In 1931, toward the end of his career, Sigmund Freud published an essay titled “Female Sexuality” wherein he lays out his case for sexual difference in development—women are naturally more “bisexual” than men (here, he means more prone to taking up both “male” and “female” gender orienta-tions and associated sexual behaviors), they are more sexually receptive, and, when properly developed, they are sexually passive (albeit active in terms of a maternal instinct). Proper female adulthood is signified by a shift in libidi-nal energies from the clitoris to the vagina. All of this is “natural”—just a part of human psychosexual development, given by body parts and their obvi-ous uses. By the time this essay was published, psychoanalysis, Freud’s much lauded and reviled theory of human psychology, had been in clinical practice for more than two decades in the US and Europe. In addition to psychoana-lytic sessions, variations of psychoanalysis were used to treat a broad swath of related and sometimes indistinguishable feminine neuroses, including hysteria and frigidity, in quasi-gynecological settings (Ehrenreich & English, 1978)—in this way, psychoanalysis was clearly an important moment in the trajectory of the development of sex therapy in the Global North. Beginning in the sec-ond half of the twentieth century, psychoanalytic theorizations and protocols would fall out of vogue, at least among practicing psychologists, psychiatrists, and sex therapists, in favor of biopsychiatric, neurobiological, evolutionary psychological, and cognitive behavioral frameworks.
One might have hoped that such universalizing and essentializing theo-ries of human sexual development would have been abandoned along with these irresponsible uses of psychoanalysis (how much Freud condoned these usages himself is debated to this day). But, almost eighty years later, promi-nent experimental sexologists, theorizing sex differences in response to por-nographic videos shown in a laboratory to subjects whose penises and vaginas are hooked up to machines that gauge their physiological sexual arousal, make conjectures about gender differences in sexual response that sound remark-ably similar to those for which Freud was so villainized. For instance, in an archetypal article in the preeminent scientific journal Archives of Sexual Behavior, some of the most renowned sex researchers of the twenty-first cen-tury describe differences in male and female arousal, positing that women may experience less mental/physiological alignment or “concordance” than men do (that is, women’s minds and bodies often do not agree about what turns them on) for evolutionary reasons: “Another possible explanation for the sex difference in concordance is that men and women are designed differently in terms of their physiological and psychological sexual response systems”
(Suschinsky, Lalumière, & Chivers, 2009, p. 571). In support of this theory of evolved sexual difference, the researchers cite sociobiology and evolutionary psychology forerunner Donald Symons, who argues for the importance of mate choice in guiding ancestral women’s interest in sexual activity—which could really be boiled down to interest in motherhood (for women, “quality over quantity” is the general rule, which evolutionary psychologists claim is an adaptation inherited by women today; according to this theory, even though women tend to be physically aroused by many things, including bonobos hav-ing sex or other entities/acts that do not align with their stated sexual pref-erences, they often are either subjectively unaware of their objective arousal or choose not to “follow” it in order to make better mate choices, although this is not conscious). The researchers extend this evolutionary psychology argument about evolved adaptations—in this case, automatic, rapid, and easy physiological arousal in women—to the hypothetical pervasiveness of rape in prehistoric environments:
Reflexive vaginal responding may have been beneficial because vaginal vasocongestion results in lubrication of the genital tract, reducing the likeli-hood of injury and subsequent infection resulting from vaginal penetration.
Ancestral women who did not reflexively lubricate and who experienced unwanted sex would have been more likely to experience injuries or infec-tions that could have rendered them reproductively sterile or resulted in their deaths after sustaining injury during genital penetration. (p. 571)
Alongside describing what has since come to be known as “the preparation hypothesis” for hardwired reflexive female genital response,1 these research-ers cite the work of psychologist Roy Baumeister, who argues that women’s sexuality is naturally more “erotically plastic” and influenced by nurture, cul-ture, and the external environment than is men’s sexuality, which is inherently more “in-born,” goal-oriented, and biologically driven. So, over the span of almost a full century, similar guiding themes regarding feminine complexity, receptivity, and responsiveness are maintained, even though the theoretical frames doing the guiding are, on their face, very different. This observed con-tinuity raises several questions: What are the consequences of these univer-salizing theories of sexual difference on treatments for low desire and sexual dysfunction in the twenty-first century? Beyond dysfunction, how do these ideas impact how we perceive “healthy” sexuality, desire, and gendered sex-ual behavior? And finally, even when contemporary experimental sexological research produces evidence-based theories and hypotheses, does that mean they are sound or worth investing in? How are these hypotheses implemented, how are resulting theories utilized, and what ideologies are inextricable from even the most replicable and reliable scientific evidence?
This book analyzes the science and medicine of low female desire, and the related contemporary notion of “female sexual dysfunction.” That history can-not be discussed without critically analyzing the corollary can-notion of feminine sexual receptivity—and specifically that receptivity within the framework of institutionalized heterosexuality, or what social theorists call heteronormativ-ity (Fischer, 2013; Ingraham, 2008; Pascoe, 2011; Wade; 2017; Warner, 1991). In each of the sex therapy and research paradigms I examine, the story remains the same: Female sexuality is murkier, more complex, more flexible, fluid, or subject to the influence of “nurture” or the external environment, and thus it is more receptive or responsive than male sexuality. A variety of histories, including pre-sexological and premodern medical histories, could be places to begin this story. In the interest of time and space, and because in the popular imagination of contemporary psychology, psychoanalysis is often considered to be synonymous with misogyny, I begin with Freud.
1. At the time of this writing, the empirical status of the preparation hypothesis regard-ing cis women’s reflexive genital response as evolutionary adaptation still has great import and much support, and continues to be a topic of debate in the experimental community.
For instance, in their in-depth review of studies on related topics since the 1990s, Lalumière, Sawatsky, Dawson, & Suschinksy (2020) ultimately conclude that “the evidence presented in [their] article suggests that there is a coordinated perceptual, cognitive, emotional, physiologi-cal, and neural system that facilitates an automatic sexual response to sexual stimuli [in cis women]—a coordinated system that may serve protective functions” (n. pag.).
Just as peculiar female sexuality has consistently posed a problem for sexology, sex therapy, sexual medicine, and psychoanalysis, these medical frames and associated technologies have been vexing for feminists. The his-tory of psychoanalysis in this regard is particularly noteworthy; whereas many feminist thinkers have taken up psychoanalytic perspectives on gender, from Lacanian to object-relations traditions, others have abandoned psychoana-lytic theory completely and argue that it is inherently sexist, particularly as psychology has moved toward what are claimed to be less “theoretical” or
“political” frameworks in the last several decades. In light of this split among feminists, it is useful to consider what Freud actually said about female sexual-ity, how these notions have been taken up in practice beyond his writings and possibly without his consent, and what these ideas have in common with con-temporary conceptions of sexual difference. This is imperative also as many contemporary practicing psychologists, sex therapists, and clinicians (fem-inist-identified or not) have disregarded Freud while simultaneously main-taining some of the worst—and most misogynistic—aspects of his theories of psychosexual development. That is, in an effort to be apolitical and atheo-retical (i.e., to distance themselves from psychoanalysis) many contemporary psychologists have embraced evolutionary and behaviorist models of human sexuality, giving up a focus on trauma and even socialization, and, paradoxi-cally, they have maintained notions of essential feminine responsiveness and receptivity in the process.
Here, I critique early psychoanalytic theories of gender and sexual devel-opment, while also acknowledging the utility of psychoanalysis as a thera-peutic framework for understanding trauma—including gendered and sexual trauma—and for understanding the impact of early experiences on our psy-chic lives. Freudian psychoanalysis has become a stand-in—to the point of caricature—for all that is misogynistic about modern psychology, a point that Angel (2010, 2012, 2013) has elaborated at length. Even in light of warranted critiques of Freud’s writings on femininity, not to mention his lack of atten-tion to difference across race, class, and culture, there are many aspects of psychoanalytic therapy that are useful and should be carried forward, includ-ing psychoanalytic insight into causes of sexual problems, acknowledgment of the unconscious and the notion that human behaviors are often guided by things that are not directly within our awareness, and acknowledging prior trauma as a cause of pathology, in addition to processing this trauma as a part of treatment. While vulgar psychoanalytic theorizations (read: narrowly Oedipal explanations) are often the focus when Freud is discussed in con-temporary mainstream psychology, or misogynistic work with “hysterical”
women is described when discussing psychoanalytic treatment, there is much
more to both psychoanalytic theory and associated therapeutic treatments.
An important positive aspect of psychoanalytic work is its use of narrative techniques for uncovering the deeper roots and explanations for understand-ing sexual desire or lack thereof. Also valuable is the psychoanalytic attri-bution of dysfunction to experiences of trauma, which has been lost in the present behaviorist focus on immediate symptoms and brief treatments. And finally, contemporary psychoanalytic conceptions are quite nuanced in their renderings of brain-body connectivity (E. A. Wilson, 2015); distributive ontolo-gies or neurological intimacies are more intersubjective, affective, and trauma-informed psychoanalytic explications than the ones we might be used to, and they allow us to consider the connections between psychoanalysis and neu-roscience, or to think of “the body in conversation with itself” (E. A. Wil-son, 2004, p. 98)—and in conversation with its environment and other bodies therein.
Throughout the rest of this chapter, I analyze the production of feminin-ity and sexual difference as these have been configured in some of the key sex therapy paradigms in the nineteenth, twentieth, and twenty-first centuries, focusing on the major figures that institutionalized these protocols: Freud and psychoanalysis, Masters and Johnson and the physiological or ist approach, Helen Singer Kaplan and the further instantiation of behavior-istic sex therapy (but with a renewed acknowledgment of desire), and those who implement contemporary individualistic sex therapy techniques, which often utilize psychopharmacology, cognitive behavior therapy, and increas-ingly, mindfulness as treatments for low desire—and who tend to theorize about sexuality and gender from the perspective of evolutionary psychology (if they theorize at all).2 Even when a clear theorization for gender differences is lacking in cognitive research today, evolutionary psychology is often in the backdrop (“we became different as cavepeople”), and gets cavalierly thrown in as an explanation—if not by the researchers themselves, then by those who interpret the research (whether that is other researchers and “experts” or pop-ular writers and journalists).
For each therapeutic model described below, I ask a series of questions: Is it the couple or the individual with sexual problems that is treated? What kind of treatment is deemed most appropriate (e.g., psychodynamic, behavioral, or pharmaceutical methods, or some combination of these)? Is treatment con-ceived of as necessarily different for men and for women? A thorough
exami-2. I do not attend to a deeper history of eighteenth- and nineteenth-century sexology here; ideas about femininity as “inverted” masculinity and the “one-sex” model of human sexu-ality are fundamental to understanding these contemporary modes, however, and more exten-sive analyses can be found in Laqueur (1992).
nation of the legacy of these regimes and treatment protocols for desire and behavior abnormalities and sexual dysfunctions is warranted in light of the themes that emerged from my interview data; the low-desiring women who participated in my qualitative study had much to say about how this history and associated notions of femininity and female desire have made it into their psyches, bodies, and bedrooms.
Freud and Deficient Womanhood: “The Little Creature without a Penis”
Even though these ideas could be traced to well before this time period, pas-sive femininity and “receptive” versus “frigid” female desire were popularized and given broad cultural sway along with the psychoanalytic turn of the late nineteenth and early twentieth centuries. In the US and Europe, Sigmund Freud’s influence on pre–sex therapeutic treatment of women’s sexual prob-lems was profound, and this was mostly clearly linked to his writings on the two (active or “masculine” and passive or “feminine”) phases of female sexual development, the female-specific instantiation of the Oedipus and castration complexes, and the primarily feminine pathologies, including frigidity, hys-teria, and other feminine neuroses. Freud was a complicated figure. He is also known for his seduction theory, for instance, the proper interpretation of which has been debated by feminists for decades. Depending on which stance you take, this theory either tells us that young women have been largely trau-matized by very real sexual violence at the hands of their male elders (see Kleinplatz, 2018 for a discussion of this interpretation) or that at the core of feminine sexuality is the fantasy of incest, the notion that young women masochistically wish to be violated by men, including their fathers and other adult male family members or adult men in their lives (see Ahbel-Rappe, 2006 for a full discussion of both perspectives). Here, I will focus specifically on Freud’s later work on female psychosexual development, specifically his 1931 essay on this topic, as it is this thread that appears to have had the great-est effect on popular ideas about female sexuality within contemporary psy-chology, about Freud and psychoanalysis more generally, and about Freudian or psychoanalytic theories of sex and gender.
Although Freud believed that both men and women were driven by the singular force of the libido, he argued that the libido’s modes of sexual grati-fication could be either active or passive. Proper human sexual development resulted in very different libidinal formations for men and women, corre-sponding to active and passive impulses—that is, masculinity and
feminin-ity, or dimorphic yet complementary gender formations and corresponding healthy behaviors and desires, along with potential dysfunctions or neuroses.
According to Freud, human development at its earliest stages is not sexually differentiated; in the pre-Oedipus phase, both boys and girls are attached to the mother, yet also project sadistic impulses onto her, as she is a frustrating denier of masturbation and loathsome disseminator of a variety of other pro-hibitions. This pre-Oedipal phase of attachment to the mother is significantly longer and more complex in girls, though; once “the little creature without a penis” (Freud, 1931/1952, p. 259) discovers the truth of her castration—her lack of a penis and subsequent horrifying realization that she will never acquire one—she quickly comes to blame her mother for this lack, which then results in a lifetime of ambivalent and often hostile feelings toward loved ones (i.e., the feminine neuroses). For Freud, the sexuality of the young child is ambiva-lent, as it lacks an object and thus an aim. But this ambivalence is more pro-nounced, profound, and formative for female children than it is for males due to the “biological reality” of penis envy—the feminine manifestation of the castration complex, which is characterized by a lifelong sense of “organic infe-riority” (Freud, 1931/1952, p. 259)—and the fact that surmounting or breaking down the Oedipus complex is simply less important to the development of proper and healthy femininity than to its masculine equivalent. As a result, adult women are less apt to adequately overcome the childish love of their fathers and find an appropriate replacement object than men are to overcome the immature love of their mothers, and thus, women are always less sexually developed and appropriately goal-oriented than are men. In Freud’s formula-tion, women’s one true and authentic desire is motherhood, which should be understood as very different than the sexual desire and concomitant individu-ated selfhood that defines the distinct ego that healthy men develop.
Freud (1931/1952) writes, “We have long realized that in women the devel-opment of sexuality is complicated by the task of renouncing that genital zone which was originally the principal one, namely the clitoris, in favor of a new zone—the vagina. But there is a second change which appears to us no less characteristic and important for feminine development: the original mother-object has to be exchanged for the father” (p. 252). Although Freud acknowl-edged that the linkage of these two “tasks” was elusive, in this statement he set forth a project in which the biological body, gendered behavior, and sexual or object orientation become fused. It was not the first time in medicine or sci-ence that this fusing had been articulated, and it certainly would not be the last. What is important and notable about Freud’s formulation is how he links a zone of the body itself (the vagina) to an essential kind of energy: feminine passivity, responsiveness, or receptivity. Later in the essay, Freud discusses the
two phases of women’s sexual development, “the first of which is of a mascu-line character [and is thus active, and guided by the clitoris], whilst only the second is specifically feminine [it is oriented around the vagina]” (p. 255). He goes on to state:
Thus in female development there is a process of transition from the one phase to the other, to which there is nothing analogous in males. A fur-ther complication arises from the fact that the clitoris, with its masculine character, continues to function in later female sexual life in a very variable manner, which we certainly do not as yet fully understand. Of course, we do not know what are the biological roots of these specific characteristics of the woman, and we are still less able to assign to them any teleological purpose.
(pp. 255–256; italics added)
This excerpt is crucial to analyze, as it pertains to two specific points that relate to contemporary conceptions of femininity and the treatment of female sexual dysfunction. First, Freud’s discussion of proper gendered sexual devel-opment and how it is correlated with teleological, evolutionary reproduction in a (cishetero)normative sense has been a running theme through different medico-scientific paradigms throughout the twentieth and twenty-first cen-turies, and it has made a distinct, forceful, and contentious comeback in the last forty years with the advent of sociobiology, evolutionary psychology, and
This excerpt is crucial to analyze, as it pertains to two specific points that relate to contemporary conceptions of femininity and the treatment of female sexual dysfunction. First, Freud’s discussion of proper gendered sexual devel-opment and how it is correlated with teleological, evolutionary reproduction in a (cishetero)normative sense has been a running theme through different medico-scientific paradigms throughout the twentieth and twenty-first cen-turies, and it has made a distinct, forceful, and contentious comeback in the last forty years with the advent of sociobiology, evolutionary psychology, and