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Common causes of orgasmic dysfunction
2 female doctor

For many women one of the most frequent causes for orgasmic dysfunction, either primary or situational, is lack of complete identification with the marital partner. The husband may not meet her expectations as a provider. He may have physical or behavioral patterns that antagonize.

Most important, he may stand in the place of the man who had been much preferred as a marital partner but was not available or did not choose to marry the distressed woman. For myriad reasons, if the husband is considered inadequate according to his wife's expectations, a negative dominance will be created in the psychosocial structure of many women. Such a situation is exemplified by the following case history.

Lack of Orgasm

Mr. and Mrs. C were 46 and 42 years of age, respectively, when referred to the Foundation. The wife complained of lack of orgasmic return. The couple had been married 19 years when seen in treatment. The marriage was the only one for either partner. There were three children, the eldest of whom was 17, the youngest 12. There were barely adequate financial circumstances.

Mrs. C's adolescent background had been somewhat restrictive. Her mother was a dominant woman with whom she developed little rapport. Her father died when she was 9 years old. There was one other sibling, a sister 8 years younger. Mrs. C went through the usual high school preparation, had two years of college, and then withdrew to take secretarial training and go to work in a large manufacturing company. During her formative years there was a number of friends, none of them particularly close with the exception of one girl with whom she shared all her confidences.

Mrs. C as a girl was fairly popular with boys, dated with regularity, and went through the usual petting experiences, but decided to avoid coital connection until marriage.

She had no masturbatory history but described pleasure in the petting experiences, although she was not orgasmic.

Shortly after her twenty-second birthday she fell in love with a young salesman for the company in which she worked. Theirs was a very happy relationship with every evidence of real mutuality of interest. She came to know and thoroughly enjoy his family, and they made plans to marry.

Three weeks before the marriage, her fiance, on a business trip, met and a week later married another woman, a divorced with two children. The jilted girl was crushed by the turn of events. This had been her only serious romantic attachment, and it had been a total commitment on her part.

Their sexual expression had been one of mutual petting and she had manipulated her fiance to ejaculation regularly. Although she had been highly stimulated by his approaches she had not been orgasmic. Coital connection had not been attempted.

Six months later she married Mr. C, whom she thought "kind and considerate." Their sexual experiences together were pleasant, but she achieved nothing comparable to the high levels of excitation provided by the first man in her life. She described life with her husband as originally a "good marriage." The children arrived as planned and the husband continued to progress satisfactorily in his business ventures, but husband and wife had very few mutual interests.

Female Masturbate

As the years passed Mrs. C became obsessed with the fact that she had never been orgasmic. She began to masturbate and reached high levels of excitation. Straining and willing orgasmic return without being able to fully accept the unrealistic nature of her imagery and fantasying, she failed, of course, in accomplishment. Her husband, with very little personal sexual experience other than in his marriage, had no real concept of effective sexual approach. She repeatedly tried to tell him of her need, but his cooperative effort, maintained for only brief periods of time, was essentially unsuccessful.

After 12 years of marriage, Mrs. C sought sexual release outside the marriage with a man sexually much more experienced than her husband. He did excite her to high plateau levels of sexual demand, but she always failed to achieve orgasmic release. This connection lasted off and on for a year and was only the first of several such extramarital commitments, always with the same disappointment in sexual return.

She was never able to avoid fantasy of her former fiance whenever she approached orgasmic return, but her fantasy included a primarily negative impetus. Her frustration at "marrying the wrong man" was a constant factor in her coital encounters, as it was in most other aspects of her life.

As time passed she blamed her husband increasingly for her lack of orgasmic facility and became progressively more discontented with her lot in the marriage. She began to find fault with his financial return and social connections.

In short, Mrs. C felt that her husband was not providing satisfactorily for her needs and inevitably compared him with the man "she almost married." This man had become a relatively well-known figure in the local area, had done extremely well financially, and apparently had a happy, functioning marriage.

Although Mrs. C never saw her former fiance, she constantly dwelt on what might have been, to the detriment of the ongoing relationship. Mrs. C sought psychiatric support for her non orgasmic status but was unable to achieve the only real goal in her life, orgasmic release. Finally, the marital couple was referred to the Foundation.

How does one overcome professionally the conditioning of an adult lifetime?

How many men could have met or continued to cope with the requirements of her sexual value system, impaired by the trauma it sustained when she was jilted by a man with whom she identified totally?

Can necessary adjustment to both her social and her sexual value systems be made in the hope of reversing or at least neutralizing the negative input of her psycho social structure and what possibility is there for positive stimulation of the biophysical structure?

These are the questions cotherapists should ask themselves when facing a problem such as that exemplified by the marital couple reported above.

There is no possible means of restructuring the negative input from "I married the wrong man" unless the problem is attacked directly. First, in private sessions the immature deification of her former fiance must be underscored. Second, Mr. C must be presented to his wife in a different light, not in a platitudinal manner, but as the female cotherapist objectively views him. A man's positive attributes as he appears in another woman's eyes carry value to the dysfunctional woman.

Then there must be stimulation of the biophysical structure to levels of positive input. This, of course, is initiated by sensate-focus procedures. Finally, the contrived somatic stimulation must be interpreted to Mrs. C's sexual value system both by the cotherapists and by her husband. If these treatment concepts are followed successfully there is every good chance to reach the goal of orgasmic attainment.

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