Conclusion

The book’s main conclusion is that sex therapists have long believed that heterosexual women should want sex as much as men want it, and in way men want it, with intercourse leading to orgasm. They have long treated departures from men’s sexuality as abnormal and suboptimal. The book closes by placing these biases within the context of other patriarchal biases and institutions, and by suggesting a series of techniques and approaches that might offer sex therapy a way forward.

Men’s Free Will

“Men’s Free Will” examines how differently sex therapy unfolds when a heterosexual male presents with the problem of low sexual desire—how heterosexual men are often treated more respectfully, more attentively, and more generously than heterosexual women. This chapter shows that for sex therapists, a man’s position in his marital orbit need not adapt to his wife’s needs. She must adapt to his. Through examination of contemporary case studies, the chapter examines how heterosexual men with low sexual desire not only present as more sexually intransigent than heterosexual women, but that their intransigence is more likely to be accepted by their spouse and therapist.

Docile Bodies

“Docile Bodies” focuses on behavioral sex therapists who were contemporaries of Masters and Johnson, including Joseph Wolpe, Arnold A. Lazarus, William Hartman, and Marilyn Fithian. This chapter shows how they valued intercourse for women partnered with men, much as Masters and Johnson did, not for what it means to women, but as a behavior that is intrinsically natural and healthful. This chapter shows that for Masters and Johnson’s contemporaries, intercourse was not only mandatory for heterosexuals; it was the unstated, unrecognized foundation of sexuality and sex therapy. Topics covered include systematic desensitization, typical hierarchies of sex scenes, and when sex therapists prescribe intercourse.

Introduction

The introduction outlines the book’s main goal, which is to describe how, during the nineteenth, twentieth, and twenty-first centuries, physicians, psychologists, social workers, sexologists, and counselors came to advocate heterosexual intercourse as the norm for both men and women without overtly acknowledging the effects of that advocacy: the legitimation of male sexuality and male supremacy. The author argues that sex therapy has been, and continues to be, based on a series of pro-male, anti-female assumptions and sustained through practices that treat those assumptions as true. The introduction describes how the research began, how the book is organized, and the kinds of materials and methodologies used to support the observations and conclusions.

Discontinuities, Deviations, and Reversals

This chapter discusses case studies where, in the name of treating a woman’s sexual disinterest/resistance, she is not etherized, overpowered, or pressured. Instead, she is taught how to become more attuned to her own feelings, to her own “authentic self.” In this chapter, we see how power in sex therapy sometimes operates more like a velvet glove than a mailed fist. We see how sex therapists sometimes operate with the understanding that a sexually disinterested woman may desire sex more if she feels she has the power to refuse. Thus conceived, sex therapy sometimes appears to support a woman’s autonomy and empowerment, yet, paradoxically, the normal conclusion of these cases is that the sexually disinterested/resistant woman becomes less resistant and more sexually compliant.

Women’s Duty

“Women’s Duty” mirrors the previous chapter on men’s free will by showing how intercourse has been treated as a husband’s right and a woman’s obligation. This chapter uses case studies to reflect on how sex therapists may accept as normal and natural heterosexual women’s obligation to adapt to men’s sexual needs. The chapter also highlights how women’s resistance to sex with men is often seen in sex therapy’s professional literature as an obstacle to achieving family goals and how overcoming that resistance—taking on the burden of unwanted intercourse—is treated as a responsible way of “saving the marriage’ and “protecting the family.”

Male Identification

“Male Identification” examines how a prominent follower of Masters and Johnson, Helen Singer Kaplan, viewed her female patients much as Masters and Johnson viewed theirs, as less deserving, as less entitled, and less credible. Kathleen Barry called this bias “male identification,” a phenomenon of growing importance since the field of psychotherapy and the subfield of sex therapy have become increasingly dominated by female practitioners. Through examination of case studies written by Kaplan, the chapter highlights how this therapist pressured women to accept masculine versions of sexual normality. It shows how she encouraged her female patients to admit that, deep down, despite their repeated denials, what they really want and need is a penis—their husband’s penis—thrusting inside their vagina.

The Frigidity Epidemic

“The Frigidity Epidemic” examines how the next generation of Freudian therapists used the concept of frigidity to cast women who did not live up to men’s sexual expectations as psychological deviants. Like Dora, “frigid” women were given no credit as tellers of their own stories. This chapter seeks to specify not only how physicians persuaded themselves and others that sexual frigidity represents a public health threat of the first magnitude—an epidemic—but also how they represented men and their sexuality as the norm and women and their sexuality as suspicious, in need of the most rigorous surveillance and control.

Freud, Dora, and Compulsory Sexuality

“Freud, Dora, and Compulsory Sexuality” examines Freud’s attempt to impose male sexuality onto a patient he renamed “Dora.” While Dora, an adolescent girl, did not begin seeing Freud to receive help with a sexual discrepancy issue, this chapter shows that a sexual discrepancy did surface during her treatment, the discrepancy between the way Dora’s male therapist interpreted her sexuality and the way she interpreted her own. The chapter shows how, in the name of treating Dora’s psychological symptoms, Freud imposed his sexual story onto Dora while simultaneously excluding and nullifying Dora’s own thoughts, feelings, and experiential reality.

Sex Therapy Without Male Privilege and Power

This chapter addresses the question of what sex therapy looks like when men are not involved as patients and partners. This chapter asks how professional wisdom about sex therapy with lesbian couples might differ from sex therapy with heterosexuals. The conclusion, based on examination of published case studies, is that when both partners are women, sex therapy appears more attentive to the couple’s relationship, more attentive to how sex fits into the relationship, the underlying meanings that sex has for the partners, and the possibility of working out compromises. In addition, when both partners are women, sex therapy applies fewer psychiatric labels, does not focus on improving either woman’s sexual technic and performance, and is less apt to identify one partner as the main problem.