Although emphasis has been placed upon the role of premature ejaculation in the etiology of primary orgasmic dysfunction, primary or secondary impotence also contributes. Again the basic theme of man and woman coital interaction must be emphasized.
If there is not a sexually effective male partner, the female partner has the dual handicap of fear for her husband's sexual performance as well as for her own.
If there is no penile erection there will be no effective coital connection.
Frequently women married to impotent men cannot accept the idea of developing masturbatory facility or being manipulated to orgasm as a substitute for tension release.
However, if there has been a masturbatory pattern established before coital inadequacy assumes dominance, most women can return to this sexual outlet. In this situation there is sufficient dominance of the previously conditioned biophysical structure to overcome negative input from a psychosocial system distressed by sexual performance fears.
But if there have been no previous substitute measures established, many women cannot turn to this mode of relief once impotence halts effective coital connection. In this situation the psychosocial structure, unopposed by prior biophysical conditioning, assumes the dominant influence in the woman's sexual response pattern.
Mr. and Mrs. D
were referred to treatment of orgasmic inadequacy after four years of marriage. When seen in therapy she was 27 and her husband 43 years old. He had been married twice previously. There were children of both marriages and none in the current marriage.
The husband also was sexually dysfunctional in that he was secondarily impotent.
His second marriage had been terminated due to his inability to continue effective coital connection. Although, when the unit was seen in consultation the marriage had been consummated, coitus occurred only once or twice a year.
Mrs. D's background reflected somewhat limited financial means. Her father had died when the three siblings were young, and the family had been raised by their mother, who worked while the grandmother took care of the children.
Clothes were hand-me-downs, food the bare essentials. Her education had of necessity terminated with high school, and she worked as a receptionist in several different offices befo3e her marriage. She continued to live at home while working and contributed what salary she made to help with the family's limited income.
Mrs. D met her future husband when he visited the office where she worked. He invited the young woman to lunch. She accepted and married him four months later without knowledge of his sexual inadequacy, although she had been somewhat puzzled by his lack of forceful sexual approach during the brief courtship.
Mrs. D's own sexual history had been one of a few unsuccessful attempts at masturbation, numerous petting episodes with boys in and out of high school, but no attempted coital connection. She had never been orgasmic.
Her husband had inherited a large estate and his financial situation certainly was the determining factor in his wife's marital commitment. Since the girl had been distressed by a family background of genteel poverty, she felt the offer of marriage to be her real opportunity both to escape her environment and to help her two younger siblings.
The wedding trip was an unfortunate experience for Mrs. D when she realized for the first time that her husband had major functional difficulties. She knew little of male sexual response beyond the petting experiences but did try to help him achieve an erection by a multiplicity of stimulative approaches at his direction. There was no success in erective attainment.
The marriage was not consummated until six months after the ceremony. In the middle of the night Mr. D awoke with an erection, moved to his wife, and inserted the penis. She experienced mild pain but reacted with pleasure, feeling that progress had been made.
However, following the usual pattern of .a secondarily impotent male, progress was fleeting. As stated, there were only a few other coital episodes in the course of the four-year marriage. In these instances she always was awakened from sleep by her husband when he awoke to find himself with an erection.
Then there was rapid intromission and quick ejaculation. There was no history of a successful sexual approach by her husband under her conscious direction, insistence, or stimulation. Mr. D tried repetitively during long-continued manipulative and oral-genital sessions to bring his wife to orgasm, without result.
When they were referred for treatment, neither husband nor wife described sexual activity outside the marriage.
There have been 193 women treated for primary orgasmic dysfunction during the past 11years. Basically, in this method of therapy the sexually dysfunctional woman is approached through her sexual value system.
If its requirements are non serving limited, unrealistic, or inadequate to the marital relationship-by suggestion she is given an opportunity, with her husband's help, to manipulate her biophysical and psychosocial structures of influence until an effective sexual value system is formed.