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Treatment begins with a thorough evaluation, which has two purposes: to determine whether the patients are suitable candidates for sex therapy and to formulate the erotic sexual tasks appropriate to that couple. The evaluation interview includes a medical and psychiatric history of the patients and a thorough sexual history. The initial aim of the therapist is to obtain as clear a picture as possible of the “target” sexual dysfunction or dysfunctions and of the current sexual relationship of the couple. The patients are asked to describe their latest sexual experience together “as a video picture”; only when the therapist understands both the symptom and the context in which it appears will the next area be explored. An attempt is made to formulate both the immediate and the remote causes of the patient’s problem. To this end the experiential description of the sexual interaction, the “video picture,” is supplemented with a description of the history of the dysfunction, including the patient’s childhood experiences. The relationships among parents and siblings are explored, and the sexual functioning of each partner in childhood, adolescence, and premarital adulthood is ascertained. The etiology is completed with a discussion of the couple’s marital history.

During the initial evaluation interview, if profound intrapsychic or interpersonal difficulties are revealed which might preclude successful sexual therapy, the patients are referred to the appropriate individual or to conjoint therapy and are not accepted at that time for sex therapy. They are, however, encouraged to return, should they still need sex therapy after the resolution of their other conflicts. Contraindications to sex therapy lie in the intrapsychic and interpersonal domains. According to Kaplan, “Sex therapy is indicated only if . . . earlier problems are not insuperable nor screens for psychotic processes. With severely disturbed individuals or couples, sex therapy is usually not indicated”. Contraindications include significant medical illness, use of narcotics, or alcoholism, and major active psycho-pathologies (“florid schizoid reactions, blatant paranoia, and significant depression in either partner”). However, if these are remedied, successful treatment is still possible, “providing the therapist is sensitive to and careful not to tamper with the crucial defense against the emergence of open illness”. Interpersonal contraindications are a lack of caring and cooperation necessary to perform the sexual tasks together.

For patients who are marginally suited for sex therapy, the next few sessions are devoted to exploratory exercises intended to clarify their status. The “sensate-focus” exercise (Masters and Johnson) is frequently used as a “probe”; sometimes the couple is merely instructed to shower together, washing and drying each other (Witkin). Usually within three sessions, but sometimes requiring as many as four or five sessions, the prognosis is much clearer, and the patients will either continue in sex therapy or be referred to another treatment modality.

Once therapy proper begins, the average course of treatment lasts between six and sixteen weeks. In almost every case, persistence of the symptom beyond twenty weeks is considered an indication that this particular problem is not amenable to rapid sex therapy and calls for other forms of therapy.

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The stages of psychosexual development constituted the basic theory of psychoanalysis, particularly the primary theory of development within psychoanalysis, for most of the early period of Freud’s thinking. It was not until the emergence of a structural theory in The Ego and the Id and the subsequent emergence of a more developed ego psychology at the hands of Anna Freud, Heinz Hartmann, David Rapaport, Erik Erikson, and others, that the basic developmental schema provided by the stages of psychosexual development came to be modified to any great extent. The stages of psychosexual development even today remain one of the best understood and most firmly established dimensions of psychoanalytic theory. Although the schema has been considerably modified since Freud’s early thinking about it, it nonetheless has remained a fundamental dimension in the psychoanalytic assessment of personality and the pathology of disturbed states of functioning.

In discussing the role of psychosexual development in disorders of sexuality, it is of particular importance to keep clearly in mind the distinction between developmental characteristics derived from the respective psychosexual stages, and the levels of regressive fixation that may characterize one or other form of psycho-pathological expression. Thus, many aspects of reasonably well-integrated and well-functioning individuals may originate in the respective psychosexual stages, but this does not mean nor can it be used to infer that the behavior in question is an expression of that level of psychological functioning and psychosexual integration, nor that it necessarily reflects a fixation at that particular developmental stage. It is quite a different matter to say that a given individual manifests oral characteristics in his behavior and to say that the organization of his personality reflects fixation at the oral stage of psycho-sexual development. There has often been a basic confusion in the use of such terms and a failure to distinguish between regressive fixations and developmental attainments.

With these cautions in mind we can turn at this point to a brief description of the psycho-sexual stages and to a brief specification of some aspects of their implications, both for pathological functioning and for personality development. The following description of the psychosexual stages is based on Freud’s early formulations but reflects the contributions of later psychoanalytic thought to the understanding of psychosexual development. Of particular importance in these later contributions are the deepening of the developmental implications of the pre-genital stages, the mutual interaction of psychosexual dynamics with object relations, and finally the interplay of psychosexual and psychosocial developmental processes.

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Rosen and Jerdee found that women were thought to be out-of-role when they took a threatening approach in filing a job grievance. These same authors (Rosen and Jerdee) found that employees’ requests for released time from work because of family problems were perceived to be more acceptable coming from a woman than a man. There also is some evidence that the sex of a manager influences how descriptions of different managerial styles are evaluated (Bartol and Butterfield; Rosen and Jerdee). Generally, these studies suggest that both women and men are evaluated more favorably when their leadership activities consist of sex-appropriate behaviors, e.g., a female manager showing consideration and a male manager initiating structure. Evidently, conformity to traditional sex role standards is regarded favorably in work as well as in other settings.

Most jobs that carry with them authority and responsibility are thought to require behavior that is explicitly male. What are the consequences for women who take such jobs? How do others react to them and how might their performance be affected by these reactions? What are the implications of these reactions for their careers?

Costrich, Feinstein, Kidder, Maracek, and Pascale investigated the reactions to women’s out-of-role behavior in a series of laboratory studies utilizing three different experimental procedures. The results indicated that women who violate norms of feminine passive-dependency were penalized by the undergraduates serving as subjects. They were rated both as less popular and as more poorly adjusted than women who abided by the behaviors appropriate to their sex. These findings’ suggest that, paradoxically, women in nontraditional fields may be evaluated negatively if they do their jobs well.

Such reactions, if they occur in work settings, can impair the advancement opportunities of women. There have been a number of field studies that examined the reactions to females in previously male-dominated roles; however, they have focused on the reactions of subordinates to female and male supervisors. Although the reactions of subordinates clearly are not as critical for our purposes as are the reactions of those who have the power to take personnel actions, these studies are nonetheless instructive in understanding the by-products of incongruence between sex and job in actual organizational settings.

Two separate research investigations (Petty and Lee; Petty and Miles), investigated the correlations between subordinate perceptions of leader behavior and subordinate satisfaction. Both in the nonacademic divisions of a university and in a social service organization, the correlation between consideration behaviors and satisfaction with supervisors was greater for female supervisors than for male, In the social service organization study the correlation between initiating structure behaviors and satisfaction also was greater for male supervisors than for female. In fact, men with women supervisors had negatively correlated satisfaction scores and ratings of initiating structure. Satisfaction was thus found to be linked with perceptions of sex-role-consistent behavior.

Rousell conducted a field study in which, as Terborg has pointed out, greater care was taken to control adequately for factors in addition to sex, thus allowing for a more precise statement about supervisor sex and subordinate reactions than in the Petty studies. The effects of department-head sex on teacher ratings of department climate in ten high schools were investigated. The teachers were randomly selected from the four largest departments in each school. The twenty-five men and fifteen women department heads had few differences in background and virtually no differences in teacher ratings of professional knowledge, aggressiveness, or power—all potentially confounding variables. Results indicated that departments headed by men were rated as having a far more favorable climate than those headed by women.

The data from these studies have several pertinent implications. First, they suggest that women in supervisory positions are limited in the extent to which they can adapt a variety of supervisory styles to do their jobs effectively. Their flexibility is constrained and their ultimate performance may suffer. Second, they suggest that negative reactions to women in non-traditional roles are confined not only to the woman herself but influence the perceptions (and perhaps the realities) of the climate of the work setting. Each of these can have costly consequences for the woman striving to move up in the organizational ranks.

An additional and not unimportant point is the fact that the anticipation of negative reactions by organization members can prevent decision makers from placing women in nontraditional positions. Results of a 1965 Harvard Business Review survey of 1,000 men and 900 women executives indicated that over two-thirds of the men and almost 20% of the women said they would not feel comfortable working for a woman. Very few of either sex (less than 10% of the men and approximately 15% of the women) felt that men employees feel comfortable working for a woman. Beliefs of this sort make the prospect of placing women in high-level jobs seem risky. Surely this must enter into decisions about who to put in what position and who to put in charge of whom.

In reviewing the literature pertinent to on-the-job sex discrimination, it again is apparent that sex stereotypes are the basis for the differential treatment of men and women. There is indication that if a woman were to perform well on the job her success might not be acknowledged or even if it were, it might be interpreted as a result of temporary conditions. There also is indication that a woman, simply by her presence in an out-of-role position, can create low morale and dissatisfaction among others at the work place, thereby limiting her effectiveness and others’ perceptions of her potential. It seems clear that when competing with men in the work world, women face a tremendous disadvantage.

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In American culture, according to Schneider, sexual intercourse is “exclusive to and distinctive of the husband-wife relationship”. Schneider knows full well that sexual intercourse as behavior occurs outside of marriage, but his point is that it never occurs outside of the marital context. In an important footnote Schneider supports his contention and demonstrates the broad scope of husband-wife sexuality in defining the impropriety, illegitimacy, and immorality of other forms of sexual activity:

Sexual intercourse between persons who are not married is fornication and improper; between persons who are married but not to each other is adultery and wrong; between blood relatives is incest and prohibited; between persons of the same sex is homosexuality and wrong; with animals is sodomy and prohibited; with one’s self is masturbation and wrong; and with parts of the body other than the genitalia themselves is wrong. All of these are defined as “unnatural sex acts” and are morally, and in some cases, legally, wrong in American culture.

With this reasoning Schneider could define the symbolic system of American kinship, consisting of and in terms of the central symbol of sexual intercourse. In later publications Schneider widened his study to additional cultural domains grounded in the same symbolic process.

Schneider’s argument allows a cultural approach to such topics as adultery. If we expand upon Schneider’s argument, we learn that adultery is wrong because it extends to outsiders the order of law, which unites individuals through marriage. Americans also reckon relatives through tracing “blood” ties. The conjugal love of marriage is opposed in the cultural system by the cognatic love between persons related “by blood.” Schneider points out that the product of conjugal love provides the actors who partake of the “blood” relationship. Sexual intercourse, therefore, is instrumental and symbolic in both conjugal and cognatic love.

Adultery, in this analysis, breaks the symmetry and threatens the entire system. Because it is a pivotal symbol, sexual intercourse outside of marriage not only threatens that marriage but threatens personal relationships defined by the “blood” with which it is dynamically associated. Note that the epithet “homewrecker” used to disparage the proverbial “other woman” refers to the total damage done to relations defined both by blood and by law.

Of particular interest to anthropologists are the arrangements of polygamous marriages. Herskovits was somewhat surprised to find that Dahomean polygynyous marriages were not necessarily tense or jealousy-arousing. Cooperative co-wives make adjustments among themselves, should a husband’s four-day cohabitational visit coincide with a wife’s menstrual cycle. She will exchange places in the rotation with a co-wife and not be deprived. Herskovits concludes: “In essence, the great mass of Dahomean matings, either because of complacency, or of human ability to make the best of a situation, are permanent ventures which in terms of human adjustment cannot be called failures”.

Schapera, reporting on the Kgatla, is not as impressed with the way the system works for them, finding jealousy, suspicion and unhappiness among a Kgatla’s many wives. His conclusion differs from Herskovits’s: “Many women grow reconciled and manage to lead a tolerable existence with husbands who are not unduly inconsiderate, others find some sort of relief by being unfaithful themselves, and some are acutely miserable”.

We have a similarly indefinite perspective from the literature on polyandry. Linton reports that jealousy among co-husbands in the polyandrous Marquesas was considered “very bad manners”. This report is contradicted, however, by Suggs, who reports that “sexual jealousy is, and was, pronounced in the Marquesas”.

Little light will be shed on the topic of jealousy in marriage, plural or otherwise, unless some consideration is given to the larger context provided by native conceptions and explanations. One start in this direction is offered by Firth who finds that among the Tikopia, jealousy is something engendered by marriage and is a natural extension of the marital relationship:

Jealousy is a definitely recognized type of behavior in Tikopia, characterized by a special linguistic expression, masaro. It is particularly evident in newly-married people, the natives say, and they regard it as a kind of accompaniment to the recently-wedded state. One of the young pair excites jealousy of the other . . . [Firth asks, "Over what?"] We don’t know; there it is, the co-habitation of a newly-married pair. They dwell together, they become jealous.

For the Tikopians, jealousy is an expectable part of marriage, especially in its earlier stages. It stems from the marriage and not from the predispositions of either mate, either to incite jealousy by behaving in certain ways or to become jealous easily because of personality.

As might be expected, people in various societies seek evidence to substantiate their suspicions of infidelity about a marital partner. Evidence may be as highly conspicuous as the love scars Trukese inflict upon one another (Gladwin and Sarason), or as subtle as a change in eating habits, as among the Tapirape (Wagley). Tapirape men are known to get ill if they eat soon after an adulterous tryst, so a woman would know if her husband had been adulterous if he should eat sparingly on mornings. A recognizable footprint or buttock-print left in the forest surrounding a Mehinaku village can spell trouble for an adulterous couple (Gregor). Suspicious Dobuan men will time their wives when they leave the compound to urinate or defecate. Extremely suspicious husbands will insist on accompanying their wives to the bush just to make certain (Fortune). Tapirape husbands carefully watch the fathers of newborn infants, for these men are liable to consort with other men’s wives, owing to the postpartum sexual prohibition which denies them access to their own (Wagley).

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Both morning erections and nocturnal emissions occur less frequently with age. Kinsey reported the median frequencies of morning erections at two per week in the thirties, one per week by age sixty-five and two per month in the late sixties. In a Sexology study reported by Rubin, 57% of a sample of sixty-five to sixty-nine-year-old males who were being treated for impotence claimed to have some morning erections. Rubin used these data to suggest that in many of these men the etiology of impotence was psychological. Kinsey reported that 71% of single males in their early twenties had nocturnal emissions. For both married and single men, emissions declined in frequency after age thirty. By fifty, about 30% of males interviewed had emissions but less frequently than in earlier years. Maximum frequencies per week recorded by Kinsey were twelve in the teens, three in the thirties, and less than one (.5) in the fifties. Only 14% of the men over sixty were still having any nocturnal emissions.

Scrotal elevation which occurs for younger males in the late excitement or early plateau phase of the sexual response cycle is attenuated for men over fifty-five. Full scrotal elevation prior to ejaculation is not always observed, and testicular descent following ejaculation may be extremely rapid. Past age fifty-five, the testicles often do not show the usual 50% increase in size due to vasocongestion. Penile detumescence during the resolution phase often occurs extremely rapidly following ejaculation rather than in the two stages typical of younger men (Masters and Johnson).

Erectile impotence is quite rare in males under age thirty-five. In Kinsey’s sample less than .005% under twenty-five and 1% under thirty-five suffered from erectile failure. For these young men, the condition frequently was transitory. However, Kinsey observed an increasing proportion of erectilly impotent males at ages above fifty. These proportions at fifty, seventy, and seventy-five years were 8%, 27%, and 55%, respectively. The degree to which generally poor health and other physical factors contribute to the rising proportions of impotence is unknown.

A number of behavioral changes in sexual activity (increased latency to ejaculate, increased reaction time for penile erection, decreases in precoital mucus) suggest that aging males lose sensitivity to stimulation or that their thresholds for erotic stimulation increase with age. Alterations in collagen and elastic tissues of the skin may contribute to increases in the threshold of cutaneous sensitivity (Magladery). The loss of accessory structures’ ability to maintain recurring penile contractions probably contributes to a diminished sense of satisfaction at ejaculation. Kinsey’s erotic responsiveness ratings by age showed that with advancing years responsiveness (or sensitivity) decreased. The average indexed responsiveness figure for males thirty to thirty-five was about fourteen; this figure fell to six by the mid-fifties, to four by the late sixties, and went to zero for persons over seventy.

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