Author: The Beauty Nation

Probably the most frequent cause for dyspareunia originating with symptoms of burning, itching, or aching is a lack of adequate production of vaginal lubrication with sexual functioning.

During attempted penile intromission or with long-maintained coital connection, there must be adequate lubrication or there will be irritative distress for either or both coital partners.

Adequate production of vaginal lubrication is for women the physiological equivalent of erective attainment for men and her representation to her male partner of psychological readiness for vaginal penetration.

A consistent lack of functional levels of vaginal lubrication is as near as any woman can come to paralleling a man’s lack of effective erection.

Inadequate development of vaginal lubrication has many causes, but by far the most common is lack of interest in the particular opportunity or identification with the involved sexual partner. Women must experience positive input from their sexual value systems if they are to respond repetitively and effectively to their mate’s sexual approaches.

Women who cannot think or feel sexually, those reflecting fears of sexual performance, and even those acting out a spectator’s role in sexual functioning, either do not develop sufficient vaginal lubrication to support a painless coital episode or, if penetrated successfully, they cease production of the necessary lubricative material shortly after intravaginal penile thrusting is initiated.

Deep Penetration

Additionally, women fearful of pain with deep vaginal penetration, fearful of pregnancy with any coital connection, fearful of exposure to social compromise, and fearful of sexual inadequacy are frequently poor producers of vaginal lubrication. Any Component of fear present in sexual experiences reduces the receptivity to sensate input, thereby blunting biophysical responsivity.

If there is insufficient vaginal lubrication, there may or may not be acute pain with full penile intromission, depending primarily upon the parity of the woman, but they’re usually will be vaginal burning, irritation, or aching both during and after coital connection.

There are tens of thousands of women who become markedly apprehensive at the onset of any definitive sexual approach, simply because they know severe vaginal irritation will be experienced not only during but frequently for hours after any significantly maintained coital connection.

Not to be forgotten as a specific segment among the legions of women afflicted by inadequate production of vaginal lubrication are those in their postmenopausal years. If they are not supported by adequate sex-steroid-replacement techniques, the production of vaginal lubrication usually drops off markedly as the vaginal mucosa routinely turns atrophic.

There well may be aching and irritation in the vagina for a day or two after a coital connection for women contending with this evidence of sex-steroid starvation.

A major category of women tending to be poor lubrication producers during coital connection is that a significant segment of the female population with overt lesbian orientation. Many women psychosexually committed to a homophile orientation attempt regularity of coital connection for socioeconomic reasons. Frequently, they may not lubricate well during heterosexual activity, although there usually is ample lubrication when they are directly involved in homosexual expression.

In most instances:

Inadequate production of vaginal lubrication can be reversed with a definite therapeutic approach. Certainly, women burdened by a multiplicity of sex-oriented fears can be provided psychotherapeutic relief of their phobias and subsequently reversed with relative ease from their particular pattern of sexual inadequacy.

Those women with chronic vaginal itching and irritation can be protected from continuing dyspareunia because both infectious and chemical vaginitis are reversible under proper clinical control. Senile vaginitis responds in short order to adequate sex-steroid-replacement techniques.

There are only two major categories of women for whom the co-therapists have little to offer to constitute effective production of vaginal lubrication: first, women mated to men for whom they have little or no personal identification, understanding, affection, or even sexual respect; and second, homosexually oriented women practicing coition for socioeconomic reasons with no interest in their male companions as sexual partners.

Undesired Sex

As opposed to the symptoms of aching, irritation, or burning in the vagina, complaints of severe pain developed during penile thrusting provide the most difficulty in delineating between subjective and objective etiology.

Although many women register this type of complaint when seeking to avoid undesired sexual approaches, there are some basic pathological conditions in the female pelvis that can and do engender severe pain in response to active coital connection.

One of the difficulties in delineating the severity of the complaint of dyspareunia is to identify pelvic pathology of a quality sufficient to support the female partner’s significant complaints of painful coition. The pelvic residual from severe infection or pelvic implants of endometriosis usually is easily identified by adequate pelvic and rectal examinations.

These clinical entities will be discussed briefly in context later in the topic. Current attention is drawn to probably the most frequently overlooked of the major physiological syndromes creating intense pelvic pain during coital connection.

One of the most obscure of pelvic syndromes, yet one of the most psychosexually crippling, is traumatic laceration of the ligaments supporting the uterus. This syndrome was described clinically. Five women have been referred to the Foundation for relief of subjective symptoms of dyspareunia after referral sources had assured the husbands that there was no plausible physical reason for the constant complaint of severe pain with deep penile thrust.

These 5 postpartum women had severe broad ligament lacerations and were relieved of their distress by definitive surgical approaches, not by psychotherapy. Therefore, they do not represent a component of the statistical analysis of treatment for sexual dysfunction.

Three women reflecting the onset of dyspareunia after criminal abortion techniques also have been seen in consultation and are not reflected in the statistics of the sexual inadequacy study. Three more women have been seen in gynecological consultation for acquired dyspareunia after gang-rape experiences.

They also have not been an integral part of the sexual dysfunction study. These clinical problems will be mentioned in context. When first seen clinically, women with traumatic lacerations of the uterine supports, acquired with delivery or by specific criminal abortion techniques, present complaints that commonly accrue from pelvic vasocongestion, dyspareunia, dysmenorrhea, and a feeling of being excessively tired.

These complaints are secondary or acquired in nature. The traumatized women consistently can relate the onset of their acquired dyspareunia to one particular obstetrical experience even from among three or four such episodes.

The basic intercourse distress arises with deep penetration of the penis. Women describe the pain associated with intercourse to be as if their husbands had “hit something” with the penis during deep vaginal penetration.

These involved women may note other physical irritations frequently seen with chronic pelvic vasocongestion, a constantly nagging backache, throbbing or generalized pelvic aching, and occasionally, a sense that “everything is falling out.”

These symptoms are made worse in any situation requiring a woman to be on her feet for an exceptional length of time, as a full day spent doing heavy housecleaning or working as a saleswoman in a department store.

Most women lose interest in any regularity of sexual expression when distressed by acquired dyspareunia. Handicapped by constant anticipation of painful pelvic stimuli created by penile thrusting, they also may lose any previously established facility for orgasmic return.

The basic pathology of the syndrome of broad ligament laceration is confined to the soft tissues of the female pelvis. The striking features of the pelvic examination are the position of the uterus and almost always in severe third-degree retroversion and the particularly unique feeling that develops for the examiner with manipulation of the cervix.

This portion of the uterus feels just as if it were being rotated as a universal joint. It may be moved in any direction, up, down, laterally, or on an anterior-posterior plane with minimal, if any, correspondingly responsive movement of the corpus and body of the uterus.

Even the juncture of the cervix to the lower uterine segment is ill-defined. The feeling is one of an exaggerated Hegar’s sign of early pregnancy, in which the cervix appears to move in a manner completely independent of the attached corpus.

In addition to the “universal joint” feeling returned to the examiner when moving the cervix, a severe pain response usually is elicited by any type of cervical movement. However, pain is primarily occasioned by pushing the cervix in an upward plane.

In the more severe cases, either in advanced bilateral broad ligament laceration or in a presenting complaint of five years or more in duration even mild lateral motion of the cervix will occasion a painful response. During the examination, the retroverted uterus appears to be perhaps twice increased in size.

Pressing against the corpus in the cul-de-sac to reduce the third-degree retroversion also will produce a marked pain response. When the examiner applies upward pressure on the cervix or pressure in the cul-de-sac against the corpus, the patient frequently responds to the painful stimulus by stating, “It’s just like the pain I have with intercourse.”

A detailed obstetrical history is a salient feature in establishing the diagnosis of the broad ligament laceration syndrome. The untoward obstetrical event creating the lacerations may be classified as surgical obstetrics, as an obstetrical accident, or even as a poor obstetrical technique.

Occasionally, women with both the positive pelvic findings and the subjective symptoms of this syndrome cannot provide a positive history of obstetrical trauma, but this situation does not rule out the existence of the syndrome.

Many women are unaware of an unusual obstetrical event because they were under advanced degrees of sedation or even full anesthesia at the time.

Precipitate deliveries, difficult forceps deliveries, complicated breech deliveries, and postmature-infant deliveries are all suspect as obstetrical events that occasionally contribute to tears in the maternal soft parts.

If these tears are established in the supports of the uterus (broad ligaments) the immediate postpartum onset of severe dyspareunia can be explained anatomically and physiologically.

It is important to emphasize clinically that although a woman may not be able to describe a specific obstetrical misfortune in her history, she well may be able to date the onset of her acquired dyspareunia to one particular obstetrical event.

Three cases have been seen in which a criminal abortion was performed by extensively packing the vaginal barrel, leading ultimately to dilation of the cervix and expulsion of uterine content.

These extensive vaginal-packing episodes created tears of the broad ligaments, completely parallel to those occasioned by actual obstetrical trauma. Each woman, although unaware of the etiological significance, dated the onset of the symptoms of acquired dyspareunia to the specific experience with the vaginal-packing type of abortive technique.

She responds physiologically to sex-tension elevation. The four phases of the female cycle of sexual response established in the 1960s will be employed to identify clinically important vasocongestive and myotonic reactions developing in the pelvic viscera of any woman responding to sexual stimulation.

Sex-tension increment, the first physical evidence of her response to sexual stimulation is vaginal lubrication.

Lubrication is produced:

By a deep vasocongestive reaction in the tissues surrounding the vaginal barrel. There also is evidence of increased muscle tension as the vaginal barrel expands and distends involuntarily in anticipation of penetration.

When sex tensions reach plateau phase levels of responsivity, a local concentration of venous blood develops in the outer third of the vaginal barrel, creating partial constriction of the central lumen.

This vaginal evidence of a deep vasocongestive reaction has been termed the orgasmic platform. The uterus increases in size as venous blood is retained within the organ tissues.

The clitoris evidence increasing smooth-muscle tension by elevating from its natural, pudendal-overhang positioning and flattening on the anterior border of the symphysis.

With orgasm, reached an increment peak of pelvic-tissue vasocongestion and myotonia, the orgasmic platform in the outer third of the vagina and the uterus contract within regularly recurring rhythmicity as evidence of high levels of muscle tension.

Finally, with the resolution phase, both vasocongestion and myotonia disappear from the body generally, and the pelvic structures specifically.

If the orgasmic release has been obtained, there is rapid detumescence from these naturally accumulative physiological processes. The loss of muscle tension and venous blood accumulation is much slower if orgasm has not been experienced and there is an obvious residual of sexual tension.

The presence of involuntary-muscle irritability and superficial and deep venous congestion that woman cannot deny, for these reactions develop as physiological evidence of both conscious and subconscious levels of sexual tension.

With the accumulation of myotonia and pelvic vasocongestion, the biophysical system signals the total structure with stimulative input of a positive nature.

Regardless of whether women voluntarily deny their biological capacity for sexual function, they cannot deny the pelvic, irritative evidence of inherent sexual tension for any length of time.

Once a month with some degree of regularity women are reminded of their biological capacity. Interestingly, even the reminder develops in part as the result of local venous congestion and increased muscle tension in the reproductive organs.

On occasion, the menstrual condition, through the suggestive sensation created by pelvic congestion, stimulates elevated sexual tensions.

The presence or absence of patterns of sexual desire or facility for a sexual response within the continuum of the human female’s menstrual cycle also has defied reliable identification.

Possibly, confusion has resulted from the usual failure to consider the fact that two separate systems of influence may be competing for dominance in any sexual exposure.

The necessity for such individual consideration can best be explained by example:

It is possible for a sexually functional woman to feel the sexual need and to respond to high levels of sexual excitation even to orgasmic release in response to a predominantly biophysical influence in the absence of a specific psychosocial requirement.

This freedom to respond to direct biophysical-system demand requires only from its psychosocial counterpart that the female’s sexual value system not transmit signals that inhibit or defer how erotic arousal is generated. In any situation of biophysical dominance, the effective sexual response requires only a reasonable level of interdigital contribution by the psychosocial system.

Conversely, it also is possible for a human female to respond to erotic signals initiated by the predominant psychosocial factors of the sexual value system, regardless of conditions of biophysical imbalance such as hormonal deficiency or obvious pathology of the pelvic organs.

A woman may respond sexually to the psychosocial system of influence to orgasmic response in the face of surgical castration and spite of a general state of chronic fatigue or physical disability. In any situation of psychosocial dominance, the effective sexual response requires only a reasonable level of interdigital contribution by the biophysical system.

An interesting variation on this classification of repression should be mentioned. There were several primarily non-orgasmic women whose receptivity to the repressive conditioning was slightly different. Their own particular personality characteristics or their relationship to negatively directive authority was such that they fully accepted the concept of sexual rejection.

They developed pride in their ability to comply with sexual repression and did so with apparent social grace. Their selection of a mate in most cases represented a choice of similar background. The difficulty arose with marriage.

For example:

On the wedding night, a completely unrealistic, negative sexual value system usually was revealed during their attempt to establish an effective sexual interaction. These women reported either total pelvic anesthesia or isolation of sexual feelings from the context of psychosocial support.

Women entering therapy in a state of non-orgasmic return reflected the complete failure of any effective alignment of their biophysical and psychosocial systems of influence.

They had never been able to merge either their points of maximum biophysical demand or their occasions of maximum psychosocial need with optimum environmental circumstances of time, place, or partner response to fulfill the requirements of their sexual value systems.

Primary Orgasmic Dysfunction:

A condition whereby neither the biophysical nor the psychosocial systems of influence that are required for the effective sexual function is sufficiently dominant to respond to the psychosexually stimulative opportunities provided by self-manipulation, partner manipulation, or coital interchange.

If the concept of two interdigital systems influencing female sexual responsivity can be accepted, what can be considered the weaknesses and the strengths of each? Input required by either system for the development of peak response is, of course, subject to marked variation.

There may be some value in drawing upon the previously described psychophysiological findings returned from preclinical studies. As a human female response to subjectively identifiable sexual stimuli, reliable patterns of accommodation by one system to the other can be defined, and tend to follow basic requirements set by earlier imprinting.

Patterns of imprinting can be either reinforced or redirected by controlled experimental influence. They can also be diverted in their signaling potential by reorientation of a previously unrealistic sexual value system. The sexual value system, in turn, responds to reprogramming by a new, positive experience.

Variations in the human female’s bio-physical system are, of course, relative to basic body economy. Is the woman in good health? Is there a cyclic hormonal ebb and flow to which she is particularly susceptible? Are the reproductive viscera anatomically and physiologically within normal limits, or is there evidence of pelvic pathology? Is there evidence of broad-ligament laceration, endometriosis, or residual pelvic infection?

Certainly, most forms of pelvic pathology would weigh against the effective functioning of the biophysical system. On the other hand, are there those biophysical patterns that tend to improve the basic facility of her sexual responsivity? Is there a well-established metabolic balance, good nutrition, sufficient rest, the regularity of sexual outlet?

Each of these factors inevitably improves biophysical responsivity. There must be professional consideration of multiple variables when evaluating the influence of the biophysical system upon female sexual responsivity.

Overcome Sexual Difficulty

However, the system with the infinitely greater number of variables is that reflecting psychosocial influence. Most dysfunctional women’s fundamental difficulty is that the requirements of their sexual value systems have never been met. Consequently, the resultant limitations of the psychosocial system have never been overcome.

Many women specifically resist the experience of orgasmic response, as they reject their sexual identity and the facility for its active expression.

Often these women were exposed during their formative years to such timeworn concepts as sex is dirty, nice girls don’t involve themselves, sex is the man’s privilege or sex is for reproduction only.

There are also those whose resistance is established and sustained by a stored experience of mental or physical trauma, rape, dyspareunia which is signaled by every sexual encounter.

Again from a negative point of view, there may be extreme fear or apprehension of sexual functioning instilled in any woman by inadequate sex education. Any situation leading to sexual trauma, real or imagined.

During her adolescent or teenage years or her sexual partner’s, crude demonstration of his own sexual desires without knowledge of how to protect her sexually would be quite sufficient to create a negative psychosocial concept of a woman’s role in sexual functioning.

The woman living with residual specific sexual trauma (mental or physical) frequently is encountered in this category.

Finally, there is the woman whose background forces her into automatic sublimation of psychosexual response. This individual simply has no expectations for sexual expression that are built upon a basis of reality. She has presumed that sexual response in some form simply would happen but has a little, idea of its source of expression.

In these instances, sexual sublimation is allowed to become a way of life for many reasons. Particularly is this reaction encountered in the woman who has failed to enjoy the privilege of working at being a woman.

The positive side:

The psychosocial value system can overcome physical disability with dominant identification that may be personal and/or situational in nature. In states of advanced physical disability, the strength of loved-partner identification can provide orgasmic impetus to a woman physically consigned to be sexually unresponsive.

When there has been a pattern of little bio-physical sexual demand, as in a postpartum period, sexual tension may be rapidly restored by the psychosocial stimulation of a vacation, anniversary, or other experience of special significance.

Again the biophysical and psychosocial systems of influence are interdigital in orientation, but there is no biological demand for their mutual complementary responsivity. It is in the areas of involuntary sublimation that the psychosocial system is gravely handicapped and would tend to exert a negatively dominant influence in contradistinction to any possible biophysical stimulative function.

For many women, a basic homophile orientation is a major etiological factor in heterosexual orgasmic dysfunction. For those women committed to homosexual expression, lack of orgasmic return from heterosexual opportunity is of no consequence.

But there are a large number of women with significant homosexual experiences during their early teenage years that, in time, have withdrawn from active homophile orientation to living socially heterosexual lives.

When they marry, many are committed to orgasmic dysfunction by the prior imprinting of homosexual influence upon their sexual responsivity.

Prior homosexual conditioning acts to create a negatively dominant psychosocial influence. Their biophysical capacity, freely evidenced in homosexual opportunity, continues operant in their electively chosen heterosexual environment, but it may not be of sufficient quality to overcome the negative input from their psychosocial system.

It is difficult to evaluate homosexual influence upon heterosexual function. There can be no question that both means of sexual expression will always be an integral part of every culture. So it has been for recorded time.

The problems of sexual adjustment do not rest with those committed unreservedly to a specific pattern of response. Rather, it is the gray area dweller that creates for him or herself a sexually dysfunctional status.

When moving from one means of sexual expression to the other for the first time, the sexual value system must be reoriented if the desired transfer of sexual identification is to be completed. Such was the problem of Mrs. G who had not been able to adapt her sexual value system to her elected heterosexual world when seen in therapy.

Mr. and Mrs. G

were referred for treatment after seven years of marriage, she was 33, her husband was 38 years old. The current marriage was his second, the first ending in divorce.

The presenting complaint was that Mrs. G had never been orgasmic in the marriage. Her childhood and adolescence were spent in-a small Midwestern town as an only child of elderly parents. Her mother was 41 when she was born.

Introverted as a teenager, the girl did well in school but had few friends and was not popular with male classmates. When she was 15 years old she formed a major psychosexual attachment to a high-school teacher, who seduced the girl into a homosexual relationship.

The courtship continued for six months before physical seduction was accomplished. Once fully committed to the homosexual relationship, the girl matured rapidly in personality and took a great deal more care with her dress and person. She vested total psychosexual commitment in her “teacher” throughout her high-school years.

Full responsivity in the sexual component of the relationship developed slowly for the teenager, although she was occasionally orgasmic with manipulation within a few months ‘of her first physical experience.

Initially, hers was primarily a receptive role, but as she matured in the relationship psychologically, mutual manipulation and oral-genital stimulation in natural sequence became part of the unit’s pattern of sexual expression.

During the girl’s last year in high school, mutual sexual tensions were maintained at a high level, and physical release was sought by either or both women at a minimum frequency level of three to four times a week. Both women were multi-orgasmic. Mrs. G has no history of heterosexual dating in high school.

There was physical separation when Mrs. G went to college, but since the separation represented a distance of only fifty miles, she and the teacher spent many weekends together. However, toward the end of Mrs. G’s sophomore year in college, the high-school teacher was apprehended approaching other girls, was discharged, and left the geographical area.

This was a major blow to the girl. She had lost her love and at the same time was made aware that the teacher had sought other outlets. Her grades suffered and she became severely depressed and totally antisocial.

She dropped out of school for a semester, during which time she did very little but write long forgiving letters to her mentor, and even visited her for a ten-day period under the pretext of going to see friends.

It was not until Mrs. G graduated from college that the homosexual relationship was finally terminated. During the four college years, she had only two dates, both involving attendance at school events and of no sexual portent.

After graduation, Mrs. G took secretarial training and began working in a larger city in the Midwest. She still suffered from recurrent bouts of depression and finally sought psychiatric support. Helped by this counseling, she gradually enlarged her social circle, began heterosexual dating, and once more showed an interest in her dress and person.

While in college she had developed masturbatory patterns for tension release. The frequency throughout college and during her early years working as a secretary was several times per week. She usually was multi-orgasmic, as she had been during her continuing homosexual relationship.

At age 25 Mrs. G deliberately took advantage of an available partner to attempt intercourse. This experience was sought purely from curiosity demand.

There were several coital exposures with this eager but relatively inexperienced young man.

She found herself repulsed by the man’s untutored, harsh approaches as opposed to those of her high school teacher. She was not physically responsive and found the seminal fluid objectionable.

Added to this general rejection of heterosexual interest was the fact that shortly after establishing the sexual relationship there was a 10-day delay in the onset of a menstrual period. Her fear of pregnancy only contributed to her rejection of any psychosocial concept of heterosexual functioning.

Shortly thereafter Mrs. G met her husband. He had been divorced six months previously for the stated reason that his wife had wanted to marry another man. There were two children of the marriage, both living with their mother.

They were both lonely people and gravitated to each other. There was warmth and affection between them and several mutual interests, so they married.

Mr. G was sexually well versed, kind, considerate, and gentle with his wife. She felt warmly toward him and enjoyed providing him with sexual release. In doing so she lost her incipient phobia for the seminal fluid.

However, she was unstimulated by his sexual approaches beyond that degree necessary to produce adequate vaginal lubrication. Both partners agreed they did not want children, so contraceptive medication was taken by the wife.

The marriage, though warm and comfortable, for several years was essentially one of convenience. However, as time passed, the two partners grew closer together, learned to communicate, and to exchange vulnerabilities.

Yet there was no improvement in the wife’s sexual responsivity, and this became an increasingly important factor in their lives. Mrs. G had never told her husband of her homosexual experience and was guilt-ridden by the concept that her past sexual orientation might have precluded any possibility of effective response in her now desired heterosexual state. The husband and wife were referred for treatment at her insistence.

Increasing complaints of the inadequacy of human sexual function, it would seem that the potpourri of cultures that influence the behavior of so many might designate some area less vital to the quality of living than the sexual expression to receive and to bear the burden of the social ills of human existence.

As recently as the turn of the century, after marriage rites and the advent of offspring were celebrated as evidence of perpetuation of family and race, the woman was considered to have done her duty, fulfilled herself, or both, depending of course upon the individual frame of reference.

In reality:

The society honored her contribution as a sexual entity only about her breeding capacity, never relative to the enhancement of the marital relationship by her sexual expression.

In contradistinction to the recognition accorded her as a breeding animal, the psychological importance of her physical presence during the act of conception was considered nonexistent. It must be acknowledged.

However, there always have been men and women in every culture who identified their need for one another as complete human entities, each denying nothing to the other including the vital component of sexual exchange.

Unfortunately, whether from sexual fear or deprivation (both usually the result of too little knowledge), those who socially could not make peace with their sexuality were the ones to dictate and record concepts of female sexual identity.

The code of the Puritan and similar ethics permitted only communication in the negative vein of rejection. There was no acceptable discussion of what was sexually supportive of marital relationships.

So far the discussion has focused on an account of past influences from which female sexual function has inherited its baseline for functional inadequacy.

Because this influence still permeates the current “cultural” assignment of the female sexual role, its existence must be recognized before the psychophysiological components of dysfunction can be dealt with comprehensively.

Socio-Cultural Influence

More often than not places a woman in a position in which she must adapt, sublimate, inhibit, or even distort her natural capacity to function sexually to fulfill her genetically assigned role. Herein lies a major source of a woman’s sexual dysfunction.

The adaptation of sexual function to meet socially desirable conditions represents a system operant in most successfully interactive behavior, which in turn is the essence of a mutually enhancing sexual relationship.

However, to adapt the sexual function to a philosophy of rejection is to risk impairment of the capacity for effective social interaction. To sublimate sexual function can enhance both selves and that state to which the repression is committed if the practice of sublimation lies within the coping capacity of the particular individual who adopts it.

To inhibit sexual function beyond that realistic degree which equally serves social and sexual value systems positively, or to distort or maladapt sexual function until the capacity.

And to function is extinguished, which is to diminish the quality of the individual and of any marital relationship to which he or she is committed.

When it is realized that this psychosocial backdrop is prevalent in histories developed from husband and wives with complaints of female sexual inadequacy, the psychophysiological and situational aspects of female orgasmic dysfunction can be contemplated realistically.

The human female’s facility of physiological response to sexual tensions and her capacity for orgasmic release never have been fully appreciated.

Lack of comprehension may have resulted from the fact that functional evaluation was filtered through the encompassing influence of socio-cultural formulations previously described in this topic.

There also has been a failure to conceptualize the whole of sexual experience for both the human male and female as constituted in two totally separate systems of influence that coexist naturally.

The potential for orgasm dysfunction: highlighted in the psychosocial-sexual histories of those women in marital units referred to the Foundation can be described in a composite profile.

A baseline of dysfunctional distress was provided by specific material recalled not only from sexually developmental years but further encompassing all opportunities of potential sexual imprinting, conditioning, and experience storage.

Described in many settings, the dissimulation of sexual feeling consistently was reported as a manifest requirement or as a residual of earlier learning, operant as a requirement. Imprinting is that process that helps define the behavioral patterns of sexual expression and signal their arousal.

Dysfunction Origin of the negative conditioning varied widely. At one pole it represented the influence of deliberate parental omission of reference to or discussion of sexual function as a component of the pattern of living. This informationally underprivileged background also failed to provide an example of female sexuality, recognizably secure in expression, which could be emulated.

In both situations, the sexually and socially maturing young woman was left to draw formative conclusions by negative implication, or, in the absence of this form of direction, she was forced to react to any influence available from her socio-cultural environment.

The other extreme of rejective conditioning was reported as rigidly explicit but consistently negative admonition by parental and/or religious authority against personal admission or overt expression of sexual feeling.

Negative variants, there were many levels of uninformed guidance for the young girl or woman as she struggled with psychosocial enigmas, cultural restrictions, and her own physical sexual awareness.

Usually, such guidance, though often well-intentioned, was more a hindrance than a help as she developed her sexual value system and ultimately her natural sexual function.

In a direct parallel to the degree to which the young girl developing a sexual value system seemed to have dissimulated her sexual interests during phases of imprinting, conditioning, and information storing, older women, now sexually dysfunctional, reported consistent precoital evidence of repression of sexual identity in mature sexual encounters.

Residual repression of sexual responsivity in the adult usually went well beyond any earlier theoretical requirements for a social adaptation necessary to maintain virginity, to restrain a partner’s sexual demand, or even to conduct interpersonal relationships in a manner considered appropriate by a representative social authority.

Not infrequently the residual repression of sexual responsivity was so acute as to be emphasized clinically with the time-worn cry.

Most primarily non-orgasmic women

Repressed expression of sexual identity through ignorance, fear, or authoritative direction was the initial inhibiting influence in the failure of sexual function.

Not infrequently this source of repression was identified as a crucial factor of influence for situationally non-orgasmic women as well, although these individuals had the facility to overcome or circumnavigate its control under certain circumstances.

When requirements of the sexual value system prevailing during initial opportunities at sexual function could not be fulfilled because of the component of repression, each woman attempted without success to compensate in her desire for sexual expression by developing unrealistic partner identification, the concept of social secureness, or pleasure in environmental circumstance.

Failure of her own sexual values to serve, there was almost a blind seeking for value substitutes. When a workable substitution was not identified and the void of psychosexual insecurity remained unfilled, sexual dysfunction became an ongoing way of life.

Both contributing positively or negatively to any state of sexual responsivity but having no biological demand to function in a complementary manner.

With the reminder that finite analysis of male sexual capacity and physiological response also has attracted little scientific interest in the past.

Compare Male And Female

It should be reemphasized that similarities rather than differences are frequently more significant in comparing male and female sexual response. By intent, the focus of this topic is directed toward the human female, but much of what is to be said can and does apply to the human male.

The bio-physically and psychosocially based systems of influence that naturally coexist in any woman have the capacity if not the biological demand to function in mutual support.

Obviously, there is an interdigitation of systems that reinforce the natural facility of each to function effectively. However, there is no factor of human survival or internal biological need defined for the female that is totally dependent upon a complementary interaction of these two systems.

Unfortunately, they frequently compete for dominance in problems of sexual dysfunction.

Woman’s Response

When the human female is exposed to negative influences under circumstances of individual susceptibility, she is vulnerable to any form of psychosocial or biophysical conditioning, i.e., the formation of man’s individually unique sexual value systems.

Based on how an individual woman internalizes the prevailing psychosocial influence, her sexual value system may or may not reinforce her natural capacity to function sexually.

One need only remembers that sexual function can be displaced from its natural context temporarily or even for a lifetime to realize the concept’s import.

Women cannot erase their psychosocial sexuality and sexual identity, being female, but they can deny their biophysical capacity for natural sexual functioning by conditioned or deliberately controlled physical or psychological withdrawal from sexual exposure.

Yet woman’s conscious denial of biophysical capacity rarely is a completely successful venture, for her physiological capacity for sexual response infinitely surpasses that of man.

Indeed, her significantly greater susceptibility to negatively based psychosocial influences may imply the existence of a natural state of psycho sexual-social balance between the sexes that has been culturally established to neutralize woman’s biophysical superiority.

The specifics of the human female’s physiological reactions to effective levels of sexual tension have been described in detail, but brief clinical consideration of these reactive principles is in order.

For woman, as for man, the 3 specific total-body responses to elevated levels of sexual tension are:

1. Increased myotonia or muscle tension
2. Generalized vasocongestion, pooling of blood in tissues
3. Sex flush and breast enlargement.

When clinical attention is directed toward female orgasmic dysfunction, one particular biological area, the pelvic structures is of the moment.

Specific evidence has been accumulated from the incidence of both myotonia and vasocongestion in the female’s pelvis.

To consider situationally non-orgasmic, a woman must have experienced at least one instance of orgasmic expression, regardless of whether it was induced by self or by partner manipulation, developed during vaginal or rectal coital connection, or stimulated by the oral-genital exchange.

Orgasmic experience during homosexual encounters would rule out any possibility of a diagnosis of primary orgasmic dysfunction. Three arbitrary categories of situational sexual dysfunction have been defined as masturbatory, coital, and random orgasmic inadequacy.

A woman with masturbatory orgasmic inadequacy has not achieved orgasmic release by partner or self-manipulation in either homosexual or heterosexual experience. She can and does reach orgasmic expression during coital connection.

Coital orgasmic inadequacy applies to the great number of women who have never been able to achieve orgasmic return during coition. The category includes women able to masturbate or to be manipulated to orgasmic return and those who can respond to orgasmic release from oral-genital or other stimulative techniques.

The random orgasmic-inadequacy grouping includes those women with histories of orgasmic return at least once during both manipulative and coital opportunities. These women are rarely orgasmic and usually are aware of little or no physical need for sexual expression.

For Example:

They might achieve orgasmic return with coital activity on a vacation, but never while at home. Occasionally these women might masturbate to orgasm if separated from a sexual partner for long periods of time. Usually, when they obtain orgasmic release, the experience is as much of a surprise to them as it is to their established sexual partner.

The situational non-orgasmic state may best be described by again pointing out the varying levels of dominance created by the biophysical and psychosocial structures of influence. If the woman’s sexual value system reflects sufficiently negative input from prior conditioning psychosocial influence, she may not be able to adapt sexual expression to the positive stimulus of the particular time, place, or circumstance of her choosing nor develop a responsive reaction to the partner of her choice.

If that part of any woman’s sexual value system susceptible to the influence of the biophysical structure is overwhelmed by a negative input from pain with any attempted coital connection, there rarely will be an effective sexual response.

Thus there is a multiplicity of influences thrown onto the balance wheel of female sexual responsivity. Fortunately, the two major systems of influence accommodate these variables through involuntary interdigitation. If there were not the probability of admixture of influence, there might be relatively few occasions of female orgasmic experience.

Sexual Partner

A major source of orgasmic influence for both primarily and situationally dysfunctional women is partner orientation. What value has the male partner in the woman’s eyes? Does the chosen male maintain his image of masculinity? Regardless of his acknowledged faults, does he meet the woman’s requirements of character, intelligence, ego strength, drive, physical characteristics, etc.?

Obviously, every woman’s, partner’s requirements vary with her age, personal experience and confidence, and the requisites of her sexual value system.

The two case stories below underscore the variables of a woman’s orientation to her male sexual partner. The histories of Mr. and Mrs. E and Mr. and Mrs. F are presented, to emphasize that a potential exists for radical change in attitudinal concepts during the course of any marriage.

Mr. and Mrs. E were referred for treatment of orgasmic dysfunction after 23 years of marriage. They had two children, a girl 20 and a boy 29.

The history of sexual dysfunction dated back to the twelfth year of the marriage. Both had relatively unremarkable backgrounds to family, education, and religious influences.

Both had masturbated as teenagers and had intercourse with other partners and with each other before marriage. Mrs. E usually had been orgasmic during these coital opportunities with her husband-to-be and with two other partners.

During the first twelve years of the marriage, the couple prospered financially and socially and had many common interests. Their sexual expression is resolved into an established pattern of sexual release two or three times a week.

There was the regularity of orgasmic return and frequently multi-orgasmic return during intercourse. During the twelfth year of the marriage, the unit experienced a severe financial reversal. Mr. E was discharged from his position with the company that had employed him since the start of the marriage.

In the following 18 months, he was unsuccessful in obtaining any permanent type of employment. He became chronically depressed and drank too much. The established pattern of couple sexual encounters was either quite reduced or, on occasions, demandingly increased.

Husband Extramarital Relationship

Then Mrs. E found that her husband was involved in an extramarital relationship and confronted him in the matter. A bitter argument followed, and she refused him the privilege of the marital bed. This sexual isolation lasted for approximately six months, during which time.

Mr. E began working again, regained control of his alcohol intake, and terminated his extramarital interest. For the duration of this isolation period, Mrs. E had no coital opportunity and did not masturbate. When the privilege of the bedroom was restored, to her surprise she was distracted rather than stimulated by her husband’s sexual approaches and was not orgasmic.

She had lost confidence in her husband not only as an individual but also as a masculine figure. Mrs. E found herself going through the motions sexually. From the time the bedroom door was reopened until the unit was seen in therapy, she was non-orgasmic regardless of the mode of sexual approach. The coital connection had dwindled to a ten-day to the two-week frequency of “wifely duty.”

When a major element in any woman’s sexual value system (partner identification in this instance) is negated or neutralized by a combination of circumstances, many women find no immediate replacement factor. Until they do, their facility for sexual responsivity frequently remains jeopardized.

When Mr. E combined loss of his masculine image as the provider with excessive alcohol intake and, also, acquired another sexual partner, he destroyed his wife’s concept of his sexual image, and, in doing so, removed from availability a vital stimulative component of her sexual value system. The negative input of psychosocial influence created by Mr. E’s loss of masculinity and impairment of her sense of sexual desirability was sufficient to inhibit her natural sexual responsivity.

Mr. and Mrs. F were referred for treatment six years after they married when he was 29 and she was 24 years old. They had one child, a girl, during their third year together. Mrs. F Was from a family of seven children and remembers a warm community experience in growing up with harried but happy parents.

Mr. F had exactly the opposite background. He was an only child in a family where both father and mother devoted themselves to his every interest, in short, the typical overindulged single child.

He had masturbated from early teens, had some sexual experiences, and one brief engagement with coital connection maintained regularly for six months before he terminated the commitment. Mrs. F, although she dated regularly as a girl, was fundamentally oriented to group-type social commitments. She rarely had experienced single dating.

The school years were uneventful for both individuals. They met and married almost by accident. When they first began dating, each was interested in someone else. However, their mutual interest increased rapidly and developed into a courtship that included regularity of coital connection for three months before marriage.

Every social decision was made by Mr. F during the courtship. The same pattern of total control continued into marriage. He insisted on making all decisions and was consistently concerned with his own demands, paying little or no attention to his wife% interests. Constant friction developed, as is so frequently the case with marital partners whose backgrounds are opposed.

Mrs. F had not been orgasmic before marriage. In marriage, she was orgasmic on several occasions with manipulation but not during coition. As the personal friction between the marital partners increased, she found herself less and less responsive during active coital connection.

Pregnancy intervened sex

There was an occasional orgasmic success with manipulation. Pregnancy intervened at this time, distracting her for a year, but thereafter her lack of coital return was distressing to her and most embarrassing to her husband.

He worried as much about his image as a sexually effective male as he did about his wife’s levels of sexual frustration. Mrs. F’s lack of effective sexual response was considered a personal affront by her uninformed husband.

They consulted several authorities on the matter of her sexual inadequacy. The husband always sent his wife to authority to have something done to or for her. The thought that the situation might have been in any measure his responsibility was utterly foreign to him.

When the unit was referred for therapy he at first refused to join her in treatment on the basis that it was her problem. When faced with the Foundation demand that both partners cooperate or the problem would not be accepted for treatment, Mr. F grudgingly consented to participate.

Little comment is needed. This intentionally brief history is typical of the woman who cannot identify with her partner because he will not allow such communication. There is no world as dosed to the vital ingredient of marital expression as that of the world of the indulged only child.

Particularly is this attitudinal background incomprehensible to a woman with a typical large family orientation. When Mr. F failed to accord his wife the representation of her own requirements, she had no opportunity to think or feel sexually. The catalytic ingredient of mutual partner involvement was missing.