Teaching Orgasm For Females With Chronic Anorgasmia Using The Betty Dodson Method
Teaching Orgasm For Females With Chronic Anorgasmia Using The Betty Dodson Method
Teaching Orgasm For Females With Chronic Anorgasmia Using The Betty Dodson Method
The objective of this study was to test the Betty Dodson method of breaking the female
orgasm barrier in chronic anorgasmic women. The aim was sexual and existential
healing (salutogenesis) through direct confrontation and integration of both the
repressed shame, guilt, and other negative feelings associated with body, genitals, and
sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective
analysis of clinic data from holistic sexological manual therapeutic intervention, an
intensive subtype of clinical holistic medicine (CHM). The patients received 3 5 h of
group therapy, integrating short-term psychodynamic psychotherapy (STPP) and
complementary medicine (CAM bodywork, manual sexology similar to the sexological
examination). The therapy used the advanced tools of reparenting, genital acceptance,
acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was
used. Participants were 500 female patients between 18 and 88 years of age (mean of 35
years) with chronic anorgasmia (for 12 years on average) who were participating in the
orgasm course for anorgasmic women; 25% of the patients had never experienced an
orgasm. Our results show that 465 patients (93%) had an orgasm during therapy,
witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were
as able to achieve orgasm as fertile women, as were women who never had an orgasm.
No patients had detectable negative side effects or adverse effects. NNT: 1.04 < NNT <
1.12, NNH > 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that
holistic sexological manual therapy may be rational, safe, ethical, and efficient.
KEYWORDS: Betty Dodson, orgasm, anorgasmia, desire, clinical holistic medicine, holistic
manual sexology, sexological examination, adverse effects, side effects, masturbation, direct
sexual stimulation, sexual and existential healing, therapeutic touch, clitoral vibrator,
transference, ethics
*Corresponding author.
2008 with author.
Published by TheScientificWorld; www.thescientificworld.com
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INTRODUCTION
The female orgasm is a variable, transient peak sensation of intense pleasure, creating an altered state of
consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic
striated circumvaginal musculature, often with concomitant uterine and anal contractions, that resolves
the sexually induced vasocongestion and myotonia, generally with an induction of well-being and
contentment[1]. Findings from surveys and clinical reports suggest that orgasm problems are the first or
second most frequently reported sexual problems in women[1,2,3,4]. Between 11 and 60% of adult
women suffer from lack of orgasm[2,3,4], depending on factors such as culture and religion. On an
individual level, self-insight and a positive attitude towards ones own genitals and sexuality are
important.
Female anorgasmia is a significant sexual problem. The woman who lacks orgasm often also lacks
desire and joy of sexuality, has low self-esteem, often feels like a sexual failure, and feels sexually wrong
and ashamed of herself for not being the woman she was meant to be. Perceptions of not being fully
able to satisfy her partner sexually are normal and quality of life is often low[3]. The problem of female
anorgasmia, from a psychodynamic perspective, often goes back to the parental lack of acceptance of the
patients genitals, body, and sexuality, often leading to intense feelings of shame and guilt, which seem to
be repressed by a denial of physical and sexual needs, and accumulate in the pelvic and genital area[5,6].
Sexual abuse and sexual traumas from rape and incest often cause lack of orgasm[7,8,9,10]. If self-esteem
is low, it is our clinical observation that there can be lack of orgasm from the simple psychological reason
that the patient feels she does not deserve such pleasure, or does not know how to get it. It is very likely
that anorgasmia is a socially inherited sexual dysfunction, but this has never been investigated
scientifically. It is generally believed that anorgasmia, as most other sexual dysfunctions, is caused by a
disturbed psychosexual development.
Holistic medicine has cared about female sexual problems from its very beginning[12], using, among
other methods, the famous method of Hippocratic pelvic massage, often called vaginal acupressure or
vaginal massage in the Nordic countries[13,14].
Holistic sexological manual therapy is a new and developing field, integrating efficient methods from
standard medical sexology, Hippocratic medicine, and CAM (complementary and alternative medicine).
There are many ways to work manually with female sexual dysfunctions in the sexological clinic; from
simple therapeutic touch and acceptance through touch[6,15], to vaginal acupressure[12,13,14], and
manipulation and stretching the pelvic muscles through the vagina. Direct sexual stimulation in the
holistic medical clinic, i.e., with a clitoral vibrator, is a new, radical, and efficient approach, where the
barrier created by accumulated and repressed shame, guilt, and lack of acceptance is taken down by direct
and confrontational sexological work, taking the woman all the way to orgasm in the clinical setting[16].
Whenever there is a physical contact with the female genitals, there is a possibility for decharging
emotions repressed to the tissues that can be used therapeutically[17].
The method can also be used for treatment of genital and pelvic pain[6,18,19,20], but we have not
collected the data to document this in the present study. We believe the method used in this study helped
the patients to heal not only sexually, but also existentially[21]. The group setting and the therapists
unusual willingness to use herself and her own sexuality as a tool in the therapy seemingly accelerated the
process of healing[22] and caused no adverse effects. The many qualitative interviews with the patients
indicated that the intervention also often alleviated mental, social, existential, and other
problems[23,24,25,26,27], but this has not been quantitatively documented in this study.
METHODS
The clinical holistic therapy used short-term psychodynamic psychotherapy (STPP) in combination with
the advanced holistic tools of reparenting, genital acceptance, acceptance through touch, and direct sexual
clitoral stimulation. The aim was sexual and existential healing (salutogenesis) through direct
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confrontation and integration of both the repressed shame, guilt, and other negative feelings associated
with body, genitals, and sexuality, and the repressed sexual pleasure and desire. The CAM bodywork
included the use of a clitoral vibrator.
When discussing the CAM bodywork use of clitoral vibrators, it must be presented in a manner that
communicates the scientific nature of the process. In the U.S., the use of vibrators in funded research
might be considered to be unethical or even illegal in some states. We understand that it might be difficult
to get this presented research accepted in these states, however, Betty Dodson, Ph.D. did this work from
1973 to 1995 in New York City, and her method is now being used and further developed by many
complementary therapists in the U.S. and Europe. We therefore find that it is time to address this kind of
work scientifically, and we hope that we will be able to present it carefully so that this quite radical work
in holistic sexology can be understood and appreciated.
The clitoral vibrator chosen for the treatment was a Hitachi Magic Wand, which has a very large head
designed for efficient transference of vibrations to the vulva and clitoral region without causing soreness
or irritation of the tissue. It can be used for an extended length of time compared to other vibrators, which
is important when treating anorgasmic women with delayed orgasmic response. From a psychodynamic
perspective, we find it interesting to note that bodily pleasure seems to be even more strongly repressed
than emotional pain, and many layers of shame and unpleasant feelings must often be confronted before
the female patient reaches the plateau of orgasm. This process needs prolonged sexual stimulation
combined with therapeutic processing of emerging negative feelings and emotions, which is made
possible by the specific design of this vibrator. Of course, this could also be done manually (compare the
historical discussion below).
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in the room to induce orgasm. In this phase, the patient learns to engage her whole body in sexuality, and
lets it free (freeing the Freudian Id, or animal aspect of the human being).
Before the intervention (3 5 h of group therapy), written information on the intervention was given
and before giving consent to the actual therapeutic procedure, a video introduction was given to the
patients, demonstrating the procedures. After the course, the patients were instructed to masturbate
according to a schedule for further improvement.
The patients were not told that they were participating in a study, as the project was planned to take
place in two phases: a test phase not planned for publication, in which only the patients age, number of
recent anorgasmic years, actual presence or lack of patients ability to achieve orgasm on the course, and
adverse effects, were registered, and a second phase now being planned, collecting much more detailed
information. Because we have found the data already collected of significant scientific value, we have
included them in our database for quality of life research and present them in the present paper. The
protocol making the use of the data possible was approved by the local Scientific Ethical Committee of
Copenhagen (see Acknowledgment). The combination of STPP and CAM led to holistic sexological
manual therapy. The method used in this study is a highly confrontational style of CHM, where the
therapy jumps right to the rehabilitation of genital sexuality; it is known from other similar studies that
this kind of therapy is efficient in curing sexual and other health problems[28,29,30,31,32,33].
The Therapist
The therapist, Pia Struck, is cochairman of the Danish Association for Sexology. Struck was trained in
psychodynamic psychotherapy (19881991) and at the beginning of the study, she had 10 years of
professional experience with the treatment of sexual dysfunctions, supplemented in 2001 with personal
sexological training by Betty Dodson.
Participants
Five hundred chronically anorgasmic female patients between 18 and 88 years of age (35 years on
average) participated in the orgasm course for anorgasmic women. On average, the patients had not had
an orgasm for 12 years and one in four had never experienced an orgasm. Of these patients, 50 were
treated individually (one-on-one) because they felt uncomfortable participating in the group.
The visitation procedure ensures that the therapist knows when participants have histories of
childhood sexual abuse and ensures that they actually engage in a search for healing, not in an activity
that allows them to recreate their past histories of abuse. Of the participants, 17% claimed that they had
been sexually abused in childhood; eight patients reported that they had been diagnosed as being mentally
ill, six with major depression, and these six patients all reported a significant improvement following
therapy. Three patients dropped out during treatment. The patients that dropped out had no adverse effects
from the therapy, such as reactive psychosis or retraumatization, and no serious events, such as mental
hospitalization or suicide attempts. The patients were interviewed for about 1 h after the therapy, to
ensure that the patients showed no signs of psychosis and no significant side effects from the course at
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this time. No patients reported side effects or experiences likely to be caused by retraumatization. There
were no follow-up procedures, but everyone was encouraged to return for a free session if they had
problems from the therapy later. No patients used this offer.
RESULTS
In over 112 courses held during 20012007 in Copenhagen and Aarhus, with three to six participants in
each period and 500 patients in total, only one course in three had a patient that did not achieve an orgasm
(a total of 35 patients, or 7%). Of the patients, 93% had an orgasm during the course that was witnessed
by the therapist. Fifty patients needed individual therapy instead of group therapy. This was done
successfully and there were no problems with transference and countertransference even though the
female therapist and the patient were alone in the session. Problems arising from sexual transference and
countertransference[34,35,36,37] can be hard to identify as such by the therapist, but are normally quite
obvious for a supervisor[38]. The therapist was under supervision during the whole period of treatment,
but the supervisor did not at any time notice any problems related to sexual transference or
countertransference in the therapy.
Some of the 35 patients that did not obtain orgasm reported that they had an orgasm after the course,
but this was not systematically registered because of limited resources for research and no follow-up
procedure in this study. Many positive effects of therapy were reported, such as marked increase in selfesteem and quality of life, but these effects were not systematically investigated.
Postmenopausal women were as able to achieve an orgasm as fertile women, as were woman who
never had an orgasm, but they became sore more often from using a vibrator. The results indicate that the
etiology of orgasmic dysfunction is a disturbance of the female psychosexual development.
NNT (number needed to treat): As 93% of 500 patients (95% CI: 8996%) were cured from
anorgasmia, then NNT (number needed to treat to benefit) is calculated to be 1.04 < NNT < 1.12.
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objective evaluation of the side effects; the only adverse effect we found was soreness from the physical
stimulation of the vulva, which was always temporary.
Patients who were severely sexually traumatized earlier in life often had some emotional difficulties,
while their old wounds healed in the weeks after the therapy. Patients who were mentally ill (with
diagnosed borderline conditions or major depression, sometimes on antidepressants) were included in the
study and all reported feeling mentally better after the intervention. No patients had severe developmental
crises or developed psychiatric disturbances, such as depression or psychosis.
Many patients reported positive additional benefits, such as increased desire and quality of life, higher
self-esteem, better relationship with partner, etc. (see case reports at www.orgasmacademy.eu). The
method of direct sexual stimulation in manual sexological therapy has no significant negative side effects
or adverse effects.
NNH (number needed to treat to harm): As none of the 500 patients reported significant side effects,
in spite of extremely confrontational sexological therapy, it is safe to conclude that even the most
intensive and provocative tools of the advanced toolbox of CHM (STPP combined with CAM bodywork)
are safe for the patients, if used correctly. NNH > 500. If we include the 500 patients treated in other
studies with CHM, we find that NNH > 1,000[28,29,30,31,32].
Calculation of therapeutic value TV = NNH/NNT: Using the largest value of NNT, we find TV =
NNH/NNT > 500/1.12 = 446.
ETHICAL ASPECTS
The most important ethical safeguards that are in place to protect the participants and therapist are the
following:
1. Full and complete information, including video demonstration of the content of the therapy.
2. Time to reflect about participation from video demonstration and the practical work.
3. Everything is done under supervision; the participants supervise every process in the group, and
the supervisor carefully supervises the therapist. Supervision is done especially carefully when it
comes to one-on-one therapy, and the therapist is not naked in these sessions. One-on-one therapy
is only done because the patients do not want to be treated with other people in the room, as
described above.
4. The therapy follows the ethical guidelines of the International Society for Holistic Health (ISHH)
for holistic practitioners.
5. Careful follow-up, with interviews about adverse effects and therapeutic outcome (qualitative
assessment) and evaluation of the therapy, is conducted.
6. The research team evaluates the process that is in place in the treatment organization to ensure
that the treatment was done according the described methods and ISHH ethical standards.
Manual sexological therapy with direct sexual stimulation must be performed according to the highest
ethical standards. The holistic sexological procedures are derived from holistic existential therapy, which
involves reparenting, massage and bodywork, conversational therapy, philosophical training, healing of
existence during spontaneous regression to painful life events (gestalts), and close intimacy without any
sexual involvement[13,14]. In psychology, psychiatry, and existential psychotherapy, touch is often
allowed, but a sufficient distance must always be kept between the therapist and client, all clothes kept on,
and it is even recommended that the first name is not used in order to keep the relationship as formal and
correct as possible. The reason for this distance is to create a safety zone that removes the danger of
psychotherapy leading to sexual involvement.
The female patients in holistic existential therapy and holistic sexology with life-long anorgasmia
often find their situation pretty hopeless; many of them have been dysfunctional and incurable for many
years or they suffer from conditions for which there has been no efficient biomedical or
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psychotherapeutical cure. They suffer from a condition that is a serious burden to their marital life, if they
have a husband; often the problem makes them unable to find or keep a partner. Often the problem of
anorgasmia is caused by traumas from earlier sexual abuse, which needs more effective and direct tools
for the induction of healing (salutogenesis).
The primary purpose of holistic existential therapy is to improve quality of life, secondarily to
improve health and ability. The severe conditions of the patients and the chronicity are what ethically
justify the much more direct, intimate, and intense method of holistic manual sexological therapy, which
integrates many different therapeutic elements and works on many levels of the patients body, mind,
existence, and personality at the same time. Holistic sexology is holistic existential therapy taken into the
domain of sexology. The general ethical rule is that everything that does not harm and in the end will help
the patient is allowed (first, do no harm), but we understand that this procedure is not accepted in many
other countries due to sexual taboos and legal regulations.
It is interesting though that this, or similar techniques, has been used for centuries by many
physicians[13,14] and, in particular, alternative therapists outside the medical profession[13,14]. An
important aspect of the therapy is that the physician must be creative and in practice invent a new
treatment for every patient. To use a sexological technique involving direct sexual clitoral stimulation, the
holistic sexologist must be able to control his/her behavior and must strictly avoid the danger of the
therapeutic session turning into mutual sexual activity. The necessary level of mastery of this art can only
be obtained through training, supervision, and preferably a third person present, which is one good reason
for doing this in a group setting. Sometimes the patients are too shy to have more than the therapist
present in the room; in this case the therapy can only be done one-on-one and this has not caused
problems. The role of the sexologist is parentally accepting, generous and supporting, loving and
therapeutic.
The treatment included patient masturbation under supervision and instruction. The client uses, under
the therapists instruction, the clitoral vibrator after initial digital stimulation.
In this study, 500 female patients with often lifelong anorgasmia received direct sexual stimulation of
the clitoris during the therapy and 93% of the patients experienced that the procedure solved their
problem. The success of this study gives us one more very important tool for holistic medicine. Together
with the other tools of holistic manual therapy, such as acceptance through touch and acupressure through
the vagina, we now have tools for solving problems related to female sexual dysfunction. We therefore
conclude that direct sexual stimulation can be a safe and efficient procedure, and an important new tool in
the holistic medical toolbox.
DISCUSSION
The History of Direct Sexual Stimulation as Sexological Therapy
Direct sexual stimulation of women has a long history in medicine. Before use in the sexological
examination (see below), it was used in holistic medicine for millennia. In the Corpus Hippocratic,
hysteria is described as a disease caused by the energies related to the womb, treatable with exercise
and pelvic massage[12,39]. In the first century AD, Celcus and Soranus recommended genital massage
for hysteria[40,41]. Aretaeus Cappadox recommended the same in the third century AD based on
Hippocrates[42]. Galen (ca. AD 129200) also understood hysteria to be caused by lack of
psychosexual development[43]. He carefully describes, obviously based on Hippocrates, the procedure of
genital massage therapy, resulting in the contractions and the release of fluid from the vagina, after which
the patient was relieved of her symptoms. (The great respect for Hippocrates and Galen made the
procedure of genital massage a standard procedure until the end of the 19th century[44].) In
Tetrabiblion, etius of Amida (502575) described a uterine contraction, muscle spasm of the entire
body, and discharge of fluid from the vagina[45]. Muschions Gynaecia describes the procedure a little
differently as manual therapy of the vulva[46]. Rhazes, an Arab physician, described a similar procedure
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around 900 AD[44, p. 24]. It is not clear from most medieval sources whether the manipulation of the
female genitals needed to go all the way to orgasm to be therapeutic[43], but many sources write that it is
necessary to continue the massage treatment until the vagina discharges its fluid, indicating that the
physicians massage must be sexually stimulating for the therapy to work[43, p. 22ff], and the descriptions
of universal muscle contractions mentioned above leave little doubt that the treatment was taken all the
way to orgasm. It is clear that many different styles of genital massage have been used, some
concentrating on raising the energy of the uterus, such as Hippocrates, and others, such as Muschion and
Rhazes, focusing more on sexual stimulation of the vulva. The many historical sources leave little doubt
that physicians have successfully used this kind of massage therapy for millennia to heal the female
patient and free her from severe physical, mental, existential, and sexual problems. The rationale for such
a therapy that seems strange and quite mysterious for most modern physicians is that there is a close
statistical connection between sexual maturity and physical and mental health and general well-being, as
recent research has documented[47,48,49,50,51,52,53,54,55,56,57,58,59,60,61].
Acquainting the female with her own body to dispel some of the feeling that the genital area is a
special place forbidden for all but physicians to see.
Searching for areas where nerve endings come together in a systematic way, suggesting that this
may develop positive feelings.
Assisting women in determining areas of perception, feeling, and awareness in their vagina.
Pointing out areas in the vagina that tend to be more sensitive and responsive for many women
(i.e., 12, 4, and 8 o'clock positions).
Determining a woman's response and arousal patterns. Indicating to her whether or not she
lubricates well and vasocongests when she does.
Locating areas digitally that may be producing pain, discomfort, or problems with sexual arousal
or intercourse such as separation of muscle in the vaginal wall; long labia minora; scarring,
which may be tender or fibrous and to pinpoint the source of pain when present.
Determining whether or not clitoral adhesions are present is more important than the stimulation
of the clitoris in the female sexological examination. This is a condition where the prepuce is
stuck or adhered to the glans clitoris. For preorgasmic women, the inability of the clitoris to
withdraw as part of sexual arousal may prevent particular women from full response. Even
890
though some women are orgasmic with clitoral adhesions, freeing them usually results in easier,
quicker orgasms and less discomfort due to calcified, trapped smegma.
Identifying, where present, reasons for vaginismus, which are not only physiological, but
psychological.
The sexological examination was called an examination, not a treatment, presumably to make it more
acceptable to the public, but it has always been as much a treatment as an examination[62,63,64,65,
66,67,68,69]. When we consider this, we must conclude that the method of direct sexual stimulation in
itself is not remarkable or problematic; it is a traditional sexological tool for treating sexual dysfunction.
What is different with the Betty Dodson method is the obligatory step of supporting the patient in going
all the way to experiencing a full orgasm during the therapy.
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(which most often is caused by transferences, but still must be thoroughly investigated), and we found
none.
The correct indication for direct sexual stimulation needs some reflection. The Hippocratic physicians
used hysteria and poor psychosexual development as sufficient indication; in our study the indication was
anorgasmia. As it is well known from recent research[47,48,49,50,51,52,53,54,55,56,57,58,59,60,61],
psychosexual development and mental illness seem to be very closely related, as Hippocrates, Galen,
Freud, Jung, Reich, and many more physicians have realized.
Direct sexual stimulation can obviously be used to facilitate the sexual development of the
anorgasmic woman (often described as caught in infantile autoerotism). The next important research
question is if the much more subtle shift from immature clitoral sexuality, closely correlated to neurotism
and immature psychological defenses[47], to mature vaginal sexuality can also be facilitated by the tool
of direct sexual stimulation. Our own findings here and in other studies[13,14,28,28,30,31,32,33,37], and
the above-mentioned findings of Brody et al. of strong associations between genital maturity and a
number of aspects of health[47,48,49,50,51,52,53,54,55,56,57,58,59,60,61], justifies such a study. From a
theoretical perspective, it is highly likely that the resistance work done in this kind of therapy is quite
unique and therefore of great value when other methods fails.
It is not clear to us if there are ethical problems connected with using the diagnosis of immature
sexuality as an indication for treatment with direct sexual stimulation. Obviously, there have been no
ethical problems with this treatment or any such indication throughout the history of European physicians,
so it is hard to see why there should be ethical problems today, as long as the intent is to help the patient
and as long as the treatment is documented to give this help.
We must remember that every procedure that allows the therapist to take the patient into her
resistance will be therapeutic and helpful, so the wise answer might be to let the resistance of the patient
guide the choice of the proper therapeutic tools of the holistic sexological treatment as recommended by
Reich, the founder of sexology[62].
CONCLUSIONS
Lack of orgasm is a very serious sexual problem for countless millions of women in our time. As 1160%
of all women seems to suffer from lack of orgasm, without getting the help they need from their
physician, gynecologist, psychotherapist, or sexologist, they often live their whole lives with anorgasmia
and related problems. Most surprisingly, almost all women can learn to have an orgasm in holistic
therapy, with 93% of female patients experiencing orgasm after only 15 h of holistic sexological manual
therapy using the tool of direct sexual stimulation[16], in spite of the patient never having had an orgasm.
Postmenopausal woman are just as able to achieve orgasm as fertile women in the therapy.
The female orgasm barrier seems to be caused primarily by the parental lack of acceptance of the
girls genitals and sexuality, and other sexual traumas, leading to arrested psychosexual development.
This theory seems to be in accordance with the presented results: this can be healed simply by giving
acceptance to the body, sexuality, and genitals that the patients never received, and thereby rehabilitating
the lost self-acceptance. A combination of parental acceptance, acceptance through touch, and direct
sexual clitoral stimulation allowed the patients to confront and let go of the shame, guilt, and other
negative feelings that had been connected to their genitals and sexuality during their upbringing. Holistic
sexological manual therapy is extremely efficient, and sexologists who are trained in psychodynamic
psychotherapy and ethics of therapy can use the tools of direct sexual clitoral stimulation when
psychodynamic psychotherapy and less sexually confrontational bodywork cannot solve the female
patients problems related to orgasm and sexual desire.
Manual sexological examination and treatment has been a practical tool in sexology for at least 50
years, and before that it was a part of the holistic medical tradition. Holistic sexological manual therapy is
therefore likely also to be efficient with other sexual dysfunctions, such as lack of sexual desire, vaginism
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and genital pain/vulvodynia, low sexual self-esteem, and poor psychosexual development in general, but
this needs further scientific investigation.
To prevent the huge problem of female anorgasmia in future generations, we need to work on a
societal and cultural level to develop parental positive attitudes towards the childs sexuality, body, and
genitals. Of course, this will start with the parents learning to accept their own bodies and sexuality,
especially the mothers learning to have orgasms themselves, as it judged from the present findings that
anorgasmia most likely is a socially inherited sexual dysfunction.
ACKNOWLEDGMENTS
The research in quality of life and complementary medicine (CAM/CHM) was approved by the
Copenhagen Scientific Ethical Committee under the numbers (KF)V. 100.1762-90, (KF)V. 100.2123/91,
(KF)V. 01-502/93, (KF)V. 01-026/97, (KF)V. 01-162/97, and (KF)V. 01-198/97. The study was funded
by the IMK Almene Foundation. We declare no conflict of interest.
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