Homosexuality in Percpective by Bill Masters & Virginia E. Johnson

Homosexuality
in Perspective
WILLIAM H. MASTERS
CO-DIRECTOR
VIRGINIA E. JOHNSON
CO-DIRECTOR
THE MASTERS & JOHNSON INSTITUTE

ST. LOUIS, MISSOURI
LITTLE, BROWN AND COMPANY

BOSTON
COPYRIGHT © 1979 BY WILLIAM H. MASTERS
AND VIRGINIA E. JOHNSON
FIRST EDITION
ALL RIGHTS RESERVED. NO PART OF THIS BOOK MAY BE REPRO

DUCED IN ANY FORM OR BY ANY ELECTRONIC OR MECHANICAL
MEANS, INCLUDING INFORMATION STORAGE AND RETRIEVAL
SYSTEMS, WITHOUT PERMISSION IN WRITING FROM THE PUB
LISHER, EXCEPT BY A REVIEWER WHO MAY QUOTE BRIEF
PASSAGES IN A REVIEW.
LIBRARY OF CONGRESS CATALOG CARD NO. 79-84197
ISBN O-316-54984-3
PRINTED IN THE UNITED STATES OF AMERICA
M V
FOREWORD
For over a millennium and a half the West has shown a marked
ambivalence regarding sexual relations, including sexual intercourse
within marriage. Pope Gregory the Great, for example, in his Pas
toral Rule, warned that married couples who sought pleasure from
intercourse “transgressed the law of marriage” and as a consequence
“befouled their intercourse with pleasure.” Concerns about sexual
pleasure and excessive sexual activity have remained a preoccupation
of the West and have at times taken special expression in particular
movements such as the Bogomils of the tenth and eleventh cen
turies and the Cathars, who followed them, as well as such recent
groups as Ann Lee’s Shakers. The established cultural attitude re
garding sexual function reflected a sense of shame beyond one of
modesty. One should note that the etymology of the word puden
dum derives from the Latin pudere “to be ashamed.” Such attitudes
have persisted. In the nineteenth centuiy, for example, physicians
concerned with sexual attitudes still announced in medical journals
that “not one bride in a hundred, of delicate, educated, sensitive
women accept matrimony from any desire of sexual gratification;
when she thinks of this at all, it is with shrinking, or even with hor
ror, rather than with desire.” Marriage manuals of this period often
contained seriously inaccurate information, such as that the peak
fertility of women was during menstruation and that in midcycle
women were most infertile. Attempts to do research concerning the
physiology of sexual response were met with condemnation, as a
St. Louis physician discovered, when in the early 1870s he studied
the physiology of orgasm.
Only very slowly, through the work of individuals such as Sig
mund Freud, Alfred Charles Kinsey, William H. Masters, and Vir
ginia E. Johnson, has there been an acceptance in our culture of the
importance of studying sexual function and dsyfunction. The
v
vi FOREWORD
cultural impediments to doing such research have been immense

when one considers the deeply ingrained senses of sin and shame the
West has associated with sexuality. On the other hand, it is striking
that it took so long to turn seriously to the study of a function so
central to human life. Given the widespread incidence of at least
minor sexual dysfunction, it is amazing that it was so difficult to ap
proach the systematic study of the physiologic bases of the treat
ment of sexual dysfunction. Yet now such research seems common
place. One can talk easily of heterosexual function and the treatment
of its dysfunction. For this newly won ease in approaching the study
of sexual function, and for the initial substantial data in the field, we
are as a culture indebted to William Masters and Virginia Johnson.
This contribution can be placed in perspective only if it is in fact
recognized not simply as a scientific achievement, but as a contribu
tion to the culture of the West. Masters and Johnson have afforded
a set of insights concerning ourselves as sexual beings. They have
shed light on an area that has been surrounded by myths, fear, and
shame. Yet this element of our lives is the foundation that supports
some of our tenderest emotions and affections. In establishing in
detail the role of the clitoris in orgasm, the multiorgasmic capacity
of women, the continuation of sexual function into old age, and the
exact physiology of sexual arousal, orgasm, and resolution, Masters
and Johnson have sketched the physical framework within which
one soul can touch another in pleasure and love.
After years of embarrassed ignorance, knowledge has become
available in Human Sexual Response and Human Sexual Inade
quacy. These works have conveyed to our culture a willingness to
assay our sexual function as a prudent prelude to talking about sex
ual normality, abnormality, and treatment. They have conveyed a
concern for complaints regarding sexual function without invoking
notions of underlying disease states. And most important, these
books have reminded us that to understand ourselves as bodily
beings, we will have to look, at least as a first step, at our bodies
and see how they work. On such a passionately discussed topic con
cerning the roots of some our strongest passions, the work of Mas
ters and Johnson has shown the scientific virtue of quiet concern
for the truth, for the facts of the matter.
FOREWORD vii
In Homosexuality in Perspective Masters and Johnson have

continued their attempts to understand the phenomena associ
ated with human sexuality and to learn the ways to help indi
viduals with their complaints of sexual dysfunction. The study
of the sexual response of homosexuals, and the comparison of that
response with the sexual response of heterosexuals, is obviously even
more difficult in terms of our cultural barriers. Though a sizable
number of persons in all Western cultures have been occasionally if
not predominantly homosexual, homosexuality has attracted scorn,
condemnation, and punishment. Unlike Plato’s Phaedrus and Sym
posium, which depict homosexuality as a paradigm of love and the
erotic, English law characterizes it as a sin one should not even
name. The result is the loss of the candor of Plato’s dialogues in
speaking of and comparing heterosexual and homosexual love. This
volume contributes importantly to a return to that candor, a candor
required in order to understand the human condition and to help
with the treatment of those who fail to function in the intimacies
of their sexuality.
By approaching and comparing the physiology and the therapy of
both homosexuals and heterosexuals with equal attention to facts
and to a concern for their needs, Masters and Johnson have again
provided a volume of facts that will have an impact upon the hu
mane understanding of our sexuality. By showing that there are no
physiologic norms clearly distinguishing homosexual and heterosex
ual function, and that the sexual dysfunctions of homosexuals can
be treated as can those of heterosexuals, they invite an abandon
ment of many of the stereotypes of normal versus abnormal func
tion. Without advocating a particular view of an acceptable sexual
life, this work suggests an attitude of quiet tolerance for the range
of ways individuals express their divergent sexual needs with fellow
humans on the basis of very similar physiologic responses. In fact,
one can see in this attitude an ethic of tolerant care, which must be
cognate even with religious traditions that disapprove of active
homosexuality.
In reading this volume one will surely find important new infor
mation concerning the physiology of homosexual response and the
ways to resolve dysfunction between homosexual partners. One will
viii FOREWORD
also find critical reflections on human attention and sloth in the

most rapturous of dramas. Sex is, after all, always a fact of life, and
yet always more than just a fact of life.
H. Tristram Engelhardt, Jr., Ph.D., M.D.

The Kennedy Institute of Ethics
Georgetown University
Washington, D.C.
PREFACE
A^íillions of men and women have interacted sexually with same-

sex partners. A significant percentage of these individuals, like those
interacting with opposite-sex partners, have developed varying
symptoms of sexual distress, but for them adequate treatment has
not been readily available.
A homosexual man or woman who is sexually dysfunctional or
dissatisfied is entitled to evaluation and treatment with the same
clinical objectivity currently accorded the sexually dysfunctional het
erosexual individual. If health-care professionals are to meet these
responsibilities, much more must be known and much less presumed
of the psychophysiologic aspects of homosexual function.
As multiple aspects of homosexual interaction are opened to sci
entific scrutiny, inadequacies, discrepancies, and errors in prior lab
oratory and clinical research will be identified. A better perspective
of homosexuality as it relates to heterosexuality inevitably will be
an important byproduct of these multidimensional laboratory and
clinical investigations. To date, research efforts have been directed
toward establishing psychosocial perspectives between the two sex
preferences. This report is only an initial step in developing equally
important psychobiological perspectives. It must not be construed
as a statement of social, legal, or religious position.
As these progressive changes come to pass, the study of human
sexual function assuredly will grow into a field of unrestricted scien
tific inquiry and develop into a mature health-care discipline.
W. H. M.
V. E. J.
St. Louis
ix
ACKNOWLEDGMENTS
There were many contributions from the hundreds of study sub

jects who trusted the intent and the conduct of the research pro
grams, and from the sexually troubled men and women who had
confidence in the therapy concepts. Without their support, this in
vestigation of homosexual function, dysfunction, and dissatisfaction
could not have been conducted.
The skills of Robert C. Kolodny, who carefully critiqued this text
and contributed the section on endocrinology in Chapter 18, are
warmly acknowledged. Beyond this we are openly in debt to
Raymond W. Waggoner, Sandra K. Webster, Rhea L. Dombush,
Mark F. Schwartz, Mary Jane Rosenfeld, Judy Yates, Chris Busby,
and to the entire Institute staff.
To these, our friends, and to all who have contributed, our re
spect and gratitude.
W. H.M.
V. E. J.
xi
CONTENTS
foreword by H. Tristram Engelhardt, Jr. v

PREFACE ix
ACKNOWLEDGMENTS XÍ
PRECLINICAL STUDY, 1957-1970
1. Preclinical Investigation 3
2. Selection Process for Study Populations 13
3. Selected Study Groups 27
4. Study Subjects in the Laboratory 45
5. Comparative Sexual Behavior Patterns 61
6. Comparative Functional Efficiency 92
7. Homosexual Physiology 124
8. Ambisexual Study Group 144
9. Incidence and Comparison of Fantasy Patterns 174
10. Preclinical Statistics 193
11. Preclinical Discussion 205
xiii
xiv CONTENTS
CLINICAL STUDY, 1968-1977
12. Clinical Investigation 235
13. Male Homosexual Dysfunction 274
14. Female Homosexual Dysfunction 310
15. Male Homosexual Dissatisfaction 333
16. Female Homosexual Dissatisfaction 361
17. Clinical Statistics 379
18. Clinical Discussion 403
BIBLIOGRAPHY 413
INDEX 437
PRECLINICAL
STUDY, 1917-1970
I
PRECLINICAL
INVESTIGATION
IVluch has been written, discussed, declaimed, or just whispered

about human homosexual function. Libraries bulge with tomes on
the subject. Personal attestations abound. Famous figures in history
have been assiduously identified as homosexual, either in defense
of or as an attack upon not only their sexual orientation but also
the totality of their personalities. Theological discussions have
ranged from learned to demagogic levels on the status of the homo
sexual in our society. And psychosocial aspects of homosexuality
have been exhaustively reported, but rarely without observer bias.
As a natural consequence of society’s continuing obsession with
the subject of sex, there are thousands of self-appointed or profes
sionally annointed experts on the subject of homosexuality. Yet,
despite this proliferation of assumed or presumed expertise, con
scientious health-care professionals are embarrassed by the lack of
a secure information base from which to respond to the multiplicity
of problems encountered by the millions of homosexual men and
women in our society.
For many years the oppressive weight of professional ignorance,
combined with the intellectually debilitating pressures of public
reprobation, has effectively immobilized health-care professionals
in their legitimate search for accurate facts about homosexuality.
How does one start to separate fact from fiction? How does scien
tific objectivity grow when public opprobrium still remains un
bridled? Literally, so little is actually known of the physiologic and
psychosexual aspects of homosexuality that it is uncertain just how
ignorant we are about the subject.
As health-care professionals we will only develop a culturally
3
CHAPTER ONE
4
unbiased perspective of homosexuality from continued basic science

research and from accepting the clinical responsibility for treating
problems of sexual dysfunction or dissatisfaction within the homo
sexual population.
In the midsixties, when considering the logical expansion of the
Institute’s investigation of human sexual function and dysfunction
by initiating a physiologically and psychosexually oriented homo
sexual research program, the need for an objective investigation
was so great that the research team’s understandable reluctance to
face both public and professional condemnation was quickly re
solved. Since a significant percentage of this country’s population
had existed in a quagmire of sexual misconception and had been
subjected to the unending trauma that public misinformation,
phobia, and taboo create, and since it was possible that to some
modest degree these levels of ignorance and prejudice might be
lessened by a definitive research effort, there was no question of
not activating the investigative programs designed to focus on
homosexuality.
PRECLINICAL STUDY GOALS
From the onset, it was clear that a multidimensional investiga

tion was needed in order to compile objective information, to re
solve various unsettled disputes, and to demystify profoundly
muddled public and professional concepts of homosexual inter
action. In short, definitive research programs were (and still are)
indicated to provide clearer perspectives of homosexuality. Several
different areas for study were defined by the research team as
logically falling within the Institute’s parameters of investigative
expertise developed over the years in heterosexual research pro
grams.
1. Laboratory investigation of the physiology of homosexual re
sponse was an obvious extension of prior research of heterosexual
physiology. It was presumed that once reliable descriptive informa
tion about homosexual physiology had been established, legitimate
comparisons could be drawn between homosexual and heterosexual
sexual response cycles. Any significant physiologic differences found
PRECLINICAL INVESTIGATION
5
between these alternative forms of sexual expression might have

direct clinical application in the treatment of heterosexually or
homosexually oriented problems of sexual dysfunction.
On the other hand, if no significant physiologic differences could
be established between sexual response patterns of homosexuals
and heterosexuals, a number of sexual myths and misconceptions
would be exploded and the investigative material derived might
still be of major clinical value. It should be stated at this point
that while significant physiologic differences between heterosexual
and homosexual response were not anticipated, the need for an
objective investigation into the issue was recognized. For if varia
tions in human sexual patterning could only be identified on an
individual, subjective basis, without regard to sexual preference,
any presumed physiologic support for the recurrent arguments of
“my way” versus “your way” would be reasonably neutralized.
2. It was anticipated that the functional efficiency of a homo
sexual study-subject population could be evaluated in the labora
tory environment. Any difference in ability of homosexual men or
women to attain orgasm in the laboratory as compared to that of
heterosexual study subjects in a similar setting would be of inves
tigative interest, just as would the absence of such differences. This
evaluation of homosexual functional efficiency * was planned to
include reports both of frequency of orgasmic response and of fail
ures to achieve orgasmic release with a particular sexual technique.
It was presumed that this information would be of value whether
or not significant differences could be established between hetero
sexual and homosexual response patterns.
3. In order to provide truly multidimensional perspectives of
homosexual function, it was decided that description and analysis
of the fantasy patterning of homosexual male and female study
subjects would provide an additional bank of resource material.
The experience of the research team in the original heterosexual
research project had indicated that study subjects participating in
the laboratory investigation were, after becoming comfortable with
* It must be acknowledged that sexual proficiency is not synonymous with orgasmic
responsiveness and that sexual gratification, sexual maturity, and sexual interest are
phenomena to be considered somewhat apart from orgasmic frequency or orgasmic
failure alone. The objectivity of documenting orgasm as a precise, definable physio
logic event made it a useful parameter to reflect one dimension of functional efficiency.
6 CHAPTER ONE
the research team and secure in the research environment, willing

to share subjective material with unusual freedom and spontaneity.
It was presumed that there would be returns of major clinical value
if fantasy content collected in interviews with homosexual study
subjects could be compared to previously unpublished data describ
ing the fantasy patterns of members of the heterosexual study
groups.
4. Any investigation of homosexual response patterns gains par
ticular perspective when related to equivalent data reflecting het
erosexual response patterns. Although an extensive heterosexually
oriented study had been conducted, it had been initiated 10 years
previously. Therefore, it was believed that a contemporary inves
tigation of heterosexual function would provide another important
measure of comparison for the contemplated homosexual study.
While data obtained in the original research project would serve
as a means of investigative check and balance, the recruitment of
a second, contemporary group of heterosexual study subjects for
further investigation was necessary for two additional reasons.
First, the stimulative techniques of cunnilingus and fellatio had
not been evaluated in the original heterosexual research project.
Such a study was not deemed prudent in the 1950s, but by 1966 it
was possible to conduct such research in a laboratory environment.
It was obvious that if any meaningful comparisons were to be
drawn between homosexual and heterosexual response patterns,
the stimulative techniques usually employed by both sexual prefer
ence groups must be evaluated.
Second, heterosexual response needed to be reevaluated in the
laboratory without an atmosphere of untoward social pressure
placed upon the research team. Although security problems were
more complex during the homosexual research program (see Chap
ter 4), the extreme social and professional pressures to discontinue
the research programs that existed during the original heterosexual
study were markedly reduced. When the homosexual program was
initiated, the researchers no longer were contending with an ever
present possibility that permission to continue the research might
be withdrawn at any moment. This is explained by the facts that
an independent research foundation had been established and the
work was not dependent on outside funding. Thus, the investiga-
7
tion of homosexual function was conducted at a much slower pace

than had been evident a decade earlier. The same pace was present
when the contemporary heterosexual study group was recruited and
evaluated.
THE STUDY-SUBJECT GROUPS
It was decided that two new study-subject groups would be re

cruited: a homosexual population of men and women, and a
heterosexual population of men and women (designated study
group A). As a final step in study-subject analysis, data were drawn
from the original group of heterosexual study subjects described
in Human Sexual Response (1966). For purposes of comparison
with the two new study-subject groups, this original group of
heterosexual study subjects was reduced to those members whose
participation was similar to that requested of members of study
group A (see Chapter 2). This reduced group was designated study
group B.
The same criteria used to recruit the original heterosexual study
population (selected members of which had been newly designated
study group B) were retained as basic recruitment guidelines for
the two new groups in terms of age distribution, levels of educa
tion, and Kinsey sexual preference ratings (Kinsey et al., 1948).
In addition, no homosexual male study subjects were selected with
out a history of facility to respond at orgasmic levels to the sexual
excitation in masturbation, partner manipulation, and fellatio, and
no female homosexual study subjects were recruited who were not
capable of attaining orgasm through masturbation, partner manip
ulation, and cunnilingus. Selection of study subjects for study
group A was restricted to heterosexual men and women who were
readily capable of achieving orgasm in masturbation, partner ma
nipulation, fellatio or cunnilingus, and with intercourse.
The homosexual research group and heterosexual study group A
were composed deliberately of individuals who were highly func
tional sexually. This selective approach to the constitution of a re
search population was established during the original heterosexual
research project (study group B) and was chosen again for several
8 CHAPTER ONE
reasons. First, protection of the welfare of study subjects had

always been of the utmost concern, and past experience had taught
that individuals who had a great deal of confidence in their sexual
facility were the least likely to experience any negative conse
quences from participation in a research study involving sexual
function in a laboratory environment. Second, if research interest
is directed toward physiologic response to sexual stimulation, the
investigation is most efficiently conducted with male and female
study subjects who react regularly and effectively at orgasmic levels
to sexual stimuli. Third, reports of behavioral patterning and de
scriptions of subjectively oriented material gathered from success
fully functioning men and women are vital in providing a com
parative basis for clinical interpretation of similar material collected
from men and women considered to be sexually dysfunctional.
It must always be kept in mind that due to specific selectivity
toward highly effective sexual function and above-average levels of
formal education, the Institute’s study-subject groups are not repre
sentative of the population as a whole. The extent to which these
groups differ from the general population is discussed more fully
in Chapter 2.
The Kinsey classification was used as a frame of reference in
rating study-subjects’ sexual preference. In brief review, and using
a liberal rather than literal interpretation, Kinsey 0 orientation
means that the man or woman has never had overt homosexual
experience. A Kinsey 1 identification describes an individual whose
minimal amount of homosexual experience has been far over
shadowed by the degree of his or her heterosexual experience. The
classification of Kinsey 2 suggests a person with a significantly
higher level of homosexual experience than a Kinsey 1, but still
with a predominant background of heterosexual interaction.
A rating of Kinsey 3 represents an individual with a history of
approximately equal homosexual and heterosexual experience. De
spite obvious ambivalence as to partner gender, there usually is a
history of periods of partner identification. An individual rated as
Kinsey 4 is one who has had a significant amount of heterosexual
experience but whose sexual outlets have been predominantly
homosexual. A man or woman with a Kinsey 5 preference rating is
an individual whose homosexual experience fully dominates his or
9
her history and whose heterosexual activity is minimal. Finally, a

Kinsey 6 describes a man or woman whose sexual preference is the
exact opposite of a Kinsey 0—that is, an individual who has no
history of overt heterosexual experience.
Only the reported history of sexual experience, not described
fantasy patterns or dream sequences, was used in this study to
determine a Kinsey classification of sexual preference. Obviously,
classification based on historical recall is not always a reliable data-
gathering method. But while this system has been criticized, it is
easy to apply, and if used only as a preference rating scale as orig
inally intended, it is a valuable means of classification.
In recruiting the homosexual study group it was decided to
select subjects representing the full range of homosexual prefer
ence. While it was anticipated that Kinsey 5 and 6 volunteers
would be the most easily recruited, a broad spectrum of homo
sexual preference was desired, including men and women pre
dominantly heterosexual in prior experience. Therefore, a major
effort was expended to develop a representative population of men
and women with sexual histories reflecting Kinsey 1 through 4
sexual preferences. If Kinsey 5 and 6 subjects had been the only
men and women evaluated, this bias toward exclusive homosexual
orientation could have obscured some of the theoretically possible
variations in sexual response patterns that might have been present
in study subjects whose sexual experience had been mixed or pre
dominantly heterosexual. It should be emphasized that, regardless
of their preference ratings, all of the study subjects selected for the
homosexual research group were involved in homosexual activity at
the time of recruitment.
The two heterosexual research populations (study groups A
and B) were limited to men and women with no higher than a
Kinsey 1 preference rating. All of these study subjects were living
heterosexually active lives when recruited.
Obviously, there was a discrepancy in the recruitment of the
men and women for the two heterosexual groups as opposed to
those who formed the homosexual study group, since heterosexual
volunteers leading heterosexual lives with sexual preference ratings
of 2 through 5 were not recruited for the program. Consistency in
recruiting practice was not maintained because the concept of
IO CHAPTER ONE
assembling a heterosexual study group that included individuals

with a history of a significant amount of homosexual experience
simply never occurred to the research team 23 years ago when
study group B was originally assembled. Since for comparative
purposes study group A was recruited in adherence to standards
established 10 years previously, the discrepancy was deliberately
maintained for methodologic consistency. The obvious variation in
distribution of sexual preference that exists between the two hetero
sexual groups and the homosexual group is emphasized at the out
set of this report. The extent to which this difference in subject
selection may have influenced the resulting data is not known.
It was believed that in order to evaluate sexual interaction pat
terns with greatest accuracy, the focus should be on couples in
committed relationships of reasonably long standing. Thus, most
of the study subjects selected were members of “committed”
couples of either heterosexual or homosexual orientation. For the
purposes of this investigation, the definition of a committed hetero
sexual relationship was the existence of a state of marriage, while
committed homosexual couples were defined as partners who had
lived together for a minimum of one year. The lack of parallelism
in these definitions was recognized at the outset of this work, but
no realistic unitary set of criteria was available to resolve this differ
ence. There were certain necessary exceptions to these definitions
that will be described in Chapter 2. The obvious fallacies in the
empirical assumption that either a year’s conjoint residency or a
state of marriage is secure evidence of a couple’s mutual commit
ment need no further discussion. Such selection criteria were
simply the best that could be imposed under the circumstances.
Reasonably stable relationships were identified on the basis of
in-depth personal interviews; in some cases, evidence of instability
in a relationship was obtained sufficient to warrant rejection of the
couple as potential study subjects.
Despite specific research concentration on committed couples,
it was believed that men and women without established relation
ships should also be represented. Therefore, a small number of
volunteers of heterosexual and of homosexual orientation who de
scribed sexual histories with a striking absence of committed rela
tionships and who expressed no current interest in forming such
PRECLINICAL INVESTIGATION 11
relationships were recruited to represent “uncommitted” men and

women of the two major sexual preferences. In the laboratory,
these men and women were designated as “assigned partners” and
arbitrarily paired with each other to create “assigned couples” (see
Chapters 4 through 6). By comparing their sexual behavior pat
terns, physiological responses, functional efficiency, and fantasy
patterning with those of homosexual and heterosexual committed
couples, another interpretative dimension was added to the re
search program, and broader perspectives inevitably were created
for homosexual interaction. The concept of commitment and the
consequences of commitment in laboratory interaction are further
discussed in Chapter 11.
Criteria for study-subject age distribution and educational levels
were based upon standards previously established by the original
heterosexual study group. These are reported in detail in Chapters
2 and 3. There was a bias toward higher than average levels of edu
cation in the population of the original study group, and therefore
the bias was continued in the new study groups. This educational
selectivity was purposefully based on the prior experience of the re
search team, in which it was observed that in general, the higher the
degree of formal education of the study subject, the more inform
ative and thoughtful would be his or her communicative response
to questioning. Since as much, if not more, was learned of ultimate
clinical value from the study-subjects' presentation of subjective
material as was gathered from observation of physical responses or
sexual behavior patterns in the laboratory, the educational bias of
the research population was important.
The investigative techniques and research results of the different
areas of study will be presented in detail in the following chapters.
Briefly, in order to gather the multidimensional data sought, each
study subject was observed and interviewed on several occasions.
Each homosexual subject was observed in at least one episode of
masturbation, manual stimulation, and fellatio or cunnilingus, and
each heterosexual study subject was observed in the equivalent
stimulative situations as well as during at least one episode of
coitus. Most study subjects were observed in repeated interactions
using the different stimulative techniques.
All of the study subjects were interviewed during the screening
12 CHAPTER ONE
process, and data relating to general attitudes and fears or prefer

ences oriented to sexual function were compiled. During and after
sexual activity in the laboratory there was opportunity for the sub
jects to express subjective reactions to the specific experience. In
case of failure to achieve orgasm or the occurrence of any problems,
the subject was questioned immediately in order to determine
his or her feelings about the incident.
In addition, in-depth interviews with a selected number of study
subjects of both homosexual and heterosexual orientations were
conducted to obtain information about fantasy patterning. The
results of this investigative program are presented in Chapter 9.
Several secondary projects were conducted in conjunction with
the major investigations. Rectal intercourse was evaluated with a
small number of homosexual and heterosexual subjects, and dildo
usage was studied with a similarly constituted research group. The
results of these secondary research projects are presented in Chap
ter 5.
An unanticipated research project that initially developed under
the impetus of the homosexual study programs evolved into a
separate investigative effort. This was the study of a previously un
identified group of men and women whose lack of any sexual
preference and whose total disinterest in even identifying with, let
alone forming, a committed relationship with a partner of either
gender required formal group designation. The investigation into
the subject of ambisexuality is reported in Chapter 8.
1
SELECTION PROCESS FOR
STUDY POPULATIONS
1 here were numerous problems associated with recruitment and

screening of the committed and assigned study groups in the homo
sexual research program. Recruiting techniques and results of the
screening program used to establish the homosexual study popula
tion and comparative heterosexual study group A are considered in
detail in this chapter. In addition, there is a description of the
process by which the original heterosexual study group reported in
Human Sexual Response was reduced to those subjects (study
group B) whose participation provided another dimension to the
homosexual study and allowed legitimate comparisons of sexual
preference groups to be drawn within the overall investigation of
human sexual function.
RECRUITMENT OF HOMOSEXUAL
STUDY GROUP
Committed Study Subjects. The homosexual study group was

recruited in an ongoing process over a four-year period, from 1964
to 1968. Recruitment of stable, committed homosexual couples
during the 1960s was difficult. The usual local resources for investi
gative referral of homosexual study subjects, such as homophile
organizations, activist groups, homosexual bars, correctional institu
tions, or medical resources were deemed inadequate in that if re
cruiting had been conducted through these sources it would have
been impossible to provide study-subject anonymity and research
security. In addition, committed homosexual couples infrequently
13
CHAPTER TWO
M
surfaced in a public declaration of sexual preference or even circu

lated openly among their peers during the decade of the sixties. At
that time, the local community of known committed homosexual
couples certainly was not of sufficient magnitude to provide a
satisfactory number of study subjects for the Institute’s research
purposes. Therefore, a decision was made to recruit the committed
homosexual research group on a national rather than on a local
level.
Following the pattern established when the original heterosexual
research population was recruited in 1957, initial contacts were
developed in the local community with stable homosexual couples
and were disseminated through the framework of local educational
institutions into immediately adjacent geographic areas. As work
progressed, word was spread through the cooperation of local
couples to committed couples in other communities. Problems
initially encountered in contacting responsible and interested homo
sexual couples were progressively overcome as stable couples, after
cooperating with the laboratory investigation, referred friends or
acquaintances whose homosexual relationships also were long
standing.
Another factor in assembling homosexual subjects that was not
present in the recruitment of heterosexual study groups (Chap
ter 1 ) was the decision to find subjects whose Kinsey sexual prefer
ence ratings represented the full range of personal homosexual
orientation, from Kinsey Scale 1 through Kinsey 6. Subjects with
preference ratings reflecting predominantly homosexual experi
ences, those rated Kinsey 5 and 6, were relatively easy to recruit.
There were more volunteers in these grades than in the other clas
sifications, but only a limited number could be accepted in order
to maintain the balance in sexual preference ratings originally
planned.
The most difficult type of subject to recruit for study participa
tion was the Kinsey 1 volunteer. Although only a relatively minimal
amount of prior homosexual experience was reported by these men
and women, their sexual responses in the laboratory were to be
entirely to homosexual stimuli. Due to the predominance of hetero
sexual experience in the backgrounds of these men and women,
criteria for selecting this group were very strict. The Kinsey 1 repre-
SELECTION OF STUDY POPULATIONS
15
sentatives were accepted into the program only if they could docu
ment that they were currently living in a homosexual relationship
of at least three months’ duration. This was the only exception
made to the criterion of a minimum of one year’s established rela
tionship before acceptance of a homosexual couple in a committed
status. Thus, the Kinsey 1 volunteers, who reported a minimal
amount of homosexual interaction compared to the predominance
of their heterosexual experience, had concentrated their homo
sexual activities in the immediate past prior to recruitment. Obvi
ously, they also were likely to be in their late thirties or into their
forties and to have been quite active heterosexually in order to have
a history of three months’ experience in a committed homosexual
relationship and still be classified as Kinsey 1 men and women.
There was also concern in arbitrarily selecting the specific clas
sification of Kinsey grades 2 through 4 for any individual who had
had a large number of both homosexual and heterosexual experi
ences. The ratings (described in Chapter 1) were assigned by the
research team after detailed history-taking, but it is difficult for any
individual to be fully objective in assessing the amounts of his or
her heterosexual versus homosexual experience when there has
been a considerable amount of both types of interaction. Some
of these preference ratings might well be subject to different inter
pretation by other health-care professionals. Generally, the Kinsey
2, 3, and 4 individuals had an estimated number of sexual contacts
that impressed the interviewer as far above the typical range of age-
related sexual experience.
The Kinsey 3 classification was the most difficult to assign of the
ratings. Relative equality in any form of diverse physical activity is
hard to establish. Particularly was this so when the interviewer, in
attempting to separate mature sexual experience into its homo
sexual and heterosexual components, was faced with a history of a
multiplicity of partners of either sex. This problem was augmented
by the subjects’ frequently vague recall of the average number of
sexual interactions with each partner. This lack of a clearly defined
sex history is an almost inevitable hazard when conducting retro
spective interviews, particularly with men and women who have
had a large number of sexual partners.
It should be emphasized that just as was true for the Kinsey 1
16 CHAPTER TWO
grade of sexual preference, men and women with 2, 3, and 4 grades

were only accepted as members of the homosexual study group if
they currently were living homosexually oriented lives.
Assigned Study Subjects. Recruitment of assigned study sub
jects for the homosexual group was done through word of mouth.
Prostitutes were never employed to function as assigned partners
in any of the Institute’s study groups. A sufficient number of volun
teers were available, so the vast majority of the men and women
who formed the assigned couples came from the local area. All of
the men and women recruited as assigned partners currently lived
lifestyles in which committed relationships were viewed with dis
interest. Their expressed purpose in sexual interchange was one of
sexual satisfaction, and tkeir interest usually was directed to quan
tity rather than quality of sexual opportunity. These homosexual
men and women saw the invitation to interact in the laboratory
as simply another variation in sexual encounter, one about which
they evidenced an honest curiosity. They were accepted on these
terms.
SCREENING
Once potential study subjects were identified, screening steps fol

lowed established patterns. First, the potential study subject was
contacted by telephone. The referral source was identified at this
time. The research program’s concepts and purposes were explained
in detail, and the study subject’s age group, formal education, and
degree of committed relationship, if any, were ascertained. If
interest in cooperating with the research program was expressed, j
personal interview was scheduled.
If the person interviewed initially evidenced a sense of comfort
with his or her sexual orientation, the next step during the inter
view was to develop a detailed psychosocial history. Psychosocial
histories were taken from each study subject in separate interviews
by both members of the research team. This was followed by a
complete physical examination, a routine laboratory evaluation,
and a detailed medical history. If the detailed history-taking and
the physical and laboratory evaluations did not identify the pres
ence of major psychopathology or severe neurosis, and if no physical
or metabolic pathology was detected, the study subject was invited
17
to participate in the research program. All potential subjects were

informed as fully as was possible about potential risks and incon
veniences of study participation. At the time this work was begun,
formal institutional review boards for the protection of human
subjects were not yet in use, but the Board of Directors of the
Institute gave approval to the overall research program.
ELIMINATION OF SUBJECTS
Evidence of social stability was a key factor in study-subject

selection. Obviously, social stability had to be related to age in all
of the study groups. For the younger males in the homosexual
population, socially secure relationships were of little importance
in the midsixties when this research program was conducted.
Except for the 51-60-year-old homosexuals, of whom there were
too few to draw valid comparisons, no other age group evidenced
as high a percentage of elimination of potential study subjects as
that of the 21- to 30-year-old males. In this age group approximately
three times more potential study subjects were screened than sur
vived the selection process (see Table 3-1, Chapter 3). The socially
unstable, migratory character of the male 21-30-year age group
accounts for the fact that approximately one out of three indi
viduals screened were finally selected as study subjects. The same
problems were encountered in recruiting uncommitted hetero
sexual male study subjects in this 21-30-year age group (see Table
3-11, Chapter 3). In the male homosexuals volunteering for this
project who were beyond 30 years of age, a significant increase in
the social stability and in the security of an existing committed re
lationship was obvious.
Of interest is the fact that a male couple with one partner in his
midsixties and the other in his early seventies was screened and
interviewed. Regretfully, at the intake interview, active participa
tion by this couple in the research laboratory had to be denied be
cause one partner had a pattern of erective insecurity that had not
been elicited during the initial screening procedures.
When recruiting female subjects for the homosexual (and het
erosexual) groups, 18-20-year-old study subjects were accepted who
had established interpersonal sexual behavior patterns, since in
Missouri 18 is the legal age of consent for women. Of course, there
18 CHAPTER TWO
was investigative interest in an opportunity to evaluate young women

who at this early age stated that they were fully committed to ho
mosexuality (Kinsey et al., 1953).
An older couple with one partner in her midsixties and the other
in her early seventies was screened and then interviewed. They
were not selected as study subjects because it was believed that
their extreme concern with the possibility of identification (they
lived in the local area) would have placed them under unaccept
able pressure in the laboratory (Table 3-6, Chapter 3).
There were 2 men and 2 women who were eliminated from con
sideration on the basis of their medical histories. The 2 men were
rejected because of severe hypertension, and 1 woman was not
included due to an established diagnosis of diabetes. All 3 were in
the over-51 age group and were members of committed couples.
One 31-year-old woman was eliminated when it was learned during
history-taking that she was under treatment for a venereal disease.
RECRUITMENT OF HETEROSEXUAL
STUDY GROUP A
Heterosexual study group A was recruited during the final two

years (1967 to 1968) of the research program in homosexuality.
Following prior successful patterning exemplified by the original
heterosexual study group and the homosexual study group, recruit
ment was accomplished initially by approaching the teaching staffs
and student bodies of local educational institutions, then by word
of mouth through the community, and occasionally through friends
in other geographic areas. There was no real problem finding com
mitted couples in the local metropolitan community, although a
significant percentage (22 percent) of the men and women in
study group A were recruited on a national level. Procedures for
recruiting heterosexual assigned partners were identical to those
described earlier for recruiting homosexual assigned partners.
ELIMINATION OF SUBJECTS
Since no study subjects were included in heterosexual study

group A who had a Kinsey rating over 1, an unacceptable sexual
preference rating accounted for the rejection of 21 volunteers.
19
Twelve of the 114 male (Table 3-11, Chapter 3) and 9 of the 121
female heterosexual volunteers (Table 3-14, Chapter 3) were re
jected because they reported a degree of homosexual experience
either beyond Kinsey 1 or, more frequently, described homosexual
experience within the year prior to organization of the research
group.
Of the total 57 male and 57 female study subjects finally selected
for study group A, 2 men and 1 woman were in the 51-60-year age
group. Actually, 4 men and 4 women in this age range were inter
viewed, but 2 of the men and 3 of the women were rejected. One
man was rejected for medical reasons (diabetes) and 1 because he
had a continuing history of rapid ejaculation. Two of the 3 women
rejected in this age group were simply not free to meet the time
commitments necessary for the laboratory scheduling, and 1 woman
was contemplating a marriage which, if established, would have
terminated her cooperation with the research program.
The age categories of 21 to 30 and 51 to 60 provided the highest
percentage of rejections for men (Table 3-11, Chapter 3), and the
older age groups (41 to 50 and 51 to 60) had the highest rejection
rates for women (Table 3-14, Chapter 3). In the male study group
ages 21 to 30 there was frequent evidence of social instability once
in-depth interviews were initiated during the selection process. The
research team may have been overly cautious, but the same general
criteria were applied to men in this age group as was true for the
selection process involving male volunteers for the homosexual
study group. The medical reasons for the high percentage of rejec
tion in the small number of older men who volunteered as study
subjects have been stated above.
For older heterosexual women, who had the highest rejection
rate, there was a different problem. Social instability was not a
primary concern; the problem was just the opposite. The hetero
sexual women expressed real concern with the possibility of public
identification as study subjects. They frequently described a fear
of general social opprobrium. Once such fears were vocalized, it
was the research team’s position that these women should not be
invited to become study subjects. It was felt that fear of identifica
tion might distract from the effectiveness of sexual interaction in
the laboratory.
20 CHAPTER TWO
Of real interest to the research team was the fact that the older
women in study group A reflected the same high incidence of fears
of identification if they cooperated as study subjects in the labora
tory that were expressed by the same age group of women volun
teers in the original heterosexual study group a decade previously.
Of further import was the fact that such fears of social opprobrium
were rarely expressed by the older female volunteers in the homo
sexual recruitment program. An outstanding exception to this state
ment has been described earlier in this chapter for an older homo
sexual couple.
Medical causes for rejection of volunteers were minimal. As
described earlier, 1 older man was rejected because he had diabetes
and 1 younger woman because she had hypertension. The only
other medical rejection was in a single woman in the 21-30-year
age group who was found to be in early pregnancy during the
routine physical examination.
FORMATION OF HETEROSEXUAL
STUDY GROUP R
(REDUCTION PROCESS)
As described in Chapter 1, study group B was comprised of

selected members of the original heterosexual study-subject popu
lation reported in Human Sexual Response (1966). The reduction
process by which study group B was established should be dis
cussed in detail. The reduction process consisted of purposeful
selection of those study subjects from the original project whose
participation in the earlier laboratory studies could be fairly com
pared to the participation requested in heterosexual study group A.
Relevant comparisons between existing data collected from the
original heterosexual study-subject population during the first in
vestigation and newly collected data from heterosexual study
group A and the homosexual study group could then be made.
During the nine-year original heterosexual investigation, 276
married couples, 106 single women, and 36 single men had coop
erated as study subjects in a multiplicity of research programs re
lated to the physiologic aspects of heterosexual function. Thus, a
SELECTION OF STUDY POPULATIONS 21
total of 382 women and 312 men had been active as study subjects
in the research laboratory during this phase of the overall research
program.
Of the 276 married couples who had cooperated with the pro
gram, 19 did not participate in each of the observed techniques of
masturbation, partner manipulation, and coitus. Fellatio and cun
nilingus had not been investigated. There were a number of rea
sons for reluctance to participate in the full range of studies, but if
either partner in a marriage expressed reservation to any form of
sexual activity, no effort had been made to seek compliance. Since
full cooperation had not been obtained, these 19 couples were re
moved from statistical consideration.
There were 6 married couples who had cooperated to record
sexual response patterns during pregnancy. Five of the couples had
participated in research programs before pregnancy, and all con
tinued to cooperate with other research programs after pregnancy.
The statistics returned during the states of pregnancy were removed
from consideration, but material developed before or after preg
nancy was included in the overall statistics.
There remained 257 married couples who had engaged in the
stimulative techniques of masturbation, partner manipulation, and
coital activity in these programs. Most of the married couples, once
committed to the research programs, had continued their participa
tion over periods of one to six years.
Most of the 106 unmarried women who were possible subjects
for selection into study group B had not been asked to respond in
the laboratory to each of the stimulative techniques. There were 7
women with artificially created vaginas who constituted a special
study group in vaginal agenesis that arbitrarily was removed from
statistical consideration (Masters and Johnson, 1961). Forty-eight
single women had cooperated only with the artificial coital experi
ments (Masters and Johnson, 1966; Johnson et al., 1970). Since
male partner interaction was excluded as a part of their laboratory
experience, the orgasmic facility of these women will not be pre
sented for comparative consideration.
Finally, there were 27 single women who had volunteered early
in the female sexual physiology studies to participate only in mas-
turbational activity and who had not wished to accept assigned
male partners in any form of sexual interaction. These women
22 CHAPTER TWO
obviously could not be considered in comparison with the other

study groups. Thus, of the 106 heterosexual single women who
had participated over the years in various investigative programs,
there were 24 who had been partners in assigned couples for studies
of sexual function among uncommitted men and women.
Of the 36 single men who had been active in the primary hetero
sexual investigation, 7 had agreed to participate for masturbational
evaluation only and thus could not be included in the overall
statistics.
Therefore, in the primary research program, a total of 24 single
women and 29 single men, all of heterosexual orientation, had
participated without reservation in the laboratory in response to
masturbation, partner manipulation, and coitus. One woman had
interacted with a total of 3 assigned male partners over a four-year
period, and 3 other women had interacted with 2 assigned male
partners, thus establishing the total of 29 assigned couples who had
participated in the original study.
There were 11 black married couples who were possible subjects
for selection into study group B. One couple was among the 19
pairs eliminated from statistical consideration, leaving 10 black
couples in the final 257 committed partnerships. There were 2 com
mitted couples with a Spanish-American background. None of the
assigned 29 male or 24 female partners was black or of Spanish-
American descent. Two single black women, part of the original
research population, were eliminated because they were in the
group of volunteers who had cooperated only with the artificial
coital experiments.
RESULTS OF THE REDUCTION PROCESS
The results of the reduction process are recorded in Tables 2-1

and 2-2. The first column in each table reports by age decade the
number of both men and women who volunteered to form the
original heterosexual research population. The second column indi
cates the number of study subjects in each age group who did not
engage in all the modes of stimulative activity and could not be
considered statistically. The third column represents the selective
total of men and women used to form study group B which, in
turn, was used to amplify reports of heterosexual functional effi-
«3
TABLE 2-1
Study Group B (Reduction Table): Male Study Subjects
Study
Group B
Original No. (Reduction Percent of
Age Population * Reduced Population) Sample
21-30 120 6 114 39.9
31-40 111 2 109 38.1
41-50 42 4 38 13.3
51-60 19 5 14 4.9
61-70 14 3 11 3.8
71-80 4 4 0 0
81-90 2 2 0 0
Total 312 26 286 100
(1957-1965)
* Reported in Masters and Johnson (1966), p. 13.
TABLE 2-2
Study Group B (Reduction Table): Female Study Subjects
Study
Group B
Original No. (Reduction Percent of
Age Population * Reduced Population) Sample
18-20 2 1 1 0.4
21-30 182 41 141 50.2
31-40 137 32 105 37.4
41-50 27 12 15 5.3
51-60 23 8 15 5.3
61-70 8 4 4 1.4
71-80 3 3 0 0
Total 382 101 281 100
(1957-1965)
Reported in Masters and Johnson (1966), p. 13.
CHAPTER TWO
24
ciency returned by heterosexual study group A. The final column

indicates the percentages of study subjects in each decade of age
grouping that made up the final total of 286 men and 281 women
who comprise the adjusted heterosexual study group (study
group B).
Since the standards for selection of the homosexual group and
heterosexual study group A were the same as those used for the
selection of the original heterosexual research population, study
group B, the reduced group, derived from the original hetero
sexual research population, should be comparable to the homo
sexual group and study group A in terms of age and educational
standards despite the reduction process described above. Statistical
comparisons between the three major study groups will be pre
sented in Chapter 10.
The formal education levels for the men in study group B are
reported in Table 2-3. The 83.6 percent total of college or post-
TABLE 2-3
Study Group B: Formal Education in

Male Study Subjects. (N = 286)
Age No. High School * College * Postgraduate *

21-30 114 22 47 45
31-40 109 19 40 50
41-50 38 5 16 17
51-60 14 0 6 8
61-70 11 1 8 2
Total 286 47(16.4%) 117 (40.9%) 122 (42.7%)
(1957-1965)
* Listing dependent only upon matriculation (highest level).
graduate matriculation for male study subjects in study group B is

the highest of the three study groups, but the other two study
populations are quite comparable (82.0 percent for the male homo
sexual subjects and 79.0 percent for men in heterosexual study
group A) (see Tables 3-4 and 3-12, Chapter 3).
The levels of formal education for the heterosexual women
25
selected in the reduced female population (study group B) are

reported in Table 2-4. There was a 61.9 percent level of college and
postgraduate matriculation. These statistics are parallel to those of
women in the homosexual group (67.1 percent) and study group A
(70.2 percent) (Tables 3-9 and 3-15, Chapter 3), and they are
essentially within the research team’s original recruitment stan-
table 2-4
Study Group B: Formal Education in
Female Study Subjects (N — 281)

18-20 1 1 0 0
21-30 141 45 69 27
31-40 105 42 43 20
41-50 15 6 7 2
51-60 15 11 3 1
61-70 4 2 2 0
Total 281 107 (38.1%) 124(44.1%) 50 (17.8%)
(1957-1965)
dards of 60 to 70 percent college matriculation set for female study

subjects. Obviously, the women in study group B had the lowest
percentage of college matriculation among the three female re
search populations despite every effort of the research team to re
cruit women with advanced educational backgrounds. But these
women volunteered to cooperate with the research from 1957 to
1965, while the other two groups were organized between 1964 and
1968. This gap of almost a decade in the recruiting of the first as
compared to the last two study-subject populations might explain
the increase in availability of female college matriculators for the
last two groups.
26 CHAPTER TWO
SUMMARY
In this chapter there has been a discussion of the problems and

screening techniques involved with establishing the homosexual
research population. In addition, background material required to
evaluate the comparability of the two heterosexual research popu
lations, not only with each other, but also with the homosexual
study group, has been reported. By following standards established
in the ultimate composition of heterosexual study group B, the
two study groups form comparable populations. Statistical analysis
of group composition is reported in Chapter 10. There is an obvi
ous bias in the level of formal education established for all the
research groups. The reasons this bias was established in the orig
inal heterosexual research population have been given; the rationale
for maintaining the bias so that significant statistical comparisons
ultimately might be drawn between all subsequently recruited
groups is apparent. Other variables, such as religion, socioeconomic
status, occupation, and regional differences, were not fully investi
gated and are thus precluded from the analyses.
3
SELECTED STUDY
GROUPS
D ata regarding the homosexual study group and heterosexual study

group A will be presented in table form and discussed in this chap
ter. The criteria for selection described in Chapter 2, the age dis
tribution, Kinsey preference ratings, and formal educational levels
will be reported, along with medical data and marriage and concep
tion histories. A description of background material from the ambi
sexual study group is reported in Chapter 8.
THE HOMOSEXUAL STUDY GROUP
There were a total of 176 study subjects in the homosexual study

group. The majority of the homosexual subjects were recruited
from large metropolitan centers or smaller academic communities
outside the St. Louis area.
Ninety-four male homosexual study subjects were evaluated in
the research project (Table 3-1). Eighty-four of the men were in
volved in committed relationships composing 42 couples. Eleven of
the committed relationships were over 10 years in duration, and an
additional 14 couples had been together more than five years.
The 10 uncommitted male subjects were chosen because they re
ported lifestyles that evidenced no significant current emotional in
volvement with a sexual partner. Five of these men cruised the local
gay bars, public toilets, or other known public meeting places in
search of casual sexual partners. None of the 10 homosexual men
reported a homosexual or heterosexual relationship that lasted more
than three months, nor did they express interest in any long-term
27
28 CHAPTER THREE
TABLE 3-I
Homosexual Study: Selection of

Male Study Subjects (N = 94)
No. of Subjects Percent of

Age Screened Interviewed Selected Sample
21-30 104 62 33 35.1

31-40 81 61 48 51.0
41-50 18 14 12 12.8
51-60 5 3 1 1.1
61-70 1 1 0 0
71-80 1 1 0 0
Total 210 142 94 100
(1964-1968)
commitment. According to their description, they interacted with

partners primarily for sexual satisfaction.
Three of the uncommitted study subjects agreed to be tested
with more than one partner in the laboratory. One man was sepa
rately assigned to three partners on different occasions, and 2 men
were assigned two partners each. The seven assigned couples formed
by these 10 study subjects were added to the 42 committed couples
for a total of 49 male homosexual couples interacting in the labora
tory (Table 3-2).
table 3-2
Homosexual Study: Couples Among Male Study Subjects
(N = 94; Male Couples, N = 49)
84 study subjects as committed partners 42 couples

1 study subject (A) with 3 assigned partners 3 couples
1 study subject (B) with 2 assigned partners 2 couples
1 study subject (C) with 2 assigned partners 2 couples
Total 49 couples
(1964-1968)
SELECTED STUDY CROUPS
29
The age distribution for the male subjects was from 21 to 54

years, with the highest concentration in the 31-40-year age bracket
(see Table 3-1). Kinsey ratings from 1 to 6 were represented, as
planned, with the greatest concentration in the 3, 5, and 6 categories
(Table 3-3). The study subjects represented a matriculation dis-
3-3
TABLE
Homosexual Study: Kinsey Classification of Sexual

Preference in Male Study Subjects (N = 94)
Kinsey Scale
Age 0 1 2 3 4 5 6 Total
21-30 0 0 6 9 5 5 8 33
31-40 0 2 5 8 8 15 10 48
41-50 0 2 0 3 0 4 3 12
51-60 0 0 0 0 0 0 1 1
Total 0 4 11 20 13 24 22 94
(0%) (11.7%) (13.8%) (23.4% )
(4.3%) (21.3%) (25.5%) (100%)
(1964-1968)
tribution of 18.0 percent high-school, 41.5 percent college, and 40.5

percent postgraduate levels (Table 3-4).
table 3-4
Homosexual Study: Formal Education in

21-30 35 6 14 15
31-40 47 8 20 19
41-50 11 3 4 4
51-60 1 0 1 0
Total 94 17(18.0%) 39 (41.5%) 38 (40.5%)
(1964-1968)
Listing dependent only upon matriculation (highest level).
CHAPTER THREE
30
There was little genitourinary pathology identified in the male

homosexual population (Table 3-5). Two volunteers had benign
table 3-5
Homosexual Study: Genitourinary Pathology in
Age Group Distribution

Findings 21-30 31-40 41-50 51-60
Pathology
Benign prostatic hypertrophy 0 0 1 1
Inguinal hernia (symptomatic) 0 1 0 0
History of gonorrhea 7 4 1 0
Additional data
Uncircumcised penis 3 3 1 1
(1964-1968)
prostatic hypertrophy, and 1 other study subject had a symptomatic

inguinal hernia. Eight men were uncircumcised.
Twelve cases of gonorrhea had been previously diagnosed and
apparently treated effectively in 10 of the 94 men in the homo
sexual population. Each of 2 men treated twice for gonorrhea re
ported being infected once in homosexual and once in heterosexual
activity.
Eighty-two female study subjects were accepted for laboratory
evaluation, including 76 women who were involved in committed
relationships forming 38 committed couples. The age range was
from 20 to 54, with the highest concentration being in the 21-30-
year age bracket (Table 3-6).
There were 6 uncommitted women who, like the uncommitted
males, were not currently interested in long-term relationships. One
study subject had been involved in a lesbian relationship of six
months’ duration that had ended more than two years before the
homosexual research program began. Three uncommitted female
study subjects sought casual sexual partners through frequenting
gay bars and joining activist groups. They described their sexual
interactions as being primarily for tension release. There was a his-
SELECTED STUDY GROUPS
31
TABLE 3-6
Homosexual Study: Selection of
Female Study Subjects (N = 82)
No. of Subjects Percent of

18-20 5 4 1 1.2
21-30 72 54 37 45.1
31-40 68 41 31 37.8
41-50 17 14 10 12.2
51-60 3 3 3 3.7
61-70 1 1 0 0
71-80 1 1 0 0
Total 167 118 82 100
(1964-1968)
tory of only one episode of heterosexual interaction for 1 study sub

ject in the six months prior to the recruitment period.
Two of the uncommitted women interacted with 2 different as
signed partners, forming 4 assigned couples. These, combined with
the 38 committed pairs, totaled 42 homosexual female couples
evaluated in the laboratory (Table 3-7).
All Kinsey ratings were represented, with highest concentrations
being in the 3, 4, and 6 categories (Table 3-8). The female study
table 3-7
Homosexual Study: Couples Among Female Study Subjects
(N = 82; Female Couples, N = 42)
76 study subjects as committed partners 38 couples

1 study subject (D) with 2 assigned partners 2 couples
1 study subject (E) with 2 assigned partners 2 couples
Total 42 couples
(1964-1968)
subjects represented a matriculation distribution of 32.9 percent

high-school, 51.2 percent college, and 15.9 percent postgraduate
levels (Table 3-9).
CHAPTER THREE
32
TABLE 3-8
Homosexual Study: Kinsey Classification of Sexual Preference
in Female Study Subjects (N = 82)
Kinsey Scale
Age 0 1 2 3 4 5 6 Total
18-20 0 0 0 0 1 0 0 1
21-30 0 0 5 12 10 4 6 37
31-40 0 2 5 6 6 5 6 30
41-50 0 1 1 2 1 2 4 11
51-60 0 0 0 0 0 1 2 3
Total 0 3 11 20 18 12 18 82
(0%) (13.4%) (22.0%) (22.0%)
(3.6%) (24.4%) (14.6%) (100%)
(1964-1968)
3-9
TABLE
Homosexual Study: Formal Education in

18-20 1 1 0 0
21-30 38 11 20 7
31-40 30 8 17 5
41-50 10 5 4 1
51-60 3 2 1 0
Total 82 27 (32.9%) 42(51.2%) 13(15.9%)
(1964-1968)
The recorded pelvic pathology in the female population was

minimal (Table 3-10). The cystoceles, urethroceles, and rectoceles
were apparent at routine physical examination. The women with
these findings of poor pelvic support had conceived and delivered
full-term pregnancies. In 1 woman, the cystourethrocele and rec-
tocele were symptomatic. Four women had undergone hysterec-
33
TABLE 3-IO
Homosexual Study: Pelvic Pathology in

Findings 18-20 21-30 31-40 41-50 51-60
Cystocele 0 2 3 1 0
Urethrocele 0 2 2 1 0
Rectocele 0 1 2 1 0
Hysterectomy 0 0 1 2 1
Myomatous uterus 0 0 1 1 0
Pelvic and labial varicosities 0 0 1 0 0
Pelvic endometriosis 0 0 1 0 0
History of gonorrhea 0 2 2 0 0
(1964-1968)
tomies; in 1 of these women the ovaries were removed. Two women

were found to have myomatous uteri at the time of physical ex
amination prior to acceptance as study subjects.
One woman had pelvic and labial varicosities that became
markedly engorged during sexual activity. There was also one case
of asymptomatic endometriosis that was an incidental finding.
Gonorrhea had been previously diagnosed and treated in 4 of the
women. Three of these women described being infected during
heterosexual activity. The fourth woman, classified a Kinsey 6, had
had numerous female sexual partners and was not sure of the source
of her infection, although she specifically denied having had any
sexual activity with a man.
HETEROSEXUAL STUDY GROUP A
The heterosexual study group A was formed by 50 married and

7 assigned couples. Eleven of the 50 married couples were from
outside the local area. All of the uncommitted heterosexual study
subjects were from St. Louis.
The age range of the male study subjects was from 21 to 57
years, with the highest concentration being in the 31-40-year age
CHAPTER THREE
34
group (Table 3-11). Except for 1 man rated as a Kinsey 1, no

heterosexual study subjects of either sex were rated higher than
Kinsey 0. The Kinsey 1 man reported no homosexual experience
in the two years previous to the research project. The study sub
jects represented a matriculation distribution of 21.0 percent high
school, 35.1 percent college, and 43.9 percent postgraduate levels
(Table 3-12).
3-11
table
Heterosexual Study Group A: Selection of Male Study Subjects
(N = 57-, Married, N = 50; Assigned, N = 7)
No- of Subjects_________ Percent of

21-30 44 29 17 29.8
31-40 49 37 30 52.6
41-50 15 11 8 14.0
51-60 6 4 2 3.5
Total 114 81 57 100
(1967-1968)
TABLE 3-12
Heterosexual Study Group A: Formal Education in


21-30 17 3 6 8
31-40 30 6 9 15
41-50 8 2 4 2
51-60 2 1 1 0
Total 57 12 (21.0%) 20 (35.1%) 25 (43.9%)
(1967-1968)
There was little male genitourinary pathology in study group A

(Table 3-13). One instance of prostatic hypertrophy without
35
TABLE 3-13
Heterosexual Study Group A: Genitourinary Pathology in

Findings 21-30 31-40 41-50 5:1-60
Pathology
Benign prostatic hypertrophy 0 0 0 1
Inguinal hernia 0 1 1 0
History of syphilis 1 0 0 0
Additional data
Uncircumcised penis 0 1 1 0
(1967-1968)
symptoms was identified at physical examination, and there were

two asymptomatic inguinal hernias. Seven cases of gonorrhea and
one of syphilis (all previously treated with apparent success) were
identified in the male study subjects at history-taking. Only 2 of the
men, both married, were uncircumcised.
The youngest female volunteer selected was 21 years old, and
the oldest, 56 years (Table 3-14). As would be expected, there was
TABLE 3-14
Heterosexual Study Group A: Selection of Female Study Subjects

(N = 57; Married, N = 50; Assigned, N = 7)
No. of Subjects________ Percent of

21-30 46 32 27 47.4
31-40 52 39 23 40.3
41-50 17 13 6 10.5
51-60 6 4 1 1.8
Total 121 88 57 100
(1967-1968)
CHAPTER THREE
36
an increased concentration of women in their twenties when com

pared to the age range in the male population. The study subjects
represented a matriculation distribution of 29.8 percent high
school, 45.6 percent college, and 24.6 percent postgraduate levels
(Table 3-15).
TABLE3-1 5
Heterosexual Study Group A: Formal Education in
21-30 27 7 12 8
31-40 23 7 11 5
41-50 6 3 2 1
51-60 1 0 1 0
Total 57 17 (29.8%) 26 (45.6%) 14 (24.6%)
(1967-1968)
As was true for their male counterparts, there were very few
instances of pelvic pathology identified at physical examination for
the 57 women in heterosexual study group A (Table 3-16). There
table 3-16
Heterosexual Study Group A: Pelvic Pathology in

Findings 21-30 31-40 41-50 51-60
Pathology
Urethrocele 1 1 0 0
Cystocele 1 2 1 0
Rectocele 1 1 1 0
Hysterectomy 0 0 1 1
Pelvic labial varicosities 0 2 2 1
Cervical lacerations 1 1 0 0
(1967-1968)
37
were two urethroceles, four cystoceles, and three rectoceles noted.

One woman with all three pelvic hernias was symptomatic but not
significantly distressed. Two women had undergone hysterectomies.
In both instances the ovaries were retained. There were five in
stances of pelvic or labial varicosities. Two women evidenced badly
lacerated cervices from childbirth injury. There were four reported
cases of gonorrhea, apparently successfully treated.
MINORITY GROUP REPRESENTATION
Attempts to recruit black male homosexual couples as study

subjects were unsuccessful. There was, however, 1 committed black
lesbian couple in the female homosexual population. Both women
were Kinsey 6 in sexual preference, 1 in the 21-30-year age group
and 1 in the 31-40-year age group.
Efforts to recruit committed black heterosexual couples were
only partially successful. Three of the committed couples in study
group A were black. In 2 of the black couples, both partners had
high school educations, while the third black couple had a post
graduate level of formal education for the husband and full college
training for the wife. There was 1 Spanish-American married cou
ple. Both partners had matriculated to high school.
Although there were only a few minority group committed cou
ples, none of the homosexual or heterosexual men or women in the
assigned study-subject populations were from a minority group.
MARRIAGE AND CONCEPTION

HISTORIES
The most significant contrast between the homosexual group and

heterosexual study group A is in the pregnancy and presumed im
pregnation histories for female and male study subjects. As ex
pected, the marriage and conception rates were significantly higher
for study group A than for the homosexual group. There were 26
marriages and 33 conceptions for the 82 homosexual women (Table
3-17) as compared to the 66 marriages and 81 conceptions for the
57 heterosexual women (Table 3-18). The 94 homosexual men re-
CHAPTER THREE
38
TABLE 3-I7
Homosexual Study: Combined Marital and Pregnancy History in

18-20 21-30 31-40 41-50 51-60 Total
Number of study subjects 1 37 31 10 3 82
Number of marriages 0 11 9 5 1 26
Conception history
Conception 1 13 14 5 0 33
Full-term or 0 8 10 3 0 21
premature delivery
Miscarriage 0 1 0 0 0 1
Abortion 1 4 4 2 0 11
(1964-1968)
table 3-18
Heterosexual Study Group A: Combined Marital and Pregnancy
History in Female Study Subjects (N = 57)

21-30 31-40 41-50 51-60 Total
Number of study subjects 27 23 6 1 57
Number of marriages 30 28 7 1 66
Conception history
Conception 26 46 9 0 81
Full-term or 17 40 8 0 65
premature delivery
Miscarriage 1 2 0 0 3
Abortion 8 4 1 0 13
(1967-1968)
ported 15 marriages and 11 presumed conceptions (Table 3-19) as

compared to 72 marriages and 93 presumed conceptions for the 57
heterosexual men (Table 3-20).
It is important to emphasize that, despite widespread public as
sumption that individuals with homosexual orientation are not in-
39
TABLE 3-19
Homosexual Study: Combined Marital and Presumed Impregnation
History in Male Study Subjects (N = 94)

21-30 31-40 41-50 51-60 Total
Conception history
Presumed conception 4 6 1 0 11
Full-term delivery 2 4 1 0 7
Abortion 2 2 0 0 4
(1964-1968)
table 3-20
Heterosexual Study Group A: Combined Marital and Presumed
Impregnation History in Male Study Subjects (N = 57)

21-30 31-40 41-50 51-60 Total
Conception history
Presumed conception 16 59 13 5 93
Full-term or 14 50 9 4 77
premature delivery
Abortion 2 8 4 1 15
(1967-1968)
volved with such matters, marriage and reproduction were impor

tant factors in the lives of the homosexual study subject population.
In order to emphasize this, the marriage and conception histories
of the homosexual study subjects will be reported in greater detail
than those of the heterosexual population.
40 CHAPTER THREE
HOMOSEXUAL STUDY GROUP: MARRIAGE

AND CONCEPTION HISTORIES
The one female study subject in the 18-20-year age group classifi
cation conceived at 17 and voluntarily aborted at approximately three
months’ gestation. Of the 37 study subjects in the 21-30-year age
group category, 11 had been married (see Table 3-17). Nine of the
women in this age category achieved 13 known conceptions that
terminated in eight full-term or premature deliveries, one miscar
riage, and four abortions (three voluntary, one involuntary). No
woman in this age group described more than two conceptions.
The most interesting history was that of a study subject who
reported that she had been married, achieved one full-term preg
nancy, had one miscarriage at five months and yet insisted that she
had had intercourse only five times in her life and, as a result, was
classified as a Kinsey 5. She had the frequently encountered history
of having a husband “not interested in sex” and gravitated to
homosexuality originally as a means of sexual release. In time, she
divorced and established a committed homosexual relationship; the
child, a girl, was welcomed into the lesbian couple’s stable social
community.
There were 31 study subjects in the 31-40-year age group, of
whom 9 had been married. Ten of the women in this group re
ported 14 pregnancy histories, from which there were eight full
term deliveries, two premature deliveries, and four voluntary abor
tions. It is interesting to note that of the 9 married women in this
group, 1 had three children and another had two children and one
abortion; yet both of these women had been so involved in homo
sexual activity before, during, and after their marriages that their
sexual preference was classified as high as Kinsey 2 and Kinsey 3,
respectively. The remaining eight pregnancies were described as sin
gle conceptions. One Kinsey 4 unmarried woman in this 31-40-year
age group conceived, carried to term, delivered, and placed the
baby for adoption.
Of the 10 individuals in the 41-50-year age group, 5 had married
and 3 had conception histories that totaled three full-term deliv
eries and two voluntary abortions. Finally, of the 3 women in the
51-60-year age group, 1 woman (Kinsey 5) had married (the mar
SELECTED STUDY CROUPS
41
riage lasted only three days), but there was no history of conception.
It is interesting that following the 21 full-term or premature de
liveries among the 82 women in the homosexual population, there
was only one attempt to breastfeed. This nursing effort was discon
tinued after approximately two weeks because, as the woman re
ported, she “didn’t like it.” Apparently there was no difficulty in
milk production.
Although the number of marriages seems high for subjects of a
homosexual research program, seven of the 26 marital commitments
were brief, lasting six months or less. The longest marriage was re
corded at 13 years (Kinsey 1). Two marriages were common-law
in character (five years in duration) and were listed as marriages
for statistical purposes; 1 of these women was classified as Kinsey 2
and 1 as Kinsey 3 in sexual preference.
In the male homosexual population there were 15 reported mar
riages among the 94 study subjects (Table 3-19). Three subjects
who had been married were rated as Kinsey 1, 6 as Kinsey 2, 4 as
Kinsey 3, and one each as Kinsey 4 and Kinsey 5. The most long-
lived marriage, that of a 46-year-old Kinsey 1, lasted for 17 years,
and the shortest, that of a Kinsey 5, lasted one week.
There were 11 presumed impregnations for the entire male study
subject group. Seven ended as full-term deliveries, and four ended
in abortions. Five of the term pregnancies occurred within mar
riages, as did two involuntary abortions. Two voluntary abortions
and the other two full-term pregnancies were reported by study
subjects who had never married, but who were convinced that they
had been responsible for the pregnancies.
The marriage and reported impregnation statistics of the male
homosexual population may have some interesting implications,
but the material must be evaluated with caution because records of
reported marriages, conceptions, deliveries, and abortions do not pro
vide all the pertinent facts necessary to suggest more than tentative
conclusions. Of particular interest, however, is the strong sugges
tion of lower than normal fertility in the male homosexual study
subject population. As stated above, there were eleven reported
conceptions for the entire homosexual male study-subject group,
seven ending as full-term deliveries and four as abortions. Two of
the marriages, one of a Kinsey 1 subject and the other of a Kinsey 2,
CHAPTER THREE
42
accounted for four of the full-term pregnancies and one involuntary

abortion. Thus, only three full-term pregnancies, two voluntary
abortions, and one involuntary abortion were reported from the re
maining 92 members of the male homosexual study population.
From the viewpoint of fertility, this material stimulates one’s
curiosity. In order to reduce the possibly confounding influence of
the male homosexual study-subjects’ low incidence of heterosexual
coitus, the total of 46 Kinsey 5 and Kinsey 6 male study subjects
(see Table 3-3) whose heterosexual experience was minimal or
absent was arbitrarily eliminated from conceptive consideration.
There remained a total of eleven conceptions reported by 48 men
with ratings of Kinsey 1 through 4. Two study subjects accounted
for five of these eleven reported conceptions, leaving only six pre
sumed conceptions among the remaining 46 homosexual male study
subjects.
There are many relevant factors not accounted for in these sim
ple marriage and conception figures. Use of contraceptive tech
niques, female partners’ fertility status, conceptions of which male
subjects were unaware, and conceptions for which they received
false credit are but a few of the factors that would prevent any firm
conclusions being drawn about the homosexual male subjects’ fer
tility levels. Perhaps most important of all would be a means of
assessing the rate of fertility in those homosexual men who genu
inely desired to father a child; regrettably, data on this topic were
not collected systematically. But the overall impression remains
that a possibility exists that there may be a relatively low level of
fertility in the male homosexual population.
Only implications can be drawn from the low conceptive inci
dence in the small reported sample. A detailed fertility study was
not done on either the male or female homosexual study-subject
population. Research attention was directed elsewhere, so sugges
tions of reduced male fertility have been drawn retrospectively.
Probably the only contention that could be supported from the
statistics available is that there is enough clinical evidence to make
a well-planned investigation of this subject of homosexual male in
fertility worthwhile. In a small subgroup of homosexual men
studied at the Institute several years after this work was completed,
it was noted that lowered sperm counts were seen in a significant
fraction of the groúp (Kolodny et al., 1971).
43
HETEROSEXUAL STUDY GROUP: MARRIAGE

AND CONCEPTION HISTORIES
The 57 heterosexual women reported 66 marriages and 81 con

ceptions (see Table 3-18). The 57 heterosexual men reported 72
marriages and 93 conceptions (see Table 3-20). When impregna
tion histories provided by the 50 married men and the 7 uncom
mitted men are compared to the pregnancy histories of their female
counterparts, it is interesting that the 57 men reported a presumed
conception number of 93 while the 57 women identified 81 concep
tions. This discrepancy is explained to some extent by the total of
72 marriages for the men as compared to 66 for the women. Also to
be taken into account is the somewhat older age of the male popu
lation, allowing more opportunity for impregnation in other rela
tionships. Also, 8 of the 57 women had no positive conception his
tories, compared to 5 of 57 men.
Of interest is the group of 7 heterosexual men and 7 heterosexual
women who cooperated as assigned couples in study group A. None
of these men and women were married at the time of their labora
tory participation, but there were histories of six prior marriages
for the men (1 man had been divorced twice) and four prior mar
riages for the women. Although they were without acknowledged
commitment at the time of their participation in the research pro
gram, only 2 men and 1 woman took the position that as of the
present they were ruling out any interest in a permanent relation
ship. Each of the 7 men and 7 women stated that they previously
had been fully responsive sexually to the various types of sexual
stimulation that were to be employed during their period of labora
tory interaction. Their only expressed concerns were for their own
physical attractiveness or for that of their assigned partner-to-be.
SUMMARY
The compositions of the homosexual study group and hetero

sexual study group A have been discussed and charted in some
depth in this chapter. With the addition of the discussion of the
reduction process by which the original heterosexual research group
CHAPTER THREE
44
became study group B (see Chapter 2), three of the Institute’s four
basic research populations have been described. These study groups
will be used to illustrate homosexual men and women’s facility of
sexual response in a laboratory setting in comparison to that of sta
tistically comparable heterosexual research populations. Further,
these study groups provide a unique opportunity for immediate
comparison of the sexual physiology and sexual behavior of men and
women of homosexual and heterosexual orientations. Finally, from
these homosexual and heterosexual study groups, comparisons can
be drawn to the ambisexual study population—the fourth basic
research population—reported in Chapter 8.
4
STUDY SUBJECTS IN THE
LABORATORY
lhere are many technical problems involved in conducting a re

search program dealing with the basic physiologic and psychosexual
aspects of human sexuality. In part the success of the project de
pended upon meeting the emotional needs of the men and women
participating in such a controversial research program. For example,
meticulous scheduling arrangements led to effective security, which
in turn provided the individual study subject with the psychosocial
support so necessary to the success of the project.
Anxious homosexual couples and older men and women of each
of the alternative lifestyles usually needed a great deal of reassur
ance about confidentiality, but once the security measures proved
effective, the concerned parties cooperated with the research pro
gram without restraint. It is of inestimable importance for the re
search staff to maintain a consistently professional atmosphere in
all interaction with study subjects so that these men and women
may feel free to express themselves in as spontaneous a way as pos
sible both in response to sexual stimuli and to questioning during
interviews. Perhaps most important to research productivity was
the decade of prior experience, which enabled the research team to
contribute more effectively to the study subjects’ general sense of
comfort in the laboratory environment. Such a sense of comfort
was not only a vital factor in effective recording of physiologic pro
cesses, it also improved the facility and frequently the integrity of
study-subject interrogation.
An attempt has been made to describe procedural problems that
arose during the research programs. The anxieties and concerns of
both researchers and study subjects are emphasized. The laboratory
45
CHAPTER FOUR
46
setting is described and concerns for privacy discussed along with

details of the acclimation process requested by many members of
the study groups. Finally, brief histories are presented of those homo
sexuals requesting exemption from standard laboratory procedures.
SCHEDULING
A problem that persisted despite many efforts at resolution was

that of scheduling homosexual partners for sexual interaction in the
laboratory. Appointments for heterosexual subjects were far more
easily arranged, since most of them lived in the local geographical
area, but there were many complicating factors for the homosexual
study subjects, particularly committed couples, most of whom lived
far from St. Louis. Transitory illness, unforeseen business or pro
fessional demands, menstrual periods, important social engagements,
children, and air-travel mix-ups were but a few of the problems
faced in scheduling laboratory commitments for homosexual study
subjects.
Without the almost unlimited cooperation of the large number
of men and women who volunteered as study subjects in all cate
gories of sexual orientation, the investigation could not have been
conducted. The study subjects’ willingness to make last-minute
scheduling changes, patience with scheduling errors, and consis
tently high degrees of cooperation were constant sources of encour
agement for the research team.
During the evaluation of the homosexual study subjects, observa
tions usually were conducted on Friday nights, Saturday afternoons
and evenings, and Sunday mornings. This concentration on week
end investigative sessions was designed for the convenience of both
the study subjects and the researchers. Weekend scheduling pro
vided both travel time and adequate opportunity for full coopera
tion by the study subjects without interfering with their normal
work demands. Weekend timing also made Monday through Friday
of each week available to the researchers for other professional com
mitments. For example, during the last two years of the homosexual
investigation (1967 and 1968), weekdays and evenings were de
voted to evaluating heterosexual study group A.
STUDY SUBJECTS IN THE LABORATORY
47
STUDY-SUBJECT POPULATION
Over the 14-year period from 1957 through 1970, a combined

total of 1,076 men and women appeared at least once as a study
subject in the laboratory. The vast majority of study subjects par
ticipated in laboratory evaluation on a number of occasions within
the same project. There were 415 committed couples who partici
pated in one or another of the various Institute projects. Assigned
couples have not been totaled, since a number of men and women
worked with more than one assigned partner within a project. The
remainder of the study subjects were committed to research projects
that did not require couple participation. These projects included
such diverse interests as evaluation of intravaginal chemical contra
ceptives (Johnson and Masters, 1962; Johnson et al., 1970) and
the physiology of the artificial vagina (Masters and Johnson, 1961 ).
For the reader’s convenience, Table 4-1 lists the number of men
and women who functioned in the various study groups and the
years the groups were activated. No man or woman ever was re
cruited to become a member of more than one study population.
In addition, it is important to realize that patients of the Institute
have never been observed in the physiology laboratory during any
phase of their evaluation or care.
STUDY-SUBJECT CONCERNS
Problems inevitably have arisen during the volunteers’ episodes of

cooperation in the laboratory. It is difficult to assign a priority to the
problems because the multiple psychosocial implications of a con
troversial research program inevitably magnify minor concerns into
major crises, at least in the eyes of the research subject.
The two most frequently expressed concerns have been those of
fears for sexual performance and fears of identification as a study
subject. Other fears, such as concern for personal attractiveness to
the partner, occurred on a less frequent basis. Obviously the pres
ence of these inhibiting factors was also cause for research team
anxiety.
4» CHAPTER FOUR
TABLE 4- 1
Study Subjects in the Laboratory, îgtf-igyo
Committed
Study Group Male Female Couples
I. Original heterosexual study group * 312 382 276

(1957-1965)
II. Heterosexual study group A 57 57 50
(1967-1968)
III. Homosexual study group 94 82 42 (male)
(1964-1968) 38 (female)
IV. Ambisexual study group 6 6 0
(1968-1970)
Assigned partners (heterosexual) t 8 14
Assigned partners (homosexual) t 11 13
Rectal intercourse group t
Heterosexual 7 7 4
Homosexual 10 0 2
Dildo usage group t
Heterosexual 1 3 1
Homosexual 0 6 2
Total 506 570 415
note: No study subject ever participated in more than one study group.
* This population was reduced to form study group B in order to compare the
originally collected data with that of study group A and the homosexual study group
(see Chapter 2).
t Assigned to ambisexual partners only.
t Small groups assembled for the purposes of these limited investigations.
Protection from personal identification as a research subject was

a constant source of anxiety. This concern was most frequently ex
pressed by the homosexual couples, specifically by older men or
women, but almost as frequently by heterosexual and ambisexual
study subjects.
Security measures for protection of the cooperating personnel and
for the research records have been of paramount importance since
the initial investigations of heterosexual physiology were conducted
during the decade of the 1950s. Even though the homosexual in
vestigative programs originated in the 1960s, the security problems
were more severe; in fact, security concerns were significantly in
49
creased, not only for the homosexual and ambisexual study subjects
involved in the research project, but for Institute personnel as well.
As was explained to every potential study subject, there is no such
thing as guaranteed protection from identification. Each individual,
however, was assured that every effort would be made to protect his
or her anonymity not only while they cooperated with the Insti
tute’s research programs, but for the future as well.
As a routine security measure, research records have always been
carefully isolated. Episodes of sexual interaction in the laboratory
usually were reserved for the late evening or early morning hours
or for weekends, and laboratory personnel were severely restricted
in number. In short, many security techniques were utilized, most
of which will not be discussed in order to preserve their effective
ness for the future. To the research team’s knowledge, of the hun
dreds of men and women involved as study subjects in the research
projects, only 6 have been openly identified as having participated
in Institute programs, and in each instance, the decision to be iden
tified as a study subject was made by the individuals themselves.
Of course, many others living at long distances may have discussed
participation in the research programs with friends or relatives with
out the research team being aware of these breaks in security; but it
is also true that persons have claimed participation in Institute pro
grams that never took place, further complicating the issue.
Fears of performance have been expressed by study subjects in
dozens of different ways during the years of laboratory investigation.
Such anxieties were expressed by both committed and assigned
pairs. One note of interest is that during the late 1950s by far the
largest number of vocalized performance concerns came from the
male study subjects, but during the investigations of the mid-1960s,
the female participants were beginning to become as concerned
about effectiveness of performance as the men. The population
without apparent concern in this area was the ambisexual study
group, none of whom ever verbalized any concern for performance.
This anxiety over study subjects’ sexual performance was shared
by the research team. It was anticipated that there might be prob
lems of satisfactory function in private arising from failure to func
tion effectively in the laboratory, but, in fact, such problems never
materialized. Despite anxieties that may have been initially ex
50 CHAPTER FOUR
pressed, the few men and women who failed to function effectively
on a specific occasion in the laboratory, with one exception (Chap
ters 6 and 11) never evidenced serious concern during or after the
failure episodes, nor did they report any functional repercussions in
their private lives. They simply explained their ineffective perfor
mance by saying, “I was tired,” “I just couldn’t get involved,” or
“It wasn’t my day,” and moved into the next opportunity with con
fidence and success.
Successful sexual experience does breed confidence. It would in
deed be rare for a sexually active man or woman to reach 60 years
of age with a perfect score in sexual performance. The rare episode
of failure to function effectively did not seem to bother sexually ex
perienced individuals significantly. The men and women who coop
erated with the Institute’s research projects had significant sexual
experience and seemed reasonably comfortable with their rare epi
sodes of failure.
Usually it is relatively inexperienced men and women who allow
a single episode of functional failure to build into crippling fears of
sexual performance. If ever there was reason to support the concept
that only sexually experienced men and women should be invited
to participate in evaluation of sexual function in a laboratory set
ting, it is the fact that a depth of experience tends to lend comfort
and objectivity to a failure episode. The functional efficiency of the
study subject is discussed in detail in Chapter 6.
Concern over one’s personal attractiveness as viewed by the part
ner was expressed frequently by male and female study subjects in
both homosexual and heterosexual assigned relationships. These in
dividuals with expressed concern for personal attractiveness fre
quently needed reassurance from their partners. Men and women
in committed relationships rarely expressed such fears.
Occasionally concerns were expressed on the opposite side of the
coin: Would the assigned partner be attractive? Would there be
time to become comfortable personally with the previously un
known partner before sexual interaction? Would the partner be
too demanding or too restrained or not cooperative enough sex
ually? These fears, like those for personal attractiveness, were ver
balized primarily by assigned partners and seemed to be at least
S.TUDY SUBJECTS IN THE LABORATORY
51
partially neutralized by the act of communicating them to the re

search team.
An anticipated complication of the research program was the pos
sibility of study-subject exhibitionism. Although there is an un
deniable element of exhibitionism inherent in volunteering for such
studies, there has been no overt display of exhibitionism in any In
stitute research program. Dressing and toilet privacy were routinely
maintained without incident, and there simply was no advantage
taken of the occasions of nudity that were the inevitable by-products
of any investigation of human sexual physiology. Every courtesy al
ways was extended to the assigned partner, and married couples in
evitably conducted themselves in a circumspect manner.
Assigned subjects voiced occasional concern about the risk of
contracting venereal disease via their laboratory exposure, but this
concern was minimized by use of appropriate screening procedures.
Finally, the anticipated problem of study subjects attempting so
cial interchange with members of the research team should be men
tioned. Again research-team anxieties proved unwarranted. No sense
of real or implied intimacy was ever acted out or even suggested in
verbal or nonverbal communication between study subjects and
members of the research team. The chaperonage inherent in the
composition of a male-female research team was ideal in preventing
any such complications and in creating a sense of comfort and con
fidence on the part of the study subjects.
As an integral part of the dual-sex research-team function, psy-
chosexual histories were taken by each member of the research
team. Physical examinations of potential male and female study
subjects were always chaperoned. But most important, no form of
sexual activity was requested of a study subject in the laboratory,
with or without a partner, unless both members of the research
team were present. The exception to this statement was when an
individual study subject or a couple was given the opportunity to
respond sexually in the laboratory in private during their requested
acclimation opportunity. Without this protective umbrella of a
combination of chaperonage and professional support, many study
subjects might have been handicapped in their freedom and con
fidence to express themselves sexually in a laboratory environment.
CHAPTER FOUR
52
THE LABORATORY
The laboratory in which the homosexual study group, hetero

sexual study group A, and the ambisexual study group were evalu
ated was essentially the same in equipment and furnishings as that
established almost a decade earlier for the investigation of the origi
nal heterosexual study group. Before the newer research groups were
evaluated, the decision was made to use the same type of recording
equipment for the investigation of physiologic response that was
used a decade previously. It was anticipated that existing data from
the original heterosexual study group * would be compared with
data from the newly constituted study groups; therefore mainte
nance of reasonable equality in recording capacity seemed indicated
in the interest of research objectivity.
The temperature in the laboratory was maintained at approxi
mately 78 degrees Fahrenheit. Lighting was controlled so that there
was no bright glare, but full visibility was maintained. Sound was
deadened but not totally controlled. Some study subjects requested
background music. When such requests were made, they were
granted.
Over 90 percent of the study subjects had never been observed in
sexual activity before cooperating with the Institute’s research pro
grams. There was no desire to put excessive pressure on any man or
woman by subjecting an individual to any possible source of anxiety
in the laboratory that could be avoided. Therefore, observers were
limited to the two principal investigators and occasional laboratory
personnel.
ACCLIMATION PROCESS
For many study subjects, acclimation to the laboratory procedure

and environment was a vital precursor to sexual interaction in the
laboratory. During the acclimation process, there was a brief discus
sion of the overall research concepts and goals of the investigative
* The original heterosexual study population was reduced to form study eroun B
(see Chapter 2).
53
program. Of course, before any laboratory episode, the specifics of

the particular experiment in which the study subjects were to par
ticipate were presented in detail. The technical problems at hand,
the information sought, the considered clinical risks, if known, and
the reasons for employing particular investigative procedures were
discussed with each volunteer at the outset of every investigative
session. These precautions were taken not only to improve study
subject cooperation, but also to support the ethical standards that
should apply to any investigative program involving human subjects.
All of the volunteers were cooperative in their laboratory appear
ances, and many became sincerely interested in the program’s goals,
the homosexual study subjects especially so. Many procedural sug
gestions were made by the study subjects that proved to be of real
value, for there was a free flow of information between these men
and women and research team personnel.
LABORATORY ACCLIMATION
The study subjects were introduced to the laboratory environ

ment as another step in the orientation process. Equipment devoted
to recording physiologic activity and the other laboratory facilities
were demonstrated for potential research participants in order to
engender in them a sense of comfort with their surroundings.
The study subjects were encouraged to set their own pace in
reaching a state of comfort within the laboratory environment be
fore sexual interaction was observed. For example, if to instill con
fidence there was a need for partners to interact sexually in the
laboratory before observation techniques were initiated by research
personnel, the opportunity was made available. Such opportunity
seemed particularly indicated (1) when requested by a study sub
ject, (2) when indicated by his or her general behavior during the
preacceptance interview, or (3) when suggested by the content of
the psychosexual histories obtained during the interview.
The acclimation process was further facilitated for the study sub
jects by prior exposure to the experiences of history-taking and
physical examinations, during which the volunteers had become
acquainted with the research team. Exposure of the potential re
search participants to these screening techniques helped to estab
lish an aura of professionalism for the research team members that
CHAPTER FOUR
54
has been of inestimable importance in conducting investigative pro

grams in an extremely controversial area.
It was observed that homosexual study subjects usually required
considerably less acclimation opportunity compared to heterosexuals
of similar age groups and educational backgrounds. For example, of
the 16 assigned homosexual partners, only 6 requested time spent
in laboratory acclimation. Of the 14 assigned heterosexual subjects
(study group A), 9 required orientation procedures. This discrep
ancy between the sexual confidence and personal comfort of inter
acting homosexual and heterosexual assigned subjects occurred de
spite the fact that each study subject had a long history of effective
sexual function. There is further discussion of this subject in Chap
ter 11.
When committed couples were compared, it was obvious that
the homosexual study subjects responding in the laboratory felt less
performance pressure than did the heterosexual study subjects. It
was even more evident from both physical action and verbal com
ment, however, that the individual act of masturbation under ob
servation was far less comfortable for the homosexual group than
for their heterosexual counterparts. These variations in psychosexual
behavior between individuals committed to alternative lifestyles will
be discussed briefly in Chapter 11.
The ambisexual study subjects evidenced no need for acclimation
opportunity before interacting sexually in the laboratory.
COMMUNICATION BETWEEN HOMOSEXUAL

SUBJECTS
Regardless of sexual preference, study subjects were always en

couraged to set their own pace when sexual activity developed in the
laboratory. They were directed to take whatever time they required,
to move into sexual approach as they saw fit, and to respond freely,
both verbally and nonverbally, as they felt need. Consideration was
given to standardizing instructions for procedures during sexual ac
tivity by regulation of time intervals, assigning which partner should
initiate, and so on, but was discarded to allow fullest assessment of
spontaneous behaviors and responses.
For committed male homosexual couples, sexual interaction fol
lowed patterns obviously familiar and fully acceptable to both part
55
ners. While the responding partners enacted many variations on

the standardized techniques of sexual stimulation, rarely was there
need for a discussion between the sexual partners as to procedural
activities. Regardless of the stimulative approaches employed or of
the decision of who approached whom first, the study subject being
evaluated almost always had erections and ejaculated before the ex
perimental session was terminated (Chapter 6).
Assigned male homosexual study subjects A, B, and C (Chap
ter 3), interacting in the laboratory with previously unknown male
partners, did discuss procedural matters with these partners, but
quite briefly. Usually, the discussion consisted of just a question or
a suggestion, but often it was limited to nonverbal communicative
expressions such as eye contact or hand movement, any of which
usually proved sufficient to establish the protocol of partner inter
action. No coaching or suggestions were made by the research team.
The committed lesbian couples also had well-established, indi
vidualized patterns of sexual interaction. Who was to stimulate
whom and in what order, and whether there was to be mutual stim
ulation or a combination of “my turn-your turn” techniques, were
rarely discussed in the laboratory. The stimulative approaches were
free-flowing, seemed essentially unreserved, and quite obviously
were not staged. The study subject being observed rarely failed to
attain orgasmic release at least once before termination of the par
ticular experimental opportunity. Actually more than 50 percent of
all women responded at multiorgasmic levels at one time or another
during sexual opportunities in the laboratory (Chapter 6).
When female study subjects interacted in the laboratory with
their assigned partners, different patterns of interaction were evi
dent when compared to the committed female pairs. While initial
stimulative activity tended to be on a mutual basis, in short order
control of the specific sexual experience usually was assumed by
one partner. This assumption of control was established without
verbal communication and frequently with no obvious nonverbal
direction, although on one occasion discussion as to procedural
strategy continued even as the couple was interacting physically.
The only other direction given specifically to the assigned indi
viduals or committed couples by the research team prior to sexual
interaction was the request that on any particular occasion they
56 CHAPTER FOUR
limit their sexual behavior to the stimulative approach designated,

whether masturbation, partner manipulation, or fellatio/cunnil-
ingus, or, for heterosexual subjects, coitus. For couples having
coitus, any desired preliminary stimulation was accepted.
PRIVILEGE OF PRIVACY
When masturbational response was requested, the responding

heterosexual and homosexual men and women were given the “priv
ilege of privacy” if desired. Defined solely for this investigative pro
gram, privilege of privacy meant the exclusion from the laboratory
of one’s sexual partner and any other individuals aside from the re
search team. For many homosexual male and female study subjects,
evaluation of masturbational response was conducted without part
ner presence. Fifty-seven of 94 males and 49 of 82 females requested
privacy from their committed partner’s observation during mastur
bational activity. Interestingly, each of the subjects who was willing
to interact in the laboratory with multiple assigned sexual partners
(Chapter 5) requested privacy for his or her own masturbational
activity. In comparison, for heterosexual study groups A and B,
privacy for individual masturbational activity was requested by less
than one-third of the male and female study subjects evaluated.
We have no secure explanation for this apparent discrepancy in
psychosexual behavior.
EXCEPTIONS TO FULL PARTICIPATION
There were five exceptions to full participation in the laboratory

requested and granted to members of the homosexual study group.
Two men and 3 women requested restricted sexual interaction. One
man requested playing purely a stimulator role; the other man in
sisted on only the role of stimulatee. Of the 3 women (X, Y, and
Z), woman X refused to masturbate in the laboratory, and women
Y and Z insisted on playing only stimulator roles. With the excep
tion of 1 man, all of the homosexual study subjects who preferred
playing a restricted role in sexual interaction were beyond 30 years
of age and were members of committed couples. When the desire
to interact sexually in a restricted manner that did not prejudice
the investigative program was so strong, the request was honored.
Heterosexual study subjects in group A did not request limited
57
sexual participation in the laboratory, and those in study group B

that were restricted in activity by investigative demand were elimi
nated from statistical consideration.
Brief consideration should be given to the histories of those
homosexual men and women who requested exemptions from the
full cooperation expected from study subjects in the laboratory.
Woman X was a Kinsey 2 in the 31-40-year age group who did not
want to masturbate in the laboratory environment. In explanation of
her request, she reported a traumatic experience that occurred during
her adolescence. She had been surprised while masturbating by her
mother, punished severely (a physical whipping by her father; social
privileges removed for a long period by her mother), and thereafter had
taken great care to lock doors, hide in closets, and to otherwise secure
her privacy in order to continue her masturbational practices. Her guilt
centered upon getting caught rather than in response to the act itself.
Woman X initially had had a heterosexual orientation, starting with
intercourse at 18 years, and she continued to be quite active sexually in
a multiplicity of casual relationships until shortly after her thirtieth
birthday. She was occasionally orgasmic, but usually she had to resort
to masturbation in private to obtain release of tension after her sexual
experiences with men.
She met and in short order became fully committed to a woman who
was in her late thirties and a Kinsey 6. They had been living together for
approximately two and one-half years when the couple was seen in the
laboratory. Even in this fully satisfactory sociosexual arrangement,
woman X had been unable to masturbate in front of her partner, al
though the partner frequently masturbated in front of her and encour
aged her to similar openness. There was full freedom of cooperation in
partner manipulation or cunnilingus on woman X’s part, but she had
been unable to reverse her early conditioning and masturbate openly.
Woman Y was a Kinsey 5 in the 41-50-year age group who had been
gang-raped as a virginal woman 20 years old. There had been a good
deal of physical trauma, necessitating some surgical repair of the vaginal
barrel and the perineum. The story of the rape was common knowledge
in the small town in which she lived, and her male contemporaries had
not only been vicious in their comments, but demanding sexually. There
had been no psychotherapeutic support provided by her family, and her
inability to cope with the situation had led to total rejection of the male
sex.
Rejecting all social and sexual experience with males, woman Y as
sumed a male role herself within 18 months after the rape episode. She
moved to a bigger community, began supporting herself, dressed in a
CHAPTER FOUR
5«
masculine fashion, cultivated a low voice, and deliberately selected a

lesbian life. When seen in the laboratory, she had ruled in complete
double-standard fashion a committed lesbian relationship of over four
years’ duration. This specific relationship had been deliberately sought
by woman Y, who seduced her best friend into a lesbian relationship.
Woman Y regularly initiated sexual interaction, relieving her partner
either by manipulation or cunnilingus or both, but she always refused
physical approach or sexual release from the partner. As the partner was
aware, woman Y masturbated at night to relieve tension. She maintained
both dressing and toilet privacy for herself, but insisted upon freedom
to observe her partner in both situations. She did not object to mastur
bating in the laboratory, but she was one of the women who requested
that her partner not be present during the episodes. She cooperated
twice with masturbational activity and was multiorgasmic on both oc
casions.
'Woman Z, 29 years of age with a Kinsey 4 preference rating, had
turned to lesbianism after a history of forced incestuous activity. Her
mother had died when she was 12; her father had not remarried. There
was one sibling, a brother three years older. Her father, apparently drink
ing heavily at that time, had initially forced intercourse when she was
19 years old. After a number of sexual experiences with her father, the
brother, aware of his sister’s new role, had demanded equal sexual op
portunity to keep from spreading the word among her friends. For
almost two years she received both men on demand. There was no re
ported sexual pleasure; frequently an artificial lubricant was necessary.
Woman Z left home at 21, refused further social interaction with any
man, drifted into the gay bar society, and had multiple casual homo
sexual experiences during which she still was not responsive at orgasmic
levels. Finally she established a long-term (over three years’ duration)
relationship with her current partner.
Woman Z also had insisted on full control of the couple’s sexual ac
tivity. She initiated opportunity, satiated her partner with manipulation
or cunnilingus, but always refused to allow the partner to approach her
physically. The partner suspected, correctly, that woman Z used a vi
brator frequently, since this activity was always conducted in private.
There was no history of dressing or toilet privacy for this committed
couple.
Woman Z cooperated fully with masturbational activity in the labora
tory, but she requested that her partner not be present. She stimulated
her partner with both manipulative and cunnilingal approaches, but she
rejected any physical approach herself.
Each of the two homosexual men who refused full cooperation
requested permission to play a specific role in sexual interaction in
59
the labbratory. One man insisted on reacting sexually only in the

role of stimulator, the other in that of stimulatee.
The stimulator was in the 41-50-year age group, a Kinsey 4 by sexual

preference. He stated that he couldn’t remember when he started mas
turbating, maintaining a frequency of at least five to seven times a week.
He found that no male partner—and he had had many—could provide
the degree of sexual pleasure that he could for himself. A number of
female partners had also proved relatively unsatisfying sexually in any
physical approach they made. He had finally stopped allowing his part
ners to approach him sexually almost 10 years before he was seen in the
laboratory. He made his sexual interest quite clear before he was accepted
as a study subject.
With his current relationship, the arrangement from the beginning
had been that this man was pleased to satisfy his partner with manipula
tion and fellatio, but would always reserve his own release activity to
self-manipulation, usually with his partner observing. The arrangement
had proved satisfactory to both partners through two years of a com
mitted relationship.
The stimulatee, a man in the 21-30-year age group and a Kinsey 6 in

sexual preference, had been introduced to homosexuality by two older
brothers who took turns manipulating the younger brother, but who
reserved release opportunity to each other. The initiation occurred dur
ing the boy’s fifteenth year. He continued as a willing responder to his
brothers’ frequent sexual approaches until age 19 without ever being al
lowed the stimulator role. He then moved into gay society, but always as
the ejaculatee. As would be expected, his casual relationships were al
most always with older men. At times he accepted money for his co
operation, but he never became a full-time prostitute.
He was totally committed to a homosexual orientation, but his co
operation in the laboratory was conditional upon not being required to
assume the manipulator role. He participated as an assigned study subject.
SUMMARY
In this chapter, frustrations with scheduling, security problems,

privacy concerns, anxieties over self-image and partner attractive
ness, and communicative ploys have been described with relation
to the study subjects cooperating with the Institute’s research pro
grams. Particular attention has been paid to the homosexual research
6o CHAPTER FOUR
population in this discussion, although comparisons with the hetero

sexual study groups have been drawn when indicated. Brief histories
have been provided for 2 homosexual men and 3 homosexual
women who made specific requests for restricted sexual interaction
in the laboratory.
COMPARATIVE SEXUAL
BEHAVIOR PATTERNS
Descriptions of study subjects’ sexual behavior patterns as ob

served in the laboratory are offered with four cautions: First, there
is no assurance that a homosexual or heterosexual couple’s overt
patterns of sexual behavior as observed and recorded in the labora
tory are identical to those that would develop for the same couple
responding in the privacy of their own bedroom. The possible
existence of discrepancy in physiologic response between sexual
behavior in a more conventional setting and that encountered in
a laboratory environment must always be kept in mind. The addi
tional element of observation adds a further confounding variable.
The same caution in interpreting laboratory results was voiced in
1966 when results were published from the original investigation of
heterosexual physiology.
Second, descriptions of sexual behavior represent only the pre
dominant variations in observed sexual response patterning. Unless
a repetitively recurring behavior pattern emerged during any form
of sexual interaction, no description of sexual behavior has been
provided. The research team was far more interested in usual rather
than extraordinary sexual behavior.
Third, over the years all of the study subjects, whether homo-
sexually or heterosexually oriented, or whether in committed or
assigned relationships, have been sexually experienced men and
women. Historically, they have had no difficulty in sexual per
formance. In fact, one of the important reasons these study sub
jects were selected by the research team was because they were
specifically facile in sexual response. In order to acquire secure
information about the basic patterns of human sexual interaction,
61
62 CHAPTER FIVE
inevitably one must work with men and women who respond
effectively. The carefully selected homosexual and heterosexual
study subjects employed in the Institute’s research programs must
not be considered representative of a cross-section of sexually adult
men and women in our culture.
Fourth, qualified investigators with similar opportunities to
observe and evaluate hundreds of male and female sexual response
cycles might occasionally have presented differing opinions of
behavioral patterning in homosexual or heterosexual response. Re
gardless of the degree of observer experience, the reported opinion
of human sexual interaction is at best suspect, and at worst, may
simply be in error.
These four reservations always should be kept in mind when
evaluating the comparisons that have been drawn by the research
team of sexual behavior patterns created by homosexual and hetero
sexual men and women responding sexually in a laboratory environ
ment.
COMPARATIVE PATTERNS:
MASTURBATION
Over the years, hundreds of masturbational cycles have been

observed in the research laboratory. It has been of real interest that
the minimal differences observed in masturbational behavior were
primarily gender-linked rather than related to sexual orientation. Of
course, many variations in technique were exhibited, but these
variations were as frequently present in homosexual as in hetero
sexual study groups. Men and women were completely free to select
whatever position and whatever technique of masturbation they
desired within the confines of the laboratory.
Men moved immediately to the penis at the onset of self-
stimulative activity. Usually one hand (the dominant hand) was
employed. Until obvious penile engorgement was attained, the play
was usually nondirective, almost aimless in character. Approxi
mately three of five men masturbated while supine in bed, one of
five standing, and the remainder sitting or lying face down. In the
early stages, play was freely distributed between shaft and glans.
Rarely was the scrotum manipulated.
COMPARATIVE SEXUAL BEHAVIOR PATTERNS
When a relatively full erection developed, the force and rapidity

of the stroking pattern increased. Manipulative concentration gen
erally focused on the penile shaft with only secondary inclusion of
the glans. When men tired, hands were alternated, but both hands
were simultaneously employed infrequently. With onset of the
second stage of the male’s orgasmic experience (ejaculation), most
men slowed or even stopped forceful stroking and simply held the
penis as the ejaculatory process continued. Only a few men con
tinued manipulative activity during the entire ejaculatory phase.
A few men of both homosexual and heterosexual orientation
masturbated successfully lying face down and using the bedding to
thrust against. There was minimal manipulation in these cases, and
observation was severely hampered. There also were two hetero
sexual men who masturbated by pressuring the erect penis between
the thighs. This technique of pressuring the thighs together was
far more frequently employed by women to stimulate the clitoral
area.
There was no incidence of ejaculation with a flaccid penis during
observation of masturbational procedures in the laboratory.
There were no specific masturbational patterns that would iden
tify women as heterosexually or homosexually oriented. Approxi
mately four of five women masturbated in the supine position, with
the remainder standing or lying face down and rubbing the mons
area against the bedding. At the onset of self-stimulation, women
generally were less direct in their approach to the clitoris than were
men in approaching the penis. Some women briefly touched their
breasts; others casually stroked the lower abdomen, the inner as
pects of the thighs, and/or manipulated the labia before palpating
the clitoris. However, once the clitoris was approached, contact
usually was maintained.
Most women tended to manipulate the clitoral glans directly at
the onset of stimulation. But as sexual tensions elevated and re
sultant increases developed in rapidity of manipulation and/or
stroking pressure, women consistently moved from the glans to
stimulation of the clitoral shaft or to the general mons area. As
with the men, manipulation was typically conducted with the
dominant hand, but when women tired they usually slowed the
pace rather than changing hands. Far more than men, women
deliberately varied the rate and pressure of genital stroking, at
64 CHAPTER FIVE
times even stopping and starting clitoral manipulation in a self

teasing manner. During orgasm most women, as opposed to most
men, continued their manipulative activity, although at a some
what slowed, irregular pace, throughout most of the episode.
Women of both homosexual and heterosexual orientation occa
sionally employed intrathigh pressure as a masturbational tech
nique rather than any form of manual stimulation. The thighs
were pressed close together, bringing pressure to the clitoral area.
Some women maintained constant pressure, while others alternately
squeezed their thighs together and then relaxed in a rhythmic man
ner. These pressure techniques were generally applied with the
woman on her back or lying face down, although two women pre
ferred the sitting position.
Although facilities were not available in the laboratory, a number
of both homosexual and heterosexual women described using
running water under pressure (usually in the bathtub) directed to
the clitoral area as the preferred method of masturbational release.
Vibrators were not used in the laboratory, although there were his
tories of such usage from all the female study groups.
COMMITTED COUPLES’ INTERACTION
When either partner manipulation or fellatio/cunnilingus was

the stimulative approach requested, the decision of who was to
approach whom sexually, and in what order, was made by the
couple before sexual interaction was initiated.
There was one dominant pattern of sexual behavior consistently
observed in the sexual interaction of committed male or female
homosexual couples that was infrequently present in the sexual
activity of committed heterosexual couples. Usually, the committed
homosexual couples took their time in sexual interaction in the
laboratory. Generally there was a deliberately slowed approach to
the entire stimulative process. The slowed approach was obvious to
the observers and was confirmed later during subject interrogation.
The interacting homosexual couples appeared to be more relaxed
and gave the impression of more complete subjective involvement
in the sexual activity than did their heterosexual counterparts.
The homosexual couples tended to move slowly through excite

ment and to linger at plateau stages of stimulative response,
making each step in tension increment something to be appre
ciated. Stimulative approaches were usually free-flowing rather than
forceful or directive in character, and rarely was there overt evi
dence of goal orientation. The exchange of pleasure at all levels of
sexual excitation appeared to be of greatest importance, with the
orgasmic experience merely one more step in the pleasure sequence.
In contrast, the sexual behavior of the married couples was far
more performance-oriented. An apparent pressure to “get the job
done” was usually evident during partner manipulation and fellatio/
cunnilingus and was consistently present during coition.
The predominant heterosexual behavioral pattern was one of
purposeful stimulation with obvious goal direction, regardless of
which stimulative technique was employed. Most married couples,
as they moved through their excitement and plateau phases toward
end-point release, spent less time than committed homosexual
couples at each phase of sex-tension increment. At times they
created the impression that the objective experience of goal attain
ment was valued almost as much as the subjective experience of
orgasmic release.
Interestingly, this sense of goal orientation, of trying to get
something done over and beyond a mutual exchange of pleasur
able stimuli, was exhibited almost as frequently by the heterosexual
women as by their male partners. Preoccupation with orgasmic
attainment was expressed time and again by heterosexual men and
women during interrogation after each testing session. Apparently,
the cultural pressures for goal attainment consistently imposed
upon coital performance also affect other modes of heterosexual
interaction, such as partner manipulation and fellatio/cunnilingus.
Obviously, there were exceptions to these generalized descrip
tions of sexual behavior. There were committed homosexual couples
who were completely goal-oriented, and there were married couples
who obviously enjoyed the pleasures of sex-tension increment re
gardless of end-point release. Still, the predominant sexual be
havior of the committed homosexual and heterosexual couples fol
lowed the described behavior patterns closely.
66 CHAPTER FIVE
PARTNER STIMULATION (FEMALE)
Sexual interaction within committed lesbian couples usually

began with full body contact. There was holding, kissing, and
caressing of the total body area before any specific approach was
made to breasts or genitals. Only 6 of 76 homosexual female study
subjects who were members of committed couples moved directly
to breast stimulation, and there was only 1 woman who approached
her partner’s genitals at the onset of sex play.
In contrast, in committed heterosexual couples’ interaction, the
male’s sexual approach to the female did include some close body
contact and kissing, but rarely more than 30 seconds to a minute
were spent holding close or caressing the total body area before the
breasts and/or genitals were directly stimulated. This was con
siderably shorter than the corresponding time interval observed in
homosexual couples. Actually, the most frequently observed be
havior pattern involved the man’s direct stimulation of his partner’s
breasts or genitals at onset of sexual interaction.
When the committed lesbian couple did turn to breast play, it
was significantly prolonged compared to similar activity during
heterosexual interaction. The full breast always was stimulated
manually and orally with particular concentration focused on the
nipples. Interestingly, almost scrupulous care was taken by the
stimulator to spend an equal amount of time with each breast. As
much as 10 minutes were sometimes spent in intermittent breast
stimulation before genital play was introduced. The stimulatee
always evidenced copious vaginal lubrication during these pro
tracted periods of breast stimulation, and, on many occasions, the
stimulator also was well lubricated (see Chapter 7). On two sepa
rate occasions a woman member of a committed couple was orgas
mic during breast play alone before her genitals had been ap
proached directly.
The focus of lesbian breast play was directed toward the sub
jective pleasure of the recipient. During the lengthy “play periods,”
the stimulator usually responded to the stimulatee’s nonverbal
communication of pleasure and expended specific effort to enhance
the recipient’s experience of the moment rather than forcing her

rapidly toward higher levels of sexual excitation. Such nondemand
ing approaches served to elevate sexual tensions slowly, but most
effectively.
In the sexual play of married couples, female breast stimulation
was far more casual. Husbands apparently spent time in stimulating
their wives’ breasts as much, if not more, for their own immediate
arousal as specifically to enhance the female partner’s sexual plea
sure. In most cases the man became so involved in his own sexual
tensions that he seemed relatively unaware of the degree of his
female partner’s sexual involvement. There were only a few in
stances when the husband seemed fully aware of his wife’s levels of
sexual excitation and helped her to expand her pleasure quotient
rather than attempting to force her rapidly to higher levels of
sexual involvement. It was no surprise, then, that in contrast to
lesbian interaction, the heterosexual women lubricated moderately
at most during breast play, and there was no instance of orgasmic
attainment during female breast stimulation by a male partner.
With four exceptions, the committed lesbian study subjects re
ported that subjectively they thoroughly enjoyed and were aroused
by breast stimulation. This degree of involvement was not de
scribed by heterosexual married women. Almost one-third of the
women queried in heterosexual study group A and in the original
heterosexual investigation (from which study group B was derived)
reported that their breasts were not a particularly important
erogenous zone to them. However, all of the women thought that
breast play was very important in their husbands’ sexual arousal.
Many committed women stated that the greatest sexual arousal
they derived from breast play was from subjective appreciation of
their husbands’ evidences of pleasure in the exercise.
Whether or not this marked difference in sensitivity to breast
stimulation between homosexually and heterosexually oriented
women is the result of operant conditioning has not been estab
lished. There is, of course, the strong possibility that the higher
levels of subjective appreciation of stimulative return from breast
play inherent in intragender eroticism would tend to make lesbian
breast play a more effective source of sensual pleasure. Particular
support is given to this contention by the observation that fre
68 CHAPTER FIVE
quently during breast play for one lesbian partner, both partners in
a committed couple lubricated extensively.
There was another important behavioral difference between com
mitted lesbian partners interacting and husbands approaching their
wives in stimulation of the female breast. The lesbian women were
well aware that at times in the menstrual cycle a woman’s breasts
and/or the nipples may be tender—even painful—to touch. A
number of times early in breast play, lesbian stimulators asked
their partners if their approach to the breasts caused discomfort.
On several occasions the instructions from the stimulatee were to
be gentle, and on two occasions the stimulatee requested that the
breast stimulation be discontinued.
Throughout the years in the laboratory with both heterosexual
research populations, no husband ever raised the question with his
wife as to whether his approach to the breasts distressed her in any
way. On three occasions wives asked for more gentle breast play,
but no heterosexual woman ever requested cessation of play.
Close observation has suggested that there were many times
when women were made physically uncomfortable by their hus
bands’ approaches to the breast. Although frequently admitting
later in private that the observer’s impression of cyclic breast ten
derness had been correct, the women simply did not inform their
husbands at the time. The usual stated reason was because “he
likes to play with my breasts so much I didn’t want to distract
him.” When the husbands were queried separately, they expressed
surprise at their wives’ cyclic distress, and the unanimous reaction
was, “Why didn’t she tell me?”
During the committed lesbian couples’ genital play, the labia,
mons, inner aspects of the thighs, and vaginal outlet were almost
always approached before the clitoris was stimulated directly. When
clitoral contact was initially established, the contact was casual.
After initial contact with the glans, the clitoral shaft usually be
came the primary focus of stimulative activity.
There were two predominant types of genital play evidenced by
committed lesbian couples. First, there was the time-consuming,
nondemanding approach, during which a responding partner was
brought to highly elevated levels of sexual excitation, allowed to
regress, and then returned to her previously elevated tension levels.
This “teasing cycle” might be repeated several times before orgas

mic release was allowed.
During the second type of lesbian genital play, the responding
woman was stimulated with more continuity and with rapidly in
creasing intensity until she was orgasmic. Shortly thereafter, the
clitoris was again directly approached and the responding woman
was provided opportunity for further orgasmic experience or expe
riences. As would be expected, a combination of the two behavior
patterns was also observed rather frequently, but most couples
seemed to prefer one of these two patterns of stimulative behavior.
When husbands moved to stimulate their wives’ genitals, the
labia, vaginal outlet, and internal vaginal barrel were manipulated
on perhaps half of the occasions before the clitoris was approached
directly. Again, there were consistent differences between lesbian
partner and husband approaches to the female genital area. Rarely
did lesbians attempt vaginal barrel stimulation with their fingers
other than at the vaginal outlet. If penetration occurred, it was usu
ally restricted to the outer third of the vagina. Husbands, however,
did not reserve manual stimulation to the vaginal introitus; fre
quently they inserted a finger or fingers deeply into the vagina.
Many heterosexual women evidenced little pleasure from digital
insertion and were obviously distracted by deep vaginal penetration,
particularly if it occurred early in genital play. Again, there was
sparse, if any, communication between husbands and wives. Only
twice did wives ask their husbands to desist from deep manual
penetration of the vaginal barrel. Yet when questioned about this
presumed stimulative practice, the wives responded as they had
when questioned about breast play. Approximately one-third of the
wives questioned said that they felt that deep manual penetration
of the vaginal barrel was more exciting to their husbands than
stimulating for them, and they willingly tolerated the approach
for this reason. The remaining two-thirds of the women ques
tioned varied in response from ambivalence to stated pleasure in
manual vaginal penetration, particularly if the penetration occurred
late in genital play.
There was also a consistent difference observed in homosexual
and heterosexual manipulative approach to the clitoris. The lesbian
approach to full cycle stimulation has already been discussed. After
70 CHAPTER FIVE
a husband made the initial contact with his partner’s clitoris, he

generally attempted to maintain continuing contact with the glans.
He rarely moved to the clitoral shaft or the mons area until after
he lost contact with the glans during the clitoral retraction phe
nomenon that is associated with the plateau phase of the female
sexual response cycle.
There was yet another difference between husbands and lesbian
partners in the approach to clitoral stimulation—a difference that
was based upon essentially parallel sexual behavioral patterning.
When approaching the clitoris, whether the stimulator was female
or male, the approach typically was a duplication of the stimu
lator’s own previously observed masturbational patterns. In other
words, the husband tended to approach his wife’s clitoris in the
same manner and with essentially the same techniques that he had
demonstrated when masturbating under observation. The same was
true for the lesbian approaching her partner’s clitoris with manual
manipulative techniques. She manipulated her partner’s clitoris
with the same physical approach that she had demonstrated when
masturbating.
Since rapid, forceful stroking was the pattern of choice during
male masturbation, it was also a consistent pattern during the
male’s manipulation of his female partner’s clitoris. Apparently,
the lesbian’s less forceful approach to masturbation and therefore
to her partner’s clitoris was generally the more acceptable or at
least the less distracting.
On the few occasions when less demanding clitoral play was evi
denced by male partners, the husbands were questioned as to the
reason for this particular variation in behavioral approach. Most
indicated that either their wives or some other woman had sug
gested that a less forceful approach to the clitoris was usually
preferred. Random questioning of some of the forcefully manipula
ting men also returned the information that either they had never
had any direction from a female partner relative to clitoral ap
proach or that requests for a less forceful approach had been
brought up on other occasions but had been forgotten.
71
PARTNER STIMULATION (MALE)
Homosexual interaction within committed male couples tended

to follow the same response patterns described for lesbian activity.
A significant amount of time usually was spent in an initial ap
proach involving the entire body. Direct genital stimulation was
rarely employed at the onset of sexual interaction.
After general body contact, holding close, kissing, or caressing,
frequently the first specific anatomic approach was to the nipples.
Only 11 of the 42 committed male couples (Chapter 3) failed to
include some form of nipple stimulation at an early stage of sexual
interaction. As with the lesbian behavioral patterns, both manual
and oral stimulative techniques were employed, but the com
mitted females’ seeming compulsion to spend relatively equal time
at each breast was not observed during the interaction of male
homosexual partners. If penile engorgement was not present before
the stimulatee’s nipples were approached, it invariably developed
during this activity. At times a partially established erection reached
an advanced expansive stage, and occasionally even nonrhythmic
pelvic thrusting occurred. The naturally occurring waxing and
waning of full penile erection (Chapter 7) was observed as the
stimulative periods were prolonged. Although the usual preejacu-
latory mucoid emission from the urethral meatus was observed on
numerous occasions, no man ejaculated in direct response to nipple
stimulation. Less than one in four of the homosexual men also
achieved erection while stimulating their partners’ nipples.
The techniques of nipple stimulation varied significantly be
tween committed male homosexual couples and married hetero
sexuals. Rarely did a woman approach her husband’s nipples, either
manually or orally. On the few occasions when nipple stimulation
did occur, it was always of brief duration and, with one exception,
did not create an erective response similar to that elicited by homo
sexual males.
Obviously, nipple eroticism was of far more significance to com
mitted homosexual men than to married heterosexual men. Not
7a CHAPTER FIVE
only the homosexual stimulatees, but also their sexual partners

were apparently influenced by prior conditioning. Regardless of
partner role-playing, almost three-quarters of the committed homo
sexual male couples included some form of nipple stimulation in
their sexual interchange, while no more than three or four in 100
married men were so stimulated by their wives.
Genital play techniques also differed between the male homo
sexual and heterosexual study populations. More time was taken
in low-key, nondemanding genital play in male-male interaction
than in female-male genital stimulation. The homosexual male
partner’s initial approach to the genital area tended to encompass
the anus, thighs, perineal area, scrotum, and lower abdomen more
frequently than when a wife stimulated her husband’s genitals. She
usually confined her stimulative approaches to the penis and the
scrotum.
As previously described for the committed lesbian couples’ sexual
interaction, teasing techniques were employed frequently during
committed male homosexual interaction. Once the responding
homosexual male reached plateau levels of sexual excitation, his
partner tended to observe him closely for nonverbal communication
of sexual tension levels. He then altered the rate of the stimulative
activity in an obvious effort to prolong the stimulatee’s high levels
of sexual excitation without moving him to orgasmic release. Char
acteristic of intragender empathy, many homosexual men fre
quently made selective approaches to the frenulum of the penis, a
most sensitive area on the dorsal surface just beneath the coronal
ridge. Time and again men were brought within obvious proximity
of their orgasmic experience and allowed to regress to low plateau
or high excitement levels before being cyclically restimulated.
On a number of occasions, stimulatees actually asked for release
well before their committed partners provided ejaculatory oppor
tunity. Obviously, this teasing technique represented a behavioral
patterning established and accepted between the committed homo
sexual participants well before their research project participation.
Regardless of which homosexual partner was the stimulator or the
stimulatee, teasing techniques were employed consistently in the
laboratory and usually occasioned extremely high levels of sexual
pleasure.
73
Whén randomly queried about behavioral patterns, the com

mitted male homosexual study subjects usually stated in essence
that they stimulated their partners the way that they (the stimu
lators) would like to be stimulated. Alternatively, the men said
that they and their partners had discussed the subject on a number
of occasions and had exchanged information about their personal
pleasure preferences.
When a wife moved to stimulate her husband’s genital area,
there was minimal stimulative attention paid to the lower abdo
men, thighs, and perineal area, although scrotal exploration was
observed consistently. Women usually concentrated their stimu
lative approach on the shaft of the penis rather than the glans. The
frenulum was rarely stimulated electively. And once penile manip
ulation began, stroking usually was conducted at a steady pace
until the male partner evidenced elevated sexual tension levels.
Then there was increased rapidity and vigor of stroking until the
man ejaculated.
Rarely did a wife identify her husband’s preorgasmic stage of
sexual involvement and suspend him at this high level of sexual
excitation in a cyclic manner by slowing or even temporarily dis
continuing the penile manipulative pattern for appreciable lengths
of time before reconstituting full erection and stimulating ejacula
tion. On the few occasions when this pattern of sexual behavior
was initiated by the wife, the man’s overt expression of sexual
pleasure was quite equal to that of the similarly treated male homo
sexual.
Wives were interrogated privately as to the sources from which
they developed their penile manipulative techniques. Only three
women reported that their husbands had suggested specific tech
niques for penile stimulation, such as identifying the sensitivity of
the frenulum, the preferred rate of manipulation, or desired appli
cation of manual pressure. The principal expressed concern of most
wives was not to stroke the penis too vigorously and hurt the male;
beyond this fear, their technical approach to penile stimulation
was totally the result of whatever personal experience they had
acquired. Frequently, ejaculation was viewed as proof of a com
pletely satisfactory manipulative technique.
Those women who had developed a pattern of teasing the male
CHAPTER FIVE
74
at some length before providing ejaculatory opportunity typically

stated that the technique had developed because they had applied
to their partner the pattern of stimulation they would have enjoyed
themselves.
When husbands were interviewed, their most frequent com
plaint was that their wives did not grasp the shaft of the penis
tightly enough. Yet not one man with this complaint had ever
taken the initiative and suggested this specific technical improve
ment to his wife.
FELLATIO/CUNNILINGUS
When fellatio/cunnilingus were the sexually stimulative tech

niques employed by committed homosexual and heterosexual
couples at the research team’s direction, the patterns of preliminary
stimulative approach such as general body contact, breast play, and
genital manipulation were identified as essentially interchangeable
with the stimulative techniques employed by the same men and
women during the partner manipulation observations. Therefore,
description of the specifics of early stimulative approach will not
be repeated.
In general terms, it can be stated that once again committed
male and female homosexual pairs tended to adopt a slower, less
demanding sexual approach. More time was taken in the sexual
preliminaries, and there was far less expression of a subjective sense
of urgency for goal attainment. During fellatio/cunnilingus, expres
sions of concern for performance were primarily restricted to the
husband and wife group.
There were specific differences in sexual behavior patterning once
the committed homosexual and heterosexual partners moved from
the preliminaries of sexual interchange to the specifics of fellative
or cunnilingal activity. The differences that existed were not essen
tially limited to those associated with sexual preference roles, as
has been described for the partner manipulation interactions. Sig
nificant variations in actual fellative/cunnilingal behavior as ob
served in both homosexual and heterosexual study-group interac
75
tions were confined to cunnilingal activity. Thus, with these tech

niques the differences were both gender and preference oriented.
FELLATIO
There was minimal difference evidenced in the technique of fel

latio between committed homosexual and heterosexual couples.
From a functional point of view, there was little observable tech
nical variation between sexually experienced homosexual males
practicing fellatio upon their partners and sexually experienced
wives similarly stimulating their husbands. The homosexual males
did follow the general pattern of proceeding without any sense of
haste, slowing and speeding up the fellative activity in a teasing
technique. Other than this sexual preference-oriented approach to
fellatio, there was little observed difference between the two groups.
Both the homosexual males and the wives were obviously interested
in creating as effective a stimulative opportunity for their partners
as possible, and they succeeded about equally. Same-sex empathy
did not seem to be of significant importance in effectiveness of
fellative stimulation.
The only appreciable difference between homosexual and hetero
sexual fellatio was in the practice of swallowing the ejaculate. The
uniform practice of both groups was for the male to ejaculate
intraorally. Most homosexual males in fellating their partners to
orgasm did swallow the ejaculate, while most women, whether
wives or assigned partners, did not. There was no absolute pattern,
however; at times there was swallowing, at times not, by the same
individual, so only a general statement can be made. It may reason
ably be presumed that unless sexual experience dominates, there is
little to choose between the sexual effectiveness of committed male
or female partners employing fellative techniques.
CUNNILINGUS
With cunnilingus, it was an entirely different matter. There

simply was no comparison between the skillfullness of men and
women when cunnilingus was employed as a stimulative technique.
Not only were committed lesbians more effective in satisfying their
partners, they usually involved themselves without restraint in the
cunnilingal activity far more than husbands approaching their
CHAPTER FIVE
76
wives. They demonstrated much more inventiveness in cunnilingal

stimulative approaches and, above all, had the advantage of gender
empathy. They inherently knew what pleased and used this knowl
edge to specific advantage.
The lesbian approach to cunnilingus started with the breasts,
moved to the lower abdomen and thighs, and, in turn, the labia
and frequently the vaginal outlet before concentrating on the
clitoris. Once focused on the clitoris, the approach varied greatly
from forceful stroking to a slow, gentle stimulative technique. And
the stimulators varied their approaches significantly from episode
to episode with the committed partner. The more variation on the
theme exhibited by the stimulators, the higher the levels of sub
jective involvement evidenced by the stimulatees.
The lesbian stimulators usually became quite involved sub
jectively during the cunnilingal activity. Most stimulators lubri
cated copiously, and there were two instances of orgasmic experi
ence recorded by stimulators while subjectively involved in a
stimulatee’s multiorgasmic response pattern.
The husbands, despite experience and lack of restraint, usually
were not as effective with cunnilingal stimulation as the lesbian
stimulators. The husbands’ approaches tended to be stylized with
repetitive episodes of cunnilingus rarely demonstrating innovation
in stimulative technique. The husbands, once focused on the
clitoris, tended to stimulate forcibly until orgasm occurred. There
was less evidence of subjective involvement by the wives than
demonstrated by the lesbian stimulatees.
Husbands had erections during cunnilingus and obviously were
sexually excited, but no husband ejaculated during cunnilingal ap
proach to his wife, regardless of her level of sexual excitation or
whether she evidenced multiorgasmic response patterning.
When interviewed in private, the consensus opinion returned
from husbands was that they had usually viewed cunnilingus as a
means to an end (coitus) and simply had not devoted as much
concentration on effective stimulative techniques as they might
have if they had viewed cunnilingus specifically as an end-point in
itself.
On the other hand, the wives in private discussion stated that
they considered fellatio to be a challenge; they saw it as a tech
77
nique that they should become expert at if they were to conduct

themselves (compete) as sexually effective women. Apparently the
husbands had not felt so challenged, for they described no competi
tive social demand to be experts with the technique of cunnilingus.
Their cultural challenge to sexual effectiveness had been and con
tinued to be confined to their role in intercourse. Such is the cul
tural influence on man’s sexual function; even the most sexually
experienced heterosexual men understandably internalize the cul
tural dogma that coitus is the be-all and end-all of end-point re
lease. There is also the possibility that some of the lack of male
effectiveness in cunnilingus may well be a response to some uncon
scious, culturally determined inhibition on the part of either hetero
sexual partner.
ASSIGNED PARTNERS’ INTERACTION
From this overview of sexual interaction in the laboratory, it is

obvious that there are clearly marked differences in the behavioral
patterns commonly practiced by committed homosexual and mar
ried heterosexual couples. When observing the behavioral character
istics of assigned homosexual and heterosexual partners interacting
in response to partner manipulation and to fellatio or cunnilingus,
however, the previously clearly established variations in sexual be
havior patterns are indeed blurred. Assigned male and female
homosexual partners spent far less time in total-body stimulation
than did the committed homosexual couples. Regardless of whether
the directed technique was to be partner manipulation or fellatio/
cunnilingus, the assigned lesbian couples moved immediately to
ward breasts and genitals, while the assigned male couples rarely
used nipple stimulation at any time. Direct approaches to the geni
tals at the onset of sex play was the procedure of choice.
The teasing techniques of controlled slowing and speeding up of
manipulative effort so frequently observed in the interaction pat
tern of committed male and female homosexual couples, both dur
ing partner manipulation and during fellatio/cunnilingus, were
much less in evidence and, when present, usually of shorter dura
tion for assigned male and female homosexual couples. Only one
CHAPTER FIVE
7»
long-continued, teasing approach was observed during interactive

episodes of homosexual male assigned couples, and this teasing
technique was specifically requested of the partner by the male
homosexual who only wished to play the role of stimulatee (Chap
ter 4).
The assigned homosexual female couples at times did slow the
stimulative process, and teasing techniques were more in evidence
than during the assigned homosexual males' interaction. But the
time spent and the variations in stimulative techniques employed
by the assigned homosexual couples did not compare to those em
ployed by the committed homosexual couples.
In brief, assigned homosexual pairs were essentially performance-
oriented, providing little of the partner “care” evidenced by com
mitted homosexual couples. Orgasm was the end-point goal, and
the presumed quickest path toward orgasmic release of the partner
was taken with alacrity by the stimulator so that it would soon be
“my turn.”
The sexual behavior patterns of the assigned heterosexual cou
ples responding to partner manipulation and fellatio/cunnilingus
were essentially indistinguishable from those of the assigned homo
sexual couples, except for the complete absence of teasing tech
niques. All assigned heterosexual partners were indeed goal-oriented.
In fact, the only situation in which the goal of end-point release was
even more evident than that of assigned homosexual couples was in
the sexual interaction of assigned heterosexual couples.
Regardless of the stimulative technique requested of assigned
heterosexual couples, the immediate approach was to the genital
areas. The female breasts were stimulated manually and orally, but
in a most perfunctory manner, by the male partners. When the as
signed heterosexual female partners became aroused, it was almost
entirely due to pelvic play. Although the assigned heterosexual fe
male study subjects were experienced women, and in a high per
centage of cases attained orgasmic levels of sexual excitation (Chap
ter 6), they did not appear to be deeply involved subjectively in
their experience. Similarly, there also was no obvious return for the
assigned heterosexual male partners from the techniques of partner
manipulation and fellatio other than the immediacy of sexual ten
sion release.
79
COMMITTED PARTNERS’ COITION
The entire process of coital interaction provides far more oppor

tunity for distraction than is true for any other method of sexual
interchange. As previously stated, manual and/or oral stimulative
approaches, when employed as precursors to coitus, were usually
cursory in nature, brief in duration, or even forceful in character
when compared to the usual pattern of slowed, tension-accumula
tive, overtly teasing techniques observed in homosexual behavior.
For that matter, the precoital stimulative approaches were much
more superficial and engendered far lower levels of subjective in
volvement than had been true for the same men and women when
they were directed to employ partner manipulation and fellatio/
cunnilingus to end-point release. This “eye-on-the-goal” precept of
precoital interaction consistently reduced the subjective input from,
and therefore the stimulative quality of, manual or oral sexual ac
tivity. Since there usually were significantly lower levels of subjec
tive involvement with precoital stimulative techniques, there was
far more opportunity for personal distraction during this phase of
the entire coital process, and the observed incidence of distraction
did elevate markedly.
With onset of the actual mounting process, there was further op
portunity for distraction from sexual involvement for either one or
both coital partners. In all but two of the observed coital oppor
tunities among married couples and in every one among the as
signed couples, the male partner initiated the mounting process
when he was sufficiently aroused sexually. He arbitrarily decided
when his female partner was ready to be mounted, hunted for the
vaginal outlet, and inserted or attempted to insert the penis. Rarely
did the man question his partner as to her level of sexual excita
tion. On the other hand, rarely did the woman offer her partner
such important information, either verbally or nonverbally. Thus,
through false presumption or poor communication or both, the ac
tual mounting process was frequently observed to be a source of
distraction for either the man or the woman or both.
When these sexually experienced men were questioned about
8o CHAPTER FIVE
their concept of when their partners were ready to be mounted, the

most frequent answer provided was, “I knew she was ready when
she lubricated.” While an obvious level of vaginal lubrication can
be safely interpreted by the male partner as evidence of a state of
physiologic penile receptivity, it must never be interpreted as an
indication of the individual woman’s psychological demand for im
mediate penetration.
Further distractive behavior developed for female partners as
soon as coital connection was established. In more than 90 percent
of the observed coital experiences, once the penis was encased in
the vagina, the man not only initiated but controlled the thrusting
pattern. This male domination of the thrusting pattern left to the
female partner not only the immediate but also the continuing task
of accommodating to the depth, the frequency, and the force of
the male’s thrusting action. This continuing requirement for ac
commodation distracted many women, at least temporarily, from
whatever levels of sexual excitation they previously had attained
during the period of precoital stimulation.
If there is full male dominance, and particularly if there is a rela
tively short period of time between vaginal penetration and ejacu
lation, the distractions of physical adjustment to coital mechanics
may prove too high a barrier for the female partner to negotiate
successfully. And although she may be orgasmic, her levels of sub
jective involvement in the coital act may remain at low levels.
Actually, the distractions of the mounting process (the timing,
the hunting for the vaginal outlet, and the act of penile insertion)
and of the woman’s accommodation to the thrusting pattern were,
at times, converted into and relished as teasing techniques when
conducted with finesse by experienced coital partners. It was inter
esting to observe the manner in which some of the significantly
experienced heterosexual study subjects converted these mounting
and thrusting distractions into teasing techniques that resulted in
exceptionally high levels of subjective involvement in the coital
process for both partners. But such conversion did not occur fre
quently.
There also were specific teasing techniques inherent in coital
thrusting patterns that were most effectively employed by respond
ing husbands and wives. These variations were deliberate altera
COMPARATIVE SEXUAL BEHAVIOR PATTERNS 81
tions in the rapidity of thrusting, the depth of thrusting, and even

in the temporary cessation of thrusting as the man or woman ob
served his or her partner’s levels of sexual involvement and delib
erately teased the partner toward higher levels of sexual excitation.
The potential for sex-tension increment with these techniques is,
of course, unlimited. In the observed couples, the greatest detri
ment to effective female response was male control of the thrusting
pattern. Had the factor of mutual cooperation generally been pres
ent, as it was on a number of observed occasions, the subjective
return in intensity and duration of the female orgasmic experience
would have been far higher than that usually observed. Obviously,
the described variations in thrusting technique could only be suc
cessfully established if the male partner had sufficient ejaculatory
control.
Coital positioning was left to the decision of the sexually reacting
couple. There was evidence of male sexual dominance in that the
male partner controlled coital position selection in by far the ma
jority of cases. Again the female partner rarely assumed a parity
role by suggesting a coital position. She simply waited for and
then followed the male’s lead. Over 80 percent of the coital epi
sodes were conducted in the male superior position. The remaining
coital episodes were experienced in the female superior position,
with the exception of perhaps 1 or 2 percent of the coital episodes
that were carried out with the female partner in the knee-chest
position. None of these three coital positions interfered with ade
quate clinical observation.
ASSIGNED PARTNERS’ COITION
When coitus was the directed sexual behavior, the assigned het
erosexual partners still approached the female breasts and the geni
tals of both sexes directly, with little or no other anatomic pream
ble. The assigned partners tended to initiate the mounting process
as soon as there was obvious lubrication and penile erection. There
was total male dominance, not only of the mounting experience
(timing and penile insertion), but of the thrusting pattern as well.
The assigned female partners adjusted to male domination of the
82 CHAPTER FIVE
coital act on the basis of their extensive prior sexual experience.

Coital activity simply became a mutual masturbational exercise,
with each partner concentrating predominantly on his or her own
needs. Because the sexually experienced male partners generally had
good ejaculatory control, the assigned female partners usually had
time to respond orgasmically. There were episodes of coital teasing
techniques evidenced by members of the assigned partner group,
but they occurred rarely. Levels of subjective involvement by either
member of an assigned couple in the coital process were generally
reported to be lower than those of members of committed couples.
POSTOBGASMIC BEHAVIOR PATTERNS
Regardless of whether the study subjects were homosexually or

heterosexually oriented, the behavior patterns during the resolution
phases of the sexual response cycles experienced in the laboratory
were more gender-linked than related to sexual preference. Although
no sense of time limitation was interjected by the professional staff,
the male study-subject population provided an interesting post-
orgasmic behavioral pattern that was quite opposite to resolution
phase female behavior.
After men were orgasmic in the laboratory, whether through
masturbation, partner manipulation, fellatio, or intercourse, they
tended to rest only briefly. Although obviously involved in the
sensuous experience, they quickly recovered and were soon ready
to leave the bed. The majority of the women reacting to masturba
tion, partner manipulation, cunnilingus, or intercourse, were also
deeply involved in the sensuous experience. But after completion
of their orgasmic experience, they usually rested quietly, evidencing
no immediate interest in leaving the bed.
When the opportunity presented itself, the postorgasmic woman
tended to move toward or curl up against her sexual partner, whether
male or female, and relax quietly, usually with her eyes closed. If
not disturbed by her partner’s sexual restlessness or departure, and
particularly if her experience was multiorgasmic in nature, the
woman usually became drowsy and frequently fell asleep. Rarely
did postejaculatory men fall asleep in the laboratory.
Brief mention should be made of the men and particularly of
the women who after the initial orgasmic experience expressed in
terest in a repeat of such experience in the immediacy of the par
ticular sexual episode. While the usual male postorgasmic pattern
was that of a brief refractory period, during which he was impervi
ous to further sexual stimulation, the experienced female frequently
moved with continuity from one orgasmic experience to the next.
There was no obvious period of time during which she was unre
sponsive to reapplication of the previously successful stimulative
techniques.
Regardless of the gender-linked differences in facility for im
mediate postorgasmic response, the approach to reapplied stimu
lative activity was always the same. Whether male or female, ho-
mosexually or heterosexually oriented, or committed or assigned
partners, there were no nongenital preliminaries when responding to
a multiorgasmic interest. Study subjects always moved immediately
to their partners’ genital organs to restimulate sexual interest. The
obvious goal of end-point attainment was omnipresent, and the di
rect genital approach was usually successful with sexually experi
enced study subjects unless satiation had intervened.
OTHER TYPES OF SEXUAL ACTIVITY
The only other sexual practices evaluated by Institute personnel

were rectal intercourse and dildo usage. Both research projects were
initiated and completed in 1970. Investigation of these two addi
tional varieties of human sexual interaction were considered neces
sary to the Institute’s basic commitment to provide perspectives for
homosexual function within the framework of the physiologic and
psychological aspects of human sexual interaction. Again, perspec
tives were to be drawn by comparing homosexual with heterosexual
response patterns. Since vibrator usage offered no potential for in
creasing perspectives on homosexuality, an investigation of this
stimulative technique was not conducted.
RECTAL INTERCOURSE
The physiology of rectal intercourse has not been presented in

prior publications dealing with human sexual physiology. There has
not been a complete investigation of rectal coition in that there
CHAPTER FIVE
«4
were a limited number of study subjects and a restricted number

of observed coital episodes by both preference groups. Five homo
sexual men and their partners (2 committed, 3 assigned couples),
and 7 heterosexual women and their partners (4 married, 3 as
signed couples) cooperated with the Institute’s investigation of
rectal intercourse. Each couple was involved in rectal coitus on
two separate occasions in the laboratory. Following prior research
patterning, none of the study subjects who were involved in the
evaluation of rectal intercourse or of dildo usage had been members
of other study groups.
Within the stated investigative restrictions, there have been no
significant differences identified in physiologic response during
rectal coitus, regardless of whether the participants were of the
same or opposite gender. Therefore, the following brief descriptions
of both the basic physiology and the behavioral patterns of rectal
intercourse apply generally to both sexual orientations. Minor
gender variations have been identified in context. The physiology
of erection and of ejaculation have been discussed extensively in
previous publications, so investigative focus was primarily restricted
to observations of the penetra tee, not the penetra tor.
With one exception, no lubricative effect has been identified for
the rectal area that can be described as a physiologic response to
sex-tension increment. One woman with a history of years of fre
quent rectal penetration routinely evidenced a minimal degree of a
mucoid moisture at the anal outlet just prior to a mounting episode.
When questioned, the woman stated that she was aware of the lu
bricative effect. This effect had only been present for the preceding
three years, although she described over ten years of frequent rectal
intercourse. She also stated that she always controlled the penetra
tive sequence in that she did not allow a mounting attempt until
she “felt wet.” Although her vaginal outlet also was well lubricated,
indicating significant sexual excitation, there was no direct exten
sion of this lubricating material to the anal area. The source of this
material remains unidentified. With this one exception, some type
of artificial lubrication was used routinely in all other rectal pene
trative episodes. Approximately half of the penetrations were lubri
cated by saliva.
Positioning in anal intercourse tended to vary with gender. Each
of the 7 women voluntarily assumed variations of the knee-chest

position, while only 2 of the 5 men assumed similar positions. The
remaining 3 men simply lay face-down in a fully prone position.
In the immediacy of anticipated anal penetration, all the coital
partners evidenced elevated levels of sexual excitation but, in addi
tion, the male and female penetratees demonstrated weak, irregu
larly recurring contractions of the rectal sphincter. These anticipa
tory contractions were evident once the anal outlet was exposed.
The contractions terminated as the sphincter was slowly dilated
with the penetrative effort.
The response of the rectal sphincter to penetrative effort appar
ently depends upon the number and frequency of prior mounting
episodes. Regardless of a history of frequent rectal coitus, the anal
sphincter responds to the initial penetrative effort with a strong
spastic contraction as an involuntary protective mechanism. When
prior penetrative episodes have been infrequent, this involuntary
spasm of the sphincter may be maintained for a minute or even
longer. If a regular pattern of rectal penetration has been previously
established, the initial protective spasm of the sphincter usually is
short-lived, and involuntary relaxation of the muscle begins within
15 to 30 seconds. The more frequent the prior penetrative episodes,
the more rapid and complete the rectal sphincter relaxation. Once
the involuntary spasm is lost, the anal sphincter usually accom
modates the penis with relative ease, and full penetration of the
lower bowel can be accomplished without incident.
A secondary physiologic response of the rectal sphincter develops
after full penetration. With the onset of a maintained thrusting
pattern, the sphincter usually reverses its relaxation reaction and
constricts tightly around the penile shaft.
In 13 of a total of 24 rectal coital experiences, the penetratees
evidenced varying levels of personal discomfort during the mount
ing episodes. But once full penetration was obtained, there was no
further evidence of penetratee discomfort. While the thrusting
pattern was always initiated by the penetrator, the female partner
usually joined actively in the thrusting experience with well-timed
counterthrusting movements, exactly as she might have been ex
pected to do with vaginal penetration. Only one male penetratee
actively cooperated with his partner by initiating counterthrusting
CHAPTER FIVE
86
behavior. Generally, the male penetratees acted in a passive service

role, while the female penetratees reacted as active sexual partners.
The female penetratees reached orgasmic levels of sexual excita
tion on n of 14 occasions during rectal intercourse. There were
three instances of multiorgasmic experience. But male penetratees
did not respond in similar fashion. There were only two male pene
tra tee orgasmic experiences in a total of 10 opportunities, and in
both instances the men masturbated while they were mounted
rectally.
During the females’ orgasmic experiences, the distended rectal
sphincters contracted in simultaneous rhythm with the contractions
of the orgasmic platform at the vaginal outlet (approximately 0.8-
second intervals). Rectal sphincter contractions usually recurred
three to five times before there was involuntary lengthening of the
intercontractile interval. The rectal sphincter did not contract dur
ing intercourse when the two male penetratees had single orgasmic
episodes initiated by self-manipulation.
There were no observed behavioral differences in the orgasmic
episodes of the penetrators, regardless of whether their partners
were women or men.
DILDO USAGE
Dildo usage was demonstrated in the laboratory by 3 lesbian cou

ples and 3 heterosexual women. Each homosexual couple (2 com
mitted, 1 assigned) followed the pattern of one woman acting as
insertee and her partner as insertor. Two of the heterosexual women
(1 was married) used the dildos as masturbational agents, and the
third heterosexual woman was joined by her husband, who used
the dildo in an insertor role. Each woman cooperated for three sep
arate episodes of sexual interaction in the laboratory. As in the
evaluation of rectal intercourse, there were too few study subjects
reacting through an inadequate number of orgasmic cycles to es
tablish investigative security. As with rectal intercourse, the subject
matter was not deemed of sufficient importance to move investiga-
tionally beyond the collection of general information.
There was little to comment on during the early stages of sexual
interaction between partners when dildos were employed. Once in
teracting sexually, each of the three lesbian couples and the one
married couple moved first to mutual general body stimulation and

then quickly to the breasts and genitals of the insertee before at
tempting dildo insertion. The sex play was apparently enjoyed by
both partners with no evidence of a dominant role. The two hetero
sexual women using dildos as masturbational agents either manipu
lated the genital area manually or used the dildo in direct stimula
tion of the clitoral area before initiating vaginal insertion. It was
only with onset of vaginal insertion of the dildos that significant
differences in behavioral patterning were observed.
Each of the three homosexual couples used the dildo differently,
evidencing variations in prior behavioral conditioning. After an
initial period of genital play, lesbian couple A moved to a self
selected position that had the insertor sitting with legs spread wide
apart and the insertee lying on her back with her pelvis positioned
between her partner’s legs. After careful initial insertion, the in
sertor continually varied the depth and rapidity of stroking. This
teasing technique was continued until the insertee was in an ad
vanced stage of sexual excitation. At this time the insertor, sensing
the insertee’s elevated level of sexual tension, increased the speed
of the stroking and carried each thrust firmly into the depth of the
vagina. With onset of orgasm, the stroking was continued force
fully until the experience was completed and the insertee signaled
her partner to stop. After less than a minute’s respite, the insertor
reconstituted the stroking pattern in a nondemanding, teasing fash
ion until high levels of sexual excitation were reexperienced. Then
the forceful thrusting pattern described above was reintroduced un
til orgasm again intervened. In each of the three episodes the in
sertee was multiorgasmic. Termination of the individual episode
was indicated by the insertee when she reached satiation.
Lesbian couple B’s pseudocoital positioning during interaction
with the dildo was different from couple A’s. The insertee assumed
a knee-chest position with the insertor sitting to her left and beside
her on the bed. Initially, the dildo was forcefully inserted into the
depth of the vagina, and a rapid thrusting pattern was constituted
from the start. The insertee immediately responded with counter
thrusting activity, and orgasmic release was quickly attained. On
two occasions, one orgasmic experience was all that the insertee re
quired. During the third episode, the insertee was multiorgasmic.
88 CHAPTER FIVE
The insertee indicated to her partner whether to continue with fur

ther stimulation after the original orgasmic experience, or whether
it was her desire to terminate the episode.
Lesbian couple C used the dildo in an attempt to simulate inter
course. The insertor strapped the dildo to her own pelvis just over
the symphysis pubis, thus positioning the dildo in reasonable simu
lation of an erect penis. Dildo positioning was accomplished by a
harnesslike belting arrangement that this couple provided for
evaluation. After preliminary breast and genital stimulation of the
insertee, the insertor penetrated her partner carefully and carried
on the pseudocoital connection in a male thrusting pattern. Again
the insertee responded with counterthrusting movements. Once
full vaginal penetration had been obtained, wide variation was em
ployed in the depth and rapidity of the dildo thrusting pattern un
til the insertee was orgasmic. In two of the interactive episodes the
insertee was multiorgasmic, and on the remaining occasion she ex
perienced a single orgasm and was satisfied. She controlled the
pseudocoital experiences, signaling her partner to continue or to
terminate the episode.
Of special note was the fact that, apparently highly excited by a
combination of the pseudocoital thrusting pattern, by mons area
stimulation from the strapped-on dildo, and by subjective appre
ciation of her partner’s obvious sexual excitation, the insertor also
was orgasmic on one occasion.
The two heterosexual women who used the dildo as a masturba-
tional device did so in the usual supine position. After vaginal inser
tion, there was obvious variation in depth and rapidity of stroking
until orgasm was experienced. One woman was orgasmic during
each of her three episodes and was multiorgasmic on one occasion.
The other woman was orgasmic on two occasions, but during one
episode could not achieve orgasmic release. She stated that occa
sionally full sexual involvement did not develop when using the
dildo in private.
The married couple had a history of using a dildo as a necessary
adjunct to full coital activity. It was their established pattern of
sexual interaction to use a dildo for the wife’s orgasmic release be
fore instituting penile insertion and completing male partner re
lease with intercourse. They followed this behavior pattern during

their cooperation in the laboratory. They agreed that the wife usu
ally wanted multiorgasmic opportunity. After more than four years
of marriage, the dildo had been introduced before intercourse as a
means of satisfying the wife because the husband tended to ejacu
late quickly and usually became quite sleepy after his orgasmic
experience.
Following the pattern of their previously reported behavior, this
couple initiated dildo insertion with the wife in a number of differ
ent positions and also practiced variations in depth of penetration
and rapidity of stroking until the wife reached orgasm and, after a
multiplicity of such experiences, indicated that she was sexually
satiated. The husband then mounted and, having only himself to
satisfy, initiated a rapid thrusting pattern and quickly ejaculated.
The dildos employed by the homosexual couples and the hetero
sexual women varied in length and width. In each case, the insertee
supplied her own dildo for the laboratory evaluation.
There actually was little difference in general patterns of dildo
usage, regardless of whether the insertees were homosexually or
heterosexually oriented. In every episode the pseudocoital behav
ioral techniques of dildo usage varied, depending primarily upon
the insertee for direction. Although in a service role, the insertors
were obviously involved in the sexual experience and were primarily
intrigued by the insertees’ exhibition of sexual pleasure.
VOCALIZATION OF SEXUAL TENSIONS
Vocalizations developed during elevated sex-tension levels and

with orgasmic experience in the laboratory and varied not only
between individuals, but even with the same individual from time
to time. In general, the more involved the man or woman became
with his or her elevated sexual tensions and the more comfortable
he or she was with the environment, the more vocalization oc
curred. Most study subjects vocalized the onset of the orgasmic
experience in a relatively uncontrolled manner, but, in addition,
many men and women indicated high levels of excitation (plateau
CHAPTER FIVE
90
phase) by a more controlled vocalization. There were no significant

differences in patterns of vocalization identified in the responses of
members of committed as opposed to assigned couples. Certainly
there were no dominant patterns of vocalization that could be iden
tified as homosexually or heterosexually oriented.
The ambisexual study group (Chapter 8) was certainly the most
vocal research group in identifying elevated levels of sexual pleasure.
In brief, men and women tended to vocalize their elevated sexual
tensions while reacting in a laboratory environment. Generally, the
more sexually responsive the individual, the more socially secure he
or she was in vocally signifying elevated levels of sexual tension.
SUMMARY
When differences in sexual behavior patterns between homo

sexual and heterosexual interaction were established, they were pri
marily in evidence in the committed couple population. The usual
approach of the assigned couples, both heterosexual and homo
sexual, was essentially one of moving toward end-point release as
quickly and efficiently as possible.
It is undeniable that the laboratory environment with its implied
interest in orgasmic attainment was a factor in the performance
orientation of the male and female study subjects. But the same
environment was usually reacted to in a different manner by com
mitted heterosexual and homosexual couples as opposed to the mat
ing patterns of the assigned couples.
A review of laboratory observations of the sexual response pat
terns of homosexual and heterosexual study subjects in both com
mitted and assigned relationships has been presented. As described,
there are significant differences in response patterning between
committed homosexual and heterosexual couples. But there are
even more marked differences between committed and assigned
couples, whether homosexual or heterosexual in orientation. These
issues will be discussed further in Chapter 11.
Various sexually stimulative techniques have been discussed in
relation to both homosexually and heterosexually oriented interac
tion in an effort to provide further dimensions to the Institute’s in-
COMPARATIVE SEXUAL BEHAVIOR PATTERNS gi
vestigation of perspectives of homosexuality. Variations in standard

stimulative techniques have also been considered. In short, this
chapter reports sexual behavior patterns developed in the laboratory
by cooperating homosexual and heterosexual study subjects at re
search team direction.
6
COMPARATIVE
FUNCTIONAL
EFFICIENCY
Oexual functional efficiency is a subject that has had essentially

no systematic investigative attention. What is the incidence of
failure to function at orgasmic levels for sexually experienced men
and women of either homosexual or heterosexual orientation? Do
homosexuals or heterosexuals have the greater incidence of failure
to function effectively in sexual encounters? Do sexually experi
enced men achieve orgasmic release more frequently than similarly
experienced women? Are committed men and women more likely
to achieve orgasmic levels of sexual tension than assigned sexual
partners? Such comparative information has not been published,
nor will the material in this chapter provide unequivocal answers
to these questions. But a start has been made.
As a point of departure, this report describes the failure inci
dence of selected men and women with homosexual and hetero
sexual orientations responding to sexual stimuli in a laboratory en
vironment. It will be recalled that chief among the criteria for
selection for the various study groups was the fact that these men
and women did not have a history of sexual dysfunction.
Thus, this chapter is a report of the response patterns of sexually
functional men and women of either sexual preference responding
in committed or assigned relationships to the stimulative techniques
of masturbation, partner manipulation, fellatio/cunnilingus, or in
tercourse. In no sense should the reported results be construed to
represent a cross-section of men and women in our culture. But
there is a picture drawn of how sexually functional men and women
92
. COMPARATIVE FUNCTIONAL EFFICIENCY
93
can and do respond in a pressure situation (the laboratory environ

ment) to sexual stimuli of both homosexual and heterosexual orien
tation. While no general conclusions should be drawn, this material
does represent one aspect of the functional effectiveness of human
sexual interaction and by use of comparative data provides yet an
other perspective for homosexuality.
The incidence of failure to achieve orgasmic levels of excitation
while employing the stimulative techniques of masturbation, part
ner manipulation, and fellatio/cunnilingus is reported for the homo
sexual study population and (with the addition of intercourse) for
heterosexual study groups A and B. The homosexual group and
heterosexual study group A are evaluated in masturbation, partner
manipulation, and fellatio/cunnilingus. Data on masturbation and
partner manipulation are reported for heterosexual study group B,
and functional efficiency in coitus is considered for both study
groups A and B. Sexual functional efficiency is evaluated both by
gender and by sexual preference, and there is specific discussion of
selected individual functional failures. Statistical considerations of
these experimental results are presented in Chapter 10.
HOMOSEXUAL STUDY GROUP
Female Study Subjects. There were 709 lesbian sexual response

cycles observed in the laboratory; these were observed in 82 study
subjects who participated in the research program (Table 6-1).
The women were members of 38 committed and 4 assigned couples
(see Table 3-7, Chapter 3). One woman requested that she not be
required to masturbate in the laboratory, and 2 women stated a role
preference, wanting to be the stimulator rather than the stimulatee
during sexual interaction in the laboratory (see Chapter 4). Thus,
the 211 cycles of masturbational origin were based on the responses
of 81 study subjects, and the remaining response cycles, 306 partner
manipulation and 192 cunnilingus, were developed by 80 of the 82
lesbians who participated fully and by 2 lesbian study subjects who
participated partially in the investigative program (Table 6-1).
The women who constituted the 38 committed lesbian couples
were observed in a total of 669 sexual response cycles, and members
CHAPTER SIX
94
TABLE 6-1
Homosexual Study: Functional Efficiency in

Female Study Subjects (N = 82 *), 709 Observed Cycles
Type of Observed Functional Failure Failure

Stimulation Cycles Failures Incidence Percentage
Masturbation 211 2 1 : 105.5 0.95

Partner 306 2 1 : 153.0 0.65
manipulation
Cunnilingus 192 1 1 : 192.0 0.52
Total 709 5 1 : 141.8 0.71
(1964-1968)
* Three study subjects offered incomplete cooperation with this study.
of the 4 assigned couples completed 40 sexual response cycles

(Table 6-2). There were five failures to reach orgasmic release in the
sexual response cycles experienced by the committed couples. Two
occurred during the individuals’ masturbational attempts; 2 women
table 6-2
Homosexual Study: Functional Efficiency in Female Committed
(N = 38) and Assigned Couples (N = 4 * ), yog Observed Cycles
Couple No. of Observed Functional Failure Failure

Status Couples Cycles Failures Incidence Percentage
Committed 38 669 5 1 : 133.8 0.74
Assigned 4 40 0 0 0
Total 42 709 5 1 : 141.8 0.71
(1964-1968)
* Four assigned couples formed by 6 lesbian volunteers.
failed to achieve release during manipulation by their partners, and

1 was unsuccessful in responding to cunnilingal stimulation (see
Tables 6-1, 6-5). There was no more than one episode of failure to
reach orgasm for any individual study subject and the failure episode
was not repeated during further sexual interaction in the laboratory.
■ COMPARATIVE FUNCTIONAL EFFICIENCY
95
These five failures were of minor moment. On one occasion there

had been a respiratory infection during the few days immediately
before cooperation in the laboratory. On another, there was onset
of a menstrual period with severe cramping a few hours prior to
the laboratory commitment. None of the women expressed the
slightest concern over the failure episodes.
In the 40 cycles experienced by the 4 assigned couples, there were
no failures to achieve orgasm (Table 6-2).
Male Study Subjects. There were 538 sexual response cycles de
veloped by 94 homosexual male study subjects who cooperated fully
or partially with the research program (Table 6-3). These men were
TABLE 6-3
Homosexual Study: Functional Efficiency in
Male Study Subjects (N = 94*), 538 Observed Cycles

Masturbation 126 1 1 : 126.0 0.79
Partner 195 2 1 : 97.5 1.02
manipulation
Fellatio 217 1 1 : 217.0 0.46
Total 538 4 1 : 134.5 0.75
(1964-1968)
* Two study subjects offered incomplete cooperation with this study.
members of 41 committed and 7 assigned couples (see Table 3-2,

Chapter 3). Each of the 94 study subjects responded to masturba-
tional opportunity. There were 126 masturbational response cycles
experienced with one episode of failure to either achieve an erec
tion or to ejaculate (Table 6-3).
One hundred ninety-five cycles were instituted with partner ma
nipulation. One man, a member of a committed couple, requested
permission to play only the role of stimulator, and 1 assigned study
subject requested only the role of stimulatee (see Chapter 4). Among
the 93 study subjects cooperating both as stimulators and as stimu-
latees, there were two failures to respond at orgasmic levels. The
96 CHAPTER SIX
same 93 stimulators cooperated to develop 217 response cycles using

fellatio as the requested means of excitation for the 93 stimulatees.
There was one failure to attain a full erection and to respond to
orgasm during fellative activity (Tables 6-3, 6-5).
The four failures to function effectively were among members of
the 41 committed couples during the 471 response cycles experi
enced by this group (Table 6-4). Three of the 4 men could not
table 6-4
Homosexual Study: Functional Efficiency in Male Committed
(N = 4i) and Assigned Couples (N = y *
), 538 Observed Cycles

Committed 41 471 4 1 : 117.8 0.85
Assigned 7 67 0 0 0
Total 48 538 4 1 : 134.5 0.74
(1964-1968)
* Seven assigned couples formed by 10 male homosexual volunteers.
achieve or maintain erections during a specific episode of sexual

stimulation and did not reach sufficiently high levels of excitation
to ejaculate. The erective failures occurred once in each of the three
types of stimulative approach under observation. One man could
not ejaculate during partner manipulation despite maintaining a
full erection for an extended period of stimulation. This transitory
episode of ejaculatory incompetence has been seen at other times in
the laboratory and will be discussed later in the chapter. There were
no repeat failures to function for any of the 4 men.
Members of the 7 assigned male homosexual couples experienced
67 of the observed 538 cycles with no functional failures (Table
6-4).
Comparison by Gender. When evaluating sexual functional ef
ficiency by gender, it is obvious that there is little difference in the
facility of the sexually experienced male and female to respond to
sexual stimulation in a laboratory environment. Of course, the
, COMPARATIVE FUNCTIONAL EFFICIENCY
97
stimulative approaches of masturbation, partner manipulation, and

fellatio/cunnilingus are those with the least risk of failure (Table
6-5).
There were 171 more female response cycles than those of male
reaction in the homosexual study group. Most of the extra female
6-5
table
Homosexual Study: Comparison of Functional Failure Rates by
Gender (Male Study Subjects, N = 94 *;
Female Study Subjects, N = 82 f)
Gender and
Male
Masturbation 126 1 1 : 126.0 0.79
Partner 195 2 1 :97.5 1.02
manipulation
Fellatio 217 1 1 : 217.0 0.46
Total 538 4 1 : 134.5 0.75
Female
Masturbation 211 2 1 :105.5 0.95
Partner 306 2 1 :153.0 0.65
manipulation
Cunnilingus 192 1 1 : 192.0 0.52
Total 709 5 1 : 141.8 0.71
(1964-1968)
* Two study subjects offered incomplete cooperation with this study,
t Three study subjects offered incomplete cooperation with this study.
cycles, however, occurred during lesbian study-subjects’ multiorgas-

mic experience, a capacity rarely exhibited by men in general and
not demonstrated in the laboratory by any of the 94 homosexual
male study subjects. This is but further support of the Institute’s
prior contention that women but not men have the natural capacity
to be multiorgasmic when responding to effective sexual stimulation.
The failure percentage of homosexual men was 0.75 and that of
CHAPTER SIX
98
homosexual women, 0.71 (Table 6-5). These variations in the gen

der failure rates are not statistically significant (see Chapter 10).
There was one more response failure for the lesbian population, but
there were 171 more sexual response cycles in the female group
than were developed by the male group. Using orgasmic attainment
as a means of measuring functional efficiency, homosexual men do
not function sexually with more efficiency than women, and women,
though frequently multiorgasmic when given the opportunity, are
not more effective sexual performers than men.
HETEROSEXUAL STUDY GROUPS
Data reflecting effectiveness of response to stimulative techniques

identical to those evaluated for the male and female homosexual
populations will be presented for both heterosexual study groups A
and B. Study group A was evaluated in all three of the techniques
described for the homosexual group: masturbation, partner manip
ulation, and fellatio or cunnilingus. Group B, for reasons previously
described (see Chapter 1), was evaluated only in masturbation and
partner manipulation, not in fellatio/cunnilingus. In addition, both
heterosexual groups were observed in coition. The functional effec
tiveness of the male and female members of the heterosexual groups
during coition will be considered later in this chapter.
It should be kept in mind that the material reported from study
group B was collected as much as 10 years before the data returned
from some members of the homosexual group and from hetero
sexual study group A.
Female Study Subjects. As described in Chapter 3, there were

50 married and 7 assigned couples who cooperated with the investi
gation. Among the 57 women there were a total of 462 observed
cycles with four functional failures. Of the 462 total observed
cycles, 142 were masturbational episodes without failure at orgasmic
attainment. There were 161 partner manipulative experiences with
two failures to reach orgasmic release, and 159 cunnilingal encoun
ters, also with two failures to reach orgasm (Table 6-6).
.COMPARATIVE FUNCTIONAL EFFICIENCY
99
TABLE 6-6
Heterosexual Study Group A: Functional Efficiency in
Female Study Subjects = 462 Observed Cycles

Stimulation Cycles Failure Incidence Percentage
Masturbation 142 0 0 0
Partner 161 2 1 : 80.5 1.24
manipulation
Cunnilingus 159 2 1 : 79.5 1.26
Total 462 4 1 :115.5 0.87
(1967-1968)
One failure to reach orgasm with cunnilingus was with a female

member of an assigned couple (Table 6-7). In this instance the
male partner, his original history to the contrary, was obviously not
effective with cunnilingal stimulation. Following suggestions, the
male partner improved markedly in subsequent opportunity, so
6-7
table
Heterosexual Study Group A: Functional Efficiency in Female
Married (N = 50) and Assigned Study Subjects (N — y),
462 Observed Cycles *

Married 50 418 3 1 : 139.3 0.72
Assigned 7 44 1 1 :44.0 2.27
Total 57 462 4 1 : 115.5 0.87
(1967-1968)
* Observed cycles refers to masturbation, partner manipulation, and cunnilingus.
much so in fact that the female partner’s failure was not repeated
in further encounters. The remaining three failures, one with cunni
lingus and two during partner manipulation, developed among the
50 married couples.
1OO CHAPTER SIX
There were no untoward circumstances associated with these fail

ures to function effectively. The women simply were not highly
aroused during the three sexual opportunities. There was no re
corded physical distress, nor was there an acute social problem.
None of the 4 female study subjects failed to function effectively
a second time in the laboratory.
Male Study Subjects. As noted in Table 6-8, there were a total
table 6-8
Heterosexual Study Group A: Functional Efficiency in
Male Study Subjects (N = 57), 384 Observed Cycles

Masturbation 115 1 1 : 115.0 0.87
Partner 123 1 1 : 123.0 0.81
manipulation
Fellatio 146 1 1 : 146.0 0.68
Total 384 3 1 : 128.0 0.78
(1967-1968)
of 384 observed male cycles among the 57 study subjects. Masturba

tion was observed 115 times with one failure. There were 123 epi
sodes of partner manipulation with one instance of failure to main
tain an erection or to ejaculate. The 57 men responded to fellatio
146 times, again with one functional failure. Each of the three func
tional failures developed during the sexual interaction of married
couples (Table 6-9).
There were no specific difficulties encountered during the failure
episodes. In each instance the man simply failed to become suffi
ciently involved in the sexual encounter to respond with full erec
tion. There was some penile engorgement evident, but it was not
of functional adequacy. None of the 3 men ejaculated. There were
no repeat failures to function effectively in further sexual encoun
ters by any of the 3 men.
The assigned couples responded without failure during 52 sexual
encounters in the laboratory (Table 6-9).
Comparison by Gender. A comparison of functional failure
.COMPARATIVE FUNCTIONAL EFFICIENCY 1O1
6-9
TABLE
Heterosexual Study Group At Functional Efficiency Male
Married (N = 57) and Assigned Study Subjects (N = 7),

Status Couples Cycles * Failures Incidence Percentage
Married 50 332 3 1 : 110.7 0.90
Assigned 7 52 0 0 0
Total 57 384 3 1 : 128.0 0.78
(1967-1968)
* Observed cycles refers to masturbation, partner manipulation, and fellatio.
rates by study-subject gender in heterosexual group A shows that

there is no significant clinical difference in failure rates of men or
women to respond to similar forms of sexual stimulation in the lab
oratory environment (Table 6-10). The failure percentage of the
6-10
table
Heterosexual Study Group A: Comparison of Functional Failure
Rates by Gender (Male Study Subjects, N — 57;
Female Study Subjects, N = 57)
Gender and
Male
Masturbation 115 1 1 : 115.0 0.87
Partner 123 1 1 : 123.0 0.81
manipulation
Fellatio 146 1 1 : 146.0 0.68
Total 384 3 1 : 128.0 0.78
Female
Partner 161 2 1 : 80.5 1.24
manipulation
Cunnilingus 159 2 1 : 79.5 1.26
Total 462 4 1 : 115.5 0.87
(1967-1968)
102 CHAPTER SIX
men in study group A was 0.78, and that of the women, 0.87- There
were 78 more observed cycles reported from the female research
population as well as one more functional failure. Again, the 78
additional cycles are evidence of woman’s innate capacity for multi-
orgasmic response. Gender equality in sexual functional efficiency
will be considered in detail in Chapters 10 and 11.
HETEROSEXUAL STUDY GROUP B
Female Study Subjects. The sexual response cycles of hetero

sexual women were evaluated with the cooperation of 257 married
women and 24 single women who formed assigned couples. This
total of 281 women were observed in masturbation and partner ma
nipulation. As previously stated, cunnilingus was not evaluated in
this study group. The 1,513 response cycles that are reported for
this group consisted of a combination of masturbational and part
ner manipulative activity. There were four failures to reach orgasm
during masturbation in 670 opportunities and an additional six fail
ures in 843 episodes of partner manipulation (Table 6-11).
The 10 failures to attain orgasmic release in the laboratory were
recorded by the 257 married couples, who provided 1,437 observed
sexual response cycles. There were no functional failures recorded
for the 24 women who constituted the female component of the
6-11
table
Heterosexual Study Group B: Functional Efficiency in Female
Study Subjects (N = 281), 1513 Observed Cycles

Masturbation 670 4 1 : 167.5 0.57
Partner 843 6 1 : 140.5 0.72
manipulation
Cunnilingus * 0 0 0 0
Total 1513 10 1 : 151.3 0.66
(1957-1965)
* Cunnilingal stimulation was not evaluated during the original heterosexual study.
■COMPARATIVE FUNCTIONAL EFFICIENCY 103
29 assigned couples, who interacted through 76 complete response

cycles (Table 6-12).
Male Study Subjects. A total of 257 married and 29 single men
responded to masturbational techniques and to partner manipula-
table 6-12
Heterosexual Study Group B: Functional Efficiency in Female
Married (N — 2^y) and Assigned Study Subjects (N = 2j),

Married 257 1437 10 1 : 143.7 0.69
Assigned 29 t 76 0 0 0
Total 286 1513 10 1 : 151.3 0.66
(1957-1965)
* Observed cycles refers to masturbation and partner manipulation; cunnilingus
was not evaluated.
t The 29 assigned couples were formed with the cooperation of 24 single women.
tion through 826 response cycles (Table 6-13). Seven functional

failures occurred among the male study subjects. Three times dur
ing 387 opportunities men were unable to masturbate to ejacula
tion. In two of these episodes the men did not achieve full erections
table 6-13
Heterosexual Study Group B: Functional Efficiency in

Masturbation 387 3 1 : 129.0 0.77

Partner 439 4 1 : 109.8 0.91
manipulation
Fellatio * 0 0 0 0
Total 826 7 1 : 118.0 0.85
(1957-1965)
* Fellatio was not evaluated.
104 CHAPTER SIX
or ejaculate, and once, despite a full, long-maintained erection, the

man could not ejaculate. There was no previous history of ejacu
latory incompetence, nor was the episode repeated by this study
subject during subsequent opportunities.
Four times in 439 cycles the male study subject did not ejacu
late in response to manipulative stimulation from his female part
ner. In three of these opportunities there was insufficient erection
for effective response, and again, 1 man was unable to ejaculate de
spite long-continued stimulation and a fully maintained erection
with no history of ejaculatory incompetence.
The seven failures of male study subjects to function effectively
occurred during the 739 cycles experienced by married couples who
cooperated with the program. The 29 assigned couples completed
87 cycles of male masturbation and partner manipulation without
a functional failure (Table 6-14).
Comparison by Gender. A comparison of functional failure
rates by gender in heterosexual study group B indicates that there
is no clinically significant difference in the failure rates of men or
women to respond to similar forms of sexual stimulation in a lab
oratory environment (Table 6-15). The overall failure percentage
of men in study group B was 0.85, and that of women, 0.66. There
were 687 more observed cycles reported for the female research
population, and there were three more functional failures to obtain
table 6-14
Heterosexual Study Group B: Functional Efficiency in Male
Married (N = 257) and Assigned Study Subjects (N = 2g),

Married 257 739 7 1 : 105.6 0.95
Assigned 29 87 0 0 0
Total 286 826 7 1 : 118.0 0.85
(1957-1965)
* Observed cycles refers to masturbation and partner manipulation; fellatio was not
evaluated.
■COMPARATIVE FUNCTIONAL EFFICIENCY
105
TABLE 6-15
Heterosexual Study Group B: Comparison of Failure Rates

by Gender (Male Study Subjects, N — 286;
Female Study Subjects, N = 281)
Gender and
Male
Masturbation 387 3 1 : 129.0 0.77
Partner 439 4 1 : 109.8 0.91
manipulation
Fellatio * 0 0 0 0
Total 826 7 1 : 118.0 0.85
Female
Masturbation 670 4 1 : 167.5 0.57
Partner 843 6 1 : 140.5 0.72
manipulation
Cunnilingus * 0 0 0 0
Total 1513 10 1 : 151.3 0.66
(1957-1965)
* Fellatio and cunnilingus were not evaluated in heterosexual study group B.
orgasmic release. Again this presents evidence of woman’s innate

multiorgasmic capacity. Gender equality in sexual functional effi
ciency will be considered in Chapter 10 and discussed in detail in
Chapter 11.
COMBINED HETEROSEXUAL
STUDY GROUPS A AND B
Table 6-16 shows the combined total of the response statistics for
heterosexual study groups A and B. For all practical purposes, there
was no significant difference in the functional efficiency of hetero
sexual men and women responding to effective sexual stimuli in a
laboratory environment. Obviously there were many more female
orgasmic cycles (765) developed during masturbation, partner ma-
io6 CHAPTER SIX
TABLE 6-16
Heterosexual Study Groups A and B: Comparison of Failure Rates
by Gender (Male Study Subjects, N = 343; Female
Study Subjects, N = 338)
Gender and
Male
Masturbation 502 4 1 :125.5 0.80
Partner 562 5 1 :112.4 0.89
manipulation
Fellatio * 146 1 1 : 146.0 0.68
Total 1210 10 1 : 121.0 0.83
Female
Masturbation 812 4 1 : 203.0 0.49
Partner 1004 8 1 : 125.5 0.80
manipulation
Cunnilingus * 159 2 1 : 79.5 1.26
Total 1975 14 1 : 141.1 0.76
(1957-1965, Group B)
(1967-1968, Group A)
* Fellatio and cunnilingus were evaluated with heterosexual study group A only.
nipulation, and fellatio/cunnilingus than were experienced by the

male study subjects, and there were four more failures to complete
the orgasmic cycle. But the difference in failure rates (0.83 percent
male and 0.76 percent female) is obviously not clinically significant.
These statistical results will be considered in more detail in Chap
ter 10. Suffice it to say that just as was true for the homosexual
study group, there was no significant gender-oriented difference in
facility to respond to effective sexual stimuli demonstrated by the
combined (A and B) heterosexual study groups.
COITAL FUNCTION
The functional effectiveness of male and female study subjects

responding during coital interaction will be considered for both
107
study groups A and B. These men and women have previously pro
vided material representing response to masturbation, partner ma
nipulation, and fellatio/cunnilingus (study group A) and masturba
tion and partner manipulation (study group B). There remain to
be considered the returns from the same heterosexual study sub
jects responding to coital opportunity.
Female Study Subjects. The coital experiences of the 57 couples

in study group A totaled 189 observed cycles. After making allow
ance for the fact that there were seven male failures to function
effectively, there remained 182 cycles during which there was full
opportunity for female orgasmic response. Six female functional
failures developed during the 182 cycles (Table 6-17). Five of these
table 6-17
Heterosexual Study Group A; Functional Efficiency in Coition,
Female Study Subjects (N = 57), 189 Observed Cycles
*

Married 50 157 5 1 : 31.4 3.18
Assigned 7 25 1 1 : 25.0 4.00
Total 57 *
182 6 1 : 30.3 3.30
(1967-1968)
* The 189 observed cycles was corrected to 182 observed cycles to allow for handi
cap of male partner failures (7).
incidences of lack of orgasmic attainment were in the married cou

ple population, and there was one functional failure in the assigned
couple group.
There was no unusual etiology in the five failures to achieve or
gasmic release in the married couple group. Four women reported
that they simply were not involved sufficiently to experience orgasm.
One woman complained that during coition she was disturbed by
vaginal irritation, and examination revealed evidence of a tricho-
monal vaginal infection. The orgasmic failure in the assigned cou-
io8 CHAPTER SIX
pie group was experienced by a woman who was not feeling well
and had just recovered from an upper respiratory infection.
Male Study Subjects. Among the male members of heterosexual
study group A there were four instances of erective failure and
three of premature ejaculation for a total of seven male functional
failures during 189 attempted coital response cycles. One episode
of erective failure and one of premature ejaculation occurred dur
ing the interaction of the assigned couples. The remaining two epi
sodes of rapid ejaculation and the three instances of erective failure
developed within the married couple group (Table 6-18).
6-18
table
Heterosexual Study Group A: Functional Efficiency in Coition,
Male Study Subjects (N — ^y), 189 Observed Cycles
Ob Functional Failures Failure

Couple No. of served Impo- Failure Percent
Status Couples Cycles tence P.E. (Total) Incidence age
Married 50 161 3 2 (5) 1 : 32.2 3.11
Assigned 7 28 1 1 (2) 1 : 14.0 7.01
Total 57 189 4 3 (7) 1 : 27.0 3.70
(1967-1968)
P.E. = premature ejaculation.
The four incidences of erective failure occurred during antici

pated coital connection. One failure was during a first episode of
coital interaction in the laboratory for an assigned partner. The
man was simply too distracted by his surroundings and did not
achieve an erection. The three failures of married men to function
effectively developed at different times in the coital interaction.
One man was not sufficiently involved from the onset of stimula
tive activity to achieve an erection. A second man lost his erection
during the mounting phase, and the third man was distracted dur
ing coition and lost his erection. Neither of the last two men could
regain full erection during the particular sexual episode. The rapid
ejaculatory response occurred once with an assigned partner with
.COMPARATIVE FUNCTIONAL EFFICIENCY 109
no previous history of similar response patterning and twice in a

married couple with an unreported tendency toward rapid ejacu
lation.
Both the male and female functional failures during coition were
handled well by the study subjects in group A. There were no re
peat coital functional failures for any of the men or women with
the exception of the man who was responsible for the two episodes
of too-rapid ejaculation. Adequate counseling and use of the
“squeeze technique” * resolved the problem for this unit not only
during further cooperation in the laboratory, but in private as well.
Comparison by Gender. Heterosexual study group A had very
similar functional failure rates when coital activity in the labora
tory was evaluated by gender alone. The functional failure inci
dence for the 57 women responding coitally in a combination of
committed and assigned partnerships was 1 : 30.3, and the func
tional failure rate was 3.30 percent (Table 6-17). For the 57 men
the functional failure incidence was 1 : 27.0 and the functional
failure rate was 3.70 percent (Table 6-18).
There was no clinical significance in the 0.40 percent higher func
tional failure rate for men in intercourse. This subject will be con
sidered in Chapters 10 and 11.
HETEROSEXUAL STUDY GROUP B
Explanation of Data (Female). A brief contributory discussion

is in order relative to the rationale for selectivity and in explanation
of previously published data. When the original heterosexual re
search program was reported in 1966, there was brief statistical con
sideration of a total of 7,500 sexual response cycles developed dur
ing the female-oriented phase of the program. The study group B
under consideration here was reduced from this original hetero
sexual study population as described in Chapter 2. In terms of the
female sexual response cycles, the records indicate that of the total
of 7,500 cycles in the original data, there were 1,513 that were a
combination of both masturbational and partner-manipulative ac
tivity. This material has been presented previously in this chapter.
As a point of information, there also were 613 cycles developed
* Masters and Johnson (1970), pp. 102-106.

110 CHAPTER SIX
by artificial coital equipment and 1,259 response cycles in other

research programs during which female orgasmic release was either
not indicated or was of no importance to the particular investiga
tion being conducted. These cycles were removed from statistical
consideration. Finally, there were nine instances in which adequate
research notations of the woman’s sexual response pattern were
lacking when the research charts were reviewed. These records also
were removed from consideration.
Thus there remain 4,106 female sexual response cycles developed
through coition and available for statistical evaluation as return
from heterosexual study group B’s participation in the Institute’s
research programs.
As men and women responded to coital stimulation during the
initial investigation of the heterosexual response patterns, it was
decided to focus on the sexual physiology of each gender separately
in order to concentrate the effectiveness of observation. Therefore,
in study group B there were 4,106 observed coital cycles during
which the female partner was the investigative subject (see Table
6-19). Obviously, the male partners also had to function effectively
in these sexual episodes, for without the man’s erective capacity and
adequate ejaculatory control, woman’s physiologic response during
coital interaction could not have been evaluated fairly. Once ob
servation directed exclusively to the female sexual response pattern
ing was terminated by the woman’s orgasmic attainment (or ob
vious failure), the cooperating men were encouraged to ejaculate
if they wished. When given such permission, the men invariably
sought orgasmic release.
The same ground rules did not apply to women during the 1,674
cycles (discussed later in this chapter) when only men were evalu
ated during coitus. It obviously was necessary for the female partner
to cooperate with the responding male, but woman’s orgasmic at
tainment was not vital to a study of male sexual physiology and
therefore was not directly observed or recorded for statistical inci
dence. If the female partner had not been sexually satisfied during
an investigative episode directed toward the male’s sexual response
patterns and needed sexual release, however, she was encouraged to
express her needs and her partner was encouraged to respond in
kind.
.COMPARATIVE FUNCTIONAL EFFICIENCY 111
There was yet another important reason why the female partner’s
orgasmic function was not evaluated objectively during the exten
sive investigation of male sexual physiology. Except for special proj
ects (intravaginal contraceptive physiology, for example) (Johnson
and Masters, 1962 and 1970), the investigation of various aspects
of woman’s sexual physiology had already been essentially con
cluded before specific attention was devoted to the physiology of
the male sexual response cycle.
There still remain for statistical consideration 4,106 coital cycles
during which observation of a complete sexual experience for the
female partner was anticipated at onset of stimulative activity.
Many diverse female response patterns were under inspection dur
ing these thousands of coital opportunities. They included breast
reactions, sex-flush color distribution, labial color changes, waxing
and waning of vaginal lubrication production, orgasmic platform
formation, onset and duration of contractions during orgasmic ex
perience, cardiorespiratory response patterns, and many other physi
ologic reactions. The more effective the female’s response in terms
of sex-tension increment, the more information was obtained.
Therefore, complete records were kept as to the effectiveness of
the woman’s sexual performance during the 4,106 observed response
Distractions. It is also important to emphasize that many times

specific observations were made during intercourse that theoretically
could have been distracting to the sexually responding female part
ner. But many similar observations already had been made of the
women during masturbation or partner manipulation, so there was
some degree of conditioning to the laboratory environment when
investigations of coitus were conducted. This direct interference
with responding sex partners by the research team was much more
of a factor during the original heterosexual investigation than dur
ing the homosexual group and study group A evaluations, where a
minimal number of physiologic patterns were recorded (see Chap
ter?).
Also pertinent to present discussion is the fact that there were
133 male failures to function effectively during intercourse while
female coital response was under direct observation and the male
partner, although necessary, was playing a secondary role. There
112 CHAPTER SIX
fore, the total of 4,106 coital cycles devoted to evaluation of female

orgasmic attainment must be reduced by 133, the number of times
when male functional failure made female coital orgasmic attain
ment impossible.
Female Study Subjects. As previously described in this chapter,
study group B consisted of 257 married couples and 29 assigned
couples formed by 24 cooperating women (Tables 6-12, 6-14).
These 281 women responded in coital activity many times in the
laboratory. There were 108 failures of female study subjects to
achieve orgasmic release during coitus, with married women ac
counting for 94 functional failures in 3,494 opportunities. The re
maining 14 failures to function effectively were recorded in 479
opportunities during sexual interaction between assigned couples
(Table 6-19).
TABLE 6-19
Heterosexual Study Group B: Functional Efficiency in Coition,

Female Study Subjects (N = 281 *), 4106 Observed Cycles t

Married 257 3494 94 1 : 37.2 2.69
Assigned *
29 479 14 1 : 34.2 2.92
Total 286 3973 t 108 1 : 36.8 2.72
(1957-1965)
* Four of the 24 single women cooperated to accept 5 extra single male partners
to form 29 assigned couples for the laboratory investigation.
t The 4106 observed cycles was corrected to 3973 observed cycles to allow for the
handicap of male partner functional failures (133) during coition.
Failure incidence and failure percentage of female orgasmic at

tainment during coition has been computed on the basis of 3,973
actual opportunities. The overall failure incidence in orgasmic at
tainment was 1 : 36.8 coital episodes, and the failure percentage
was 2.72. There was no significant difference in the failure inci
dence of female partners in married couples compared to women
113
in assigned couples. This is in marked variation to the results of

the male study-subject evaluation (see Table 6-20).
Among the married couples there were 9 women who failed to
function effectively on two occasions and 4 women who failed three
times to reach orgasm during periods of laboratory observation.
None of these 13 women stated that she always reached orgasm in
private with her husband. Distraction was by far the most frequent
explanation given when the women were not orgasmic during co
ition in the laboratory.
Each of 2 assigned female partners failed to achieve orgasmic
release on two occasions. The remainder of the failures were single
episode experiences. Again, all of the women had reported previous
instances of lack of orgasmic release during intercourse in private
with partners of their choice.
Explanation of Data (Male). Of the 2,500 cycles specifically
devoted to an investigation of male sexual physiology in study
group B, 826 cycles were restricted to masturbational or partner-
manipulative activity. The male’s functional effectiveness in re
sponse to these two stimulative activities both as an individual and
as a member of a married or an assigned couple has been reported
earlier in this chapter (see Table 6-15).
Each of the 1,674 remaining response cycles was devoted to in
vestigation of many facets of male coital behavior. There was spe
cific interest in such diverse physiologic responses as variations in
penile thrusting patterns, gross testicular physiology, urethral bulb
reactions, prostatic physiology, and male behavioral response during
the ejaculatory process.
When male functional efficiency during coitus in the research
laboratory is considered statistically, the 1,674 male coital response
cycles must be added to the 4,106 coital cycles developed by study
group B participants during investigation of female coital physi
ology. As previously stated, the male role was obviously one of sec
ondary importance to the unidimensional female investigative pro
gram; however, notes were made as to the effectiveness of the male
partner’s sexual function, for without successful male functioning,
female cycles could not have been completed and evaluated. There
fore, there were a total of 5,780 coital response cycles during which
114 CHAPTER SIX
male sexual function, even when it was of secondary importance to

the research interests, was observed and reported as to effectiveness
of coital performance.
Male Study Subjects. There were 80 incidences of male func
tional failure during the 1,674 cycles when the male was the pri
mary investigative target as opposed to 133 failures during the 4,106
cycles when his functional role, although acknowledgedly vital, was
still not under direct investigation. This failure percentage of 4.78
percent while under direct investigation as opposed to a 3.24 per
cent failure rate while functioning in a less performance-oriented
capacity indicates that expressed performance demand may invol
untarily generate some measure of functional anxiety even for sex
ually experienced men.
There were a total of 213 male functional failures in 5,780 coital
opportunities (Table 6-20). These statistics are reported for the
6-20
table
Heterosexual Study Group B: Functional Efficiency in Coition,
*
Functional Failures Failure

Couple No. of served Impo Failure Percent
Status Couples Cycles tence P.E. (Total) Incidence age
Married 257 5179 156 18 (174) 1 : 29.8 3.36
Assigned 29 601 33 6 (39) 1 : 15.4 6.49
Total 286 5780 189 24 (213) 1 : 27.2 3.69
(1957-1965)
* Total accrued from 1674 response cycles in which male sexual physiology was
the subject of investigation plus 4106 response cycles developed by male study sub
jects during the investigation of female coital physiology (reported in Table 6-19).
individual male and are also considered within the framework of

his relationship as either a married man or a member of an assigned
There were 257 married men responding to 5,179 coital oppor

tunities. Married men were unable to establish or sustain erections
COMPARATIVE FUNCTIONAL EFFICIENCY
115
satisfactory for coital function 156 times, and 18 times men ejacu
lated during or shortly after penetration. Both erective insufficiency
and premature ejaculation were classified as coital failures. The 29
assigned couples interacted coitally 601 times. There were 33 occa
sions of erective failure and six instances of too-rapid ejaculation.
When the functional failure statistics of married men and the men
in assigned couples are combined, the overall incidence of male fail
ure to function effectively was 1 : 27.2 coital episodes and the fail
ure percentage was 3.69.
There were no incidences of ejaculatory incompetence as had
been noticed during both homosexual and heterosexual response to
partner manipulation or to heterosexual masturbation.
The percentage of failure to function effectively during coition
for men in assigned couples was approximately twice that of the
married men. We have no secure information that would explain
this significant statistic. Interestingly, a similar functional failure
discrepancy between married men and men in assigned couples did
not occur when the same men were responding to the stimulative
techniques of masturbation or partner manipulation (see Table
6-14).
Of the 156 failures to attain or sustain erections in the married
couples group, there were 7 men who failed to function effectively
on two occasions and 1 man who could not function during three
different episodes. These failures occurred over several years of
laboratory cooperation, with the shortest time between erective fail
ures being approximately 18 months. The man with three failures
to attain secure erections participated with his wife over a five-year
period in different laboratory programs. There was a minimum of
20 months between erective failures. The remaining failure episodes
developed singly for men cooperating with the various programs.
Almost unanimously the men’s complaint was one of distraction
leading to erective dysfunction. This was true for men in married or
assigned couples. None of the men who failed to achieve or main
tain erections in the laboratory environment reported similar oc
currences in their private lives.
There were 4 men functioning as assigned partners who had two
episodes each of erective failure. Again, the failure episodes were
separated by periods of time. In no instance were they recorded in
116 CHAPTER SIX
sequential episodes. No assigned partner reported continued erec-

tive insecurity in his private life.
Comparison by Gender. Heterosexual study group B also had
very similar functional failure rates when coital activity in the lab
oratory was evaluated by gender alone. The functional failure in
cidence of the 281 women responding coitally in a combination of
committed and assigned partnerships was 1 : 36.8, and the func
tional failure rate was 2.72 percent (see Table 6-19).
For the 286 men the function failure incidence was 1 : 27.2 and
the functional failure rate was 3.69 percent (see Table 6-20).
There was no clinical significance assigned to the 0.97 percent
higher functional failure rate for men in intercourse. This subject
will be discussed in Chapters 10 and 11.
EJACULATORY INCOMPETENCE
Three men experienced single episodes of ejaculatory incompe

tence during the laboratory study, 2 in heterosexual study group B,
and 1 in the homosexual study group. None of the 3 men had ever
experienced the dysfunction previously, nor was there a repeat of
the functional disability during subsequent sexual encounters in the
laboratory. The following is a more detailed description of these
unusual episodes of functional failure.
One man, a member of heterosexual study group B, was unable
to ejaculate during a masturbational episode. An erection was rap
idly and fully established, but during the next half-hour, despite
long-continued periods of self-manipulation, he could not ejaculate.
Even during the interludes between masturbational activity, the
erection was maintained at approximately one-half to three-quarters
of full engorgement.
The ejaculatory incompetence developed during the man’s first
experience in the laboratory. He had not requested an opportunity
for orientation to laboratory procedure and gave no history of func
tioning sexually under observation. He ejaculated within 3 minutes
of onset of masturbational stimulation during his second visit.
With masturbation, partner manipulation, and coitus he ejacu
lated a total of 11 times in the laboratory without further dysfunc-
COMPARATIVE FUNCTIONAL EFFICIENCY 117
tion. This was the only incidence of ejaculatory incompetence dur

ing 387 masturbational episodes developed in the laboratory by
male members of heterosexual study group B.
A second man, also a member of heterosexual study group B,
could not ejaculate during an episode of partner manipulation. He
had been married for three years before cooperating with the labora
tory study and had not reported prior sexual dysfunction. He had
ejaculated without incident with masturbational stimulation. How
ever, during the first partner-manipulative opportunity, he could
not ejaculate. An erection was readily obtained and maintained over
a 25-minute period through several episodes of forceful manual
stimulation by his wife, but he could not ejaculate. Both husband
and wife were distressed by this failure episode and apprehensive
about further laboratory experience. They decided to continue in
the research program, however, and subsequently this man ejacu
lated a total of eight times in the laboratory during masturbation,
partner manipulation, and coition without further evidence of dys
function. This was the only incidence of ejaculatory incompetence
in 439 episodes of partner manipulation of male study subjects
recorded by couples in heterosexual study group B.
Finally, there was a homosexual male who also could not ejacu
late during partner manipulation. He gave no history of functional
failure, and the dysfunction was not repeated during further labora
tory experience. His committed partner (two years) also stated that
he had not observed this difficulty in their previous sexual inter
change. After the failure episode, the man ejaculated a total of five
times without further functional inadequacy during episodes of
stimulation by partner manipulation and fellatio. This was the only
incidence of ejaculatory incompetence in 195 observed episodes of
partner manipulation by homosexual male couples.
A month to six weeks after the episode of dysfunction, each of
the 3 men was questioned about subjective attitudes and feelings
experienced during and after the functional failure. There were sev
eral reasons for research team curiosity. First was the constantly
present concern for research subject protection. What manner of
residual trauma might become a factor of consequence in the fu
ture for these cooperative study subjects? What was the possibility
that this unusual sexual dysfunction might develop in other mem
118 CHAPTER SIX
bers of the male study groups? Once these anxieties were alleviated,
research interest was focused on any information that might lead
to better understanding of and improved treatment for clinically
established states of ejaculatory incompetence. Although inter
viewed independently, the 3 men gave almost identical accounts of
their subjective impressions as the incompetence was experienced.
In each episode there had been initial sexual anticipation, fol
lowed by sensual pleasure occasioned by the physical stimulation
whether by self or partner. Erection developed for the homosexual
man during the anticipation phase and for the 2 heterosexual men
during the early stages of penile manipulation either during mas
turbation or by the female partner. Increasingly elevated stages
of sexual excitation were readily achieved until plateau phase levels
of sexual involvement were experienced. As each man described his
reactions, it was apparent that from a psychophysiologic point of
view he had reached that level of sexual excitation when he sub
jectively felt ejaculation imminent, but had not moved far enough
into the plateau phase to have reached the stage of ejaculatory in
evitability.
The research team had noted that as plateau-phase levels of sexual
involvement continued without ejaculatory release, each man de
veloped a somewhat anxious facial expression and requested or ap
plied increased manual pressure or a more rapid penile stroking
pattern. At this point in time, the 3 men were obviously trying to
force the ejaculatory experience, but despite their every effort, it
simply did not happen.
In describing the failure experience, all 3 men stated that shortly
after they had sensed that ejaculation was imminent, the feeling
developed that they could continue indefinitely at current excitation
levels without ejaculating. They further stated that initially they did
not lose the feeling that ejaculation was imminent, but they had
lost any real sense of ejaculatory demand. The subjective descrip
tion was one of being suspended in sexual pleasure and able to go
on indefinitely. When the sense of lack of interest in ejaculating
turned to that of inability to ejaculate, the men tried to force the
issue, and when unsuccessful, they became anxious and lost most
of their prior sense of sexual pleasure.
When the 3 men verbally expressed the feeling that they did not
COMPARATIVE FUNCTIONAL EFFICIENCY
119
think they were going to ejaculate, stimulative activity was tempo

rarily discontinued. After resting briefly, each man independently
requested a return or returned to sexual stimulation. In no instance
did the men reach as high levels of subjective sexual involvement
during subsequent stimulative activity as that accomplished during
the initial episode. The stimulative approaches, always confined to
the penis, continued alternating with rest periods from 20 minutes
to half an hour and were finally terminated at research team sug
gestion.
The 3 men also stated that although some level of sexual plea
sure was maintained throughout the encounter, their sexual excite
ment was certainly blunted after the first break in stimulative ac
tivity. They attributed this lowered level of sexual involvement to
performance anxiety.
COMMITTED VERSUS
ASSIGNED COUPLES
The issue of the sexual functional facility of committed as op

posed to assigned partners should be discussed briefly. The basic
question is, of course, do men and women in a committed relation
ship tend to function sexually as well as, better than, or less effec
tively than men and women who have no emotional bond? As a
secondary issue, the question also might be raised as to whether
there is a significant difference between the sexual functional effi
ciency of committed versus assigned couples, if the factor of sexual
preference is added. Both questions can be reasonably resolved by
perusal of Tables 6-21 and 6-22.
If the stimulative approaches of masturbation, partner manipula
tion, and fellatio/cunnilingus are accepted as basically manipulative
opportunities, the factor of sexual preference can easily be added to
the primary question of the relative functional efficiency of com
mitted versus assigned couples.
It can be determined from Table 6-21 that although there is a
minimal statistical difference between assigned and committed cou
ples in functional efficiency in orgasmic attainment, the difference
is of no clinical consequence. There were obviously fewer functional
120 CHAPTER SIX
T A BL E 6-21
Homosexual and Heterosexual Study Groups A and B:
Functional Efficiency in Manipulative Stimulation
Female Male
Study Group, Type Ob- Failure Ob- Failure
of Stimulation, and No. of served Percent- No. of served Percent-
Couple Status Couples Cycles age Couples Cycles age
Homosexual study
group: masturba
tion, partner manip
ulation, fellatio/
cunnilingus *
Committed 38 669 0.74 41 471 0.85
Assigned 4 40 0 7 67 0
Heterosexual study
group A: mastur
bation, partner ma
nipulation, fellatio/
cunnilingus t
Committed 50 418 0.72 50 332 0.90
Assigned 7 44 2.27 7 52 0
Heterosexual study
group B : mastur
bation and partner
manipulation 1
Committed 257 1437 0.69 257 739 0.95
Assigned 29 76 0 29 87 0
* Refer to Tables 6-2 and 6-4.
t Refer to Tables 6-7 and 6-9.
failures in assigned couples than in committed couples, both for the

homosexual study group and for heterosexual study groups A and B.
But the number of sexual response cycles for the committed couples
outstrips those of assigned couples by literally hundreds of op
portunities.
The clinical position can safely be taken that when men or
women respond to the sexually stimulative techniques of masturba
tion, partner manipulation, and fellatio/cunnilingus in the labora
tory, the gender of the study subjects, their sexual preference, or
COMPARATIVE FUNCTIONAL EFFICIENCY 121
TABLE 6-2 2
Heterosexual Study Groups A and B:

Functional Efficiency in Coition
Female Male
Study Group Ob Failure Ob Failure
and Couple No. of served Percent No. of served Percent
Status Couples Cycles age Couples Cycles age
Heterosexual study
group A *
Committed 50 157 3.18 50 161 3.11
Assigned 7 25 4.00 7 28 7.01
Heterosexual study
group B t
Committed 257 3494 2.69 257 5179 3.36
Assigned 29 479 2.92 29 601 6.49
* Refer to Tables 6-17 and 6-18.
whether they are members of committed or assigned couples makes

not the slightest bit of difference in their overall sexual functional
facility as measured by orgasmic attainment. Gender, sexual prefer
ence, or relationship commitment did not influence the sexual func
tional efficiency statistics significantly.
Turning to Table 6-22, the additional response of committed and
assigned couples in heterosexual study groups A and B to coital
stimulation is portrayed. Here there is a different picture. Regard
less of whether the number of observed cycles was between 100 and
200 (study group A) or 3,000 and 5,000 (study group B), the com
mitted couples, despite an overwhelmingly greater number of ob
served cycles, consistently evidenced a lower functional failure rate
than was true for the assigned couples. While there is lack of statis
tical security in comparing the large and small numbers of ob
served response cycles, the committed couples did function more
effectively in intercourse than did the assigned couples.
When considering intercourse from a gender point of view, the
picture is not so clear. There simply was not any clinically signifi
cant difference in sexual functional efficiency between men and
women in committed couples, but the men in the assigned couples
122 CHAPTER SIX
certainly had a higher failure percentage than their women part

ners. Aside from the possibility of increased social pressures to per
form, which lack of knowledge of the assigned female partner may
have placed on the male, the research team has no ready explana
tion for this clinical discrepancy.
When evaluating this material, the reservation must always be
kept in mind that the research team was dealing with sexually ex
perienced men and women. Yet the clinical implications that may
be drawn from these statistics are relatively unlimited. The cultural
concepts that men are the sex experts or that they function more
effectively sexually than women may be seriously questioned on the
basis of these data.
The frequently stated preference concept that insists, “My way
is better than your way” also may go by the boards. Barring levels
of subjective involvement, there is no difference in functional effi
ciency between homosexual and heterosexual men and women in
response to similar sexual stimuli.
It is also apparent that men and women who move to coital ac
tivity are at greater risk of sexual functional failure than the same
men and women who confine their sexually stimulative activity to
masturbation, partner manipulation, or fellatio/cunnilingus. There
will be additional discussion of this material in Chapter n.
SUMMARY
A significant amount of clinically and statistically comparable

material has been presented relative to the functional facility of
homosexual and heterosexual men and women to respond effec
tively in the laboratory to various types of sexual stimulation both as
individuals and as active members of committed or assigned couples.
Background material necessary to appreciate the dimensions of the
heterosexual aspects of the Institute’s investigation of human sexual
function (study groups A and B) has been presented as well as
similar material for the homosexual group.
Further perspectives for homosexuality have been created by pre
senting comparable statistics relative to homosexual and hetero
sexual men and women’s facility to respond at orgasmic levels to
123
similar sexual stimuli. For the first time, sexual functional efficiency
in terms of failure of orgasmic attainment has been reported so
that comparisons may be made relative to gender, to sexual prefer
ence, and to the roles of committed and assigned partnerships for
the sexually experienced study subjects. Finally, selected individual
failures to function effectively in the laboratory have been discussed
briefly, and the unusual male functional failure of ejaculatory in
competence has been considered in more detail.
The statistics returned from the 14-year laboratory investigation
of alternative styles of human sexual interaction will be considered
in Chapter 10. Implications that may be drawn from these statistics
will be discussed in Chapter 11.
7
HOMOSEXUAL
PHYSIOLOGY
Information about human sexual physiology has been reasonably

established in the last quarter century through the cooperation of
hundreds of men and women responding to heterosexually oriented
sexual stimuli in a laboratory environment. Analysis of the physio
logic patterns of homosexual men and women has been made far
simpler by prior experience with heterosexual research programs.
The four phases of the human sexual response cycle have been es
tablished; sexual anatomy not only reidentified but specific func
tion in response to effective sexual stimuli established as target
organ responses; general body reactions to effective sexual stimuli
confirmed; and the astonishing number of similarities between male
and female sexual physiology underscored.
A number of investigators have made fundamental contributions
to our knowledge of this subject, but they have evaluated and dis
cussed only the heterosexual man’s and woman’s physiologic ca
pacity to respond to effective sexual stimuli, not that of the homo
sexual male or female. Is there a fundamental difference in sexual
physiology if the respondents are homosexually rather than hetero
sexually oriented? Based upon more than four years of intensive
observation of hundreds of completed sexual response cycles in
homosexual men and women in response to a multiplicity of sexual
stimulative techniques, the answer is an unequivocal no.
All of the physiologic response patterns originally identified in
heterosexual study subjects were present in homosexual study sub
jects as well. No additional response patterns unique to homosexual
interaction were identified. The physiologic reactions that develop
in men and women in response to effective sexual stimuli follow
124
HOMOSEXUAL PHYSIOLOGY
125
gender-linked patterns from the onset of the excitement phase

through the resolution phase, regardless of whether the stimuli are
homosexually or heterosexually oriented. The only identifiable dif
ference between homosexual and heterosexual reactions to similar
sexual stimuli was in the wide range of subjective appreciation of
these stimuli (see Chapter 5).
In homosexual functioning there are, of course, variations on the
generally established theme of the heterosexual man or woman’s
physiologic response to effective sexual stimulation; this is particu
larly true with respect to advanced degrees of deep vasocongestion
in the primary and secondary organs of reproduction (the target
organs). But there are similar variations that have been identified
during heterosexual and ambisexual encounters (see Chapter 8).
Since the fundamental patterns of physiologic response to effec
tive sexual stimulation have been identified and described, there is
no value in detailed repetition. This abstracted report of the physio
logic responses of homosexual men and women in a laboratory en
vironment is presented for casual reference. For a more detailed,
anatomically oriented discussion of human sexual physiology as de
veloped in a laboratory environment by heterosexual study subjects,
reference should be made to Human Sexual Response.
SEXUAL RESPONSE PATTERNS:
SCHEMATIC DIAGRAMS
Schematic representation of the sexual response patterns previ

ously published for heterosexual men and women have been repro
duced here for reference convenience. These representative response
patterns are equally applicable to men and women responding to
homosexual stimuli. Every phase of the established heterosexual re
sponse cycle is duplicated in homosexual interaction.
Homosexual male and female sexual response cycles were re
corded only at the beginning of the research program. Since it was
immediately obvious that there was to be no identification of
significant differences from the physiologic patterns previously es
tablished in heterosexually oriented response cycles, recording was
discontinued as a nonproductive distraction to the study subjects.
126 CHAPTER SEVEN
FIGURE 7-I
The male sexual response cycle. (From Masters and Johnson, 1966.)
It should always be kept in mind that these schematic diagrams

of intensity of response to effective sexual stimuli are indeed just
schematic diagrams. Figure 7-1, which schematically illustrates a
single male sexual response cycle, obviously could have had a num
ber of other variations in plotted patterns of response, but the
illustration still represents the most frequently experienced male
response cycle regardless of whether the sexual stimuli are hetero-
sexually or homosexually oriented.
The three sexual response cycles illustrated for the female (Fig
ure 7-2) are the most frequently observed patterns of sexual reac
tion. Obviously, there are any number of variations on the three
main themes. Pattern A represents the most consistently identified
complete response cycle for women. The dual orgasmic peaks are
drawn to represent woman’s natural physiologic potential for multi-
orgasmic experience; they do not represent an established consis
tency in her sexual response cycle.
Pattern B schematically outlines woman’s most frequently occur
ring sexual frustration—that of attaining relatively high levels of
sexual stimulation without developing subsequent orgasmic release
of these sexual tensions. When denied orgasmic release, women
usually experience a slow, drawn-out resolution phase with subjec
tive feelings of pelvic engorgement or aching that develop from
continuing pelvic venous congestion.
Pattern C illustrates the explosive potential of woman’s sexual
HOMOSEXUAL PHYSIOLOGY 127
ORGASM
PLATEAU
EXCITEMENT
ABC (C)
FIGURE 7-2
The female sexual response cycle. (From Masters and Johnson, 1966.)
capacity as she responds to a “teasing technique” of repeated initia

tion and withdrawal of or reduction in an effective stimulative ap
proach. The resultant lengthened duration and increased intensity
of her orgasmic experience is illustrated by the flattened peak of
the curve, and the resolution phase not only is of short duration,
but usually is accompanied by excessive lethargy, rapid onset of
drowsiness, and even sleep. As in the male cycle, it matters not in
the plotting of a female sexual response pattern whether the stim
uli that initiate the reactions are homosexually or heterosexually
oriented.
When orgasmic release is experienced, the major difference in
the sexual response cycle between men and women is the male re
fractory period present in both homosexual and heterosexual re
sponse cycles. The duration of this refractory period generally in
creases in direct parallel to the man’s age. It represents that period
of time during which the male cannot repeat his orgasmic experi
ence, regardless of the availability of previously effective stimulative
techniques, a cooperative partner, or even a continuing erection.
In essence, the plotted response patterns indicate that the hu
man female is innately multiorgasmic and the male is not. The
128 CHAPTER SEVEN
heterosexual or homosexual woman may move from orgasmic ex

perience to orgasmic experience without lowering her sexual excita
tion level below that of a low plateau-phase or high excitement
phase reaction.
If the homosexual or heterosexual man is to return to orgasmic
experience, his sexual tensions must drop to low excitement-phase
levels before his response cycle can be reactivated. Most men need
a matter of at least several minutes’ respite before they are capable
of restimulation to achieve a second ejaculatory response. The min
utes may turn into hours or even days as aging progresses.
Since the four phases of the sexual response cycle, excitement,
plateau, orgasm, and resolution, apply to sexually stimulated homo
sexual as well as sexually excited heterosexual men and women,
they will be used to facilitate the reportorial process.
HOMOSEXUAL PHYSIOLOGY:
TOTAL-BODY RESPONSE
Homosexual men’s and women’s physiologic responses to effec

tive sexual stimuli are not confined to the reproductive organs. As
with heterosexual subjects, the total body responds to the influence
of elevated sexual tension. This generalized total body response is
best exemplified by a widespread increase in myotonia (muscle ten
sion) and in superficial and deep vasocongestion.
There are, of course, specific as well as generalized physiologic
responses to sex-tension increment. As sexual interest elevates, so
does the respiratory rate, the heart rate, and the blood pressure.
Bowel tone may be increased, kidney function amplified, the neuro
endocrine system stimulated, and even the special senses of hear
ing, sight, and smell modified by sex-tension increment.
There are no consistent differences in electrocardiographic re
cordings of homosexual men and women responding to various
levels of sexual stimulation when these tracings are compared to
those of heterosexual men and women at similar levels of sexual
excitation. Also, respiratory rates, blood pressure elevations, and
circulating blood volumes only vary with the intensity and duration
of the individual man’s or woman’s sexual excitation, not with his
129
or her sexual preference. Since electrocardiographic material has

been published previously in Human Sexual Response and by a
number of other investigators (Fletcher and Cantwell, 1977; Littler
et al., 1974; Stein, 1977), the publication of a sample cardiogram
will not be repeated in this text.
Throughout the body both a generalized increase in muscle tone
and spasticity of specific muscles are apparent in both sexes. Exam
ples of generalized increase in muscle tone were provided by homo
sexual men and women during sexual interaction under direct ob
servation. The fingers clinch, the toes curl, the abdominal muscles
contract, and muscles of the face and neck evidence tension. There
may be tightening of the entire muscle complex of the perineal
body as well as of the musculature that supports the female pelvic
organs. This generalized increase in muscle tone rarely becomes ap
parent until late in the excitement phase, and it increases through
the plateau phase.
An example of increased tension in a specific muscle is the invol
untary constriction of the rectal sphincter that frequently occurs
late in the plateau phase in sexually responsive homosexuals of both
sexes (see Chapter 5). This same pattern was also seen in hetero
sexual study subjects.
Muscle tensions, whether generalized or specific, reach their peak
during orgasmic experience, and fairly rapid dissipation of these
tensions is an integral part of the resolution phase. If orgasm is
not experienced, however, recognizable levels of generalized muscle
tension may linger for hours in various muscle groups.
There also are a number of examples of both superficial and deep
concentration of blood (vasocongestion) that are an integral part
of each homosexual man’s or woman’s physiologic response to sub
jectively appreciated sexual tension, just as they are part of the
heterosexual’s physiologic response. An example of superficial vaso
congestion would be that of the sex flush that develops over the
diaphragm and may spread to the abdomen, chest, neck, face, fore
head, as well as to the arms, back, and buttocks. This flush rarely
appears until late in the excitement phase, increases and spreads
widely during plateau, and vanishes immediately after orgasmic ex
perience. If orgasm is not experienced, the sex flush involutes more
slowly and in reverse order from its onset: first from the back and
CHAPTER SEVEN
13®
the arms; then from the face, neck, chest, and abdomen; and finally
from the diaphragm.
Deep vascular engorgement is usually confined to the primary
and secondary organs of reproduction (target organs) and to other
auxiliary pelvic structures. Some examples of the concentration of
venous blood in the target organs are increase in female breast
size, onset of penile erection, or development of the orgasmic plat
form in the outer third of the vagina. Existing varicosities in the
pelvis and legs may become severely engorged as sexual tensions
elevate. These specific anatomic reactions to elevated sexual ten
sions will be discussed in context.
It may be of psychological as well as physiologic significance that
severe degrees of deep vasocongestion in the target organs were
established by homosexual women far more frequently in com
mitted as opposed to assigned relationships. As described in Chap
ter 5, committed homosexual women usually spent an extraordinary
amount of time in sexual play. On an average, they took far more
time in sexual interaction than homosexual women in assigned rela
tionships, than ambisexual women in their homosexual phases, or
than heterosexual women responding to their husbands’ sexual ap
proaches.
It was apparent that advanced degrees of deep vasocongestion
resulted from more time spent with such teasing techniques as
starting and then slowing or even temporarily suspending sex play,
or varying both the intensity and ingenuity of sexual approaches.
When assigned female homosexual partners moved through sexual
response cycles with relative rapidity, or for that matter, during the
infrequent occasions when committed homosexual women also
moved rapidly through their sexual response cycles, an appreciable
reduction was identified in the venous congestion of the target or
gans. It also should be mentioned that on the few occasions during
heterosexual partner manipulation and cunnilingus when husbands
took long periods of time to stimulate their wives and teasingly
varied the intensity and even the ingenuity of their stimulative ap
proaches, an advanced degree of venous engorgement was present
in the breasts and pelvic organs of these heterosexually oriented
women.
The same increases in vasocongestion of the target organs were
evident during the interaction of committed male homosexual cou-
131
pies. These men usually spent significant periods of time during

partner manipulation and fellatio in teasing their partners by alter
ing the intensity and the rapidity of the sexually stimulative process
before encouraging ejaculation. Again, the longer the time spent
in stimulative play, the more advanced the venous stasis of the
penis and testes (target organs). Similarly, on the relatively rare oc
casions when wives spent long periods of time with deliberately
controlled teasing techniques during partner manipulation or fel
latio, their husbands evidenced similarly advanced degrees of deep
vasocongestion of the target organs. There also were occasional in
cidences of advanced vasocongestion of the target organs identified
in assigned male homosexual couples and in ambisexual men in
their homosexual phase. But these incidences were the exceptions,
not the general rules.
Thus, the slowed venous flow in the target organs that was so
frequently observed during the sexual interaction of committed
male and female homosexual couples is not a specific effect of ho
mosexuality. It was observed on infrequent occasions in ambisexual,
assigned homosexual, and heterosexual interaction. Instead of being
related to sexual preference, the physiologic response of advanced
deep vasocongestion is usually a secondary result of spending long
periods of time in effective sexual stimulation before experiencing
sexual release.
REPRODUCTIVE ORGANS
The physiologic changes in the primary and secondary organs of

reproduction That develop in response to effective sexual stimula
tion should be restated briefly.
FEMALE TARGET ORGANS
The homosexual female’s breasts are indeed target organs when

sexual stimulation is initiated. As described in Chapter 5, a signifi
cant amount of time usually is spent by committed female homo
sexual couples in breast stimulation. The nipples erect early in the
excitement phase unless they are partially or completely inverted,
in which case no overt reaction has been recorded.
The areolae begin tumescence during late excitement and early
CHAPTER SEVEN
13«
plateau phases. When the breasts have not been nursed, the entire
breast increases in size as sexual excitation progresses. Since only
one homosexual study subject nursed a baby and then only for
two weeks (Chapter 3), breast engorgement was pronounced in all
observed female response cycles when the interaction between
stimulator and stimulatee continued at a leisurely pace. When
there was long-continued breast play, the stimulatee’s breasts usu
ally increased in size from one-quarter to an estimated one-third
over sexually unstimulated baseline measurements.
A pattern of female breast reaction to sexual stimuli unique to
the lesbian study group was identified. The stimulator’s breast size
also was observed to increase measurably during long-continued
periods of sexual interaction. Though lesbian couples were almost
always in a “my tum-your turn’’ interaction pattern, with one giv
ing and one receiving physically stimulative approaches to the
breasts, the woman giving (manipulating or suckling her partner’s
breasts ) frequently reached that level of sexual excitation necessary
to achieve obvious increase in her own breast size. In most instances
there was minimal breast engorgement for the stimulators, but oc
casionally the engorgement was estimated at as much as a one-
quarter increase over the sexually unstimulated baseline size. This
pattern of breast engorgement for the stimulators was particularly
obvious for the two women who insisted on manipulating their
committed partners and did not allow their partners to approach
them physically at any time (Chapter 5).
The stimulator was not only responding to her sexual arousal
that developed from the physical approach to her partner’s breasts,
but she was also subjectively appreciating and being sexually stimu
lated by her partner’s verbally and nonverbally communicated high
levels of sexual excitation. As a matter of sequential timing, it was
noted that once the stimulatee’s breast engorgement was obvious,
the stimulator’s breast distention, if it was to occur, followed within
2 to 5 minutes. Only one stimulator developed breast engorgement
more than 5 minutes after the stimulatee had responded, and there
were no instances when the stimulator evidenced breast engorge
ment before the stimulatee.
There was no obvious breast reaction to orgasmic experience.
During the resolution phase, breasts lost their deep vascular en-
»33
gorgement far more rapidly when the responding lesbian was or
gasmic than in the very few instances when she was unable to
achieve release (Chapter 6).
Deep vasocongestion was also easy to identify in the female geni
tal organs during lesbian interaction. When stimulative approaches
are confined to masturbation, partner manipulation, and cunni
lingus, effective observation of the external genitalia is far simpler
than when intercourse is a factor. Again, obvious physiologic re
sponses to elevating sexual tensions were identified for both the
stimulator and the stimulatee.
When the genitals were approached in partner manipulation or
cunnilingus, almost all committed lesbian partners had moved into
stimulator-stimulatee roles. Both partners usually had experienced
some degree of overt sexual stimulation varying from general body
stroking to breast suckling, and both partners, regardless of their role
of giving or receiving sexual pleasure, usually had developed an ob
vious amount of vaginal lubrication.
Vaginal lubrication appears early in response to any form of ef
fective sexual stimulation experienced by the human female. It is
but a matter of a few seconds from onset of stimulation to obvious
lubrication production. However, once initiated, lubrication is not
produced at a steady pace by either homosexually or heterosexually
oriented women. In general, lubrication flow increases or diminishes
in direct proportion to the elevation or regression of sexual tension.
In other words, the production rate of lubrication is tied to the de
gree of involvement with or distraction from the sexual opportunity
at hand.
Homosexual or heterosexual women rarely respond from the on
set of the excitement phase through plateau to orgasm in a direct,
continuing line of constantly elevating sexual tension. Usually there
are distractions that at least momentarily lower the degree of sexual
involvement. Most distractions, such as reduction in effectiveness
of a particular stimulative technique, sounds or sights foreign to the
specific sexual interchange, or introduction of irritating or unac
ceptable stimulative approaches, slow the production of vaginal
lubrication. Of course, if the distractive element is of sufficient in
fluence, there may be complete cessation in the flow of lubrication.
And responding women, regardless of their sexual preference, are
CHAPTER SEVEN
134
easily distractable until late in the plateau phase of the sexual re
sponse cycle.
As has been noted, by the time an approach was made to the
genitals of one partner, both lesbians in a committed relationship
were usually well lubricated. Once genital play was instituted, how
ever, the stimulatee usually far outproduced the stimulator. There
were exceptions to this observation. The two women who insisted
on playing only the stimulator role (see Chapter 5) were as well
lubricated while manipulating their partner’s genitals as were the
highly aroused partners themselves. One lesbian member of a com
mitted couple, a very heavy lubricator, did indeed produce more
lubrication than her partner, regardless of whether she was in a
stimulatee or stimulator role.
There was no obvious difference in lubrication production be
tween homosexual or heterosexual women as long as the stimula
tive techniques of masturbation, partner manipulation, or cunni-
lingus were used exclusively throughout the entire sexual response
cycle. When the techniques of partner manipulation or cunnilingus
were employed by husbands as a preamble to anticipated coital con
nection, however, lubrication frequently developed irregularly and
was estimated to be in less copious amounts than that produced by
the same women when they were anticipating end-point release
from a stimulative technique other than intercourse. Women an
ticipating intercourse may involuntarily put a different value on
the stimulative techniques of manipulation and cunnilingus when
considering them as a means to an end rather than an end in them
selves. Certainly women anticipating intercourse were more easily
distracted while responding to precoital manipulative or cunnilingal
stimulation than during episodes employing these standard stimu
lative techniques when coitus was not allowed.
The clitoris responds in identical fashion to effective stimulation
regardless of whether the stimulators are heterosexually or homo-
sexually oriented. The retraction reaction that elevates and flattens
the shaft of the clitoris on the inferior surface of the symphysis
pubis occurs late in the plateau phase, regardless of the source of
stimulation. It has not been established whether there is a pre-
orgasmic expansion of the clitoral glans to parallel the immediate
preejaculatory penile glans expansion described in the section on
135
male target organs later in this chapter. This lack of information

results from the fact that as the clitoris retracts, it withdraws be
neath the minor labial hood and the glans cannot be observed read
ily during the woman’s orgasmic experience.
The orgasmic platform develops as a deep vasocongestive re
sponse that encompasses the outer one-third of the vagina and ex
tends to the minor labia. It results from engorgement of the vestibu
lar bulbs that lie in the lateral walls in the outer third of the vagina
and join in the midline just below the clitoris through the clitoral
veins. The vestibular bulbs are a plexus of thin-walled veins quite
similar to the erective tissue of the penis. The degree of venous
engorgement that forms the orgasmic platform varies with the in
tensity of sexual stimulation, regardless of the sexual preference of
the responding woman. The orgasmic platform develops late in the
excitement phase or even well into the plateau phase. But once
established, the platform is not static in dimension. It increases
modestly in dimension as sexual tensions elevate and decreases in
size if the effective stimulative approach is withdrawn, a severe dis
traction is introduced, or orgasm is experienced.
Apparently there is no such entity as a fully formed orgasmic plat
form in the sense that the platform continues to evidence modest
increases or decreases in venous engorgement as effective stimula
tive activity is prolonged or delayed. Slowly increasing engorgement
is particularly noted during the late plateau phase, just before or
gasm is experienced. This lack of a static dimension for the vaso-
congestion of the orgasmic platform parallels the plateau-phase
cyclic vasodistention and vasoconstriction of erective tissue in the
penis described later in this chapter.
In many instances of lesbian interaction, a grossly engorged or
gasmic platform almost occluded the outlet of the vaginal barrel.
These women were completely lost in sexual excitation. This degree
of platform development was usually identified in lesbian women
who had been exposed to long-continued sexual stimulation before
the genital organs were approached directly, a pattern of sexual
behavior typical of the interaction of committed lesbian couples
(see Chapter 5).
Contractions of the orgasmic platform in the outer third of the
vagina and of the uterus during the homosexual woman’s orgasmic
CHAPTER SEVEN
136
experience are physiologically identical to those of heterosexual

women. There always are individual variations in the intensity of
orgasmic contractions and duration of orgasmic experiences. But
even these physiologic response patterns vary from woman to
woman and within the same woman from one experience to the
next, regardless of whether the sexual stimuli are homosexually or
heterosexually oriented. The ambisexual research program provided
further information to confirm these investigative findings (see
Chapter 8).
When the orgasmic platform is well established, there also is
an advanced degree of both superficial and deep venous congestion
of the other genital viscera. The color change of the minor labia
(sex skin) is a superficial vasocongestive reaction that is particularly
evident in responding lesbians. This onset of labial color change ap
proximates in timing sequence the development of the orgasmic
platform. Since there were only two lesbian study subjects who had
experienced more than one full-term delivery (see Chapter 2), the
usual burgundy-wine, sex-skin coloration characteristic of multi
parous women was rarely observed. The labial coloration observed
ranged from a bright pink to a cardinal red. When a labial color
change takes place, the woman will be orgasmic if the stimulative
approach that has brought about the color change is maintained
and no major distraction is experienced.
The vagina involuntarily lengthens and then expands in diameter,
particularly at the transcervical level, in response to elevated sexual
tensions, but these alterations in vaginal physiology are coital pre
cursors and of little importance in lesbian interaction unless a dildo
is employed. There are other physiologic alterations in the pelvic
viscera, however, that are of some consequence in lesbian response.
With long-continued sexual stimulation, the uterus, particularly
that of a multiparous woman, usually increases in size; and the
broad ligaments that support the uterus also may be palpably en
gorged with venous blood. Uterine enlargement is particularly ap
parent in women who have had children, with approximately a 50
percent increase in size identifiable with some frequency just before
orgasmic-phase experience being identified with some frequency.
The nulliparous uterus also evidences passing engorgement, but on
a much smaller scale; its engorgement is identified as a transitory
137
deep vasocongestive reaction that may only provide one-fifth to one-

quarter enlargement. If there is no orgasmic release of the sexual
tensions that have created this advanced degree of deep venous
congestion, lesbians may experience clinical symptoms of lower ab
dominal or pelvic aching, or even significant pain.
Four lesbian members of committed couples demonstrated ad
vanced degrees of pelvic congestion during sexual interaction with
their partners and complained of a sense of fullness and mild ach
ing in the pelvis, but no pain. These four women were examined
just before the onset of sexual stimulation and were examined again
when the pelvic vasocongestive reaction was at its maximum, just
before they could have anticipated orgasmic release. Finally, the
four women were examined a third time, immediately after their
orgasmic experiences. For each of these women, orgasms devel
oped during partner manipulation and were quite intense, with the
orgasmic platforms contracting a minimum of 10 and a maximum
of 13 times. Each of the four women cooperated with the research
team to allow the three sequential pelvic examinations to be done
on two separate occasions when they were responding successfully
to partner manipulation. While there is the factor of potential
stimulation from the pelvic examination techniques, at least it was
present in all cases.
As the result of the sequential pelvic examinations, the examiner
had the distinct impression that the ovaries had enlarged to an
estimated 30 to 40 percent over their initial baseline size during the
period of sex-tension increment, and then had lost this transitory
venous engorgement in the immediate postorgasmic period.
This clinical observation merely represents the examiner’s sub
jective impression and not only has not been confirmed, but may
be no more than an example of wishful thinking. Although the
ovarian stroma is more concentrated than that encountered in the
testicle, the ovarian blood supply certainly is profuse. It is theo
retically possible that there could be transitory deep venous engorge
ment of the ovaries concomitant with venous congestion of the
vagina and the uterus. A more detailed investigation of the possibil
ity of transitory ovarian venous congestion resulting from advanced
degrees of sexual tension certainly is in order. The theoretical influ
ence of such a physiologic response pattern on the ovary as a pos
CHAPTER SEVEN
138
sible etiologic agent in multiple ovulation warrants continued re

search.
One lesbian regularly developed aching and occasions of pain in
both lower quadrants of the abdomen when she was delayed from
attaining orgasm for long periods by her partner’s deliberate “teas
ing” or holding back of release opportunity. The woman had de
livered two children, had had one abortion (see Chapter 3), and
had obvious varicosities of the legs and in the pelvis. She stated that
for the previous three years when there was long-continued sex play
without orgasmic release, she would begin to ache in the lower
abdomen.
A baseline pelvic examination was done before the initiation of
sexual stimulation. A second pelvic examination was conducted
shortly after the onset of bilateral lower quadrant aching and dem
onstrated palpable venous engorgement of the broad ligaments and
an obvious increase in uterine size. Ovarian palpation was equivocal
in that the examiner could not be sure whether there was definitive
enlargement. Presumably the engorged varicosities in the broad
ligaments or even the transitory enlargement of the uterus could
have caused the pelvic aching.
When the ovaries were palpated during the pelvic examination,
the complaint of aching in the lower quadrant intensified to an
acute pain level. This was a relatively stoic woman, and the pain
response was far beyond that which might be normally anticipated
from ovarian palpation during a pelvic examination. The pelvic
aching disappeared soon after the woman was provided with op
portunity for orgasmic release by her partner. When a postorgasmic
pelvic examination was done, the vasoconcentration in the broad
ligament had dispersed, the uterus had returned to baseline size,
and selective ovarian palpation did not produce anything resembling
the level of physical distress that had been present when there was
an advanced degree of venous congestion in the pelvis.
Whether this is an example of female gonadal congestion that
corresponds to the testicular engorgement men experience in late
plateau-phase sexual excitation is, of course, questionable, but it is
not beyond the realm of possibility. Three women have been iden
tified in a gynecologic practice with similar histories of severe ach
ing that develops in the lower abdomen during long-continued sex
139
play and is relieved by orgasmic experience. No pelvic pathology

was evident during routine pelvic examination of these three women.
MALE TARGET ORGANS
Both superficial and deep vasocongestive reactions to sex-tension

increment are evident in the penis and the testes.
An example of a superficial vasocongestive reaction is the transi
tory color change that develops in approximately 20 to 25 percent
of males responding to late plateau-phase levels of sexual tension.
The coloration, which varies in intensity, appears on the coronal
ridge of the penis at the separation of the glans and shaft and, when
present, is as pathognomonic of impending orgasm for the male as
is the minor labial color change for the female. The committed ho
mosexual males demonstrated a penile coronal color change of
greater intensity and with greater frequency than did the assigned
male homosexual couples.
The phenomenon of erection results from the slowing of venous
drainage from the two corpora cavernosa and from the corpus spon
giosum, which are cylinders of erectile tissue that make up the
body or shaft of the penis. In addition, the corpus spongiosum,
which contains the urethra, expands distally to form the glans or
head of the penis and proximally to form the urethral bulb.
We have tended to believe that once penile erection has been
accomplished, it becomes a static entity that usually continues
without alteration until after ejaculation. But such is not the case.
Sexual interchange between committed homosexual males particu
larly emphasized this point: There are many degrees of penile en
gorgement. Incomplete penile engorgement is obvious, but what
represents a state of complete penile engorgement? There is no
secure answer to the question of when an erect penis is fully erect.
When committed male couples, either in partner manipulation
or fellatio, took long periods of time to tease the stimulatee, speed
ing or slowing stimulation repetitively, apparently well-established
erections continued to expand. Many times the research team felt
certain that the particular erection had peaked in engorgement,
only to observe minimal further expansion. Late continuing expan
sion of the erective process usually is confined to increases in the
diameter of the penile shaft or to overall engorgement of the penile
140 CHAPTER SEVEN
glans or both. Routinely, men responding to long-continued stim

ulative techniques of partner manipulation or fellatio had a more
pronounced degree of penile erection immediately before ejaculation
than did the same men when they masturbated. They usually took
less time in masturbation because they were much more goal-
oriented.
In contrast, the assigned male homosexual couples usually spent
significantly less time during partner manipulation and fellatio, and
these men only evidenced approximately the same degree of penile
engorgement immediately prior to orgasmic release as that devel
oped when the men masturbated individually.
Heterosexual husbands responding to their wives’ manual and
oral stimulation generally had more penile engorgement when these
techniques were used to obtain end-point release than when re
sponding to the same stimulative techniques employed by the same
women but as stimulative precursors to directed intercourse. On
the infrequent occasions during partner manipulation or fellatio
when wives spent a great deal of time in teasing play with the erect
penis before providing their husbands with ejaculatory opportunity,
there was slow, continuing expansion in penile diameter that con
tinued in such an inevitable manner up to the orgasmic sequence
that the inference was created that there always was the anatomic
possibility of minimal further shaft or glans expansion. This con
tinuing slow expansion in shaft or glans diameter of the established
erection until orgasm intervenes parallels in physiologic potential
the continuing modest expansion of the established female orgasmic
platform described earlier in this chapter.
When intercourse occurred, there was usually less penile engorge
ment evident during the mounting process than was present for the
same man late in plateau phase when responding to masturbation,
partner manipulation, or fellatio.
To date, there is no mechanism for evaluating the possibility of
late-continuing expansion in penile diameter during coital connec
tion. But it would be a surprise if the deep vasocongestive reaction
of the penis did not continue as a slowly progressive, expansive
process during coital connection, presuming, of course, that the
mental or physical distractions that so frequently accompany inter
course were held to a minimum and that the male partner did not
ejaculate rapidly.
Ml
One other minor variation on the basic theme of the male’s physi
ologic response to effective homosexual stimulation was the im
mediate preejaculatory expansion of the penile glans. This deep
vasocongestive reaction was not identified during the original in
vestigation of the heterosexual male’s physiologic response to sex
tension increment, but probably it was present, for it has occasion
ally been identified in heterosexual study group A males. This
further expansion of the already grossly engorged glans does not
occur with established regularity, but when it does develop, it paral
lels the man’s subjective appreciation of unusually high levels of
sexual excitation.
The terminal glans expansion phenomenon was most in evidence
when committed male homosexual partners interacted in the labora
tory. It also was seen on a few occasions in heterosexual group A
males when married couples spent a good deal of time in partner
manipulation and fellatio before releasing the highly excited male to
his ejaculatory experience. Terminal glans expansion rarely was seen
during masturbational experience. To date, its occurrence as an
immediate preejaculatory reaction during coital connection has not
been determined, but it would be surprising if terminal glans ex
pansion did not occur with some regularity during intercourse. In
essence, terminal glans expansion is physiologic evidence of a high
degree of sexual excitation, and it only develops in the male’s im
mediate preorgasmic phase.
Man’s two-stage orgasmic experience occurs in physiologically
identical fashion, regardless of whether the stimuli are heterosex-
ually or homosexually oriented. Just as is evidenced by the lesbian
study subjects, there are individual variations in intensity and dura
tion of the homosexual male’s orgasmic experience, but these are
variations between individuals or within the same individual from
time to time and not significant physiologic variations that can be
attributed to sexual orientation alone. Additional information to
support this position came from the ambisexual investigation (see
Chapter 8).
Penile erection also occurred regularly for the homosexual stimu
lator while manipulating his partner either manually or orally. Usu
ally the stimulator’s penis achieved reasonably full engorgement
from 5 to 10 minutes after the stimulatee’s erection was fully estab
lished. No stimulator ejaculated while manipulating his partner.
CHAPTER SEVEN
142
Engorgement of the testes is a consistent deep vasocongestive

response to effective sexual stimulation. The testes begin to expand
in diameter late in the excitement phase or in the early plateau
phase. It was rare to have no observable testicular engorgement by
the time responding homosexual males ejaculated in the laboratory.
The only times when testicular engorgement could not be demon
strated was when men ejaculated very rapidly after onset of mas
turbation, partner manipulation, or fellatio.
Testicular engorgement was occasionally observed in men in
stimulator roles who became so involved in their male partners’
reactions that their own sexual excitation reached plateau-phase
levels while they were satisfying their partners either with manipu
lation or fellatio.
Testicular Aching. Widely known clinically is the development
of aching, even severe pain, that can occur in the scrotum when long-
maintained sexual excitation without subsequent ejaculation keeps
the testes engorged with blood for significant periods of time. This
pain syndrome also has been noted when a male loses an erection
or fails to ejaculate for any reason after experiencing high levels of
sexual excitation for long periods of time. The testicular aching or
pain is relieved promptly by an ejaculatory experience. The clinical
syndrome of testicular pain during episodes of long-continued sexual
excitation parallels that experienced by the few female study sub
jects who developed lower abdominal aching under similar circum
stances. The testicular and lower abdominal distress were both re
lieved immediately by orgasmic experience.
SUMMARY
The physiologic material returned from the laboratory phase of

the Institute’s overall investigation of human sexual function sup
ports the contention that evidences of deep vasocongestion and in
creased muscle tension are specific indicators of advanced degrees
of sexual excitation in men and women whether of homosexual or
heterosexual orientation. Penile erection and vaginal lubrication are
parallel phenomena. Continuing engorgement of the female’s or
gasmic platform during high levels of sexual tension parallels con
M3
tinuing expansion in penile diameter as the male also reaches high

levels of sexual excitation. The color changes of the minor labia sex
skin and penile coronal ridge are also parallel phenomena and are
pathognomonic of impending orgasm. And testicular pain from
localized, deep vasocongestion may have a parallel reaction in the
ovarian pain that also develops as a localized, deep pelvic vasocon-
gestive response to long-continued sexual stimulation.
8
AMBISEXUAL STUDY
GROUP
Jjy mid-1968 the Institute’s investigation of homosexual response

patterns was terminating and there was an end in sight for the work
with the heterosexual study subjects in group A. The functional ef
ficiency of homosexual and heterosexual study subjects in the labo
ratory had been assessed, and restricted subjective and objective
comparisons were being drawn between persons with homosexual
and heterosexual orientations. There remained the need to broaden
the dimensions of recently acquired information on alternative pat
terns of sexual behavior.
While recruiting the homosexual study-subject population, the
research team encountered many men and women who had re
ported a considerable degree of sexual experience involving partners
of both sexes. Subjects describing a history of sexual experience in
which male and female partners were involved in approximately
equal numbers had been encountered frequently. These men and
women were given a Kinsey preference rating of 3.
From 1964 to 1968 the recruitment of Kinsey 3 men and women
who were living as homosexuals was not particularly difficult. In
fact, during the four-year period, 20 female and 20 male Kinsey 3
subjects were selected as members of the homosexual study-subject
population. Most of these recruits had been living in committed
homosexual relationships of at least one year’s duration, while 1
man and 2 women volunteered to participate in the assigned homo
sexual groups. They also had been living as homosexuals for at
least one year when recruited.
On the other hand, 5 Kinsey 3 individuals were encountered
who, when contacted, were living as heterosexual partners in com
144
AMBISEXUAL STUDY GROUP
145
mitted relationships. Since the decision had been made to include

as heterosexual subjects only individuals with a Kinsey preference
rating of 1 or 0, these men and women were not recruited for
heterosexual study group A (see Chapter 1).
During the active recruiting period, research team members be
came aware that occasionally they were being confronted by an
other type of potential study subject with an atypical history. These
men and women reported frequent sexual interaction with mem
bers of both sexes and also described the additional exceptional
characteristic of an apparent complete neutrality in partner prefer
ence between the two genders. These individuals were living life
styles in which commitment to a dyadic relationship had never
played a part. Sexual experience was viewed as purely a matter of
physical release, and gender was of no importance in acquiring a
partner for any sexual episode. These individuals were clearly not
sociopaths: They had no histories of trouble with the law or with
authority figures; no patterns of poor performance at work, school,
or in the military; and no difficulty in functioning responsibly in
most facets of their lives. Furthermore, none of these persons had
histories of psychologic pathology.
The research team believed that it would be valuable to assemble,
interview, and evaluate a number of such people, both male and
female, in a manner similar to that used with the homosexual and
heterosexual research groups. It was thought that this group of sub
jects with no subjectively identifiable or outwardly expressed sexual
preference might serve as a valuable reference group in interpreting
the significance of patterns of physical response, sexual behavior, or
fantasy material reported from study groups of homosexually and
heterosexually oriented subjects.
A decade later, in evaluating and analyzing the data from this
project, it appeared that a new term must be employed to designate
the specific characteristics identified in this unusual group of men
and women. Although others (Richard Green, 1974) have spar
ingly used the term synonymously with bisexual, the Institute, fol
lowing the suggestion of Mark Schwartz, has taken the option of
creating its own definition for the term ambisexual. According to
Institute parlance, an ambisexual is a man or woman who unre
servedly enjoys, solicits, or responds to overt sexual opportunity
146 CHAPTER EIGHT
with equal ease and interest regardless of the sex of the partners,
and who, as a sexually mature individual, has never evidenced in
terest in a continuing relationship.
There is clearly a different (and larger) group of individuals who
are bisexual, in the sense of having significant sexual experience
with partners of both genders, who do not meet the above criteria
that define ambisexuality. It is also fair to say that the term bisexual
has been widely abused and distorted in both public and profes
sional usage. Current public usage of the bisexual label has been so
misused that today any man or woman who previously has lived a
totally committed heterosexual or homosexual lifestyle and experi
ences a single episode of sexual interaction with a partner of the
opposite sexual preference may immediately consider himself or
herself bisexual. As a result of this current pattern of indiscriminate
application, the label of bisexuality often means whatever the user
wishes to imply.
Thus, from early in 1968 through most of 1970, a multidimen
sional investigative program was conducted to recruit and evaluate
a group of study subjects who could be identified by the Institute’s
definition of ambisexuality. The criteria for identification and selec
tion of a subject as ambisexual were (1) that the individual express
no preference in terms of sexual partner selection either through
personal history or by subjective description, (2) that he or she was
currently living an uncommitted ambisexual lifestyle and had never
as an adult evidenced any interest in a continuing relationship, and
(3) that the man or woman could be rated close to Kinsey 3 in
sexual experience. It was decided that fantasy patterns, while they
were expected to have a unique composition, would not be included
as a primary selection criterion.
Fantasy patterns collected from men and women in homosexual
or heterosexual study populations usually reflected evidence of tran
sitory individual or group fixation (see Chapter 9). But any com
position of fantasy patterning that is individual- or group-directed
is not considered as representative of the ambisexual individual, for
such is not his or her orientation. The ambisexual is primarily con
cerned in fantasy with past or anticipated sexual opportunities or
experiences. He or she rarely individualizes a partner in fantasy.
147
RECRUITMENT
It was difficult to find men and women who met the criteria of
ambisexuality not only in their overt sexual behavior but in their
lifestyles as well. Obviously, no study subjects used in previous stud
ies could be included in the ambisexual group.
Although the first tentative recruiting steps were taken on a na
tional level in January, 1968, it was late summer of that year before
a total of 12 men and women could be assembled who were truly
ambisexual both in psychosocial orientation and in overt sexual ex
perience. Admittedly the numbers are small, too small for objective
comparison with the other study groups, but 11 years ago this repre
sented a significant recruiting success. The size of this group should
not be taken as indicative of the prevalence of ambisexuality in the
general population; no such figures are available.
During careful history-taking, no expression of sexual preference,
present or past, could be elicited from these men and women. After
early or midadolescence, they had always thought of themselves as
completely free to express their sexual needs with a partner of
choice, regardless of the sexual orientation of that prospective part
ner. In short, their mature sexual preference was, and apparently
always had been, that of the partner of the moment.
The 6 ambisexual men recruited for this project were primarily
classified as Kinsey 3 in sexual preference rating. The Kinsey 2 and
Kinsey 4 study subjects were close to a Kinsey 3 preference classi
fication when histories of sexual experience were taken. The 6 am
bisexual women also were either Kinsey 3 or near 3 in sexual prefer
ence when recruited. A Kinsey 2 rating was assigned to 1 woman,
and 2 women were determined to be Kinsey 4 when their histories
were taken (Table 8-1).
The male ambisexuals ranged in age from 26 to 41 years and the
females from 27 to 43 years (Table 8-2). A minimum formal edu
cational level of college matriculation was required for each of the
12 ambisexual subjects (Table 8-3).
The marital, pregnancy, and presumed impregnation histories of
148 CHAPTER EIGHT
TABLE 8- 1
Ambisexual Study Interchange Experiment:

Sexual Preference Classification *
Sexual Preference Classification

Age Group Male Ambisexual Female Ambisexual
21-30 2-3-3 4-3-3

31-40 3-3 3-4
41-50 4 2
Total 6 6
(1968-1970)
* Kinsey classification of sexual preference.
TABLE 8-2
Ambisexual Study Interchange Experiment: Age Distribution
Ambisexual Study Assigned Study Subjects

Age Subjects Homosexual Heterosexual
Group Male Female Male Female Male Female
21-30 3 3 4 5 3 6
31-40 2 2 5 5 3 5
41-50 1 1 2 3 2 3
Total 6 6 11 13 8 14
(1968-1970)
the 6 men and 6 women are so brief that charting is not warranted.
One woman (Kinsey 2) had been married for four months and di
vorced at her instigation. According to her history, the marriage was
contracted purely for the convenience of her partner: She had no
investment in the personal relationship. She maintained an open
lesbian relationship during the brief marriage. None of the other
11 ambisexual men or women had ever married. Two women (Kin
sey 3 and Kinsey 4) described conceptions that resulted in one full
term pregnancy and one voluntary abortion. In both cases the preg
nancies were designated by the women as contraception failures.
149
TABLE 8-3
Ambisexual Study Interchange Experiment: Formal Education ♦
High School College Postgraduate

Study Subjects (Percent) (Percent) (Percent) Total
AMBISEXUAL
Male 0 3 (50.0) 3 (50.0) 6
Female 0 5 (83.3) 1 (16.7) 6
Total 0 8 (66.7) 4(33.3) 12
ASSIGNED PARTNERS
Male
Heterosexual 2 (25.0) 3(37.5) 3(37.5) 8
Homosexual 4(36.4) 5 (45.4) 2 (18.2) 11
Subtotal 6 (31.6) 8(42.1) 5 (26.3) 19
Female
Heterosexual 3(21.4) 7 (50.0) 4 (28.6) 14
Homosexual 4(30.8) 6 (46.2) 3 (23.0) 13
Subtotal 7 (25.9) 13 (48.2) 7 (25.9) 27
Total 13(28.3) 21 (45.7) 12 (26.0) 46
(1968-1970)
The woman who had the full-term pregnancy (Kinsey 4) did

not nurse and placed the baby for adoption immediately after birth.
Two ambisexual men (Kinsey 3 and 2) reported three presumed
conceptions that terminated in two full-term pregnancies and a vol
untary abortion. The Kinsey 3 man claimed responsibility for two
of the conceptions—a term pregnancy and the abortion. They de
veloped from two different relationships.
All 6 women practiced contraception. Four were using oral con
traceptives, 1 an intrauterine device, and 1 a vaginal diaphragm
when they participated in the Institute’s research program. Two of
the 6 men had vasectomies.
No physical or metabolic defects were identified among the am
bisexual research group or the heterosexual or homosexual assigned
CHAPTER EIGHT
15»
partners when routine physical and clinical laboratory examinations

were conducted prior to final selection as study subjects.
ASSIGNED PARTNERS
The recruitment of assigned partners to interact with the ambi

sexual study group was also an unusual experience for the research
team because of the multidimensional sexual orientation inherent
in ambisexuality. In order to provide adequate research breadth, as
signed partners were assembled to represent four different sexual
orientations: male homosexual, male heterosexual, female homo
sexual, and female heterosexual.
The assigned partners were recruited by the same techniques that
had been established for the three prior research populations. The
assigned partners were recruited specifically so that their ages were
reasonably close to those of the ambisexual study subjects with
whom they were to interact sexually (see Table 8-2). With the ex
ception of 1 homosexual man who described a single, overt hetero
sexual experience some six years before laboratory cooperation, all
of the 46 assigned partners were either totally homosexual (Kin
sey 6) or totally heterosexual (Kinsey 0) in reported sexual experi
ence. Formal education ranged from high-school to postgraduate
levels of matriculation (see Table 8-3). There were no black or
Spanish-American volunteers among the ambisexual study subjects
or their assigned partners.
The assigned partner population comprised a total of 19 men, of
whom 11 were homosexual and 8 heterosexual, and 27 women, of
whom 13 were homosexual and 14 heterosexual. This relatively
large number of assigned partners was necessary for two reasons.
First, extra numbers of assigned female partners were necessary in
order to work around their menstrual periods. Second, the rela
tively large number of assigned partners made scheduling less diffi
cult, particularly a scheduling that always had to revolve around the
availability of the ambisexual study subjects, 9 of whom did not
reside in the St. Louis area.
151
SCHEDULING
The assigned partners were active in the research program on at

least one occasion and frequently interacted with more than one
ambisexual subject when substitution was required. Generally, when
an assigned partner and an ambisexual man or woman were paired,
they continued as sexual partners throughout the required pattern
of stimulative techniques, whether homosexually or heterosexually
oriented. Exceptions to this ideal investigative pattern were created
by scheduling difficulties, illness, menstrual periods, or assigned part
ner withdrawal from the program. Different assigned partners were
substituted freely as required to maintain scheduling continuity.
The episodes of sexual interaction in the laboratory were sepa
rated by at least a week and, in some instances, by several months.
This time gap was created by two factors. First, it was the research
team’s intent that personal familiarity or a comfortable, confident
sexual relationship between responding ambisexuals and their as
signed partners be minimized. Second, the actual scheduling diffi
culties previously described made continuity impossible. Laboratory
observations of the sexual interaction were conducted primarily on
weekday evenings and over weekends to facilitate study-subject
cooperation.
ORIENTATION PROCEDURES
Before the observed sexual response episodes were scheduled,

there was opportunity offered for those who wished to be oriented
to laboratory procedures and the laboratory environment. Repeat
ing the pattern set by study subjects in the homosexual and the
heterosexual research populations (see Chapter 4), the heterosexual
assigned partners requested more orientation opportunity than did
the homosexual assigned partners.
Eight of the 22 heterosexual assigned partners required orienta
tion procedures, while only 6 of the 24 homosexual assigned part
ners expressed such a need. None of the 12 ambisexual subjects re
CHAPTER EIGHT
152
quested an opportunity for laboratory orientation or expressed need

for privacy during their masturbational episodes (see Chapter 4).
There was no concern for sexual performance evidenced by the am
bisexual men and women in either their homosexual or heterosexual
phases.
For the purposes of this research project, the assigned partners
were deliberately not informed that they were interacting sexually
with an ambisexual man or woman. The assigned partners were en
couraged to interact with the available (ambisexual) partner, set
ting their own pace and responding without reservation at whatever
levels of sexual tension developed in response to sexual stimuli. In
every instance of sexual interaction in the laboratory, the assigned
partners simply presumed that the ambisexual partners were of the
same sexual orientation as themselves, and reacted accordingly.
Since homosexual and heterosexual physiology had been investi
gated in detail before the onset of the ambisexual study, only the
ambisexual study subjects were evaluated physiologically. All par
ticipants in this research program were involved in the psychosexual
aspects of the investigation.
The assigned partners were informed that the research team was
interested primarily in sexual behavior; that they would not be in
volved in an investigation of sexual physiology; that they were per
fectly free to interact sexually and to respond both verbally and
nonverbally as they saw fit; and that the research team’s only con
dition during any sexual episode was that subjects were to employ
the specific technique requested as the primary form of sexual
interaction.
The ambisexual men and women were requested not to reveal
the duality of their sexual preference to the assigned partners; as far
as is known, they complied with this request. They were directed
to react to their assigned partners’ sexual approaches and to strive
for an equal exchange of stimulative opportunity rather than at
tempting to dominate the sexual interaction. They were not to play
passive sexual roles; they were simply to refrain from imposing any
particular sexual behavior pattern. The purpose of these instruc
tions was to enable the research team to observe the ambisexuals’ re
action to both homosexual and heterosexual approaches rather than
to encourage them either to set the pace of the interaction or to be
153
in conflict for dominance with the assigned partners. In short, ambi

sexual men and women were specifically encouraged to allow their
assigned partners freedom of sexual expression whenever possible.
The ambisexuals were to react rather than to initiate. Only if the
assigned partner’s sexual interest appeared to lag was the ambisexual
to assume a role of initiating rather than reacting to sexual stimuli.
PROJECT DESIGN
The 12 ambisexual study subjects cooperated in the laboratory

investigation over approximately a two-year period. Each of the 6
ambisexual men reacted sexually with 3 men of homosexual orien
tation and with 3 women who reported only heterosexual experi
ence. Each of the 6 ambisexual women responded sexually to 3
women who were entirely homosexual in orientation and to 3 men
who were totally heterosexual in experience.
Masturbation was evaluated in the laboratory for the 12 ambi
sexuals, but not for their assigned partners. The ambisexual subjects
were observed only to determine the physical pattern of their mas-
turbational activity. They each were asked to provide one episode
of masturbation to orgasm while under observation. Each of the
men had one masturbational ejaculation. Four women were multi-
orgasmic and 2 women had single orgasms for a combined total of
13 female orgasmic experiences.
It was planned that each ambisexual would interact with 3 as
signed heterosexual partners in response to the stimulative tech
niques of partner manipulation, fellatio/cunnilingus, and coition.
Thus, each ambisexual experienced a total of nine episodes that
were heterosexually oriented.
Each ambisexual man and woman responded to two different
stimulative techniques with each assigned homosexual partner
(partner manipulation and cunnilingus/fellatio). There were 3 as
signed homosexual partners, so a total of six homosexually oriented
episodes were experienced by each ambisexual.
Counting the single masturbational episode, each of the 12 am
bisexual study subjects participated in 16 different episodes of sexual
interaction during the research project (nine heterosexual, six homo-
CHAPTER EIGHT
154
sexual, and one masturbational episode). Frequently, more than

one orgasm was experienced by either the ambisexual or the as
signed study subject during any specific episode, for both partners
were given full freedom to enjoy orgasmic expression on every oc
casion of sexual interaction in the laboratory.
Observation of rectal intercourse was not requested by the re
search team, nor was it suggested by the interacting partners. Two
of the 6 ambisexual men described experience with rectal inter
course, i who had interacted with several different female partners
and i as the penetrator in a homosexual relationship. One of the
li male homosexual assigned subjects described frequent experi
ence with rectal intercourse, preferring the role of penetrator. Four
other members of the group reported occasional experiences in
penetrator and/or penatratee roles while the remaining 6 men gave
histories of rare or no experience with rectal intercourse.
FUNCTIONAL EFFICIENCY
The orgasmic cycles that developed in free sexual interchange

between the ambisexual study subjects and their assigned partners
have been charted, and failures to function effectively have been
identified. A brief review of this material is in order.
AMBISEXUAL MALE FUNCTIONAL EFFICIENCY
Homosexual Phase. The homosexual phase of the ambisexual

male interchange experiments is presented in Table 8-4. Each am
bisexual male responded to 3 homosexual assigned partners. He ex
perienced episodes of partner manipulation and fellatio with each
assigned partner. Each assigned partner also had full opportunity
for sexual involvement and orgasmic release using the same stimu
lative techniques.
The 6 ambisexual males and the 11 homosexual male assigned
partners combined to produce a total of 36 orgasmic cycles in re
sponse to partner manipulation and 41 cycles with fellatio (Table
8-4). During the 77 complete orgasmic cycles that developed for
both ambisexual and assigned male partners in response to partner
manipulation and fellatio, there was one functional failure. A male
ambisexual in the 41-50-year age group failed to maintain an erec
tion during manipulation by his partner and did not ejaculate.
155
8-4
TABLE
Ambisexual Study Interchange Experiment: Male Homosexual Phase
No. of Orgasmic Cycles

No. of No. of
Ambi Homo Partner Manipulation Fellatio
sexual sexual Ambi Ambi
Age Study Assigned sexual Assigned sexual Assigned
Group Subjects Partners Male Male Male Male
21-30 3 4 10 9 9 11
31-40 2 5 6 6 7 7
41-50 1 2 *
2 3 3 4
Total 6 11 18 18 19 22
(Total = 36) (Total = 41)
(1968-1970)
* One ambisexual male failed to maintain an erection or to ejaculate during one
episode of partner manipulation.
When queried, he stated that he had repeatedly distracted himself

and just had not felt involved sexually during that particular ex
perience. This man had no recurrent episodes of dysfunction dur
ing further opportunities for sexual interaction in the laboratory.
From the viewpoint of functional efficiency, there were no ap
preciable differences between the ambisexual males in their homo
sexual phase and their homosexual assigned partners in ability to
respond at orgasmic levels. There also were no obvious differences
in the levels of subjective involvement experienced in their sexual
interaction.
Heterosexual Phase. Table 8-5 represents the same 6 ambisexual
males reported in Table 8-4. In this instance, however, the men
were in their heterosexual phases. The sexual interaction between
the ambisexual men and their 3 assigned female heterosexual part
ners consisted of partner manipulation, cunnilingus/fellatio, and
coition. The results reported are typical of those usually encoun
tered when sexually experienced heterosexual men and women in
teract freely in the laboratory. Consistently, more female orgasmic
cycles were recorded than those developed by males with each of
the different stimulative techniques.
A heterosexual female assigned partner in the 41-50-year age
CHAPTER EIGHT
156
TABLE 8-5
Male Heterosexual Phase
No. of
Hetero _____________ No. of Orgasmic Cycles_____________
No. of sexual
Ambi- Female Partner Fellatio/
sexual Assigned Manipulation Cunnilingus Coition
Males Partners Male Female Male Female Male Female
21-30 3 6 9 12 10 14 9 12
31-40 2 5 7 7 6 9 6 7
41-50 1 3 3 3 4 4 3 2*
Total 6 14 19 22 20 27 18 21
(1968-1970)
* One female assigned partner failed to obtain orgasmic release during one coital
episode.
group failed to obtain orgasmic release during one coital episode.

She stated that she did not know why she was not orgasmic. She
felt well, was involved sexually, had not noticed any distraction, but
“it just hadn’t happened.” There was no repetition of the dysfunc
tion during her other sexual episodes in the laboratory.
AMBISEXUAL FEMALE FUNCTIONAL

EFFICIENCY
Homosexual Phase. The 6 female ambisexuals’ performance

statistics in their homosexual phase are charted in Table 8-6. Again,
during partner manipulation and cunnilingus there is repeated evi
dence of the physiologic capacity of sexually active women to be
multiorgasmic. The female ambisexuals in their homosexual phase
combined with their lesbian partners to provide a total of 49
partner manipulation and 56 cunnilingal orgasmic cycles.
One failure to achieve orgasmic release was recorded by a female
ambisexual study subject during cunnilingus. This was the woman’s
only experience with the particular assigned partner. Early in their
sexual interaction the ambisexual subject approached the assigned
partner first, at the assigned partner’s request. The assigned partner
was multiorgasmic with cunnilingus. When it was the ambisexual’s
157
TABLE8-6
Female Homosexual Phase
No. of Orgasmic Cycles

No. of No. of Partner
Ambi Homo Manipulation Cunnilingus
sexual sexual Ambi Ambi
Age Study Assigned sexual Assigned sexual Assigned
Group Subjects Partners Female Female Female Female
21-30 3 5 12 14 16 13
31-40 2 5 8 7 10 8
41-50 1 3 4 4 3* 6
Total 6 13 24 25 29 27
(Total = 49) (Total = 56)
(1968-1970)
* One ambisexual female failed to obtain orgasmic release during one episode of
cunnilingus.
turn to be stimulated, an argument developed over an extraneous

matter, and thereafter the ambisexual woman could not become
sufficiently involved to be orgasmic. There was no other failure of
functional efficiency by this woman with other lesbian partners in
the laboratory.
It is interesting to compare the functional facility in orgasmic
attainment of the female ambisexuals in their homosexual phase
with that of their assigned lesbian partners. As was true for the
male ambisexuals in their homosexual phase (see Table 8-4), there
is no significant difference between the ambisexual women and
their lesbian assigned partners in effectiveness of sexual perfor
mance as measured by orgasmic attainment. There also were no
obvious differences in expressed levels of subjective involvement in
their sexual interaction.
Heterosexual Phase. In Table 8-7 the ambisexual females’
heterosexual phase is charted. As expected, when the heterosexual
male assigned partners reacted with the ambisexual women through
partner manipulation, fellatio/cunnilingus, and coition, there was
CHAPTER EIGHT
158
TABLE 8-7

Female Heterosexual Phase
No. of
Hetero No. of Orgasmic Cycles
No. of sexual
Partner Fellatio/
Ambi Male Coition
Manipulation Cunnilingus
Age sexual Assigned
Group Females Partners Male Femah3 Male Female Male Female
21-30 3 3 9 12 9 15 9* 11
31-40 2 3 6 8 7t 10 6 7
41-50 1 2 3 4 3 4 3 4
Total 6 8 18 24 19 29 18 22
(1968-1970)
* One male assigned partner had premature ejaculation during one coital episode,
t One male assigned partner failed to maintain an erection or to ejaculate during one
episode of fellatio.
female dominance in frequency of orgasmic attainment. A compari

son of Tables 8-6 and 8-7 demonstrates that it made no difference
whether the assigned partner was male or female insofar as the
ambisexual female’s capacity to attain orgasm was concerned.
There were two sexual functional failures of male assigned part
ners. One man had an episode of premature ejaculation during
intercourse, and another man failed to achieve erection or to
ejaculate while responding to fellatio. The man who experienced
the rapid ejaculation stated that he had not had any sexual activity
for approximately 10 days and “got too excited.’’ The assigned
partner with erective failure offered no explanation, stating quietly,
“This has never happened to me before.” He laughed with his
partner about his failure and was apparently quite comfortable
with the situation. Neither incident was repeated in other oppor
tunities.
SUMMARY OF FUNCTIONAL EFFICIENCY

EXPERIMENTS
In order to provide statistics that can be evaluated with refer

ence to those of the homosexual study group and heterosexual
study groups A and B, the combined responses of the ambisexual
AMBISEXUAL STUDY GROUP 159
study subjects and their assigned partners have been summarized

in Table 8-8.
The summary table lists 56 homosexual and 37 heterosexual
male orgasmic cycles, all accumulated in response to partner ma
nipulation. The 36 homosexual orgasmic cycles were developed
during the ambisexual males’ homosexual phase while interacting
with homosexual male assigned partners. (The 36 orgasmic cycles
table 8-8
Ambisexual Study Interchange Experiment: Summary of
Orgasmic Cycles in Ambisexuals and Assigned Partners *
Orientation Partner Fellatio/

of Stimu Masturbation Manipulation Cunnilingus Coition
lation Male Female Male Female Male Female Male Female
Ambisexual 6 13
(self)
Homosexual 36 49 41 56
Heterosexual 37 46 39 56 36 43
Total 6 13 73 95 80 112 36 43
(1968-1970)
* Summation of Tables 8-4, 8-5, 8-6, and 8-7.
were developed mutually between ambisexual and homosexual

males [see Table 8-4].)
The 37 heterosexual male orgasmic cycles experienced during
partner manipulation were developed from two sources. First, the
male ambisexuals responded 19 times in their heterosexual phase to
partner manipulation provided by heterosexual female partners
(see Table 8-5); second, the heterosexual male assigned partners
responded 18 times to partner manipulation provided by ambi
sexual women in their heterosexual phase (see Table 8-7).
From the same sources and accumulated in the same manner,
there were a total of 41 fellatio-stimulated male orgasmic cycles
developed by ambisexual males in their homosexual phase in coop
eration with their assigned homosexual male partners (see Table
8-4). Also, there were a total of 39 fellatio-stimulated male orgasmic
cycles developed by the combined stimulative approaches of as-
16o CHAPTER EICHT
signed heterosexual female partners during the ambisexual males’

heterosexual phase (see Table 8-5) and by ambisexual females
approaching their assigned heterosexual male partners (see Table
8-7).
There were 49 partner manipulation orgasmic cycles developed
conjointly by ambisexual women and their assigned lesbian partners
during the ambisexual women’s homosexual phase (see Table 8-6).
There were an additional 46 partner manipulation orgasmic cycles
developed from the two remaining sources: First, there were 22
orgasmic cycles experienced by the assigned female study subjects
when stimulated by ambisexual males in their heterosexual phase
(see Table 8-5); second, the ambisexual women experienced 24
orgasmic cycles when stimulated by the assigned male heterosexual
partners during the ambisexual women’s heterosexual phase (see
Table 8-7).
The total of 80 fellatio-stimulated orgasmic cycles (41 homo
sexual and 39 heterosexual) experienced by the ambisexual men
and the assigned male study subjects was accumulated in a manner
similar to that described for the partner manipulation statistics.
Reference is suggested to Tables 8-4, 8-5, and 8-7 as statistical
sources.
Similarly, the total of 112 cunnilingus-stimulated orgasmic
cycles (56 homosexual and 56 heterosexual) experienced by the
ambisexual women and the assigned female study subjects was
accumulated using the same method as that described for the
partner manipulation statistics. Reference is suggested to Tables
8-5, 8-6, and 8-7 as statistical sources.
The assigned partner statistics were included in the overall sum
mary tables both as further support of and as clarification of the
sexual response efficiency of the ambisexual study subjects. If the
ambisexuals had not responded or involved themselves sexually
with approximate equality in both their homosexual and hetero
sexual phases, a lack of equal commitment might have been
reflected by some statistically demonstrable loss of sexual respon
sivity evidenced by either their homosexual or heterosexual assigned
partners. There was no loss of physiologic responsivity that could
be statistically determined, and there certainly was no loss of sub
jective involvement that could be observed for the assigned partners
of either preference.
When the same stimulative techniques were employed, it did

not make the slightest difference in facility of orgasmic attainment
whether the ambisexual men or women were responding to homo
sexual or heterosexual stimulation from assigned partners. During
partner manipulation, the number of orgasmic cycles developed
was almost equal regardless of the heterosexual or homosexual
orientation of the stimulative activity; the same was true in re
sponse to fellatio and cunnilingus (see Table 8-8).
The ambisexual statistics also reinforce the consistently observed
fact that, given the same environment, the same number of sexual
opportunities, and effective sexual stimulation, sexually functional
women will respond at orgasmic levels more frequently than men.
This dominance in orgasmic attainment can be seen in Table 8-8.
The 6 female ambisexuals developed 13 masturbational orgasmic
cycles, as compared to one each for the 6 male ambisexual subjects.
During both homosexually and heterosexually originated partner
manipulation, the combined male subjects (ambisexual males and
assigned male homosexual and male heterosexual study subjects)
developed 73 orgasmic cycles, while the combined female group
(ambisexual females and assigned female homosexual and female
heterosexual study subjects) developed 95 orgasmic cycles.
Fellatio (homosexually and heterosexually employed) resulted in
80 male orgasmic cycles and cunnilingus (homosexually and hetero
sexually employed) in 112 female response cycles. Finally, there
were a total of 36 male and 43 female orgasmic cycles developed
during intercourse by both male and female ambisexuals in com
bination with their assigned heterosexual male and female partners.
Yet another way to evaluate the ambisexual study subjects and
the assigned homosexual and heterosexual partners is by evaluating
functional efficiency in orgasmic attainment. The incidence of
failure to achieve orgasm has been presented in failure percentages
for the homosexual study group and for heterosexual study groups
A and B (see Chapter 6). The statistics accumulated in the ambi
sexual study group will be presented in the same manner as those
from these previous research groups. A measure of evaluating the
functional efficiency of the ambisexuals in both their homosexual
and heterosexual phases can be achieved by comparing the results
reported in Tables 8-9 and 8-10 with those presented in Chapter 6
for the other study groups (see Tables 6-5, 6-10, and 6-15).
162 CHAPTER EIGHT
When the ambisexual males and their assigned homosexual and

heterosexual partners were evaluated, there were 2 men who failed
to complete an orgasmic cycle in 159 sexual opportunities during
masturbation, partner manipulation, and fellatio for a failure per
centage of 1.26 (see Table 8-9). When the ambisexual females and
8-9
table
Functional Efficiency of Ambisexuals and Assigned
Partners in Manipulative Stimulation
Gender and
Male *
Partner 73 1 1 : 73 1.37
manipulation
Fellatio 80 1 1 : 80 1.25
Total 159 2 1 : 79.5 1.26
Female t
Partner 95 0 0 0
manipulation
Cunnilingus 112 1 1 : 112 0.89
Total 220 1 1 : 220 0.45
(1968-1970)
* Male ambisexuals, N = 6; homosexual male assigned partners, N = 11; hetero
sexual female assigned partners, N = 14.
t Female ambisexuals, N = 6; heterosexual male assigned partners, N = 8; homo
sexual female assigned partners, N = 13.
their assigned homosexual and heterosexual partners were evalu

ated, there was one failure to achieve orgasmic release in 220
opportunities of masturbation, partner manipulation, and cunnilin
gus for a failure percentage of 0.45.
During coital opportunity (see Table 8-10), the male research
population (ambisexual males in their heterosexual phase and as-
TABLE 8-10

Functional Efficiency of Ambisexuals and
Assigned Partners in Coition
Observed Functional Failure Failure

Gender Cycles Failures Incidence Percentage
Male * 36 1 1 : 36 2.80
Female f 43 1 1 : 43 2.33
(1968-1970)
* Male ambisexuals, N = 6; male assigned partners for female ambisexuals, N = 8.
t Female ambisexuals, N = 6; female assigned partners for male ambisexuals,
N= 14.
signed heterosexual male study subjects) failed to function effectively

once in a total of 36 coital opportunities for a failure percentage
of 2.80, and the female group (ambisexual females in their hetero
sexual phase and assigned heterosexual female study subjects)
failed to achieve orgasm once in 43 cycles for a failure percentage
of 2.33. As was also true for both heterosexual study groups A and
B, the failure to function effectively during intercourse exceeds that
associated with any of the other frequently employed stimulative
techniques.
Finally, the functional efficiency of the ambisexual men and
women in both their heterosexual and homosexual phases should
be considered apart from response statistics in conjunction with
their assigned partners. These data describing the functional effi
ciency of ambisexual men and women as a separate group are pre
sented in Tables 8-11 and 8-12.
Each of the 6 ambisexual men masturbated to orgasm once in
the laboratory (see Table 8-11). Combining the ambisexual males’
homosexual and heterosexual phases, there were 37 orgasmic cycles
in response to partner manipulation with one failure to maintain
an erection and ejaculate, and 40 full cycles in response to fellative
stimulation without a functional failure. The 1 ambisexual male
functional failure, which occurred during partner manipulation in
a homosexual phase, created a failure percentage of 1.20 (see
Table 8-12).
CHAPTER EIGHT
164
TABLE 8-11
Ambisexual Study: Summary of Orgasmic Cycles in

Ambisexuals (Male, N = 6; Female, N = 6)
No. of No. of Cycles

Ambi Fellatio
sexual Partner (Male)/
Gender and Study Mastur Manipu Cunnilingus
Age Group Subjects bation lation (Female) Coition
Male
21-30 3 3 19 21 9
31-40 2 2 13 12 6
41-50 1 1 5* 7 3
Total 6 6 37 40 18
Female
21-30 3 7 24 28 11
31-40 2 5 16 20 7
41-50 1 1 7 8t 4
Total 6 13 47 56 22
(1968-1970)
* Male ambisexual partner failed to maintain an erection or ejaculate in homo
sexual phase.
t Female ambisexual partner failed to obtain orgasmic release in homosexual phase.
The 6 ambisexual women masturbated to orgasm 13 times in six

laboratory episodes (see Table 8-11). Combining both heterosexual
and homosexual experiences, there were 47 partner-manipulation
orgasmic cycles without dysfunction and 56 cunnilingal cycles with
one episode of orgasmic failure. The failure occurred during cun
nilingus in a homosexual-phase encounter. The failure percentage
was 0.86 (see Table 8-12).
When the ambisexual men and women experienced coition in
the laboratory, they were paired with heterosexual female and
heterosexual male assigned partners. The ambisexual study group
responded with 18 male and 22 female orgasmic cycles without any
recorded failure to function effectively (see Tables 8-11 and 8-12).
Obviously, the functional efficiency of the sexually experienced
ambisexual men and women responding to sexual stimulation in a
laboratory environment is fully comparable to that of the three
165
TABLE 8-12
Ambisexual Study: Functional Efficiency of Ambisexuals in

Manipulative Stimulation and Coition
(Male, N = 6; Female, N = 6)
Gender and
Male
Partner 37 1 1 : 37.0 2.70
manipulation
Fellatio 40 0 0 0
Total 83 1 1 : 83.0 1.20
Female
Partner 47 0 0 0
manipulation
Cunnilingus 56 1 1 : 56.0 1.79
Total 116 1 1 : 116.0 0.86
Coition
Male 18 0 0 0
Female 22 0 0 0
(1968-1970)
other basic study-subject populations. When in their homosexual

phase, ambisexual men and women responded approximately as
effectively at orgasmic levels as the male or female homosexual
study subjects (see Chapter 6). When in their heterosexual phase,
the ambisexuals’ functional efficiency is comparable to that re
ported for the men and women in heterosexual study groups A
and B (see Chapter 6).
PSYCHOSEXUAL PATTERNS
The psychosexual response patterns of the ambisexual study

subject populations should be considered in context. How did
ambisexual men and women interact in the laboratory with homo
166 CHAPTER EIGHT
sexual and heterosexual assigned partners? Was different behavioral

patterning evident for the ambisexuals during their homosexual
and heterosexual phases? Was there a gender-linked difference
apparent in ambisexual responsivity? These legitimate questions
and others in a similar vein can be dealt with through the descrip
tions of the behavior of the ambisexual study subjects and their
assigned partners during the various combinations of sex preference
interaction in the laboratory.
As a general observation, it can be stated that there were no
apparent reservations in sexual approach between the interacting
ambisexual and his or her assigned partners of either homosexual
or heterosexual orientation. The ambisexual men and women not
only were confident in their approach to any sexual opportunity,
they obviously thoroughly enjoyed any sexual opportunity that was
presented.
AMBISEXUAL MALES
When male ambisexuals interacted with assigned homosexual

male partners during episodes of partner manipulation and fellatio,
the sexual response patterns were almost exactly those reported in
Chapter 5 for sexual interaction observed in assigned homosexual
male couples. The sexually interacting ambisexual man and his
homosexual partner were obviously performance-oriented. The ap
proach to the genitals was immediate and direct. Early in the inter
action, a “my tum-your turn” pattern was established, usually
without obvious verbal or nonverbal communication. With one
exception, neither the male ambisexuals nor their assigned homo
sexual partners evidenced much interest in more than one ejacu
latory experience.
When the same ambisexual men responded in their heterosexual
phase to assigned heterosexual female partners in partner manipula
tion and fellatio/cunnilingus, there was initially usually more
mutuality in genital stimulative activity, but there was little general
body contact before the couple turned to my tum-your turn pat
terning. Cultural influence did not appear to dominate; during
most of these sexual opportunities, the ambisexual men were ini
tially approached by the heterosexual women more frequently than
the men had to approach the women.
Repeating the interaction pattern previously demonstrated by

assigned heterosexual couples (see Chapter 5), during partner
manipulation and fellatio/cunnilingus the ambisexual males usually
moved directly to their female partners’ breasts and genitals. When
it was the women’s turn to be the stimulator, they usually moved
directly to penile manipulation. There was little demonstration of
deliberately slowed or purposefully “teasing” stimulative techniques
in genital stimulation by either sex. The approaches to the genitals,
whether manipulative or fellative/cunnilingal, were not only direct,
they were demanding.
The assigned heterosexual female partners were frequently multi-
orgasmic, thereby elevating the ambisexual males’ levels of involve
ment with their overtly expressed sexual responsivity. The men
made no attempt to match the women in multiorgasmic attain
ment. Had it not been for the multiorgasmic demands of the
female partners, the heterosexual episodes of the ambisexual men
might have terminated more rapidly than the homosexual episodes,
since the heterosexual interactions moved so quickly toward mutual
conclusion.
Although the ambisexual males in their homosexual phase were
certainly performance-oriented, there was much more striving for
the goal of orgasm evident in their heterosexual phase. This expres
sion of cultural influence was evidenced not only by the ambi
sexual study subjects but by their assigned heterosexual partners.
Of special interest was the behavior of the ambisexual men
during intercourse. Despite the directions from the research team
to not initiate but to react to the assigned partner if possible, direc
tions that were usually followed during partner manipulation and
fellatio/cunnilingus, the male ambisexuals deviated from these in
structions during intercourse. The ambisexual men initiated and
controlled the mounting process and set the thrusting patterns
during every coital opportunity.
The assigned female partners never suggested any variation in
the cultural pattern of male coital dominance. These sexually expe
rienced women, who initiated activity and interacted freely and
with a sense of equality during partner manipulation and fellatio/
cunnilingus, moved immediately to the culturally established, re
strictive role of only reacting to rather than initiating mounting
168 CHAPTER EIGHT
procedures or thrusting patterns when coition was the required

technique of sexual interchange.
AMBISEXUAL FEMALES
When the interactions of ambisexual women were evaluated, it

was evident that less culturally derived restraint was expressed by
the ambisexuals in their homosexual phase than in their hetero
sexual phase. The ambisexual women evidenced more initiative in
performance programming, more comfort both in giving and re
ceiving pleasure, and more freedom in expressing themselves in
orgasmic experience during their partner-manipulative and cun-
nilingal interactions with female partners.
There seemed to be two dominant factors in the ambisexual
women’s homosexual-phase response patterns. First, when the as
signed lesbian partners initiated sexual interaction and the ambi
sexual women simply reacted (in compliance with the instructions
from the research team), the breasts or genitals usually were not
approached at first contact by either the assigned female partners or
the ambisexual women.
Second, variation in stimulative approach and alteration of
stimulative pace were regularly recurrent behavior patterns during
the interaction of ambisexual women with their lesbian assigned
partners. As a result of the absence of immediate approach to the
target organs and the recurrent use of teasing techniques when
there was genital approach, far more time was taken in partner
manipulation and cunnilingal interaction than was consumed by
the male ambisexuals with their assigned male homosexual partners
during partner manipulation and episodes of fellatio.
Once the interaction between the ambisexual women and their
female partners was in full sway, the ambisexual women did not
play a passive role. A my turn-your turn pattern developed rapidly,
usually without overt communication. Many times women were or
gasmic and then were provided with or requested opportunity for ad
ditional orgasms before the stimulator and the stimulatee roles were
reversed. Frequently the ambisexual women played the role of the
stimulator first, controlling the orgasmic episodes of their partners
before enjoying release themselves. There was only one exception
to this general pattern of equality in dominance of role-playing.
One assigned homosexual partner preferred to dominate the sexual

episodes in their entirety. She did so on each of the occasions that
she interacted with ambisexual women, whether through partner
manipulation or cunnilingus. After initially establishing a mutually
stimulative approach, she always insisted on giving before receiv
ing pleasure.
Despite the partner mutuality demonstrated during homosexual
phase interactions, the same 6 ambisexual women reacting to
partner manipulation and fellatio/cunnilingus in their hetero
sexual phase with assigned heterosexual male partners let the men
set the pace throughout the entire sexual interaction. Adapting to
the change in stimulative pace that inevitably occurred because the
men routinely initiated the sexual behavior patterns, the women
responded freely to immediate pelvic and breast play. With the
heterosexual male assigned partners dominating the sexual inter
change, the women routinely were satisfied first in the my tum-
your turn pattern of partner manipulation and fellatio/cunnilingus
before accepting the responsibility of providing their male partners
with release.
COITUS
When coition was anticipated, the assigned heterosexual males

approached the ambisexual women’s breasts and genitals directly.
The women moved quickly to male genital play, but only after the
initial male approach. Thereafter, the stimulative techniques were
employed mutually until the male partner decided that mounting
was in order. In every instance the initiation of the mounting
episode, the decision as to coital positioning, and the thrusting pat
tern were instigated and controlled by the male assigned partners.
Despite this male dominance, ambisexual women responded with
out any evident reservation and were multiorgasmic as frequently
as during their homosexual phase.
When the ambisexual men and their assigned heterosexual
female partners were directed toward intercourse, the males again
dominated: The ambisexual men did not wait for the female
partners’ approaches, but moved to the women (against specific
170 CHAPTER EIGHT
research team direction) and reacted just as described above for

the assigned heterosexual males during intercourse with the ambi
sexual women.
In short, whether the study subject was an assigned heterosexual
male or an ambisexual male, there was usually reasonable equality
evidenced in role-playing during partner manipulation and fellatio/
cunnilingus opportunities with the female partners, but when inter
course was the directed form of interaction, the cultural influences
were too strong for both the male and female partners. Dominance
was immediately initiated by the men and cooperated with fully
by the women, regardless of whether the man or woman was ambi
sexual or heterosexual in preference.
Both ambisexual men and ambisexual women verbalized more
freely in homosexual episodes. But homosexual men and women
also tended to verbalize more freely than their heterosexual coun
terparts. The ambisexuals did not identify any greater subjective
pleasure from orgasmic return occasioned by homosexual stimula
tion as compared to their experiences with heterosexual stimula
tion. Rather, such factors as physical well-being, periods of con
tinence, social pressures occasioned by demands of their jobs, or the
menstrual cycle were identified as being responsible for differences
in subjectively appreciated pleasure in orgasmic attainment. As a
general observation, it should be repeated that it was apparent that
the ambisexual men and women not only were confident in their
approach to any sexual opportunity, but they thoroughly enjoyed
whatever opportunity was presented.
PHYSIOLOGIC OBSERVATIONS
The ambisexual study subjects were observed carefully to deter

mine possible physiologic variations from the responses previously
identified in homosexuals and heterosexuals. There simply was no
difference observed in the physiologic response patterns of ambi
sexual men or women, whether they were responding to homo-
sexually or heterosexually oriented stimuli. Since the physiology
of human sexual response has been described for heterosexual inter
171
action (Masters and Johnson, 1966)and for homosexual encounter

(see Chapter 7), there will be no restatement of this material as
recorded from ambisexual interaction.
The only major physiologic difference between ambisexual men
and women in their ability to respond to both heterosexual and
homosexual stimulation in the laboratory was the repeatedly men
tioned natural physiologic capacity for multiorgasmic response in
women.
FANTASY PATTERNS
The fantasy patterns of the ambisexual men and women are

reported and discussed in Chapter 9.
DISCUSSION
To suggest that definitive answers have been found to questions

the research team raised about the subject of ambisexuality at the
outset of this chapter would be to deny the complexity of the issue.
It is hoped, however, that the material described has provided
some insight. The Institute’s concept of ambisexuality has been
established and expanded through many interview opportunities as
well as through laboratory observations of sexual behavior. This
concept is summarized from a psychosexual viewpoint in the fol
lowing paragraphs.
The true ambisexual is neither homosexual nor heterosexual: He
or she is, quite simply, ambisexual. It is interesting to note that
while the exclusive heterosexual (Kinsey 0) usually considers any
form of bisexuality (Kinsey 1 to 5) to be a bastardized form of
homosexuality, and that the equally exclusive homosexual (Kinsey 6)
frequently describes the bisexual (Kinsey 1 to 5) as an individual
with insufficient courage to commit himself or herself to a fully
homosexual orientation, the ambisexual rarely if ever expresses
such a value judgment concerning the sexual behavior of other
people. He or she thinks, feels, and acts from both heterosexual
and homosexual points of view and does not feel called upon to
defend or reject either orientation.
172 CHAPTER EIGHT
From the ambisexual’s point of view, heterosexuality and homo

sexuality are neither right nor wrong, good or bad, better or worse.
In fact, the true ambisexual really has no frame of reference for
evaluating either orientation. Human sexual function is seen as a
reality, a birthright, an integral and important part of every man
and woman’s life, to be directed and controlled as he or she chooses.
Sexual opportunity is accepted or rejected on the basis of physical
need, and the attractant is the personality and physical attributes
of the potential partner, certainly not the gender of that partner.
In fact, the most important attractant is the sexual opportunity,
and a distant second would be the personality or physical attractive
ness of the potential partner. There simply is no thought given to
the gender of the potential partner as a qualifying factor in sexual
attraction.
An important insight into the nature of the ambisexual man or
woman is the frequently expressed lack of interest in either a com
mitted relationship or a family structure. Whether this attitude
bespeaks a diminished capacity for love and affection, or whether
it is a true matter of preference alone, is unknown at present. As a
general pattern, ambisexual men and women reported little or no re
sidual affection for their siblings and more a sense of nostalgia than
any depth of affection for their parents. No sense of rejection was
identified. By free admission, the lifestyle of the ambisexual is a
lonely one. This loneliness may prove to be the Achilles’ heel of
the ambisexual, one that may prove more significant to each in
dividual with the passage of time.
Only with longitudinal, prospective studies will it be possible to
judge the permanence of the ambisexual’s lifestyle. Companion
ship becomes vital to all individuals, particularly as they age.
Mental deterioration associated with the aging process can be as
much delayed by psychosexually stimulating companionship as
advanced by arteriosclerosis. Whether the ambisexual can find
sufficient resources within himself or herself to counteract the nega
tive aspects of the inevitable social isolation that is concomitant
with his or her chosen lifestyle will be the ultimate test of the
ambisexual’s permanence and prevalence in society.
Anthropologists have speculated on the existence of the ambi
sexual in our culture. This study is only an early step in the quan
AMBISEXUAL STUDY CROUP
173
tification of their presumptions. When considering ambisexuality

within our social framework, two immediate possibilities come to
mind. The ambisexual may represent a stage of psychosocial orien
tation from which we have moved to a state of relative sexual dis
crimination represented by full heterosexual or homosexual com
mitment. Alternatively, the ambisexual may represent a level of
sexual, if not social, sophistication toward which heterosexual and
homosexual societies are moving.
In brief, ambisexuality may represent either a prior point of
departure or an anticipated end-point in our psychosocial structur
ing. The research team is currently more comfortable with the
speculation that ambisexuality represents more a prior point of
departure than a societal end-point.
In the meantime, it is best to take any self-proclamation of ambi
sexuality with a degree of skepticism. It is safe to presume that if a
man or woman supports or attacks either a homosexual or a het
erosexual lifestyle, he or she is probably not an ambisexual. The
ambisexual is relatively atypical in our population. He and she are,
however, most interesting persons from whom the health-care pro
fessions have a great deal to learn, particularly in the area of psy-
chosexual adjustment.
9
INCIDENCE AND
COMPARISON OF
FANTASY PATTERNS
As material in this text attests, many currently held concepts of

standardized sexual behavior and of homosexual and heterosexual
role-playing have been based on cultural myths and misconceptions,
some of which have been exploded by the research techniques of
laboratory evaluation and in-depth interview. This brief discussion
of the basic aspects of sexual fantasy is presented to underscore how
little we know of the fantasy patterning of fully functional hetero
sexual, homosexual, and ambisexual men and women.
Since the emphasis of this book is on perspectives of homosexual
ity, equal attention has been given to the fantasy patterns of hetero
sexual study subjects. This has been done for two reasons: First,
although collected from 1957 to 1970, the material has not been
previously reported. Second, some knowledge of the incidence of
fantasy patterns of sexually functional heterosexual men and women
provides yet another facet in the ongoing process of placing homo
sexuality in perspective. One of the better means of acquiring per
spectives of homosexual function is to establish fully comparable
dimensions of heterosexual function.
Again, it should be emphasized that the sexually functional study
subjects who cooperated with the Institute’s laboratory investiga
tion of human sexual response were a highly selected group of men
and women (see Chapter 1). They must not be presumed to rep
resent a cross-section of the general population, nor should this
discussion of their reported fantasy patterning be considered out of
context.
174
FANTASY PATTERNS
175
Before moving further, it is also important to emphasize clearly

that this report of a portion of the Institute’s fantasy material has
been confined appropriately to the basic aspects of the subject. At
tention will be devoted exclusively to attempts to categorize sub
jectively identified sexual fantasies and to establish the relative in
cidence of these fantasies in a comparative fashion by gender and
by sexual preference. There will be no attempt at clinical inter
pretation of fantasy material in this text. This basic approach is
used to provide yet another dimension to the perspective of ho
mosexuality.
At this time, no attempt will be made to develop a clinically
oriented discussion. Detailed descriptive material of individual fan
tasy patterns and clinical interpretations of the fantasy material will
be presented in a separate monograph at a later date. There sim
ply is not space available in this text for an adequate clinical discus
sion of the fantasy material.
The research team was interested in whether there were any gen
eral trends in reported fantasy patterns that could be identified in
a highly selected, sexually functional study-subject population and
whether, if present, these trends might vary significantly with the
study-subjects’ established sexual preference.
METHODS
The fantasy material was derived from homosexual, ambisexual,

and heterosexual (A and B) study groups. Interviews including
questions related to fantasy patterning have always been an integral
part of every volunteer’s intake interview. But the research team
has never considered intake interviews to be a secure source of
subjectively oriented information. After study subjects had had the
opportunity to develop a sense of comfort and of accomplishment
in the laboratory, men and women in the various study groups were
randomly selected for further discussion of their fantasy pattern
ing. Dream-sequence material was not elicited. Two interviews were
conducted, one by each member of the research team. Both inter
views were completed within one month. Over the years, 50 men
and 30 women were recruited from each sexual preference study
176 CHAPTER NINE
group for interviews directed toward fantasy material. The obvious

exception in stated recruiting numbers was the ambisexual study
group, which totaled only 6 men and 6 women; however, each of
the 12 ambisexual volunteers was interviewed for fantasy content
in the format described above.
It was presumed that after successful sexual interaction in the
laboratory, the study subjects would have increased confidence not
only in themselves, but in the professionalism of the research team
and in its commitment to the protection of volunteers. In turn, it
was anticipated that this unique climate of comfort with sexual
material would produce a more candid and detailed disclosure of
sexual fantasies than might otherwise have been expected. These
presumptions proved correct, for there was far more communicative
freedom demonstrated during the second set of interviews than had
been evidenced during the intake interviews. Material obtained dur
ing the second set of interviews will be given primary consideration
in this chapter.
It was also presumed possible that fantasy patterns identified dur
ing these in-depth interviews of sexually functional men and women
might place a different perspective on fantasy content described by
sexually dysfunctional homosexuals and heterosexuals while in
treatment at the Institute. Sexual fantasies of dysfunctional homo
sexual men and women are considered briefly as an integral part of
the case history material reported in Chapters 13 through 16 in the
clinical section of this text.
CATEGORIES: FREE-FLOATING AND

SHORT-TERM FANTASIES
When the interview material was reviewed, it was evident that

study-subject sexual fantasy patterns usually could be separated into
two categories. In the first category are free-floating fantasies spon
taneously evolved by men and women in response to sexual feelings
or needs without restraints of time or place. In the second cate
gory are fantasies employed as short-term, stimulative mechanisms,
frequently in response to imminent sexual opportunity. These short
term fantasies usually can be identified as repetitively enjoyed “old
FANTASY PATTERNS 177
friends” used to initiate or enhance a sexual experience or as a sup

portive mechanism when concern for sexual performance develops.
Of course, there are instances when the two categories overlap,
particularly before and during masturbational opportunity, but gen
erally they are easily distinguishable.
By far the most frequently reported of the two categories were
fantasies of the free-floating variety. Perhaps the lower incidence
of short-term fantasy can be explained by the consistently high
levels of sexual effectiveness of the chosen study-subject population.
Little or no delay in arousal during sexual opportunity in the lab
oratory was evidenced, and expressed concern for performance was
rare. In other words, little need developed for an “old friend.” It
appears that with unquestioned sexual confidence developed from
a background of essentially positive sexual experience, the need for
the crutch of short-term fantasy support is lessened immeasurably.
COMPARATIVE INCIDENCE
OF REPORTED FANTASIES
The collected fantasy material has been separated by category

and listed by incidence in relation both to gender and to sexual
orientation of the study subjects. Table 9-1 presents the five fan
tasy patterns most frequently reported by committed men and
women of homosexual and heterosexual orientation. Material re
turned from interviewing ambisexual study subjects is not included
in this table, since the number of men and women interviewed was
too small to be considered a representative sample. There will be
brief mention of frequently recurrent fantasy patterns of these
ambisexual study subjects, however, during the discussion of the
most common fantasies of the different preference groups.
In general, homosexual, heterosexual, and ambisexual women re
ported more active sexual fantasy patterning than the male study
subjects of the same sexual orientations. Homosexual men and
women described a more active and diverse fantasy patterning than
their heterosexual counterparts. Ambisexual men and women were
far behind both heterosexual and homosexual groups in reported
frequency of sexual fantasizing.
CHAPTER NINE
17«
TABLE 9-1
Comparative Content of Fantasy Material:
Frequency of Occurrence
Homosexual male (N = 30)

1. Imagery of sexual anatomy
2. Forced sexual encounters
3. Cross-preference encounters
4. Idyllic encounters with unknown men
5. Group sex experiences
Homosexual female (N = 30)
1. Forced sexual encounters
2. Idyllic encounter with established partner
4. Recall of past sexual experience
5. Sadistic imagery
Heterosexual male (N = 30)
1. Replacement of established partner
2. Forced sexual encounter
3. Observation of sexual activity
5. Group sex experiences
Heterosexual female (N = 30)
1. Replacement of established partner
2. Forced sexual encounter
3. Observation of sexual activity
4. Idyllic encounters with unknown men
5. Cross-preference encounters (1957-1968)
HOMOSEXUAL MALES
The homosexual male study subjects reported a higher incidence

of free-floating fantasy than the heterosexual men. Both groups in
frequently used short-term fantasy with sexual encounters, except
during masturbation. The most frequently described fantasy by
homosexual males was in the free-floating category. It involved spe
cific male body imagery. Fantasies concentrated primarily on the
penis and buttocks, although shoulders and facial characteristics
were mentioned. Usually when body imagery was the fantasy tar
get, there was no identification of an individual male as a fantasy
FANTASY PATTERNS
179
subject. Only one committed (and no assigned) homosexual study

subject identified his current partner in his fantasies.
The homosexual males’ fantasies contained more violence than
did those of the male heterosexual study subjects. Free-floating fan
tasies of forced sexual encounters were the second most frequently
reported fantasies by homosexual male study subjects. In the forced
sexual encounters men were imagined as victims almost as fre
quently as women. In all but one instance, the homosexual male
subject played the role of rapist. The rapes were consistently fan
tasized as particularly repellent to the rapee, who usually was pic
tured as restrained and forced into sexual service by physical abuse
such as whippings or beatings.
Of particular interest was the high incidence of cross-preference
fantasies in the homosexual study population. This was the third
most frequently described fantasy among homosexual men. Usually
the free-floating content was of forced sexual participation, although
there was frequent switching between the roles of forcing and be
ing forced. As opposed to the physical rapes described above, when
force was present in cross-preference sexual encounters, it usually
was psychosocial in origin. For example, the fantasy of being forced
by a dominant older woman to service her sexually and that of se
ducing a resisting younger woman into unwanted sexual participa
tion occurred with about equal frequency.
There were also a number of fantasized cross-preference relation
ships with identified women from the homosexual man’s past ex
perience. In these instances there was no suggestion of forced sexual
participation. Instead, content ranged from simple sexual curiosity
to expectations of pleasure. When coital activity was imagined, cu
riosity or anticipated pleasure was described with about the same
frequency as psychosocially forced participation.
The fourth most frequently described fantasy pattern for homo
sexual men involved idealized sexual encounters. These fantasies
were free-floating in category. The imagery was almost always di
rected toward partners unknown to the men personally but fre
quently identified as entertainers or men seen at a distance. In
every instance, these idealized sexual encounters involved a day
dream of a chance encounter on a specific occasion. No continuity
in relationship or even a repeat performance was fantasized.
18o CHAPTER NINE
The fifth most common fantasy pattern was in the short-term

category. The fantasy pattern usually was of observing rather than
participating in group sexual activity. The groups involved in the
imagery of free sexual interchange were always of mixed gender.
HOMOSEXUAL FEMALES
The lesbian population recorded the highest fantasy incidence of

the four study groups. Although a wide range of content was re
ported, targets were divided almost equally into male and female
subjects.
Forcing or being forced sexually was the most frequently re
ported fantasy pattern. These fantasies were almost entirely free-
floating in category. Forced sexual encounter was more frequently
initiated by psychosocial pressure than by physical means. Sexual
dominance and sexual subservience were regularly recurrent fan
tasy content. There was no frequency correlation possible between
forced compliance in a stimulatee role and forcing compliance in a
stimulator role because the fantasizing lesbians reported frequently
switching back and forth from the role of stimulatee to that of
stimulator.
The committed lesbian population did report a far higher inci
dence of free-floating fantasy involving their established partners
than any of the other study groups. These fantasies were second in
frequency of occurrence. Relationships were idealized and the in
dividual sexual encounters savored step by step to mutual sexual
satiation. Forced sex was never an element when established part
ners were involved in the fantasy pattern. No partner identification
was reported by members of assigned lesbian couples.
Cross-preference fantasies involving male partners and generally
resulting in intercourse were reported third in frequency by the
homosexual women. They were generally free-floating in character.
In these cross-preference encounters, sexual activity forced by imag
ined social pressures or other psychologically threatening circum
stances dominated the fantasy content. When an identified male
was involved in the fantasy, psychosocially forced coital activity was
usually imagined; however, pleasurable fantasies involving coital
opportunity were frequently described. When the coital act was
anticipated as a desired encounter, the imagined male partner usu
ally was unidentified.
Lesbians used recall of past sexual experience (short-term fan

tasies) as sexually stimulative mechanisms in both masturbation
and cunnilingus, as opposed to the heterosexual females’ concentra
tion of short-term fantasy on masturbational opportunity. The fan
tasy content varied considerably, but it consisted primarily of recall
of some particularly gratifying sexual experience that became an
“old friend” through constant replay. These varying short-term fan
tasies of past sexual experience were the fourth most often reported
pattern.
Fantasy patterns with sadistic content were fifth in reported fre
quency. There were fantasies of physically destructive approaches
to helpless victims, who were imagined as male and female with
approximately equal frequency. The fantasy content usually went
beyond physically forced rape to include sadistic specifics almost al
ways directed to the reproductive organs. The female objects of
these fantasy patterns usually were personally identified, while the
men who were attacked generally remained faceless. These fantasies
were usually free-floating in category, but an occasional short-term
pattern was reported.
HETEROSEXUAL MALES
The committed heterosexual male’s most frequently reported

free-floating fantasy pattern was specific identification of another
woman in place of his established partner. In most instances, the
sexual object was well known to the fantasizing male, while in
others the woman, though identified usually as a public personality,
was not known personally. When a woman was idealized in fantasy,
she always was more than willing to comply with the fantasizing
male’s sexual demands.
Forced sexual encounter was the second most frequent fantasy
pattern reported by heterosexual men. Many heterosexual men in
troduced thoughts of rape during free-floating fantasies and even
occasionally as a short-term performance stimulant. For hetero
sexual men the mental imagery of being forced sexually was of just
slightly greater incidence than the imagery of using force in sexual
assault. Usually when heterosexual men imagined themselves forced
sexually, it was by a group of unidentified women rather than by a
single female. When they were forcing the sexual encounter, the
fantasy usually involved one woman who generally was identified.
182 CHAPTER NINE
When first cooperating in the laboratory, both married and as

signed heterosexual male partners developed short-term fantasy
patterns based on an awareness of the research team’s observation
of their sexual activity. The fantasy content was one of being ob
served during sexual activity, usually by a number of people. Occa
sionally, the fantasizing man imagined himself having intercourse
in the laboratory with an unimportant partner while a specific
woman he desired as a sexual partner looked on. These fantasies,
specific to the laboratory situation, were the third most frequently
reported patterns. The short-term stimulation of “awareness of
observation” diminished in value and in frequency of recurrence,
however, as the man had further experience in the laboratory.
After the stimulative value of playing to an audience was lost, the
men occasionally found it necessary to revert to a short-term “old
friend” fantasy as a sexual stimulant. The “old friend” was usually
one of rape content.
Some form of homosexual imagery was the fourth most fre
quently reported fantasy pattern. This cross-preference encounter
almost always developed as a free-floating fantasy. The subject mat
ter was generally limited to physical attributes, although personality
identifications were made. Facial attractiveness, muscular develop
ment, penile erection, and shape of buttocks were the most fre
quently imagined physical features. Fellatio was the most frequently
fantasized sexual activity. Although curiosity was expressed regard
ing rectal penetration, it was an infrequent fantasy element. Many
aspects of homosexual interaction were imagined, some with cu
riosity, many with a suggestion of social rejection. The fantasy
content ranged from physical anticipation and performance envy
to impulses toward sadism.
Fifth in frequency were free-floating fantasies of group sex. The
membership of the group was usually described as including both
sexes, but women were far more frequently fantasized than men as
sexual partners. At times there was personal identification of group
members, but more frequently they were faceless. Women’s breasts
and buttocks were far more frequently fantasized than their faces.
The least frequently reported fantasy by the committed hetero
sexual men was that involving the currently established partner.
The current partner was rarely identified in free-floating and never
as a short-term stimulative fantasy, regardless of whether the hetero

sexual male was married or an assigned subject.
HETEROSEXUAL FEMALES
The heterosexual female study subjects were more deeply in

volved in fantasy than their male counterparts. Like the hetero
sexual men, the female study subjects rarely fantasized their
married and never their assigned partners. The most frequently
reported fantasy was free-floating in category and involved a specific
male. The imagery ranged from entertainers to casual acquaintances
to men seen at a distance. When the fantasized male was identified
by but not known to the woman, her fantasies were frequently di
rected toward different parts of the anatomy, such as shoulders,
hair, penis, legs, buttocks; intercourse was the constantly fantasized
sexual activity.
Forced sexual encounter with an unidentified male or males was
the second most commonly described fantasy. This type of fantasy
was usually free-floating in category, although occasionally being
forced sexually was a short-term, “old friend” fantasy pattern. Be
ing raped while helpless to resist was consistently fantasized, while
the heterosexual women rarely reported assuming the role of rapist
and attacking a helpless male. Although usually fantasizing them
selves as restrained from effective resistance to the rape episode,
there was little sadism and no masochism reported as fantasy
content.
Compared to the heterosexual males, there was greater use of
short-term fantasies during the heterosexual women’s first few
visits to the laboratory. Observation fantasies ranked third in re
ported frequency. These women consistently imagined themselves
having intercourse before a large group of men and women. As was
true for the heterosexual men, fantasies stimulated by the laboratory
experience tended to disappear as comfort with the environment
and security in sexual performance were established. The lack of
stimulative return from the observation process was usually replaced
by the same short-term fantasy used with masturbation. This short
term fantasy most frequently was forced sexual encounter.
Fourth in frequency were free-floating fantasies of idyllic trysts.
Occasionally there was identification of a specific male to share the
184 CHAPTER NINE
tryst, but generally faceless men were the sexual partners. Escape to
the perfect lover was usually the content of the married women’s
sexual daydreaming, rarely the assigned partners.
Daydreams of homosexual content were the fifth most frequently
reported fantasy by the female heterosexual study subjects. They
were almost entirely of the free-floating category. As stated above,
when the heterosexual women’s fantasy content involved a male
partner, there was only an occasional instance of personal identifi
cation of a well-known partner. But in more than half of the hetero
sexual women’s homosexual fantasy patterns, specific identification
of the female partner was reported. Usually the identified female
subject was an older woman who by strength of personality, by em
ploying societal blackmail, or by threatening physical punishment
had seduced the fantasizing woman and, after destroying her will
to resist, forced her into sexual participation, either in the role of
stimulatee or as stimulator. There were also a number of instances
in which the seducer role was played in fantasy by the heterosexual
female. Again, the woman to be seduced was usually identified. In
these homosexual fantasies, heterosexual women were most aroused
by thoughts of forced participation, regardless of whether they were
being forced sexually or doing the forcing.
AMBISEXUAL MALES
The 6 ambisexual male study subjects described less frequent use

of fantasy than any other study group. When fantasy was em
ployed, it was always of the free-floating category. There was no
reported use of short-term fantasy as a sexual stimulant, nor did the
ambisexual men indicate unusual sexual stimulation arising from
laboratory observation of their sexual activity. This may be ex
plained by the fact that 5 of the 6 men reported prior group-sex
experience.
When used, the free-floating fantasies were of a different vein
than those described by heterosexual and homosexual men. The
content rarely involved men or women as sexual objects. There also
was very little imagery of sexual anatomy, such as breasts, buttocks,
or penis. Instead, fantasy content usually was directed toward po
tential sexual opportunity or consisted of a detailed review of some
particularly stimulating prior sexual experience. The ambisexual
men’s free-floating fantasy content usually involved reliving the

physical aspects of a specific sexual episode, regardless of whether
the partner was male or female. There also were reported patterns
of fantasizing anticipated sexual events, with little attention paid
to the gender of projected partner or partners.
There was no reported imagery of forced sexual encounter, nor
were there recorded statements of need to dominate or to be domi
nated in sexual interaction.
AMBISEXUAL FEMALES
Although the ambisexual women were significantly more involved

in sexual fantasy than the ambisexual men, there certainly was not
the degree of fantasy involvement reported by homosexual and
heterosexual female study subjects. Unlike ambisexual men, the
ambisexual women concentrated on their peers as sexual objects,
so there were personalized men and women in their fantasy con
tent. Neither gender nor specific partner identification, however,
seemed to be of great importance. The focus was primarily on spe
cific details of sexual activity or a review of a successful sexual epi
sode, even though the particular activity or episode was fantasized
with a partner or partners. Like the ambisexual men, the ambisexual
women tended to concentrate more on future sexual opportunity
and the details of prior sexual experiences than on the actual men
or women who had been or might become partners.
Again, there was no reported content of forced or violent sex, nor
was there expressed need to dominate or be dominated sexually.
Four of the 6 ambisexual women described a moderately repres
sive childhood environment with free-floating fantasies, not neces
sarily of sexual content, employed as a major release mechanism.
When there was specific personalization in the fantasy, the adoles
cent’s daydreams involved both sexes without apparent dominance.
This point of information on psychosexual development, although
replicated in the history of only one ambisexual male, may be one
of the keys to future investigation of the ambisexual man’s or
woman’s psychosocial orientation.
186 CHAPTER NINE
THE HIGH-INCIDENCE FANTASIES
CRO S S - PREFERENCE FANTASY
By far the most intriguing return from investigation of the fan

tasy patterning reported by homosexual and heterosexual men and
women and most relevant to this particular investigation was the
high incidence of cross-preference fantasies. In cross-preference
fantasy, homosexual men and women imagined overt heterosexual
interaction and, conversely, heterosexual men and women fanta
sized homosexual interchange.
Frequently, the content of the cross-preference fantasies returned
from the in-depth interviews differed markedly from material re
ported by the same study subjects during intake interviews and from
opinions expressed during their periods of laboratory participation. In
handling sexual fantasy material, particularly that which runs coun
ter to cultural mores, there must be a constant awareness of the
great difference between what men and women publicly profess as
acceptable sexual conduct, what they report as fantasy content dur
ing most interviews, and what they fantasize privately and reveal
only in unusual circumstances.
Cross-preference sexual interaction had been described as “un
thinkable,” “revolting,” “inconceivable,” during discussions with
small groups of fully committed heterosexual or homosexual men
and women. Yet the very men and women whose public condemna
tion of variant sexual activity was most vitriolic evidenced a signifi
cant curiosity, a sense of sexual anticipation, or even fears for effec
tiveness of sexual performance when musing in private interviews
on the subject of cross-preference sexual interaction.
The high incidence of cross-preference fantasy patterning was of
particular relevance to the Institute’s research programs. The pat
tern was reported frequently by members of each study group with
the exception of the ambisexual study subjects, for whom—obvi
ously—the concept of cross-preference is irrelevant. This was the
third most frequently reported fantasy by both male and female
homosexual study subjects, the fourth most common pattern de
scribed by heterosexual male study subjects, and fifth in popularity
for heterosexual female study subjects (see Table 9-1 ).
FANTASY PATTERNS
187
Although content of the cross-preference fantasies covered a

wide range, the most frequently expressed attitude by both homo
sexual and heterosexual study subjects was more of curiosity than
of rejection. Some heterosexual men and women fantasized homo
sexual activity in a positive sense by expressing curiosity, obvious
sexual excitation, and anticipation of sexual interaction in a freely
interactive pattern. Homosexual men and women also frequently
expressed a sense of curiosity and a pleasure perspective in their
cross-preference daydreaming.
Of course, there was negative content in which forcing or being
forced sexually into cross-preference activity was fantasized, par
ticularly by heterosexual women. But the negative-content fan
tasies were in the minority for all other study groups.
It may be recalled that heterosexual male and female study sub
jects were overwhelmingly Kinsey 0, with no higher than a Kinsey 1
sexual preference rating (see Chapter 3). Thus, as a result of the
Institute’s controlled selection process, the heterosexual study groups
represented a far greater concentration of unequivocal heterosexual
orientation than would be true for a cross-section of this country’s
avowed heterosexual population.
The Institute’s homosexual study group ranged in sexual prefer
ence ratings from Kinsey 1 to Kinsey 6 (see Chapter 3). Obviously,
there was a far greater incidence of prior heterosexual experience
among the male and female homosexual study subjects than previ
ous homosexual experience in the heterosexual study groups.
Initially, the research team presumed that the high incidence of
cross-preference fantasy by the homosexual male and female study
subjects might be explained by the significant amount of their prior
heterosexual experience. This concept proved false, however. When
the material was reviewed, the recorded fantasy patterns of the
Kinsey 5 and 6 male and female subjects were just as frequently
directed toward cross-preference imagery as those reported by the
remaining members of the homosexual group with sexual preference
ratings from 1 through 4.
When coitus was the subject matter of homosexual fantasy, men
tal imagery expressing curiosity and anticipated pleasure was en
countered with a slightly higher frequency than the incidence of
imagined forced participation. When other sexual techniques were
188 CHAPTER NINE
fantasized, the incidence of curiosity and anticipated pleasure was

significantly higher, but there were rare occasions of fantasized
forced sexual participation.
IDENTIFICATION VERSUS NONIDENTIFICATION
OF PARTNER
The content most frequently reported by members of the male

heterosexual study group included identification of a specific woman
(other than the current partner) as a desired sexual partner. The
heterosexual women (also ignoring their current partners) tended
to fantasize sexual activity with a man they could identify but did
not know. The homosexual males continued in the pattern of ig
noring their current partners in sexual fantasy. The fantasies of the
lesbian group were somewhat different in content, however; they
were the only study group to bring their current partners into the
fantasy content with any significant frequency, but they did so pri
marily in idealized situations rather than in imagery related to
daily-living backgrounds.
While the homosexual and heterosexual men and women fre
quently fantasized individual partners with or without personal
identification in stimulative situations, the ambisexual men and
women tended to fantasize sexually stimulative situations rather
than individualizing their partners. Ambisexual men adhered to
this content patterning more than did ambisexual women. In their
daydreaming, ambisexual women identified individual sexual part
ners but with little apparent regard for their gender.
FORCED SEXUAL ACTIVITY FANTASY
The second most frequently reported fantasy content of hetero

sexual men and women and of homosexual men was that of forced
sexual interaction. It was also an integral part of sadistic imagery,
which was the fifth most frequently reported fantasy by homosexual
women (see Table 9-1). In the fantasies of forced sexual interac
tion, the homosexual or heterosexual men or women imagined
themselves as either being forced to respond sexually under physical
or psychosocial duress or forcing a similarly handicapped target to
respond to sexual approach against his or her will. Frequently, the
fantasizing men or women played both the role of rapist and that
of rapee interchangeably; this was particularly true for heterosexual

men. Obviously, there is always an element of sadomasochism in
volved in rape or sexual coercion. This discussion arbitrarily labels
as sadistic only those fantasy patterns in which overt physical sado
masochism occurred that was beyond the element of forced sexual
activity.
Although minimally reported, the homosexual group fantasized a
higher incidence of sexual violence (sadism) as a part of the forced
sexual activity than did the heterosexual study groups. There was
no fantasized violence reported by the ambisexual group.
When gang rape was fantasized, there was variation in reported
role-playing both by sexual preference and by gender. In his fan
tasies, the homosexual male was consistently active in the gang
rapes, but occasionally he reported playing an additional role of
planner or organizer of the rape. His victims were as frequently
men as women.
The heterosexual man employed gang-rape fantasies frequently,
but, interestingly, he played the role of rapee a little more fre
quently than that of rapist. When in the rapee role, he was usually
restrained and forced by a gang of women. When playing the role
of rapist, the fantasy content more involved observation of the
victim’s distress from other men’s sexual approaches than actual
participation in the rape.
The homosexual woman switched back and forth between rapist
and rapee roles in most gang-rape sequences; however, there was
sadistic content in a number of her gang-rape scenes. In most cases,
the sadistic gang-rape segments were fantasized in revenge against
another woman. Her role was one of organizer of the rape, and her
pleasure usually was derived from observation of the rapee’s suffer
ing rather than from her own active participation in debasing her
chosen victim.
In the heterosexual woman’s fantasies of gang rape, she was pre
dominantly the victim. She usually fantasized herself as powerless
to resist, whether physically restrained or socially dominated, and in
her daydreaming she was forced sexually time after time. Hetero
sexual women repeatedly used gang-rape fantasies as a short-term
stimulant when masturbating or when responding to cunnilingus.
The heterosexual and homosexual men and the homosexual
igo CHAPTER NINE
women usually employed gang-rape imagery as a free-floating, not a

short-term fantasy.
CROUP-OBSERVATION FANTASY
Although the homosexual and heterosexual study groups were

equally exposed to observation procedures in the laboratory, it was
only the heterosexual study groups that incorporated the laboratory
environment into frequently recurrent fantasy content. The hetero
sexual males and females each reported group observation of their
sexual activity as the third most frequently recurrent fantasy, and
both study goups also noted that as comfort with the laboratory en
vironment and confidence in sexual activity increased, the incidence
of the observation fantasies decreased. Neither the male nor the fe
male homosexual study group reported a significant incidence of
personal observation fantasies.
It may be recalled that with onset of sexual activity in the labora
tory, it was far more important to the heterosexual than to the ho
mosexual study groups to have orientation periods before actually
being observed in sexual interaction. This suggestion of relatively
greater psychosexual insecurity in heterosexual than in homosexual
study subjects has no ready explanation, but it continues to intrigue
the research team. This subject is discussed in Chapter 11.
CONCLUSION
As stated in the introduction to this chapter, only the basic as

pects of the fantasy material collected by the research team have
been released at this time. This material has been collected from a
carefully selected group of sexually functional study subjects of both
genders and varying sex preferences. Before any attempt is made
to establish presumed clinical significance, consultation will be
sought from multiple sources. However, categories of fantasy pat
terning and incidence of specific content has been considered in a
reportorial context.
Every study subject, regardless of sexual preference, indicated
that he or she had recurrent fantasies that the subject felt no desire
or need to act upon in real life. Thus, the fact that homosexual
FANTASY PATTERNS
191
men and women had fantasies of heterosexual activity did not nec
essarily indicate the presence of a latent or unrealized commitment
to heterosexuality, nor did cross-preference fantasies enjoyed by het
erosexual men and women necessarily indicate a latent demand for
overt homosexual experience. Similarly, forced sexual encounter
fantasy was frequently reported by both homosexual and hetero
sexual males and females, but again no desire to act out such fan
tasies was evidenced. Further research is required to distinguish the
occasional individuals who actually have a strong tendency to act
out their fantasy patterns from the vast majority who do not.
If interpreted correctly, fantasy patterns and dream sequences
may be important sources of information for psychotherapists. But
aside from disciplinary influence, interpretative guidelines usually
are based on the therapists’ own concepts of culturally standardized
gender portrayal and sexual behavior. These concepts include pre
sumed specifics of homosexual and heterosexual role-playing. Of
necessity, a gross lack of empirical research data has forced thera
pists into the position of relying heavily on cultural dictum when
dealing with problems of sexual preference.
As an aid to interpretation of fantasy material derived from sex
ually dysfunctional men or women, regardless of preference, psy
chotherapists might profit from familiarity with the categories and
frequencies of fantasy patterns developed by sexually functional
men and women. For example, since cross-preference sexual fan
tasies occurred so frequently among the sexually functional homo
sexual and heterosexual men and women who formed the Institute’s
study-subject groups, currently popular psychotherapeutic interpre
tations of this type of fantasy patterning may profit from some re
thinking.
This chapter reflecting categories and incidence of study-subject
sexual fantasy patterning has been presented in accordance with
the Institute’s overall research concept of learning from those men
and women who function effectively in order to help those with
sexual difficulties. Future publication will include detailed coordina
tion of the bulk of the fantasy material, together with provision of
sufficient background material to orient the reader to the individual
members of the study-subject groups that were the reportive sources
of this material. Such information must be at hand in order to sup
192 CHAPTER NINE
port interpretive comment and to encourage objective evaluation of

the material by interested health-care professionals.
It should be borne in mind that the general subject matter of
fantasy patterning reported in this section represents material that
in many instances was collected more than a decade ago. This ma
terial may or may not be representative of today’s social structuring.
As cultural mores change, so may fantasy content. For example,
only male homosexual and heterosexual study subjects reported
fantasies of group sex frequently enough to have this type of imag
ery listed in the five most frequently described fantasy patterns by
any study group (see Table 9-1). Quite possibly female homosexual
and heterosexual study subjects, if currently interviewed, might re
port this fantasy pattern as an increasingly popular sexual daydream.
Certainly it is incumbent upon the health-care professionals to
avoid being locked into preconceived concepts of recurrent fre
quency, stylized content, or even established interpretation of fan
tasy patterns. Therefore, there may be real value in a repetition of
this type of investigative scrutiny of sexually functional men and
women at least every decade. For if fantasy patterns of sexually
functional persons vary significantly in recurrence, so may the recur
rent fantasy patterns of the sexually dysfunctional population alter
significantly. If and when fantasy patterning alters, so must clinical
interpretation.
I o
PRECLINIC AL
STATISTICS
In order to develop legitimate comparisons between homosexual,

heterosexual, and ambisexual men’s and women’s facility in re
sponding to various types of sexual stimuli in the laboratory, there
must be evidence that the separate study groups are indeed com
parable research populations. Only if such evidence can be pre
sented should comparisons of functional efficiency in sexual inter
action be drawn between the two genders and the three sexual
preferences.
Heterosexual study group B was selected from the men and
women in the Institute’s first research population (1957 to 1965).
If comparisons were to be drawn between existing data from this
first research population and data returned by study groups recruited
later, reductions had to be made in the total population of the first
study group because many of its members were recruited for special
projects that did not include intercourse or the other common stim
ulative techniques (masturbation, partner manipulation, or fellatio/
cunnilingus). This reduction process has been described in Chap
ter 2.
The homosexual study group, recruited from 1964 to 1968, and
heterosexual study group A (1967 to 1968) were established nearly
a decade after the first research population was originally consti
tuted. Finally, the ambisexual study group was recruited and evalu
ated during a two-year period from 1968 to 1970. Thus, the total
time span for study-subject recruitment and laboratory evaluation
covered a 13-year period from 1957 to 1970. No members of any
specific study group were members of any other study group.
Over the years, the research team’s primary concern in recruiting
193
CHAPTER TEN
194
was that the study groups constituted later should correspond as

closely as possible in composition to the original heterosexual study
group (from which group B was derived). The necessity of match
ing study subjects’ ages and levels of formal education was con
stantly kept in mind during each recruiting process (see Chapter 2).
The one specific criterion required for selection of all study subjects
was that each man and woman give a history of effective sexual
functioning. An individual who described any prior difficulty with
sexual interaction was not accepted as a volunteer.
Unless criteria set for the original heterosexual study group had
been matched successfully while recruiting heterosexual study
group A and the homosexual study group, comparable research
populations would not have been established. Hence, it remained
the Institute’s responsibility to establish the comparability of the
research groups when presenting and comparing statistically the
sexual functional efficiency of the study-group members both by
gender and by sexual preference. The ambisexual study group (see
Chapter 8) is composed of too few members (6 men and 6 women)
to be statistically evaluated in comparison to the three major study
groups described above; however, the average ages of the men and
women and their formal educational levels were certainly com
parable to those of the original heterosexual study group.
In order to compare the study-group membership as to age and
levels of formal education, Tables 10-1 and 10-2 have been pre
pared. In these tables, the study-group members are listed in total
numbers, by gender, and in their assigned or committed couple
roles. In this chapter all statistical comparisons that are reported as
significant met the p < 0.05 level of significance. Age comparisons
were accomplished through the appropriate factorial analyses of
variance. Comparisons of formal educational levels were computed
with chi-square analyses.
It is quite evident (Table 10-1) that there are no statistically
significant differences in the average age of male subjects in the
three basic study groups (homosexual group and heterosexual
groups A and B) or in the ages of female members of the same
three groups. There is a significant difference in the mean age of
the total male study population (34.19) and the mean age of the
total female study population (31.90). This male-female age dif
ferential is expected in social relationships, however, and since the
PKECLINICAL STATISTICS
195
table10-1
Age Distribution of Homosexual Study Group—
Heterosexual Study Groups A and B
Total Mean Standard

Number Age * Deviation
Homosexual study
group
Males 94 3335 6.90
Assigned males 10 33.10 7.72
Committed males 84 33.38 6.85
Females 82 32.22 8.24
Assigned females 6 30.83 9.66
Committed females 76 32.32 8.15
(1964-1968)
Heterosexual study
group A
Males 57 34.51 7.73
Females 57 31.68 7.28
(1967-1968)
Heterosexual study
group B
Males 286 34.72 10.36
Females 281 31.80 9.40
(1957-1965)
* Mean age of male study subjects, 34.19; mean age of female study subjects,
31.90.
disparity is consistently present in all three study groups, it would

not appear important to this discussion.
In order to simplify comparisons, the homosexual study group
and its recruitment contemporary, heterosexual group A, will be
ig6 CHAPTER TEN
evaluated briefly. In turn, the statistical comparability of hetero

sexual study groups A and B will be established.
There were no significant differences in the average ages of male
and female study subjects in the homosexual group as compared to
the heterosexual men and women in study group A (see Table
10-1). There also were no significant differences between the two
study groups in the mean ages of committed males and committed
females, nor were there any significant differences between the same
two groups in the average ages of the assigned males and assigned
females.
Direct statistical comparisons of mean ages between the assigned
and committed study subjects in any study group were not done
because of the disproportionate sample sizes. Comparisons of such
disproportionate sample sizes in an analysis of variance (the analy
sis employed in determining differences in mean age) would yield
incorrect statistical results.
When comparing the levels of formal education for the men and
women in the homosexual groups and those in heterosexual study
group A (Table 10-2), no statistically significant differences were
demonstrated. But there was a statistically significant difference be
tween the levels of formal education of the men and women, re
gardless of study-group association. There was a disproportionately
larger number of males than females who had postgraduate levels
of formal education and, consequently, a disproportionately larger
number of females than males who had no more than high school
levels of formal education. But this gender discrepancy in levels of
formal education was present in both the homosexual group and
heterosexual study group A.
For evaluation of formal educational levels, in contrast to age
analyses, comparisons were made directly between assigned and
committed individuals even though there were large differences in
sample size. This was done because the statistical technique used
for evaluating formal education levels was chi-square (x2) analysis,
which is not affected by differences in sample size.
There were no significant differences in levels of formal educa
tion between assigned and committed males in heterosexual study
group A and the homosexual study group, and also no differences
in levels of formal education between the men forming the same
PRECLINICAL STATISTICS
I97
TABLE 10-2
Formal Education of Homosexual Study Group—
Heterosexual Study Groups A and B
Assigned Couples_______ _____ Committed Couples

Group and Male Female Male Female
Level of Per Per Per Per
Education No. cent No cent No. cent No. cent
Homosexual
study group
High school 2 20.00 3 50.00 15 17.86 24 31.58
College 5 50.00 2 33.33 34 40.48 40 52.63
Postgraduate 3 30.00 1 16.67 35 41.66 12 15.79
Total 10 100 6 100 84 100 76 100
(1964-1968)
Heterosexual
study group A
High school 1 14.28 2 28.57 11 22.00 15 30.00
College 3 42.86 3 42.86 17 34.00 23 46.00
Postgraduate 3 42.86 2 28.57 22 44.00 12 24.00
Total 7 100 7 100 50 100 50 100
(1967-1968)
Heterosexual
study group B
High school 5 17.24 9 37.50 42 16.34 98 38.13
College 12 41.38 10 41.67 105 40.86 114 44.36
Postgraduate 12 41.38 5 20.83 110 42.80 45 17.51
Total 29 100 24 100 257 100 257 100
(1957-1965)
two preference groups. Similarly, there were no significant differ

ences in formal education between assigned and committed females
and no differences between female members of these two prefer
ence groups.
Finally, there were no statistically significant differences between
heterosexual study groups A and B either in mean age or in formal
education. There still remains a statistically significant difference
between the amount of formal educational experience reported by
the men as compared to the women, but, as stated previously, this
difference was present within each study group.
198 CHAPTER TEN
Thus, the statistical comparability of the homosexual study group

and heterosexual study groups A and B has been established.
A major dimension of homosexuality can be put in perspective
by drawing comparisons in the functional efficiency of human sex
ual interaction. How effective is the sexual interchange of homo
sexual men and women as compared with that of heterosexuals?
Are there significant differences in functional efficiency either be
tween the genders or between sexual preference groups? How do
ambisexuals fit into the overall picture of sexual functional effi
ciency—can any valid comparisons be made for ambisexuals? An
swers to these questions are reflected by the data presented in
Tables 10-3, 10-4, and 10-5.
The facility to achieve orgasm in response to various forms of
sexual stimulation is one way to carry out a comparison both be
tween genders and between sexual preference groups. However uni
dimensional this type of physical measurement may be, it at least
allows generalized comparisons to be drawn between statistically
comparable populations.
Tables 10-3 and 10-4 summarize the results of 12 years of labora
tory observation of human sexual function. In addition, they pro
vide comparative statistics reflecting the functional efficiency of
study subjects involved in sexual interaction, both by gender and
by sexual preference.
Sexual functional efficiency statistics have been reported from a
negative point of view: namely, the incidence of failure to achieve
orgasmic release in response to specific forms of sexual stimulation.
Functional failure statistics are presented for masturbation, partner
manipulation, and fellatio/cunnilingus (Table 10-3) and for coi
tion (Table 10-4).
It is obvious from perusal of Table 10-3 that there were no quan
titative differences between homosexual men and heterosexual men
in facility to respond at orgasmic levels of sexual excitation when
masturbating or in response to the stimulative techniques of part
ner manipulation or fellatio.
Exactly the same statement can be made when comparing the
sexual functional efficiency of homosexual women to that of hetero
sexual women in response to masturbation, partner manipulation,
PRECLINICAL STATISTICS
199
TABLE IO-3
Summary Comparison of Failure Rates in Manipulative Stimulation

by Gender and Preference in Homosexual Study Group—
Heterosexual Study Groups A and B *
Sexual Preference
Homosexual Heterosexual
Func Fail Fail Func Fail Fail
Gender and Ob- tional ure ure Ob tional ure ure
Type of s erved Fail Inci Per served Fail Inci Per
Stimulation (Cycles ures dence centage Cycles ures dence centage
Male t
Masturbation 126 1 1 : 126.0 0.79 502 4 1 : 125.5 0.80
Partner 195 2 1 : 97.5 1.02 562 5 1 : 112.4 0.89
manipulation
Fellatio 217 1 1 : 217.0 0.46 146 t 1 1 : 146.0 0.68
Total 538 4 1 : 134.5 0.75 1210 10 1 : 121.0 0.83
Female J
Masturbation 211 2 1 : 105.5 0.95 812 4 1 : 203.0 0.49
Partner 306 2 1 : 153.0 0.65 1004 8 1 : 125.5 0.80
manipulation
Cunnilingus 192 1 1 : 192.0 0.52 159Í 2 1 : 79.5 1.26
Total 709 5 1 : 141.8 0.71 1975 14 1 : 141.1 0.76
(1957-1968)
* Summary developed from combination of Tables 6-5 and 6-16 (see Chapter 6).
t Homosexual males, N = 94; heterosexual males, N = 343.
Î Heterosexual fellatio and cunnilingus evaluated only with study group A, not
study group B.
J Homosexual females, N = 82; heterosexual females, N = 338.
or cunnilingus. There simply is no quantitative difference between

homosexual and heterosexual female study subjects in facility to
respond at orgasmic levels to these stimulative techniques in the
laboratory.
Not only is there no quantitative difference in capacity for or
gasmic attainment when comparing men and women of different
sexual preferences, there also is no significant difference found
when comparing the functional facility of the two genders. The
failure percentages (Table 10-3) attest to no quantitative differ
ences in the functional failure rates of sexually experienced men as
200 CHAPTER TEN
TABLE IO-4
Summary Comparison of Failure Rates in Coition by Gender—

Heterosexual Study Groups A and B *
Stud .________________ Male Study Subjects________________ Female Study Subjects
Group Ob- Functional Failures Failure Failure Ob- Func- Failure Failure
and served Impo- Inci- Per- served tional Inci- Per-
Years No. Cycles tence P.E. (Total) dence centage No. Cycles Failures dence centage
Study 57 189 4 3 (7) 27.0 3.70 57 182 6 1 : 30.3 3.30

group A
(1967-
1968)
Study 286 5780 189 24 (213) 27.2 3.69 281 f 3973 108 1 : 36.8 2.72
group B
(1957-
1965)
Total 1 345 5969 193 27 (220) 27.1 3.69 338 ■1155 114 1 : 35.5 2.76
(1957-1968)
'Summary combines information from Tables 6-17, 6-18, 6-19, and 6-20 (see Chapter 6).
t Reduction in female numbers explained in Table 6-18 (see Chapter 6).
t Combined study groups A and B.
compared to the functional failure rates of sexually experienced

women responding to the same types of sexual stimulation. The
total combined failure rates (the combined failure percentages for
masturbation, partner manipulation, and fellatio/cunnilingus) are
remarkably similar: 0.75 percent for homosexual males, 0.71 percent
for homosexual females, 0.83 percent for heterosexual males, and
0.76 percent for heterosexual females.
In brief, it can be stated unequivocally that in the laboratory
there is no significant quantitative difference in subjects’ ability to
respond at orgasmic levels to the stimulative techniques of mastur
bation, partner manipulation, and fellatio/cunnilingus, regardless
of whether the gender is male or female or the sexual preference is
homosexual or heterosexual. The implications of these statistics,
the results of 12 years of laboratory evaluation of sexually func
tional heterosexual and homosexual couples, will be discussed in
Chapter 11.
Table 10-4 provides a different perspective of sexual functional
efficiency; it summarizes functional failure statistics when coition
was evaluated as the primary source of sexual stimulation. It may
be recalled that all the men and women in heterosexual study
PRECLINICAL STATISTICS 201
groups A and B were evaluated in coital interaction in addition to

the other forms of sexual stimulation (see Chapter 4). In Table
10-4 comparisons are made between the functional effectiveness of
these men and women in coital connection. The last horizontal
column reports the statistics returned from the two combined
heterosexual study groups (A and B). A total of 343 men responded
through 5,969 coital opportunities with 220 functional failures, re
sulting in a failure rate of 3.69 percent; while 338 women responded
through 4,155 coital opportunities with 114 failures to attain or
gasm, yielding a failure rate of 2.74 percent.
These figures may be somewhat misleading. In view of the num
ber of episodes of observed coital function (5,969 for men, 4,155
for women), there clearly is statistical significance in the 0.95 per
cent differential in facility of male and female study subjects to
respond effectively during coital activity (Rao, 1952). From a prac
tical point of view, however, there is little clinical significance in
the minimal percentile difference in sexual functional effectiveness
between heterosexual male and female study subjects.
As a matter of fact, if we were to consider orgasmic facility alone,
the reported percentage of male failures during coitus would be
slightly lower. This figure (369 percent) specifically represents
men’s failures to function effectively in intercourse—but criteria for
male functional failure in coition must include the incidence of
premature ejaculation as well as that of erective inadequacy. While
premature ejaculation does indeed lead to coital functional failure,
it does not represent orgasmic failure. If comparison is made solely
between male and female orgasmic failures, the corrected male
functional failure rate is 3.24 percent instead of 3.69 percent. There
fore, the final comparative statistics for failure to attain orgasmic
release during intercourse are 3.24 percent for men and 2.74 percent
for women, leaving a differential of only 0.50 percent. Although
even this small percentile differential remains statistically signifi
cant, there certainly is no significant clinical difference between sex
ually experienced men and women in facility to attain orgasmic
release when responding to coital opportunity in a laboratory
environment.
But there is a marked difference between the ability to respond
202 CHAPTER TEN
at orgasmic levels of sexual excitation during intercourse and facil

ity for orgasmic expression in response to other forms of sexual
stimulation (see Table 10-3). The significance of these differences
between sexual functional efficiency in coition and in manipulative
stimulation was presented in Chapter 6 and will be discussed in
detail in Chapter 11.
Table 10-5 reports the facility of ambisexual men and women to
respond effectively to sexual stimulation in the forms of masturba-
TABLE IO-5
Summary Comparison of Failure Rates by Gender:

Ambisexual Study Group *,t
Gender and
Male
Partner 37 1t 1 : 37.0 2.70
manipulation
Fellatio 40 0 0 0
Total 83 1 1 : 83.0 1.20
Female
Partner 47 0 0 0
manipulation
Cunnilingus 56 is 1 : 56.0 1.79
Total 116 1 1 : 116.0 0.86
Coition
Male 18 0 0 0
Female 22 0 0 0
(1968-1970)
* Summary is a restatement of Table 8-12 (see Chapter 8), given here for reader
convenience.
t Male ambisexual study subjects, N = 6; female ambisexual study subjects, N = 6.
t One male ambisexual failed to maintain an erection or ejaculate.
J One female ambisexual failed to obtain orgasmic release.
PRECLINICAL STATISTICS 203
tion, partner manipulation, fellatio/cunnilingus, and coition. Al

though the number of study subjects was too small and their lab
oratory experiences were too few to allow statistical comparisons
with the returns from the homosexual and heterosexual study popu
lations represented in Tables 10-3 and 10-4, an obvious trend in
clinical response patterns has been established. The general pattern
would indicate that there is no specific clinical difference evident
between the response patterns of the ambisexual in his or her homo
sexual or heterosexual phase and the sexually responsive men and
women in the homosexual or heterosexual study groups, respec
tively. The implications of these statistics will be discussed in Chap
ter 11.
SUMMARY
The dimensions of this chapter have been confined to the presen

tation of pertinent statistical material. At the outset, the statistical
comparability of the three basic study groups (the homosexual
study group and heterosexual study groups A and B) was estab
lished. It has been demonstrated that there is no quantitative dif
ference in the functional efficiency of sexual interaction in the
homosexual study group as compared with the heterosexual study
groups. In addition, it has been pointed out that there is no quan
titative difference between the functional efficiency of sexually ex
perienced men and women, regardless of their sexual preference,
when responding in a laboratory environment to the stimuli of mas
turbation, partner manipulation, and fellatio/cunnilingus. There is,
however, a significant difference in functional failure percentage be
tween heterosexual men and women in response to coital oppor
tunity in the laboratory, but the difference is so small (0.50 per
cent) as to be of little if any clinical significance.
The functional efficiency of the ambisexual population is also
presented. Although the small size of the ambisexual study popula
tion prohibits valid quantitative comparisons with the other study
groups in sexual functional efficiency, the trend in response pattern
ing is emphasized.
204 CHAPTER TEN
In brief, the statistical dimension of functional efficiency in sex

ual interaction is used to compare the male and female members of
the homosexual and heterosexual study populations. This approach
is yet another means of providing perspective for the homosexual
population.
11
PRECLINICAL
DISCUSSION
In 1964 the Institute initiated a long-term research program de

signed to broaden the dimensions of currently held perspectives on
homosexuality. The dimensions to be expanded were those upon
which Institute personnel traditionally have concentrated investi
gative interest: the physiologic and psychological aspects of human
sexual function and dysfunction. For example, it was anticipated
that if the physiologic patterns of homosexual study subjects’ sexual
interaction could be identified, comparisons might legitimately be
drawn to the physiologic patterns previously described for men and
women in heterosexual study groups. If such comparisons could be
drawn effectively, a new dimension would be added to health-care
professionals’ perspectives on homosexuality.
PHYSIOLOGIC CONSIDERATIONS
SEXUAL FUNCTIONAL EFFICIENCY
Table 10-5 (see Chapter 10) is by far the most important table
in the preclinical section of this text. Brief scrutiny of this table
makes if abundantly clear that there is no statistically significant
difference between sexually experienced male homosexual and male
heterosexual study subjects in facility to respond at orgasmic levels
to the stimulative techniques of masturbation, partner manipula
tion, and fellatio. Similarly, it is evident that there is no statistically
significant difference in facility of orgasmic attainment between
sexually experienced female homosexual and female heterosexual
study subjects in response to masturbation, partner manipulation,
205
206 CHAPTER ELEVEN
and cunnilingus. How should health-care professionals interpret

this information?
Results returned from research projects must be viewed with
objectivity, for the statistics can easily be given undue importance
and can just as easily be undervalued. For example, major pitfalls
may be encountered if attempts are made to draw universally
applicable conclusions from the ability of sexually experienced
study subjects to respond successfully in the laboratory to various
forms of sexual stimulation.
Pertinent questions must be raised to avoid unwarranted assump
tions. For example, does this knowledge of equality in sexual effec
tiveness between homosexual and heterosexual males and females
mean that these men and women would react in private with
essentially the same levels of functional efficiency as were evidenced
in the laboratory? The answer is that we have not the slightest idea.
There might be a physiologic difference between sexual response
patterns developed in private and those observed in the laboratory.
To make the unfounded assumption that there could be no differ
ence between sexual response in private and in the laboratory
would be to give undue importance to the statistics presented in
Table 10-3. But to give little credence to the laboratory findings
because they cannot be directly compared to private sexual inter
action would be to grossly undervalue the research returns. What
must not be done under any circumstance is to bend the research
results to satisfy personal need. Unsupported connotations that
tend to give credence to personal beliefs about patterns of human
sexual interaction or even about sexual orientation must not be read
into these reported research results.
Few important conclusions, but some very interesting specula
tions, can be safely drawn from the material at hand. A secure base
of indisputable fact should lead the inquiring researcher more
toward speculation than to leave him or her resting in a safe scien
tific harbor, pontificating conclusions. It is a fact that under spe
cifically controlled conditions, there is no inherent difference in
physiologic facility to respond at orgasmic levels between homo
sexual and heterosexual men and between homosexual and hetero
sexual women. And it is interesting to speculate that if there were
an inherent genetic differential between homosexual and hetero
PRECLINICAL DISCUSSION 207
sexual men and women, as has been frequently claimed by the

general public, by members of the theological profession, and—at
times—by health-care professionals, there might well be demon
strable differences in physiologic facility for sexual interaction and
in capacity to respond to similar forms of sexual stimulation. There
were none. Yet, the fact that homosexuals and heterosexuals func
tion in an essentially identical manner in the laboratory certainly
does not warrant a didactic statement that no genetic differences
will be established by future research. To date, no such differences
have been demonstrated. The Institute’s current position is simply
that the results of these controlled laboratory experiments suggest
that it is unlikely that the identification of a genetic determinant
for homosexuality or heterosexuality will be accomplished in the
future.
But there is more to be gleaned from Table 10-5 (see Chap
ter 10). Vertical perusal of the Failure Percentage columns lends
statistical support to another fact. There are no demonstrable phys
iologic differences between sexually experienced men and women
in facility to respond at orgasmic levels to masturbation, partner
manipulation, and fellatio/cunnilingus in a laboratory setting.
Time and again in this text and in Human Sexual Response
(1966), evidence has been presented of woman’s innate multi-
orgasmic capacity as opposed to man’s usual restriction to single
orgasmic experience. Now there is reliable evidence that in addi
tion to a significantly increased orgasmic capacity, sexually experi
enced women have a facility to attain orgasm equal to that of
sexually experienced men when responding to the same forms of
sexual stimulation under controlled laboratory conditions.
Table 10-4 (see Chapter 10) adds yet another dimension to this
presentation of facts, conclusions, and speculation. The new dimen
sion has been created from the results of over a decade of evalu
ating male and female functional efficiency during intercourse. In
simplified form, it can be stated that in just over three times in 100
episodes of intercourse in the laboratory men failed to reach or
gasmic release, and that the incidence of female failure to achieve
orgasmic release in similar circumstances was just under three times
in 100 opportunities. Over the 12 years of observation of coital
function in the laboratory, the research team has been amazed at
2o8 CHAPTER ELEVEN
the low incidence of sexually experienced men and women failing

to achieve orgasmic release during episodes of coital interaction in
the laboratory. Now the fact that there was such a minimal per
centile difference (0.50 percent) between the two genders in failure
of orgasmic attainment lends further credence to the Institute’s oft-
stated conclusion that men and women are incredibly similar, not
different, in facility to respond to effective sexual stimuli.
The safe conclusion can be drawn that, from a purely functional
point of view, woman has the physiologic potential to be a more
responsive sexual entity than man. These laboratory returns also
lead to the speculation that, in this country at least, man’s cul
turally established role as the sex expert, as the more facile sexual
responder, or as the more effective sexual performer will not be
supported much longer.
In short, we now know that when selected heterosexual and
homosexual study subjects interact sexually in the laboratory in
response to masturbation, partner manipulation, or fellatio/cunni-
lingus, there are no significant statistical differences in facility of
orgasmic attainment, regardless of the sexual preference or the
gender of the interacting study subjects. We also know that with
the same experienced heterosexual study subjects responding to
coital stimulation in the laboratory, there is no clinical difference
between men and women in facility to attain orgasmic release. It is
impossible to assess how important this information will prove to
be, particularly when considering its potential application to the
understanding and treatment of clinical problems of sexual dys
function. Since we simply have not had these facts at our disposal
prior to completion of these research programs, it will take clinical
trial to determine their true worth.
Yet another important fact can be gleaned from contemplation
of the figures in Tables 10-3 and 10-4 (see Chapter 10). Functional
failure rates for sexually experienced men and women during
coition in the laboratory were approximately four times higher than
the average functional failure rates experienced by the same men
and women when responding to the stimuli of masturbation, part
ner manipulation, and fellatio/cunnilingus. This fact leads to the
speculation that the coital functional failure rate may be higher
because two people are simultaneously involved in sexual interac
PRECLINICAL DISCUSSION
209
tion during coitus, as opposed to the individual alone (masturba

tion) or two persons usually alternating in the stimulatee/stimu-
lator roles (partner manipulation and fellatio/cunnilingus). It
would seem inevitable that two people, however sexually experi
enced, would have greater difficulty in responding effectively to the
mutual sexual stimulation of intercourse than would either indi
vidual when responding primarily to his or her own sexual interests
(masturbation, partner manipulation, fellatio/cunnilingus).
Immediate clinical application might be made of this heretofore
unpublished information. One might speculate that the additional
risk of functional failure apparently inherent in coition as opposed
to the other forms of sexual stimulation would make heterosexual
partners all the more eager to communicate freely and to leam all
that they can about the opposite gender’s facility in coital inter
action. For the more one knows of the opposite sex’s sexual anat
omy, sexual interests, sexual needs, and sexual facilities, the more
effectively he or she can function in sexual intercourse.
As described in Chapter 6, there was no statistical difference in
ability to respond at orgasmic levels between men and women in
committed relationships and those in assigned partnerships when
masturbation, partner manipulation, and fellatio/cunnilingus were
the stimulative techniques (Table 6-21, Chapter 6). During inter
course, however, the men and women in assigned relationships had
a slightly higher incidence of functional failure than those in com
mitted relationships (Table 6-22, Chapter 6).
When considering the functional efficiency of sexually experi
enced individuals responding to sexual stimuli in the laboratory, it
does not seem to make much difference whether the individual is
male or female, homosexual or heterosexual, committed to a sexual
partner or not. Although these facts may be hard to deal with from
a psychosocial point of view—for they certainly run against the
current of our cultural heritage—they are indeed facts. Again, to
draw untoward conclusions from these facts would be just as un
fortunate as to ignore them. The interpretation and application of
this material will certainly involve a multiplicity of disciplines in
the future.
Table 10-5 (see Chapter 10) reports the functional efficiency of
a small group of ambisexual male and female study subjects. It is
210 CHAPTER ELEVEN
obvious from the recorded statistics that when ambisexuals were in

their homosexual phases, they reacted to the same forms of sexual
stimulation with the same levels of physiologic effectiveness and
with the same types of subjective involvement as homosexual men
and women, and when in their heterosexual phases, their sexual
efficiency and subjective involvement paralleled that of hetero
sexual male and female study subjects.
This small group was not of sufficient numbers nor were enough
laboratory episodes observed for the returns to be statistically com
parable to the much larger homosexual and heterosexual research
populations. Yet, careful examination of the material reported in
Chapter 8 does add important clinical support to the concepts pre
viously discussed in this chapter, namely, that sexual preference
makes no difference in the sexual facility of experienced men and
women and that gender alone carries with it neither an increased
nor decreased potential for effective sexual response. Ambisexuality
by its very existence lends strong support to the concept of equality
in functional efficiency between the two sexual preference groups.
PSYCHOSEXUAL CONSIDERATIONS
In the laboratory specific psychosexual differences were identified

between the sexual behavior of committed male and female homo
sexual couples and that of married men and women (see Chapter 5).
There were even greater psychosexual differences identified between
the sexual interaction patterns of committed and assigned couples,
whether of homosexual or heterosexual orientation (see Chapters 4
and 5). But far more important than identification of these varia
tions in sexual behavior is the development of plausible explana
tions for the etiology of the differences.
When members of the four research populations, the homo
sexual study group, the heterosexual study groups (A and B), and
the ambisexual study group, were interacting in the laboratory,
there was every opportunity to observe sexual behavior. In addition
to unlimited opportunity for observation, there was equally exten
sive opportunity for discussion with and questioning of the coop
erative male and female study subjects before or after any partic
ular episode of sexual interaction. The material that follows in this

chapter reflects the research team’s selective filtration of informa
tion acquired from the study groups during extensive interview
opportunity. Rather than presenting this material in outline form
supported by a series of questions and answers or with a specific
disciplinary orientation, a free-flowing, reportorial style has been
selected. A separate publication is planned for the future to deal
in far greater depth with the subjectively oriented material acquired
from discussions held with representative members of the study
subject population during the years of laboratory investigation of
human sexual function.
Before moving further, the Institute’s use of the terms com
mitted and assigned warrants further consideration. The Institute’s
working definition of a committed homosexual couple is a couple
that has lived together for a year or more, and a committed hetero
sexual couple is indicated by the existence of a marriage license
(see Chapter 1). Obviously, these criteria of commitment are com
pletely inadequate, but they were the best available in 1957 when
the research began and, unfortunately, may still be the best avail
able today, for any word that presumes to describe a subjective
state of mind inevitably is inadequate. To be “committed” to some
one is, if possible, even more vague in delineation than to be “in
love” with someone. Since there are hundreds of levels of subjective
involvement that have been termed “love,” there may be an even
greater number of subjectively determined levels of interpersonal
identification verbalized as commitment.
There is difficulty with interpretation particularly when the term
“committed couple” is used in an attempt to define a subjectively
derived relationship involving two people. Perhaps it may relieve
the confusion a bit to state that beyond the working definition’s
basic criteria of a marriage license and a year’s coresidency, the
Institute’s long-held concept of a committed couple is a unit of two
people, whether of homosexual or heterosexual orientation, who
are reasonably familiar with each other’s individual personalities
and who, for reasons that they usually cannot define, have chosen
to share a life together in spite of such significant knowledge.
By Institute dictum, an “assigned couple” is composed of sex
ually responsive men and women formed into a transitory homo
212 CHAPTER ELEVEN
sexual, heterosexual, or ambisexual partnership by a process of

research-team selection. The men and women who functioned in
the assigned-couple category in the Institute’s research programs
had never met before being introduced in the laboratory.
VARIATIONS IN SEXUAL BEHAVIOR
When considering variations in sexual behavior between com

mitted homosexual couples and marital units, one can always fall
back on the concept of intragender empathy, usually verbalized by
the old cliché, “It takes one to know one.” This aphorism leaves
much to be desired as an explanation of the etiology of the varia
tions in sexual behavior patterning reported in Chapter 5. There is
even difficulty in assigning a specific role to the cliché, for it obvi
ously serves both as a widely accepted explanation for homosexual
preference and as a most effective homosexual recruiting slogan
for the sexually timid. (As a successful recruiting slogan directed
toward the sexually unsophisticated, “It takes one . . probably
ranks third behind “If you loved me, you would ...” and “How
do you know, if you haven’t tried?”) If accepted at face value, this
oft-employed recruiting slogan would discourage any attempt to
understand subjectively appreciated variations in sexual behavior.
Does the fact that in the laboratory there were observable varia
tions in sexual patterning between committed homosexual and
married couples warrant in-depth consideration? Probably, for there
are lessons to be learned through appreciation of the psychosexual
aspects of both lifestyles. Why did committed homosexual couples
generally become more involved subjectively in the sexual inter
action than married heterosexual couples? If this be true—and it
was—why was there no statistically significant difference in the
facility of orgasmic attainment between the two research popula
tions when responding to similar sexual stimuli (see Chapters 6
and 10)?
In order to provide acceptable answers to these questions, in
formation from years of observation of sexual interaction and
material from multiple study-subject interviews are blended with a
significant degree of research-team speculation in the remainder of
this chapter.
Homosexuals. Perhaps the key to the clinically apparent higher
213
level of subjective involvement of committed homosexual couples

in sexual interaction compared to that evidenced by married
couples was the observed tendency in homosexuals toward free
flow of both verbal and nonverbal communication between stimu
lator and stimulatee (see Chapter 5). Information relative to sexual
needs, levels of sexual involvement, what pleased or what dis
tracted was usually exchanged openly during sexual activity or dis
cussed without reservation after any specific sexual episode in
anticipation of future sexual opportunity.
What occasioned such an unusually high level of communicative
interchange between committed homosexual partners? Quite prob
ably: necessity. For inherent in committed homosexual relation
ships are immediate sexual advantages and long-range disadvan
tages. An immediate advantage is the previously mentioned factor
of intragender empathy. Men know quite specifically, merely by
subjective anticipation, what usually pleases men, and women are
indeed the only experts on the subjective appreciation of women’s
sexual feelings. Subjective involvement in the committed homo
sexual couple’s sexual interaction is usually maintained at highly
effective levels by this intragender empathy and by freedom to
identify individual sexual needs, distractions, pleasures, or anti
pathies.
The committed homosexual also has the immediate advantage
of security in sexual performance that is inherent in any sexual
relationship in which there is no built-in functional dependency
upon a partner. When totality of sexual interest can be focused
almost exclusively on self, as is inherently true in any “my tum-
your turn” pattern of sexual interaction, and when one’s own
sexual facility does not depend on more than a partner’s voluntary
cooperation (specifically not the partner’s sexual facility), there is
marked reduction in the incidence of fears of performance or indul
gence in spectator roles during sexual interaction. In a committed
homosexual relationship, each partner has the psychosexual free
dom to enjoy the couple’s overt sexual interplay for himself or her
self alone. Therefore, he or she is far more free to appreciate the
subjective aspects of the sexual interaction as an individual with
out the major distractions inherent in the heterosexual couple’s
culturally oriented assumption of responsibility for the partner’s
CHAPTER ELEVEN
214
degree of sexual involvement. This cultural concept of responsi

bility for the partner is, of course, particularly apparent during
coition.
But there are long-range disadvantages inherent in the basic
stimulative techniques available to homosexual men and women—
partner manipulation and fellatio/cunnilingus. Although there are
also the two pseudocoital techniques of rectal intercourse and dildo
usage, plus occasions of mutual masturbation, these were regularly
employed by only a minority of the committed homosexuals
who volunteered as study subjects. Therefore this brings the dis
cussion back to the previously expressed point: necessity. Since
there are only two widely popular stimulative approaches employed
by interacting committed homosexuals, these techniques of neces
sity must be constantly varied and refined to the utmost to avoid
the loss of stimulative effectiveness through long-continued famil
iarity.
The inherent disadvantage of these stimulative approaches is
that they are fundamentally my tum-your turn interactions, as
opposed to the “our turn” potential of coitus. While the my tum-
your turn approach is obviously a satisfactory means of accomplish
ing sexual release, the partners’ preorgasmic levels of sexual tension
and their orgasmic episodes are usually experienced separately,
not as an immediate return from mutual stimulation as supplied
during coition.
When elevated levels of sexual stimulation are mutually experi
enced rather than individually enjoyed, there is potentially a
broader dimension of sexual arousal than is available to individuals
with a pattern of responding in the relatively restrictive stimulatee
or stimulator roles. Of course, there are many sources of sex-tension
increment, but when partners become mutually involved sexually,
these sources tend to resolve into three major facets of sexual
stimulation. First, it is sexually stimulating for individual A when
he or she approaches the partner’s body physically. When the
partner simultaneously moves to stimulate A’s body, A indeed has
developed a second source of physical pleasure. Finally, if A’s
partner reaches high levels of sexual tension during their mutual
sex play and effectively communicates this degree of sexual in
volvement to A, either verbally or nonverbally, there is a third
215
source of sex-tension increment that is subjectively appreciated by A.

A becomes increasingly involved sexually by identifying subjectively
with his or her partner’s elevated levels of sexual involvement.
When partner manipulation and fellatio or cunnilingus were
employed as the selected methods of sexual release by homosexual
and heterosexual couples reacting in the laboratory, opportunities
for sexual arousal after preliminary erotic approaches usually were
restricted to two of the three major facets of sex-tension increment,
because the mutuality of simultaneously giving and receiving
physical stimulation was generally held to a minimum. When an
individual is acting essentially in a stimulator role in a my tum-
your turn situation, the stimulator enjoys the sensual return from
approaching his or her partner’s total body and has the simultaneous
opportunity of subjectively appreciating his or her partner’s sexual
arousal, if present. Lacking for the stimulator, however, is the third
source of sex-tension increment, which would be present if his or
her erogenous areas were simultaneously being manipulated by the
stimulatee.
If sexual partners had consistently employed mutually stimu
lative approaches when using manual or oral techniques in the
laboratory, the three major sources of sex-tension increment would
have been present.
How does this discussion of the multiple aspects of stimulative
involvement explain the fact that there generally was an even
greater difference in subjective involvement evident in sexual inter
change between committed and assigned homosexual couples than
between committed homosexual and married couples? It does not,
of course, for both committed and assigned homosexual couples
have the same long-range handicap of inherent restriction in the
variety of basic stimulative techniques, and both usually employed
the my turn-your turn stimulative approaches in the laboratory.
But committed as opposed to assigned homosexual couples usu
ally made every effort to get the most from their technically re
strictive opportunities at sexual interchange. Originality of sexual
approach and subjective appreciation of the partner’s pleasure
quotient, together with the highest level of verbal and nonverbal
communication of any of the study groups, tended to enhance the
sensuous aspects of the committed homosexual relationship and
216 CHAPTER ELEVEN
therefore to neutralize the long-range disadvantage of channelized

stimulative opportunity.
Comparably, a number of the homosexual men and women who
functioned as assigned partners took the easy-and-popular way out
of this persistent dilemma of channelized stimulative techniques.
The assigned subjects made little attempt to establish communica
tion in order to enhance the sensuous aspects of their transitory
sexual relationships. Instead, they consistently moved to neutralize
the long-range disadvantage of the restrictive number of basic stim
ulative techniques by adding to their subjective appreciation of the
sexual interaction the zestful “seasoning” of regularly recruited new
partners. It was their position that, if need be, or if the mood struck,
there could be a different seasoning for every sexual encounter. It
seemed to them that little or no effort need be expended on the art
of communication or in establishing and maintaining a relation
ship, as long as new recruits were in unlimited supply.
The concept of maintaining high levels of subjective sexual in
volvement by constantly changing partners works well, particularly
when the man or woman devoted to this lifestyle is relatively young
and acceptably attractive. But this circle of freedom constricts when
one grows older, or unfortunately, is no longer physically or socially
attractive enough to acquire new partners with satisfactory regu
larity. Then the casual homosexual devoted to a “cruising” lifestyle
is in difficulty. He or she usually reacts to reduction in physical at
tractiveness in a self-protective manner by attempting to establish
a committed relationship. If for any reason there is not a seemingly
inexhaustible supply of new partners available, the uncommitted
homosexual may be forced to make some restriction in his or her
heretofore highly valued, independent lifestyle in order to establish
and support a committed relationship, which—when there is ade
quate motivation—can provide sufficient variety to stimulate lag
ging sexual interest or facility.
Of course, the problem is not as simplistic as this limited discus
sion would suggest. But in the laboratory the basic differences be
tween committed and assigned homosexual couples in subjective
appreciation of sexual interchange existed as described, and as in
telligent men and women they discussed openly the advantages of
their sexual preference and its inherent disadvantages. They also
discoursed at length on the importance of committed relationships

or the lack of them. This discussion drew heavily for source mate
rial from these freely communicative interchanges.
From the aspect of facility in orgasmic attainment, there was
little to choose between the committed and assigned homosexual
groups as they interacted in the laboratory (see Chapters 6 and 10).
But frequently during in-depth discussions with the study subjects,
an assigned homosexual partner’s fears for the future emerged. He
or she usually openly admitted that the motivation behind his or
her cruising propensities was the continuing requirement for new
partners to serve as a vital aphrodisiac to his or her sexual satis
faction.
Of course, committed homosexual and married couples also re
ported “other partner” opportunities. The concept of supplement
ing the established partner by a transitory “new face” as a reliable
source of maintaining sexual interest and sexual facility is hardly
new for men or women of any sexual persuasion. There were major
attitudinal differences verbalized for the role or value of the new
face. For the members of committed heterosexual and homosexual
couples, new faces usually were “sometime things” in their sexual
value systems. For the men and women constituting assigned ho
mosexual and heterosexual couples, the need for new faces was a
way of life.
Heterosexuals. A discussion of the subjective aspects of com
mitted heterosexual couples’ sexual interaction should add com
parative dimensions to perspectives of homosexuality. As was true
for the homosexual study population, there are immediate technical
advantages and long-range disadvantages to sexual interaction be
tween heterosexual men and women. Heterosexual couples can use
any combination of the popular techniques of partner manipulation,
fellatio/cunnilingus, and intercourse as well as the less frequently
experienced rectal intercourse, dildo usage, or mutual masturba
tion. Therefore variation in stimulative approaches is potentially
greater than that available to homosexual couples, and in theory,
at least, the heterosexually oriented man or woman has greater op
portunity for subjective pleasure derived from the free, inventive
interchange of sexual techniques. Of course, in order to achieve this
freedom of sexual expression, he and she must deny both theological
218 CHAPTER ELEVEN
and cultural concepts that coitus is the only acceptable form of end
point release during sexual interaction. For example, as long as ma
nipulation of partner or fellatio/cunnilingus are considered only as
means to an end sexually rather than as potential ends in them
selves, the heterosexual’s inherent advantage in multiplicity of sexu
ally stimulative techniques is severely reduced and the immediate
technical advantage in committed heterosexual interaction as op
posed to committed homosexual activity is neutralized.
Then the long-range disadvantages inherent in intergender inter
action make themselves felt. Committed heterosexual partners in
evitably encounter difficulties when they attempt intergender inter
pretation of sexual expression. There is an immediate sense of
frustration that eventually may turn to trauma when men presume
to understand the subjective aspects of female sexuality or when
women become convinced that they are “experts on men’s sexu
ality.” Men simply have no frame of reference from which to ap
preciate the subjective aspects of women’s orgasmic experience, any
more than women have the slightest concept of what it feels like to
ejaculate.
As previously suggested, this relatively inviolable barrier to sub
jective appreciation of the opposite gender’s sexual feelings should
inspire committed men and women to attempt to educate each
other in the intricacies of intergender interpretation. Obviously, this
process of mutual sex education can best be accomplished by iden
tifying pleasurable or distracting sexual approaches or by occasion
ally discussing at some length after sexual encounters how each
partner feels or has felt during the activity. In short, the abysmal
lack of knowledge of men by women and of women by men should
constantly stimulate communicative interchange, particularly if the
men and women are partners in a committed relationship. Yet, this
pattern of communicative interchange was notably present in com
mitted homosexual, not heterosexual relationships, even though the
homosexual partners already had the immediate advantage of intra
gender empathy.
Free communicative flow was only occasionally evidenced by
committed heterosexual couples, even though these men and
women repeatedly identified the necessity for such communicative
interchange during casual discussions with the research team. For a
219
few committed heterosexual couples this vital exchange of informa

tion did take place in the laboratory, but between the great major
ity of married partners there was little voluntary exchange of psycho-
sexual material. As the direct result of this communicative vacuum
in material of sexual content, the cliché “It takes one to know one”
stands unchallenged, and the married couple’s inherent sexual ad
vantage over the committed homosexual couple in diversity of sexu
ally stimulative approaches is more than neutralized in two ways:
first, by the concept that intercourse is the only acceptable end
point of sexual interchange, and second, by persistent neglect of
the vital communicative exchange of letting one’s partner know
what pleases, what distracts, what might be enjoyable, and what is
not acceptable.
In other words, the committed heterosexual couple is handi
capped sexually, first by theological and cultural covenant, and—a
far more important second—by a potentially self-destructive lack of
intellectual curiosity about the partner.
There was full agreement in open discussion with committed het
erosexual men and women that the third most frequent long-range
sexual disadvantage married couples face arises from the cultural
concept that man should function in the role of sex expert. In view
of the material already presented in this chapter, it is indeed for
tunate that this particular cultural influence is waning rapidly. It
simply cannot be destroyed fast enough, for adherence to the con
cept of inherent male expertise in matters sexual is an anathema to
effective heterosexual interaction.
Man in his culturally assigned expert’s role is presumed to know
or, more likely, presumes that he knows what pleases his partner
sexually. He does not ask, listen, or anticipate suggestion or direc
tion from her, he just acts. And woman, equally exposed to the
same unfortunate cultural concept of man’s sexual expertise, does
not inform, direct, or suggest, she usually just endures. For, she
reasons, “He should know; he’s the expert,” and if his approach
leaves something to be desired, she simply assumes that he doesn’t
care. So neither heterosexual partner enjoys the subjectively experi
enced sexual pleasure that is his or her right, regardless of whether
there is regularity of orgasmic attainment. But that is not all.
As a corollary to the “male-is-the-sex-expert ” myth, the culture
220 CHAPTER ELEVEN
is also responsible for another long-range disadvantage that has con

sistently been evidenced by heterosexual couples interacting sexually
in the laboratory. And this disadvantage has been aimed at the
heart of heterosexual interchange: intercourse.
Intercourse becomes only a means of sexual service, or even just
a sexual contest, instead of one of the better means of communica
tion between committed heterosexual couples when, responding to
cultural influence, the man exerts his “expert’s role” by arbitrarily
setting the pace during coital interaction.
As described in Chapter 5, the man initiates the mounting pro
cess when he is ready, presuming that if his partner is lubricated,
she is ready. Usually he hunts for, finds the vaginal outlet, and in
serts the penis; yet, the woman could have accomplished the inser
tion with greater facility, for she certainly would not have had to
hunt and find. He selects coital positioning, usually without con
sultation as to his partner’s preference, and she almost always defers
to his decision. He predominantly sets the thrusting pattern and
presumes that she will respond and will be pleased. And usually she
makes every effort to cooperate with his thrusting pattern whether
she is pleased or not.
One wonders by what divine gift of providence the human male
is endowed with such infinite knowledge of woman’s sexual anat
omy and sexual needs. When reflecting on the degree of male domi
nance in coital interaction, we have a better understanding of the
many pitfalls that the culture has placed in the way of an enduring
heterosexual partnership for unsuspecting men and women. The re
search team has consistently been amazed at how little thought
even the most experienced sexual performer gives to the subject of
coital interaction and, as a result, how little heterosexual men and
women know of the subject of sexual interaction. The major con
cern is not how much sexual pleasure committed heterosexual part
ners miss in their ignorance, but how severely they handicap and
even destroy the potential of one of their better means of com
munication.
Having to contend with so many cultural pressures, it would
seem that the average married couple would follow the behavioral
pattern set by committed homosexual couples of neutralizing their
inherent psychosexual disadvantages by improving communication
of sexual information, laughing at mistakes, and educating each

other by making pertinent suggestions—yet so few do. The few
married couples who did communicate freely in the laboratory in
order to enhance their sexual pleasure gave every evidence of being
as fully involved subjectively in their mutually stimulative sexual
interaction as any committed, freely communicative homosexual
Members of assigned heterosexual couples, the least involved sub

jectively of the committed and assigned homosexual and hetero
sexual study groups in sexual interaction, routinely substituted the
“grass is greener” concept of a multiplicity of new partners as an
effective source of sexual stimulation—at least this was the tenor
of their answers to interviews with the research team. The assigned
heterosexual couples suffered in comparison with the assigned ho
mosexual couples in two regards: (1) While the men and women in
assigned homosexual couples usually freely communicated their im
mediate sexual needs and responses (predominantly in a nonverbal
manner), there was little similar communicative exchange between
the members of assigned heterosexual couples, and (2) the imme
diate advantage of intragender empathy was, of course, absent for
the heterosexual couples.
The men and women who formed assigned heterosexual couples
had the common ground of elevated sexual tensions amplified both
by the stimulation of an unusual environment and of a new part
ner, and they responded with the expected surge of sexual tension
and urge for orgasmic release. Theirs was essentially an exercise in
mutual mechanical service. There simply was no verbal and little
nonverbal communicative dimension to their sexual interaction.
From the point of view of end-point release, they were most suc
cessful—yet, they missed so much, and most of the men and women
were unaware of the loss.
Ambisexuals. The ambisexual study group should be considered
briefly, although a more detailed report of the psychosexual aspects
of ambisexuality is presented in Chapter 8. As previously discussed
for homosexual and heterosexual orientations, there are also imme
diate sexual advantages and long-term disadvantages inherent in
the ambisexual lifestyle.
The ambisexual has an immediate sexual advantage in that he
222 CHAPTER ELEVEN
or she is totally without sexual preference. While this orientation

has an unarguable advantage when it comes to partner availability,
the theoretical advantage of having everybody as a potential sexual
partner is actually of minor moment to the ambisexual. Of far more
importance is the great advantage that accrues from his or her pref
erential nihilism. The ambisexual enjoys a unique vantage point in
social interaction that homosexual or heterosexual men or women
rarely if ever attain. For as an immediate corollary to the absence
of sexual preference, the true ambisexual inevitably is without any
significant level of sexual prejudice. And any individual who can live
in today’s society without the handicap of sexual prejudice is indeed
privileged, for sexual prejudice is a cornerstone that supports any
number of other social biases. Certainly the most bemusing return
from interviews with the 12 ambisexuals (see Chapter 8) was the
development of reasonably secure evidence of an almost complete
absence of sexual prejudice and a startlingly low level of personal
bias. It is no wonder that the true ambisexual is rarely encountered
in today’s society.
The immediate sexual advantage that the lack of sexual prejudice
and accompanying low levels of personal bias provides the ambi
sexual is that it turns many potential partners into available part
ners. The ambisexual seems to embody a tremendous sexual appeal
that springs not only from unrestricted confidence in sexual perfor
mance but also from freedom to express sexual interest without
prejudice or bias that might neutralize the appeal.
The ambisexual has the immediate, short-term advantage of two
major sources of sexual stimulation. First, merely because he or she
is ambisexual, there is the potential of an almost infinite variety of
sexually stimulative activity as compared with inherent preference
limitations of men and women with restrictive homosexual or het
erosexual orientation. Second, the ambisexual relies even more than
the uncommitted heterosexual or homosexual man or woman on
the constantly revolving door of new-partner rotation as a continu
ing source of sexual pleasure. As has been described, the unceasing
parade of new faces and bodies is a well-established sexual stimu
lant, but only up to a point. Beyond that point, the ambisexual’s
long-range sexual disadvantage rears its head. For even with con
stant partner rotation, there can, in time, come sexual boredom,
when a new face is just a new face.
223
The ambisexual’s life is not without thorns. As a long-term psy

chosocial disadvantage, he or she is essentially alone in a crowd. Al
though the ambisexuals evaluated during the research program had
relatively extrovertive personalities, they gave no history of interest
in identifying with a partner. Ambisexuals apparently do not de
velop a common ground for continuing psychosocial interchange
with any man or woman, for they either do not have the facility
for it or do not feel the need to establish a continuing relationship.
Their effectiveness in sexual performance as judged by facility in
orgasmic attainment was fully equal to that of sexually effective
homosexual and heterosexual study subjects (see Chapter 10). But
without the aptitude for or interest in subjective identification with
other personalities, the ambisexual man or woman is almost uni
dimensional in sexual behavior. He or she obtains satisfaction only
from goal attainment and has little or no appreciation of the part
ner’s involvement in the sexual interaction.
The ambisexual’s firmly established pattern of sexual behavior is
an initial identification of mutual sexual attraction with a potential
partner; then a well-rehearsed move to sexual interaction resulting
in an explosive experience of tension release; and then on to an
other partner. There is essentially no communicative dimension to
the ambisexual’s sexual experiences. The sexual experience is simply
one of mutual service.
Obviously, the ambisexual’s long-range disadvantage is the almost
total lack of psychosexual identification with any partner. Ulti
mately this “man-is-an-island” philosophy creates a lifestyle of so
cial isolation, which the older ambisexual study subjects described
during interviews as “too much,” “overwhelming,” and “depress
ing.”
As emphasized in Chapter 8, what the future holds for the ambi
sexual men and women as they age is unknown, for there has been
no research. Whether they continue in the same vein of personal
isolation or forsake their ambisexual orientation for a continuing
relationship (following the frequently recurrent behavior pattern of
unattached, aging homosexual males or females) remains to be
seen. After in-depth interviews with ambisexual study subjects, the
research team would be surprised if “aloneness” did not become
an intolerable burden and in time the die was not cast for com
panionship.
224 CHAPTER ELEVEN
COMFORT FACTOR IN THE LABORATORY
Significant variations in comfort levels were evidenced during

sexual interaction in the laboratory when men and women with
homosexual preference were compared to those with heterosexual
orientation. There were a number of homosexuals who sought ori
entation opportunity and heterosexuals who requested masturba-
tional privacy. However, there was a significantly higher percentage
of homosexual study subjects who requested privacy * when mas
turbating in the laboratory than was true for members of the het
erosexual study groups, and on the other hand, a much higher
percentage of heterosexuals than homosexuals who requested op
portunity to orient themselves to the laboratory environment before
cooperating actively with the research programs.
There are no ready explanations for these observations of variant
behavior in the laboratory reflecting study-subject privacy needs or
area orientation requirements. Why should the homosexual be
more concerned with privacy during masturbation and the hetero
sexual more anxious about facility to function effectively in a lab
oratory environment? Interrogation of the men and women who
requested the special privileges of privacy or laboratory orientation
was not particularly productive in determining the etiologic factors
responsible for these variations of psychosexual behavior.
However, a leading suggestion was returned from interrogation
of two homosexual men. Both stated that they enjoyed self
manipulation a great deal more when it was done in mutual ac
cord with a partner. To masturbate individually seemed to them to
be a questionably acceptable practice, even though they thoroughly
enjoyed the act when there was simultaneous partner participation.
A request to masturbate without the partner simultaneously en
gaging in similar action created a sense of discomfort. Feeling pres
sured by the research team’s request that they masturbate on an
individual basis and believing that their potential pleasure quotient
was being reduced by the request or that the partner might feel
“left out,” they became somewhat anxious and asked for the privi
lege of masturbating in private.
* The privilege of privacy as defined solely for the Institute’s investigative pro
grams means the exclusion from the laboratory of one’s sexual partner and any other
individuals aside from research team members (see Chapters 4 and 5).
PRECLINICAI DISCUSSION 225
In contrast, heterosexual study subjects reported engaging in

simultaneous masturbation with their partners far less frequently
than the homosexual research population. Thus, when scheduling
individual rather than mutual masturbational activity, the research
team obviously requested more alteration in sexual behavior pat
terning for homosexual than for heterosexual study subjects. This
alteration in behavior pattern may have been a factor in the in
creased anxiety on the part of some homosexual men masturbating
as individuals rather than with their partners, but it certainly was
not the complete explanation.
Any factor that increases levels of performance anxiety can be
detrimental to effective sexual interaction, and no one would deny
the fact that contemplating sexual interaction in the laboratory
tends to increase performance pressures. Heterosexual study subjects
demonstrated an increased need for orientation opportunity as com
pared with members of the homosexual study group. Regardless of
degree of sexual experience, heterosexual men and women have con
sistently evidenced a far higher level of concern or even anxiety for
effectiveness of sexual performance in the laboratory than have ho
mosexuals (see Chapters 4 and 5). As will be described and dis
cussed in the clinical section of this text (see Chapters 15 and 16),
there have been a number of instances when multidimensional fears
for sexual performance have moved men and women from anxious
heterosexual into confident homosexual orientations. When the in
dividual is immersed in pressures to perform sexually, interaction
between the two genders obviously has higher possibility of func
tional failure than intragender sexual interchange.
Responding to interrogation, committed heterosexual men and
women frequently admitted that they were anxious not only about
their own performances but about those of their partners. Expressed
concerns for the partner’s sexual performance were uniquely hetero
sexual in origin. If present, this specific type of performance fear
was never verbalized by a homosexual study subject. Thus, the more
frequent requests by heterosexual study subjects for orientation op
portunities before interacting sexually under observation became
more comprehensible. Both heterosexual partners gained perfor
mance courage through quiet, unobserved opportunities at sexual
interaction in the laboratory before participating actively in re
226 CHAPTER ELEVEN
search programs. In short, being allowed to set their own pace in

acclimatization to the laboratory environment greatly increased the
comfort factor for many heterosexual study subjects, not only in re
lation to their own sexual function, but to that of their partners.
There was an additional advantage that the increased incidence
of orientation opportunity provided the heterosexual study group.
Those heterosexual men and women who requested orientation op
portunity went through their acclimatization process before mas
turbating openly in a laboratory setting. Since the homosexual study
subjects requested less orientation opportunity, they placed them
selves in the bind of an immediate performance demand. Some of
the homosexuals’ increased incidence of requested masturbational
privacy may have been in response to a need for orientation oppor
tunity, which they had not recognized subjectively or refused to
admit consciously.
As anticipated, the 12 ambisexual study subjects requested nei
ther orientation opportunity nor masturbational privacy during
their episodes of cooperation with the Institute’s research pro
grams; nor did they demonstrate clinically any need for such special
handling.
In any event, the research team can only speculate as to the
etiologic factors in the sexual behavior variance evidenced by mem
bers of the two major sexual preference study groups when first ex
posed to demand for sexual functioning in the laboratory.
CONCLUSIONS TO BE DRAWN
When speculating on possible clinical applications of the textual

material, what reasonably secure conclusions can be drawn from
the facts assembled? The central thesis developed from this research
program is that no real difference exists between homosexual men
and women and heterosexual men and women in their physiologic
capacity to respond to similar sexual stimuli. In other words, there
is no basis in physical fact for the oft-repeated dictum, “My way is
better than your way.” It is reasonable to speculate that, when ab
sorbed, this finding should lead to significant modification in cur
rent cultural concepts.
Now that it has been established that homosexual men and

women are not physiologically different, it is also reasonable to
speculate that in the near future, a significant measure of the cur
rent onus of public opprobrium will be eased from the men and
women with homosexual preference. Of course, there will continue
to be adjustment problems for homosexuals as cultural concepts
alter. Homosexual men and women must gather the social courage
to move quietly away from the bulwarked position of “preference
denial” to which they have been driven by cultural condemna
tion; at the same time, however, they must not make the mistake
of overreacting to the newly developing opportunities for social ac
ceptance. Psychosocial prejudice does not alter overnight.
Of equal importance to the foreseeable increased acceptance of
homosexuality is the fact that the potential of woman’s physiologic
sexual capacity will have to be acknowledged, accepted, and ad
justed to by both men and women in our culture. From a specula
tive point of view, this leaves the heterosexual male in the pressured
circumstance of having to undergo a major cultural alteration from
a psychosexual point of view. Whether he adjusts well or cannot
withstand the ego shock of role alteration will be a fascinating scene
to observe. If the heterosexual male accepts the basic physiologic
fact that he does not have the physical potential to ejaculate as
often as his female partner can be orgasmic, if he realizes that he
need only establish ejaculatory control or, with required frequency,
provide his partner with other means of sexual release, he will ad
just well. If he clings to the male dominance role in sexual inter
change, insisting on maintaining control of male-female sexual in
teraction by presuming he understands his female partner’s sexual
needs and goals, he probably will be in difficulty. The male in our
culture has the most to gain both physiologically and psychosexually
as a full sexual partner. He no longer has a future as the “sex
expert.”
Woman also has a major psychosexual adjustment to make. If
she interprets her potential capacity for multiorgasmic attainment
as a psychosocial advantage rather than as a simple physiologic fact,
she may nullify any possibility of an effective psychosexual partner
ship with the man of her choice. Nor should her physiologic ca
pacity become an effective recruiting argument for lesbianism. It is
228 CHAPTER ELEVEN
primarily the male population, in its refusal to assume a sexual

partnership role and to acknowledge woman’s inherently high level
of sexual capacity, that will provide significant social argument for
lesbian commitment.
There is one more important lesson to be learned from this re
port of laboratory observations of human sexual function. The
teachers of this lesson are the men and women who had episodes of
sexual failure in the laboratory. How did they handle these failures?
With one exception (the man and wife who became quite anx
ious when he had an episode of ejaculatory incompetence), the
sexually experienced men and women who failed to function effec
tively did not become anxious or fearful. They reacted positively,
offering an explanation if there was a legitimate one, or they simply
smiled and said, “Let’s try again another time.” They did not auto
matically anticipate future sexual difficulty on the basis of a specific
episode of functional failure. In short, the sexually experienced
study subjects treated sexual function as a natural function that at
times fails to respond in a fully satisfactory manner, as do all other
natural functions. The study subjects treated their episodes of sex
ual failure without fanfare, and although several subjects experi
enced more than one episode of failure in the laboratory, none of
these individuals ever reported any residual sexual dysfunction in
their private lives.
The lesson is a basic one. Episodes of sexual dysfunction can and
do occur at any time for anybody. If they could be treated casually,
if they could be discussed quietly, and if the partners could smile
and say, “Let’s try again another time,” the incidence of male and
female sexual dysfunction in this culture would be markedly
reduced.
REACTION TO PUBLIC OPPROBRIUM
Brief consideration must also be given to the ever-present prob

lem faced by the homosexual community, namely, anticipating and
responding to the varying levels of social opprobrium initiated by
religious conviction and maintained by legislative dictum and the
personal discomfort of the critics. Interestingly, the degree of pub
licly expressed social antipathy toward homosexuality probably varies

in intensity on a reasonably well-delineated geographic basis. Multi
faceted aspects of this subject were discussed in depth with most of
the homosexual study subjects.
The majority of committed homosexual couples who participated
in the research program came from major metropolitan areas out
side the St. Louis area (see Chapter 2). When the homosexual
research population was queried privately as individual men and
women independent of their committed or assigned partners about
the social pressures they had encountered or were facing, presumably
as a result of the lifestyle they were living, the tenor of their answers
was geographically oriented. As expected, there was generally less
concern for social ostracism or job security expressed by homosex
uals living in larger cities than by those from smaller communities.
A more important factor than population concentration must be
taken into account, however. There was a much higher incidence of
fear of identification reported by homosexual study subjects who
lived in metropolitan areas in what might fairly be termed politi
cally and religiously conservative sections of the country than was
verbalized by the research subjects who lived in cities of comparable
size located in currently more liberal areas of the country.
An example of this geographic influence on comfort with public
expression of homosexual preference was provided by those study
subjects living academically oriented lives. Regardless of size or
prestige of the academic institution, if the college or university was
located in a conservative area, not a single homosexual man or
woman had publicly identified his or her sexual preference. When
the academic institution was located in a more liberal section of the
country, approximately half of the couples had publicly acknowl
edged their committed homosexual relationship. Most of these
couples were, of course, from larger metropolitan areas. None of
the couples in the academically oriented group were from a sec
ondary school environment, where increased social and professional
pressures inevitably would have been encountered if a homosexual
relationship had been acknowledged.
From a psychosocial point of view, it is evident that pressures aris
ing from threatened or real societal rejection frequently strengthen
the bonds of a committed homosexual relationship when the indi
CHAPTER ELEVEN
23°
vidual members are relatively well-educated, intelligent men and

women. Regardless of geographic placement or prior public state
ment of sexual preference, committed partners repeatedly described
the strength of their relationship as their “port-in-the-storm” re
treat from social pressures. When interviewed individually and in
similar depth, no married man or woman ever expressed a similar
level of need for personal security that he or she anticipated might
be derived from their ongoing partnership.
One can speculate that the uniquely high levels of communica
tive interchange previously described in Chapter 5 as characteristic
of the committed homosexual couple may be an inevitable result of
the partners’ mutual effort to build their relationship into a strong
social bulwark. The research team has no other ready explanation
for the consistently effective communicative interchange that was
evidenced by committed homosexual partners and—with but a few
outstanding exceptions—was comparatively absent in the married
couples who cooperated with the Institute.
Thus, social opprobrium can even be a long-term sexual advan
tage to the committed homosexual in that it tends to make the
partners place particular value upon the established relationship.
When such value in a relationship is expressed by both partners,
freedom of communication is inevitably enhanced. The couple usu
ally reflects this high level of communicative interchange achieved
outside the bedroom by elevated subjective involvement in sexual
interaction in the bedroom. At least such was true for the committed
homosexual study subjects, as they reported a mutual dependency
on their relationship and reacted to their partners’ sexual approaches
subjectively as well as physiologically in the laboratory.
Obviously, the unattached homosexual, with his or her increased
cruising tendency, has a higher chance of encountering social
trauma and, of course, legal difficulty. Again, the incidence of pub
lic retribution depends primarily on the geographic area in which
the homosexual lives and on whether the area is politically and re
ligiously conservative. Since the unattached homosexual usually
takes more chances with public identification than does the com
mitted homosexual, and since the unattached homosexual’s posi
tion not infrequently is one of defying rather than living with
prejudice, his or her life usually runs a more stormy course.
PRECLIN ICAL DISCUSSION jgi
The preclinical section of this text has been written in an effort

to present the essence of the years of laboratory evaluation of hu
man sexual function. Amplification of various aspects of this mate
rial will come from future publications. The baseline information
has been presented for one overriding purpose: to provide com
parative dimensions of human sexual function so that secure per
spectives on homosexuality can be developed.
CLINICAL STUDY,
1968-1977
I X
CLINICAL
INVESTIGATION
W hen the program for continuing investigation of human sexual

response was established in 1954, the first step taken was adoption
of a research protocol that called for basic science evaluation of
male and female sexual function as exemplified by experienced het
erosexual partners responding to effective sexual stimuli in a labora
tory setting. It was anticipated that theretofore unknown data re
turned from that phase of the overall research program would be
valuable in the development of more effective techniques for the
clinical treatment of heterosexual dysfunctions.
A report of the basic science investigation of heterosexual func
tion was made to the health-care professions in 1966 with the pub
lication of Human Sexual Response. Once basic science research
productivity had been generated, the second step in the investiga
tive process was the creation of a 10-year clinical control period for
evaluation of the Institute’s newly developed techniques for treat
ment of heterosexual inadequacies. This control period terminated
in 1968, and returns from the clinical treatment programs were re
ported in 1970 in Human Sexual Inadequacy.
The homosexual phase of the open-ended investigation of human
sexual response began in 1964 with the Institute attempting to re
spond to the overwhelming cultural and scientific need for an ob
jective investigation of homosexual function. The same protocol of
basic science precedence to new clinical treatment constructs was
employed. The research program was initiated with an evaluation
of physiologic response patterns demonstrated by sexually experi
enced homosexual men and women responding to effective sexual
stimuli in a laboratory setting. This evaluation of homosexual func
235
CHAPTER TWELVE
236
tion was completed in 1968 after almost five years of laboratory

involvement.
The 10-year period of clinical control for creating and evaluating
treatment techniques for homosexual dysfunctions and dissatisfac
tions began in 1968 and was terminated in 1977. With this textual
presentation, the Institute reports to the health-care professions
both the basic science investigations of homosexual function and
the new clinical programs designed to treat sexual inadequacies of
homosexual orientation.
Although the original investigations of physiologic response to
heterosexually and homosexually oriented sexual stimuli were com
pleted over a decade ago, the new clinical treatment techniques,
which were originated in 1959 (heterosexual) and 1968 (homosex
ual) and were directed toward relief of sexual dysfunctions and dis
satisfactions, will be continued indefinitely.
In the future, as the Institute’s therapy concepts alter, treatment
techniques improve, and educational and training facilities expand,
pertinent information gleaned from the experiential maturity of
these clinical research programs will regularly be made available to
the health-care professions.
DEFINITIONS
When the Institute’s clinical therapy programs were expanded to

include treatment of homosexual dysfunction, it was soon evident
that the definitions of impotence and anorgasmie states previously
established for the heterosexual phase of the clinical research pro
gram were not always applicable to dysfunctional homosexual men
and women. As discussed later in this chapter, the ability to mas
turbate effectively has been employed in defining male potency or
female orgasmic status in homosexuals as a replacement for defini
tions based upon coitus. The ability to masturbate effectively was
not used as a criterion to define sexual dysfunction in heterosexuals.
The rationale behind this specific difference is that both mutual
masturbation and partner manipulation are frequently encoun
tered—indeed, almost universal—patterns of male and female ho
mosexual interaction. In contrast, these techniques are less fre
quently employed in heterosexual interaction for specifically directed
end-point release.
CLINICAL INVESTIGATION
237
The act of vaginal penetration so uniquely involved in the defi

nitions of heterosexually oriented male impotence and female coital
anorgasmia is clearly not an integral part of homosexual interaction.
It is also apparent that since rectal intercourse is not a consistently
utilized form of male homosexual interaction, facility in rectal pene
tration could not be considered a vital factor in arriving at a defini
tion of homosexual impotence.
Thus, an important difference in sexual potency between hetero
sexually and homosexually oriented men is that the homosexual
male has no absolute requirement for attaining or maintaining an
erection of sufficient quality for accomplishing a penetrative act.
(Though admittedly a penetrative act, fellatio creates only minor
nomenclature confusion because the male does not need even a
partial erection for oral penetration.)
Similarly, since it is also apparent that rectal and vaginal penetra
tion are not regularly recurrent sexual techniques employed by
lesbians, these penetrative acts have not been considered in defin
ing lesbian anorgasmic states.
It was decided that the most commonly used forms of homo
sexual interaction would be used as a composite measuring device,
just as was done when establishing definitions for heterosexually
oriented dysfunctions a decade previously. Thus, male and female
homosexual function would be measured by the individual’s facility
to respond to masturbation, partner manipulation, and fellatio/
cunnilingus. Further, once a male or female homosexual was found
to be impotent or anorgasmic through his or her lack of effective
response to these stimulative techniques, impotency was labeled as
primary, secondary, or situational and anorgasmia as primary, situa
tional, or random. It was anticipated that if these specific defini
tions could be established, the research team initially and, later, the
health-care professions would have a common language with which
to identify and discuss homosexual dysfunctions or dissatisfactions.
A primarily impotent homosexual male has been defined as a
man who has never been able to respond by attaining and main
taining full erection with any of the techniques of masturbation,
partner manipulation, or fellatio. A diagnosis of secondary impo
tence reflects a homosexual man who in the past has been able to
respond effectively with all three stimulative techniques, but cur
CHAPTER TWELVE
238
rently is losing or has completely lost his erective security. A situa-

tionally impotent homosexual has been defined as a man who has
responded at least once by attaining and maintaining a full erec
tion in response to one or two of the three stimulative techniques,
but who has no history of full erective response to all three stimula
tive approaches.
The primarily anorgasmic lesbian has been defined as a woman
who has never been orgasmic in response to any of the techniques
of masturbation, partner manipulation, or cunnilingus. The situa-
tionally anorgasmic lesbian has been identified as a woman who has
responded at orgasmic levels to one or two of the three stimulative
techniques, but never to all three. The randomly anorgasmic lesbian
reflects a woman who has been orgasmic at least once in response to
each of the three stimulative approaches, but has rarely reached or
gasmic levels of sexual excitation in response to any form of sexual
stimulation.
The only real intergender difference in definition of sexual dys
function is between the diagnoses of secondary impotence and ran
dom anorgasmia. A diagnosis of secondary impotence implies actual
loss of physiologic or psychosexual capacity to achieve erection.
A random anorgasmic state does not imply loss of facility' to be
orgasmic. It connotes a low level of stimulative interest or sexual
involvement or both rather than a lack of capacity to respond to
effective sexual stimuli.
The subtle difference in these definitions reflects the fact that dif
ferent facilities are being measured. A diagnosis of impotence indi
cates a lack of facility to function effectively in the cultural male
role of attaining and maintaining an erection, not the specific lack
of orgasmic capacity. For example, occasionally men can and do
ejaculate through a completely flaccid penis. Anorgasmic states re
flect inability to achieve orgasmic release of sexual tensions, not
lack of a facility to function in a culturally defined female role of
involuntary preparation for vaginal penetration by developing lubri
cation (the female physiologic counterpart to male erection).
Any general discussion of male sexual dysfunctions should in
clude the frequently encountered distress of premature ejaculation
and the infrequently identified dysfunction of ejaculatory incom
petence. But the Institute has not described premature ejaculation
239
as a major homosexual dysfunction, because it rarely represents a

serious problem to interacting male homosexuals. It is usually not
considered a matter of major moment if one or both men ejaculate
rapidly after onset of sexual interaction, because neither man is de
pendent upon the other’s ejaculatory control to achieve sexual sat
isfaction. Over the 10-year control period, only two homosexual
men have requested admission to therapy at the Institute for treat
ment of rapid ejaculation. Both men had originally become rapid
ejaculators during heterosexual interaction as young men. Each
man had a history of usually ejaculating in heterosexual interaction
before he could completely undress.
Instead of being treated in the Institute’s therapy program, these
two men and their partners each received brief counseling on two
occasions. The “squeeze technique” was explained,
* and after work
ing with their partners for a few days, the men reported “satisfac
tory” control. Since these couples were not admitted to the research
program because their distress was easily reversible and did not war
rant employing intensive sex-therapy techniques, these couples have
not been included in the recorded treatment statistics.
The rapidly ejaculating homosexual is far easier to reverse than
the prematurely ejaculating heterosexual, because the heterosexual
man must learn ejaculatory control during cooperative intravaginal
thrusting patterns with a responsive woman. The homosexual has
no such requirement for security of ejaculatory control. The homo
sexual man’s concern for control is primarily to extend his own per
sonal pleasure factor, while the heterosexual man’s need is primarily
focused on providing for his companion’s personal pleasure factor.
As a homosexual dysfunction, ejaculatory incompetence has been
described as the consistent inability to ejaculate in response to the
stimulative techniques of masturbation, partner manipulation, or
fellatio without difficulty in attaining or maintaining an erection.
Ejaculatory incompetence has not been described in this text as a
problem in homosexual interaction, simply because no homosexual
man has presented this complaint to the Institute. When such a
complaint is encountered in an applicant from the homosexual
population, it will be acknowledged and treated with essentially the
* Masters and Johnson (1970), pp. 102-106.

240 CHAPTER TWELVE
same techniques as those employed in treating the heterosexual

with ejaculatory incompetence. This sexual dysfunction should be
reversed when possible, because lack of effective treatment for ejacu
latory incompetence can lead the homosexual male to fears of per
formance and to secondary impotence.
CLINICAL RESEARCH POPULATIONS
From 1968 through 1977, the Institute accepted for treatment

151 homosexually oriented men and women with complaints re
flecting sexual inadequacy. For investigative purposes, the problems
of homosexual inadequacy have been separated into two definitive
categories: the sexually dysfunctional and the sexually dissatisfied.
Homosexual men and women categorized as sexually dysfunctional
were contending with such sexual distresses as impotence, anorgas
mie states, or sexual aversions. They were leading overt or covert
homosexual lives and had Kinsey ratings ranging from 3 through 6.
Homosexuals identified as sexually dissatisfied were men and
women who expressed the desire to convert or revert to heterosexu
ality. As employed by the Institute, the terms conversion or rever
sion warrant further explanation. For a homosexual individual to
be considered as a candidate for therapeutic conversion to hetero
sexuality, he or she would have had little or no prior heterosexual
experience (Kinsey ratings of 5 or 6). Homosexuals listed as candi
dates for reversion to heterosexuality had Kinsey ratings that ranged
from 2 through 4. These applicants represented three basically dif
ferent lifestyles. The first was a group of men and women who had
been living overt homosexual lives, with or without an established
relationship. The second was a similar, socially oriented group of
men and women who were living as covert homosexuals. The third
group was composed of married men and women living openly as
heterosexuals and involved in covert homosexual interchange.
THE SEXUALLY DYSFUNCTIONAL POPULATION
During the 10-year clinical control period for treatment of homo

sexual inadequacy (1968-1977), a total of 81 homosexual couples
requested treatment for sexual dysfunction. This dysfunctional pop
CLINICAL INVESTIGATION 24I
ulation was composed of 56 homosexual male couples and 25 les

bian couples. The 56 male couples are listed by diagnosis in
Table 12-1.
TABLE 12-1
Dysfunctional Homosexual Male Couples
(N = 56; Dysfunctional Homosexual Males; N = 57)
Couple
Involvement Functional Homosexual
and Type of No. of No. of Partners
Impotence Patients * Couples Committed Casual
One partner
dysfunctional
Primary 3 3 3 0
Secondary 49 49 34 15
Situational 3 3 1 2
Both partners
dysfunctional
Primary 2 1
Total 57 56 38 17
* One primarily impotent, 2 secondarily impotent, and 1 situationally impotent
homosexuals were secondarily diagnosed as sexually aversive.
There were 5 homosexual males who were primarily impotent,

and 2 of these primarily impotent men formed 1 committed couple.
The remaining 3 primarily impotent men were members of com
mitted homosexual relationships with no homosexual dysfunction
evidenced by the other partner.
There were 49 secondarily impotent men who requested treat
ment. Thirty-four men came with partners from currently com
mitted relationships of six months to 23 years in duration. The re
maining 15 men came to the Institute for treatment with casual
partners. All of the partners, whether committed or casual, were
sexually functional homosexuals.
Three men were diagnosed as situationally impotent. Two of
these men sought treatment with casual partners, 1 with a com
mitted partner. These 3 partners also were sexually functional ho
mosexuals.
242 CHAPTER TWELVE
One man with primary impotence, 2 men with secondary im

potence, and 1 man with situational impotence were additionally
treated for sexual aversion.
*
There were 25 sexually dysfunctional lesbian couples who sought
treatment from the Institute (Table 12-2). Twenty-three of these
table 12-2
Dysfunctional Homosexual Female Couples

(N = 25; Dysfunctional Homosexual Females; N= 27)
Couple
Involvement Functional Homosexual
and Type of No. of No. of Partners
Anorgasmia Patients * Couples Committed Casual
One partner
dysfunctional
Primary 7 7 5 2
Situational 13 13 8 5
Random 3 3 3 0
Both partners
dysfunctional
Primary 1 } 1
Situational 21 1}
Random 1
Total 27 25 16 7
* Three primarily anorgasmie, 1 situationally anorgasmie, and 2 randomly anor
gasmie lesbians were secondarily diagnosed as sexually aversive.
couples were formed by anorgasmie lesbians and their sexually func

tional partners. There were 2 couples in which both partners were
sexually dysfunctional.
* The diagnostic category of sexual aversion was not described in Human Sexual
Inadequacy and will be only briefly mentioned in this text, since a full discussion
of this disorder will appear in the forthcoming book, Textbook of Sexual Medicine
(Little, Brown, and Company, 1979). Succinctly stated, sexual aversion is a con
sistent negative reaction of phobic proportions to sexual activity or the thought of
sexual activity. Sexual aversion occurs in both males and females, heterosexuals and
homosexuals; it does not refer to a situation of esthetic preference or to dislike of a
specific type of sexual activity, but rather to a pervasive negative reaction marked by
high levels of anxiety.
«43
The 25 couples were formed into four separate categories: (1)

There were seven primarily anorgasmie women seen with their 5
committed and 2 casual partners. (2) Thirteen situationally anor
gasmie women were treated with 8 committed and 5 casual part
ners. (3) Three women entered therapy with the complaint of
random anorgasmia. These were seen with committed partners. (4)
Two lesbian couples were seen in therapy with both partners dis
tressed by states of sexual dysfunction. One couple was formed by
a primarily anorgasmie lesbian with her committed partner who
was situationally anorgasmie. The other couple was composed of a
situationally anorgasmie lesbian with a committed partner who was
randomly anorgasmie.
Additional complications were encountered during the treatment
programs when interviews revealed that 3 of the primarily anorgas
mie, 1 of the situationally anorgasmie, and 2 of the randomly an
orgasmie lesbians were also sexually aversive.
THE SEXUALLY DISSATISFIED POPULATION
During the 10-year clinical control period, the Institute accepted

a total of 67 clients and their opposite-sex partners in treatment of
homosexual dissatisfaction (Table 12-3). This group of applicants
TABLE 12-3
Dissatisfied Homosexual Population (N = 67)

Sexually
Prior or Aversive
Present Present Prior (Hetero
No. of Homo Hetero Sexual sexual
No. of Uncom sexual sexual Aversion and
Patients in Therapy Married mitted Dysfunc Dysfunc ( Hetero Homo
Gender No. Patients Patients tion tion sexual ) sexual)
Male 54 33 21 0 11 * 8 0
Female 13 7 6 1 9 t 5 2
Total 67 40 27 1 20 13 2
* Eleven men were sexually dysfunctional as heterosexuals (7 were impotent pre-

therapv, and 5 had premature ejaculation posttherapy); 1 of the 11 was sexually
dysfunctional both pretherapy (impotent) and posttherapy (premature ejaculation).
t Nine women were sexually dysfunctional as heterosexuals (7 were anorgasmie
pretherapy and 2 were anorgasmie pretherapy and posttherapy).
CHAPTER TWELVE
244
was composed of 54 men and 13 women. Thirty-one of the homo

sexual men were married and 2 men were living in long-term male
female relationships and were listed as married for reportorial ease.
Twenty-one men were without committed relationships and were
seen for reversion or conversion therapy with their female partners
of choice.
Of the 13 lesbian women admitted to therapy, 7 were married
and the remaining 6 women were seen in therapy with their male
partners of choice.
None of the male applicants were sexually dysfunctional as homo
sexuals. One woman (Kinsey 6) was primarily anorgasmie during
her homosexual commitment before requesting conversion treat
ment with a heterosexual male partner of choice.
The fact that the majority of the men (61.1 percent) and women
(53.8 percent) accepted for sex-preference reversal were married
warrants specific comment. The percentage of applicants who were
living in married states or in long-term commitments was indeed a
surprise to the research team, which had anticipated that the greater
percentage of men and women requesting preference alteration
would be uncommitted homosexuals. Of course, the general cate
gory of “married” does misdirect. For to live a married life does not
in any sense indicate that the individual is living entirely a life of
heterosexual orientation, nor does it indicate that the individual is
even active in a heterosexual role.
Of the 33 committed men who applied for treatment, 14 were
living apart from their wives and had been separated for periods of
time varying from 10 months to 13 years. These 14 men were liv
ing almost entirely homosexually oriented lives and rarely had coital
experience.
Five married men were identified as primarily or secondarily im
potent in prior heterosexual experience and were leading lives of
full homosexual orientation. Two of these men had separated from
their wives, and 3 remained in the home. In all five instances their
wives were fully aware of the husband’s current sexual commitment.
In the remaining 14 men, 9 were identified by their wives as
homosexuals only after they had fully withdrawn from all hetero
sexual interchange, in some instances for years. The remaining 5
men had been leading dual-preference lives. In these cases, either
245
they had been surprised and identified as homosexuals by their

wives or had admitted this orientation voluntarily to their wives in
response to psychosocial pressures.
Three of the 7 married women were situationally anorgasmic as
heterosexuals and, although living in the home, were not interacting
heterosexually. They were functioning at orgasmic levels as homo
sexuals with their husbands’ knowledge. Two other married women
were living separately from their husbands and seemed entirely com
mitted to homosexuality. In the 2 remaining married women ap
plicants, the husbands had no prior knowledge of their wives’ ho
mosexual orientation until the wives told them that they needed
the support of role-preference therapy.
Because a state of overt marital commitment exists, in no sense
does this indicate a similar full heterosexual commitment for either
men or women. Perhaps the existence of the legal commitment was
a major influence in propelling the couples to seek professional sup
port. In many cases the problems these couples brought to therapy
were more severe than those encountered in direct treatment of
unmarried conversion or reversion applicants, for not only were the
usual problems of sex-preference alteration present, but frequently
there was a history of severe heterosexual dysfunction.
Additional complications in the applicants’ backgrounds added
further intricacy to the treatment program for sex-preference re
versal. Eight of the homosexual male applicants were secondarily
diagnosed as sexually aversive in prior heterosexual interaction. Five
of these men were married and were seen in therapy with their
wives, and 3 were treated with female partners of their choice.
Three of the 7 married women were also diagnosed as having been
sexually aversive to heterosexual approach when originally apply
ing to the Institute for reversion treatment. Two uncommitted les
bians seen in treatment for homosexual dissatisfaction were sexu
ally aversive to heterosexual interaction (Table 12-3).
Two more of the 6 uncommitted women who applied for rever
sion treatment with male partners of choice were identified as sexu
ally aversive to both homosexual and heterosexual interaction (see
Table 12-3). Their heterosexual aversive reactions were treated at
the same time they were in therapy with their casual male partners
for homosexual dissatisfaction.
246 CHAPTER TWELVE
Of the 67 individuals who cooperated as partners in therapy,

there were 33 committed heterosexual women and 7 committed
heterosexual men. Six men were casual heterosexual partners, as
were 21 women (Table 12-4). Some of the heterosexual partners
table 12-4
Dissatisfied Homosexual Population
(Partners in Therapy, N = 67)
No. No. Heterosexually

Partners in Therapy Married Casual Dysfunctional
Gender No. Partners Partners Partners
Male 13 7 6 1*
Female 54 33 21 4t
Total 67 40 27 5
* One husband had premature ejaculation.
t Two wives were situationally anorgasmie, 1 female casual partner was situation-
ally anorgasmie, and 1 female casual partner was primarily anorgasmie.
in therapy were also sexually dysfunctional. One husband was a

premature ejaculator, and 2 wives were situationally anorgasmie.
One casual female partner was primarily anorgasmie, and another
casual female partner was situationally anorgasmie. All 5 dysfunc
tional partners in therapy were treated for their sexual dysfunctions
simultaneously with the treatment of their homosexual partners for
sexual dissatisfaction.
CLIENT COOPERATION
One of the important variables to be taken into account when

treating homosexual dysfunction or dissatisfaction is the degree of
cooperation offered by those men and women who come for treat
ment. When considering this problem, two generalizations can
safely be made.
First is the observation that the homosexual men and women
who were contending with the distresses of sexual dysfunction and
CLINICAL INVESTIGATION 247
who expressed the desire to become sexually effective as homosex

uals were far more cooperative with the therapy program than those
homosexuals complaining of sexual dissatisfactions and requesting
conversion or reversion to heterosexuality. The second generaliza
tion would be anticipated by experienced psychotherapists. With
two specific exceptions, committed or casual partners of the homo
sexual men and women who sought treatment from the Institute’s
staff were far more cooperative while in therapy than were the
clients who sought specific therapeutic relief from their complaints
of sexual dysfunction or dissatisfaction.
There is no all-encompassing explanation for the significantly re
duced levels of cooperation in therapy evidenced by sexually dis
tressed homosexual men and women when compared to the levels
of cooperation offered by sexually distressed heterosexuals. Initially,
it was presumed that pressures of social rejection had sensitized the
sexually inadequate homosexual to such a degree that any manner
of helping hand was viewed with suspicion, even though the help
ing hand had been specifically solicited by the suspicious individual.
While the factor of public opprobrium cannot be ignored, it should
not be given too much credence as the single cause of the homosex
ual patient’s lessened cooperation. Experience has taught that the
combination of the pressures of public rejection and the ego
deflating experience of contending with sexual dysfunction or dis
satisfaction exerts a cumulative influence that usually is detrimental
to the homosexual’s emotional stability.
PRIOR REJECTION BY
HEALTH-CARE PROFESSIONALS
Another detrimental factor that understandably elevated the dis

tressed homosexuals’ levels of anxiety in therapy, and to a signifi
cant degree could be held responsible for their relatively low level
of cooperation in the treatment programs, was the widespread, well-
founded fear that members of the health-care professions would be
far from impartial in dealing with sexually distressed homosexual
men and women. The available evidence certainly supports the ho
mosexual population in their general contention that if they ex
pected the worst from health-care professionals, they would be
rarely disappointed. Many health-care professionals have refused
248 CHAPTER TWELVE
treatment to sexually dysfunctional homosexual men and women.

Of the 57 homosexual men who were treated by the Institute for
sexual dysfunction, 26 reported that they previously had sought
psychotherapeutic support from other health-care facilities, and 23
stated that they had been refused treatment for their specific sexual
dysfunction (see Table 12-5). Eleven of these 23 men had been re-
TABLE 12-5
Male Homosexual Prior Treatment History

(Sexually Dysfunctional, N = 57; Sexually Dissatisfied, N = 54)
Previous Treatment Attempts

Re In
Refused ferred Active
for to Ac Termi Ther
Treat An cept nated apy
Refused ment other ed Treat at
Sought for (More Ther In ment Ad
Chief Total Treat Treat Than apy Treat (Unsatis mis
Complaint No. ment ment Once) Source ment factory) sion
Dysfunction 57 26 23 11 0 3 3 0
Dissatisfaction 54 36 21 10 1 15 12 3
Total 111 62 44 21 1 18 15 3
fused treatment on more than one occasion. Not a single one of the
23 men refused treatment for sexual dysfunction had been referred
to another treatment source. Three homosexuals had previously been
accepted in therapy when they specifically requested treatment of
sexual dysfunction. They terminated the therapy when it became
apparent that the treatment program was directed toward conver
sion or reversion to heterosexuality rather than amelioration of their
homosexually oriented dysfunction.
Of the 54 homosexual men who sought help in converting or re
verting to heterosexuality, 36 had previously requested treatment
for their sexual dissatisfaction (see Table 12-5). Twenty-one men
stated they had been refused treatment for homosexual dissatisfac
tion by health-care professionals. Ten of these homosexuals re
ported more than one instance of refusal of treatment. Only 1 of
the 21 men refused treatment for the complaint of sexual dissatis-
249
faction was referred to another source of professional treatment by

the health-care professional first consulted. Fifteen homosexual pa
tients had been accepted in treatment for sexual dissatisfaction, and
12 of these had voluntarily terminated their therapy programs,
deeming the results unsatisfactory. Three patients were still in ac
tive therapy when they requested admission to the Institute’s pro
grams. Permission to enter treatment was granted by the psycho
therapists involved.
Nor were the homosexual men the only ones who were refused
treatment for sexual dysfunction or dissatisfaction. Of the total of
27 lesbians who requested treatment by the Institute for sexual dys
function, 14 had sought professional help from another health-care
facility (see Table 12-6). Eleven of these women had been refused
table 12-6
Female Homosexual Prior Treatment History

(Sexually Dysfunctional, N = 27; Sexually Dissatisfied, N = 13)
Previous Treatment Attempts

Re- In
Refused ferred Active
for to Ac Termi Ther
Treat An cept nated apy
Refused ment other ed Treat at
Sought for (More Ther In ment Ad
Chief Total Treat Treat Than apy Treat (Unsatis mis
Complaint No. ment ment Once) Source ment factory) sion
Dysfunction 27 14 11 8 0 3 3 0
Dissatisfaction B 5 2 1 0 3 3 0
Total 40 19 B 9 0 6 6 0
psychotherapeutic support, 8 on more than one occasion. None of

the 11 women refused therapy for sexual dysfunction had been re
ferred to another treatment source. Three of the 14 lesbians who
sought treatment for sexual dysfunction had been accepted in treat
ment, and each had voluntarily terminated her treatment program
as unsatisfactory.
Thirteen lesbians requested support in their attempts to revert
or convert to heterosexuality. Only 5 of these women had sought
CHAPTER TWELVE
250
help from other professional sources, and 2 had been refused, 1 on

several occasions. Neither of the 2 women refused treatment had
been referred to another source of professional care. All 3 of the
women who had been accepted in therapy had terminated the treat
ment programs when they became convinced sufficient progress had
not been made.
OTHER FACTORS IN COOPERATION
A number of other factors tended to lower the degree of the

homosexual clients cooperation with the therapists. Fears that suc
cessful treatment results could not be attained were frequently ver
balized by homosexuals in both the dysfunctional and dissatisfied
categories. There was also a resistance factor uniquely evidenced by
the dissatisfied homosexuals. These clients frequently indicated
and occasionally verbalized a deeply ingrained ambivalence as to
whether they really wanted to convert or revert to heterosexuality.
When there was a significant level of ambivalence, the clients, frus
trated by their psychosexual insecurity, frequently projected their
anxieties on the therapists.
Cooperation in treatment was at a particularly low ebb with the
men and women who were living in overtly committed heterosexual
relationships but were covertly engaged in homosexual encounters.
Despite requesting treatment for some form of sexual inadequacy
and despite having the courage during treatment to acknowledge an
ongoing homosexual orientation, these men and women were still
quite fearful of their spouses’ reaction to the information. They
were concerned initially whether the spouses would continue to ac
cept them as sociosexual partners, and secondarily whether the
spouses would break security and release their previously well-
camouflaged identification with homosexual interests to members
of the family, friends, or even to the general public. Faced with
these understandable anxieties, they frequently relieved their ten
sions by attempting to force a break between themselves and their
therapists. The covertly homosexual married men were particularly
concerned with the presumed loss of face that might develop from
a discussion of their homosexual activities with their female
partners.
In short, fear of treatment failure, fear of spouse rejection, or fear
251
of loss of public acceptance as information was leaked by a con

demning spouse led to continuing high levels of client anxiety dur
ing the course of therapy. Such anxiety was occasionally relieved by
open hostility, but far more frequently it was released by varying
levels of foot-dragging or noncooperation with therapeutic sugges
tions or concepts. Once anticipated, such evidences of social or sex
ual insecurity can be neutralized with reasonable effectiveness by
experienced therapists.
While there is no doubt that there was a multiplicity of factors
leading to lowered levels of cooperation in treatment by sexually
inadequate homosexual men and women, there is an even more
important message contained in this section on client cooperation.
The message is spelled out in the statistics reported in Tables 12-5
and 12-6 and discussed earlier in this chapter. No longer should
the qualified psychotherapist avoid the responsibility of either ac
cepting the homosexual client in treatment or, at the very least,
referring him or her to an acceptable treatment source. The statis
tics tell a lamentable story of professional bias: If the applicants
had been heterosexual men and women complaining to health-care
professionals of the distress of sexual inadequacy, the statistics re
lated to acceptance in treatment or referral to an acceptable au
thority would not have borne the slightest resemblance to those
reported in Tables 12-5 and 12-6.
APPLICATION ACCEPTANCE
During the 10-year clinical control period of evaluation and treat

ment of homosexual inadequacy (1968 through 1977), the Institute
accepted a total of 151 homosexual men and women who requested
professional support in treating their sexual dysfunctions or revers
ing or converting their sexual orientations. Since there were dif
ferent criteria exercised for acceptance into therapy for treatment
of dysfunction as opposed to dissatisfaction, there should be passing
mention of the process of client selection.
Before acceptance into therapy, homosexual applicants under
went a pretreatment interview. Some of the interviews were con
ducted in person with members of the research team. But most
CHAPTER TWELVE
«3«
pretreatment interviews were conducted by telephone, because a

predominant number of applicants lived far from St. Louis.
If a homosexual male or female applicant complained of a sexual
dysfunction, such as impotence or an anorgasmic state, and ex
pressed sincere interest in becoming a functional sexual partner in
a homosexual milieu, the individual was freely accepted into treat
ment with but two areas of reservation. The first reservation cen
tered upon therapeutic demand for an accompanying partner. The
Institute insisted that sexually dysfunctional men and women have
available a committed or casual partner of the same sex to share in
the treatment program. The Institute also insisted that if there was
to be a casual partner and he or she was not prepared to share
sexual opportunity with the dysfunctional client after termination
of the acute (two weeks) phase of the therapy program, there must
be another homosexual companion available who was prepared to
offer such cooperation.
A partner of choice is of markedly reduced value in the treat
ment of sexual dysfunction when his or her availability terminates
with the acute phase of therapy. This is particularly true if there is
no intimate companion available to substitute immediately after
termination of therapy. This factor is so important in the outcome
of treatment of both homosexual and heterosexual dysfunctions
that the Institute historically has not accepted an individual into
treatment with a casual partner unless there was some plan for con
tinuity of a sexual partnership in the immediate future, either with
the casual partner or with another acceptable companion.
The second reservation focused upon the client’s psychological
stability. It has always been the Institute’s position that if symptoms
of severe psychopathology are identified, the applicant will not be
accepted in therapy. Had there been such identification, the homo
sexual man or woman would not have been accepted in therapy.
Fortunately, there was no rejection of any homosexual applicant for
treatment of sexual dysfunction resultant from a diagnosis of major
psychopathology. In fact, no homosexual male or female applicant
for treatment of sexual dysfunction was rejected by the research
team.
When the homosexual applicant stated that he or she wished
therapeutic support in his or her attempt to convert or revert to
253
heterosexuality, such a request was very carefully screened. The in

dividual and his or her committed or casual partner were accepted
into the treatment program only if both members of the research
team were fully convinced of the sincerity of the request. The ho
mosexual applicant for treatment of sexual dissatisfaction under
went a far more detailed selection process than did the homosexual
man or woman complaining of sexual dysfunction. Since men and
women accepted for treatment of homosexual dissatisfaction were
very carefully screened before the research team made a therapy
commitment, they certainly do not represent an average cross
section of the applicant population.
Research team members were acutely aware that many homo
sexuals verbalize a desire to alter their sexual preference role both
psychosocially and psychosexually. Although they may seek profes
sional support with statements of unqualified sincerity in preference
alteration, they are really quite ambivalent about desiring full con
version or reversion to heterosexuality.
On the other hand, when homosexuals sought treatment at the
Institute stating that they wished to function effectively in both
homosexual and heterosexual roles, and if their cooperating part
ners were fully aware of the applicant’s admitted sexual ambiva
lence, such men and women were freely accepted into treatment.
The Institute felt more secure in accepting homosexually dissat
isfied men and women in treatment when the applicants for con
version or reversion to heterosexuality freely expressed their reserva
tions about making the complete change in role preference or
openly stated their desire to function in both roles.
Twelve homosexual men requesting reversion and 4 men apply
ing for conversion therapy were refused treatment by the Institute’s
staff (see Table 15-1, Chapter 15). Three lesbian women also were
refused treatment when they requested professional support in their
considered attempt to revert to heterosexuality (see Table 16-1,
Chapter 16).
Discussions of the rationale for refusal of treatment are presented
in Chapters 15 and 16, which consider the treatment program for
male and female sexual dissatisfaction. Every effort was made to
see that those homosexuals who were refused treatment were di
rected to theoretically effective means of psychotherapeutic sup
CHAPTER TWELVE
«54
port; however, not all of the men and women applying for treat
ment took advantage of the referral suggestions.
There was one type of homosexually oriented client who escaped
the Institute’s screening techniques. This was the married man or
woman who was accepted into treatment for some other form of
stated sexual distress (a sexually dysfunctional partner, for exam
ple) and whose covert homosexual interest was not identified until
during the course of therapy. Usually the client’s homosexual orien
tation was either unknown to or was only partially surmised by the
committed partner. When such an individual and his or her spouse
had already been accepted in the therapy program under some other
guise, he or she was treated for sexual reversion only if there was a
specific request for such treatment, and if the partner was fully in
formed of the covert homosexual orientation.
If the individual did not desire reversion therapy, preferring in
stead to keep information relative to his or her covert homosexual
interests from the partner, such a request was honored, and, when
possible, treatment for the previously stated sexual or relationship
distresses continued without interruption. If the covert homosexual
influences precluded a successful treatment program, the therapy
was terminated. This clinical situation occurred twice in the con
comitantly conducted heterosexual dysfunction program during the
io-year clinical control period for treatment of homosexual dysfunc
tion. When it was necessary to terminate treatment for heterosexual
dysfunction because the covert homosexuality prevented successful
treatment of the relationship distresses, the Institute always ac
cepted full responsibility for treatment failure, thereby protecting
the security of the information. When referral to another source of
psychotherapeutic support for the uninformed partner was possible,
such a procedure was followed assiduously.
FINANCIAL CONSIDERATIONS
When payment of fees for professional services was considered,

the research team followed the precedent established a decade ear
lier when the new techniques for treatment of heterosexual inade
quacies were first introduced. No homosexual applicant or his or
her committed or casual partner was charged for treatment during
the first five years of the clinical control period. In addition, during
255
this five-year period, each couple was fully informed that the treat
ment techniques to be used were in experimental stages and that
the therapists were inexperienced in the treatment of homosexual
men and women for their sexual inadequacies. After the first five
years, the charges for therapy have been exactly those requested for
the heterosexual treatment program. A full fee has been charged
when applicable. Since the Institute was established in 1964, ap
proximately 30 percent of all applicants accepted for treatment of
homosexual or heterosexual inadequacy have been treated on a
sliding-scale basis or without charge.
TREATMENT FORMAT
The basic therapy format was essentially the same as that previ
ously developed for the treatment of heterosexual dysfunctions and
dissatisfactions (see Human Sexual Inadequacy). Until the inves
tigation of the homosexual male and female’s sexual physiology was
established, there had been no effort to conceptualize therapeutic
modalities for the treatment of problems of homosexual inade
quacy. But once it was apparent that there were no basic physi
ologic differences in the sexual functioning of homosexual men
and women when compared to heterosexual men and women, spe
cific attention was devoted to the format of the therapy program.
It was decided to use the same techniques for the treatment of
the sexually dysfunctional homosexual that had been developed 10
years previously to treat the sexually dysfunctional heterosexual.
Since the same problems of impotence and anorgasmic states
existed in both homosexual and heterosexual individuals, it seemed
reasonable to assume that these dysfunctions would respond equally
well to similar therapeutic approaches, regardless of whether the
dysfunctional men or women were of homosexual or heterosexual
orientation.
When first considering treatment for homosexual dissatisfac
tions, it was presumed that a different therapy format might be
indicated, but this presumption soon proved to be without founda
tion. As experience was gained in evaluating homosexuals who ex
pressed the desire to convert or revert to heterosexuality, it was
256 CHAPTER TWELVE
apparent that there were two immediate requirements in order to

achieve treatment success. First, there must be a high degree of
client motivation for alteration of sexual preference, and second,
there must be available an understanding opposite-sex partner who
could be a major source of psychosexual support during the sexual-
preference transition phase. Once the paramount need of the ho
mosexual for partner support in therapy was recognized, the rapid
treatment techniques again seemed particularly indicated. Since
partner support is a major requirement for success in treatment, the
sooner the therapy program can be concluded, the better the chance
of maintaining a high level of continuing partner cooperation.
Thus, the rapid-treatment techniques (two weeks’ duration) for
heterosexual inadequacies first introduced in 1959 were continued
in the treatment of problems of homosexual dysfunction and dis
satisfaction when these programs were first constituted in 1968.
No sexually dysfunctional homosexual man or woman has been
treated without the presence and support in therapy of a committed
or casual partner of the same sex, and no sexually dissatisfied homo
sexual man or woman has been treated for conversion or reversion
to heterosexuality without the presence and support in therapy of a
committed or casual partner of the opposite sex.
A brief review of the relatively standardized protocol of the first
two days of rapid treatment is in order.
In the standard dual-sex team approach to treatment of homo
sexual dysfunction, both members of the dual-sex research team
interview the members of the homosexual couple. When a homo
sexual man or woman presents with a same-sex partner for treat
ment of sexual dysfunction, the dysfunctional man or woman is
first interviewed by the same-sex therapist and the accompanying
partner by the opposite-sex therapist. The initial history is con
ducted in a most detailed fashion, with particular attention paid
to the chronology not only of the sexual dysfunction, but also of
the individual’s personal history. Later in the first day, after the
two therapists have had the opportunity to exchange information,
second sex histories are taken, during which clients and therapists
are interchanged so that the dysfunctional homosexual man or
woman is interviewed by the opposite-sex therapist and the partner
257
by the same-sex therapist.

* During the second interviews, there
routinely is more concentration by the therapists on attitudinal
material and background information.
When homosexual dissatisfaction is the complaint, and the dis
tressed homosexual is accompanied by a partner of the opposite sex,
initial histories are taken in the same manner as those of sexually
distressed heterosexual couples. The male therapist takes a first his
tory from the male client, regardless of whether the male client is
the sexually dissatisfied partner or the functional partner. There is
similar initial interview linkage between female therapist and fe
male client for first history-taking. The second histories are then
taken in the usual cross-sex manner of switching therapists and
clients. Again, the first histories are basically directed toward estab
lishing the chronology of the developing homosexual dissatisfaction
and an understanding of the applicant’s lifestyle. The second or
cross-sex histories are primarily concerned with attitudinal material
and relationship status.
Physical examinations are also conducted on the first day of
therapy for both the sexually inadequate homosexual and his or
her committed or casual partner. General laboratory and basic meta
bolic studies are conducted on the morning of the second day of
treatment. The physical examination and laboratory studies are
instituted as clinical controls in an attempt to identify possibly
detrimental physical and metabolic influences on the client’s sexual
functioning. It matters not whether a man or woman has a hetero
sexual or homosexual orientation when physical disabilities or meta
bolic disease are considered as etiologic factors in complaints of
sexual inadequacy, for the influence of physical disability or meta
bolic dysfunction on sexual function is the same, regardless of the
sexual-preference role of the involved person.
On the second day of therapy the couple in treatment and the
therapy team meet to discuss the material gathered from the psy-
chosexual and social histories taken and from the physical exami-
* The completion of both histories during the first day of the two-week period
(rather than over the first two days, as described in Human Sexual Inadequacy) was
begun for both homosexual and heterosexual clients during 1972. Prior to that time,
the history-taking process was spread over two days. The actual time spent in ob
taining histories has not been altered.
CHAPTER TWELVE
258
nations conducted on the first day. Every effort is made by the

therapy team to minor back to the distressed couple an unbiased
reflection of the influences (when they can be identified) that
played etiologic roles in the development of the homosexual dys
function or dissatisfaction. Once identified and explained, these
influences are attacked psychotherapeutically over the remaining
course of the rapid-treatment program in an effort to at least neu
tralize their effects, if not to reverse their dominance.
Also during the second day of treatment, the client couple is
given a beginning orientation to the fundamentals of both verbal
and nonverbal communication as an important adjunct to the suc
cess of treatment.
Therapy on subsequent days varies with the severity of the com
plaint, the cooperation of the couple, the therapeutic progress at
hand, and a myriad of other influences that alter from couple to
couple. The therapeutic regime of the rapid-treatment technique
for heterosexual dysfunction described in detail in Human Sexual
Inadequacy is the treatment form employed for homosexual inade
quacies and will not be repeated in this text, since the basic thera
peutic techniques employed have been the same, regardless of
whether homosexual or heterosexual inadequacies are under treat
ment. There will be a detailed discussion of the psychodynamics of
the dual-sex team therapeutic format in future publications.
As in the treatment of heterosexual dysfunction, there was an
important cumulative effect when the therapy was conducted on a
daily basis. When treatment crises occurred (and they occurred reg
ularly), the clients were never more than 24 hours away from active
professional support. Therapy crises can be turned into important
teaching opportunities rather than therapeutic setbacks if faced in
the relative immediacy of their onset. The two-week rapid-treatment
format with daily therapy sessions conducted on a seven-day-a-week
basis inevitably provides an opportunity to approach treatment
crises in the relative immediacy of onset that a once- or twice-a-week
therapy format cannot provide. Even if the crisis cannot be resolved
satisfactorily, immediacy of therapeutic effort usually eases the se
verity of the trauma experienced by the distressed couple, and, of
course, lessens the hazards to the therapeutic regime. In addition,
the importance of continuing therapeutic reinforcement and model
259
ing is maximized in a daily treatment format, drawing upon the

underlying principles of social learning theory in a most efficient
manner.
Although the dual-sex team was routinely used as a basic com
ponent of treatment, alterations in professional personnel were
made on an experimental basis. Four times a male therapist was
substituted for the female member of the dual-sex team when dys
functional homosexual male couples were at the end of the first
week of therapy. In each instance, the return of the female therapist
was requested by the clients. Variation in the established format of
the dual-sex therapy team was interpreted by the homosexual male
patients as meaning the therapists thought them “different” from
sexually dysfunctional heterosexual men. Once drawn, such an im
plication was resented, and each of the four experimental attempts
at therapist substitute was rejected.
A similar technique of substitution of a female therapist for the
male member of a dual-sex team was attempted experimentally dur
ing treatment of two lesbian couples with complaints of sexual dys
function. Again, the substitution effort resulted in a request for the
return of the opposite-sex therapist, and again, the same rationale
to support the clients’ requests was presented.
FOLLOW-UP PROCEDURES
In order to provide an additional dimension for evaluating the

treatment of homosexual males and females for sexual dysfunction
or dissatisfaction, the research team attempted to follow for five
years all men and women who were not overt treatment failures
during the acute phase of the treatment program. The follow-up
procedures consisted of regularly scheduled telephone calls and oc
casional revisits to the clinic if difficulties developed. The treated
couple was also offered the opportunity to contact the Institute at
any time when or if either partner felt that he or she was facing
some manner of crisis.
Certainly this is not as secure a method of patient follow-up as
that made possible by the opportunity to see the individuals for
personal interviews on a regular basis. But since approximately 95
26o CHAPTER TWELVE
percent of the homosexual men and women who applied for treat
ment came from outside the St. Louis area, there were no viable
alternatives to the techniques described above.
A brief statement should be made as to the reliability of informa
tion provided during the follow-up periods. Of course, there can
never be real security in any information of this type. There is no
doubt that some of the clients have purposefully misled the thera
pists with false reports. Others may have inadvertently accomplished
the same result. As long as any clinical program is forced to rely
upon data obtained by any form of verbal or written interrogation,
the investigator can never be fully confident of the security of his
information, regardless of the statistical evaluations made of the
reported material.
PERFORMANCE PRESSURES
When cultural performance pressures, real or imagined, intrude

upon the psyche of a sexually dysfunctional or dissatisfied man or
woman, the immediate response ranges from dissimulation (sexual
fakery) to severe anxiety (fears of performance and spectator roles).
When he or she is faced with an immediate sexual opportunity and
the overt physiologic responses of erection or lubrication are either
delayed or absent, the elevated levels of psychosexual anxiety that
develop in such a situation consistently force a retreat from reality
for the involved man or woman. It matters not whether he or she
is homosexually or heterosexually oriented.
This section will consider some of the dissimulation techniques
and anxiety states that result from such cultural pressures together
with clinical suggestions for reversal of these escape mechanisms.
SEXUAL FAKERY SYNDROME
Sexual fakery has probably always been a refuge for sexually in
adequate men and women, regardless of sexual preference. Sexual
fakery as practiced in a heterosexual milieu is discussed initially to
provide perspective for the practice of sexual fakery as observed in
the homosexual community.
Wives have fooled husbands for centuries by faking orgasm or
by pretending to be sincerely involved in sexual interchange while

mentally doing their culture’s equivalent of the next day’s market
ing list. Unless the men were exceptionally experienced sexually,
the wives’ sexual fakery might be practiced successfully through
many years of sexual interaction. But her thespian success put the
wife in a dreadful bind, for she had painted herself into a corner.
If she ever tired of mental marketing and opted for increased sexual
involvement, she was forced to admit to years of sexual fakery in
order to support her request for major alterations in the committed
dyad’s sexual practices. Failing the courage of full confession or
fearful of her husband’s reaction to the admitted sexual fakery, she
usually continued indefinitely as a seemingly pleased, even antici
patory sexual partner. For her husband, having no reason to believe
that his wife was not generally pleased with their mutual sexual ex
periences, rarely voluntarily changed his presumed “successful” sex
ual approaches.
As a result, the wife rarely became fully involved sexually. In
stead, she frequently became a neurotic, sexually frustrated woman
who ultimately rejected her husband on at least two counts: first,
because he consistently evidenced no real concern for her sexual
needs, for he certainly didn’t fulfill them (obviating the fact that
he had been deliberately kept unaware of them), and second, be
cause he was a much duller man than she had realized since he
had been so easily fooled on so many occasions for such a long
period of time.
No one knows the extent of the sexual fakery indulged in by het
erosexual women in our culture, but the women who at least on
occasion have felt it necessary to fake their degree of sexual involve
ment certainly numbers into the millions.
Just the opposite is true for the married heterosexual male. As
much as he might like to fake the levels of his sexual involvement
on occasion, he cannot; either he has an erection of sufficient qual
ity for penetration—or he does not. He can dissimulate with ex
cuses like “tough day at the office,” “have an important appoint
ment tomorrow,” or “don’t feel well,” but these excuses are at best
short-term escape hatches. His wife is soon fully aware of the in
security of his erective prowess and of the increasingly severe levels
of anxiety that accompany the emergence of his symptoms of im
262 CHAPTER TWELVE
potence. If he is in a committed relationship, a heterosexual male

cannot indulge in any long-continued sexual fakery simply because,
try as he might, he cannot successfully fake an erection.
The uncommitted heterosexual man can initiate sexual fakery
with significant success by practicing various sociosexual withdrawal
techniques. He may typically project the image of the perfect gen
tleman who never approaches sexually beyond a chaste “goodnight
kiss,” and in self-defense he withdraws socially from a female part
ner as soon as the frustrated woman begins to press for any form
of overt sexual involvement. He also practices the time-honored
excuses of a “busy day at the office,” “don’t feel well,” and so on,
when pressured to perform sexually by his casual female companion.
The single heterosexual male who consistently practices sexual
fakery usually runs out of potential female companionship among
his peer group rather quickly and either becomes progressively anti
social or drifts into an almost exclusively male social structure. In
short, the impotent single heterosexual male frequently recruits
himself into previously unconsidered homosexual opportunity as
an escape mechanism from the threatening possibility that some
female companion will have the opportunity to identify his impo
tent state and then spread that information throughout his social
circle.
It is far easier for homosexual men than for heterosexual men to
be successful sexual fakers. There is no reliable information on the
extent to which the syndrome is practiced by homosexual men—
just as there is no secure knowledge of the amount of sexual fakery
among heterosexual women. But if detailed reports from the few
sexually dysfunctional homosexual men treated by the Institute in
the last 10 years are of any value, sexual fakery may be far more
widespread among the male homosexual population than previously
suspected.
The impotent homosexual male has at his disposal a most effec
tive method of sexual fakery. He can easily assume a passive rather
than an active role during sexual encounter. Once erective insecur
ity achieves dominance, the homosexual man tends to live a casual
lifestyle, avoiding or dissolving committed relationships. If the
impotent homosexual decides to pursue the path of sexual fakery,
continuing relationships are quite threatening, for they place the
dysfunctional male in jeopardy. In a committed homosexual rela

tionship, just as in a marriage, erective insecurity is virtually impos
sible to hide.
With onset of erective insecurity, the ego-oriented fears of public
disclosure surface immediately. Fear of identification as an impo
tent man is just as threatening to a homosexual as to a heterosexual
man. It is just such fear that can place a committed homosexual
relationship in jeopardy. A committed partner not only has a far
greater opportunity to identify his partner’s erective insecurity than
a casual partner, but he also has every opportunity to disseminate
the threatening information to the community of their mutual
friends. By every evidence, the committed male homosexual rela
tionships that were treated by Institute personnel for one partner’s
impotence were indeed secure social commitments. In addition to
the usual stresses of homosexual partnerships, these relationships
had withstood not only the trauma of the one partner’s sexual dys
function and his accompanying fears of disclosure, but, in most in
stances, also had weathered episodes of attempted sexual fakery by
that partner.
With the exception of the couple composed of two primarily im
potent men, every homosexual man treated for impotence admitted
indulging in sexual fakery at least once, and most of the men de
scribed practicing sexual fakery many times. Typically, the man
either insists that he has little or no sexual drive himself or that his
sexual pleasure is derived principally from stimulating and relieving
his partner. His sexual fakery can only succeed if he assumes control
of the sexual interchange.
Homosexual men with different degrees of impotence usually
practice different levels of sexual fakery. For example, men with
occasional erections feign overwhelming sexual demand when the
erections do occur, forcing the specific sexual episode to a rapid
conclusion so that they can use the engorged penis as quickly as
possible before losing the erection. This pattern of sexual behavior
has a complete parallel in the reactions of increasingly impotent
heterosexual men. When they do achieve an effective erection, they
try to mount immediately, even if it is the middle of the night or
on awakening in the morning. If they just can get the penis into
the vagina and ejaculate before losing the erection, they can gain
264 CHAPTER TWELVE
reassurance relative to their potency—at least for themselves—and

at least for the moment.
If penile erection occurs irregularly or consistently has a short
maintenance time, homosexual men move into a different form of
sexual fakery by assuming a role of sexual service. When playing
the service role, the impotent homosexual manipulates or fellates
his partner, or serves as the penetratee in rectal intercourse. The
relatively passive role in sexual interchange is well established in
the homosexual community. It is frequently assumed by aging or
physically unattractive homosexual males who have no established
sexual partners. With the loss or absence of physical attractiveness,
these men must concentrate on providing pleasure for their casual
partners if they are to continue to attract sexual opportunities. Since
this behavior pattern is widely practiced, the impotent homosexual
is usually not suspect when he moves into a role of sexual service
as a means of faking his sexual prowess.
But when impotence is fully established, when erections rarely if
ever develop during sexual interchange, and when all performance
confidence is lost, men of both sexual preferences have in common
the safest of all sexual fakery techniques: that of negation of sexual
interest. Many impotent men, homosexual and heterosexual alike,
simply withdraw first from sexual and second from social inter
action. If they are primarily or secondarily impotent at an early
age, they tend to become almost exclusively antisocial. These men
usually live alone without any continuing relationship or live with
their families into their thirties or even forties. They tend to confine
their social life to family events, interact with an ever-tightening
circle of a few old friends, and lose themselves in their professions
or their hobbies. They are constantly on guard to avoid any social
interaction that conceivably could lead to sexual opportunity. To
paraphrase: If nothing is ventured sexually, nothing is revealed.
The primarily impotent homosexual male is a man who rarely
achieves an erection, and when he does, it usually is quickly lost.
Therefore, his means of sexual fakery are severely limited. Besides
sociosexual withdrawal from his peers, he can only play a full ser
vice role. His opportunities for sexual release are confined to noc
turnal emissions, when they occur. In simple truth he rarely enters
the sexual arena, for his only consistent return is sexual frustration.
The secondarily impotent homosexual lives with somewhat less

restriction on sexual activity. As the security of his erections de
creases, he loses confidence to interact in an active sexual role with
other men. Therefore, if he is to fake sexually, it is generally in a
service role. He usually retains the facility to masturbate and pro
vides most of his own sexual release in this manner. Actually, his
impotence may have become so severe that masturbation is his only
outlet. The psychosexual trauma occasioned by loss of sexual func
tion is frequently so serious that he carefully withdraws from sexual
opportunity.
The situationally impotent male generally adjusts to his dysfunc
tion far better than primarily or secondarily impotent men. He prac
tices sexual fakery quite successfully by simply staying within the
restrictions of his inadequacy. He tends to maintain an active but
well-controlled sexual life. If only masturbation can be successfully
completed, he will enter only mutual masturbational opportunities.
If he can respond to partner manipulation and not to fellatio, he
again arbitrarily limits sexual activity to manipulation. If fellatio is
his basic outlet, only fellatio is given or received. At least he can
move into homosexual interchange with some sense of security, al
though at times his casual sexual partners may be somewhat sur
prised when confronted by his seemingly autocratic limitations on
acceptable sexual approaches.
Sexual fakery does not appear to be nearly as prevalent in the
lesbian population as it is among heterosexual women. There are
several reasons for the lesbians’ comparative freedom in acknowl
edging sexual dysfunction when it occurs rather than attempting to
deny the inadequacy.
First, it is obviously far more difficult for a woman to deceive an
other woman in a continuum of sexual encounters than it is to prac
tice fakery successfully with an unsuspecting man. Inevitably the old
cliché of “It takes one . . .” comes into play. Just as subjective ap
preciation of the partner’s level of sexual involvement was used to
their advantage by interacting homosexual women in the research
laboratories (see Chapter 5), so the same levels of subjective ap
preciation would tend to make the interacting lesbian aware that
her partner was not consistently reaching orgasmic release. Ob
viously, the lesbian with a succession of casual partners would have
s66 CHAPTER TWELVE
a far better chance of practicing successful sexual fakery than the

homosexual woman with a committed partner.
Second, until the past few years there has not been the same
level of cultural pressure placed upon lesbian women to reach
orgasmic levels of sexual excitation as that experienced by hetero
sexual women. The heterosexual woman is faced with performance
demands placed upon her by her male partners, who in turn are
reacting to cultural pressures to service their female partners “suc
cessfully” to prove their masculinity. The pressures of having to be
orgasmic to satisfy a partner’s ego do exist in lesbian interaction,
but not to the degree evidenced in heterosexual orientation.
Third, there also appears to be a pattern of freedom of open dis
cussion and frank admission of sexual dysfunctions (when present)
among committed lesbian couples. In the Institute’s limited experi
ence with sexually dysfunctional lesbian couples, a sense of failure
as a woman or loss of face when anorgasmic were not expressed as
frequently as was noted when working with anorgasmic wives.
These reasons may explain the lower incidence of reported sexual
fakery among anorgasmic lesbian women when compared to simi
larly anorgasmic heterosexual women.
When sexual fakery is identified by the therapist, the practice
usually is reversed with relative ease. The therapeutic mirror is em
ployed to reflect to the client that even though he or she may be
able to misdirect the sexual partner or partners indefinitely, the only
one injured by the practice is the individual resorting to the fakery.
This cover-up technique only delays the moment when the dysfunc
tional man or woman must face the reality of his or her sexual in
adequacy. When a sexually distressed individual abandons fakery
and openly admits the existence of a dysfunction, he or she has
taken the first positive step toward reversal of the complaint. Once
the individual realizes the practice of sexual fakery belittles the
faker and, in continuing the dissimulation, makes reversal of the
dysfunction extremely difficult, if not impossible, most men and
women quickly move to a position of open honesty by admitting
both the fakery and the sexual distress.
FEARS OF PERFORMANCE
Regardless of whether the sexually inadequate individual is a man

or woman, homosexually or heterosexually oriented, 18 or 80 years
old, fears for sexual performance, once firmly established, rarely if

ever are permanently resolved with or without psychotherapeutic
support. Occasionally sexual opportunities may be experienced with
out the incapacitating presence of performance fear, but if the sex
ual inadequacy is not reversed effectively soon after onset, the fears
become too firmly implanted to ever be completely erased. The In
stitute’s basic method of treating the homosexual’s fears of perfor
mance is to initiate direct confrontation between the client and his
or her fears. This therapeutic confrontation is conducted in a quiet,
controlled, and positive manner by the same-sex member of the
therapy team.
For generations cultural pressures have imposed the burden of
sexual performance fears upon men, but in recent years, as a price
they are paying for sexual equality, women have increasingly shared
this cultural imposition. In discussing the techniques of homosexual
client confrontation, male impotence will be used as an example of
a sexual dysfunction that inevitably engenders fears of performance.
The problem could have been illustrated equally well by discussing
a lesbian’s anorgasmic state.
The male therapist’s insistence upon direct confrontation be
tween the impotent man and his performance fears probably con
stitutes the most important step in the treatment of the homosexual
male’s sexual inadequacy. Not only is the impotent man made to
face his Achilles’ heel directly, but there is another most important
therapeutic result. The confrontation procedures are also of vital
educational value to the committed or casual sexual partner. It is
the Institute’s position that the simultaneous education of the sex
ual partner, whether committed or casual, is theoretically almost as
important as the educational approach to the dysfunctional man
himself.
The confrontation of the impotent man must be well directed
and well organized, but it should be presented in a controlled man
ner and with a carefully projected sense of complete neutrality. The
discussion is opened by the male therapist’s quiet but commanding
statement to the impotent man that his fears of performance will
probably be with him for the rest of his life. A succinct explanation
is given that the thought processes that engendered his paralyzing
performance fears have become so deeply ingrained that they prob
ably will not be completely erased, regardless of the psychothera
268 CHAPTER TWELVE
peutic technique employed. The basic confrontation and the accom

panying explanation must be conducted with sufficient educational
skills for the impotent man and his committed or casual partner to
be made fully aware of the implications of such a disclosure; and
yet there must be no panic or undue precipitation of anxiety.
Having so confronted the dysfunctional homosexual man and
educated his partner, the vital next step in therapy is to suggest that
there is a way out of the dilemma. The procedure of choice is to
assure the impotent man that although he will never lose his fears
of performance completely, therapeutic suggestions will be made by
the therapy team, which, if followed by both partners, will enable
him to go a long way toward neutralizing the influences of these
fears.
Actually the specific suggestions presented by the therapists en
compass a high level of dyadic cooperation. In most cases, the dys
functional man is directed to select a word or brief phrase that will
serve as a “catch phrase” to alert both parties in the dyad that im
mediate cooperation is imperative. The impotent man is then spe
cifically directed to use the catch word or phrase to indicate to his
partner that at that moment he is engulfed in his fears of perfor
mance. Of course, the fears can and do occur any time, anywhere,
but he need only identify his performance anxieties when he is
overtly involved in sexual encounter.
The mere fact that the dysfunctional man will acknowledge his
performance fear when actively engaged in sexual interchange is of
the utmost importance to both partners. For the impotent man, it
not only means that he has found the courage to acknowledge
openly his performance anxieties, but the taking of such action is
concrete evidence that he is making a positive effort to help re
verse his sexual distress. For the committed or casual partner, the
sexually insecure man’s acknowledgement of performance fears may
have a possible twofold impact. First, it accentuates the trust placed
in him by the dysfunctional man; and second, it provides an op
portunity to make a contribution of significant value not only to
the sexually inadequate man, but also to a mutually supported rela
tionship, if one exists.
The two partners are instructed to follow a reasonably structured
protocol after the catch word or phrase is uttered. When the signal
phrase is verbalized, each partner should move to the other in a

mutual exchange of sexually stimulative activity. Each man is urged
to take advantage of the partner’s immediate availability by using
his (the partner’s) body for his (the individual’s) pleasure.
Generally, this open approach is a radical departure from the pre
viously established pattern of sexual interchange within the relation
ship. The sexually functional partner has frequently made the mis
take of allowing concern for his dysfunctional partner to influence
or even control the frequency of the couple’s sexual opportunities
and/or the freedom of their sexual interaction. The dysfunctional
individual usually controls the dyad’s pattern of sexual interaction
by default. The functional partner consistently expresses concern
that the impotent man might feel pressured if he (the functional
partner) were to openly admit his high level of sexual frustration.
An unfortunate result of the functional partner’s voluntary hold
back is that he unwittingly increases the impotent man’s perfor
mance pressures by leaving to him the responsibility for initiating
most of the couple’s sexual interaction.
There is another, somewhat obscured, hardship placed upon the
relationship by the functional partner who has been reluctant to
play a naturally responsive role in the couple’s sexual interchange.
As a result of his assumed pattern of sexual passivity, the func
tional partner frequently loses a sense of involvement in the dyad’s
sexual interaction. This course of passive compliability by the func
tional partner and its accompanying reduction of sexual involve
ment deprives the dysfunctional man of subjectively appreciated
sexual stimulation that develops for any individual when his part
ner reaches high levels of sexual response. Thus, the impotent ho
mosexual man who needs all the help he can get in sexual interplay
has the additional disadvantage of losing the subjectively appreci
ated stimulus of interacting with a sexually involved partner.
When in response to use of the catch phrase the impotent man
and his committed or casual partner move to each other physically
and each uses the other’s body for his own pleasure, the impotent
man is immediately subjected to three different sources of sexual
stimulation. When the impotent man uses his partner’s body for
his own (the impotent man’s) pleasure, it is indeed sexually stimu
lating. Also sexually stimulating for the impotent man is the part
270 CHAPTER TWELVE
ner’s sexual approach to his (the impotent man’s) body. Finally, if

the partner, as a result of the sensual interaction patterns, happens
to reach obviously elevated levels of sexual involvement and com
municates his high levels of sexual excitement both verbally and
nonverbally, the impotent man has a third source of sexual stimu
lation, that of an inherent subjective appreciation of his partner’s
sexual arousal.
The functional homosexual partner must not make the mistake
of approaching the dysfunctional man's body in an overt effort to
stimulate him sexually by specifically trying to help him attain or
maintain an erection. As previously stated, penile erection cannot
be willed. It can only be experienced when it develops in response
to subjectively appreciated physiologically or psychosexually initi
ated stimuli. The functional partner should always approach the
dysfunctional man for his (the functional man’s) pleasure, not
with specific intent of providing the impotent man with an erec
tion. If the functional partner approaches the dysfunctional man
with the express intent of helping him achieve an erection rather
than to enjoy his (the impotent man’s) body for his own (the func
tional man’s) self-centered pleasure, the motive of attempting to
force an erection will be subjectively recognized by the impotent
man and he will comply by trying to force an erection to accommo
date the functional partner’s presumed sexual demands. Again, no
man can will an erection. Thus, sexual failure adds to sexual
failure, the grave gets a little deeper, and the fears of performance
become more firmly fixed.
There is one more advantage in having the functional partner
please himself in self-centered sexual activity rather than act in a
passively supportive manner. If the functional partner becomes in
volved sexually, his involvement then becomes an important factor
in helping to neutralize the other great psychosexual problem of
the impotent man, that of involuntarily playing a spectator role
when he is engaged in overt sexual interaction.
SPECTATOR ROLES
As described in Human Sexual Inadequacy, the spectator role

occurs when sexually dysfunctional men and women respond to the
dominating influences of their fears of performance. For example,
271
in addition to his role as participant, the impotent homosexual man

becomes a spectator whenever overt sexual interaction develops.
When sexual interaction is joined, he agonizes over whether he is
to have an erection. If by chance he becomes erect, he can not be
lieve his good fortune, so he anxiously watches to see if the erec
tion will last. When the impotent man becomes a spectator, con
centrating on the state of his own erection, he immediately distracts
himself from the ongoing sexual interaction and negates or neu
tralizes most of the sexual stimuli that naturally develop from his
partner’s sexual approaches or his own sexual approaches to his
partner.
If the impotent man is conditioned to be a spectator, he can be
taught to direct his observational tendencies toward becoming sub
jectively involved with his partner, and not to continue self
distraction by observing his erective progress. When the functional
partner is sexually involved, the impotent man receives a stimula
tive bonus by exposure to and subjective appreciation of the high
levels of his partner’s sexual excitation.
The essence of the therapeutic message given the impotent man
is that he has been distracting himself by watching to see if there
is to be an erection. Instead, it is suggested that he watch his part
ner for overt signs of sexual arousal, because appreciating a partner’s
sexual arousal is a sure source of increased sexual involvement for the
observer. This partner observation technique is but one more thera
peutic approach to increasing the dysfunctional homosexual’s levels
of sexual involvement.
PROGRAM CONCEPTS
When dealing with problems of sexual preference, it is vital that

all health-care professionals bear in mind that the homosexual man
or woman is basically a man or woman by genetic determination
and is homosexually oriented by learned preference. In the same
vein, a heterosexual man or woman is first a man or woman by
genetic determinants and then is heterosexually oriented by learned
preference.
Of course, it must be acknowledged that there always is the pos-
272 CHAPTER TWELVE
sibility of genetic influence that increases the potential predisposi

tion of any man or woman to respond to homosexual rather than
to heterosexual stimulation. While the possibility of such a factor
is unarguable, there currently is not any convincing evidence to sup
port this contention. Since there is no such evidence to date, it would
be most unfortunate to continue support of current cultural con
cepts of the origins of behavioral patterning of homosexual commit
ment. There must no longer be blind support of cultural concepts
that are obviously based on the vagaries of supposition, presumed
potential, or scientifically unsupported contention.
For many decades, cultural bias and specific religious tenets have
engendered public opposition to homosexual relationships. It is also
obvious that these prejudices have existed in the health-care disci
plines, where above all else professional neutrality should exist. As
previously noted, Tables 12-5 and 12-6 fully support this conten
tion. Thus, a major problem is raised for the practicing psycho
therapist. What attitudes should he or she bring to the evaluation
and treatment of homosexual men’s and women’s sexual inade
quacies?
Primarily, the therapists must realize that homosexuality is not a
disease. The therapists must also realize that homosexual dysfunc
tion or dissatisfaction should only be treated if or when requested
by the client. Any treatment conducted to support conversion or
reversion to heterosexuality should only be initiated at the request
of and with the full support of the client. Such therapy should only
be undertaken after careful evaluation of the applicant’s history to
assure high levels of motivation for change, and after careful self
scrutiny on the therapists’ part to be sure that a heterosexual bias
does not exist.
In other words, the goal in therapy should always be stated by
the client. A basic concept of the Institute’s treatment method is
that the therapy team does not have the right to impress its con
cepts or its principles upon the client. The client’s social or sexual
value systems are those that must be accepted and worked with in
the therapeutic process, NOT those of the therapists.
Thus, the Institute's concepts for treatment of homosexual dys
function or dissatisfaction are: Treat such dysfunctions or dissatisfac
tions with the same psychotherapeutic techniques, with the same
professional personnel, and with the same psychosexual objectivity

with which heterosexual dysfunctions are treated. In general, the re
sults should approximate or improve on those returned from treat
ing heterosexual dysfunctions. The Institute’s only real reservation
is that the sexually inadequate homosexual, particularly the man or
woman who is sexually dissatisfied, must offer the therapist the
same level of cooperation as that provided by the sexually distressed
heterosexual if equally positive results are to be obtained. To date
this level of open cooperation has not been fully accomplished.
I?
MALE HOMOSEXUAL
DYSFUNCTION
For the first time, impotent homosexual men have been treated
for sexual dysfunction as an integral part of a io-year controlled
program of clinical evaluation. They have been accompanied in
therapy by their same-sex committed or casual partners. Because
such a long-range treatment program has not been described previ
ously, discussions of investigative background, recruitment proce
dures, therapy principles, clinical syndromes, and presentations of
relevant case reports are in order.
Fifty-seven homosexual men were treated for sexual dysfunction
by the Institute during the io-year clinical control period (1968
through 1977). Five of these men were primarily impotent, 49 sec
ondarily impotent, and 3 sitúationally impotent (see Table 12-1,
Chapter 12). Four of these 57 men were additionally diagnosed as
sexually aversive. Actually, the 57 men constituted 56 couples, since
1 couple was formed by 2 primarily impotent men, 1 of whom was
additionally sexually aversive. All of the committed or casual homo
sexual partners in the remaining 55 couples were sexually func
tional.
The laboratory investigation of homosexual men’s and women’s
sexual physiology (see Chapter 7) was the first step leading toward
a treatment program for dysfunctional homosexual males and fe
males. As knowledge of the physiology of homosexual function ac
cumulated, the concept of treating existent homosexual dysfunction
seemed increasingly plausible, and satisfactory therapeutic results
appeared attainable.
274
MALE HOMOSEXUAL DYSFUNCTION
275
RECRUITMENT
Sexually functional homosexual male and female couples were re

cruited from many metropolitan and/or academic centers through
out the United States to cooperate with the preclinical research
programs (see Chapter 1). When these couples returned home,
word spread quietly within the homosexual community, not only
of the Institute’s research interests in homosexual function, but of
the treatment programs being developed in St. Louis for sexually
inadequate male and female homosexuals.
The first request for treatment of male sexual dysfunction came
from a situationally impotent male who was accompanied by a
casual partner, and the second request came from a primarily im
potent male who was treated with his committed partner. Both
couples lived far from St. Louis. These 2 men represented the sum
total of the sexually dysfunctional homosexual males treated by the
research team in 1968, the first year of the 10-year period of clinical
control. As knowledge of the treatment programs spread slowly
through the homosexual community, 2 cases of impotence were
treated the second year, 6 the third year, and 4 the fourth year.
During the fifth year, 7 impotent men and their same-sex partners
were treated by the research team. For the last five years of the
clinical control period, 7 admissions per year has been the approxi
mate level of case intake for treatment of homosexual impotency
(Table 13-1)..
TABLE I3-I
Homosexual Male Impotence =

Distribution by Year During the 10-Year Clinical Control Period
Year Treated
Type of
Impotence One Two Three Four Five Six Seven Eight Nine Ten Total
Primary 1 0 3 0 0 0 1 0 0 0 5
Secondary 0 2 3 4 6 7 8 6 7 6 49
Situational 1 0 0 0 1 0 0 1 0 0 3
Total 2 2 6 4 7 7 9 7 7 6 57
(1968-1977)
276 CHAPTER THIRTEEN
PRIOR AVOIDANCE OF TREATMENT
While the total number of impotent homosexual males treated

over a 10-year period by the research team is not large, the fact that
such a treatment program was in existence represented a major
breakthrough in health care. For the first time, sexually dysfunc
tional homosexual men were requesting therapeutic support with
firm anticipation of professional cooperation and with a reasonable
chance of successful treatment. Why had it taken so many years
for sexually dysfunctional homosexual men to seek health-care sup
port with some degree of confidence? Of course, a variety of reasons
were expressed by the client population in response to specific in
terrogation, but three fears, apparently widespread in the homo
sexual community, seemed to dominate the answers to this ques
tion. They were: (1) the homosexual male’s fear of rejection by
health-care professionals when requesting psychotherapeutic sup
port, (2) his fear of treatment failure, regardless of the type of
therapeutic approach, and (3) his fear of social exposure during or
after the treatment process.
Even casual scrutiny of Table 12-5 (see Chapter 12) will clearly
identify the validity of the first fear—the sexually dysfunctional
man’s fear that he would be denied treatment as soon as his homosex
uality was identified. There is also further evidence of the health
care professional’s refusal to accept sexually dysfunctional homo
sexual men in therapy. When the Institute’s clinical treatment
programs for homosexual dysfunction were initiated in 1968, no
report was found in a search of the literature of any therapeutic
attempt to reverse a homosexual man’s basic complaint of im
potence while allowing him to maintain the full integrity of his
homosexual commitment.
The second fear, that of treatment failure, has been reflected by
the dysfunctional homosexual males’ extreme reluctance to seek
professional aid for an established state of impotence. It is reason
ably safe to assume that such attitudinal negativism with its accom
panying therapeutic nihilism developed because clinical experience
had convinced both the homosexual population and the health-care
community that psychotherapy directed toward the homosexual
MALE HOMOSEXUAL DYSFUNCTION 277
male (and previously confined to attempts to convert or revert him

to heterosexuality) would not be particularly productive.
Actually, the Institute’s decision to differentiate between the
widely differing clinical problems of homosexual dysfunction and
those of homosexual dissatisfaction has no precedent in psycho
therapy. Understandably, sexually dysfunctional homosexuals felt
that they had the same relatively poor treatment prognosis as those
who were sexually dissatisfied. In addition, remembering that in
1968 the general literature on the treatment of sexual dysfunction
in heterosexuals was indicative of less than a high rate of success
with therapeutic approaches that were time-consuming and expen
sive, it is little wonder that the impotent homosexual male had a
real fear of treatment failure.
In order to provide perspective for the Institute’s fledgling ther
apy program directed toward homosexual dysfunction, it might be
recalled that 10 years earlier, when treatment programs for hetero
sexual inadequacy were originally constituted, the same fears of poor
clinical results were widely prevalent among both the sexually dys
functional heterosexual population and the health-care professions.
The third fear, that their sexual problems would become public
knowledge, has been the overriding reason why so few dysfunctional
homosexual males have sought treatment for impotence in the past.
Male homosexuals have had little confidence that health-care pro
fessionals would provide them with the degree of security normally
anticipated in a client-therapist relationship. In all probability, this
protean fear of social exposure has a far higher incidence among
dysfunctional men than the combined incidence of the two previ
ously mentioned fears of treatment refusal and treatment failure.
Actually, the long-standing obsession of both men and women
(homosexual and heterosexual alike) with possible identification of
their sexual dysfunctions by the public or even by their sexual part
ner has been of such paramount importance that it has led not
only to avoidance of therapy, but also to the widespread practice
of a self-protective mechanism identified by Institute personnel
under the all-inclusive term of sexual fakery (see Chapter 12).
PRIMARY IMPOTENCE
In a sense, primary impotence is the ultimate in male sexual dys

functions, for a man so stricken, whether homosexually or hetero-
sexually oriented, rarely develops a secure place in society. Unfor
tunately, he is so consumed with his psychosexual handicap that
it assumes an all-pervasive control of his life. Since primary im
potence of homosexual origin has not been considered previously,
case reports will be presented in detail. No suggestion is made that
these reports are generally typical of primarily impotent homosexual
men. There have been so few cases to treat that the research team
has no concept of what constitutes the general behavior pattern.
Five primarily impotent homosexual men were treated by the re
search team during the 10-year clinical control period. In each in
stance, the dysfunctional men were accompanied in therapy by
committed partners. All 5 men responded positively during the
acute phase of the treatment program, but there was one treatment
failure. Approximately a year after the acute phase of treatment,
1 man experienced the return of erective insecurity. He lost con
fidence in his ability to interact sexually with his committed partner
during episodes of partner manipulation and fellatio. Within a
month’s time, fears of performance so overwhelmed him that he
ended his long-term relationship and reportedly withdrew from
social or sexual encounter. Masturbational activity served as his
only form of sexual release. The man refused to return for further
treatment and also refused continuing cooperation with routine
follow-up procedures.
On the basis of results obtained during the rapid-treatment phase
and of five years of follow-up information, the other 4 primarily im
potent homosexuals were not treatment failures. Statistical consid
erations of the treatment program are presented in Chapter 17.
CASE REPORT: COUPLE 1
Certainly the most psychosexually dysfunctional couple treated

by the research team was a committed dyad of two men seen dur
ing the third year of the program. For identification purposes, the
279
two men have been labeled Couple 1 and individually identified as

Partner A, who was primarily impotent, and Partner B, who was
also primarily impotent, and, in addition, sexually aversive. Because
of the uniqueness of their plan of treatment, their case history will
be presented in some detail.
Partner A, 34 years old, and Partner B, 29 years old, had been living
in a committed relationship for approximately three and one-half years
when they sought treatment as a sexually dysfunctional couple. Although
from quite different backgrounds, the men had a unique commonality in
the etiology of their sexual dysfunctions. As individuals, they unknow
ingly moved into what was to become an intensely committed homosex
ual relationship as an involuntary means of escape from years of psycho-
sexual trauma that in both instances had been heterosexual in origin.
For over three years, their relationship had been entirely asexual in
character. It had become a satisfying psychosocial haven before the
two men finally moved into attempted sexual interchange, an attempt
that was completely unsuccessful.
A, a second sibling with a sister eight years older, grew up in an at
mosphere of female dominance. His father left home when A was 4,
and his mother worked to support the family, frequently holding two
jobs. With the exception of weekends, this work schedule usually kept
her out of the home during the majority of the children’s waking hours.
A’s older sister was given the responsibility for her younger brother after
she reached 15 years of age. After that time, there was essentially no
supervision in the home. There also was no importance assigned to edu
cation, nor was there any attempt to establish a religious influence.
When A was 9 years old and his mother was at work, his 17-year-old
sister began a series of attempts to masturbate the boy. When repeatedly
unsuccessful, she frequently shamed him by telling him he would never
grow up to be “a man.” These episodes of attempted sexual interaction
continued approximately twice a month for more than two years. Usu
ally little or no erection occurred. There was no ejaculation. The boy
never made a sexual approach to his sister. His reactions to her sexual
approaches were described as ranging from strong resistance to passive
acceptance. Finally, on one weekend when the mother was out of town,
the sister had two female friends spend the night. The three girls appar
ently spent hours trying to masturbate the boy, now 11, two of them al
ways holding him to keep him from running away. Their repeated as
saults produced recurrent penile engorgement, but no ejaculation. He
recalls crying and begging them to stop, for it was a very painful as well
as frightening experience. The girls were apparently extremely vigorous
in their manipulative attempts, as the penis was rubbed raw in a num
ber of areas. When finally released by the girls, the boy couldn’t void
z8o CHAPTER THIRTEEN
for hours and, when finally successful, noticed gross blood in the urine.
A was both mortified and terrified. The girls had threatened to tell
his friends that “he wasn’t a man” if he told his mother about their
assault. Yet he was fearful of both the bloody urine and the fact that he
had difficulty voiding, both of which lasted several days. In addition, his
penis was very painful for many days after the episode. Even at 11 years
of age, however, his fear of exposure to public ridicule won out over his
concerns for the physical aftermaths of the attack, and he kept his own
counsel. This was the last time his sister approached him sexually.
The symptoms of the physical trauma cleared, but not those of the
psychosexual trauma. Fearful that word would be circulated of his in
adequacy, the boy withdrew from friends at school and had many mis
erable nights as his anxieties and vengeful fantasies reigned unbridled.
As he grew older, he became essentially antisocial. Stimulated by the
onset of nocturnal emissions, his first attempt to masturbate at age 16
was an utter failure when he couldn’t obtain an erection. The failure
only reinforced the image created by his sister and her friends that he
was sexually inadequate. As he grew older, his generalized sexual anxi
eties became specific apprehensions at the thought of “making out” with
a girl, as was frequently discussed by his peers, for he was afraid that
“making out” might be painful and was certain he would be a failure.
At age 23 A gathered his social courage and made his first attempt at
intercourse by soliciting a prostitute. Following the usual pattern of
many men contending with anxieties for sexual performance, A chose
the prostitute knowing that if he failed, his friends wouldn’t know. As
would be expected, he was totally impotent. Again he was told he
“wasn’t much of a man,” and having conclusively proved this fact to
his own grim satisfaction, he never attempted to interact sexually with
a woman until after meeting Partner B.
A sublimated his sexual needs. He lived alone, worked hard, and was
advancing well in his profession. Masturbation was attempted on rare
occasions, usually after he had been drinking, but it was always unsuc
cessful. He could not maintain erections and was never able to ejaculate.
He had no overt homosexual interests, nor were there fantasies of spe
cific homosexual content. His most frequent fantasies were of exacting
revenge upon women in general and his sister in particular to make up
for what had been done to him.
Partner A met Partner B as a staff member of the company for which
he worked. B had been transferred from out of town and was apartment
hunting. A offered B the use of his apartment until B “could find some
thing of his own.” At history-taking, A had no explanation for this quite
uncharacteristic behavior, nor did B have any reason other than con
venience for his acceptance. Yet, in a brief period of time and to the
complete surprise of each, the two very lonely men came to like each
other so much that they decided to continue living together.
B was an only child in a reasonably well-to-do family. The most vivid
memories of his childhood revolved around sexual activity—that of his

mother and father. He couldn’t remember when he first heard his mother
protesting loudly from behind the closed doors of the parents’ bedroom.
It seemed to him that she had always suffered from physical abuse by
his father. By the time the growing boy was 10 years old, the mother
probably was fully aware that he must be anxious—even frightened—
by his parents’ continuing bedroom conflict. She began privately describ
ing to the boy the horrors suffered by women while sleeping with their
husbands. Sex was portrayed as a wickedly sinful act, as something
women should only be expected to tolerate to have children, and as
men’s vengeance upon unprotected women. The boy learned to hate
weekends when his father, who traveled extensively on business, was at
home, because that was when episodes of his mother’s forced sexual
participation and her accompanying cries of rage or pain (the boy was
never sure which) usually occurred.
The boy grew up in a home that was devoid of warmth and was dom
inated by an angry, unhappy, possibly lonely wife who released her frus
trations by vigorously supporting an extremely orthodox Catholic com
mitment for herself and her son.
At age 12, B was so upset during one particular episode when his
mother’s loud cries of protest seemed to go on much longer than usual
that he rushed into his parents’ bedroom and apparently saw them in
intercourse. He was convinced that his father was seriously hurting or
even killing his mother, and he tried to separate them physically. His
enraged father jumped from the bed with a full erection, knocked the
boy down, threw him out of the room, and locked the door. The boy
was further traumatized when his mother’s screaming soon redoubled
in intensity. B vividly recalled the threatening sight of his naked mother
trying to hide from him under the sheets and his first sight of a full
erection when his father attacked him.
Shortly thereafter, the father left the home, and although he appar
ently continued to provide financially, he never returned. But the boy
was still subjected to his mother’s horror stories of sexual assault—she
repeatedly described his father’s bestiality and told him of the disgust all
decent women felt for men’s uncontrollable sexual appetites. As he
moved through his teenage years, the boy dreaded the possibility that
he might grow up to be an animal like his father.
B was horrified when he awoke one night with a full erection at age
17, and he was overcome with a sense of guilt and disgust when his first
episode of nocturnal emission occurred at age 18. He showered for an
hour to wash away the signs of his male sexual weakness. Whenever he
overheard his peers talking, telling real or imagined stories or joking
about sex, he always grew anxious, frequently was nauseated, felt faint,
and quickly moved away from the storytellers. B was developing a gen
eral aversion to sexuality.
His mother had insisted upon a Catholic education for him. During
his teens his every sexual thought was routinely repressed and just as
routinely confessed. His psychosexual trauma was reinforced by religious
dogma, and B never attempted to masturbate. His occasional nocturnal
emissions caused him great anxiety, for he did not want to acknowledge
any part of man’s bestial nature. He was so threatened by any thought
of sexual content that he never had a social date with a girl in his life.
The thought of any manner of sexual interaction with a woman made
him quite anxious.
After his mother’s death when he was 20, B lived with an aunt,
finished college, and went to work. At age 24 he was promoted and
transferred to another city by his firm. He met a man (Partner A) who
was also working with the firm and who offered to share his apartment
while B looked for one of his own. As previously described, mutual com
patibility was soon evidenced, and the two men decided jointly to con
tinue living together to share expenses and enjoy each other’s company.
The first six months A and B lived together were spent breaking
down social defenses and establishing the first real friendship either man
had ever known. One weekend and well into the next week they told
each other every detail they could recall of the painful episodes of their
past lives. Social fears and anxieties were first confessed, and finally
sexual fears and anxieties were broached. Eventually, the catharsis of
confession brought such a state of complete vulnerability that both men
were encouraged to give a full exchange of the vividly remembered de
tails of the psychosexual traumas in their lives.
Each man found it almost impossible to believe that the other part
ner had never successfully experienced any form of sexual activity. They
both had thought themselves totally unique as severe sexual cripples. The
relationship was strongly reinforced by the mutual vulnerability derived
from the full confessions of their personal feelings of complete sexual
inadequacy.
Over the following year, each man encouraged his partner to estab
lish social relationships with selected women, but without success. After
two such trials by A and one very abortive, anxiety-ridden attempt by
B to talk with a girl in a bar, the men openly discussed their problems,
realized that their sense of social inadequacy was strongly reinforced by
their complete lack of sexual confidence, and following A’s now some
what time-worn suggestion, they decided to solicit help from a prosti
tute. Obviously neither A nor B had access to any other source of fe
male sexual cooperation. A prostitute was solicited by A and brought to
the apartment to spend the night. As might be expected, the experiment
ended in disaster. The first sexual venture was in A’s bedroom. During
more than an hour’s time with the prostitute, he failed to respond to
any sexual approach. B was initially so anxious, continually so nause
ated, and after an hour so terrified of even touching the woman that he
refused to try when it was his tum.
During the next two years these two men grew even closer together.
They worked well together professionally and were inseparable socially.
There were no further attempts at heterosexual interaction. Actually,
neither partner expressed interest in female companionship of any kind.
A continued his attempts at masturbation once every month or so, con
sistently without success. Despite occasionally considering the possibil
ity, B made no attempt to masturbate. Until the relationship had lasted
more than three years there were no overt or covert homosexual over
tones, although each man reported that a few times he fantasized some
vague form of physical interaction with his friend. The fantasies were
only of physical warmth or of general body contact. Neither A nor B
reported daydreaming of specific sexual activity.
One night, after both men had spent several hours in a bar, A openly
stated his masturbational need and retired to the privacy of his bed
room, where he again failed to masturbate successfully. B heard A sob
bing and went to comfort him, only to be confronted by his naked
friend with a full and threatening erection. B was immediately nauseated
by seeing the erection, but he still moved to comfort his anguished
and inebriated partner. A begged him to help, saying he would rather
die than live this way. Despite his intense aversion to the erection, B
clumsily attempted to release his partner, only to have the erection dis
appear soon after he approached. For both men the return from the
episode was more in a positive than a negative vein. Despite A’s func
tional failure, the experience broke down any barriers that still may
have remained in the relationship.
Within the week the partners had agreed to try mutual masturbation.
Although neither man ever approached the other physically, A tried to
teach B by demonstration what little he knew about the subject. B still
became quite anxious when observing the comings and goings of his
partner’s erections, but they persisted in their mutual masturbational
attempts. Neither B nor A reported successful termination to their
mutual masturbational experiences. Sometimes fleeting erections were
achieved, sometimes not, but neither man ever ejaculated. Yet, each
man described an increasingly strong sense of personal need to prove
that he could function sexually as a man and the sincere hope that his
partner would also be sexually successful. Careful questioning clearly
established that neither man ever considered himself as being homo
sexual.
The couple came to the Institute for treatment neither as men

committed to heterosexuality nor as men jointly or individually
considering a homosexual commitment, but rather as two men
deeply devoted to each other and in sincere need of psychothera
peutic support. Neither man even implied that he had a sexual role
preference. Their mutually voiced demand was “to learn to func

tion sexually.” They looked to the Institute for support and direc
tion and were accepted in treatment on these terms.
The men had a difficult decision to make. Their available alter
natives in treatment were to become sexually effective homosexuals
or sexually responsive heterosexuals or both. Exhaustively defined
histories underscored the virtual impossibility of either man estab
lishing an ongoing heterosexual relationship within the foreseeable
future. The use of surrogate partners was considered, but since there
was no hope of finding immediately available female sexual part
ners when the men finished the acute phase of treatment, the pos
sible role of sexual surrogates was forfeited. Both partners’ severe
levels of social insecurity and B’s state of overwhelming anxiety at
the thought of even a social, let alone a sexual, relationship with a
woman, were also contributing factors in their treatment decision.
Previous work has pointed up the possibility of reversing a man’s
homosexual orientation that has resulted from severe heterosexual
trauma at an early age. While both A and B were subjected to se
vere sexual trauma of heterosexual origin at an early age, neither
man had responded by openly embracing homosexuality, nor could
either man function sexually in any manner. If either man could
be considered homosexually oriented, it would be Partner A. He
did offer to share his apartment for no reason he could or would
declare. On one occasion, when a masturbational effort had failed
and his defenses may have been lowered by alcohol ingestion, A did
ask for sexual help from his partner some three and one-half years
after they initially decided to live together. The two men did
attempt mutual masturbation and, most important, they were ob
viously devoted to each other. B had a history of rejection of
women in general, but he also became severely anxious at the sight
of the male erection. Each man denied that he had ever thought of
himself as homosexual. Although presuming that they were hetero
sexual, both men also stated that they had no interest in heterosexual
interaction.
In the research team’s clinical judgment, neither A nor B could
be arbitrarily labeled homosexual, nor could they be considered het
erosexual. They were evaluated as two men who, due to the pressure
of circumstances, were currently living without an established sexual
preference. Although admitting to continuing levels of sexual ten

sion, neither man’s physical need had been targeted.
In view of the investigative material presented in the preclinical
section of this text, it should be underscored that the Institute does
not utilize the diagnosis of latent homosexuality or, for that matter,
that of latent heterosexuality. But, if the concept underlying such a
diagnosis was applied to these two men, in truth one would have to
say that their basic sexual orientation was latent or undifferentiated.
The basic concern expressed by both men was that they could
not function sexually; they were mutually agreed that they wanted
to alter this aspect of their lives. There was no question that they
were primarily impotent, regardless of whether they were judged by
heterosexually or homosexually defined criteria. Certainly, it was
the psychosocial distress occasioned by their sexual inadequacies
that brought the two men to therapy—not any concern for sexual
preference.
The problem of how best to treat the individual sexual dysfunc
tions was discussed in all of its ramifications with both partners.
For B, the potential influence of his Catholic background on his
future comfort with any decision made was emphasized for both
partners’ consideration. Each man quietly made his own decision
on the basis of the information at hand. They were decisions with
which the research team was in full concurrence, but it should be
emphasized that the decisions were not made for A or B by the
research team. The partners decided that they had the best chance
of functioning sexually by interacting with each other. Thus, this
case is reported as a specific decision made jointly by two men to
request professional assistance in orientation to full homosexual
commitment. In addition, they requested continuing professional
support during their transition phase. The research team responded
positively to their requests.
The course of therapy was relatively uneventful. Initially, thera
peutic attention was directed toward B’s sexual aversion. Sensate-
focus opportunities * were initiated while the genitals of both part
ners were off limits, and this anxiety-reducing approach was
continued until B could touch his partner’s body with comfort and
even with a tentatively expressed sense of pleasure. A was fully co-
* Masters and Johnson (1970).
operative and made no attempt to push B to higher levels of in

volvement. B made rapid progress, due in no small part to the fact
that he had taken giant strides to neutralize his sexual aversion to
masculine sexual anatomy when he had participated in the couple’s
attempts at mutual masturbation.
When overt sexual involvement between the two men seemed
indicated, B was again the research team’s initial therapeutic target.
It was felt that A’s many failures at masturbation had created such
elevated fears of performance that the best way to neutralize these
anxieties was through B’s demonstration of a successful masturba-
tional experience. Technical suggestions were made, and B did re
spond successfully within 24 hours, ejaculating in A’s presence much
to the delight of both men. It was B’s first ejaculatory experience
other than during episodes of nocturnal emission. Attention was
then focused on A, and with different suggestions for masturba-
tional techniques based upon his own negative past experience, A
also successfully reached orgasm as he followed B’s example.
Taking therapeutic advantage of the euphoria created by their
first individually successful sexual experiences and the significant
degree of anxiety reduction that had already occurred, it was but
a short step to successful mutual masturbational experiences.
It would be a serious clinical mistake to assume that therapeutic
procedures only involved improving the impotent men’s masturba
tional techniques. To avoid such an assumption, the technical sug
gestions have not been described. The mere mechanics of sexual
function could never provide sufficient building materials to create
and support an empathetic, secure relationship. Without the un
qualified support provided each man by his partner, the most so
phisticated of sexual gymnastics would probably have been of little
value in altering either man’s personally repugnant state of primary
impotence.
At this point in therapy, the research team pointed out to the
couple that they had the option of remaining at their present level
of sexual interchange rather than moving further into overt homo
sexual interaction. For two days the men continued with successful
mutual masturbational experiences while considering their options
at great length. Apparently they were both concerned, because B
was still apprehensive about approaching A’s genitals and was even
more concerned about having A approach him sexually. B resolved

the problem by deciding not to let past traumatic experiences stand
in the way of continuing expansion of mutual sexual interaction.
The sexual neophytes moved through partner manipulative ex
periences with little difficulty. A failed to maintain an erection
during their first joint venture, but he responded successfully dur
ing a second opportunity. As expected with his aversive background,
B had major difficulties with fellatio, both in approaching A’s erect
penis and in allowing A to approach him orally. Although he func
tioned effectively in both situations, he was not pleased with or
even highly stimulated by fellatio. B’s level of anxiety was at a
higher level when his penis was in his partner’s mouth than when
he was fellating A. On the other hand, A enjoyed the experience
of mutual fellatio more than that of partner manipulation.
This couple was followed for five years after the acute phase of
therapy was terminated. They continued as a closely knit, most ef
fective social partnership and as a fully responsive sexual dyad. B’s
continuing reluctance to participate in fellatio necessitated an al
teration in their sexual behavior pattern. He compromised by learn
ing to fellate A with some degree of comfort, but he requested
manipulation rather than fellatio when A approached him. There
was no description of attempting rectal intercourse.
Neither man ever expressed interest in establishing a continuing
heterosexual relationship, nor for that matter did either partner
make a move toward interacting sexually with another man. They
continued to live essentially asocial lives, confining their public so
cial activities, whether with men or women, to those required by
their professional commitments.
Three other primarily impotent men were treated by the research
team during the 10-year period of clinical control. These men had
similar case histories typical of the environmental influences which
apparently make a major contribution to the ultimate selection of
a homosexual life. Each of the 3 men was accompanied in therapy
by a committed partner. The committed partners’ sociosexual back
grounds (although of significant importance to therapy) are not
described in full detail due to space restrictions.
C, a primarily impotent homosexual, was 31 years old when he sought

treatment from the Institute accompanied by his committed homosex
ual partner.
C could never remember when his mother and father were not polar
ized in their value systems or attitudes toward child care, yet he also
recalled his parents’ high level of mutual devotion. He was the younger
of two brothers. His older brother (by four years) was an extrovert,
well coordinated, an excellent athlete but at best a fair student. His
father was openly delighted with the elder brother’s athletic prowess,
while his mother was sincerely distressed with his academic mediocrity.
C was apparently an introvert as a child and overweight during
adolescence. He was poorly coordinated physically and could never play
boys’ competitive games with any success. In this area he was a disap
pointment to his father. But his excellent grades pleased his mother.
As a boy there was required attendance at a Protestant Sunday school,
but neither of his parents evidenced much religious conviction.
When his elder brother went to college, C was starting high school.
As the only child in the home, he continued to receive mixed messages
from his parents. His father was concerned with helping the boy im
prove his physical image and social attitude. His mother was oriented
to academic and intellectual pursuit. Both parents felt that if he im
proved in their area of interest he would be far happier, for his was an
essentially antisocial existence. C remembered his high-school years as a
reasonably pleasurable existence while at home, but as a depressing ex
perience in social interaction at school.
He had no friends. When he couldn’t compete in games, he with
drew from his male peer group. There were no female peers as friends
either. This lack of interest in girls originated more from a sense of re
jection by them rather than from lack of interest on his part. For plea
sure he read extensively, evidenced some real talent with the violin, and
ate constantly.
Possibly resulting from envy of his older brother’s physical coordina
tion and outgoing personality, C could not remember when he wasn't
intrigued with the male body. He admired the high-school athletes’
muscles and always surreptitiously observed and compared genitals
when he shared the shower room. H was delighted when, to his surprise,
he found that in a flaccid state his penis was as large as or larger than
theirs.
He had begun to play with his penis when he was 13 and was in
trigued when it enlarged and disappointed when it lost engorgement.
Since he had no male friends nor even a close relationship with his
elder brother, there was no real source of sexual information. Neither
parent ever talked to him about sex, but at 14 he was given a book to
read on this subject.
As C moved through his early teens, he became more concerned
about his appearance, lost a large amount of weight, and attempted to
establish male relationships.
A major sexual trauma occurred during C’s fifteenth year. Although
he had tried a number of times, he had never masturbated successfully.
By this time he had acquired his first friend, a boy from his class who
also was struggling with social handicaps. One evening after both boys
had been talking about sex, C showed the boy how he played with his
penis. Although C reportedly only demonstrated penile manipulation
with his own penis and never moved to or even thought of approaching
his friend’s genitals, the boy told his parents about the incident. These
parents in turn not only told C’s parents but many other parents and
the high-school administrators as well. The friend’s parents insisted that
C was an active homosexual who had tried to seduce their son and that
he was a threat to all the boys in his class. Of course, the word immedi
ately spread through his peer group. He was ostracized socially, made
the butt of jokes by both boys and girls, and was frequently attacked
physically by his male peers. C’s family, severely distressed by the trauma
their son was experiencing, sent him away to school. (Whether C’s story
is the true version of the event with his friend is, of course, open to
question. But when interviewed at length, and with nothing to gain or
lose, C held staunchly to the theme.)
C never recovered from his public humiliation. He hated to come
home for vacations, and when home, he rarely left the house. He finally
accepted public opinion that he was homosexual; as a result, he was
certain that he was considered unacceptable socially by his peers. His
fantasies were of both homosexual and heterosexual content but were
primarily focused on the penis. Thus, C was actually socially oriented to
a homosexual preference role well before his first overt homosexual ex
perience.
One night during his second year at boarding school, his roommate
moved into C’s bed. C was not only comfortable with this overt sexual
approach, he welcomed the sexual opportunity. Both boys played freely
with each other’s genitals. When the roommate quickly erected and
ejaculated, C was quite surprised, for he had never had this experience.
He was both intrigued with his friend’s ejaculatory experience and em
barrassed that he could not do the same. He attempted to masturbate
many times privately, always trying to force an erection and an ejacula
tion, but he rarely had a full erection and never an ejaculation. C be
came increasingly anxious about what he presumed was further evidence
of physical weakness comparable to not being well coordinated enough
to excel at competitive games.
The boys continued their sexual encounters, always with the friend
ejaculating quickly. C became increasingly anxious when he couldn’t

ejaculate and, worrying about his sexual prowess, soon lost most of his
ability to achieve or maintain an erection. However, he did leam to
enjoy relieving his partner.
C visited the boy’s home during a vacation and learned fellatio from
one of the boy’s friends. He spent the vacation fellating the two boys
daily, thoroughly enjoying himself in the process although he rarely had
penile engorgement. Even though the two boys tried to help several
times, C could not respond to either manipulation or fellatio.
Thereafter, C’s sexual interests and activities were homosexually ori
ented. He was quite active sexually when in college. He always serviced
his partner and never allowed an approach to his genitals, since he was
afraid his inability to achieve or maintain an erection would be dis
covered and discussed.
He rarely interacted with girls. At age 23 there was one abortive sexual
episode when a girl moved to play with his genitals as he drove her home
from a symphony concert. No erection occurred, and he never saw the
girl again.
By the time he finished college and moved into the business world
as an accountant, C was an active, cruising homosexual. He frequented
gay bars and had a large number of casual sexual partners. He manipu
lated men freely, practiced fellatio routinely, was the penetratee in
rectal intercourse occasionally, and enjoyed himself thoroughly.
Finally at 29 he met and became socially committed to a man who
was five years older and who had been an active homosexual for six
years. This man gave a history of a failed marriage based on sexual
refusal by his wife and had moved into homosexual activity after a
divorce.
C and his partner had lived together for almost two years when seen
in therapy. They had approached two other professional sources in the
hope that C could leam to interact sexually with his partner in other
than a service role. In both instances they had been refused treatment
and given no referral to another potential source of psychotherapeutic
support.
When C and his partner entered therapy, C had never ejaculated in
response to any form of sexual stimulation with the stated exception of
nocturnal emissions. These reportedly occurred approximately once every
seven to 10 nights and had continued at this level since onset when C
was 15 years old.
What had not been appreciated by the partner or initially by the
research team was the extent of C’s fears of performance as a sexually
dysfunctional man and his paralyzing fear that his sexual dysfunction
would be revealed publicly. He had kept these fears well hidden. C had
previously avoided any opportunity at a committed relationship, not
because he didn’t want or need the warmth and security of such com
panionship, but because he feared that his dysfunction, once revealed

in the relationship, would become common knowledge among his peer
group.
His sexual fakery had, of course, placed him in an almost inextricable
position. His entire sexual experience, one of sexual service, had been
portrayed to peers in his homosexual community as a role of his own
choosing. Time and again he reiterated the position that he thoroughly
enjoyed releasing a partner by manipulation or fellatio—and he did—
but that he had no real need for the partner to provide him with release.
This was hardly the truth, but it was good sexual fakery. What he did
not admit to his peer group was that time and again during or after
sexual encounters he had testicular aching, pain in his groin, and often
had prayed for some means of release from his masked sexual tensions.
When he tried to masturbate, and he often tried, he usually could not
achieve, or maintain a full erection. He was always too fearful of
erective failure and possible exposure to allow a casual partner to
attempt manipulation or fellatio.
Only after several months in his committed relationship did C make a
clean breast of the degree of his sexual dysfunction to his partner. The
partner then tried diligently and with a surprising degree of originality
to relieve C, but without success. As more than a year passed and the
committed relationship remained one-sided sexually, evidences of strain
developed in the two men’s social interaction. C’s partner had repeatedly
suggested that C seek treatment for his dysfunction, and C just as
steadfastly refused.
Finally, the partner took the position that C either seek aid or he (the
partner) would regretfully terminate the relationship. The partner was
only too aware of the destruction that can be wrought in a relationship
when there is a persistent level of sexual dysfunction or dissatisfaction,
since he believed he had lost a valued marriage for this reason. He did
not want to see their relationship end in strife or bitterness, preferring
a quietly agreed upon separation rather than to continue facing the
usual consequences of continued tensions related to C’s sexual dys
function.
C finally accepted the fact that his partner was adamant in his
demand that he seek help. As described, C did approach two other
therapy sources that would not accept him in treatment before the cou
ple requested and were accepted in treatment by the Institute.
Therapy problems centered almost exclusively around C’s fears

of performance. His fears of public identification with his dysfunc
tion had been reasonably allayed by his sense of security in the
relationship, his own voluntary admission of his sexual fakery, and
the fullness of the commitment so frequently expressed by his part
CHAPTER THIRTEEN
29«
ner. But by far the most important positive force in therapeutic

progress was the free, open cooperation of C’s committed partner.
C’s fears of performance were as strongly entrenched as any that
had been previously treated by the therapy team. The problems that
arise in the treatment of fears of performance have been discussed
in Chapter 12. Early stages of sensate-focus experiences provoked
severe levels of anxiety for C, particularly when it was the partner’s
turn to approach C’s body and even though the genital organs were
off limits by direction of the therapists.
C repeatedly stated that he loved to touch his partner’s body but
that he was most anxious when the partner approached him. His
established behavior pattern was severely resistant to alteration. But
over a period of four days, confidence was gained and comfort ex
pressed with general body touching. Then mutual genital approach
was encouraged. At first C failed to achieve an erection when the
genitals were placed on limits to manual exploration, but in 48
hours he was repeatedly experiencing though not maintaining
full erections. C was by this time also suffering from testicular en
gorgement and was most uncomfortable with groin pain.
Early in the second week of therapy, during an episode of slow,
nondemanding manipulation by his partner, C suddenly ejaculated
through a partially erect penis. He had experienced no sense of
ejaculatory inevitability. Within two more days erective security was
reasonably established, although penile engorgement was not totally
developed. Next, C responded orgasmically to the stimulation of
fellatio, and finally, on the twelfth day of therapy, he was able to
masturbate to orgasm. On both of these occasions he did experience
the stage of ejaculatory inevitability. By this time his erections were
full but were maintained for only a brief time span. When the
therapy was terminated, C had met the criteria of a sexually func
tional homosexual male.
For the following months, C and his partner continued their ef
fective social and sexual relationship, and C functioned sexually
with increasing security. His fears of performance returned occa
sionally, but both C and his partner were able to contend comfort
ably with his occasional episodes of remission.
Approximately a year after the acute phase of treatment, C at
tempted to interact with another male homosexual in his peer
293
group while his partner was out of town. The sexual experience fol
lowed an evening spent drinking together, and C failed to achieve
an erection. The casual partner derided him when at the last min
ute C resorted to his sexual-fakery practice by attempting to return
to his service role.
C was devastated by the experience. All of the fears of perfor
mance were reconstituted and were compounded by the return of
fears of public identification. He feared his casual partner would
describe his sexual inadequacy to their mutual friends. C lost all
ability to function sexually with his committed partner, terminated
the relationship, and followed this step by withdrawing from social
interchange with any member of his established homosexual peer
group. He did retain the facility to masturbate and used this tech
nique frequently for sexual tension release. C refused an Institute
offer of a revisit to confront the performance fears and shortly
thereafter refused any further cooperation with follow-up proce
dures.
Although the complaint of primary impotence was reversed dur
ing the acute treatment phase and follow-up procedures revealed
almost complete reversal of the dysfunctional status approximately
one year later, this case is categorized as a treatment failure. Since
C failed to function effectively during the first opportunity he made
to interact sexually with a casual homosexual partner, the therapy
could hardly be termed fully effective.
The depths of C’s fears of performance as evidenced during ther
apy surprised the research team. Every effort was made to neutralize
these anxieties. The committed partner was in large measure re
sponsible for initial treatment progress, but neither partner coopera
tion nor therapeutic direction could counteract effectively the en
gulfing return of C’s performance and public identification fears
after his failure to function under the performance pressures that
are inherent in a homosexual male’s casual sexual encounters. Par
ticularly unfortunate, of course, was the fact that he chose to try
his wings after a long evening of drinking. Under such circum
stances any man, homosexually or heterosexually oriented, regard
less of his level of prior sexual experience, can and frequently does
fail to attain or maintain an erection due to the pharmacologic
properties of alcohol as a central nervous system depressant.
CHAPTER THIRTEEN
«94
C’s retreat from reality as evidenced by his course of action after

the trauma of the casual sexual episode suggests not only that his
fears of performance had been dealt with inadequately but that
there remained a significant degree of underlying psychopathology
which had not been identified during the acute phase of therapy.
Professional concern, not only for the effectiveness of his sexual
performance, but also for his emotional stability, was discussed with
C by telephone, but he refused to return to therapy despite the as
surance of full and continued cooperation from his partner.
Regretfully, textual requirements do not allow for detailed case
reports of the remaining 2 primarily impotent homosexual men.
This material will be presented in other publications. However,
since there are no previous reports available reflecting this sexual
dysfunction, pertinent elements in the case histories are summa
rized. Despite their entirely different backgrounds, there is a certain
parallelism in the two men’s lifestyles.
CASE REPORTS: PRIMARY IMPOTENCE
D and E were just as severely handicapped psychosexually as the three

men whose backgrounds have been described. They had an additional
disadvantage. Neither man had ever achieved sufficient personal se
curity to hold down a regular job or support himself. One man, 28-year-
old D, was fully supported by his family, while E, at 34 years of age had
moved from minor job to minor job until he finally established a com
mitted homosexual relationship with a partner who was able to support
him. Both D and E had been severely traumatized sexually as teenagers.
D reported an orthodox Jewish home with an implacably rigid but quiet
father and a domineering mother. The subject of sex was totally un
acceptable in his home. There was exposure to both heterosexual and
homosexual opportunities within his peer group. Overcome with anxiety
and guilt during these experimental episodes, D failed to function ef
fectively. He presumed that his failure to respond sexually was just
retribution for his sins of sexual pleasure.
E’s mother had died when he was 10 years old. His education was
routine. There was little interest expressed in academic accomplishment.
The family was in the low-income group, and there was no religious
input into the home. At age 14 he had been seduced into a role of sexual
service by his stepfather and 22-year-old half-brother. The boy was
taught to manipulate and fellate, and he was forced into the penetratee’s
role in rectal intercourse. He was never helped to function sexually by
his seducers, and when at age 19 he sought personal relief in a casual
homosexual opportunity, he could not function. Fearful of inadequate
295
performance and subsequent public exposure, he returned to his service

role.
The all-consuming levels of their sexual frustration led both D and E
into almost complete resignation from any concept of a socially respon
sible, masculine role in society. D became both stringently asocial and
patently effeminate in both verbalization and physical actions, while E
had moved to alcohol and drugs as an escape.
In each case the two men were fortunate to develop relationships with
men who cared for them, saw them as severely handicapped persons,
and were most willing to cooperate in any way to enable them to acquire
sexual facility.
Primary impotence is overwhelmingly devastating to the involved

man, regardless of whether he is homosexually or heterosexually
oriented. Not only is he utterly frustrated sexually, but he rarely
attains sufficient emotional maturity to function in a masculine role
in society. Since an impotent man has no source of psychosocial
support for his enforced chastity, his sexual frustrations probably
far outweigh those of men who electively choose chastity as a way
of life. The primarily impotent homosexual’s inherent levels of
sexual frustration are compounded by the fact that he usually lives
a life in which overt sexual activity surrounds or engulfs him, for
in a sexual service role, the homosexual male is constantly stimu
lated by his pattern of physical interaction with sexually functional
men.
But there may be a ray of light at the end of the tunnel. Perhaps
the most depressing influence to which the primarily impotent ho
mosexual or heterosexual man has previously been exposed has been
relieved. These men have been severely traumatized psychosexually
by being forced to accept the popular concept that nothing could
be done to relieve them of their gross handicap of sexual inade
quacy. Fortunately, this implacable burden has been effectively
neutralized and to a large extent removed by the treatment pro
grams that have been developed in this country in the last 10 years.
SECONDARY IMPOTENCE
Forty-nine homosexual men were treated for secondary impo

tence by the research team during the 10-year clinical control pe
riod. Fifteen of these men have been available for follow-up for
five years after termination of the acute phase of treatment (see

Table 13-1).
The major etiologic influences that moved these homosexual
men from full function to varying levels of erective insecurity were
primarily psychosocial in character. There have been 2 histories of
men experiencing overt physical trauma (including one incident of
a sexual attack followed by a brutal beating) that resulted in sec
ondary impotence for the men involved. In addition, 2 men had
physical disabilities that probably contributed to their acquired
impotence.
Of course, homosexual secondary impotence has many of the
traumatic psychosocial aspects that have been described for primary
impotence. The three fears of refused treatment by authority, of
treatment failure, and above all else, of peer identification of the
sexually dysfunctional status are equally present in the secondarily
impotent homosexual man.
However, there are additional perspectives that apply to both ho
mosexual and heterosexual men who have previously enjoyed a pat
tern of successful sexual interaction. Regardless of role preference,
when effective sexual function has become an integral part of any
man’s lifestyle, the prospect that at any time he might become
sexually inadequate rarely occurs to him. Yet at a peak of success
ful performance, he may be experiencing or even initiating influ
ences that well may leave him impotent in the immediate future.
Perhaps the most important additional perspective that secondary
impotence carries with it is an additional fear of performance—that
of impermanence of symptom resolution. This perspective has rarely
been described by previously primarily impotent men.
Once the primarily impotent man has reversed his dysfunctional
status, he rarely gives great credence to this level of negativism in
concerns for performance. His tendency is to accept the great good
fortune of the reversal of his impotence and to totally immerse him
self in sexual opportunity with the partner of his choice with far
less fear for the future than appreciation of the present.
Not so for the secondarily impotent man. His fears of perfor
mance not only focus on the present, he is equally pessimistic about
his future (see Chapter 12). While reversal of impotence, when it
occurs, is hailed with delight, he immediately tempers his unre
297
strained pleasure with expressions of anxiety about the future. His

reasoning follows a well-established pattern. After all, he had func
tioned well in the past. If he can move from confident sexual facil
ity to threatening sexual inadequacy and then be reversed and begin
functioning again, what is to keep him from repeating the cycle?
So the secondarily impotent man experiences a continuing com
bination of fears of performance, and whether homosexual or het
erosexual, he becomes a spectator at his own bedding. When inter
acting with any partner, he fearfully watches his own erective status,
not the physical reactions of his partner. Even if a completely suc
cessful sexual episode is experienced, he immediately is concerned
about his functional potential for “the next time.” For the second
arily impotent man concerned with the fear of impermanency of
sexual performance, a successful sexual episode gives little assurance
that the next sexual opportunity will be experienced in an equally
rewarding fashion.
But another perspective, this time positive in nature, is more fre
quently observed in secondary than in primary impotence. The sec
ondarily impotent man, whether homosexual or heterosexual, is
usually far more secure in his masculine role in society. Although
devastated by sexual dysfunction when it occurs, men usually do
not become secondarily impotent in their teens or early twenties.
They have more opportunity to develop confidence in the potential
of their male role in society and to establish themselves profession
ally as well as socially because their sexual dysfunctions usually are
not millstones around their necks during their formative years. Judd
Marmor’s well-stated aphorism that “an impotent man is an im
potent man” applies far more frequently to the primarily than to
the secondarily impotent man.
Successful treatment of secondarily impotent homosexual men is
significantly dependent upon whether the dysfunctional man and
the research team can elicit full cooperation from the committed or
casual partner. The impotent man’s fears of performance and his
concomitant spectator role in sexual interchange can be reversed
far more effectively if the functional partner will interact freely and
comfortably with his or her disadvantaged partner.
CHAPTER THIRTEEN
298
CASE report: couple 3
F was 42 years old when he and his partner of nine years petitioned
the Institute for admission to the therapy program. His had been a
distressed, imbalanced home. When he was 7, his seriously ill mother
was institutionalized, leaving him and his 5-year-old sister; the mother
died a year and a half later. No other woman assumed the maternal
role. His father was a beleaguered, apparently insecure man who was
unable to cope with the exigencies of the family situation. During F’s
teenage years there was essentially a total lack of parental control or
guidance. His memory of home was of a succession of full- or part-time
female help and a father who tried and failed to control his son’s quickly
asserted social freedom. There was no control of the educational process
and no defined religious influence.
At an early age F was involved with drugs, alcohol, and petty crime.
He was introduced to sexual activity by a neighbor’s wife when he
was 13 and thereafter was sexually promiscuous with his peers and with
many older women. When F was 18, he was jailed for robbing a
grocery store. He was sentenced to one to three years in jail. Within
10 days of his incarceration, he was servicing older inmates either
through fellatio or as the penetratee in rectal intercourse. He mastur
bated regularly, but was given no opportunity to interact sexually with
the inmates other than in a service role. Paroled shortly after a year in
prison, he found a job working as a house painter. Within a few years
he had his own contracting service and was doing well financially.
After serving his prison sentence, F had no further contact with his
father or sister.
His sexual cooperation with other inmates had developed at first un
der the threat of physical punishment, but it continued as a source of
pleasure. His sexual activity after release from prison included both in
discriminant homosexual and heterosexual opportunities, always with
casual partners. During his late twenties his interest in heterosexual in
terchange lessened, and he began a series of brief homosexual relation
ships. At 32 he joined his partner in a committed relationship.
After the first year of their relationship but without his partner’s
knowledge, F began having occasional casual sexual experiences, usually
with homosexual and occasionally with heterosexual partners. It was
during one of the casual heterosexual experiences that he first failed to
function sexually. He had picked up a girl in a bar and had gone to her
apartment. When in bed, he found that he had no real interest in
sexual activity and no erection developed. He tried to force the issue,
to will an erection, but he could not respond. F panicked, resorted to
sexual fakery by feigning illness, dressed, and left quickly. Blaming the
girl for his functional failure, it was the last time he ever became in
volved in heterosexual interaction.
299
Although he confined his sexual involvement to interacting with his

partner and with an occasional casual male partner, he worried increas
ingly about his erective facility. F began wondering whether his episode
of erective failure was really just because he had been with a girl or
whether it might recur in a homosexual setting. It was six months
before he failed again, once more with a casual bar pickup, but this
time it was with a man.
Thereafter F restricted his sexual activity to his ongoing relationship.
Despite his self-enforced faithfulness, his fears of performance and his
spectator role increased to such an extent that he had been almost com
pletely impotent for approximately three years before treatment was
initiated at the Institute.
F was extremely anxious and obviously emotionally unstable

when first seen as a client. His partner was most cooperative in
therapy, evidencing a sincere commitment to the relationship. The
partner, while empathetic with F’s dysfunctional sexual status, was
also concerned with F’s increasingly frequent episodes of acute de
pression. F was so concerned with his own dysfunctional status that
his equally strong commitment to his partner was not fully ascer
tained during the first week of treatment.
F progressed rapidly in therapy. His fears of performance dimin
ished significantly, and his spectator role was soon neutralized. The
couple’s acute phase of treatment was terminated in eight days.
They have been followed for four years without reported recurrence
of F’s erective dysfunction with the single exception of an episode
of erective failure after an evening of drinking. F was not perturbed
by this episode. He simply turned to the therapeutic suggestions
that had been made to neutralize his fears of performance, and with
his partner’s cooperation he continued to function sexually with
confidence.
F’s recurrent episodes of depression have not been entirely dis
pelled. Their frequency of recurrence has been markedly diminished,
however, and even when depressed, he continues to function effec
tively sexually. Medication has not been prescribed for the occa
sional depressed states, since they are being handled well.
This is a case report of a man who was originally fully hetero
sexual. He became a facultative homosexual during a year in prison
and continued as interchangeably homosexual and heterosexual
after his release. As time passed, his homosexual orientation as
3oo CHAPTER THIRTEEN
sumed dominance. The fears of sexual inadequacy that ultimately

severely handicapped him in homosexual interchange originated in
a failure to function effectively during a casual heterosexual oppor
tunity. Once initiated by heterosexual failure, his fears of perfor
mance and spectator role spread slowly into what had become a
full commitment to homosexuality. F’s emotional instability prob
ably made him an easy target for debilitating fears of performance.
The uncommitted homosexual male exists in a threatening psy-
chosexual position. He is a man living a life of sexual risk. Moving
from one casual partner to the next, he continually places himself
in the situation of having to function on demand. The gay bar,
public-toilet type of sexual partner solicitation places a man in the
position of having to respond to immediate sexual demand.
The subjectively appreciated sexual stimuli necessary to meet this
severe functional demand comes from the “grass is greener” con
cept of a constant stream of new faces and bodies. And for varying
lengths of time a multiplicity of partners is often sufficient sexual
tonic for most men to respond to the challenge of instant sex.
Many homosexual men do live through a pleasant lifetime of a
seemingly unending stream of casual sexual partners and continue
to function well sexually. For many others, however, satiation oc
curs; and with it comes the compelling psychosexual need to force
interest, to make erections happen, to evidence objectively an inten
sity of sexual involvement that simply is not there subjectively.
Since men simply cannot force erections, these are times when the
erective process is slowed, anxiety creeps in, full penile engorgement
falters, performance fears swell, and the erective process is progres
sively impaired. The following is a report of such a case.
case report: couple 4

G was 29 years old when seen in therapy. His partner, a 32-year-old
casual acquaintance from the same homosexual community, had accom
panied G in treatment both as a favor and in the expectation of enjoy
ing an educational opportunity.
G was an only child; his father had been killed in an accident when
the boy was 2 years old. His mother apparently had enough money from
her family to support herself and her son. She never remarried.
G’s educational experience was a positive one in that he had full sup
port from his mother, who encouraged academic achievement. There
were good grades and a number of extracurricular interests. The family
MALE HOMOSEXUAL DYSFUNCTION 3OI
religious background was Catholic, but there was little sustained interest
in religion.
Childhood and adolescence were essentially uneventful. G did not
describe a turbulent household, although he came to expect that an
occasional male visitor would spend the night with his mother. Some
men even stayed for a few weeks.
After the “playing doctor” stage, G’s first overt sexual experience was
with a girl in the neighborhood. She was three years older than the 15-
year-old boy. She freely joined him in sexual play, during which he
learned that if his penis was manipulated effectively, he would ejaculate.
Within a few weeks they were having intercourse regularly.
At sixteen G was an apparently well-adjusted young man with many
male and female friends. His social life revolved around his high-school
peers rather than focusing on family. When he became 16 and obtained
his driver’s license, G no longer was subject to maternal authority.
G was a counselor in a summer camp when he experienced his first
homosexual approach. It was made by a fellow counselor who was the
high-school athletic hero. After a few beers the boys joined in an ex
perience of mutual masturbation that led two nights later to participa
tion in an episode of partner manipulation. Although it was G’s first
homosexual experience, he found himself strongly stimulated both
by the physical activity and by the sense of warmth and strength ema
nating from his partner. He had not had these feelings with his neigh
borhood girlfriend.
His heterosexual and homosexual partnerships continued actively for
another year, and each in turn led to other sexual partners.
G completed two years of college, became interested in the theater,
and began living and training in the theatrical community. Sexual op
portunities apparently were limitless, but G voluntarily confined him
self to homosexual experiences.
There was no background of strong maternal dominance, of social or
sexual trauma, of religious orthodoxy, or even of rejection of hetero
sexuality. G simply found that he preferred the homosexual experience.
He frequented gay bars and sought sexual opportunities with other
young men involved in the theatrical world. There was an occasional het
erosexual episode, but these occurred with progressively less frequency.
Finally, at 27 G openly declared himself homosexual. Moving freely be
tween casual partners, he neither took the opportunity nor expressed
the desire to live in a committed relationship.
Early in his twenty-eighth year, G noticed that he seemed to be forc
ing sexual involvement. His constant array of casual partners became
increasingly unappealing, and he voluntarily slowed the frequency of
new partners from at least twice a week to perhaps once every two
weeks. His erections were progressively slower to develop, did not seem
to be quite full, and occasionally were lost during sexual activity.
G became increasingly concerned about his functional facility. Al
though rarely feeling interested, he increased his sexual cruising. Within

a short period of time, there was one sexual episode when G completely
failed to achieve an erection. Following this traumatic experience, his
anxiety levels increased severely, and he stopped all homosexual activity.
Feeling that possibly he would function better in a heterosexual
milieu, G invited a girl he knew casually to spend a weekend. Again
there was total lack of erective response as he struggled to force himself
into an active sexual role.
After this experience, G was fearful of failure in both homosexual and
heterosexual opportunities. Sexual fakery came into play, and he began
“concentrating on his career,” leaving sexual opportunities to others.
He became depressed and sought medical assistance. Medication was
given for the depressed state, but there was no attempt to reverse his
impotence. He was told that as his mood elevated, his sexual function
would probably improve. His mood did respond to the medication; his
sexual function didn’t.
G contacted the Institute for treatment. He was told that treatment
was available but that he would have to provide a partner of choice to
accompany him in therapy. G tentatively selected and approached a
man who agreed to become his partner in therapy at a time that was
mutually satisfactory. This occurred four months later. Meanwhile both
men tried to interact sexually a number of times without success on
G's part.
In therapy, G’s fear of performance and his spectator role were
reasonably neutralized, his homosexual orientation confirmed, and
his emotional security reinforced. G’s partner was fully cooperative
through the first week of therapy, but he became restless and pro
gressively less involved the second week. The couple was discharged
on the tenth day of treatment.
At discharge G was specifically alerted to the potential complica
tion of continuing to live in his casual sexual lifestyle. It was sug
gested that he continue in regular sexual activity with his casual
partner until he could establish a more permanent relationship. The
partner promised full cooperation. The cooperation lasted for about
three weeks, when after an argument, the men terminated their
relationship.
G contacted the staff and asked for advice. Again, it was sug
gested that he seek a continuing relationship. The inevitability of
increased performance pressures engendered by casual sexual epi
sodes was discussed.
During the acute treatment phase, G had described the possibility
3»3
of establishing a committed relationship with a specific man of his
acquaintance, and after Institute consultation he moved quickly
to establish such communication. He was successful in his ap
proach. On the strength of a growing emotional bond with his new
partner, G interacted sexually with confidence and effectiveness
both before and after the couple began living together.
But within four months after establishing the relationship, G be
gan cruising again and his erective insecurity returned. G found he
could function in his relationship but not in sexual opportunities
with a casual partner. In time, his committed relationship became
jeopardized because he could not or would not discontinue his
cruising propensities and his partner did not approve of such li
cense. With repeated failure to function effectively under the cruis
ing demand for immediate sexual performance, G’s erective security
was slowly destroyed. Five years after participating in the treatment
program in St. Louis, G reported that he could function occasion
ally in a casual sexual opportunity, but that he almost always as
sumed a service role. He has never attempted to establish another
continuing homosexual relationship, nor has he made any attempt
to reestablish heterosexual interaction.
This is a case of a man functioning successfully both homosexu-
ally and heterosexually as a teenager and finally voluntarily choos
ing a homosexual orientation. There were no etiologic factors that
could be specifically identified as exerting major influences on his
choice of lifestyle. His erective insecurity originally may have de
veloped from sexual satiation, and while it was reversed during the
acute phase of therapy, he could not maintain his erective security.
Probably he could have continued functioning effectively on an in
definite basis had he chosen to support his sexual partnership, but
despite sure knowledge that he was gambling with his future as a
sexually effective individual, he could not give up his cruising life
style with its accompanying severe demands for sexual performance.
Certainly G is a treatment failure. Either the research team was
deficient in its communication of the necessity for, or G was defi
cient in motivation to pursue, a lifestyle that was centered around
a committed relationship. For in such a relatively pressureless en
vironment, he would have had his best chance of effective sexual
function.
CHAPTER THIRTEEN
304
SITUATIONAL IMPOTENCE
Three homosexual men were treated for situational impotence

together with their partners. Two of the partners were casual, and
i was committed. One of the situationally impotent men was also
sexually aversive.
Of the three categories of impotence, the situationally dysfunc
tional man is by far the easiest to treat effectively. As might be
expected, the situationally impotent man infrequently seeks pro
fessional support. When histories were taken, the 5 men provided
strong testimony to support their reluctance to seek treatment. Each
man admitted that a situationally impotent homosexual man could
easily practice successful sexual fakery (see Chapter 12) and lead a
full and reasonably satisfying sex life. In each of the 3 cases, some
specific event occurred or an additional sexual distress developed
before the sexually handicapped man felt sufficiently pressured to
seek treatment.
He was a 36-year-old Kinsey 5 and his partner a 32-year-old, sexually
functional Kinsey 6 when the couple applied to the Institute for treat
ment of H’s combined complaints of situational impotence and sexual
aversion. The two men had been living in a committed relationship for
approximately four years. A problem that the partners mutually agreed
severely handicapped their freedom of sexual expression forced them to
treatment. The Institute was the fourth potential source of support con
tacted by the couple. They had been refused treatment and given no
referral by three other professional sources.
H had been committed to a homosexual orientation from his teen
age years. He was the youngest of three children in a middle-class family
with a fundamentalist Protestant background. He did not remember his
father and mother ever evidencing any degree of emotional involvement
with each other, but he was fully aware that his parents were completely
committed to a life that revolved about their church. He expressed no
particular emotional attachment for either parent or their lifestyle, but
he did value highly their church affiliation. He also described no par
ticular depth of relationship between himself and his siblings, a brother
and sister four and two years older. The siblings had been severely re
stricted socially as adolescents, since the entire family closely followed
church dogma.
3<>5
At approximately 12 years of age H began masturbating. When he

was 13 he joined in a number of mutual masturbational opportunities,
sometimes with two and at times with as many as five other boys his
own age. Although H did well in school, played on the high-school
basketball team, and was quite active in school dramatics, he was rarely
involved in social activities. He attributed his antisocial stance both to
parental control and to an inherent lack of interest on his part. He
far preferred male company. H could not recall any situation that might
have created a sense of anxiety with or rejection of female companion
ship. His stated position was that he had never rejected girls; he simply
had no interest in them.
H’s first overt homosexual interaction occurred during his senior year
in high school. He was with a friend overnight who had been a par
ticipant at a number of mutual masturbational episodes in their earlier
years. This particular night the boys followed the established pattern of
mutual masturbation, but soon each boy was freely manipulating the
partner rather than confining himself to self-manipulation. Each boy
ejaculated with ease. Apparently they enjoyed the experience, for they
continued with episodes of partner manipulation for the rest of the
academic year.
H spent two and one-half years in college. There he was moderately
active homosexually, confining his sexual activity to the established pat
terns of mutual masturbation or partner manipulation. He refused co
operation with any other manner of stimulative activity. He left college
to work at a steady job that made it necessary for him to move away
from home. The only strong connection that he maintained with his
previous lifestyle came through his church affiliation. During college
and as he moved into an independent, adult existence, his religious
commitment became more intense. His tenuous family relationship
soon diminished to occasional visits at home during Christmas holi
days.
H had a number of social opportunities to interact with women while
in college, all but one of which he rejected. He dated one girl three
times. The third evening they went to her room, played together sexu
ally, and had intercourse. He left as quickly as possible after he had
ejaculated. He experienced no sense of pleasure in this episode, nor did
he feel any sense of rejection. The episode was essentially meaningless
to him, and he never dated the girl again. He reported this episode as
his only overt heterosexual encounter, but he stated that he was glad
he had had intercourse for the experience gained. There seemed to him
to be no plausible reason for repeating the experience.
His sexual aversion began at 24, when he spent a week in another
city on business. He was lonely and sexually aroused, so he began cruis
ing local bars—something he had never done before. One evening he
had more to drink than usual and joined a group of men who were
3o6 CHAPTER THIRTEEN
leaving the particular bar to go to an apartment for a private party. H

described his first experience with fellatio as having a sense of being
forced by group pressure to accept a penis, although he denied that
there was any implied or real threat of physical retribution. As soon as
he accepted the penis orally, he became severely nauseated and vom
ited. His casual partner was repulsed by the episode, and his host made
him leave the apartment.
After this experience, H found himself increasingly anxious about fur
ther casual homosexual activity for fear that fellatio would be required.
He did try this sexual technique four other times during the next year,
always with the immediate response of nausea and, on two occasions,
vomiting. Not only was he nauseated when attempting fellatio himself,
but he rapidly lost whatever degree of erection he had when approached
orally by other men. H never ejaculated in response to fellatio.
The handicap of a sexually objectionable behavioral pattern markedly
reduced his number of homosexual partners, since fellatio was a con
sistently employed interaction technique. He persuaded a number of
men to limit sexual activity to partner manipulation, but when oral
stimulation or rectal penetration was suggested or even demanded, he
always refused. In time, the mere thought of possible oral or rectal
penetration was enough to create an anxiety reaction.
H moved from casual to established homosexual relationships to pro
tect himself from demands for fellatio and rectal intercourse. Unlike
the other two men who were treated for situational impotence by the
research team, his was not a sufficiently dominant personality to success
fully impose his sexual restrictions on most casual partners and still
maintain their sexual interest. He occasionally attempted to practice
sexual fakery, but he was not particularly successful. His obvious levels
of anxiety when fellatio was requested apparently alerted his sexual
partners. It is one thing to deny interest in a specific sexual technique
and request an alternative approach; it is quite another to become overtly
anxious or even nauseated when the particular sexual technique is
suggested.
Over the years H’s increasing anxiety with fellatio slowly encompassed
his ability to respond to partner manipulation as well. Initially he found
it more difficult to respond to a partner’s manipulation of his penis.
Then he began to be nauseated when a partner ejaculated in response
to his manipulative efforts. In due course, the sight of any seminal
fluid other than his own created anxiety responses and occasional nausea.
At 32, H joined a 28-year-old man in what was to become a comfort
able, committed relationship. The men had a great deal in common.
Neither was a dominant personality. They had similar tastes in music
and literature, and each was at approximately the same income level.
But most important to both was the fact that they had the same church
affiliation. In fact, they initially met during a church-sponsored social
307
activity. H’s partner had a level of sexual need that was expressed ap
proximately once every ten days or two weeks. This pleased H tremen
dously, for by the time these two men became sexual partners, all H
could accept in the way of sexual interaction were episodes of mutual
masturbation, and he no longer would allow himself to observe his
partner’s ejaculatory experience. Perhaps once a week H masturbated in
private.
For two years this pattern of sexual interchange proved acceptable to
both men. Then the partner began expressing increasing need for the
warmth of personal contact in sexual interchange. When H tried but
could not respond to these requests for partner manipulation or fellatio
without becoming extremely anxious, the partner sought occasional
sexual opportunities outside the relationship. This outside activity was a
source of great concern for H; he agreed to seek professional help
initially for his sexual aversion and subsequently for his situational im
potence.
As an initial step in treatment, desensitization procedures were
instituted that were designed to create a sense of comfort with
seminal fluid. Once this was accomplished, the next step was to
neutralize the crippling levels of anxiety that H associated with any
suggestion of fellatio. When the excessive levels of anxiety were
also neutralized, fellatio was accomplished with a rapidly decreas
ing incidence of nausea. Finally H’s fears of erective failure when
being fellated by his partner were also reasonably neutralized by
following the techniques designed for treatment of fears of per
formance (see Chapter 12).
H responded to treatment and was functioning well in response
to partner manipulation and to fellatio when the acute phase of
treatment was terminated.
Two major sources of support were vital to H’s progress in treat
ment. First, his committed partner was most cooperative through
out the demanding acute phase of the treatment program. Second,,
both men found mutual strength in their active religious commit
*
ments. They felt that their shared religious interests added the im
portant dimensions of stability and security to their troubled rela
tionship.
H and his partner were followed for five years after termination
of the acute phase of treatment. Occasionally H experienced a re
turn of his anxiety state during sexual interaction and had to termi
nate a particular episode. But as time passed and with his partner’s
3o8 CHAPTER THIRTEEN
full understanding and continued support, the anxious moments

occurred less and less frequently. The relationship between H and
his partner continued to be stable and productive during the entire
follow-up period.
This is a case of a man in his midthirties who was prejudicing a
committed homosexual relationship of four years’ duration by a
progressive aversion to sexual interaction. There was no history that
could even be used retrospectively to establish an etiologic back
ground for his homosexual orientation. He simply never remem
bered having the slightest interest in girls sexually or socially. The
only evidence of family influence was an active orthodox religious
orientation in which he found continuing support. H’s positive re
sponses to desensitizing treatment procedures were in large part due
to his partner’s full support in therapy.
DISCUSSION
The incidence of male sexual dysfunction in the homosexual

community is unknown. For a variety of legitimate reasons de
scribed earlier in Chapter 12, homosexual men have been loathe to
seek clinical treatment for impotence or sexual aversion. Yet ade
quate treatment for their sexual dysfunctions is available with a
treatment failure rate that should not be as high as that previously
reported for treatment of heterosexually oriented, sexually dysfunc
tional men in Human Sexual Inadequacy (1970).
The homosexual male always has certain advantages in being
able to interact with a same-sex partner. There is a sense of iden
tification and a level of subjective appreciation of fears of perfor
mance that perforce are lacking when a sexually dysfunctional man
is interacting with an opposite-sex partner. In addition, there is not
the inherent performance demand for an erection of sufficient qual
ity to accomplish vaginal penetration that the culture always places
on the sexually active heterosexual male. Presuming that the male
partners are living in committed relationships, there usually is sig
nificantly less performance pressure placed upon the homosexual
than there is on the heterosexual male in our culture.
A change in attitude is increasingly evident in the health-care
profession. Psychotherapeutic support has recently become avail

able to sexually dysfunctional homosexual men and women in a few
clinics. Homosexuals have every reason to request, and to expect,
this level of support from the health-care community.
The Institute’s failure statistics in treatment programs for homo
sexual male dysfunctions are reported in Chapter 17.
14
FEMALE HOMOSEXUAL
DYSFUNCTION
Iwenty-five lesbian couples were treated for sexual dysfunction

during the Institute’s io-year clinical program. In 23 of these cou
ples only 1 of the partners complained of sexual dysfunction. There
were 7 primarily anorgasmie, 13 situationally anorgasmie, and 3
randomly anorgasmie women. There also were 2 couples in which
both partners were anorgasmie. The first couple was formed by a
combination of a primarily anorgasmie lesbian with a partner who
was situationally anorgasmie. The second couple was composed of
a situationally anorgasmie lesbian with a partner who was randomly
anorgasmie. Thus, a total of 27 homosexual women were treated
for anorgasmia by the research team. Six of 27 anorgasmie women
also complained of and were treated for sexual aversion (see Table
12-2, Chapter 12).
In the 23 lesbian couples with only one sexually dysfunctional
partner, there were 16 committed and 7 casual partners, all of
whom were sexually functional. The 2 couples that reported each
partner as anorgasmie and requested treatment for both partners
were living in firmly committed relationships (see Table 12-2,
Chapter 12).
To assume that this chapter reports a treatment approach to an
orgasmia would be correct. To assume that it is just another report
would be in error. There has been no prior report of treatment of a
series of anorgasmie homosexual women in a clinical program of
10 years’ duration. Nor has there even been a previous report of
five-year follow-up of anorgasmie lesbian clients after the acute
phase of treatment has been terminated (see Table 14-1 ).
The 25 lesbian couples seen over a 10-year period hardly repre
310
• FEMALE HOMOSEXUAL DYSFUNCTION
311
sent a thriving practice. Yet the fact remains that this small sample
of what must be an incredibly frustrated segment of society has
found the courage to seek professional support. If this totally un
coordinated social movement continues, gathering strength in stead
ily growing numbers and confidence in the health-care professionals’
acceptance of its need, this trend will indeed represent a major
breakthrough in the health-care field. Homosexual women’s frus
trations have come not only from contending with the exigencies
of their sexual inadequacies, but also from a widespread concept
within the homosexual community that there was nowhere sexually
dysfunctional men and women could go or no one they could see
to seek relief from their sexual distresses.
The incidence of anorgasmia in the lesbian population in this
country is a complete mystery, but the numbers are likely to be of
significance. Parenthetically, despite a number of publications on
the subject, there also is no secure knowledge of the actual inci
dence of anorgasmia among heterosexual women. We do know,
however, that heterosexual anorgasmia is sufficiently widespread to
involve millions of women.
Despite lack of research support, it is probably correct to presume
that the incidence of anorgasmic states is lower in the homosexual
than in the heterosexual female community. If such a discrepancy
in the incidence of anorgasmic states exists, and there is in fact
less anorgasmia in the homosexual than the heterosexual female
populations, it probably is due to a combination of two factors.
First, the culture places a markedly increased performance demand
on the heterosexual woman to respond at orgasmic levels during in
tercourse, which, as Chapter 6 has shown, is more difficult to respond
to than manipulative types of stimulation. Second, the Institute
has established divergent definitions of heterosexual and homosex
ual anorgasmia (see p. 312). If a divergence in the incidence of
anorgasmia does exist between the two female sexual preferences,
the research team does not believe that it represents a variation in
woman’s inherent physiologic capacity to respond to effective sexual
stimuli.
CHAPTER FOURTEEN
31«
DEFINITIONS
The primarily anorgasmie lesbian has been defined by the Insti

tute staff as a woman who has never been orgasmic in response to
the techniques of masturbation, partner manipulation, or cun
nilingus. The situationally anorgasmie lesbian has been identified as
a woman who has responded at orgasmic levels to one or two of
these three stimulative techniques, but never to all three. The defi
nition of a randomly anorgasmie lesbian reflects a woman who has
been orgasmic at least once in response to each of the three stimu
lative approaches, but has infrequently reached orgasmic levels of
sexual excitation while reacting to any form of sexual stimulation.
It may be recalled that the Institute defines dysfunctional status
differently for homosexual and heterosexual men and women be
cause of their established variations in sexual activity. When viewed
from this perspective, there should be a major difference in fre
quency of anorgasmie states between homosexual and heterosexual
women. For example, if a heterosexual woman is orgasmic in re
sponse to masturbation, partner manipulation, and cunnilingus,
she would still be labeled as situationally anorgasmie if she has no
history of responding at orgasmic levels during intercourse. On the
other hand, the homosexual woman who has a history of respond
ing orgasmically to masturbation, partner manipulation, and cun
nilingus would be identified as a fully functional woman. If these
definitions are accepted, it will come as no surprise that there is a
higher incidence of anorgasmia among women in the heterosexual
than in the homosexual community.
CLINICAL POPULATION
During the first year of clinical study, only 2 situationally anor

gasmie lesbians were seen in therapy with their partners, 1 of whom
was in the committed and the other in the casual category. The
second year, a primarily anorgasmie lesbian was treated with her
committed partner. This was the only dysfunctional female homo
FEMALE HOMOSEXUAL DYSFUNCTION
313
sexual couple the research team treated in the entire year. Actually,
for the next eight years the clinical facilities were certainly not
overrun with applications for treatment. There were only 2 to 4
dysfunctional lesbian couples treated each year (Table 14-1).
TABLE 14-1
Homosexual Female Anorgasmia (N — 2y):

Type of Year Treated

Anorgasmia One Two Three Four Five Six Seven Eight Nine Ten Total
Primary 0 1 1 2 0 2 1 0 0 1 8
Situational 2 0 3 1 2 1 2 2 2 0 15
Random 0 0 0 1 0 0 1 1 0 1 4
Total 2 1 4 4 2 3 4 3 2 2 27
1968-1977
Lesbian couples applied for treatment from various metropolitan

areas and from academic centers throughout the United States and
Canada. Only 1 couple lived in the St. Louis area. Just as was pre
viously reported by the homosexual males who applied for treat
ment of sexual dysfunctions (see Chapter 13), the lesbian couples’
knowledge of the Institute’s treatment programs came by word of
mouth within the homosexual community.
Every couple entering therapy was self-referred. Of the 27 anor
gasmie lesbians treated, 14 had sought and 11 had been refused
treatment by other health-care facilities. Of these 11 women, 8 had
been refused treatment by more than one health-care source. Each
of the 3 sexually dysfunctional lesbians who had previously entered
therapy for an anorgasmie state had been treated without a partner,
and each of these women had terminated her therapy program as
unsatisfactory. None of the women had been referred to another
source of treatment by any consulted health-care authority (see
Table 12-6, Chapter 12).
These statistics have been repeated here to emphasize the fact
that in the past sexually dysfunctional lesbian women have had to
contend with the same general fears of social rejection that have
CHAPTER FOURTEEN
3U
haunted homosexual men when considering treatment for their

sexual inadequacies. Sexually dysfunctional lesbians fear—and with
good reason—that they will not be accepted in therapy when they
finally gather their courage and apply for psychotherapeutic sup
port. lliey also tend to be skeptical of the percentage chance of
any treatment program terminating successfully, regardless of the
clinical techniques employed. Although they evidence far less
anxiety about the problem than do homosexual men, lesbians are
traditionally fearful that their homosexual status will be revealed to
the general public by the consulted health-care authority or by
members of his or her paraprofessional staff.
There also are the various fears for sexual performance that must
be dealt with, whether these are culturally or physiologically engen
dered. Judging only by the sample of both homosexual and hetero
sexual women who have applied for treatment at the Institute dur
ing the last 10 years, the fears of the dysfunctional woman in our
culture for her ability to react in a sexually effective manner in
crease every year. There is, of course, the classic example of the
pervasive influence of the printed word upon culturally induced
sexual performance fears. Until the hundreds of articles released
for public consumption in the last decade emphatically pointed out
that every woman has the birthright of effective sexual expression,
women’s fears of failure to function effectively in sexual interchange
were not nearly as incapacitating as they are today. Times certainly
have changed—as have attitudes—and not entirely for the better.
This statement must not be construed as a denial of every
woman’s birthright to be an effectively functional sexual being. Far
from it. The research team is fully committed to the contention
that every woman should have the privilege of effective sexual ex
pression. Nor is there a problem with the accompanying contention
that sexual freedom should be shared equally by the sexes. The
problem arises from the implication that is inevitably drawn by the
general public once these contentions have been widely accepted.
Loosely interpreted, the culture now implies that an anorgasmic
woman is less than a woman.
Where have we heard these words before? They remarkably re
semble the psychologically devastating cultural accusation that an
impotent man is really not a man. So every woman is now hearing
315
in ever-increasing decibels the equally devastating cultural accusa

tion that if she is sexually dysfunctional, she really is not a woman.
When this measure of female denigration happens to be combined
with the cultural imposition of unworthiness that is frequently as
sociated with a barren state, the pressures may become overwhelm
ing. While it may take just such a preposterous level of public ridi
cule to bring the anorgasmic lesbian to treatment, it is most un
fortunate that she must now bring with her into treatment the
additional burden of a culturally imposed fear, disseminated by the
popular press, that she is far less a woman than her orgasmically
facile sister. Due to current cultural influence, “An impotent man
is an impotent man” can be readily paraphrased to suggest that a
sexually dysfunctional woman is indeed a dysfunctional woman.
Not only does the anorgasmic woman have to face the culturally
derived implication that she is really not a woman in the true sense
of the word (whatever that is), but she also must face another cul
tural implication that is inherent in anorgasmia. It is the fearful
question of, “Will I be able to fully satisfy my partner if I don’t
function effectively?” These fears are as consistently present in dys
functional homosexual women as they are in dysfunctional heterosex
ual women. This fear of losing the committed partner, if the partner
has been consistently frustrated by inability to provide sexual satis
faction for the dysfunctional individual, was verbalized by a higher
percentage of anorgasmic lesbians than impotent male homosexuals,
although partner concern certainly was expressed by both sexes.
So freedom of sexual expression, for years the social perquisite of
the male in our culture, is now being shared by the female. Unfor
tunately, with freedom of sexual expression comes the immediate
corollary of yet another sexually oriented fear, in this instance the
most devastating of all sexual fears, the fear for one’s own physio
logic capacity to function effectively.
A detailed consideration of male or female fears for sexual per
formance and the concomitant spectator roles has been presented
in Chapter 12. Although the impotent male was used as the pri
mary example, the discussion is equally applicable to the anorgas
mic lesbian and therefore will not be repeated.
Both of the anorgasmic homosexual couples who entered therapy
with each partner dysfunctional will be considered in detail. When
CHAPTER FOURTEEN
316
combined, the two couples provide insights into the sexual dys
functions of primary, situational, and random anorgasmia.
Before presenting case reports, a comparison should be drawn
between the sexually dysfunctional homosexual male and female
populations. When a dysfunctional lesbian entered therapy, there
was a major difference between her approach to treatment and that
of the dysfunctional homosexual male. Generally, the anorgasmic
lesbian and her partner were significantly more cooperative during
the therapy program than were the impotent homosexual males
and their partners. The lesbian couples not only tended to fol
low therapeutic suggestions more conscientiously, but they com
municated far more openly and probably more honestly with the
therapists.
J was a 29-year-old Kinsey 6 when she applied to the Institute for
treatment of primary anorgasmia. Her committed partner K requested
treatment for situational anorgasmia that was further complicated by
the existence of sexual anxiety. K was 31 years old, a Kinsey 4, and had
a daughter 7 years old. When the women were seen in therapy, their re
lationship was of almost three years’ standing.
J described her childhood as an uneventful but happy time. She had
one sibling, a sister two years older. There were no recalled troubles in
school. She had a number of friends, both boys and girls. There was no
preference for one parent over the other, nor did she feel herself to be
the preferred or rejected sibling.
J came from a financially secure background. In retrospect she judged
her parents as well-adjusted, well-educated people who appeared to be
living comfortably together, although she did not think they were un
reservedly committed to each other. She was aware that her father had
enjoyed an occasional relationship outside the marriage, and for a
period of time when she was about 16 had suspected that her mother
was similarly involved. Her background was of Jewish orientation, but
the family held formalized religious commitment to a minimum. J’s for
mal education included graduation from one of the well-known women’s
colleges. She had moved into a banking career after college and was a
junior executive at a large bank in an eastern city when seen in therapy.
By this time both parents were dead and she was financially independent.
J could not recall any sexual orientation other than homosexual. She
had first been taught how to masturbate at age 10 by her sister, and al
though she described a pleasurable response, she knew nothing of
orgasm. After she had started to menstruate at 12, her sister began to
317
exchange episodes of partner manipulation with her. J soon found that it

was far more pleasurable to stimulate her sister than to be stimulated
by her. She was pleased when her sister experienced orgasm (J didn’t
know what it was at the time) and approached her sister frequently
just to watch what happened. She felt no sense of loss when “it” didn’t
happen to her.
When her sister began interacting socially with boys, opportunities
for sexual play diminished rapidly and soon stopped completely. J then
turned to her peers. She described creating opportunities to "play” by
her own aggressive approaches. During her high-school years she had
two friends, with each of whom she interacted sexually at least once a
week. Neither of the friends was attractive physically nor was dating.
Both girls apparently became multiorgasmic with J’s help. Sexual activ
ity was restricted to partner manipulation. Again J’s sexual pleasure
came from manipulating her friends; she simply didn’t feel very aroused
sexually when they stimulated her.
J was an attractive, tall girl with a good figure. She was moderately
active in sports, playing competent games of tennis and golf. But, much
to her mother’s distress, she simply had no interest in social interchange
with boys. Throughout high school the total of her overt sexual experi
ence with boys consisted of three episodes of breast play and one experi
ence with penile manipulation. The boy ejaculated, soaking the dress she
was wearing, and for five years thereafter there was no further dating.
J had her first and last attempt at intercourse during her senior year
in college. She went out on several occasions with an older divorced
man who was one of her professors. More from curiosity than any other
reason, she agreed to spend a night with him. The entire sexual episode
was unappealing from the outset, for she was taken to a dingy motel
room and as the night passed she found the experience less and less
attractive. On each of three occasions the man ejaculated before he
could establish penetration. Again she felt a sense of contamination from
the seminal fluid. She could not respond to the man’s manipulative at
tempts and retrospectively rejected the episode as not only of little value,
but as a sexual experience in which she had little further interest. There
after, her relations with men were held entirely to social interchange.
During college J had three female friends (one a roommate for a
year) with whom she interacted sexually. Her total sexual interest was
in playing with and satisfying her partners. She became quite facile with
manipulative techniques and cunnilingus. Although she allowed her
sexual partners full freedom to approach and stimulate her as they
wished, she was rarely highly aroused sexually and never orgasmic. She
tried to masturbate frequently but continued to be unsuccessful. J
became completely convinced that she was incapable of orgasmic ex
perience and that her sexual gratification would come only from excit
ing and then releasing her sexual partners, during which she could vi
318 CHAPTER FOURTEEN
cariously enjoy their orgasmic experiences. Certainly her highest levels

of sexual excitation coincided with observing her partners in orgasm.
J’s most frequently employed fantasy patterns involved the mental
imagery of wildly excited women who were begging her for sexual re
lease. She also fantasized about seducing married women, a number of
whom she personified and each of whom protested vigorously that they
didn’t want homosexual experience but were powerless to resist her ap
proaches.
At no time did J adopt masculine mannerisms or assume an overtly
dominant role with her sexual partners. She encouraged her partners to
take as much sexual freedom with her body as she took with theirs.
She simply considered herself as a woman who had the permanent sexual
handicap of inability to achieve orgasmic levels of sexual response and
who was seeking whatever level of pleasure she could achieve in homo
sexual interaction.
J met K as a member of a lesbian social group. The two women ap
parently enjoyed a strong mutual attraction, for J moved into K’s apart
ment within three months after they first met.
K’s history was more involved. She was the only child in a family of
restricted financial means. She remembers that she was very close to
her mother and somewhat frightened of her father. Beyond this there
are no recalled instances of severe childhood distress. Her mother and
father divorced when she was 13 years old. Her mother had a Catholic
religious orientation; her father had a Protestant commitment. After the
divorce she lived for two years with her mother, who died when she was
15. Her life from then until she finished high school was complicated by
brief visits with relatives and/or family friends and longer visits with her
father, who lived in the area and had remarried. She despised her step
mother, who she felt had completely rejected her.
As she grew up, K had many friends. She apparently was an attrac
tive teenager, dated regularly, and enjoyed her interaction with and at
traction for boys. She began menstruating at 13, first masturbated to
orgasm at 14, and started active sex play with boys at 15. After her
mother died, K lived with no social control, dated whom and when she
pleased, and stayed out as late as she pleased. There were many epi
sodes of genital manipulation, during which her partners frequently
ejaculated and she was highly stimulated sexually but not orgasmic. She
would usually masturbate at home after such experiences to relieve her
sexual tensions.
K was a 16-year-old high-school sophomore when she had her first
coital experience in the back seat of a friend’s car. There followed many
such episodes with many different boys. She was always sexually excited
but was never orgasmic. She discovered that her stepmother used a
contraceptive foam and began using the same product regularly. Ap
parently K used sex primarily as a means of identifying with someone,
319
in these instances with her male peers. With her mother dead, her fa
ther successfully isolated by her stepmother, and the few relatives or
family friends apparently indifferent to her unrestrained promiscuity,
she needed some feeling of belonging and she paid the price willingly.
During her sophomore and junior years in high school she was con
stantly in demand as the boys passed her around. At that time, she
apparently was quite willing to be passed around, since she rarely raised
an objection and sex was a part of almost every date.
During the summer before her senior year at high school, she went
out for the evening with a boy she had never met before, and they were
soon joined by four other boys who also were strangers to her. K spent
the night in a summer cottage with the five boys. At first she was afraid
when the boys insisted that she join them in group sexual activity and
when they did not respond to her tearful request to go home. Then she
was embarrassed in the bedroom, both by her forced nudity and by the
requirement that she perform sexually before an audience. But after of
fering what she stated retrospectively was really only token resistance,
she apparently spent the rest of the night as a cooperative sexual partner.
After participating in repeated coital episodes, she was introduced to
fellatio by the group. When the group changed its sexual approach from
intercourse to fellatio, she was overwhelmed with the sense of being
used. This was a feeling that she had never experienced during her coital
episodes with many different boys in the past two years or, for that
matter, even when intercourse had been required by the group members
earlier in the night. Hearing what the boys had to say as they watched
her fellating their friends had an even greater effect on her sense of
personal debasement. Yet, despite the trauma of the verbal denigration
and the exhaustion of long-continued physical activity, she was very
excited sexually when the boys took her home. The episodes of fellatio
had been more arousing than intercourse had ever been. She remem
bered masturbating several times the next day to relieve her tensions,
but her sexual excitation always seemed to return.
Although she thought of little else for weeks, she had no desire to
seek retribution for the group-sex episode. Instead, K completely changed
her lifestyle after the experience. Still only 17, she was mature enough
to realize that once word spread of her group sex experience, and spread
it would, what little reputation she might have had left would be de
stroyed in her male and female peer groups. She also was fearful that
she might be pregnant, for no contraceptive had been used. There was
an additional six weeks of anxiety before she menstruated. Many boys
called her for dates. K refused them all. She transferred to another school
in the city, lived with her father, tolerated his wife, and finished high
school.
K began living on her own at 19. She went to secretarial school and
then moved to another city and got a job in a typist pool for an in
surance company. Although she was quite attractive, she refused almost
all social opportunities with men. She confined her social activities to
interacting with the women she met at work.
K’s first homosexual experience was with a woman in her forties who
worked for the same company. After several lunches together and one
dinner during which K told the woman of many of her past experiences
with men, K was invited to spend a weekend with the woman. When
she accepted the invitation, she thought she might be approached sex
ually and was resolved to respond to such an opportunity if it developed.
It did. K, who had felt sexually frustrated for over a year, reacted to the
woman’s manipulative approach with the first orgasmic episode she had
ever experienced other than with masturbation.
For the next two months she was with the woman whenever they
could meet. Their sex play did not move beyond the level of partner
manipulation, to which both women were fully responsive. One night
the woman made a cunnilingal approach, and K became quite anxious,
somewhat nauseated, and could not cooperate. She vividly recalled the
sense of being used during the night when she had fellated boy after
boy. The relationship terminated after another month because K con
sistently refused cunnilingus, but she continued to circulate socially
within the homosexual community to which she had been introduced by
the woman.
When K was 23, she had intercourse with one of the married execu
tives of the company in a car on the way home from the company
Christmas party. It was the first heterosexual activity she had experi
enced since the night of group sex. She became pregnant. When the
pregnancy was confirmed she confronted the man, who agreed to sup
port her through the pregnancy.
She left the company and went to a different part of the country, got
a similar type of job, and had the baby—a girl—after an uneventful
pregnancy and delivery.
K never had another sexual experience with a man. Her social and
sexual activities were completely devoted to lesbian opportunities, which
she quickly developed in her new geographic location. She masturbated
regularly, manipulated her partners, was as frequently manipulated to
orgasm by them, but continued to refuse cunnilingus.
As time passed, she dwelt more frequently in her fantasies on the
pseudorape scene of her group-sex experience. As the episodes of fellatio
were relived in detail, she usually became somewhat anxious but also
found herself so highly excited sexually that she began fantasizing the
scene regularly when she masturbated.
But her feelings of anxiety associated with thoughts of oral sex in
creased and in time were transferred from her heterosexual past and ap
plied to her current homosexual opportunities. She could meet, enjoy,
and in time initiate or cooperate in sexual play with a casual partner,
FEMALE HOMOSEXUAL DYSFUNCTION 321
but after one or two sexual experiences with a new partner she became
anxious and fearful that cunnilingus would be requested or initiated.
Over a period of time, her anxieties increased to such a level that she
began refusing all physical approaches other than mutual masturbation,
an approach that few of her older lesbian acquaintances would accept as
a satisfactory pattern of sexual interaction. Although her social life was
almost entirely confined to lesbian groups that she helped organize or
run and within which she found vital psychosocial support, there was
little sexual interaction with the individual group members.
J and K met at such a lesbian social gathering. The women were
mutually attracted and immediately began spending a great deal of
time together. In three weeks they had told each other of their back
grounds, of their sexual histories, and of their sexual dysfunctions and
anxieties. Since J thoroughly enjoyed K’s daughter and there seemed no
other potential hindrance, the two women agreed to live together. Neither
woman had participated in such a living arrangement previously. J re
acted to the new relationship by sharing her financial independence with
K and her daughter.
Fully cognizant of K’s negative feelings, J played a totally nonde
manding sexual role, letting K set the pace. On her part, K, although
quite anxious, did enjoy masturbating in J’s presence even though J,
try as she would, could not respond successfully in kind. Within six
months’ time K had achieved sufficient security in their relationship to
allow J to approach her with manipulative techniques, which apparently
J enjoyed thoroughly and K responded to freely, although she still had
anxious moments. They had lived together for approximately three years
in a stable, secure relationship before entering therapy.
The two women entered treatment because they were firmly con
vinced that they wanted to spend the rest of their lives together.
They expressed the hope that J would become fully responsive
sexually and that K would lose her anxiety about cunnilingus and
become responsive to this sexual approach.
Therapy was initially directed toward K’s sexual anxiety. At out
set the anxiety seemed of minor moment, particularly in view of
the progress K had already made with J’s cooperation, but as
therapy progressed it was evident that K was still in real conflict.
K was actually at cross-purposes. She had felt totally devalued as
a woman by her group-sex experience with the boys, yet she was
objective enough to realize that she had practically issued an open
invitation to such an experience by her uninhibited promiscuity.
Since she had not experienced fellatio before her pseudorape epi
sode, oral sex had come to represent the physical aspect of her com
plete humiliation. However, she also stated that she had been
highly stimulated sexually during and immediately following the
fellatio experience and was easily restimulated by reliving the ex
perience in fantasy while masturbating. She had become extremely
anxious when cunnilingus was requested because she felt that she
might be so sexually aroused by the experience that this might force
a return to unrestricted promiscuity, this time of lesbian origin.
And, of course, she anticipated further humiliation. She knew she
had been used by the teenage boys, and she felt threatened that
responding to or initiating cunnilingus would put her in the same
position of being used by women. She did not want her female
friends to view her as an easy mark, as the boys had done.
K felt no sense of regret in relation to her pregnancy. She had
categorized the sexual experience as one of those things that should
not have happened but did, and other than some modest financial
support for her daughter, had made no demands on the father. She
even stopped asking for child support when J was generous finan
cially. At the time the couple was in therapy, the girl had not been
told who her father was or given any information about him other
than that he and K were permanently separated.
Once the guilt that had resulted from the years of promiscuity
was reasonably neutralized, K was encouraged to use her oral sex
fantasies, first with masturbation, then during manipulation by J,
and finally simultaneously with J’s cunnilingal approach. K’s sexual
anxieties were soon neutralized, and she became freely responsive
to J regardless of the manner of stimulation. She reported during
follow-up that as her freedom to respond sexually increased, she
made less use of her fantasy pattern.
J responded well to the sensate-focus approach, despite her previ
ous lack of involvement in sexual activity. She had usually been
approached in a forceful or demanding manner and consistently
had used the same type of approach herself when she attempted to
masturbate. Little time had been taken in reassurance, and there
also had not been a great deal of identification with her partners
except as sex objects. She was now fully committed to her relation
ship with K and was openly pleased that she could play an active
part in releasing K from the self-imposed restrictions of her anxiey
about oral sex.
323
J noted that after the first week in therapy she was becoming in
creasingly excited sexually as she and K became more involved in
resolution of K’s anxiety. One night, immediately after K had first
allowed and then responded orgasmically to cunnilingus, J, highly
excited by observing K’s orgasmic experience, masturbated to orgasm
with little difficulty. It was her first orgasmic experience, and her
concept that she was incapable of orgasmic attainment was shat
tered. She was soon responsive to K’s manipulative approaches.
Finally K began approaching J with cunnilingus just at the end of
the two-week acute phase of treatment, and J was multiorgasmic
during the second such approach.
Both women left treatment confident in their sexual responsivity
and firmly committed to the expanding dimensions of their rela
tionship. They looked forward to a full life together and seemed
equally concerned in giving K’s daughter a secure home and full
social and educational opportunities. They planned to talk freely
with the girl about their own relationship when they considered
her mature enough to understand.
This lesbian couple was followed for five years. Their relationship
continued as a source of mutual security. Their patterns of sexual
interaction continued to be mutually stimulating and completely
satisfying for both women. Each woman denied any further inter
est in sexual experience with other partners. The daughter was
denied access to her father both at his request and with K’s agree
ment. J and K’s relationship was discussed with the daughter in
detail.
After treatment the two women decided to expend their energies
on social welfare projects. They have been regularly employed in
such endeavor and have broadened their social horizons to include
male as well as female friends. They interact socially with a num
ber of married couples, with their own relationship an open book.
This is a study of a firmly committed dyad of two lesbian women,
each of whom brought to their relationship the strengths that
the other partner needed. Both women matured psychosocially
as well as psychosexually within the warmth and security of the
relationship. Theirs was a positive response to the treatment pro
gram.
The second lesbian couple that applied to the Institute for treat
ment of anorgasmia with both partners sexually dysfunctional will
CHAPTER FOURTEEN
324
also be reported in detail and treatment concepts and techniques

discussed.
L was a 44-year-old situationally anorgasmic Kinsey 3 who had been

living for nine years in a committed lesbian relationship with her part
ner M, who was 41, a Kinsey 5, and randomly anorgasmic. L had two
children, a daughter 21 and a son 19. She had been married twice, once
for six years (during which both children were born) and once for seven
months. M had not married. This was the only committed lesbian
relationship that L had experienced and the second such relationship
for M.
L was born into a family with wealth in both her father’s and mother’s
background. The family religious orientation was Protestant, with ob
ligatory church-school attendance until age 12 and a family record of
church attendance that concentrated on religious holidays. Her parents
were divorced when she was 16. L did not describe a close relationship
with her father either when she was a child or later as an adult. She be
lieved that he had only a perfunctory interest in her as an individual.
She had one brother five years older who was killed at age 20 in an
automobile accident. He was described as having no significant influ
ence in her life. She did not appear to have a close attachment to either
her mother or her father.
L was a reasonably attractive girl with an extrovertive personality. Her
formal education included high school and two years of college.
L was conscious of pelvic feelings at a very early age. She could not
remember when she first masturbated, but she clearly remembered that
her mother had played with her genitals two or three times a week dur
ing her preschool years under the guise of helping her “wash well.” It
was play that L apparently learned to enjoy, looked forward to, and
tried to emulate with her own early masturbational attempts. L also
could not remember when she was first orgasmic but thought it was at
five or six years of age. Throughout her teenage years she usually mas
turbated at least once and sometimes twice a day. The intensity of her
response seemed to increase after onset of menstruation late in her
thirteenth year.
At 14, when sex play began with boys, she was freely cooperative but
did not experience the sexual release that she had enjoyed for years with
masturbation. The boys always seemed clumsy at sex play. She did be
come sexually excited but had to wait for privacy to gain masturbational
release. Intercourse was first experienced at 17, and she continued to
be active sexually through casually maintained relationships with seven
different men until she married at 22. Despite a variety of sexual ap-
325
proaches, she was never orgasmic with any of the men she knew before
her marriage.
She was married for six years and divorced her husband primarily
because she had never been sexually satisfied. Her husband was a pre
mature ejaculator and throughout the marriage never evidenced or ex
pressed concern for his wife’s sexual needs. L did not have time to re
spond during coital connection, which she estimated usually lasted for
a minute or less, and she also never achieved orgasmic release from other
stimulative approaches by her husband. Not until divorce proceedings
had been initiated did the husband learn that his wife had been severely
frustrated sexually. She not only had not communicated her need, she
also had practiced sexual fakery and during many sexual episodes had
pretended orgasmic release.
L had continued her almost daily pattern of masturbational release
throughout her marriage except when she was pregnant. She found the
state of pregnancy to be so sexually stimulating that she usually mas
turbated two or three times a day. She had always masturbated in pri
vate, keeping her husband completely unaware of her level of sexual
need and her means of releasing this need.
After the divorce, L was involved with a series of lovers but was un
successful in responding to them sexually at orgasmic levels. She mar
ried a second time three years after her divorce. With this marriage, L
reversed her previous noncommunicative behavior pattern and, deciding
that honesty was the best policy, told her husband before they were
married that she had what she considered to be a high level of sexual
need. She also told him of her lack of sexual relief during her first mar
riage. Although her honesty was to be commended, the timing of her
disclosure could not have been worse. Perhaps the second husband was
initially made anxious at the concept of marrying a woman with an
overwhelming sexual need that he might not be able to meet. He be
came impotent 10 days after the wedding when, despite his every effort,
L had still not achieved orgasmic release and had begun openly
masturbating in his presence. L divorced him after seven months of
marriage, a decision with which he was apparently in full agreement.
There were two more brief, sexually frustrating affairs for L, who
then deliberately terminated all sexual interaction with men. She con
tinued her daily masturbational pattern, which she now was pleasurably
enhancing by fantasizing herself being manipulated despite her objec
tions by various women of her acquaintance, including, at times, her
mother.
L found that her unresolved sexual frustrations were altering her per
sonality and making her socially restless. It was apparent that her effec
tiveness as a mother was being jeopardized, so she made a deliberate
decision to completely alter her lifestyle.
When she was 32, L quietly decided to involve herself in homosexual
3^6 CHAPTER FOURTEEN
interaction. There had been no prior sexual interaction with women

other than her mother’s pattern of genital stimulation when she was a
child. However, she had lived through two marriages and a number of
lovers and had never been orgasmic in response to any male sexual ap
proach. She was still masturbating daily as her only established means
of sexual release. As she stated her case for moving into a homosexual
orientation, "I felt I had nothing to lose.”
Having made a decision to try homosexual interaction, she deliber
ately went to a gay bar and let herself be “picked up.” She responded
immediately at orgasmic levels to partner manipulation, but not to cun-
nilingus. Even so, she was delighted with such a level of response dur
ing her first lesbian experience.
Over the next three years, L continued cruising lesbian bars until she
had interacted sexually with many partners and tried a variety of dif
ferent sexual approaches; yet she was orgasmic only with manipulative
play. She finally tired of casual sex and began looking for the social
stability of a committed relationship. When L was 35 years old, she
met M at a married friend’s home.
M, who was 32 when she met L, had lived with the personal handicap
of what she described as complete lack of sexual interest. She had a his
tory that was almost the exact opposite of L’s. She did have in common
the fact that hers was a financially secure family background, but there
any real similarity ended.
M was an only child in an austere fundamentalist Protestant family.
Their religion was the center of the family’s social world. The family
held long daily prayer meetings, and their lives were socially structured
by church dogma. M only learned in her twenties that her mother had
forced her father to leave their home for presumed adultery, which he
denied, when M was 7 years old. M could not remember another man
(other than immediate family) ever visiting the home. When she was
12, her mother told her about menstruation and about sex at the same
time. Both were portrayed as woman’s burden. Sex was also described as
an evil thing, something only men needed, and, of course, only accept
able by women for reproduction.
M believed all that her mother taught her. Although she wasn’t quite
sure what sex was, as her mother had been quite vague on the details of
the subject, she grew up afraid of boys, all of whom she knew would
want sex.
M went through high school and college as a good student, but she
did not involve herself in extracurricular activities or social interchange.
She was an overweight girl with an introvertive personality who con
sidered herself to be unattractive.
Near the end of her junior year in college, M’s mother, who was 44
years old, died of peritonitis caused by an illegal abortion. According to
the doctors, the mother had been at least four months pregnant. She
327
never identified the abortionist or the man responsible for the pregnancy.
As expected, this was an overwhelmingly shocking episode in M’s es
sentially colorless and certainly uneventful life. Word of the cause of
death spread quickly through the family’s social circle, and by asso
ciation, M was made to feel almost as guilty about her mother’s sins as
if she had been the one who had obtained an abortion. She resolved
never to have sexual experience with men because the price that had to
be paid was obviously too high.
This resolve lasted about two weeks. M returned to college severely
depressed, and one night while aimlessly walking the campus and openly
crying, she was stopped by a man who was in a class with her and who
asked if he could help. She was caught completely off guard, told him
her story, and promptly “fell in love” while they had coffee. M pursued
the man constantly until he took notice. She responded to his notice
with rapidly developing sexual interest until, two weeks after they met,
she spent the night in his room. Although she had never had any kind
of sexual experience previously, M was orgasmic with manipulation and
with intercourse the first time she experienced either sexual approach.
She was overwhelmed with the intensity and the pleasure of her feelings
and more than ready for further experimentation when the next night
the man told her that he was engaged and was going to be married in
six weeks.
M immediately reverted to all of the sexual “thou shalt nots” that
her mother had taught her. The single night was all the sexual ex
perience she ever had with any man. The more she involuted socially,
the less she was interested in any form of sexual activity. After college
she worked irregularly, traveled extensively, and lived alone until she
met, quite by accident, a woman she had known in college who had re
cently moved to her geographical area. This woman was also single, and
the two women saw each other a number of times socially.
After a brief period of time M, to combat her loneliness, invited the
woman to share her apartment. Before moving in, the woman told M
that she was a lesbian. It didn’t matter to M, who wasn’t really quite
sure what a lesbian was and anyway had no interest in sex.
After some months together, the woman, again with M’s permission,
began bringing an occasional friend home for the night or the weekend.
Although M clearly heard the bedroom noises, she did not recall either
feeling sexually aroused or even sexually curious. One night, after more
than a year of living together, the woman openly moved into M’s bed
in a direct sexual approach. Despite every effort on the woman’s part
and despite M’s clumsy cooperation, M was not responsive.
In the next few weeks the woman did teach M something of female
anatomy and of how to stimulate another woman. Thereafter, M co
operated to release her partner when the partner expressed her sexual
need by coming to M’s bed. Mutual attempts at releasing each other
3«8 CHAPTER FOURTEEN
occurred approximately once a month. In these episodes the partner usu

ally was fully responsive but M was not. It was during this time that,
at the partner’s suggestion and following her explicit directions, M at
tempted masturbation for the first time in her life and was orgasmic.
After orgasmic episodes on two other occasions, however, M lost in
terest in masturbation. During the remaining two years that the couple
lived together, M was orgasmic once with cunnilingus and twice with
manipulation. Both women agreed that M simply had a low level of
sexual interest.
The couple separated because the company for which the woman
worked transferred her to another city. Having enjoyed the companion
ship of the low-keyed relationship, M was left with an even greater
sense of social isolation.
After her mother’s death and her one night of heterosexual sex, M’s
only consistently expressed interest was in her religion. Apparently the
few homosexual experiences with her roommate were not equated in
her mind with sexual sin, or at least they were not considered as sinful as
her mother’s indiscretion and her own campus episode. After her friend
moved to another city, M spent almost a decade in a social vacuum with
no male and but a few female acquaintances, most of whom were mar
ried and all of whom she met at church functions. M reported no sexual
activity of any kind during this time. She did not masturbate and had
no sexual fantasies or sex dreams.
M met L one evening in the home of a married woman she had
known through her church activities.
What the two women found immediately appealing neither could say,
but they did move directly into social interchange. Within a brief pe
riod of time the two people, poles apart in social consciousness, sexual
experience, and knowledge of the world and the people in it, were fully
committed to each other.
L found M’s social and sexual naivete completely unbelievable, most
appealing, and sexually very stimulating. For M the change was far
more dramatic. L turned on a light in her world. She “fell in love”
again, this time in a promising, secure relationship.
M began spending long weekends with L in her home, getting to
know L’s children, who were almost teenagers at the time. The women’s
mutual social world seemed more secure when they found they had
some of the same tastes and so many of the same needs.
Although L was highly excited sexually by her new friend, she was
reluctant to aproach M for fear of turning her away. Both women agreed
that this problem was solved by M. One night while spending a week
end together, M simply asked L if she could help her with her sexual
feelings. Knowing M’s sexual history, L was warmed by M’s offer but
insisted that each should enjoy the other. During their first sexual ex
perience together, L responded freely to manipulation but M could not.
329
After this weekend of sexual interchange, the women agreed to live

together in L’s home.
M responded to her new environment with a sense of sexual com
mitment. She released L almost daily by manipulation but was not
successful with many attempts at cunnilingus. Although L also ap
proached M without reservation, M was rarely aroused to orgasmic
levels, reporting orgasm perhaps once or twice a year. However, she had
no conscious feelings of sexual frustration and thoroughly enjoyed the
feelings of physical awareness and, most of all, the physical closeness of
sleeping with L.
Both women lived openly but quietly within their homosexual rela
tionship. L’s children freely accepted M. Most of L’s friends became
M’s friends. M only regretted that she had so few acquaintances and
no friends to share with L.
The two women decided to enter therapy to expand the dimensions
of their relationship. L wanted to be able to respond to cunnilingus,
and M wanted to feel and respond as openly and freely sexually as she
had seen L respond so many times.
There was little difficulty in helping L achieve her goal of or

gasmic release with cunnilingus. She had developed real fears of
performance and became an immediate spectator whenever cun
nilingus was initiated, something she never did when being ma
nipulated or when masturbating. With M’s full cooperation and
following the concepts outlined in Chapter 12, L’s situational anor-
gasmia was reversed during their first week in therapy.
M was more of a problem. Over the years she had been inun
dated by feelings of unworthiness. Her social insecurities were re
flected in her sexual inadequacies. M had adopted the standard
pattern of voluntary social isolation that is frequently employed by
such insecure men or women. She was the type of individual who
rarely takes social risks or forms close personal attachments and
therefore is rarely disappointed by relationships that fail to mature
satisfactorily. Her pattern of not venturing personal involvement
with social interchange was identically repeated in her pattern of
not venturing personal involvement in sexual interaction. When
she “didn’t feel anything sexually” she was only withdrawing sensu
ally to protect herself against the disappointment of sexual failure.
The key to therapy was to reflect back to M how freely respon
sive she had been during the one night with her male classmate.
Here she identified with the individual, was fully confident and
CHAPTER FOURTEEN
33®
trusting, and gave of herself completely. Supported by her sense of

total commitment, she was fully responsive sexually even though it
was her first heterosexual experience. When she had found that her
sense of commitment was misplaced, she did not have the courage
to trust another man or woman fully until L entered her life.
Instead she had tried to drown her sense of personal inadequacy in
the sea of security provided by her religious commitment.
It was suggested that since she voluntarily had made a major
contribution to her current relationship by giving of herself socially
without reservation, it was now time to give of herself sexually with
confidence. If she could conceive of giving of herself sexually as
she had socially, her level of sexual interest inevitably would in
crease and her ability to respond to sexual stimuli would probably
follow the same pattern.
There was, of course, an additional psychosocial hurdle to over
come. If M were to express herself sexually with complete freedom
in a continuing lesbian relationship, her “sex is sin” background
had to be confronted directly. She had to come to terms with the
inevitable clash between the tenets of her religion and her chosen
lifestyle. M made a free commitment to the relationship far more
readily than the therapists deemed possible under the circumstances.
M had little difficulty in accepting the concept that her volun
tary decision to live a life apart socially had been directly reflected
in her life apart sexually. She slowly began responding to L’s quiet,
nondemanding sexual approaches. She was orgasmic once with
manipulative and also once with cunnilingal stimulation while in
therapy.
During follow-up, M reported increasing sexual involvement in
response to L’s persistent but low-keyed approaches, and in six
months she reached an approximate twice-a-week stage of orgasmic
attainment. She also thoroughly enjoyed making sure that L had
sexual release on at least a daily basis, using a multiplicity of dif
ferent stimulative approaches.
These two women are currently living productive lives in n mu
tually enhancing relationship. They have met and to a significant
degree neutralized public resistance to their status by openly stating
their relationship but not forcing it upon their peers. M has become
far more of a contributor to both the sexual and social aspects of
331
the relationship since she has been able to join L in mutually re
sponsive sexual interchanges.
DISCUSSION
The therapy of the 23 couples that applied for treatment of anor-

gasmia with one partner dysfunctional and the other fully sexually
responsive was conducted using the same general psychotherapeutic
approaches that were employed in the treatment of the two cou
ples reported above. As stated in Chapter 13, a detailed discussion
of the psychodynamics involved will be published separately. Suffice
it to say for the present that, as in the treatment of anorgasmic
heterosexual women, the necessary technical suggestions for more
effective sexual interaction are implemented with the cooperation
of the functional partner. But far more important, the arts of com
munication are not only taught but are stressed; psychosocial road
blocks are directly confronted; and anxieties are neutralized insofar
as possible. Fears of performance and spectator roles are identified,
discussed with the couple, and treated, again primarily through the
cooperation of the functional partner.
The sexually dysfunctional homosexual woman has a significant
advantage over the similarly dysfunctional heterosexual woman.
She does not have the added cultural requirement of orgasmic re
sponse during intercourse. Potentially it is less demanding for a
woman to become orgasmic during masturbation, partner stimula
tion, and cunnilingus, when the clitoral glans and/or shaft is stimu
lated by direct manual or oral approaches, than it is during inter
course, when the clitoral shaft usually is stimulated only indirectly
by the tension on the minor labia created by the usual coital thrust
ing pattern. As was shown in Chapter 6, sexually responsive women
have an increased incidence of failure to function at orgasmic lev
els in coital interaction as compared to other forms of sexual stimu
lation. Therefore, when sexually dysfunctional homosexual women
are treated with essentially the same techniques as sexually dys
functional heterosexual women, the treatment failure rates in terms
of facility of orgasmic attainment should be lower for dysfunctional
homosexual women—and they are. The failure statistics pertaining
CHAPTER FOURTEEN
33«
to the treatment of lesbian dysfunction are reported in Chapter 17.

For the first time a long-range clinical program for the treatment
of lesbian sexual dysfunctions has been presented to the health
care professions. This program is only the first step in a new dimen
sion of health-care growth. Psychotherapists have the responsibility
to respond to the requests for support presented by sexually dys
functional women, regardless of whether the women are homosex-
ually or heterosexually oriented. If a woman is allowed to continue
to be sexually dysfunctional on an indefinite basis, in due course
she may well become psychosocially dysfunctional, for the culture
equates woman's recently acquired sexual equality with a demand
for effective sexual performance. It has become increasingly obvious
that the pressures for sexual performance are as much directed to
homosexually as to heterosexually oriented women. Therefore the
culture can no longer afford to ignore the sexually dysfunctional
homosexual woman.
I í
MALE HOMOSEXUAL
DISSATISFACTION
lhe homosexually oriented male population that applied to the

Institute for reversion or conversion therapy has been described in
Chapter 12 and listed in Tables 12-3 and 12-4. Fifty-four men, to
gether with their committed or casual heterosexual partners, were
treated over the 10-year period of clinical control (see Table 15-2).
Thirty-one of these men were married and entered therapy with
their wives, 2 men were living in long-term heterosexual relation
ships and were listed as married, and 21 men were treated with
casual female partners.
The terms conversion and reversion have been employed by the
Institute to connote relative degrees of previous heterosexual and
homosexual experience. If a man or woman expressed the desire to
move into full heterosexual involvement and described little or no
prior heterosexual experience (Kinsey 5 or 6), he or she was clas
sified as requesting conversion to heterosexuality. On the other
hand, if the man’s or woman’s degree of prior heterosexual experi
ence ranged decreasingly from dominant to considerable (Kinsey
2 to 4), he or she was identified as requesting reversion to hetero
sexuality.
Providing therapeutic support for the homosexually oriented man
or woman who wishes to convert or revert to heterosexuality has
been an integral part of the practice of psychotherapy for decades.
Some reported treatment results have been acceptable, others have
not. Any number of difficulties have been encountered in the treat
ment of homosexual men and women requesting alteration of sex
preference, but the major stumbling block that creates the highest
failure rate in any treatment program concerns problems of atti
333
CHAPTER FIFTEEN
334
tude, both of the therapists and of the sexually dissatisfied men

and women.
If the therapist cannot develop and stabilize an objective, per
sonal attitude toward the subject of homosexuality, he or she can
easily prejudice the reversal of a sex preference at the very onset of
therapy. Therapists have openly taken such biased pretreatment po
sitions as identifying homosexuality as a congenital anomaly, as a
major neurosis, as a sexual perversion, or even as a physical illness.
In short, therapists have frequently insisted on treating the rever
sion or conversion applicant for a state of physical, psychological,
or social pathology, the clinical existence of which has never been
established. This escape from vital professional neutrality under the
protective cloak of cultural dictum has usually resulted in the thera
pist’s attempted imposition of his or her own social or sexual value
systems on the client. As stated in Chapter 12, it is the Institute’s
fundamental position that the therapist as a committed profes
sional does not have the privilege of imposing his or her cultural
value systems on the client, regardless of whether the client is ho-
mosexually or heterosexually oriented.
In therapy, the Institute’s modus operandi is to identify, evaluate,
and then openly discuss the positive and/or negative contributions
that the client’s social and sexual value systems are making to his
or her lifestyle. If an alteration need occur in the client’s value sys
tems in order to either instigate or implement the therapy process,
the alteration must be accomplished within the psychosocial restric
tions imposed by the client’s frame of reference—and this frame of
reference might not be at all compatible with that of the therapist.
A carefully designed treatment program has the best chance for
long-range success if it enables the client to live effectively within
the encompassing but familiar restrictions of his or her own sexual
and social value systems. Of course, established behavior patterns
should be modified when necessary, but no attempt should be made
to reconstruct the client’s basic value systems in a new image (the
therapist’s). For once the treatment program is terminated, the
client will have little chance of enjoying a positive treatment result
if he or she is committed by authoritative dominance to inter
preting, adjusting to, and living within the social and sexual value
systems of the therapist.
MALE HOMOSEXUAL DISSATISFACTION
335
A major treatment concern is, of course, the applicant’s attitude.

Degrees of client motivation are hard to evaluate at any time, and
they are particularly difficult to determine when the expressed re
quest for alteration of established behavior patterns encompasses a
controversial area. The research team made a determined attempt
to identify each applicant’s degree of motivation for alteration of
sex preference. When there is questionable client motivation, the
possibilities of a positive therapeutic result are markedly reduced.
MOTIVATING FACTORS
What are the Institute’s methods of evaluating treatment suit

ability? How does the therapist determine the degree of client
motivation for alteration of sexual preference? How does the thera
pist handle the questionably motivated client?
Much has been learned from the pioneering efforts of other pro
fessionals in this field. After considering their reported experiences,
the research team decided to give a relatively low priority to the
content of the applicant’s verbal protestations of interest in sexual
preference alteration. It is so easy for any homosexually oriented
man or woman to react to psychosocial pressures by claiming, and
at the precise moment believing, that he or she is fully committed
to heterosexuality, but it is far more difficult to continue living in
a heterosexual lifestyle when the psychosocial pressures have been
reasonably neutralized or even removed by the passage of time or
by an adequate therapy program.
Rather than attempting to determine levels of client motivation
merely from the content of ■ direct interview, it seemed far more
equitable to evaluate the factors underlying the presumed motiva
tion. As experience accumulated, criteria developed for evaluating
these factors.
If the motivation for sex-preference alteration only developed in
apparent response to social threat, the research team felt insecure
about the prospects for a permanent therapeutic result and there
fore was particularly careful in client selection. When the expressed
motivation for change reportedly was stimulated by socially or pro
fessionally threatening situations, the involved men and women
CHAPTER FIFTEEN
336
were judged not so much by what they said when applying for treat
ment, but by how they had handled their culturally induced anxi
eties. For example, individuals in socially vulnerable positions, such
as teachers in secondary schools or image-conscious public figures,
were evaluated far more by their actions in response to the pres
sured situation than by the content of their verbalizations. Accord
ingly, the length of time between the client’s determined need for
change in sex-preference and the first contact with a health-care au
thority became an important criterion in evaluating motivation lev
els. If the psychosocially threatened individual or couple sought pro
fessional support within approximately three months or less of the
first suggestion of public or professional exposure, the motivation
for change was presumed to be at a higher level than that of men
or women who procrastinated for six months or more before seek
ing some type of health-care consultation. Many of those who
procrastinated verbalized their motivation for alteration of sexual
preference in the highest terms, but they had actually given such
alteration a less than immediate priority. In other words, if the
primary motivation for altering a sexual preference was derived di
rectly from a presumed need for social or professional survival, there
seemed to be a better chance of client cooperation if there had been
a relatively immediate request for support. If every other means of
coping with the situation had been employed before facing what
the individual obviously thought of not only as the least attractive
but as a finally forced alternative, the therapists had little confi
dence that attempted conversion or reversion therapy would pro
duce a permanent result.
Of course, a number of other factors were considered in evaluat
ing motivation for alteration in sexual preference. An applicant oc
casionally expressed open dissatisfaction with his or her homosex
uality. Reacting to a significant amount of unfortunate sexual or
social experience or both, a few clients not only expressed the de
sire to alter their sexual orientation but wanted to be relatively cer
tain that the change in role preference would be permanent. These
few men and women (there were 7) usually had at hand a desired
heterosexual partner (there were 6) with whom they anticipated
living in a committed relationship. They had decided that arbi
trarily altering sexual preference on their own, without adequate
337
psychotherapeutic support, would be taking an unnecessary risk

with the new relationship. They were also intrigued with the con
cept that they might stimulate a greater degree of support and a
higher level of cooperation from their prospective heterosexual
mates if the mates were fully informed of the applicants’ previous
homosexual orientation and, if possible, even of some of the rea
sons for it.
Couples exemplifying exactly the opposite set of motivating fac
tors were also seen as applicants for reversion therapy. The counter
part to the uncommitted couples who voluntarily sought psy
chotherapeutic support in altering sex preference before entering
marriage was seen in the couples whose existing marriages were
threatened by the sexual ambivalence of one partner.
Most of the male and female applicants with a poorly function
ing heterosexual commitment admitted to having had a significant
amount of both homosexual and heterosexual experience prior to
marriage. The marital partner had rarely been informed before the
marriage of the mate’s ambivalence in sexual preference and had
become aware of the dual preference either by accident (a truly
traumatic means of enlightenment) or by confronting the indi
vidual after suspicions had been raised by the mate’s markedly al
tered heterosexual patterning.
In most instances the couple’s immediately expressed need was
for relationship support, but also verbalized was anticipation that
the dual-preferenced individual could be reverted to full hetero
sexual commitment. In these situations the factor of motivation
was primarily evaluated not by the couple’s verbalization of interest
in therapy but by their pattern of interaction with the therapists.
If a request for alteration of sex preference was forcefully ex
pressed by the heterosexual partner and was only casually acknowl
edged or even hesitantly acceded to by the dual-preferenced indi
vidual, there was reluctance to accept the couple in treatment.
Occasionally there was a deliberate attempt by the dual-preferenced
applicant to use the treatment program as a camouflage. For ex
ample, several couples applied for reversion treatment with the
sexually ambivalent male partner saying one thing in front of his
wife and yet another to the therapists in private. When such self
incriminating phrases as “of course I’ll need an occasional chance
CHAPTER FIFTEEN
338
to be with my friends” or “I want to be 95 percent heterosexual”

were used in private with a therapist, the couples were refused treat
ment. The Institute’s position was that the male applicants had
the right to take any position they wished and to express their
sexual value systems as they saw fit, but they did not have the privi
lege of using the Institute’s treatment program as a means of mis
leading their wives. It must always be borne in mind that the ap
plicant’s partner has equal privilege in therapy and the right to
equality of protection.
Historically, reversion therapy has rarely been successful if the
individual enters a treatment program under duress from a spouse
or with the expressed concept that complete reversion is neither
possible nor fully desired. However, if the dual-preference partner
initially evidenced specific concern for the relationship and then
personally requested support in sex-preference limitation and made
the request without any stated reservations, the research team was
quite willing to accept the couple in therapy.
The highest incidence of questionable motivation occurred in the
group of uncommitted homosexual men who, with their casual fe
male partners, applied for conversion or reversion therapy. It was
extremely difficult to establish the motivating factors within this
group. The uncommitted men had in common with their casual
female partners only the factors of sexual curiosity and an apparent
freedom from personal commitment.
When evaluating this type of uncommitted homosexual male ap
plicant for conversion or reversion therapy, little priority was given
to what was said when requesting treatment. Instead, the research
team was far more concerned with evaluating motivation by look
ing at the potential for gain if treatment were successful. Was the
applicant’s potential for gain great enough to motivate him or her
to cooperate in therapy? If not obviously forced by social pressures
and if the applicant evidenced no homosexual dysfunction or dis
satisfaction, what positive gain could be anticipated from successful
treatment? Since a permanent commitment to the casual female
partner was not contemplated, the motivating factors of an antici
pated or even a secure relationship could be discounted.
Some of the men were simply concerned with developing confi
dence in heterosexual function so that their sexual opportunities
339
could be more broadly based. With two exceptions, men with this
type of motivation were not accepted in therapy.
The uncommitted male applicants who were selected for therapy
with their casual female partners had one motivating factor in com
mon in addition to their concept of having something definitive to
gain by moving into a full heterosexual commitment. They had the
common factor of anxiety—that of fear of performance in a het
erosexual role. Whether the alteration in preference was requested
by a Kinsey 2 with a large amount of prior heterosexual experience
or a Kinsey 6 with none, there was a universal anxiety among the
males accepted for therapy that after their homosexual experience
they might not be able to function effectively with their selected
female partners. In fact, some of the men had attempted inter
course before applying for treatment and generally had been unsuc
cessful in heterosexual interchange.
It is probably true that fears of performance keep many more
homosexually oriented men from experimenting with heterosexual
interaction than we have realized or than might have been admitted
if the men had been openly interrogated. Quite possibly the reverse
may be equally true. Fears of performance and of social opprobrium
keep many men fully restricted to a heterosexual lifestyle who might
otherwise have experimented with homosexual opportunity.
Of course, there were the occasionally expressed motivating fac
tors for role alteration that by their very uniqueness intrigued the
therapists into acceptance of obligation. For example, a man was
accepted who was primarily impotent as a heterosexual. He had
married but could not consummate the marriage. He had tried to
function with other women and failed and then had turned to
homosexual interaction as an ego-salvaging measure. Identified as
homosexual four years later by his still-committed wife, he re
quested support both in neutralizing his established homosexual
orientation and in gaining a sexually functional status as a het
erosexual.
There was also a Kinsey 6 woman who had been primarily anor-
gasmic as a homosexual and who, after living approximately n years
as a sexually active but completely frustrated homosexual, insisted
that homosexuality had nothing to offer her. She stated that she
wanted to live in a heterosexual relationship with a specifically se
CHAPTER FIFTEEN
34«
lected heterosexual partner and to function sexually at orgasmic

levels with him. The research team was intrigued not only by her
stated motivation for change, but also by the ambiguity of the pro
fessional situation. Had she requested support in developing sexual
facility as a lesbian, such help would have been freely offered. In
stead, her specific request was for therapeutic support in the altera
tion of her sexual value system, and she was accepted just as openly.
There were also requests for conversion therapy that were based
on the simple factor of an openly expressed curiosity for experience
with heterosexual interaction, and these were accepted.
Finally, there were 4 couples in which the previously homosexual
male partner (Kinsey 5 or 6) was motivated by an in-depth attach
ment to an opposite-sex individual and was sincerely interested in
consummating physiologically the psychosocially committed rela
tionship, even though the consummation had already been tried
and had failed repeatedly. These couples were accepted for conver
sion therapy.
It should be stated that there are a number of other criteria for
defining motivation that cannot be openly published. Public iden
tification of these criteria would prejudice the Institute’s screening
procedures that have been developed over the last n years. In the
future each individual clinical program, as it is constituted to treat
homosexual male or female dissatisfaction and as it gains experi
ence, will develop its own screening concepts and procedures. Meth
ods of screening for motivation are not nearly as important as the
fact that applicants for the treatment of homosexual dissatisfaction
must be screened for motivation in order to maintain a therapy fail
ure rate at reasonably low levels. Of course, regardless of how firmly
established the screening procedures might be, a certain amount of
latitude in client selection must always be left to the clinical judg
ment of the therapist.
The distribution of conversion and reversion cases is shown in
Table 15-1. A total of 45 male homosexuals were accepted for re
version therapy and 9 male homosexuals for conversion therapy over
a 10-year period. Case distribution during this time is indicated in
Table 15-2. With the exception of the first two years, approximately
6 cases of homosexual male dissatisfaction were treated each year.
Treatment results are presented in Chapter 17.
34I
TABLE 15-1
Dissatisfied Homosexual Male Population

(Total Applicants, N = 70; Applicants Accepted, N = 54)
Reversion Conversion
Candidates Candidates
Kinsey Kinsey Kinsey Kinsey Kinsey Total
Applicants 2 3 4 5 6 No.
No. of applicants * 2 15 40 9 4 70
No. refused t 0 4 8 3 1 16
No. accepted 2 11 32 6 3 54
(1968-1977)
* No Kinsey 1 men applied for treatment,
t Overall refusal rate, 22.8 percent.
TABLE 15-2
Dissatisfied Homosexual Male Population (N = ^):

Year Treated
Dissatisfaction
Therapy One Two Three Four Five Six Seven Eight Nine Ten Total
Reversion 3 2 6 4 5 7 3 5 6 4 45
Conversion 0 2 1 1 0 1 2 0 1 1 9
Total 3 4 7 5 5 8 5 5 7 5 54
(1968-1977)
R E F U SED A P P L I C A T ION S
Male applicants for sex-preference alteration are identified by

their Kinsey rating in Table 15-1. Also reported are the number of
applicants in the same preference categories who were refused treat
ment by the Institute. There was approximately a 23 percent rate
of application refusal. Those men refused treatment were referred
to other sources of therapy, but only after a full explanation had
been given not only of the Institute’s selection policies but also of
the specific reasons for refusal of the individual applicant.
CHAPTER FIFTEEN
342
Sixteen homosexual men and their female partners (2 committed

and 14 casual) were refused treatment for sexual dissatisfaction dur
ing the 10-year period of clinical control (see Table 15-1)- There
were a variety of reasons for refusing access to the treatment pro
gram, but by far the most frequent reason for refusal (9 applicants)
was the research team’s clinical decision that there was insufficient
motivation evidenced by the homosexual applicant for alteration of
his sexual preference. Some of the measures by which the team ar
rived at such decisions have been described earlier in the chapter.
Two of the male applicants were diagnosed as psychotic and re
ferred to other clinical resources. Three were refused therapy be
cause their casual female partners were considered severely neurotic
(2) or psychotic (1). The remaining 2 applicants were refused
treatment when they were identified as supplying false information
during the selection process.
In all probability, mistakes were made in both acceptance and
refusal of applications for treatment. In order to ensure consis
tency in admission policies, the decisions to admit or reject were
made by the same individual during the entire 10-year period of
clinical control. While the possibility of personal bias in client
selection was always present, at least the same level or type of bias
existed for the entire clinical control period.
The problem of the health-care professions’ refusal to accept into
treatment severely distressed homosexual men has been discussed
at length for the dysfunctional homosexual male population (see
Chapter 13). The same problem has existed (though to a lesser de
gree) for sexually dissatisfied homosexual men. Of the 54 homo
sexual men accepted in therapy by the Institute, 36 had previously
sought treatment from another health-care facility for their com
plaints of sexual dissatisfaction (see Table 12-5, Chapter 12).
Twenty-one of the 36 men had been refused treatment, 10 of the
21 men more than once. Surprisingly, only 1 of the 21 men refused
treatment had been referred to another therapy source. Fifteen men
had been accepted in treatment elsewhere, but 12 of these men had
terminated their treatment as unsatisfactory. Three men were in
active therapy when they applied to the Institute for treatment and
were released by their therapists.
It must be acknowledged that a degree of bias exists in these
343
statistics for at least two reasons: First, homosexual men who were
successful in obtaining treatment elsewhere were not seen at the
Institute; second, these numbers reflect an historical phenomenon
of rejection by health-care professionals that probably would not be
found to the same extent today.
The prejudice of the health-care professions was not as apparent
when support was requested by the dissatisfied homosexual male as
it was when the dysfunctional homosexual male asked for help.
Since this subject has been discussed in detail (see Chapter 13),
there is no need for further exposition.
THERAPEUTIC PROCEDURE
To exemplify the clinical situations encountered, representative

case reports are presented. They will be briefly discussed individu
ally and then summarized in principle. A detailed discussion of
therapeutic techniques will be presented as a separate publication.
No attempt has been made to describe in detail the general back
ground or the psychosexual status of the heterosexual female part
ners that were an integral part of the relationships treated by the
Institute’s staff. But when specific information about the female
partner is necessary to complete the clinical picture, it has been
provided.
N was a 37-year-old Kinsey 4 male who had been living for seven
years as an unattached homosexual when seen in therapy. Previously,
he had been married for two years and divorced because of sexual inade
quacy. He was a lawyer whose career was being threatened by rumors
that he “didn’t like girls,” and he sought professional support in reorien
tation to heterosexuality.
N was the youngest of three children in a family with few or no
financial resources. He could only describe his childhood as one of con
stant turmoil. He remembered whippings from his coal miner father,
who was an alcoholic and an uncontrolled tyrant in the home. N de
scribed his mother as a woman who lived only to keep the family clothed,
fed, and passively protected and who didn’t always succeed at these
tasks. Fear of the husband-father pervaded the home.
N’s siblings were a brother six years older and a sister 17 months
CHAPTER FIFTEEN
344
older. He had little direct contact with his brother, who began working
in the mines after two years of high school and married at age 18. His
relationship with his sister was much closer. They shared the insecuri
ties of the home and at times were able to provide each other with some
degree of comfort. He felt deserted when she married at 16 in order to
leave the home.
N could not recall a single religious direction. He had never been in
a church.
N seemed always to be separated from his peer group by necessity.
As he grew up, he worked at odd jobs after school, so his opportunities
for social interchange were markedly limited. Since his mother also
worked, his sister was held responsible for much of the housework. Both
N and his sister were whipped repeatedly for what N described as minor
offenses, and his mother was subjected to a number of physical beatings
that severely traumatized both N and his sister.
After the older brother left home, the father began an open incestu
ous relationship with N’s sister despite both her pleas and those of the
mother. About a year later the sister ran away to marry, leaving N alone
in the home.
N continued part-time work to contribute to the family’s support
throughout high school. His grades were excellent, and with the help
of the school principal he was granted a full scholarship at a state uni
versity. He worked his way through the university and—again with a
full scholarship—through law school. Once he entered the university,
he never again lived at home. His mother died during his first year in
law school.
N’s social life was essentially nonexistent throughout his undergradu
ate years. He worked steadily at part-time jobs to help pay for his room
and board and was seriously involved in his course work. His under
graduate academic achievement was of the highest order, and he gradu
ated near the head of a class of many hundreds of students.
N began masturbating at approximately 13 and continued at a rate
of once or twice a week through his teens. In his last year in the uni
versity, he became involved with a girl who was working with him in a
part-time job. After she took the initiative of expressing interest and
providing the opportunity, they began a sexual relationship. N had not
disliked girls, but he simply had had little time for social interaction as
he grew up. Before he met this girl, he had never had a date, kissed a
girl, or had any other form of sexual experience with either women
or men.
N’s social and sexual behavior with his first girl was understandably
clumsy and awkward, but since he could not bring himself to admit
his virginal status, he was easily misinterpreted by his female partner.
He had no concept of female anatomy or, for that matter, of any man
ner of sexual interaction. Since the girl was quite experienced, at least
345
by comparison, it was not long before she was criticizing his sexual ap
proaches. At first she quietly suggested alternatives and then, when her
suggestions apparently fell on deaf ears, she told N specifically that he
“wasn’t any good” sexually. Soon thereafter she terminated the rela
tionship.
N had occasional sexual experiences with other women during law
school and for two years after he graduated, but almost all were of the
one-night-stand variety. When he was 26, N was attracted to a secre
tary in the law firm in which he was a junior member. After a six-month
courtship, they married. The sexual aspects of the first few months of
the marriage were approximately a repeat of those of his first sexual
experience. Again he did not admit his profound ignorance of female
sexual needs. His wife began complaining that he hurt her, didn’t give
her enough time, didn’t know how to please her, was only interested in
self-satisfaction, and so forth. Probably, all complaints were justified.
Finally, there was a very angry scene during which N was told that he
simply didn’t know how to treat a woman. His wife told him she was
“tired of being used like a whore.” This statement immediately evoked
memories of his father’s frequent drunken use and abuse of his mother
and sister.
The next time the couple attempted intercourse, N lost his erection
shortly after penetration as he thought of his wife’s accusation that he
was using her like a whore. Within two months N had lost what little
sexual confidence he had ever attained. There were no further erections
other than when he masturbated. N’s wife divorced him after two
years of marriage because he no longer could function sexually. He in
sisted that the divorce complaint read “incompatibility” and was actu
ally relieved to be free of this anxiety-provoking situation. He never at
tempted further heterosexual interaction until he was in therapy.
Over the next two years N masturbated regularly but had no other
sexual experience and buried himself in his career; he also did not take
advantage of any opportunities to gain social experience.
When he was 30, N met a man eight years older who was quite suc
cessful in business. The man soon became very friendly and saw to it
that N was given an opportunity to do a great deal of legal business
that otherwise might not have come his way. This man was married,
but he was also a very active homosexual. He simply seduced the sex
ually naive N. The process started with lengthy discussions of sexual
problems, proceeded to mutual masturbation, and—in two months—to
partner manipulation and fellatio. N consistently refused anal inter
course.
Homosexuality provided an entirely new sexual vista for N. He was
no longer accused of being an unsatisfactory sexual partner. When the
men were together, usually in N’s apartment, sex was quickly initiated
and as rapidly and effectively terminated. N was completely satisfied
CHAPTER FIFTE EN
346
with his homosexual orientation and had no further heterosexual inter

ests. The relationship continued for seven years, during which N’s career
prospered with his friend’s support.
Finally, rumors began to circulate, not about the two men specifically;
however, attention was being called to the fact that N never expressed
interest in women. The man, by this time fully devoted to N’s career and
aware of the political threat in the rumors, decided that he and N should
no longer be active sexual partners and insisted that N start seeing
women socially and even sexually. This N tried to do, but he was quite
unsuccessful. He recalled quite vividly the sexual disasters of his failed
marriage and with his first sexual partner. Although N could and did
leam to meet women at a casual social level with reasonable comfort,
he became extremely anxious when circumstances placed him alone
with any woman.
Once N began to move in heterosexual social circles, several women
openly provided him with sexual opportunity, but this possibility proved
too threatening. Finally a woman in her late forties who was widowed
and financially independent, whom he met initially through his male
sexual partner, also became interested in N. After a brief period of
time, both N and his male friend decided that she could be trusted and
she was told the whole story of N’s failed heterosexual experiences, his
complete lack of sexual know-how, and of his subsequent homosexual
orientation. After N asked for help, the woman freely agreed to join
him as a casual partner in the Institute’s treatment program for homo
sexual dissatisfaction.
N had been accepted in treatment because he had honestly ex

pressed his sexual ambivalence, acknowledged the threat to his pro
fessional career, and then made it quite clear that he was very fear
ful of moving into a heterosexual lifestyle since he was convinced
that he was totally sexually inadequate in heterosexual opportunity.
He felt that he could not choose objectively between the two sexual
preferences in view of his heterosexually oriented fears of per
formance.
This case is representative of a number of men who turn to ho
mosexual outlets once they have become convinced that, for what
ever reasons, they cannot hope to function effectively in a heterosex
ual role. The most important therapeutic step beyond determining
a positive motivation to function heterosexually is to fully under
stand the reasons for the homosexual orientation. In this case, N
moved into homosexuality from psychosexual need, but he was pri
marily pressured by his overt failures to sexually satisfy the two
347
women with whom he had a continuing sense of sexual commit

ment. He initially returned to heterosexuality with real reservation,
but he was inordinately pleased when his confidence in heterosexual
interchange was restored by the full cooperation of the older woman
in the treatment program.
At no time was N pressured by the therapists to alter his sexual
orientation. Once his heterosexual effectiveness had been restored,
his alternatives were explained and it was made very clear that the
choice of sexual preference was his alone to decide. He evidenced
no indecision in making a full heterosexual commitment.

Q was a 33-year-old Kinsey 3 who had been married for four years and
had one child when seen in therapy. He and his wife requested psycho
therapeutic support first to rescue a traumatized relationship and second
to alter his role from one of dual sexual preference to that of a full
heterosexual commitment.
P came from a stable, middle-class background. His father was 42
and his mother 39 when Q was bom. He was an only child. Apparently
a real effort was made by his parents to compensate for their age, but
the net result seems to have been a substitution of things for personal
warmth. When questioned about childhood memories, Q repeatedly
stated that he had never felt close to either parent. As he grew up he
felt loved, but as someone or something quite apart from and to a sig
nificant degree excluded from their relationship. He did not have a lot
of time with his parents in the home, as his father traveled extensively
on business and was frequently accompanied by his mother. Yet Q did
not describe a sense of loneliness, nor did he recall any feelings of rejec
tion. The parents apparently were able to project a sense of warmth and
support, for Q did describe an uneventful, happy childhood.
The family’s religious background was Protestant, but religion received
only a token acknowledgment in the home.
Despite his single-child status, Q mixed well with his peers. As he
grew older, he was encouraged by his parents to have boys stay over for
the night and to respond to their return invitations. At 12 he learned
to masturbate, and at 14 he was practicing partner manipulation with
two different boys over weekends.
Q’s first heterosexual experiences also began at 14. They were con
fined to kissing and breast play. With his parents frequently absent, he
had a great deal of privacy in his home, so experimentation continued
with a first coital experience with a peer when Q was 16.
For the remainder of his time in high school and through his college
CHAPTER FIFTEEN
348
years, Q lived a relatively independent and very active sexual life. He

responded to both homosexual and heterosexual opportunities as they
developed without social hesitation and without sexual reservation.
When he graduated from college, Q started on a business career with
his father’s support. He had his own apartment and was freely social
and openly sexual. He interacted with a number of men and women
who also lived without sexual reservation. There were group sex experi
ences, but Q did not particularly enjoy this means of sexual expression,
personally preferring privacy for sexual interchange.
He progressed well professionally and at 28 met the daughter of one
of the partners in a competitive firm. She was 24, two years out of col
lege, a devout Catholic and a virgin. These two people developed a
strong personal commitment. They were constantly together. By mutual
agreement their sexual interchange was limited to manipulation, and
when they married nine months later the bride was still a virgin. During
the courtship, Q denied himself all sexual outlets other than two iso
lated homosexual experiences.
After the marriage, the sexual interaction between Q and his wife was
severely stylized. His wife controlled their sexual activity by her rigid
convictions about what was acceptable sexual conduct and what was
not. This was a situation Q had never encountered, and he didn’t know
how to deal with his feelings. Yet he had no outside sexual activity for
more than two years until after his wife was hospitalized with a threat
ened abortion. For the rest of the pregnancy there was a continuing
threat of miscarriage or premature delivery, and intercourse was con
traindicated by the obstetrician. To his wife, the obstetrician’s interdic
tion of intercourse meant that any form of sexual expression was unac
ceptable since it could not culminate in intercourse.
Q became very restless sexually and turned to outside sexual oppor
tunity. His selected opportunities for sexual release were entirely homo
sexual in orientation. In response to some strange rationalization, Q
decided to honor his marital commitment by not turning to another
woman, but he did not hesitate to approach other men. After the preg
nancy terminated successfully and his wife became fully involved in her
new maternal role, Q continued with homosexual activity. When sexual
interchange was resumed with his wife, his homosexual experience con
tinued at the same pace.
One of Q’s best friends, a business associate, was openly homosexual.
The men enjoyed a number of sexual episodes together. They were to
gether in Q’s office after business hours early one evening when Q’s wife,
deciding to surprise her late-working husband and take him to~dinner,
walked in unannounced.
For almost three months husband and wife lived in separate rooms in
their own home. Then, after weeks of religious council for his wife,
reconciliation occurred following Q’s vow of full marital commitment.
This was a vow he found he couldn’t keep. Once he denied himself out
349
side sexual experience, he was even more intensely drawn to homosexual

interaction. He had a number of homosexual episodes over the next five
or six months. Following each episode, he experienced strong guilt feel
ings, but he still felt a continuing need to pursue his homosexual
interests.
Q finally realized that he was at a crossroad in his life. He decided
that he could not continue to live a dual-preference life without his
wife’s knowledge. Over a long weekend he quietly told his wife not
only about his inability to keep his vow of marital commitment, but of
the sexual details of his past life. He had not given her this information
previously. Separation and divorce were seriously considered, but both
marital partners felt themselves fully committed to their relationship.
They decided to seek professional support in an attempt to salvage the
marriage, and they applied to the Institute for therapy.
Both husband and wife clearly stated that their primary concern was
for maintenance of the family, while Q specifically asked for help in
achieving a full heterosexual orientation. Q’s wife offered unreserved
cooperation with the treatment program.
With the tremendous therapeutic advantage of working with a
committed relationship, and with client motivation at a high level,
the therapists were quite free to innovate. Q wanted a complete
heterosexual relationship with his wife, but he frankly stated that
his homosexual experiences were far more rewarding sexually than
most of his recalled heterosexual episodes. This had been particu
larly true w'hen he was interacting with his uninformed, inexperi
enced, and sexually very inhibited wife.
The success of the therapy program depended entirely upon con
stituting the marital bed as the major communicative attraction for
both partners. Q’s wife was informed of the direction to be taken
in therapy. If there was to be a relationship, both partners had to
alter their value systems for the other’s benefit. It was explained
that the therapists had no intention of making her anxious about
or fearful of sexual interchange. Rather, they wished her to be par
ticularly receptive to suggestions from her husband. It was empha
sized that much of successful sexual interaction between a man and
woman depends on two factors. The first factor obviously is the
psychosocial security that comes to each individual from the part
ner’s full commitment to the relationship. The second factor is the
extensive knowledge each partner has of the other’s sexual needs
and of the means and measures of fulfilling those needs. Q’s wife
was not only an apt, but a most cooperative pupil. She openly
35» CHAPTER FIFTEEN
stated that her marriage was the most important aspect of her life
and that no prior sexual reservations, regardless of how ingrained
they might be, would be allowed to stand in the way of a func
tional relationship.
It was suggested to Q that he really had no prior experience with
the potential depth of sexual pleasure that could be realized from a
committed heterosexual situation. He had only to join his wife
without prejudicing the result by recalling her prior sexual rigidity.
His inexperienced but most receptive wife quickly convinced him
that he wanted his marriage as a way of life. As their mutual sexual
comfort increased, so did the communicative base of the relation
ship. For the first time, Q and his wife found themselves communi
cating freely without inhibition and without reservation.
In follow-up, Q reports that he has kept his commitment to his
wife and family. He consistently works at improving their sexual
and social communication in order to contribute to the strength of
the relationship. His wife apparently works even harder at the same
goals.
This was a relatively easy problem in sorting out sexual prefer
ences. In fact, Q’s homosexual orientation really did not pose much
of a problem. His wife’s personal interpretation of religious ortho
doxy was as much if not more of a problem. Fortunately, it was a
problem easily solved by the wife when she realized that her inter
pretation of orthodoxy as well as her husband’s dual sexual prefer
ence were major obstacles to a functional relationship.
This case was chosen to illustrate the fact that there are instances
when the existence of an active homosexual involvement need not
be of significant concern to therapists, if they will place the problem
in proper perspective. It was not Q’s homosexual orientation that
needed therapeutic confrontation; it was the potential strength of
the relationship that had to be emphasized, and every therapeutic
effort was devoted to expanding this potential. Once Q realized
what he had in his relationship with his wife, his homosexual orien
tation was neutralized by his own choice.
CASE REPORT: COUPLE IO
R was a 30-year-old Kinsey 6 when seen in therapy. He was accepted

in treatment with his wife of 18 months. They had married after full
disclosure of R’s prior sexual orientation, but they had been unable to
consummate their marriage.
351
R’s family background was one of both security and trauma. R was
the third and last child (all boys) in a middle-class family. His brothers
were 11 and 8 years older. As a youngster, he remembers feeling either
left out or in the way. He could not recall any instance of affectionate
interchange between his parents, nor did he feel particularly close to
either mother or father. His much older brothers were no source of
identification or support. R’s was indeed a lonely childhood.
When R was 11, his father died, and when he was 14, his mother re
married. By this time both older brothers had left the home, and R
was truly rather than theoretically an only child. During both marriages,
R’s mother was continuously involved in volunteer work. R recalled that
she was rarely at home during the day and was infrequently there in
the evenings. R’s stepfather accompanied her to the evening meetings
and social activities only part of the time. The remainder of the time he
was home with R.
R had an introvertive personality, limited social interests, and no sense
of social comfort. He had few friends, male or female, while in school.
He read a lot, was very much involved in music as a pianist, and earned
excellent grades.
R’s family was strongly committed to the Jewish religion and were
active members of a conservative synagogue. It was in this environment
that his mother and stepfather had met, courted, and married.
When R was 15, his stepfather showed him how to masturbate, and
shortly thereafter R and his stepfather were actively engaged in mutual
masturbation and then in partner manipulation. Their interaction con
tinued on a once- or twice-a-week basis until R finished high school.
During this time, R had no social activity with nor could he recall any
interest in girls.
When R went to college, his interaction with his stepfather was con
fined to an occasional weekend or vacation, so R sought out other homo
sexual opportunities. He was successful in his search, and, fortified by
his positive experiences, continued as a completely committed homo
sexual after he left college. When in need, he cruised the local bars and
the public toilets wherever he was located. He thoroughly enjoyed fel
latio and on a few occasions was the penetratee in anal intercourse. He
never sought the role of penetrator.
R had several jobs, two of which he lost when his ill-concealed homo
sexual orientation was identified. At 26, he decided to return to aca
demic life for postgraduate work in psychology and was successful in
entering a postgraduate program on a fellowship.
His social exposure to women had been negligible. When he thought
it necessary as a camouflage, he occasionally took women to dinner or
to other social events but never involved himself sexually beyond the
level of a goodnight kiss. To protect himself from any possible sexual
demands, he rarely had more than two dates with the same woman.
When R was 28 he met a young woman (23) who also was a very
CHAPTER FIFTEEN
352
talented pianist. They had so much in common that R broke his two-
date rule gladly. In brief, R and the young woman fell in love. But
whenever she vigorously pushed for sexual involvement, he just as
vigorously retreated. After about three months of steady companionship
and of sexual advance and retreat, the young woman confronted R.
She told him that she loved him but believed him to be homosexual,
and she begged him to seek help, stating that she wanted to marry
him.
Overwhelmed with this burst of warmth and offer of commitment,
something he had never encountered in his life, R told the woman the
details of his sexual orientation. The woman, in turn, reported a mod
erate amount of sexual experience with four different men. After their
mutual confession, the two people decided to try to solve their own
problem.
Despite living together for 10 months and then living as man and wife
for 18 months, and despite every sexual effort on his wife’s part, R could
not achieve or maintain an erection of sufficient quality to consummate
his marriage.
The couple applied to the Institute for support. When accepted into
therapy, R was a sexually functional homosexual and a primarily im
potent heterosexual. His wife described herself sexually as a fully func
tional woman.
From a therapeutic point of view, it was unfortunate that the
couple had tried to resolve their own problem. Not only did they
fail, but after the repeated episodes of failure with his wife trying
time after time to force an erection, R had developed severe fears
of performance and had become a constant spectator at every sex
ual opportunity. His wife had separately developed fears for his
sexual performance and had become a confirmed spectator herself.
R also had begun comparing himself negatively with the men
with whom his wife had been active sexually, even though he had
never met them. Not only was R jealous, but he also developed an
acute sense of inferiority in his masculine role socially. He had
never had such feelings of inadequacy before.
Treatment was initiated by attempting to neutralize the negative
input from the coital failures that had occurred while husband and
wife were trying to treat themselves. Both R and his partner be
came fully involved in sensate-focus experiences. As their nonverbal
communication improved, the concept of using the partner’s body
for one’s own pleasure, not to arouse the partner sexually, got
through to R’s wife. She learned to stop trying to force an erection
353
and so did he. R learned the basics of female anatomy, female

sexual physiology, and female psychosexual needs. The information
was amplified with his wife’s full cooperation.
In addition to his acquired fears of sexual performance, R had
other fears that needed confrontation. He had been fearful of the
sexual unknown from the outset of his marriage. With his anxieties
about woman’s sexual responses reasonably resolved, R’s perfor
mance fears were satisfactorily neutralized and both partners’ spec
tator roles were resolved.
R’s wife was a vital element in therapy. She made every effort to
support, educate, and interact, but she never ridiculed R’s homo
sexual orientation or joked about his complete lack of heterosexual
experience. Through this approach by his wife, R’s jealousy and
sense of sexual and personal inferiority were rapidly neutralized.
R was never told he must convert to heterosexuality. He was only
assured that he could do so if there seemed to be sufficient value
for him in the transition. He did convert. He began functioning suc
cessfully in intercourse on the tenth day of therapy. The follow-up
of this couple has been uneventful. The family has children, R is
having a successful career as a clinical psychologist, and both part
ners describe an effective marriage.
Obviously, this storybook type of history is the exception, not
the rule, in any sexual partnership between a Kinsey 6 man and a
Kinsey 0 woman. As emphasized before, the limitations in ability
to convert or revert to heterosexuality are dependent not only upon
the degree to which the client is motivated to become subjectively
involved in heterosexuality, but also upon the rewards potentially
available from such a conversion.
Lest there be any illusion that therapy for male homosexual dis
satisfaction always turns out well, a brief discussion of a complete
clinical failure is in order.
S was 28 years old and a Kinsey 6 when seen in therapy with his
casual female partner. He had been accepted in response to his request
for psychotherapeutic support during an attempt to convert to hetero
sexuality.
S was the middle child in a family of three children. He had two sis
ters, one three years older and another two years younger than himself.
CHAPTER FIFTEEN
354
His mother was in full control of the family. The father was described
by S in retrospect as both passive and ineffectual. He earned an ade
quate living for the family but in return was essentially ignored.
The family’s religious commitment was Catholic. His mother was very
active in her church. His father rarely attended services.
S did not remember his childhood with any sense of pleasure. He was
overweight and uncoordinated, and he intensely disliked any manner of
physical contact. His mother dressed him carefully, constantly demand
ing that he not get his clothes dirty. S was essentially rejected by his
male peers, who called him a sissy. He responded by withdrawing from
male social interchange.
S spent his formative years believing himself to be fully committed to
the priesthood. Once past his first year in high school, however, he gave
up the idea of a life of religious commitment. During this time he be
came increasingly afraid of male companionship, yet he secretly ad
mired the muscles of the football heroes. He was labeled a “fairy” long
before he understood the connotation of the term. His manners were
impeccable, his teachers applauded his academic efforts, and he was
generally miserable in school.
Aside from his sisters’ friends, he knew no girls. When S finished high
school he had had no social or sexual experience. He spent one year in
college at a similar asocial level. Then he decided to work in television,
left college, and was successful in obtaining a job in the production side
of the profession. As the years passed, his career prospered.
S first attempted masturbation at age 16. He was unsuccessful and
despite frequent effort was not able to masturbate successfully until just
after he graduated from high school. He never approached a girl or a boy
sexually while he was in school, nor was he ever approached sexually to
his knowledge.
When S was 22 he became strongly attracted to a young man his age
who also had a history of serious difficulties with social interaction when
he was in school. The two friends filled obvious gaps in each others’
lives. After about a year of close companionship, the friend approached
S sexually one night and manipulated him to ejaculation. S thoroughly
enjoyed the experience, and within a month the two men were living
together. The men continued to be active sexually almost on a daily
basis, and both were most pleased with the companionship and sense of
closeness that neither man had ever experienced previously.
S began interacting with other men sexually about a year and a half
after he and his friend started living together. There were no reported
sexual difficulties, nor did his friend offer any objection, for he was en
joying the same state of sexual freedom. Both men felt that they had
missed a lot socially as they went through school and were determined
to make up for some of their lack of sexual experience.
When S was 27 he approached a younger member of the firm where
355
he worked, and this man reported S to the head of the firm. S was ter
rified that he might lose his employment. He denied all homosexual
intent, and to prove his point, he began an active dating pattern with
young women in the office. This change in social behavior marked S’s
first social experiences with women. One night one of the women openly
approached S sexually, and this terrified him. Not only was there no
erection, but S apparently had what can best be described as a severe
anxiety attack.
He realized the need for professional help and applied to the Institute
for support. S stated simply that he would have to learn to function
heterosexually if he was to survive socially and professionally. He also
felt cheated by his lack of prior heterosexual experience. When conver
sion therapy was requested, it was explained that the Institute did not
treat homosexual men without female partners. In addition, it was
pointed out that there must be some opportunity for regular sexual ac
tivity after the acute phase of treatment was terminated; just the co
operation of a female partner during the acute phase of treatment would
be of little value.
S decided to continue an overt heterosexual social life, protecting him
self against sexual approaches if possible, until a cooperative partner
could be found that he felt he could trust. He had a few homosexual ex
periences, but they were conducted far from his place of employment.
This search for a female partner in therapy with whom he could con
tinue sexual activity afterward took almost a year. When S was 28, he
reapplied for therapy with a female partner of choice. His apparent
persistence in searching for an available partner distracted the research
team from the deeper issues in the case, and he was accepted in therapy.
The acute phase of treatment was completely unsuccessful. S not

only had no frame of reference for heterosexual activity, he also be
came extremely anxious at the thought of any manner of sexual
interaction with a woman. He knew unequivocally that he would
never be able to function in intercourse and was certainly able to
prove himself right. Although he had full cooperation from his fe
male partner, S never had an erection during the acute phase of
the treatment program. His fears of performance were never sig
nificantly reduced, and if anything, his levels of anxiety increased
during therapy. In addition to his sexual dysfunction, he evidenced
severe sexual aversion to the female body. This aversion also seemed
to increase as therapy continued. The program was terminated by
the therapy team at the end of the first week of the two-week acute
phase of treatment. It was patently obvious that an error had been
CHAPTER FIFTEEN
356
made by accepting S into therapy. To continue treatment would

have been to threaten S’s psychosexual security.
The entire problem was discussed at length with S. The research
team’s failure in therapy was openly acknowledged, and it was
pointed out that his was a far more stable personality when he was
psychosexually comfortable as a homosexual than when he was
extremely anxious and increasingly aversive as a potential hetero
sexual. There was no indication that he needed therapeutic sup
port in his homosexual status, but it was suggested that he might
profit from short-term professional support for the psychosocial in
securities that had developed as the result of his failure to convert
to heterosexuality. lie accepted the Institute’s offer in this regard.
S returned to homosexuality, and his anxieties disappeared. He
followed specific suggestions that he be far less overt in his sexual
solicitations and restrict his heterosexual social commitments to
business demands only. With a few clearly defined but modest al
terations in his lifestyle to protect against any manner of hetero
sexual pressure, he has had no further social or professional diffi
culties to date.
While S’s theoretical motivation to change his sexual preference
may have been strong, his fears of failure and his aversion to the
female person were far stronger. Actually, the extreme level of his
anxiety about heterosexual involvement had not been correctly de
termined by the research team during the intake interview. Thus,
not only did the therapy fail, it should not have been attempted.
Instead, S should have been counseled with suggestions to improve
his sociosexual behavior as a homosexual.
This typical case report of a fully oriented Kinsey 6 homosexual
man has been presented to underscore the divergence of sexual
orientations in our culture. There are any number of Kinsey 0 men
who would have anxiety attacks if they thought they might have to
interact sexually with another man; and there are also a large num
ber of men who, like S, might have anxiety attacks at the thought
of sexual interaction with a woman. Neither should ever be pres
sured to interact sexually in a manner that poses such a threat to
personal security.
357
DISCUSSION
A brief discussion of the general principles involved in conversion

and reversion therapy is in order. Certainly, each case must be in
dividualized and the therapeutic approach frequently drastically al
tered, not only at outset but at different times during the course
of the treatment program. Without this flexibility in therapeutic
approach, treatment programs for homosexual dissatisfaction are
doomed to a high percentage of failure.
There are a few basic “don’ts” in conversion and reversion therapy
that should constantly be borne in mind by the reacting therapist,
regardless of his or her level of professional flexibility.
The therapist constantly must be aware that there are any num
ber of good reasons for the individual to seek change in a homo
sexual orientation. For example, there may be the real or implied
threat of social rejection or a constant concern for job security. Of
course, the reasons for requesting conversion or reversion therapy
must be defined, but in the process, the man’s prior sexual experi
ence should never be devalued. His sexual facility as a homosexual
is his current security blanket. If the therapist suggests that ho
mosexuality is a psychosocially unacceptable way of life to a man
who is in the midst of attempting to alter his sexual value system,
the client tends to move to heterosexual expression with a sense
that all bridges have been burned. He has the impression that he
must succeed in therapy in the immediacy of the present or that
his life will have little or nothing to offer in the future. Denigration
of homosexual preference by the therapist may create unacceptable
pressure from a presumed requirement for immediate success in the
mind of a man already gravely concerned with his fears for effec
tiveness of heterosexual performance.
If a man’s motivation for alteration in sexual preference is high
and there is a cooperative female partner available, reversion to
heterosexuality can best be accomplished by concentrating on neu
tralizing or even removing the psychosocial roadblocks to effective
heterosexual interchange. Once functioning with an increasing de
gree of sexual effectiveness, the man must be allowed to make his
CHAPTER FIFTEEN
358
own sex-preference decision. By the simple expedient of realizing

that he now has two ways to go, he can decide for himself which
road offers the greater reward. Such an opportunity for an open,
unpressured decision promises far more permanence to the altera
tion of sexual preference than any attempt at reversion or conver
sion therapy under the presumed threat of an all-or-nothing ap
proach. A change in role preference has a far better chance of
permanence if it comes as the result of the client’s decision rather
than as the result of a therapist’s imposition.
As is true for most men, the homosexual male is made anxious
by that which he does not understand or by a situation that makes
him feel insecure because of his lack of knowledge or experience.
In a quiet, comfortable manner, the therapists must thoroughly
educate the male homosexual in female anatomy and sexual physi
ology and answer any questions he may have about the female’s
psychosexual attitudes. This information is far more effectively re
ceived if it is presented by a female therapist.
The role of the female partner in male conversion or reversion
therapy is difficult. The therapist must always keep in mind the
trauma she may possibly be experiencing. Her cooperation in ther
apy depends in large degree on her level of understanding of the
treatment process. This is one of the important reasons why the
committed or casual female partner typically should be made aware
of the homosexual man’s background. Once informed, she will not
expect the usual level of sexual knowledge from her partner nor
anticipate any real evidence of sexual comfort or effective sexual
performance at the outset of their relationship or early in therapy.
However, the therapist must always individualize the case. In cer
tain situations in which the potential exists for high levels of trauma
to the relationship because of disclosure of historical material that
may not be critical to the progress of therapy, it may be necessary
to modify this strategy.
In short, during therapy for reversion or conversion to hetero
sexuality, the man’s prior homosexual orientation is deemphasized.
He is never told he must decide between homosexuality and het
erosexuality. Only when the psychosexual roadblocks have been
reasonably neutralized or even removed, and only when he has been
359
able to function sexually as a heterosexual, is he then encouraged

to make his own choice of sexual orientation. After he has had the
opportunity to consider the pros and cons of each sexual preference,
the therapists stand ready as a reference source to discuss these
pros and cons. The therapists never pressure the client for a prefer
ence decision.
In response to these treatment principles, some men have re
turned to homosexuality, some now function with sexual ambiva
lence, but most of the men treated for conversion or reversion have
decided upon a full heterosexual commitment and have apparently
maintained that commitment (see Chapter 17).
PARTNERS IN THERAPY
For decades therapeutic effort has been directed toward reversion

or conversion of sexual preference on the one-to-one basis of direct
interaction between client and therapist. In general, the results
have been far less than satisfactory, but valuable lessons can be
learned from these published experiences of the pioneers in the field.
The Institute’s therapeutic approach has varied significantly from
prior techniques. As has been emphasized repeatedly, no homo
sexual male or female is treated for conversion or reversion without
the support in therapy of a partner of the opposite sex. These men
and women make a vital contribution to the effectiveness of thera
peutic procedure.
When the homosexual can immediately put into practice sug
gestions made by the therapist, when communicative techniques
can be practiced in and out of the bedroom, when social or sexual
mistakes can be corrected, performance anxieties neutralized, and
vital information imparted, all on a daily basis, there is a signifi
cantly lower failure rate in treatment.
The casual or committed opposite-sex partner acts as a source of
psychosocial support and information, and, if fully cooperative, pro
vides opportunity for the client to react sexually in a nonpressured
atmosphere. Since the partner is well aware of the client’s problems,
a significant portion of the multiple fears of performance is neu
36o CHAPTER FIFTEEN
tralized. These are anxieties that develop when the sexually dis
tressed individual tries to hide his or her performance concerns from
a partner.
Potential difficulties in the use of partners in therapy come from
two major sources: (1) The therapists must retain adequate con
trol of the casual or committed partner to keep the partner from
assuming that he or she is yet another therapist. The distressed
homosexual needs a partner in the bedroom as a source of warmth
and support, but not as a coach. (2) It also must be constantly
borne in mind that a casual partner who is cooperating only for the
two-week period of the acute phase of therapy is of limited value.
Of course, if another partner is immediately available, a satisfactory
transition usually can be accomplished. But once the homosexually
distressed client is functioning effectively in a heterosexual orien
tation, there should be no significant interruption in sexual oppor
tunity for at least a two- or three-month period.
SUMMARY
This report of the treatment of 54 homosexual men for conver

sion or reversion to heterosexuality has been presented in some de
tail. Representative case reports have been made available. Specific
case discussions and general considerations of the problems of both
clients and therapist are reported. The statistical returns from the
clinical treatment programs for homosexual male and female dis
satisfaction are presented in Chapter 17.
i 6
FEMALE HOMOSEXUAL
DISSATISFACTION
D uring the 10-year period of clinical control, 13 homosexually ori

ented women were accepted by the Institute for treatment of sexual
dissatisfaction. Three women were conversion candidates in the
Kinsey 5 and 6 categories, while the remaining 10 women who gave
Kinsey 3 and 4 preference histories were accepted as reversion ap
plicants (see Table 16-1).
Thirteen is indeed a small number of clients to be treated over a
10-year period, but a total of only 16 lesbians applied for therapy.
In fact, the number of women admitted to treatment is so small
that the research team has been loathe to formulate any general
conclusions in view of its limited experience in treating the sexually
dissatisfied lesbian. During the same time period, four times as
many men were treated for homosexual dissatisfaction.
The fact that so few women applied for treatment of homosexual
dissatisfaction poses a number of questions. Were homosexual
women more reluctant to request therapeutic support than men
when considering transition to heterosexuality? Were homosexual
women generally less interested in moving into a heterosexual ori
entation than men? When lesbians decided to move to heterosex
uality, did they simply initiate heterosexual interaction without
feeling any need for professional support?
There is no secure information to answer the questions of
whether a lower percentage of active homosexual women than ho
mosexual men decide to move to heterosexuality or whether the
women are more reluctant than the men to seek professional guid
ance. There is some modest support for a positive answer to the
question of whether a lesbian who decides to move to heterosexual
361
362 CHAPTER SIXTEEN
orientation does so without any considered need for professional

support.
The suggested answer is that she probably makes the transition on
her own cognizance—unless she has good reason to anticipate com
plications. Each of the 13 homosexual women who were treated for
sexual dissatisfaction had specific reasons to anticipate difficulties.
Nine of the 10 women accepted for professional support in rever
sion therapy had a history of significant sexual dysfunction during
prior heterosexual experience (see Table 12-3, Chapter 12). Five
of the women had been sexually aversive in prior heterosexual en
counters. In addition, 2 women were aversive in both homosexual
and heterosexual interaction before requesting reversion therapy.
Although the Kinsey 5 client who applied for conversion therapy
also had been dysfunctional during prior heterosexual experience,
the heterosexual opportunities had been too few in number to label
this woman as heterosexually dysfunctional.
Every woman who applied to the Institute for professional sup
port during her active attempt to revert to heterosexuality had a
history of prior heterosexual dysfunction, sexual aversion, or a com
bination of the two distresses associated with heterosexuality. It
was not surprising, then, that these women applied for psychothera
peutic support when they made a decision to revert or convert to a
heterosexual orientation.
The marital status of the women clients was also a factor in their
decision to solicit professional support for reversion attempts. Six
women were married, and 1 woman had been living for seven years
in a committed male/female partnership and was listed as married
for reportorial ease. Four of these 7 married women were among
the women described above as aversive to any form of heterosexual
activity, and all 7 were heterosexually dysfunctional. All of the
married women had been sexually active as homosexuals for periods
ranging from two to nine years. Thus, it is apparent that the 10
women who applied for professional support during reversion at
tempts had reason to anticipate specific psychosexual impediments to
heterosexual function.
Of the 3 women who applied for conversion therapy (Table 16-1),
one woman, a Kinsey 6, had been living 11 years as a sexually active
lesbian but had been primarily anorgasmic during this time. She
FEMALE HOMOSEXUAL DISSATISFACTION
finally decided that homosexuality had nothing to offer her sexu

ally, found a man she wanted to live with, and asked for professional
support during the transition period. Of course, she was fearful that
she also would not be sexually responsive in heterosexual inter
action.
Each of the other 2 women in the conversion category had been
fully responsive sexually as lesbians. One woman (Kinsey 5) had
experienced five prior heterosexual episodes during which she de
scribed herself as extremely anxious and occasionally nauseated;
her comment was that she “felt nothing” during intercourse. The
other woman, a Kinsey 6, had decided to try coitus twice but both
times, before permitting penetration, withdrew from the sexual
opportunity by complaining of nausea and faintness. On the basis
of the severe levels of anxiety experienced during their few prior
heterosexual opportunities, these women sought help in their con
version attempts. Each woman entered therapy with a male part
ner of choice.
While the numbers are small, these data suggest that homosexual
women without sexual complications either during prior experience
as heterosexuals or currently as homosexuals do not seek and prob
ably rarely need professional support when they decide to alter
their sex-preference roles.
There is another factor that tends to make female transition to
heterosexuality less perilous than male conversion or reversion. The
lesbian is not necessarily faced with immediate fears of performance
when she voluntarily alters her choice of sexual orientation. She
may be anxious, she may be fearful, she may even be aversive, but
if she has been sexually responsive as a lesbian she rarely brings
crippling fears of performance into the inevitable tensions asso
ciated with the alteration of her sexual patterns. Even the women
in this report, all of whom had a history of some manner of hetero
sexual distress, did not exhibit high levels of performance fears.
Generally, the male homosexual, no matter how sexually effec
tive he may have been as a homosexual, immediately reacts nega
tively to cultural performance pressures when he moves into hetero
sexual coital opportunity. When a man has lived, as the homosexual
does, with the far more realistic concept that he has little, if any,
responsibility for his partner’s sexual function other than the ob
CHAPTER SIXTEEN
364
vious requirement for a certain amount of mutual cooperation,

and then voluntarily moves to heterosexual commitment, the cul
tural pressures associated with the false concept that the man is
primarily responsible for woman’s sexual responsivity may prove
severely demanding psychosexually; erective insecurity may then
develop. Thus, homosexual men may be in greater need of profes
sional support than homosexual women in their attempts to con
vert or revert to heterosexuality.
MOTIVATING FACTORS
One dominant factor motivated the small group of lesbians who

sought assistance from the Institute for alteration of sexual prefer
ence. This was the factor of social pressure. For homosexual men,
social pressures were evidenced by fear of public identification or
the concomitantly implied threat to their job security. Not so for
the women. The social pressures were primarily engendered by
woman’s cultural role in the maintenance of a marriage. Seven of
the 13 women who applied for reversion treatment were married,
and each of these married women stated that her decision to face
alteration of her primary sexual orientation was a specific effort to
either reconstitute or provide support for a committed marital rela
tionship. Interestingly, only 1 woman expressed fear of public dis
closure of her homosexuality. Lesbianism is usually either openly
admitted or easily hidden from the public.
The remaining motivating factors were completely individualized
among the unmarried women. One woman was concerned about
job security. She had never been publicly identified as a lesbian
but was extremely anxious that her homosexual orientation would
become common knowledge. Another woman simply felt homo
sexuality had nothing to offer her and wanted to experiment with
heterosexuality. Yet another woman formed a strong attachment to
a heterosexual man and, despite a history of severe aversion in pre
vious heterosexual experience, wanted help in reverting so she could
live in a committed state with this man.
REFUSED APPLICATIONS
Three women who applied to the Institute for support of at

tempted reversion to heterosexuality were refused treatment (Ta
ble 16-1). One woman (Kinsey 2) was diagnosed as psychotic and
referred to appropriate treatment. The Kinsey 3 woman actually
did not need professional support to revert to heterosexuality with
the man to whom she was fully committed. She wanted very much
TABLE 16-1
Dissatisfied Homosexual Female Population

(Total Applicants, N = 16; Applicants Accepted, N = 13)
Reversion Conversion
Candidates Candidates
Kinsey Kinsey KinseyKinsey Kinsey Total
2 3 4 5 6 No.
Total applicants * 1 3 9 1 2 16
Applicants refused t 1 1 1 0 0 3
Applicants accepted 0 2 8 1 2 13
(1968-1977)
* No Kinsey 1 women applied for treatment,
t Overall refusal rate, 18.8 percent.
for her desired marriage to succeed and had been pressured into
requesting treatment by a concerned family that was fully aware
of her previous ambivalence in sexual preference. She was counseled
for her family-engendered anxieties and accepted the therapy team’s
position that further therapy was not really indicated. When the
third woman (Kinsey 4) applied for treatment, she was involved
in a major personality conflict with her committed lesbian partner
of eight years. She had selected a man she scarcely knew as a part
ner and requested support in converting to heterosexuality. During
evaluation it became apparent that she was deeply committed to
both a homosexual orientation and to her lesbian partner. She was
366 CHAPTER SIXTEEN
refused treatment for reversion. Instead, counseling was instituted

for the distressed lesbian couple and they were able to resolve their
personality conflicts. This woman was basically well adjusted as a
homosexual, and once this was determined the therapy team en
couraged her to remain committed to that sexual preference.
Of the 13 homosexual female applicants accepted for treatment
of sexual dissatisfaction, 5 had requested therapy from other health
care facilities. Two had been refused treatment; 1 of the 2 women
had been refused treatment on other occasions. Neither had been
referred to another health-care facility. Three of the 13 women
had been accepted in treatment, but all 3 terminated their therapy
programs as unsatisfactory (see Table 12-6, Chapter 12). These sta
tistics are not as prejudicial as those presented in Chapters 13, 14,
and 15, but they do tend to support the Institute’s position taken
in prior discussions concerning the cultural bias of the health-care
professions.
The 10-year case distribution of female homosexuals with com
plaints of sexual dissatisfaction is outlined in Table 16-2. As indi-
TABLE 16-2
Dissatisfied Homosexual Female Population (N = ij):

Year Treated
Dissatisfaction
Therapy One Two Three Four Five Six Seven Eight Nine Ten Total
Reversion 0 2 1 1 2 0 1 2 1 0 10
Conversion 0 0 1 0 1 0 1 0 0 0 3
Total 0 2 2 1 3 0 2 2 1 0 13
(1968-1977)
cated in the table, 8 of the 13 women have been available to follow-up

procedures for five years after termination of the two-week acute
phase of treatment. A statistical review of the therapeutic results
obtained during the acute phase of treatment and the problems of
recidivism during the five-year follow-up period are presented in
Chapter 17.
THERAPEUTIC PROCEDURE
Two case reports will be presented to exemplify the marked vari

ance in problems that confront the therapist responding to requests
made by sexually dissatisfied homosexual women for support in
reversion or conversion to heterosexuality. After the case reports
have been presented, the individual cases will be discussed briefly
and general therapeutic concepts considered. As previously stated
in Chapters 13, 14, and 15, there will be separate publication of a
detailed discussion of the therapeutic process.
The general background and specific details of the psychosexual
status of the two male heterosexual partners will not be presented.
When specific information about the male partner is necessary to
amplify the clinical picture, it has been provided.
T was a 31-year-old Kinsey 6 woman who applied to the Institute for

professional support in her attempt to convert to heterosexuality. She
entered treatment with a partner of her choice whom she expected to
marry if the attempted conversion therapy was successful. T had lived
an active lesbian life for 11 years and was still primarily anorgasmic. She
had voluntarily decided that homosexuality had little to offer and had
actively sought male companionship. Ten months later she was involved
with a man of her choice and entered therapy.
T came from a middle-class family of modest financial circumstances.
She was an only child. Her mother and father lived what T described as
a dull marriage. Apparently there were few social outlets. The religious
background was Protestant, and her parents maintained a moderately
active involvement with the church. As soon as the required years of
Sunday-school attendance passed, however, T avoided further religious
involvement.
T described her father as warmer and more understanding than her
mother. There was also the feeling that the mother was the disciplinarian
while the father was obviously the more permissive parent. What T
remembered more than anything else about her childhood was that she
could not recall ever seeing a spontaneous demonstration of affection
between her parents. Even perfunctory goodbye and hello kisses were
not exchanged. Nor did she recall any physical contact with her mother.
She did remember some occasions of sitting on her father’s lap, but
they were few in number.
368 CHAPTER SIXTEEN
T could not recall any significant amount of sexual interest until she
was about 15 years old. She tried masturbating several times, but al
though it “felt good,” she was not orgasmic. There were occasional dates
with boys during high school, but she allowed no sexual activity beyond
kissing and some breast play, neither of which she found particularly
stimulating. She was a moderately successful student, reasonably popu
lar with her peers, but she was not a "joiner.”
When T graduated from high school, she worked at odd jobs for
more than a year and then decided to enroll in secretarial training. She
lived in a small town, so arrangements were made for T to move to a
city in another state and live with an aunt while in training. The aunt
was in her late thirties, had never married, had a good job, a pleasant
apartment, and a number of friends, almost all female.
T worked hard each day in school and enjoyed her new freedom. Her
aunt was very active socially and either had friends at the apartment or
was out many evenings. T was pleased by the warmth of social accep
tance exhibited by several of her aunt's friends.
When T finished secretarial training, her aunt offered her the use of
the apartment while she was looking for a job or for as long as she
wished to stay if she did not want to move back home. T accepted her
offer, soon found a job, volunteered to share some of the expenses, and
felt completely at home.
Previously, T had not given any thought to the fact that at least once
a week a female friend stayed the night with her aunt. Since it was a two-
bedroom apartment, T assumed that the friend who slept with her aunt
did so because she (T) occupied the other bedroom.
One day T fell and strained her back, and that night her aunt gave
her the first backrub she had ever had. There was welcome relief from
the aches of the fall, but when the massages were repeated the next two
nights T felt increasing sexual pleasure. She began lubricating so heavily
she was afraid her aunt would notice. T offered no protest, so the back-
rubs continued for another week or 10 days before her aunt moved
gently but firmly one night to genital manipulation, despite T’s tentative
objections. T was highly aroused sexually by the experience, but not
orgasmic. In a brief period of time she was returning the backrub favor
and responded to her aunt’s careful coaching by manipulating her to
orgasm. T was pleased when she observed her aunt’s orgasmic responses.
Her aunt assured her that she would reach a similar level of sexual
response shortly, but that never happened.
T lived with her aunt for over two years before feeling the need to
express her independence. She moved to her own apartment with the
aunt’s blessing. Her social life continued to involve the women to whom
she had been introduced by her aunt, most of whom were lesbians. In
the privacy of her own apartment she saw these women socially and
accepted those with whom she wished to interact sexually. During
sexual activity, she always became highly excited but was never orgasmic,
regardless of the type of or the time spent in stimulative approaches pro
vided by her friends. She repeatedly attempted masturbation but with
out orgasmic response.
T was consistently frustrated sexually. After one woman commented
that she (T) took a long time to “come,” she began to fake orgasm by
behaving as she had seen her aunt and her friends act in response to
her stimulation. As time passed, her pattern became one of applying
sexual fakery quickly. This was done in order to cut down the time her
casual companions had to spend stimulating her, since she knew she
would be unable to respond effectively.
T lived for approximately 11 years as a sexually active lesbian without
ever experiencing orgasmic release. For the last three years of this period,
she became increasingly restless. In addition to her continuing sexual
frustrations, she was also disturbed with what she felt was an entirely
too restricted social life.
During the 11-year period, T’s heterosexual experiences consisted of
a few dates with several different men. When approachd sexually, she
froze and would not cooperate. With her lack of sexual confidence
T did not attract many men, and those that she occasionally did attract
quickly withdrew after being overtly rejected sexually.
Finally, at age 30, T decided to abandon her familiar lesbian social
structure and to move into heterosexual society for as long as it would be
necessary to form some objective evaluation of the heterosexual lifestyle.
It took several months of looking and some very anxious moments
sexually before she met and was immediately attracted to a man in his
late thirties who was recently divorced. He had two children who lived
with their mother.
The couple soon were spending all of their time together. After a
number of sexual approaches were made and parried, the man expressed
concern. T, deciding to take a risk, told the man she was a virgin and
then agreed to spend a weekend with him. She did not tell him of her
lesbian orientation. Over the weekend the man, appreciating her ob
vious anxiety and presuming her fearful of loss of virginity, was as gentle
as possible, but he could not penetrate. T was quite disturbed when the
man finally ejaculated after a long-continued play period.
With the failure of a desired relationship at stake, T took an even
greater risk, told the man her entire story, and begged his cooperation
in helping to change her sexual orientation. The man, who by this time
was fully committed to T, offered help in any way he could. The
couple tried to consummate their relationship sexually on two other
weekends but were unsuccessful. T was increasingly disturbed when
ever the man ejaculated, and on the last occasion she became nauseated.
After their third failure at consummation, T asked the man if he would
join her in treatment at the Institute. He agreed without reservation.
CHAPTER SIXTEEN
37®
When seen in therapy, T was a primarily anorgasmic woman

who also had a moderately severe degree of vaginismus. In addi
tion, she described a sense of discomfort with seminal fluid.
The therapists’ great advantage in treatment was, of course, the
cooperative, committed, sexually experienced man T picked to ac
company her in therapy. He was devoted to T and stated that de
spite her position that she would marry him only if treatment were
successful, he wanted to marry her regardless of the outcome of the
therapy program.
With T’s full agreement, the man was made completely aware
of the last 11 years of T’s life. At first he found it very hard to be
lieve she had never been fully responsive sexually as a lesbian, but
he was most receptive to supporting the attempted sex-preference
transition in every way possible.
The initial step in therapy was to draw T’s attention to her aunt’s
backrub approach, and she was questioned in great detail. What
had pleased? Had she been anxious or frightened? If so, of what
and when? How did she resolve her conflicts, if any?
The full story was that she had loved the backrubs, was highly
excited sexually, confused by the strength of her sexual feelings,
but then terrified when her aunt insisted on playing with her geni
tals. She felt ashamed and guilty that she had liked what happened
and felt morally weak when she continued to cooperate with re
peat performances. T apparently became quite anxious when pres
sured into approaching her aunt physically, but she was openly in
trigued when the aunt was readily multiorgasmic and freely verbal
ized her orgasmic attainment.
With this information, T was introduced to sensate-focus therapy
with the man’s full cooperation. Initially, the genitals of both part
ners were declared off limits. T’s return to sensual pleasure began
by using her partner’s body for her own pleasure and allowing the
partner access to her body for his pleasure.
When confidence and pleasure in sensate focus had been attained,
the genitals were included in the touching and the vaginismus was
treated as described in Human Sexual Inadequacy (1970). First T
and then her partner inserted the plastic dilators in graduated sizes
until the involuntary vaginal spasm was overcome.
The entire process of neutralizing both her dislike of seminal fluid
371
and her vaginismus took 10 days, during which T and her partner
slowly increased their degree of mutual sexual involvement by
nondemanding approaches to the genital organs. On the afternoon
of the tenth day, after T had finished inserting the vaginal dilators,
she lay on the bed resting. There was no sexual activity at the time,
but she suddenly experienced her first orgasm. She was frightened,
did not know what had happened to her, but fortunately was with
a sexually experienced man who thought he recognized the signs
of orgasm. T was in tears when later reassured by the female thera
pist that she had simply experienced her birthright of sexual ex
pression.
That night T tentatively approached her partner sexually and
had intercourse for the first time without any distress. She was
orgasmic in response to manipulation the next day, and about three
weeks after termination of the acute phase of treatment was or
gasmic during intercourse.
Although by definition the man had to be labeled a casual part
ner, since the couple had no formal commitment, he was far from
casual in his approach to T. He was quiet, confident, and comfort
ing. Without his full cooperation a positive therapeutic result would
have been most unlikely.
Aside from her most cooperative partner, T’s support in her al
tered preference role came from the female therapist. Every step of
the treatment program was explained in detail. Such questions as
what was to be looked for and what was to be gained were answered
in detail. Fears were analyzed, anxieties explained, and female anat
omy and sexual response patterns discussed repeatedly. T’s fears of
performance, both homosexual and heterosexual, were approached
directly. Her problems of vaginismus and dislike of seminal fluid
were also dealt with primarily by the female therapist.
As the treatment program progressed, training in the arts of com
munication posed no problem for the couple, particularly since the
bedroom aspects of the communicative interchange went so well.
The male therapist’s responsibility was to keep the male partner in
formed as to the details of the treatment process, suggest attitudinal
approaches to the complexities of T’s transition process, evaluate
treatment progress, and educate and explain as the therapy program
unfolded. Every effort was expended to maintain the male partner
372 CHAPTER SIXTEEN
as an effective adjunct in therapy. Care also was taken to be sure

that he did not become a third therapist.
Understandably, the debate in this case might center on whether
T was ever fully homosexually oriented. As is usual in most rever
sion and in a few conversion cases, a good argument could be made
for either side of the fence. On the one hand, T had freely inter
acted sexually on many occasions with a number of women using
and responding to every type of homosexually oriented physical
approach. She had thoroughly enjoyed releasing her female partners
and was sexually excited by the process. For years she was fully in
volved socially in a lesbian orientation and had no interest in male
companionship. She had never been sexually responsive to men. She
had found male company socially unstimulating, and, on a few
occasions, sexually threatening. In fact, she had developed vaginis
mus and a dislike of seminal fluid.
On the other hand, she had been quietly but firmly se
duced into homosexual activity and had never been fully sexually
responsive to women. After 11 years, she had openly rejected a
female-oriented society and voluntarily sought heterosexual ex
perience.
In any event, T ultimately chose heterosexuality and, despite her
inexperience, was extremely fortunate in her choice of the man with
whom she was to share her life.
Follow-up information records that T is freely responsive sexually.
The couple has married and T has had her first child. She does not
describe the slightest interest in homosexual activity.

V was a 32-year-old Kinsey 4 woman who had been married for over
three years when seen in therapy. Her husband was reluctant to accom
pany her in treatment because he felt that the relationship was at an
end. He entered therapy only as a favor to his wife.
V’s family history was that of a turbulent home. Her mother and
father were constantly at war. She recalled that her parents never
seemed to agree on any subject. As a young girl she frequently got
conflicting messages from her parents and also noted that there were
different directions given to her brother who was three years younger.
Her father increasingly spent longer time periods out of the home and
when V was 12, filed for a divorce and married another woman. He
rarely saw his children after the divorce and remarriage. Two years
later he moved to a different section of the country and had little con-
373
tinuing contact other than minimal financial support. There was no

identifiable religious influence in the home.
V’s mother started working, frequently at two jobs. V, as the older
sibling, at 13 was left in charge of the home and her brother. Since hav
ing to keep house and care for her brother severely restricted her social
opportunities while in high school, V usually had girlfriends coming to
her house. With no supervision, there was unlimited sexual freedom. V
and two of her friends frequently showed each other how they mastur
bated and in time began manipulating each other.
V thoroughly enjoyed the sex play and, in addition, continued to
masturbate frequently in private. She didn’t remember when she was
first orgasmic, but she was fully responsive during the play episodes.
Actually, during her socially deprived years, masturbation was her princi
pal source of entertainment and was enjoyed on at least a daily basis.
V was an attractive girl. When she did date a boy and allowed pet
ting, the boy could never satisfy her as she did herself or as her two
friends were doing. At 16 she had her first coital experience. It not only
was unanticipated, it was unappreciated. There had been a petting ses
sion during which she had not been aroused sexually. The boy sud
denly forced his penis into the vagina and ejaculated. There was some
physical distress, but she was more enraged than pained. However, her
anger turned to anxiety when she bled and continued to bleed during
the night. The next morning, her bed soaked with blood, she told
her mother what had happened. She was taken to the hospital, and a
small bleeding site in the ruptured hymen was sutured.
The surgery was minor in character. The trauma was not. Her an
gered mother confronted the boy’s parents to no avail, but as a con
sequence word of the event soon spread through her peer group. She
was severely embarrassed and resolved never to let “that” happen again.
It didn’t—for many years.
After this episode, V refused all dates until the boys stopped calling.
At 17 she dropped out of high school half-way through her junior year
and began working at odd jobs during the day. After leaving high school,
she only interacted socially with the women who worked with her. She
became more aggressive sexually, learned to be carefully selective, and
usually had at least one available friend with whom she could interact
sexually.
By the time V was 20 years old, she was living in a rooming house,
providing her own support, and cruising gay bars for sexual partners
when in need.
As she grew older, she entered three separate, continuing lesbian rela
tionships that lasted significant lengths of time. In each instance, she
felt fully committed to the other woman at the outset of the relation
ship. The briefest commitment lasted about six months, the longest for
over four years.
During this time, most of the few social relationships she had with
CHAPTER SIXTEEN
374
men were with homosexual men. She did recall that two different half
hearted attempts at intercourse with one man were unsuccessful; she
could not cooperate for fear she might be hurt and bleed again. The two
fiascos left her with even less interest in sexual interaction with men.
When V was 28 years old, she met a junior executive in the manu
facturing firm where she was working. Their relationship was at first
casual, for a few weeks quietly social, and then, with real apprehension
on V’s part, overtly sexual. The man could not penetrate when attempt
ing intercourse. V told him of her traumatic coital episode as a teenager,
but not of her lesbian orientation. The man suggested a visit to a doctor,
and V complied. She was told that there was no physical reason why
she couldn’t have intercourse. Again, the couple tried intercourse, but
the man still could not penetrate. They attempted to terminate the
relationship but soon found that they were too strongly attracted to
each other to separate, so they decided that things would work out
sexually if they took their time.
They married six weeks later. It took another four weeks to consum
mate the marriage. During the first three months of the marriage V was
extremely anxious every time they had intercourse. There was no real
pain, but since she lubricated poorly, there was a good deal of vaginal
irritation. V found herself hoping each coital episode would terminate
quickly. She felt little sexual stimulation and, in a matter of months,
was regularly using artificial lubrication and had assumed a completely
passive role physically during intercourse. She frequently masturbated
in private, but this didn’t seem to bring sufficient relief to her sexual
tensions.
Her husband, aware that V was experiencing little sexual pleasure
during intercourse, frequently tried to develop sexual release through
manipulation or cunnilingus, but these approaches also failed to provide
sexual satisfaction.
V was severely frustrated sexually, and after six months of marriage
began to visit gay bars occasionally. Whenever she had a cooperative
woman as a partner, sexual release was readily accomplished and V was
fully satiated.
The marriage continued in this manner for about three years. V was
frequently depressed, and there were increasingly longer intervals be
tween the marital unit’s sexual episodes.
Approximately four months before requesting therapy, V was seen
entering the apartment of a known lesbian by a friend of her husband’s
who told him of the occasion. When quietly confronted, V not only
freely admitted the episode but then told her husband that she was
fully committed to a lesbian orientation. They agreed to divorce and
separated.
A month later V asked her husband to accompany her in treatment
so that she could learn to function sexually as a heterosexual woman.
She said that she was fearful of being unable to alter her lesbian status,
375
but also felt handicapped in being without freedom of choice, since she
had no history of a satisfactory heterosexual experience.
Reluctant to enter therapy, the husband agreed to accompany V as a
last gesture to a marriage that he understood was to be terminated by
mutual consent. Although the therapists were concerned that the hus
band might not cooperate fully, V’s plea that if hers was to be a
lesbian orientation, she wanted it to be by choice, not by default, was
considered sufficient motivation for the Institute to accept the couple
in treatment.
At first, the treatment program did not progress satisfactorily. As
feared, the husband was not fully cooperative; despite the ther
apists’ suggestions and appeals, he seemed to be just going through
the motions. V, sensing this, was as unresponsive to his styl
ized sexual approaches as ever. Near the end of the first week in
therapy, after preliminary attempts to alter this pattern had proved
unsuccessful, the couple was directly confronted; it was suggested
that they either spend the next week in an all-out attempt to pro
vide V with the freedom of choice she sought or that they with
draw from the treatment program.
Thereafter the husband became far more cooperative, and V,
recognizing the crucial nature of her situation, apparently altered
her psychosexual attitudes almost overnight. The couple spent
hours talking about their past lives—something they had never
done—and V took the initiative of showing her husband what
pleased her. She made a number of suggestions to improve his
sexual techniques, which again was something she had not had the
courage to do previously. She had always been afraid that he would
raise the question of where she had acquired her sexual expertise
if she coached him in his sexual approaches. He proved an apt
pupil, for V was orgasmic with manipulation two days later.
This breakthrough pleased V and delighted her husband. It was
the first time that he had seen his wife obviously sexually involved
and fully sexually responsive. His mental picture of V had been of
an initially somewhat anxious and subsequently completely passive
sexual partner who was intent only on providing sexual service as a
“good” wife should. He told V how personally rejected he had
felt by her sexual behavior patterns. She had no idea that he
had felt denigrated as a person by her “let’s get it over with” atti
tude.
Her feelings of rejection had not been directed to him as an in
CHAPTER SIXTEEN
37®
dividual but to his sexual clumsiness in comparison to the sexual

effectiveness of her lesbian partners. He, of course, had no idea of
the fact that he was living with direct sexual competition, nor of the
nature of the competition.
After the manipulative orgasmic experience, V’s performance
fears and spectator roles that previously had been such constant
companions during intercourse could be approached with some
hope of therapeutic reversal.
Within 48 hours V was feeling comfortable with intercourse, lu
bricating well, and “feeling something.” When therapy terminated,
V was orgasmic regularly with manipulation, occasionally with cun-
nilingus, and was responding pleasurably during intercourse.
The couple moved back together a week later. Their sexual in
volvement has continued to prove satisfactory to both partners. V
has only been orgasmic occasionally with intercourse, but she fre
quently initiates sexual interaction and plays a very active role. Her
husband has been consistently receptive to her requests for sexual
release. Occasionally he needs direction when approaching her sex
ually. She gives it freely, and he accepts it gracefully. V states that
she has no interest in further lesbian experience. Since the full five-
year follow-up period has not yet been completed, no final conclu
sions can be drawn in this regard.
This case report has been selected as reasonably representative
of the majority of the women who asked the Institute for profes
sional support during requested reversion therapy. Eight of the 13
applicants accepted in therapy had a Kinsey 4 preference rating.
There was a history of a significant amount of heterosexual experi
ence, but it usually was considered of little value by the women in
volved or actually had been a series of traumatic episodes. There
was considerable variation in whether lesbian opportunity had been
experienced as an original sexual outlet or lesbian interests had
been kindled when the heterosexual aspects of the women’s lives
resulted in sexual and/or social disappointments.
DISCUSSION
Generally, the women seeking reversion to heterosexuality have

been unresponsive to or fully rejecting of heterosexually oriented
377
stimuli in prior sexual experience. This lack of heterosexual respon

sivity has been created by a variety of factors. The most frequently
stated factors were: (1) psychosocial rejection of the particular men
in whom the woman had been interested; (2) lack of sufficient male
sexual expertise in providing the woman with effective sexual oppor
tunity; (3) apparent disinterest on the man’s part in providing his
female partner with sexual release; (4) male use of the female part
ner sexually with little or no regard for either her personal or sexual
needs; (5) long-continued physical or psychological abuse of the
woman; and (6) either lack of sexual interest on the man’s part or
deliberate withholding of sexual opportunity from the woman as a
means of punishment.
Of course, there were many other etiologic factors leading to the
rejection of a heterosexual role. The lesbian role was described as
preferable because women reported that it was not only more sex
ually stimulating, but it was psychosocially more enhancing to the
individual. Women in this study consistently reported that they
experienced far more freedom for self-expression during their com
mitment to a lesbian orientation.
Therapy for those who wished to convert or revert to heterosex
uality was primarily directed toward providing each female client
with some opportunity for the self-expression she had grown to
appreciate in her experience with lesbian society. By improving the
communicative skills of both partners, the woman’s inherent privi
lege of expressing herself as an individual was either initiated or en
hanced, depending upon the psychosocial values preexistent within
the relationship. If it was a committed relationship, the woman was
usually extremely encouraged by her husband’s altered receptivity
to communicative exchange. If it was a casual relationship, the
woman was pleased with the opportunity to be heard, to be given
full freedom of self-expression, and, in short, to practice communi
cative interchange.
Emphasizing the potential advantages in woman’s role as a fully
social as well as an effective sexual partner has been the cornerstone
of effective reversion therapy. It has given the female client the
freedom of expressing her social and sexual value systems in a het
erosexual partnership just as she consistently had been accorded
this privilege in a homosexual relationship.
CHAPTER SIXTEEN
378
The therapeutic process has been one of pointing out the po
tential psychosocial advantages of and the specific psychosexual
opportunities in the relationship brought to treatment. Both men
and women have responded well to the Institute’s controlled edu
cational programs. The men had little frame of reference for ap
preciating woman's psychosexual needs. The women usually were
contending with a background of objectionable heterosexual experi
ence, and they had to have their negative sexual impressions neu
tralized and the usual "men are all alike” concepts dispelled.
Further detailed discussion of the advantage of working with a
couple when one member of the unit seeks treatment for sexual dis
satisfaction is superfluous. Nor is there further need to point out
the distinct advantages of having a dual-sex team in control of the
treatment program in these circumstances. These discussions have
been presented previously to the health-care professions in other
publications and reviewed in previous chapters of this clinical sec
tion. Suffice it to say that from a clinical point of view the use of
the dual-sex team in treating problems of homosexual dissatisfac
tion as well as homosexual dysfunction represents a significant im
provement over other therapeutic approaches.
Most homosexual women who applied for support in attempts
to convert or revert to heterosexuality opted for an ongoing hetero
sexual relationship if within the relationship their status could be
established as that of a partner, not merely a provider of sexual
service. If the women who requested support in attempted reversion
or conversion were satisfied psychosocially as well as psychosexually,
they usually remained committed to a heterosexual lifestyle.
i7
CLINICAL STATISTICS
From an academic point of view no investigative program, par

ticularly one involving new clinical concepts and techniques, is
considered complete until the investigators have made a reasonably
detailed report to the health-care professions. As an integral part of
this report, there must be appropriate discussions, not only of con
cepts and techniques, but of results returned from the therapeutic
process. For these reasons, a brief statistical review is presented of
the results of treatment of homosexual men and women for sexual
dysfunction or dissatisfaction.
Before attempting statistical evaluation of the treatment pro
grams, the Institute’s position relative to the inherent value of
statistics published in the field of psychosexual therapy should be
restated. Statistics mean little in. physiologic or psychological re
search if the statistician is attempting to establish levels of subjective
responsivity to objective stimuli. Since the clinical interpreter cannot
define with exactitude subjectively appreciated points A, B, or C,
claims of statistically significant therapeutic success are unjustified
when evaluating the interrelationships of these variables. On the
other hand, treatment failures always loom large on any clinical ho
rizon. If the clinical research errs on the side of conservatism, de
claring as a treatment failure every unit involved in the program
about which the slightest question of effective therapeutic progress
exists, failure statistics become increasingly important. Therefore,
statistical evaluation of therapeutic procedure in the 10 years of
treatment for homosexual dysfunction or dissatisfaction will be con
sidered only from the point of view of failure rates.
The preceding paragraph, a free quote from Human Sexual In
adequacy (1970), reiterates the Institute’s position on the statistical
379
380 CHAPTER SEVENTEEN
evaluation of treatment programs devoted to the reversal of human

sexual inadequacies.
There always remain two unresolved questions when psycho
therapists of any persuasion attempt to report therapeutic successes.
First, what does constitute success in treatment for a particular psy-
chosexual dysfunction, and second, who is to be the judge of suc
cessful treatment? Not only are criteria for judging clinical success
ill-defined, but an even greater problem centers around the anoint
ing of authority.
The therapist is the least acceptable authority to define levels of
successful treatment in his or her own clinical program. There in
evitably is uncontrolled judgmental bias if the therapist and the
individual who evaluates the progress and records the successes of
any therapy program are one and the same individual. What the
therapist may see as a successfully completed treatment program,
the client may consider in a different light. Has he or she really
achieved what was wished for in treatment? Has the projected goal
been reached? Or has the result been judged in the light of what
the therapist told the client or clients was within the realm of treat
ment probability?
Nor should the client be the sole judge of success or failure of
the therapeutic process. What real frame of reference, either theo
retical or clinical, does he or she have in goal attainment? How
can he or she have any objective perspective on the effectiveness
of the therapeutic program? If the client wants the moon and stars
from treatment and gets only the moon, the therapist may consider
with professional justification that the therapeutic accomplishment
was a job well done. With equal justification, the client may con
sider it a job half done.
If neither the therapist nor the client is consistently capable of
providing an unbiased, objective report of therapeutic success, who
is to evaluate clinical treatment programs? It must and should re
main for professional peers to provide the ultimate evaluation of
the success potential of any clinical treatment methodology. Can
they reduplicate the effort with reasonable parallelism in results?
This is the acid test of new or divergent clinical programs. There
fore, it is of utmost importance that the reported results of any
clinical research program be made interpretable with relative ease.
CLINICAL STATISTICS 381
If the subjective aspects of any particular psychotherapeutic pro

cess cannot be interpreted as treatment success with statistical se
curity (and they cannot), what of treatment failure? Are we always
sure of the extent and degree of our failures? Emphatically not—
but there usually is more agreement between therapist and client
on what constitutes failure than what constitutes success in the
treatment process. What the therapist knows is almost unbelievable
progress in treatment may be termed by the client as unsatisfactory—
“not what I anticipated.” What the client is delighted with as ef
fective therapeutic progress, the authority may well realize is but a
short-term gain at best. But both authority and client usually are in
reasonable accord as to what constitutes either immediate or long
term treatment failure.
For these reasons, the Institute will follow the precedent it orig
inally established in 1969 when reporting the results of the clinical
research programs designed to develop treatment techniques for
heterosexual inadequacies. The results of treating homosexual dys
function or dissatisfaction will be described in terms of treatment
failures rather than as estimates of therapeutic success. It must be
emphasized that a 20 percent treatment failure rate should not au
tomatically be converted into the suggestion that the therapy pro
gram was blessed with an 80 percent success rate. A 20 percent
treatment failure rate means just that—and nothing more.
The same format employed in presenting and discussing therapy
failures incurred during the heterosexual treatment programs will
be used to report results of the homosexual treatment programs.
But only a superficial comparison can be presented of results re
turned from treating men and women of the two sexual orienta
tions, because there were too many clinical variables. For example,
the patient population treated for homosexual inadequacies was
far smaller than the total number of men and women treated for
heterosexual distresses. In addition, sexual behavior patterns inher
ent in homosexual and heterosexual orientations necessitated sepa
rate definitions of sexual dysfunctions and dissatisfactions (see
Chapter 12). Thus, similarities and differences between the therapy
results returned from the two clinical populations can be generally
appreciated from selective scrutiny but not with statistical security.
There are a number of other factors that must be taken into con
sideration in analyzing treatment failure data. The treatment of

homosexual distresses has certainly been facilitated by the Institute
staff’s years of prior clinical experience with treatment of hetero
sexual inadequacy. It also is generally true that with one exception,
the sexually dysfunctional homosexual man or woman does not
face as difficult a problem in returning to effective sexual function
as does the heterosexual. The one exception to this general rule,
the primarily impotent homosexual male, will be discussed in con
text in the next section.
TREATMENT FAILURE STATISTICS
(DYSFUNCTION)
In reporting the clinical statistics returned from treating dysfunc

tional homosexual men and women, consideration will be given
first to the failure rate encountered during the initial or rapid
treatment phase of the program. Second, the incidence of failure
during the required five years of the follow-up program will be re
ported. And third, the overall treatment failure rate will be pre
sented. This statistic has been established by combining the num
ber of men and women who have initial treatment failures during
the acute phase of therapy with the number of individuals who re
turned to dysfunction during the first five years after treatment.
When reporting initial treatment failures, N represents the total
number of clients treated for the specific sexual distress; F, the
number of immediate treatment failures with the rapid-treatment
method; and IFR, the initial failure rate. For reference convenience,
data will be summarized in numbered lists.
MALE DYSFUNCTION
1. Primary Impotence: N = 5; F = o; IFR = 0%.

The Institute treated 5 primarily impotent homosexual males
during the rapid-treatment phase of the clinical program. Despite
the lack of initial treatment failure, it generally has been more diffi
cult to treat primary impotence of homosexual than heterosexual
orientation. While he does not have the added burden of function
ing effectively during intercourse, the homosexual is usually the
CLINICAL STATISTICS
383
more psychosexually devastated of the two types of primarily im

potent men, since by Institute definition he has not even been able
to achieve and consistently maintain a full erection with masturba
tion and has never experienced orgasmic release in response to
any form of direct sexual stimulation by self or partner. His only
ejaculatory experience (if any) has been during nocturnal emis
sions. The primarily impotent homosexual client has not only
been psychosexually dysfunctional, but he has consistently evi
denced a significant degree of psychosocial pathology.
2. Secondary Impotence: N = 49; F — 4; IFR = 8.2%.

The failure rate in the rapid treatment of secondarily impotent
homosexual men is at an acceptable level. If the distressed man is
seen with a cooperative partner, there is reason to expect an initial
failure rate below 10 percent when treating this category of homo
sexual dysfunction. Levels of motivation are particularly important
in treating secondary impotence, for they usually determine whether
the impotence stays reversed during the posttreatment years of the
follow-up period. Men frequently have more of a problem in main
taining their functional status after treatment than in regaining it
during therapy.
3. Situational Impotence: N = 3; F = o; IFR = 0%.

Only 3 cases in this category of impotence were treated by the
therapy team. There should be only a rare failure in this category
of homosexual impotence. The additional distress of sexual aver
sion, which occasionally accompanies this type of male potency dys
function, usually presents more problems in treatment than does
reversal of this form of impotence. The category of situational im
potence was not established during the heterosexual treatment pro
gram. At that time clients in this category were incorrectly identified
as secondarily impotent.
4. Ejaculatory Incompetence: N= o.
Although this complaint of sexual inadequacy must exist in the
homosexual community, it was not encountered in the 10-year pe
riod of clinical control. Had the problem been presented, it would
have been approached with the techniques originally described for
CHAPTER SEVENTEEN
384
the treatment of ejaculatory incompetence of heterosexual ori

entation.
The ejaculatorily incompetent homosexual should not be con
fused with the primarily impotent homosexual. While neither man
has an orgasmic experience during overt sexual activity with a
partner, the man with ejaculatory incompetence has the facility to
maintain erections indefinitely; the primarily impotent homosexual
does not. The ejaculatorily incompetent man can and does ejaculate
during masturbation; the primarily impotent man cannot.
5. Premature Ejaculation: N = 2; F = o; IFR = 0%.

The treatment of premature ejaculation in the homosexual male
population has not been presented or discussed in any detail. As
noted in Chapter 12, homosexual men rarely registered the com
plaint of premature ejaculation with the research team. If too-rapid
ejaculation is believed to be a functional problem by male homo
sexuals, it was not considered of enough importance to bring men
to treatment. The complaint is reversed so easily that it does not ne
cessitate the usual two-week, acute-treatment program. The reversal
techniques employed are identical to those developed for treating
the far more functionally handicapped heterosexual premature ejac-
ulator. Usually, two or three counseling sessions will serve to resolve
a problem of too-rapid ejaculation that might exist for a homosexual
male. The same usually cannot be said for the heterosexual rapid
ejaculator and his usually psychosexually traumatized female partner.
Because the complaint was rarely registered and its reversal easily
accomplished without requiring admission to the formalized treat
ment program, the dysfunction will not be discussed further, nor
will treatment results be included in the Institute’s overall report of
treatment failures. This material is only presented for reader infor
mation and reference convenience.
FEMALE DYSFUNCTION
6. Primary Anorgasmia: N = 8; F = 1; IFR = 12.5%.

The most difficult problems in treatment are the client’s ex
tremely low levels of self-esteem, her overwhelming sense of inade
quacy as a woman, and, of course, her fears of sexual performance.
C1INICAL STATISTICS 385
These problems are present regardless of whether the primarily anor-

gasmic woman is homosexually or heterosexually oriented.
But the primarily anorgasmic lesbian has a better chance of
complete symptom reversal than her heterosexual counterpart be
cause she does not have the added requirement of orgasmic return
during intercourse. In primary homosexual anorgasmia a low initial
failure rate should be anticipated. There may be an additional com
plication, however: A high incidence of sexual aversion has been
associated with primary anorgasmia in the Institute’s small series
of cases.
7. Situational Anorgasmia: N = 15; F = 1; IFR = 6.7%.
An occasional situationally anorgasmic client presents approxi
mately the same complications in treatment as that of primary anor
gasmia, but generally the complaint is reversed with less difficulty.
In fact, if there is an accompanying secondary diagnosis of sexual
aversion, the latter clinical problem usually represents more of a
therapeutic challenge than the problems associated with reversal
of the basic complaint.
8. Random Anorgasmia: N = 4; F = o; IFR = 0%.
Random anorgasmia in the small series of lesbian clients was also
frequently associated with the secondary complaint of sexual aver
sion. Presuming an adequate level of client motivation for allevia
tion of the random anorgasmic state and a cooperative partner in
therapy, initial failure rates in treatment should be quite low.
9. Vaginismus: N = 2; F = o; IFR = 0% (not treated).

Vaginismus was identified as a secondary diagnosis on only two
occasions in the treatment of anorgasmic lesbians. The diagnosis
can be firmly established only by adequate pelvic examination.
Since its presence was of little consequence to anorgasmic lesbians,
the condition was not treated directly when identified. In both
cases of homosexual vaginismus, the women were also sexually aver
sive, so therapy was primarily directed toward the aversive state.
As is true for the concerns of premature ejaculation, the presence
of the distress in sexually dysfunctional lesbians is noted for refer
ence ease, but since treatment was not indicated, these statistics
will not be included in the overall treatment report.
CHAPTER SEVENTEEN
386
SEXUAL AVERSION
There was a significant incidence of sexual aversion as a second

ary diagnosis during the treatment of male and female homosexual
dysfunction. This sexual problem is not classified as a dysfunction,
however. The statistics recorded below reflect the incidence of
therapy failure in symptom reversal during the rapid-treatment pro
gram. N represents the number of cases of diagnosed sexual aver
sion; F, failure to reverse the symptoms; and FR, the failure rate
during follow-up in the io-year period of clinical investigation.
The numbers in parentheses represent the cases of each type of
homosexual dysfunction treated as the primary diagnoses.
10. Male Sexual Dysfunction Aversion

a. Primary impotence (5): N = 1; F = o; FR — 0%
b. Secondary impotence (49): N — 2; F = o; FR — 0%
c. Situational impotence (3): N — 1; F = o; FR — 0%
11. Female Sexual Dysfunction Aversion

a. Primary anorgasmia (8): N = 3; F = o; FR = 0%
b. Situational anorgasmia (15): N = 1; F = o; FR = 0%
c. Random anorgasmia (4): N = 2; F = o; FR = 0%
Four instances of homosexual male sexual aversion and 6 in
stances of homosexual female sexual aversion were identified as sec
ondary diagnoses during treatment of the primary complaints of
sexual dysfunction. There was a far higher incidence of sexual aver
sion identified in the sexually dysfunctional lesbian population than
in the dysfunctional male clients. The aversive symptoms were re
versed without treatment failure. Since statistics from this category
of sexual distress were not recorded during the investigation of het-
erosexually oriented sexual inadequacy reported in Human Sexual
Inadequacy, the failure-rate statistics will not be included in those
of the overall treatment program for homosexual inadequacy.
SUMMATION STATISTICS (DYSFUNCTION)
The totals of the initial treatment failures and the failure rates
in the rapid-treatment phase of the therapy programs for homo
sexual dysfunction are listed below. For reference convenience, the
totals are separated first by sex and then recorded as a total re
search population.
12. Total Male Dysfunction: N — 57; F = 4; IFR = 7.0%.
13. Total Female Dysfunction: N = 27; F = 2; IFR = 7.4%.

Accumulation of the initial failure rate statistics supports the In
stitute’s 21-year contention that there should be no significant clini
cal difference in the overall failure rates returned from treating sex
ually dysfunctional men and sexually dysfunctional women. This
position presumes that the dual-sex team is employed as a basic
ingredient of the treatment program and that the sexually dysfunc
tional individual is accompanied in therapy by a partner of choice.
This lack of a clinically significant differential in treatment failure
statistics between the two sexes was first reported in Human Sexual
Inadequacy.
14. Total Male and Female Dysfunction: N — 84; F = 6; IFR =

7.1%.
The initial failure rate of 7.1 percent in the treatment of dys
functional homosexual men and women is an acceptable figure.
The initial treatment failure rate should not rise above a theorized
10 percent level and probably will be lowered to the 5 percent area
as more clinical experience is acquired. It must be emphasized
that this figure only represents the treatment failures that developed
during the acute phase of the therapy program. To these failures of
clinical treatment must be added those incidences of treatment re
versal that occurred during the required five-year follow-up period
before an overall treatment failure rate for homosexual dysfunction
can be determined.
In order to present significant follow-up information, there should
be a large number of cases available that can be carefully evaluated
to determine rates of treatment reversal. The Institute cannot pro
vide such information at this time. The fault is not that of lack of
effective follow-up procedures, though there are always difficulties
in any program of continuing clinical control. The Institute’s basic
difficulty is lack of numbers. There have been only a small number
of male and female applicants for treatment of homosexual dys
function and dissatisfaction. Over the 10-year period of clinical
control the number of homosexual men treated for sexual dysfunc

tion has only totaled 57; the corresponding figure for females is 27.
Those treated for sexual dissatisfaction have totaled only 54 male
and 13 female applicants. Since the applicant populations were
small, every effort was expended to maintain adequate follow-up
procedures for those men and women who were not immediate
treatment failures.
Immediate treatment failures were referred directly to other
sources of professional support. Since follow-up attempts might
have proved distracting to the client’s new treatment program and
because the information returned could not be used statistically
after other treatment modalities had been involved, no attempt
has been made to follow the initial treatment failure group of male
and female clients.
Statistics cited below refer to the number of clients who have
reversed treatment gains and returned to their prior sexually dys
functional status during the 10-year clinical control period. It is
important to emphasize that since the final years of follow-up have
not been completed, there may be other instances of return to a
prior sexually dysfunctional state. Also recorded are the numbers
of men and women lost to follow-up.
In Lists 15 and 16, N represents the number of men or women
treated for sexual dysfunction over the 10-year control period.
F identifies those men and women who were immediate treatment
failures during the acute phase of therapy; TR, the known in
stances of treatment reversal during the required five-year follow-up
period; and LF, the number of clients lost to follow-up in each of
the dysfunctional categories.
15. Male Sexual Dysfunction

a. Primary impotence: N — 5; F = o; TR = 1; LF = 1
b. Secondary impotence: N = 49; F = 4; TR = 1; LF = 2
c. Situational impotence: N = 3; F = o; TR = o; LF = o
One primarily impotent man became secondarily impotent and
refused to continue follow-up one year after his acute treatment
phase terminated.
One secondarily impotent man had the return of prior erective
inadequacy and refused further treatment or referral to another pro
CLINICAL STATISTICS
389
fessional source, but he has cooperated in routine follow-up proce

dures. Two secondarily impotent men have been lost to follow-up
four and three years, respectively, after the acute-treatment phase.
They reported functioning well sexually when last contacted.
16. Female Sexual Dysfunction

a. Primary anorgasmia: N = 8; F = 1; TR = o; LF — o
b. Situational anorgasmia: N = 15; F = 1; TR = 1; LF — 1
c. Random anorgasmia: N = 4; F = o; TR = o; LF — o
Among the original 27 women treated for homosexual dysfunc
tion, 2 have experienced immediate treatment failures and there
has been 1 instance of posttreatment return of symptoms when the
woman lost a committed partner and turned to casual partners foi
sexual release. One previously situational anorgasmic woman was
lost to follow-up two years after the rapid-treatment phase. She re
ported effective sexual function when last contacted.
FOLLOW-UP (DYSFUNCTION)
Only 3 homosexual men and 1 woman have been lost to follow-up

in 57 male and 27 female cases of sexual dysfunction. Since s total
of only 3 men and women reverted to prior states of sexual dys
function during the same observation period, a significant return
to dysfunction would not be anticipated among the 4 cases lost to
follow-up. One individual, at the most, might be expected to have
returned to dysfunction. One additional treatment failure would
not alter the statistics to a clinically significant degree (from 10.7
percent to 11.9 percent).
As a statistical summary, the overall therapy failure rates that
developed from treating homosexual men and women for sexual
dysfunction are recorded in Table 17-1. The overall failure rate is
a combination of the faliures that occurred during the acute
treatment phase and those incurred during the required five years
of follow-up observations after termination of the rapid-treatment
program.
The program statistics reported in Table 17-1 are encouraging
when it is realized that this level of treatment failure was attained
in a pilot clinical program. The vast majority of cases were seen in
therapy by the research team, which treated 78 of the total of 81
CHAPTER SEVENTEEN
39°
TABLE 17-1
Male and Female Homosexual Dysfunction:
Treatment Failure Statistics
Gender and IFR OFR

Complaint N F (%) TR (%)
Male
Primary impotence 5 0 0 1 20.0
Secondary impotence 49 4 8.2 1 10.2
Situational impotence 3 0 0 0 0
Male total 57 4 7.0 2 10.5
Female
Primary anorgasmia 8 1 12.5 0 12.5
Situational anorgasmia 15 1 6.7 1 13.3
Random anorgasmia 4 0 0 0 0
Female total 27 2 7.4 1 11.1
Male and female 84 6 7.1 3 10.7
total
N = number of clients; F = initial treatment failures; IFR = initial failure rate;
TR = treatment reversals; OFR = overall failure rate.
sexually dysfunctional homosexual couples. The remaining 3 cou

ples were treated by other staff teams at the Institute.
Since there had been no prior professional experience with such
treatment programs, mistakes were made that would not be re
peated today. A great deal has been learned about patient manage
ment. For example, the ill-concealed levels of antagonism that the
secondarily impotent man frequently exhibits toward the therapists
are far easier to cope with since the devastating level of his social
and sexual performance fears has been recognized. At least 2 of
the 4 initial treatment failures to reverse secondary impotence (see
List 2) should have been avoided. The therapists found real diffi
culty in maintaining their vital state of professional neutrality in
the face of deliberate lack of cooperation with the therapy program.
These professional mistakes were made early in the 10-year period
of clinical control. It is not expected that they would be repeated
at this time.
CLINICAL STATISTICS
391
The overall failure rate (10.7 percent) for the treatment of ho
mosexual male and female sexual dysfunction is perhaps higher
than it should be. Once the dysfunctional homosexual is reasonably
sure that he or she will be openly received by the health-care pro
fessional and has confidence that his or her sexual distress can be
alleviated in a high percentage of cases, there should be a marked
increase in applications for treatment, and far better client coopera
tion in therapy. Consequently, failure rates for treatment of homo
sexual dysfunction should shrink. When sufficient professional
experience has been acquired, an overall failure rate of 5 to 8 per
cent can be safely anticipated for similarly constituted treatment
programs.
TREATMENT FAILURE STATISTICS
(DISSATISFACTION)
The initial failure rate during the 10-year period of clinical con
trol for treatment of homosexual dissatisfaction is at a much higher
level than that found in treating dysfunctional homosexuals. This
higher failure rate had been anticipated for a variety of reasons.
There has been a long-established belief among health-care profes
sionals that attempting to support a homosexual applicant in his
or her stated request to move to heterosexual orientation entails a
frighteningly high level of therapy failure. It has also been openly
stated that among the men and women who have converted or re
verted to heterosexuality in response to various treatment programs,
there has been a high percentage of return to homosexuality. The
homosexual community has also adopted and freely propagandized
these cultural concepts.
Other attitudes or concepts exhibited by both clients and thera
pists have been severe handicaps to any treatment program. Poten
tial homosexual clients have presumed a professional bias on the
part of the therapist and, more often than not, such a bias may
have existed. Therapists exhibiting bias have tried to move their
clients to a “better way of life” (heterosexuality) or have ap
proached clients with preconceived ideas of the origin or develop
ment of homosexuality. Clients have sometimes requested pro
CHAPTER SEVENTEEN
39«
fessional support in sex-preference alteration without any real

motivation for change.
If treatment of homosexual dissatisfaction is to be effective,
therapists must attempt and attain a reasonable degree of profes
sional neutrality in conducting the treatment programs, and the
clients must demonstrate sincere levels of motivation for altering
their sexual orientation.
At the outset of this discussion of the results of the treatment pro
gram for homosexual dissatisfaction it must be made quite clear
that the Institute is reporting statistics on a highly selected treat
ment population. As discussed in Chapter 12, there was careful
screening of prospective clients with reference to their levels of mo
tivation for alteration of sexual preference roles. For, regardless of
the etiology of the demand for the role change, without sufficient
client motivation therapeutic attempts at conversion or reversion
have markedly reduced chances of success. Therefore, no applicant
was accepted in treatment unless he or she passed the scrutiny of
the Institute’s evaluation techniques for treatment motivation as
described in Chapter 12. Since this was a pilot project and the ther
apy team was without prior experience in the field, retrospectively
it is obvious that mistakes were made both in accepting and in
rejecting candidates for reversal of preference roles. The overall
screening procedures have proved reasonably effective, however, and
are being improved on a year-to-year basis.
In reporting the clinical statistics pertaining to the treatment of
homosexual men and women for sexual dissatisfaction, considera
tion will be given first to the failure rate encountered in the rapid
treatment phase of the program. In succession, the incidence of
treatment reversal during the required five years of the follow-up
program will be reported and then the overall treatment failure rate
will be presented.
Finally, the overall failure rates of men and women treated for
homosexual dissatisfaction will be combined with similar statistics
developed from those treated for homosexual dysfunction to pro
vide some concept of the composite clinical failure rate of the In
stitute’s 10-year treatment program for homosexually distressed men
and women.
CLINICAL STATISTICS
393
MALE DISSATISFACTION
17. Conversion Clients: N = 9; F = 2; IFR = 22.2%.

Given the low number of conversion clients and the rigorous
selection process, which eliminated 4 clients (see Table 15-1, Chap
ter 15), this is a lower immediate failure rate than might have been
anticipated from prior publications on the subject. Had the screen
ing process been more effective, 1 of the treatment failures, a
Kinsey 6, would not have been accepted in therapy. Although there
is little clinical difference in the initial treatment failure rates, the
conversion clients were generally far more cooperative in therapy
than were the reversion clients. It was anticipated that the con
version clients’ fears of the sexual unknown would work against
their free acceptance of heterosexuality, and this proved to be
true.
18. Reversion Clients: N = 45; F = 9; IFR = 20.0%.

This is the initial failure rate that most surprised the research
team, since an initial failure rate of 50 to 60 percent had been an
ticipated from prior professional communication. Again, the statis
tics were significantly aided by the Institute’s screening process, for
12 of an original number of 57 reversion candidates were refused
admission to the treatment program (see Table 15-1, Chapter 15).
The initial failure rates for male conversion and reversion clients
are quite comparable statistically. Prior to outset of the treatment
program, the research team evidenced their own bias, anticipating
that for homosexual males conversion might be more difficult than
reversion. This presumption was based on the fact that, by defini
tion, all of the reversion clients had a significant degree of prior ex
perience with heterosexual interaction. It was theorized that this
familiarity with heterosexuality could be used to therapeutic ad
vantage. What the team had not taken into account in its theoriz
ing was the fact that a significant number of reversion clients were
severely handicapped by negative rather than positive or even neu
tral prior heterosexual experiences. In fact, a number of reversion
clients had originally moved to a homosexual orientation when
their heterosexual experiences had been, at best, unrewarding and, at
CHAPTER SEVENTEEN
394
worst, repulsive. Therefore, prior heterosexual experience and its at

tendant fears for effective heterosexual performance were usually
hurdles that the reversion client had to surmount, rather than an
aid to his treatment progress.
FEMALE DISSATISFACTION
19. Conversion Clients: N = 3; F = o; IFR = 0%.

There were only 3 homosexual women who underwent conver
sion therapy. No conversion applicants were rejected during screen
ing episodes (see Table 16-1, Chapter 16). None of the 3 women
treated by the research team failed to convert to effective hetero
sexual function.
There have not been enough clients to allow the therapists the
privilege of drawing secure conclusions on the subject. In at least 3
instances, the previously expressed concept that no Kinsey 5 or 6
woman could or would convert effectively to a full heterosexual
orientation has proved incorrect. No further comment is indicated
at this point in time.
20. Reversion Clients: N = 10; F — 3; IFR = 30.0%.

While the initial failure rate is high, it is lower than had been
anticipated at the outset of the program. Three women were re
fused admission to reversion programs by the screening process (see
Table 16-1, Chapter 16).
The staff have not had enough clinical experience in treating
female conversion or reversion to undertake any professional dis
cussion other than this brief statistical report. The therapy team
anticipates that publication of this material will provide impetus
for women to seek treatment who previously have not dared to
request conversion or reversion therapy.
Paralleling the histories of the male reversion clients, there was
a high incidence of prior unsuccessful or even repugnant hetero
sexual experiences. Again, such negative heterosexual experiences
had originally turned some of the reversion clients to homosexual
ity.
21. Vaginismus: N = 5; F = o; IFR = 0%.

Vaginismus was identified in 5 of the 13 women who applied for
CLINICAL STATISTICS
395
treatment of homosexual dissatisfaction. One conversion client and

4 reversion clients were diagnosed as vaginismic during physical ex
aminations. They were treated without incident and with the aid of
their male partners of choice, in the same general manner as de
scribed in Chapter 16 and in Human Sexual Inadequacy. Following
the reporting pattern established in the section of this chapter
devoted to problems of sexual dysfunction, the incidence of this
secondary diagnosis is presented for reference but will not be in
cluded in the overall treatment statistics.
SEXUAL AVERSION
Just as was noted previously in the statistics for male and female
homosexual dysfunction, the incidence of sexual aversion as a sec
ondary diagnosis for homosexually dissatisfied men was high and
for homosexually dissatisfied women even higher. The statistics re
corded reflect the incidence of therapy failure in symptom reversal
during the rapid-treatment program.
N represents the number of cases of diagnosed sexual aversion;
F, failure to reverse the symptoms; and FR, the failure rate.
The numbers in parentheses represent the cases of each type of
homosexual dissatisfaction treated over the io-year period of clini
cal control.
22. Male Homosexual Aversion
Dissatisfaction
a. Conversion clients (9): N -- 1; F = 1; FR — 100%
b. Reversion clients (45): N - 7; F = 1; FR = 14.3%
23. Female Homosexual Aversion
Dissatisfaction
a. Conversion clients (3): N= i;F = o; FR = 0%
b. Reversion clients (10): N - - 6; F = o; FR = 0%
There is little to discuss in these statistics. The only clinical fail
ure to reverse a sexual aversion was in the case of primary impotence
that also was a treatment failure in a therapeutic attempt at role
reversal.
The high incidence of the diagnosis of sexual aversion in both
male and female clients undergoing reversion therapy has been com
mented upon previously in the discussion of the results of male re
CHAPTER SEVENTEEN
396
version therapy. Since these statistics were not recorded during the
program for heterosexually oriented sexual inadequacy, the failure
rate statistics will not be included with those of the treatment pro
gram for homosexual functional inadequacy.
SUMMATION STATISTICS (DISSATISFACTION)
The initial therapy failures and the initial failure rates in treat
ment of homosexual dissatisfaction are listed below. They have first
been separated by gender, then recorded as a total research popu
lation.
24. Total Male Homosexual Dissatisfaction: N = 54; F = 11;

IFR = 20.4%.
25. Total Female Homosexual Dissatisfaction: N = 13; F = 3;

IFR = 23.1%.
Again, these statistics support the Institute’s contention that
there should be little significant clinical difference in the results
obtained from treating male and female sexual inadequacy. In this
case, the initial failure rates in treatment of male and female homo
sexual dissatisfaction were in the same general clinical range. The
same essential equality between the sexes in initial failure rates was
demonstrated earlier in the chapter when the failure rate statistics
were presented for the treatment of male and female homosexual
dysfunction (see Lists 12 and 13). In addition, the same lack of a
major differential between the sexes in initial failure rate statistics
was reported for the treatment of heterosexually dysfunctional men
and women in Human Sexual Inadequacy.
26. Total Male and Female Homosexual Dissatisfaction: N = 67;

F — 14; IFR = 20.9%.
An initial failure rate of 21 percent in the treatment of highly
selected male and female clients for conversion or reversion therapy
is three times higher than the 7.1 percent initial failure rate re
corded from treatment of homosexual men and women for sexual
dysfunction (see List 14), but the figure is still lower than the
original expectation.
Again, emphasis must be placed on the fact that these statistics
only represent the initial treatment failure rates. To these totals
CLINICAL STATISTICS
397
must be added the statistical incidence of treatment reversal dur

ing the follow-up period before the overall failure rates for homo
sexual dissatisfaction can be determined.
If there is to be adequate follow-up information, there must be
full cooperation from the clients treated during the two-week rapid
treatment program. It had been presumed by the research team
that men and women who had undergone therapy for sex-preference
alteration at their own request and had moved psychosexually into
a different pattern of sexual orientation would be willing to help
others accomplish the same purpose by occasionally relaying infor
mation as to their current status, describing their problems and pro
viding insight into their vastly altered lifestyles. The reverted and
converted clients have not been that cooperative.
During the entire 14 years of investigation into various aspects
of homosexuality, this is the only segment of the clinical or labora
tory populations that, as a group, evidenced a high percentage of
refusal to continue informational interchange with the Institute.
There were a number of reasons for the generalized lack of coopera
tion, but by far the most important was fear of disclosure of the
past orientation.
As indicated in Table 12- 3 (see Chapter 12), 3 3 of the 54 men and
7 of the 13 women were married or living in long-term committed
relationships when seen in treatment for homosexual dissatisfac
tion. They were seen with their spouses, not only to secure partner
involvement and support during the therapeutic effort, but to re
constitute the relationship. But when there was no immediate treat
ment failure and the relationship had been revitalized, the couple
frequently did not want to be reminded of the past. There were
expressions of fear that continuing contact with the Institute might
rekindle prior homosexual interests or place an undue strain on the
relationship by invoking memories of prior traumatic experiences.
There also was an openly expressed fear of identification. Most
couples, particularly those with children, wanted no possibility of
outside sources identifying their prior involvement in treatment pro
grams at the Institute. Telephone calls were not particularly wel
come and, in some instances, even mail in unmarked envelopes was
considered to be threatening.
There was an additional fear that had not been anticipated by
the research staff. This fear has been reflected by applicants who
CHAPTER SEVENTEEN
398
at the time of therapy were not seen in committed relationships.

There were 21 men and 6 women in this group. A number of these
men and women have not only continued in their converted or re
verted roles to heterosexuality, but have married and/or are living
entirely different lifestyles. The Institute staff are aware that very
few of these men and women have confided the details of prior
homosexual orientations to partners in the new relationships. To
these men and women, any continued communication with the In
stitute poses a threat to their new relationship in that they have
no desire to have their prior sexual preference identified even in
retrospect.
There have been a number of other difficulties in maintaining
adequate follow-up procedures. To the surprise of the research team,
the conversion and reversion treatment population proved to be far
more migratory in character than the homosexually dysfunctional
group. Also, a significant number of the members of this group had
hardly been cooperative during the acute phase in therapy, and
despite the fact that they had accomplished the preference altera
tion they had requested, they continued to be almost as uncoopera
tive after therapy as they had been during treatment. For these
reasons, it proved very difficult to maintain contact with the con
version and reversion clients.
In short, the follow-up program for the 54 men and 13 women
treated at their request for conversion or reversion to heterosexu
ality represents the Institute’s disaster area statistically. During the
10-year contact period, 16 of the 54 men and 3 of the 13 women
have been lost to continuing communication with the Institute. In
comparison, it should be noted that during the same 10 years of
clinical control, 57 homosexual men and 27 homosexual women
were treated for sexual dysfunction. Only 3 of these 57 men and
1 of the 27 women have been lost to follow-up in an identical time
period.
In essence, the follow-up procedures, at least as currently consti
tuted, basically cannot be faulted. Probably there should have been
some early alteration in follow-up techniques to compensate for the
particular social problems of the conversion and reversion clients,
but the widespread lack of cooperation in this particular population
had not been anticipated, so satisfactory research-team reaction to
CLINICAL STATISTICS
399
the problems was delayed until a disconcerting number of clients

had already been lost to follow-up.
The following statistics present the Institute’s current level of
knowledge of the treatment reversal rate incurred during the treat
ment program for homosexual dissatisfaction. In Lists 27 and 28,
N represents the number of men and women who were clients in
conversion or reversion therapy during the 10-year control period.
F identifies those men and women who were immediate treatment
failures during the acute stages of therapy; TR, the instances of
known treatment reversal during the required five-year follow-up
period; and LF, the number of clients lost to follow-up procedures.
27. Male Homosexual Dissatisfaction

a. Conversion clients: N — 9; F = 2; TR = 1; LF = 2
b. Reversion clients: N = 45; F = 9; TR = 3; LF — 14
There have been 4 known reversals to prior homosexual status.
One client was a prior Kinsey 5, and the remaining 3 men were
in Kinsey 3 and 4 categories before attempting reversion therapy.
All 4 of the reversion clients known to have returned to prior homo
sexual commitment were married men. With the loss to follow-up
of 16 cases, further incidences of treatment reversal would be an
ticipated but cannot be documented.
28. Female Homosexual Dissatisfaction

a. Conversion clients: N — 3; F = o; TR = o; LF = 1
b. Reversion clients: N = 10; F = 3; TR — 1; LF = 2
One reversion client returned to her prior homosexual orientation.
She was a married Kinsey 4 when seen during the acute phase of
therapy. One conversion and 2 reversion clients have been lost to
follow-up procedures.
It should be pointed out that of the combined total of 67 male and
female cases of sexual dissatisfaction, 52 clients were treated by the
research team and 15 by other therapy teams on the Institute’s staff.
As a statistical summary of the homosexual dissatisfaction pro
gram, the overall therapy failure rates developed from treating ho
mosexual men and women for sexual dissatisfaction are listed in
Table 17-2.
4oo CHAPTER SEVENTEEN
TABLE 17-2
Male and Female Homosexual Dissatisfaction:
Treatment Failure Statistics
Gender and IFR OFR

Male
Conversion 9 2 22.2 1 33.3
Reversion 45 9 20.0 3 26.7
Male total 54 11 20.4 4 27.8
Female
Conversion 3 0 0 0 0
Reversion 10 3 30.0 1 40.0
Female total 13 3 23.1 1 30.8
Male and female 67 14 20.9 5 28.4
total
N — number of clients; F = initial treatment failures; IFR = initial failure rate;
FOLLOW-UP (DISSATISFACTION)
As noted in Table 17-2, there was a known overall failure rate of

28.4 percent in the treatment of homosexual male and female sex
ual dissatisfaction. These are misleading figures, however, for 16
men and 3 women were lost to follow-up. Although these individ
uals had been supported without treatment failure during the acute
phase of therapy, a small number of these individuals could be ex
pected to return to their prior homosexual orientation during the
five-year follow-up period.
The male statistics in Table 17-2 can be used to estimate the un
recorded level of male client treatment reversal. Fifty-four men were
originally treated for sexual dissatisfaction, and there were 11 im
mediate treatment failures. Of the remaining 43 men, 16 were lost
to follow-up. There remain 27 men who have been followed for
varying lengths of time ranging from one to five years. Four of
these 27 men returned to prior homosexual orientation. Assuming
the same reversal proportion (15 percent), it must be anticipated
that 2 or possibly 5 more among the 16 men lost to follow-up may

have returned to homosexual activity. Presuming 5 men returned to
their prior homosexual orientation, such a theorized return would
leave an overall failure rate for the treatment of male homosexual
dissatisfaction of approximately 33 percent.
The statistics on the female side are too meager to support pre
sumption. There has been 1 return to prior homosexual status
among the 10 women who did not experience acute-treatment
failure. But 3 of the 10 women have been lost to follow-up. At least
1 of these 3 women lost to follow-up may be presumed to have re
verted to homosexual orientation. Such a reversal would provide an
overall treatment failure rate of 40 percent for female conversion or
reversion clients.
Yet another factor remains. The treatment program reported in
this text was initiated in January, 1968, and terminated in De
cember, 1977. Therefore, at current writing (January, 1979), the
Institute staff have completed only six years of five-year follow-ups.
Four years of observation remain. There may be additional conver
sion or reversion clients who return to homosexuality. However, an
overall treatment failure rate of more than 45 percent for homo
sexual dissatisfaction is considered unlikely.
Ominous as these statistics appear, they are encouraging. For the
first time we can be sure of a relatively low immediate treatment
failure rate. Improved follow-up procedures with increased post
treatment support may reduce the treatment reversal rate. The
current concept that the sexually dysfunctional or dissatisfied ho
mosexual male or female cannot be treated without an 80 to 90
percent overall failure rate is simply erroneous.
Regardless of the obvious inadequacies of these follow-up statis
tics, the overall failure rate for the treatment of homosexual dissatis
faction over the 10-year period of study is a positive return. To a
major degree, the positive results can be attributed to the rigorous
selection procedures for clients, the vital use of opposite-sex part
ners in therapy, and the multiple advantages inherent in the use
of the dual-sex therapy teams in treatment of human sexual in
adequacy.
Finally, the current overall failure rate for the entire clinical ther
apy program directed toward treatment of homosexual dysfunction
TABLE 17-3
Program Failure Statistics
Gender and IFR OFR

Homosexual dysfunc 84 6 7.1 3 10.7
tion population
(male and female)
Homosexual dissatis 67 14 20.9 5 28.4
faction population
(male and female)
Total treatment 151 20 13.2 8 18.5
population
N = number of clients; F = initial treatment failures; IFR = initial failure rate;
and dissatisfaction should be considered. In Table 17-3, the overall

statistical returns from the two treatment programs are combined.
The two programs have been conducted simultaneously by the
same research team.
As stated in the discussion of Tables 17-1 and 17-2, problems of
loss of follow-up and of possible further treatment reversal might
add another 9 or 10 failures to the overall failure rate reported in
Table 17-3, thus raising the total program failure rate to a level of
approximately 25 percent. Such an estimate is, of course, conjectural.
While the statistics reported in this chapter are of interest, no
secure conclusions can be drawn. The statistics support two tenta
tive impressions. First, the popular concept that the treatment of
homosexual dissatisfaction has little chance of being effective is
certainly open to question. Second, there is real potential of a pro
fessional breakthrough in the treatment of homosexual dysfunc
tions.
Selected positive and negative aspects of the entire treatment
program will be discussed in Chapter 18.
i8
CLINICAL DISCUSSION
Fourteen years of laboratory and clinical investigation of human

homosexual function and dysfunction have provided broad-based
support for the Institute’s major premise that from a functional
point of view homosexuality and heterosexuality have far more
similarities than differences. Yet today, many decades after cultural
dictum originally introduced the concept that important functional
differences do exist between the two sexual preferences, the over
whelming pressure of public opprobrium still blindly reinforces this
false assumption. The general public as well as many segments of
the scientific community remain convinced that there are marked
functional disparities between homosexual and heterosexual men
and women.
This cultural precept was originally initiated and has been mas
sively supported by theologic doctrine. The Institute has no point
of contention with the relatively well-defined position of theology
on the subject of homosexuality. It is not our intention to assume
a role in interpreting or implementing moral judgment. These
privileges and their accompanying awesome responsibilities are
not within the purview of a research group devoted to psycho
physiologic aspects of human sexuality.
Actually, interviews have provided tentative support for the cul
tural concept of physical differences. Kinsey 0 men or women have
unhesitatingly contended that homosexuality was without any sem
blance of psychosexual appeal because “they (homosexuals) are
different,” while Kinsey 6 individuals have been just as adamant in
rejecting any possible personal interest in heterosexual interaction—
and for the same reason. Unfortunately, many individuals have
loosely interpreted the “they-are-different” doctrine as meaning
physically different in sexual response. Men and women represent-
4»3
404 CHAPTER EIGHTEEN
ing both ends of the Kinsey spectrum have based their intractable
belief in the existence of physical differences in sexual interaction
entirely upon culturally engendered impressions, for they have had
no personal experience with which to support or deny their socially
reinforced opinions.
The bioethical problem in evaluating supposed physical differ
ences has centered on the fact that until 15 years ago cultural preju
dices were so powerful that their precepts could not even be
challenged in the research laboratory. Therefore, subjective opin
ions, the basic fodder of cultural dictum, have neither been sup
ported nor denied by objectively developed investigative material.
Fortunately, the culture can no longer dictate this degree of blind
obeisance from investigative science.
When we admit to judging the physical aspects of sexual prefer
ence on the shaky foundation of subjective impression rather than
from relatively secure research objectivity, there is another and far
less appealing pattern of human behavior that has consistently de
veloped as a cultural consequence. In order to lend credence to our
personal preference for a particular sexual orientation, we not only
categorically deny value in “the other way,’’ we insist on attempt
ing to discredit it completely. It frequently follows that those
individuals who adhere to opinions and practices that are contra
dictory to our own in this controversial area are personally rejected.
Meanwhile, the small voice of reason has gone unheeded. For
decades, Kinsey 2, 3, and 4 men and women who have had a sig
nificant amount of both homosexual and heterosexual experience
have consistently contended that there was not any difference in
the functional aspects of the two preference roles. These individ
uals may indicate a personal bias for either homosexual or hetero
sexual encounter, but any cultural concept of physical difference in
sexual interaction has been replaced by the more pragmatic process
of enjoying sensual aspects of the sexual encounter, regardless of
the gender of the partner.
We are genetically determined to be male or female and, in
addition, are given the ability to function sexually as men or women
by the physical capacities of erection and lubrication and the in
herent facility for orgasmic attainment. These capacities function
CLINICAL DISCUSSION
4»5
in identical ways, whether we are interacting heterosexually or

homosexually. When a man or woman is orgasmic, he or she is re
sponding to sexual stimuli with the same basic physiologic response
patterns, regardless of whether the stimulative technique is mas
turbation, partner manipulation, fellatio/cunnilingus, vaginal or
rectal coitus—and also regardless of whether the sexual partner is of
the same or the opposite gender.
Of course, the “they-are-different” doctrine has had many inter
pretations other than the concept that homosexuals and heterosex
uals function differently sexually. The Kinsey 0 considers the Kin
sey 6 vastly different in many ways because he or she expresses sexual
interest in a same- rather than an opposite-sex partner.
The Kinsey 0 man or woman who identifies with an opposite-sex
individual as a sex object does so on an individual basis. The iden
tification does not extend to all members of the opposite sex. In
fact, although he or she might never admit the interest level
openly, the Kinsey 0 man or woman is occasionally committed far
more closely psychosexually with a same-sex individual than he or
she ever is with many opposite-sex acquaintances. The same be
havior pattern is followed by Kinsey 6 men and women, who often
identify far more closely with an opposite-sex individual than with
same-sex acquaintances.
In the middle of the spectrum are many men and women (Kinsey
2, 3, and 4) who closely identify with partners of both the same
and opposite sex and find them equally stimulating sex objects.
When responding to these partners, they react in the same physical
manner regardless of the gender of the particular partner.
Finally, there are ambisexual men and women. They simply do
not care whether the partner is male or female, for the gender of
the partner is not an important source of sexual arousal. As abun
dantly demonstrated in the laboratory, ambisexuals respond in
identical fashion regardless of the gender of the partner or the
mode of sexual activity. Therefore, it appears that the “they-are-
different” doctrine is also consistently interpreted as “they do not
feel precisely as we do about a potential sex object.” When making
this “they-are-different” social judgment, it is always convenient to
overlook the fact that we usually feel differently about a potential
sex object from day to day. We tend to require consistent sexual

focus on one partner or a specific type of sex object from other
individuals, but not from ourselves.
Over the last 15 years, it also has become apparent that the in
dividual’s sexual orientation does not significantly alter his or her
problem of sexual dysfunction. Impotence and anorgasmic states
have just as devastating an effect on homosexual as on heterosexual
men or women. Fears of performance and spectator roles can make
a sexual cripple out of any sexually dysfunctional individual, homo
sexual or heterosexual. Sexual fakery is freely practiced by repre
sentatives of both sex preferences. Therefore, the Institute strongly
supports the concept that sexual dysfunction be treated with the
same therapeutic principles and techniques regardless of the sexual
orientation of the distressed individual.
If therapeutic procedures are carried out effectively, differences
in the clinical failure statistics should be minimal. Generally, there
may be a lower failure rate in treating the dysfunctional homosex
ual than the dysfunctional heterosexual because the sexually dys
functional homosexual does not have the extra demand for effective
function during coition that is inherent in heterosexual interaction.
In support of these statements a comparison of the overall failure
rates in treating homosexual and heterosexual dysfunction is indi
cated.
Overall treatment failure rates have been compiled from a com
bination of acute treatment failures and both recorded and theo
retical instances of renewed dysfunction during the required five-
year follow-up period after termination of the acute treatment
phase (see Chapter 17). The combined (male and female) overall
treatment failure rate for homosexual dysfunction was approxi
mately 12 percent. The corresponding heterosexual statistic pub
lished in 1970 (Human Sexual Inadequacy) was approximately 20
percent.
The lower overall failure rate returned from treating dysfunc
tional homosexual men and women not only reflected the fact that
effective function during intercourse was not required, but also the
additional influence of another important factor. The research team
had the enormous advantage of a decade of clinical experience treat
ing heterosexual dysfunction before it initiated the homosexual
CLINICAL DISCUSSION
407
treatment program. From a clinical point of view, a significant

differential between the two estimated overall failure rates was to
be expected.
Therapy for sexual dissatisfaction represents the “disaster area”
in the Institute’s treatment program for sexually distressed homo
sexuals. The overall combined (male and female) failure rate was
estimated at approximately 35 percent (see Chapter 17). Actually,
a significantly higher failure rate was anticipated for the treatment
of homosexual dissatisfaction than that developed from treating
homosexual dysfunction, but the marked differential in the failure
rates was not expected. The overall failure rate for homosexual dis
satisfaction was approximately three times that recorded for sex
ually dysfunctional homosexual men and women. This poor clinical
return developed despite the fact that there was careful screening
of clients in every case of sexual dissatisfaction accepted into the
therapy program.
In brief, approximately one in three homosexual men and women
treated for sexual dissatisfaction either failed to convert or revert
to heterosexuality during the acute phase of the treatment program
or actively or theoretically returned to overt homosexual interaction
during the required five-year follow-up period. In comparison, ap
proximately one in 10 homosexual men and women had a similar
report of a failed therapy program for sexual dysfunction (see Chap
ter 17).
The elevated overall failure rate for the treatment of homosexual
dissatisfaction is, of course, unacceptable. There should be no over
all failure rate higher than 20 percent for treatment of any form of
either homosexual or heterosexual inadequacy.
An important factor that has contributed significantly to failures
in treating male homosexual dissatisfaction in the past should
prove far less of a barrier to effective therapy in the future. It is
anticipated that the degree of cooperation with the therapeutic
process by those homosexual men requesting reversion or conver
sion therapy will improve markedly. The clients’ increased confi
dence in the treatment modalities and, subsequently, their higher
levels of clinical cooperation should come from two sources. First,
the homosexual community will soon realize that there are im
proved therapeutic procedures available to the dissatisfied as well
as the dysfunctional homosexual. This realization should, in turn,

increase confidence in and cooperation with the therapeutic process.
Second, there also should be a better rapport between client and
therapist when there is unmistakable evidence of the health-care
professional’s full assumption of its professional responsibility to
ward the treatment of sexually distressed homosexual men and
women.
There is a discrepancy between treatment programs involving
sexually inadequate homosexual and heterosexual populations. This
imbalance revolves about the clinical problems of dissatisfied homo
sexual men and women who entered treatment with the expressed
interest of converting or reverting to heterosexuality (see Chapters
15 and 16). The problem is that there is no facet of the treatment
program for the sexually distressed heterosexual population cor
responding to the section for homosexual dissatisfaction. Over the
20-year period during which the Institute has been treating sexually
distressed heterosexual men and women, there have only been 2
men asking for professional help in converting to homosexuality,
and they were primarily impotent as heterosexuals to start with
(see Chapter 13).
With this discrepancy in mind, the only statistics that remain of
more than passing interest are those that provide an open compari
son between the overall failure rates of the treatment programs for
all forms of heterosexual inadequacy and those for all forms of ho
mosexual inadequacy. The overall failure rate for the heterosexual
dysfunction program was estimated at a combined (male and fe
male) total of approximately 20 percent (Human Sexual Inade
quacy), and the overall combined failure rate for the treatment
programs for homosexual dysfunction and dissatisfaction was esti
mated at approximately 25 percent (see Chapter 17).
Of necessity, these are estimated statistics, for as previously stated,
they are a combination of the numbers of acute treatment failures
and the number of actual and theoretical failures during the
required five-year follow-up program. Yet, the figures are in such
close clinical parallel that they lend support to the concept of simi
larity, not difference, between the sexual functions and dysfunctions
of the two sexual preferences.
The parallelism in overall failure rates also underscores the fact
that the treatment techniques, which were essentially identical in
CLINICAL DISCUSSION
409
concept and format, were generally as effective in treating homo

sexual as heterosexual inadequacies. Regardless of the distressed in
dividual’s sexual preference, the research team insisted upon the
use of dual-sex therapy teams and requested that the sexually in
adequate individual be accompanied in therapy by a partner of
choice. A detailed discussion of the psychotherapeutic principles
involved in the treatment of homosexual dysfunction and dissatis
faction by the dual-sex team techniques will be published at a
later date.
HORMONES AND HOMOSEXUALITY
In the last decade, research interest has been rekindled in the

quest to identify biologic factors important in the genesis of homo
sexuality. Since the Institute’s endocrine section under the direc
tion of Robert C. Kolodny has been active in this area, we would
be remiss if the cunent status of these research programs were not
summarized.
Investigative endocrinologists have been aided by technologic
advances such as radioimmunoassay techniques, which for the first
time have permitted precise quantification of various hormones re
lated to reproduction and sexual functioning. Such work has also
been stimulated by related advances clarifying embryologic mecha
nisms of sexual differentiation—with increasing evidence that in
certain instances the fetal hormonal environment may predispose
individuals toward particular patterns of sexual behavior.
A large body of experimental literature, only briefly mentioned
here, documents the fact that in a variety of animal species hor
monal manipulation during critical phases of sexual differentiation
can produce subsequent alterations in adult sexual behavior that
have been interpreted as paralleling homosexual behavior in humans.
While it is difficult to decide if interspecies comparisons of these
behaviors provide accurate etiologic insights or, indeed, whether
such behavior patterns are truly homologous, there are additional
findings stemming from isolated studies of clinical situations in
volving humans that lend credence to the observations derived from
animal studies. These diverse situations, including females with the
adrenogenital syndrome (exposed in utero to high levels of andró-
4io CHAPTER EIGHTEEN
gen), men with Klinefelter’s syndrome (usually marked by both a

fetal and adult relative deficiency of androgen), and instances of
prenatal exposure to exogenous hormonal intake (principally pro
gestins and estrogens) seem to be associated with a higher inci
dence of subsequent homosexuality than would occur by chance
alone.
In 1970, Margolese reported that the urinary excretion of an
drosterone and etiocholanolone was different in homosexual and
heterosexual men. That same year, Loraine and his colleagues re
ported that urinary excretion of testosterone was low in two homo
sexual men and elevated in four homosexual women. Subsequently,
work by Kolodny and his colleagues from the Institute (1971-
1972)—undertaken with a degree of skepticism about such hor
monal variations in homosexuals—found that plasma testosterone
levels were significantly lower in young men who were either exclu
sively or almost exclusively homosexual (Kinsey 5 or 6) than in
an age-matched group of heterosexual controls. These investigators
carefully stated: “There is no suggestion that endocrine abnormali
ties will be found in the great majority of homosexuals. ... In
fact there must be speculation that the depressed testosterone levels
could be the secondary result of a . . . depressive reaction relayed
through the hypothalamus from higher cortical centers.”
Following this study, a large number of additional reports have
appeared with considerable disagreement in results. While Evans
(1972) and Margolese and Janiger (1973) separately found fur
ther evidence of altered urinary hormone metabolites in homosex
ual men, others have not confirmed this difference. Similarly, while
Starká and co-workers (1975) described lower circulating testos
terone in homosexual men than in heterosexual controls, and Rohde
and his colleagues (1977) found significantly lower free plasma
testosterone in 35 homosexual men than in 38 heterosexual men,
studies by other investigators—including Brodie et al. (1974), Birk
et al. (1973), Friedman et al. (1977), Doerr et al. (1973, 1976),
Toumey and Hatfield (1973), Pillard et al., and Barlow et al.
(1974)—found no differences in circulating testosterone between
homosexual and heterosexual men. To further complicate the situa
tion, Doerr and his colleagues (1973) noted that there were sig
nificant differences in estrone and dihydrotestosterone between ho
CLINICAL DISCUSSION
411
mosexual and heterosexual men; significant differences in luteinizing

hormone secretion in these same groups were also observed by
Doerr’s group (1976), by Kolodny and his colleagues (1972), and
by Rohde and his co-workers (1977). Similar controversy exists in
hormonal studies of homosexual women, although this topic has
not received such intensive investigative scrutiny.
What conclusions or inferences can be drawn from the available
evidence? First, it is apparent that all of these reports are signifi
cantly handicapped by methodological limitations ranging from
relatively small sample size to problems in sampling intervals. Until
these problems are remedied, it is difficult to assess the evidence
with any security. Second, it is apparent that homosexuality is no
more a unitary phenomenon than is heterosexuality: Until it is
possible to separate specific subgroups of homosexuals and hetero
sexuals by precise classification criteria, the heterogeneity that cuts
across the basic lines of homosexual versus heterosexual—supported
by the heterogeneity found in the physiologic and clinical studies
reported in this text—complicates the identification of significant
hormonal differences even if these exist. Third, until more is known
about the origins of heterosexuality, it is difficult to believe that
meaningful insights will be reached regarding the origins of homo
sexuality. Finally, in view of the current lack of secure information
in this field, we must maintain an intellectually open stance ac
knowledging that in at least some instances—though clearly not in
most cases—hormonal predispositions may interact with social and
environmental factors to lead toward a homosexual orientation.
There is little need for further detailed comment. A start has
been made. Far more sophisticated basic research in the neuro
physiology of human sexual function is next in order. In time, the
neuroendocrinology of sexual response must be established. Newer
and more effective variations in the basic therapeutic techniques
for sexual dysfunction and dissatisfaction must be developed. These
techniques must also be combined with improved applicant screen
ing and more effective follow-up procedures. In response to such
investigative efforts, there will be progressive lowering of the overall
failure rates for the treatment of both homosexually and hetero-
sexually oriented sexual inadequacy.
BIBLIOGRAPHY
Most successful collections of multidimensional bibliographies on the

subject of homosexuality have been accomplished by Martin Weinberg
and Alan Bell, by Arno Karlen, and by William Parker. There isn’t the
slightest indication for further reduplication of their massive efforts.
Therefore, the bibliography presented in the following pages only rep
resents reading conducted in conjunction with the Institute’s basic
science investigation of homosexual function and its clinical programs
designed to treat homosexual dysfunction and dissatisfaction.
Since there have been no previous reports on the subject of human
homosexual physiology and in the last year just two reports of treatment
of homosexual dysfunction, there are really a negligible number of ap
plicable bibliographic references. The treatment of homosexual dissatis
faction by dual-sex teams incorporating partners of the opposite sex in
the therapy program also has not been previously reported. And with the
exception of Harold Lief’s pioneering effort, there have been no reports
in the literature of five-year follow-up of homosexual males or females
treated for sexual inadequacy.
Thus, aside from those references pertaining to statistical evaluation
and to endocrinology, the bibliography represents only the Institute’s
general scan of the literature devoted to problems of the homosexual
and, of necessity, has little applicability to material presented in this
text.
Achilles, N. Development of the Homosexual Bar as an Institution.

In Sexual Deviance (J. H. Gagnon and W. Simon, Eds.). New York:
Harper & Row, 1967.
Adler, A. The Individual Psychology of Alfred Adler (H. L. and R. R.
Ansbacher, Eds.). New York: Harper Torchbook, 1964.
Allen, C. The treatment of sexual abnormalities. Med. Press 210:23-
25,1943.
Allen, C. Homosexuality: The psychological factor. Med. Press 218:
222-223, 1947.
Allen, C. The Sexual Perversions and Abnormalities: A Study in the
Psychology of Paraphilia (2nd ed.). London: Oxford University Press,
1949.
413
BIBLIOGRAPHY
4M
Allen, C. On the cure of homosexuality. Inf. J. Sexol. 5:148-150, 1952.

Allen, C. The problem of homosexuality. Inf. J. Sexol. 6:40-42, 1952.
Allen, C. Homosexuality: Its Nature, Causation, and Treatment. Lon
don: Staples, 1958.
Allport, G. The Nature of Prejudice. Cambridge, Mass.: Addison-
Wesley, 1954.
Altman, D. Homosexual: Oppression and Liberation. New York: Dut
ton, 1971.
Alverson, C. A. A minority’s plea—U.S. homosexuals gain in trying to
persuade society to accept them. Wall Street Journal July 17, 1968.
Asprey, R. The Panther’s Feast. New York: Putnam, 1959.
Aubrey, J. Brief Lives (O. L. Dick, Ed.). Ann Arbor: University of
Michigan Press, 1957.
Bailey, D. S. Homosexuality and the Western Christian Tradition.
London: Longmans, Green, 1955.
Barlow, D. H., et al. Plasma testosterone levels and male homosex
uality: A failure to replicate. Arch. Sex. Behav. 3:571-575, 1974.
Beach, F. A. Sex reversals in the mating pattern of the rat. J. Genet.
Psychol. 53:329-334, 1938.
Beach, F. A. Hormones and Behavior. New York: Hoeber, 1948.
Beach, F. A. Sexual Behavior in Animals and Men (Harvey Lectures,
1948, 254-280). Springfield, Ill.: Thomas, 1950.
Beach, F. A. The descent of instinct. Psychol. Rev. 62:401-410, 1955.
Beach, F. A. Factors Involved in the Control of Mounting Behavior by
Female Mammals. In Perspectives in Reproduction and Sexual Be
havior (M. Diamond, Ed.). Bloomington: Indiana University Press,
1958.
Beach, F. A. (Ed.). Sex & Behavior. New York: Wiley, 1965.
Beach, F. A., et al. Coital behavior in dogs: Effects of estrogen on
mounting by females. J. Comp. Physiol. Psychol. 66:296-307, 1968.
Becker, H. S. Outsiders. New York: Free Press, 1963.
Becker, H. S. (Ed.). The Other Side: Perspectives in Deviance. New
York: Free Press, 1964.
Becker, R. de. The Other Face of Love (M. Crosland and A. Daventry,
Trans.). New York: Grove, 1969.
Begelman, D. A. Homosexuality and the ethics of behavioral interven
tion. J. Homosex. 2(3) ¡213-219, 1977.
Beigel, H. G. The Meaning of Coital Postures. In Sexual Behavior and
Personality Characteristics (M. DeMartino, Ed.). New York: Grove,
1966.
Bell, A. P., and Weinberg, M. S. Homosexualities: A Study of Di
versity Among Men and Women. New York: Simon & Schuster, 1978.
BIBLIOGRAPHY
41S
Belot, A. Mademoiselle Giraud, My Wife. Chicago: Laird & Lee, 1891.

Bern, S. L. The measurement of psychological androgyny. J. Consult.
Clin. Psychol. 42:155-162, 1974.
Bern, S. L. Sex-role adaptability: One consequence of psychological
androgyny. J. Pers. Soc. Psychol. 31:634-643, 1975.
Bene, E. On the genesis of female homosexuality. Br. J. Psychiatry
3:815-821, 1965.
Bene, E. On the genesis of male homosexuality: An attempt at clarify
ing the role of parents. Br. J. Psychiatry 3:803-813, 1965.
Benson, R. O. D. In Defense of Homosexuality. New York: Julian,
19^5-
Bergler, E. Homosexuality: Disease or Way of Life? New York: Hill &
Wang, 1956.
Bergler, E. 1000 Homosexuals. Paterson, N.J.: Pageant, 1959.
Bieber, I. Clinical Aspects of Male Homosexuality. In Sexual Inver
sion: The Multiple Roots of Homosexuality (J. Marmor, Ed.). New
York: Basic Books, 1965.
Bieber, I., et al. Homosexuality: A Psychoanalytic Study of Male
Homosexuals. New York: Basic Books, 1962.
Birk, L. Group therapy for men who are homosexual. J. Sex Marital
Ther. 1:29-52, 1974.
Birk, L., et al. Serum testosterone levels in homosexual men. N. Engl.
J. Med. 289:1236-1238, 1973.
Bowman, K. M., and Engle, B. A psychiatric evaluation of the laws of
homosexuality. Temple Law Q. Rev. 2t):2y}-^26, 1956.
Brill, A. A. Freud’s Contribution to Psychiatry. New York: W. W.
Norton, 1962.
Brodie, H. K. H., et al. Plasma testosterone levels in heterosexual and
homosexual men. Am. J. Psychiatry 131:82-83, 1974.
Brown, J. S. A comparative study of deviations of sexual mores. Am.
Sociol. Rev. 17:135-146, 1952.
Burgess, E. W. The Sociologic Theory of Psychosexual Behavior. In
Psychosexual Development in Health and Disease (P. H. Hoch and
J. Zubin, Eds.). New York: Gruñe & Stratton, 1949.
Bychowski, G. The ego and the object of the homosexual. Int. J. Psy-
choanal. 42:255-259, 1961.
Cantor, D. J. Deviation and the criminal law. J. Crim. Law, Criminol.,
Polit. Sci. 55:441-453, 1964.
Cappon, D. Toward an Understanding of Homosexuality. Englewood
Cliffs, N.J.: Prentice-Hall, 1965.
Caprio, F. 'Variations in Sexual Behavior. New York: Grove, 1955.
Caprio, F. S. Female Homosexuality. New York: Citadel, 1954.
416 BIBLIOGRAPHY
Carpenter, E. The Intermediate Sex: A Study of Some Transitional

Types of Men and Women. London: Allen & Unwin, 1908.
Carpenter, E. Love’s Coming of Age. New York: Liveright, 1911.
Carrier, J. Participants in urban Mexican male homosexual encounters.
Arch. Sex. Behav. 1:279-291, 1971.
Carrier, J. Urban Mexican male homosexual encounters: An analysis
of participants and coping strategies. University of California Ph.D.
Thesis, 1972.
Carrier, J. Cultural factors affecting urban Mexican male homosexual
behavior. Arch. Sex. Behav. 5:103-124, 1976.
Carrier, J. M. “Sex-role preference” as an explanatory variable in homo
sexual behavior. Arch. Sex. Behav. 6:53-65, 1977.
Catlin, G. Illustrations of the Manners, Customs, and Condition of
the North American Indians. Cited in The Origin and Development
of the Moral Ideas (E. Westermarck). London: Macmillan, 1908.
Chang, J., and Block, J. Study of identification in male homosexuals.
J. Consult. Psychol. 24:307-310, i960.
Churchill, W. Homosexual Behavior Among Males: A Cross-Cultural
and Cross-Species Investigation. New York: Hawthorn, 1967.
Clemmer, D. The Prison Community. New York: Holt, Rinehart &
Winston, 1958.
Coates, S. Clinical Psychology in Sexual Deviation. In The Pathology
and Treatment of Sexual Deviation: A Methodological Approach
(I. Rosen, Ed.). London: Oxford University Press, 1964.
Cory, D. W. The Homosexual in America: A Subjective Approach.
New York: Greenberg, 1951.
Cory, D. W. (Ed.). Homosexuality: A Cross-Cultural Approach. New
York: Julian, 1956.
Cory, D. W. The Lesbian in America. New York: Citadel, 1964.
Cory, D. W., and LeRoy, J. P. The Homosexual and His Society:
A View from Within. New York: Citadel, 1963.
Cotton, W. L. Role-playing substitutions among homosexuals. J. Sex
Res. 8:310-323, 1972.
Cotton, W. L. Social and sexual relationships of lesbians. J. Sex Res.
11:139-148,1975.
Croft-Cooke, R. The Verdict of You All. London: Warburg, 1955.
Crowley, M. The Boys in the Band. New York: Farrar, 1968.
Curran, D., and Parr, D. Homosexuality: An analysis of 100 male cases
seen in private practice. Br. Med. J. 1:797-801, 1957.
Dank, B. M. Coming out in the gay world. Psychiatry 34:180-195,
197!.
BIBLIOGRAPHY
417
D’Arcangelo, A. The Homosexual Handbook. New York: Ophelia,

1969.
Darwin, C. The Descent of Man and Selection in Relation to Sex
(2nd ed., rev. and augm.). New York: Appleton, 1909.
Davenport, W., and Davenport, P. Sexual Patterns and Their Regu
lation in a Society of the Southwest Pacific. In Sex and Behavior
(F. A. Beach, Ed.). New York: Wiley, 1965.
Davis, A. Sexual assault in the Philadelphia prisons and sheriff vans.
Trans-Action 6(2):8-i3, 1968.
Davis, K. B. Factors in the Sex Life of Twenty-Two Hundred Women.
New York: Harper & Brothers, 1929.
Davison, G. C. Homosexuality and the ethics of behavioral interven
tion: Homosexuality, the ethical challenge. J. Homosex. 2(3) ¡195-
204, Bi
Davison, G. C. Not can but ought: The treatment of homosexuality.
J. Consult. Clin. Psychol. 46:170-172, 1978.
Davison, K., et al. A male monozygotic twinship discordant for homo
sexuality. Br. J. Psychiatry 118:675-682, 1971.
Dean, R. B., and Richardson, H. Analysis of MMPI profiles of 40
college-educated overt male homosexuals. J. Consult. Psychol. 28:483-
486, 1964.
DeFries, Z. Pseudohomosexuality in feminist students. Am. J. Psy
chiatry 133:400-404, 1976.
DeLuca, J. N. Performance of overt male homosexuals and controls on
the Blacky test. J. Clin. Psychol. 23:497, 1967.
Devereaux, G. Institutionalized Homosexuality of the Mohave Indians.
In The Problem of Homosexuality in Modern Society (H. Ruiten-
beek, Ed.). New York: Dutton, 1963.
Diethelm, O. Treatment in Psychiatry. Springfield, Ill.: Thomas, 1950.
Doerr, P., et al. Plasma testosterone, estradiol, and semen analysis in
male homosexuals. Arch. Gen. Psychiatry 29:829-833, 1973.
Doerr, P., et al. Further studies on sex hormones in male homosexuals.
Arch. Gen. Psychiatry 33:611-614, 1976.
Donnelly, R. C., et al. Consensual Homosexual Acts Between Adults
in Private—A Crime: A Problem for the Legislature? In Criminal
Law: Problems for Decision in the Promulgation, Invocation, and Ad
ministration of a Law of Crimes. New York: Free Press of Glencoe,
1962.
Dörner, G. Hormonal induction and prevention of female homosex
uality. J. Endocrinol. 42:163-164, 1968.
Dörner, G. Hormones and Brain Differentiation. Amsterdam: Elsevier,
1976.
418 bibliography
Dörner, G., and Hinz, G. Induction and prevention of male homo

sexuality by androgen. J. Endocrinol. 40:387-388, 1968.
Douglas, J. D. American Social Order: Social Rules in a Pluralistic
Society. New York: Free Press, 1971.
Dunbar, J., et al. Attitudes toward homosexuality among Brazilian and
Canadian college students. /. Soc. Psychol. 90:174-175, 1973.
Edwards, D. A. Neonatal administration of androstenedione, testos
terone, or testerone propionate: Effects on ovulation, sexual recep
tivity and aggressive behavior in female mice. Physiol. Behav. 6:223-
228, 1971.
Eisinger, A. J., et al. Female homosexuality. Nature 238:106, 1972.
Elliott, R. H. Enforcement of laws directed at homosexuals: A typical
metropolitan approach. Drum 26:10-13, 26-28, 1967.
Ellis, A. Homosexuality: Its Causes and Cure. New York: Lyle Stuart,
1965.
Ellis, A. The right to be wrong. /. Sex Res. 4:96-107, 1968.
Ellis, H. Studies in the Psychology of Sex. New York: Random House,
1936. Vols. 1 & 2.
Evans, R. B. Childhood parental relationships of homosexual men.
J. Consult. Clin. Psychol. 33:129-135, 1969.
Evans, R. B. Physical and biochemical characteristics of homosexual
men. J. Consult. Clin. Psychol. 39:140-147, 1972.
Farber, L. H., and Fisher, C. An Experimental Approach to Dream
Psychology Through the Use of Hypnosis. In Contemporary Psycho
pathology (S. S. Tomkins, Ed.). Cambridge, Mass.: Harvard Univer
sity Press, 1943.
Feldman, M. P., and McCulloch, M. J. A systematic approach to the
treatment of homosexuality by conditioned aversion: Preliminary re
port. Am. J. Psychiatry 121:167-171, 1964.
Feldman, M. P., and McCulloch, M. J. Aversion therapy in manage
ment of 43 homosexuals. Br. Med. ]. 2:594-597, 1967.
Féré, C. Sexual Degeneration in Mankind and in Animals (U. van de
Horst, Trans.). New York: Anthropological Press, 1932.
Ferenczi, S. On the Part Played by Homosexuality in the Pathogenesis
of Paranoia. In Contributions to Psychoanalysis (E. Jones, Trans.).
New York: Brunner, 1950.
Ferenczi, S. The Nosology of Male Homosexuality. In The Problem
of Homosexuality in Modern Society (H. M. Ruitenbeek, Ed.). New
York: Dutton, 1963.
Fisher, P. The Gay Mystique: The Myth and Reality of Male Homo
sexuality. New York: Stein & Day, 1972.
BIBLIOGRAPHY
419
Fletcher, G. F., and Cantwell, J. D. Continuous ambulatory electro

cardiograph monitoring: Use in cardiac exercise programs. Chest 71:
27~32> *977-
Fonzi, G. J. The Furtive Fraternity. San Francisco: Pan-Graphic, 1965.
Ford, C. S., and Beach, F. A. Patterns of Sexual Behavior. New York:
Harper & Brothers, 1951.
Forel, A. The Sexual Question (English adapt, from 2nd German ed.,
rev. and enl. by C. F. Marshall). New York: Rebman, 1908.
Freud, A. Homosexuality. 3ull. Am. Psychoanal. Assoc. 7:117-118,
1951.
Freud, S. The Problem of Anxiety (H. A. Bunker, Trans.). New York:
W. W. Norton, 1936.
Freud, S. Three Contributions to the Theory of Sex. In The Basic
Writings of Sigmund Freud (A. A. Brill, Ed. and Trans.). New York:
Modern Library, 1938.
Freud, S. Letter to an American mother. Am. J. Psychiatry 107:786-
787,1951-
Freud, S. Collected Papers (E. Jones, Ed.). New York: Basic Books,
1959. Vols. 1-5.
Freud, S. The Ego and the Id (J. Strachey, Ed. and J. Riviere, Trans.).
New York: W. W. Norton, 1961.
Freud, S. New Introductory Lectures on Psychoanalysis (J. Strachey,
Ed. and Trans.). New York: W. W. Norton, 1965.
Freud, S. Three Essays on the Theory of Sexuality (J. Strachey,
Trans.). New York: Avon, 1965.
Freud, S. An Outline of Psychoanalysis (rev. ed., J. Strachey, Ed. and
Trans.). New York: W. W. Norton, 1970.
Freund, K. A note on the use of the phallometric method of measur
ing mild sexual arousal in the male. Behav. Ther. 2:223-228, 1971.
Freund, K., et al. Heterosexual aversion in homosexual males. Br. J.
Psychiatry 122:163-169, 1973.
Freund, K., et al. The phobic theory of male homosexuality. Arch.
Gen. Psychiatry 31:495-499, 1974.
Friedman, R. C., et al. Psychological development and blood levels of
sex steroids in male identical twins of divergent sexual orientation.
J. Nerv. Ment. Dis. 163:282-288, 1976.
Friedman, R. C., et al. Hormones and sexual orientation in men. Am.
J. Psychiatry 134:571-572, 1977.
Friedman, R. C., et al. Plasma prolactin levels in male homosexuals.
Horm. Behav. 9(1): 19-22, 1977.
420 BIBLIOGRAPHY
Frumkin, R. M. Early English and American Sex Customs. In En

cyclopedia of Sexual Behavior (A. Ellis and A. Abarbanel, Eds.). New
York: Hawthorn, 1967.
Gagnon, J., and Simon, W. Homosexuality: The formulation of a so
ciological perspective. J. Health Soc. Behav. 8:177-185, 1967.
Gagnon, J., and Simon, W. Femininity in the lesbian community. Soc.
Probl. 15:212-221, 1967.
Gagnon, J. H. Sexual Behavior: Sexual Deviation: Social Aspects. In
International Encyclopedia of the Social Sciences (D. E. Sills, Ed.).
New York: Macmillan, 1968.
Gagnon, J. H., and Simon, W. Perspective on homosexuality. Dublin
Rev. 241:96-114, 1967.
Gagnon, J. H., and Simon, W. (Eds.). Sexual Deviance. New York:
Harper & Row, 1967.
Gartrell, N. K., et al. Plasma testosterone in homosexual and hetero
sexual women. Am. J. Psychiatry 134:117-119, 1977.
Gebhard, P., et al. Sex Offenders: An Analysis of Types. New York:
Harper & Row, 1965.
Gebhard, P. H. Situational Factors Affecting Human Sexual Behavior.
In Sex & Behavior (F. A. Beach, Ed.). New York: Wiley, 1965.
Gebhard, P. H. The 1965 Kinsey Report: Our dangerous sex laws.
Ladies Home Journal 82:66-67, 121, and 82:42-44, May and June,
1965.
Gebhard, P. H. Homosexual socialization. Excerpta Medica Int.
Congr. Ser. 150:1028-1031, 1966.
Gebhard, P. H. Incidence of Overt Homosexuality in the United States
and Western Europe. In National Institute of Mental Health Task
Force on Homosexuality: Final Report and Background Papers, Publ.
No. HSM 72-9116 (J. M. Livingood, Ed.). Washington, D.C.: U.S.
Government Printing Office, 1972.
Geller, J. J., and Rouslin, S. A psychoanalytic view of homosexuality:
An interview with Joseph J. Geller, M.D. Perspect. Psychiatr. Care
16(2)76-79, J978-
Gerassi, J. The Boys of Boise: Furor, Vice, and Folly in an American
City. New York: Macmillan, 1966.
Giallombardo, R. Society of Women: A Study of a Women’s Prison.
New York: Wiley, 1966.
Gittings, B. B. The Homosexual and the Church. In The Same Sex
(R. Weltge, Ed.). Philadelphia: Pilgrim, 1969.
Gittings, B. B. A Gay Bibliography. Philadelphia: Task Force on Gay
Liberation, American Library Association, 1974.
BIBLIOGRAPHY 421
Glass, S. J., et al. Sex hormone studies in male homosexuality. Endo

crinology 26:590-594, 1940.
Goffman, E. Stigma. Englewood Cliffs, N.J.: Prentice-Hall, 1963.
Goode, E., and Haber, L. Sexual correlates of homosexual experience:
An exploratory study of college women. /. Sex Res. 13:12-21, 1977.
Goode, E., and Troiden, R. R. (Eds.). Sexual Deviance and Sexual
Deviants. New York: William Morrow, 1974.
Green, R. Sexual Identity Conflict in Children and Adults. New York:
Basic Books, 1974.
Greenblatt, D. R. Semantic differential analysis of the “triangular sys
tem” hypothesis in “adjusted” overt male homosexuals. University of
California Ph.D. Thesis, 1966.
Griffiths, P. D., et al. Homosexual women: An endocrine and psycho
logical study. J. Endocrinol. 63:549-556, 1974.
Gross, A. A. Strangers in Our Midst: Problems of the Homosexual in
American Society. Washington, D.C.: Public Affairs Press, 1962.
Gross, M. J. Changing attitudes toward homosexuality—or are they.
Perspect. Psychiatr. Care 16(2)-.71-75, 1978.
Gundlach, R. H., and Reiss, B. F. Self and Sexual Identity in the Fe
male: A Study of Female Homosexuals. In New Directions in Mental
Health (B. F. Reiss, Ed.). New York: Grune & Stratton, 1968. Vols.
1 & 2.
Gunnison, F. An Introduction to the Homophile Movement. Hart
ford, Conn.: Institute of Social Ethics, 1967.
Hadden, S. B. Group psychotherapy of male homosexuals. Curr. Psy
chiatr. Ther. 6:177-186, 1966.
Hadden, S. B. Treatment of male homosexuals in groups. Int. J. Group
Psychother. 16:13-22, 1966.
Hadden, S. B. A way out for homosexuals. Harper’s 234:107-108, 114-
120, Mar., 1967.
Hadden, S. B. Group psychotherapy for sexual maladjustments. Am. J.
Psychiatry 125:327-332, 1968.
Hadfield, J. A. The cure of homosexuality. Br. Med. J. 1:1323-1326,
!958.
Hagmeier, G., and Gleason, R. Homosexuality. In Counseling the
Catholic. New York: Sheed & Ward, 1959.
Hagmeier, G., and Gleason, R. Moral Aspects of Homosexuality. In
Counseling the Catholic. New York: Sheed & Ward, 1959.
Hampson, J. L., and Hampson, J. G. The Ontogenesis of Sexual Be
havior in Man. In Sex and Internal Secretions (W. C. Young, Ed.).
Baltimore: Williams & Wilkins, 1961.
422 BIBLIOGRAPHY
Harlow, H. F. Of love in infants. Natural History 69:19-23, i960.

Hart, M., et al. Psychological adjustment of nonpatient homosexuals:
Critical review of the research literature. J. Clin. Psychiatry 39:604-
608, 1978.
Hatterer, L. J. Changing Homosexuality in the Male. New York:
McGraw-Hill, 1970.
Hauser, R. The Homosexual Society. London: Bodley Head, 1962.
Havemann, E. Homosexuality in America: Scientists search for an
swers to a touchy and puzzling question—why? Life 56:76-80,
June 26, 1964.
Hefner, H. M. The legal enforcement of morality. Univ. Colo. Law
Rev. 40:199-221, 1968.
Heilbrun, A. B., Jr., and Thompson, N. L., Jr. Sex role identity and
male and female homosexuality. Sex Roles ^(11) 1977.
Hemphill, R. E., et al. A factual study of male homosexuality. Br.
Med. J. 1:1317-1323, 1958.
Hendin, H. Black Suicide. New York: Basic Books, 1969.
Hendin, H. Homosexuality: The psychological dimension. J. Am.
Acad. Psychoanal. 6:479-496, 1978.
Henry, G. W. Sex Variants: A Study of Homosexual Patterns. New
York: Hoeber, 1948.
Henry, G. W. All the Sexes: A Study of Masculinity and Femininity.
New York: Holt, Rinehart & Winston, 1955.
Hess, E. H., et al. Pupil response of heterosexual and homosexual
males to pictures of men and women. J. Soc. Abnorm. Psychol. 70:
165-168, 1965.
Hirschfeld, M. Men and VFomen. New York: Putnam, 1935.
Hirschfeld, M. The Sexual History of the World War. New York:
Cadillac, 1946.
Hirschfeld, M. Sexual Anomalies. New York: Emerson, 1956.
Hoffman, M. The Gay World: Male Homosexuality and the Social
Creation of Evil. New York: Basic Books, 1968.
The homosexual: Newly visible, newly understood. Time 94:56-67,
Oct. 31, 1969.
Homosexual wedding. Newsweek 70:59, July 17, 1967.
Homosexuality: Coming to terms. Time 94:82, Oct. 24, 1969.
Hooker, E. A preliminary analysis of group behavior of homosexuals.
J. Psychol. 42:217-225, 1956.
Hooker, E. The adjustment of the male overt homosexual. ]. Proj.
Tech. 21:18-31, 1957.
BIBLIOGRAPHY
423
Hooker, E. Male homosexuality in the Rorschach. J. Proj. Tech. 22:

33-54, 1958.
Hooker, E. What is a criterion? /. Proj. Tech. 23:278-281, 1959.
Hooker, E. The case of El: A biography. J. Proj. Tech. 25:252-267,
1961.
Hooker, E. Male Homosexual Life Styles and Venereal Disease. Wash
ington, D.C.: Department of Health, Education, and Welfare, 1961.
Hooker, E. Review of Hervey Cleckley’s “the caricature of love.” J.
Crim. Law, Criminol., Polit. Sci. 52:12-13, 1961.
Hooker, E. Male Homosexuality. In Taboo Topics (N. L. Farberow,
Ed.). New York: Atherton, 1963.
Hooker, E. The Male Homosexual (Venereal Disease Control Infor
mational Report No. 8). Sacramento: California State Health Depart
ment, 1964.
Hooker, E. An Empirical Study of Some Relations Between Sexual
Patterns and Gender Identity in Male Homosexuals. In Sex Research:
Hew Developments (J. Money, Ed.). New York: Holt, Rinehart &
Winston, 1965.
Hooker, E. Male Homosexuals and Their “Worlds.” In Sexual Inver
sion: The Multiple Roots of Homosexuality (J. Marmor, Ed.). New
York: Basic Books, 1965.
Hooker, E. The Homosexual Community. In Sexual Deviance (J. H.
Gagnon and W. Simon, Eds.). New York: Harper & Row, 1967.
Hooker, E. Homosexuality. In International Encyclopedia of the So
cial Sciences. New York: Macmillan, 1968.
Hooker, E. Sexual Behavior: Homosexuality. In International En
cyclopedia of the Social Sciences. New York: Macmillan, 1968.
Hooker, E. Parental relations and male homosexuality in patient and
non-patient samples. J. Consult. Clin. Psychol. 33:140-142, 1969.
Hooker, E., et al. Problems of Sex Ethics: Homosexuality. In Founda
tions for Christian Family Policy (E. S. Genné and W. H. Genné,
Eds.). New York: National Council of Churches, 1961.
Hopkins, J. H. The lesbian personality. Br. J. Psychiatry 115:1433-
1436, 1969.
Homey, K. New Ways in Psychoanalysis. New York: W. W. Norton,
1939.
Howard, W. L. Sexual perversion in America. Am. J. Derm. Genito
urinary Dis. 3:9-14, 1904.
Hudson, B. Christian Homosexuality. North Hollywood, Calif.: New
Library Press, 1970.
Humphreys, L. Tearoom Trade: Impersonal Sex in Public Places. Chi
cago: Aldine, 1970.
BIBLIOGRAPHY
424
Hunt, M. The Natural History of Love. New York: Knopf, 1959.

Hunt, S. P. Homosexuality from a contemporary perspective. Conn.
Med. 42:105-108, 1978.
Hyde, M. H. The Love That Dared Not Speak Its Name. Boston:
Little, Brown, 1970.
Jacobs, H. Decoy enforcement of homosexual laws. Univ. Penn. Law
Rev. 112:259-284, 1963.
James, S., et al. Significance of androgen levels in the aetiology and
treatment of homosexuality. Psychol. Med. 7:427-429, 1977.
Jennings, T. W., Jr. Homosexuality and Christian faith: A theological
reflection. Christian Century Feb. 16, 1977, pp. 137-142.
Johnson, V. E., and Masters, W. H. Intravaginal contraceptive study:
Phase I. Anatomy. West. J. Surg. Obstet. Gynecol. 70:202-207, 1962.
Johnson, V. E., and Masters, W. H. Intravaginal contraceptive study:
Phase II. Physiology (a direct test for protective potential). West. J.
Surg. Obstet. Gynecol. 71:144-153, 1963.
Johnson, V. E., and Masters, W. H. A product of dual import: Intra
vaginal infection control and conception control. Pacif. Med. ó
Surg. 73:267-271, 1965.
Johnson, V. E., et al. The Physiology of Intravaginal Contraceptive
Failure. In Manual of Family Planning and Contraceptive Practice
(2nd ed., M. E. Calderone, Ed.). Baltimore: Williams & Wilkins,
1970.
Jones, H. K. Toward a Christian Understanding of the Homosexual.
New York: Association Press, 1966.
Judson, F. N., et al. Screening for gonorrhea and syphilis in the gay
baths—Denver, Colorado. Am. J. Public Health 67:740-742, 1977.
Jung, C. G. Collected Works (H. Read et al., Eds.). New York: Pan
theon, 1953-1970.
Kallmann, F. J. Comparative twin study on the genetic aspects of male
homosexuality. J. Nerv. Ment. Dis. 115:283-298, 1952.
Kallmann, F. J. Twin and sibship study of overt male homosexuality.
Am. J. Hum. Genet. 4:136-146, 1952.
Kameny, F. E. Gay Is Good. In The Same Sex (R. Weltge, Ed.).
Philadelphia: Pilgrim, 1969.
Kardiner, A., and Ovesey, L. The Mark of Oppression. New York:
Meridian, 1962.
Karlen, A. Sexuality and Homosexuality: A New View. New York:
W. W. Norton, 1971.
Katz, S. The homosexual next door. Maclean’s Magazine 77:10-11,
28-30, Feb. 22, 1964.
BIBLIOGRAPHY
425
Kauffmann, S. Homosexual drama and its disguises. New York Times

Jan. 23, 1966.
Kauffmann, S. On the acceptability of the homosexual. New York
Times Feb. 6, 1966.
Kaye, H. E., et al. Homosexuality in women. Arch. Gen. Psychiatry
17:626-634, 1967.
Ketterer, W. A. Venereal disease and homosexuality. J.A.M.A. 188:
11-12, 1964.
Kinsey, A. C. Homosexuality: Criteria for a hormonal explanation of
the homosexual. J. Clin. Endocrinol. 1:424-428, 1941.
Kinsey, A. C., et al. Sexual Behavior in the Human Male. Philadel
phia: Saunders, 1948.
Kinsey, A. C., et al. Concepts of Normality and Abnormality in Sexual
Behavior. In Psychosexual Development in Health and Disease (P. H.
Hoch and J. Zubin, Eds.). New York: Gruñe & Stratton, 1949.
Kinsey, A. C., et al. Sexual Behavior in the Human Female. Philadel
phia: Saunders, 1953.
Kitsuse, J. I. Societal response to deviant behavior: Problems of theory
and method. Soc. Probl. 9:247-256, 1962.
Kolodny, R. C., et al. Plasma testosterone and semen analysis in male
homosexuals. N. EngZ. J. Med. 285:1170-1174, 1971.
Kolodny, R. C., et al. Plasma gonadotrophins and prolactin in male
homosexuals. Lancet 2:18-20, 1972.
Krafft-Ebing, R. von. Psychopathia Sexualis (H. E. Wedeck, Trans.).
New York: Putnam, 1965.
Krich, A. M. (Ed.). The Homosexuals: As Seen by Themselves and
Authorities. New York: Citadel, 1954.
Lanahan, C. C. Homosexuality: A different sexual orientation. Nurs.
Forum 15:314-319, 1976.
Lawrence, J. C. Gay peer counseling. J. Psychiatr. Nurs,
*977-
Lemert, E. Social Pathology. New York: McGraw-Hill, 1951.
Leznoff, M. Interviewing homosexuals. Am. J. Sociol. 62:204, 1956.
Leznoff, M., and Westley, W. A. The homosexual community. Soc.
Probl. 3:259-260, 1956.
Licht, H. Sexual Life in Ancient Greece. New York: Barnes & Noble,
1963.
Liddicoat, R. Homosexuality: Results of a survey as related to various
theories. Br. Med. J. 2:1110-1111, 1957.
Liebow, E. Tally’s Corner. Boston: Little, Brown, 1967.
426 BIBLIOGRAPHY
Lief, H., and Mayerson, P. Psychotherapy of Homosexuals: A Follow

up Study of Nineteen Cases. In Sexual Inversion: The Multiple Roots
of Homosexuality (J. Marmor, Ed.). New York: Basic Books, 1965.
Lief, H. I., et al. Psychoendocrinologic studies in a male with cyclic
changes in sexuality. Psychosom. Med. 24:357-368, 1962.
Lim, K. S., et al. Role of sexual and non-sexual practices in the trans
mission of hepatitis B. Br. J. Vener. Dis. 53:190-192, 1977.
Lindner, R. M. Homosexuality and the Contemporary Scene. In Must
You Conform? New York: Holt, Rinehart & Winston, 1956.
Linton, R. Marquesan Culture. In The Individual and His Society
(A. Kardiner, Ed.). New York: Columbia University Press, 1939.
Littler, W. A., et al. Direct arterial pressure, heart rate and electro
cardiogram during human coitus. J. Reprod. Fértil. 40:321-331, 1974.
Livingood, J. M. (Ed.). National Institute of Mental Health Task
Force on Homosexuality: Final Report and Background Papers, Publ.
No. HSM 72-9116. Washington, D.C.: U.S. Government Printing
Office, 1972.
Livingstone, I. R., ef al. The effect of luteinizing hormone releasing
hormone (LRH) on pituitary gonadotropins in male homosexuals.
Horm. Metab. Res. 10:248-249, 1978.
Lofgren, L. B. Difficulties and ambiguities in using “results” as an
evaluating norm in psychiatry. Br. J. Med. Psychol. 33:95-103, i960.
London, L. S. Homosexual panic with hallucinations—a case study.
Med. Times 92:175-189, 1964.
Loraine, J. A., et al. Endocrine function in male and female homo
sexuals. Br. Med. J. 4:406-408, 1970.
Lorenz, K. Evolution and the Modification of Behavior. Chicago:
University of Chicago Press, 1965.
Lowry, A. S. Entry into homosexual lifestyles: A trimodal formulation.
Goddard University M.A. Thesis, 1973.
Lucas, D. S. (Ed.). The Homosexual and the Church. San Francisco:
Mattachine Society, 1966.
Ludovici, A. Homosexuality, the law and public sentiment (com
mentary by C. Allen). Int. J. Sexol. 5:143-150, 1951-1952.
MacAlpert, L. East coast homophiles discuss the great society. Tan
gents 1:13, 1965.
McGuire, R. J., and Vallance, M. Aversion therapy by electric shock:
A simple technique. Br. Med. J. 1:151, 1964.
McIntosh, M. The homosexual role. Soc. Probl. 16:182-192, 1968.
McWhirter, D. P., and Mattison, A. M. The treatment of sexual dys
function in gay male couples. J. Sex Marital Ther. 4:213-218, 1978.
BIBLIOGRAPHY 427
Magee, B. One in Twenty; A Study of Homosexuality in Men and

Women. New York: Stein & Day, 1966.
Malthus, T. R, On Population (G. Himmelfarb, Ed.). New York:
Modem Library, i960.
Marcus, F. The Killing of Sister George. New York: Random House,
1967.
Margolese, M. S. Homosexuality: A new endocrine correlate. Horm.
Behav. 1(2)-.151-155, 1970.
Margolese, M. S., and Janiger, O. Androsterone/etiocholanolone ratios
in male homosexuals. Br. Med. J. 5:207-210, 1973.
Marks, I. M. Aversion therapy. Br. J. Med. Psychol. 41 ¡47-52, 1968.
Marmor, J. (Ed.). Male Homosexuals and Their Worlds. In Pro
ceedings of the XIVth International Congress of Applied Psychology
and Personality Research. Copenhagen: Munksgaard, 1962. Vol. 2.
Marmor, J. (Ed.). Sexual Inversion: The Multiple Roots of Homo
sexuality. New York: Basic Books, 1965.
Marmor, J. Homosexuality. Stud. Pers. Newsl., State Univ. Coll.,
Buffalo 1(3): 15-34, j967-
Marmor, J. Homosexuality and objectivity. S.I.E.C.U.S. Newsl. 6(2):
1, 3-4, 6, 8, 10-12, Dec. 23, 1970.
Marmor, J. Homosexuality in males. Psychiatric Ann. 1:44-59, 1971.
Marmor, J. “Normal” and “deviant” sexual behavior. J.A.M.A. ziy:
165-170, 1971.
Marmor, J. Notes on Some Psychodynamic Aspects of Homosexuality.
In National Institute of Mental Health Task Force on Homosexuality:
Final Report and Background Papers, Publ. No. HSM 72-9116
(J. M. Livingood, Ed.). Washington, D.C.: U.S. Government Print
ing Office, 1972.
Marmor, J. Homosexuality—mental illness or moral dilemma? Int. J.
Psychiatry 10:114-117, 1972.
Marmor, J., and Green, R. Homosexual Behavior. In Handbook of
Sexology (J. Money and H. Musaph, Eds.). New York: Elsevier/
North Holland Biomedical Press, 1977.
Maslow, A. H. Love in Self-Actualizing People. In Sexual Behavior
and Personality Characteristics (M. F. DeMartino, Ed.). New York:
Grove, 1966.
Maslow, A. H. Self-Esteem (Dominance-Feeling) and Sexuality in
Women. In Sexual Behavior and Personality Characteristics (M. F.
DeMartino, Ed.). New York: Grove, 1966.
Maslow, A. H., et al. Some Parallels Between Sexual and Dominance
Behavior of Infra-Human Primates and the Fantasies of Patients in
BIBLIOGRAPHY
428
Psychotherapy. In Sexual Behavior and Personality Characteristics

(M. F. DeMartino, Ed.). New York: Grove, 1966.
Masters, R. E. L. The Homosexual Revolution: A Challenging Expose
of the Social and Political Directions of a Minority Group. New
York: Julian, 1962.
Masters, W. H., and Johnson, V. E. The artificial vagina: Anatomic,
physiologic, psychosexual function. West. J. Surg. Obstet. Gynecol.
69:192-212, 1961.
Masters, W. H., and Johnson, V. E. Human Sexual Response. Boston:
Masters, W. H., and Johnson, V. E. Human Sexual Inadequacy.
Boston: Little, Brown, 1970.
Masters, W. H., and Johnson, V. E. The Pleasure Bond. Boston:
Mattachine Society of Washington. Federal Employment of Homo
sexual American Citizens. Washington, D.C.: Mattachine Society,
J965-
Max, L. W. Breaking up a homosexual fixation by the conditioned
reaction technique. Psychol. Bull. 32:734, 1935.
Mead, M. Cultural Determinants of Sexual Behavior. In Sex and
Internal Secretions (W. C. Young, Ed.). Baltimore: Williams &
Wilkins, 1961.
Meyer, R. G., et al. A social episode model of human sexual behavior.
/. Homosex. 2(2) :i23-i3i, 1976-1977.
Meyer-Bahlburg, H. F. L. Sex hormones and male homosexuality in
comparative perspective. Arch. Sex. Behav. 6:297-325, 1977.
Mildvan, D., et al. Venereal transmission of enteric pathogens in male
homosexuals: Two case reports. J.A.M.A. 238:1387-1389, 1977.
Moll, A. Perversions of the Sexual Instinct: A Study of Sexual Inver
sion (M. Popkin, Trans.). New York: Julian, 1931.
Moll, A. Libido Sexualis. North Hollywood, Calif.: Brandon House,
1966.
Money, J. Components of Eroticism in Man: Cognitional Rehearsals.
In Recent Advances in Biological Psychiatry (J. Wortis, Ed.). New
York: Gruñe & Stratton, i960.
Money, J. Sex Hormones and Other Variables in Human Eroticism.
In Sex and Internal Secretions (W. C. Young, Ed.). Baltimore:
Williams & Wilkins, 1961.
Money, J. Factors in the Genesis of Homosexuality. In Determinants
of Human Sexual Behavior (G. Winokur, Ed.). Springfield, Ill.:
Thomas, 1963.
BIBLIOGRAPHY
429
Money, J. Psychosexual Differentiation. In Sex Research: New Devel

opments (J. Money, Ed.). New York: Holt, Rinehart & Winston,
1965.
Money, J. (Ed.). Sex Research: New Developments. New York: Holt,
Rinehart & Winston, 1965.
Money, J. The genetics of homosexuality. N.Z. Med. J. 66:745-748,
1967.
Money, J. Sex Errors of the Body. Baltimore: Johns Hopkins Press,
1968.
Money, J. Sexual dimorphism and homosexual gender identity. Psy
chol. Bull. 74:425-440, 1970.
Money, J. Pubertal Hormones and Homosexuality, Bisexuality and
Heterosexuality (Appendix B). In National Institute of Mental
Health Task Force on Homosexuality: Final Report and Background
Papers, Publ. No. HSM 72-9116 (J. M. Livingood, Ed.). Washing
ton, D.C.: U.S. Government Printing Office, 1972.
Money, J. Statement on antidiscrimination regarding sexual orienta
tion. J. Homosex. 2(2): 159-161, 1976-1977.
Money, J. Bisexual, homosexual, and heterosexual: Society, law, and
medicine. J. Homosex. 2(3) ¡229-233, 1977.
Money, J., and Alexander, D. Psychosexual development and absence
of homosexuality in males with precocious puberty. J. Nerv. Ment.
Dis. 148:111-123, 1969.
Money, J., and Daléry, J. Iatrogenic homosexuality: Gender identity
in seven 46, XX chromosomal females with hyperadrenocortical her
maphroditism born with a penis, three reared as boys, four readed as
girls. J. Homosex. 1 (4) ¡357-371, 1976.
Money, J., and Ehrhardt, A. Man & Woman, Boy & Girl: The Differ
entiation and Dimorphism of Gender Identity From Conception to
Maturity. Baltimore: Johns Hopkins Press, 1972.
Money, J., and Hosta, G. Negro folklore of male pregnancy. J. Sex
Res. 4:34-50, 1968.
Money, J., and Wang, C. Human figure drawings: II. Quality com
parison in gender-identity anomalies, Klinefelter’s syndrome, and
precocious puberty. J. Nerv. Ment. Dis. 144:55-58, 1967.
Morin, S. F. Heterosexual bias in psychological research on lesbianism
and male homosexuality. Am. Psychol. 32:629-637, 1977.
Neumann, H. H. Urethritis caused by anal coitus. Med. Aspects Hum.
Sex. 1976.
Nichols, J., and Clarke, L. I Have More Fun With You Than Any
body. New York: St. Martin’s, 1972.
BIBLIOGRAPHY
430
Oswald, I. Induction of illusory and hallucinatory voices with con

siderations of behaviour therapy. J. Merit. Sci. 108:196-212, 1962.
Ovesey, L. The homosexual conflict: An adaptational analysis. Psy
chiatry 17:243-250, 1954.
Ovesey, L. The pseudohomosexual anxiety. Psychiatry 18:17-25, 1955.
Ovesey, L. Pseudohomosexuality, the paranoid mechanism, and para
noia. Psychiatry 18:163, 1955.
Ovesey, L. Masculine aspirations in women. Psychiatry 19:341-351,
1956.
Ovesey, L. Fear of vocational success. Arch. Gen. Psychiatry 7:30-40,
1962.
Ovesey, L. Pseudohomosexuality and Homosexuality in Men: Psycho
dynamics as a Guide to Treatment. In Sexual Inversion: The Multiple
Roots of Homosexuality (J. Marmor, Ed.). New York: Basic Books,
1965.
Ovesey, L. Homosexuality and Pseudohomosexuality. New York:
Science House, 1969.
Parker, W. Homosexuality: A Selective Bibliography of Over 3000
Items. Metuchen, N.J.: Scarecrow, 1971.
Parsons, T. The Social System. New York: Free Press, 1951.
Perloff, W. H. The role of hormones in homosexuality. Albert Ein
stein Med. Cen. 11:165-178, 1963.
Pillard, R. C., Rose, R. M., and Sherwood, M. Plasma testosterone
levels in homosexual men. Arch. Sex. Behav. 3:453-458, 1974.
Ploscowe, M. Sex and the Law (rev. ed.). New York: Ace Books, 1962.
Poe, J. S. The successful treatment of a 40-year-old passive homosexual
based on an adaptational view of sexual behavior. Psychol. Rev. 29:
23-36, 1952.
Pomeroy, W. B. Human Sexual Behavior. In Taboo Topics (N. Far-
berow, Ed.). New York: Atherton, 1963.
Pomeroy, W. B. Homosexuality. In The Same Sex (R. Weltge, Ed.).
Prosin, S. The concept of the lesbian, a minority in reverse. Ladder
6(10) ¡5-22, 1962.
The psychoanalytic treatment of male homosexuality (Eng. abstr.).
J. Am. Psychoanal. Assoc. 25:183-199, 1977.
Ranier, J. D., et al. Homosexuality and heterosexuality in identical
twins. Psychosom. Med. 22:251-259, i960.
Rao, C. R. Advanced Statistical Methods in Biometric Research. New
York: Wiley, 1952.
BIBLIOGRAPHY
431
Rees, J, T., and Usill, H. V. (Eds.). They Stand Apart: A Critical

Survey of the Problems of Homosexuality. London: Heinemann,
*955-
Regelson, R. Up the camp staircase. The New York Times Mar. 3,
1968.
Reik, T. A Psychologist Looks at Love. New York: Farrar & Rinehart,
1944.
Reik, T. The Psychology of Sex Relations. New York: Farrar & Rine
hart, 1945.
Reik, T. Myth and Guilt: The Crime and Punishment of Mankind.
New York: George Braziller, 1957.
Reiss, A. J., Jr. Sex offenses: The marginal status of the adolescent.
Law Contemp. Probl. 25:319, i960.
Reiss, A. J., Jr. The Social Integration of Queers and Peers. In The
Problem of Homosexuality in Modern Society (H. M. Ruitenbeek,
Ed.). New York: Dutton, 1963.
Riess, B. A new psychology of women or a psychology for the new
woman, active or passive. Int. Ment. Health Res. Newsl. 14(4) a-4,
1971.
Ritchey, M. G. Venereal disease among homosexuals (letter to the
editor). J.A.M.A. 237:767, 1977.
Ritchey, M. G., and Left, A. M. Venereal disease control among
homosexuals: An outreach program. J.A.M.A. 232:509-510, 1975.
Robinson, V. Encyclopedia Sexualis. New York: Dingwall-Rock, 1936.
Robinson, W. J. Woman, Her Sex and Love Life. New York: Eugen
ics, 1931.
Roesler, T., and Diesher, R. W. Youthful male homosexuality: Homo
sexual experience and the process of developing homosexual identity
in males aged 16-22 years. J.A.M.A. 219:1018-1023, 1972.
Rohde, W., et al. Plasma basal levels of FSH, LH and testosterone in
homosexual men. Endokrinologie 70:241-248, 1977.
Rosen, I. (Ed.). The Pathology and Treatment of Sexual Deviation.
London: Oxford University Press, 1964.
Rosen, I. The basis of psychotherapeutic treatment of sexual devia
tion. Proc. R. Soc. Med. 61:793-796, 1968.
Rubington, E., and Weinberg, M. Deviance: The Interactionist Per
spective (2nd ed.). New York: Macmillan, 1973.
Rubinstein, L. H. Psychotherapeutic aspects of male homosexuality.
Br. J. Med. Psychol. 31:74-78,1958.
Ruitenbeek, H. (Ed.). The Problem of Homosexuality in Modern
Society. New York: Dutton, 1963.
BIBLIOGRAPHY
43«
Saghir, M. T., and Robins, E. Homosexuality: I. Sexual behavior of

the female homosexual. Arch. Gen. Psychiatry 20:192-201, 1969.
Saghir, M. T., and Robins, E. Male and Female Homosexuality: A
Comprehensive Investigation. Baltimore: Williams & Wilkins, 1973.
Saghir, M. T., et al. Homosexuality: II. Sexual behavior of the male
homosexual. Arch. Gen. Psychiatry 21:219-229, 1969.
Saghir, M. T., et al. Homosexuality: III. Psychiatric disorders and dis
ability in the male homosexual. Am. J. Psychiatry 129:1079-1086,
197°-
Saghir, M. T., et al. Homosexuality: IV. Psychiatric disorders and dis
ability in the female homosexual. Am. J. Psychiatry 127:147-154,
x97°-
Schmerin, M. J., et al. Amebiasis: An increasing problem among
homosexuals in New York City. J.A.MA. 238:1386-1387, 1977.
Schmidt, G. Letter to the editor. Arch. Sex. Behav. 7:73-75, 1978.
Schofield, M. The Sexual Behavior of Young People. London: Long
mans, Green, 1965.
Schofield, M. Sociological Aspects of Homosexuality. London: Long
mans, Green, 1965.
Schott, W. Civil rights and the homosexual. New York Times Mar. 3,
1966.
Schur, E. M. Homosexuality. In Crimes Without Victims. Englewood
Cliffs, N.J.: Prentice-Hall, 1965.
Scott, P. D. Definition, Classification, Prognosis and Treatment. In
The Pathology and Treatment of Sexual Deviation: A Methodological
Approach (I. Rosen, Ed.). London: Oxford University Press, 1964.
Secor, N. A. A Brief for a New Homosexual Ethic. In The Same Sex
(R. W. Weltge, Ed.). Philadelphia: Pilgrim, 1969.
Siegelman, M. Parental background of male homosexuals and hetero
sexuals. Arch. Sex. Behav. 3:3-18, 1974.
Siegelman, M. Psychological adjustment of homosexual and hetero
sexual men: A cross-national replication. Arch. Sex. Behav. 7:1-11,
1978.
Simmel, G. Soziologie. In Behavior in Public Places (E. Goffman,
Ed.). New York: Free Press, 1963.
Simon, W., and Gagnon, J. H. The Lesbians: A Preliminary Over
view. In Sexual Deviance (J. H. Gagnon and W. H. Simons, Eds.).
New York: Harper & Row, 1967.
Simon, W., and Gagnon, J. H. (Eds.). Sexual Deviance. New York:
Harper & Row, 1967.
BIBLIOGRAPHY
433
Simon, W., and Gagnon, J. H. Homosexuality: The Formulation of a

Sociological Perspective. In The Same Sex (R. W. Weltge, Ed.).
Socarides, C. W. The Overt Homosexual. New York: Gruñe &
Stratton, 1968.
Socarides, C. W. Homosexuality and medicine. J.A.M.A. 212:1199-
1202, 1970.
Society for Individual Rights. The Armed Services and Homosexuality.
San Francisco: Society for Individual Rights, 1968.
Society for Individual Rights. The Military Discharge and Employ
ment Experiences of 47 Homosexuals. San Francisco: Society for
Individual Rights, 1969.
Sonnenschein, D. Homosexuality as a subject of anthropological in
quiry. Anthropol. Q. 39:73-82, 1966.
Sonnenschein, D. The ethnography of male homosexual relations.
J. Sex Res. 4:69-83, 1968.
Stahl, F., et al. Significantly decreased apparently free testosterone
levels in plasma of male homosexuals. Endokrinologie 68:115-117,
1976.
Star, J. The faces of the boys in the band. A changing view of homo
sexuality? Look 33:62-68, Dec. 2, 1969.
Starká, L., et al. Plasma testosterone in male transsexuals and homo
sexuals. J. Sex Res. 11:134-138, 1975.
Stein, R. A. The effect of exercise training on heart rate during coitus
in the post myocardial infarction patient. Circulation 55:738-740,
in
Stephan, W. G. Parental relationships and early social experiences of
activist male homosexuals and male heterosexuals. J. Abnorm. Psychol.
82:506-613, 1973.
Stevenson, I., and Wolpe, J. Recovery from sexual deviations through
overcoming non-sexual neurotic responses. Am. J. Psychiatry 116:737-
742, i960.
Stoller, R. J. The “bedrock” of masculinity and femininity: Bisexuality.
Arch. Gen. Psychiatry 26:207-212, 1972.
Stow, M. Closet queens. Vector 7:4, 1971.
Sturgis, E. T., and Adams, H. E. The right to treatment: Issues in the
treatment of homosexuality. J. Consult. Clin. Psychol. 46:165-169,
1978.
Sullivan, H. S. The Interpersonal Theory of Psychiatry (H. S. Perry
and M. L. Garrel, Eds.). New York: W. W. Norton, 1953.
Swerdlow, H. Trauma caused by anal coitus. Med. Aspects Hum. Sex.
10:93-94, 1976.
BIBLIOGRAPHY
434
Szasz, T. The Myth of Mental Illness. New York: Hoeber, 1961.

Szasz, T. Law, Liberty and Psychiatry. New York: Macmillan, 1963.
Szasz, T. Legal and Moral Aspects of Homosexuality. In Sexual In
version (J. Marmor, Ed.). New York: Basic Books, 1965.
Szmuness, W., et al. On the role of sexual behavior in the spread of
hepatitis B infection. Ann. Intern. Med. 83:489-495, 1975.
Tamowsky, B. Pederasty in Europe. North Hollywood, Calif.: Brandon
House, 1967.
Taylor, G. R. Sex in History. New York: Vanguard, i960.
Thielicke, H. The Problem of Homosexuality. In The Ethics of Sex
(J. W. Doberstein, Trans.). New York: Harper & Row, 1964.
Thompson, C. Changing concepts of homosexuality in psychoanalysis.
Psychiatry 10:183-189, 1947.
Thompson, N. L., et al. Parent-child relationships and sexual identity
in male and female homosexuals and heterosexuals. J. Consult. Clin.
Psychol. 41:120-127, 1973.
Tiger, L. Men in Groups. New York: Random House, 1969.
Toumey, G., and Hatfield, L. M. Androgen metabolism in schizo
phrenics, homosexuals, and normal controls. Biol. Psychiatry 6:23-26,
!973-
Tripp, C. A. Who is a homosexual? Soc. Prog. J. Church Soc. 58(2):
13-21, 1967.
Tripp, C. A. The Homosexual Matrix. New York: McGraw-Hill, 1975.
Tylor, E. Primitive Culture. London: Oxford University Press, 1963.
United Church of Christ, Council for Social Action. Civil Liberties
and Homosexuality: An Issue in Christian Responsibility. Lebanon,
Pa.; United Church of Christ, 1967.
United Presbyterian Church in the U.S.A. Office of Church and Society
of the Board of Christian Education. What About Homosexuality?
Lancaster, Pa.: United Presbyterian Church, 1967.
United States Department of Health, Education, and Welfare. Na
tional Institute of Mental Health. Final Report of the Task Force
on Homosexuality (“The Hooker Report”). Oct., 1969.
Vaisrub, S. Homosexuality—a risk factor in infectious disease (edi
torial). J.A.M.A. 238:1402, 1977.
Vander Veldt, J. H., and Odenwald, R. P. Homosexuality. In Psychia
try and Catholicism (2nd ed.). New York: McGraw-Hill, 1957.
Vanggaard, T. Phallos: A Symbol and Its History in the Male World.
New York: International Universities Press, 1972.
Ward, D. A., and Kassebaum, G. G. Women’s Prison: Sex and Social
Structure. Chicago: Aldine, 1965.
BIBLIOGRAPHY
435
Watson, J. B. Behaviorism (rev. ed.). Chicago: University of Chicago

Press, 1930.
Weinberg, G. H. Society and the Healthy Homosexual. New York:
St. Martin’s Press, 1972.
Weinberg, M., and Bell, A. (Eds.). Homosexuality: An Annotated
Bibliography. New York: Harper & Row, 1972.
Weinberg, M. S., and Williams, C. J. Male Homosexuals. New York:
Oxford University Press, 1974.
Welch, P. Homosexuality in America: The “gay” world takes to the
city streets. Life 56:68-74, June 26, 1964.
Weltge, R. W. (Ed.). The Same Sex: An Appraisal of Homosexuality.
West, D. J. Parental figures in the genesis of male homosexuality. Int.
J. Soc. Psychiatry 5:58—97, 1959.
West, D. J. Homosexuality. Chicago: Aldine, 1968.
West, L. J., and Glass, A. J. Sexual Behavior and the Military Law. In
Sexual Behavior and the Law (R. Slovenko, Ed.). Springfield, Ill.:
Thomas, 1965.
Westermarck, E. The Origin and Development of the Moral Ideas.
London: Macmillan, 1908.
Westermarck, E. The History of Human Marriage. New York: Aller
ton, 1922. Vols. 1-3.
Westwood, G. Society and the Homosexual. New York: Dutton, 1953.
Westwood, G. A Minority: A Report on the Life of the Male Homo
sexual in Great Britain. London: Longmans, Green, i960.
Whitam, F. L. Childhood indicators of male homosexuality. Arch.
Sex. Behav. 6:89-96, 1977.
Whitam, F. L. The homosexual role: A reconsideration. J. Sex Res.
13:1-11, 1977.
White, J. Those others: A report on homosexuality. Washington Post
Jan. 31-Feb. 4, 1965.
Wildeblood, P. Against the Law. London: Weidenfeld & Nicolson,
1955-
Wille, L. Chicago’s twilight world—the homosexuals. Chicago Daily
News June 20-23, *966-
Williams, C. J., and Weinberg, M. S. Homosexuals and the Military.
New York: Harper & Row, 1971.
Willis, S. E., II. Understanding and Counseling the Male Homo
sexual. Boston: Little, Brown, 1967.
Woetzel, R. K. Do our homosexuality laws make sense? Saturday
Rev. 48:23-25, Oct. g, 1965.
BIBLIOGRAPHY
436
Wolfenden, J. Report of the Committee on Homosexual Offenses and

Prostitution. New York: Stein & Day, 1963.
Wolpe, J. Psychotherapy by Reciprocal Inhibition. Stanford, Calif.:
Stanford University Press, 1972.
Wolpe, J., and Lazarus, A. Behavior Therapy Techniques. New York:
Pergamon, 1966.
Wood, R. W. Christ and the Homosexual. New York: Vantage, i960.
Wysor, B. The Lesbian Myth. New York: Random House, 1974.
Yale Cross-Cultural Index. New Haven, Conn.: Yale University Library.
Yalom, I. D., et al. Prenatal exposure to female hormones. Arch. Gen.
Psychiatry 28:554-561, 1973.
Young, W. C. (Ed.). Sex and Internal Secretions. Baltimore: Wil
liams & Wilkins, 1961.
INDEX
Abortions in homosexual phase, 154-155, 166

in ambisexual females, 148 number of subjects in, 48
in homosexual females, 40 physiologic responses in, 170-171
Acclimation to laboratory, 52-54, 224 project design for, 153-154
by ambisexuals, 54, 151-153, 226 psychosexual response patterns in,
by assigned subjects, 54 165-169, 185, 221-223
by committed couples, 54 in females, 168-169
by heterosexuals, 54, 190, 224 in males, 166-168
by homosexuals, 54, 190, 224 recruitment of, 147-150
Aching requirement for new partners, 222
pelvic, in female homosexuals, 137, responses to coition, 162-163,
138 165, 169-170, 203
testicular, from sexual excitation, 142 female, 169
Age of study subjects, 194-196 male, 167, 169-170
in ambisexuals, 147 scheduling for, 151
in heterosexual group A, 19-20, 195 sexual functional efficiency of, 154-
females, 35-36 165, 202-203, 209-210
males, 33 social isolation of, 172, 223
in heterosexual group B, 22-24, 195 verbalization during sexual activity,
in homosexuals, 17-18, 195 170
female, 17-18, 30 Anal intercourse. See Rectal intercourse
male, 17, 29 Anorgasmia in female homosexuals, 237,
and marital history of females, 40 310-332
and refractory period in males, 127, definition of, 312
128 incidence of, 311
Ambisexual study group, 12, 144-173, number of women treated, 310
x93> 4°5 primary, 237, 238, 312
acclimation to laboratory, 54, 151- case report of, 316-321
153, 226 failures in therapy, 384-385, 389,
advantages of, 221-222 390
assigned partners for, 150 requests for treatment, 242, 243
criteria for selection of, 146 treatment of, 316-323
disadvantages of, 223 random, 237, 238, 312
fantasy patterns in failures in therapy, 385, 389, 390
female, 177, 185 requests for treatment, 242, 243
male, 177, 184-185 and sexual aversion, 386
females in, 147-149, 156-158 and sexual fakery, 265-266
in heterosexual phase, 157-158, 169 and sexual preference reversal, 370-
in homosexual phase, 156-157, 372
168-169 situational, 237, 238, 312
goal attainment in, 166, 167, 223 case report of, 324-329
lack of sexual prejudice in, 222 failures in therapy, 385, 389, 390
lifestyle of, 172 requests for treatment, 242, 243
males in, 147-149, 154-156 treatment of, 324-331
dominance in coition, 167, 169- Anxiety, and ejaculatory incompetence,
170 118. See also Fears
in heterosexual phase, 155-156, Assigned partners, 11, 22
166-167 acclimation to laboratory, 54
437
INDEX
43«
Assigned partners—Continued in male homosexual couples, 71

for ambisexual subjects, 150 in married couples, 66
female heterosexuals, 155-156 Body imagery fantasy, in homosexual
female homosexuals, 156-157 males, 178
male heterosexuals, 157-158 Breast stimulation
male homosexuals, 154-155 female
concerns for physical attractiveness, 43, in homosexual couples, 66
in married couples, 67, 68
L 47’ ,
heterosexual couples, 33, 221 male
age of subjects, 195 in homosexual couples, 71
coition activity, 81-82 in married couples, 71
educational levels, 197 sensitivity to, in homosexuals and
fellatio techniques, 75 heterosexuals, 67
in group A, failure incidence in, 99, Breastfeeding, by homosexual females,
101, 107, 108, 120 4l
in group B, failure incidence in,
103, 104, 112, 114, 120
lack of communication in, 221 Case reports
marital histories of, 43 anorgasmia in female homosexuals
requirement for new partners, 221 primary, 316-321
homosexual couples, 16, 216-217 situational, 324-329
age of subjects, 195 homosexual dissatisfaction
educational levels, 197 female, 367-369, 372-375
female, 31 male, 343-346, 347-349, 350-352,
male, 28 353-355
requirement for new partners, 216- impotence in homosexual males
217 primary, 278-283, 288-291, 294-
masturbational activity of, and requests 295
for privacy, 56 secondary, 298-299, 300-302
number of subjects, 48 situational, 304-307
sexual functional efficiency of, 209 Clitoral stimulation
compared to committed couples, and duplication of masturbational pat
119-122 terns, 70
sexual interactions compared to com by female homosexuals, 69
mitted couples, 210 by male heterosexuals, 70
Attractiveness and responses in homosexuals, 134-
concerns for, in assigned subjects, 43, „ . . B5
47> 5° Coition activity
loss of, and reactions in homosexuals, in assigned couples, 81-82
216, 264 distractions in, 79, 111
Aversion, sexual, 242 failure rates in, 200-202
failures in therapy, 386, 395 in ambisexuals, 203
in female homosexuals, 243, 245, 362, in females
370 in committed vs. assigned couples,
and homosexual dissatisfaction, 395 121
and homosexual dysfunction, 386 in group A, 107
in male homosexuals, 242, 245, 274, in group B, 112-113
355 in males
in committed vs. assigned couples,
121
Behavior patterns. See Comparative pat in group A, 108
terns in sexual behavior in group B, 114
Bisexuality. See Ambisexual study group male dominance in, 220, 227
Black study subjects, 22, 37 in ambisexuals, 167, 169—170
Body contact control of coital position, 81
in female homosexual couples, 66 control of thrusting pattern, 80, 81
INDEX
439
initiation of mounting process, 79- Contraception
80 in ambisexual subjects, 140
in married couples, 79-81 intravaginal agents in, evaluation of,
as mutual experience, 214-21; 47
rectal. See Rectal intercourse Conversion clients, 240, 333
and responses of ambisexuals, 162- failures in therapy
163, 164, 165, 169-170, 203 in females, 394, 399, 400
female, 169 in males, 393, 399, 400
male, 167 sexual aversion in, 39;
risk of failure in, 122, 208, 209 Cross-preference encounters, as fantasy
and sexual functional efficiency, 200, material, 178, 186-188
201, 207-209 in females
Coloration heterosexual, 184
labial, in homosexuals, 136 homosexual, 180
penile, in homosexuals, 139 in males
Committed couples heterosexual, 182
acclimation to laboratory, 54 homosexual, 179
heterosexual, 10, 211, 217-221. See Cultural concepts
also Married couples and attitudes of health-care profes
homosexual, 10, 13-16, 211, 212-216. sionals, 247-230, 231, 272,
See also Homosexual study 276- 34 ’ 334> 342> 366> 391
*
group and fears of performance, 267, 314
and sexual functional efficiency, 209 and female view of fellatio, 76-77
sexual interactions compared to as and male dominance in coition, 170
signed couples, 210 and male view of cunnilingus, 76, 77
Communication and men as sex experts, 122, 219-220,
in homosexual committed couples, 73, 227
213, 215, 230 and performance pressures, 260-271
lack of, in heterosexual couples, 79 and physical aspects of sexual prefer
in assigned couples, 221 ence, 403-40;
in married couples, 68, 69, 74 and public opprobrium of homosex
need for, in heterosexual couples, 218- uals, 227, 228-230, 272, 403
219, 220-221, 350 Cunnilingus, 6
Comparative patterns in sexual behavior, failure incidence in, 199
61-91, 212-226 in ambisexuals, 203
in ambisexuals, 165-169 in female homosexuals, 94, 97
in coition in committed vs. assigned couples,
in assigned couples, 81-82 120
in married couples, 79-81 in group A females, 99, 101
in committed couples, 64-65 in homosexual couples, 73-76
in cunnilingus, 75-77 in married couples, 76-77
in dildo usage, 86-89 and responses of ambisexuals, 137,
and fantasy patterns, 177-18; 1 ;8, 160, 161, 162, 164, 165,
in fellatio, 7; 203
and functional efficiency, 92-123, 198- and sexual functional efficiency, 199,
204. See also Functional effi 203-208
ciency of study subjects
in masturbation, 62-64 Desensitization procedures, in male
in partner stimulation, 66-74 homosexual dysfunction, 307
and postorgasmic behavior, 82-83 Dildo usage, 12, 86-89
in rectal intercourse, 83-86 by female homosexuals, 87-88
in vocalization of sexual tensions, 89- by married couple, 88-89
9° in masturbation, 88
Concerns of study subjects, 45-46- See number of subjects studied, 48
also Fears Dissatisfied homosexuals, 240, 243-246.
and security measures, 6, 4;, 48-49 See also Sex-preference reversal
INDEX
440
Dissatisfied homosexuals—Continued Ejaculatory incompetence

conversion therapy in. See Conversion in homosexuals, 239-240
clients failures in therapy, 383-384
criteria for acceptance into therapy, transitory, 96, 104, 116-119
252-253 Electrocardiogram, sexual excitation af
failures in therapy, 391-402, 407-408 fecting, 128-129
female, 361-378 Elimination of subjects from study
male, 333-360 h eterosexuals, 18-2 o
marital status of, 244-245 homosexuals, 17-18
and partners in therapy, 246 Empathy, intragender, in homosexual
prior treatment history of couples, 213
in females, 249, 366 female, 67, 76
in males, 248, 342 male, 72, 308
reversion therapy in. See Reversion Endocrines, and homosexuality, 409-411
clients Erections
therapy format for, 255-256, 257 in cunnilingal activity, 76
Dissimulation techniques. See Fakery, and expansion of penile diameter,
sexual 139-140
Distractions during sexual activity, 79, waxing and waning of, in nipple stim
111 ulation, 71
and erective failure, 108 Exhibitionism, concerns for, 51
and vaginal lubrication, 133
Dysfunctional homosexuals, 240-243
criteria for acceptance into therapy, Failure episodes in sexual function. See
252 also Functional efficiency of
failures in therapy, 382-391, 402 study subjects
compared to failures with hetero reactions to, 50, 95, 100, 109, 118,
sexuals, 406-407 158, 228
in females. See Anorgasmia in female risk of, 122, 208, 209
homosexuals Failures in therapy of homosexuals, 382-
in males. See Ejaculation, premature, 402
in homosexuals; Ejaculatory in in anorgasmia, 384-385, 389, 390
competence; Impotence in male compared to failures with hetero
homosexuals sexuals, 406-407, 408
prior history treatment of in conversion clients
in females, 249 female, 394, 399, 400
in males, 248 male, 393, 399, 400
and sexual fakery, 262-265 in dissatisfaction, 391-402, 407—408
therapy format for, 255, 256 female, 394-395
follow-up studies, 397-398, 400-
Educational levels of study subjects, 11, 402
196-197 maJe, 353-356, 393-394
ambisexual subjects, 147 summation statistics of, 396-400
heterosexual group A total cases treated, 396, 402
females, 36 in dysfunction, 382-391, 402
males, 34 compared to failures with hetero
heterosexual group B sexuals, 406-407
females, 25 female, 384-385
males, 24 follow-up studies, 389-391
homosexual male, 293, 303, 382-384
females, 32 summation statistics of, 386-389
males, 29 total cases treated, 387, 402
Ejaculation, premature, in homosexuals, in ejaculatory incompetence, 383-384
£ 2.38-;2?9 in impotence, 382-383, 388-389, 390
failures in therapy, 384 in premature ejaculation, 384
squeeze technique in, 239 in reversion clients
INDEX
441
female, 394, 399, 400 in homosexual couples, 75
male, 395-394, 399, 400 failure incidence in, 95, 97, 199
in sexual aversion, 386, 395 in committed vs. assigned couples,
Fakery, sexual, 260-266, 277 120
in heterosexuals and treatment of dysfunction, 287,
female, 260-261 307
male, 261-262 and responses of ambisexuals, 155,
in homosexuals 156, 160, 161, 162, 164, 165
female, 265-266, 369 and sexual functional efficiency, 199,
male, 262-265, 29*> 293 205-208
therapeutic approach to, 266 and swallowing of ejaculate, 75
Fantasy patterns, 5-6, 146, 174-192 Female ambisexuals, 147-149, 156-158.
in ambisexuals See also Ambisexual study
female, 177, 185 group
male, 177, 184-185 Female heterosexuals
comparative incidence of, 177-185 adjustment problems for, 227-228
cross-preference, 186-188 as assigned partners for male ambi
forced sex, 188-190 sexuals, 150. See also Assigned
free-floating, 176-177 partners
in heterosexuals in committed couples. See Married
female, 177, 178, 183-184 couples
male, 177, 178, 181-183 group A, 35-37. See also Croup A
in homosexuals heterosexuals
female, 177, 178, 180-181 group B. See Group B heterosexuals
male, 177, 178-180 masturbation in, 63-64
methods of research in, 175-176 postorgasmic behavior patterns of, 82-
replacement of established partners in, 83
188 and responses of ambisexual male
short-term or “old friend,” 176-177 partners, 155-156
Fears sexual fakery in, 260-261
of identification, 19-20, 48-49 sexual response cycle in, 126-127
in homosexuals, 18, 229, 397-398 Female homosexuals, 30-33
of performance, 49-50, 225 abortions of, 40
and concerns for performance of age range of, 17-18, 30, 195
partner, 225 anorgasmia in, 237. See also Anor-
in female homosexuals, 314, 329 gasmia in female homosexuals
in male homosexuals, 266-270, as assigned partners, 31
296-297, 339 for female ambisexuals, 150
and dissatisfaction, 346, 352 patterns of sexual interaction in, 55,
treatment of, 291-294 77. 78,
reduction of, in homosexual couples, and sexual functional efficiency, 95,
213 120
therapeutic approach to, 267-268 breastfeeding by, 41
of reaction of spouses, 250 committed couples, 30
of rejection by health-care profes patterns of sexual interaction, 55,
sionals, 247-250, 276, 314, 64-65
342, 366 compared to married couples,
of social exposure, 250, 277, 314 210
of treatment failure, 250, 276-277, cunnilingus in, 75-76
3*4 dildo usage by, 87-88
Fees for professional services, 254-255 dissatisfaction in, 361-378
Fellatio, 6 educational levels of, 197
in heterosexual couples, 75 fears of performance in, 314, 329
failure incidence in, 100, 101, 199 masturbation in, 63-64
in committed vs. assigned couples, partner stimulation by, 66-70
120 pelvic pathology in, 32-33
INDEX
44«
Female homosexuals—Continued with coition, 200, 201, 207-209

physiologic responses in, 131-138 in committed relationships, 209
breast reaction, 131-132 vs. assigned couples, 119-122
clitoral responses, 134-135 comparative studies of, 198-204
labial coloration, 136 and dissatisfied homosexuals, 240,
orgasmic platform, 135-136 243-246
ovaries, 137, 138 and dysfunctional homosexuals, 240-
pelvic congestion, 137, 138 243
reproductive organs, 131-138 and ejaculatory incompetence, 116-
and responses in stimulators, 132, 119
*34 in heterosexuals
sex flush, 129 with coition, 107-116, 200-202
total-body response, 128-131 group A, 98-102, 199, 205-208
uterus, 136, 138 in assigned couples, 99, 101, 107,
vaginal lubrication, 133-134 108, 120
vasocongestion, 132-133 in coital function, 107-109
postorgasmic behavior patterns in, 82- comparison by gender, 100-102,
83 109
pregnancy histories of, 38, 40-41 females, 98-100, 107, 201
and responses of ambisexual female males, 100, 108-109, 200
partners, 156-157 in married couples, 99, 101, 107,
sexual aversion in, 243 108, 120
sexual fakeiy in, 265-266 statistics combined with group B,
sexual functional efficiency of, 93-95, 105-106
120, 199, 205-208 group B, 102-105, J99> 205-208
in assigned couples, 95, 120 in assigned couples, 103, 104,
in committed couples, 94-95, 120 112, 114, 120
compared to males, 96-98 in coital function, 109-116
sexual response cycle in, 126-127 comparison by gender, 104—105,
stimulator role in, 57-58 116
Fertility, of male homosexuals, 41-42 females, 102-103, 201
Financial aspects of therapy, 254-255 males, 103-104, 200
Follow-up studies in married couples, 103, 104, 112,
of dissatisfied homosexuals, 397-398, 114, 120
400-402 statistics combined with group A,
of dysfunctional homosexuals, 389- 105-106
391 with manipulative stimulation, 199,
Forced sexual encounters, as fantasy 202
material, 178, 188-190 in homosexuals, 5, 93-98, 199, 205-
in heterosexuals 208
female, 183 in committed vs. assigned couples,
male, 181 119-122
in homosexuals comparison by gender, 96-98
female, 180 comparison with heterosexuals, 198-
male, 179 200
Frustration, sexual females, 93-95, 120
in females, 126, 369, 374 males, 95-96, 120
in impotent males, 295 with manipulative stimulation, 199,
Functional efficiency of study subjects, 205-208
7-8, 92-123 and response to failure episodes, 50,
in ambisexuals, 154-165, 202-203, 95, 100, 109, 118, 158, 228
209-210 and risk of failure in coital activity,
female, 156-158 122, 208, 209
male, 154-156
in assigned relationships, 209 Genital play
vs. committed couples, 119-122 female
INDEX
443
in homosexual couples, 68-70 masturbational activity in, and requests
in married couples, 69-70 for privacy, 56
male sexual functional efficiency of, 102-
in homosexual couples, 72 105, 199, 205-208. See also
in married couples, 72 Functional efficiency of study
teasing cycles in. See Teasing tech subjects
niques in genital play single men in, 22
Genitourinary pathology in males single women in, 21-22
heterosexual, 34—35 Group sex experiences, as fantasy mate
homosexual, 30 rial, 178
Goal-oriented sexual behavior in heterosexual males, 182
in ambisexuals, 166, 167, 223 in homosexual males, 180
in assigned couples
heterosexual, 78
homosexual, 78 Health-care professionals, attitudes to
in married couples, 65, 79 ward homosexuals, 247-250,
Goals of research program, 4-7 251, 272, 276, 314, 334, 342,
Gonorrhea. See Venereal disease 366, 391
Group A heterosexuals, 7, 33-37, 193 Heterosexual study group
acclimation to laboratory, 54 assigned couples in, 33, 221. See also
age range of, 19-20, 195 Assigned partners
female, 19-20, 35-36 committed couples in, 10, 211, 217-
male, 19, 33 221. See also Married couples
assigned couples in, 33 as covert homosexuals, 240, 250, 254
educational levels of, 197 fantasy patterns in
female, 36 female, 177, 178, 183-184
male, 34 male, 177, 178, 181-183
elimination of subjects in, 18-20 group A, 7, 33-37, 193. See also
female, 35-37 Group A heterosexuals
genitourinary pathology in males, 34- group B, 7, 20-25, 193- $ee a^°
35 Group B heterosexuals
Kinsey ratings for, 18-19 Kinsey preference ratings for, 8, 18-
female, 19 19, H5- 187
male, 34 original group, reduction of, 20-
male, 33-35 25, 194. See also Group B
marital histones in heterosexuals
female, 38, 43 recruitment of, guidelines for, 7
male, 39, 43 requests for masturbational privacy,
married couples in, 33 224
masturbational activity in, and requests requests for orientation to laboratory,
for privacy, 56 54- 224 , ,
number of subjects in, 48 sexual fakery in, 260-262
pelvic pathology in females, 36-37 Heterosexuality
presumed impregnation histories of therapeutic conversion to, 240, 333
males in, 39, 43 therapeutic reversion to, 240, 333
recruitment of, 18 History-taking, for homosexual subjects,
sexual functional efficiency of, 98-102, 16
199, 205-208. See also Func Homosexual content in fantasies. See
tional efficiency of study groups Cross-preference encounters
Group B heterosexuals, 7, 20-25, 193 Homosexual study group, 7, 27-33, 193
age range in, 22-24, 195 acclimation to laboratory, 54, 190, 224
educational levels of, 24-25, 197 adjustment problems for, 227, 272
explanation of data age range in, 17-18, 195
for females, 109-111 female, 17-18, 30
for males, 113 male, 17, 29
married couples in, 21 assigned subjects in, 11, 16, 216-217
INDEX
444
Homosexual study group, assigned sub recruitment of, 13-18

jects in—Continued guidelines for, 7
female, 31 screening of, 16-17
male, 28 sexual aversion in, 242, 243, 245
committed couples in, 10, 13-16, 211, sexual fakery in, 262-266, 277
212-216 sexual functional efficiency of, 5, 93-
advantages of, 213 98, 199, 205-208
age of subjects in, 195 in committed vs. assigned couples,
communication in, 73, 213, 215, 230 119-122
disadvantages of, 214 comparison by gender, 96-98
educational levels of, 197 comparison with heterosexuals, 198-
female, 30 200
intragender empathy in, 213. See in females, 93-95, 120
also Empathy, intragender, in in males, 95-96, 120
homosexual couples uncommitted subjects
male, 27 female, 30
"my tum-your turn” interaction in, male, 27
132, 213-215 verbalization during sexual activity,
psychosexual aspects of, 212-217 170
sexual interaction in, 54-55, 64-65 Hormones, and homosexuality, 409-411
compared to married couples, 210 Hysterectomies
covert, 240, 250, 254 in heterosexual group A subjects, 37
dissatisfied, 240, 243-246 in homosexual subjects, 32-33
female, 361-378
male, 333-360 Idealized sexual encounters, as fantasy
dysfunctional, 240-243 material, 178
female, 237, 310-332 in heterosexual females, 183-184
male, 237, 238-240, 274-309 in homosexuals
educational levels of, 197 female, 180
female, 32 male, 179
male, 29 Impotence in male homosexuals, 237,
elimination of subjects from study, 274-309
17-18 and fears of performance, 267-268,
exemptions from full cooperation, 57- 296-297
• r 59 number of men treated, 275
in females, 57-58 primary, 237
in males, 59 case reports of, 278-283, 288-291,
fantasy patterns in 294-295
female, 177, 178, 180-181 failures in therapy, 582-383, 388,
male, 177, 178-180 39°
female, 30-33. See also Female homo and fears of performance, 291-294
sexuals and lack of sexual orientation, 284-
hormone studies in, 409-411 285
Kinsey ratings for, 8, 14-15, ^7 requests for treatment, 241
female, 31 sensate-focus therapy in, 285-286
male, 29 and sexual fakery, 264, 291, 293
male, 27-30. See also Male homo treatment of, 278-295
sexuals prior avoidance of treatment, 276-
marital histories of J 277
female, 38, 40—41 secondary, 237, 238
male, 39, 41 case reports of, 298-299, 300-302
masturbational activity of, and requests failure in therapy, 583, 388, 590
for privacy, 56, 224 requests for treatment, 241
overt, 240 and sexual fakery, 265
physiologic responses in, 124-143 treatment of, 295-303
public opprobrium of, 227, 228-230, and sexual aversion, 386
272, 403 and sexual fakery, 262-265
INDEX
445
situational, 237, 238 dominance in coition, 167, 169-170

case report of, 304-307 Male heterosexuals
failures in therapy, 383, 388, 390 adjustment problems for, 227
requests for treatment, 241 as assigned partners for female ambi
and sexual fakery, 265 sexuals, 150, 157-158. See also
treatment of, 304-308 Assigned partners
and spectator role, 271, 297, 299 in committed relationships. See Mar
Impregnations, presumed ried couples
by heterosexual males in group A, 39, cultural influence on sexual function,
43 J . 77 . ••
by homosexual males, 39, 41 dominance in coition, 220, 227
Intercourse. See Coition activity control of coital position, 81
control of thrusting pattern, 80, 81
Kinsey sexual preference ratings, 8-9 initiation of mounting process, 79-
of ambisexuals, 146, 147, 171 80
of heterosexuals, 8, 18-19, M5» *87 group A, 33-35. See also Group A
of homosexuals, 8, 14-15, 144, 187 heterosexuals
and conversion to heterosexuality, group B. See Group B heterosexuals
r 24°> 333’ 341 masturbation in, 62—63
female, 31 postorgasmic behavior patterns of, 82-
male, 29
8?
and reversion to heterosexuality, refractory period in, 127
24°. 333’ 341 sexual fakery in, 261-262
and sexual dysfunction, 240 sexual functional efficiency of, 199,
and marital histories of homosexuals 205-208
female, 40 sexual response cycle in, 126
male, 41 Male homosexuals, 27-30
Labial coloration, in female homosexuals, age range of, 17, 29, 195
as assigned partners, 28
136
Laboratory for research, 32 for male ambisexuals, 150, 154-155
and acclimation process, 52-54, 224. and patterns of sexual interaction,
See also Acclimation to labora 55> 77-78
tory physiologic responses in, 139, 140
comfort factor in, 224-226 sexual functional efficiency of, 96,
and exceptions to full participation, 120
56-59 in committed couples, 27
and instructions tor procedures, 54- and patterns of sexual interaction,
56 54-55. 64-65
lighting in, 52 compared to married couples, 210
music in, 52 dissatisfaction in, 333-360
and privilege of privacy, 56, 224-225 dysfunction in, 237, 274-309
recording equipment in, 52 educational levels of, 29, 197
temperature in, 52 ejaculatory incompetence in, 239-240
Lesbian couples. See Female homosexuals fears of performance in, 267-268,
Lubrication, vaginal 290-297, 299, 339. See also
from breast stimulation Fears, of performance
in heterosexuals, 67 fellatio techniques in, 75
in homosexuals, 66, 68 fertility of, 41-42
in cunnilingal activity, 76 genitourinary pathology in, 30
distractions affecting, 133 impotency in, 237, 274—309. See also
in homosexuals, 133-134 Impotence in male homosexuals
Luteinizing hormone levels, in homo masturbation in, 62-63
sexuals, 410-411 partner stimulation by, 71-73
physiologic responses in, 139-142
Male ambisexuals, 147-149, 154-156. in assigned couples, 139, 140
See also Ambisexual study penile color change, 139
group penile engorgement, 139-141
INDEX
446
Male homosexuals, physiologic responses control of thrusting pattern, 80, 81

in—Continued initiation of mounting process, 79-
reproductive organs, 139-142 80
responses in stimulators, 141, 142 need for communication, 218-219,
sex flush, 129 220-221, 350
testicular aching, 142 partner stimulation in
testicular engorgement, 141-142 by females, 71, 73-74
total-body response, 128-131 by males, 66-70
vasocongestion, 139 reversion therapy for, 337-338
postorgasmic behavior patterns in, 82- and role of male as sex expert, 219—
83 220, 227
premature ejaculation in, 238-239 sexual fakery in, 260-262
presumed impregnation histories of, sexual functional efficiency of, 200,
î9» 4* , 201
refractory period in, 127 compared to assigned couples, 119-
sexual aversion in, 242, 245 122
sexual fakery in, 262-265, 277 sexual interactions in, 65
sexual functional efficiency of, 95-96, compared to homosexual couples,
120, 199, 205-208 210
in assigned couples, 96, 120 Masturbation
in committed couples, 96, 120 by ambisexuals, 153, 162
compared to assigned couples, 120 failure rate in, 203
compared to females, 96-98 female, 164, 165
sexual response cycle in, 126 male, 163, 164, 165
stimulatee role in, 59 and acclimation to laboratory, 54
stimulator role in, 59 comparative patterns in, 62-64
Manipulative stimulation, and sexual and dildo usage, 88
functional efficiency, 199, 205- and fantasy patterns, 177, 181, 183
208. See also Partner manipu by female heterosexuals, 63-64
lation failure rate in, 199
Marital history in group A subjects, 99,101
of ambisexual subjects, 148 in group B subjects, 102, 105
of assigned heterosexual subjects, 43 in members of committed vs. as
of heterosexuals in group A signed couples, 120
female, 38, 43 by female homosexuals, 63-64
male, 39, 43 failure incidence in, 94, 97, 199
of homosexual subjects in members of committed vs. as
and dissatisfaction, 244-246, 362 signed couples, 120
female, 38, 40-41 by male heterosexuals, 62-63
male, 39, 41 failure rate in, 199
Married couples, 10, 211, 217-221 in group A subjects, 100, 101
advantages of, 217-218 in group B subjects, 103, 105
age range of, 195 by male homosexuals, 62-63
coition activity in, 79-81 failure rate in, 95, 97, 199
cunnilingus in, 76-77 in members of committed vs. as
dildo usage by, 88-89 signed couples, 120
disadvantages of, 218 patterns affecting approach to clitoral
educational levels of, 197 stimulation, 70
fellatio techniques in, 75 and privilege of privacy, 56, 224-225
in group A, 33 refusal of, 57
failure incidence in, 99, 101, 107, and sexual functional efficiency, 199,
108, 120 205-208
in group B, failure incidence in, 103, Medical histories of study subjects
104, 112, 114, 120 and elimination from study
lack of communication in, 68, 69, 74 of heterosexual group A subjects,
male dominance in coition, 220, 227 19, 20
control of coital position, 81 of homosexuals, 18
INDEX
447
and genitourinary pathology and postorgasmic behavior, 82-83
in heterosexual males, 34-35 Orgasmic platform, in female homo
in homosexual males, 30 sexuals, 135-136
and pelvic pathology Orientation procedures. See Acclimation
in heterosexual females, 36-37 to laboratory
in homosexual females, 32-33 Ovaries, response to sexual stimuli in
and venereal disease homosexuals, 137, 138
in heterosexual males, 35
in homosexuals Partner manipulation
female, 33 in ambisexuals, failure rate in, 203
male, 30 in assigned couples
Minority groups, represented in study, failure incidence compared to com
22, 37 mitted couples, 120
Multiorgasmic episodes in females, 55, heterosexual, 78
83, 97, 126, 127, 207, 227 homosexual, 77, 78
in ambisexuals, 153 evaluation of techniques in, 6
and responses of ambisexual males, by female homosexuals, 66-70
167 in assigned couples, 77, 78
Muscle tone, sexual excitation affecting, and failure incidence, 94, 97, 199
129 in committed vs. assigned couples,
"My tum-your turn” interaction 120
in ambisexuals in heterosexual couples
female, 168 assigned, 78
male, 166 failure incidence in, 199
in homosexuals, 132, 213-215 in females of group A, 99, 101
Myotonia, in sexual response cycle, 129 in females of group B, 102, 105
in males of group A, 100, 101
New partners as sexual stimulation in males of group B, 103, 105
in ambisexuals, 222 by male homosexuals, 71-73
in assigned couples in assigned couples, 77-78
heterosexual, 221 and failure incidence, 95, 97, 199
homosexual, 216-217 in married couples
in male homosexuals, 300 by females, 71, 73-74
Nipple stimulation by males, 66-70
female and responses of ambisexuals
in homosexual couples, 66, 68 female, 157 158, 160, 161, 162,
in married couples, 68 164, 165
male male, 155, 156, 159, 161, 162, 163,
in homosexual couples, 71-72 164, 165
in married couples, 71-72 and sexual functional efficiency, 199,
205-208
Observation of sexual activity, as fan in committed vs. assigned couples,
tasy material, 178, 190 120
in female heterosexuals, 183 Partner replacement, as fantasy material,
in male heterosexuals, 182 178, 181, 183, 188. See also
Orgasm New partners as sexual stimula
from breast stimulation, in female tion
homosexuals, 66 Partners in therapy
and functional efficiency of study in homosexual dissatisfaction
groups. See Functional effi female, 370, 375
ciency of study subjects male, 358, 359-360
and multiorgasmic episodes in fe in homosexual dysfunction
males, 55, 83, 97, 126, 127, female, 322, 330
207, 227 male, 286, 292, 297, 299, 307
in ambisexuals, 153 Pelvic congestion, from sexual stimuli in
and responses of ambisexual males, female homosexuals, 137, 138
167 Pelvic pathology
INDEX
448
Pelvic pathology—Continued Rape

in female heterosexuals, 36-37 and case history of female homo
in female homosexuals, 32-33 sexual, 57-58
Penis as fantasy material, 178. See also
color change in homosexuals, 139 Forced sexual encounters, as
engorgement in homosexuals, 139-141 fantasy material
terminal glans expansion, preejacula- Recall of past sexual experience
tory, 140-141 in ambisexuals
Performance-oriented behavior. See Goal- female, 185
oriented sexual behavior male, 184-185
Performance pressures, 49-50, 260-271. in homosexual females, 178, 181
See also Fears, of performance Records, security measures for, 49
and sexual fakery syndrome, 260-266 Recruitment of study-subjects, 13-26,
spectator role in, 270-271 193-194
Physical aspects of sexual preference, ambisexuals, 147-150
cultural concepts of, 403-405 assigned partners
Physiologic responses to sexual activity for ambisexual subjects, 150
in ambisexuals, 170-171 heterosexual, 18
in heterosexuals, 125-128 homosexual, 16
female, 126-127 guidelines for, 7-12
male, 126 heterosexuals in group A, 18-20
in homosexuals, 4-5, 124-143 homosexuals, 13-18
female, 131-138 Rectal intercourse, 12, 83-86
male, 139-142 number of subjects studied, 48
Population for research studies. See physiologic responses in, 84-86
Study-subject groups Rectal sphincter, contractions of, 85, 86,
Pregnancy histories 129
of ambisexual subjects, 148-149 Replacement of established partner, as
of heterosexual subjects, 38, 43 fantasy material, 178, 188
of homosexual subjects, 38, 40-41 in heterosexual females, 183
Prejudice, sexual, lack in ambisexuals, in heterosexual males, 181
222 Reproductive organs in homosexuals,
Privacy for masturbation, requests for, sexual stimulation affecting,
56, 224-225 . , 131-142
Professionals, health-care, attitudes to in females, 131-138
ward homosexuals, 247-250, in males, 139—142
251, 272, 276, 314, 334, 342, Research subjects. See Study-subject
366, 391 groups
Psychosexual aspects of sexual behavior, Research team
210-226 concerns of, 45-46, 51
in ambisexuals, 165-169, 185, 221- dual-sex approach of, 51, 256, 378
223 alterations in, 259
female, 168-169 interference with sex partners, 111
male, 166-168 Restricted sexual interaction, in homo
and comfort factor in laboratory, 224- sexual subjects, 57-59
226 Reversion clients, 240, 333
comparative studies of. See Compara failures in therapy
tive patterns in sexual be female, 394, 399, 400
havior male, 393-394, 399, 400
in heterosexuals, 217-221 sexual aversion in, 395
assigned couples, 221
committed couples, 217—221
insecurity in, 190 Sadistic content of fantasies, in homo
in homosexuals, 212-217 sexual females, 178, 181. See
assigned couples, 216-217 also Forced sexual encounters,
committed couples, 212-216 as fantasy material
INDEX
449
Scheduling of study subjects, 46 female, 126-127
for ambisexual study, 151 male, 126
Screening procedures, for homosexual in homosexuals, 4-5, 124-143
subjects, 16-17 female, 131-138
Security measures, for study subjects, 6, male, 139-142
45, 48-49 Social instability
Sensate-focus therapy in heterosexual males, 19
in homosexual dissatisfaction in homosexual males, 17
female, 370 Spanish-American couples, 22, 37
male, 352 Spectator role in sexual activity, 270-
in homosexual dysfunction 27b 297
female, 322 in female homosexuals, 329
male, 285-286 therapeutic approach to, 271, 299
Sex flush, in homosexuals, 129 Squeeze technique, for premature ejacula
Sex-preference reversal. See also Conver tion, 239
sion clients; Reversion clients Statistical results
female, 361-378 for comparative studies. See Compara
case reports of, 367-369, 372-375 tive patterns in sexual behavior
number of women treated, 361 in evaluation of treatment programs,
and refused applications for therapy, 379-402
365-366 failure rate in, 382-402. See also
treatment program, 367-376 Failures in therapy of homo
male, 333-360 sexuals
case reports of, 343-346, 347—349, factors in analysis of, 379-382
£ 350-352, 353-355 in functional efficiency studies. See
tai lure m therapy or, 553-356 Functional efficiency of study
motivating factors in, 335-341 subjects
number of men treated, 333 precautions in interpretation of, 61,
and partners in therapy, 358, 359— 206
360 Stimulatee role
and principles of therapy, 357-359 in female homosexuals, 55, 66, 68
and refused applications for therapy, in male homosexuals, 59
342-343 Stimulation of partners. See Partner
treatment program, 343-356 manipulation
motivating factors in, 335-340, 357, Stimulator role
364, 392 in female homosexuals, 57-58
in homosexuals committed to hetero in male homosexuals, 59
sexual partners, 336-337, 339— Study-subject groups, 7-12
34°, 363 age range in, 194-196
in married applicants, 337-338, 362, for clinical research in homosexual
364 inadequacy, 240-246
in uncommitted homosexual males, educational levels of, 11, 196-197
33S-339 fears of. See Fears
Sex-tension increment, three sources of, functional efficiency in, 7-8, 92-123
214-215 in homosexual dissatisfaction
Sexual aversion, 242. See also Aversion, female, 366
sexual male, 341
Sexual fakery syndrome, 260-266, 277. in homosexual dysfunction
See also Fakery, sexual female, 313
Sexual interactions. See Comparative male, 275
patterns in sexual behavior; Kinsey ratings for. See Kinsey sexual
Psychosexual aspects of sexual preference ratings
behavior medical histories of, 18, 19, 20
Sexual response cycle, 125-128 minority groups in, 22, 37
in ambisexuals, 170-171 number of subjects in, 47, 48
in heterosexuals, 125-128 original heterosexual group, reduced to
INDEX
450
Study-subject groups—Continued financial aspects of, 254-255

Group B, 7, 20-25, 194 in first day of therapy, 256-257
reaction to failure episodes, 50, 95, and follow-up methods, 259-260
100, 109, 118, 158, 228 format for therapy, 255-259
recruitment of, 13-26 history-taking in, 256-257
guidelines for, 7-12, 194 in male dysfunction
scheduling of, 46, 151 failures in, 293, 303
Subjective involvement in sexual activity and partner cooperation, 286, 292,
in assigned couples, 82 297, 299, 307
in committed homosexual couples, 213 primary, 278-295
by female homosexuals, 76 secondary, 295-303
with breast stimulation, 132 situational, 304-308
in married couples, 79 physical examination and laboratory
studies in, 257
Teasing techniques in genital play and prior rejection by health-care pro
by ambisexual women in homosexual fessionals, 247-250, 251, 272,
phase, 168 276, 342
by female homosexuals, 68-69 program concepts in, 271-273
in assigned couples, 78 rapid-treatment techniques in, 256
by heterosexual couples, 73-74 and refusal of treatment, 253-254
and coital activity, 80-81 in second day of therapy, 257-258
by male homosexuals, 72 and selection of clients, 251-254
in assigned couples, 78 in sex-preference reversals
and physiologic response female, 361—378
in females, 127 male, 333-360
in males, 139-140 in sexual fakery, 266
Testes, engorgement in homosexuals, in spectator role, 271, 299
141-142 statistical evaluation of, 379-402
Testosterone levels, in homosexuals, 410 factors in analysis of, 379-382
Time factor in sexual interactions and support of partners, 256
in assigned homosexuals, 77-78 and termination of therapy, 254
in heterosexual couples, 66
in homosexual couples, 64-65, 68-69, Uncircumcised males
heterosexual, 35
J 72' 74 homosexual, 30
and responses in homosexual males,
139-140 Uncommitted study subjects. See As
and teasing techniques. See Teasing signed partners
techniques in genital play Uterus, response to sexual stimuli, in
and vasocongestion of target organs, homosexuals, 136, 138
Vagina, artificial, 21, 47
Treatment procedures for homosexuals Vaginal lubrication. See Lubrication,
in anorgasmia in females vaginal
primary, 316-323 Vaginismus, 385, 394-395
situational, 324-331 treatment of, 370 1
and client cooperation, 246-251 Vasocongestion in homosexuals, 129-
and clinical research populations, 240- *3»
246 female, 132-133
dissatisfied homosexuals, 243-246 male, 139-142
dysfunctional homosexuals, 240- Venereal disease
243 in heterosexual males, 35
crises in, 258 in homosexuals
dual-sex team approach in, 256 female, 33
alterations in, 259 male, 30
failure rate in. See Failures in therapy Vocalization of sexual tension, 89-90
of homosexuals in ambisexuals, 170
in fears of performance, 267-268 in homosexuals, 170

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Homosexuality

THE MASTERS & JOHNSON INSTITUTE

LITTLE, BROWN AND COMPANY

ALL RIGHTS RESERVED. NO PART OF THIS BOOK MAY BE REPRO­

LIBRARY OF CONGRESS CATALOG CARD NO. 79-84197

PRINTED IN THE UNITED STATES OF AMERICA

cultural impediments to doing such research have been immense

In Homosexuality in Perspective Masters and Johnson have

also find critical reflections on human attention and sloth in the

H. Tristram Engelhardt, Jr., Ph.D., M.D.

A^íillions of men and women have interacted sexually with same-

There were many contributions from the hundreds of study sub­

foreword by H. Tristram Engelhardt, Jr. v

PRECLINICAL STUDY, 1957-1970

2. Selection Process for Study Populations 13

3. Selected Study Groups 27

4. Study Subjects in the Laboratory 45

5. Comparative Sexual Behavior Patterns 61

6. Comparative Functional Efficiency 92

7. Homosexual Physiology 124

8. Ambisexual Study Group 144

9. Incidence and Comparison of Fantasy Patterns 174

10. Preclinical Statistics 193

11. Preclinical Discussion 205

CLINICAL STUDY, 1968-1977

12. Clinical Investigation 235

13. Male Homosexual Dysfunction 274

14. Female Homosexual Dysfunction 310

15. Male Homosexual Dissatisfaction 333

16. Female Homosexual Dissatisfaction 361

17. Clinical Statistics 379

18. Clinical Discussion 403

IVluch has been written, discussed, declaimed, or just whispered

unbiased perspective of homosexuality from continued basic science

PRECLINICAL STUDY GOALS

From the onset, it was clear that a multidimensional investiga­

between these alternative forms of sexual expression might have

the research team and secure in the research environment, willing

tion of homosexual function was conducted at a much slower pace

THE STUDY-SUBJECT GROUPS

It was decided that two new study-subject groups would be re­

reasons. First, protection of the welfare of study subjects had

her history and whose heterosexual activity is minimal. Finally, a

assembling a heterosexual study group that included individuals

relationships were recruited to represent “uncommitted” men and

process, and data relating to general attitudes and fears or prefer­

1 here were numerous problems associated with recruitment and

Committed Study Subjects. The homosexual study group was

surfaced in a public declaration of sexual preference or even circu­

grade of sexual preference, men and women with 2, 3, and 4 grades

Once potential study subjects were identified, screening steps fol­

to participate in the research program. All potential subjects were

Evidence of social stability was a key factor in study-subject

was investigative interest in an opportunity to evaluate young women

Heterosexual study group A was recruited during the final two

Since no study subjects were included in heterosexual study

As described in Chapter 1, study group B was comprised of

obviously could not be considered in comparison with the other

RESULTS OF THE REDUCTION PROCESS

ALL RIGHTS RESERVED. NO PART OF THIS BOOK MAY BE REPRO

There were many contributions from the hundreds of study sub

From the onset, it was clear that a multidimensional investiga

It was decided that two new study-subject groups would be re

process, and data relating to general attitudes and fears or prefer

surfaced in a public declaration of sexual preference or even circu

Once potential study subjects were identified, screening steps fol

tory of only one episode of heterosexual interaction for 1 study sub

an increased concentration of women in their twenties when com

volved with such matters, marriage and reproduction were impor

The 57 heterosexual women reported 66 marriages and 81 con

The compositions of the homosexual study group and hetero

lhere are many technical problems involved in conducting a re

partially neutralized by the act of communicating them to the re