Comprehensive Sex Therapy
Let us consider in more detail the sex-therapeutic treatment of alibidemia (frigidity) in women, developed by X. Kaplan (1987). His main therapeutic strategy is to train a woman to respond adequately to sexual stimulation while she is in a relaxed and serene state. The following sequence of treatment for women with complete frigidity is commonly used: 1) sensory focusing – I; 2) sensory focusing – II; 3) non-binding coitus; 4) intercourse with orgasm.
Sensual focusing means that spouses refrain from intercourse and orgasm for several days or weeks. At the first stage (sensory focusing-I) they are engaged in love games and gentle caresses that exclude direct stimulation of the genitals. In this case, the partners are free from the obligations, according to which they will certainly expect certain sexual reactions from each other. He does not need to have an erection, and she is relieved of the obligation to call her at her partner. Neither she nor he is advised (the therapist insists on this) to reach orgasm, but at the same time they are required to deliver each other maximum pleasure. This setup allows partners to overcome their fears and concerns. Under such circumstances, the emerging feeling of joy and pleasure serves as reinforcement and stimulus for adequate sexual functioning. Sensual focusing – II is used after the couple has successfully coped with mutual enjoyment, or in the event that the therapist deemed it advisable to bypass the first stage. Genital enjoyment exercises are prescribed for partners, the essence of which is gentle, seductive stimulation of the genitals, while there is one important condition: arousal should not lead to orgasm.
Frigid patients may experience negative reactions to sensory focusing exercises, which must be taken into account. They are recommended if it is known that during the premarital period, the woman experienced sufficient excitability in the situation of preliminary caresses and during petting. At first, these exercises should be carried out in clothes, which allows a woman to perceive them without undue fear.
Non-binding coitus. In the best case, this exercise is performed under the condition that the woman showed a positive reaction to the sensory focusing exercises. But if touching the genitals causes her irresistible resistance, then one of the ways to get around this resistance is to exercise non-binding coitus.
The couple gets the installation on mutual caress to obtain an erection in a man and lubrication in a woman. If a woman does not have sufficient moisturizing of the vagina, the man is invited to lubricate the penis with a lubricant. Then the woman takes a pose from above. She inserts the penis into the vagina, after which she rests for a while to get comfortable with the feeling of the phallus in herself. After that, she makes several compressions of the pubic-coccygeal muscles to adapt to sensations in the vaginal area. Next, she makes a slow motion “up – down” on a member of a man. She “plays”, experimenting with various frictional and translational movements. She is driven solely by her own feelings and does not pay attention to her partner. On her part, a certain amount of egoism is required in order to evaluate and become aware of her own, vaginal sensations. A man seems to be giving in for temporary use his erect member, while he strongly encourages a woman in her actions. If a man feels the approach of an orgasm, he warns his spouse about it and the couple takes a short break. At this time, you can leave a member in the vagina. Such an interrupted coitus gives a woman a pleasant sensual sensation and sharpens her arousal. During the break, the couple is usually recommended to refrain from stimulation. But sometimes a man can stimulate the clitoris or the woman does it herself. The exercise ends when she is tired or reaches orgasm (at this stage orgasm occurs extremely rarely). It is clear that non-binding coitus requires a sexologically normal male partner with good potency and sufficient control of ejaculation.
X. Kaplan (1987) describes various types of reactions to non-binding coitus. In women: pleasure and arousal, and sometimes orgasm; Enhance pleasant vaginal sensations, the awakening of love experiences; but sometimes negative manifestations in the form of anesthesia or even emotional turmoil. Men also react differently to the exercise. Some are inspired by the opportunity to help his wife, getting sexual pleasure from the process. Others experience anxiety and hostility, as the woman is very active and self-centered.
In case of positive reactions, the spouses switch to a regular coitus. Negative reactions require analysis and correction. Many frigid women are overly concerned about the satisfaction of their partner to the detriment of themselves. This is where the masochistic pattern of behavior in relation to the opposite sex is manifested. It is deeply disturbed. A woman cannot believe that a man is able to love her and accept her as she is. She feels the obligation to constantly serve, to bring him pleasure. She can not afford to relax and take pleasure. The husband, often unconsciously, is interested in this passive behavior of his wife, and he quietly contributes to his fixation. He allows her to serve, to bring him pleasure and to please herself. This behavior allows a deeply insecure man not to expose his own manifestations of anxiety.
The exercises of non-binding coitus, in which a woman directs her activity to the desired course for herself, ignoring the principle of gratifying a man, often bring out stereotypes of masochistic behavior, behavior that serves the unconscious needs of both men and women. Therefore, both partners may experience increased anxiety and increased protection mechanisms that contain this alarm. The repetition of tasks and psychotherapy aimed at correcting the level of self-esteem of a woman helps to cope with these resistant states.
In cases where the sadomasochistic manifestations are stable and cannot be corrected during short-term psychotherapy, X. Kaplan recommends using the “collateral” method. Spouses are invited to keep all the features of their relationship, but at the same time follow sexological prescriptions, that is, in fact, actively engaged in sex. They can enter into hassles, sort things out, if they wish, but outside the bedroom.
Fear of rejection is another common cause of frigidity. Some women are able to dissociate well the sexual and affective reactions. They get pleasure from sexual activity and demonstrate good sex, even if they are indifferent or negatively disposed towards their partner. But much more often, women are not able to experience positive emotions from sex in such cases. Moreover, frigid women often do not even realize hostility or ambivalence towards their husbands. A woman feels deceived, used as a weapon, completely unaware of her hostility, which suppresses her sexuality in her relationship with her husband. The fear of being rejected can be overcome “collaterally”, and a woman can sometimes enjoy sex, despite the very contradictory attitude towards a man. In other cases, manifestations of hostility become an insurmountable obstacle, and psychotherapeutic assistance is required. Similar problems arise in the case of feelings of guilt about sexual pleasure.
Orgasm. In the case when a non-binding coitus leads to the appearance of an erotic response in a woman, the couple gets a set of intercourse aimed at reaching orgasm with both partners. However, in the initial stages of therapy there is no need to force the onset of an orgasm in frigid women. Initially, the goal of therapy should be to enhance her sexual reactions and awaken the desire for intimacy. A focused orientation on orgasm can slow down the awakening of sexuality. But if frigidity is secondary in nature, being the result of repeated unsuccessful attempts to achieve orgasm, then it is prescribed to perform special exercises aimed at achieving it.
A useful addition to sex therapy are exercises for the development of pubic-coccygeal muscles.
They were offered by A. Kegel, who considered the weakness of the pubic-coccygeal musculature to be one of the characteristic causes of female alibidemia and anorgasmia. Sensations of okolovaginal muscles are an important source of voluptuous erotic experiences. The physiological substrate of the female orgasm includes contractions of the bulbous-spongy and pubic-palar muscles. Therefore, improving the tone of these muscles contributes to a brighter orgasm. If there is evidence that indicates the lethargy or atrophy of the indicated muscles, the woman is required to perform exercises to reduce heroconus coccygeal muscle once or twice a day. To identify these muscles, the patient is recommended to periodically interrupt and continue urination.