I recently attended the AASECT 2024 annual conference in St. Louis, MO as an exhibitor for MendEd. For me, one of the highlights of the conference was Emily Nagoski’s talk on her new book, Come Together: The Science (and Art!) of Creating Lasting Sexual Connections. 

Low sexual desire or mismatched desire is a frequent reason for couples to see a sex therapist. I think Emily introduces a creative and innovative approach to working with couples in long-term relationships who have a good connection but find themselves lacking desire and passion as time goes on. In a seemingly effortless presentation of comedic playfulness grounded in academic affective neuroscience, Nagoski presented her unique approach to working with low sexual desire based on her own experience. 

Without overtly identifying it, Nagoski positioned her approach against other approaches to working with couples with low sexual desire. She included Sue Johnson’s emotion-focused therapy that aims to resolve relationship conflict to foster intimacy and Ester Perel’s view that desire emerges for long-term couples through establishing personal space or distance. These are dominant themes in couples counseling and sex therapy - that couples need to be close or be far away to feel desire. Now, with Nagoski’s approach, couples who otherwise have a good relationship and want to better understand how to enhance sexual desire have an alternative way of thinking about it. 

Nagoski’s approach, rooted in Polyvagal theory and Jaak Panksaap’s affective neuroscience theory of emotion, includes lust as a primary emotion. Nagoski encourages couples to explore and discover which primary emotions lead to lust and which takes them out of lust. Within this framework, if one person believes that play leads to lust while another person believes that care leads to lust, they can move from one emotional state to another to get closer to being in a mutual lust state. Likewise, when one identifies that fear or rage leads them away from lust, these emotions can be managed and worked through to move into states that foster lust. In her book, Nagoski literally gives readers a floor plan for how to move from one emotional “room” to another, how to map “rooms” within a house, and how to communicate these “floor plans” to foster sexual desire and satisfying sex over the long term. 

In my experience, given sex therapy has its origins in Masters and Johnson’s studies of sexual dysfunctions and developing treatments, one of the less studied aspects of sexual functioning and health in long-term relationships is how to create ongoing sexual connection and pleasure when the relationship doesn’t have a sexual dysfunction and the couple otherwise has a good relationship. With Nagoski’s scientific approach to tackling this common issue, she brings to the table an approach rooted in science that is easy to understand and practical for both professionals and lay audiences. 

It’s important for couples to understand that not all low desire stems from the same causes. Working with a sex therapist to understand the nature of what is causing low sexual desire in one’s relationship is helpful for determining which approach to use to restore it. To learn more about sex therapy, contact me through my practice, Kimberly Keiser & Associates.

The AASECT conference has always been a great place to meet colleagues, exchange ideas and catch up. I was happy to have the opportunity to run into a colleague and friend, Mike Giancola. Mike Giancola is a licensed Marriage and Family Therapist in San Diego. We are in a monthly out of control sexual behavior (OCSB) consultation group with Doug Braun-Harvey. 

Here’s a snapshot of us catching up at the conference. 

Until next time,

Kim

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As an AASECT-certified sex therapist, Kimberly Keiser has spent years working with clients who experience struggles with their sexual relationships. She’s used research-based methods and therapeutic exercises to help people break free from what's holding them back from a truly satisfying sex life.