Masters and Johnson believed that cultural bias against women held back research in female sex response. Until they started there'd been no knowledge of the biophysics of female sex. Men had the permission - indeed, the expectation and encouragement of society - to develop their sexuality in a natural context. Women, even then, were not so permitted. Growing girls were taught to repress or romanticize their sexual expressions, and the hope was expressed that they will be "good" girls - that is, not have any active sexual feelings or sex activity until they marry. How, then, can a young married woman proceed, to do effectively what all her life she has been taught not to do? How, having held her boyfriends at arms' length for six or seven years, can she suddenly permit herself to be responsive?
Even the vocabulary used by sympathetic and "modern" parents in discussing sexuality with their daughters is unintentionally repressive. "I hope you won't, but if you..." Female virginity is still a moral virtue and even a commercial asset. "Yielding to temptation..." is still heard in mother-daughter talks. The sex act is still something a man does to a woman and not something they do together! Thus women have been forced to inhibit or distort their sexuality to the point where they can't even achieve orgasm honestly in the privacy of the bedroom.
Masters and Johnson stated, "The human female's facility of physiological response to sexual tensions have never been fully appreciated." (In other words, information on how to make a woman come has never been fully disseminated.) Even more startling, Masters and Johnson suggested that women may have subconsciously consented to having their superior capacity for response repressed in an attempt to balance themselves with their vastly less capable men folk! Male readers won't like this notion much, but in their first volume, Human Sexual Response, Masters and Johnson cited a case history of a couple that engaged in sex play and recurrent coitus for a period of nearly two hours, during which the male had two orgasms and the female experienced seventy-five! It does give one something to think about, even now, in our supposed sexually liberated times.
In Human Sexual Inadequacy, there is a skillful review of 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 produces a lubricant, logically a device for easing the entrance of the penis. Her vagina 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. Masters and Johnson maintained that every woman, whether or not she has an active sex life, receives periodic "demands" from her body for sexual intercourse. The vasocongestion or pooling of blood in the tissues give her a warm, swollen, throbbing, and itchy feeling in the genital area. They said that occasionally menstrual periods, which also produce blood congestion in the vulva and sensitive nerve reactions, may stimulate sexual desire. Yet some religions and most custom prohibits sex relations while a woman is menstruating. Women who have responded to sex urges while menstruating say that while they experience orgasms as intense as any they know about, they feel apologetic about "messing up" their partners with bloody discharge.
But Masters and Johnson were concerned with orgasmic dysfunction. They saw women who were suffering because they had either never known sexual fulfillment or had had the ability and lost it.
Masters and Johnson did not say how many of the women who presented themselves for treatment of orgasmic dysfunction had had children, but one can't help but sympathize with the woman who has been impregnated, delivered, and raised a child and never or almost never experienced a sexual incentive or reward. 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 vital features separate the complaining female from the complaining male.
1 A man can usually satisfy himself sexually regardless of whether he has a sexually responsive partner or not. All she has to do is spread her legs and be compliant. He may have a better experience with a responsive female, but he can do it 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 intromission - but what woman feels free to take charge of a sexual encounter? Yet few men hesitate to say, "Do this" or "Do that." So Masters and Johnson got some fairly angry women coming to see them - and therapists today will still relate the same story. These women felt they'd been subjected to discrimination and shortchanged.
Dr. Masters and Mrs. Johnson wrote a lengthy indictment of religious orthodoxy and its effects on sexual responsiveness. It was summarized as follows: Mrs. A. was reared in a strict Protestant home with Sundays totally devoted to church and church activities, weekly prayer meetings, and the like. At home everyone in her family or anyone else was never seen in an undressed state. Sex was never mentioned in the family; books were evaluated for their purity and radio programs censored. When Mrs. A. first menstruated she was totally unprepared. She thought she was dying. She ran home from school. Her mother reacted coldly and told her young daughter she must suffer the curse of Eve all her life until 'old age' and must be prepared for monthly pains in the stomach.
She went to a church-sponsored college that was coed but the school had what was called the 18-inch rule. It meant boys and girls were forbidden to hold hands and had to keep 18 inches between them at all times. At graduation she went to work for a publisher who specialized in religious material. She met and fell in love with a young man of similar background. They kissed three times before their wedding. It was the only time she'd ever been kissed by a man. Her father, she said, had never kissed her. The day before she was married her mother told her she must allow her partner certain physical privileges. These were not defined, but she was assured it would hurt. On her wedding night her partner tried to find the proper place to insert his penis. He failed. Nine years later, the marriage was not yet consummated. Fortunately the couple was referred to the Foundation for treatment.
Another history cited by Masters and Johnson warns of what happens when there is no dominant influence in the home. Students of psychology and related fields know what happens when there is an absent parent or when one parent rules to the exclusion of another but it is less well known that when both parents sweetly agree all the time that can make trouble, too. Mrs. B. was an only child, a fragile, curly-haired, exquisite "doll baby." Her parents dressed her in white kid shoes and pink ruffled dresses and hardly ever picked her up or cuddled her - maybe for fear of wrinkling the ruffles. She was supposed to be a walking china doll. She felt she was disregarded emotionally - that her parents didn't care if she was sad or happy, just that she look pretty. When she was a junior in college she made what she remembers as the one major decision of her life. She got engaged and married to a man seven years older who promptly took her parents' place and made all the decisions.
At first, Mrs. B. was complacent and undemanding about sex. The case history doesn't say how or why it happened, but she apparently decided she was missing something. She wanted to give more and get more. The B's came to the Foundation. The result was ironic. Encouraged through the use of the Masters and Johnson influence on his body the partner developed into a much more adept lover. He began to enjoy himself and respond as he never had before - or even dreamed of doing. But she remained "sensately anesthetized." Neither body lotion nor the sensate exercises nor discussions nor the prescribed sexual relations did much to increase her response. The therapists viewed this case with mixed reaction. While the male partner improved beyond his wildest expectations, the woman's symptoms were not successfully treated.
When a woman patient went to the Masters and Johnson complaining that she was non-orgasmic she, like her male counterparts, was classified.
Class 1 included the woman who could not masturbate or be successfully manipulated to orgasm by hand or mouth but could reach orgasm during ordinary sexual intercourse, regardless of sexual positions, with her partner's penis in her vagina. (An unusual and presumably small group! We're used to hearing of men and women who cannot reach orgasm during sexual intercourse but are fully functional, as t were, during masturbation, but to hear of those who cannot reach orgasm with manual stimulation, but can do so during intercourse is positively bizarre. One has to imagine that there is a considerable level of shame at work, which allows the individual to reach orgasm when they see themselves as not being responsible for either bringing climax about or by not having to touch their genitals - so sexual intercourse could be see as a "natural" and acceptable way to reach climax. Of course, as we know, it isn't that easy for women to reach orgasm during intercourse, so the skill involved is considerable.)
Class 2 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 stimulating techniques.
Class 3 rounds up women who 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's how it happened to one couple: Mr. and Mrs. E. grew up, met, courted, and married in a most conventional mid-twentieth century way. Each had masturbated as teen-agers and had several love affairs before they met. Their marriage was almost instantly and mutually orgasmic and for twelve years they were sexually and socially happy. Then, through no apparent fault of his own, Mr. E. was fired. He was out of a job for eighteen months. He began for the first time in his life to drink heavily. Their sex life was painfully derailed. Sometimes Mrs. E. rejected and taunted her partner or reproached him. In turn, he made unreasonable demands on her - presumably because he felt financially inadequate and needed to feel sexually more than adequate. His wife slammed the bedroom door on him. It was a bad time for both. Then Mr. E. got a new job. He stopped drinking. There was money in the bank. His wife reopened the bedroom door - and found to her amazement, distress, and horror that she could no longer respond to him, no matter what kind of sexual approach he employed.
Masters and Johnson spoke repeatedly of how easily a sexual relationship is distorted or used as the focus for a nonsexual problem. This woman paid a high price for equating sex with money, status, and sobriety.
Masters and Johnson believed that early experiences in woman-to-woman homosexual relationships make an imprint that is difficult to reverse. The problem arises when a homosexual woman decides she wants to switch. She wants to get a male partner and have babies. She often finds that she can't respond to her partner. She is afraid to tell her partner that her early introduction to sex was homosexual. Guilt-ridden, she is unresponsive. In such cases, therapy of the Masters and Johnson format is indicated.
Other problems of orgasmic dysfunction include those of low sexual libido - women who cannot achieve climax either in sexual intercourse or manual stimulation. Dr Seymour L. Halleck of the University of Wisconsin Medical Center said, "The sex act is more than a mere physical fulfillment of sexual needs. 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."
The type of woman who had nothing wrong with her but low sexual drive was described in another instance by Masters and Johnson. Here, all went well until the woman's partner became depressed over the fact that while his partner was totally cooperative when it came to sex - she never said no - it was plain she just wasn't much involved. One of the few high points of their sex life, occurred one night when they had been celebrating a successful business deal. That night, she was orgasmic by masturbation. Another problem Masters and Johnson discussed was that of a woman who was successfully and responsively orgasmic through penile intromission but couldn't masturbate - or be masturbated - successfully either by hand or mouth.
The researchers concluded that these women had had severe "no-no's" repeatedly imposed on them in childhood or else they had tried masturbation a few times and failed - and thought, "Who needs it?" Masters and Johnson believed that a sexually healthy woman was one who could masturbate successfully as well as respond to her partner's caresses. The single, the widowed, and the divorced also need to be able to relieve sexual tension for themselves, and should feel free to do so. Masters and Johnson believed that masturbation helps to keep you healthy and sexually active.
In interviews with Masters and Johnson women talked freely about past sex experiences, if any, with other partners. Often a woman faced the fact that she had been lying to herself or living with absurd fantasy. The guy she had an affair with in her junior year of college wasn't really all that great. Or she may have been badly heartbroken and rejected and not have wanted her partner to do any of the things her rejecting lover did. But how could the poor guy know? Clearly a woman arrives at an erotic arousal and an orgasmic giving and receiving response when she is getting the physical attention her lifelong experience has taught her to value. Some women have rape fantasies and dream of being overwhelmed. Some fiercely resent over-aggressive lovemaking and want to be treated tenderly all the way through it. Dr. Masters and Mrs. Johnson hazarded the fascinating idea that just as the trigger mechanism that sends women into labor is unknown, so is the mechanical system - probably a combination of brain imprints, nerves, and chemistry - that sends a woman into orgasm unknown. They speculate that the two may be set off by the same or closely related mechanism. It is a common legend that many women become more responsive sex partners after childbirth.
The couple reporting orgasmic dysfunction got the same prescription for the first few days as all the other patients. They answered questions and got physical exams and instructions in developing sensate focus. Dr. Masters and Mrs. Johnson emphasized that the sexually dysfunctional woman needed an additional element in the prescription. She needed to be "given permission." Then - and now - she needs to be told that it's all right. She needs to learn to honor her privilege to enjoy sex. If she has been faking, 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 to get" concept and behave toward one another with honesty. Women still seem to be focused or hung-up on the need to make a sincere and idealistic commitment.
The man's commitment may be something really naive like, "Sure, honey, this is something special between you and me forever." For generations, men have lied to women, and women have provoked men to lie merely to unleash the conscientious permission that a woman in our culture needs to respond. Good practice enjoins silence when a man and woman are trying to repair their sex life. That's a good idea. The verbalized anxieties that emerge in sexual interaction, even among people who describe themselves as well adjusted, are really amazing. (Twelve couples were asked (ranging in age from 22 to 53) to say what they most commonly recalled saying during lovemaking. Here's the summation of the run down: He: "Tell me you like it, baby!" She: "Do you love me?")
When the practice in sensate focus has reached the point where the non-orgasmic woman and her partner are granted therapeutic permission to indulge in active sex, the couple is instructed in assuming a position that is designed to be non-demanding for the male and educational for the non-orgasmic female. This is only recommended as a troubleshooting position for the non-orgasmic woman. 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 - for many others it's 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 the borrowed ecstasy. If ecstasy - orgasmic release - didn't occur for her, it was emphasized that she was surely building up to it, and it should happen the day after or the next day. The couple was encouraged to believe that they'd get there. 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 them finally made it. The day after success with the "male undemanding sex position" the female turned around and assumed the "superior coital sex position" (the man lying on his back, the woman crouched over his hips) and then they rolled over to the recommended lateral position. This still left the woman in the driver's seat, but it's the love posture we could all do with knowing about.
Men asked Dr. Masters and Mrs. Johnson, "But suppose at that point I feel like ejaculating?" The co-therapists told him that he'd be happier and have a better time if he didn't. He could signal his woman to use the squeeze play (see page on premature ejaculation for more information). If ejaculation occurred anyway it was reported, discussed, and 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.
In bed (Masters and Johnson told such women) masochism gets you nowhere. But the man was not left outside the design. He was told that his woman should masturbate him to ejaculation at least as often as he wanted it.
Of 342 women patients who were treated for orgasmic dysfunction, there were 66 failures and 276 successes. The cooperation of the partners was considered a vital factor. Women who were lucky enough to have concerned, loving, and helpful partners were the ones who made it. A few managed to "break through" without partner help, but not many. Clearly, Dr. Masters and Mrs. Johnson considered women's orgasmic problems more complicated than men's. I suppose that the worst fear is when a woman has a phobia about sexual intercourse.
Here's the testimony of a woman who finally experienced orgasm. The speaker had been married five years and had two children. She's describing orgasmic sex: "What's it like? It really blows your mind and your body at the same time. You feel yourself getting so close to your partner and so absolutely right with him and yourself. I don't care what they say about masturbation, there's got to be another person that you care about that's going with you. You begin wrestling around and he puts his hands all over you and pretty soon you get this crazy, zapped-up feeling that you're driven upward by a pulsation in your body. If you're underneath him, you arch your back and beg for it. If you're on top, you bear down and go for it. Then suddenly you're both up and over for a little moment and in some kind of earthly heaven!"