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CHAPTER 1
Am I Normal?
Why are so many women dissatisfied with their sex lives? With the possible exception of Paris Hilton (and the mademoiselle who once had the room next to mine at the Hilton Paris), women are not enjoying sex as much as they would like to, or even as much as they used to. I know this because of what I hear from patients in therapy, volunteers in medical studies, friends in restaurants, and well-dressed women in business class who learn I’m a psychiatrist and, if the flight is long enough, share a lot more with me than an armrest. Something has gone out of their intimate lives, they say. They’re not interested in sex anymore, or they are interested but can’t get aroused, or they can get aroused but have neither the desire nor the energy to follow through. Their relationships are suffering, and they want to know what’s wrong with them.
It’s not just the people I happen to encounter who feel this way; millions of women across the country—as well as across ethnic, cultural, and economic lines—want to enjoy sex more. If you have frank conversations with your female friends, this probably isn’t news. But it was big news indeed back in 1992, when social scientists conducted a study of adult sexual behavior and found that 43 percent of American women were unhappy with their sex lives1—which doesn’t sound that bad unless you believe, as I do, that the other 57 percent were lying.
If you wish I had quoted a more recent study, I don’t blame you; I also wish we had newer numbers to look at. That we don’t have fresher research reveals a void in the literature of femalesexuality: coy conversations with girlfriends aside, we just don’t know that much about it. Moreover, what we do know isn’t necessarily the gleanings of rigorous research. For example, several years ago, the television show Primetime Live aired a segment on sexuality based on the results of a telephone poll it had conducted the previous summer. The interviewers were all women (people are allegedly more willing to disclose intimate details to female voices than to male ones) who rang up 1,500 randomly selected Americans— undoubtedly in the middle of dinner—to ask them about their sex lives. And while a few juicy morsels did emerge—three out of four men said they always had an orgasm during sex, while only three out of ten women said they did; and a strapping 57 percent of women and men said they’d had sex either outdoors or in a public place—an informal survey of this kind hardly qualifies as a scientific study.To make things even murkier, when sex researchers do learn something new, it’s often reported in a way designed less to illuminate the issue than to sell the one on the newsstand. A Newsweek cover story in June 2003 proclaimed, “Sexless Marriage on the Rise: 15 to 20 Percent of Couples Have Sex No More Than 10 Times a Year.” Uh-oh—you could almost hear a gasp sweep the heartland: Is that me? I know we’re having sex less often than we used to, but it’s not that bad . . . or is it? Is my marriage sexless? Well, wait a minute—what does sexless mean? To me, it doesn’t mean ten times or eight times or one time. It means zero times—no sexual contact, no physi- cal intimacy, nothing. But this headline says that having sex every five weeks or so is the same as having no sex at all. It implies that making love infrequently is the same as never doing it—the implication being that either way, you’re screwed.
The message resonates throughout the land: everyone is getting more and hotter sex than you are, especially if you’re a woman. You have to have a certain kind of look (drop-dead gorgeous), a particular kind of body (microscopic rear, bountiful breasts), and unassailable self-confidence to qualify as sexually viable. It’s different for guys; they can be awkward, goofy, grungy, or all three and still end up in bed with the star by the end of the show. But if humanness makes men more appealing, it does the opposite for us. For a woman to be sexy, she’s got to be more than human—sleeker, surer, supremely in control. You’ve seen these creations in the movies and on television: supple, gleaming, straight-talking gals who render guys mute with withering glances and keen-edged dialogue. These women are hip, glib, and quick; they are exquisitely in touch with their feelings and never lack words to express them. They may be inner-city detectives or winsome wives and mothers, but no matter: whether they’re packing lunches or .38s, they are firm and unflappable, with nerves, buns, and coiffures of steel. They know what they want, especially in bed, and neither stammer nor apologize when telling their husbands, boyfriends, and lovers what feels good, what doesn’t, and what drives them to ecstasy. Like the lusty protagonists of HBO’s classic Sex and the City, these women know good sex, and they know how to get it.
But these women aren’t real; when it comes to sex, no one is as self-aware and sure of herself as these figments of a screenwriter’s imagination. Real women, such as the ones I see in my practice, are fascinating flesh-and-blood contradictions: perceptive and unaware, intelligent and ill informed, partnered yet lonely. This one has a husband and three young children, that one is barely out of childhood herself, another has a married lover eighteen years her senior. They have little in common, yet they are alike: they are all women, and they all wish the sex were better.
The thing is, many of them don’t know the sex could be better. They figure that lusty, chandelier-swinging lovemaking isn’t meant for the likes of them, even if they did have the appropriate lighting fixture. They’ve bought into the culture’s bogus belief that a woman’s sexual potential is measured by her appearance and limited by her score on the ever changing eye-candy scale.
It’s hard to resist this fiction, surrounded as we are by images of women who have been surgically and digitally enhanced to conform to this season’s concept of feminine perfection, however unnatural and distorted it might be. The fakery in these images doesn’t diminish their persuasiveness: the cheekbones, eye color, skin tone, noses, hair, breasts, and rear ends are phony, but no matter—the women to whom they’re attached have been anointed as sexy, so we yearn to resemble them.
Well, you might wonder, what’s wrong with that? What’s so bad about trying to look good?
What’s bad is pursuing an artificial, faddish, skin-deep aesthetic that denies your true and enduring sexual nature and thwarts its expression. Sexuality isn’t something visible about you; it’s something you feel within yourself. It’s down in there, dark and tangled, funky and wild. It’s forged in the mind and enacted by the body; it’s not only between your legs, it’s also between your ears. If others perceive it, it’s not because of what they’re seeing but because of what you are feeling and exuding. It’s about how you feel and how you think, not about how you look.
But if you believe your sexuality is about your appearance, as so many of us do, you become fixated on superficial characteristics and obsessed with altering them. You increase your bustline, de-crease your eyelids, hoist your bottom, and have your lipo sucked. You go under the knife and over your credit limit. And eventually you learn that no matter how many surgeries and procedures you undergo, you’ll never be as flawless, voluptuous, and boldly coquettish as the babes in the Victoria’s Secret commercials (nor as skilled at sliding backward, mouth half open and eyes half closed, onto a satin-sheeted bed without banging your head on the night table). Never mind that each of us knows at least one woman who bears not the slightest resemblance to a lingerie model yet is inexplicably, inescapably seductive. You know who I mean: the woman who’s not exactly pretty and whose body isn’t great, but to whom men are drawn like ants to a fallen scoop of Rocky Road. If we’d take the time to analyze her appeal, we’d see that it has little to do with her exterior and everything to do with what’s emanating from within her—but no matter. We still equate sexiness with how we imagine we look to others rather than how we feel inside. So we lower the estimate of our sexual potential along with our expectations.
How did this happen? How did we mature into a generation of women who demand excellence in every area of our lives except for sex? We graduate from top colleges and professional schools; we work construction and fight fires; we sit on the Supreme Court, run for the House and Senate, and stand by our men. Yet when it comes to sex, we’re pretty willing to accept what we get, minimize our disappointment, and channel our erotic energies elsewhere. Why?
One reason is that for women, sex is as much about connection as it is about climax, and we tend to conflate the two, settling for the comforts of closeness when we’re also wishing the sex would improve. While most women would agree that a toe-curling orgasm goes a long way toward putting things right in their world, they would also say that having an emotional connection with their partner is the best way to ensure they’ll have an orgasm in the first place. The emotional intimacy that results from feeling connected to her partner is, for a woman, a prime component of good sex. This means that a woman’s sexual identity (the way she perceives her sexuality, revealed by the sorts of people to whom she is erotically attracted) might manifest itself in terms of her relationships rather than her actual sexual behaviors. For that reason, some women may seem to have chronic relationship problems—always falling in love with married men or repeatedly getting involved with guys who mooch off them—and blame their sexual dissatisfaction on the relationship when it is actually their sexual attraction for such men that is the problem.
I also believe we settle for so-so sex because most of us don’t know how sexual we could be; we know only how sexual we are. How sexual we are has been shaped by decades of indoctrination by mothers and fathers, sisters and brothers, family and friends, teachers, religious leaders, and romantic partners, not to mention a society that worships a bewildering fusion of childlike sexual innocence and cynical, nihilistic hedonism. If Marilyn Monroe doesn’t do it for you, there’s always RuPaul. The culture’s sexual pulse throbs so lustily for both the sublime and the ridiculous, it’s hard to separate the sensible from the absurd, the nutty from the normal.
So what is normal?
It all depends on what’s normal for you. What do you need to feel sexually stimulated? What makes you feel desire? How do you become aroused enough to achieve orgasm? How much sex is enough for you? How often is often enough, and how seldom feels like never? I am reminded of a scene in Annie Hall with Woody Allen and his therapist on the right side of the screen and Diane Keaton and her therapist on the left. Allen’s therapist asks, “How often do you sleep together?”; then Keaton’s asks, “Do you have sex often?” “Hardly ever,” Allen says. “Maybe three times a week.” Then Keaton says, “Constantly—I’d say three times a week.” The scene is funny because of its intrinsic honesty: “hardly ever” to him is “constantly” to her. The thing is, each of them is a reliable witness; both she and he are reporting accurately how frequently they make love. But even though they possess the same information, they interpret it differently. And notice that neither of them is complaining about the quality of the sex—it’s the three-times-a-week part that rankles both of them. Neither one of them is happy about it, and they’re both right.
But what if hardly ever or even never is just fine—is there something wrong with you? Society says yes, but science says otherwise. According to a Canadian study published a few years ago, about 1 percent of adults are utterly uninterested in sex, or asexual.3 For this 1 percent, no sex is more than enough. Asexual adults do not engage in sexual activity, nor do they miss it. And there is nothing wrong with them. If you are content living without sex and have always felt that way, no sex is normal because you are probably asexual, and that’s what is normal for you.
The contentment factor is significant, as it is one criterion by which doctors determine whether or not a person has a diagnosable sexual disorder. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), published by the American Psychiatric Association, is, at 943 pages, a mother lode of information and the primary reference tool used by American mental health professionals to formulate diagnoses. According to the DSM-IV, you don’t have a sexual disorder unless distress is one of your symptoms. It follows that if you have never felt sexually attracted to anyone and are not distressed about it, you are most likely asexual, not dysfunctional, and normal, if not average. If you and your partner have sex four or five times a year and both of you are content and neither of you feels deprived, then you most likely don’t have a problem, either, because that’s normal for you. On the other hand, if you and your partner are having sex four or five times a week but you’re left feeling empty, frustrated, and dissatisfied and you are distressed about it, that’s not normal for you, and you might want to do something about it.
The key is becoming aware of yourself, learning what your sexual normal is, and raising your expectations to that level—and knowing the difference between what’s normal for real human beings and those phony, jazzed-up media femmes fatales. If you don’t, you erode your capacity for intimacy and eventually become estranged from both your sensual self and your partner. The erosion is so gradual, you don’t realize it’s happening until the damage is done and you’re shivering at the bottom of a chasm, alone and untouched, wondering how you got there. To climb out, you must become aware of your sexual self. You must become actively conscious of your body (how you inhabit it, not how it looks), your mind, and the galvanic influence each has upon the other. And once the light begins to dawn, you need to speak up—to yourself and your partner—and stop settling for less than you want and need.
What if the light dawned a while ago? What if you’re aware that your sex life could use some work but you don’t know how to fix it? While awareness is a prerequisite for better sex, it isn’t enough on its own. Women who know that the sex could be better often lack the motivation and moxie to make it happen, especially when they can’t put their finger on what’s wrong. Is the problem with you or your partner? Is it physical or emotional, biological or psychological? Is it that you have an infant and are tired all the time, or are you resentful that no one helps with the housework? Is it the wild hormonal swings after childbirth or your irrational fear that the baby might stop breathing if you don’t check him every ten minutes? Or is it all these things happening at once?
Sexual dissatisfaction is not as distinct for a woman as it is for a man: if he’s not aroused, he can’t get it up; if he can’t get it up, he can’t have sex; and if he can’t have sex, he feels like less of a man. For most guys, this is a crisis and worrisome enough to motivate them to pick up a phone, call a doctor, and get help.
But for women, sexual dissatisfaction is more a disappointment than a crisis. Our fundamental sense of self, our essential womanhood, isn’t threatened, so the situation doesn’t seem dire. Women’s sexual frustrations are more subtle: we can have sex whether we’re aroused or not; we just might not enjoy it very much, or at all. Most women tend to be stoic about sexual disappointments: if we feel deflated after an anticlimactic lovemaking session, we might not oooh and ahhh about how great it was, but we’re not likely to declare a state of emergency, either.
What if you know it isn’t you? Even when a woman has the insight to know that the problem lies with her man’s behaviors or technique (or lack of it), she will probably be too concerned about hurting his feelings or losing his affection to say anything—better he should think she’s undersexed than a ballbreaker. (For lesbians, the issue is less about fear of damaging their partners’ egos than about women’s capacity for verbal intimacy and emotional relatedness, which may obviate a lesbian couple’s need for sex to achieve closeness.) Rather than rock the boat or bore another hole in a sinking ship, a woman is likely to smooth the waters by reframing the situation and telling herself that she’s the one with the problem.
That is, unless the problem is undeniably his.
A few years ago, the only Americans who knew about erectile dysfunction were the men who had it and the physicians who treated them. Now every man, woman, and child in the country is accustomed to seeing foxy middle-aged couples gazing saucily at each other, because for the guy, at least, help is just a tablet (and about thirty minutes) away.
It would be sweet if we too could swallow a pill and banish our sexual woes, but alas, things aren’t that simple for us. When Pfizer, maker of the anti-impotence drug Viagra, announced it was abandoning efforts to develop a similar formula for women, it was no small event; the company had studied the effects of sildenafil citrate (which it markets as Viagra) on more than three thousand women and spent more than eight years—and a great deal of money—hoping it could duplicate its colossal success with men. I had firsthand experience with the process, as I helped administer several of the clinical trials here at the University of Virginia.
I was disappointed that Viagra didn’t solve our problems, but I wasn’t surprised. It’s not that the drug doesn’t do for us what it does for guys; in fact, it dilates blood vessels in women just as it does in men, collecting blood in the genitals and creating the symptoms of arousal. But while men almost always want to make love when they’re aroused, women don’t necessarily want to do any such thing. We might be physically able, but that alone isn’t enough to get us in the mood. We need something more, and that something is more than robust circulation. Mitra Boolel, head of Pfizer’s research team, told The New York Times, “There’s a disconnect in many women between genital changes and mental changes. This disconnect does not exist in men. Men consistently get erections in the presence of naked women and want to have sex. With women, things depend on a myriad of factors.” Dr. Boolel said his researchers were continuing their work but were “changing their focus from a woman’s genitals to her head. The brain is the crucial sexual organ in women.”4
This wasn’t exactly breaking news to me, and it might not be to you, either. But it is the crux of the matter: the vast power of a woman’s brain—your brain—to influence your interest in making love, and to collude with timing, self-awareness, circumstance, culture, and chemistry to either ignite or extinguish your capacity to take pleasure in it. As every woman knows, it’s seldom a seamless and soaring progression from desire to arousal to orgasm to cigarettes and sighs of contentment. Woman’s libido rarely launches into orbit unimpeded; instead, it ricochets off the facets of her several selves (lover, mother, daughter, wife, breadwinner, cook, driver, housecleaner, social director, dishwasher, volunteer, gatherer of groceries, clipper of coupons) until it comes spinning back, with or without amorous intentions. This is a very different dynamic from that which governs man’s sexual urge: when he is aroused, he wants to make love; if the flesh is able, the spirit is fierce. Man is direct, woman is oblique. For a candid explanation we can thank Mr. Rogers, who was in the right neighborhood when he sang, “Some are fancy on the outside; some are fancy on the inside.” That’s precisely the point: woman’s sexuality is almost entirely on the inside, out of sight (and, all too often, out of mind).
I’ve treated hundreds of intelligent, highly competent women whose sexual self-awareness has hardly evolved since their mothers handed them a box of Modess . . . because. Because why? Because woman’s sexuality runs rampant every twenty-eight days, a crimson reminder of what’s really going on underneath all the daintiness we’re supposed to be about. We were handed a dirty little message along with those sanitary unmentionables: your teeming womb is the crowning glory of your womanhood—and you’d better keep every trace of it hidden, or else. It’s the or else part that keeps us trembling on the brink of self-awareness, longing for a lover’s unstoppable passion to touch us where we dare not touch ourselves. My own research confirms what I instinctively knew long before I earned a medical degree: that the sexual nature of woman is a subtle fusion of mind with body, flesh with feeling, and what we know about it could fit in the backseat of a Miata.
Woman’s sexuality is an intricate, interwoven phenomenon—you can’t pull just one thread, unravel the fabric, and reveal the mystery within. It’s a densely textured cloth, woven here and braided there, sometimes elaborate, other times plain. My mission is to direct your gaze toward the tapestry of your sexual self and coax you to both revel in the beauty of its complexity and recognize the stitches, loops, and imperfections in the weave. I want to pique your curiosity about your sex life, heighten your awareness that it can be better (and could probably be worse), and reassure you that all women—Victoria’s Secret models included—experience a dose of agony along with ecstasy when it comes to sex.
One reason for this is that women tend to focus on problems in their sexual lives as if those problems could be isolated from the rest of existence, and the fact is that they cannot. You find little nubs in the weave and think, Oh, the stitches aren’t quite right here—if I snip them out, it will be perfect, mistaking the nubs for flaws. This misperception is the reason for the little tag on your new dupioni silk suit, which proclaims that the imperfections in the fabric are not blemishes but rather the signature of its natural beauty. The small lumps, known as slubs, result when two silkworms work together on one cocoon, producing strands of varying thicknesses that are then spun together to create dupioni silk cloth. The slubs occur randomly, rendering each swatch of dupioni silk different from every other.
So it is with woman: the myriad threads of biology, sensuality, psychology, and soul entwine to loom a cloth of infinite variation. Your exultations and fears, memories and fantasies, friendships and intimacies, work and obligations, kinks and quirks comprise the pattern, hue, smoothness, and slubs in the tapestry of your sexual self. To view its abundant variety as a flaw is to misconstrue its essential character: the motley nature of the weave is a manifestation of its vigorous, pulsing vitality.
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