The Technology of Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction (12 page)

There are many historical examples of physicians’ imposing conceptual frameworks on their clinical evidence that are difficult for modern observers to understand. It is important to recognize that it is not necessary to argue for conspiracy or even misogyny among doctors over time: the evidence suggests that physicians called disease paradigms as they saw them. Conceptual frameworks, as we have learned from many other historical contexts, can determine what observers actually see, and therefore what they report in their accounts of the observation. Thomas Laqueur cites significant examples of this in the evolution of concepts of male and female anatomy.
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In an entirely different context, Mirko Grmek says that many ancient Greek physicians were simply defeated by the “two-sided causality … so complex that reason is no longer able to track down all the interconnections.” It was easier to simply rule part of reality out of bounds than to try to make all the data fit the system.
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Ancient physicians as a rule had little to say on the subject of female orgasm, except to debate whether it was necessary for conception. Writings attributed to Aristotle, though probably not written by him, noted that women often have difficulty reaching orgasm in coitus. Äetius thought that “a certain tremor” indicated conception; Soranus believed that desire, not orgasm, was the important factor in pregnancy.
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This
debate continued until the twentieth century: Franz Josef Gall mentions it in his
Anatomie
(1810–19), and even authors of modern medical texts feel the need to assert that there is no known correlation between either desire and fertility or orgasm and conception.
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Medieval writers such as Avicenna and Giles of Rome thought that women experienced pleasure by receiving male semen. Although Avicenna, apparently a realist about female sexuality, was careful to caution his readers that this pleasure would not be adequate to satisfy the female partner, Giles and other writers preferred to think that nothing was required beyond male ejaculation. Danielle Jacquart and Claude Thomasset remark that “without casting doubt on the intentions of Giles of Rome, one might suggest that he supplied arguments capable of clearing the male of all responsibility in the woman’s quest for pleasure.”
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Helen Lemay summarizes Avicenna’s account of a woman’s “three delights in intercourse: one from the motion of her own sperm, a second from the motion of the male sperm, and a third from the motion or rubbing that takes place in coitus.” The physician cautions men that to be sexually satisfied the woman should experience her own “movements of the matrix” before the man ejaculates.
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In Tudor and Stuart England, prevailing medical beliefs were that orgasm was necessary for conception, that lack of sexual satisfaction, following Galen’s teaching, caused unhealthful imbalances in the humors, and that orgasm provided an incentive for women to risk their lives in pregnancy.
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Many works of this era discussed the role of the clitoris as the principal locus of sexual pleasure. Ambroise Paré expressed the view in 1634 that women with strong sexual desires, languid lifestyles, and hearty appetites were less likely than other women to suffer disorders of the menses, since their humors flowed more freely:

There are some that are purged twice, and some thrice in a month, but it is altogether in those who have a great liver, large veines, and are filled and fed with many and greatly nourishing meats, which sit idely at home all day, which having slept all night doe notwithstanding lye in bed sleeping a great part of the day also, which live in a hot, moyst rainie and southerly ayre, which use warme bathes of sweet waters and gentle frictions, which use and are greatly delighted with carnall copulation: in these and such like women the courses flow more frequently and abundantly.
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Paré does not seem to entirely approve of these women, but their sexual enthusiasm forms part of his list of behaviors that promote a healthful flow of humors.

Women who wanted more sexual gratification than their partners were willing to provide, however, were serious threats to the androcentric and pro-natal model of sexuality: Abraham Zacuto wrote in 1637 that nymphomania “is a dreadful and odious ailment, for it interferes with intercourse and conception.”
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This concern persisted for centuries: Gall worried in 1825 about a patient of his, a prostitute who was not sexually satisfied by coitus, whom he diagnosed as an incurable nymphomaniac.
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Nathaniel Highmore, writing in 1660, discussed orgasm in considerable detail, placing it in the context of the theory of humors. Blood rushed to the sexual organs during arousal, and it was unhealthful for it to remain there. Orgasm caused contractions that returned the blood to the rest of the body. The action of the lungs—the heavy breathing—assisted the process.
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William Cullen, a century later, was sure that “the exercise of venery certainly proves a stimulus to the vessels of the uterus; and therefore may be useful, when, with propriety, it can be employed.” Like most of his contemporaries, he was concerned about the swollen condition of the female genitalia (it was not customary until the nineteenth century to distinguish the uterus from the vagina and external genitalia) and thought it must be pathological. He made analogies to the “distention of the vessels of the brain” in epilepsy and to the “turgescence of the blood in the vessels of the lung” in asthma, and he proposed that a similar “turgescence of blood in the uterus, or in other parts of the genital system, may occasion the spasmodic and convulsive motions which appear in hysteria.”
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Relief from unhealthful congestion was, as we have seen, a standard refrain in medical discussions of the importance of orgasm to both men and women. Renaissance and later physicians who recognized the role of the clitoris in producing orgasm may have had reservations about stirring up women’s passions by this means, but most of them agreed that unsatisfied sexual desire was unhealthful.

Views of female orgasm, although not of congestion, changed significantly between the mid-eighteenth century and the early nineteenth. In the nineteenth century the “orgasmic” (that is, turgescent or
congestive) condition in women was supposedly relieved by the soothing effect of semen released into the vagina, in the manner suggested centuries earlier by Giles of Rome and others.
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Thus, in this model ejaculation outside the vagina was conducive to “uterine disease,” since the female genitalia did not receive the health benefits of male emission. Some physicians regarded all contraceptive practices as injurious to women for this reason.
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The American physician C. Bigelow, writing in 1875, was one of many who subscribed to this view, asserting that withdrawal causes pelvic congestion and thus hysteria in women. He also warned against masturbation on the grounds that “many [women] experience the nervous orgasm or spasm, which acts as harmfully on them, when much indulged in, as on males.” In intercourse, though, orgasm in women was considered healthful and medically desirable.
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William Goodell, a highly respected American gynecologist of the latter part of the nineteenth century, considered coitus interruptus unhealthful for women and recommended intercourse to male orgasm as a treatment for hysteria. He was highly articulate on the health benefits of ejaculate: “I believe that the semen itself, aided of course by the general relaxation following the crisis, has a special property of allaying the congestive orgasm and the vascular turgescence of venereal excitement.” Notwithstanding the efficiency and convenience of this arrangement—at least to men—Goodell notes with concern the prevalence of pelvic congestion in women as a sequel to intercourse.
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The feminist and medical radical Edward Bliss Foote, who had been recently imprisoned for dispensing contraceptives, in 1901 took husbands to task for failing to understand their wives’ sexual needs. He said that when the husband is brutish and insensitive, women are sexually unresponsive and that “with this state of apathy and aversion on the part of the female, intercourse is mechanical, and the contusions of her organs by the organ of the male, is just about as injurious as if a billet of wood were introduced instead of the organ which Nature intended.” Like his colleagues, however, Foote considered coitus the norm for sexuality and did not approve of masturbation for either sex, on the grounds that it did not permit a healthy exchange of animal magnetism between the sexes.
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Others, such as the famous Richard von Krafft-Ebing, were unwilling to permit sexual pleasure to women even in the context of marital
intercourse. He has often been quoted in the opinion that “woman, however, when physically and mentally normal and properly educated, has but little sensual desire. If it were otherwise, marriage and family life would be empty words.” Clearly he regards women’s sexuality as a significant threat to social stability. The androcentric picture is completed by his flat assertion that “the distinctive event in coitus is ejaculation.” He opposed masturbation in both sexes, claiming that it weakened desire for the opposite sex.
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Other doctors observed that women “learned frigidity” by a lack of satisfaction in marriage: where disappointment was the rule, women simply ceased to take any interest in the proceedings.
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G. Kolischer wrote in 1905 in the
American Journal of Obstetrics
:

Sexual excitement, not brought to its natural climax, the reaction leaves the women in a very disagreeable condition, and repeated occurrences of this kind may even lead to general nervous disturbances. Some of these unfortunate women learn to suppress their sexual sensation so as to avoid all these disagreeable sequelae. Such a state of affairs is not only unfortunate, because it deprives the female partner of her natural rights, but it is also to be deplored because it practically brings down such a married woman to the level of the prostitute.
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The French physician Gilles de la Tourette saw this process as part of the cycle of hysteria: the “frigid” hysteric is disappointed by coitus and communicates her distaste to her husband. His resentment and rejection then contribute to the development of her pathology.
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Even doctors who understood the function of the clitoris did not want to give up the comforting notion of female orgasm in coitus. Theodore Thomas, for example, wrote in 1891 that the purpose of the clitoris was “to furnish to the female the nervous erethrism which is necessary to a perfect performance and completion of the sexual act” and went on to observe that orgasm could be produced by clitoral stimulation “outside of intercourse.”
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Many physicians warned against manipulation of the clitoris, either by husbands or by the women themselves. Smith Baker said in 1892 that a common “source of marital aversion seems to lie in the fact that substitution of mechanical and iniquitous excitations affords more thorough satisfaction than the mutual legitimate ones do.”
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Thus
one of the perceived health risks of unsatisfactory coitus for women was that it could lead to masturbation.

MASTURBATION

Physicians until the second half of this century have traditionally been deeply suspicious of the pleasure women had in masturbation, and not only for the reasons they condemned or questioned it for males. Havelock Ellis, who wrote synopses of what most of his illustrious predecessors had to say about female sexuality, thought that after adolescence “masturbation is more common in women than in men.” He thought it likely that all widows and single divorced women masturbated, which concerned him because he concurred with his colleague Smith Baker, who believed that masturbation caused “marital aversion” in women. He says of this that healthy and vigorous “women living a life of sexual abstinence, have asserted emphatically that only by sexually exciting themselves, at intervals, could they escape from a condition of nervous oppression and sexual obsession which they felt to be a state of hysteria.” This view, of course, was not far removed from the earlier perspective on hysteria as the sequel of sexual deprivation. The most disquieting female masturbators, from the physicians’ point of view, were the married women, whose behavior raised doubts about the ideal of mutual bliss in coitus. Like others of Ellis’s contemporaries, some of whom I have quoted, Alfred Adler was convinced that married women masturbated because coitus so often failed to satisfy them.
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It is likely that this observation was the source of many physicians’ discomfort with the notion of female masturbation: it conflicted at a literally visceral level with the androcentric paradigm.