The Massive Cultural Changes That Made Dr. Ruth Possible

Dr. Ruth Westheimer, who died this past Saturday at the age of 96, had an astonishing career as a sex therapist who combined professional expertise and an impish sense of humor. Through her radio program, two television shows, nearly 50 books, and innumerable public appearances, Dr. Ruth made clear that she considered sexual pleasure extremely important—and she had a blast talking about it. She found joy in the world around her and urged others to have fun, too.

Her optimistic outlook emerged from a childhood of unimaginable loss and struggle, making her emphasis on joy a choice, not merely a quirk of personality. Dr. Ruth left a legacy of sexual candor and the need to defend pleasure as a universal right—a conversation that is more relevant today than ever.

In 1938, a 10-year-old Westheimer (born Karola Seigel) was sent by her parents and grandmother from their home near Frankfurt, Germany, to Switzerland to escape the Nazis. An only child, she never saw her family again. Instead, among other Jewish refugee children at the Swiss orphanage, she formed friendships and had her first boyfriend, a relationship she credits with not only helping her smile while being forced to provide domestic labor to the Christian children who lived there, but with advancing her education. Her boyfriend snuck her his textbooks at night, as girls were not admitted to the village school. The pleasures of learning and the pleasures of physical affection (at that point in her life, “a little kissing,” as she explained in her 2003 memoir) went hand in hand.

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Her life was full of upheaval. She moved to Palestine in the mid-1940s and nearly died from shrapnel wounds amid Israeli-Palestinian fighting, followed a new husband to France, and then moved to the United States and married for a second and then a third time. Happily married to Fred Westheimer, who adopted her daughter from a previous marriage and with whom Ruth had a son, she earned a Ph.D. in education in 1970 and then became a licensed sex therapist with a private practice and teaching jobs.

Her career in sex therapy was possible only because of dramatic shifts in American life. Landmark studies of sexuality, from the “Kinsey Reports” of 1948 and 1953, to Human Sexual Response (1968) by William Masters and Virginia Johnson, revealed that women had sex lives as varied and complex as men did—and that much of the received wisdom about female sexuality, queer desires, and marital sex bore little relation to reality. The sexual revolution of the 1960s and feminist demands for sex equality created new opportunities for frank discussions of erotic desires. Feminists called for unrestricted access to contraception and abortion, insisting that sexual pleasure and bodily autonomy were basic human freedoms. Gay liberationists and LGBTQ+ reformers protested discrimination in everything from employment to mental health care.

As Westheimer herself would argue strenuously throughout her career, these activists insisted that when it came to sex, there was no “normal.” Framing sexuality as an essential component of human self-determination, they insisted on their right to the varied pleasures of consensual sex.

Yet non-judgmental sexual candor remained controversial. Comprehensive sex education, first introduced in the 1960s, almost immediately became a source of right-wing radicalization, as thousands of conservative white women mobilized to ban discussions of homosexuality, premarital sex, and masturbation in their children’s schools. In the 1970s, some states and municipalities put in place new antidiscrimination protections for LGBTQ+ people, but others reinforced their laws against sodomy and banned gay men and lesbians from public-sector employment. Speaking out in favor of sexual equality and against anti-gay prejudice remained controversial. Many of the more mainstream sex advice guides of the time, such as Alex Comfort’s The Joy of Sex (1972), reiterated older ideas about the primacy of male sexual needs and almost entirely overlooked queer sexualities.

A few sexual iconoclasts persisted. Betty Dodson, a less formally trained sex educator than Westheimer was, gained a measure of fame from her self-published treatise Liberating Masturbation (1972) and its follow-up, Sex for One: The Joy of Self-Loving (1987). Dodson urged women to explore orgasmic self-sufficiency as part of their political emancipation, but she never attained anything near the name recognition of Dr. Ruth.

Dr. Ruth’s petite frame stood above the rest, as she rose to become the nation’s most visible advocate for a wide range of sexual pleasures in the conservative 1980s. In 1982, when Westheimer was in her 50s, she landed her first radio program (initially, just 15 minutes long, airing at midnight on Sundays). “Sexually Speaking,” as it was called, was a platform that enabled her to share her joyful sexual ethos with the wider American public. It was only then that her career as “Dr. Ruth” began.

Her ethos of sexual acceptance was nothing short of radical in the United States in the 1980s.

As the HIV/AIDS crisis roiled the nation and gay men were falsely blamed for its spread, Dr. Ruth  advocated for people with AIDS and insisted on destigmatizing sex between consenting adults, whatever the genders of the partners. She ignored television network prohibitions on sexually explicit language by talking about vaginas, orgasms, and masturbation on Late Night with David Letterman, the Arsenio Hall Show, Good Morning America, and other programs, all with her trademark combination of wit and candor, winking and chuckling as she explained everything from how to do Kegel exercises to the importance of clear communication in sexual relationships.

The nation turned rightward, but Westheimer held her ground. She matter-of-factly discussed the value of masturbation (including recommendations to incorporate vibrators and other sex toys into partnered sex) even as Dr. Joycelyn Elders, the first Black person and the first woman to be the U.S. Surgeon General, was forced to resign in 1994 after suggesting that sex-education programs include mention of masturbation. Critics tried to ban her from their universities and even states (including one attempt at a citizen’s arrest during a talk at Oklahoma State University in 1985), but she was undeterred. There was nothing dirty or wrong about sex, she taught, and refused to concede to anyone who found her advice shocking.

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Dr. Ruth also refuted any notion that sex was less important to women than it was to men. “Women need sex,” she explained in 2019. She urged women not to fake orgasm unless they had to, a “little white lie” to protect a man’s feeling—although she recommended that women break off relationships with men who couldn’t handle a little critical feedback about their performance in bed. With her German accent and diminutive stature (she was, at her peak, 4’7''), Dr. Ruth was at once a grandmotherly advice-giver and a sexual-health expert.

As many states continue to debate the appropriateness of books about LGBTQ topics and to ban discussions of queer sex in high school curricula, Westheimer’s non-judgmental approach to sexual pleasure remains both important and, for many Americans, controversial. Conservative proposals to outlaw not only abortion but also many of the most reliable forms of contraception threaten to return women in the United States to the days of fearing unwanted pregnancies from otherwise wanted sex.

For Westheimer, sexual pleasure was not the least superficial. Experiencing joy was, for her, an act of defiance. “I did not know that my eventual contribution to the world would be to talk about orgasms and erections,” she told the Harvard Business Review in 2016, “but I did know I had to do something for others to justify being alive.”

Rebecca L. Davis teaches history at the University of Delaware. She is the author, most recently, of Fierce Desires: A New History of Sex and Sexuality and America and writes the Carnal Knowledge newsletter.

Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors.