Female Sexual Dysfunction – Anorgasmia

Masters and Johnson believed that cultural bias against women held back research in female sex response. (And of course, female sexuality as a force for good, freely expressed.) Men had the permission – indeed, the expectation and encouragement of society – to develop their sexuality in a natural context. Women, then, were not so permitted. And in many cultures, even now this remains the status quo.

Growing girls were taught to repress or romanticize their sexual expressions, and the hope was expressed that they would be “good” girls. That meant, not have any active sexual feelings or sex activity until they married. The question Masters and Johnson asked was: How can a woman suddenly permit herself to be sexually responsive when she marries with a background like this?

Women were (and continued to be) forced to inhibit or distort their sexuality to the point where they could not even achieve orgasm honestly in the privacy of the bedroom. Masters and Johnson set out to change this. They clarified the nature of female sexual response.

What happens to a woman in the process of sexual response?

Her muscles become tense. There is a pooling of blood in certain tissues, producing a discernible pink blush in the skin and an increase in breast size. Her vagina lubricates and expands or “tents,” ready to accommodate the penis. The clitoris erects and flattens out, ready to respond to contact with the male penis.

The uterus itself actually gets bigger and when orgasm occurs the outer third of the vagina and the uterus both begin to throb and undergo contractions that are accompanied by a high level of sensual pleasure.

Immediately afterward there is a rapid letdown of both muscle tension and blood congestion. The woman who has been stimulated to the point of orgasm and not achieved it takes a lot longer to relax and get muscles and blood cells back to normal.

We are too concerned with orgasmic dysfunction. But orgasmic dysfunction is not confined to older women. An 18-year-old coed may bed down with numerous boyfriends but she may never have an orgasm unless she demands it. Even now, about ten percent of women remain anorgasmic, and few experience orgasm during intercourse.

Two  features separate male from female sexual dysfunction 

1 A man can usually satisfy himself sexually regardless of whether he has a sexually responsive partner or not. He may have a better experience with a responsive female, but he can orgasm easily anyway. To experience orgasm during intercourse, a woman is dependent on a sexually competent partner.

2 The woman is usually captive to the age-old idea that it’s her duty, primarily, to satisfy her partner. She rarely feels free to say, “Never mind what you want. This is what I want.” Many women have said they get a bigger sexual charge out of cunnilingus than penile penetration – but how many women feel free to take charge of a sexual encounter?

So Masters and Johnson got some fairly angry women coming to see them – and therapists today will still relate the same story. These women feel they’ve been subjected to discrimination and shortchanged.

Sexual problems do not mean the end of your sex life!

Masters and Johnson met a few women who could not masturbate or be successfully manipulated to orgasm by hand or mouth but could reach orgasm during ordinary sexual intercourse. This was an unusual and presumably small group! 

Another group included women who have never experienced orgasm from sex with penetration, but who can and do, with or without a partner (male or female), reach orgasm with other kinds of stimulation.

A third group of women have infrequent and unpredictable orgasms, whether by conventional sex or other methods. What bothers them is that they aren’t confident. They can’t tell when they go to bed and begin sex play if they will have an orgasm or not. Either way, they don’t know why. (Here is some data on the frequency of female orgasm.)

Masters and Johnson spoke repeatedly of how easily a sexual relationship is distorted or used as the focus for a nonsexual problem.  For example, problems seeming to be about a lack of orgasm may hide  low sexual libido. Also, sex can be used to relieve tension, to gain status, to obtain reassurance, to flatter one’s vanity, to express love, and to gain a certain amount of control over the behavior of others. In short, it is not only a loving act but can also be a vehicle for establishing one’s sense of power. 

Low sexual drive

Women who had nothing wrong but had a low sexual drive were described by Masters and Johnson. They believed that a sexually healthy woman was one who could masturbate successfully as well as respond to her partner’s caresses. And they emphasized that some women needed to be “given permission”: to be told that sex is alright and that it is fine to want to learn how to enjoy sex.

Implicit in this is the idea that if a woman has been faking orgasm, she has to stop. If she has been cheerfully accommodating, she has to stop that, also. The sex partners have got to be helped to adopt the “give and get” concept and behave toward one another with honesty and equality. 

Sensate Focus

Most sexual therapy is based on a technique called sensate focus. When a non-orgasmic woman and her partner practice the art of orgasm, here’s how it goes:

Step 1: The man sits up against the headboard of the bed. Unless the headboard is padded, he will probably wish to pad his back with pillows.

Step 2: The man spreads his legs and his woman, with her back against his chest, sits between his legs. Her back is resting against his chest. His arms are around her waist and clasped over her stomach. Her hands are under his thighs, holding on to the backs of his knees.

Step 3: The man waits for her request to insert his penis. He can stimulate her breasts, kiss her neck. The position means that the man is unlikely to directly touch the woman’s clitoris in a manner that hurts or irritates her.

Some women indicate that they like to have the clitoris directly stimulated. Most don’t. For many it’s painful, or just plain annoying. When both are sitting upright with the woman’s back resting on the man’s chest it’s up to him to do the teasing.

His partner should be producing natural juices and the man’s fingers will gently but suggestively spread the natural lubricant over the entire vulva area.

Step 4: The penis gently, undemandingly, is thrust into the vagina. The man at this stage is supposed to be warm, tender, altogether giving. Masters and Johnson recommended that he should let his partner drift along and learn to feel good about the vaginally contained penis without any obligation to pay back “his” ecstasy.

In this kind of therapy, each experience was a step forward, even the failures. When serious failures occurred, the couple went back to the beginning and started over with the early exercises of sensate focus.

About 80 percent of couples finally made it (i.e. the woman reached orgasm during intercourse). The day after success with the “male undemanding sex position” the woman turned around and assumed the “woman on top sex position”. This is the man lying on his back, the woman squatting over his hips; then they rolled over to the recommended side by side sex position. Then, the man can signal the woman to use the squeeze play (see page on premature ejaculation – click here – for more information).

If ejaculation occurred too soon (i.e. before the woman reached orgasm), the next sexual contact was redesigned as follows: the woman who was trying to become orgasmic was told, “The penis belongs to you just as much as your vagina belongs to him!” She was instructed to withdraw if she wasn’t ready. Many women needed this kind of reassurance.

Women who were lucky enough to have concerned, loving, and helpful partners were the ones who became orgasmic. A few managed to “break through” without partner help, but not many.