Behavior: Repairing the Conjugal Bed

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Harry Miller is not his true name, but his problem is genuine enough. He is a failure in bed. Years have passed since Harry and his wife, who are in their late 30s? have given or taken any pleasure in sex. With considerable hesitation and embarrassment, they confided their difficulty to their minister, who was sympathetic but unable to help. He referred them to the Reproductive Biology Research Foundation in St. Louis. On arrival, the Millers checked into a red brick residential building where the foundation leases apartments at $100 a week for out-of-town patients. At 9 the next morning, they called for their first appointment.

Before long, the sexual anxieties and fears that had brought the Millers to St. Louis began to dissolve. The foundation, which is discreetly identified as the Central Medical Building, could pass for an ordinary medical clinic anywhere. Inside, piped music vies softly with a professional and somehow reassuring hush. A woman attendant, dressed in the white pantsuit and beige silk scarf that is the uniform for the foundation’s female staff, directed them to the second floor.

Ultimate Communication

There they met Dr. William Howell Masters, the director, an owlish, stern-looking man of 54, and Mrs. Virginia Johnson, 45, his research associate, whose manner is as outgoing as Masters’ is reserved. The Millers were told that this first interview, and all others, would be taped—a measure designed to protect the patients by eliminating stenographers from the necessary history-taking. They were reminded of the foundation’s credo as worded by Masters: “There is no such thing as an uninvolved partner in a sexually distressed marriage.” Indeed, had the Millers not entered treatment together, they could not have entered at all. Finally, they were asked to refrain from any sexual activity whatsoever until otherwise directed.

The message, in short, was that the Millers were not there to perform or be judged. They were there to rediscover, under guidance but not observation, the ultimate form of human communication that takes place in the marriage bed.

The Millers are a hypothetical though representative example of the 790 cases of sexual incompatibility that have been treated in St. Louis over the past eleven years. In a new book called Human Sexual Inadequacy (Little, Brown; $12.50), Dr. Masters and Mrs. Johnson summarize their therapeutic approach to the problem of what they call sexual “dysfunction.” Written in less than six weeks, the book is poorly organized and clotted with a jargon that makes it almost unreadable for all but the doctors, psychologists, marriage counselors and other professionals for whom it was intended. Nonetheless, the work is already a bestseller, and with some reason. In the underdeveloped field of sex research, the authors are pioneers; they are the most important explorers since Alfred Kinsey into the most mysterious, misunderstood and rewarding of human functions.

Masters and Johnson take a modest view of their work. “We do not pretend expertise in anything,” says Masters. “Ours is a small, somewhat determined research effort—the first study of the physiology, and to a major degree the psychology, of sexual function. Many people will be in the field in due course and will do a better job.”

It is a job that needs to be done. Masters argues that “the great cause for divorce in this country is sexual inadequacy. And I would estimate that 75% of this problem is treated by the psychologist, the social worker, the minister, the lawyer. Medicine really has not met its responsibility.” No one knows the extent of the problem. The foundation’s educated guess is that perhaps half of the 45 million married couples in the U.S. are sexually incompatible to some degree.

Sex as Salvation

In an era of pop sex, which fictionally and visually glorifies coition and accepts the idea of honeymoon-before-marriage, it might seem strange that there are any sexual hang-ups left to be treated. Whatever the “sexual revolution” may mean, it certainly has freed modern woman of the Victorian notion that females do not enjoy sex; the modern woman knows what she is missing, erotically speaking. On the other hand, the American male has succumbed to the widely advertised notion that he should be the super-performer in what has been called the decade of orgasmic preoccupation—a preoccupation that could be enhanced by Masters’ and Johnson’s emphasis on sex as a form of salvation.

Behind this new (or old) morality lurk many of the same fears of inadequacy, the same sexual myths and mistakes, that disturbed earlier generations. Dr. Eugene Schoenfeld (“Dr. HIPpocrates”), whose freewheeling column of medical advice runs in 15 underground newspapers, reports that a surprising number of his supposedly liberated young male readers worry about penis length. He also gets letters from men with hang-ups about masturbation: “They’re worried that it will grow hair on the palms of their hands or rot their brains out or something.” Virginia Johnson has known women who thought that men, like Priapus, have permanent erections. “A lot of uninformed women,” she says, “are like the little kid who, upon learning about pregnancy for the first time, said, ‘In there with all that spinach!’ ”

In their treatment of sexually myth-ridden patients, Masters and Johnson use an eclectic and considerate approach. For example, the use of therapeutic teams composed of one man and one woman relieves the couple entering treatment from having to discuss, at first, humiliating shortcomings with someone of the opposite sex. The foundation has two such teams and hopes eventually to train two or three more.

Within three days, if things go right, the patients are talking openly to both therapists—and to each other. By then they have been given a thorough physical examination and are ready, despite nervousness, to begin the physical part of the treatment, which is carefully calculated to ease the burden of fear, shame and ignorance that impedes normal sex function. The couples are told that nothing is expected of them and that much more can be learned from occasional failures than from unbroken success in the course of treatment.

Role Reversal

At the direction—never the command —of their therapists, the patients are encouraged to begin exploring the latent capabilities and mysteries of their bodies. As a first step, they are asked to disrobe in the privacy of their apartment bedroom and caress each other in ways only indirectly sexual—a gentle stroking of the back, a hand lightly tracing the contours of a thigh. Taking turns is an important part of the therapy. One spouse is the giver, the other the getter of pleasure. The roles are then reversed. In succeeding sessions, the caressing becomes more intimate, until at last the partners explore the full pleasure potential of sexual union. The clinic’s approach is to remove, or at least reduce, the pressures that can turn sex into a dreaded command performance. Each day, the couples return to the clinic for an extended discussion with the therapists. Outside of that, their schedule is their own; they find their own way freely, and at their own pace. As part of the process, the couples are granted what might be called sexual vacations. One day, for instance, without warning, they will be asked to do nothing more intimate that evening than go out to dinner and a movie. And never are the patients graded in any way; never is it proposed that they are ready for the consummating moment. Says Virginia Johnson: “Just going from A to B may be enough; it is not necessary always to go from A to Z.”

Indeed, Masters and Johnson do not speak of success rate but of failure rate. “Sexual adequacy,” says Masters, “is probably a state of mind.” So is sexual inadequacy. Chief among its manifestations are primary impotence (the male’s lifelong inability to achieve vaginal penetration), secondary impotence (at least one successful penetration), and among women, the inability to reach orgasm, either all or most of the time.

Failure rates varied widely. For primary impotence, a symptom treated in 32 males, it was 40%—in the authors’ judgment, a clinical “disaster.” On the other hand, vaginismus—a form of muscular spasm making intercourse difficult or impossible—proved totally amenable to treatment. All 29 of the patients with this complaint were cured within two weeks.

The foundation’s overall failure rate, after five years of follow-up by telephone, was only 20%. The calls are supportive inquiries about how the former patients are getting along. As it turns out, most are getting along fine: 95% of those successfully treated during their two weeks at the foundation report continuing success after five years. Without question the large majority of cases treated by the foundation showed some improvement, however modest. “The level of discovery,” says Virginia Johnson, “is often quite phenomenal. It’s like ‘Gee, oh, gee whiz’—almost that ridiculous—’I felt it. Wow!’ ”

The very idea that sex researchers like Masters and Johnson can professionally guide couples to mutually satisfactory intercourse still produces some outrage. “There are many people who think that sexual function should never be investigated, that it is simply ‘sacred ground,’ ” says Masters. “For those who feel this way, I have no answer except to say that’s their opinion and I honor it. I happen to think it is a field in which medicine has a responsibility. It is not a popular opinion.”

It has never been popular. The pioneers of research into sexuality—Freud, Wilhelm Reich, Havelock Ellis, Richard von Krafft-Ebing, Marie Slopes, Alfred Kinsey—were initially vilified. Bill Masters openly acknowledges his debt to these precursors, particularly to Kinsey, whose studies, Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953), were the first serious attempts to analyze quantitatively the variety and nature of “orgasmic encounters.” Kinsey’s data were flawed by the narrow range of his interviewed sampling and by his determinedly mechanistic approach to the subject of sex. Nonetheless, his research legitimized the study of a hitherto taboo subject. Says Masters: “He opened the door. We wanted to kick it all the way open.”

The first kick produced Human Sexual Response in 1966, a meticulous description of the physiological changes that take place in the male and female body during sex. The subjects were recruited largely from the academic community at Washington University and its medical school. They were paid to perform coitus, self-manipulation and a variety of other acts while clinic personnel, including Masters and Johnson, watched and filmed the proceedings. Although the book was deliberately written in clinical terms digestible only by doctors, it sold 250,000 copies in hardcover—at $10 each. Response also sparked a number of journalistic ponies, plus at least two lubricious novels —Venus Examined, The Experiment —about goings-on at sex-research centers. Masters and Johnson became public figures.

Within the medical profession, commentary on Human Sexual Response was overwhelmingly favorable. Like most of their predecessors, Masters and Johnson were also subjected to a barrage of stinging criticism that has yet to subside. They were accused of using a troupe of sexual athletes wholly untypical of the population at large. Masters had built a rather bizarre device: a plastic dildo connected to a camera, which could photograph the interior of the vagina. Partly because of this apparatus, the authors were accused of dehumanizing sex and concentrating on technique at the expense of romance and morality. Psychiatrists and clergymen attacked the project as an invasion of privacy. Masters and Johnson were rebuked for writing a book about sex without once using the word love. The authors have chosen not to defend their books, but Masters does have a comment about this particular accusation. “Can you imagine that [as a criticism of] a physiology textbook?” he asks. “The word love is in Human Sexual Inadequacy. Just twice. On the same page. Find it.”* He believes that the detailed study of sexual physiology in Response was a necessary first step toward their second objective: the treatment of sexual failure. “We are studying sexuality in the total context of human experience,” he insists. “But we had to start with the how and the what of sex before we could go on to the why.”

Insights gained in the authors’ earlier study have proved invaluable in therapy. Working with the subjects who contributed to Response, for instance, they discovered a simple technique for the prevention of premature ejaculation that has proved highly successful in treatment. In matters of sexual technique, they suggest that the “female superior” position in coitus should be used more often. Not only does this position offer the woman a better chance of achieving orgasm, but it is also useful in the relief of most male inadequacies, since it allows the woman partner more freedom of movement and, hence, more control.

Masters and Johnson have disproved a host of myths that can and do affeet sexual satisfaction. Among their conclusions:

> Penis size has nothing to do with sexual effectiveness.

>Baldness is not a sign of virility.

>There is no physiological difference, as Freud first proposed, between a clitoral orgasm and a vaginal orgasm.

> Humans can remain sexually active well into their ninth decade. “All that is necessary,” says Masters, “is reasonably good health and an interested and interesting partner.”

> Intercourse is not dangerous at any time during pregnancy—unless, says Masters, it is contraindicated by “ruptured membranes, pain and bleeding.”

> Masturbation is not harmful.

All of their research reflects Masters’ and Johnson’s conviction that in the exercise of sex nothing is forbidden as long as it is acceptable and pleasurable to both partners.

So far, their new book has stirred less controversy than their earlier work, perhaps because its intended professional audience has not yet read it. Nonetheless, the Masters and Johnson approach has been sharply criticized by some medical authorities. Manhattan Psychiatrist Natalie Shainess contends that the authors’ coldly technical attitude toward therapy robs sex of its joy and meaning. Existential Psychoanalyst Rollo May, who was less than enthusiastic about the authors’ research into the mechanics of coital function, says that Masters and Johnson are fighting puritanism with “the new technology”—a dangerous weapon because it contributes to the depersonalization of sex by assuming that sex is part of technology.

The sharpest attack on Masters and Johnson centers on their therapeutic use of what they euphemistically call “partner surrogates” for 41 single men who were accepted by the foundation for treatment. One-third of these patients had once been married; sexual inadequacy was a key factor in their divorces. Even though the philosophy of the clinic is treatment within the marriage context, Masters and Johnson decided to accept these patients.

Giving to Get

The 13 female surrogates, drawn from the St. Louis area, were considered and trained as part of the therapeutic team. They were enjoined against becoming emotionally involved with, or even seeing, male patients once the two-week treatment ended—and none did. To some critics, the surrogates were nothing other than well-meaning unpaid prostitutes. But Dr. Masters, arguing that “these men are societal cripples,” asks: “Does society want them treated? If they are not treated, it is discrimination of one segment of society over another.” Surrogates were not supplied for women, since, explains Mrs. Johnson, “in our society, the female is taught that only marriage gives her permission to be a sexual creature, and we are only giving her more difficulty if we try to treat her outside of marriage.”

Some critics suggest that Masters and Johnson see no relation between sex and morality. In fact, they do take an implicit stand on sexual morality. They believe in the principle—hardly new but easily forgotten—of “giving in order to get.” They also believe that sex is a mutual experience into which both partners must enter without reservation or shame, and that the ultimate goal of sex is communication—the only true basis for marriage. Their entire course of therapy is aimed at expelling from the bedroom two invisible people who do not belong there. Masters and Johnson call them “spectators”: the man worrying whether he will be successful this time; the woman concerned about her own chances of pleasure in so precarious a situation. Once anxieties about performance have been allayed, once the spectators have left the room, nature can take over unassisted.

Lifelong Goal

Bill Masters and Virginia Johnson reached St. Louis and their dedication to sex research by entirely different routes. Inspired by the passionate medical interests of his younger brother Francis, now a plastic surgeon in Kansas City, Kans., Masters also chose to study medicine. During his junior year at the University of Rochester’s medical school, he fixed on his lifelong professional goal. An internship in obstetrics and gynecology in St. Louis reinforced his conviction that sex was the last important biological function that was still largely unexplored. “I got no training in sexual functioning,” he says. “Neither did any doctor who went to school. When patients came and began to question me as the ‘authority,’ I had to admit my appalling ignorance. You get awfully tired of saying ‘I don’t know.’ ” After a decade of study in hormonal treatment for the wasting effects of age, Masters began a research program in sexual physiology under the auspices of the Washington University medical school in 1954.

His research associate, born of a Missouri farm family named Eshelman, grew up within the rigid sexual taboos of the back country. “I was never told about menstruation or anything,” she says. “There was a very rigid rejection of anything sexual. You didn’t talk about it.” Her 1950 marriage to a musician ended in divorce six years and two children later. Says she: “Musicians are night people and babies are day people, and I couldn’t handle it all.” She met Masters in 1956 when job-hunting in St. Louis. He was looking for a female research associate for his program. “My attitude was,” he says, “that if you’re going into sex research, it is apparent that both sexes should be represented. No man is going to know very much about the human female, and no woman is going to know very much about the male.” Although Mrs. Johnson now has some credits toward a doctorate in psychology, she has no college degree. “The disciplinary background for this work really doesn’t matter very much,” Masters explains. “There’s no discipline that one can say is uniquely vital to the program.”

The foundation claims seven days and two nights of every week and permits the researchers little or no private life. Masters is married and the father of two children, but he adamantly sequesters his family from the inquisitive, presumably because it must not be easy to be the wife or child of a sex researcher. “His whole life is here at the lab,” says Virginia Johnson. So is hers, although she does, like Masters, take Sunday afternoons off.

Since 1964, their clinic has operated as a private foundation. It currently has half a dozen projects in motion, among them an inquiry into the physiology and treatment of homosexuality, chiefly female, another aimed at the prevention rather than the treatment of sexual inadequacy. Its operating budget of $500,000 a year comes from private contributions, such small grants as it is able to wheedle out of philanthropic foundations (“None of the big ones would touch us,” says Masters. “Too controversial”), and fees from patients, who are charged on a sliding scale that ranges from nothing to $2,500 for the treatment. Masters and Johnson divide their publishing royalties three ways: one-third to the foundation, the rest for themselves.

“Mom and Pop”

They insist that they are not sex educators but sex investigators. Nonetheless, they are acutely aware of the public appetite for knowledge—and of the generally unreliable character of the sex information now available. “The greatest form of sex education,” Masters once said, “is Pop walking past Mom in the kitchen and patting her on the fanny, and Mom obviously liking it. The kids take a look at this action and think, ‘Boy, that’s for me!’ ” Otherwise, the uninformed must depend largely on the flood of literature—1,500 marriage manuals in print, more published every month—that pours out in response to the demand. Much of it is trash. One contemporary marriage manual warns that the health and happiness of man and wife may be destroyed unless their every sexual congress ends in joint climax. By contrast, Masters and Johnson believe that simultaneous orgasm is unnecessary and that its occurrence is “just a beautiful coincidence.” Equally undependable as guides to conjugal happiness are two books soaring high on the bestseller lists (see box).

The magnitude of the problem of sexual inadequacy, and their own limitations in treating it, distress both Masters and Johnson. They know that Human Sexual Inadequacy will inspire sexually incompatible couples to try do-it-yourself therapy, and they hope that the result will be beneficial. At the very least, says Masters, the book may create a land-office demand for professional help that will force therapists —especially those in medicine—to enlarge their own understanding of sexual function.

Beyond that, he says, readers who suffer from sexual malfunction “will find out that they’re not the only ones in the world with this affliction, and this in itself is reassuring. They will know that professional help can be sought, and they may have some concept of how to do it. Finally, if they read with any objectivity, they’ll come to realize that the one thing that is lacking in their marriage is some form of communication.” Clearly, in the opinion of Masters and Johnson, the best communication of all is conjugal sex.