Come as You Are by Emily Nagoski Read Free Book Online Page B

stimulation begins, her heart rate, blood pressure, and respiration rate increase, and her labia minora and the clitoris darken and swell, separating the outer labia. The walls of the vagina begin to lubricate and then lengthen. Her breasts swell and the nipples become erect. Late in excitement, she may begin to sweat.
    Plateau. Lubrication begins at the mouth of the vagina, from the Bartholin’s glands. Her breasts continue to swell, so much that the nipples seem to retract into the breasts. She may experience “sex flush,” a concentration of color over the chest. By now her inner labia have doubled in size from their resting state. The internal structures of the clitoris lift, drawing the external portion up and inward, so that it retracts from the surface of the body. The vagina itself “tents” around the cervix, open and wide deep inside the body. She experiences the involuntary muscle contraction known as myotonia, including carpopedal spasms (contraction of muscles in the hands and feet). She may begin to pant or hold her breath, as the thoracic and pelvic diaphragms contract in unison.
    Orgasm. All the sphincters of her pelvic diaphragm (the “Kegel” muscle) contract in unison—urethra, vagina, and anus. She experiences rapid breathing, rapid heartbeat, and increased blood pressure. Her pelvis may rock, various muscle groups may tighten involuntarily. She experiences the sudden release of the tension that has accumulated in the muscles throughout her body.
    Resolution. Breasts return to baseline, clitoris and labia return to baseline, heart rate, respiration rate, blood pressure all return to baseline.
    This four-phase model of sexual response quickly became thefoundation of sex therapists’, educators’, and researchers’ understanding of the human sexual response. As the first scientific description of the physiology of sexual response, it would become the basis for defining sexual health and also sexual problems.
    Now imagine you’re a sex therapist in the 1970s, using the four-phase model to understand and treat clients with sexual dysfunction. Some of them you can help. Clients with anorgasmia (lack of orgasm) can learn to have orgasms, those with premature ejaculation can learn to control orgasm, those with vaginismus (vaginal spasms) can learn to relax those muscles. But there’s a group of clients who just don’t seem to respond to therapy informed by the four-phase model.
    This is what happened to psychotherapist Helen Singer Kaplan. Reviewing treatment failures among her own and her colleagues’ patients, she found that the clients with the least successful outcomes were those who lacked interest in sex. Kaplan realized something important was entirely missing from the four-phase model: desire . The entire concept of sexual desire was utterly missing from the dominant theory of human sexual response.
    It seems like a glaring oversight in retrospect, but of course it was missing—people who come to a laboratory to masturbate for science don’t have to want sex before they begin; they just have to get aroused for the purpose of the experiment.
    So Kaplan took the four-phase model out of the laboratory and adapted it to the lived experience of her clients. Her “triphasic” model of the sexual response cycle begins with desire, which she conceptualized as “interest in” or “appetite for” sex, much like hunger or thirst. The second phase is arousal, which combines excitement and plateau into one phase, and the third phase is orgasm.
    For decades, Kaplan’s new triphasic model of sexual response served as the foundation for diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual . You could have normal or problematic desire, normal or problematic arousal, and normal or problematic orgasm. A number of these diagnoses now have effectivetreatments, including cognitive-behavioral therapy, mindfulness, sensorimotor therapies, and