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Sexual Pleasure

When conceptually she has a penis to play with, usually the woman will do just that. If she will allow the vaginally contained penis to stimulate slowly and feelingly, in the same manner, she enjoyed sensate pleasure from manual body stroking or the manipulation of her genital organs under her controlled directions, she will find herself overwhelmed with sexual feeling.

As vaginal sensation increases for the woman and confidence in ejaculatory control develops for the man, penile-containment episodes progress in a more confident vein. The teasing technique of mounting, dismounting, and remounting is extremely valuable as a means of female sex-tension increment.

There are several clinical pitfalls to be avoided under careful co-therapist direction as the marital unit is moved from phase to phase of increasing sexual responsivity by day-by-day consideration and direction.

  1. the cooperating male partner must be manipulated to ejaculation with a regularity at least approximating that described during the interrogation periods on day one or two as his concept of ideal ejaculatory frequency. This concern for regularity of release of cooperative male partners’ sexual tensions is but turn-about application of the principles of sex-tension relief, directed toward regularity of orgasmic release for the cooperative wife of the premature ejaculator.
  2. there must be regularly recurring vacations from the physical expression of sexual functioning. At least every fourth day is declared a holiday from physical sexual expression. However, the daily conferences between marital partners and the co-therapists continue at a seven-day-a-week pace. Through the two week period during which the distressed marital unit is following the Foundation program. There is so much material that must be presented, evaluated, and restated when the unit’s marital relationship is explored in depth that daily conferences are a regular part of the treatment format. When the wife’s physical progress is obvious, the partners are infinitely more willing to look at their particular contributions or lack of them to the marital relationship. As they improve the climate of the marriage, inevitably they are contributing a vital ingredient to the woman’s psychosocial structuring. This structure, in turn, positively influences the accrual of her sexual tensions. There is yet another factor of sex-tension increment derived from daily living with the subject by the marital partners. Presuming strategically placed vacations from overt sexual function, there is tremendous tension increment in the continuity of sexual expression, if orgasmic or ejaculatory levels of tension are restricted by frequency control.Once confidence in the female superior coital position has been established, with the woman enjoying the sensate pleasure of pelvic play with the intravaginally contained penis, the marital unit is directed to convert the female-superior position to a lateral coital position.

Effective Sexual Performance

With husband and wife mounted in a female superior position, there may be some difficulty in converting to a lateral coital position without first practicing the maneuver.

Initially, practice should take place without intromission if the conversion is to be accomplished smoothly, but the functional return for both sexual partners certainly is well worth the effort expended in the learning process.

The lateral coital position is reported as the most effective coital position available to men and women, presuming there is an established marital-unit interest in mutual effectiveness of sexual performance.

As described in premature ejaculation, when a facility in lateral coital positioning has been obtained, there is no pinning of either the male or female partner. There is mutual freedom of pelvic movement in lateral coital position in any direction, and there will be no cramping of muscles or necessity for tiring support of body weight.

The lateral coital position provides both sexes flexibility for free sexual expression. This position particularly is effective for the woman, as she can move with full freedom to enjoy either slow or rapid pelvic thrusting, depending upon current levels of sexual tensions.

In this coital position, the male can best establish and maintain ejaculatory control.

In order to convert from the female superior to a lateral coital position, there are several successive steps to be taken. The husband with his left hand should elevate his wife’s right leg while moving his leg under hers so that his left leg (now outside of her right leg) is extended from his trunk at about a 45-degree angle.

The wife simultaneously should extend her right leg (the one that is being elevated) so that positionally she is now supporting her weight on her left knee with the right leg extended, instead of being on her knees as in the female-superior position.

As she makes these adjustments, she should lean forward to parallel her trunk to that of her husband. Then the male clasps his partner with his left arm under her shoulders, his hand placed in the middle of her back, and his right hand on her buttocks, holding the two pelves together.

The two partners then should roll to his left (her right) while still maintaining intravaginal containment of the penis.

Once the partners have moved into the lateral positioning, the two trunks should be separated at roughly a 30-degree angle.

The male rolls back from his left side to rest on his back. The female remains relatively on her stomach and chest with minimal elevation of her left side and her head turned toward her husband. Pillows should be placed beneath both heads for comfort and to provide support for the woman’s slightly angled position.

Occasionally there is value in a supportive pillow placed along her right side. The only weight that must be supported is that of the wife’s right thigh, which rests upon the husband’s left thigh. His left thigh is supported by the bed, so there is no problem with long-continued weight support.

The concern for arm placement is resolved if the woman’s right arm is circled under her pillow and the husband’s left arm (in the same fashion) moves under her pillow beneath her shoulders or underneath her neck.

This leaves the woman’s left arm and hand and the husband’s right arm and hand for mutual play and body caressing. The female accomplishes leverage for pelvic thrusting by pulling up her extended right leg slightly so that her knee comes to rest on the bed. Her left leg should be cast over her husband’s right hip with the knee resting comfortably on the bed.

The two knees provide her with all the traction she needs for pelvic thrusting whenever sex-tension demands for any form of thrusting develop.

In view of the physical complexity of changes in position, usually it is suggested that man and wife try converting the simulated female superior mounting position to the lateral position at least two or three times before establishing coital connection and then attempting conversion from superior to lateral positions.

The trial runs usually begin in a humorous vein; yet with functional seriousness husband and wife easily can work out the problems of comfortable arms and legs placement and rapidly accomplish facility with the position-conversion technique. Again, the lateral coital position is the most effective coital position from mutuality of shared male and female freedom of sexual experimentation.

The potential return is well worth the effort of the marital unit involved in learning to convert from the female-superior positioning. One of the more realistic goals this form of therapy may suggest to the non orgasmic woman relates to self-reorientation which tends to improve or helps to insure maximum interdigitation of the dual-system basis of effective sexual function theorized in the topic of therapy and orgasmic dysfunction.

The goal seeks to create or encourage the best possible climate in which each system (biophysical and psychosocial) can function.

Attainment of this climax first is dependent upon self-knowledge. A sexually dysfunctional woman can be therapeutically assisted to identify and develop understanding of her own psycho-social needs (the psychosocial system of sexual function).

She also can be educated to take advantage of her naturally occurring, maximum levels of sexual drive (the biophysical system of sexual function). Much can be derived from the exchange of information among the non orgasmic woman, her husband, and the cotherapists, to help her define her actual physical awareness of sexual desire.

This specific awareness of sexual need is relied upon by most sexually effective women, although not necessarily at an actively conscious level. The dysfunctional woman’s husband has a definitive contributing role in helping to develop her sense of freedom and grace in the spontaneous expression of her sexual feelings.

The husband’s role is vital to success in the treatment of orgasmic dysfunction. His attitudinal approach is the most important contributing factor (positively or negatively) to therapeutic procedure.

If he is totally cooperative, interested, supportive, and identifies quietly and warmly with his wife as she lives through the strain of the interpretive look in the mirror provided by the cotherapists, her chances of orgasmic attainment are significantly increased.

If the husband’s attitude is one of hostility, indifference, impatience, or even regimented cooperation, the chances of failure in treatment are correspondingly increased. It is not sufficient to be simply a cooperative partner.

There must be the opportunity for the beleagured wife to identify with her husband. She must be able to feel the warmth of his interest in her as an individual and as a woman, to count on him for emotional support and, above all, to feel him as much a’ partner in concern and as vitally interested in reversing her dysfunction as she is in accomplishing full expression as a woman.

Under authoritative control many women can and do break through the shell created by a husband’s indifference and ultimately develop a pattern of orgasmic release. Many more fail.

For discussion purposes, the immediate failure rates for both primary and situational orgasmic dysfunction are included as followed. A detailed presentation of failure rates and five-year follow-up of treated patients is presented in Program Statistics.

The failure rate in reversal of the presenting complaint of orgasmic dysfunction in the two week rapid-treatment program is 19.3 percent. There is little difference between the failure rates returned in treating the primarily or situationally non orgasmic woman. The one category that obviously needs significant improvement of the therapeutic approach is that of random orgasmic inadequacy (37. 5 percent).

Orgasm Experience

Infrequent or rare orgasmic return with both masturbatory and coital experience has defied the Foundation’s current therapeutic approaches. In some cases there were detrimental interpersonal relationships that could not be altered successfully.

In others there was no evidence of inherent levels of sexual tension either presently or historically described. In the majority of situations, however, the cotherapists did not find an answer to resolve the problem of random orgasmic inadequacy.

Were the failure rate in this category improved to parallel that of other categories of orgasmic inadequacy, there would be no statistical significance in reported return between the failure rates in treatment of primary or situational orgasmic dysfunction.

The close approximation of failure rates in the two arbitrary clinical divisions of woman’s non orgasmic status supports the concept of uniformity of treatment approach, regardless of whether the woman has ever had previous orgasmic experience.

An overview of female sexual dysfunction commonly reveals a stalemate in the sociosexual adaptive process at the point at which a woman’s desire for sexual expression crashes into a personal fear or conviction that her role as a sexual entity is without the unique contribution of herself as an individual.

For some reason, her permission to function as a sexual being or her confidence in herself as a functional sexual entity has been impaired. The stalemate may be derived from negation of her own sexual identity or from the attitudes and circumstances of marital interaction.

The influence may emanate from her partner’s unwitting or deliberate contribution to her loss of personal and sexual self-esteem; or it may emerge on signal from her earlier imprinted, conditioned, and experientially created sexual value system.

The blocking of receptivity to sexual stimuli is an unfortunate result of factors which deprive her of the capacity to value the sexual component of her personality or prevent her from placing its value within the context of her life.

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Treat Orgasm

Sexual Intercourse Technique

Sexual Intercourse

Probably the most effective technique is that of the teasing approach of light-touch moving at random from the breasts to the abdomen to the thighs to the labia to the thighs and back to the abdomen and breasts without concentrating specifically on pelvic manipulation early in the stimulative episode.

Particularly should direct approach to the clitoral area be avoided initially in this process. This “exercise” becomes even more effective as a means of female sex-tension increment, when interlaced with sensate-focus, stroking techniques introduced after roundtable discussion.

The male partner must be careful not to inject any personal demand for sexual performance into his female partner’s pattern of response.

The husband must not set goals for his wife.

He must not try to force responsivity.

His role is that of accommodation, warmth, understanding, and holding, but he should not be so pacific that his own sexual pleasure is negated for either himself or his partner.

Through total cooperation he allows his wife to drift with sensate pleasure and provides her with sensual stimulation without forcing her to contend with an accompanying sense of goal oriented demand to respond to a forcing form of manipulation.

The cotherapists must make it quite clear to the husband that orgasmic release is not the focus of this sexual interaction.

Manipulation of breast, pelvis, and other body areas varying from the lightest touch to an increase in pressure only at partner direction, should provide the wife with the opportunity to express her sexual responsivity freely, but without any concept of demand for an endpoint (orgasmic) goal. It must be emphasized that the effectiveness of a stimulative session is not lost to the woman simply because the session is terminated without orgasmic experience.

There is a tremendous accrual of sexual facility and interest for any woman when she knows that there will be a repeat opportunity for further sexual expression in the immediate future.

Sexual Stimulative Effects

Thus, the husband’s light, teasing, non demanding approach to touch and manipulation allows the female partner full freedom to express her interests, her demands, her sexual tensions. This sequence of opportunities permits accumulation of stimulative effects which will provide the source of her ultimate release of maximum sex-tension increment at some future point.

All specific exercises aimed toward the wife’s fulfillment of her orgasmic capacity always are introduced by direction of the cotherapists on the basis of marital-unit report. When husband and wife describe the fact that previous directions have produced a positive return of stimulative pleasure, their next level of sexual involvement is approached.

This treatment concept means, of course, that a steady progression of exercises does not necessarily take place on daily schedule. For instance, marital partners who never have verbally shared sexual reactions or expressed sexual preferences to each other usually take longer to appreciate a positive level of sexual-tension return than less restrained, more communicative husbands and wives.

Another example of delayed reactive potential centers upon marital units that have coped with functional distress for extended periods of time. These husbands and wives usually require longer to adapt to and become comfortable with their revised patterns of sexual behavior than those whose sexual dysfunction has been relatively brief.

It has been further observed that successful marital-unit adaptation to a state of sexual dysfunction, in itself a possible indication of individual and marital-unit strengths, may present a higher level of inherent resistance to reversal of the stated inadequacy than more dissident, fragmented marital relationships.

Cotherapists must constantly bear in mind during the rapid-treatment program that the authoritative introduction of specific exercises represents a deliberate breakdown of woman’s sexual responsivity into its natural components. Each exercise is introduced singly and continued until appreciated. All exercises are accrued one after another in a natural building process until they have been reassembled into the whole of an established sexual response pattern.

The directive pattern, in which each item is repeated as a new one is added in each successive verse until all items are assembled. Therefore, the marital unit must be reminded quietly each time a new direction for specific sexual activity is introduced that this introduction of new material is not an indication that previous exercises and their concomitant pleasures must be relinquished in order to enjoy the new experience.

Rather, as each new psycho physiological concept is provided for marital partner assimilation, older exercises are constantly restated until the whole reactive process is assembled.

At this point, marital partners frequently may have acquired a gavotte-like approach to sexual expression when employing the directive suggestions rather than spontaneously incorporating each new physical approach or stimulative concept into their own style or pattern of behavior.

The marital couple will need reminding that on a long-range basis there is little return from clocking each component of the therapeutic pattern for a specific length of time or introducing each new exercise into their sexual interaction in a purely mechanical manner, solely because it has been suggested by impersonal authority rather than mutually evolved.

Emphasis should be placed upon the fact that there is marked individual variation in the time span in which each area of sensory perception is appreciated. Mood, level of need, quality of partner involvement, etc., all vary widely, frequently on a day-to-day basis.

There will be occasions when spontaneous non specific or even a sexual social interaction will replace all the “touch and feeling” (foreplay) that have been so enjoyable and so necessary at other times.

Whenever exercises in sensate focus, especially those using specifically positioned opportunities have initiated newfound levels of stimulative appreciation for the non orgasmic woman, the appropriately sequential step is suggested for unit exploration during their next phase of sexual interaction.

It is essential to successful therapy to emphasize again and again the concept that sexual response can neither be programmed nor made to happen. The marital unit also must be encouraged continually to create an environment that fulfills the stimulative (bio-physical and psychosocial) requirements of each partner and in which sex-tension increment can occur without any concept of performance demand.

Each successive phase of physical approach is introduced subsequent to establishing some evidence of encompassing psychosensual pleasure as perceived by the non orgasmic woman during a prior episode.

These phases develop in sequence from the first day’s sensory exploration which takes place following the roundtable discussion. If there is obvious female pleasure in the first sensate experience, the next phase includes specific manipulative approach to genital excitation, using, if possible, the positioning.

If the first day’s exercise in sensate pleasure has not developed a positive experience for the non orgasmic woman, the second day will again be devoted to these primary touch-and-feeling episodes, instead of moving into the genital manipulative episodes usually scheduled for Day two.

Genital manipulative episodes are continued until there is obvious evidence of elevated female sex tension, before moving on to the next phase in the psychosensory progression.

Subsequent to reported success in manual genital excitation, the marital, partners are asked to try the female-superior coital position, by which means the wife may translate previously established levels of sensate pleasure into an experience which includes the sensation of penile containment.

The specific intercourse techniques of this position have been discussed and illustrated as Female superior mounting is but another step in the gradual development of sexual awareness leading from simple, sensate focus to effective response in coital connection.

The husband is asked to assume a supine position in anticipation of his wife’s superior mounting. Intromission is to take place when both partners have reached the level of sexual interchange, full erection for the man and well-established lubrication for the woman that suggests the desire for further physical expression.

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Sexual Function Contribution

During the rapid treatment program, the daily report and ensuing discussions between the cotherapists 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 is able to adapt her requirements.

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

The treatment of both primary and situational orgasmic dysfunction requires a basic understanding by patients and cotherapists that the peak of sex-tension increment resulting in 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 psycho physiological 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 by reason of their correlation 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 cotherapists’ 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.

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 sexually (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 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 inherent in capacity and facility for effective sexual responsivity.

Professional direction must allow for 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 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 enjoyment of sexual expression for its own positive return and for 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 cotherapists 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.

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Sexual Dysfunction Treatment

Sexual Therapy

A basic premise of therapeutic approach originally introduced, and fully supported over the years by laboratory evidence, is the concept that there is no such thing as an uninvolved partner in any marriage in which there is some form of sexual inadequacy.

Therapeutic technique emphasizing a one-to-one patient-therapist relationship, effective in treatment of many other psychopathological entities, is grossly handicapped when dealing specifically with male or female sexual inadequacy, if the sexually dysfunctional man or woman is married. Isolating a husband or wife in therapy from his or her partner not only denies the concept that both partners are involved in the sexual inadequacy with which their marital relationship is contending, but also ignores the fundamental fact that sexual response represents (either symbolically or in reality) interaction between people. The sexual partner ultimately is the crucial factor.

If treatment is directed separately toward the obviously dysfunctional partner in a marriage, the theoretically “uninvolved” partner may actually destroy or negate much therapeutic effort, initially from lack of knowledge and understanding and finally from frustration.

Sexual Response

If it is little or no information of sexual import, or for that matter, of total treatment progress reaches the wife of the impotent husband, she is in a sincere quandary as to the most effective means of dealing with the ongoing marital relationship while her husband is in therapy. She does not know when, or if, or how, or under what circumstances to make sexual advances, or whether she should make advances at all. Would it be better to be simply a “good wife,” available to her husband’s expression of sexual intent, or on occasion should she take the sexual initiative.

During actual sexual functioning should she maintain a completely passive, somewhat active, or a mutually participating role? None of these questions, all of which inevitably arise in the mind of any intelligent woman contending with the multiple anxieties and the performance fears of an impotent husband, find answers in the inevitable communication void that develops between wife and husband when one is isolated as a participant in therapy.

Of course, an identical situation develops when the wife is non orgasmic and enters psychotherapy for constitution of effective sexual function. It is the husband that does not know when, or if, or how, or under what circumstances to approach her sexually.

If he approaches his wife in a physically demanding manner, she reasonably might accuse him of prejudicing therapeutic progress. If he delays or even restrains expression of his sexual interest, possibly looking for some signal that may or may not be forthcoming, or hoping for stone manner of behavioural guideline, he may be accused of having lost interest in or of having no real concern for his sexually handicapped wife.

Not infrequently he also is accused (probably with justification) of being a significant contributor to his wife’s sexual dysfunction. But if no professional effort is made to explain his mistakes or to educate him in the area of female sexual responsivity, how does he remove this continuing road block to his wife’s effective sexual function?

Methods of therapy using isolation techniques when approaching clinical problems of sexual dysfunction attempt to treat the sexually dysfunctional man or woman by ignoring half of the problem, the involved partner. These patient-isolation techniques have obliterated what little communication remained in the sexually inadequate couple at least as often as the techniques have returned effective sexual functioning to the distressed male or female partner.

It should be emphasized that the Foundation’s basic premise of therapy insists that, although both husband and wife in a sexually dysfunctional marriage are treated, the marital relationship is considered as the patient. Probably this concept is best expressed in the statement that sexual dysfunction is indeed a husband and wife problem, certainly never only a wife’s or only a husband’s personal concern.

Dual Sex Therapy

Definitive laboratory experience supports the concept that a more successful clinical approach to problems of sexual dysfunction can be made by dual-sex teams of therapists than by an individual male or female therapist.

Certainly, controlled laboratory experimentation in human sexual physiology has supported unequivocally the initial investigative premise that no man will ever fully understand woman’s sexual function or dysfunction. What he does learn, he learns by personal observation and exposure, repute, or report, but if he is at all objective he will never be secure in his concepts because he can never experience orgasm as a woman. The exact converse applies to any woman.

Since it soon became apparent in the laboratory that each investigator needed an interpreter to appreciate the sexual responsivity of the opposite sex, it was arbitrarily decided that the most theoretically effective approach to treatment of human sexual dysfunction was to include a member of each sex in a therapy team. This same premise applied in the clinical study provides husband and wife of a sexually dysfunctional couple each with a friend in court as well as an interpreter when participating in the program.

By repute, report, observation, and by personal exposure in and out of bed, she too learns to conceptualize male sexual functioning and dysfunctioning, but she will never fully understand the basics of male sexual responsivity, because she will never experience ejaculatory demand or seminal fluid release.

For example, it helps immeasurably for a distressed, relatively inarticulate, or emotionally unstable wife to have available a female cotherapist to interpret what she is saying and, far more important, even what she is attempting unsuccessfully to express to the uncomprehending husband and often to the male cotherapist as well.

Conversely, it is inevitably simpler for any wife to understand the concerns, the fears, the apprehensions, and the cultural pressures that beset the sexually inadequate man that is her husband when these grave concerns can be defined simply, effectively, and unapologetically to her by the male cotherapist. The Foundation’s therapeutic approach is based firmly upon a program of education for each member of the dysfunctional couple.

Multiple treatment sessions are devoted to explanations of sexual functioning with concentration on both psychological and physiological ramifications of sexual responsivity. Inevitably, the educational process is more effectively absorbed if the dual-sex therapy teams function as translators to make certain that no misunderstandings develop due to emotional or sexual language barriers.

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Sexual Dysfunction Treatment

Sexual Intercourse

The ultimate level in couple communication is sexual intercourse. When there is couple complaint of sexual dysfunction, the primary source of absolute communication is interfered with or even destroyed and most other sources or means of interpersonal communication rapidly tend to diminish ineffectiveness.

Again, this loss of warmth and understanding is frequently due to fear and/or lack of comprehension on the part of either marital partner. The wife is afraid of embarrassing or angering her husband if she tries to discuss his sexually dysfunctional condition. The husband is concerned that his wife will dissolve in tears if he mentions her orgasmic inadequacy or asks for suggestions to improve his sexual approaches.

Usually the failure of communication in the bedroom extends rapidly to every other phase of the marriage. When there is no security or mutual representation in sexual exchange, there rarely is freedom of other forms of marital communication.

It should be made abundantly clear, in context, that Foundation philosophy does not reflect the concept that sexual functioning is the total of any marital relationship. It does contend, however, that very few marriages can exist as effective, complete, and ongoing entities without a comfortable component of sexual exchange. With detailed interchange of information, and with interpersonal rapport secured between marital partners, the dual-sex therapy team moves into direct treatment of the specific sexual inadequacy brought to its attention.

After roundtable discussion, the team anticipates that both partners in the distressed couple will have become reassured and relatively relaxed by the basic educational process and will have established a significant step toward effective communication. Treatment approaches to specific sexual dysfunctions will be discussed separately under appropriate headings in subsequent individual case.

Sexual Advice

From a professional point of view, formal training contributes little of positive value if a specific discipline is emphasized to a dominant degree in the treatment of sexual dysfunction. It is current foundation policy to pair representatives of the biological and behavioural disciplines into teams of cotherapists.

From a purely practical point of view, there is obvious advantage in having a qualified physician as a member of each team. This disciplinary inclusion avoids referring embarrassed or anxious couples to other sources for their vitally necessary physical examinations and laboratory (metabolic function) evaluations. The behavioural member provides invaluable clinical balance to each team with his or her particular contribution of psychosocial consciousness.

Many combinations of disciplines should and will be used experimentally as representative individuals are available, complying with the Foundation’s basic concept of a member of each sex on each team.

The Foundation is constantly looking for professionals with the individual ability necessary to work comfortably and effectively with people in the vulnerable area of sexual dysfunction. There must be an established research interest; this requirement is peculiar to the Foundation’s total research program but is unnecessary for purely clinical programs.

There also must be an expressed interest in and demonstrated ability to teach, for so much of the therapy is but a simple direct educational process. Not a negligible requirement is the willingness to make a commitment to a seven day week or its equivalent.

Most important, the individual must be able to work in continual cooperation with a member of the opposite sex in what might be termed a single standard professional environment. Team dominance by virtue of sex-linked or discipline-linked status by either cotherapist would tend to dilute their mutual effectiveness in this particular psychotherapeutic design.

Finally, individual members of any dual sex therapy team, if they are to concentrate professionally on the distress of the couples complaining of sexual inadequacy, must be fully cognizant and understanding of their own sexual responsivity and be able to place it in perspective. They must be secure in their knowledge of the nature of sexual functioning, in addition to being stable and confident in their own sexuality, so that they can in turn be objective and unprejudiced when dealing with the controversial subject of sex at the fragile level of its dysfunctional state.

Many men and women who are neither personally secure in nor confidently knowledgeable of sexual functioning attempt the authoritative role in counselling for sexual inadequacy. There is no place in professi6nal treatment of sexual dysfunction for the individual man or woman not culturally comfortable with the subject and personally confident and controlled in his or her own manner of sexual expression.

The possibility for disaster in a therapeutic program dealing with sexual dysfunction cannot be greater than when the therapist’s sexual prejudices or lack of competence and objectivity in dealing with the physiology and psychology of sexual functioning become apparent to the individuals or couples depending upon therapeutic support.

If the therapist is in any way uncomfortable with the expression of his or her own sexual role, this discomfort or lack of confidence inevitably is projected to the patient, and the possibility of effective reversal of the couple’s sexual dysfunction is markedly reduced or completely destroyed.

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Sexual Dysfunction Treatment

Sexual Health

At onset of the program, couples were requested to devote three weeks of their time to the therapeutic program. This concept of time commitment was maintained for the first two years of this clinical research program.

Evaluation of sexual experience made clear that three weeks was simply too long for a couple’s comfortable commitment of time away from home and, from the stand point of therapy demand also was an unnecessarily extended period. Therefore, the outer limit of time demand became two weeks and has remained so for the last nine years.

An important clinical contribution to effective therapy in sexual dysfunction can be made by scheduling husband and wife partners on a continuum; all units in the acute phase of the treatment program are seen daily (seven days a week) during their two weeks in the foundation’s intensive educational program.

One of the therapeutic advantages inherent in the two-week phase of rapid education and/or symptom reversal is the isolation of the husband and wife partners from the demands of their everyday world.

Approximately 90 percent of all couples treated by the Foundation are referred from outside the St. Louis area. These people are regarded and treated as though they were guests. Every effort is made to insure their enjoyment of a “vacation” during time spent in the city.

Care is taken to familiarize them with the geographic area and supply up-to-date information regarding restaurants, areas of interest, amusement, educational potentials, etc.

Inevitably they rekindle, in part, their own communicative interests when there is no child crying, no secretary reminding of business commitments, or no relatives or friends inadvertently intruding. With this isolation from social demand, opportunity develops for closeness or a unity that almost always is missing between marital partners facing crises of sexual dysfunction.

This arbitrary social isolation certainly is an important factor supporting the effectiveness of the therapy program. Under these circumstances protected from outside pressures the marital partners frequently accept for the first time the Foundation’s basic premise that “there is no such thing as an uninvolved partner in any marriage distressed by a complaint of sexual inadequacy.”

Sexual Interest

Yet another advantage of the social-isolation factor is its effect upon the sexual interest of both marital partners. With the subject of sex exposed to daily consideration, sexual stimulation usually elevates rapidly and accrues to the total relationship. This specific psycho physiologieal support is indeed welcome to the cotherapists dealing with the blocking of sexual stimuli in individuals distressed by sexual inadequacy.

To help develop a level of sexual interest:
for the couple which is realistic to their life style, vacations from any form of specific sexual activity are declared for at least two 24-hour periods during the two weeks, in a system of timely checks and balances. However, daily consideration of sexual matters and social isolation continue to give maximum return to this facet of the psychotherapy.

It might be held as part of this therapeutic concept that patients must have the opportunity to make those mistakes which reveal factors contributing to their particular distress. This means of learning is particularly important in reversing sexual dysfunction. In this interest, the patients are told that the cotherapists are not interested in a report of perfect achievement when they are following directions in the privacy of their own bedroom.

The cotherapists are interested in couple’s making their usual errors of reaction and interaction as they involve themselves in situations that provide opportunity for natural response to sexual stimuli. If the mistakes then are evaluated and explained in context, the educational process is infinitely less painful and more lasting. There are significant advantages in this technique.

When mistakes are made, they are examined impartially and explained objectively to the unit within 24 hours of their occurrence. Additionally, they are discussed within the context of the misunderstanding, misconceptions, or taboos that may have led to or influenced their occurrence initially.

There is yet another specific advantage in daily conferences. If the distressed unit waits a matter of days after mistakes are made before consulting authority, the fears engendered by their specific episode of inadequacy or mistake in performance increase daily in almost geometric progression. In such a situation, alienation between partners is a common occurrence. By the time the next opportunity for consultation arises, a great deal of the effectiveness of prior therapy may have been destroyed by the takeover of the fears.

Fears of performance do not wait a few days or a week until the next appointment; in the meantime, the couple, separately or together, must use their own methods of coping. Most often this will be withdrawal of sexual or total communication, which places them further away from altering the sexual distress than before therapy was initiated.

When patients do not make mistakes during their acute phase of treatment, the cotherapists arrange for them to do so. It is inevitably true that individuals learn more from their errors than from their ability to follow directions effectively on the first attempt.

If marital partners reverse their sexual dysfunction and fully understand, through comparison with episodes of failure, why and what made it possible for them to function effectively, the probability of reduplicating the success in the home environment is increased immeasurably.

As evidence of the advantage to the therapeutic program of the unit’s social isolation, those couples referred from the St. Louis area require three weeks to accomplish symptom reversal rather than the standard two weeks for those living outside the local area. It is difficult to isolate oneself from family demands and business concerns if treatment is being ear tied out in the environment in which the couple lives.

For this reason it has been found more effective to see patients referred from the St. Louis area on a daily basis for the first week, there after five times a week, and to assign a total of three weeks to accomplish reversal of symptomatology. Partners in sexually distressed marriages who cannot or do not isolate themselves from the social or professional concerns of the moment react more slowly, absorb less, and communicate at a much lower degree of efficiency than those advantaged by social retreat.

The Foundation’s request for two weeks’ withdrawal from daily demands, at first rather an overwhelming suggestion to most patients, pales into insignificance when compared to the isolation demands engendered by necessary hospitalization for acute surgical or medical problems. When the couple’s presenting complaint is one of sexual inadequacy, it should constantly be borne in mind that there is not only the equivalent of two distressed people but also an impaired marital relationship to be treated.

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Sexual Dysfunction Treatment

Sexual Function

In order to establish at least a minimum of patient screening, at onset of the clinical treatment program no units were accepted in therapy unless the complaining partner in the couple (e.g., the impotent male or the non orgasmic female) had a history of at least six months of prior psychotherapeutic failure to remove the symptoms of sexual dysfunction. Very soon this proved to be a poorly contrived standard, of little screening value.

As should have been apparent at onset, there was no secure way of establishing the functional effectiveness of the prior therapeutic program. How determined and well oriented was the therapist, how cooperative or fully responsible was the patient? After two years this original standard was abandoned in favour of that currently in effect.

Sexual Screening

A reasonably effective method of screening has been substituted by requiring that no patients be accepted at the Foundation unless they have been referred from authority. As authority, the Foundation accepts physicians, psychologists, social workers, and theologians.

Beyond screening the patients for appropriate referral to the Foundation, the referral source further is asked to provide available details of psychosocial background relevant to the husband and wife sexual dysfunction.

A telephoned report is made to the referring authority describing husband and wife progress (or lack of it) during or immediately following the acute phase of treatment at the Foundation. Well-informed authority then can provide a most important reinforcement for newly acquired patterns of sexual interaction for the couple once removed from the Foundation’s direct control by termination of the acute phase of therapy.

In many instances, patients in established psycho therapeutic programs have been referred for removal of symptoms reflecting a somewhat broad area of distress in which sexual inadequacy is only a part. After their two weeks at the Foundation, these couples are, of course, returned to referring authority to continue their established treatment programs.

Obviously, the referring authority, before continuing in therapy with his patient, is briefed in detail as to the couple’s response to its Foundation exposure. The screening process as currently constituted has several aims, all obviously selective in nature.

Symptoms of Sexual Inadequacy

Primarily, control which prevents referral of major psychopathology is presumed. In other words the psychoneurotic is acceptable, but not the psychotic.

It should be emphasized that the reversal of symptoms of sexual inadequacy in psychoneurotic patients is indeed a significant portion of the Foundation’s objectives. Acceptance of this role by the Foundation is based on the premise that the reversal of particularly troublesome sexual symptoms may speed the progress of a psychoneurotic patient within the greater context of his established and broader-based psychotherapy.

However, the majority of the couples contending with sexual dysfunction do not evidence psychiatric problems other than the specific symptoms of sexual dysfunction. Socio-cultural deprivation and ignorance of sexual physiology, rather than psychiatric or medical illness, constitute the etiologic background for most sexual dysfunction.

Therefore, when a couple is properly educated in sexual matters, and their specific symptoms are reversed, there is no need for further psychotherapy unless the extensive duration of the distress has created psychosocial complications no longer directly related to the sexual dysfunction.

Other areas of selective screening for information vital to the therapeutic program center on such questions as:

  1. Are both members really interested in reversing their basic dysfunctional status? If one member of the unit simply has no interest whatsoever in reversing the symptomatology of sexual dysfunction in the marital relationship, the unit probably needs legal rather than medical or behavioural advice. The chances of reversing the sexual dysfunction under the circumstances of total disaffection for a marital partner are negligible.
  2. What, if anything, is known of the couple’s adjustment or maladjustment to its social community?
  3. Do the referred members of the couple understand the programs, procedures, and policies of the Foundation? If not, it is suggested that the local authority, quietly briefed in advance by the Foundation’s professional staff, present the information in more specific detail to his patients.
  4. What is the couple’s basic financial picture? Should the Foundation offer the patients an adjusted fee scale or free care?

Sexual Therapy Commitment

The original research premise emphasized the fact that positive reversal of symptoms of sexual inadequacy during the acute phase of the treatment program was not of great import. If there were to be any clinical claim for positive effect in the Foundation’s concentrated approach to symptom reversal, the clinical results would have to be judged in retrospect over a significant period of time, not at the termination of the acute phase of therapy.

Therefore, the policy of five years of follow-up for couples after termination of the rapid-treatment phase of the program became an integral part of research standards. Failures to reverse symptoms are, of course, considered most significant.

Little of clinical value can be established for any therapeutic program, regardless of length of its ongoing treatment phase, if the results are not evaluated in long-term follow-up after termination of the acute phase of therapy. The abiding guide to treatment value must not be how well the patients do under authoritative control but how well they do when returned to their own cognizance without therapeutic control.

This result finally must place the mark of clinical failure or success upon the total therapeutic venture.

Individual members of couples seen in treatment must agree to cooperate with five years of follow-up after termination of the acute phase of the therapy program. They fully understand.

The Foundation’s basic premise that success in reversal of the symptoms of sexual dysfunction means little during the two weeks of intensive treatment, unless the symptom reversal is maintained for at least the first five years after separation from direct Foundation influence.

Success in maintenance of symptom reversal for this length of time does provide some sense of permanency in the continuing effectiveness of the couple’s sexual functioning.

Those couples whose acute treatment phase was judged inadequate or a failure arbitrarily have not been placed in the five-year follow-up program. This type of follow-up would indeed have been a study of major importance, but such continuing interrogation certainly could have interfered seriously with other clinical approaches designed to relieve the unit’s problems of sexual dysfunction.

The therapy concepts and clinical procedures depict basic methodology of cotherapist interaction, first, between team members, and second, directed toward husband and wife of the sexually dysfunctional marital, unit. Jules Masserman has so aptly described psychotherapy as “anything that works.” This “works” in a healthy percentage of cases.

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Sexual Dysfunction Treatment

Sexual Dysfunction Treatment

In any approach to a psycho-physiological process, treatment concepts vary measurably from school to school and, similarly, from individual therapist to individual therapist. The Reproductive Biology Research Foundation’s theoretical approaches to the treatment of men and women distressed by some form of sexual dysfunction have altered significantly and, hopefully, have matured measurably during the past 11 years. There are founded on a combination of 15 years of laboratory experimentation and 11 years of clinical trial and error.

Sexual Response

When the laboratory program for the investigation in human sexual functioning was designed in 1954, permission to constitute the program was granted upon a research premise which stated categorically that the greatest handicap to successful treatment of sexual inadequacy was a lack of reliable physiological information in the area of human sexual response.

It was presumed that definitive laboratory effort would develop material of clinical consequence. This material in turn could be used by professionals in the field to improve methodology of therapeutic approach to sexual inadequacy. On this premise, a clinic for the treatment of human sexual dysfunction was established at Washington University School of Medicine in 1959, approximately five years after the physiological investigation was begun. The clinical treatment program was transferred to the Reproductive Biology Research Foundation in 1964.

When any new area of clinical investigation is constituted, standards must be devised in the hope of establishing some means of control over clinical experimentation. And so it was with the new program designed to treat sexual dysfunction. Supported by almost five years of prior laboratory investigation, fundamental clinical principles were established at the onset of the therapeutic program. The original treatment concepts still exist, even more strongly constituted today. As expected, there were obvious theoretical misconceptions in some areas, so alterations in Foundation’s policy inevitably have developed with experience.

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Sexual Dysfunction

Woman Sexual Phrase

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Necessity for such individual consideration can best be explained by example:

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

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

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

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

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Sexual Dysfunction

Sexual Values

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

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

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

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

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

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

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

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

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

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

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

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

Overcome Sexual Difficulty

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

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

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

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

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

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

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

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

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

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

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

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