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SEXUAL DYSFUNCTIONS IN WOMEN
There was a time when men used a single word to describe all possible female sexual dysfunctions: frigidity (literally, coldness, from Latin frigidus: cold). Today, we know that this vague and derogatory term is no longer acceptable. After all, just as the sexual responses of males and females are quite similar, so are their sexual inadequacies. We therefore need a terminology that can be applied to both sexes.
Modern sex research has shown that both the male and the female sexual response can be dysfunctional in three ways:
1. Coitus cannot begin because the sex organs do not show the necessary initial reaction (lack of arousal in either sex and vaginismus in women),
2. Coitus is frustrating because, in the opinion of one or both partners, orgasm occurs either too early or too late (unsatisfactory timing of orgasm).
3. No orgasm is reached at all (absence of orgasm).
The following pages deal with these three basic inadequacies as they affect women.
Lack of Arousal and Vaginismus
The lack of penile erection in men is physiologically equivalent to the lack of vaginal lubrication in women. However, for a woman this inadequacy is less upsetting than for a man because it is easily overcome by the use of artificial lubricants. Thus, unlike a man with a limp penis, a woman with an unlubricated vagina can still easily begin coitus, if she so chooses. Nevertheless, women, like men, may also find themselves in a condition which denies them his choice:
There are some women who cannot engage in coitus because of involuntary muscular spasms which close the opening of the vagina. As a result, the insertion of a man's penis becomes extremely difficult or even impossible. The condition is known as vaginismus. In a few rare cases, vaginismus develops as a protective reaction against previously experienced pain during sexual intercourse which, in turn, was caused by some injury or disease of the internal sex organs. Obviously, in such a case, the underlying physical cause must be treated. (See "Pain During Sexual Intercourse.")
However, very often the causes of vaginismus are entirely psychological. For example, a woman whose husband is unable to have or hold an erection may become so frustrated and apprehensive about his futile attempts at coitus that her vagina tightens involuntarily. On the other hand, even a man with normal sexual responses may eventually become dysfunctional if he always finds the woman's vagina too tight for penetration. Thus, a couple may enter a vicious circle of mutual disappointment. It then makes little difference how the problem began. Both the man and the woman need treatment. Another possible cause of vaginisrnus is a strict and puritanical upbringing that teaches a girl to consider sex dirty or evil. Such negative attitudes can very well prevent her from functioning sexually at all. In other cases, a woman's vaginisrnus can be traced back to a particular traumatic experience, such as rape or coitus with an inconsiderate partner.
Whatever its cause, vaginisrnus can always be treated successfully if the couple is willing to cooperate. The first and most important therapeutic step is simply an educational one. A sex therapist explains the phenomenon in detail and then demonstrates it physically by placing the woman on the examining table. As soon as he tries to insert a finger into her vagina, the involuntary spasm closes the opening. The woman's sexual partner is then asked to put on a rubber examining glove and to feel the constriction himself. Once both partners realize that they are indeed dealing with a clear physical obstacle to coitus, they are ready to take the appropriate practical steps. The therapist gives them several special vaginal dilators in graduated sizes which they can use in the privacy of their bedroom. There, under the woman's direction, the man begins by inserting the smallest dilator into her vagina. As she becomes more relaxed, he is able to use the larger dilators, and, after a few days, the woman is asked to keep a fairly large dilator in her vagina for several hours during the night. Eventually, the man can attempt to insert his own penis instead of the mechanical device. If the dilators are used every night, the vaginal spasms usually disappear within less than a week, although, in rare cases, the dilators may still be needed before coitus for a month or so.
The successful physical therapy is usually followed by some psychological counseling. This is the best time for the therapist to build the confidence of his clients and to relieve them of any remaining tensions and misconceptions.
It should perhaps also be mentioned in this context that, according to a popular belief, vaginal spasms can occur not only before, but also after the insertion of a penis, thus trapping it inside the woman's body. However, among humans, this is impossible. (The phenomenon, also known as penis captivus [Latin: trapped penis], is found only in certain animals.)
Unsatisfactory Timing of Orgasm
There are women who are much slower in reaching orgasm than most men. As long as such women engage only in "solitary sex", they have no reason to feel inadequate. It is only when they begin sexual intercourse that they may find themselves at a disadvantage. Their male partners may reach orgasm much sooner than they and therefore leave them unsatisfied.
In the past, it was customary to define this problem exclusively in terms of male failure. Today, however, we understand that it is more helpful and realistic to see it as a problem of male-female adjustment. After all, given the proper stimulation, the average female can respond just as quickly as the average male. Many women can also train themselves through masturbation to speed up their sexual responses. (See "The Female Sexual Response.") Still, a woman may feel that there is little virtue in such efficiency, and that leisurely lovemaking is preferable to a race for orgasms. She may also enjoy having more than one orgasm during coitus, and this may be reason enough to wish for a better sexual adjustment with her partner.
Fortunately, such an adjustment can almost always be achieved if both partners are sufficiently motivated. Modern sex therapists have developed some simple exercises that can help men and women make their sexual intercourse last longer. Indeed, using these exercises, a woman can train any man to delay his orgasm for as long as either of them may wish. As a result of his improved sexual abilities, she may then also become more responsive herself. In short, the unsatisfactory timing of orgasm need not be a problem for either sex. (For a detailed description of the exercises, see the corresponding section under "Sexual Dysfunctions in Men.")
Finally, it should perhaps also be mentioned that, according to a popular belief, sexual perfection requires both partners to reach orgasm at the same time. However, the pursuit of such an ideal can do more harm than good. It forces the partners to observe and control their own responses at all times and thus kills their spontaneity. It is better to think of simultaneous orgasms as agreeable coincidences. There is no point in considering them in any way superior.
Absence of Orgasm
While virtually all men easily reach orgasm, many women find it difficult to achieve this simple goal. There may be many different reasons for this, but the most important reason is undoubtedly the negative attitude toward sexual pleasure that women in our society learn to adopt early in their lives.
It has often been observed that our Western culture does not encourage girls to develop sexual needs, to be proud of themselves as sexual beings, and to feel entitled to sexual activity. On the contrary, from their earliest childhood, girls are taught to be "nice", "good", "decent", "proper", and "respectable". They are asked to control, hide, or deny their sexual urges and are discouraged from actively exploring their bodies. They may be allowed to entertain some vague romantic fantasies, but are prevented from having any practical sexual experiences. In fact, they are told that girls who seek such experiences are worthless, despicable creatures. At the same time, they are warned against the base and animalistic instincts of men who are "all after only one thing" and who use and abuse women as sexual objects. It is never admitted that women might have the same instincts or might be able to reciprocate.
As a result of this negative conditioning, many women develop unrealistic and very restrictive sexual values. They feel that they need some special permission to be sexual, and that they can grant themselves this permission only under very unusual, almost ideal circumstances. Unfortunately, these ideal circumstances may never be found in real life, and thus the women may never become relaxed enough to enjoy their sexual capacities to the fullest.
Apart from this general handicap, women may, of course, also have individual reasons of their own for being nonorgasmic. For example, a woman may have been raised with especially rigid religious views about sex and may therefore be unable to enjoy it. In another case, the woman may have a partner whom she does not realty like very much. Consequently, she never allows herself to "get carried away" with him. In still another case, the partner himself is sexually inadequate in some way and therefore makes the woman apprehensive and frustrated. There are also some women with homosexual tendencies who just do not like heterosexual intercourse, but would be responsive with a female partner. Finally, one has to concede the possibility that some individuals are simply not very interested in sex.
There are women who have never had an orgasm in their lives, and there are others who just fail to have orgasms a great deal of the time. However, today most of these women can be helped by appropriate sex therapy. So far the best known of these therapies is that devised by Masters and Johnson. In their intensive short-term program, they treat nonorgasmic women together with their partners by means of intensive counseling and indirectly supervised exercises. The counseling aims at restructuring the couple's approach to sex and to each other. The exercises are specifically designed to unblock the inhibited natural sexual responses.
Obviously, there is no substitute for individual personal treatment, and, in this book, we cannot attempt to offer anything like a do-it-yourself sex therapy program. However, for the sake of general information, we can at least describe some of the physical exercises that therapists recommend for nonorgasmic women.
The first of these exercises consists simply of touching and stroking the body in a relaxed and nondemanding way. This allows the couple to discover their erogenous zones and to feel sensual pleasure without any pressure to perform. When pleasuring each other in this fashion, the partners can gently guide each other's hands in order to increase their enjoyment. In addition, they are often encouraged to use some massaging oil or body lotion which may help the woman overcome her fear of sex as "wet" and "messy".
After a few days of these exercises, the couple can begin to concentrate on stimulating the female sex organs. The best way to do this is for the man to sit directly behind the woman who spreads her legs by throwing them over his thighs. This position enables the man to hold the woman reassuringly close while he manipulates her breasts and her vulva. The woman, in turn, can guide the man's hands to those areas of her body that give her the greatest pleasure. At the same time, she can teach him to avoid stroking the sensitive glans of her clitoris directly and to caress instead the general area of the clitoris and the minor lips (labia minora). As she becomes sexually excited, her vagina begins to lubricate naturally, and this lubrication can then be spread to the clitoral area to reduce the possibility of irritation. Both partners are warned, however, not to strive for orgasm. Instead, they are encouraged to relish their sexual feelings and to abandon themselves to the pleasures of the moment.
Once the partners have learned to perform and enjoy these simple exercises, they are ready for the next step: coitus in the female-superior position. That is to say, while the man lies passively on his back, the woman straddles him and then lowers herself on his erect penis. However, once it has entered her vagina, she remains motionless in order to get used to the feeling. A few minutes later she begins to move very slowly without any particular aim other than simple enjoyment. Eventually, the man may respond to her movements with some slow pelvic thrusting of his own. Still, both partners are asked not to aim for orgasm but to enjoy the stimulation for its own sake. If orgasm does occur, it should be regarded as a pleasant surprise.
It is often useful for a couple to interrupt this kind of coitus when it becomes too demanding and to relax again in each other's arms. Some simple pleasuring can then lead to new arousal and to a new insertion of the penis. Finally, when both the man and the woman have learned to control their sexual impatience and are comfortable with each other's sexual responses, they can try coitus in a side-by-side position. The change from the female-superior position is easy; the man remains lying on his back, raising one knee. The woman stretches out on top of him with one leg between his legs. Then both partners roll slightly over to one side.
If all of these exercises are done properly, they sooner or later free the woman from her inhibitions and thus allow her to reach orgasm. Nevertheless, there are some cases that may require additional therapy. For example, sometimes the female sexual response during coitus is impaired by a wide and slack vaginal entrance. In other words, the muscles inside the woman's body which surround the vagina are in such poor condition that there is not enough friction between the penis and the vaginal walIs. Indeed, neither of the partners may even feel very distinctly whether the insertion has taken place or not.
The main muscle that needs to be strengthened in this case is called the pubococcygeus. It can be described as the master sphincter of the entire pelvic area, and it runs from the pubic bone in the front all the way to the coccyx, or end of the spine, in the back. A few decades ago, a gynecologist by the name of Arnold H. Kegel developed some exercises for this particular muscle which can be practiced by any woman at any time anywhere. Naturally, first she must learn how to identify the muscle for herself. In order to do this, she is advised to sit on the toilet with her legs spread as far apart as possible. If she then starts and stops the flow of urine, she becomes aware of the pubococcygeus because it is the only muscle that can stop urine under this circumstance. Once the muscle is identified, the woman can practice contracting it repeatedly whenever she has the time. She simply flexes this muscle ten times in a row three to five times a day until it is firm. As a result, coitus becomes much more enjoyable for both partners because the contact between penis and vagina is closer. While it is true that the vaginal walls themselves contain hardly any nerve endings and therefore no feeling, the muscles surrounding the vaginal barrel do contain nerve endings, and, if these muscles are firm, their stimulation can be felt and enjoyed. In any case, the ability to control her vaginal muscles is bound to be welcomed by any woman who wants to make the most of her sexual relationships.
Still another way in which a woman can increase her sexual responsiveness involves the use of an electric vibrator. There are basically three types of such vibrators available in drugstores and large department stores. The best known is perhaps the battery-operated, penis-shaped model that sells for about five dollars. However, it is also the one that is least effective. More useful is a model that consists of a small electric motor encased in plastic which is held in the hand, and which has a vibrating rubber cup. It costs between ten and twenty dollars. Finally, there are some rather expensive models, priced between fifteen and sixty dollars, which consist of a small motor that is held on the back of the hand with an elastic strap. The motor's vibrations are thus transmitted through the hand itself.
The woman or her sexual partner places the vibrator (or the vibrating hand) over those areas near her vaginal opening or her clitoris where it causes the greatest pleasure. As a result, she usually becomes aroused and reaches orgasm very quickly. Women who decide to use a vibrator should remember that it cannot be guaranteed to produce an orgasm every time. Still, if the woman is relaxed enough, it is often remarkably effective.
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