During the rapid treatment program, the daily report and ensuing discussions between the cotherapists and marital partners describing the non orgasmic wife's reactions and as well as those of her interacting husband, provide an incisive measure of the degree to which the requirements of her functioning sexual value system are being met or negated, or the extent to which she progressively is able to adapt her requirements.
These discussions provide simultaneous opportunity for a more finite evaluation of the levels of interactive contribution to sexual function by her bio physical and psychosocial systems.
The treatment of both primary and situational orgasmic dysfunction requires a basic understanding by patients and cotherapists that the peak of sex-tension increment resulting in orgasmic release cannot be willed or forced.
Orgasmic experience evolves as a direct result of individually valued erotic stimuli accrued by the woman to the level necessary for psycho physiological release. Just as the trigger mechanism which stimulates the regularity of expulsive uterine contractions sending a woman into labor is still unknown, so is the mechanism that triggers orgasmic release from sex-tension increment.
Probably they are inseparably entwined to identify one may be to know the other.
It seems more accurate to consider female orgasmic response as an acceptance of naturally occurring stimuli that have been given erotic significance by an individual sexual value system than to depict it as a learned response.
There are many case histories recorded in this and related studies reporting orgasmic incidence in the developing human female at ages that correspond with ages reported in histories of onset of male masturbation and nocturnal emission.
These clearly described, objective accounts are considered accurate by reason of their correlation with subjective recall provided by several hundred women interrogated during previously reported laboratory studies. The initial authoritative direction in therapy includes suggestions to the marital unit for developing a non demanding, erotically stimulating climate in the privacy of their own quarters.
At no time during the two-week therapy program is either of the marital partners under any form of observation, laboratory or otherwise. Only the phenomenon of vaginismus is directly demonstrated to the husband of the distressed wife, under conditions routinely employed by appropriate practitioners of clinical medicine.
The cotherapists' initial directions suggest ways of putting aside tension-provoking behavioral interaction for the duration of the rapid-treatment program and allow the woman to discover and share knowledge of those things which she personally finds to be sexually stimulating.
Further professional contribution must suggest to the marital unit ways and means to create an opportunity for the woman to think and feel sexually with spontaneity. She must be made fully aware that she has permission to express her sexual feelings during this phase of the therapy program without focusing on her partner's sexual function except by enjoying a personal awareness of the direct stimulus to her sexual tensions that his obvious physical response provides.
Every non orgasmic woman, whether distressed by primary or situational dysfunction, must develop adaptations within areas of perceptual, behavioral, and philosophic experience.
She must learn or relearn to feel sexually (respond to sexual stimuli) within the context of and related directly to shared sexual activities with her partner as they correlate with the expression of her own sexual identity, mood, preferences, and expectations.
The bridge between her sexual feeling (perception) and sexual thinking (philosophy) essentially is established through comfortable use of verbal and nonverbal (specifically physical) communication of shared experience with her marital partner.
Her philosophic adaptation to the acceptance and appreciation of sexual stimuli is further dependent upon the establishment of "permission" to express herself sexually. Any alteration in the sexual value system must, of course, be consistent with her own personality and social value system if the adaptation is to be internalized.
Keeping in mind the similarities between male and female sexual response, the crucial factors most often missing in the sexual value system of the non orgasmic woman are the pleasure in, the honoring of, and the privilege to express need for the sexual experience.
Restoration of sexual feeling to its appropriate psychosocial context (the primary focus of the therapy for the non orgasmic woman) is the reversal of sexual dissembling. This, in turn, encourages a more supportive role for her sexuality. In the larger context of a sexual relationship, the freedom to express need is part of the "give-to-get" concept inherent in capacity and facility for effective sexual responsivity.
Professional direction must allow for woman's justifiable, socially enhancing need for personal commitment, because her capacity to respond sexually is influenced by psychosocial demand.
The commitment functions as her "permission" to involve herself sexually, when prior opportunities available to formation of a sexual value system have not included an honorable concept of her sexuality as a basis upon which to accept and express her sexual identity.
Commitment apparently means many things to as many different women; most frequently encountered are the commitments of marriage or the promise of marriage, the commitment of love (real or anticipated) according to the interpretation of "love" for the particular individual.
Regardless of the form the commitment takes, after it is established the goal to be attained is enjoyment of sexual expression for its own positive return and for its enhancement of those involved.
During daily therapy sessions, interrogation of the sexually dysfunctional woman is designed to elicit material that expresses the emotions and thoughts that accompany the feelings (sexual or otherwise) developed by the sensate-focus exercise.
Also continually explored are the feelings, thoughts, and emotions that are related to the behavior of her marital partner. Her reactions when discussing material of sexual connotation are evaluated carefully to determine those things which may be contributing to ongoing inhibition or distortion being revealed by the regular episodes of psycho physiological interaction with her husband.
When a non orgasmic female involves herself with her partner in situations providing opportunities for effective sexual function, her ever-present need is to establish and maintain communication.
Communication, both physical and verbal in nature, makes vital contributions, but it loses effectiveness in the rapid-treatment method if allowed to be colored by anger, frustration, or misunderstanding. While verbal communication is encouraged throughout the two-week period, physical communication is introduced in progressive steps following the initial authoritative suggestion to provide a non demanding, warmly encompassing, shared experience for the woman, with optimal opportunity for feeling.
After the early return from sensate-focus opportunity as directed at the roundtable discussion has been judged fully effective by marital partners and cotherapists the marital unit is eucouraged to move to the next phase in sensate pleasure genital manipulation.
The cotherapists should issue specific instructions to the marital partners as "permission" is granted to the female to enjoy genital play.
Sexual instructions should include details of positioning, approach, time span, and above all, a listing of ways and means to avoid the usual pitfalls of male failure to stimulate his partner in the manner she prefers rather than as she permits him the privilege to function.