Book Summary - Sex research and Sex Therapy: A Sociological Analysis of Masters and Johnson

A reader and friend who is always giving me good tips for reviews and keeping me inspired, recommended a book called Sex Research and Sex Therapy: A Sociological Analysis of Masters and Johnson by Ross Morrow (2008) critiquing Masters and Johnson's (M&J's) research and particularly their sex therapy work. So I got it, and I read it. This seems to be, I think, as of now the most comprehensive critique of M&J's landmark Human Sexual Response (1966) and Human Sexual Inadequacy (1970) books simply because it seems to pull a significant amount of all the existing critiques together -at least I assume this author did a pretty full survey of previous work.  If you are wanting deeper critiques, there are primary works referenced in the book (and I'll add those cited in this post at the end) that you can dig deeper into.

I was super curious about what this book had to say because I've been thinking about going through Master and Johnson's Human Sexual Response and reviewing it chapter by chapter as I do other Journal articles (here's a list of ones I've done). I think it's something I need to do simply because M&J's work changed the scientific landscape of female orgasm knowledge so sharply. They actually recorded observations of bodies as they move through arousal and/or orgasm, and their work remains fundamental. There has never been a bigger study of this type, and largely, physiological research that came after either built upon or reiterated their findings. Basically, it's the research used as the base for all modern understandings of how the body works in arousal as well as in orgasm, and I think it's only appropriate that it is included in my collection of summaries/reviews of scientific articles on female orgasm, arousal, anatomy, etc. The only difference is this research came out as a book called Human Sexual Response not a journal article. 

All that said, I am also aware that at the same time, the scholarly and sexpert communities love to give Masters and Johnson's regular side eye. Don't get me wrong, there are very important aspects of their work that deserve strong criticism, but I find their physiological research gets marginalized and ignored in strange ways while also being the silent building blocks of any sexpert, sexologists, or sex researcher's knowledge of the physical sexual body. There are weird dichotomies to Master and Johnson's legacy and work that is both real and made up. The problem, to me, is that there are many critiques that do not come from a place of really knowing M&J's work, but instead of blanket poo-pooing it because it stinks of an obsession with intercourse-focused, hetero-centric, normality. That critique is not exactly wrong. Much of it does, but that stink doesn't necessarily damage the physiological research they did. Their physiological research described what bodies do during arousal and orgasm and indicated that external clitoral area stimulation, and not vaginal stimulation, is as important to female orgasm as penile stimulation is for male orgasm. That changed the landscape and served as a scientific basis for the deeply important and groundbreaking feminist discussions of female orgasm from people like Shere Hite, Anne Koedt, Mary Jane Sherfey, Alix Kates Schulman, and Barbara Seaman to name a few. 

My point is, I want to know criticisms of Master and Johnson's work. It is important for a clear understanding of what their research can and cannot reliably tell us about human body reactions to arousal and orgasm.  I want to really hear the criticism of their work and understand it better before I write a summary/review of Human Sexual Response so that I can incorporate it. I have a real love for the best parts of their work, and I'm afraid I might be a bit too soft on them if I'm not confronted with good criticism. So, here is a summary of Morrow's book combined with a bit of my own take on criticisms that are brought up. My take will always be clearly denoted inside brackets [Me:] or under a heading denoting it's my opinion. Otherwise, I will be relaying as best a summary of this book as I can.

SUMMARY

Sex Research and Sex Therapy: A Sociological Analysis of Masters and Johnson. Ross Morrow. Routledge Taylor and Francis Group. NY, 2008.

MY GENERAL FEELINGS

Most of the criticism of Human Sexual Response (which was M&J's 1st book and includes their research in the physiology of arousal and orgasm) in Morrow's book weren't surprising. They were things I had heard or noticed before, although some were emphasized and verbalized in ways that made me consider them a bit differently. The criticism for M&J's 2nd book, Human Sexual Inadequacy - which was focused on their sex therapy work with couples, however, had plenty of things I hadn't thought much about before, and I found it quite relevant. 

After reading this book, my feelings and understanding of M&J's physiological research has not changes significantly. It is still by far the largest and most comprehensive study of actual bodies going through actual arousal and orgasm, and the data still stands as the foundational element of almost all physiological research on the female orgasm. The criticisms don't change that in any significant way.  

What I believe now is that the very relevant and pretty serious critiques of M&J's therapy techniques and assertions from Human Sexual Inadequacy have bled into people's -and specifically sexperts, sex researchers, and scholars- perspective of M&J's initial physiological research in Human Sexual Response -tainting aspects of the research that do not deserve it. 

So, I will talk about the critiques of both books in this summary/review, but I really care most about how strong M&J's physiological research is, and much, much less about how strong their therapy work is because it's M&J's physiological research on female orgasm and arousal that has the power to educate and change our sexual culture, not their ideas about how to use that information for sexual therapy.  

GENERAL OVERVIEW SOCIOLOGICAL HISTORY SECTIONS

This book is a scholarly sociology argument. It's aim is to "provide a sociological analysis and critique of the conceptual foundations and practices of Master and Johnson's (1966; 1970) sex research and sex therapy as articulated in their 'seminal' texts Human Sexual Response and Human Sexual Inadequacy." p11.

Morrow, the author, is a sociologist and is arguing that when M&J's 2 main works came out, there was very little specific criticism of their research and methods. Certainly there was criticism on a moral and cultural level because it was a study where the researchers observed and recorded actual people doing sex stuff. However, outside of those critiques, their work was largely accepted and the 2 researchers were heralded as the authority on human sexuality. Because of this, Morrow believes that an in-depth critique is needed.

Before he gets to the critiques though, he has to first address a couple underlying issues: 

First he must convincingly argue that there really was little critique of M&J's work and part of this argument is Morrow describing why that was the case. One reason is that there is an idea Sociology didn't much address sex until sometime after WWII and even some would say not until the 70's. He goes back through history, however, and shows that there was a sociological discussion of sex well before those times. He also describes how the writing chosen as cannon for modern Sociology scholarship simply didn't include discussions of sex. Thus that history was somewhat erased from the discipline and generally sociologists didn't feel as though sex was a relevant topic of Sociology. The very little sociological critiques of M&J's work that did exist were not particularly critical, and the main sociological criticisms didn't begin to appear until after 1980. 

Secondly, Morrow goes through the good and bad of the 2 major theoretical perspectives in sexuality - essentialism and social constructionism and decides that the best way to move forward in critiquing Masters and Johnson lies in the social constructionist camp, but grounded in realist philosophy. 

Both those arguments take up the 1st two chapters and a significant portion of the book. I appreciate that this is a comprehensive Sociology argument around Masters and Johnsons, and I enjoy the thoroughness of his argument, but I'm no sociologist.  These two chapters are pretty dense and if you don't have an interest in or background in Sociology, it might get to be too much. But, once he gets through that we get to the M&J stuff.

HUMAN SEXUAL RESPONSE SECTION -BACKGROUND

The Research Program: Morrow starts out simply describing some of the history of M&J's Research program and also the results of that research that become the book Human Sexual Response.

History of the Program: Dr. William Masters was an Ob/Gyn and set his sites on creating the kind of groundbreaking sexual work that Alfred Kinsey created but focused on what the body actually does in response to sexual stimuli as opposed to what people say they do. He was advised to become respected as a doctor before trying that kind of research, and so he did. 

The research program eventually was started in 1954 (6 years after Kinsey's Sexual Behavior in the Human Male was published and 1 year after Sexual Behavior in the Human Female was published) at Washington University's Department of Obstetrics and Gynecology in the School of Medicine at St. Louis, MI; originally known as the "Sex Research Project" and later known as the "Reproductive Biology Research Project." 

Other physiological studies were done before M&J's, but all largely were kept secret and were small with often abnormal samples. Recording instruments were rarely used, and there tended to be a reliance on anecdotal information, so although there were some before, there was nothing even close to this.

There were 3 main reasons for doing this research: 

• First, sexual research at the time was mostly on animals, and Masters wanted to accumulate human physiological research and debunk fallacies.

• Second, Masters also wanted to use a baseline of normal sexual response obtained from the research to treat human sexual inadequacy. There was a belief that many marriages were sexually dysfunctional, and he hoped to use education and therapy as 2 ways to end sexual inadequacy.

• Third, Masters thought his unemotional and stodgy approach would help free future sex investigators from the idea that their work was obscene and unpublishable - he wanted to reduce the silly social restraints placed on the discipline of sex research.

"By promising to use their scientific research to save the institutions of marriage and the family, and to help preserve the existing social order, Masters and Johnson could simultaneously maintaining research funding, enhance the legitimacy and profile of sexology, and generate support from social groups also concerned with the same social ‘problems’, such as divorce and family breakdown." p88-89.

Funding: Starting in 1954, the 1st 2 years were funded by Washington U. After that, small grants by individuals and $14,000 from St. Louis businessmen kept it going.

In 1958, there was a United States Public Health Service grant of $25,000 per year for 4 years.

Since then it was funded by Master's gynecological practice, book sales, workshop and clinical fees (from M&J's Sex Therapy institute), local companies, small philanthropic organizations, individual donations, and the Playboy Foundation. Playboy alone gave M&J $300,000 by November 1979.

Location: The research project was in St. Louis, MI; first based at Washington University until 1964, then it moved to a place close by and the name was changed to Reproductive Biology Research Foundation.

It changed to Masters and Johnson Institute by 1979 (25 staff and a long client waitlist). By the end of 1994, the institute closed due to lack of funding, dwindling client list and M&J's lack of agreement on direction and successor. Masters died in 2001. This book claims there is rumor that Johnson was doing a tell-all. [Me: Johnston died 5 years after this book came out though, and there was no tell-all.]

Research Beginnings: Masters began the study by watching and talking to prostitutes. The St. Louis Police Commissioner and Catholic Archdioceses knew about it (as was termed in the grant from Washington University). They kept it quiet. Masters watched prostitutes all over Canada, the Midwest, California, Mexico and the West Coast; the techniques learned from the prostitutes were said to have helped in M&J's therapy work, but none of the physiological data from prostitutes were used in Human Sexual Response. Partly, Masters felt he couldn't use prostitutes because the high incidence of pelvic swelling, that he thought was due to being aroused so often with no orgasm release, would be different than normal women because he believed normal women didn't have coitus with no orgasm that often...even though Kinsey showed that exact thing seems to happen all the time, women having intercourse with no orgasm, that is. [Me: and we clearly know this coitus-without-orgasm is actually quite common for all women and Master's was simply not very knowledgeable about the sexual experiences of women. Also, I don't think it's wrong to assume that Masters simply didn't want to use prostitutes in his final data because he knew criticism of that data would be intense given the deep bigotry against sex workers]. 

The prostitutes, quite smartly, suggested hiring a lady assistant to help with volunteers

The Addition of Virginia Johnson: Virginia Johnson was hired in 1957 as a type of secretary. He had wanted a mature, intelligent woman who 'knew where babies came from.' Being a divorced mother of 2, she fit the bill, and although she had no degree and was not hired as an equal, she quickly became an indispensable co-researcher.

BASIC RESEARCH SET-UP AND CONCLUSIONS IN HUMAN SEXUAL RESPONSE

Participants: There were a total of 694 research participants included in the data from 1273 that had been interviewed; 276 married couples, and 142 single individuals; 382 women and 312 men.

Participants had to undergo a screening interview and physical examination. They were paid a small amount to participate.

"The interview was to ascertain the willingness of volunteers to participate in the research, their capacity for sexual response, and their ability to articulate in fine detail the nature of their sexual responses. The physical examination was to establish that the reproductive systems of volunteers were anatomically 'normal.' While people with 'normally' occurring variations in reproductive anatomy were included in the research, people with grossly abnormal reproductive systems were not. Masters and Johnson (1966, 12) did not define what they meant by 'grossly abnormal reproductive viscera.' Volunteers also had to have a 'positive history of masturbatory and coital orgasmic experience' before they could be accepted (Masters and Johnson, 311). Masters stated that 'If you are going to find out what happens, obviously, you must work with those to whom it happens' ('Playboy Interview: Masters and Johnson' 1976, 129). If participants could not reach orgasm during coitus and masturbation while being observed in the laboratory, they were excluded from the research (Brecher 1970, 298). This apparently did not include individuals who experienced intermittent performance failures (Masters and Johnson 1966, 312-315). In addition, Masters and Johnson (1966, 12) excluded any volunteers with 'sociosexual aberrancy.' They did not define the meaning of this term either." p95.

After being introduced to the lab space and getting comfortable engaging sexually alone in it, the participants would engage in sex acts in a laboratory with a variety of monitoring equipment to test things like heart rate, breathing, and internal and external bodily changes. Cameras were often focused on particular parts of the body. Lab personnel were also generally in the room, but ideally not a distraction.

Conclusions: A main finding in Human Sexual Response was that male and female bodies were largely more alike than different in how they reacted to arousal and orgasm.

They also proposed the 4-stage Human Sexual Response Cycle; Excitation, Plateau, Orgasm, and Resolution. 

• Excitation: The first stages of Excitation result from increased blood flow into the genitals. For men it causes erection and for women it causes vaginal lubrication to form something like sweat beads on the vaginal wall. This understanding of how vaginal lubrication happens was an important discovery of M&J's research. Increased muscle tension in the pelvic region also occurs, causing the inner 2/3 of the vagina to widen and lengthen as the cervix and uterus are pulled up. The outer labia flatten and separate and the inner labia swell. The clitoris increases in size and pulls up closer to the the clitoral hood. Nipple erections might occur, and breasts might increase in size. The scrotal skin tenses and thickens and the testes pull up towards the body.  

• Plateau: "In the plateau stage, sexual arousal is basically intensified beyond excitement levels to a point where it could lead to orgasm ifstimulation continues." p100. In addition to what happens in Excitation, the vaginal lubrication slows, the inner labia swell and spread even more and may drastically deepen in color. The clitoris pulls up so it retracts toward the pubic bone. The areola may swell. A 'sex flush' might appear on the skin. The glans of the penis might deepen in color and increase in size. The testes continue to pull up into the body and will increase in size. Heart rate, breathing and blood pressure increase. 

• Orgasm: If effective stimulation continues, orgasm occurs as a sudden, involuntary release of the muscle tension and blood congestion that has been built up through arousal. It's the shortest part of the sexual response cycle. The pelvic muscles spasms about every 0.8 seconds. For males, there is also an ejaculation, which is a 2 part process. It begins before the orgasmic spasms in a first stage where semen is expelled from the vas deferens. The second stage is when the muscle contractions expel the ejaculate forcefully out of the urethra. 

• Resolution: This is a reversal of the arousal. If orgasm occurs, the arousal levels down to pre-excitation phase fairly quickly. If no orgasm occurs, the reversal takes much longer. M&J found there was one major difference between males and females in this stage. Females can have a subsequent orgasm at this stage if appropriate stimulation is continued. However, males will need to get all the way back to low levels of excitation before they can begin to stimulate to orgasm again. Basically, M&J tell us that females can have multiple orgasms and men cannot.

GENERALLY POSITIVE REVEIWS AT THE TIME FOR ‘HUMAN SEXUAL RESPONSE’

Morrow discusses some of the initial criticism of Human Sexual Response when it came out - mostly relating to moral issues. He also points out how incredibly dense and hard to read the book is - intentionally. M&J were specifically incredibly medical and complicated in their language so as not to give any idea that their work or their writing was inappropriate or pornographic. 

Morrow notes, otherwise, Human Sexual Response was almost universally accepted.  Masters, in a 1976 Playboy interview said there had been almost no medical courses on human sexuality when it came out, and now there were 50 to 60 out of  possible 92 programs that had one. 

Also, an amended version of the 4-stage sexual response cycle was added to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSMIII 1980). "This cycle is used as the norm of sexual functioning from which sexual dysfunctions are distinguished." p.104. However, it isn't actually M&J's cycles. It was adjusted due to sex therapist Helen Kaplan's argument that sexual desire (appetite) should be included. So the 4 cycles in the DSMIII are actually different. They are Appetitive, Excitement, Orgasm, and Resolution. As well as the addition of 'Appetitive,' Excitement and Plateau were collapsed into just 'Excitement.' Later in 1994 and thereafter, Appetitive was changed to Desire. Despite the differences, Morrow emphasized the strong relationship between the 4 stages in the DSM and M&J's 4 stages, saying "Masters and Johnson's research, however, remained the major underpinning of the model and they are cited in the DSM footnotes as the primary source' (Tiefer 1991a, 12)." p105. 

[Me: Morrow cares to make a clear connection between M&J's cycles and the ones used in the DSM because the DSM is respected and widely used as a reference for diagnosis and treatment of psychological issues. So, those DSM cycles are considered the 'norm' of sexual functioning, and if that 'norm' came from M&J, then what M&J wrote about these cycles matter a great deal to all the people out there being treated for their 'abnormal' sexual functioning. So, with that said, I understand the 4 stages used in the DSM clearly sprang from M&J's original research. However, I think there's an important difference that tends to be ignored and minimized in such a way that it twists the original intent of M&J's work. Sexual Appetite or Desire is not squarely a physiological or physical element, and not something M&J studied or even asserted to have understood from the research in Human Sexual Response. I've heard M&J's research criticized both for being too mechanical (i.e. not accounting for things like emotion and desire in sexuality) and also for misinterpreting how desire plays in a person's sexuality. Both criticisms ignore that M&J Human Sexual Response research was not about a wholistic sexuality, but about the body's response to mental and physical sexual stimuli - whatever that stimuli might be. Using Desire or Appetitive as the first stage of the cycle and then making connections to the sexual response cycles that M&J used in Human Sexual Response, to me, muddies the already incredibly muddy understanding of their work because it disconnects their findings from its strong bodily, physiological focus. Granted, having a focus on the body does not make this research objective and beyond reproach, but it does give it a more sensible scope from which to understand and interpret their findings. Without seeing that M&J had an intentionally limited scope that did not include trying to understand why a person is sexual or what encompasses the whole of a person's sexuality, strange misconceptions can arise about the power and limitations of the findings in Human Sexual Response.] 

Morrow also spoke of the feminist take on Human Sexual Response.  Despite the prevailing Freudian idea that vaginal orgasms (and not clitorally stimulated orgasms) were the only mature type of female orgasm, M&J said without a doubt that there was no such thing as a 'clitoral' and a 'vaginal' orgasm. All orgasms were the same and orgasms that happened during intercourse happened because the clitoral glans area was also being stimulated. Feminists used this new research as a basis for their own groundbreaking research and for important philosophical writings about females and sex. Feminists also took note of the female ability to have multiple orgasms which they felt indicated that women may be the more sexual of the sexes. 

[Me: If you ask me, that first point up there is the most currently underrated element of Masters and Johnson's work. They concluded, through numerous observations that the vagina is not an organ of orgasmic pleasure (which btw has not yet been shown false despite decades of trying- there has yet to be any physical evidence in scientific literature of stimulation inside the vagina causing orgasm). Contemporary assessment of M&J's work seems to me to ignore, minimize, or forget the vital importance of this given that even today it still isn't really believed. However, the feminists of the 60's and 70's caught it immediately and leapfrogged to some revolutionary work; work such as Shere Hite's 1976 book, The Hite Report: A Nationwide Study of Female Sexuality, Alix Kates Schulman's "Organs and Orgasms," and Anne Koedt's "Myth of the Vaginal Orgasm." These works are deeply on-point to this day (no joke) even though there was some intense hate towards them and plenty of criticisms of "extremism" - just as there was towards most of the feminist activism and activists of the time...and it still persists. To this day the sexual feminist works of this era are still discussed as "extreme" (see a critique I had of Edward Clint's writing), and I do believe that this largely irrational feeling of extremeness that was/is perceived from feminist piggy-backing off M&J's work, still leaves a stink on M&J - even for self-proclaimed progressives. In fact, even in this book, Morrow writes, "Some feminists went even further and argued that if the notion of a distinct vaginal orgasm was a myth then in anatomical terms men's penises could be regarded as irrelevant for female sexual pleasure." p106. It feels like a statement written to emphasize just how far the idea was taken by feminists...a bit too far, a bit too radical. It's not though. It's 100% sensible. 

Penises are actually quite irrelevant to female orgasm. Granted, the word used was 'pleasure' not 'orgasm,' and I mean pleasure and orgasm are not the same thing. Realistically anything can give anyone pleasure, depending on preference, so yeah penises could be involved in female pleasure - ya know visually or even because it feels good in the ol' vag or in your hand or something. However, I believe the insinuation and the feel of that statement is about orgasm and the pearl-grasping at the idea that women literally don't need penises to have satisfying and orgasmic sex lives. Believe me, I've spent almost 2 decades saying just that, and I assure you people don't like that insinuation, and assume it's quite 'extreme.' My point is, M&J started a flame that a lot of badass feminists picked up, nurtured and carried...but the importance and undeniable truth of that work is not only overlooked, but it's also unfairly and ignorantly ridiculed and minimized all the time by people who would call themselves sexually educated and progressive.]

CRITIQUES OF THE M&J 4 PHASE SEXUAL RESPONSE CYCLE

1. Morrow argues that M&J didn't make up the idea of  a 4 phase response - Moll, a researcher in Berlin 1912, wrote about 4 phases of  'the curve of voluptuousness.' He names the four phases as an ascending limb, the equable voluptuous sensation, the acme, and the rapid decline. [Me: Those are some wild terms, but acme means highest point by the way. I had no idea] Morrow also says that in 1948 Havelock Ellis had a 2 stage cycle, and some say M&J's cycles are just a refinement of that. Both these people are cited in Human Sexual Response, so clearly M&J knew of them. This critique, I believe, is largely to point out that maybe M&J's conclusions and assertions did not come merely from pure objective reactions to their objective research methods, but actually included existing elements of the social, sexual, and scientific paradigm. [Me: I do very much appreciate Morrow's continuing theme of pointing out how M&J's claims of almost total objectiveness are not only silly for their work, but of all research. Humans cannot obtain that kind of objectiveness and pretending that we can turns a blind eye towards or buries biases that should be out in the open so that the research may be clearly understood and improvements made over time.]

2. The next large criticism is that M&J had an essentialist belief about human sexuality. "Masters and Johnson rarely refer in an explicit way to the notion of sex drive but it is clear from their work that they see normal sexual response as embodying psychological demands for copulation (implicitly stemming from the influence of an underlying sex drive) and a physical process designed to prepare the bodies of males and females for reproductive sex." p111.  The problem is that there's actually not much evidence to indicate an innate human drive for sexual activity, much less an innate drive for heterosexual, reproductive copulation (intercourse), and there is no reason to believe that heterosexual intercourse is the natural outcome of sexual functioning. 

[Me: It is 100% true that M&J are overly focused on intercourse as how sex should go, and they do frame the body's response often in this way. The penis getting erect is described as preparing for mounting and the vagina getting lubricated and expanding is to prepare for a penis being inserted.]

Morrow discusses the lack of desire in M&J's studies, and says that without assuming an innate sex drive, their model is left without adequate answer as to why people want to have sex. 

[Me: I find this argument a bit empty. Morrow later admits that M&J very specifically in Human Sexual Response say that they cannot answer why people have sex only what happens to the body after adequate sexual stimulus begins, so I disagree with Morrow's assessment that "Masters and Johnson's omission of a concept of sexual desire ultimately led to an impasse in the understanding of human sexual response, and it was not until the mid-70's that other sexologists began to discuss sexual desire as an integral part of the response process." p114. I mean, I guess? I get that desire is clearly important for the understanding of human sexuality in general and for understanding human sexual problems and interests and actions, but how important really is it to understanding what is happening to the body in response to effective sexual stimulation. Granted, what is effective sexual stimulation is a huge and varied questions that admittedly M&J may have overstepped on. However, once a person gets enough sexual stimulation (whatever mental or physical stimulation that may be) to cause bodily changes, has there really been further research that has revealed anything significantly different from the bodily changes M&J described simply related to taking 'desire into consideration'? I could be wearing blinders, but I don't feel like I've seen this, and I don't think Morrow's argument showed that. However, if we are talking about M&J writings on Sex therapy, and not simply on their physiological research from Human Sexual Response, I see this argument as incredibly relevant, and I agree that M&J absolutely made conclusions about therapy that stepped well beyond what they could sensibly conclude from their physiological research. Again, though, I think it muddies the meaning and interpretation of the Human Sexual Response's information to criticize it for something that it was never meant to be. Could/should there be more research that incorporates desire into the physiological reactions to arousal and orgasm? Maybe, but Human Sexual Response is not that. A study cannot be everything at once, and I don't think M&J asserted that it was.] 

CRITISISM THAT THE INFO M&J GATHERED IS NOT APPROPRIATE TO SUPPORT THIER PRPOSED MODEL OF SEXUAL RESPONSE

1. M&J claim male and females resolve in a symmetrical way, but males have a refractory period and females do not. [Me: It's true and I am usually a stickler for precise language, but two things. 1. It actually is quite similar, and I get why M&J kept driving home the idea that male and female arousal and orgasmic functioning were not in any way as different as people thought. It's because the idea was so foreign and so hard for people to believe that it needed extra emphasis just to get the right idea out there  -  it's in fact so hard to believe that people are still resistant to that idea. 'Women are so complicated!' 'Every woman needs something different in order to orgasm!' - still not true but still commonly believed and said even by many 'sexperts.' 2. Further research from others that builds off M&J's work actually showed even the stuff related to multiple orgasms, ejaculations and refractory periods that M&J thought were the biggest differences between males and females were actually more alike than they thought. In fact the things M&J described as differences were what M&J got most wrong in their conclusions...so ya know, I'm not mad at their instinct to emphasize the similarities.]

2. There is criticism that the 4-stage cycle doesn't represent how continuous the arousal process is. There is also recognition that M&J say it's not perfect, but that they believe it is still useful to describe some of the fleeting things that don't continue through entire process like erection and lubrication do.

3. The delineation of excitation and plateau for males doesn't make sense because there is not really anything specific that happens in one excitation but not plateau. It's noted that statements like "late plateau" describe the moments right before orgasm and seem to insinuate that the idea of a specific 'plateau' stage is not a good descriptor.

4. This issue is also noted for females because, again, there are pre-orgasmic events that use a description of "late plateau." However, a distinct plateau stage does make more sense for females because there are events such as the cessation of vaginal lubrication, the withdrawal of the clitoris into the hood, or the outer 1/3 of the vagina swelling with blood and reducing the vaginal opening that take place in the plateau and not excitation phase. In fact, there are those that argue M&J's 4-stage cycle was really created to highlight the female orgasmic platform.

5. M&J kept highlighting the similarities between male and female response even through there were differences. Particularly, that only females can have multiple orgasms and only males can ejaculate. [Me: see what I said about #1 up there - same deal. But also, the way M&J reacted to new information on refractory periods, ejaculation and multiple orgasms is interesting and this book gets into that.]

Morrow is clear that #5 up there is an ironic criticism because M&J were actually wrong about those two things, and the fact that they were wrong actually makes the criticism about M&J claiming similarity when they obviously found differences weaker in a way and M&J's original claims that male and female sexual response is more alike than different even stronger. The criticism still stands because at the time, they didn't know they were wrong. They didn't know that males can have multiple orgasms and females can ejaculate - which later research from others has since proved, and Morrow goes into how M&J interacted with the new revelations, and also what M&J getting those things wrong says about the bias inherent in their work.

M&J didn't acknowledge that there were males that could have multiple orgasms until 1985. 

"Hartman and Fithian (1985, 151) learned from their personal correspondence with Masters and Johnson that the latter did not know anything about male multiple orgasm and did not research the topic. Because they did not know anything about it, they did not actively look for evidence of it in their research. That is, their lack of knowledge on the topic, and their preconceptions, affected the planning and conduct of their research. This would have meant, for example, that Masters and Johnson did not try to recruit male volunteers with this capacity, or that if they did unwittingly recruit them, Masters and Johnson did not raise the subject with them or ask them to demonstrate this capacity in the laboratory." p.122  

This brings up another larger issue with M&J's discussion of the male orgasm. They regularly conflate orgasm and ejaculation in the book even though they are separate physiological events (and that separation is key to understanding how males could have multiple orgasms; males who do are somehow able to separate the two and can have more than 1 orgasm before a final orgasm that also includes an ejaculation). [Me: I do not think that M&J did not know that ejaculation and orgasm were different things, but I think they took it for granted that they happen simultaneously for males. I say this because even though they did conflate the words ejaculation and orgasm in the book, they were clear about what was physiologically happening in the body. They described the muscular contractions of orgasm and also the 2 phases of ejaculation. So, their bias and blind spot overtook their the information.]     

In Human Sexual Response, M&J had written about accounts that could possibly be female ejaculation, but dismissed them. 

"During the first stage of subjective progression in orgasm, the sensation of the intense clitoral-pelvic awareness has been described by a number of women as occurring concomitantly with a sense of bearing down or expelling. Often a feeling of receptive opening was expressed. This last sensation was reported only by parous study subjects, a small number of whom expressed some concept of having an actual fluid emission or of expending in some concrete fashion. Previous male interpretation of these subjective reports may have resulted in the erroneous but widespread concept that female ejaculation is an integral part of the female orgasmic expression. (Masters and Johnson 1966, 135)" p123.

It was also 1985 before M&J acknowledges female ejaculation.

"Even the previously skeptical Masters and Johnson admitted that they themselves have 'observed several cases of women who expelled a type of fluid that was not urine' (Masters et al 1985, 88). Research is continuing into this phenomenon and questions still remain about the source of the fluid, it's actual composition and the number of women who are capable of ejaculating (Bullogh 1994a, 254; Masters et al 1985, 88)." p124

Again, there is a criticism that because of M&J's preconceived notions about sexual response in males and females, they recruited in a particular way and investigated for particular things that may have obscured the occurrence of female ejaculation as well as male multiple orgasm in the population. 

[Me: That's a completely valid criticism, and it's also valid to wonder if there are other phenomenon that were missed. Although, seemingly nothing else of this significance has been uncovered in the approximately 55 years since. I also think it's worth noting that female ejaculation and male multiple orgasm, while clearly real phenomenon, seem to be fairly rare, and it isn't such a crazy thing that M&J missed them. Alfred Kinsey in his large study of both male and female sexual behavior did not note occurrences of either of these phenomenon. Shere Hite in a large survey of female as well as male sexual feelings, behaviors etc., also did not seem to find incidence of these phenomenon. Also, with all the cameras and observations that M&J had on their subjects, these phenomena did not seem to occur in their lab, and although they did not recruit or aim their investigations toward these phenomenon, these phenomenon could have occurred naturally during the observed sexual cycle of a participant that otherwise fit the volunteer criteria. They did not though - at least prior to the writing of Human Sexual Response.]

    
HUMAN SEXUAL INADEQUACY SECTION

Human Sexual Inadequacy was the 2nd book written by M&J. It focused on their categorization and understanding of sexual dysfunction as well as their sexual therapy techniques and outcomes from their clinic. Their research outlined in Human Sexual Response was used as a baseline for what is expected as "normal" sexual response. So, a lot of the criticisms focus on how the research from Human Sexual Response is not actually adequate for that purpose or for basing a comprehensive sexual therapy from.

Background: M&J Classifications of Dysfunction 

M&J describe several categories of dysfunction. This was better than what was the existing categorization, which basically consisted of either frigidity or impotence. Interestingly, M&J didn't use 'frigidity,' because it was pejorative and imprecise, but they continued using 'impotence.' The full description Morrow gives for each of the categories is quote below from pages 129-130.

1. ‘Premature ejaculation’: this occurs when a man is unable to delay his ejaculation for a sufficient period of time during penis in vagina intercourse so that his partner is satisfied (orgasms) in at least half of their coital encounters (Masters and Johnson 1970, 92). 

2. ‘Ejaculatory Incompetence’: this arises when a man is unable to ejaculate in his partner's vagina (Masters and Johnson 1970, 116). The dysfunction may be primary (lifelong) or secondary (have developed after at least one successful performance). 

3. ‘Primary Impotence’: this refers to a man's lifelong inability to develop or maintain an erection sufficient to permit coitus. ‘Secondary Impotence’ is when a man has produced an erection sufficient to accomplish at least one successful coital encounter but who otherwise has difficulty achieving or sustaining an erection (Masters and Johnson 1970, 157). 

4. ‘Dyspareunia’: this means painful or difficult coitus (Masters and Johnson 1970, 266).  

Masters and Johnson also identified three main types of female sexual dysfunction: 

1. a) ‘Primary Orgasmic Dysfunction’: this refers to a woman's lifelong inability to achieve orgasm from all forms of attempted physical stimulation (Masters and Johnson 1970, 227). 

    b) ‘Situational Orgasmic Dysfunction’: this is when a woman has had an orgasm on at least one occasion but who otherwise has difficulties reaching orgasm. There are three sub-categories of situational orgasmic dysfunction: 

i) ‘Masturbatory Orgasmic Inadequacy’: this occurs when a woman has been unable to achieve an orgasm via masturbation by herself or a partner but she can reach orgasm during coitus. 

ii) ‘Coital Orgasmic Inadequacy’: this refers to a woman who has never been able to achieve an orgasm during coitus but who has been able to reach orgasm through other means such as masturbation or oral-genital contact. 

iii) ‘Random Orgasmic Inadequacy’: this refers to a woman who has been able to reach orgasm at least once from both manipulation and coitus but who is rarely orgasmic and usually feels minimal or no physical need for sexual activity (Masters and Johnson 1970, 240). Masters and Johnson (1970, 247) further suggest, from one of their case histories of a woman with ‘random orgasmic inadequacy’, that ‘low sexual tension’ is also a potential clinical entity. 

2. ‘Vaginismus’: this refers to an intense involuntary muscle spasm of the vaginal introitus (entrance of the vagina) that impedes or prevents penile penetration (Masters and Johnson 1970, 250). Vaginismus may be primary or secondary.

3. ‘Dyspareunia’: this again means painful or difficult coitus (Masters and Johnson 1970, 266).

The categories of sexual inadequacy that M&J created, "...'has served as the prototype  for the diagnosis...of sexual dysfunction' (Irvine 1990a, 192). Their categories were adopted by the DSM-III (1980) 'and are now considered official "mental disorders"' (Irvine 1990a, 193)." p.131. So, point is, these categories are or very recently were fundamental to mainstream sex therapy, so they very much matter to our sexual culture. Here are some of the major criticisms of these "sexual inadequacies." 

[ME: I think it's pretty clear how deeply embedded these "inadequacies" are in the idea that penis-in-vagina intercourse is necessary for a healthy sexual functioning. I mean "this arises when a man is unable to ejaculate in his partner's vagina"  or "this occurs when a man is unable to delay his ejaculation for a sufficient period of time during penis in vagina intercourse so that his partner is satisfied (orgasms) in at least half of their coital encounters." I mean, obsessed much? Ever hear of things like mutual masturbation? And Coital Orgasmic Inadequacy is basically just a new name for Frigid. Granted, M&J were always clear that female coital (intercourse) orgasms were always related to simulation on the clitoral glans that happened during intercourse (as opposed to the stimulation of the vaginal canal itself), but they were so focused on making sure that women were able to come while a dick was up their junk, that they continually minimized their own finding that intercourse was pretty shit for female orgasm. So, these are ripe for solid criticism.]

CRITICISM: The sexual inadequacies are based on a model of 'normal' sexual response, outlined in their first book Human Sexual Response, that may not be generalizable

The following reasons are given:

1. (Sample Selection Bias: Orgasmic Experience From Coitus And Masturbation)The M&J physiological research may have been limited because only people that have had coital and masturbatory orgasmic history were included.

"This entry requirement seems to have been based on the assumption that sexual response normally leads to and includes orgasm. This means that Masters and Johnson's notion of a human sexual response cycle was assumed from the very outset of their research. It was not empirically discovered along the way as just one possible pattern of sexual response. Indeed, Masters and Johnson's research, which was based on the responses of pre-selected orgasmic subjects, could do little else than to confirm the researchers' prior assumptions about human sexual response (Tiefer 1992, 234). p132.

1A. M&J assumed an orgasm must be included in a 'complete' sexual response cycle. Masters and Johnson in a variety of different ways in their 1st book Human Sexual Response describe a 'complete' cycle of sexual response as moving from unaroused to aroused to orgasm and then back to unaroused. They ignore that possibility that some people may not describe a successful sexual event in exactly that way. To drive this point home a British survey of sexual attitudes and lifestyles was referenced that showed only about 49% of men agreed or strongly agreed that orgasm was essential for male sexual satisfaction. Only about 29% of women felt that female orgasm was essential to female sexual satisfaction. The point being that sexual response short of orgasm is considered successful for lots of people 

1B.  The entry criteria they put on participants, that they have had successful orgasms during masturbation and during intercourse, was not indicative of the general public (or specifically of women), citing that The Kinsey Reports showed 92% of men and only 58% of women masturbated at the time. It is asserted that this criteria 'virtually ensured' that both male and females displayed similar sexual responses, which was an important pillar of their research results. [Me: I think it's a bit much to assume that just because a woman doesn't masturbate, somehow means that her physiological sexual response is or would be different than a woman that does. I also would like to note that the more problematic issue that this book does not quite discuss is that M&J required women to be able to orgasm during intercourse. That is much less common in the female population than masturbation. Granted, it's completely possible because it simply requires that the clitoral glans area be stimulated during the intercourse, which is doable, but unfortunately not often done.] 

2. (Sample Selection Bias: Desire for Effective Sexual Performance) M&J acknowledged their study subjects wanted to be good sexual performers, so this might be the biggest difference between the study subjects and the larger population -  using 'enthusiasts' as the norm could make the attainment of 'normal' very hard.

3. (Bias of "Effective" Sexual Stimulation) M&J regard effective sexual stimulation as stimulation that moves the body through the response cycle, and so it's kind of a circular argument. 

4. (Experimenter Bias) M&J basically told their subjects what they wanted. They might allow them to fail a few times in orientation and then give some advice that helped the participant give the desired results - which was take their bodies from unaroused to aroused to orgasm and then back to unaroused.

5. (Sample Selection Bias: Socioeconomic Differences) M&J used largely a particular class of people (socioeconomic status, race, etc.). This book points out that those qualities may be responsible for physiological differences in sexual response that would have gone unnoticed in M&J's research because they lacked that diversity. This claim is supported by data in the Kinsey Reports indicating that lower class people had less nocturnal emissions.

My thoughts on those criticisms:

To be fair to M&J, getting a truly diverse population for an in-person study is always difficult for all researchers, and as of yet, this is still the largest study of this type by far, so even though it's not perfect, it is the most diverse population that exists for observed physical reactions to arousal and orgasm. 

However,  I get the points being made here - simplistically, that M&J's study failed to incorporate a diverse enough population and thus cannot be assumed to provide a good generalization of the human sexual experience. Particularly, there may be other ways to experience or enjoy things that are deemed as 'sexual' other than moving through bodily arousal and orgasm - and Human Sexual Response does not investigate that. I think given the multitude of lived experiences that this is an important consideration for the understanding of human sexuality and sexual therapy. However, Human Sexual Response never claimed to understand all of sexuality. It only claimed to understand what happens to the body with affective sexual simulation, and to this day with further (although not nearly enough) investigation into different populations, the only real significant new revelations have had to do with multiple orgasms and ejaculation. 

Although M&Js research (quite possibly overreachingly) only labels cycles 'complete' if they include orgasm, it also describes how the body reacts when no orgasm occurs. Even if M&J were not as accepting of the idea that a sexual event without orgasm could be both "normal" and wanted, they still gave us information about what that situation looks like in the body. If there is another type of sexual event out there from another untested population that does not include any kind of bodily arousal (which M&J would tell you can be brought on by any number of a large variety of highly individualized mental or physical stimuli), can we really call it a sexual event? And if we can call it a sexual event, then how can it be identified if not by a specific bodily response? What then is the difference between a general type of pleasure and something that is deemed sexual? Granted these are complicated questions, but I think they deserve comprehensive thought alongside these types of critiques, particularly because I believe criticism like these have long been (often unintentionally) used to gloss over problematic sexual norms that leave females with strikingly less orgasmic sexual encounters than males. It allows everyone to ease their minds because females getting aroused, but not orgasming during sexual encounters, in such high numbers doesn't really need our attention given that it's just 'another way bodies enjoy sex,' or 'another way to move through the sexual response cycle.' 

So, my point is that while I completely understand how using Master and Johnsons' idea of a 'complete' sexual cycle as a baseline for all human sexual normality is problematic - especially for sexual therapy ideology, the underlying observations about how the body sexually responds to arousal, orgasm, and lack of orgasm are still quite relevant...and if there is another identifiable quality of sexual reaction than the arousal described by M&J, it is yet to be discovered and described in the 55 years since Human Sexual Response.

Criticism: Gender Bias in the Classification of Sexual Dysfunction

1. For males premature ejaculation is considered a sexual dysfunction, but there is no equivalent category for females; as in a female  'coming too quickly" is not considered a sexual dysfunction. 

This is problematic for a number of reasons, but 2 main ones. Firstly, this discrepancy seems to be related to M&J's penile/vaginal intercourse obsessed sensibility that assumes a male must delay his orgasm to stay hard during vaginal intercourse long enough to allow his partner to orgasm. That's silly because they completely ignore the fact that a female's orgasm is not actually dependent on that and the female could easily orgasm before or after the intercourse [ME: and they also ignore that intercourse is a generally terrible circumstance for attaining female orgasm anyway, and it's completely nonsensical in an anatomical sense, based on M&J's own research btw, to connect female orgasm to intercourse much less connect it to a male's ability to delay orgasm during intercourse]. 

That brings up the second big issue. How is Premature Ejaculation even considered a sexual dysfunction? It is more likely a socially constructed problem. A premature ejaculation is still an ejaculation, so all the parts are working just fine. Timing is just a social preference. [Me: This is a super important point. It should absolutely not be considered a dysfunction. The reason it is, however, is the same reason females not being able to orgasm from intercourse were deemed 'frigid' - because of a completely anatomically incorrect idea that intercourse should be as orgasmic for females as it is for males. We need to get away from the intercourse obsessed notion of sexual encounters.]

2. There is no female equivalent to male impotence (keeping erections). M&J discern between arousal and orgasm problems in males, but only discuss orgasm problems for females. There are 3 huge issues with that.

• According to M&J's own research, male and female bodies should both have a capability for arousal and for orgasm. Those 2 things are not one and the same, although orgasm cannot happen without some level of arousal preceding. For males, M&J rightly discern problems with arousal (impotence), which necessarily would also impede orgasm/ejaculation from problems specifically with orgasm/ejaculation, but not necessarily arousal. However, this difference is ignored for females. Any problem that involves a lack of orgasm, whether it be a problem with having arousal in the first place or a problem specifically moving from arousal to orgasm are put into the same category, but they are not the same, just as with males. 

• This difference makes it seem like male genital swelling is more important than female genital swelling. This is likely again because of a laser focus on intercourse that seemed to plague M&J. Basically, to achieve intercourse a male needs to be swollen (a hard dick) but a female does not (especially if she has artificial lubricant). [ME: Female genital swelling is still constantly overlooked, misunderstood, or there is simply ignorance on the subject. For instance, in porn, women are constantly faking orgasms during times when their vulvas are clearly not aroused at all. It is as much an impossibility for her to orgasm as it would be a man to orgasm while his penis is totally flaccid, but we accept this with females because like this criticism claims, male genital swelling is deemed more important - even to M&J, knowledgeable researchers who should know better through their own research results.] 

• This omission of a category for female vasocongestion (swelling) problems during arousal "Serves to deny or invalidate women's own experiences of this phenomenon. It also restricts the development of a language with which women can think about their sexual responses and communicate with others (Boyle 1993, 81)." p142. [ME: and might I point out that partners of females are simply not equip with the knowledge about how genital swelling relates to arousal and orgasm in the same way that partners of males can easily become knowledgeable in our society about how erections relate to arousal and orgasm/ejaculation. This greatly affects a person's ability to get their partner off. Females are at a disadvantage because of this, but the problem is rarely if ever acknowledged or spoken of] 

• It has also impeded research into female vasocongestion issues - particularly in relation to drug research.

3. There is no male equivalent to the female category of  "primary orgasmic dysfunction" (POD). POD is used when a female has never had an orgasm during either masturbation or intercourse ever in her life. There is no category for male lifelong lack of orgasm. Things to consider:

• Females who have never engaged in sexual activity - never masturbated and/or never had sex - could be diagnosed with POD. Also, if a female had engaged in sexual activity, but never received adequate sexual stimulation to orgasm, she would also be diagnosed with POD. So, women who may be capable of orgasm, but have never had the opportunity or understanding to orgasm are deemed dysfunctional.

• Female who have not orgasmsed because they have not become highly aroused would be diagnosed with POD, but a male in the same situation would be diagnosed with impotence - an arousal-based issue not available to women. 

4. There is not a male equivalent to female 'situational orgasmic disfunction,' which includes women who have had at least 1 orgasm but have trouble generally reaching orgasm. "Men who have had an orgasm at least once from masturbation and coitus but who otherwise are rarely orgasmic and have little need for sexual expression would not be considered dysfunctions." p144-145.

Criticism: Hetero-Coital Bias

This is the most obvious of the M&J biases for me. "Masters and Johnson assumed that normal sexual response developed from an underlying sex drive and was the body's involuntary preparation for heterosexual coitus (penis in vagina sex). They implicitly believed that heterosexual coitus was the ‘natural’ form of sexual interaction between male and female partners (as did probably most of their clients) and that marital relationships were threatened if spouses could not have ‘sex’ in this ‘normal’ way. Consequently, their (1970) nosology of sexual dysfunction is overwhelmingly concerned with problems of genital functioning which impede the ‘effective’ physical performance of heterosexual coitus (Morrow 1996, 170)." p145

There are various problems that come with this view. All those that cannot or do not function in this hetero-intercourse-centric way are deemed dysfunctional, homosexuals for instance. There is also the problem that penis-vagina intercourse is shit for female orgasm and great for male orgasm given that it necessarily creates direct penile stimulation but not direct clitoral simulation. So, creating dysfunction categories that focus specifically on ability to complete intercourse and to orgasm during intercourse is ludicrous and creates quite a bit of dysfunction where there may not be any. 

Other Criticism

The book goes on to discuss some other criticisms regarding the categorizations of sexual dysfunction  that are a bit less relevant to this blog's interests, so I'll go over them quickly. They include; Omission of Sexual Desire, the Medicalization of Sexual Response, and the Conflation of Sexual Dysfunction and Sexual Problems, a criticism which addresses the truth that just because the genitals may not do as expected for a 'complete sexual cycle,' it doesn't mean the person is having a sexual problem. Also, the reverse is true. A person may feel there is a sexual problem, but everything works as expected. 

Critique of Master's and Johnson's Sex Therapy Program in Human Sexual Inadequacy

I will be summarizing this section more quickly. I find it interesting, but it is less related to my prime focus, which is understanding the good, bad and ugly about what M&J's physiological research of arousal and orgasm can and cannot contribute to the larger compilation of physiological research of arousal and orgasm. But, like I said, it's interesting, so below I'll touch on some of the points in this chapter. 

• M&J's therapy technique was not totally original as they tend to claim. It was actually largely based on behavior therapy although they did not acknowledge that. The use of a male and females therapist to jointly work with each couple was new though.

• The therapy was aimed at the marriage as the patient and returning the marital sex to its 'natural context, ' which in practice seemed to mean 'satisfactorily' perform sexual intercourse. 

• M&J only accepted couples into therapy. They did accept a small number unmarried couples with an ongoing sexual relationship, and for single men, but not women, they also would provide a surrogate female partner. Surrogates were paid, and over the years surrogates were provided for 41 single men.  

• "They were aware that they could be accused of a sexual double standard here. However, they said their clinical decision was based on patients’ existing value systems and that these were different for men and women." p161

• "Masters and Johnson stopped using female partner surrogates in 1972 after they settled out of court with a man who sued them for prostituting his wife (Wolfe 1978, 496; Heidenry 1997, 168–9)." p161

• M&J tended to focus on the personal issues of the patients; educating, advising, and giving permission to enjoy sexual activity. However, they did little to address the larger cultural issues that affect people's sexual functioning (gender roles, heter-intercourse focus that limited female opportunity for orgasm while maximizing male opportunity, etc.).

• The results M&J presented about their therapy's effectiveness was full of methodological errors, and in the end is so confusing it's hard to tell how effective it really was. 

• Some years after the results were released it was noticed other sex therapists were not getting near the treatment results M&J reported in Human Sexual Inadequacy, and there started to be questions. Zilbergeld and Evans (1980) wrote a critical piece that included lots of questions, but M&J refused to answer it because it was published in a 'popular forum.'

• In 1981, Robert Kolodny, Associate Director and Director of Training at the Masters and Johnson Institute, did reply and answered a number of their questions, but there was still unanswered questions, particularly about the criteria used to determine failure and non-failure for specific sexual dysfunctions that were treated. So, Zilbergeld publicly went after M&J at a series of lectures.

• "He particularly focused on the lack of a criterion for the nonfailure of treatment for female orgasmic dysfunction. He wondered whether nonfailure meant that a woman could now have an orgasm 100%, 50%, 10%, or some other percentage of the times she had sex. After Zilbergeld attacked Masters and Johnson on this issue at the annual meeting of the Society for the Scientific Study of Sex in 1982, Zilbergeld, Masters, and a number of associates met to discuss the criteria of failure and nonfailure. Zilbergeld took notes of what Masters said, read them back to him for confirmation and Masters agreed they were accurate (Heidenry 1997, 285). Masters reportedly said that ‘therapeutic success was predicated upon a non-orgasmic woman having one orgasm during the two weeks of therapy and one orgasm during the next five years’ (Irvine 1990a, 200). This criterion seemed to explain Masters and Johnson's incredible treatment results: two orgasms in over five years was regarded as a cure. Masters later denied this was his criterion but a number of other people at the meeting confirmed what he had said. He again refused to discuss the matter until he could do so in a scientific setting (Irvine 1990a, 200; Heidenry 1997, 285). In the meantime, Dr Sallie Schumacher, who trained with Masters and Johnson and collaborated on Human Sexual Inadequacy , revealed that as ‘far as she understood there were no clear outcome criteria’ (Heidenry 1997, 286)." p182

• Morrow argues in the end that M&J's therapy program, with its wide popularity and deep influence on the whole sex-therapy market, serves in a way as an institution of social control. "...the program medicalised, individualised and depoliticised individuals’ sexual ‘problems’ while responding to them with commodified treatments and ‘cures’." p187

My Final Thoughts

First off, if you made it here, I'm impressed. I got hardcore long-winded with this one. It is a summary of a whole book, though. Also, writing it all down helps me remember and understand it more, so I'm glad I did it. Hopefully most of it made sense. 

I have not wavered from my position that the research done in Human Sexual Response continues, over half a century later, to stand largely solid as a fundamental piece of the whole scientific understanding of physiological arousal and orgasm in females. Research on those subjects since have only helped solidify and deepen M&J's findings - with few exceptions. The biggest exceptions are the observations of female ejaculation and male multiple orgasms that negated M&J's stance that those things did not exist. However, in a way the observation of those 2 things actually solidified further the overall assertion from M&J that male and female physiological sexual responses are more similar than not. Those exceptions were not news to me, but something that made me think a bit more was the discussion in this book about how M&J seemed to conflate orgasm and ejaculation for males. As I said above, I believe they clearly knew there was a difference because they described the process, but their bias was assuming that for males, they could not exist apart, and I think that's important to see clearly as I'm going through their book again. 

The criticisms relating to M&J's hetero-intercourse-centic sensibilities are the most relevant to my interests, completely valid, and something I was already keenly aware of. It is, I believe, their most problematic bias in Human Sexual Response (and a HUGE bias in Human Sexual Inadequacy), and causes more confusion than it should about their results because they wrap their language so tightly around the idea that P-in-V intercourse is the pinnacle of sexuality. The other criticisms related to bias in the participant population are absolutely valid, but they don't poke large holes in M&J's contribution to the physiological understanding of arousal and orgasm (I feel especially comfortable saying that now with the luxury of seeing how the research has held up over the years). As for criticisms relating to the 4-Phase Sexual Response Cycle not adequately portraying the research, it is a sensible criticism, but in the end, how M&J chose to categorize and express their physiological findings doesn't change those findings. Whether something happens in the Plateau or excitation phase doesn't matter much for my needs, only that it happened and was observed and recorded. And frankly, M&J were super clear in Human Sexual Response that the the phases were not perfect and only a way to help understand what was happening.

The criticisms of their therapy research are well-founded, important, and interesting, and I had not thought much about many of them. Granted, there's important findings and insights in Human Sexual Inadequacy that plenty of people and therapist find useful to this day, but the scope of their focus was much too enormous and complicated to assume the kind of objectivity M&J asserted.  I know that a focus on the body alone does not make for objectivity, but I believe the comparatively narrow objective in Human Sexual Response was useful in not letting biases run too wild. It might also be a matter of being more careful and less arrogant in the first book, given that they were not yet famous and still proving themselves. Even with its imperfections and bias, Human Sexual Response hasn't gone off the rails with hindsight the way their therapy research has. Either way, observing and reporting (although that's not all they did in Human Sexual Response, it is the bulk of it), is always going to be more straightforward than trying to apply that observing and reporting as a way to understand and affect human behavior like they attempted in Human Sexual Inadequacy.

Point is - I got a good sense of what great critiques of M&J's work have looked like over the years, and I'm ready to move on to the next Masters And Johnson related summary. Thanks for indulging me (I just realized that if this were in a Word document, it would be 22 pages). 

Citations

Boyle, M. (1993). ‘Sexual dysfunction or heterosexual dysfunction?’, Feminism and Psychology , 3, 1, 73–88.

Brecher, E. M. (1970). The Sex Researchers , London: Andre Deutsch.

Bullough, V. L. (1994a). Science in the Bedroom: A history of sex research , New York: Basic Books.

Hartman, W. and Fithian, M. (1985). Any Man Can , Sydney: Angus & Robertson.

Heidenry, J. (1997). What Wild Ecstacy: The rise and fall of the sexual revolution , Melbourne: William Heinemann.

Hite, S. (1989). The Hite Report on Female Sexuality , London: Pandora.

Irvine, J. M. 

——(1990a). Disorders of Desire: Sex and gender in modern American sexology , Philadelphia: Temple University Press. 

—— (1990b)..‘From difference to sameness: gender ideology in sexual science’, The Journal of Sex Research , 27, 1, 7–24.

—— (1994). ‘A place in the rainbow: theorizing lesbian and gay culture’, Sociological Theory , 12, 2, 232–48. 

—— (1995). Sexuality Education Across Cultures: Working with differences , San Francisco: Jossey-Bass. 

—— (2005). Disorders of Desire: Sex and gender in modern American sexology , 2nd edn, Philadelphia: Temple University Press.

Koedt, A. (1973). ‘The myth of the vaginal orgasm’ in Koedt, A., Levine, E., and Rapone, A. (eds.) Radical Feminism , New York: New York Times Book Co.

Kolodny, R. C. (1981). ‘Evaluating sex therapy: process and outcome at the Masters and Johnson Institute’, The Journal of Sex Research , 17, 4, 301–18.

Masters, W. H., Johnson, V. E., and Kolodny, R. C. (1985). Human Sexuality , 2nd edn, Boston: Little Brown & Co.

Masters, W. H. and Johnson, V. E.

—— (1966). Human Sexual Response , Boston: Little Brown & Co. 

—— (1970). Human Sexual Inadequacy , Boston: Little Brown & Co.

Morrow, R. 

——(1994). ‘The sexological construction of sexual dysfunction’, The Australian and New Zealand Journal of Sociology , 30, 1, 20–35. 

—— (1995). ‘Sexuality as discourse - beyond Foucault's constructionism’, Australian and New Zealand Journal of Sociology , 31, 1, 15–31. 

—— (1996). ‘A critique of Masters’ and Johnson's concept and classification of sexual dysfunction’, Revue Sexologique , 4, 2, 159–80. 

—— (2005). ‘Sexual dysfunction and sex therapy’ in Hawkes, G. and Scott, J. (eds.) Perspectives in Human Sexuality , Melbourne: Oxford University Press.

‘Playboy Interview: Masters and Johnson’, (1976). in Lehrman, N. (ed.) Masters and Johnson Explained , New York: Playboy Paperbacks.

Shulman, A.K. (1971). “Organs and Orgasms’ , in Escoffier, J.  (ed.) Sexual Revolution, New York: Thunder Mouth Press.

Tiefer, L. 

—— (1987). ‘Social constructionism and the study of human sexuality’ in Shaver, P. and Hendrick, C. (eds.) Sex and Gender , Newbury Park, California: Sage. 

—— (1988). ‘A feminist critique of the sexual dysfunction nomenclature’ in Cole, E. and Rothblum, E. D. (eds.) Women and Sex Therapy , New York: The Haworth Press. 

—— (1991a). ‘Commentary on the status of sex research: feminism, sexuality and sexology’, Journal of Psychology and Human Sexuality , 4, 3, 5–42. —— (1991b). ‘Historical, scientific, clinical and feminist criticisms of “the human sexual response cycle” model’, Annual Review of Sex Research , 2, 1–23. 

—— (1992). ‘Critique of the DSM-III-R nosology of sexual dysfunctions’, Psychiatric Medicine , 10, 2, 227–45. 

—— (1995). Sex is Not a Natural Act and Other Essays , Boulder, Colorado: Westview Press. 

—— (1996). ‘The medicalization of sexuality: conceptual, normative and professional issues’, Annual Review of Sex Research , 7, 252–82.

Wolfe, L. (1978). ‘The question of surrogates in sex therapy’ in LoPiccolo, J. and LoPiccolo, L. (eds.) Handbook of Sex Therapy , New York: Plenum Press.

Zilbergeld, B. and Evans, M. (1980). ‘The inadequacy of Masters and Johnson’, Psychology Today , August, 28–43.