Author: The Beauty Nation

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.

Professionals many times look for a specific influence or conditioning that predetermines sexual failure, and in most instances, it can be identified if the delving goes deep enough.

Instances of neither positive nor negative dominance by either biophysical or psychosocial influence structures. If a woman has never established a close juxtaposition between the biophysical and psychosocial systems of influence because she has lived in a protective vacuum, she will not have been stimulated to develop her own sexual value system and therefore will tend to neutralize most input material of sexual implication.

The case history

below is presented to emphasize the fact that there need be no dominant influence (either positive or negative) in the development of primary orgasmic dysfunction.

Mrs. B was the only child of parents in their thirties when she was born. Both parents, teachers in a small, church-oriented college, were more restrained by the habit of life-style and their own relationship than by religious influence.

The child did not develop as an extension of their presumed intellectual interests but became the “doll” whom they dressed exquisitely, handled little, and disregarded emotionally (as she perceived her upbringing). There was no real source of female identification, no opportunity to establish a sexual value system.

All decisions on her behalf included the theoretically objective presentation of two alternatives, but parental, primarily mother’s preference was emphasized. Mrs. B had no recollection of making a definitive decision of her own until her sophomore year at college when she chose for a husband a relatively older man (he was in graduate school and seven years her senior). With this one decision, she again relinquished all opportunity for self-determination.

They married upon his graduation at the end of her junior year in college. His assumption of total authority in marriage appeared more by default than demand and continued through 11 years of marriage, during which two children were born.

During the first years of the marriage, Mrs. B maintained a complacent attitude toward her sexual role within the marriage. However, in the last six years of the marriage, she developed an intense desire to realize full sexual expression for herself and greater sexual pleasure for her husband.

Husband behavior

In this latter period her husband’s behavior, though warm and protective, was highly restrained in sexual as well as other facets of the marital relationship. He participated in the Foundation’s program with complete willingness, although with little concept of what or how anything in the marriage could be changed.

Reared by an older aunt and uncle he had learned little, by the direction of observation, of the potential for human interaction on a personal level. However, he fortunately had not been given any primarily negative indoctrination.

Mrs. B’s enthusiasm for an effective sexual relationship within the marriage was and still is defined as real, but she has been unable to overcome anesthesia to any sensory perception that she can relate to erotic arousal. She has been unable to establish sensory reference within which to develop and relate her well-defined affection and regard for her husband.

The two contributing systems of influence on sexual function:

Remained in displaced positioning one from the other. To date, she has the demonstrated-insufficient emotional or intellectual capacity to establish a symbiotic state between her two systems of influence.

It is with the mixed clinical reaction that the co-therapists regard the positive reaction of Mr. B to therapy. His response was one of delighted enthusiasm for the concept of interaction marked by both physical and verbal communication.

His feeling for his wife was intensified and he has become completely comfortable in a demonstrative marital role. While both partners feel that the alteration in the quality of the marital relationship is of significant proportion, the therapy has in fact failed to achieve the aim of reversal of the presenting distress.

This case represents a strikingly intense degree of negative conditioning, yet there was little content in the history that could be termed specifically negative in its rejection of sexual expression.

This case also represents an example of the possible clinical warning system revealed by a negative reaction to the use of a moisturizing lotion as a medium of physical exchange. Mrs. B found its use “distracting” and of little meaning to the exchange with her partner.

While Mr. B found it to be a crucial contribution to establishing his initial ability to touch and feel with comfort and receptivity.

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 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 sensation 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.

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 opportunity 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.