The Changing View of Normal Female Sexuality

Excerpted from
Perfectly Normal: Living and Loving with Low Libido
By Sandra Pertot, Ph.D

"I never feel like [having] sex," says Julia. "What's wrong with me?
When I know Tom wants sex, I usually feel that I just can't be
bothered. He's upset because I always seem to be saying no,
and I never come on to him."

There is nothing obvious to distinguish Julia from other women. She could be a businesswoman or a housewife, twenty-something or in her midlife, in a caring relationship or one that is emotionally barren. She is just as likely to be fit and healthy as she is to be overweight and rundown. She may once have felt very strong sexual desire or have always had little energy for sex. There are many women who feel like Julia does, and they may have only one thing in common: They sometimes think that they wouldn't care if they never had sex again.

In TODAY'S WORLD, young women expect to want sex with passion and enjoy it with abandon. A good sex life is regarded as a right that is taken for granted. With increasing recognition of women's rights in both the personal and public domains, women are no longer expected to play a subservient role to men in their personal relationships, and positive images of female sexuality are the norm. Lead characters in books and movies are routinely portrayed as sexually confident women, and numerous books and magazine articles are dedicated to helping the average real-life woman discover her sexual potential.

Of course, female sexuality hasn't always been viewed so positively. During the past century, female sexuality was variously denied, trivialized, repressed, and subjugated. To understand our current view of female sexuality, we have to start by looking to the past.

FEMALE SEXUALITY IN THE 20TH CENTURY

Medical and religious writers in the early decades of the 20th century viewed sex as a necessary evil that should be controlled at all times. They thought that masturbation, for example, could lead to mental or physical illness and even early death. Men were unfortunately more susceptible to the evils of sex, but women, mercifully, were often spared. Influential writers such as Dr. William Acton believed that normal women lacked sexual feelings of any kind and had sex only to please their husbands or to become pregnant.

Not everyone shared this view. The famous Viennese psychiatrist Dr. Sigmund Freud believed that sexual pleasure was a basic need for both men and women. However, he wasn't at all confident that women could mature enough to reach their sexual potential. Writing in the early part of the century, Dr. Freud had a powerful negative influence on the understanding of the sexual nature of women. He characterized them as mutilated males, biologically inferior because they lacked penises. And he insisted that an essential phase in the psychosexual development of women was acquiring the ability to achieve orgasm from penile thrusting alone. Although he recognized that the clitoris was highly sensitive and the vagina relatively insensitive, he stated that the inability of a woman to achieve orgasm with only the stimulation of intercourse was an indication of severe personality disorder.

Female Sexuality in the 20th Century

The legacy of writers such as Acton and Freud continued into the second half of the century. In 1972, British sex educator Clare Raynor echoed Acton by declaring that though men have strong sex drives, women want sex only for babymaking. Many experts continued to support Freud's view that it might be difficult for women to mature sufficiently enough to come to orgasm during intercourse, and writers such as Canadian gynecologist Marion Hilliard, M.D., advised women not to be selfish and to consider their partner's feelings. This meant that sometimes they should fake arousal and orgasm so that their partner could feel proud and confident as a man.

Maxine Davis, a popular author in the 1950s whose books were still highly regarded and read decades later, gave women some conflicting advice. She advised young wives that it was their responsibility to adapt themselves to their husband's needs in order to have a successful marriage, because their own sexual pleasure wasn't an essential part of love-making. Like Raynor, she advised women to sometimes fake orgasm, but she also recommended that they come to climax during intercourse at least some of the time, because this was the only true path to sexual ecstasy. At the same time, Davis felt that they should never take charge, because she believed that men don't like bossy women.

In the early 1960s, popular psychologist Joyce Brothers, Ph.D., advised women who did indeed desire sex to not make it too obvious. She felt that for a marriage to be good, the husband had to dominate both sexually and financially. Wives could certainly work outside the home, provided they didn't have a more-responsible and more-financially successful job than their husband did, and they could want and even enjoy sex as long as they weren't too aggressive about it and allowed their husband to set the sexual pace.

It's no wonder that many women found the whole notion of sex confusing. Premaritally, it was the woman's responsibility to control any sexual behavior to avoid pregnancy, and within marriage, she should not be too keen on having sex but certainly be prepared to do her conjugal duty. If she was doing her marital duty, maybe she could or should enjoy it and perhaps even have an orgasm but only if she could do it in the normal way (that is, through intercourse). Even then, because of the absence of realistic sex education, there was a good chance that a woman wouldn't know what intercourse actually was-the wedding night was something of a shock to many a virgin bride. And if she did know what was expected of her, how did she know? Was she "that kind of girl"?

While there were some writers throughout the century who questioned the notion that sex was inherently sinful and tried to bring some enlightenment into the lives of married couples, overall, society remained essentially conservative. Married couples had limited access to information on sexual matters, and girls were typically denied even basic information about menstruation, so the onset of menarche was often terrifying.

All that was about to change.

The Cultural Shift

When world-renowned sex researchers William Masters, M.D., and Virginia Johnson published their groundbreaking work Human Sexual Inadequacy in 1970, they estimated that as many as 50 percent of couples led unsatisfying sex lives. At that time, they believed that the most significant causes of sexual problems were conservative cultural attitudes about sex, and ignorance about basic sexual functioning.

As difficult as it may be to believe now, the extent of sexual ignorance at that time was such that most people were unaware of the existence of the clitoris; many young brides had no idea that men had erections; and even into the 1970s, there were some couples whose apparent infertility was due to the fact the wife was still a virgin-neither partner knew where to put the penis!

It was assumed that a man knew more about sex and had to be patient with his virgin partner, guiding her through the mysteries of sex. It isn't clear how men were supposed to acquire this greater sexual knowledge and understanding, because sex education seems to have consisted of furtive schoolyard discussions, awkward "talks" from parents, and what was learned by self-discovery. If sex education in any formal sense did occur, it concentrated on reproduction and the immorality of premarital sex and masturbation; techniques for sexual pleasure were certainly not on the agenda.

There were many influences that combined in the 1960s to help shape a significant shift in our attitudes toward sex over the subsequent decades. These changes provided a climate for Masters and Johnson's work that had not existed before (although their ideas still met with considerable hostility from the conservative sections of society).

One of the most significant of these changes was the development of the contraceptive pill. Effective contraception meant that couples could explore sex for pleasure without fear of unwanted pregnancy. Still, no one, not even the sex researchers, asked the obvious question: What makes sex pleasurable? Instead, it was assumed that sexual pleasure was inevitable with certain sexual behaviors and that appropriate sex education would give couples all the information they needed.

Improved contraception led to a new phase in the women's movement. Control of fertility meant the opportunity to explore other life choices and redefine relationships with men. Women began to question the traditional view of sex as a wifely duty. The view of women as sexually naive and uninterested was seriously challenged during the 1960s, and for many women, being expected to endure male caresses without consideration for their own enjoyment was no longer acceptable. More and more women wanted a part of the "sex for pleasure" movement, and they developed the confidence to seek it. Not only that, many women felt strongly that they should participate in sex only when they felt like it. Saying no to your partner was becoming accepted as a fundamental right.

This change in focus away from reproduction and marital duty drew attention to the problems of people who did not automatically find sex an enjoyable pastime. The time was right for serious researchers to explore the sexual difficulties many people reported, and Masters and Johnson took up the challenge.

One of their major starting points was to discredit the long-held view that sexual problems are always a symptom of deep, underlying psychiatric illness that can be cured only by long-term psychotherapy. Instead, they claimed an impressive cure rate with their treatment program, which combined sex education, a series of couples exercises called Sensate Focus, and specific behavioral strategies for each of the sexual dysfunctions. This approach came to be known as sex therapy.

Sex therapy challenged old beliefs and lack of knowledge. It came as a surprise to many that women were capable of orgasm and that it was most likely achieved by clitoral rather than vaginal stimulation. Couples learned that what happened prior to intercourse (foreplay) was as important as the act itself. Men learned that they could delay ejaculation to enhance the satisfaction of both partners and that they didn't have to endure impotence in painful, embarrassed silence.

One of Masters and Johnson's most fundamental aims was to abolish goal-oriented performance. They believed that if people stopped being anxious about their performance and were willing to put into practice some basic techniques, good sex would happen naturally, making sexual pleasure within easy reach of everyone. (Interestingly, early sex therapy did not address the problem of sex drive: It was assumed that once a couple stopped being anxious about sex and learned how to achieve sexual pleasure, sex drive would automatically increase.)

As a young sex therapist in the early 1970s, I remember embracing all this exciting knowledge and the associated treatment protocols with an almost evangelical zeal. It seemed, back then, that sexual liberation was about to be realized-and my colleagues and I often joked that we'd be working ourselves out of a job, because there would be no need for sex therapists in the new millennium.

The Irony of It All

Despite 30 years of access to sex therapy and an increasing openness about sex during that time, the reported rates of sexual problems have not changed significantly-making for an interesting paradox. There's more sexual content in books and films than ever before, and there are hundreds of books and magazine articles dedicated to exploring and offering solutions for all kinds of sexual difficulties. In spite of this, a large population survey conducted in 1994 by University of Chicago sociologist Edward Laumann, Ph.D., and his associates estimated that 43 percent of women and 31 percent of men in the United States have sexual problems. One in three women rated themselves as lacking interest in sex, which was double the reported rate for men. (The major concern for men was worry that they climaxed too quickly.)

These results were astounding, particularly the figures on low sex drive in women. Although other more recent studies haven't found the same high rates, they still report that 20 percent of women, or one in five, complain of low libido. These numbers don't come as a surprise to sex therapists. Our offices are busy with women of all ages who worry because they don't feel like having sex as often as they believe they should, or as often as their partners would like.

Think about it. Sit in a mall and watch the crowds go by, and consider that at least one of every five women walking past you is likely to not be too keen on sex. That's an awful lot of worried or dissatisfied women and stressed relationships.

How did this happen? In an age of sexual sophistication and celebration of sexuality, when one of the best-selling books in the late 20th century was called The Joy of Sex, what went wrong? Why has the optimism we sex therapists had in the 1970s failed to be vindicated? Why, in particular, do so many women not want sex?

These are the questions the first part of this book seeks to answer. (And although I am focusing specifically on women's lack of sexual interest, this isn't to say that men don't have their own problems. Indeed, one in six men in Dr. Laumann's 1994 study rated themselves as having little or no interest in sex, but in my clinical experience, the issues affecting male libido are different from those of concern to women, and they would justify a book of their own.)

This book is not about a mystical philosophy to put your sex life on a higher plane. It's not a guide to sexual positions and a variety of sexual techniques nor a manual of behavior programs to help you learn to be orgasmic or deal with painful intercourse. There are hundreds of books already available on these topics. Rather, it's a book for women-and their partners-who often feel irritated at the thought of sex or simply can't be bothered, then worry that there must be something wrong with them or their relationship. You'll be relieved to learn that this isn't necessarily the case.

To solve the problem, though, we have to start trying to see through a well-constructed illusion, which is the focus of the next chapter.

The Illusion of Sexual Individuality

Sexually, we like to think that we have it together, that we are more sophisticated and sexually aware now than at any other time in history. Yet, as we have seen, the current stereotype of normal, desirable sex is still quite narrow and rigid.

One exercise I often do when training sex therapists is ask them to describe what normal sexual frequency is. Typically, the answer is, Whatever is right for the individual. Then I ask how they would describe someone who only rarely desires sex, or a couple where one partner wants sex twice a week and the other once a month. Is one person closer to "normal" than the other? How would they, as sex therapists, go about helping this couple achieve sexual harmony? Which person is under more pressure to change? Despite the standard answer from therapists that this couple suffers from mismatched libidos and that both people are "normal," the pressure in therapy is most commonly on the person with the lower sex drive to pick up the pace.

When people claim to be liberated sexually, what they really mean is that they explore and enjoy experimentation and variety at the active, lusty, passionate end of the scale. We feel we are being broad-minded when we are comfortable with or tolerant of sexual diversity, such as homosexuality or bisexuality, or are prepared to experiment with oral sex, sex toys, threesomes, or bondage and discipline. However, if we are to truly embrace the notion of individual differences in sexuality, we need to think far more broadly than this and become respectful of people who are at the other end of the spectrum. Where does the asexual individual fit into the scheme of things? How is a person who prefers only "conventional" sex judged? What label is given to someone who is turned off by oral sex or by being touched on the genitals? What words are used to describe a woman--or man--who doesn't seem interested in sex? What are some of the factors that are commonly thought to lead to this disinterest?

In a recent survey in the United States, 43 percent of women and 31 percent of men identified themselves as having one or more sexual problems. Among women, 33 percent complained of low sexual desire 24 percent reported inability to come to Orgasm, and 14 percent stated they experience pain during sex. For men, the most frequently reported problem was premature ejaculation, accounting for 28 percent of complaints, while 15 percent rated themselves as lacking interest in sex, 10 percent said they had problems attaining or maintaining an erection, and 3 percent had physical pain during intercourse.

Some researchers have criticized this study because these problems were identified by self-rating rather than by clinical evaluation, but it is precisely this aspect of the survey that intrigues me. If one in three women believes she is not as interested in sex as she should be, and one in four men doesn't last as long as he thinks he should last, which of the following is more likely?

. We have a major epidemic on our hands.

. Many in this self-selected group aren't dysfunctional at all but are either variations on the norm or comparing themselves unrealistically with an ideal.

It's difficult to believe that such a large proportion of our population is sexually inadequate. Because problems such as painful intercourse and difficult erections are relatively objective, the figures given are likely to be fairly accurate, but even within these categories, the problems may be caused by worry about performance rather than by any psychological or physical disorder.

Many women who believe they are not experiencing arousal and orgasm have been influenced by the stereotype of hot and powerful sexual response portrayed in the media and promoted by the myth that if you aren't sure whether you've had an orgasm, you haven't! Some women who believe they are unable to reach orgasm are surprised to learn that that nice warm feeling or that sigh of relaxation is an orgasm, even if it is perhaps a 2 on a 10-point scale.

Sexual desire and ejaculatory control are more subjectively determined and evaluated. What is sexual desire? Is it physical passion, Or is it an emotional desire for intimacy? Can it be different things at different times? Is it possible to want sex but prefer to avoid it, and if so, why? What is a "normal" level of sexual interest?

Interestingly, this survey did not include questions about desiring sex with great frequency. Does that mean that you can't want sex too much, but you can want it too little?

How quick is too quick for ejaculation? Which partner is worried about it? Why? Is the problem that the woman finds it difficult to come to orgasm with penile thrusting despite the man controlling ejaculation for a reasonable time?

Additionally, for those people who rated themselves as not having problems, how did they decide this? Were all of them behaving close to the cultural norm, or were some of them confident enough to be happy to be different?

These questions need to be carefully considered before anyone, including sex therapists and researchers, can begin to understand the extent of individual variation in sexuality. Until these issues are thoroughly explored and discussed in sex manuals, magazine articles, and self-help books, people in the community will continue to rate themselves as having sexual problems even when there's a good chance that they're perfectly normal.

Normal Variation in Individual Sexuality

Thirty years as a sex therapist has highlighted for me what should be recognized as a self-evident truth--that people are not the same sexually, in the same way that they are not the same with respect to height, weight, intelligence, personality, food preferences, general health, and so on. In spite of the fact that the many ways in which people differ sexually become evident from just listening to them talk about their sexual experiences, there is little or no discussion of such differences by authors writing in the field of human sexuality. There are the acknowledged differences in sexual orientation, but gay and lesbian couples can also find it difficult to negotiate differences in individual wants and needs.

One of the most obvious ways in which people differ is in terms of their interest in sex, usually called sex drive. However, there are several other characteristics that also vary among individuals, as evident from the following list.

Frequency of sexual activity. Some people hope for, keenly want, or desperately need sexual activity several times a week or perhaps even more than once a day, whereas others are entirely satisfied to have sex once a month or even less often. Although there is general acceptance that the need for sex varies, there is no agreement as to what, if anything, constitutes an abnormally low or abnormally high sex drive. It's easy to see, however, that there would be some tension in a relationship where one person wants sex several times a week and the other would like it less than once a month.

Robustness of desire. Fluctuation of interest is a specific aspect of sex drive that can be confusing. Some people's level of interest remains reasonably constant no matter what else is happening in their lives, whereas others may switch off if they feel overwhelmed by other issues. This can lead to misinterpretation of motives: A person whose interest stays steady regardless of life events may seem insensitive, while one whose desire fluctuates may sometimes seem emotionally less committed to the other partner.

Type of desire. Currently, the expectation in Western culture is that sex drive is about hot passion or physical lust, but for some people, desire is much more muted and may be softly emotional rather than intensely physical. How does one partner interpret the signals of the other?

Desire versus response. This difference has been recognized in sex research for many years, but it doesn't seem to be widely appreciated in the community. Some people want to engage in sexual activity quite frequently but may not necessarily become aroused and orgasmic. Conversely, there are many people who aren't aware of any regular interest in sex and feel they could live without it, but if the partner initiates sex under the right circumstances, they can respond with enthusiasm.

Initiation versus response. It makes sense that if someone rarely feels the desire for sex even though she may enjoy it when it occurs, she isn't likely to initiate it very often. It simply doesn't occur to her, and her partner may be devastated, seeing it as a rejection or an indication that he's not sexually attractive. An imbalance in frequency of initiation of sex can be a major hurdle for couples to overcome.

Ease of arousal. Some people find it difficult to get turned on, and their partner complains that it takes a lot of work to start to get them hot, while others respond quickly. Sometimes, those who are slow to arouse are not confident enough to say what they need, or their partner persists in trying to stimulate them in various ways that actually turn them off. Nevertheless, the bottom line is that some people simply arouse more quickly than others.

Time to orgasm. Why do some people come more quickly than others? Should everyone be able to reach orgasm in a standard period of time? There are behavioral programs that can teach men who ejaculate rapidly how to delay reaching orgasm and that can help those with inhibited ejaculation come more easily, and there are strategies that will help women become aroused and come to orgasm more quickly. However, there will still be a range of times that it takes to come to orgasm, with some people having characteristic patterns of early (easy) or late (difficult) orgasm and others varying widely, depending on the circumstances.

Variation in response style. Perhaps this variable would be better termed variation in pleasure style. Sometimes, one partner has little interest in sex and doesn't really want to become aroused and have an orgasm, being quite happy to have quiet, cuddly sex, while at other times, the physical response is strong and urgent. This can be confusing if the other partner thinks sex is always about arousal, experimentation, and so on. And, Of course, there are individuals who mostly prefer quiet intimacy and find attempts at sexual arousal irritating, which can leave both partners bewildered and frustrated.

Variety in sexual behaviors. There seems to be an almost limitless range of things that people can do for sexual pleasure. Titles of magazine articles such as " 1,001 Ways to Drive Your Man Wild in Bed" give some idea of the smorgasbord that's available. However, it would be unreasonable to expect all people to like all of these behaviors. There are those who find particular acts abhorrent and those who find them simply boring. Some people prefer to rely on a limited number of tried-and-true activities, while others crave variety and experimentation.

Importance of sex. People's responses differ significantly when they're asked to rank the importance of sex in a relationship when compared with other variables, such as love, affection, companionship, financial security, children, and so on. Although studies consistently show that men tend to rate sex as more important than women do, this is a generalization, and either gender may give sex a high or low priority.

These are some of the variations in human sexuality that I have encountered in my long practice of sex therapy. I don't know how the normal/abnormal boundaries should be set, but it's my view that most of this variation should be considered part of normal human diversity.

Does this mean we must just accept how we are and not try to reach goals that may make sex more satisfying or relationships easier? If not, how do we decide what can be changed, and by what method? These are not easy questions to answer.

Certainly, sexual problems exist. If people believe they have a problem, then clearly something is worrying them. However, if they are comparing themselves with an unattainable ideal, their individual level of sexual functioning is not validated, and what is normal for them becomes defined as sexual dysfunction. The real problem confronting us is how to decide if someone's concern is a matter of definition and misinformation or if the behavior is truly outside the normal range. Even if it's not common, does this make it a dysfunction?

Sexual Potential: Not Created Equal

Lack of acceptance of the extent of individual differences, and the associated belief that normal people experience regular sexual desire and enjoy experimentation, has led to the belief that everyone has the same sexual potential. Surely, the thinking goes, if it's normal to have a persistent physical sex drive, for example, there must be some way to help people who don't have it to overcome their problem. The idea that what many people are already doing may be the best they can do is just not acceptable. It's this assumption that has caused so much misery in our time.

The emergence of sex therapy in the 1970s encouraged the view that everyone has the same sexual potential. Behavioral programs to teach women to be orgasmic and men to delay ejaculation assumed that with the right strategies, everyone could achieve these goals. If these programs didn't work for some people, the usual conclusion was that they were suffering from some form of sexual pathology that was loosely labeled sexual inhibition. The logical conclusion that perhaps the particular goals or techniques weren't right for those people wasn't even discussed. Although sex therapy has undergone many shifts in recent times, the idea that there may be many definitions of a successful sexual relationship is still not usually addressed by either therapists or clients.

Instead, we have spent a lot of energy trying to identify the factors associated with sexual "failure." A common view is that if we "fail" sexually, there must be some sexual trauma or secret in our past to account for it and that not reaching the standard is inevitably bad and should be corrected with therapy.

Sexual Personalities

Look around at your friends, family, and colleagues. Each person has a unique set of behaviors, thoughts, and feelings that make up the sum of whom they are. This set of characteristics forms the personality of the individual and is consistently present for that person. Some characteristics may dominate or be present in all interactions, while others may reveal themselves only in specific situations.

In general, personality is considered to be stable over a person's lifetime, but not all characteristics are fixed or inflexible, and people can and do adapt according to circumstances and life experiences.

At the present time, there is a tendency to use sexual personality characteristics in a critical way. For example, for "conservative," read "inhibited"; for "shy," read "hung up"; and so on. However, if we acknowledge that each person has a unique personality and that what one person likes and admires in a friend, another may find annoying, then we can assume that the situation is similar with sexual personalities. In other words, what one person finds attractive, endearing, or exciting in someone else's sexual personality may be a complete turnoff for a different person.

Who is in a position to make a judgment as to which personality is the most functional? In the end, this judgment tends to become relevant only when an individual becomes involved in a sexual interaction. Of course, this brings into play the importance of the relationship between the two: A relationship characterized by mutual generosity, kindness, and gentleness is more likely to be able to resolve or accommodate differences than is one that is harsh, critical, and rigid.