexual
currency’.

Sexual currency
‘Sexual currency’ is the sex science terminology often used to refer to the
use of sex as a bargaining tool, or the relative value of a person’s sexuality.
I use this term in another context, as a way to refer to the amount of sexual
charge or interaction between us and a sexual partner outside of actual
sexual experiences. The distinction between what constitutes a sexual
experience and what can be better considered acts of sexual currency is an
arbitrary one, so bear with me on this. After all, as we discussed in Part
One, one of the problems we face with our sex lives is our definition of
what constitutes enough or ‘proper’ sex – and heaven knows I don’t want to
add to that already narrowly defined concept. But, if you’ll humour me for a
second, should ‘sex’ be thought of as any sexual act involving a body part
of yours or your partner’s designed to bring pleasure to one or both of you,
then sexual currency can be defined as any way of relating to a partner
which has the undertones of sex to it, but does not necessarily include a
sexual act. This could be a brief but suggestive touch as you pass your
partner in the kitchen, a seconds-long but passionate kiss before heading off
to work, or just spending time naked in bed together not having sex. The
litmus test is: would you do it with your aunt? If not, and it doesn’t involve
a sexual act of some type, it’s sexual currency.

Let me use the analogy of eating to illustrate the point (I’m fond of food
analogies for sex, in case you hadn’t noticed). If ‘sex’ is equivalent to
holding food and biting, chewing or swallowing it, and feeling the sensation
of food in your mouth, and the fullness of it in your belly, then sexual
currency is thinking about food, talking about food with others, meal
planning, looking at food, remembering food you’ve had, sharing stories
about your favourite food, touching the food before you cook it and
enjoying the process of cooking. Using this analogy, we start to see the
importance food takes on in our lives, even when we’re not eating. We can
also see that even when we’re not eating food, it has time devoted to it
outside of eating which undoubtedly adds to the experience when we do
actually eat. Thought about food, anticipation or communication about
food, adds to our eating experience in terms of both building excitement to
eat but also by ensuring we know what we want from our food (and
potentially, so do others). But when you consider the relational aspect of
sexual currency (i.e. it needs at least two people to happen), you start to see
how having high levels of sexual currency becomes more than the way we
as individuals relate to something, but a way that, as a couple, we relate to
and define each other and our relationship. We become a more sexual
couple whether we are having sex once a day or once a year.

In the early stages of a relationship, we typically have extremely high levels

of sexual currency. We spend large amounts of time kissing, making intense
eye contact, hand-holding, complimenting, touching, giving affirmations
about our desire, flirting, being suggestive by looks, comments, texts and
emails and being physically close. If you watch a couple in the early stages
of their relationship, you can see the high levels of sexual currency running
between them. Their interaction is sexually charged, even when they are not
having sex. Their relationship is defined by a sexual connection. The more
this couple continue to act this way towards one another, the more they feel
sexual towards each other, as this is the nature of their relationship, what it’s
about, it’s the way they relate. It’s a virtuous circle which results in more
desire and more sex.

As relationships become more established, we generally settle into other,

more sustainable ways to co-exist, as well as new habits. It would be rude
eight years into a relationship to spend the whole time at brunch with a
group of friends kissing, gazing into each other’s eyes or whispering
erotically changed things to our partner, to the exclusion of all others. Plus,
after the first flush of lust, the intensity of those early feelings subside to
pave the way for less obsessive and maddening feelings, and thank heavens,
as if we behaved the way we did in the beginning, we might lose sight of all
else in our lives and not have any friends to go to brunch with anyhow.

I want to impress on you that it’s the habits we fall into regarding how we
relate to each other that are crucial, if we are to consider the sustainability
of our sex lives over the long term. Continuing to relate to our partners as
sexual beings, not just as housemates, friends, or co-parents, is a way of
making our relationship a sexual one, even in the absence of acts of sex.
Continuing to share moments like this together reminds us that we are
sexual beings, and that we are being looked at in this way by the other.
Having moments of connecting via sexual currency, on a typical day or
dotted over the week, provides us with natural, frequent opportunities to
transition into being more sexual together, should we want to, by providing
us with a scaffolding to move from the basement level (washing up, talking
about our day) to the first or second floor (more of a sexual zone) naturally
and without awkwardness, as, after all, it’s what our relationship is about
and the reason we are not just friends . Considering sexual currency as part
of our sex lives rightly situates the performance of our sexuality on a
spectrum rather than an on/off switch.

For some couples, sexual currency is ever present and, though it may have
declined since those first heady few months of their relationship, they still
feel there is a sexual charge between them that they enjoy indulging and
intentionally nurture. For these couples, no matter how often they have sex
together, they feel connected sexually, and find the transition from putting
the weekly shop away to kissing passionately against the fridge an easy one
to make. These couples may find a period of time without having sex makes
less difference to their sexual satisfaction, as they are still getting most or
all of their motivations for sex met via sexual currency (for example,
feeling desired, feeling close, feeling excitement).

For others, sexual currency has become increasingly absent since those first
months and this absence makes it hard to see their partner (or relationship)
as particularly sexual. Compliments, passionate kissing, and suggestive
looks are so absent that, even if you wanted to do them, they can feel
awkward, and even if they are intended simply to convey attraction, they
can feel like a clumsy initiation of sex. There’s a vicious circle here, as the
less you relate to each other in this way, the less your relationship feels
defined as a sexual one, and the less sexual it is. The less sexual it is, the
harder it is to transition into being sexual together, even if you both want to.
You’ll see why this is important once you have read about models of desire
in Chapter 7.

Sexual currency is about the culture of our relationship, and what’s good
about culture is that it is fluid and shifting, depending on how the people
within it act. If you are reading this and realizing that you and your partner
only ever passionately kiss as part of sex, and never at any other time, or
some other aspect of relating to each other mainly as flatmates or co-parents
rings true, then the important thing is that you can create a change in this
culture easily by starting to do something differently. The other thing that
I’d like to say here is that although I’ve talked about two types of couples
here, one with high levels of sexual currency and one where it’s virtually
non-existent, there’s plenty of variation in the space between these two,
even for the same couple throughout the course of a typical month.
To reflect on this more, ask yourself the following questions:

Do I see my partner as a sexual person, and do I feel they see me in this

way?

Do we find any sexual interactions a bit stilted and a stressful signal of

more to come? Or do we enjoy fleeting moments of flirting or passion as
just that?

Do we feel comfortable sometimes sharing sexual thoughts, fantasies or

memories?

Can we be sexual without it having to lead to sex?

Do we ever passionately kiss when it’s not a precursor to sex?

Would I feel able to send an explicit text to them if I wanted to?

Could we watch a sex scene on TV and talk about what was hot about it?

How would you feel in your sexual relationship if you had more sexual
currency but the same amount of sex? How do you think your partner
would feel?

What impact do you feel it would have on the sex that you have if the two
of you had higher levels of sexual currency between you?

What small things would make a difference if you brought them

back/invested in doing them more? (This does not have to be a complete
overhaul of how you relate to each other, as this is drastic and also might
not feel authentic.) What do you genuinely miss but, for whatever reason,
very rarely do?

How would it make you feel about yourself or your relationship if you did
these things more?
Remember those motivations for sex we discussed earlier in this chapter?
Revisit yours for a second. How many of them could be met by increased
sexual currency rather than sex? How about your partner’s?

In my experience of working with couples who want to improve their sex

life, improving sexual currency often brings drastic changes in how people
feel about their sex lives, even before we’ve gotten into talking about the
acts of sex itself. I’m not sure I’ve ever worked on desire with a couple who
haven’t benefitted from making this kind of change.

In Chapter 7 you will see how helpful sexual currency can be when it
comes to desire, and why. But, for now, if the above questions have got you
thinking, perhaps it’s time to invest in your sexual currency a bit more.
We’ll revisit the benefit of sexual currency for futureproofing your sex life
in order to deal with some of life’s unexpected challenges in Part Three.

In this chapter, we have focused on the very obvious fact that partnered sex
usually happens with someone else and, for this reason, if we want sex to be
as satisfying as it can be and if we want to nurture desire, it’s important to
pay attention to how the relationship is helping, hindering or stifling our
sexual connection.

Often in magazines, or in advice columns, the state of the relationship is

referenced in connection with crucial dynamics, such as conflict,
contentment, communication and respect, and these are all very important
and must be examined. But it’s easy to muddle this with an assumption that,
if the relationship is generally ‘good’, then sex and desire should work
okay, and this isn’t necessarily so. What I’d like you to take away from this
chapter is that the relationship context and its influence on sex are wider
than an absence of problems between you. I’d like you to take away that, to
truly nurture desire within a relationship context, we must consider how
facilitative or constraining our relationship culture allows our sexual
expression to be, how intimacy or distance helps or hinders our desire and
how our motivations for sex and the complex and intertwining meanings we
make of sex separately and together might be responsible for creating
sexual problems, or promoting sexual satisfaction.

Take-home messages from this chapter

Talking about sex is difficult, but couples who talk about sex more have
higher levels of sexual satisfaction than couples who don’t

Talking about sex helps us navigate the inevitable changes in our sexual
preferences, overcome sexual problems and keep our sex life good over
time

A difference in desire for sex between you and your partner is normal and
not in itself a problem

Desire happens between people, not within one person’s body

Understanding our motivations for sex (and that of our partner) is crucial
for understanding the function that sex serves in a relationship and for
maintaining sexual satisfaction

Having sex for avoidance reasons, such as preventing a row or conflict,

can lower desire over time

Relationship dynamics such as the concept of intimacy can help or hinder

desire, depending on the couple

Some couples would find an improvement in their sex life if they spent
less time together and invested in their own interests and activities

Some couples would benefit from spending more time together, to create
more emotional intimacy, especially with self-expanding activities.
Giving each other the scraps does not count.

Sexual currency can buffer against ‘having sex’ being the most crucial
part of our sexual relationship
 Increasing sexual currency in your relationship meets some of your
motivations for sex, makes you feel like a sexual couple, and provides a
transition to move seamlessly into more sexual time together should you
wish it to, but often falls off the agenda after couples have been together
for some time

To have a great sex life, many couples will need to prioritize and make
time for these aspects of their relationship, but often our belief that sex
should happen easily and spontaneously gets in the way of us thinking of
sex as a part of our life that we should take care of
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Exercises
Reflection – Understanding your motivations for
sex
1) Spend some time reflecting on the last year, the last five years, and
perhaps what happened in previous relationships, if you can remember.
Write a list of some of your reasons for having sex, or ones you think
may have influenced you even if you can’t remember, with the aim of
understanding yourself and what needs sex meets for you. Revisit Axa, if
you like, or think back to the last few times you had sex.

2) Make a note of whether these are mainly ‘approach’ (to get positive
rewards) or ‘avoidance’ (to prevent something negative) motivations.

3) Discuss this with your partner and get them to work on their list too.
Show them this chapter so that they can get an idea of the kinds of things
it could be. Get them to think about when sex isn’t happening and what is
it they feel they are missing out on.

4) Once you’ve done your lists, set some time to discuss this together and
take turns sharing your lists. The person listening’s job is to:

not judge

ask open-ended questions about the reason, for example: ‘tell me a bit
more about that’ or ‘describe that to me – what does it feel like, or how
do you feel about us when you get that?’

5) Make a commitment to not having sex to avoid a row or someone else’s

upset, instead try to find other ways to meet these needs instead of sex.

6) Try out what it’s like to focus on approach motivations, by thinking

about positive things that you, your partner or your relationship might get
from sex that could be nice, or perhaps write them down. Now that you
 are more aware of your motivations generally, try out what it’s like to
communicate what it is that you want when you want to be sexual and
encourage your partner to do the same. In this way, you are both giving
each other the opportunity to understand what the other might be needing,
and having ideas about other ways to meet this if not sex. It’s also
possible that knowing why your partner wants to be sexual (for example,
‘they want to feel close to me’, rather than ‘they just want to come’)
might make a difference to how open you feel to exploring your own
desire.

Trying it out – sexual currency overload

This is an experiment for ‘going to town’, as it were, on increasing your
sexual currency, to see what difference it makes to your sexual satisfaction,
your feelings about yourselves as a sexual couple, your motivations for sex
and sexual desire.

For this exercise to be most effective, you need to make a commitment to

each other that the efforts you make to increase sexual currency won’t lead
to any type of sex together (in terms of sexual acts). Taking sex off the
agenda allows you both to be free to take risks to create and be receptive to
each other without expectation.

You will have an idea from this chapter what this could look like for your
relationship, and it may be connected to things you did more of in your
early days together. Do as much as you can of the things you know you
both like but also throw in anything else you can think of to try. This might
be reinstating passionate kissing or doing it more often, being flirtier,
sending sex texts, complimenting each other’s appearance, touching each
other suggestively, flirting with other people, sharing sexual thoughts,
fantasies or memories, touching each other in a more sexual way whilst
watching TV or talking – anything you can think of.

Aim to ‘try on’ a more sexual ‘couple identity’ by doing as much of this as
you can throughout the day. After a week or two, sit down together to
discuss:

How easy or difficult was it? Did it get easier as you got more used to it?

How did it make you feel about yourself? Your relationship? Each other?

What impact did it have on your intimacy or closeness?

What impact did it have on your perception of yourselves as a sexual

couple?

Did it make sex or desire feel closer or further away?

What else did you notice?

If it’s been positive for you, make a commitment to build this into your
sexual relationship from now on. Remember that life will get in the way
from time to time and that this is normal. Ultimately, you have the power to
change the culture in your sexual relationship.
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6
Sex in our brains

The physical experience of sex might happen in our body, but our brains
have the deciding vote in how we experience it. Our brains allow us to be in
the moment, or can take us completely away from what’s happening with a
running commentary of distracting thoughts or judgements. These thoughts
or judgements can take their toll on our pleasure and desire and, rather
tragically, are often based on our learning, the absorption of societal
messages, our experiences so far or the influence of the world around us
rather than what might be actually happening in that moment.

In the last few decades, advances in sex science have taught us a

revolutionary fact. Our physical experience of sex, such as how much
sensation we can feel, or how much desire we experience, can be altered,
for better or for worse, by our minds. This chapter will take you through
how this might be playing out in your own sex life and how you can use
this knowledge to your advantage.

First, we’ll get a handle on what desire actually is as, without that, it’s hard
to understand how it can fluctuate and what our brains have to do with it.
We’ll then consider why your ability to pay attention to what’s going on
matters so much. Next, we’ll cover how your brain is generating thoughts
about sex and how these thoughts turn your desire up or down. Lastly, we’ll
consider the role of past experience in how we think about and approach
sex and how crucial this is to future desire. My aim in this chapter is to
move you to a place where you understand how your brain can be your best
friend or your worst enemy when it comes to your sex life. Then, as always,
I’ll give you something you can do about it.
‘Sex drive’
Before we understand how our brains help or hinder sex, we first need to
understand more about the processes that influence our desire to be sexual
in the first place.

Historically, sexologists and sex scientists conceptualized the way humans

approached sex in a similar way to drives such as hunger or thirst. That is,
as a universal human need that we are driven to seek out. The common
colloquial use of the phrase ‘sex drive’ fits with this idea of something we
just feel the need to do. We have all been socialized to understand sex in
this way. But in the last few decades we have learned that the idea of desire
being a ‘drive’ is not supported by science. 1

One of the reasons for this is that, when something is essential to our
survival, such as eating or drinking, and we go some time without it, we
experience physical deprivation and so are driven towards it. Desire doesn’t
behave like this (something which any of you who are reading this who
have not had or wanted sex for a while will be all too familiar with). In
many ways, for humans, the longer they go without sex, the less feeling of
‘drive’ they have. This ‘the less you have it the less you want it’, model
would not happen with any of our other essential human drives.

Human sexuality does have an instinctive component to it, as humans have

an automatic response of arousal when we come into contact with things
which our brains code as sexual (from now on I’ll refer to these things as
‘sexual stimuli’). This automatic response is pretty much outside of our
conscious control and leads us to respond with some level of physiological
arousal. Basically, there’s a part of our sexual response which we share with
other mammals, which is triggered easily by sexual cues, sometimes
without our conscious awareness. Desire is kickstarted by this instinctive
arousal, but has the potential to be sidelined or shut down completely by
what our ‘newer’ brain – the parts of our brain which make us human –
does with this information as it processes it.
The sexual stimulus could be the sight of a naked body, a sensation on our
skin, or a sexual thought. Arousal is triggered, and fairly easily, in fact.
However, our ‘newer’ cognitive (thinking) brain then uses complex
processes, such as attention, learning and memory, to decide how much
desire we feel. What’s important to note is that the content of our learning
and memory, and the kinds of things that distract our attention, are
completely related to all the factors we’ve discussed in previous chapters.
For example, if sex has been largely unpleasant so far, then our learning
might be ‘it’s not worth it’. If our experience of sex is that it’s more about
someone else’s pleasure than our own, we will not be that motivated to get
involved. If we can’t pay attention to sexual stimuli or our own
physiological arousal because we are too distracted by other things in life,
or all the things that could go wrong, desire won’t follow. If we have a view
that sex is largely lacking in reward or if our relationship dynamic is stifling
of desire, our brains won’t necessarily evaluate the stimulus of, say, a
partner’s kiss as erotic.

This is crucial to your new understanding about desire, as it’s likely that, up
until now, you’ve imagined that you should just feel like having sex
instinctively (as a drive) and that, if you don’t, there’s a problem with you.
What actually needs to happen for you to feel desire is something like this: 2
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So, your brain first has to notice this arousal (what’s going on in your body
or your mind), then make meaning of this, based on a lifetime of learning
and experience (is this sexual? And, if so, is it positive and good for me, or
not?). Before moving towards sexual behaviour, our brains will then do a
quick calculation of the anticipated rewards of acting on our impulses or the
anticipated costs (i.e. ‘this will feel great’ versus ‘this will cut my sleep
short by thirty minutes and mean I’m tired tomorrow’). A key factor and the
final piece of the jigsaw is how much of a ‘pull’ the stimulus (a sexual
partner) has. We’ll come on to this later but, in basic terms, a new partner
has more of a pull for us, as a rule, which is one of the reasons why people
generally have more desire in a new relationship, as lack of novelty and
predictability are disincentives to sexual motivation. A partner who we see
as a ‘sexual being’ (as our interactions with them have high levels of sexual
currency) will have more pull as a sexual stimulus than one who has started
to feel like a brother/sister over time. Depending on how each of these
aspects compete against the others, the outcome in terms of whether desire
is felt or not will be different for all of us on different days and in different
scenarios.

In this way, our brains act like a mental magnifying glass for desire. In one
direction, they can amplify the strength of sexual thoughts, feelings and
desire. But the flip side can just as easily minimize sexual thoughts,
sensations and desire, through a process of distraction, negative evaluation
and disincentive. This role that our brain has as a sort of data processor
means that (even in any situation outside of sex) we are actually never
experiencing true reality, just a filtered version of it based on our past
experiences, social influences and unique thinking style. It is this filtered
version of reality that can jeopardize our sex lives in a number of ways.

To help us really understand how all of this happens, let’s look at the key
brain processes, which are essential to our experience of desire, in more
detail.
Arousal
We’ve covered the fact that the physical processes we associate with sexual
arousal, such as changes to our body, particularly our genitals, are mostly
automatic reflexes. This means that they happen to all of us without much
conscious awareness when we come across something our brain has coded
as ‘sexual’. This process happens at a speed that indicates that it is
bypassing parts of our brain that are more suggestive of conscious or
cognitive awareness. When we come into contact with these sexual stimuli ,
which could be an image of something sexual, touch from a partner, a kiss,
or the sound of people having sex, for example, our brains instinctively and
automatically instigate an arousal response. You might not be noticing that
this is happening in your body, but it is.

Much ground-breaking research by Dr Meredith Chivers and others has

brought new understandings of the relationship between genital arousal and
how this matches with what’s going on in our minds (‘subjective arousal’).
This research has crucial relevance to desire, given that we now know that
desire often emerges from arousal, not the other way around. For our desire
to emerge, then, we must understand how our arousal works and what can
put a spanner in the works of this chain of events.

Sex researchers like Chivers set out to understand just that – the mechanics
of arousal. Over a series of important studies, participants in the study were
wired up to machines that measure genital arousal. For women, this was
done with a tampon-shaped probe which measured physical arousal by
taking a reading of genital blood flow. The device for men is worn around
the penis and does a very similar job. They found that when you do this in a
laboratory environment and you show men and women porn, their bodies
react physically with genital arousal, as measured by these devices. This
response happens just as easily in the bodies of women who are feeling
concerned about their desire as those who aren’t. But how can the body and
the brain be out of sync in this way?
In a 2010 paper, Chivers and her colleagues used the word ‘concordance’ to
describe this phenomenon. 3 It basically means to what degree your brain
and your genitals are in sync when it comes to arousal. What they found is
that, when wired up to these devices, men’s concordance is significantly
higher than women’s, on average, meaning that, when they are turned on in
their bodies, they often report feeling ‘turned on’ in their heads at the same
time. For women, this synchronicity between body and mind is typically
much lower, on average, with great variation between women. Chivers and
the rest of the research team put forward several theories to explain this
phenomenon, varying from men’s advantage in having a more visual
feedback loop their whole life (hard penises are easier to see than engorged
clitorises and vulvas), social restrictions on the acceptability of women’s
sexuality leading to women being less tuned in, and evolutionary strategies
to protect women’s bodies from harm.

Fascinatingly, more research from the labs of Chivers and others found that
automatic genital response to sexual stimuli (essentially, what happens to
your vaginal blood flow and lubrication when you are shown sexual images
or porn) operates differently for women who identify as heterosexual than it
does for people of all other sexual orientations. Men who are attracted to
women, women who are attracted to women and men who are attracted to
men all demonstrate the same pattern of their genitals automatically
responding to a greater degree to their preferred sexual stimulus (i.e.
gender). Not so with heterosexual women: their genitals respond to all types
of stimulus, even if they don’t report being turned on in their heads to it. 4
It’s likely that this non-specificity has some relationship to concordance, as
it suggests that (the majority of) women’s bodies are not always matched up
to what’s going on in their heads. The truth is we don’t yet know for sure
why there is so much variation in women’s concordance, but the evidence
we do have suggests that being in tune with what’s going on in our bodies is
important when it comes to sex.

This makes sense, given our understanding of how desire works, in that it is
first dependant on us being able to tune in to the arousal in our bodies. If we
can’t do this, we are unlikely to go on to experience desire. What the
research evidence suggests is that the more what’s going on in your body
matches up to your feelings of being turned on in your head (i.e.
concordance), the better your sexual response generally is. 5 Therefore,
when your body and your mind are in tune it is good for your sex life. But
what would cause us to not be in tune?

The role of attention in sex

A number of studies have demonstrated the devastating power of distraction
on sexual arousal. Researchers in one study 6 wired men and women up to
the devices which measure arousal, and showed one group porn and played
the sound of the porn in one ear of the headphones they were wearing. In
another group, they did the same, but in the other ear of the headphones
verbal instructions were given, asking the participants to repeat out loud a
sentence that they were hearing. In a final group, they were asked to do the
same, but also repeat the sentence backwards after saying it forward once (a
more complex task for the brain). What they found is that the more complex
the distraction, the more it negatively affected sexual response. Listening to
a meaningless sentence and repeating it or reversing it is certainly
distracting, but as the researchers noted, in the real world, you’d never be
distracted by repeating a sentence but rather by thoughts about your own
life or sexual response. It’s likely that these thoughts have more personal
weight attached to them and so are probably more distracting still. Not
being able to pay attention to what’s going on is one of the key culprits for
stopping us being in tune. The more out of the moment and in our heads we
are, the less arousal (and therefore desire) we will feel. Remember your
‘conditions for good sex’ triangle from Chapter 3? This is where being in
the moment is key for arousal, pleasure and desire.

This means that whatever is going on sexually, for example watching a

sexual partner undress, a sudden intrusive sexual thought or the experience
of a kiss, our physical sexual response is affected by how much attention we
are able to pay to it. The kiss could be really hot, but if you are too busy
thinking about the fact that you’ve got to be up in six hours, your body
won’t respond to it as if it is. Seeing a new partner’s body for the first time
might really do it for you, but if you suddenly feel fear when you see it, as
you think ‘what are they going to think of mine?’, your attention is diverted
from the sexual stimulus to these thoughts instead. Both the amount of
attention you have for sex, plus the kinds of thoughts that divert your
attention, matter to your arousal and, therefore, your desire.

This makes perfect sense if you think about it. Our brain has only got so
much attention at any one time to devote to something, and as soon as
something else competes for our attention it is divided. It’s a bit like when
you’re at home streaming Netflix and someone else in the house goes
online and your connection starts to buffer and stall, but in your own head .
Generally, all non-sexual distraction is unhelpful: we want our attention to
be focused on nothing but positive sexual thoughts and sensations.

Our brains are complex, especially when it comes to sex. Yes, they
instinctively trigger the physical processes of genital arousal, and paying
attention to this process is linked to how much pleasure we feel, but the
parts of our brain that allow us to worry about sex and make judgements
about it can reduce our attention to what’s going on and switch off that
arousal and desire by a process of anxiety and distraction.

Of course, all of us have streams of thoughts about anything and everything

running through our mind at any point in time, as that is the nature of being
human. It’s also completely normal to have fleeting worries or moments of
self-consciousness during sex (in fact, it would be odd if you didn’t). But
frequent thoughts like these that dominate our sex life can be enough to tip
the scales, interrupting sexual response and negatively impacting on our sex
lives over time.
What’s also interesting about our thoughts is that many of the ones we have
minute to minute don’t stand out to us and we let them pass by almost
unnoticed. Others we pay attention to, as they are stressful, exciting,
worrying or in another way emotionally charged. It’s the thoughts that can
lead to more intense emotions, that distract us in the way those people in the
porn headphones were earlier, by potentially leading to a further reduction
in our sexual response.

Our brains generate thoughts like faulty time machines. One minute we’re
in the future, visualizing ourselves messing up that big presentation at work.
A second later we’re in the past, chastising ourselves for that time we said
something stupid. Our minds can also do this during sex, worrying about
what’s to come and what it will be like, or remembering that time a person
we were having sex with had a look on their face that must have meant they
thought we were hopeless. We might allow ourselves to be in the present
moment fleetingly, to notice that our partner is looking at us with sultry
come-to-bed eyes, which acts as a sexual stimulus and immediately ramps
up our arousal. But then we quickly get distracted by another thought –
‘They want sex, but how could I possibly, when I’ve not had a bikini wax?’
– and feel anxiety. We’re not even just at the mercy of our worry about the
future or the legacy of the past. Today’s humans are also a product of
intense social conditioning and comparison. The kind that convinces us that
having pubic hair (which is normal, by the way) or seeing our skin wobble
when we’re in certain positions is such a crime that we’d be better off
sacrificing our own pleasure to avoid it. The kind of social nonsense we
talked about in Chapter 4, in essence.

Hopefully you can see by now that, as well as the importance of not being
distracted, the thoughts that we have during sex themselves are important to
our sexual response. In fact, research suggests that intentionally trying to
reduce or amplify our arousal through our thoughts has an impact on our
sexual response. 7 This means choosing to focus on thoughts such as ‘they
are really into this’, ‘I’m so attracted to this person’ and ‘this is so hot’,
which will turn up sexual response, in the same way that focusing on
thoughts related to body image, performance or other negative aspects of
sex will turn it down.

Let’s talk a bit more about the kinds of thoughts we might have. They might
be related to what the other person is thinking about us or what is
happening. They could be self-critical thoughts about how we look or are
behaving, i.e. ‘they can see my cellulite’ or ‘they think I’m no good at this’.
Our thoughts can be related to how close or far away we are from desire or
pleasure, i.e. ‘this is awkward’ or ‘I’m never going to come’. They could be
thoughts about unwanted consequences from sex, such as pain, unintended
pregnancies and STIs, or, alternatively, worries about not getting pregnant
or sex being about potentially just going through the motions for people
who are trying to conceive. We might also be plagued with thoughts about
what we are doing and whether we feel it’s acceptable or shameful, and
whether sex generally is an okay thing to do. Lastly, we could be distracted
by thoughts about the environment around us or worries about something
non-sex-related, such as someone walking in or hearing, or tomorrow’s
meeting.

There’s almost no limit to the types of thoughts our brains can generate
during sex, one of all distract us or heighten our anxiety. Given our
relationship with sex as a society tends to be shame, and tied up with
anxieties about our performance or physical attributes, it’s no surprise that
many of us have the experience of thoughts about the things I’ve listed
above impacting on our sex lives negatively. Negative thoughts during sex
are also often related to many unhelpful ideas around sex found in society at
large, rather than reflective of your reality in that moment. This is a real
shame, right? You might predict that your partner is turned off by your
stomach, as you’ve been sold an idea that only flat stomachs are sexy, and
this means you start losing sexual sensation, when, in fact, your partner
isn’t thinking about your stomach at all.
Reflect on this for a minute. When you are sexual with someone else, what
kind of thoughts swim around in your mind most often? It’s really common
for women to worry about things like how they look during sex, or to feel
self-conscious when they are the sole recipient of pleasure, for example.
Many women tell me that, when receiving oral sex, they are more focused
on their partner’s experience of giving them oral sex than being able to
focus on their own experience of receiving it. The key thing about these
thoughts (and I’m sure by now you’ve spotted this) is that we can trace
many of them back to ideas about sex that dominate our society.

In my clinical work with couples and individuals, I notice that thoughts that
cause problems during sex often fall into one of the following categories:

How you look naked

What they think of your genitals up close (particularly appearance, taste

and smell)

Their enjoyment and what they think of what’s happening

Your enjoyment – whether you’re turned on enough or how close you are
to orgasm

Worry about experiencing pain, STIs, getting pregnant (or not getting
pregnant)

Self-judgement about enjoying sex itself, or the type of sex you’re having
or want

What other people (family, friends, cultural or religious groups) would

think

Distractions from the environment (what if the kids hear/come in, TV on

in the background)

Worries about other things (work, kids, lack of sleep, household jobs to
 do)

Once you’ve figured out which feature most for you (feel free to add other
categories, if you have any), compare them to the cultural contexts and
social messages influencing you that we talked about in Chapter 4.
Research tells us that appearance-based distracting thoughts during sex,
which reduce attention, arousal and then desire, are common for women,
illustrating the role of society in our personal thoughts. 8 Our experience of
being female is so tied up with Western concepts of being-thin-equals-
beauty that it can be hard to switch off and let your body feel good rather
than look good. Is this one of the main culprits for you? Is it because, as
soon as someone goes near your genitals, you feel shame about how they
look/taste/smell? Is it because you bear the majority of the household admin
for the family and so feel the weight of all the jobs that need doing around
the house and find it hard to switch off? Is it because you were brought up
to feel that sex is shameful and you find it hard to let go and just enjoy it?

Working this out for yourself can be a great way to tackle these thoughts at
their root, and to try to create a new reality that is based on how you really
want to feel about these things instead. For example, given we know the
impact that societal messages can have on all of our ideas about sex,
imagine the difference it would make to how positive you felt about being a
sexual person with sexual needs if you started to engage in movements
which were all about women from all walks of life embracing their
sexuality unashamedly. If you feel underconfident about your genitals,
imagine the difference it would make if you followed social media accounts
which celebrate vulvas in all their diversity. If you are too distracted by
thoughts about the present that needs buying for the birthday party your
youngest is going to this weekend to be present during sex, imagine what it
would be like if this didn’t feel like it was solely your responsibility and
your partner held these things in mind in equal amounts. If you’re interested
in tracking these thoughts a bit more, so you can do something about them
to reduce their impact on your sex life, there’s an exercise which will enable
you to explore this more at the end of this chapter.

By now you might be starting to get a picture of how complex our brains
are when it comes to sex. Yes, our brains do instinctively trigger the
physical processes of arousal, but the parts of our brain that allow us to
worry about sex, make judgements about it, or not pay attention to it, can
switch off that arousal or pleasure and get in the way of our sexual
functioning. 9

A word on psychological wellbeing and its impact on sex

We know that when people feel low or depressed, they tend to see
the world through the equivalent of dark glasses, meaning that their
view of the world, themselves and their future is negative. It
shouldn’t be surprising to hear that, as well as having negative
thoughts about all areas of our life, if we are feeling very low we
will also tend to have very negative thoughts about our own self-
worth, attraction and sex lives. If we are feeling anxious, we might
also experience anxiety in relation to our relationships and sexual
lives. The physical manifestations that accompany anxiety or low
mood can impact on our sexual response.

It’s normal for all of us to feel low or anxious from time to time. But
if you feel so low, or so anxious, that it’s interfering with your daily
life, you might benefit from understanding that this will impact on
your sex life too, and working on your psychological wellbeing
might also shift your experience of sex. Talk to your GP and let them
know how you are feeling. You can be referred to an NHS
psychologist or therapist to consider how the thoughts in your head
are creating a picture of reality for you that isn’t that positive and
find ways to overcome this. It’s important to know that there is good
evidence that talking therapy can improve your mood, and help is
available. It’s also useful to know that some versions of medications
used to treat mood difficulties, such as selective serotonin reuptake
 inhibitors (SSRIs), also have side effects of lowered sexual desire
and difficulties with orgasm, so if you’re taking one of these drugs
and have concerns about your sex life, talk to whoever prescribed
them and get their opinion. Don’t stop taking them without
discussing it, but if they are not helping the situation, it’s worth
knowing that there are other versions of these drugs that you can
take instead.

Where do we want our thoughts to be?

By now, you might be wondering ‘so which is it? A brain helping arousal
and desire or a brain hindering it?’ The truth is, it can be either, depending
on whether our brain is focused on erotic thoughts and arousal or distracted
by non-sexy or negative thoughts. The constant stream of thoughts we
talked about related to all the learning in life we’ve done up until now will
always be constantly circling through our heads, but it’s the amount of
attention we devote to those thoughts that will dictate their effects on sex.

Imagine your brain as a pie chart. You have a maximum of 100% of your
attention to focus on the sexual situation in front of you. The breakdown of
your attention might look something like this:
Positive/erotic thoughts – ‘They look so sexy’, ‘I love it when they do that’, ‘They are really
turned on by me’
Pleasurable sensations – touch feels good, vulva throbbing, feel of skin on skin, warmth
Negative thoughts or distractions– ‘I can hear next door’s cat – is it locked out?’
Unpleasant bodily sensations – feel cold, bit of cramp in left calf.

Versus this one:

Positive erotic thoughts– ‘They are so hot’

Positive sensation– touch of their hair on my skin
Negative thoughts/distractions – ‘They are too good for me’, ‘I look fat’,
‘My belly is wobbling’, ‘I hate it when they do that’, ‘I’ve got to be up soon’,
‘The neighbours will hear’
Unpleasant bodily sensations – some of the touch a bit painful, vaginal dryness, lack of
pleasurable sensation

Given that the amount of attention you are able to devote to sex is
important, imagine the impact of the differences in the two pie charts above
on the sex lives of these two women. But it’s important to note that both of
these women might describe a completely different pie chart on another
day, in another situation, depending on their ‘conditions for good sex’
triangle and where they are with their psychological and physical wellbeing,
mediated by their hormones and other physical states. These pie charts
could also be the same woman days, weeks or years apart, or with a
different partner.
For the second chart, if it’s a pattern that is repeated over time, it’s possible
that the woman might get into a habit of the weight of the negative thoughts
or distraction taking up more brain space than the erotic or her focus on
sensation, making arousal less likely, sex less pleasurable, and having a
knock-on effect on how much she wants sex over time. It’s a bit of a Catch-
22, I’m sure you can see. It can be worth considering this for yourself, just
to get an idea of where you feel your brain is at for the most part, and
whether there’s a benefit in making some changes to how you use your
attention during sex.

Before you start to worry too much about your wandering mind, it’s
important to know that being distracted by non-sexual thoughts is totally
normal and happens to all of us frequently. In fact, in one study, 92% of
people reported non-erotic thoughts during sex. 10 The key factor is the
amount of time you spend distracted versus being in the moment. Exciting
recent findings from sex science tell us that we can use our brains to change
the size of each of these slices of pie and, in doing so, alter our sexual
experience. I’ll tell you more about this towards the end of this chapter.

Our brains have evolved to have such incredible capabilities, for example
the ability to create art, music, and positive social movements that allow
people to feel connected over an abstract common purpose. But our brains
have also evolved to make links, associations and meanings in the events of
our lives and to form judgements and future predictions for ourselves in
ways that, at times, can make us our own worst enemies. This means that
the nature of our thoughts and the meaning we make of them can turn down
our sexual response like you can turn down the sound on the TV.

Understanding the role of learning

Our past learning has a huge part to play in our distraction, the content of
our thoughts and, ultimately, our experience of pleasure, arousal and desire.
But how does this process happen?
If you remember the summary of what desire is from early on in this
chapter, it goes like this: we first need to be able to pay attention to what’s
going on and notice our emerging sexual arousal. Next, our brain decides
what to make of it by drawing on past experience, memory and social
learning. This helps us to decide whether to move towards this stimulus, or
away from it. This motivation to move towards something, based on our
past learning , the reward we feel it will bring to us and, crucially, the
attention we are able to devote to it, is how desire works.

In Chapter 4 I introduced you to the role of social learning theory on how

we learn and think about sex and ourselves in relation to it. In this chapter
I’ll be introducing you to more individual rather than social learning
processes, and how these influence us when it comes to sex. Both are
important for your desire.

The advent of early behavioural and cognitive theory in psychology were

two key movements that provided us with some of this information.
Behavioural theory came out of an era of science associated with testing
cause and effect under controlled circumstances. Cognitive theory builds on
this by explaining how our brains process information, build up memories,
use language and pay attention, and how our behaviour is dependent on the
interaction between these processes and the consequences of a behaviour.

In the study of this type of cause-and-effect learning, some theories evolved

that are crucial to our understanding of how humans build relationships
with the world around them.

‘Classical conditioning’ is the name given to a type of learning where we

associate two things with each other. For example, after repeatedly
witnessing its owner pick up its lead before taking it for a walk, a dog will
learn to get excited as soon as it sees the lead, as it associates the lead with
the feelings of enjoyment from the walk.

‘Operant conditioning’, meanwhile, is a type of learning where the reward

for the behaviour makes a difference to our chances of wanting to repeat
that behaviour in the future. For example, if the same dog gets a treat every
time it stops and sits when approaching a road, it will be more likely to stop
and sit at the road. When a behaviour is rewarded with something positive,
we are more inclined to do it, and when it is not, we are less likely to do it
(it’s actually a bit more complex than this, but this aspect of it is all we need
to know just now).

As these theories progressed, cognitive psychologists were adding to this

mix by demonstrating the role of memory, learning, perception, language
and attention to this behaviour–consequence picture. These key basic
psychological theories are important when it comes to understanding our
relationship with sex, given we are not instinctively programmed to seek
sex, but rather our motivation for sex is underpinned by noticing arousal
and integrating this with our learning and evaluation of the situation. 11
Asking ourselves ‘do I associate sex with pride or shame? Is sex
emotionally and physically rewarding for me?’ gives us some clues to this
learning process in our lives thus far.

Pleasure (whether emotional, physical, or spiritual satisfaction) is a good

example of a consequence that might make us more likely to be motivated
to repeat a behaviour such as sex. Negative sexual experiences, such as
pain, fear, embarrassment or shame, could add to the likelihood of us
evaluating sex more negatively and being less inclined to do it (unless you
get off on pain, or the experience of shame or fear, in which case it is, of
course, a reward). Therefore, repeated experiences of sex which are either
lacking in enjoyment or reward, or unpleasant, will reduce our desire for
sex over time, by a simple process of conditioning. The orgasm gap is
crucial here, as women simply have less reward for partnered sex than men
when they have sex together. The value of the incentive (sex) reduces by
negative associations or outcomes and increases with reward and positive
associations.
Remember those motivations to be sexual that we talked about in the last
chapter? These also come into the rewarding nature of sex (therefore
strengthening our future desire) in terms of whether the experience of sex
meets these initial motivations. For example, if you are someone who has
an overall life goal of having a relationship characterized by intimacy and
closeness, and you notice that you seek out sex when you are wanting to
meet that need, the reward of an orgasm might be positive (and will
certainly be useful), but the reward that might have most value is how close
you felt during or after sex.

Another rewarding aspect of sex that can make a difference to our

motivation and desire is how it impacts on our mood. If sex makes us feel
better by relieving stress, offering distraction or making us feel valued, then
this will act as a reward in itself. For some people, this is why sexual
behaviour can start to feel out of control, as it is perhaps the only, or the
most effective, way to make them feel good in the short term. If sex makes
us feel bad, as we feel uncomfortable, bored, insecure, lacking in agency or
as though it’s about someone else, then this will act as a disincentive over
time.

Other cornerstone psychological theories also give us clues about the

involvement of our brains with our desire. For example, when the same
incentive is presented in the same way over and over again, we develop a
habituation to it, so it increasingly becomes less of an incentive. This is
called ‘opponent process effect’, 12 and could well be one explanation for
the finding from the Natsal team that people who have other types of sex
without intercourse as part of their sexual lives report better sexual
function, as the more different types of sex we have in our repertoire, the
more variety we have at our disposal. It’s also one of the reasons why our
desire for the same person can lessen over time. These understandings
provide us with the rationale for why we should be approaching sex,
especially in a long-term monogamous relationship, as a buffet rather than
the set menu of A then B then C, as, basically, the more often we eat the
same meal in the same order, the less exciting and interesting the meal gets.
After a period of time we might not be that interested in the food at all, as
variety is associated not just with sexual satisfaction but also with the
maintenance of desire. 13

In contrast, the ‘Coolidge Effect’ is a psychological phenomenon describing

how our sexual interest increases or resurfaces with novelty. 14 If you feed
rats until they are full, they stop eating the same food until you present them
with a different type of food, which they will eat even if they are full. Think
of this as the equivalent of feeling desire for someone other than your
partner. Understanding the role of novelty – and by this I’m not necessarily
talking about nipple tassels (though also, why not?!) – but novelty in how
you relate to each other, the roles you each play in sex, how you might use
fantasy, and in the nuts and bolts of how sex happens, is crucial for the
maintenance of desire. 15 Basically, our appetite for something predictable
and familiar decreases over time, and re-emerges with something less
predictable, known or expected.

Lastly, the interplay between behavioural theories detailing how we learn

by association demonstrates how allowing sex to fall off our agenda as
couples can make it harder to see our partner as a sexual being over time.
The more we spend time with that person in a non-sexual way, the less we
might see them as sexual. The tendency for our brains to make associations
in this way is one explanation why couples who maintain sexual currency
might see a benefit that couples who stop relating to each other in that way
might not. This does not mean that it’s harmful or dangerous not to have sex
for a while, as you risk losing your sexual connection. Neither does it mean
that you have to have lots of sex. But it does indicate that it might be easier
to maintain a sexual association and see your partner as a sexual stimulus if
you have ways of relating to each other that keep the association of that
person as a ‘sexual’ being, whether you’re having sex or not.
 A word on the impact of sexual trauma
Sadly, many women have experienced non-consensual sexual acts,
such as childhood sexual abuse or sexual assault, and these
experiences can impact on mood and wellbeing as well as affecting
our learning, memories, evaluations of sex and perceptions of
ourselves as sexual. It’s important to note that the effects of such
experiences can show themselves in different ways for different
women, so there is no one-size-fits-all relationship between these
types of sexual experience and desire. For some women, this type of
experience can dramatically affect their desire, through the activation
of the ‘fight or flight’ response when triggered by sexual acts, words
or memories or through a learned association that sex is harmful,
deeply upsetting or about the abuse of power. For others, traumatic
sexual experiences do not affect their desire in the same way. The
key here is understanding which it might be for you and then acting
accordingly with what you feel might help. If you are unsure what
will help, you might want to consider asking your GP for a referral to
a therapist who can help you to process the impact of the assault and
help you find ways of managing triggers, limiting the sense of being
out of control or fear when being sexual.

How can we get our brains working for us, not against us?
In the last decade there has been an explosion of research into the impact of
learning to focus our attention during sex and the startling positive impact it
can have on our sex lives. There is a growing and convincing body of
research providing us with the solution for our wandering, self-critical
minds, which have been sabotaging our sex lives. That research is in the
application of mindfulness meditation practices to sex.

If you’ve not heard of mindfulness already, where have you been?! It’s a
technique that has its roots in Eastern spirituality and was brought to the
West by a practitioner called Jon Kabat-Zinn. 16 Awareness of the usefulness
of mindfulness in Western approaches to health and wellbeing has been
growing since Jon Kabat-Zinn’s successful application of mindfulness in
the lives of people managing chronic pain, when medical treatments
weren’t helping.

Mindfulness is not a practice of clearing the mind of all thoughts , but one
of directing our attention in the way that we want , and therefore not getting
seduced into following emotionally distracting thoughts down a rabbit hole
when they appear. In relation to sex, it’s about paying attention to sexual
sensations or the sexual thoughts that benefit us. In this way, the thoughts
we don’t want to focus on at that moment (the negative wedge of your pie)
have less influence on our bodies.

In relation to sex, a growing number of studies have shown that

mindfulness helps people be more in tune between body and mind and
therefore improves sexual response. Several pivotal studies in the last
decade have shown that women who practise mindfulness report an
increase in their arousal, pleasure and desire. 17 In fact, research tells us that
women who find it easier to have orgasms are typically more ‘mindful’ in
everyday life, and find it easier to be in the moment in sex. 18

I’m sure you can understand how this works by now. Mindfulness has been
shown to increase our attention 19 to sex and move away from thoughts or
distractions which are less helpful. It’s a way of taking control of our brains
and getting them to work for us, not against us. It fits perfectly into our
understanding of how desire works and what can get in the way of it.

As well as helping us develop skills in focusing attention on sexual stimuli,

mindfulness also helps us to notice our wandering mind and gently redirect
our thoughts back to where we want them to be when this happens. It’s a
practical, in-the-moment way of shifting the percentage of attention in the
pie chart we talked about earlier towards a bigger wedge of the positive. If
we want better sex, sex where our bodies feel great, respond how we want
them to, and with our mind staying totally in the moment, we now know
that mindfulness is an incredibly effective tool to have at our disposal. We
can have control over our wandering minds, no matter how self-critical our
minds want to be.

This is precisely because desire depends on our ability to notice sexual

arousal. Also, the nature of where we focus our attention. Our attention
could be focused on predicting a negative outcome, i.e. ‘they’ll be upset if I
don’t come’, or be totally absorbed in sensation – and I’m sure by now you
understand what a difference it makes to sex which it is.

Dr Lori Brotto is one of the world’s leading sex researchers looking into
mindfulness, and she and others have demonstrated over several key studies
in the last decade that, as well as being able to increase arousal and desire,
mindfulness can also reduce sexual pain. 20 Mindfulness is a great way of
becoming in tune with our bodies, and a great way of turning that
magnifying glass of attention on to our sexual thoughts and feelings and
away from distraction. It’s beginning to become a cornerstone technique in
sex therapy, and I have seen the power it can have to create sensations of
arousal and desire in people who felt completely cut off from their sexual
selves.

I’m hoping by now you can see what benefit getting your attention to work
for you, not against you, during sex could have, regardless of how well sex
is going for you just now. It’s also worth noting, though, that all of us could
probably benefit from being more mindful in everyday life, as well as in
sex. It is clear that mindfulness works in many areas of health and
wellbeing to a magnitude we’re only just really starting to understand. The
original studies were focused on pain management and showed startling
results. 21 This is because, like sex, our experience of pain is mediated by
how much attention we pay to it and the thoughts or attributions we give it.
People started to take note of the impact that mindfulness could have, and
so research began in other areas of mental and physical wellbeing. In the
decades that followed, we gained solid evidence that mindfulness has a role
in reducing anxiety and depression, managing impulse control in
compulsive behaviours, improving how well children are able to learn or
concentrate, and working against negative self-judgement, amongst many
other things.

Throughout this chapter you might have recognized yourself as someone

who is distracted or plagued by non-sexual or negative thoughts. Consider
for a second, now you understand more about how desire works, the
difference it would make if you could change this. The key thing here is
that you can harness your brain to devote more focus to arousal and desire
once you know more about what your brain is up to and how to focus it.
Mindfulness is a skill that you can develop, and there is strong evidence
that it will benefit your sex life. It’s also extremely accessible, low cost and
something which you can fit into daily life. What’s not to like?

At the end of this chapter there are some tips in the exercise section on how
to build your mindfulness skills outside of sex, then how to bring them
gradually into your sex life as well, so that you can reap the rewards
mentioned here. There’s so much to say about mindfulness I would suggest
that, if your interest has been sparked by this chapter and you’d like to learn
more, you get yourself a copy of Dr Lori Brotto’s recent book Better Sex
through Mindfulness: How Women can Cultivate Desire . 22

How the way we use language influences our thoughts

We talked about the importance of language and how it shapes our view of
sex and how we understand the ‘rules’ of how we should be sexually in
Chapter 4, but language is also important when it comes to how we (and our
partners) talk about ourselves. It’s important, as our choice of language is
one of the ways we influence our thoughts about ourselves, our sex lives
and what’s possible.

We live in a society where we constantly refer to each other and aspects of

ourselves with labels and categorization, which is probably based on our
desire to categorize and group ourselves and others, based on social
psychology processes. We label ourselves and others with fixed character
traits that provide us with a shorthand to describe what we or each other can
expect, but the words we use to describe ourselves and others can become
stories about who we are that then define who we are, sometimes helping
and sometimes hindering our journey in life. This generally means that the
more we hear or repeat unhelpful stories about ourselves throughout our
lives, the more imprisoned we can be by them.

How we talk about ourselves in relation to sex is important, especially as

the backdrop to this is a medical and psychiatric system that has created
language of ‘dysfunctions’ around sex, therefore giving us labels to use to
describe what’s wrong with us in the process. For example, the Natsal team
found that a small minority of women in the UK feel they orgasm sooner
than they would like. DSM has never had a category for early orgasm for
women, even though this happens, probably as women’s orgasm has never
disrupted penis-in-vagina sex. But what would happen if we did have a
dysfunction called ‘early orgasm’ for women? The likelihood is that more
of us would worry about it, as then it’s ‘a thing’. What the medical world
defines as a problem then provides the language for something to become a
real-life problem, and it can be helpful to try not to get sucked into defining
ourselves by such terms.

‘I have low desire’ is a good example of a label we might use for ourselves
which can be quite limiting in the story of our sex lives, offering us little
clue about helpful solutions, should we want them. It’s used frequently in
our culture and is the reason why those pioneering female scientists and sex
researchers we talked about in Chapter 1 argued against the old definitions
of women’s low desire, as they felt it was a useless label if it wasn’t situated
within the woman’s social and relational context.

‘I have a low sex drive’ is equally as unhelpful. As well as implying that sex
drive is a biological urge that is innate and fixed (which we have already
established it isn’t), it situates sex outside of mood, context or meaning,
which takes away our ability to understand or change our experience of it.

A more helpful use of language might be ‘I don’t often feel like sex when
I’m tired, stressed or when I know the type of sex I’m about to have won’t
be that pleasurable to me’ or ‘It’s been challenging recently to have a type
of sex which excites me.’ Talking about desire in this way takes it out of
who we are as a person (a ‘person with low desire’) and situates it in
context, which not only makes us feel less of a problem but immediately
provides a clue to a way forward. I mentioned in the previous chapter that I
talk to couples about there being a desire discrepancy , rather than one
person having low desire. The reason for this is not just because there is no
norm to judge that person’s low desire against, and desire should be thought
of as a responsive motivation, not an urge, anyway, but because using this
language positions the couple as equal participants in the challenge to
overcome it.

It can be useful to pay attention to these labels, but also any others that
we’ve adopted to describe who we are, as they can also inadvertently
impact on our thoughts about sex. I work with so many women who have
grown up with labels that hinder their sexual expression or experience of
desire. Women who feel they are ‘too uptight’ as a person to ever really
enjoy sex, too ‘underconfident’ to ask for what they want, or women who
feel so defined by the label of having ‘low desire’ that they avoid
relationships for fear of never being able to resolve it. For each of these
women, the beliefs or understandings they then deduced about themselves
as a result of this language resulted in behaviour which served as a self-
fulfilling prophecy.

I’d like you to take a minute to consider any labels you or others use about
you, your nature and your sexuality.
 What stories have you told yourself so many times that you believe them
to be the truth?

To what extent are these stories or labels connected to unhelpful social

discourses about culture, race, age, gender, ability, size?

How might stories, labels or language be impacting on your sexual life?

Is it possible that these stories are either wholly untrue, or just more or
less like you, depending on the circumstances you find yourself in?

What possibilities does it open up for you in life generally and in sex if
you reject these labels as facts about you that are set in stone?

My aim in this chapter is to give you an overview of how your brain, as the
driving seat of your thoughts and other cognitive processes, might be
impacting on your sex life at times, in a not so helpful way. We’ve
understood the importance of our attention on processing sexual stimuli that
might kickstart desire. We’ve also looked at the influence of our history and
the world around us on the thoughts or associations we might have in
relation to ourselves and sex. We’ve understood that sexual desire is how all
these things come together to either motivate us to do it, or to have a cup of
tea instead.

If there’s one thing we can be sure of, it’s that our brains are largely
responsible for how sex goes and that, despite our brains being located
within us, the factors which influence them come from outside of us.
There’s a reason this chapter follows the society and relationship chapter, as
what we feel is expected from us, the dynamics of our relationships and the
meanings we make of other people’s behaviour become the fuel for our
sexual thoughts.

In this chapter we’ve talked about the impact of attention and learning on
the thoughts that we might have individually in the moment. We have the
ability to improve our sex lives by becoming skilled at using our attention
for us, not against us. We have the option to notice key themes in the types
of thoughts that bother us most during sex and to try to find ways of
ensuring they hold less influence over us. We also have the opportunity,
now that we understand that sex is a motivation rather than a drive, to
reflect on the benefits that novelty, a lack of predictability, positive reward
and the opportunity to continue to see our partners as a sexual stimulus over
time can bring to our future sex lives. We will build on this in the next
chapter.

Take-home messages from this chapter

Our brain is crucial to our experience of arousal, pleasure and desire

Some aspects of our sexual response are automatic, such as physical

arousal, but our body and our minds are not always in sync

Negative or distracting thoughts can disrupt our sexual response by

distracting us from the erotic

Our ability to direct our attention towards or away from negative or

distracting thoughts, and to pay attention to sexual sensations or stimuli,
make a difference to what we feel in our bodies

Sex for humans is not a drive but a complex interplay of our physiology,
attention, learning and memory, leading to a motivation for sex

Our brains generate thoughts all the time, but we can be distracted by
ones which feel worrying and spend time focusing on them

The more we tune in with our body, the more desire, arousal and pleasure
we experience; and our attention can be harnessed through mindfulness

Mindfulness is known to increase arousal, pleasure and desire and has

been a key revolution in sex therapy over the last decade or so
The language we use to describe ourselves can amplify the way we see
ourselves in relation to sex, and stop us seeing how to create change
OceanofPDF.com
Exercise :
Reflection – What kinds of thoughts interfere
with your enjoyment of sex?

Earlier on in this chapter we talked about how the things we think can
influence our enjoyment of the sexual experience. We talked about the fact
that there are often key categories of thoughts that come into our mind
when we are being sexual, and that it can be useful to note which category
your thoughts fall into most, and where these ideas come from.

In this exercise, pay attention to the thoughts you have during your next
sexual experience with someone else. Afterwards, write down all the
thoughts you had that you feel distracted you from your enjoyment, or were
negative in some way. Once you have your thoughts written down in the
same way they popped into your head (for example, ‘They are looking at
my stretch marks and will be turned off’), try to group the thoughts you
have written into categories, as we did in this chapter.

You might do this over a few sexual experiences, if you feel you are
someone who has a lot of negative thoughts during sex and you want to
really understand this for yourself. Don’t do this every time you have sex
from now on, though, and please make sure that you also follow up this
exercise with some of the mindfulness exercises afterwards. The reason for
this is that, although understanding thoughts that are less helpful for you
and questioning where they have come from and how you can challenge
them can be helpful, as you have learned, it’s not great for your sex life to
get into the habit of paying attention to the less helpful thoughts during sex
as a regular thing.

Once you have your categories, and perhaps find that it’s one or two
categories of thoughts particularly that affect you (for example, ‘body
image’ or ‘focusing on their enjoyment rather than my own’), spend some
time writing a plan for how you can minimize the impact of this on your sex
life, taking what you have learned from Chapter 4 into consideration. For
example, you might wish to limit your exposure to airbrushed magazines
and look at lots of social media accounts celebrating body diversity instead,
or find other ways to increase your body confidence: attending a life
drawing class which celebrates bodies in all their forms, say, or reading
books about body positivity. You can change the script you are exposed to
by lessening your exposure to the social messages that aren’t helping and
increasing your exposure to the ones that are.

Trying it out – mindfulness and sex

You will remember that mindfulness is a way of paying attention to
something, non-judgementally, and being in the moment. It’s also a practice
of bringing our attention back to what’s erotic, rather than to negative or
distracting thoughts.

Mindfulness needs to be practised if you want to be able to develop the

skills over time, and I encourage you not to rush this three-stage
programme. The aim here is to first become skilled at mindfulness outside
of a sexual situation, so that you become accustomed to directing your
attention, noticing when your mind has wandered and bringing it back.
When you feel confident with this, you can then start to incorporate these
practices into your solo sexual experiences (masturbation), then into sexual
situations with someone else.

Part 1 : Download a mindfulness app and practise daily mindfulness

outside of sex. The key here is to hone your skills in focusing your
attention, being in the moment and gently and without judgement
redirecting your attention when you notice it wandering. Given that
mindfulness is a skill that needs to be practised, I’d be keen for you
to feel confident at this level before you move on. It’s up to you
when you feel that you are confident to do so, but I would suggest
you do this daily practice for a couple of weeks at least, if you are
new to mindfulness.

Part 2 : If you’ve been practising mindfulness a bit generally, by

now you should feel more skilled in bringing your attention gently
back to whatever it is you’re focusing on. I now want you to move
this on to two new mindfulness exercises, if you feel able:

Choose to listen to mindfulness exercises that are centred on body

scans and use your body focus to pay attention to genital sensation
particularly (incidentally, you will notice most body scans you can
download talk you through body parts then skip over the pelvis –
fascinating from a sex-negative society point of view!).

Bring this same technique of focus and curiosity in genital

sensation to masturbation, as well as paying attention to sensations
all over your body during self-touch.

Paying attention to sensation in your genitals/sexual sensations

strengthens the mind/body connection and desire, and it’s also great
practice for focusing your attention where you want it to be during
sex.

Part 3 : After this, if you feel able, you can practise during sexual
contact of any type with someone else. Use the same practice as
when you’re alone, but this time you can be mindful either to:

1) Your own sensations (i.e. what does your body feel like just
now?)

2) One of your senses (pay attention to what you can

touch/smell/taste/warmth/a visual image of a part of your partner’s
body)

As always, if you notice your mind wandering to a negative thought

or a distraction, congratulate yourself for noticing it and direct your
attention back to the present moment.
OceanofPDF.com
7
Gaps in our understanding of desire

I firmly believe that one of the biggest challenges to our sex lives is the gap
in our understanding of desire. How can we expect to know how to enjoy
our own sexuality and sexual relationships with others if we don’t
understand how our desire works? How can we organize our own sex lives
if we don’t have an idea of the relationship contexts that will fan the flames
or put them out? How can we not feel that we are broken if we don’t realize
what’s normal? This chapter is focused on redressing these
misunderstandings by giving you the final pieces of the picture in order to
complete your new understanding of desire.

Desire facts to blow your mind

You might remember that, in Chapter 2, we talked about the fact that, in
research, many women report they feel little, or zero, spontaneous sexual
desire (i.e. feeling like sex ‘out of the blue’) over the course of a typical
month. These findings are important for several reasons. Firstly, we had
previously been judging female desire by men’s standards, and men
typically report higher levels of this type of seemingly-out-of-the-blue
desire. Judging women by men’s standards and seeing men’s standards as
the baseline (hello, patriarchal bias!) meant that women reporting not
feeling any or much desire automatically looked problematic in comparison
and were judged as such by the women themselves, their partners and their
healthcare practitioners.

These new understandings, however, were so important because they told

us that not feeling like sex out of the blue is normal for many women and
therefore should not be thought of as a problem. The original question
posed – ‘How often do you feel like engaging in sexual activity?’ – was
measuring a type of desire we might call ‘spontaneous’ desire, which
translates to how often do you feel like sex with no obvious trigger for it?
Despite most women reporting ‘rarely’ or ‘never’, the majority of women
reported that they still went on to experience arousal during sexual activity
most of the time. What this means is that it is normal for women not to ever
feel like sex out of the blue, and that this in itself does not indicate a
problem with desire. 1 It also reaffirms our understanding that often desire
follows arousal rather than being the trigger for it. This point is crucial to
this chapter.

Given that sex scientists know this variability in how desire shows itself to
be true and normal, why are so many women still concerned about their
desire? The answer is simple. Women’s arousal and desire work perfectly
well for most in the right circumstances, but our current gaps in our
understanding of desire stop us being able to create the right circumstances.
Ironically, these gaps in our understanding even lead to us putting barriers
up to those circumstances when they do arrive, firmly closing the lid on the
possibility of our desire emerging.

The history of sexology and our current understanding

So why do these outdated views of women’s desire persist, leading women
to feel that they are missing something that other women have in spades? In
Chapter 1, I briefly introduced you to some key players in the field of
psychology and sex research and how they contributed to our understanding
of sexology, both in that era, and in the legacy of understanding that we’ve
had since. You will probably remember Masters and Johnson – the
pioneering researchers who observed couples in their lab having sex. Their
observations led to the first time the ‘sexual response cycle’ was identified
and presented as a uniform aspect of human sexual experience. 2 Though it
was first developed by Masters and Johnson in the 60s, it was added to by
Kaplan in the late 70s – the crucial addition being the inclusion of desire as
the first stage, the precursor to all else. 3

This is how it goes:

The model proposes that first we experience desire , a psychological urge to

engage in sexual activity. This desire then prompts the physiological state of
arousal , where chemical messengers are sent around the body by this
altered brain state, preparing the body and genitals for sexual activity. The
next stage in this model is orgasm , associated with the rhythmic
contraction of the pelvic floor, uterus and rectal muscles, producing
pleasurable sensations, then on to resolution , where the body returns to its
unaroused state.

Now, this model has been heavily critiqued over the years for:

The exclusion of anything social, relational and psychological, and

therefore its assumption that sex is a simplistic biological process

The assumption that people’s experience of sex is linear and always

follows this order (for example, orgasms always happen after arousal)

That desire comes first (even though plenty of people describe having sex
without desire and we now know that often what comes first is arousal)

That it has been designed and based largely on male physiology and
privileges male biology and experience over women’s

You can see one aspect of this male-centric argument if we talk about
orgasm. If this model were based on female arousal, it could go from
arousal to orgasm back to arousal then orgasm continuously, given that
many women are multi-orgasmic. We spoke about gender politics and their
enormous influence on our sex lives in Chapter 1, but here’s another
example of it in action in sex science – for decades, women’s sexual
experience has been conveniently sidelined for a model that, essentially, fits
men better. When Masters and Johnson observed couples in their lab, they
observed this sequence in men, and also observed and documented
variations of this response in women, but in their proposal of a final model
they settled on one which was more aligned with male experience.

In my clinical experience, many men subscribe to the above model and say
it fits quite well for them. If you have a male partner, perhaps show it to
them and ask them what they think about it. It’s a great way to understand
their experience (and a good way a good way to start a conversation about
how your experiences may differ). Research has found that a good
proportion of men (and also some women) feel it fits for them too. There is
nothing wrong with a person subscribing to this model. 4

So, Masters and Johnson’s and Kaplan’s model first told us what was
considered at that time to be normal. We feel desire – we act on it – our
body gets turned on – we come – the end. As we reflected in Chapter 4,
language that starts off in science becomes collective social and cultural
understanding. It becomes ‘truth’ and informs our reality without us even
realizing. Our conceptualizations of desire are the perfect example of this.
The only model we had for decades told us desire comes first , that desire is
present spontaneously, before anything else. The absence of this kind of
desire then became one of the criteria in making a diagnosis of a problem
with desire based on this model. What science and medicine dictate is
normal filters down and becomes cultural and popular understanding. So
that’s what we take as our truth, that’s what informs our sexual scripts, and
that’s what we then feel we fail at, if this is not our experience. It’s the
reason women incorrectly feel they have ‘low desire’ if they don’t feel like
sex out of the blue.
Despite a general trend for spontaneous desire to show itself in situations
with new partners or after some time apart, there are some theories of why
some women might experience higher levels of spontaneous desire in long-
term relationships than others.

New, important theories of sexual response, such as the Dual Control

model, suggest that sexual response is influenced by the interaction between
two internal systems – ‘sexual excitation’ and ‘sexual inhibition’ – and that
depending on the balance of these, people have the propensity to be more or
less likely to engage in sex. 5 We can roughly think of this as what makes
the difference between two people in terms of their ‘arousability’.
‘Arousability’ in this context means that you might think about sex often, or
feel more inclined to invest in or notice sexual stimuli and desire. These
separate but connected systems are underpinned by both neurophysiological
and psychological processes – that is, the roles of our body, hormones and
brain and the role of all of our past learning and experience. ‘Sexual
excitation’ might be described as how easy it is for a person to become
aroused in response to things like sexual thoughts, images, interactions with
others and bodily sensations. ‘Sexual inhibition’ refers to the tendency to
lose arousal in response to perceived threats, such as reactions from others,
distractions, negative feelings about sex, risk of unintended pregnancy or
pain, or perceptions of transgressing social norms and values. Sex educator
and researcher Emily Nagoski has made the useful analogy of ‘sexual
excitation’ being akin to a car accelerator and ‘sexual inhibition’ being the
brakes as a way of conceptualizing these two systems. 6 One of the aspects
of sexual inhibition which has been shown to be particularly important for
women with concerns about sex is something called ‘arousal contingency’, 7
meaning how easily you find yourself getting distracted from sex, or
needing the conditions to be ‘just right’ to get and stay turned on. The more
this is the case, the more it will interrupt sexual responses such as desire.
Another aspect of sexual inhibition is being overly attentive to your own
sexual function by focusing on worries that you won’t get turned on or
orgasm. For women, high levels of sexual inhibition are more predictive of
concerns with desire, regardless of levels of sexual excitation.

I’m sure you can make some educated guesses from what you’ve read so far
as to which types of experiences, learning and attitudes might influence
your sexual excitation or inhibition in a unique way. The Dual Control
model tells us that it’s the interaction between the two that will make a
difference to whether desire/sexual response flourishes or is extinguished,
based on all of the other factors we have discussed so far as well as the
result of neurochemical processes. Again, it comes back to the idea that
desire is not a drive but a result of the processing of our learning, memory
and attention, a projection of future consequences and rewards and how all
of this interacts with our biology. This means that it’s possible that if you’re
someone with high sexual excitation and low sexual inhibition, this might
lead you to notice more spontaneous desire than someone with the opposite
combination.

So, is your desire responsive or spontaneous? The truth is, for the purpose
of this book and your sex life, it probably doesn’t matter which it is. What
you can expect is that, if you are in a newer relationship, having sex with
(or fantasizing about) someone other than your regular partner, or have had
a period of time away from your partner, you might have the experience of
feeling like sex out of the blue. But there will also be some of you who
regularly feel like sex seemingly out of the blue.

There will also be many of you who never feel like sex out of the blue at all
(or rarely) and whose desire only ever seems to come from non-sexual
motivations (wanting to feel close or other ‘approach’ reasons, such as
because a partner wanted to) or as a consequence of allowing yourself to
feel physical arousal first. For some of you, it will be a mixture of the two.
What is key is that the context that you exist within (society, culture, your
relationship and the messages you receive in relation to gender) will be
influencing it.
There’s a bit of a caveat here, in that current thinking in sex science is that
there is no such thing as ‘spontaneous’ or ‘responsive’ desire and that it’s
more likely that all desire is technically responsive but that we may not
always be consciously aware of the triggers for our spontaneous desire.
What’s important at this stage is understanding that both experiences are
valid and normal, and there are plenty of factors in your life, relationships,
contexts, circumstances and psychology which will impact on your own
experience of it.

A new understanding
In 2000, a Canadian doctor with a special interest in sexual medicine, Dr
Rosemary Basson, proposed a new model of sexual response for women,
which set the path of understanding and research into women’s desire on a
new trajectory. 8 Basson’s circular model of sexual response included many
aspects that had been picked up by recent research, among them the
importance of context, that the initial motivation for sex might not be
sexual, the impact of the relationship and the importance of pleasure as
reward. Basson’s model also included the fact that many women in
established relationships feel little ‘spontaneous’ desire, so they must be
assumed to be starting from a place other than this. Basson questioned how
fitting other existing models could really be if they did not include these
aspects. She also questioned whether a lack of understanding about female
desire was largely responsible for the high rates of women reporting
concerns about desire in global studies.

The key points of the circular model are that women in established
relationships usually start from a state of sexual neutrality (that is, without
desire). However, the model suggests that if women are willing to seek out
or be receptive to sexual stimuli, and if there are no negative psychological
or biological barriers, they may find themselves experiencing sexual
arousal. In this model, only then do they go on to experience sexual desire.
This means that we first must be receptive to the idea of desire (this is not
the same as having desire), then have something to trigger it, and then there
to be nothing that gets in the way of it. After this, arousal (physical
changes) come before desire. Remember how this process happens from the
last chapter? If, after desire, the sexual encounter is experienced as
physically or emotionally rewarding (pleasure, orgasms, satisfaction),
women report increased emotional intimacy directed towards their partner,
and this makes them more likely to be receptive to or to seek out sexual
stimuli in the future. Equally, a decrease in pleasure, satisfaction or
emotional intimacy could negatively influence the picture and leave us
feeling less receptive to sex (the effect of low reward).

This circular model, as you can see, makes provision for the spontaneous
desire of some women, or some women in some contexts, at several points.
It’s important to remember that it’s not the case that women in long-term
relationships can’t or don’t experience spontaneous sexual desire in its own
right. Some women report high levels of spontaneous sexual desire, just as
some men don’t. And some women experience spontaneous sexual desire
from time to time, say once a month, which (for women not on hormonal
contraception) can be linked to the period around ovulation and just before
their period. 9 But it’s not the case for all, and it’s certainly not the three-
times-a-week spontaneous desire that everybody feels they should be
feeling, as described in Chapter 4.

Basson’s model normalized the experience of non-sexual motivations for

seeking out or being receptive to sexual stimuli (think of the list you came
up with for your own motivations in Chapter 6). It may be these reasons,
not feeling desire, which prompt a woman to seek out or be receptive to
sexual stimuli. Following this, and as long as there are no barriers to this,
arousal and desire follow.

The key messages in Basson’s model are:

Women’s desire is often experienced as responsive and can be triggered

by being receptive to sexual stimuli

Many things come before desire; desire is not first. In fact, women
waiting for desire to come first might be waiting a really long time

There are many different motivations for sex other than desire and, once
women have decided to invest in sex, arousal and desire often follow

In my clinic, many women tell me that this model really fits their
experience, and plenty of men do too. Does it fit for you? How might
having different experiences of desire than your partner have impacted on
your sexual relationship so far? Basson’s model is exceptionally useful in
helping some people understand how desire features in their life and where
they can make changes that will make a difference to desire. For this
reason, I want to focus on each part of the model in a little more detail, so
you can really understand how it might fit with your experience.

Being receptive
The seeking out or being receptive to aspect has sometimes been called
‘willingness’, a kind of ‘start-and-see-how-you-go kind of thing’ – the
problem, though, is when we’re waiting for sexual desire before we engage
in any type of sexual activity (and we often do this, as we have been led to
believe that this is how things should be), we sometimes do the opposite of
being receptive, by putting a virtual stop light to any situation where sex
might be expected. We can even become hypervigilant to any subtle cue or
initiation from a partner that they might want things to go this way. This
stage can, therefore, be the first place our desire is extinguished, even
before it’s had a chance to catch alight, as in the case of Tori below.

Tori knows that Dan always wants to have sex on a Saturday

morning, as it’s the first day of the week that both of them don’t have
to jump out of bed when the alarm goes off. She wakes up before
him and jumps out of bed for a shower to avoid any awkwardness.

In the above example, Tori is hypervigilant to Dan’s desire, is not feeling

receptive and, as such, makes decisions to actively avoid any sexual stimuli.
This can be a common experience when differences in desire have become
a source of conflict. In contrast, in the example below, Meena is more
receptive to sexual stimuli and this pays off in the gradual building of
arousal.

Meena knows that Roxy has sex on her mind when Roxy starts
stroking the small of her back with her fingers while they watch TV.
Meena doesn’t, at that moment, feel like she wants sex, but she is
enjoying the touch and is happy to let Roxy keep touching her in this
way, as it feels nice. After a while, Meena starts to feel the familiar
sensation that her arousal is building and, before she knows it, they
are kissing passionately. At some point Meena starts to feel that she
would like things to go further.
One of the biggest barriers, in my clinical experience, to being receptive to
sexual stimuli in order to allow desire to emerge is the pressure that comes
from sexual scripts – ideas such as ‘don’t lead people (especially men) on’,
‘it’s impolite to start then stop’, and that sex must unfold in a certain way
(ending with a penis in a vagina). These scripts stop us at the first hurdle, as
how can you enjoy a passionate kiss for a kiss’s sake if you feel it will lead
to turning a partner on, giving them the idea that you want sex when you
(currently) don’t and then, ultimately, when you turn them down? The truth
is you can’t, and in the playing out of these scripts opportunities for sexual
stimuli (the passionate kiss), which might trigger arousal, are lost.

In my experience, women and their partners have to really understand the

importance of being able to be truly receptive to experiencing desire by
having a culture of high receptivity and low pressure when it comes to how
they relate to each other sexually. In reality, the opposite often happens
when there is a desire discrepancy, with one partner hypervigilant to being
disappointed and the other hypervigilant to disappointing. Add this to the
experience of less sex in the relationship than (at least) one person might
like, and every kiss, touch or moment of being naked together can feel that
it is loaded with pressure for it to lead to sex. For the person who has been
feeling less desire, it can feel easier to avoid this rather than feel immense
pressure for more. For the person who has been feeling more desire, the
rarer these moments are, the more important it can feel for them to be
responded to or to go somewhere. Before you know it, you’re in a spiral of
pressure and disappointment around something as simple as a kiss.

This is where sexual currency comes in, as well as the importance of how
women have been socialized sexually to prioritize someone else’s pleasure
and not disappoint people. If you remember from Chapter 5, sexual
currency is a way of describing the amount of relating to each other as
sexual partners you do, the sexual culture of your relationship. Increasing
sexual currency promotes a culture of enabling receptivity, by virtue of the
fact that sexual stimuli are frequent and not in themselves signals of sex.
Importantly, to be receptive to situations which might trigger desire, women
need to feel able to prioritize their own sexual needs above someone else’s,
not fear ‘letting someone down’, and have the sexual agency to feel able to
draw the line anywhere they like in the encounter without fear of
repercussion.

Sexual stimuli
In the example of Roxy and Meena earlier, the frequency of this type of
sexual currency between them acts as a sexual stimulus and will have an
impact on how often Meena feels desire. Meena won’t always feel desire
when Roxy touches her back and kisses her in this way – for example, if
she’s had a stressful day and is preoccupied, if they’ve just had a row and
she’s feeling resentful, or if she’s feeling tired. However, the more they
have these kinds of interactions, the more chance there is that some of the
time desire will be triggered. You might remember that sexual stimuli are
anything that can trigger our arousal, whether we mean it to or not.
Intentionally thinking about sex or fantasizing is a sexual stimulus, as might
be a partner’s attempt at initiation using indirect means. We might interpret
something that someone (a partner or someone else) does as a sexual
stimulus even if they didn’t intend it to be. We also can’t always adequately
guess what kind of sexual stimuli might turn us, or our partners, on and they
will be different for all of us, at different times, in different relationships.
Also, sometimes sexual stimuli might be erotic for us on one occasion but
completely turn us off the next. Remember Tori from just a second ago?
Let’s imagine that Tori was feeling receptive and didn’t jump out of bed on
Saturday morning.

Tori interpreted Dan’s behaviour in bed on a Saturday morning as a

sexual stimulus, as he often rolled over to her half asleep, ran his
 hands over her naked stomach and kissed her neck. She enjoyed the
sensation of his hands on her body, and there was something about
him doing this in bed when they were sleepy and warm that she
found really sexy. Tori had woken up ten minutes earlier than Dan,
and in this time had wondered whether they might have sex, given it
was Saturday and they had nowhere to be. In these ten minutes
before Dan awoke, Tori indulged in sexual thoughts and found
herself feeling arousal and some desire before he’d even woken up.

In this example, Tori has the sexual stimuli of being physically close to Dan
and the experience of enjoyable touch from him, as well as her own inner
world of sexual thoughts, which has acted as a kickstarter for her desire. In
the first example, Tori rarely got to experience these sexual stimuli as she
had already got out of bed in anticipation, knowing it was coming and
second-guessing where Dan wanted it to go – somewhere she didn’t, at that
moment. In the second example, Tori was feeling receptive and had the
opportunity for arousal and desire to be triggered.

What about Dan? There are several things that could have been going on for
Dan. Firstly, he may not have intended this touch and kiss to be any more
than that; it might just be his way of connecting and enjoying Tori’s body
for five minutes before they get out of bed. It’s also possible for Dan that
this touch might be a way he stimulates his own arousal and desire, if he
also wanted to feel like sex (remember, men are not from Mars). Finally
(and even in combination with the last reason), it’s possible that Dan could
have been communicating with Tori, via indirect sexual initiation, that he
would like them to be sexual together. Remember also that Dan would have
had his own reasons or motivations to be sexual, and it is likely that Tori’s
reaction of seeming to want to avoid him and jump out of bed or,
alternatively, enjoying five minutes of touch or a kiss, might have made an
enormous difference to his needs being met, depending on the reasons he
was prompted to connect with Tori in that way.

In Chapter 5, we considered the role of a particular communication called

‘sexual initiation’ and that it could be direct or indirect. Alongside
‘accidental’ sexual stimuli (for example, seeing a sex scene on TV that you
find hot) and increasing sexual currency (an intentional way of relating
sexually, such as reinstating passionate kissing, which at times will act as
such), ‘sexual initiation’ is a direct attempt at using sexual stimuli to
communicate something to someone else.

Let’s use Amy and Mark as example here to help us. Look at this list of how
sexual initiation features as a sexual stimulus in their relationship. At the
bottom of the list we can see the sexual initiations that don’t act as adequate
sexual stimuli for Amy. In fact, she finds them a turn-off. In the middle are
the sexual stimuli that sometimes Amy might be receptive to, that
sometimes work for her and sometimes don’t, depending on what else is
going on. The few at the top represent the things which Amy has never
shared with Mark which she thinks, if she was feeling receptive, would
really work for her as sexual stimuli.

Mark sending her explicit texts or images about what he would like to do
to her that evening

Mark making the effort to buy himself new underwear and surprising her
by wearing it

Mark offering to give her a whole-body massage but insisting it mustn’t

lead anywhere

Mark looking all hot, sweaty and sporty when he comes in from a run

Mark running his fingers through her hair absent-mindedly while they are
watching TV

Watching Mark at a party flirting a bit and being confident and fun
 Mark saying, ‘It’s been a while – how about tonight, then?’

Mark coming up behind Amy and grabbing her breasts roughly while she
is getting ready for work

We might want to nurture our responsive desire and be receptive to sexual

stimuli so that we can go on to experience sexual arousal and desire, but as
well as considering our exposure (and our ability to notice or pay attention)
to sexual stimuli on a broader level, it is also worth considering:

Have we got stuck in a non-sexy rut around sexual initiation?

Does our relationship actually feature very little sexual stimuli these
days?

Might we even feel unskilled at knowing how and what to do to take

things further, even if we want to?

Is one of us holding up a virtual stop sign to these triggers even before

they’ve started?

Are there things that we don’t know about each other that might work
very effectively as sexual stimuli and sexual initiation if we were able to
discuss them?
What are the things we wish we could say to each other about what we’d
really like the other to do/try?

Reflect on this for a second. Is there one thing your partner does when you
think they’d like sex that doesn’t work for you or really closes you down
psychologically for more sexual intimacy? Are there things you would love
them to do that you think would work for you but you’ve never asked for?
How do you indicate a want for sexual intimacy with your partner
(verbally? non-verbally?) and how do you think they feel about this?
 ‘My ex used to kiss me in a certain way, but it got “samey” and, in
the end, I hated it. He wouldn’t do anything else and sex really dried
up for us as I found the predictability a real turn-off .’ (Amanda)
‘My partner simply says, “Fancy a shag?” It makes me feel annoyed
rather than anything else. I never really know how to let him know
when I do feel like sex – I’m at a total loss. I just kind of hope he
picks it up .’ (Serena)
‘I don’t think my partner has any idea there are things that really
turn me on when they do them, and things that really don’t .’
(Roberta)

One of the exercises for you to choose from at the end of this chapter will
be to consider this for yourself and discuss it with your partner. It’s a really
important aspect of the model, as if you are feeling receptive but the things
that either one of you are currently doing or saying is stopping your arousal
and desire from emerging, it’s crucial to address it.

It’s also vital that we don’t see ourselves or our partners as having failed or
got something wrong here. The fact is, it’s both people’s responsibility to
find a way to communicate about what works when it comes to sex, and if
we’re not doing that effectively, we can’t expect to mind-read what each of
us might like. Remember that we have also reflected that sex can be hard to
talk about, so it’s no wonder we can be out of sync with these things
sometimes, especially given our wants and preferences can change over
time. Sarah and Clio, below, are examples of how actions intended to be
sexual stimuli by one partner can actually become turn-offs over time, or
barriers to desire, if not addressed.

Sarah was in a relationship with Oli. When Oli was feeling like sex,
he would come up behind Sarah and put his hands between her legs
 over her clothes. He’d learned to do this in a previous relationship,
when an ex-partner had often responded positively to it. Sarah found
it too much and really offputting, but had never told Oli for fear of
hurting his feelings. Instead of acting as a sexual stimulus to her, this
actively got in the way of Sarah’s desire.

Clio was in a relationship with Abi. Clio and Abi had lots of physical
affection but very little kissing or sexual contact in the months
between when they were sexually active. One of the things Clio
found hard is that it was clear to her when Abi wanted to initiate sex
because she started talking in a different voice. Clio found this
‘baby’ voice quite infantile and unsexy but went along with it as she
didn’t want to upset Abi and knew that Abi was just trying to
communicate something that was hard for both of them to talk about
directly. They would often get through this initial awkwardness and
both end up feeling connected sexually, but it never felt like the most
comfortable start.

Sexual stimuli are not all about another person and what they do or don’t
do. We know that, for many women, fantasizing or thinking about sex acts
as a sexual stimulus, as does watching porn, reading or listening to erotica
or talking about sex with others. Some women report that there may be
certain types of touch, smell, music or memories which act as triggers for
them. Reflecting on and experimenting with discovering this for yourself
can be useful information in regard to understanding your own desire. It can
also be a revelation to see what happens to your arousal and desire if you
expose yourself to a sexual stimulus, such as reading or listening to erotica
or watching porn, as, in my experience, it helps women in two ways.
Firstly, to understand that their responsive desire is working as it should and
that, therefore, they are normal. Secondly, to understand that, if this is the
case, there is something else going on with a partner that is getting in the
way. This could be the notion of having not previously been receptive for
the reasons we have mentioned. It could be connected to a lack of sexual
stimuli due to having little time together or being out of the habit. It’s also
possible that this part of the model does go to plan, then something else
kicks in to interrupt desire.

Psychological barriers
In the last chapter we looked in detail at how what is going on in our minds
affects what’s happening in the moment with sex. You will remember that
there are several key psychological barriers, based on the attention we are
able to pay to our arousal or our ability to be in the moment, the content of
thoughts we have related to sex and how they add to this, and the learning
or associations we have about sex related to every element of our sex and
relationship history to date.

By now you should have a pretty good idea of the impact of what’s going
through your mind during sex. You’ll also understand how negative
thoughts about ourselves, sex and our bodies or not being able to pay
attention to the good stuff turns down the intensity and even stops sexual
arousal (and therefore prevents us from feeling desire). In the example of
Andie, below, there were high levels of receptivity, sexual currency and
therefore sexual stimuli, but there were psychological barriers that
threatened to dampen her desire.

Andie often felt open to the idea of sex happening, and she and her
partner created loads of opportunities for sexual stimuli in their
relationship – they often kissed for the sake of kissing and frequently
spent lots of time in bed together talking, laughing and with close
physical contact. However, as soon as Andie had the thought that she
or her partner might want it to go further, she was plagued with a
whole host of worries about herself and her body. These were often
 focused on body image in one way or another. She worried that she
didn’t have the right underwear on, that it had been a while since
she’d showered, how much body hair she had right now and what
her body would look like in this light. Sometimes she’d notice that
she’d almost have to battle through these thoughts until the point
came where she noticed that she felt arousal and desire kick in.
When this happened, she suddenly had the experience that these
thoughts had faded into the background and desire had taken over.

A key psychological barrier we haven’t covered in detail so far, which I

want to draw your attention to at this stage, is expectation and pressure.
There’s nothing like feeling we have to do something or that something is
expected of us to make that thing less enticing, and sex is no different. If we
feel every kiss has to lead to sex, and if we feel that every time we have sex
it has to lead to a certain type of sex, desire takes a hit. In my experience,
expectation and pressure for a foregone conclusion are two of the key
ingredients for a less than satisfactory sex life. The cultural phenomenon of
‘blue balls’ that we discussed in Chapter 4 is crucial here, as feeling as
though ‘we’ve started something so we have to finish it’ (especially if this is
privileging one person’s needs over another) is just not great for long-term
desire. Similarly, wedding nights, date nights, weekends away and nights in
hotels can all have a similar effect.

The flip side of this is that anticipation can build desire and shouldn’t be
underestimated as a tool at your disposal to trigger it, and we talked about
this when we covered scheduling physical intimacy. The key difference here
is that pressure and predictability are about a foregone conclusion;
anticipation is building excitement for something that may or may not
transpire. Take a minute here to consider how pressure, predictability or
anticipation feature in your sex life, alongside any other problematic
thoughts or distractions you identified in the last chapter. The way to
overcome this potential psychological barrier is to create a culture of low
pressure between you and your partner. This means creating situations of
physical or emotional intimacy which trigger desire but to have a solid
agreement that this need not lead to a certain conclusion. I often explain to
couples that I’d like them to move towards a ‘trivial and often’ idea of
sexually relating, rather than ‘rarely and crucial’. This, I find, can often
require a complete shift in understanding for most couples, but once they
are able to see the results that this low-pressure/high-frequency way of
sexually relating brings, it can often have a remarkable impact on their sex
life moving forward.

Circumstantial barriers
In Chapter 2 I introduced you to the interesting fact that we are having less
sex as a nation than we have ever had before. In my opinion, couples often
don’t give enough credit to the impact of their individual life circumstances
on their sex life. It’s so important to examine this, and it’s one of the easiest
things to change. Circumstantial barriers such as these are not named
explicitly as part of Basson’s model, but they would fit under the heading of
psychological barriers, or as part of the wider context of the relationship. I
encourage couples to think explicitly about the practical aspects of their life
that dampen desire.

There’s nothing more powerful and freeing than a couple who feel that their
sex life is doomed due to some kind of incompatible desire problem
realizing that they simply don’t prioritize sex and that if they did, it might
be different. The information this provides for a significant and meaningful
change can be relationship-changing. They may not have come to this
understanding before, as they believed that desire and sex should just
happen spontaneously and ‘naturally’, without effort.

You might remember Alexandra and Will from Chapter 5, whose schedule
for diet and exercise prevented them from having any time for their sexual
relationship. Katy and Ryan, below, reached a similar conclusion.
 Katy and Ryan had a realization that their schedules had no space for
sex in them, and their expectation that sex should happen randomly
and spontaneously when they didn’t see each other alone that often
was probably not that realistic. They made a decision to sacrifice one
night a fortnight that was Katy’s yoga night and which Ryan usually
spent with friends to really connect emotionally and physically, to
create the right kind of environment, space, time and conditions for
sex. They didn’t always have sex on these nights, but more often
than not they did. Making space in their schedule meant other things
had to give, but it was a sacrifice they felt was worth making. This
solution was not apparent to them until they understood how desire
worked.

When there are practical factors, such as time, which get in the way of
desire emerging, the options are to choose to prioritize sex in your life and
to devote regular time to your relationship in a way that works for you both
(a compromise might also be required here) or to accept that your sex life
can’t happen the way you’d like it to, as life gets in the way, and rest safe in
the knowledge that this doesn’t mean there is anything wrong with either of
you, or that your relationship is doomed.

Physical barriers
We discussed physical barriers in the form of prescribed medication use,
tiredness and hormonal changes in Chapters 5 and 6 when we discussed the
impact of having children, as well as low mood and anxiety.

However, another physical factor which we haven’t talked about so much

yet is the experience of painful sex. Penetrative sex can be uncomfortable
for all of us from time to time if we’re not turned on enough, if the position
isn’t great for us or if we don’t use enough lube for vaginal or anal
penetration, and, as a rare occurrence, this is nothing to worry about.
However, around 7.5% of women in the UK experience pain either from
penetration, or from touch to the vulva, and this can drastically impact on
sexual satisfaction and the desire to have sex. 10 The impact of pain is linked
with the associations and learning we make, as discussed in the last chapter.
If something isn’t rewarding, we are less likely to do it, but if something
leads to a negative consequence, such as pain, we are even less likely to do
it than if it’s just not rewarding. Sex should not hurt and, if this is something
that you experience, go to your GP and let them know so that they can refer
you for an investigation and so you can access support (typically, once
medical causes for pain have been ruled out, this would be for sex therapy
and pelvic-floor physiotherapy) to help you overcome it.

Arousal and desire

In the last chapter, we learned that having our brain and body in sync when
it comes to arousal is called ‘concordance’ and that there is evidence that
concordance is associated with better sexual function. One of the key
aspects of the circular model is that arousal comes before desire. In fact, the
process of noticing our own genital arousal and the other bodily changes
and pleasurable sensations that come with it can often be what triggers our
psychological desire.

This means that it is possible that women might not be noticing their own
arousal, which might, for some, be a missed opportunity to kickstart desire.
This concept is further evidenced by some of the research coming from the
lab of Dr Lori Brotto and her colleagues, who, as you know, have found that
women who pay attention to genital sensation using mindfulness have
higher levels of concordance, arousal and desire after practising
mindfulness regularly.

The other interesting aspect of genital arousal is that, when I work with
women in therapy around their concerns about ‘low sex drive’ and I ask
them whether they notice any genital tingling, throbbing and wetness over
the course of a typical month, perhaps in response to something they’ve
seen, read or thought about, they often say that, actually, they have. If they
are not sure, sometimes I set them a task to do where I ask them to pay
attention to this over the next few weeks, and they very rarely return saying
they haven’t noticed it. This often leads to a conversation about how they
equate this with their perception of having little or no sex drive. These
conversations can be very useful, as they often turn into a realization that
the problem might not be about experiencing arousal or even desire but
experiencing arousal and desire directed at or in response to their partner ,
at convenient times of the day , or feeling confident or motivated to turn
their own physical urges into the action of having sex with someone else .

It’s also interesting when women understand that their desire is often
responsive to this arousal, to see whether they want to try and experiment
with triggering it, to recognize and learn to trust this process in action. They
could do this by watching porn, using fantasy or listening to or reading
erotic stories, for example. It can be incredibly reassuring, as well as crucial
for developing more of an understanding of your own desire, to realize that
desire is triggered easily when the time is invested in doing so and the
circumstances are favourable.

Practising this alone can also be a great way of understanding how your
arousal and desire works, with sexual stimuli that work for you, and without
any of the interfering psychological barriers. At the end of this chapter
you’ll find exercises to try out related to generating and amplifying arousal,
so that you can learn more about this process, then make it work for you in
a way that benefits your sex life.

In the circular model, the psychological state we might call responsive

desire more often comes at this stage, after all these other things have
happened. This means that waiting for desire to happen first as a way of
running your sex life might not be all that useful for many women. It might
also mean that, for many women, waiting for spontaneous desire might
mean they are waiting a very long time.

Only when all the other circumstances are in place (erotic stimuli, an
absence of psychological or physical barriers) should we really start to
worry about our desire and arousal if they are not happening. I’ve only met
a few women in my career who fell into this category, as opposed to several
hundred who found no problems triggering desire once the other aspects
were considered.

Emotional and physical satisfaction

Sex is not all about orgasms, and certainly Basson usefully frames
‘emotional and physical satisfaction’ as a broader definition of having
enjoyed the experience. However, as you learned in the last chapter, having
less pleasure during sex, or not enjoying it for other reasons, will limit the
positive consequences and reduce desire over time. In Chapter 3 we talked
about the orgasm gap between women and men when they have sex
together. The orgasm gap is crucial to desire and, hopefully, when we
looked at the importance of learning and memory for us to feel incentivized
to be sexual, that explained why. Put simply, our desire flourishes, or is
inhibited, by the amount of pleasure or satisfaction we experience.

Making sex mutually satisfying is not a goal that is out of reach for ANY
couple, and couples who allow their sex lives to move towards something
that benefits male biology and pleasure over women’s should expect desire
to decrease over time. This is more common than you’d think in
relationships between women and men, for the reasons we have previously
mentioned in how we view sex and gendered roles in relation to it. It is less
common in relationships between women, and this is backed up by the data
of the higher levels of sexual satisfaction for women in same-sex
relationships.

If sex has become less frequent and less pleasurable, this will need to be
addressed to avoid a potential decline in desire over time. Sex that doesn’t
always end in penetration can feel like a big culture shift for most
heterosexual couples, especially if you’ve been having sex the same way
for ages. This means that how we have sex, or what we see as sex is crucial
for sexual satisfaction, especially for male/female couples. It takes a
significant shift in understanding and, ultimately, a greater awareness to
make a change away from something that has become routine for you. The
risk, though, is that, without this shift, it’s possible that your sex life might
lose its charm over time due to habituation, predictability and lack of
novelty reducing the rewards that sex has to offer.

Other rewarding aspects of sex outside of orgasms could include, for

example, feeling attractive, finding it erotic, feeling connected, feeling
close, having fun together or feeling free to express your sexuality. The
more these things are happening, as you can see from the model, the more
likely it is that the experience will be satisfying and reinforce future desire.
Reflect on your ‘conditions for good sex’ from Chapter 3. It’s the presence
of these things that will make a difference here. But if these things aren’t
happening, if sex is lacking in reward generally, not just in orgasms, then
this might need to be addressed.

Emotional intimacy
The circular model suggests that the positive consequence of sexual activity
featuring emotional and physical satisfaction is increased emotional
intimacy with a partner, leading to a sense of closeness and wellbeing. In
contrast, it can be assumed that a lack of emotional and physical satisfaction
from sexual activity might result in a lowered sense of sexual intimacy and
connection over time.

This is important to the model, as the level of emotional intimacy feeds into
the likelihood that the woman might feel receptive, or not, to future sexual
stimuli. This allows women to be open to the idea of sex for non-sexual
motivations, as with those mentioned in earlier chapters. However, a less
rewarding version of this circular response might lead to a situation where
sexual neutrality is more difficult, and it may become more challenging,
therefore, to feel motivated to be sexual, or to feel receptive to sexual
stimuli over time. Consider for a moment when you feel most emotionally
intimate with your partner and what it is that facilitates this feeling. For
some of you, it will be about time together to really connect, for others it
will be about good communication and feeling listened to, for others it will
be about having fun together. Maximizing these aspects of your relationship
by making time to create opportunities for them, or simply treating them as
important and essential to nourish, is key.

How does your desire work?

At this stage you can probably see that, over the course of your life, there
may have been be a range of ways you’ve experienced desire (based on
what we know about desire from sex science). The first is frequent thoughts
of sex out of the blue, and although this is more common in the early stages
of a relationship, and more common for men, some women certainly
identify with this as a way their desire works. More likely, perhaps, might
be a pattern of rarely noticing yourself thinking about sex or feeling like sex
out of the blue, but if you read, watch or think about something erotic you
noticing arousal in your body, which you may or may not act on. Or
perhaps you very rarely think about sex but notice that, once you’ve let
yourself be open to it and started some kind of sexual touch, kiss or act with
a sexual partner, desire usually, or always, follows. For some people there
may be a mixture of times when they feel like sex out of the blue, times
when they are motivated to have sex for another reason and actively seek
out sexual stimuli in the absence of feeling desire, and times when they are
receptive to sexual stimuli and happy to see if desire builds. All of these
manifestations of desire are normal.

Bringing this all together – Amy and Mark

Amy felt that she was someone with a low sex drive and she was
often aware that she didn’t meet the three-times-a-week feeling-like-
sex thing she thought she should. She very rarely thought about
having sex with Mark, but when she did, which was about every two
months, she acted on it by showing him some kind of signal that she
wanted to be sexual (like wearing nothing to bed) and he usually
responded. When she did this, and they had satisfying sex, she often
thought afterwards: ‘That’s was great – we should do that more.’

The rest of the time, if Mark kissed her – the kind of kiss that’s more
than a peck on the lips – her immediate thought was ‘Oh no! He
wants sex and I’m not feeling like it! I better close it down now so
he doesn’t get the wrong idea.’ She had started to wear more to bed,
and avoided any conversations about sex, mostly as she felt
awkward, or wanted to sidestep a row.

Because of this, they had far less sexual stimuli in their life than they
had before. They had stopped kissing passionately unless it was part
of sex, and she didn’t let Mark run his hands over her body in bed
when they woke up like he used to, as she could feel him getting
hard and this made her worry. Mark picked up on all of this and
stopped touching Amy in this way or telling her he fancied her, as it
was met with this reaction.

Amy and Mark had young children and were pretty much always
exhausted. By the time they had put the kids to bed, tidied up,
cooked dinner and got everything ready for the next day, they were
shattered and keen to go to sleep. If they did try to have sex at these
times, Amy found herself distracted by thoughts of ‘have I got
everything ready for the kids tomorrow?’ or ‘I have to be up in six
hours’, which made it hard for her to experience much arousal and
desire. Sometimes she’d be happy to have sex anyway, more for
Mark’s pleasure than hers (and also as she felt it was unkind to turn
him down once he’d got turned on), and these more perfunctory
sexual experiences were lacking in pleasure for her. Mark would
 come and then they would go to sleep, without even discussing her
pleasure or satisfaction.

Amy noticed that she did feel the sensation of arousal in her genitals
every once in a while, when there was a sex scene on TV, or when
she was reading a book with some hot sex in it. The problem, she
said, was that it felt difficult to translate this into action with Mark,
as she didn’t always know what to say, or it would happen at times
when the kids were awake, or she was alone. Sometimes she would
choose to masturbate instead of approaching Mark, either because it
was more convenient, quicker, or because her pleasure was more
guaranteed, without any of the pressure of pleasing him.

Over time, they had sex less and less, and it became a bit of a sore
subject. The less sex they had, the more awkward it felt to get started
and the more pressure there was for it to go well and for it to be
more about Mark’s pleasure and preferences than Amy’s. Amy
started to avoid sexual stimuli more, as the longer the gaps between
them having sex became, the more pressure there was for a
passionate kiss to turn into more.

Amy and Mark are, in many ways, a very typical couple. At this stage, my
hope is that, in this example, you can spot all of the different aspects of the
picture that we have discussed in each chapter so far and how they are
impacting on their sex life.

Which of the following did you notice in the example of Amy and Mark?

What’s normal about Amy’s experience of desire in relation to what you

have learned so far?

Sex-positive sex education and early learning for women about sex,
gender politics and appeasing others
 The impact of the orgasm gap and female sexual pleasure on desire

The expectation of what sex looks like, men’s desire and sexual scripts
around how sex should be

Their motivations for sex and why this matters

Myths around the ease of spontaneous sex, and around three-times-a-

week sex

Relationship dynamics and sex communication, initiation, having

children, sexual currency, priorities and time together

The role of attention, distraction and negative thoughts

The unhelpful use of labels

The role of learning and incentive on sex

Reductions in sexual currency

Approach or avoidance motivations for sex

Predictability, novelty and pressure

So what can Amy and Mark do about it?

Well, Amy and Mark can make changes related to any of the points above,
or any of the factors we’ve discussed in this book so far. As I mentioned at
the very start of the book, a significant change for some couples can come
from understanding things differently, and an adjustment in, for example,
understanding responsive desire and increasing sexual currency is all that’s
needed. For others, changes across several areas are needed, and may have
to happen for them to break relationship habits and find a new way forward
that suits desire much better. In therapy, I would probably target every area
identified in a systematic way, making sure that I’m doing so in a way
where couples see changes quickly, to help them stay motivated to do things
differently. For the purpose of Amy and Mark just now, let’s use Basson’s
model as a framework for mapping out where the room for change is in
their sex life moving forward. At the end of this chapter I’ll encourage you
to develop a similar understanding for yourself and see if there are any
changes you feel could be useful in your own sex life. And, in Part Three,
we’ll be taking those ideas forward.

Moving forward
Amy’s new understanding of desire would hopefully mean that she would
be feeling more receptive to or willing to seek out sexual stimuli, though
it’s important to note that she would need to be feeling emotionally intimate
as a foundation (so it would be useful for her to reflect on how their
relationship is going generally). She would also need to feel confident that
this receptivity wouldn’t always be positioned as the green light for sex.

As a couple, they would benefit from resurrecting the things she enjoys but
doesn’t let Mark do for fear of it having to turn into more. This might be
about reinstating passionate kissing for kissing’s sake, or massage, allowing
Mark to touch her in bed in the mornings again, or always wearing little to
bed, not just when she feels like sex. This would bring a change in the
sexual currency between them.

In fact, if I were seeing them for therapy, I’d recommend they have a period
of a few weeks where they complete the ‘sexual currency overload’ exercise
(at the end of Chapter 5), so that they can see first-hand what difference it
makes to desire if they flood their relationship with sexual stimuli, without
pressure. An exercise like this gives couples an opportunity to get
reacquainted with flirting, reinstating or strengthening the relationship
between them as a sexual one, creating more of an association of your
partner as a sexual being, and many more opportunities to trigger desire.
Again, for this to be useful for their sex life, Mark would need to commit to
these things not needing to lead anywhere so that there is truly no pressure
and that there is no expectation that either of them should feel desire. Many
couples find that making this subtle change immediately starts to improve
their sexual satisfaction, even in the absence of sex. For example, one of
Mark’s reasons for having sex was to feel wanted, and this was why he was
so concerned about Amy’s avoidance. Imagine the effect it would have on
Mark to have Amy sending him suggestive texts or flirting with him
throughout the day.

Amy and Mark might want to try making more time together to really
connect without the kids, both emotionally and physically. This doesn’t
need to be outside their home, if a babysitter is out of reach. It could
involve an evening of making dinner for each other, for example, talking
without the distraction of TV or devices, having a bath together, or going to
bed early to chat naked under the covers. Even better if they can make some
time for self-expanding activities, such as learning a new skill together,
trying a new sport or going somewhere different and fun. Creating space for
physical intimacy that might trigger desire is also important if we want to
kickstart our responsive desire, so they might want to kiss, lie naked in bed
together and talk, or have an evening once a fortnight where they give each
other a massage. Remember that arousal and desire might need to be
triggered. Spending time together might not be enough without more
physical /sexual triggers.

Ultimately, Mark and Amy need to decide what priority sex should have
and treat it as such, carving out regular time and space between them to
have more triggers of desire without pressure for it to lead to more. Often I
get asked what I think about scheduling sex as a strategy for couples in
long-term relationships. The answer is that scheduling sex is rarely a good
idea, as it creates pressure to have to feel/do something, but scheduling
physical intimacy for the sake of physical intimacy is always a good idea,
as it is both enjoyable in its own right, keeps this part of a relationship high
on the priority list and provides the perfect environment for responsive
desire.
Amy might identify that she would like to feel more comfortable with her
body and might work on this by avoiding any media or social media that
portrays unrealistic or ‘perfect’ body shapes. She might also find ways to
reduce her stress levels more generally. They are both shattered, and they
may find that, if bedtime is really the only time they can schedule physical
intimacy, they might want to move their bedtime thirty minutes earlier, in
the hope of reducing their overall tiredness. Even better still, spend this
time together as soon as the kids are asleep, rather than last thing at night.
Amy struggles with distraction, and negative thoughts are a big feature of
their current sex life. She would benefit from starting a mindfulness
practice outside of sex, with the aim of moving it into sex in time, as well as
reducing her general stress levels.

Amy is carrying all the psychological burden of the household chores and
family admin tasks, without this ever having been discussed and agreed by
both of them. They could decide to share this more equally so that Amy
doesn’t find herself going to bed worrying about all the tasks that need to be
completed for the kids the next day, knowing that, if she doesn’t do it, no
one will. It’s important for Mark to understand that this is one of her
barriers to desire, even if it wouldn’t be to him. In some ways, this is where
gendered scripts of responsibility might need to be spelled out as operating
differently for women and men.

Ideally, Amy should move towards a belief that it’s not acceptable for Mark
to enjoy sex more than her, and to not accept sex with low reward every
time as the status quo. Amy has never felt confident asking for what she
wants during sex and, especially now, her enjoyment is really important.
Can Mark make her come easily? Does he know how? If this is not the
case, Amy needs to teach him, and Mark needs to be committed to learning.
Amy and Mark would benefit from having equal amounts of sex that
prioritize Mark’s pleasure (like vaginal penetration), and Amy’s (like oral
sex), rather than their sex life always following a set and predictable pattern
ending in penetrative vaginal sex. It’s important that they consider the role
of predictability and novelty in their sexual expression, in how their sex
looks and the freedom they both have for sexual expression of different
types.

Amy is sometimes having sex for avoidance reasons, meaning she is having
sex to avoid conflict rather than because she wants to, or for Mark’s
pleasure. Amy’s long-term desire would benefit from no longer continuing
to have sex for these reasons. If Mark wants to be sexual and Amy doesn’t
feel ‘receptive’ to seeing if her arousal can be triggered, then they would
benefit from talking more about what’s behind Mark’s motivations for sex
on that day and whether there are any other ways it can be met. Amy could
use that opportunity to reassure Mark if he’s feeling insecure.

We could go on. But hopefully you can see that there are lots of ways Amy
and Mark can start to turn this around now that they understand desire
better. I’ve worked with hundreds of couples over the years who have made
huge changes to their sex lives by first understanding this then making
practical changes to how they are sexual together. A small change in any
area usually has a positive impact, but a handful of changes, like those
suggested above, can make a massive impact to a couple’s sex life over
time.

So where are you at? Consider the points below to reflect on this before we
move on to Part Three.

Prior to reading this book, how much did you subscribe to the belief that
you should be feeling spontaneous sexual desire (rate it as a percentage, if
you like, with 100% being that you completely believed it)?

How did this belief impact on your willingness to be receptive to sexual

stimuli in the way it did for some of the women in the examples?

What have you found yourself doing/not doing not to give your partner
the ‘wrong idea’ in response to this?
 What has your partner stopped doing over time as a result?

What would be the effect on your sex life if you started to be more willing
to trigger arousal and desire? (note: if you are going to do this, have a
discussion with your partner about the importance of there needing to be
no pressure for this to turn into more)
My hope is that your understanding of how desire might work for you is
different now this book has provided you with some ideas about how desire
is given the opportunity to flourish, or is inhibited, in your own sex life.

Generally, with most areas of our life where we want to create change, it
can be useful to first understand what’s going on and then to put a plan in
place that we know will undermine what’s keeping us stuck. Desire is no
different. For some people, simply hearing about how desire works is the
quick fix, as knowing they are normal and understanding their body are all
they need to take the stress of the situation away or know how to action it.
For others, the additional step of making a plan to undermine any
previously less helpful patterns, as outlined in the actions Amy and Mark
could take above, will take you closer to a more rewarding sex life.

If you’re interested, it can be really helpful to start building up your own

personalized visual picture of how desire features in your sex life, including
ideas from everything you’ve read so far. The key features should include:
your sexual history, societal messages, the context of your relationship and
what’s happening in your mind, as well as aspects from the circular model
presented in this chapter, such as receptivity, sexual stimuli, barriers to
desire and the effects of positive or negative rewards. Doing this will help
you identify what you can do to create positive change in your sex life,
should you feel (as is the case with most of us) that your sex life has room
for improvement.

There is no doubt that we all have our own individual relationship with sex,
which is based on our unique histories, contexts and life experiences up
until this point, and that these influence our desire. It’s also true that these
experiences play out consciously and unconsciously in what’s going on in
our minds and relationships. But it doesn’t stop there. Desire is a fluid
entity that is cultivated or extinguished minute by minute, day by day,
between us and a partner, based on how we nurture it. Defining our and our
partner’s desire as fixed, static and not amenable to change, based on our
past experiences of it, is the first obstacle we create to long-term sexual
satisfaction, as it forms a perception that nothing we do or say makes a
difference and that it’s a problem with us. Framing desire in this way not
only stops us from making any effort to guide our sex life in the way we
want it to go, but it prevents us from being curious to learn anything about
how desire actually works .

Take-home messages from this chapter

Women’s’ desire is more often responsive rather than spontaneous in
long-term relationships

Waiting for sexual desire before being receptive to sexual stimuli, like a
touch, a kiss or being naked together, might result in less and less sexual
contact over time

Societal messages tell us the opposite (based largely on an outdated and

male-focused model of sexual response), but this makes us feel bad, as
we wonder what is wrong with us and our relationships

Our partners wonder too, and they might wonder why, take it personally,
or evaluate it as a problem

This can lead to conflict at worst, awkwardness at best, and make sex the
‘elephant in the room’ or a sore point in our relationship.

We might try to avoid conflict by trying not to give our partners the
wrong idea by being less receptive to sexual stimuli or by closing down
any advances by our partners by giving verbal or non-verbal clues of ‘not
interested’

Women’s sexual desire is very easily triggered, but we don’t get to see or
benefit from this, as we stop any chances of desire emerging with the
above strategies

Kissing, touching and other flirtation falls more and more off the agenda
and we can get out of sync with what works to turn each other on, or
things that would have been considered sexual stimuli in the first few
years of our relationship become so infrequent that we feel odd doing it
together, and it becomes like a big neon sign over both of us, saying ‘sex
is on the agenda’ (which is, of course, offputting)

When we feel pressure to feel desire, such as on a weekend away, this

acts as a psychological barrier which, paradoxically, inhibits desire

Understanding how desire works and mapping out ways to encourage it to

thrive based on these understandings is the key
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Exercise :
Reflection – sexual stimuli, hot or not?

Construct a list like Amy’s from earlier in this chapter. Try to come up with
something your partner does that doesn’t necessarily work, something that
does and which you want them to keep doing, and something you’ve never
mentioned but you’d be keen for them to try at some point in the future. It’s
good to be honest, but please be careful how you phrase things that could be
taken personally or construed by your partner as them not being good
enough. For example, Amy could say to Mark: ‘I can’t stand it when you
grab my boobs out of the blue – it’s awful!’ Instead, she might say: ‘I
sometimes find sensitive areas like my breasts are not the best place to
touch first – it can feel a bit too much! I really like it when you touch me
around my shoulders and neck first.’ If you’ve been together a long time
and you’ve never discussed these things, do be aware that it can feel hurtful
to be told many years in that you’ve never liked something that your partner
has been doing.

What would make this exercise even more effective would be to explain it
to your partner and have them construct their own list, to give you some
insight also.

Take time together to share your lists and remember the principles of:

1) Listening well

2) Not ridiculing each other’s lists

3) Making an attempt to sidestep well-practised and familiar arguments

about it

4) Being careful with the words you use: go gently

Trying it out – an experiment in kickstarting desire
This is an experiment with the circular model alone, to see what you notice
in your body. Find some time to be alone privately and choose a film or
book that you know has sex scenes in it, erotic literature or audio stories or
porn you feel comfortable watching. Notice the sensations you feel in your
body, particularly in your genitals. If you don’t notice anything, ask
yourself – is the scene you are watching/reading arousing to you or is it a
turn-off? If the scene is arousing but you are not noticing any sensation,
could there be any particular psychological, situational or physical barriers
getting in the way (e.g. tiredness, stress, worry about being interrupted,
feeling shame about what turns you on, etc.). Try this several times. It’s
likely that you will experience genital arousal, and this might turn into
psychological desire. What does this tell you about what you might need
more of in your own sex life? What does it tell you about how the circular
model fits for you? What would happen if you started to build more of these
cues into your own life, day to day, or as part of investing in spending some
time fantasizing from time to time?
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Three
How to Futureproof Your Sex Life, for
Life
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8
What next?

In Part One I set the scene for the reasons women’s sexuality has the place
that it does in history, culture, politics and science. We understood the
importance of understanding our preferences and our anatomy and reflected
on how all the gaps we currently have in our sex lives or in our
understanding of sex inhibit, or misrepresent, women’s sexual desire.

In Part Two, I took you through the impact that society has had on how we
socialize women to be sexually, but also the impact of how we teach
women to see their bodies and their place in society more widely. We
looked at the impact of relationship dynamics, communication and the
meaning of sex, as well as the impact of our brains in processing our past
history, our thoughts and our attention. We learned about models of desire
that women often feel more aptly help them conceptualize their desire, and
how these models, based more accurately on the science of desire, make
sense of the experience of large numbers of women sitting at home waiting
to feel something that is unlikely to come.

By now, my hope is that you feel what you’ve read so far has connected
you with your experience of your sexuality in a way you haven’t ever
considered before. When I started writing this book, I wanted it to be the
book that I wanted all women to read, given that my clinics were full of
women thinking they were broken when they were not; women and couples
feeling powerless to resolve issues of conflict related to sex, even when
their relationships were otherwise strong. For years I’ve imagined the
impact of some of this information being known on a wider scale than it
currently is, and the impact this could have on people’s life satisfaction and
relationships, as well as their sex lives. In this final part of the book my aim
is to encourage you to look forwards, both at how you might create change
based on what you’ve learned, and how you might futureproof your sex life
by steering it in the direction you want, rather than letting it drift
somewhere you don’t.

How does change happen?

Change can happen in a number of ways. The new understanding you have
gained might be the only change you need, and you might now respond and
react to your sex life in a few key ways which are low in effort but have a
large impact on your sexual satisfaction. For some people and relationships,
small changes have far-reaching consequences. Alternatively, perhaps you
are seeing things differently but there is a bit more work that needs to be put
in for you to feel you will really see change. The latter might be especially
likely if you have found yourself falling into any of the less helpful habits
we’ve spoken about, and many of the exercises you have already completed
will be the facilitators of a change in this, to start things moving in another
direction.

In this chapter I’m going to be helping you think through how you put this
plan into action and how you might get someone else on board with this
idea. The thing about sex, of course, is that it often involves more than one
person, and sometimes it doesn’t matter how much our perception or
understanding changes – if that other person is not on the same page, they
are unable to jump on our sexual revolution bandwagon.

Getting partners on board

When it comes to partners, the simplest thing you could do is get them to
read this book. Or, at the very least, ask them to read the bits that made the
most sense or had the biggest impact on you. In the absence of this, of if
they read it and still feel cautious, here are my top tips for getting them
onboard in a way that can help you make changes:
1) State what you feel the impact of making changes might be

2) Talk thought the effect you feel this will have on you/them/the
relationship

3) Speculate that it must be tough for them to hear facts and ideas that
contradict all they’ve understood about sex so far in life, especially since
the current messages feel like they are in their favour

4) Suggest that, although a change in the way you think of or ‘do’ sex might
feel like it’s moving away from their preferences in favour of yours, it’s
actually benefitting you both, as it’s futureproofing your sex life over
time

5) Tell them they don’t have to believe that everything in this book, or that
you’re telling them, is true, but just to agree to suspend judgement to test
it out, with the intention of gathering evidence to see whether it works

Here’s an example of how this conversation might go, between Jamilia and
Adam.

Jamilia : Hey! I’ve been meaning to tell you about this book that
I’ve been reading, all about sex and women’s sex lives. It’s got some
shocking stuff in there about the fact that women’s sex lives in
heterosexual sex have always been sidelined in favour of men’s. You
know, ’cos of the patriarchy and everything, and that, actually,
although there are tons of women feeling like there’s something
wrong with their desire, there’s actually nothing wrong with their
desire except the way in which they’ve been doing sex, and the way
they’ve been understanding desire and stuff. It’s got me really
thinking about our sex life and that we should do something
different.
Adam : What’s wrong with our sex life?

Jamelia : Well, nothing major. You know it’s great when we do it,
but I know you always feel like you want it more than me, and I
always feel like there’s, you know, pressure for me to feel like it, and
I just think it could be better, you know?

Adam : Erm . . . I’ve never heard you say this before . . .

Jamelia : To be honest, I’ve never said anything as I’ve always

thought there was something wrong with me, as in every relationship
I’ve had I feel really into sex for the first few months or year and
then I just start to feel really uninterested. Since I’ve read this book,
I’ve been thinking that the influence of worrying about how I look
all the time, or how my family talked about sex being really dirty, is
probably coming into it, but now I’ve found out that this experience
of desire is normal, and that I – we – can do something different
about it. I think it would be great? Don’t you?

Adam : I just thought it was all right as it was, to be honest, but I

suppose it has been the thing we’ve rowed most about.

Jamelia : Yeah. I just keep thinking what it would be like to get out
of that cycle of you going on about sex like it’s my duty and me
feeling pressured to do it and then us both getting all stressed and
narky about it. I think if we did this, we might both feel a bit more
equal and relaxed about it, you know? And also it might mean that
we get to feel even more connected in that way. I think it would be
really good for us. I’d like it if I thought about and felt like sex more,
you know? It would make me feel normal and that we were really
solid.

Adam : I’d really like that too, actually. I do sometimes wish I felt
like I wasn’t always the one bringing it up, as it sometimes makes
 me feel like you don’t want me, or you’re not that into it. What kinds
of things are in this book, then?

Jamelia : Oh, it’s probably best if you read it, but there’s stuff
around the fact that women’s desire is more responsive than
spontaneous – it needs triggering rather than being something that
just happens – but that as we often expect desire to come first, we
don’t try and trigger it but just wait until it happens, which it often
doesn’t. There’s also stuff about how sex between men and women
isn’t really the type of sex physically that works best for women, and
that this leads to sex carrying less pleasure than it could, oh – and
stuff around how the best type of sex life is one with loads of variety
and not always ending in penis-in-vagina sex as, like, the ‘main
course’ of sex.

Adam : That sounds drastic and a bit weird.

Jamelia : Okay . . . well, I’m not sure we really need you to believe
it all, actually . . . and I know it must be hard as, without either of us
even realizing it, sex might have been skewed towards the types of
sex that fit your preferences and anatomy over mine, so it’s bound to
sound less appealing to you. But if you agree that if we could feel
more equal and argue less about sex, perhaps you can suspend your
judgement for a few months and see it as a bit of an experiment, then
decide what you make of it? You will have to really try, though; I
can’t do it on my own, as then it just won’t work. It’s a two-person
job. What do you think? Shall we do it?!?

Adam : Okay. I’ll reserve judgement. Let’s give it a go.

Jamelia employed points 1–5 in her conversation with Adam (though,

unfortunately, if he’s now read the book, he’s also probably realized that
was what she was doing). She stayed away from any heavy critique of their
sex lives, instead selling a picture of what it would be like if it were
different. She focuses not on changing his understanding at this stage (as
the force is strong when it comes to social scripts and societal norms), but
instead just asks for his participation in a trial of doing things differently.
All Jamelia needs is Adam’s commitment to try to be an active participant
and to let the changes that happen as a result of their actions influence his
understanding and potentially make a permanent change in how he sees
things.

In my clinical work, if I’m working with a heterosexual couple, it can

sometimes be the case that the male partner struggles to get on board with
all the ideas we’ve talked about, and another small gap opens up, where the
female partner suddenly feels understood and revitalized, can see what
might be the impact of them doing things differently, and is galvanized into
action. He, on the other hand, can sometimes find this new way of relating
to sex and desire hard to grasp, mainly as if it doesn’t fit his experience (for
example, he is someone with high levels of spontaneous desire, and is really
wedded to an idea that this is preferable, ‘right’ and ‘normal’). It’s also fair
to say that, although not a conscious resistance, the movement of the
location of the problem in his mind from ‘there’s something wrong with her
sex drive’, which affects me, to ‘as a couple we need to manage our sex
lives differently to keep us both interested and fulfilled’ can be a hard move
to make. After all, the male partner may have started the process feeling like
he had no problem, and he’s there to support someone else, and he ends the
process understanding the role that he is playing, unknowingly, is both
causing and maintaining it. He is also now an active agent required to put in
‘work’. Saying all of this, I have worked with many men who at first felt
quite resistant, but were happy to experiment with making some changes to
test out these ideas, who experienced this process as revelatory and hugely
rewarding once they invested in it.

For same-sex couples, it can be the same scenario, where one person
experiences high levels of spontaneous desire, and one doesn’t, but in my
experience the process of social and cultural learning that women share
means that, when I talk through these things with two women, they can
often both get on board with it, even if one of them has a slightly different
experience than the other.

What do you stand to lose or gain?

At this point I’d also suggest that it might be worth taking a moment to
reflect on the future trajectory of your sex life, should you decide not to
take any action. Consider how things are now and how long you’ve been
together. Consider any life challenges you might have coming your way
(such as becoming parents, ill health, ageing and body changes). Now
imagine what the sex life you have now might be like in five years, ten
years, twenty years, based on what you’ve learned. Ask yourself the
following questions about your current (or future) sex life trajectory:

What would it be like if the current pattern we have beds in even more or
is amplified over time?

How essential do I feel mutual pleasure, sexual adventure and sexual

fulfilment are to both of us for long-term sexual satisfaction?

How has my sexuality evolved in the past fifteen years? Is my current sex
life a fertile ground to allow it to evolve this much again over the next
fifteen? Or might it by stifled by habit, expectation and routine?

How able will we be to withstand the impact of significant life changes

on our sex life?

How able will we be to negotiate mutually satisfying change when we

need to?

If something happened which meant we could no longer have sex in the

way we currently do, what impact would this have on our relationship
 satisfaction?

These questions are a starting point for you to consider your sex life now
but also to think realistically about where it’s headed in its current form.
Our sexuality is a lifelong journey for all of us, and it changes as a result of
changes in identity, in our circumstances, in perspective and in our body.
The contexts of our sexual relationships need to be able to allow room for
this growth and adaptation, so that each of us can experience more sexual
satisfaction as we age, not less.

Working on your own sexuality

Given that our sexuality is a lifelong journey, it’s also worth noting that it’s
a journey that we are in control of. Yes, the influences of our lives so far,
including social learning, shame, unwanted or abusive sexual experiences,
may have steered it to places we are not totally happy with thus far, but,
from here on in, it’s up to us to create situations and contexts which amplify
our sexual confidence and facilitate our sexual exploration in a way which
benefits the sex life we have with others. We have covered how the
relationship we have with our sexual selves is a key part of how we relate to
sex with others, and this relationship is something we all have direct control
over.

Women who masturbate have higher levels of sexual satisfaction than

women who don’t. 1 Not only does masturbation help us explore what we
like without the pressure of someone else’s preferences, it allows us to push
boundaries privately, explore a rich fantasy or erotica world, and have
positive, rewarding sexual experiences that boost our desire and keep sex in
the forefront of our minds. There’s also research to suggest that women who
masturbate more frequently show greater concordance. 2

There is no doubt that masturbation is a great way to get comfortable and

continually evolve and build positive association with our sexuality, but our
sexuality is so much more than the physical, and exploring our sexual self
in ANY way can be useful. Whether it’s through art, reading, music, by
talking with friends, in the way you dress, through dancing – there are many
ways we can practise engaging with our sexual selves in a way that builds
confidence with who we are and what we need.

Sexual confidence is just one aspect of who we are, but if we’re struggling
with it, it can really impact on our sex lives with others. Focusing on
developing our own sexuality and sexual confidence is known to be good
for long-term desire. 3 It’s important to remember that we’re all on a
journey with this and no one has it totally sorted or feels crazy confident all
of the time. Most of us just need to work out the contexts in our life that
build or knock our confidence (in sex, in relationships, with friends, with
work, on social media) and pay attention to how they do this, then act
accordingly.

What contexts increase your sexual confidence and how accessible are
they to you right now?

What things do you feel you need to work on or connect with alone to
benefit your sexuality with others?

What aspects of your sexuality would you like to invest in that you
currently don’t?

If there are things you’ve identified that would make a difference to how
you feel about sex or your sexuality, and ways you feel you could invest in
this part of yourself outside of your relationship, then this is something to
consider as part of investing in your sex life in the long term.

Maximizing success – where do you want to go?

One of the factors that will give you the most chances of success with
futureproofing your sex life (alongside new understandings and having a
shared commitment to making it happen) is having a clear co-constructed
idea of where you want to go. This is the same in face-to-face sex therapy,
and I never start off a piece of work with an individual or a couple without
having the final destination clearly and explicitly mapped out. There are
several reasons for this: knowing where you are going provides an
indication to all involved about the key steps needed to get there; starting
off talking about where you want to be creates a shared vision that makes
you feel more connected with each other and the plan; and talking about the
ideal rather than the problematic version of your sex life is what
psychologists call ‘problem-free talk’, and creates hope and optimism that
benefits your journey. 4 It also provides a much-needed different type of
conversation about sex, which is especially useful if the same conversations
about sex – ‘You always do this, you never do that, etc., etc.’ – happen so
regularly that you can predict who will start it, who will say what and when,
who will get defensive, who will get angry and what format the
unsatisfactory conclusion would take. In fact, the whole point of therapy,
especially with couples, is to have a different experience of talking about
something which is very familiar to you both. After all, if the same
conversations were helpful, people wouldn’t be stuck with them in the first
place.

I often explain to clients that a good therapist is like a black cab driver
(sorry, Uber). When you get in the cab, they should have no opinion on
where you go, only the knowledge, means and expertise to get you there in
the most efficient and effective way. It’s very common in therapy for people
to be extremely adept at explaining to you where they don’t want to go.
Destinations like ‘I just don’t want to feel like this any more’, ‘I want him
to stop going on about it’, ‘I don’t want our sex life to be like this’, are
really common ones for people to offer up in response to the question of
where they want to be by the end of the work. The thing is, these answers
give no clue about where they want to go, just where they don’t want to go.
They are the equivalent of me getting in a black cab and saying, ‘I don’t
want to go to St Paul’s Cathedral. It makes me feel rubbish,’ A bad black
cab driver would say, ‘Okay, great’ and just start driving aimlessly around
London, avoiding St Paul’s and hoping they would stumble on the right
place eventually. A slightly more effective driver might think, ‘Okay, they
don’t want St Paul’s, so I’ll take them to another cathedral? Westminster
Abbey it is,’ and perhaps drive them to a similar location (this is an example
of where the bias of the cab driver comes in – they have guessed it’s another
cathedral the person wants but, of course, this is just their perspective and
they could well be wrong). A good black cab driver would say, ‘Okay, I
understand you don’t want to go to St Paul’s, but where is it exactly that
you do want to go?’ Good therapy is a bit like this, but the problem is that
we are socially conditioned through the media to believe that therapy is all
about talking about what’s going wrong rather than what you would like to
be happening instead, so those alternative destinations often need lots of
encouragement in the early sessions in order to develop them fully.

I especially enjoy spending time with individuals or couples at the start of

our work talking not just about where they want to go (and reaching a
destination that suits both of them) but also what the impact of getting to
their destination will be on them individually, and the relationship. This is
useful as a) their goals are usually very achievable and it’s useful to have a
hopeful conversation, bringing to life this more satisfying future sex life,
especially if they’ve been worrying about it for some time, and b) asking
why this destination is important to them and what difference it will make
to get there tells us all a great deal about what’s really important and why.
This is often the start of the real work, as it may be a level of depth to
talking about sex that’s never been reached by them before, as often people
get stuck at the same surface-level gripes about things, such as frequency of
sex, for example, with the same unsatisfactory outcomes.

Let’s use these same therapy concepts to consider how you can maximize
success to get the sex life you want moving forward. It doesn’t matter if
your sex life feels desperately broken, or if it’s wonderfully satisfying and
you just want to take time to prioritize and nurture it. In either scenario a
conversation following the below structure will be helpful.
Picking your moment
The best time to have a conversation about sex is when you’re feeling
connected, close and content. Starting from a place of irritation, anger or
distance is not an inherently bad place to speak from but might make it
more challenging for either of you to feel open, honest and transparent
about how you feel and to listen and really hear what someone else thinks.
Sometimes people can feel as though raising things you’d like to be
different at a time when things are going really well – such as on a really
fun weekend away together – is a bad idea, as it would ‘rock the boat’ and
ruin an otherwise great time. This is especially true for those whose
concerns about sex might be connected to a history of resentment or
arguments, as opposed to those who have no major concerns but want to
create space in their sex life for expansion and growth. But it’s important to
remember that a good conversation, where you both feel heard and you
share ideas of where you want to go, could be a very positive experience
and make an already blissful time away even better. Similarly, talking about
things you want to be different does not have to mean you spend an hour
talking about how much you hate St Paul’s. You can spend that hour talking
about all the places in London you love to go and you miss visiting instead.
The latter conversation in relation to your sex life will generally leave both
of you feeling much more positive than the former, even though you’re
essentially talking about the exact same thing.

How to have this conversation

There are four key aspects to this conversation that you can use as guiding
principles.

1. What you appreciate/what you used to appreciate; state that you

miss/want it

2. What you’d like to build on/where you’d like things to go

3. What difference you think it would make to you/the relationship if you

 got there

4. Inviting their perspective and response to this and being able to listen and
really hear it

This is a slightly different version of the conversation Jamelia and Adam

had earlier, building on the concept of the destination more clearly. Here’s
where their conversation got to:

Jamelia : I’ve been thinking about our sex life and how it’s changed
a bit recently and I was remembering all the things I used to love
about it that we don’t do so much of any more. Like, do you
remember when we used to get all excited about having time
together to have sex? You used to send me texts throughout the day
telling me how much you fancied me and all the things you were
thinking of doing. I used to love that.

Adam : Oh yeah, I miss that too. But I also miss how much you used
to seem into me, like knowing that you were looking forward to it as
much as me, and that you couldn’t wait to see me.

Jamelia : Do you? Oh, I didn’t realize . . . And when we spent time

together I used to feel like you really took your time on me, like
really spending time being close, kissing, touching me all over my
body and stuff. We used to have much longer, more time to really
enjoy it. I miss that, as it feels like we don’t take the time as much
any more? I was thinking that it feels a bit harder to be like that now
we’re living together. There’s not really an opportunity to miss each
other and get excited about seeing each other in that way, plus we’ve
often got other things to do, so sex takes a bit of a back seat.

Adam : Yes, I think you’re right. I miss that too, but I suppose I
often do rush it a bit more now, as I don’t feel like you’re as into it as
 you were back then, so I feel like I’m doing you a favour by making
it quicker and getting to the point.

Jamelia : Oh, really? That’s ironic! It would be great if we could

bring those days back again, don’t you think? Like, not always or
every time we have sex, as I know things are different in our life
now, but if we could have the odd time, like once a month, where we
made a bit of a deal of it and got each other excited about it over the
course of the day. I’d like to have that anticipation back. I think it
would make me feel more into it, which might make you feel like I
was more into it and into you?

Adam : Yes, that sounds good. I just haven’t been doing those
things, as I thought you’d feel like I was harassing you about it. I’d
love it if it was you that suggested it as well, so I don’t always feel
like it’s up to me and you’re just going along with it?

Jamelia : Okay, let’s do that. I think it will really bring back some
excitement into our sex life and make us feel close again. I also think
that having sex like that would really be good for my desire.

The problem and the solution to having the sex life that you want lies
between you and the person (or people) you are having sex with, and in
many ways this is both the curse and the joy of sex. We’ve spoken so far in
this book about all the ways that you relate to sex and how these things
impact your sex life, but it would be a huge omission to assume that you
can make these changes without bringing whoever you’re having sex with
on board with you. The more of these types of conversations you have, the
more chance there is that you can move towards a sex life that allows you
space for satisfaction, pleasure and desire, but also sets the scene for a sex
life that will allow space to grow, adapt and expand.
Take-home messages from this chapter
Making changes based on your new understanding can come from
understanding things differently, or doing things differently

Doing things differently works best with the understanding and

commitment of whoever else is involved

Making changes such as the ones in this book goes against the grain of
how we’ve been brought up to think about sex and can be challenging

Partners might find this hard to get on board with, but they need to be
open to the idea of testing this out (rather than being fully sold on it
immediately)

Not doing anything is also doing something, as your sex life is already on
a trajectory that will lead to a destination eventually, whether that
destination is your preferred one or not

Investing in your own sexuality is a crucial part of this journey and is

about much more than masturbation

Being clear about the destination you both want to go to, and what
difference you feel this would make, makes getting there easier
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9
Futureproof your sex life, for life

Given everything we’ve covered in this book so far, it should come as no

surprise to you that your sex life (as well as your sexual desire) will not
follow a fixed, predictable or set trajectory from here on in. That is not to
say that there cannot be a general ‘up trend’ in your sexual satisfaction from
now until you take your last breath – I believe there can. But, rather, this
general increase in satisfaction that you can achieve with purposeful
intention and action , as I’ve described in this book, will see peaks and
troughs, ups and downs and ebbs and flows, as you, your body, your mind
and your relationship adapt to challenges and circumstances that come your
way. It is the foundations that you put in place for your sex life, the beliefs
you have about your sex life, and the way you respond and communicate
about these challenges that will result in long-term sexual satisfaction.

In this final chapter we will consider what constitutes a ‘good’ sex life over
time and work out what this means for you. We will reflect on the kinds of
life events that can result in this ebb and flow and necessitate adaptation.
We will look at what the research tells us are the behaviours and qualities
associated with long-term sexual satisfaction and how you can apply these
to your own sex life in a tailored and convenient way. Crucially, given that a
good sex life for many couples isn’t accidental, we’ll look at the actions and
strategies you can put in place to futureproof your sex life, for life.

What do we mean by a good sex life?

Sometimes, when people talk about a good sex life they use it as a synonym
for frequency. Evaluating a sex life on the basis of frequency is one of the
greatest red herrings we have at our disposal as a society when it comes to
‘good sex’. Frequency tells us nothing about connection, pleasure, variety,
intimacy, adventure, passion, expression or novelty. It tells us that sex is
happening, yes. But as we’ve learned so far, if sex is happening frequently
but the sex that is happening is lacking in emotional or physical reward, it’s
usually not only not good sex but it’s potentially lowering our desire and
sexual satisfaction slowly but surely over time.

So, what is the definition of good sex? Well, the truth is no one can define
that but you, but I can offer you some ideas to help your thinking. You’ll
remember early on in this book we talked about your ‘conditions for good
sex’. This was a guide to considering how your psychological arousal,
physical touch and being-in-the-moment are important to you to allow you
to really enjoy sex. It’s likely that a possible definition of good sex for you
is not about frequency but about the presence or absence of these things.
My hope is that this book may have given you the rationale and the
confidence to seek out or insist on these conditions moving forwards, even
if cultural/religious/gendered restrictions based on societal messages have
held you back from doing so thus far.

Establishing what good sex means for you might also be understanding the
function of sex for you and in your relationships and working out if the
original motivation you had for sex is being met when you have it. If you
have sex to feel close, for example, and you find your partner distant or
absorbed in their own pleasure and body in a way that makes you feel
disconnected from them, perhaps this might not feel like ‘good sex’ to you,
even if it looks on the surface like it’s meeting your conditions. Hopefully,
you have spent some time reflecting on the function that sex serves in your
life and relationship and you are closer than you have been before to
understanding this. Crucially, if you have had this discussion with a partner,
you will also have a greater understanding of your partner’s motivations for
sex, which may have given you a totally different perspective on what’s
important to them and why.
Good sex for you might mean changing the sexual script in your
relationship, including more novelty, more variety and more pleasure from
non-penetrative sex acts than you’ve ever had before. As you now know,
such a change is not just about more consistent pleasure for women (though
it definitely leads to it), but rather a way to make sex more playful, less
boring and keep desire alive over time.

Lastly, good sex for you might mean having less sex than you do now but
feeling connected sexually in other ways (using sexual currency) and
having the confidence to know this is something that you don’t need to
worry about. Sex once a year can be just the ticket if it’s the kind of sex that
meets both of your needs and makes you feel alive.

I’d like you to reflect on all we’ve covered in this book so far, to work out
what your definition of ‘good sex’ at this moment in time is. Consider your
‘conditions’ triangle, the shackles of social scripts and the constraining
beliefs about sex we’ve talked about, aspects of your relationship more
widely, the habits you’ve got into that you’d like to break free of, the
impact of your mind on sex, the emphasis on your pleasure and your new-
found understanding of how desire works.

How important is frequency? How important is connection? Intimacy?

Pleasure? Variety? Equality? Passion? Trust? Exploration? If you can, make
a note somewhere detailing the definition of good sex for you at this point
in your life. Try to be as thorough as you can be, and if you feel able and
have one at the moment, ask your partner to do the same. Knowing the key
aspects of each other’s version of a ‘good’ sex life right now is a crucial
part of futureproofing your sex life over time, as it allows you to navigate
your sex life around what’s important, rather than an arbitrary societal
yardstick, such as frequency.

What does the science say about what makes sex good in the
long term?
Now that you’ve worked this out for yourself, let’s also look at what
science tells us about sexual satisfaction in long-term relationships. Recent
ground-breaking research tells us that there are several qualities of sex lives
that are associated with couples who report ‘good sex’, and they are not
necessarily the ones you’d think. Knowing about these can help you foster
them or aspire to do more of them to see what difference they can make for
you.

Responsiveness
‘Communal giving’ is a term used to describe giving to others when we
don’t expect to receive in return 1 and ‘communal strength’ is a term used to
describe how inclined we might be to meet the needs of a partner. 2 The
basic principle of communal strength is that we place value on meeting a
partner’s needs for the sake of meeting their needs and not for our own
personal gain. We meet needs that are within our ability/resources, and not
unreasonable, and we trust that at some future point they will meet our
needs in return. Sexual communal strength has been defined by Amy Muise
and colleagues as the ability to be receptive to a partner’s sexual needs (to
have or not have sex as well as how), based on their partner’s wants and
preferences rather than the impact that this might have on them. 3 This
might include things like agreeing to have sex when they aren’t really
feeling like it, * trying out things our partners are interested in, or being
understanding about a partner’s desire not to have sex. Research has found
that, in long-term relationships, people who report higher levels of
communal strength in their relationship report higher levels of sexual
satisfaction and desire. 4 There is, of course, an interesting nuance here in
heterosexual relationships, where gender equality intersects with sexual
communal strength. For example, how does this responsiveness play out
when there is a gendered script of whose pleasure is expected as a given,
with weighted opinion on the expectation of men’s pleasure as a priority?
* There are limits to this. Having repeated experiences of consensual unwanted sex is not helpful for
long-term sexual desire. Agreeing to have sex when you’re not feeling like it in terms of sexual
communal strength refers to feeling sexually neutral, but being willing to have sex from time to time,
with an idea that responsive desire and enjoyment might follow rather than having sex for avoidance
motivations, such as to avoid a row.

It can be useful for all of us to consider how empathic we are towards our
partner’s needs and wants sexually, and the positive change in desire or
satisfaction we both might see if we were prepared to sometimes put our
partner’s sexual needs before our own without expecting anything in return.
Being overly fixated on your own needs, wants and preferences, as opposed
to someone else’s, or having a strong sense of personal sexual entitlement
(dubbed ‘sexual narcissism’) lowers sexual satisfaction and desire for both
partners over the course of a relationship. 5

Conscientiousness
Sex researchers have moved outside the realms of sex to look at personality
characteristics and how they impact on sexual satisfaction in relationships
more generally. Fascinatingly, in one study published in The Journal of Sex
Research , a personality trait found to predict sexual satisfaction was
conscientiousness. 6

Conscientiousness, typically described as being good at planning, attention

to detail, being organized and dependable, is not necessarily the one
personality trait of the ‘Big Five’ (the constructs we usually think of as
defining people- the other four are openness to experience, extraversion,
agreeableness and neuroticism) that you would expect to see connected
with better sex. Or perhaps not until reading this book. Conscientiousness
seems like a surprise due to our societal emphasis on good sex being about
spontaneity and passion . However, it’s likely that conscientiousness is so
good for our sex lives as people who have more conscientious traits are
more likely to factor in time to be intimate, to consider their partner’s
needs, try hard to please, remember what partners like and spend time
considering setting the context and overcoming obstacles. All things which
I’m sure you can see at this stage might be good for long-term desire and
particularly good for scheduling emotional and physical intimacy.

Self-expanding activities
Another key influential study has added to what we know about how we
spend time with our partners and the impact of this on sexual satisfaction
and desire.

Research has already shown that couples who engage in activities that are
exciting, inspiring or challenging are able to revisit or regenerate some of
those much-sought-after early relationship feelings towards one another, 7
and Muise and her colleagues wanted to look at the impact of this on sexual
desire.

They discovered that an injection of novelty and ‘self-expansion’ into

ourselves or our relationship outside the bedroom can affect what happens
within it, and that couples who spend more time doing novel, interesting
and challenging activities individually or together see an improvement in
their sex life as a result. 8 They found that couples who spent time on these
self-expansion activities (as opposed to just time together as usual) were
more likely to experience sexual desire, and more likely to have sex than
couples who didn’t.

Self-expanding activities could include things like going on a road trip

together, learning to dance, developing a new skill together, or undertaking
some kind of challenge, such as cooking a new meal from scratch or going
rock climbing. These experiences mirror some of the earlier relationship
dynamics when couples are still learning about each other and having novel
experiences together. The rationale behind this is that self-expanding
activities bring with them a change in intimacy, and new information or
perspectives on a partner who might otherwise seem well known and
overfamiliar. This can bring with it a resurgence or injection of desire.
Hopefully, you can spot the link between this research and some of the
relationship dynamics around overfamiliarity, intimacy and giving each
other the scraps that we discussed in Chapter 5.

What’s important to take note of is that, in this research, it was not the time
couples spent together but how they spent this time that resulted in higher
reported desire and sexual activity. Couples who found ways to ‘excite,
inspire and connect’ with each other may have created some space to learn
new things about themselves or each other and so created conditions of
novelty, distance and excitement, akin to those early months, fanning the
flames of desire. There was another crucial finding of this study: the longer
sexual partners had been together, or the more pressed for time they were
(think new parents), the more impact self-expansion activities such as these
had on their sex lives.

What does this mean for our long-term sexual relationships? It means that,
if we want to keep our sex lives hot, then perhaps it’s time to prioritize
making time to really connect, by having explorative and meaningful
conversations with the intention of discovering new things about each other
– not just about what we ate for lunch or who said what at the photocopier.
For some of us, it might be as simple as looking at each other through
another person’s eyes, or in a different environment, such as watching our
partners charm the new neighbours at a party. It might be planning an
adventure together, trying something new and exhilarating, or learning
something new. The bottom line is: the challenge to creating time together
that involves something novel and exciting might take a bit of thought and
planning but it could have some serious benefits to our sex lives.

Our experiences of desire and sexual satisfaction are complex, and there are
many things adding to this picture (what’s going on in our bodies, our
personal relationship with sex, our relationship with our cultural and social
contexts), but there is a tangible real-life value in studies such as this, which
demystify what practical steps we can take to improve things when it comes
to futureproofing our sex lives.
How to deal with being thrown off course
Earlier in this chapter I mentioned that, throughout the course of our sexual
lives, there will be changes to our bodies, minds, relationships and
circumstances that impact upon our sex lives, requiring a temporary halt, a
change of course or even a total rethink as to what sex even is/looks like.
These changes are normal and not necessarily to be feared. In fact, they
provide us with an opportunity for novelty and recalibration.

The impact of life transitions, such as being pregnant, having young

children, ill health, periods of intense stress, anxiety, physical changes,
relationship stresses, ageing, moving house, grief and many more, will
bring with them challenges for sex and desire. This might mean sex loses
momentum for a while, becomes less satisfying, or that it falls off the
agenda completely. This is normal and not something to worry about. In
fact, research shows us that understanding that sexual desire ebbs and flows
is a key predictor of long-term sexual satisfaction and that subscribing to
this view is, in itself, a barrier to desire dropping. 9 One of the reasons for
this is that it changes the interpretation we make of our partner’s low desire
if we attribute it to their stress levels rather than to something about us or
our relationship. It also means we are more likely to make efforts to get
things back on track. So, the first thing you need to do to keep your sex life
good in the long term is to understand that your sex life will go through up
and downs in response to these events, and that this is to be expected . In
some ways, this is where the understanding of sex as a fluid and responsive
motivation , rather than a drive , comes in, as it helps make sense of these
changes when they happen, unlike the fixed idea of a drive that is innate,
inflexible and unwavering. I hope that, after reading this book, you now see
this differently and understand that, due to the nature of desire, it will ebb
and flow as your life and relationship unfolds, as having this belief is in
itself good for your sex life.

This normal ebb and flow is where sexual currency can be so vital. Relating
to each other as sexual people not only meets some of the motivations each
of you might have for sex (feeling attractive, feeling connected), but allows
you to maintain a sexual connection no matter what else is going on for you
or however ‘time poor’ you are. A good example of this is the experience of
becoming parents for the first time. We know from research that almost
90% of new parents report at least one concern about sex in the first year
after having a baby, 10 and in Chapter 6 I mentioned that sexual satisfaction
can be at its lowest during a couple’s lifetime in the first few years of
having small children. Being new parents creates obvious challenges for sex
in all the ways we have spoken about (tiredness, increased household tasks,
changes in body image, less time together as a couple, stress, increased
distraction, etc.), but also in the biological ways we mentioned (especially
tiredness). Having young children, therefore, is a time when many couples
can expect there to be multiple barriers to their pre-existing sex life, in a
way that might require both an acceptance that this is usual and nothing to
worry about, but also that they should find ways to maintain sexual
connection in the absence (or reduction) of sex.

Importantly, creating a culture of sexual currency even outside of having an

active ‘sex life’ (by that I mean partaking in sexual acts together) maintains
that scaffold which allows an easier climb to sexual activity when the
moment is right. Not maintaining a culture of sexual currency, or of sexual
connection, in times of low sexual activity not only means there’s a risk that
some of the needs that sex serves are not met, but it can leave couples with
a sense that restarting sex again feels awkward or jolting. When I see
couples like this for sex therapy, they often describe their relationship in
terms of it feeling non-sexual (like ‘brother and sister’; or ‘sister and sister’,
if a female couple). What they mean by this is ‘we’ve not related to each
other sexually for so long that it’s started to feel odd to even contemplate
that’. It’s this dynamic that maintaining sexual currency avoids.

Being new parents isn’t the only life stage or transition during which a
couple can benefit from considering the role that increasing sexual currency
can have on maintaining a good sexual connection. Any situation which
puts the time or inclination to keep sex a priority in jeopardy fits. This
might be around work stress, moving house, feeling time pressured around
family demands, through ill health, the menopause or when caring for
someone else. The mistake couples often make is perceiving that it is the act
of sex itself that matters, the physical release – even more: penetrative sex.
But as we spoke about in Chapter 5, it is rarely the act of sex itself that
motivates us to move towards sex with someone else but rather the need
that it is meeting. These needs, if you remember, might be about closeness,
excitement, intimacy, feeling wanted, resolving conflict, expressing
attraction or ‘feeling alive’, for example. In a period of lower sexual
interaction for whatever reason, understanding and nurturing these needs in
other ways can help relationships survive when sex is off the menu. Let’s
look at Anna and Doug, whose experience of a significant life event
affected their sex life.

Anna and Doug had been together fifteen years when they came to
see me due to differences in desire, which was causing problems in
their relationship. Anna had been feeling like having sex less in the
last few years, partly, she thought, as she was experiencing early
menopausal symptoms and had noticed a change in her mood and
sleep, which was making her not feel like herself. Partly it was
because she was caring for her sister, who had recently received a
diagnosis of cancer. Anna felt like sex was the last thing she wanted
to be thinking about and was feeling less receptive to sex with Doug.
This was showing itself in reduced sexual stimuli between them,
sometimes because she experienced Doug’s pleas for sex as irritating
and she wanted to avoid them. Once we got talking, it transpired that
Anna perceived Doug’s repeated requests for sex, or ‘jokes’ about
how long it had been, as insensitive and hurtful. After all, she knew
that men could be ‘sex mad’, but she experienced this as frivolous
 and disrespectful when there was so much more going on.

Anna was making assumptions about Doug’s motivations for sex based on
societal views of male desire (i.e. ‘men always want sex’, ‘men have a need
for physical release’) and interpreting this as unimportant and insensitive.
During the course of therapy we spent some time understanding their
motivations for sex and the function that sex served in the relationship. We
learned that Doug was actually motivated to have sex when he wanted to
feel close to Anna, and that, over the course of her sister’s diagnosis and
illness, he had become increasingly worried about Anna’s mortality and
preoccupied with her becoming ill. He was craving closeness with Anna
more than ever, at a time where she was restricting her affection for him, for
fear of turning him on or ‘giving him the wrong idea’. Anna was shocked to
hear about how Doug really felt, and understanding what sex meant for him
totally changed her feelings towards him when he expressed how he missed
it or when he suggested it. Doug reassured Anna that being physically
intimate together – whether it was sex or not – would make him feel better,
and Anna was really happy to bring this back, given her new knowledge.
Anna and Doug found that Anna’s new understanding of Doug’s
motivations, changing her entrenched beliefs from ‘he just wants to satisfy
a physical urge’ to ‘he adores me and is also frightened for the future’,
reignited their sexual relationship, as sex took on an important and life-
affirming meaning in a time of heightened mortality and stress.

The lesson from all of this for couples wanting to maintain a good sex life,
despite the challenges that will undoubtedly come their way, is to
understand exactly what is missing when ‘sex’ is and to find other ways to
meet these needs until things return to an even keel.

How to deal with changing needs

Our sexuality doesn’t remain static over the course of our lifetime. Our
sexual confidence, likes, dislikes, preferences, what we find erotic, our
bodily function and ability to experience physical sensations are constantly
changing. As a society we would do well to hold this in mind more when
thinking about sex over the course of our sexually active years on the
planet. It is certainly the case that some people’s sexual problems at any life
stage are a direct consequence of their sexual relationship not being able to
adapt to these changes successfully, not the changes themselves.

The assumption of sex and sexuality as static can discourage us from

having useful conversations about where we might like our sex lives to go,
what changes we might like in how we do things or how changes in our
identity might be indicative of new possibilities for sex. For example,
women generally report fewer concerns about body image the longer they
have been with a partner. 11 Women also report higher levels of sexual
assertion, and therefore sexual satisfaction, as they age. 12 For some women,
this can show itself in a new-found sexual confidence and feeling of
wanting more variety of sexual expression as they move through life. The
myth of women reaching their ‘sexual peak’ at an older age to men is not
about sexual function per se but an awareness that (sadly) it can take
women decades to shake off the restraints of body-image oppression, lack
of knowledge about their genitals, acceptance of the orgasm gap and
restrictions on assertiveness in order to be able to know about and demand
the types of sex that they need. This increase in sexual confidence and
satisfaction is to be celebrated, but the relationship women find themselves
in needs to be able not just to withstand this change but adapt to it.

It’s normal to develop new preferences in sexual touch, want to try out new
things or suddenly develop a new interest and want to try out something
different. The danger comes when we develop a relationship culture which
does not support this, either because the way in which we have defined sex
has become predictable and fixed, so there’s no room for change, or the part
we’ve got used to playing sexually has become predictable, or because we
have not nurtured a concept of sex as flexible and ever changing, and so
suggesting a change feels too ‘out of the blue’ or a big deal.

One of the ways I often talk about couples creating this culture of
anticipated change and growth in their sexual relationships is to create a
ritual of regular review and conversation about sex which follows three key
lines of enquiry:

What’s been going well in our sex life that we want to continue?

What would we like to do more of in our sex life and how can we pre-
empt barriers that might get in the way?

What new directions might we want to explore in our sex life? What
would we like to try out together or alone, or learn more about?

It’s useful to get into the habit of having this type of conversation regularly,
linked to another date or event, for example, as part of a New Year’s Day
‘looking forward’ conversation, linked to an anniversary, or as a ritual on a
yearly summer’s holiday. Building in this kind of checking-in and future-
focused conversation about sex circumvents the need to only talk about sex
when there is a problem, which is often the hardest time to respond and
react to feedback. It is also likely to mean that conversations about sex
become more positive as, by the nature of this type of discussion, sexual
problems are more likely to have been avoided by pre-emptive
conversations about building in changing needs and wants around sex.

Apart from changing preferences, tastes and sexual identity, there are also
physical changes happening throughout the course of our lives. We often
think of changes in bodily function, health and ability as negatives for
sexual function, but they don’t need to be.

In fact, forced modifications to our sex lives as a result of physical changes

can be a time of golden opportunity in so many ways. They provide an
opportunity to break free of predictable, societally dictated sexual scripts
and habits or the routines we can easily fall into with the same person over
time. These changes can allow us the opportunity to experience new
sensations, new ways of being, or to bring different definitions to what sex
means. These aspects of life challenges don’t get the airtime they should, in
my opinion, in terms of the potential impact they could have on revitalizing
sexual expression and satisfaction.

Consider pregnancy, for example. Pregnancy is a time of intense physical,

psychological and relational transition. It is also a time of well-documented
changes in sexual function. Desire might increase or decrease, penetrative
sex might feel more or less welcome, orgasms might change in their trigger,
intensity or sensation. These experiences can provide great opportunities for
novel experiences of pleasure, expression and desire if we welcome them. It
we don’t, they might show themselves in sexual problems (which are
actually very common in pregnancy). Adapting to new sexual positions that
don’t put pressure on the abdomen from the second trimester onwards can
be challenging for couples who only ever have sex in the ‘missionary’
position. Equally, adapting to a sudden dislike of penetrative sex can be
difficult if you have reduced your sex life to very little else. For some
people, however, experimentation in pregnancy can lead to the emergence
of new sexual preferences that would otherwise have gone undiscovered.
Having to communicate and adapt in times of physical change opens doors
around sex that might have otherwise stayed closed. The benefits of this
adaptation is also true for the impact of ageing and health-related sexual
changes, such as age-related declines in genital sensitivity, difficulties with
erectile function linked to ill health or changes in mobility. As with many
other aspects of our sex life, it is the way we respond to these challenges,
not the challenges themselves, that dictates our future sexual satisfaction.

It’s important to note that, for some women, going through the menopause
can have a negative impact on desire, and this is a good example of how our
sex life might need to temporarily or permanently adapt to our changing
needs. The physical and psychological impact of the menopause – hot
flushes, sleep difficulties, vaginal dryness, painful sex and low mood – are
well documented, and for obvious reasons (which by this stage in the book
you will be super familiar with) reduce desire. Who wants someone
touching them when they feel as though they are in an oven and dripping
with sweat? Who wants to continue a sex life with their partner if it’s only
been penetrative vaginal sex for the last fifteen years and penetrative sex
now hurts? One piece of good news about this is that this doesn’t happen
for everyone, and for many women not having to think about contraception
or periods brings with it a new sense of sexual freedom. The other good
news is that research suggests that how your sex life was pre-menopause
and your feelings towards your partner are more reliable predictors of how
your sex life will be post-menopause than your oestrogen levels.13 This
makes sense when you think about it, as hormones are essential to the
process of arousal and desire but, as desire is a largely a psychological,
relational and social event, these other aspects are key to how easily desire
can emerge. When you add in the other life changes which might be
happening for women around the same time, such as the possibility of
having elderly parents to look after, experiencing being seen as ‘less sexual’
by society, being in a long-term relationship, and the increased chance of a
partner of a roughly similar age having a sexual problem, we can see how
these things might also contribute. The menopause is certainly a time of
physical change for women which can bring with it transitions in sex and
desire, but it is important to remember that there are effective physical
treatments for these symptoms, such as hormone replacement therapy
(HRT), local oestrogens and the use of vaginal moisturizers and lubes
which can really help to alleviate symptoms. Research tells us that many
people in mid-life and older don’t feel comfortable talking to their doctor or
health-care provider about their sex life.14 This is unfortunate, and a
byproduct of the impact of ageist (and inaccurate) ideas of people in mid-
life and beyond being less sexual, as well as the challenge of a lifetime of
being socialised not to talk about sex. Please do talk to your health-care
provider if you are experiencing symptoms which are affecting your life in
this way, so that you can be supported effectively during this transition.

Is sex a priority?
For some people, sex is the most important, or one of the most important,
things in a relationships; for others not so much. It’s possible that you are
reading this book because you are somebody who rates sex as important,
and doing so is one of the ways in which you are treating it as such. It’s also
possible that you are reading this book because society tells you that sex is
important, but actually, for you, it’s not so much of a big deal. Whichever
way you look at it, there’s no doubt that, for many couples, the research
shows that sexual satisfaction is good for relationship satisfaction, even if
it’s not the most important thing.

I firmly believe that, if we feel sex is important, we should treat it as such,

by taking purposeful and intentional action to prioritize it. I also feel that
the way in which sex and desire are framed to us in society is that ‘it
shouldn’t need work’ and ‘it should just happen’, which totally gets in the
way of us knowing how to action prioritizing it. You don’t stay healthy
without taking purposeful and intentional action around your diet and
exercise, and sex is similar, except possibly more challenging, as it involves
the understanding, communication and commitment to action of someone
else. A change in mindset, therefore, is what’s needed to understand what
needs to be done and to choose to do it.

We lead busy lives, but we are constantly making choices about how to
spend our time and we need to consider the impact that this will have on our
lives and relationships. The problem with how we’ve perhaps seen sex until
now is that we haven’t thought of it as something we need to dedicate time
to. Perhaps now we have identified the multitude of reasons and ways in
which we might give it more priority, we might have to consider other
sacrifices or changes in our routine to make this possible. After all, I’m not
sure there are many of us who routinely sit twiddling our thumbs and have
time to spare. These decisions about prioritizing are tough, but there is often
room for some compromise. For example, it can be hard to make time for
self-expanding activities as a couple, especially if you have young children
and can’t afford a babysitter. But it might be that you make a commitment
to doing this once a month. If this isn’t possible, there is no reason you
can’t swap one night of TV viewing a week for a night dedicated to novel
fun together, or other types of connection, at home. Buy some paints and try
to paint each other’s portrait, try to cook a complex recipe together, play a
board game, plan a future project, talk about your hopes and dreams. Other
useful changes, such as increasing sexual currency, don’t have to take any
extra time in a person’s day but do require intentional effort and
consideration. Creating moments of increased emotional intimacy or
physical triggers for desire, such as dedicating one night a week to go to
bed early after dinner and lie naked to talk – really talk – and listen will
require a decision to reprioritize this over spending time with friends,
scrolling through Instagram, going to the gym or whatever else.

It is, of course, your call. But I’d like you to consider that not taking action
to prioritize sex is taking action, just in a different way. Your sex life is
happening and unfolding on its own trajectory; the question for you is how
much you want to steer it versus see in which direction it drifts.
OceanofPDF.com
Conclusion

I hope that, in reading this book, you have learned that female sexuality,
satisfaction and desire have historically been presented to us in a way that
disadvantages women’s sex lives from flourishing and that the problem
with ‘low desire’ does not lie within the bodies or minds of individual
women. What I hope you are taking away is that much of this unhelpful
discourse around women’s sexuality is situated within our societies and
gender politics (including how these biases have influenced science) and
that the real truth of women’s desire can set us free. By now, I hope you
have understood that women’s desire, albeit a complex response to a
collection of factors which might require some purposeful action to be
triggered, is much more than meets the eye, and is very closely related to
our social, political, cultural and relationship circumstances than is often
presented to us in soundbites in the press. Women’s desire is not broken; it
just needs to be understood.

I also hope you have taken away the fact that women’s experience of sex,
from early learning about bodily autonomy, safety and pleasure, is heavily
influenced by gender politics around whose needs or pleasure is privileged.
Similarly, societal messages about women’s sexuality and sex more
generally, plus the objectification of women’s bodies, can disadvantage
desire in a way that we are not always consciously aware of, but we do have
the power to take action around. This can be a personal movement, such as
in how we decide to relate to sex or our bodies through what we choose to
expose ourselves to in magazines/social media, or by participating in wider
social movements grounded in feminism, such as #MeToo. I hope you feel
angry about the forces that impact on women’s sexuality, not just so you
can more easily reject some of the less helpful forces in your own sex life
but so you have the inclination to be part of facilitating change for younger
generations to come.

I hope that this book has taken you on a journey of understanding how you
relate to sex and what you need from it in a way that is reassuring for your
sex life, regardless of whether a good sex life for you is letting go of the
importance of sex, or on focusing more attention on it. My aim is to give
you the knowledge and skills to futureproof your sex life, and I hope that,
no matter how good or in crisis your sex life feels at the moment, you have
learned things that will not only make you feel empowered to make it better
right now, but also arm you with the information and science you need to
create a lifetime of good sex, no matter what life throws at you.

After all, the key to sexual satisfaction and desire over the course of your
life is to understand it and then make a decision to move towards what will
help, based on these new understandings. This is how our sex lives can
continue to improve over time rather than stagnate or decline. I hope that
this book has given you new understandings and ideas of how you can do
this for yourself. The rest is up to you.

Here’s to your revolution.

OceanofPDF.com
Acknowledgements

I would like to acknowledge and sincerely thank the following people,

whom, without their faith, support and encouragement this book would not
have been possible.

Firstly, my wonderful editor Anna Steadman, of Headline Home, for

providing the guidance, support and expertise for me to put my thoughts
and words into Mind The Gap . I have total respect and admiration for you
and wish to thank you for having so much faith in my initial vision for this
book and in my writing from the outset.

Huge thanks also to my agent Julia Silk, of Kingsford Campbell, for

helping me navigate the literary world, creating this opportunity and for the
support, encouragement and phone calls along the way. I’m so glad our
paths crossed!

Thanks to the rest of the incredible team at Headline Home, particularly my

publicist Jessica Farrugia, Caroline Young for creating such a bold, modern
cover but also for listening to my preferences throughout the process and
Anna Hervé for her fantastic attention to detail and thoughtfulness in
refining this book at the copy-edit stage.

Without the contribution of sex scientists and researchers all over the world,
too numerous to mention, this book would have been purely clinical
opinion, and I wish to thank them for the work that they do in helping all of
us understand sexuality better. I have learned (and am still learning) every
day from the work that you do. I would particularly like to thank Professor
Lori Brotto, Professor Cynthia Graham, Professor Helen King and
Professor Kirstin Mitchell for their comments on early versions of this
manuscript, and also for their professional guidance, inspiration and
friendship. Lori and Cindy, I have not forgotten that lovely meal we had on
the Titanic(!) and how humble and generous you both were (and still are)
about the things that you have achieved and in your support.

I also wish to thank all of the women who have attended my online desire
workshops and the women and couples that I have worked with in sex
therapy over the last few decades who have taught me so much about
working with sex. It’s always a privilege to sit in a room with clients and I
am grateful for that every day. I am moved, enthused, excited, invigorated
and thankful that you allow me to share in your journey to a better sexual
life and seeing the impact of this on you and your relationships has been a
motivation to me to convey some of these ideas on a wider level.

Thank you to all my friends who have read chapters, provided

encouragement, support and a listening ear during this process. Particular
thanks to Paul Lawrenson, Steven Thwaite, Chloe Potter, Lindy Fittall, Kate
Baxter, Tamzin Davis, Lizzie Thorne, and Jyothi Parekh who have all heard
more about this book than they needed to over many meals out and whose
enthusiasm for it has been a huge source of motivation along the way.

Thank you to fellow authors and friends Maisie Hill, Sarah Hyndman and
David Bodanis for being a source of encouragement, inspiration and for
being the ‘yes, do it!’ cheerleading team when I was offered this
opportunity. It was so useful to have your experience and perspective on the
book writing process. Thank you to all of my Paragon family for being a
constant source of friendship and inspiration, and for listening to me talk
about the book when I’m supposed to be training, particularly Jessica Shivji
and Rob Taliesin Owen. Thanks also to Rae Langford for her friendship,
enthusiasm and support and for providing a tranquil space to write when I
needed it.
Thank you to the rest of the Havelock Clinic team, Dr Ali Mears, Dr Jane
Ashby, Dr Michael Yates, Sarah Wolujewicz and Katy Harrad for teaching
me so much, being such inspirations and allowing me to take my foot off
the accelerator for a few months to focus on this book. I’m so proud to
work with the best in the business and I am forever grateful for having you
as my colleagues. Thank you also to all of the incredible team at 56 Dean
Street who have provided encouragement and flexibility over the last few
months. It really is a joy to work with you.

Thank you to the psychology teacher and my first supervisor who told me
to give up on my dreams of being a clinical psychologist as it was ‘too
competitive’ and I was not ‘academic enough’. I’m glad I was too young
and enthusiastic back then to listen to you. Real thanks and appreciation to
Glenda Fredman, who taught me the joy of systemic therapy and how to
truly work well with couples. I hope you see the influence of the seed you
planted within me in this book. Thank you for being such an inspiration to
me professionally. I use your teachings in every therapy session I do.

Lastly, I could not have succeeded in this endeavour without the support of
my family, who have sacrificed and given themselves in a way that they
always do to support me in my goals. Thank you to my mum, dad, brother
and sister-in-law Anna for unconditional love and bearing with my lack of
visits up north, the endless childcare and me needing to work all the time.
Thank you to my two boys for being magnificent and accepting that I’ve
worked a lot recently – I can play now, boys! Get the Lego out!

My final and most important thanks to my partner AJ, for whom this book
is dedicated, and for whom I am grateful for every single day. Thank you
for the online shops, the washing, for taking the kids swimming, for talking
me out of my doubts, for the (very slow) reading, and most importantly for
your unfaltering belief in me and this book. I adore you.
OceanofPDF.com
Notes

1. A brief history of sex, science and gender politics

1 . E.g.: https://quod.lib.umich.edu/w/wsfh/0642292.0033.009/--marriage-
calculations-in-the-eighteenth-century?rgn=main;view=fulltext .
2 . Dabhoiwala, F., The Origins of Sex: A History of the First Sexual
Revolution (London: Allen Lane, 2012).
3 . Forde, K., Beddard, H. and Angel, K., The Institute of Sexology
(London: Wellcome Collection/Prestel Publishing, 2014).
4 . Diagnostic and Statistical Manual of Mental Disorders , 3rd ed.
(Washington, DC: American Psychiatric Association, 1980).
5 . Ellis, H., Sexual Inversion (1896); republished in Studies in the
Psychology of Sex , vol. 2, ‘Sexual Inversion’ (CreateSpace Independent
Publishing Platform, 2014).
6 . Kaplan, H.S., ‘Hypoactive Sexual Desire’, Journal of Sex & Marital
Therapy , 3:3–9 (1979).
7 . Jaspers, L., Feys, F., Bramer, W.M., Franco, O.H., Leusink, P. and Laan,
E.M., ‘Efficacy and Safety of Flibanserin for the Treatment of
Hypoactive Sexual Desire Disorder in Women: A Systematic Review and
Meta-Analysis’, JAMA Internal Medicine , 176, 453–62 (2016).
8 . Working Group for a New View of Women’s Sexual Problems (2000):
The New View Manifesto: A New View of Women’s Sexual Problems ,
http://www.fsd-alert.org/manifesto5.asp . Accessed 28 February 2019:
Kaschak, E. and Tiefer, L. (eds.), A New View of Womens’ Sexual
Problems (New York, NY: Haworth Press, 2001).
9 . Diagnostic and Statistical Manual of Mental Disorders , 5th ed.
(Washington, DC: American Psychiatric Association, 2013).

2. Mind the gap – statistics around sex and desire

1 . See all key findings and papers at http://www.natsal.ac.uk/home.aspx.
2 . Wellings, K., Palmer, M.J., Machiyama K. and Slaymaker, E., ‘Changes
in, and Factors Associated with, Frequency of Sex in Britain: Evidence
from Three National Surveys of Sexual Attitudes and Lifestyles (Natsal)’,
British Medical Journal , 365:1525 (2019).
3 . Mitchell, K.R., Mercer, C.H., Ploubidis, G.B., et al., ‘Sexual Function in
Britain: Findings from the Third National Survey of Sexual Attitudes and
Lifestyles’, The Lancet , 382 (2013).
4 . Mitchell, Kirstin R., Jones, Kyle G., Wellings, Kaye, Johnson, Anne M.,
Graham, Cynthia A., Datta, Jessica, Copas, Andrew J., Bancroft, John,
Sonnenberg, Pam, Macdowall, Wendy, Field, Nigel, and Mercer,
Catherine H., ‘Estimating the Prevalence of Sexual Function Problems:
The Impact of Morbidity Criteria’, Journal of Sex Research (2015).
5 . Taylor, P., Funk, C. and Clark, A., ‘Generation Gap in Values, Behaviors:
As Marriage and Parenthood Drift Apart, Public is Concerned about
Social Impact’, Pew Research Centre (2007).
6 . Burleson, M.H., Trevathan, W.R. and Todd, M., ‘In the Mood for Love
or Vice Versa? Exploring the Relations among Sexual Activity, Physical
Affection, Affect, and Stress in the Daily Lives of Mid-Aged Women’,
Archives of Sexual Behavior , 36, 357–68 (2007).
7 . Muise, A., Impett, E.A., Desmarais, S. and Kogan, A., ‘Keeping the
Spark Alive: Being Motivated to Meet a Partner’s Sexual Needs Sustains
Sexual Desire in Long-Term Romantic Relationships’, Social
Psychological and Personality Sciences , 4, 267–73 (2013).
8 . Fallis, E.E., Rehman, U.S., Woody, E.Z. and Purdon, C., ‘The
Longitudinal Association of Relationship Satisfaction and Sexual
Satisfaction in Long-Term Relationships’, Journal of Family Psychology
, 30, 822–31 (2016).
9 . Mitchell, K.R., Mercer, C.H., Ploubidis, G.B., et al., ‘Sexual Function in
Britain: Findings from the Third National Survey of Sexual Attitudes and
Lifestyles’, The Lancet , 382 (2013).
10 . Sprecher S., ‘Sexual Satisfaction in Premarital Relationships:
Associations with Satisfaction, Love, Commitment, and Stability’,
Journal of Sex Researc h, 39:190–96 (2002); Heiman, J.R., Long, J.S.,
 Smith, S.N., Fisher, W.A., Sand, M.S. and Rosen, R.C., ‘Sexual
Satisfaction and Relationship Happiness in Midlife and Older Couples in
Five Countries’, Archives of Sexual Behavior , 40, 741–53 (2011).
11 . Brezsnyak, M. and Whisman, M.A., ‘Sexual Desire and Relationship
Functioning: The Effects of Marital Satisfaction and Power’, Journal of
Sex and Marital Therapy , 30, 199–217 (2004); Hinchliff, S. and Gott,
M., ‘Intimacy, Commitment, and Adaptation: Sexual Relationships within
Long-Term Marriages’, Journal of Social and Personal Relationship s,
21, 595–609 (2004).
12 . Regan, P.C., ‘The Role of Sexual Desire and Sexual Activity in Dating
Relationships’, Social Behavior and Personalit y, 28, 51–9 (2000).
13 . Traeen, B., ‘When Sex becomes a Duty’, Sexual and Relationship
Therapy , 23(1), 61–84 (2008).
14 . Revicki, D.A., Fisher, W., Rosen, R.C., Kuppermann, M., Margolis,
M.K. and Hanes, V., ‘The Impact of Hypoactive Sexual Desire Disorder
(HSDD) on Women and Their Relationships: Qualitative Data from
Patient Focus Groups’, Journal of Sexual Medicine , 7(3), 124–125
(2010).
15 . Muise, A. and Impett, E.A., ‘Applying Theories of Communal
Motivation to Sexuality. Social and Personality Psychology’, 455–67
(2016).
16 . Mitchell, K.R., King, M., Nazareth, I. and Wellings, K., ‘Managing
Sexual Difficulties: A Qualitative Investigation of Coping Strategies’,
Journal of Sex Research , 48:4, 325–33 (2011).
17 . Klusmann, D., ‘Sexual Motivation and the Duration of Partnership’,
Archives of Sexual Behavior , 31, 275–87 (2002); Sims, K.E. and Meana,
M., ‘Why Did Passion Wane? A Qualitative Study of Married Women’s
Attributions for Declines in Sexual Desire’, Journal of Sex and Marital
Therapy , 36(4), 360–80 (2010).
18 . Velten, J. and Margraf, J., ‘Satisfaction Guaranteed? How Actor,
Partner, and Relationship Factors Impact Sexual Satisfaction within
Partnerships’, PLoS ONE , 12, e0172855 (2017); Acevedo, B.P. and
Aron, A., ‘Does a Long-Term Relationship Kill Romantic Love?’, Review
of General Psychology , 13(1), 59–65 (2009).
19 . Both, S., Everaerd, W., Laan, E. and Janssen, E., ‘Desire Emerges from
Excitement: A Psychophysiological Perspective on Sexual Motivation’, in
Janssen, E. (ed.), The Psychophysiology of Sex (Bloomington, IN: Indiana
University Press, 2007), pp. 327–39.
20 . Murray, S. and Milhausen, R., ‘Factors Impacting Women’s Sexual
Desire: Examining Long-Term Relationships in Emerging Adulthood’,
Canadian Journal of Human Sexuality , 21, 101–15 (2012).
21 . Herbenick, D., Mullinax, M. and Mark, K., ‘Sexual Desire Discrepancy
as a Feature, Not a Bug, of Long‐Term Relationships: Women’s Self-
Reported Strategies for Modulating Sexual Desire’, Journal of Sexual
Medicine , 11, 2196–206 (2014).
22 . Dawson, S.J. and Chivers, M.L., ‘Gender Differences and Similarities
in Sexual Desire’, Current Sexual Health Reports , 6:211–19 (2014).
23 . Basson, R., Brotto, L.A., Petkau, J.A. and Labrie, F., ‘Role of
Androgens in Women’s Sexual Dysfunction’, Menopause: The Journal of
the North American Menopause Society , 17(5), 962–71 2010).
24 . Hyde, J.S., Bigler, R.S., Joel, D., Tate, C.C. and van Anders, S.M., ‘The
Future of Sex and Gender in Psychology: Five Challenges to the Gender
Binary’, American Psychologist. Advance online publication (2018).
25 . Murray, S. and Milhausen, R., ‘Sexual Desire and Relationship
Duration in Young Men and Women’, Journal of Sex & Marital Therapy ,
38, 28 (2012).
26 . Martin, Wednesday, Untrue: Why Nearly Everything We Believe about
Women and Lust and Infidelity is Untrue (London: Scribe Publications,
2018).
27 . Laumann, E.O., Nicolosi, A., Glasser, D.B., Paik, A., Gingell, C.,
Moreira, E., et al., ‘Sexual Problems among Women and Men Aged 40–
80 Years: Prevalence and Correlates Identified in the Global Study of
Sexual Attitudes and Behaviors’, International Journal of Impotence
Research , 17, 39–57 (2005).
28 . Cawood, E.H. and Bancroft, J., ‘Steroid Hormones, the Menopause,
Sexuality and Wellbeing of Women’, Psychological Medicine , 26, 925–
36 (1996); Cain, V.S., Johannes, C.B., Avis, N.E., Mohr, B., Schocken,
M., Skurnick, J. and Ory, M., ‘Sexual Functioning and Practices in a
 Multi‐Ethnic Study of Midlife Women: Baseline Results from SWAN’,
Journal of Sex Research , 40:3, 266–76 (2003); Avis, N.E., Zhao, X.,
Johannes, C.B., Ory, M., Brockwell, S. and Greendale, G.A., ‘Correlates
of Sexual Function among Multi-Ethnic Middle-Aged Women: Results
from the Study of Women’s Health across the Nation (SWAN)’,
Menopause , 12, 385–98 (2005).
29 . Chivers, M.L. and Brotto, L.A., ‘Controversies of Women’s Sexual
Arousal and Desire’, European Psychologist , 22(1), 5–26 (2017).

3. Gaps in the foundations

1 . Palmer, M.J., Clarke, L., Ploubidis, G.B., Mercer, C.H., Gibson, L.J.,
Johnson, A.M., Copas, A.J. and Wellings, K., ‘Is “Sexual Competence” at
First Heterosexual Intercourse Associated with Subsequent Sexual Health
Status?’, Journal of Sex Research , 54:1, 91–104 (2017).
2 . Wellings, K., Nanchahal, K., Macdowall, W., McManus, S., Erens, B.,
Mercer, C.H. and Field, J., ‘Sexual Behaviour in Britain: Early
Heterosexual Experience’, The Lancet , 358(9296), 1843–50 (2001).
3 . Blechner, M.J., ‘The Clitoris: Anatomical and Psychological Issues,
Studies in Gender and Sexuality’, 18:3, 190–200 (2017).
4 . O’Connell, H., Sanjeevan, K. and Hutson, J., ‘Anatomy of the Clitoris’,
Journal of Urology : 174, 1189–95 (2005).
5 . Carvalheira, A., and Leal, I., ‘Masturbation among Women: Associated
Factors and Sexual Response in a Portuguese Community Sample’,
Journal of Sex & Marital Therapy , 39(4), 347–67 (2013).
6 . Brewer, G. and Hendrie, C.A., ‘Evidence to Suggest that Copulatory
Vocalizations in Women are Not a Reflexive Consequence of Orgasm’,
Archives of Sexual Behavio r : 40(3), 559–64 (2011); Hite, S., The Hite
Report: A Nationwide Study of Female Sexuality (Dell Publishing
Co.,1976); Kinsey, A.C., Pomeroy, W.B., Martin, C.E. and Gebhard, P.H.,
‘Sexual Behavior in the Human Female’, Saunders (1953).
7 . Frederick, D.A., St John, H.K., Garcia, J.R. and Lloyd, E.A.,
‘Differences in Orgasm Frequency among Gay, Lesbian, Bisexual, and
Heterosexual Men and Women in a US National Sample’, Archives
Sexual Behaviour , 47:273–88 (2018).
8 . Armstrong, E.A., England, P. and Fogarty, A.C.K., ‘Accounting for
Women’s Orgasm and Sexual Enjoyment in College Hookups and
Relationships’, American Sociological Review , 77(3) 435–62 (2012).
9 . http://www.tandfonline.com/doi/abs/10.1080/00224499.2017.1303437?
journalCode=hjsr20 .
10 . Fugl-Meyer, K.S., Oberg, K., Lundberg, P.O., Lewin, B. and Fugl-
Meyer, A., ‘On Orgasm, Sexual Techniques, and Erotic Perceptions in 18-
to 74-year-old Swedish Women’, Journal of Sexual Medicine , 3, 56
(2006).
11 . Purnine, D.M., Carey, M.P. and Jorgensen, R.S. ‘Gender Differences
Regarding Preferences for Specific Heterosexual Practices’, Journal of
Sex & Marital Therapy , 20(4), 271–87 (1994).
12 . Blair, K.L., Cappell, J. and Pukall, C.F., ‘Not All Orgasms were
Created Equal: Differences in Frequency and Satisfaction of Orgasm
Experiences by Sexual Activity in Same-Sex versus Mixed-Sex
Relationships’, Journal of Sex Research , 55:6, 719–33 (2018).
13 . Frederick, D.A., St John, H.K., Garcia, J.R. and Lloyd, E.A.,
‘Differences in Orgasm Frequency among Gay, Lesbian, Bisexual, and
Heterosexual Men and Women in a US National Sample’, Archives
Sexual Behaviour , 47:273–88 (2018).
14 . Bell, S.N. and McClelland, S.I., ‘When, If, and How: Young Women
Contend with Orgasmic Absence’, Journal of Sex Research , 55:6, 679–
91 (2018).
15 . Wade, L. D., Kremer, E. C. and Brown, J. ‘The Incidental Orgasm: The
Presence of Clitoral Knowledge and the Absence of Orgasm for Women’,
Women and Health , 42, 117–38.
16 . Summarized in Frederick, D.A., St John, H.K., Garcia, J.R. and Lloyd,
E.A., ‘Differences in Orgasm Frequency among Gay, Lesbian, Bisexual,
and Heterosexual Men and Women in a US National Sample’, Archives
Sexual Behaviour , 47:273–88 (2018).
17 . Lloyd, E., The Case for Female Orgasm: Bias in the Science of
Evolution (Cambridge, MA: Harvard University Press, 2005).
18 . Kleinplatz, P.J. and Menard, A.D., ‘Building Blocks towards Optimal
Sexuality: Constructing a Conceptual Model’, Family Journal:
 Counselling and Therapy for Couples and Families , vol. 15, 1, 72–8
(2007).

4. Sex in our society

1 . E.g.: see https://www.telegraph.co.uk/women/life/happened-primary-
school-went-gender-neutral/ .
2 . Gagnon, J. and Simon, W., ‘Sexual Conduct: The Social Origins of
Human Sexuality’, Aldine (1973).
3 . Alarie, M., ‘Sleeping with Younger Men: Women’s Accounts of Sexual
Interplay in Age-Hypogamous Intimate Relationships’, Journal of Sex
Research (2019); Blair, K.L., Cappell, J. and Pukall, C.F., ‘Not All
Orgasms were Created Equal: Differences in Frequency and Satisfaction
of Orgasm Experiences by Sexual Activity in Same-Sex versus Mixed-
Sex Relationships’, Journal of Sex Research , 55:6, 719–73 (2018);
Séguin, L.J. and Milhausen, R.R., ‘Not All Fakes are Created Equal:
Examining the Relationships between Men’s Motives for Pretending
Orgasm and Levels of Sexual Desire, and Relationship and Sexual
Satisfaction’, Sexual and Relationship Therapy , 31:2, 159–75 (2016);
Gewirtz-Meydan, A. and Ayalon, L., ‘Why Do Older Adults Have Sex?
Approach and Avoidance Sexual Motives among Older Women and
Men’, Journal of Sex Research (2018); Klein, V., Imhoff, R., Reininger,
K.M. and Briken, P., ‘Perceptions of Sexual Script Deviation in Women
and Men, Archives of Sexual Behavior , 48:631–44 (2019); Chadwick,
S.B. and van Anders, S.M., ‘Do Women’s Orgasms Function as a
Masculinity Achievement for Men?’, Journal of Sex Research , 54, 1141–
1152 (2017).
4 . Blair, K.L., Cappell, J. and Pukall, C.F., ‘Not All Orgasms were Created
Equal: Differences in Frequency and Satisfaction of Orgasm Experiences
by Sexual Activity in Same-Sex versus Mixed-Sex Relationships’,
Journal of Sex Research , 55:6, 719–73 (2018); Holmberg, D. and Blair,
K.L., ‘Sexual Desire, Communication, Satisfaction, and Preferences of
Men and Women in Same-Sex versus Mixed-Sex Relationships’, Journal
of Sex Research , 46(1):57–66 (2009).
5 . Rosenkrantz, D.E. and Mark, K.P., ‘The Sociocultural Context of
 Sexually Diverse Women’s Sexual Desire’, Sexuality and Culture , 22:
220 (2018).
6 . https://www.ofcom.org.uk/__data/assets/pdf_file/0021/149124/adults-
media-use-and-attitudes-report.pdf .
7 . The Erika Lust not-for-profit site, www.thepornconversation.org [URL
inactive], reports that a third of internet traffic is porn.
8 . Mercer, C.H., Tanton, C., Prah, P. et al., ‘Changes in Sexual Attitudes
and Lifestyles in Britain through the Life Course and over Time: Findings
from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)’,
The Lancet (published online 26 November 2013).
9 . Séguin, L.J., Rodrigue, C. and Lavigne, J., ‘Consuming Ecstasy:
Representations of Male and Female Orgasm in Mainstream
Pornography’, Journal of Sex Research , 55:3, 348356 (2018).
10 . Hurlbert, D.F., ‘The Role of Assertiveness in Female Sexuality: A
Comparative Study between Sexually Assertive and Sexually Non-
Assertive Women’, Journal of Sex & Marital Therapy , 17, 183–90
(1991).
11 . Muehlenhard, C.L. and Shippee, S.K., ‘Men’s and Women’s Reports of
Pretending Orgasm’, Journal of Sex Research , 47:6, 55–567 (2010).
12 . Shirazi, T., Renfro, K.J., Lloyd, E. and Wallen, K., ‘Women’s
Experience of Orgasm during Intercourse: Question Semantics Affect
Women’s Reports and Men’s Estimates of Orgasm Occurrence’, Archives
Sexual Behaviour , 47:605–13 (2018).
13 . Lewis, R. and Marston, C., ‘Oral Sex, Young People, and Gendered
Narratives of Reciprocity’, Journal of Sex Research , 53:7, 776–787
(2016).
14 . Graham, C.A., Sanders, S.A., Milhausen, R.R. and McBride, K.R.
‘Turning On and Turning Off: A Focus Group Study of the Factors that
Affect Women’s Sexual Arousal’, Archives of Sexual Behavior , 33, 527–
38 (2004).
15 . Davison, T.E. and McCabe, M.P., ‘Relationships between Men’s and
Women’s Body Image and Their Psychological, Social, and Sexual
Functioning’, Sex Roles , 52, 463–75 (2005).
16 . Fredrickson, B.L. and Roberts, T.A., ‘Objectification Theory’,
 Psychology of Women Quarterly , 21, 173–206 (1997).
17 . Summarized in Dosch, Alessandra, Ghisletta, Paolo, and Van der
Linden, Martial, ‘Body Image in Dyadic and Solitary Sexual Desire: The
Role of Encoding Style and Distracting Thoughts’, Journal of Sex
Research , 53:9, 1193–206 (2016).
18 . Claudat, K. and Warren, C.S., ‘Self-Objectification, Body Self-
Consciousness during Sexual Activities, and Sexual Satisfaction in
College Women’, Body Image , 11, 509 (2014).
19 . Robbins, A.R. and Reissing, E.D., ‘Out of “Objectification Limelight”?
The Contribution of Body Appreciation to Sexual Adjustment in Midlife
Women’, Journal of Sex Research (2017).
20 . Frederick, D.A., Lever, J., Gillespie, B.J. and Garcia, J.R., ‘What Keeps
Passion Alive? Sexual Satisfaction is Associated with Sexual
Communication, Mood Setting, Sexual Variety, Oral Sex, Orgasm, and
Sex Frequency in a National US Study’, Journal of Sex Research , 54:2,
186–20 (2017).
21 . Ward, L.M., Jerald, M., Avery, L. and Cole, E.R., ‘Following Their
Lead? Connecting Mainstream Media Use to Black Women’s Gender
Beliefs and Sexual Agency’, Journal of Sex Research (2019).
22 . https://www.theguardian.com/commentisfree/2015/mar/25/women-of-
color-police-sexual-assault-racist-criminal-justice .

5. Sex in our relationships

1 . Martin, Wednesday, Untrue: Why Nearly Everything We Believe about
Women and Lust and Infidelity is Untrue (London: Scribe Publications,
2018).
2 . Lehmiller, J., Tell Me What You Want: The Science of Sexual Desire and
How It Can Help You Improve Your Sex Life (London: Robinson, 2018).
3 . Mallory, A.B., Stanton, A.M. and Handy, A.B. ‘Couples’ Sexual
Communication and Dimensions of Sexual Function: A Meta-Analysis’,
Journal of Sex Research (2019).
4 . Murray, S.H., Milhausen, R.R. and Sutherland, O., ‘A Qualitative
Comparison of Young Women’s Maintained versus Decreased Sexual
Desire in Longer-Term Relationships’, Women and Therapy , 37, 319–41
 (2014).
5 . Bateson, G., ‘Steps to an Ecology of Mind’, Chandler Publications for
Health Sciences (1972).
6 . Gonzalez-Rivas, S.K. and Peterson, Z.D., ‘Women’s Sexual Initiation in
Same- and Mixed-Sex Relationships: How Often and How?’, Journal of
Sex Research (2018).
7 . Kim, J.J., Muise, A. and Impett, E.A., ‘Not in the Mood? How Do
People Reject Their Partner for Sex and How Does It Matter? Paper
presented at the Canadian Sex Research Forum, Kelowna, Canada 1
September 2015, in Muise, A., Maxwell, J.A. and Impett, E.A. (2018)
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to Sex Research’, Journal of Sex Research , 55:4–5, 540–62 (2018).
8 . Meston, C.M. and Buss, D.M., ‘Why Humans Have Sex’, Archives of
Sexual Behavior , 36, 477–507 (2007).
9 . Impett, E.A. and Peplau, L.A., ‘Sexual Compliance: Gender,
Motivational, and Relationship Perspectives’, Journal of Sex Research ,
40:1, 87–100 (2003).
10 . Muise, A., Impett, E.A. and Desmarais, S., ‘Getting It On versus
Getting It Over With: Sexual Motivation, Desire, and Satisfaction in
Intimate Bonds’, Personality and Social Psychology Bulletin , 39, 1320–
32 (2013).
11 . Muise, A., Impett, E.A., Kogan, A. and Desmarais, S., ‘Keeping the
Spark Alive: Being Motivated to Meet a Partner’s Sexual Needs Sustains
Sexual Desire in Long-Term Romantic Relationships’, Social
Psychological and Personality Science , 4, 267 (2013).
12 . Dewitte, M., ‘Different Perspectives on the Sex-Attachment Link:
Towards an Emotion-Motivational Account’, Journal of Sex Research ,
49:2–3, 105–12 (2012).
13 . Sims, K.E. and Meana, M., ‘Why Did Passion Wane? A Qualitative
Study of Married Women’s Attributions for Declines in Sexual Desire’,
Journal of Sex & Marital Therapy , 36(4), 360–80 (2010).
14 . Ferreira, L.C., Fraenkel, P., Narciso, I. and Novo, R., ‘Is Committed
Desire Intentional? A Qualitative Exploration of Sexual Desire and
Differentiation of Self in Couples’, Family Process , 54, 308–26 (2015);
 Ferreira, L.C., Narciso, I., Novo, R.F. and Pereira, C.R., ‘Predicting
Couple Satisfaction: The Role of Differentiation of Self, Sexual Desire,
and Intimacy in Heterosexual Individuals’, Sexual and Relationship
Therapy , 29, 390 (2014).
15 . Rubin, H. and Campbell, L., ‘Day-to-Day Changes in Intimacy Predict
Heightened Relationship Passion, Sexual Occurrence, and Sexual
Satisfaction: A Dyadic Diary Analysis’, Social Psychological and
Personality Science , 3, 224–31 (2012).
16 . Perel, E., Mating in Captivity: Reconciling the Erotic and the Domestic
(New York, NY: HarperCollins, 2006).
17 . Muise, A., Harasymchuk, C., Day, L.C., Bacev-Giles, C., Gere, J. and
Impett, E. A., ‘Broadening Your Horizons: Self-Expanding Activities
Promote Desire and Satisfaction in Established Romantic Relationships’,
Journal of Personality and Social Psychology , advance online
publication (2018).
18 . https://www.telegraph.co.uk/news/2018/08/01/decade-smartphones-
now-spend-entire-day-every-week-online/ .
19 . Kalmbach, D.A., Arnedt, J.T., Pillai, V. and Ciesla, J.A., ‘The Impact of
Sleep on Female Sexual Response and Behavior: A Pilot Study’, Journal
of Sexual Medicine , 12 :1221–32 (2015).
20 . Ahlborg, T., Rudeblad, K., Linnér, S. and Linton, S., ‘Sensual and
Sexual Marital Contentment in Parents of Small Children – A Follow-Up
Study When the First Child is Four Years Old’, Journal of Sex Research ,
45:3, 295–304 (2008).
21 . Maas, M.K., McDaniel, B.T., Feinberg, M.E. and Jones D.E., ‘Division
of Labor and Multiple Domains of Sexual Satisfaction among First-Time
Parents’, Journal of Family Issues , 39:1, 104–27 (2015).

6. Sex in our brains

1 . Both, S., Everaerd, W., Laan, E. and Janssen, E., ‘Desire Emerges from
Excitement: A Psychophysiological Perspective on Sexual Motivation’, in
Janssen, E. (ed.), The Psychophysiology of Sex (Bloomington, IN: Indiana
University Press, 2007), pp. 327–39.
2 . Toates, F.M., ‘An Integrative Theoretical Framework for Understanding
 Sexual Motivation, Arousal, and Behavior’, Journal of Sex Research ,
46:2–3, 168–93 (2009); Singer, B. and Toates, F.M., ‘Sexual Motivation’,
Journal of Sex Research , 23:4, 481–501 (1987).
3 . Chivers, M.L., Seto, M.C., Lalumière, M.L., Laan, E. and Grimbos, T.,
‘Agreement of Self-Reported and Genital Measures of Sexual Arousal in
Men and Women: A Meta-Analysis’, Archives of Sexual Behavior , 39, 5
(2010).
4 . Chivers, M.L., ‘The Specificity of Women’s Sexual Response and Its
Relationship with Sexual Orientations: A Review and Ten Hypotheses’,
Archives of Sexual Behavior , 46:1161–79 (2017).
5 . Chivers, M.L. and Brotto, L.A., ‘Controversies of Women’s Sexual
Arousal and Desire’, European Psychologist , 22(1), 5–26 (2017).
6 . Anderson, A.B. and Hamilton, L.D., ‘Assessment of Distraction from
Erotic Stimuli by Nonerotic Interference’, Journal of Sex Research , 52:3,
317–26 (2015).
7 . Beck, J.G. and Baldwin, L.E., ‘Instructional Control of Female Sexual
Responding’, Archives of Sexual Behavior , 23(6), 665–84 (1994).
8 . Silva, E., Pascoal, P.M. and Nobre, P., ‘Beliefs about Appearance,
Cognitive Distraction and Sexual Functioning in Men and Women: A
Mediation Model Based on Cognitive Theory’, Journal of Sexual
Medicine , vol. 13 (9), 1387–94 (2016).
9 . Janssen, E., Everaerd, W., Spiering, M. and Janssen, J., ‘Automatic
Processes and the Appraisal of Sexual Stimuli: Toward an Information
Processing Model of Sexual Arousal’, Journal of Sex Research , 37:1, 8–
23 (2000).
10 . Purdon, C. and Holdaway, L., ‘Non-Erotic Thoughts: Content and
Relation to Sexual Functioning and Sexual Satisfaction’, Journal of Sex
Research , 43(2), 154–62 (2006).
11 . Laan, E. and Both, S., ‘What Makes Women Experience Desire?’,
Feminism and Psychology , 18, 505–14 (2008); Toates, F.M., ‘An
Integrative Theoretical Framework for Understanding Sexual Motivation,
Arousal, and Behavior’, Journal of Sex Research , 46:2–3, 168–93
(2009).
12 . Solomon, R.L., ‘The Opponent Process Theory of Motivation’,
 American Psychologist , 35, 691–73 (1980).
13 . Frederick, D.A., Lever, J., Gillespie, B.J. and Garcia, J.R., ‘What Keeps
Passion Alive? Sexual Satisfaction is Associated with Sexual
Communication, Mood Setting, Sexual Variety, Oral Sex, Orgasm, and
Sex Frequency in a National US Study’, Journal of Sex Research , 54:2,
186–201 (2017).
14 . Dewsbury, D.A., ‘Effects of Novelty on Copulatory Behavior: The
Coolidge Effect and Related Phenomena’, Psychological Bulletin , 89,
464–82 (1981).
15 . Sims, K.E. and Meana, M., ‘Why Did Passion Wane? A Qualitative
Study of Married Women’s Attributions for Declines in Sexual Desire’,
Journal of Sex & Marital Therapy , 36(4), 360–80 (2010); Ferreira, L.C.,
Fraenkel, P., Narciso, I., and Novo, R., ‘Is Committed Desire Intentional?
A Qualitative Exploration of Sexual Desire and Differentiation of Self in
Couples’, Family Process , 54, 308–26 (2015).
16 . Kabat-Zinn, J., Full Catastrophe Living: How to Cope with Stress, Pain
and Illness Using Mindfulness Meditation (London: Piatkus, 1990).
17 . Brotto, L.A., Seal, B.N. and Rellini, A., ‘Pilot Study of a Brief
Cognitive Behavioral versus Mindfulness-Based Intervention for Women
with Sexual Distress and a History of Childhood Sexual Abuse’, Journal
of Sex & Marital Therapy , 38, 1–27 (2012); Velten, J., Margraf, J.,
Chivers, M.L. and Brotto, L.A., ‘Effects of a Mindfulness Task on
Women’s Sexual Response’, Journal of Sex Research , 55:6, 747–57
(2018); Gunst, A., Ventus, D., Arver, S., Dhejne, C., Görts-Öberg, K.,
Zamore-Söderström, E. and Jern, P., ‘A Randomized, Waiting-List
Controlled Study Shows that Brief, Mindfulness-Based Psychological
Interventions are Effective for Treatment of Women’s Low Sexual
Desire’, Journal of Sex Research (2018).
18 . Adam, F., Géonet, M., Day, J. and de Sutter, P., ‘Mindfulness Skills are
Associated with Female Orgasm?’, Sexual and Relationship Therap y,
30:2, 256–67 (2015).
19 . Wolkin, J.R., ‘Cultivating Multiple Aspects of Attention through
Mindfulness Meditation Accounts for Psychological Well-Being through
Decreased Rumination’, Psychology Research and Behavior
 Management , 8, 171–80 (2015).
20 . Brotto, L.A., Basson, R., Smith, K.B., Driscoll, M. and Sadownik, L.,
‘Mindfulness-Based Group Therapy for Women with Provoked
Vestibulodynia’, Mindfulness , 6:417–32 (2015).
21 . Kabat-Zinn, J., Lipworth, L. and Burney, R., ‘The Clinical Use of
Mindfulness Meditation for the Self-Regulation of Chronic Pain’, Journal
of Behavioural Medicine , 8, 163–90 (1985).
22 . Brotto, L.A., Better Sex through Mindfulness: How Women Can
Cultivate Desire (Vancouver, BC: Greystone Books, 2018).

7. Gaps in our understanding of desire

1 . Laan, E. and Both, S., ‘What Makes Women Experience Desire?’,
Feminism and Psychology , 18, 505–14 (2008); Basson, R., ‘The Female
Sexual Response: A Different Model’, Journal of Sex & Marital Therapy
, 26, 51–65 (2000).
2 . Masters, W.H. and Johnson, V.E., Human Sexual Response (Boston,
MA: Little Brown, 1966).
3 . Kaplan, H.S., ‘Hypoactive Sexual Desire’, Journal of Sex & Marital
Therapy , 3, 3–9 (1977).
4 . Nowosielski, K., Wróbel, B. and Kowalczyk, R., ‘Women’s
Endorsement of Models of Sexual Response: Correlates and Predictors’,
Archives of Sexual Behavior , 45, 291–302 (2016).
5 . Bancroft, J. and Janssen, E., ‘The Dual Control Model of Male Sexual
Response: A Theoretical Approach to Centrally Mediated Erectile
Dysfunction’, Neuroscience and Biobehavioral Reviews , 24, 571–79
(2000).
6 . Nagoski, E., Come as You Are: The Surprising New Science that Will
Transform Your Sex Life (London: Scribe Publications, 2015).
7 . Sanders, S.A., Graham C.A. and Milhausen, R.R., ‘Predicting Sexual
Problems in Women: The Relevance of Sexual Excitation and Sexual
Inhibition’, Archives of Sexual Behavior , 37:241–51 (2008).
8 . Basson, R., ‘The Female Sexual Response: A Different Model’, Journal
of Sex & Marital Therapy , 26, 51–65 (2000); Basson, R., ‘Using a
Different Model for Female Sexual Response to Address Women’s
 Problematic Low Sexual Desire’, Journal of Sex & Marital Therapy , 27,
395–403 (2001).
9 . Elaut, E., Buysse, A., De Sutter, P., Gerris, J., De Cuypere, G. and
T’Sjoen, G., ‘Cycle-Related Changes in Mood, Sexual Desire, and Sexual
Activity in Oral-Contraception-Using and Nonhormonal-Contraception-
Using Couples’, Journal of Sex Research , 53:1, 125–36 (2016).
10 . Mitchell, K.R., Geary, R., Graham, C.A., Datta, J., Wellings, K.,
Sonnenberg, P., Field, N., Nunns, D., Bancroft, J., Jones, K.G., Johnson,
A.M. and Mercer, C.H., ‘Painful Sex (Dyspareunia) in Women:
Prevalence and Associated Factors in a British Population Probability
Survey’, British Journal Obstetrics and Gynaecology , 124:1689–97
(2017).

8. What next?
1 . Carvalheira, A.A. and Leal, I.P., ‘Masturbation among Women:
Associated Factors and Sexual Response in a Portuguese Community
Sample’, Journal of Sex & Marital Therapy , 39, 347–67 (2012).
2 . Laan, E., Everaerd,W., van Aanhold, M. and Rebel, M., ‘Performance
Demand and Sexual Arousal in Women’, Behaviour Research and
Therapy , 31, 25–35 (1993).
3 . McCarthy, B. and Wald, L.M., ‘Strategies and Techniques to Directly
Address Sexual Desire Problems’, Journal of Family Psychotherapy , 26,
286–98 (2015).
4 . De Shazer, S., Keys to Solution in Brief Therapy (New York, NY:
Norton, 1985).

9. Futureproof your sex life, for life

1 . Clark, M.S. and Mills, J.R., ‘A Theory of Communal (and Exchange)
Relationships’ in Van Lange, P.A.M., Kruglanski, A.W., and Higgins, E.T.
(eds.), Handbook of Theories of Social Psychology (Thousand Oaks, CA:
Sage, 2012), vol. 2, pp. 232–50.
2 . Mills, J.R., Clark, M. S., Ford, T.E. and Johnson, M., ‘Measurement of
Communal Strength’, Personal Relationships , 11, 213–30 (2004).
3 . Muise, A., Impett, E. A., Desmarais, S. and Kogan, A., ‘Keeping the
Spark Alive: Being Motivated to Meet a Partner’s Sexual Needs Sustains
Sexual Desire in Long-Term Romantic Relationships’, Social
Psychological and Personality Sciences , 4, 267–73 (2013).
4 . Muise, A. and Impett, E.A., ‘Good, Giving, and Game: The Relationship
Benefits of Communal Sexual Motivation’, Social Psychological and
Personality Sciences , 6(2), 164–72 (2015); Muise, A., Impett, E.A., and
Desmarais, S., ‘Getting it On versus Giving It Up: Sexual Motivation,
Desire, and Satisfaction in Intimate Bonds’, Personality and Social
Psychology Bulletin , 39, 1320–32 (2013); Muise, A., Impett, E. A., and
Desmarais, S., ‘Getting it On versus Giving It Up: Sexual Motivation,
Desire, and Satisfaction in Intimate Bonds’, Personality and Social
Psychology Bulletin , 39, 1320 (2013).
5 . McNulty, J.K. and Widman, L., ‘The Implications of Sexual Narcissism
for Sexual and Marital Satisfaction’, Archives of Sexual Behavior , 42(6),
1021–32 (2013).
6 . Velten, J., Brailovskaia, J. and Margraf, J., ‘Exploring the Impact of
Personal and Partner Traits on Sexuality: Sexual Excitation, Sexual
Inhibition, and Big Five Predict Sexual Function in Couples’, Journal of
Sex Research (2018).
7 . Aron, A. and Aron, E.N., Love and the Expansion of Self: Understanding
Attraction and Satisfaction (New York, NY: Hemisphere, 1986).
8 . Muise, A., Harasymchuk, C., Day, L.C., Bacev-Giles, C., Gere, J. and
Impett, E. A., ‘Broadening Your Horizons: Self-Expanding Activities
Promote Desire and Satisfaction in Established Romantic Relationships’,
Journal of Personality and Social Psychology (2018).
9 . Ferreira, L.C., Narciso, I., Novo, R.F. and Pereira, C.R., ‘Predicting
Couple Satisfaction: The Role of Differentiation of Self, Sexual Desire,
and Intimacy in Heterosexual Individuals’, Sexual and Relationship
Therapy , 29, 390 (2014); Murray, S.H., Sutherland, O., and Milhausen,
R.R., ‘Young Women’s Descriptions of Sexual Desire in Long-Term
Relationships’, Sexual and Relationship Therap y, 27, 3 (2012).
10 . Lagaert, L., Weyers, S., Van Kerrebroeck, H. and Elaut, E., ‘Postpartum
Dyspareunia and Sexual Functioning: A Prospective Cohort Study’,
 European Journal of Contraception and Reproductive Health Care , 22,
200–206 (2017); Wallwiener, S., Muller, M., Doster, A., Kuon, R.J.,
Plewniok, K., Feller, S., Wallwiener, M., Reck, C., Matthies, L.M., and
Wallwiener, C., ‘Sexual Activity and Sexual Dysfunction of Women in
the Perinatal Period: A Longitudinal Study’, Archives of Gynecology and
Obstetrics , 295, 873–83 (2017).
11 . Dosch, A., Ghisletta, P. and Van der Linden, M., ‘Body Image in
Dyadic and Solitary Sexual Desire: The Role of Encoding Style and
Distracting Thoughts’, Journal of Sex Research , 53:9, 1193–206 (2016).
12 . Forbes, M.K., Eaton, N.R. and Krueger, R.F., ‘Sexual Quality of Life
and Aging: A Prospective Study of a Nationally Representative Sample’,
Journal of Sex Research , 54(2):137–48 (2017); Hinchliff, S. and Gott,
M., ‘Challenging Social Myths and Stereotypes of Women and Ageing –
Heterosexual Women Talk about Sex’, Journal of Women and Aging ,
20(1/2), 65–81 (2008).
OceanofPDF.com
Further Reading

Andrejek, N. and Fetner, T., ‘The Gender Gap in Orgasms: Survey Data
from a Mid-sized Canadian City’, International Journal of Sexual Health
(2019).

Brotto, L.A., Chivers, M.L., Millman, R.D. and Albert, A., ‘Mindfulness-
Based Sex Therapy Improves Genital-Subjective Arousal Concordance in
Women with Sexual Desire/Arousal Difficulties’, Archives of Sexual
Behavior , 45, 1907–21 (2016).

Frost, R. and Donovan, C., ‘A Qualitative Exploration of the Distress

Experienced by Long-term Heterosexual Couples when Women Have Low
Sexual Desire’, Sexual and Relationship Therapy (2019).

Herbenick, D., Fu, T.C., Arter, J. and Sanders, S.A., ‘Women’s Experiences
with Genital Touching, Sexual Pleasure, and Orgasm: Results from a US
Probability Sample of Women Aged 18 to 94’, Journal of Sex & Marital
Therapy , 0 (0), 1–12 (2017).

Hendrickx, L., Gijs, L., and Enzlin, P., ‘Who’s Distressed by Sexual
Difficulties? Exploring Associations between Personal, Perceived Partner,
and Relational Distress and Sexual Difficulties in Heterosexual Men and
Women’, Journal of Sex Research (2018).

Impett, E.A., Muise, A. and Rosen, N.O., ‘Is it Good to be Giving in the
Bedroom? A Prosocial Perspective on Sexual Health and Well-being in
Romantic Relationships’, Current Sexual Health Reports , 7, 180–90
(2015).
Meana, M., ‘Elucidating Women’s (Hetero)Sexual Desire: Definitional
Challenges and Content Expansion’, Journal of Sex Research , 47:2–3,
104–22 (2010).

Murray, S.H., Milhausen, R.R., Graham, C.A. and Kuczynski, L., ‘A

Qualitative Exploration of Factors that Affect Sexual Desire among Men
Aged 30 to 65 in Long-Term Relationships’, Journal of Sex Research , 54:3,
319–30 (2017).

Salisbury, C.M.A. and Fisher, W.A., ‘“Did You Come?” A Qualitative

Exploration of Gender Differences in Beliefs, Experiences and Concerns
Regarding Female Orgasm Occurrence during Heterosexual Sexual
Interactions’, Journal of Sex Research , 51(6), 616–31 (2014).

Suschinsky, K.D., Huberman, J.S., Maunder, L., Brotto, L.A., Hollenstein,

T. and Chivers, M.L., ‘The Relationship between Sexual Functioning and
Sexual Concordance in Women’, Journal of Sex and Marital Therapy
(2019).

Velten, J., Scholten, S., Graham, C.A., Adolph, D., and Margraf, J.,
Archives of Sexual Behavior , 45:1957–71 (2016).
OceanofPDF.com
Index

#MeToo 287–8
#MeToo movement 82

abortion rights 21
Addyi 22
adequate sexual stimuli 25
advice columns 159
age of consent 49
ageing 282
agency 83 , 216
American Psychiatric Association, Diagnostic and Statistical Manual 16 , 19 , 23 , 25
anal penetration 23
anal sex 90
androgens 40
animalistic sex 122–3
anticipation 105 , 224
anxiety 20–1 , 33 , 179–80 , 191
anxious attachment style 139
approach reasons 137–8
arousability 208
arousal 21 , 101–2 , 167 , 169 , 170–2 , 223
and attention 172–80 , 180
and desire 191 , 204 , 217 , 227–9 , 237
psychological 61 , 63 , 64–5 , 67
arousal contingency 208
asexuality 35 , 44
assertiveness 93
association, learning by 188
attachment style 139–40
Attachment Theory 139–40
attention 184 , 198–201 , 222
importance of 182
mindfulness 189–92
role of 172–80 , 180
and sex 25
during sex 180–3 , 181 , 182
attraction 39
Australia 30 , 32
autonomy 12 , 49 , 79 , 93 , 108
average, the 27
avoidance reasons 137 , 138 , 239
Basson, Rosemary 210–13
Bateson, Gregory 127
behavioural and cognitive therapy 20–1
behavioural sex therapy 20
behavioural theory 184
beliefs 124–5
perpetuation of unhelpful 103–7
benefits 35
bias 28 , 30
black women 109–10
Bletchner, Mark 53
blue balls 101–2 , 224
bodily autonomy 21 , 267
body image 99–100 , 178 , 279
brain, the
arousal 170–2
attention during sex 180–3 , 181 , 182
capabilities 183
complexity 174 , 179
concordance 171
and learning 184–9
negative thoughts 175–9 , 179–80 , 180 , 181 , 182 , 183 , 192
responsibility 196
role of 169
role of attention 172–80
sex drive 166–7 , 168 , 169–70
breastfeeding 151
Bremelanotide 22
Brotto, Lori 191 , 227
Better Sex through Mindfulness 192
Buss, David 132 , 135

casual partners 118

cause-and-effect learning 184
celibacy 36
change 250–1
benefit and loss assessment 255–7
commitment to 254
conversation 252–4 , 261–4
exploring sexuality 257–8
facilitators of 250
goals 259 , 259–61
maximising success 258–64
and men 254–5
 partners and 251–5 , 261
and same sex relationships 255
selling 251–5
shared commitment 259
work 255
children, negative impact of 151–3 , 276 , 285
Chivers, Meredith 170–2
Christianity 12 , 13
circular model of sexual response 210–13 , 227 , 229
circumstantial barriers, to desire 225–6
classical conditioning 185
clinical psychology 29
clitoral orgasm 17
clitoris 51–2
discovery of 53
removal 15
role of 49 , 53
significance 57
stimulation 54 , 56 , 58 , 94
structure 52 , 52
closeness 278
cognitive theory 184 , 185
commitment 259
communal giving 270–1
communal strength 270–1
communication 125–31 , 221
companionate love 37 , 38
compulsive behaviours 192
concordance 171 , 227
conditions for good sex see good sex
conflict 133
connection 135 , 146 , 149 , 156 , 159 , 285
Connell, Helen O. 53
conscientiousness 272
consensual non-monogamy 36
consent 49
control 6
Coolidge Effect, the 187
couple identity 164
cultural shifts 12
demographics, sexual problems 32
depression 32 , 191
desire 2 , 193–4 , 203–43
and arousal 191 , 204 , 217 , 227–9 , 237
baseline 203–4
change over time 37–40
change within a relationship 37–40
 circular model 210–13 , 227 , 229
circumstantial barriers 225–6
and conditions for good sex 64–6
constraining framework 11
decline in 41–2 , 230
drop in 38
Dual Control model 208–9
emotional and physical satisfaction 229–30
and emotional intimacy 231 , 236
expectations for 40
extinguishing 213–14
as first part of human sexual response 19–20
and gender 40–2 , 43
key features 241
kickstarting 245
levels 42–5
long-term 258
loss of 232–4
maintaining 35 , 38–9 , 44–5 , 64–6
measurement 42–3
and men 40–2
normal 43 , 44
and physical attraction 39
physical barriers 226–7 , 237
and pregnancy 282
processes 166–7 , 168 , 169–70
psychological barriers 222–4
and receptivity 213–16
responsive 235 , 238
resurrecting 236–41
same sex relationships 84–5
and sexual currency 215–16 , 216
sexual response model 205–7 , 205
and sexual satisfaction 237 , 241
and sexual stimuli 214–15 , 216–22 , 232
spontaneous 207 , 210 , 212 , 229
triggers 43 , 44 , 211–12 , 228
understanding 231–6 , 240–1
and variety 187
women’s 287
see also sexual desire
desire discrepancy 138 , 194 , 215
desire killers 104
difference which makes a difference, the 127
differences, navigating 40
dissatisfaction 2 , 3 , 47 see also sexual dissatisfaction
distance 274
distraction 65 , 65–6 , 178 , 238
 power of 172–4
distress 33
causes 37
Dual Control model 208–9
dysfunctions 193

early sex 48–9

Ellis, Havelock 17
emails 150
emotional and physical satisfaction 229–30
emotional closeness 37 , 132
emotional health 35
emotional intimacy 146 , 149 , 212 , 231 , 236 , 285
empathy 271
Encyclopaedia of Pleasure 14
enjoyment, lack of 32
equality 98
erectile problems 20–1 , 32
erotica 222 , 228
eroticism, maximum 63
Europe 32
Eve appeal, the 59–60
evidence, importance of 28–9
evidence-based practitioners 29
exercises
conditions for good sex 69–72
desire 244–5
mindfulness 198–201
motivations for sex 162–3
sexual biography 113–15
sexual currency 163–4 , 236
sexual stimuli 244–5
social and cultural factors 113–15
expansion 261
expectation 223–4
expectations, unrealistic 96

Facebook 150
family of origin 78
family values 15
fantasies 121 , 122 , 222 , 228
feedback 63
female sex researchers, numbers 24
Female Sexual Interest/Arousal disorder 25 , 44
feminism 23–5
Finland 30
First World War 15
Flibanserin 22 , 33
flirting 236
focus 175
food and diet 87
Food and Drug Administration (US) 22
foreplay 102–3
freedom 118–19 , 239
frequency, of sex 27 , 30–1 , 42 , 268 , 270
declines in 30–1
dissatisfaction with 31
orgasm 56 , 57 , 58 , 102
in relationships 124–5
Freud, Sigmund 17–18 , 20
futureproofing 258 , 267–85
G spot 59
gap, the 4
gatekeepers, women as 13
gender 79–80
and desire 40–2 , 43
influence 5
as social construct 41
social construction of 108
gender bias 23 , 24
gender equality 4 , 15 , 37 , 42 , 271
gender identity 5
gender inequality 14 , 54 , 55 , 57 , 67
gender politics 108 , 152
gendered roles 230
genital anatomy 53
genital arousal 171–2 , 227–8
genital contact, and sexual functioning 95
giving each other the scraps 143
Global Survey of Attitudes and Behaviours 42
good sex 5
and conscientiousness 272
definition 268–70
over time 267–85
overcoming challenges 274–9
physical touch 66–7
responsiveness 270–1
science of 270–4
self-expansion and 272–4
good sex, conditions for 61 , 65 , 67–8 , 119 , 122–3 , 173 , 182 , 230 , 268
and maintaining desire 64–6
physical touch 62 , 63 , 64–5
presence 62 , 64–5 , 67
psychological arousal 61 , 63 , 64–5 , 67
reflection 69–72
 sharing reflection 71–2
growth 261
habits 123 , 235
habituation 230
heteronormativity 83–4 , 85–6 , 86
heterosexism 85
heterosexual 94 , 94–9
historical influences 11–25
feminism 23–5
male domination 23
medicalization 16 , 21–2
psychiatry 14–15 , 16
psychoanalysis 17–18
religion 12–14
sexology 17–21
subjugation 15–16
history, evidence of 2
HIV 31–2
homosexuality 13 , 17 , 86
hormone replacement therapy 283
hormones 5 , 40
hot flushes 282
human sexual response cycle model 19 , 23
Hypoactive (low) Desire 44
Hypoactive (low) sexual desire disorder 25
hysterectomies, forced 15
hysteria 14–15

Impett, Emily 36
impossible ideal, the 3
impulse control 192
incentives 187
indirect communications 129–30
inequality 4 , 24 , 94–6 , 152
infatuation 37
infidelity 35 , 133
Inhibited sexual desire 16
initiation 127 , 130–1 , 217
injustice 83
innuendo 3
Instagram 51 , 150
instinctive component, lack of 167
interest, lack of 32 , 33 , 40 , 91
internalized beliefs 76–7
intersectional identities 108–11
intimacy 141–2 , 220
changes in 142
 emotional 146 , 149 , 212 , 231 , 236 , 285

Japan 30
Johnson, Virginia 18–21 , 23 , 205–7 , 205
jokes 3
Journal of Sex Research, The 90–1 , 272

Kabat-Zinn, Jon 189–92

Kama Sutra 14
Kaplan, Helen Singer 19 , 205–7 , 205
keeping the peace 137–8
Kinsey, Alfred 18
knowing yourself 61
knowledge, gaps 47–9 , 67
Kobel, Georg Ludwig 53

labels 193–5
language 100–3 , 112 , 125 , 192–6
gaps in 59–60
gender specific 79
helpful use of 194
labels 193–5
learning 167
about sex 79
by association 188
role of 184–9
learnt skill 20
Lehmiller, Justin 121
lesbian bed death 84
lesbian sex 83
LGBT community 17 , 85 , 100 , 103
LGBT couples 95
liberal attitudes 14
life challenges 256
life changes 281–3
life transitions, impact of 275 , 277–9
life-affirming 31 , 279
limitations 123
listening 20 , 71 , 143 , 146
lobotomies, forced 15
low desire medications 22
lust 37, 88 , 117 , 133

madness 14–15
magazines 159
male experience 23
male-centric argument 205–7
manual stimulation 55 , 56
marriage 12–13 , 15
 sex outside 13
Mars, men not from 40–2 , 217
Martin, Wednesday 41–2
masculinity 78 , 91
Masters, William 18–21 , 23 , 205–7 , 205
masturbation 2 , 49 , 54 , 76 , 92 , 94
dangers of 13
mutual 23
and orgasm 55 , 57
and sexual satisfaction 257
matriarchal communities 14
media influence 86–9 , 109 , 112
medical policing 14–15
medicalization 16 , 21–2
memory 167
men 13 , 205
activities resulting in orgasm 56
arousal 101–2
as baseline 203–4
and change 254–5
concordance 171
and desire 40–2
enjoy giving oral sex 98
expectations for 40
initiation of sex 130–1
lack of interest 33 , 40
motivations 135
not from Mars 40–2 , 217
orgasm rates 55
sexual pleasure prioritised 56–7 , 58 , 97–8
sexual problems 32 , 33
sexual response model 205–7
sexual scripts and 92
unrealistic expectations 96
menopause 282–3
messages, conflicting 87
Meston, Cindy 132 , 135
mindfulness 189–92 , 198–201 , 227
mindset 284
minority stress 85
moment, being in the 62 , 64–5 , 67
monogamy 2 , 12 , 12–14 , 36 , 41–2 , 107 , 120–1 , 143
mood difficulties 180
motivations
approach reasons 137–8
avoidance reasons 137 , 239
keeping the peace 137–8
non-sexual 212 , 231
 responsive 275
for sex 132–7 , 162–3 , 185 , 186 , 269 , 277–9
type of 136–7
understanding 135
Muise, Amy 36 , 144–5 , 271 , 273
mutual consent 49
mutual satisfaction 229–30

Nagoski, Emily 208

Natsal study (National Survey of Sexual Attitudes and Lifestyles) 29–30 , 30–1 , 31–2 , 39 , 40 , 90 ,
95 , 138 , 187 , 193
needs 169 , 224
changing 279–83
negative experience 185–6
negative thoughts 175–9 , 179–80 , 180 , 181 , 182 , 183 , 192 , 223 , 238
negotiation 126 , 138
neuroses 17–21
New View, The 24 , 42
newness 274
non-binary people 5
non-sexual motivations 212 , 231
non-verbal communications 129–30
normal, definition 29
novelty 122 , 144 , 187 , 239 , 274 , 275
lack of 230
nymphomania 14–15

objectification theory 99–100

oestrogen levels 283
operant conditioning 185
opponent process effect 187
oral sex 55 , 58
and orgasm 98
and reciprocity 97–9
thoughts during 177
orgasm
activities resulting in 55–6 , 58
clitoral 17
difficulty reaching 32 , 37
early 193
faking 96–7
frequency 56 , 57 , 58 , 102
gender inequality 55
male-centric argument 206
and masturbation 55
and mindfulness 190
not a competition 59
and oral sex 98
 in porn 91
and pregnancy 13 , 281–2
role of 57
orgasm gap, the 4 , 54–7 , 97 , 102 , 112 , 186 , 229
orgasmic capacity 55
outside 13
pain 185–6 , 191 , 226–7
painful sex 191 , 226–7 , 282–3
Papua New Guinea 14
partners
change and 251–5 , 261
responsiveness to needs of 270–1
passion 3 , 37 , 88 , 117 , 133 , 236
past learning 184
patriarchal bias 203–4
patriarchal culture 15
patterns, unravelling 4
pelvic-floor physiotherapy 227
penetrative vaginal sex 57
orgasm rates 55 , 56 , 58
penis-in-vagina sex 86 , 101
privileging 23
Perel, Esther 142
personal boundaries 141
personality traits 272
physical attraction 39
physical barriers, to desire 226–7 , 237
physical changes 281–3
physical experience 165
physical health 32
physical needs 65
physical sensation 132
pill, the 21
planning 104
pleasure 14 , 185 , 238–9 , 269
disregard for 48
male prioritised 56–7 , 58 , 97–8
in porn 90–1
popular culture 44
popular opinion 2
porn 89–91 , 112 , 222
positive experiences 48
power 24
predictability 224 , 230 , 239 , 280 , 281
preferences 66 , 68
pregnancy 13 , 281–2
premature ejaculation 23 , 33
presence 62 , 64–5 , 67 , 237
pressure 223–4
impact of 102
overcoming 224
primary school age 79–80
prioritizing 284–5
privilege 83
problem-free talk 259
procreation 13
Protestant Reformation 13
psychiatric institutions 15
psychiatry 14–15 , 16
psychoanalysis 17–18
psychological arousal 61 , 63 , 64–5 , 67
psychological barriers, to desire 222–4
psychological burden 238
psychological functioning 132
psychological well-being 179–80 , 183
psychotherapy 12 , 17–18
pubic hair 175

racism 109–10
recalibration 275
receptivity 213–16 , 239
reciprocity 97–9
refractory period 23
relational factors, relationships 38
relationship culture 159
relationship difficulties 32
relationship dynamics 118–19 , 119–20 , 122 , 123 , 196
attachment style 139–40
and bad sex 140–1
changes in 39
children 151–3
connecting 143
giving each other the scraps 143
intimacy 141–2
priorities 146–9
provocative 142–3
security 140 , 142–3
time use 144–6 , 149
relationship education 51
relationship identity 122
relationship quality, and sexual problems 35
relationship satisfaction 35 , 284
relationship stability 35
relationships
attachment style 139–40
 and bad sex 140–1
communication 125–31
context 159 , 257
culture of 157
desire change over time 37–40
desire discrepancy in 138
early stages 117–18 , 155
frequency of sex in 124–5
function of sex in 268–9
habits 235
impact of sex on 34–6
initiation of sex 127 , 130–1
intimacy 141–2
like it was in the beginning 117
long-term 3 , 118 , 132 , 138 , 145 , 187 , 237
motivations for sex 132–7
negative impact of children 151–3
negotiation 126
non-sexual parts 144–6
normal 38
priority of sex 284–5
relational factors 38
role of sex 121–5
security 140 , 142–3
self-expansion and 273–4
sex in 117–61
sexual currency 153–9
sexual dissatisfaction in 118
sexual satisfaction in 117–21 , 131 , 140–1 , 159
religion 12–14 , 16
respect 122–3
responsibility 221
responsive desire 235 , 238
responsiveness 270–1
rewards 57 , 169 , 184 , 185 , 186 , 211–12 , 230
routine 123

same sex relationships 83–6 , 101 , 131 , 255

satisfaction 57 , 59 , 83 , 229–30 , 237 , 241
scaremongering 47
scheduling 104 , 105 , 225–6
science 16 , 23
scientific studies, importance of 28–30
secure attachment style 139
security 140 , 142–3
Selective Serotonin Reuptake Inhibitors 180
self-expansion activities 144–5 , 272–4
self-judgement 192
semen, taste of 98
sensual sex 122–3
sex
as biopsychosocial phenomenon 60–1
cultural and social impact 1
definition 5 , 60–1 , 64
fascination of 27
function of 268–9
importance of 34 , 132 , 284–5
life-affirming 31
like it was in the beginning 117
meaning of 124
motivations for 132–7 , 162–3 , 185 , 186 , 269 , 277–9
normal 12 , 19–20 , 23
not a competition 59
outside marriage 13
quality of 31
in relationships 117–61
review conversation 280–1
role in relationships 121–5
with strangers 118 , 119
sex drive 166–7 , 168 , 169–70 , 194 , 228
sex education 67
disregard for pleasure 48
influence 48
media influence 89
and porn 90 , 91
responsibility for 51
sex negativity 40–50 , 47–8
sex neutral 49
sex positive 49–51
sex life
benefit and loss assessment 255–7
changing needs 279–83
comparisons 4
futureproofing 258 , 267–85
good 268–70
improving over time 288
normal 6
overcoming challenges 274–9
perception of 30
and physical changes 281–3
prioritizing 146–9
reality 4
sustainability 156
trajectory 267
sex negativity 40–50 , 47–8
sex neutral talk 47
sex neutrality 49
sex positive families Instagram feed 51
sex positivity 14 , 49–51
sex science 2 , 20
male domination 22–3
sex therapists 28–9 , 259–61
sex therapy 2 , 20–1 , 117 , 227
acceptability 21
key turning points 127
sexology 12 , 17–21 , 205–10
sexual agency 216
sexual assertion 279
sexual biography 113–15
sexual competence 48–9
sexual confidence 257 , 258 , 279–80
sexual connection 188 , 276–7
sexual cues 167
sexual currency 153–9 , 188 , 218 , 236 , 269 , 276–7 , 285
definition 153–4
and desire 215–16 , 216
high 155 , 157
increasing 163–4
investing in 159
relational aspect 154–5
spectrum 155–7
working on 157–9
sexual debut 49 , 100–1
sexual desire
androgens and 40
change over time 37–40
difference in 39–40
discrepancy 138
key to 288
levels 42–5
low 93–4 , 138
portrayal of 133
same sex relationships 84–5
self-expansion and 273–4
sexology 205–10
spontaneous 2–3 , 203–4 , 209–10 , 212
stages 37–40
triggers 43 , 44
sexual dissatisfaction 47
impact of 34–6
negative effects 35 , 36
and porn 91
psychological consequences 35
relationship consequences 35
 in relationships 118
sexual diversity 14
sexual dysfunctions 16 , 19 , 23
sexual excitation 208 , 209
sexual expression, Kinsey’s discoveries 18
sexual freedom 283
sexual function 32 , 95
sexual inhibition 208–9
sexual initiation 217–20
sexual needs 36
prioritization 215–16
sexual neutrality 210–11 , 212
sexual orientation 84
Kinsey’s discoveries 18
sexual pain 191 , 226–7 , 282–3
sexual peak, women 279–80
sexual personas 119–20
sexual problems 32–3 , 159 , 281
coping with 33
hidden concerns 133
internalized 124
negative thoughts and 177–8
and relationship quality 35
understanding 121–5
sexual response 167 , 190
circular model of 210–13 , 227 , 229
sexual response model 205–7 , 205
sexual satisfaction 31–3 , 267
and body image 100
and conscientiousness 272
decline in 39 , 106
and desire 237 , 241
gender differences 42
importance of 34–5
key to 288
long-term 275
and masturbation 257
in relationships 117–21 , 131 , 140–1 , 159
science of 270–4
self-expansion and 272–4
sustaining 106
and variety 187
women who have sex with women 83–6
see also satisfaction
Sexual Script Theory 80–6
sexual scripts 56–7 , 80–91 , 93 , 108 , 109 , 112 , 146
changing 269
dominant 80–2
 and faking orgasms 96–7
heterosexual 76–7 , 83–4 , 86 , 94 , 94–9
and initiation of sex 130–1
media influence 86–9
men and 92
narrowness 101
and oral sex 97–9
pervasiveness 80
and porn 89–91
pressure from 214–15
ramifications 82–3
and reciprocity 97–9
straight=best 85
for women who have sex with women 83
sexual situation 61
sexual stimuli 167 , 169 , 170 , 173 , 190 , 208 , 212 , 228
adequate 25
and desire 214–15 , 216–22 , 232
exercises 244–5
sexual trauma, impact of 188–9
sexual urges, fear of 14
sexuality 108
change over lifetime 125 , 256–7 , 257 , 279–83
changing needs 279–83
connecting with 105
control 16
exploring 257–8
influences on 257
relative value 153–9
standards 1
Sexually Transmitted Infections 32
shame 14 , 48 , 176
sin 12–14 , 18
skill 20
sleep deprivation 151
smartphones 149–50
social and cultural factors 75–112 , 124–5 , 175 , 287–8
body image 99–100 , 178 , 279
heteronormativity 83–4 , 85–6 , 86
heterosexual 76–7
importance of 91–4 , 111
internalized beliefs 76–7
and intersectional identities 108–11
language 100–3 , 112
learning about sex 79–86
media influence 86–9 , 109 , 112
porn 89–91 , 112
reflection 113–15
 sexual scripts 80–91 , 94–9
shifts over time 111
social norms 77–9 , 82
unhelpful beliefs 103–7
social chat 31
social conditioning 132 , 175
social control 15
social learning 79
social learning theory 184
social media 150 , 179
social norms, role of 77–9 , 82
social psychology 77–9 , 80
social rules 82
socialization 98–9 , 127 , 166 , 215
solo sex 66
spontaneous passion 88
spontaneous sex 148–9
ease of 103–5
stimulation 62
strangers, sex with 118 , 119
stress 238 , 276
stress relief 186
subjective arousal 170–2
subjugation 15–16

talking therapy 180

technology 149–50
testosterone 40
thoughts
language influence on 192–6
negative 175–9 , 179–80 , 180 , 181 , 182 , 183 , 192 , 223 , 238
non-erotic 183
three-times-a-week myth 105–6
Tiefer, Leon 24
touch 62 , 63 , 64–5 , 66–7 , 92–3 , 236 , 280
transgender people 5

unhelpful beliefs
ease of spontaneous sex 103–5
expect the worst for your sex life 106
monogamy 107
three-times-a-week myth 105–6
United States of America
declines in frequency, of sex 30
Food and Drug Administration 22
sexual problems 32

vagina 60
vaginal dryness 32 , 282
vaginal moisturisers 283
variety 187
Viagra 21
virginity 75–112 , 100–1
vulva 60 , 97 , 98
Vyleesi 22

well-being 35 , 93 , 191
psychological 179–80 , 183
Wellings, Kaye 48–9
willingness 213–16
women
concordance 171
decline in desire 41–2
desire 287–8
employment 15
as gatekeepers 13
genital arousal 171–2
initiation of sex 131
lack of interest 33 , 91
medicalization 21–2
objectification 287–8
orgasm rates 55
policing of 21
political and social context 42
self-blame 38
sexual peak 279–80
sexual problems 32 , 32–3
social control over 15
subjugation 15–16
worries 37
women of colour 109–10
women’s movement 12
women’s rights 12

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