The History of 'Female Sexual Dysfunction' as a Mental Disorder in the 20th Century

Katherine Angel

Disclosures

Curr Opin Psychiatry. 2010;23(6):536-541. 

In This Article

Psychoanalysis and Marital Advice

Female sexual problems have been discussed in sexological, gynecological, psychiatric, and psychoanalytic literature, as well as marital advice material. The salience of psychiatry in discussions of female sexual problems has its roots in the mutually entangled development of psychiatry, sexology, and criminology in the last quarter of the 19th century. A forensically minded sexology classified sexual behaviors, identities, and relationships, with nomenclature (homosexuality, sadism, masochism, nymphomania, fetishism, and so on) flourishing from the late 19th century well into the 20th.[3–5,6••,7]

In the early 20th century, American psychiatry became increasingly professionalized and medicalized; from the 1930s, it also became significantly psychoanalytic. Psychoanalysis – not Freud's own writings as much as their elaboration by others – dominated discussions of female sexuality and its problems, frigidity in particular. Too much – or too little – desire figured in this period as indices of developmental psychopathology, where that psychopathology involved the failure to adhere to norms of gender and femininity.[8–10] Freud's account of the development of femininity and female sexuality[11••,12–14] posited a transfer of erotic zones in the young girl's life from the clitoris to the vagina; this process was interpreted by many analysts and commentators as a crucial part of a biological imperative to reproduction, as well as to heterosexuality. In work going beyond Freud's own pronouncements, the failure of vaginal orgasm became the conceptual lynchpin of 'frigidity'; Hitschmann and Bergler[15•] defined the condition as the inability of a woman to have a vaginal orgasm (cf[16,17]). Moreover, the woman desiring clitoral stimulation, as opposed to vaginal intercourse, became representative of women who behaved like men and denied their maternal obligations – behavior that led to neurosis, isolation, and social disintegration. In addition, social and psychological ills such as feminism and lesbianism were also linked to a clitoral sexuality.[10,18–21] Here, the elucidation of norms for female sexuality was also a way of enjoining norms of femininity and heterosexuality.

Marital advice literature, which burgeoned in the United States and the UK from the early 20th century,[22••,23–25] emphasized the importance of sexual pleasure in marriage. Women's sexual problems were cast as technical problems to be understood in terms of social phenomena and resolved through education regarding the profound physical, emotional, and spiritual differences between men and women. Sexual fulfillment was vital for a happy marriage – and by extension also for a healthy society. Numerous obstacles lay in the way of sexual compatibility, however. As Helena Wright put it[23] (p. 50): A 'man's sex feelings are easily and quickly aroused, and quickly satisfied, and the actual sensations are limited to the relatively small area of the skin of the penis. A woman's desires, on the contrary, are neither quickly aroused nor quickly satisfied'. A traumatic wedding night, in which a bride discovers both the brutality of men and what sex is, could stunt forever her potential for sexual happiness.[26] In fact, the frequency of 'sexual anesthesia' or 'frigidity' in women was due to their not having been 'taught to love'.[24] A wife has the 'potentiality of a keen sexual appetite', which it is the husband's 'privilege to arouse and maintain' with patient tenderness[17] (p. 383).[27] Frigidity (defined variously as failure to reach vaginal orgasm, failure to reach orgasm, or absence of desire)[15•,16,17] had myriad possible causes: lack of adequate friction, childbirth injuries, male premature ejaculation, coitus interruptus, and fear of pregnancy. Many of these could be addressed medically or educationally. Men, wrote Huhner[17] (p. 400), will often have experienced sexual intercourse with prostitutes before marriage; this could make them either unaware of how to elicit female pleasure, as prostitutes 'from long experience' know 'how to simulate passion', or indifferent to it, mistakenly believing 'women do not have pronounced sexual feelings as they, men, do'[17] (p. 394). Women's lack of education in their own sexual capacity meant that many 'not knowing any better, suffer in silence'; never experiencing sexual pleasure, some 'never know the cause of their irritability or hysteria, as it is often diagnosed'[17] (p. 394). Inadequate knowledge could, then, lead to chronic nervous and mental illness.

While these texts underlined female sexual pleasure, they also sought to contain it by emphasizing the role of husbands in eliciting and managing it within social norms of gender, heterosexuality, and motherhood. Female sexuality is to be elicited from women's asexual innocence, but, if too assiduously awakened, threatens to tip into voracious nymphomania[17,24] – a condition with often tragic consequences such as incarceration in insane asylums. For the woman unable to reach coital orgasm, sitting astride the man 'is certainly better than titillation of the clitoris'[17] (p. 407). Where nothing else can be done, such 'titillation' is admissible, for the alternatives are serious: 'unhappiness in the marriage relationship, possibility of divorce, and even the temptation of the wife to try her luck elsewhere'[17] (p. 407). Women who cannot reach coital orgasm but nonetheless have normal or even intense desire are put under a tremendous nervous strain, with resulting neurasthenic symptoms of pain and exhaustion[17] (p. 394), through the chronic irritation of organs. Insanity is the consequence, then, not only of too much desire, but also of too little pleasure.

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