Female sexual unresponsiveness

“I’d love to kiss you, but I just washed my hair.” BETTE DAVIS in The Cabin In The Cotton

By Alex P. Vidal

LOS ANGELES, California – Sex therapist, Helen Singer Kaplan, discloses in the second edition of her popular and widely used authoritative guide to the techniques and exercises for sex therapy, The Illustrated Manual of Sex Therapy, that major cultural changes, new theoretical and scientific concepts, and extensive clinical experience “have had a tremendous impact on the practice of sex therapy” although the basic concepts of sex therapy and techniques describe in her manual have not changed.

Among the developments discussed by Dr. Kaplan are the effects of the AIDS epidemic; treatment of the increasing population of older patients; the new scientific knowledge about disorders of sexual desire and the triphasic concept of the human sexual response; new methods of diagnosing medical sexual problems; and the combined use of anti-panic medications and sex therapy in the treatment of sexual aversion disorders and sexual phobias.

Meanwhile, the unresponsive woman, Dr. Kaplan explains, feels no erotic sensation or sexual pleasure. She does not show the signs of physiological arousal, i.e., she remains relatively dry even though she is stimulated by her partner and has intercourse. Her conscious attitudes vary, adds Dr. Kaplan. She may loathe sexual activity, feel neutral, or even enjoy the physical contact.

“The truly unresponsive woman is rare, and this is fortunate because she is difficult to treat. In our experience general unresponsiveness—particularly when it is primary, i.e., the woman has never been responsive to any man in any situation—has of all the dysfunctions the poorest prognosis with brief sex therapy,” explains Dr. Kaplan. “The prognosis is much better if the woman has been responsive in other situations but is now unresponsive to her husband.”

Even in situational frigidity however, extensive psychotherapy is often necessary before the patient is amenable to sex therapy and before sexual functioning can be obtained, she stresses in the manual’s Erotic Techniques Used for Specific Dysfunctions.

DYSFUNCTION

Nevertheless, even in this difficult dysfunction, which often requires prior solution of tenacious unconscious intrapsychic and marital conflict, the prescribed sexual tasks play an important role in therapy. Sometimes, she says, these are not employed until the patient has resolved basic conflicts by means of psychotherapy. At other times the tasks may be used concurrently with psychotherapy in order to facilitate rapid resolution of obstacles which arise during the course of treatment.

Perhaps one can formulate the basic dynamics of unresponsivity as follows: The woman harbors an unconscious conflict about allowing herself sexual pleasure with a man. There does not seem to be one specific conflict in this disorder. It may involve deep oedipal fears of injury, hostility towards men in general or towards the specific man in questions, fears of rejection if she “lets go,” performance anxiety, erotic guilt, and so forth, explains the therapist.

The defenses against these conflicts specifically prevent the woman from responding, she further explains. She either avoids receiving adequate stimulation, or if she doesn’t actually prevent her lover from stimulating her, she erects perceptual defenses against enjoying this stimulation. She literally does not allow herself any erotic feelings. She unconsciously does not allow herself to respond. She prevents herself from abandoning herself to the sexual experience.

TREATMENT

Dr. Kaplan discloses the basic strategy in therapy which is to attempt to structure the sexual situation so that the woman is able to respond to adequate and heightened sexual stimulation while she is in a relaxed, nonanxious and loving state.

“Under such conditions, she must learn to resensitize herself to the sensations she has defensively suppressed for a long time. Again the creation of a tranquil sexual system between the partners often requires considerable psychotherapeutic intervention but with this in mid, the following is a typical (but not universal) sequence of events which we employ at the Cornell Sex Therapy Clinic to treat the generally unresponsive female. 1. Sensate focus I 2. Sensate focus II 3. Nondemand coitus 4. Coitus to orgasm

Among this group of patients, she reveals, there is a very high prevalence of negative responses to the sensate focus exercises. “These reactions are of course incorporated into the psychotherapeutic process. In addition to the psychotherapeutic explorations, when the history reveals that the woman experienced high levels of arousal in precoital and premarital “petting” situations, we might initially prescribe such activity while the couple is clothed, instead of the traditional nude and more exposed and therefore more threatening, pleasuring,” she explains.