Category: Women’s Health

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a large number of women with significant homosexual experience during their early teenage years that, in time, have withdrawn from active homophile orientation to living socially heterosexual lives.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

During the rapid treatment program, the daily report and ensuing discussions between the co-therapists and marital partners describing the non-orgasmic wife’s reactions and as well as those of her interacting husband, provide an incisive measure of the degree to which the requirements of her functioning sexual value system are being met or negated, or the extent to which she progressively can adapt her requirements.

These discussions provide a simultaneous opportunity for a more finite evaluation of the levels of interactive contribution to sexual function by her biophysical and psychosocial systems.

The treatment of both primary and situational orgasmic dysfunction requires a basic understanding by patients and co-therapists that the peak of sex-tension increment resulting in the orgasmic release cannot be willed or forced.

Orgasmic experience evolves as a direct result of individually valued erotic stimuli accrued by the woman to the level necessary for psychophysiological release. Just as the trigger mechanism which stimulates the regularity of expulsive uterine contractions sending a woman into labor is still unknown, so is the mechanism that triggers orgasmic release from sex-tension increment.

Probably they are inseparably entwined to identify one may be to know the other.

It seems more accurate to consider female orgasmic response as an acceptance of naturally occurring stimuli that have been given erotic significance by an individual sexual value system than to depict it as a learned response.

There are many case histories recorded in this and related studies reporting orgasmic incidence in the developing human female at ages that correspond with ages reported in histories of onset of male masturbation and nocturnal emission.

These clearly described objective accounts are considered accurate because they correlated with subjective recall provided by several hundred women interrogated during previously reported laboratory studies. The initial authoritative direction in therapy includes suggestions to the marital unit for developing a non-demanding, erotically stimulating climate in the privacy of their own quarters.

At no time during the two-week therapy program is either of the marital partners under any form of observation, laboratory, or otherwise. Only the phenomenon of vaginismus is directly demonstrated to the husband of the distressed wife, under conditions routinely employed by appropriate practitioners of clinical medicine.

The co-therapists’ initial directions suggest ways of putting aside tension-provoking behavioral interaction for the duration of the rapid-treatment program and allow the woman to discover and share knowledge of those things which she personally finds to be sexually stimulating.

The further professional contribution must suggest to the marital unit ways and means to create an opportunity for the woman to think and feel sexually with spontaneity. She must be made fully aware that she has permission to express her sexual feelings during this phase of the therapy program without focusing on her partner’s sexual function except by enjoying a personal awareness of the direct stimulus to her sexual tensions that his obvious physical response provides.

Every non-orgasmic woman, whether distressed by primary or situational dysfunction, must develop adaptations within areas of perceptual, behavioral, and philosophic experience.

She must learn or relearn to feel sexual (respond to sexual stimuli) within the context of and related directly to shared sexual activities with her partner as they correlate with the expression of her own sexual identity, mood, preferences, and expectations.

The bridge between her sexual feeling (perception) and sexual thinking (philosophy) essentially is established through comfortable use of verbal and nonverbal (specifically physical) communication of shared experience with her marital partner.

Her philosophic adaptation to the acceptance and appreciation of sexual stimuli is further dependent upon the establishment of “permission” to express herself sexually. Any alteration in the sexual value system must, of course, be consistent with her own personality and social value system if the adaptation is to be internalized.

Keeping in mind the similarities between male and female sexual response, the crucial factors most often missing in the sexual value system of the non-orgasmic woman are the pleasure in, the honoring of, and the privilege to express the need for the sexual experience.

Restoration of sexual feeling to its appropriate psychosocial context (the primary focus of the therapy for the non-orgasmic woman) is the reversal of sexual dissembling. This, in turn, encourages a more supportive role for her sexuality. In the larger context of a sexual relationship, the freedom to express need is part of the “give-to-get” concept of inherent incapacity and facility for effective sexual responsivity.

Professional direction must allow for a woman’s justifiable, socially enhancing need for personal commitment because her capacity to respond sexually is influenced by psychosocial demand.

The commitment functions as her “permission” to involve herself sexually, when prior opportunities available to the formation of a sexual value system have not included an honorable concept of her sexuality as a basis upon which to accept and express her sexual identity.

Commitment apparently means many things to as many different women; most frequently encountered are the commitments of marriage or the promise of marriage, the commitment of love (real or anticipated) according to the interpretation of “love” for the particular individual.

Regardless of the form, the commitment takes after it is established the goal to be attained is the enjoyment of sexual expression for its own positive return and its enhancement of those involved.

During daily therapy sessions, interrogation of the sexually dysfunctional woman is designed to elicit material that expresses the emotions and thoughts that accompany the feelings (sexual or otherwise) developed by the sensate-focus exercise.

Also continually explored are the feelings, thoughts, and emotions that are related to the behavior of her marital partner. Her reactions when discussing material of sexual connotation are evaluated carefully to determine those things which may be contributing to ongoing inhibition or distortion being revealed by the regular episodes of psychophysiological interaction with her husband.

When a non-orgasmic female involves herself with her partner in situations providing opportunities for effective sexual function, her ever-present need is to establish and maintain communication.

Communication, both physical and verbal in nature, makes vital contributions, but it loses effectiveness in the rapid-treatment method is allowed to be colored by anger, frustration, or misunderstanding. While verbal communication is encouraged throughout the two-week period, physical communication is introduced in progressive steps following the initial authoritative suggestion to provide a non demanding, warmly encompassing, shared experience for the woman, with optimal opportunity for feeling.

After the early return from sensate-focus opportunity as directed at the roundtable discussion has been judged fully effective by marital partners and co-therapists the marital unit is encouraged to move to the next phase in sensate pleasure genital manipulation.

The co-therapists should issue specific instructions to the marital partners as “permission” is granted to the female to enjoy genital play.

Sexual instructions should include details of positioning, approach, time span, and above all, a listing of ways and means to avoid the usual pitfalls of male failure to stimulate his partner in the manner she prefers rather than as she permits him the privilege to function.

Treat Orgasm

Neither the biophysical nor the psychosocial systems which influence the expression of the human sexual component have a biologically controlled demand to make specifically positive or negative contributions to sexual function.

This fact does not alter the potential of the systems’ interdigitation contribution to the formation of effective patterns of sexual response. When this potential is not realized by the natural development of psychophysiological sexual complements, the result is sexual dysfunction.

The initial psychosocial contributions toward the realization of this potential may come through a positive experience of early imprinting. Imprinting is a process whereby a perceptual signal is matched to an innate releasing mechanism that elicits a behavioral pattern. Established at critical periods in development, imprints thereafter are considered more or less permanent.

Infantile imprinting of sexually undifferentiated sensory receptivity to the warmth and sensation of close body contact is considered a source of formative contribution to an individual’s baseline of erotic inclinations and choices.

This material essentially is unobtainable in specific form during history-taking. It becomes important to the rapid-treatment program only as it is reflected by statements of preference in physical communication or other recall pertinent to ongoing patterns of sexual responsivity.

Treatment Of Orgasmic Dysfunction

Foundation personnel makes use of two primary sources of material. These sources reliably reflect the female’s prevailing sexual attitudes, receptivity, and levels of responsivity. The first source, derived from history, is the identification by the non-orgasmic woman of erotically significant expectations or experiences (positive or negative) currently evoked during a sexual interchange with her marital partner.

The co-therapists must identify those things which the husband does or does not do that may not meet the requirements of his wife’s sexual value system previously shaped by real or imagined experience or expectation.

Past experiences of positive content involving other partners, or unrealizable expectations perceived as ideal, maybe over idealistically compared by her to the current opportunity; or negative experiences or negative expectation-related attitudes may intrude upon receptivity to her partner’s sexual approach.

Thus, a rejection or blocking of sexual input may be the result.

A discussion of memories of perceptual and interpretive reactions associated with the specific sexual activity may add a further dimension to the knowledge of the wife’s currently constituted sexual value system since these memories often have been noted to function as signals for the subconscious introduction of stored experience, either positive or negative in nature.

The second source of reliable, directly applicable material upon which the rapid-treatment therapy relies for direction indeed, it characterizes this particular mode of psychotherapy is developed from the daily discussions that follow each sensate-focus exercise.

As repeatedly stressed, defining the etiology of the presenting sexual inadequacy does not necessarily provide the basis for treatment. A reasonably reliable history is indispensable, but it is used primarily to provide interpretive direction and to amplify the definition of that which is of individual significance. (It even is used from time to time to demonstrate negative patterns of sexual behaviors)

While the multiplicity of etiological influences is acknowledged, the factor of religious orthodoxy remains of major import in primary orgasmic dysfunction as in almost every form of human sexual inadequacy.

Investigation of 193 women who have never achieved orgasmic return before referral to the Foundation for treatment, 42 were products of rigidly channelized religious control. Eighteen were from Catholic, 26 from Jewish, and 7 from fundamentalist Protestant backgrounds.

It may also be recalled that 9 of these 42 primarily non-orgasmic women reflecting orthodox religious backgrounds also were identified as having the clinical complaint of vaginismus, while 3 more women with orthodox religious backgrounds had to contend with situational orgasmic dysfunction and vaginismus simultaneously.

A history reflecting the control of orthodox religious demands upon the orgasmically dysfunctional woman and her husband is presented to underscore the Foundation’s professional concern for any orthodoxy-influenced imprinting and environmental input that can and does impose severely negative influences upon the susceptible woman’s psychosocial structure relative to her facility for sexual functioning.

Mr. A and His Wife

After 9 years of a marriage that had not been consummated, Mr. and Mrs. A were referred to the Foundation for treatment. He was 26 and she 24 years old at marriage. Mrs. A’s family background was one of unquestioned obedience to parents and disciplinary religious tenets.

She was one of three siblings, the middle child to an elder brother by three years, and a younger sister by two years. Other than her father, religion was the overwhelming influence in her life. The specific religious orientation that of Protestant fundamentalism encompassed total dedication to the concept that sex and sin were synonymous words.

Mrs. A remembers her father, who died when she was 19, as a Godlike figure whose opinion in all matters was an absolute law in the home. Control of dress, social commitment, educational direction, and in fact, school selection through college were his responsibility.

There were long daily sessions, of family prayer interspersed with paternal pronouncements, never family discussions. On Sunday the entire day was devoted to the church, with activities running the gamut of Sunday school, formal service, and young people’s groups.

The young woman described a cold, formal, controlled family environment in which there was complete demand for the dress as well as toilet privacy.

Not only were the elder brother and sisters socially isolated, but the sisters also were given separate rooms and encouraged to protect individual privacy.

She never remembers having seen her mother, father, brother, or sister in an undressed state. The subject of sex was never mentioned, and all literature, including newspapers, available to the family group was evaluated by her father for possibly suggestive or controversial material. There was a restricted list of radio programs to which the children could listen.

Mrs. A had no concept of her mother except as a woman living a life of rigid emotional control, essentially without a described personality, fully dedicated to the concept that a woman’s role was one of service. She considered it her duty and her privilege to clean, cook, and care for children, and to wait upon her husband.

There is no recall of pleasant moments of quiet exchange between mother and daughter, or, for that matter, of any freedom to discuss matters of the moment with either her brother or her sister.

As a young girl, she was totally unprepared for the onset of menstruation. The first menstrual period occurred while she was in school she was terrified, ran home, and was received by a thoroughly embarrassed mother who coldly explained to the young girl that this was a woman’s lot.

She was told that as a woman she must expect to suffer this “curse” every month. Her mother warned her that once a month she would be quite ill with “bad pains” in her stomach and closed the discussion with the admonition that she was never to discuss the subject with anyone, particularly not with her younger sister. The admonition was obeyed to the letter.

The mother provided the protective materials necessary and left the girl to her own devices. There was no discussion of when or how to use the menstrual protection provided.

Menstrual cramping had its onset with the second menstrual period and continued to be a serious psychosocial handicap until Mrs. A was seen in therapy. She also described the fact that her younger sister was confined to bed with monthly frequency while maturing.

During the Teenage Years

Dating in groups was permitted by her father for church-social activities and occasionally, well-chaperoned school events. College, selected by her father, was a coeducational institution which was described by her as living by the “18-inch rule,” i.e., handholding was forbidden and 18 inches were required between male and female students at all times.

Her dating was rare and well chaperoned. After graduation, she worked as a secretary in a publishing house specializing in religious tracts. Here she met and married a man of almost identical religious background.

The courtship was completely circumspect from a physical point of view. The couple arrived at their wedding night with a history of having exchanged three chaste kisses, which not only was the total of their physical courtship but also represented the only times she remembered ever being kissed by a man. Her father had felt such a display of emotion unseemly.

The only time her mother ever discussed a sexual matter was the day of her wedding. Mrs. A was carefully instructed to remember that she now was committed to serve her husband. It would be her duty as a wife to allow her husband privileges.

The Husband Privileges

were never spelled out. She also was assured that she would be hurt by her husband, but that “it” would go away in time. Finally and most importantly, she was told that “good women” never expressed interest in the “thing.” Her reward for serving her husband would be, hopefully, in having children.

She remembers her wedding night as a long struggle devoted to divergent purposes. Her husband frantically sought to find the proper place to insert his penis, while she fought an equally determined battle with nightclothes and bedclothes to provide as complete a modest covering as possible for the awful experience.

The pain her mother had forecast developed as her husband valiantly strove for intromission.

Although initially there were almost nightly attempts to consummate the marriage, there was a total lack of success. It never occurred to Mrs. A that she might cooperate in any way with the insertive attempts.

And since this was to be her husband’s pleasure, it, therefore, was his responsibility.

She evidenced such a consistently painful response whenever penetration was attempted that frequency of coital attempt dwindled rapidly. The last three years before referral, attempts at consummation occurred approximately once every three to four months.

For 9 years this woman only knew that she was physically distressed whenever her husband approached her sexually and that for some reason the distress did not abate, Her husband occasionally ejaculated while attempting to penetrate, so she thought that he must be satisfied.

Whenever Mr. A renewed the struggle to consummate, she was convinced that he had little physical consideration for her. Her tense, frustrated, negative attitude, initially stimulated by both the pain and the “good woman” concept described by her mother, became in due course one of complete physical rejection of sexual functioning in general and of the man involved in particular.

When seen in therapy, Mrs. A had no concept of what the word masturbation meant. Her husband’s sexual release before marriage had been confined to occasional nocturnal emissions, but he did learn to masturbate after’ marriage and accomplished ejaculatory release approximately once a week, without his wife’s knowledge. There was no history of extramarital exposure.

Of interest is the fact that Mrs. A’s brother has been twice divorced, reportedly because he cannot function sexually, and her younger sister has never married. As would be expected, at physical examination Mrs. A demonstrated a severe degree of vaginismus in addition to the intact hymen.

In the process of explaining the syndrome of involuntary vaginal spasm to both husband and wife, the procedures described were followed in detail. When vaginismus was described and then directly demonstrated to both husband and wife.

It was the first time Mr. A had ever seen his wife unclothed and also the first time she had submitted to a medical examination.

There obviously were multiple etiological influences combining to create this orgasmic dysfunction, but the repression of all sexual material inherent in the described form of religious orthodoxy certainly was the major factor.

Under Foundation direction, the process of education had to include reorientation of both the sexual and social value systems. The influence of the psychosocial system was turned from a dominant-negative factor to a relatively neutral one during the acute phase of treatment.

This alteration in repressive quality allowed Mrs. A’s natural biophysical demand to function without determined opposition, and orgasmic expression was obtained. Obviously, the husband needed a definitive psychosexual evaluation as much as did his wife.

Male Sexual Dysfunction

To be diagnosed as having primary orgasmic dysfunction, a woman must report a lack of orgasmic attainment during her entire lifespan. There is no definition of male sexual dysfunction that parallels this severity of exclusion.

A Male Is Judged Primarily Impotent:

The definition means simply that he has never been able to achieve intromission in either homosexual or heterosexual opportunity. However, he might, and usually does, masturbate with some regularity or enjoy occasions of partner manipulation to ejaculation.

For the primarily non-orgasmic woman, however, the definition demands a standard of total orgasmic responsivity.

The edict of lifetime non-orgasmic return in the Foundation’s definition of primary orgasmic dysfunction includes a history of consistent non-orgasmic response to all attempts at physical stimulation, such as masturbation, male or female manipulation, oral-genital contact, and vaginal or rectal intercourse.

In Short

Every possible physical approach to sexual stimulation initiated by self or received from any partner has been totally unsuccessful in developing an orgasmic experience for the particular woman diagnosed as primarily non-orgasmic.

If a woman is orgasmic in dreams or fantasy alone, she still would be considered primarily non-orgasmic.

Foundation personnel has encountered two women who provided a positive history of an occasional dream sequence with orgasmic return and a negative history of physically initiated orgasmic release.

However, no woman has been encountered to date that described the ability to fantasy to orgasm without providing a concomitant history of successful orgasmic return from a variety of physically stimulative measures.

There are salient truths about male and female sexual interaction that place the female in a relatively untenable position from equality of sexual response.

Of primary consideration is the fact of a woman’s physical necessity for an effectively functioning male sexual partner if she is to achieve a coitally experienced orgasmic return.

During coition, the non-orgasmic human female is immediately more disadvantaged than her sexually inadequate partner in that her performance fears are dual in character. Her primary fear is, of course, for her own inability to respond as a woman, but she frequently must contend with the secondary fear for the inadequacy of male sexual performance.

The outstanding example of such a situation is, of course, that of the woman married to a premature ejaculator. From mutual responsibility for sexual performance, the woman has only to make herself physically available to provide the male with ejaculatory satisfaction.

The premature ejaculator in turn makes himself available, there usually is little correlation between intromission, rapid ejaculation, and female orgasmic return during the episode.

Married Premature Ejaculator

The biophysically disadvantaged female usually is additionally disadvantaged from a psychosocial point of view. Not only is there the insufficient bio-physical opportunity to accomplish orgasmic return, but in short order, the wife develops the concept of being sexually used in the marriage.

She feels that her husband has no real interest in her personally nor any concept of responsibility to her as a sexual entity. Many times the wife might be at a peak of sexual excitation with intromission. Without fear for her husband’s sexual performance, she could be orgasmically responsive shortly after the coital connection, displaying a full bio-physical capacity for sexual response.

But as she sees and feels the male thrusting frantically for ejaculatory release, she immediately fears the loss of sexual opportunity, is distracted from the input of biophysical stimuli by that fear, and rapidly loses sexual interest.

With the negative psychosocial-system influence from the concept of being used more than counterbalancing the high level of biophysically oriented sexual tension she brought to the coital act, the orgasmic opportunity is lost.

A brief attempt should be made to highlight the direct association of male and female sexual dysfunction in marriage, for there were 223 couples referred to the Foundation for treatment with bilateral partner complaints of sexual inadequacy. By far the greatest instance of a combined diagnosis was that of a non-orgasmic woman married to a premature ejaculator.

Of the total 186 premature ejaculators treated in the 11-year program, 68 were married to women reported as primarily non-orgasmic and an additional 39 wives were diagnosed as situationally non-orgasmic. Thus, in 107 of the 223 marriages with bilateral partner complaints of sexual dysfunction, the specific male sexual inadequacy was premature ejaculation.

Since the in-depth descriptions of the premature ejaculator presented in the earlier topics include full descriptions of the problems of female sexual functioning in this situation, there is no need for a detailed history representative of the 68 women primarily non-orgasmic in marriages to prematurely ejaculating men.

Another salient feature in the human female’s disadvantaged role in coital connection is the centuries-old concept that it is a woman’s duty to satisfy her sexual partner. When the age-old demand for accommodation during coital connection dominates any woman’s responsivity, her own opportunities for orgasmic expression are lessened proportionately.

If a woman is to express her biophysical drive effectively, she must have the single-standard opportunity to think and feel sexually during coital connection that previous cultures have accorded the man.

The male

must consider the marital bed as not only his privilege but also a shared responsibility if his wife is to respond fully with him in coital expression. The heedless male driving for orgasm can carry along the woman already lost in high levels of sexual demand, but his chances of elevating to orgasm the woman who is trying to accommodate to the rhythm, depth, and power of his demanding pelvic thrusting are indeed poor.

It is extremely difficult to categorize female sexual dysfunction on a relatively secure etiological basis. There is such a multiplicity of influences within the biophysical and psychosocial systems that to isolate and underscore a single, major etiological factor in any particular situation is to invite later confrontation with pitfalls in therapeutic progression.

Random orgasmic inadequacy is illustrated in the history below. With but two episodes of orgasmic attainment in her life, Mrs. H provides a history of one manipulative and one coital effort to orgasmic release. Her two highlighted sexual experiences were as much of a surprise to her when they occurred as they were to her husband.

There seems to be a clinical entity of low sexual tension which by history does not represent specific trauma to a sexual or any other value system. If so, it is rare both in occurrence and in professional identification. Perhaps the case history reported below is representative of such a situation.

Mr. and Mrs. H

were referred to the Foundation after 11 years of marriage with the wife’s stated complaint that she was just not interested in sex. She was 47 and her husband 44 years old. Her childhood and adolescent years had been spent in comfortable surroundings. She was the eldest by three years of two sisters and reported a relatively uneventful, non-traumatic background for growth and development.

Mrs. H was a relatively attractive woman with a reasonable number of dating opportunities during her high school and college years. Despite thoroughly enjoying the social aspects of the dating opportunities, there was little sexual stimulation from the few petting experiences she accepted.

She never masturbated and recalled no awareness of pleasant pelvic sensations during her childhood.

Her mother was a relatively self-sufficient woman with multiple socio-cultural interests. She never discussed the material of sexual content with her daughter. When Mrs. H. was 15, her father was killed in an automobile accident.

After college, Mrs. H sought the opportunity for a professional career in the business world. She continued working throughout her twenties, doing exceptionally well professionally. There was established social opportunity, but she found herself resistant to both male and female (one occasion) approaches to the shared sexual experience.

Her resistance was not described as aversion. It was just that she was essentially unstimulated by any sexual approach and saw no point in a commitment without interest.

She had several women and men friends and many interests. She worked hard, enjoyed her vacations, traveled extensively, but simply avoided sexual approach. At age 36 she met and married a man three years her junior who was working in the same professional field. They formed their own business venture.

From Mrs. H’s point of view, the marriage was simply a form of a business merger. The same could not be said for her husband. He was very much interested in sexual functioning. He had been married for less than two years in his mid-twenties and listed a large number of sexual opportunities with a wide variety of experiences before this marriage.

Mrs. H was totally cooperative in sexual functioning but was basically unmoved. She lubricated well with coital connection, found pleasure in providing a release for her husband, but was totally uninvolved personally.

She had never masturbated, and her husband’s attempts to stimulate her not only were unsuccessful but at times she even found them amusing when “nothing happened.” Neither repulsed nor frustrated, she simply wasn’t involved in sexual expression.

This was not her husband’s reaction to their mutual sexual experiences. He found her lack of responsiveness utterly frustrating. Together they prospered from a financial point of view, but her obvious lack of sexual interest was depressing to him as an individual:

Eighteen months before referral to the Foundation, Mrs. H was highly stimulated on one occasion during coital connection and was orgasmic. The couple thought success had been attained, but subsequent coital episodes found her essentially unstimulated. There was one other such episode of orgasmic attainment.

On this occasion, the business had gained an important new source of financial return and the unit had celebrated its success with dinner and the theater. She was orgasmic that night by manipulation only. Thereafter, there was no significant level of response regardless of the mode of stimulation. It was a high level of male frustration that brought the unit to the Foundation for treatment. Through the above article, we can recommend you the latest dresses.in a variety of lengths, colors and styles for every occasion from your favorite brands.

Orgasm and Masturbation

These were a few cases of masturbatory orgasmic inadequacy. The classification represents a stage of a woman’s sexual responsivity and, other than for categorizing purposes has no assigned value and will not be illustrated in-depth. Two types of history dominate this classification.

The first: is the story so often obtained from women guilt-ridden from masturbatory experimentation. They try to masturbate as young women, and after failing a time or two, simply withdraw from experimentation with the concept that they have fallen from grace. Later in their mature sexual experience, genital-area manipulation as a means of sexual excitation is at best moderately successful, but they are not orgasmic except during coition.

The second: is that of the female “don’t touch” syndrome. When taught that masturbation is evil they react by avoiding any approach to self-stimulation during adolescence and their maturing years. They may be orgasmic during socially acceptable coital opportunities but cannot be manually or orally elevated to orgasmic return.

The sexually dysfunctional woman as an effect of the male sexual function has been discussed in depth. There are so many variations on the theme of orgasmic inadequacy that many chapters could have been written, and the subject still would not have been covered adequately.

The concepts of a duality of psychosocial and biophysical structuring that influence a woman’s sexual response patterns have been advanced. If any woman’s sexual value system is either undeveloped or damaged by an imbalance of either of these two theoretical systems of influence, the return may be varying degrees of orgasmic inadequacy.

When faced with the clinical responsibility of treatment demand for primary or situational orgasmic dysfunction, the therapist must have established theoretical concepts of sexual dysfunction if he is to treat effectively.

Male Female Sexual Response

Both contribute positively or negatively to any state of sexual responsivity but have 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 responses. 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 remember 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 a 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 a 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 women, as for men, 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.

For many women, one of the most frequent causes for orgasmic dysfunction, either primary or situational, is a lack of complete identification with the marital partner.

The husband may not meet her expectations as a provider. He may have physical or behavioral patterns that antagonize.

Most Important

He may stand in the place of the man who had been much preferred as a marital partner but was not available or did not choose to marry the distressed woman. For myriad reasons, if the husband is considered inadequate according to his wife’s expectations, a negative dominance will be created in the psychosocial structure of many women.

Such a situation is exemplified by the following:

Mr. and Mrs. C

were 46 and 42 years of age, respectively, when referred to the Foundation. The wife complained of a lack of orgasmic return. The couple had been married 19 years when seen in treatment. The marriage was the only one for either partner. There were three children, the eldest of whom was 17, the youngest 12. There were barely adequate financial circumstances.

Mrs. C’s adolescent background had been somewhat restrictive. Her mother was a dominant woman with whom she developed little rapport. Her father died when she was 9 years old. There was one other sibling, a sister 8 years younger. Mrs. C went through the usual high school preparation, had two years of college, and then withdrew to take secretarial training and go to work in a large manufacturing company.

During her formative years, there were several friends, none of them particularly close except for one girl with whom she shared all her confidences. Mrs. C as a girl was fairly popular with boys, dated with regularity, and went through the usual petting experiences, but decided to avoid coital connection until marriage. She had no masturbatory history but described pleasure in the petting experiences, although she was not orgasmic.

Shortly after her twenty-second birthday, she fell in love with a young salesman for the company in which she worked. Theirs was a very happy relationship with every evidence of real mutuality of interest. She came to know and thoroughly enjoy his family, and they made plans to marry.

Three weeks before the marriage, her fiance, on a business trip, met and a week later married another woman, a divorced with two children. The jilted girl was crushed by the turn of events. This had been her only serious romantic attachment, and it had been a total commitment on her part.

Their Sexual Expression: petting and manipulated her fiance to ejaculation regularly.

Although she had been highly stimulated by his approaches she had not been orgasmic. The coital connection had not been attempted.

Six months later she married Mr. C, whom she thought kind and considerate. Their sexual experiences together were pleasant, but she achieved nothing comparable to the high levels of excitation provided by the first man in her life.

She described life with her husband as originally a good marriage. The children arrived as planned and the husband continued to progress satisfactorily in his business ventures, but husband and wife had very few mutual interests.

As the years passed Mrs. C became obsessed with the fact that she had never been orgasmic. She began to masturbate and reached high levels of excitation. Straining and willing orgasmic return without being able to fully accept the unrealistic nature of her imagery and fantasying, she failed, of course, in accomplishment.

Inexperience Husband

Her husband, with very little personal sexual experience other than in his marriage, had no real concept of an effective sexual approach. She repeatedly tried to tell him of her need, but his cooperative effort, maintained for only brief periods of time, was essentially unsuccessful.

After 12 years of marriage, Mrs. C sought sexual release outside the marriage with a man sexually much more experienced than her husband.

He did excite her to high plateau levels of sexual demand, but she always failed to achieve orgasmic release. This connection lasted off and on for a year and was only the first of several such extramarital commitments, always with the same disappointment in sexual return.

She was never able to avoid the fantasy of her former fiance whenever she approached orgasmic return, but her fantasy included a primarily negative impetus. Her frustration at “marrying the wrong man” was a constant factor in her coital encounters, as it was in most other aspects of her life.

As time passed she blamed her husband increasingly for her lack of orgasmic facility and became progressively more discontented with her lot in the marriage. She began to find fault with his financial return and social connections.

In short, Mrs. C felt that her husband was not providing satisfactorily for her needs and inevitably compared him with the man “she almost married.” This man had become a relatively well-known figure in the local area, had done extremely well financially, and apparently had a happy, functioning marriage.

Although Mrs. C never saw her former fiance, she constantly dwelt on what might have been, to the detriment of the ongoing relationship. Mrs. C sought psychiatric support for her non-orgasmic status but was unable to achieve the only real goal in her life, orgasmic release.

Finally, the husband and wife were referred to the Foundation to overcome professionally the conditioning of an adult lifetime and to cope with the requirements of her sexual value system impaired by the trauma it sustained when she was jilted by a man with whom she identified totally.

It is necessary to adjust to both her social and her sexual value systems be made in the hope of reversing or at least neutralizing the negative input of her psychosocial structure. There is no possible means of restructuring the negative input from “I married the wrong man” unless the problem is attacked directly.

First, in private sessions, the immature deification of her former fiance must be underscored.

Second, Mr. C must be presented to his wife in a different light, not in a platitudinal manner, but as the female co-therapist objectively views him.

A man’s positive attributes as he appears in another woman’s eyes carry value to the dysfunctional woman. Then there must be stimulation of the biophysical structure to levels of positive input. This, of course, is initiated by sensate-focus procedures.

Finally, the contrived somatic stimulation must be interpreted to Mrs. C’s sexual value system both by the co-therapists and by her husband. If these treatment concepts are followed successfully there is every good chance to reach the goal of orgasmic attainment.

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 the 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 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 encounter 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 the therapy he at first refused to join her in treatment on the basis that it was her problem. When faced with 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.

Although emphasis has been placed upon the role of premature ejaculation in the etiology of primary orgasmic dysfunction, primary or secondary impotence also contributes. Again the basic theme of man and woman coital interaction must be emphasized.

If there is not a sexually effective male partner, the female partner has the dual handicap of fear for her husband’s sexual performance as well as for her own.

If there is no penile erection there will be no effective coital connection.

Frequently women married to impotent men cannot accept the idea of developing a masturbatory facility or being manipulated to orgasm as a substitute for tension release.

However, if there has been a masturbatory pattern established before coital inadequacy assumes dominance, most women can return to this sexual outlet. In this situation, there is sufficient dominance of the previously conditioned biophysical structure to overcome negative input from a psychosocial system distressed by sexual performance fears.

But if there have been no previous substitute measures established, many women cannot turn to this mode of relief once impotence halts effective coital connection. In this situation, the psychosocial structure, unopposed by prior biophysical conditioning, assumes the dominant influence in the woman’s sexual response pattern.

Mr. and Mrs. D

were referred to the treatment of orgasmic inadequacy after four years of marriage. When seen in therapy she was 27 and her husband 43 years old. He had been married twice previously. There were children of both marriages and none in the current marriage.

The husband also was sexually dysfunctional in that he was secondarily impotent.

His second marriage had been terminated due to his inability to continue the effective coital connection. Although, when the unit was seen in consultation the marriage had been consummated, coitus occurred only once or twice a year.

Mrs. D’s background reflected somewhat limited financial means. Her father had died when the three siblings were young, and the family had been raised by their mother, who worked while the grandmother took care of the children.

Clothes were hand-me-downs, food the bare essentials. Her education had of necessity terminated with high school, and she worked as a receptionist in several different offices befo3e her marriage. She continued to live at home while working and contributed to what salary she made to help with the family’s limited income.

Mrs. D met her future husband when he visited the office where she worked. He invited the young woman to lunch. She accepted and married him four months later without knowledge of his sexual inadequacy, although she had been somewhat puzzled by his lack of forceful sexual approach during the brief courtship.

Mrs. D’s own sexual history had been one of a few unsuccessful attempts at masturbation, numerous petting episodes with boys in and out of high school, but no attempted coital connection. She had never been orgasmic.

Her husband had inherited a large estate and his financial situation certainly was the determining factor in his wife’s marital commitment. Since the girl had been distressed by a family background of genteel poverty, she felt the offer of marriage to be her real opportunity both to escape her environment and to help her two younger siblings.

The wedding trip was an unfortunate experience for Mrs. D when she realized for the first time that her husband had major functional difficulties. She knew little of male sexual response beyond the petting experiences but did try to help him achieve an erection by a multiplicity of stimulative approaches in his direction. There was no success in erective attainment.

The marriage was not consummated until six months after the ceremony. In the middle of the night, Mr. D awoke with an erection, moved to his wife, and inserted the penis. She experienced mild pain but reacted with pleasure, feeling that progress had been made.

However, following the usual pattern of .a secondarily impotent male, progress was fleeting. As stated, there were only a few other coital episodes in the course of the four-year marriage. In these instances, she always was awakened from sleep by her husband when he awoke to find himself with an erection.

Quick Ejaculation

Then there was rapid intromission and quick ejaculation. There was no history of a successful sexual approach by her husband under her conscious direction, insistence, or stimulation. Mr. D tried repetitively during long-continued manipulative and oral-genital sessions to bring his wife to orgasm, without result.

When they were referred for treatment, neither husband nor wife described sexual activity outside the marriage.

There have been 193 women treated for primary orgasmic dysfunction during the past 11years. Basically, in this method of therapy, the sexually dysfunctional woman is approached through her sexual value system.

If its requirements are non-serving limited, unrealistic, or inadequate to the marital relationship-by suggestion she is given an opportunity, with her husband’s help, to manipulate her biophysical and psychosocial structures of influence until an effective sexual value system is formed.