As we have seen in a previous section, some men and women are restricted in their sexual expression by physical malformations, handicaps, diseases, or injuries (see "Some Physical Problems."). However, there are also physically healthy individuals who cannot fully enjoy sexual intercourse because their sexual responses have become weakened, inhibited, or even completely blocked for psychological reasons. Today, such a person is usually said to suffer from "sexual inadequacy" or "sexual dysfunction".
Obviously, the distinction between physical and psychological causes of sexual inadequacy is, to a certain extent, arbitrary, since body and mind are so closely interrelated that a sharp dividing line between them cannot be drawn. Furthermore, it may be an oversimplification to speak of sexual inadequacy in any individual, because, as a rule, it manifests itself only in relation to another individual. Indeed, in many cases it may be more useful to speak of an inadequate sexual relationship between two persons. At any rate, sex therapists today often act on the assumption that it is less the individual than the couple who has a problem. Consequently, they insist on treating both partners together.
It has recently been estimated that in more than half of all American marriages at least one partner suffers from some form of sexual inadequacy. Needless to say, this, in turn, is bound to affect the other sexually adequate partner, and thus both of them spend their lives in sexual frustration. In some marriages, this frustration is, of course, due to permanent physical handicaps, although even in these cases realistic counseling can sometimes increase sexual options and thereby restore a reasonable minimum of satisfaction. Most often, however, the problems are of a psychological nature and could be completely eliminated by modern sex therapy. Following the pioneering work of William H. Masters and Virginia E. Johnson in the 1960s, a variety of new therapeutic techniques have been developed which are now being used successfully in many parts of the United States.
Curiously enough, the very success of sex therapy and the growing demand for it have underlined the general need for new sexual attitudes. Sexual misery seems to be widespread, and while one can argue about precise figures, the importance of the problem is no longer in doubt.
In the past, a man's sexual inadequacy was often ascribed to witchcraft or some evil curse (if he was believed to be innocent) or to "degeneracy", "self-abuse", "immorality", and "excess" (if he was held responsible for his condition). Today, we have learned, however, that both kinds of explanation are false, and that the real causes lie elsewhere. In fact, as sex therapists have shown, people become sexually inadequate mainly because of a rigid upbringing, traumatic sexual experiences, ignorance, narrow religious beliefs, and bad advice from ill-informed clergymen, marriage counselors, doctors, psychotherapists, and other professionals. All of these different causes, in turn, can be traced to the sexually oppressive character of our civilization.
The sexual oppression under which all of us live has many aspects, and most of them are discussed in various other sections in this book. However, with regard to human sexual functioning, we can point to one specific negative factor which seems to be more significant than any other—the nearly exclusive concern, indeed the obsession, with the male and female sex organs. The exaggerated importance ascribed to the sex organs has blinded not only the average person, but even certain theoreticians of sex to the full range of human sexual capacities. "Genitality" still reigns as the supreme sexual ideal, and, as a result, the sexual relationships in our society suffer a triple distortion:
• An overemphasis on the male initiative (at the expense of the female initiative),
• an overemphasis on coitus (at the expense of other forms of sexual intercourse), and
• an overemphasis on orgasm (at the expense of leisurely sensual enjoyment).
Therefore, we now find countless men and women who are sexually dysfunctional. Fortunately, in recent years we have learned that many of them can be helped simply by redirecting the emphasis and restoring a more balanced sexual approach. For example, the stereotypes of the sexually active male and the passive female, after which men and women try to model themselves, are often too confining. A man who is always expected to initiate coitus, and who is never allowed to "take it lying down", may begin to worry about his continued ability to perform. In fact, eventually this worry is likely to grow into an outright fear of failure. This fear, in turn, then blocks his natural sexual responses, and thus he becomes unable to satisfy his partner. A woman, on the other hand, who is told that taking the initiative is unfeminine may try very hard to restrain herself and become so frustrated in her artificial passivity that sexual intercourse becomes unpleasant and unrewarding. Not surprisingly, she then also becomes dysfunctional. The solution in both of these cases is obvious: A conscious temporary reversal of attitudes relieves anxiety and frustration, and the inhibited sexual responses are set free again. As the following detailed discussions will show, modern sex therapy often involves specific exercises which shift the initiative to the female.
Secondly, the overemphasis on coitus causes many men and women to neglect other forms of lovemaking and thus to fall victim to boredom and rigidity. Even worse, by focusing only on their genital contact, they may gradually desensitize other erogenous zones. This, in turn, leads to a situation where the sex organs alone "carry the entire responsibility" for sexual satisfaction, while the rest of the body remains "uninvolved". However, the sexual response is not to be restricted, divided, or compartmentalized in this fashion, and, in the long run, it may therefore become seriously impaired. On the other hand, it is truly remarkable how the sexual response often regains its full strength as soon as a couple turns to noncoital forms of sexual intercourse. It is for this reason that many modern sex therapists instruct their clients to practice manual and oral intercourse as a means of rebuilding sexual self-confidence. It is also worth noting that homosexual couples, who cannot engage in coitus, rarely suffer from the severe dysfunctions so common among heterosexuals. Both male and female homosexuals take it for granted that sexual satisfaction can be obtained in many different ways, and therefore they are used to making the best of any sexual situation. There is no doubt that many "straight" couples could profit from adopting the same attitude. It is ironic, however, that in many states of the United States noncoital forms of sexual intercourse (even between husband and wife) are legally defined as "crimes against nature", and that offenders can be sentenced to long prison terms. This, perhaps more than anything else, shows the barbarity of our official sexual standards (for details, see "Conformity and Deviance— Legal-Illegal.").
Finally, the overemphasis on orgasm robs men and women of much sexual pleasure by shortening the duration of their sexual intercourse and by turning it into a goal-oriented task. Thus, sex becomes work and, as such, still another testing ground for personal success or failure. At the same time, the successful finale, the "climax" of sexual intercourse, not the intercourse itself, becomes the major concern. In other words, it is no longer the process but the product which now commands all the attention. Unfortunately, this narrow fixation on the possible outcome tends to diminish the real pleasures of the moment. Indeed, it may seriously interfere with the normal sexual response. As a result, males may reach orgasm much too quickly for their own satisfaction, and women may not reach any orgasm at all. Modern sex therapists have shown, however, that these sexual dysfunctions (just as the others mentioned above) may disappear when the partners adopt a different attitude. Indeed, in therapy programs both the man and the woman are now often asked to deliberately avoid orgasm in their sexual intercourse. For example, the couple may be told to engage in extended mutual pleasuring, but to interrupt their physical contact as soon as either of them approaches orgasm. Some therapists even go so far as to prohibit their clients from reaching orgasm while at the same time ordering them to touch and caress each other for several hours every day. This simple regimen often produces dramatic results. Relieved of their "duty to perform", both partners may, for the first time in their lives, abandon themselves to sexual pleasure, and therefore they may change their whole attitude toward each other. This new attitude then becomes the source of a greatly increased orgasmic potential. Finally, after a few weeks, when the sexual response has been restored and the therapist has lifted the prohibition, orgasm becomes a regular, welcome experience, and its timing is no longer a problem. By the same token, however, this experience has now turned from an obligation into an option. Orgasm is nothing more and nothing less than a delightful interruption of an otherwise continuous process of generating pleasurable sensations. Most importantly, the partners have learned that they do not have to reach orgasm simultaneously or in every sexual encounter. An occasional lack of orgasm need not diminish their happiness. After all, making love is neither a battle nor an athletic competition. Notions of success or achievement have no place in a happy sexual relationship.
It seems that sexual dysfunctions of one kind or another have plagued many people in many societies since the dawn of history. We know, for example, that ancient and medieval physicians studied the problem and sought various medical remedies. However, it also seems that these dysfunctions have become more severe and widespread in modern times. In the 19th and 20th centuries, they were often treated by psychiatrists, and the rate of "cure" was not always encouraging. Today, we can see that this could hardly have been otherwise, since the physiological processes involved in sexual functioning were still poorly understood. (For details, see "Conformity and Deviance—Healthy-Sick.")
It was only the specific research of scientists like Masters and Johnson which finally allowed therapists to approach sexual dysfunctions directly, instead of treating them as symptoms of something else. Masters and Johnson themselves established a clinic for sexual therapy, and their success soon encouraged others to follow their example. Masters and Johnson also pioneered the male-female "dual team" of therapists and treated couples rather than individuals. These couples were either husband or wife or single men and women who brought along their (heterosexual or homosexual) partners. Some persons who did not have partners of their own were supplied with "replacement" or "surrogate" partners for the duration of the therapy. These and many other features of Masters' and Johnson's approach have, in the meantime, been copied widely. Today, there are many competent sex therapists in the United States and other Western countries who are increasingly successful in helping their clients.
An interesting new program of sex therapy has also been developed by the National Sex Forum in collaboration with the University of California Medical Center in San Francisco. This program, known as SAR (Sexual Attitude Restructuring) involves the use of films and various other visual aids.
Unfortunately, at the present time there are also still many unqualified people who call themselves sex therapists and who exploit their clients doing more harm than good. It is to be hoped, therefore, that in the future sex therapy will become a licensed profession. In this important field, nobody should be allowed to practice without having demonstrated the necessary knowledge and experience.