The Technology of Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction (22 page)

Both Strasser and the author she quotes seem unaware that the “respectable” housewares industry has been involved in the production and sale of vibrators for nearly a century, and they fail to note that women have traditionally lacked the methods of “releasing the tensions of day-to-day living” available to men.

But a persistent theme in the background of these concerns about the vibrator is the classic male fear of sexual inadequacy, to which the new technology adds a threat once associated only with industrial artisans: technological obsolescence.

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REVISING THE ANDROCENTRIC MODEL

ORGASMIC TREATMENT
IN THE PRACTICE OF WESTERN MEDICINE

The history of physical therapies for hysteroneurasthenic disorders as I have discussed it here tells us several things about Western physicians. Some we already knew. For example, that normal conditions can be medicalized, especially in women, has been widely observed concerning masturbation, pregnancy, and menstruation. That doctors both create and become invested in dominant social and medical paradigms is also well known; Haller, Foucault, and Gay have all directed our attention to physicians’ roles as arbiters and recorders of sexual behavior. That disease paradigms go in and out of fashion has been widely noted, by Brumberg, Shorter, Figlio, Hudson, and many others. I have already mentioned some of the feminist sources on hysteria, which highlight its character as a feminine pathology even in men.

Mirko Grmek and others have pointed out that history’s physicians have had to deal with a bewildering universe. They have been frustrated by the organic complexity of the living body and its opacity to scientific
observation, hampered by inadequate instrumentation and testing techniques. Added to the awe-inspiring biochemical and physiological mysteries of the human organism have been mental processes and behaviors, which often defy efforts to arrange them neatly within the framework of scientific theory. We should hardly be surprised that sexuality, existing at the intersection of the mind and the body and bearing heavy, sometimes impenetrable overlays of social construction, should have been subject to successive waves of medical interpretation.

What is impressive, however, is that the androcentric paradigm of sexuality—that sex consists of penetration (usually of the vagina) to male orgasm—is a fixed point in the otherwise shifting sands of Western medical opinion. By 1930 Freud’s notion that women had two types of orgasms, clitoral and vaginal, of which only the latter was mature and healthy, had become the dominant paradigm of normative female sexuality. It was to persist well into the 1970s. Galenism and Freudianism had few points of agreement, but they concurred that orgasm for both parties during heterosexual coitus was the healthiest form of sexual expression. Clearly the cultural emphasis on intercourse is so deeply entrenched that physicians simply do not perceive it in themselves and their patients. And what they do not notice, they cannot question. Certainly there is an understandably pro-natal bias in Western medical practice, beginning with Hippocrates, but there is more to it than that. There is a systematic effort to subsume the knowledge that the clitoris, not the vagina, is the seat of greatest sexual feeling in most women into the androcentric model and to avoid one-to-one heterosexual confrontation over orgasmic mutuality by shifting the dispute onto medical ground.

When physicians from John Pechey to David Reuben have instructed men to stimulate the clitoris, this advice has been given mainly in the context of a prelude or adjunct to coitus. There typically is great concern that the male partner not be significantly inconvenienced. To take a modern example, Alexander Lowen, writing of his medical experiences with female sexuality in 1965, did not like to recommend clitoral stimulation to his patients because “most men … feel that the need to bring a woman to climax through clitoral stimulation is a burden.” If coitus is delayed while the man brings the woman to orgasm in this way, “it imposes a restraint upon his natural desire for closeness and intimacy,” possibly resulting in a loss of his erection, and “the subsequent act
of coitus is deprived of its mutual quality.” During coitus, he may employ clitoral stimulation to “help the woman to reach a climax, but it distracts the man from the perception of his genital sensations and greatly interferes with the pelvic movements upon which his own feeling of satisfaction depends.” Bringing his partner to orgasm after his own climax will not do either, “since it prevents him from enjoying the relaxation and peace that are the rewards of sexuality. Most men to whom I have spoken who engaged in this practice resented it.”
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Lowen shows here what Sophie Lazarsfeld calls “the cloven hoof of the true masculine view.”
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In this text it is quite clear that women who need clitoral stimulation to reach orgasm are thought to be making unfair and unreasonable demands on their male partners, and that life would be simpler for all concerned if they would simply adjust to the androcentric model and have their orgasms vaginally. Lowen wrote at a time when it was no longer possible to simply hand off the job of producing orgasm to a physician or midwife. When the one-to-one confrontation cannot be avoided, Lowen expects the woman to yield.

This raises another question about orgasmic treatment as a medical procedure: its parallels with prostitution. There have been many arguments, historical and modern, regarding whether it should be legal for women and men to sell the service of producing orgasm. Some feminists in this and previous centuries have argued that there cannot be prostitution without systematic degradation of its practitioners.
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In the case of Western physicians, the legal question apparently never arose, although, as we have seen, there was some controversy within the profession as to the propriety of vulvular massage. Physicians, unlike prostitutes, did not lose status by providing sexual services, in part because the character of these services was camouflaged both by the disease paradigms constructed around female sexuality and by the comforting belief that only penetration was sexually stimulating to women. Thus the speculum and the tampon were originally more controversial in medical circles than was the vibrator. The aura of respectability that physicians cast over their provision of sexual services suggests that the task of producing orgasm is not in itself demeaning; performing it did not cause loss of caste for its elite practitioners, who were capable of disguising its earthy character.

As I observed earlier, there is no evidence that physicians as a class enjoyed performing these services for their patients, apart from the not
unrelated satisfactions of providing needed therapy and collecting their fees. Some, perhaps, may have taken more intimate liberties, but we have no evidence that such behaviors were widespread. On the contrary, when technology or midwife assistants could get the job done, doctors seem to have been more than willing to lighten the burden of massage therapies. Physicians seem to have been no more eager to take on the task of producing orgasm in women than were the sexual partners who sent them for therapy, but the doctors were paid for their services. Moreover, since physicians for the most part seem to have regarded these therapies simply as routine clinical tasks, the necessity for such stimulation did not interfere with their own sexual enjoyment, as it reportedly did with male sexual partners.

Doctors who employed physical therapies for hysteria and related female disorders wanted the means of providing them to be routine, convenient, and affordable. Since physicians at all times and places have had to acquire a large number of very diverse skills, any area of practice that could be partially deskilled by instruments represented an advance in efficiency not only of practice but also of education. As Nathaniel Highmore tells us, vulvular massage was difficult to learn, an obstacle removed by the invention of the vibrator in the nineteenth century. Hysterical patients must have been a good source of cash flow, since they were in no mortal danger from their illness and required regular treatment.

Finally, it must be conceded that the therapy is by no means inappropriate to many of the manifestations of what was known until 1952 as a disease: orgasm usually does relieve such symptoms as pelvic hyperemia, sleeplessness, anxiety, headaches, and nervousness. At the very worst, the physicians in question have been true to the Hippocratic injunction to do no harm.

THE ANDROCENTRIC MODEL
IN HETEROSEXUAL RELATIONSHIPS

We have seen that the hysteroneurasthenic disorders have been the focus of an elaborate network of controversies over the past two and a half millennia. Since 1952 their definition has been so substantially
altered as to rule out many of the clinical descriptions of history. This, of course, is not unusual in medicine: physicians no longer diagnose their patients as plethoric or choleric, and “died of a fever” would be considered unacceptably imprecise on a modern death certificate. Historically, there has been controversy over whether hysteria was necessarily a female disease, but it was clear when Charles Mills wrote of it in 1886 that only a minority of physicians believed men could have the disorder and that even they were convinced that only a very few hysterics were male.
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Most of the debates among clinicians have been over proper methods of treatment, including the production of orgasm. If marriage and intercourse failed to cure hysterical women, some doctors, at least, were convinced that responsibility for producing the necessary therapeutic effect rested with them. It is interesting that though marriage and intercourse were sometimes recommended for hysterical males, I have found no accounts of therapeutic massage of the male genitalia by physicians.

Many questions can and should be raised about the persistence of Western belief that women ought to reach orgasm during heterosexual coitus. Certainly, its importance to impregnation must have contributed to our doggedly maintaining it in the face of abundant individual and societal evidence that penetration unaccompanied by direct stimulation of the clitoris is an inefficient and, more often than not, ineffective way to produce orgasm in women.
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It is hardly worth belaboring the point that most men enjoy coitus and that men have been the dominant sex through most of Western history. Yet the fact remains of our normative preference for coitus, in which the constant from Hippocrates to Freud—despite breathtaking changes in nearly every other area of medical thought—is that women who do not reach orgasm by means of penetration alone are sick or defective. The penetration myth is not a conspiracy perpetuated by men; women too want to believe in the ideal of universal orgasmic mutuality in coitus. Even the sexual radical Wilhelm Reich could not see beyond this time-honored norm.
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The feminist questioning of androcentric sexuality over the past three decades is recent and, one might say, long overdue.
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Carole Vance, reporting on a 1977 “Program on Human Sexuality” conducted by the Center for Sex Research and funded by the National Institute of Mental Health, noted that in presentations at the program it was assumed that “all heterosexual contact culminated in vaginal penetration, indicating a progression
through hierarchies of sexual activity, from the now acceptable normal ‘foreplay’ to ‘real sex.’ Heterosexual sex, then, requires genital contact, male erection, and penetration.”

Vance goes on to describe one of the presentations, in which a psychiatrist recounted work with couples who reported “the female’s inability to experience orgasm during vaginal penetration, although many of these women were orgasmic during masturbation or other forms of clitoral stimulation.” When asked whether this state of affairs should, in fact, be considered a dysfunction requiring treatment, the psychiatrist replied that it should, whereas the opposite condition, ability to reach orgasm through penetration but not through masturbation, did not require therapeutic intervention.
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The personal and social cost to individual men and women of defying or questioning the androcentric model remains high enough to deter rebellion. Even historians, who are notoriously gimlet-eyed about cultural myths, have been reluctant to challenge the hypothesis that penetration of the vagina to male orgasm is the only kind of sex that matters and the only kind that can and should result in sexual bliss for women. Seymour Fisher observed in 1973 that “it is particularly remarkable how widespread has been the acceptance of assumptions about the ‘more mature’ nature of vaginal arousal in the absence of any empirical evidence to support them” and went on to say that 64 percent of his sample of women respondents preferred clitoral to vaginal stimulation.
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The lack of correspondence between the observed data and the androcentric model, and the reasons the model persisted even among professionals, was analyzed by Jeanne Warner in 1984, in a discussion about the advantages of “emotional,” rather than physical, orgasm for women. She argues for “a male bias for phallic stimulation” even though “the literature conveys a strong impression that the penis is not the most effective means of producing a maximal level of arousal and response for a woman.” Arguments that “emotional orgasm” is superior to the physical kind “seem to suggest that whatever provides the greatest satisfaction for the male should also provide the greatest pleasure for the female.”
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What is surprising about the androcentric hypothesis is not that it exists, which, as we have seen, is readily explained, but that we have been willing to sacrifice so much to it. Female orgasm is not necessary to conception, so it can take place (or not) outside the context of intercourse
without interfering either with male enjoyment of sex or with conception. The central position in history occupied by these two concerns to a large extent explains the omissions, silences, and learned misunderstandings about female sexuality. As long as female orgasm could be medicalized, it did not have to be discussed, which would have called uncomfortable attention to its apparent conflict with the norm of coitus. Cultures such as existed in some parts of Asia, in which female orgasm was more smoothly integrated with patriarchy, at least encouraged married couples to explore methods and positions conducive to women’s pleasure.