Talkin’ Nerdy about Gettin’ Dirty

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Donald Trump threatens to cut off federal school funding over vaccine mandates. President Biden releases his 2025 federal budget with several important implications for American health care. A new study sheds light on the risks of microplastics. Oh, and a German man was vaccinated for COVID 217 times.

Dissectors, before I get started, a big thank you to all of you who shared your interest in earning CME credits through the pod. If you didn't get a chance to share your CME needs with us, there's still time. Head on over to americadesectedcme.com. That's America Dissected, like the show title, cme.com. All right, let's get nerdy.

About getting dirty. Y'all know the drill, I usually start each episode with some personal or professional anecdote that I try to build out to a broader, evidence-driven arc about a circumstance that's ailing us all, and then introduce the interview. But I'm not taking anyone in my bedroom. Why? Because I was taught from a very young age that one ought not to talk about that in front of polite company.

After all, sex is a shameful, dirty act, but also the physical act of showing love. And that's exactly it. Sex is a quandary wrapped in a quagmire. We both call it making love and getting dirty. And I get that there are versions of it that are closer to each of those.

But it's still sex. that's both love and dirty. Make it make sense. So why do we think about making love as getting dirty? Let's start with the evidence, as we are wont to do here.

A study from 2017 found that Americans in their 20s had sex about 80 times a year, compared to Americans in their 60s, who did it about 20 times a year. But what's interesting is that the kids these days are just having less sex. Millennials and Zoomers are betting less than their parents' generation did. The Atlantic's Kate Julien went as far as to call it a, quote, sex recession. Must be all of our lattes and avo toast, no?

Or maybe it's the housing crunch and student debt. Or maybe it's online porn. All possible hypotheses. Except the lattes and avo toast, of course. Whatever it is, it means that the average adult is having 13% less sex than in the late 90s.

In fact, another survey found that one in four American adults reports not having had sex in the last year. And that's pretty consistent from what I hear from a number of folks these days. Mostly millennials like me, often in loving, committed, long-term relationships. Many with kids. Life gets hectic.

Between work commitments, the struggle to keep up with various chores inside and outside the house, and the absolute libido killer that is the existence of children in your home, there's just not time. And when there's time, there's not desire. And when there's desire, there's not space. And when there's all three, there's not the partner. And subordinating that most natural human act to the tyranny of our ever-so-busy lives is just one way capitalism steals our sex from us.

The other? Well, there's this irony. Society has never been more open about sex, but we're having a lot less of it. And part of that, as we'll discuss more later in the show, is that the sex we're being sold, yes, sold, is exactly that. It's a productized version of the thing.

Not the real thing you have with a real partner built on a real relationship. Warts and all. We've talked a lot about social media on this show, and the way that it destroys so much of our confidence by showing us a highlight reel of other people's lives on Infinite Scroll. That's what modernity's done to sex. What's that they say?

Comparison is the thief of joy? If so, that's the other way. capitalism has become the thief of sex. Sex positivity isn't about being exposed to the highlight reel, picked and pruned version of sex that is so ubiquitous on our screens. It's about embracing the sex we actually have.

Dr. Emily Nagoski, our guest today, is a sex educator and New York Times bestselling author. She was riding high after the publication of her first book about women's sexual health, and then, let's just say, she found challenges of her own. And that forced her to reconsider all the ways we think about sex in long-term relationships, which inspired her to write another bestseller about it, as one does. Here's my conversation with Dr.

Emily Nagoski.

Why not? So I did. I got trained to go into residence halls to talk about condoms, contraception, and consent. And while I was getting a degree in psychology with minors, in cognitive science and philosophy, the work I was doing as a sex educator and then as a sexual violence prevention educator, and then as a sexual violence crisis responder, that work made me like who I am as a person. in a way, the brain stuff never could, much as I love the brain stuff.

I decided that sex education was the path I was going to choose. So I went to grad school. I got a master's degree in counseling. I was going to be a sex therapist. About halfway through that degree, I realized I do not have the magical thing it takes to sit with people week after week and go, mm-hmm.

What was that like for you? I don't have it. But I am a nerd, and I am a woman who likes to be in charge of things. So I continued on to get a PhD in what is now the IU School of Public Health, concentrating in human sexuality, and ultimately got a job as the director of wellness education at Smith College, where I taught a course called Women's Sexuality, which is a deliberately provocative name for a course at Smith College, because what's a woman and what is sexuality? And at the end of the first semester teaching there, the last question on the final exam was, just tell me one important thing.

You get the two points, no matter what you say. Very important that you get the two points. Just one important thing you learned. And more than half of my students, 187 students, more than half of them wrote something like, I learned I'm normal. I'm normal.

Just because I'm different from other women doesn't mean I'm broken. I can trust my body because I know I'm normal. And you may have had this experience of grading final exams. So you know it's not usually like this. I was in my office grading with tears in my eyes.

Yeah, wow. Feeling like something important had happened for my students. And I wanted to do it again and bigger. And that's the day I decided to write. Come As You Are.

Five and a half years later, Come As You Are gets published. And in the process of writing that book, I was so stressed that I lost all interest in actually having any sex with my husband. And then I finished the book and it got better. And then I went on book tour and it got worse. I would try to follow my own advice.

in Come As You Are. I talk about responsive desire and how, like you set up a time. You put your body in the bed. You let your skin touch your partner's skin. And your body will wake up and go, oh, right.

I really like this. I really like this person. And I would put my body in the bed and let my skin touch my partner's skin. And I would cry and fall asleep. And I thought I need better advice than I gave in my own book.

So I did what anyone would do. I went to Google Scholar and I looked at the peer-reviewed research on couples who sustain a strong sexual connection over the long term. And what I found there contradicted the whole mainstream discourse about sex in long-term relationships, right? Because it was 2014, deep in the conversation about. is intimacy the enemy of the erotic?

And you need distance to keep the spark alive? Or is intimacy the foundation of the erotic? And you need closeness to keep the spark alive. When you look at the research on couples who sustain a strong sexual connection over the long term, they do not talk about spark. They don't talk about desire and how much they want sex.

They don't talk about craving. They don't talk about desire. They talk about pleasure. They talk about engaging in sexual behaviors that everybody involved enjoys.

Which is a fundamental transformation of the way to think about how sex in a long-term relationship works. It is not about how much you want the sex. It's about whether or not you like the sex that's available to you in that relationship. I actually told my literary agent what I was learning and she was like, so would you consider writing another sex book? And that's how that happened.

I think about, thank you. And I think about a lot of folks in my relationship peer group, people who got into committed relationships at about the same time and distance. And I think about the conversations I've shared with my friends, and it seems like there's this sort of silent epidemic of unfulfilling sex lives. Um, when you look across the population, how common is that?

The most common thing is for it to come and go. Pardon the expression. For like the sexual connection to be really strong, and then life gets in the way.

And God knows we are busy. And just like roll around naked with lube and lick each other and have fun and giggle.

Why would I do this? And it's actually a question that I started asking in my workshops a couple decades ago. What is it that you want when you want sex? And people's sort of off-the-cuff, flippant answer is, well, orgasm. But most people can do that on their own.

And if you can't, there's whole books and workshops just about that. But most people can have an orgasm on their own. And so what is it that you want when you want sex with this other person present? At this point, I've asked a few thousand people that question, and there's four big themes. And the first one, with isolation, you hit the nail on the head.

The number one thing people say they want when they want sex is connection. Human beings have a lot of ways that they can experience connection with each other. For some people, sex is a fairly peripheral way that they experience connection. And for other people, it is like the primary way. It is the most powerful channel for experiencing connection with another person.

So connection is number one. The second thing people say they want when they want sex with another person is shared pleasure. There's something specific, not just about. like, you know, I put my body in the bed, I let my skin touch my partner's skin, and I enjoy how it feels for my body to touch that other person's body. I also want my partner to enjoy that sensation.

And I want them to enjoy my pleasure. And I want to enjoy their pleasure. That shared pleasure is a specific thing that people want when they want sex with another person. Third, people want to be or feel wanted. And no wonder so many of us grow up being taught that the sexual parts of ourselves are dirty, dangerous, and disgusting.

So, to have a connection where those parts are not merely acceptable and sort of okay, but wanted, desirable, yum, give me more of that. Of course, that is the thing we want. Not to mention all the gendery messages about how being wantable as a sex object validates us in our identities. There's a whole chapter about the patriarchy. Don't worry.

And the fourth most common theme is a variable that I called freedom, which is this ability, like I said, to close the door on all our other responsibilities and obligations and roles and identities and functions in life and just disappear into the pleasurable things that are happening in this moment. It is incredibly nourishing for us to experience pleasure in our bodies. Pleasure is only available to us neurologically in an appropriate context. I'm a big polyvagal theory. nerd.

Pleasure is mostly available to us when we're in a ventral state, which is the safety and connection state, as opposed to the sympathetic activation, fight or flight, run for your life. When you're being chased by a lion, that's not a great time to be savoring pleasure. And when you're in a dorsal shutdown conservation state, literally the way your brain functions shifts depending on your activation state. When you are feeling safe enough and connected enough, the nucleus accumbens—how nerdy should I get?

Yeah.

So, first of all, can we just say it's 2024 and we do not live in a world where there is one universally agreed upon theory of human emotion. There are at least three actively competing models of how human emotion works, and only one of them includes sex, includes lust. So that's the model I picked when I was trying to figure out what was going on with me when I put my body in the bed. I love my partner. We have a great relationship.

I know that if I could just get there, wherever there was, we would have great, pleasurable, joyful, connected, loving sex. If I could just get there instead of crying and falling asleep. And so I turned to the affective neuroscience of the father of affective neuroscience, Jak Panksepp, whose book, Archaeology of Mind, sort of changed everything. I tried to shoehorn it into Come As You Are, and it wouldn't fit. But now I've got two chapters in.

Come Together. So I took his model of seven primary process emotions, sort of the universal core mammalian emotions, and put it into this metaphor of a floor plan. So he says there are seven primary process emotions. Lust is one of them, and that's the mammalian motivation system of courtship and mating. That's one of the pleasure-favorable spaces.

There are three other pleasure-favorable spaces. One of them is seeking, which is this curiosity, exploration kind of space. For some people, it's going to be intellectual, like it is for me. For some people, it's going to be like adventure out in the world. I know people who sold everything they own and traveled around the world together for a year.

Sounds like a nightmare to me, but they loved it. Things went wrong all the time, usually in places where neither of them spoke the language. And for them, the adventure and the problem-solving and the excitement of it was like right next to the lust space, and they now have the babies to show for it.

Sex at its best is play with nothing at stake. So a context for me that makes it easy to enjoy sex is vacation. Honestly, that's play sex, because you can step away from all the dimensions of your life where the stakes are high, parenting and work and all those other identities that we have, and just connect and play, separated from all of the places that are serious.

So there are lots of different kinds of play. Object play, obviously. With little kids, they start out being like, what is this? Exploring. What is this object?

When they're in the bathtub, what is this? And then they start to play with the water in the bathtub, and playing is, what can I make this object? do? They start splashing in the water.

Nothing at stake. No performance demand. No expectation. Just what happens when I try this? Is that good?

Play. There's story play. There's rough and tumble play. The most important thing is that nobody has anything to lose. Nobody's identity is on the line.

And then the last of the pleasure-favorable spaces is the care space, which is vast. Attachment is really important for humans because, I'm sure, like, cephalopelvic, disproportion and neoteny, human beings are born underbaked. And so we attach very intensely, and we carry that attachment into our adult lives. And for a lot of people, feeling like they are cared for, and like they can care for someone, I think of it as like the living room of the emotional floor plan, where you're lying on the couch in front of a crackling fire, snuggling with your certain special someone. For a lot of people, that emotional experience of feeling held and cared for and having their needs met is very adjacent to the left space.

Join at caseygrants.

org book club. That's C-A-S-E-Y-G-R-A-N-T-S.org book club.

And these imperatives are expectations about what something ought to be. And then you develop that into thinking a little bit about how we think about our own body and sex and body positivity. Can you tell us a little bit about imperatives and how they operate sometimes to take away that focus on shared pleasure?

So there's the sex imperative itself, the imperative to be a sexual person who has and likes and wants lots of sex. The performance imperative is maybe my favorite, in an ironic way, because the performance imperative is about being obliged, morally obliged, to constantly work on getting better at sex, like you're an employee who wants a promotion. There's the intercourse imperative, because heterosexuality is just assumed and penis and vagina sex is, I guess, the expectation, the whole point of having sex is to put the penis in the vagina.

And all of the beauty imperatives, the pretty imperative to have a body that looks a certain way and never, ever, to simply welcome your body as it is, but always to work on it and try and change it, or else you have like given up on yourself rather than embracing yourself as you truly are. And for me, as I was writing the book and thinking about this contradiction between the mainstream conversation that like, how do you keep the spark alive? versus what the research says, which is, people who have great sex are not worried about spark. They are really interested in co-creating a life that makes pleasure easy to access. And I've interrupted myself.

Pleasure is only available in our brains when our brains are in a certain state. The nucleus accumbens shell has what Kent Berridge calls the affective keyboard, where, when you're in like a relaxed, happy, safe, connected state of mind, 90% of the nucleus accumbens shell becomes devoted to approach motivation. So almost any stimulation will result in an oh, oh, oh, what's that sort of response. When they do these studies in rats, they put a probe in the nucleus accumbens shell, they zap it, and the rats in like a happy, I call it the rat spa. In the research, they just call it the home environment.

So it's a peaceful, calm, connected state. Almost anywhere that you zap on the nucleus accumbens shell, the rat goes, oh, oh, what's that, oh. And then, when they put the rat into a different room where the lights are on really bright and there's music on, not even just loud, but at different volumes, so the rat can't even habituate to the sound, it's a very stressful environment. Almost anywhere that you zap on the nucleus accumbens shell will result in, oh, what the.

So even in response to the same stimulation, your response will be different depending on the state of mind you are in. This is your internal context, which is why it's so important to think about. like, what state of mind was I in when it was easy to transition into a sexy state of mind? Chances are. you felt safe enough.

You felt connected enough. You felt like the stakes were low enough. When people experience high desire, that doesn't even necessarily mean that they experience high pleasure. Humans can want things. One of the primary, one of the motivations for sex is connection.

But one of the ways we can want connection is suppose our connection is threatened. There's an instability in our connection. And so sometimes we move towards sex as a way to repair the threat to the connection. Sometimes that will feel good, like makeup sex. And sometimes it's intense, but doesn't feel good like breakup sex.

Does that make sense?

And while, rather than this being a reflection of a connection and a sense of safety and a sense of almost returning to a space in your relationship together, rather than the carnal excitement of a person to have sex with, right? Getting horny. Yes, yeah. And the interesting thing about it is that when you stop for a second and ask, what does it look like to have a mature sexual relationship? I think almost anybody would almost intuit this idea that, of course, after 10 years or 20 years or 30 years, and the aging that comes with that, it's not going to feel like day one or two, right?

But you can mature it because there's so much more safety in the relationship if you've matured that relationship. And it's like finding that safety in the relationship that opens up and unlocks this kind of pleasure-seeking sex rather than this kind of horny, hormonally driven, more objective, almost sense of sexuality. I want to ask you, because you write a lot about sex positivity in the context of body positivity, and you have this construct where you differentiate between confidence and joy in your body. Can you talk a little bit about that? Because I thought that was really insightful.

And so much of the negative thought cycles that tend to disrupt sexuality and set up these imperatives are this constantly comparing yourself, to, quote, what you used to be. Oh, gosh, yes. I don't have X, I don't have Y. And so I thought these confidence and joy constructs were really helpful in terms of being able to break down and normalize that. Can you share a little bit more about that?

When you can know what is true in this moment about your sexuality and your relationship and your body, my definition of perfect sex, well, it starts with the definition of normal sex. People love a definition. So normal sex, for me, is when everybody involved, or peers who are glad to be there and free to leave, with no unwanted consequences, including no unwanted emotional consequences. No, but if you love me, no, if, oh, come on, no, but you said you would. And no unwanted pain, obviously.

Perfect sex is all of that. Glad to be there, free to leave, with no unwanted consequences, no unwanted pain. And everybody turns toward what's happening in this moment with confidence and joy and compassion and, if you possibly can, a sense of play. So that if, for example, somebody wants an erection and an erection isn't happening, you turn toward the absence of an erection with confidence. You know what's true.

You love what's true. Compassion and a sense of play. There are so many neat things you can do with a penis that is not erect that you cannot do with a penis that is erect. It is a real opportunity for object play, but also you can just transition your attention to something else entirely different if you want to. As opposed to problematizing it, deciding there's a dysfunction, this means something about this partner or that partner, or about the relation that there's something wrong, or it could just be.

this is what's happening right here in the present moment, and we're going to turn toward it with confidence and joy, and compassion and a sense of play.

And it's an interesting sort of question about this role of imperatives and this expectation of what bodies ought to do. I guess my question to you is that it seems like, and you talk a bit about this in the book, that there is a sense of shame that sits under a lot of this. And I think the way that it gets constructed is that in a lot of cultural norms, and I think these are starting to change, but they're deep seated, that sex is implicitly dirty. It's implicitly bad. It's implicitly something negative.

And the sex that you have- Oh, yes.

It's like, I'm not doing the disgusting thing well enough, or we're not sharing the disgusting thing with enough performative gusto. And the funny thing about it is, in most long-term relationships, it's not like you're doing this on a camera. In most long-term relationships, you might. But I guess my point is that there is no, usually there's no audience.

And we all have a script in our heads, not just about, there's a sort of like order of operations of like, which behaviors come first, second, third, like. which clothes come off? when, who goes down on who, when. Nina Hartley, the feminist sex porn star. Her summary is, head, head, two positions and a pop.

Like, there's a script. And it also is a script of who has the sex. We have an image in our mind of like, who is allowed to have and enjoy sex? Like, we know what their bodies look like. We know what age they are.

We know what their relationship structure is. And it's all a myth, right? It's all just this like, thing. we have been fed by our culture and our family of origin, and none of it has anything to do with what actually happens in our lives. And yet, there is this sort of phantom ideal, sexual self that we're supposed to be.

And we are always comparing ourselves, who we truly are, against that fantasy, fictional self. And when we feel that pressure to perform, we're trying to pretend that we are that fantasy, fictional self, instead of being the self that we truly are. When you can, with confidence and joy, know who you truly are, love who you truly are, believe that who you are is someone worth being as a sexual person, that the sexual relationship you have is a sexual relationship worth having, as opposed to trying to make it into somebody else's idea of what it's supposed to be.

We talk about sex positivity as being open to and engaging with, putting sex into more places than it is denied. I worry, though, that the version of sex that people put in those places is this manufactured version that sets up an expectation of what sex ought to be versus what sex actually is. And I think that version of this tends to do more harm than good. So I want to ask, what do you think about that? And then, how do we actually create a healthier sex positivity that does not, then, create this sort of idealized version of sex that then everyone is comparing themselves to and feeling like they're falling short?

. So well said. So well said. Go ahead.

So we need a medication to make sure she wants the sex, so that cis-hetero patriarchy can be reinforced. Hooray. Cool. But here's the thing. What if she doesn't like the sex that's available in her relationship?

What if a couple is having sex at a frequency that, if I told you the number, you'd be like, wow, that's a pretty high frequency. But at least one of the partners does not enjoy any of the sex they are having.

So for me, I define sex positivity as everybody gets to choose how and when they are touched. They get to choose how they feel about their bodies. Basic bodily autonomy. When I say it out loud, it sounds like a political definition. And it's not not political.

But it honestly is just like the mammalian biology. Pleasure is only available to us when we feel safe enough, when we feel connected enough. And that autonomy, when we don't feel isolated, when we don't feel trapped, that is the mindset where our brain is capable of interpreting a sensation as being pleasurable. And did you know that people believe you more when what you say rhymes?

It's a thing that I learned in the preparation for book tour with Come As You Are. So here's the way I put it. Pleasure is the measure. Pleasure is the measure of sexual well-being. It is not about how often you do it.

Definitely not how often. It's not what you do, or where, or with whom, or how many times, or even how many orgasms you have. It's whether or not you like the sex you are having. And if you like it, you're already doing it right. It's not about judging yourself against a standard.

It's not about reaching a benchmark. It's do you like the sex? And if you don't, of course you don't want it. It's not dysfunctional not to want sex you don't like. There's a therapist and researcher, Peggy Kleinplotz.

The way she puts it in a fairly devastating way is that sometimes low desire is evidence of good judgment.

And that couple will go to therapy and one partner will be like, I'll be fine if we never have sex again. I used to be into it, but I feel like I'm done with sex forever. And if their therapist is Peggy Kleinplotz, she'll say, well, tell me more about this sex you don't want. And do you suppose the sex they're having is joyful, playful, connected, authentic, vulnerable, exploratory? Or is it, you know, dismal and disappointing?

Sex by rote. Sex where at least one person feels like they can't show up as their authentic self. Sex where they're just doing it out of a sense of obligation. Or they're trying to pretend that they are someone that they are not. And that is when Peggy will say, well, you know, I rather like sex.

But if that's the sex I were having, I wouldn't want it either. So what kind of sex is worth wanting?

I really appreciate you joining us to get nerdy about getting dirty. And it really was a really thoughtful and, I think, really important conversation. So thank you for what you do. And thank you for sharing your wisdom with us here.

So when he says he's going to pull federal funding from all schools with vaccine mandates. Yeah, I'm worried. See, almost every school in America has a vaccine mandate. They're required to enter kindergarten. Now, we've made them way too easy to bypass on, quote, philosophical grounds.

But to end them all together, that'd be disastrous. And that's because we're already watching as the number of kindergartners going to kindergarten with vaccine waivers is growing amidst an increase in vaccine preventable diseases, measles. But there's another feature here. Even if he never gets elected, even using his platform to push anti-vax policies will have devastating knock-on effects. Whether it's Trump wannabes running for school board or just parents deciding whether to vaccinate their kids.

What he says creates a permission structure to continue to choose against vaccines and policies that protect them. God be with us. in November. For his part, President Biden released his 2025 federal budget, with several important implications for American health care. As we discussed last week, the president wants to increase the number of prescription drugs that Medicare could negotiate prices for from the current 20 to 50..

And he wants to extend the cap on out-of-pocket prescription drug spending from Medicare beneficiaries to all privately insured people. He's also proposing a small tax increase on individuals making more than $400,000 a year from 3.8% to 5%. to extend Medicare solvency over the next 25 years. And, finally, to extend Medicaid coverage for vulnerable folks living in the nine states that have yet to extend Medicaid, he's proposing a Medicaid-like coverage plan that would offer that coverage to nearly 1.5 million more people. A new study published in the New England Journal of Medicine shows the emerging hazards of microplastics.

The researchers followed people who had had small fat plaques removed from the arteries in their necks, the kinds that grow to cause strokes. They analyzed those plaques for the presence of microplastics. And get this, nearly 60% of them had evidence of microplastics, described as the presence of, quote, jagged foreign bodies under electron microscopy. Here's the downright scary part. They followed those folks for the next three years and found that those with microplastics in their plaques were four and a half times as likely, four and a half times as likely to have a stroke, heart attack, or die over that time period.

The study isn't causal, but that's a serious effect measure. That's the kind that should spur us to act. Look, microplastics aren't inevitable. They're a choice that corporations are making for us. In the end, they don't really get recycled.

What we're learning is that they simply get ground down into microscopic particles that wind their way into our bodies. Microplastics like these have been identified in all sorts of human tissues, including fetal placentas. Get this, people who haven't even lived in the world. So why are companies choosing them? Save money.

But they may be costing lives. Congress, this might be one of those few truly bipartisan causes left. Let's get to it. And now for this headline.

But also, dude's fine. No horns, no tail. Nope, just fine. So to all those folks harping on about the vaccine risks, apparently you can get this thing 217 times and be just fine. So there's that.

That's it for today. On your way out, don't forget to rate and review the show. It really does go a long way. And if you haven't told us about your CME needs yet, americadissectedcme.com, please do share. Also, if you love the show and want to rep us, drop by the Crooked store for some America Dissected merch.

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