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

Central to the book is the dual control model of sexual response: the sexual excitation system (accelerators) and the sexual inhibition system (brakes). These systems interact to shape arousal, and understanding them can transform how individuals interpret their sexual responses. Nagoski debunks the myth that low desire is a pathology. Instead, she reframes it as a function of context and brake activation. For example, stress, body image concerns, or partner conflict might act as brakes, even when accelerators are present. Rather than trying to “fix” desire through medication or guilt, Nagoski encourages readers to identify and address the specific stimuli that suppress or enhance arousal. Therapists and educators can use this model to support clients in sexual dysfunction treatment, while individuals can apply it by tracking their own patterns of arousal, identifying brakes, and creating contexts that optimize desire.

Contrary to cultural messaging, most women experience sexual desire as responsive; rather than arising spontaneously, desire emerges in reaction to context, emotional safety, and physical stimulation. Nagoski argues that the myth of spontaneous desire, modeled after male-centric understandings of sexuality, leads women to believe they are broken or uninterested in sex. Nagoski reframes women’s responsive patterns of sexual desire as functional and normal. For instance, a woman may not feel initial desire but may become aroused after initiating physical intimacy. Recognizing this can help partners set realistic expectations, reduce performance anxiety, and foster patience and communication. In healthcare settings, this understanding supports more accurate diagnoses and treatment plans. At home, couples can experiment with affectionate rituals, stress reduction, or shifting their focus from outcome-driven sex to exploratory, playful intimacy.

Nagoski dedicates significant attention to the stress-response cycle, arguing that unresolved stress is a major source of sexual inhibition. Stress affects the body’s capacity for pleasure and primes the brain to prioritize survival over intimacy or pleasure. Stress of any type may inhibit sexual intimacy, but Nagoski also notes that for many women, sex itself is a source of stress due to past sexual trauma. To address these issues, individuals should focus not just on eliminating stressors but on completing the stress cycle through movement, creativity, affection, and rest. For example, someone dealing with work burnout may benefit more from exercise or art than from cognitive reframing alone. This lesson is especially relevant for those in caregiving roles or high-stress environments. Couples can co-regulate through physical affection or joint relaxation rituals. Therapists might use this model to help clients distinguish between stress-related inhibition and deeper relational or psychological blocks.

Nagoski dissects damaging myths—about orgasms, virginity, genitalia, and desire—that perpetuate shame and misinformation. These myths often stem from patriarchal, medicalized, or media-driven narratives that frame female sexuality as inadequate, mysterious, or deviant. She proposes science-backed counter-narratives to combat these myths: for instance, that clitoral stimulation is the primary driver of female orgasm, that genital response and desire are not always concordant, and that sexual satisfaction is highly context-driven. Practically, this means replacing prescriptive “shoulds” with evidence-informed “coulds,” recognizing that everyone is different and that there is no one “right” way to enjoy sex. Educators can incorporate this approach into comprehensive sex education curricula; individuals can use it to critically evaluate the sources of their sexual beliefs. Media literacy, inclusive representation, and open conversations all play a role in dismantling these myths.