The Vaginal vs. Clitoral Orgasm Debate
It was the early 1970s and it was one of the first annual meetings of the American Psychiatric Association which I attended. I donâ€™t recall the city but remember that there was one particular program that I decided I would not miss. It was debate between a well known psychoanalyst (or perhaps a group of analysts) and William Masters and Virginia Johnson- two psychologists who were doing research into human sexuality. The topic was â€œVaginal vs Clitoral Orgasmâ€
Freudian Point of View
The concept of vaginal orgasm as a separate phenomenon was first postulated by Sigmund Freud. Psychoanalysis was not far from itâ€™s prime and Freudâ€™s theories were still highly respected although certainly questioned and modified by various schools of thought. In 1905, Freud stated that clitoral orgasm was purely an adolescent phenomenon, and upon reaching puberty the proper response of mature women was a changeover to vaginal orgasms, meaning orgasms without any clitoral stimulation. While Freud provided no evidence for this basic assumption, the consequences of this theory were considerable. Many women felt inadequate when they could not achieve orgasm via vaginal intercourse alone or involving little or no clitoral stimulation.Â Many psychiatrists trained in psychoanalytic theory, or influenced by some of their teachers who were primarily Freudian analysts, were influenced by these writings. Therefore, they would focus on a patientâ€™s report of orgasmÂ mainly by clitoral stimulation as being indicative of early conflicts and failure to mature properly. This might lead to deeper psychoanalytic treatment. In other situations, the nature of current relationships might be questioned. Still another approach was to consider this a sexual inhibition which might respond to aÂ cognitive therapy where corrective suggestions were offered toÂ women to achieve orgasm with â€œproper masturbation.â€
Masters & Johnson
In 1966, Masters and Johnson published their workÂ about the phases of sexual stimulation. Their work included women and men, and unlike Alfred Kinsey earlier (in 1948 and 1953), they tried to determine the physiological stages before and after orgasm. Masters and Johnson observed that both clitoral and vaginal orgasms had the same stages of physical response. They argued that clitoral stimulation is the primary source of both kinds of orgasms. Physicians trained prior to this time had little instruction in human sexuality. Therefore the work of Masters and Johnson was viewed with great interest by many psychiatrists especially those training at this time.
The second wave of the Womenâ€™s Movement often called womenâ€™s Liberation was also at itâ€™s peak. Jane Gerhard had published â€œThe Myth of the Vaginal Orgasmâ€ in 1968. Freudian thinking was a lightening rod for women to reject psychoanalytic theory in particular and male psychiatrists in general. Many women would only agree to see a woman psychiatrist. Some women expressed great anger towards the psychoanalytic theories about female sexuality. The concept of the vaginal orgasm was not far from the center of this hostility.
Time Marches On
I wish I could remember the details of the this debate (one does repress these sexual things). IfÂ there isÂ transcript of it I would think it be worth publishing. I do recall that they moved the venue several times prior to starting it because the crowds were getting larger and outgrew the seating capacity. I know that on the basis of that meeting andÂ from subsequent reading of the growing literature about human sexualityÂ as well as talking to patients, I understood that vaginal vs. clitoral orgasm was not the to key successful sexual function. Our understanding has progressed greatly and the previous point of contention has little relevance although some people still hold on to the dichotomy.
In 1974 Helen Singer Kaplan reported that stimulation of the clitoris is usually experienced in the vagina. This made sense and closer anatomical and neurological advances confirmed this observation. Recent discoveries about the size of the clitoris show that clitoral tissue extends some considerable distance inside the body, around the vagina. This discovery may possibly invalidate any attempt to claim that clitoral orgasm and vaginal orgasm are two different things. Clitoral tissue is more widespread than the small visible part most people associate with the word. It is possible that some women have more extensive clitoral tissues and nerves than others, and therefore whereas many women can only achieve orgasm by direct stimulation of the external parts of the clitoris, for others the stimulation of the more generalized tissues of the clitoris via intercourse may be sufficient.
The GrÃ¤fenberg spot, or G-spot, although first identified in the 1940s still has not been scientifically identified. However discussion about it has added a newÂ dimension to understanding the location of an orgasm. More recently.it has been an area of discussion among experts in human sexuality. ItÂ is a small area behind the female pubic bone surrounding the urethra and accessible through the anterior wall of the vagina. The size of this spot appears to vary considerably from person to person. A recent theory receiving some publicity is that the female body can achieve orgasm both from stimulation of the clitoris and of the G-spot. Such orgasm is sometimes referred to as “vaginal,” because it results from stimulation inside the vagina, including during sexual intercourse.
A great deal has changed in the past 50 years , not only in our understanding of human sexuality but also in the comfort of patients and theirÂ doctors in discussing sexual functioning. Most psychiatrists are not only comfortable in talking about it but are well trained in treatment approaches to complaints about sexuality.Â We understand that there are a number of medical conditions which need to be ruled out from the onset. A full evaluation of patients psychological functioning is obviously also essential. For example depressed patients often have sexual problems. Drug and alcohol definitely effect sexual functioning. We also know that sexuality should not be viewed in a vacuum. The nature of relationships certainly effects sexual functioning.
Treatment approaches have a wide range of possibilities, which I hope we can examine in future blogs. Most psychiatrists and other mental health specialists todayÂ do agree that we are now past the clitoral vs. vaginal debate.