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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 man and woman, presuming there is an established marital-unit interest in mutual effectiveness of sexual performance.

As described in premature ejaculation, when 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 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 of 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 therapeutic approach is that of random orgasmic inadequacy (37. 5 percent).

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