The treatment of primary and secondary orgasmic dysfunction: a methodological review of the literature since 1970

This paper reviews the studies since 1970 which examined the treatment outcome of primary and secondary nonorgsmic women. The studies were evaluated within the following sections: subjects, therapists, time format, treatment, and outcome criteria. Many methodological deficiencies were found, most notably the lack of specificity regarding subject characteristics, a reliance on women's self-reports of outcome without obtaining partner validation, the failure to assess the influence of the woman's partner on her orgasmic responsivity, the failure to control for expectancy factors, and the use of different criteria for treatment success. The problems in the literature suggest that it is premature to place any confidence in the identification of the treatment format which is most successful for a defined population of women who experience a specific form of primary or secondary orgasmic dysfunction. The data tentatively suggest that (1) secondary nonorgasmic women would show greater gains than primary nonorgasmic women in treatments emphasizing sexual and nonsexual communication techniques, (2) primary nonorgasmic women would show greater gains than secondary nonorgasmic women in desensitization and sexual technique training procedures, (3) desensitization may be the appropriate treatment for women whose sexual anxiety contributes to secondary orgasmic dysfunction. These hypotheses should be examined in controlled research.