Woman; 342; Sex Therapy. Part 2

She. An in-depth exploration of the world with good evening and welcome to woman. Tonight we're going to continue our discussion of sex therapy. With me is Dr. Helen singer Kaplan who serves as head of the sex therapy and Education Program at the pain Whitney clinic at New York Hospital Cornell Medical Center where she's developed and directs the clinic for brief treatment of sexual disorders. Dr. Kaplan is the author of the illustrated manual of sex therapy. She also conducts a private practice in psychoanalysis and sex therapy. Dr. Kaplan's new book you and sex a book on the biology and psychology of sex for young people will be out in the fall. Welcome once again Helen. Helen why don't more women have orgasm. Well that's starting off with a direct question.

And it's true. Well let me first give you the statistics eight to 10 percent of females in the United States never had an orgasm at all. A unknown proportion of women can only have an orgasm when they masturbate by themselves without any audience. Another undisclosed number of women can have an orgasm but only on clitoral stimulation when they're together with a partner and approximately 40 to 30 percent of women have orgasms on intercourse Now which part of that segment do you want me to talk. I'd like to first for you to talk about a woman who has never had an orgasm. That is of course you know the most severe inhibition of function in that that really clearly constitutes a patient population I mean these women really do need

help because there isn't anybody you can't have an orgasm. Let me correct that maybe two or three percent. Of people in the United States have an organic and women in the United States have an eye Gammick problem. I'm born without a clue terrorists or have advanced diabetes are taking some drugs but the overwhelming majority you can have orgasms if they are stimulated properly and if they learn to let go. Not having an orgasm is a failure to learn to let go at a certain level of sexual arousal and that's usually due to a repressive upbringing and very strict message either verbal and non-verbal about masturbation. How do you treat these women specifically. Well first of all I do eat again the sarra valuation which is always very important with any sexual problem and I find out whether they put any special symbolic significance to the orgasm. And if they do that has to be worked out first otherwise if you directly attack that problem

you can get depression and anxiety and guilt in a woman. But they recall an example of this and symbolic significance. Oh yes. Some women feel they will go crazy and lose control. I've had others who have dreams of being murdered when they get close to orgasm otherwise they feel is some unspoken danger in letting go of control enough to really experience an orgasm. Gently some men have that problem also. It's not. Only confined to women. Others think unconsciously or close to conscious if they let go to a man that much then he'll abandon them or hurt them in some way. It's a it's a fear of abandonment and fear losing control which is usually. At the bottom. Is it common. In our gas to Gwen. Yes. Yes. Other women simply have not touched themselves had never allowed themselves to stimulate go through the normal masturbate story stage that we're all supposed to go through and they just

need a few session of simple teaching. More than. Not. More likely than not. Women are afraid of the fantasies they have or are guilty about the fact that the seats because you can't have an orgasm on masturbation without a fantasy. You have to accompany this stimulation with some fantasy and they're more guilty and ashamed and upset about the fantasy than about the stimulation so you have to work that through. But principally the man after you get. After you work through some of these emotional blocks which can be done in a session or two in most instances. And not deep necessarily except in very sick women. Then you simply teach the woman had to stimulate herself in other words you could make her go through a master but gory stage when she's all by herself and doesn't have an audience. Isn't worried by thoughts oh it's taking too long and he's going to get tired and. So forth and you really teach women to masturbate first. Do you advise the use of a vibrator in this circumstance.

Only if manual stimulation is not sufficiently strong I first try the singer. If that doesn't work because of the inhibition is too massive I certainly will suggest a vibrator. If that's within the person's value system if it isn't I wouldn't have to respect the person and their value system. You do this kind of work for some people it's an abomination to use a mechanical device other people say hey that's cool. And they were interested in using it. You can't and so you have to really think and be sensitive to the woman's value system and her husband's as well. Some husbands get very threatened by the vibrator. You do more harm than good by suggesting it because you'll be very threatened. Still some women also get hooked you took me on a migraine right. Sometimes it takes a vibrated to produce an orgasm. The moment will experiment an experience of first sexual pleasure she has and a life that not. Surprisingly doesn't want to give up that vibrator and we have to.

Wean. And separate person from the vibrator. Not that healthy sexual people shouldn't occasionally if it's within their value system use a vibrator would you shouldn't use it all the time and shouldn't have to rely on it all the time. Now what about the woman who is not orgasmic during intercourse. That's one of the great controversies in medicine. And also in the women's movement. I imagine so close one of Freud's great mistake he knew nothing about sociology and didn't understand the many people many men still resist the idea that these sensitive trigger woman's erratic responses the clutter of it's anatomically exactly analogous to the tip of the penis the same nerve supply the same sensation. And nobody is very upset that the male orgasm is triggered off by stimulation of the penis although the orgasm proper really occurs deep inside and deeper muscle the pelvis. On the floor of the palace in the same muscles produce an orgasm in a female but there surrounding the vagina.

Nobody gets upset. That the male orgasm is triggered off by stimulation of the penis. But everybody seemed to get terribly upset. About the idea that it isn't the vagina. That needs to be stimulated by clutter. And for many years all psychoanalysts in particular thought that women who couldn't have an orgasm during into corners. Were sick and neurotic if they were erotic I had one or something had penis envy you know hated man and so forth. Of course that isn't true necessarily could be true but it's certainly not often true it's just that the natural trigger point for the female orgasm is the cluttering. Of the clit or is does get stimulation during intercourse. But rather mild mechanical stimulation has some traction as a penis moves in and out. For most women it's a very enjoyable experience to have an orgasm. Through into course but they certainly when asked there was one big study. Dr. Fisher did at Syracuse and he asked 500

normal women which they preferred and two thirds preferred. Clitoral stimulation stimulate it. This is still frowned upon isn't it. In some circles but less and less. Well certainly one of the things in sex therapy would teach women not to be ashamed if they enjoyed them your life but to freely express that. I don't want to say that women who can have both kinds of experience. Those are the really lucky ones and they have the fullest sex lives of course. I. Do like the idea that you know it's emotionally very satisfying to have an orgasm going into court. I'm not trying to take away from that. But a woman may be perfectly normal. And be multiple your gas to get a perfectly satisfying sex partner if she requires some literal stimulation. For her enjoyment and for our gas. And that's been one of the great controversies and misunderstandings which is that pro bono says Helen for the completely you know orgasmic woman it's practically 98

percent. To a point of masturbatory were a catch but of course that in my mind isn't a cure it's a step along the way. I would feel better as defining as a cure if a woman can have an orgasm together with her partner. If she's trusting and relaxed enough with her part and to be so they can have orgasms. Give each other orgasms or have orgasms in each other's presence. That's a slightly lower percentage. Depends on the nature of the relationship and the trust of the man. Now as far as we also take a woman who doesn't have quite a orgasm orgasm and into chords. And. I can't give you the percentages and that that varies but many such women can be taught with special techniques. To have an orgasm during intercourse if they desired so that once a woman seeks the proper kind of help it's a very hopeful situation. It is but those women who even with the best kind of help can't have an orgasm and

intercourse and not necessarily sick they can have super sex with the couple except that. Collaterals Daniel a should not as a second best means. But as a good and healthy means of sexual expression I can have a very good sex life with them sometimes. A male isn't secure and feels that unless. His pain is gives the woman the orgasm he's left in a matter she'll she won't really loth and these kinds of emotional feelings have to be worked through. This reminds me of feeling we were talking about last night we brought up the fact that a lot of what you do believe me to believe that you think you're making women take more responsibility for their sexuality is that correct. How does this sit with the husband had it. How do men respond to this in a variety of ways and then surely some men may be very threatened and may say I don't need instruction and I don't want to hear all this talk of going I can really make love with all this talk. That's really rather rare. And that may be because the woman is expressing herself in an

aggressive or defensive matter. Actually men like active interested. Sexual partners more than very passive parts. For. Throughout history men have sought out very active women and always married one of have sought them out as sexual partners. And if a woman takes is more bad. Also a man usually takes enormous pleasure if he sees that his partner is really enjoying herself. That she really abandons her self and it's able to really. Enjoy herself that makes him feel good and that adds to his excitement. So that the ultimate outcome of having a woman act more responsible more mature sex except in those cases where you're really dealing with a very frightened and insecure man usually has a very happy outcome for both. Sex gets better for both. Have you heard of this total woman thing that's sweeping the country. Yes but. What do you feel about that and how does that

fit into all of our sort of sexual awareness. Well I have mixed feelings I guess you expected me to condemn it completely. But I can't. There are certain things that are very bad and alienating about it because it it suggests that the woman play a phony role. And manipulate the man by childishness and guilt provoking. That's of course terrible in any relationship human relationship organizational relationship any relationship built on manipulation as it were inherently violent. However there is one part of it which is pretty good. And that is that says to the woman stop being so narcissistic and self-involved and start thinking of the feelings of your partner and what you might like. And that's to both their benefit. But isn't it true though that mostly women have taken the path of giving role in six anyway. They think I've taken a passive giving the role out of fear of

rejection not out of a genuine sense of duty and the desire. To please. You and I are being very sensitive and nice to each other but that's not because I'm afraid you'll never invite me back on your program again because I really like talking to you and I and you to me and that's an entirely different thing. And if I were very worried I'd have to say the right thing. I will get back. Asked back on the program again and that's perhaps a good analogy is what it used to go on in the bedroom. You say in the book that the outcome of six their pay depends on three things. When is the nature of his function. The other is the quality of the relationship. And I think I've forgotten the third. But I'd like you to talk about the three of them and the quality of their relationship especially L.K. the nature of the dysfunction. There are as I said there are six dysfunctions three of male and three female just to recapitulate the the biology of it the sexual response

is divided into razzle and orgasm and these. Two reflexes really can't be inhibited separately and that's gives you the six dysfunctions in the male. If the direction is impaired. Then you've got impotence or erectile dysfunction. The prognosis for that depends on the severity. If a man has always been in. All his life and is now middle age chances are only about 40 or 50 percent that he can help. But they aren't that good. If a man has recently become impotent the chances are in the 80's percent. That he can be helped. With premature ejaculation which is a failure to have adequate control over the orgasm reflex. The chances are up in the 90s that a man can be helped. No matter what the quality of the relationship with the other problems are. Retarded ejaculation which is very analogous to the woman who has trouble having orgasm knows a man who even have trouble orgasm I don't feel ill as I'm screwing up.

That again depends on the severity in the mild cases where a man. Can have an orgasm an extra bad fuel stimulation or a manual stimulation but not in the vagina that has a pretty good crack houses in the aids. In the severe cases where a man has never had an idea of him his whole life. That's a pretty poor performance. In the middle range one man maybe doesn't feel the orgasm or sometimes doesn't feel as though you had some Or sometimes has trouble they have a pretty good crack Nims. I guess you just your interest in the female this. One is you know I mean I mean you know you're interested in both and we eventually are going to do with the male dysfunctions. Good. Well the female also has three dysfunctions one is Bajan is from. We have his mates mentioned it was fairly rare fortunate and that is a conditioned reaction of the Bacchanal muscles work when anything gets

near the battle and can they just snap. Shut. It's not a voluntary response It's a conditioned. Response. And that's also usually accompanied by sexual avoidance a woman is very frightened. That can come from causes that are unknown. Barking come from an early brutal rape experience or some brutal attack or some paying some pelvic bone once. If it's purely psychogenic. That has a 90 percent chance of being rather rapidly. Cured by sex therapy. The non-response of woman as we talked before has a mixed prognosis now what is the quality of the relationship would end the orgasm the advances the very high prognosis for learning how to have an orgasm in the 90s. So that's the nature of the function not of quality of the relationship and its and its relevance to the success of the therapy. While if you're dealing with a badge and those of us or with you. Well let's see if you're dealing with premature ejaculation. The relationship

has very little bearing on whether a man can be successfully treated. That seems to have little bearing on anything some bearing. If a man is afraid for example the few cases of failure that I've seen and premature ejaculation. Have been because of the disturbance in the relationship the man was really afraid to let go. Yeah. He was afraid to really engage in full sex with his wife for a number of weeks and dealing with unresponsive A-T also orgasm has little to do with the quality of the relationship. Women can learn to have an orgasm pretty independent of the relationship but when it comes to responsivity and from really feeling a lot of pleasure and from potency. Then the relationship is crucial. If the parties are not attracted to each other are hostile to each other. No amount of sex star is going to give them a good spot. So you know some men just don't want to repel you and there's no amount of sex therapy that can fix that

or should fix that. You should respect those feelings. Let's talk about one of the male dysfunction so we can try to jack elation. First I think maybe you do find it a little bit but maybe you can be a little more explicit what it's exactly analogous to the woman in the end our gastric one by the way you asked me about treatment and I should tell you that one of the most successful forms of. The initial stages of treatment is groups and our gastric womens groups. Were six or seven when we we when those at the clinic for example 6 0 7 1 of never happened I gather is that something new. It's relatively new. But the group practice is actually facilitated when everybody just goes around and tells their fantasies of what they're afraid of and having an orgasm in their dreams about it and then everybody goes home and tries it and then they come back the next week. And. Some will say hey I had an orgasm that the other women will be encouraged by that and they'll exchange information and that's probably one of the most successful ways of teaching women to stimulate

themselves after they've reached orgasm by themselves then they're treated individually. I mean as a couple than to bring your damned relationship. Now we don't have that for men yet. Which is an un stats a sexist discrimination. Because men are not so quick to admit that they have gas problems. They can hide that they can hide direction problems that kind of forced him to seek help with that. But many men won't admit to their part and they feel there are gaps. Or they may fake an orgasm. They can't have one. Just the way women do. So that's a dysfunction which is only coming out of the closet. Rather recently and we do the same thing we teach first self-stimulation we try to relieve the man's guilt about having fantasies. Encourage fantasy stimulation and gradually bring the orgasm from self-stimulation closer and closer to the vagina. A sort of behavioral thing very behavioral

but as he gets each step closer to the vagina he very often has all kinds of anxieties and killed some a couple start quarrelling and resistance may come from the woman she may get frightened. And then you have to deal with that very carefully in the session or you can do a lot of mischief. You stow it old man let's admit it because I didn't realize that that was one of the problems that men can fake an orgasm I didn't realize. That. In fact sometimes a couple would show up at a fertility clinic. Because they haven't had any children for four or five years. And then that will then it'll be discovered the man's faking and maybe has his orgasm alone and asked for patients away from his wife and she never knew and he never admitted it only became apparent in the sterility workout. Man Have a great difficulty admitting that that seems to be a. Very sensitive topic.

That seems to be true for both of us. Food for as long as we could remember women have been you know not admitting they weren't having orgasms. But women seem to have a different motivation I think the woman is afraid. Of being rejected. Of not being a good sex object of the man will think she's not responsive. She's frigid and he won't be pleased and leave her. A man is more afraid of admitting some kind of performance failure. Little boys in our society are unfortunately taught that they have to be performers and producers and always look good and always put on a show and look to reffing. And that's a terrible burden to carry. And that's. That's more why a man might hide that. A woman has taught us to be pleasing I'm oversimplifying terribly Of course. But she had a little girl has to be pleasing and pleasant. And that's what she's more afraid. Now what about premature ejaculation. What are the. Can you describe

that way this inference. Sure. The normal male learns after the first initial few initial sexual experience. To have voluntary control over as I gather from reflex. That some reflexes in the body you can never have voluntary control over like a directional lubrication or heartbeat. But there are other reflexes we do like that occasional urine and orgasm and if for some reason the man is too excited or too distracted at the moment of high sexual arousal he never learns control. And he wraps himself and is part of a great deal of pleasure there. And the treatment consists of a modified to training procedure rather than real psychotherapy. Where a man. Is brought to the heights of arousal by his wife first manually the use of the lubricant. To heights of arousal and he stops learns to identify those and sage and. He lets the sensations go down for a few seconds and up and

down and finally has his orgasm. It's really a training procedure and then this is done inside the John. And again we get enormously high success rates with fat although it can be emotionally. Very intense experience it can be a very intense experience for both the partners are more likely to get upset than men why the partners we're likely to get upset. Well because they. If a woman is a killer she'll say OK now I'm helping them overcome this. Sent them in now who go out and. Find themselves three other women and leave me and the other reason is then the woman has to face her own sexuality she's been saying well I don't have orgasms because he comes into second as he gets along a control's Yast is herself and her own inhibitions which is sometimes pretty hard. Is it typical that problems occur after success or problems occur because of success in treatment. Well that's a big argument in psychoanalysis psychoanalysis is very

suspicious of even curing cultures because that's a psychosomatic disease in many cases a symptom removal was very afraid because nobody wants to harm the patient. And the rapid cures and behavioral cures were looked upon with some suspicion because. According to psychoanalytic theory if you remove a symptom you might harm the patient might come out in some other form or page and I get very depressed and anxious. And indeed that does happen a small percentage of cases the sicker patients. And I'd say my experience around 5 to 10 percent of our patients do become at least temporarily either depressed or anxious or develop other symptoms. Can you give me an example for instance hell a woman might respond after successful treatment of her husband's premature attempt that she might go into a profound crash again. Very paranoid and jealous calling that the office 10 nature is really at the

office and that out somewhere and she might get bad dreams and she might just see your Abana get very paranoid about his abandoning her. Get very hostile and fat but you can deal with that if you're sensitive to that. And. But most of the time I really the couple feels either the same or much better after their sexual funk grooves. It's rare that a person or partner but it's not unheard of will feel worse. Ah the same is true with the relationship the relationship may improve usually does with the increased communication the whole process not just the outcome but the whole process of therapy and greater intimacy. Less anxiety more communication so the but sometimes usually the relationship proves hell and I think we have a proper perspective on the importance of sex in this country I do think we mean we have only a few seconds but I wanted to know what you think about what our society attitudes I mean are

we being misled are we being taken down the garden path. We have a whole mosaic of attitudes. Some of us and some of us I do do it and most of us admit we really don't know exactly where we would be if we were left alone. Thank you. Produced by w any DTV which is only responsible for its content and was funded by a public television stations. The Ford Foundation and the Corporation for

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