It is always wise to obtain a complete and detailed sexual and background history. At the Masters and Johnson Institute, two histories are taken from each member of the couple: one each by both of the therapists, first, male-male, female-female; then male-female, female-male, with an opportunity for the therapists to discuss the first history with each other before the second one is taken. This gives an opportunity for obtaining additional information by exploring any lead which may have been developed in the first history session.

The next day the therapists meet with the couple to go over the histories and to clarify any misunderstandings which may have occurred. This is described as the «round table.» Should any material in the individual history reveal something that the patient does not want the partner to know, then this is red-lined and not disclosed. However, if it seems essential to the therapeutic process for this to be discussed with the other partner, then this is explained to the person concerned, but even then is not disclosed if the individual insists on it even after its importance is explained.

It is believed at the Masters and Johnson Institute that no sexually dysfunctional relationship can exist with an uninvolved partner, even though the presenting complaint is primarily by one partner, such as impotence in the male or a non-orgasmic female. As Masters and Johnson have written, «There is no such thing as an uninvolved partner in any marriage in which there is some form of sexual inadequacy».

Both primary and secondary orgasmic dysfunction, vaginismus in the female, and impotence, premature ejaculation, and ejaculatory incompetence in the male are usually successfully treated by the method developed by Masters and Johnson. The basic approach is that of the history and round-table routine. Each type of dysfunction requires some variation in approach. At the round table after clarification of the history, the couple is instructed to carry out what Masters and Johnson describe as the «sensate focus.» In effect, each partner is instructed in ways of caressing the other in order to give the greatest degree of pleasure without involving the breasts or genitals. This is done first by one, then the other partner. The following day these areas may be included in the caressing, but without any attempt to perform sexually, thus obviating performance anxiety. It is emphasized that this should be a sensual, not a sexual activity. Although no time limit is given, it is suggested that the exercise should last for twenty to thirty minutes. The reaction of the couple to this experience is discussed with them, since it is usual in most instances that this type of activity would lead to sexual performance. It does, however, lead to a significant degree of sexual stimulation without performance anxiety, which is an important factor in causing sexual dysfunction. The fear of inability to perform may be a very important factor in causing whatever type of dysfunction exists. The sensate-focus activity is, of course, undertaken with both partners in the nude and in comfortable and pleasant surroundings.

Following the basic approach described above, attention in therapy is directed to the type of dysfunction involved. Thus, the treatment of impotence requires a different approach from that of premature ejaculation, even though such symptoms are quite likely to be closely inter-related. Different procedures are also used in the treatment of the non-orgasmic female or the female with vaginismus. In treating premature ejaculation it is generally conceded that the squeeze technique is the best approach.

This was first described by Semans and more specifically developed by Masters and Johnson. In this approach the female stimulates the male to erection and when the male is aware that ejaculation is about to occur, she is instructed to squeeze the phallus with the first two fingers, one above and one below the corona on the anterior surface of the penis, with the thumb on the frenulum. Considerable pressure can be applied without causing pain when the penis is erect, and if the squeeze is undertaken soon enough it invariably prevents ejaculation. This can be repeated a number of times at each session and after satisfactory reaction has been developed, it should be kept in mind that this procedure should be repeated occasionally. Dr. Kaplan and others recommend this even after the premature ejaculation is under control.

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Diagnosis

As in the case of homosexuality, bisexuality per se is a condition or way of behaving erotically, not a syndrome. Therefore, in the strict sense, there is no diagnosis. The condition is identified by the history either of sexual practice or imagery, or both. In its most covert form, bisexuality may not be identifiable as such, being manifest only as a failure of complete heterosexual abandon. Physical signs are noncontributory.

Differential Diagnosis

The issues are the same as in the differential diagnosis of homosexuality.

Therapy

Of and by itself alone, bisexualism is not a disease and does not require therapy. The vast majority of individuals with a bisexual history never see a therapist. If bisexualism is associated with a lack of well-being, however or if it is experienced as a source of distress to the person or partner, then either or both will benefit from some form of psychological counseling or therapy. The goal of treatment most often is to restore a sense of bisexual well-being. Less often and in selected instances, the goal may be one of predominant heterosexual eroticism.

Prognosis

Bisexuality as an optional life style, equally acceptable to consenting partners; is like a vocational life style in not requiring a diagnosis. If a prognosis is required, it is for the sequelae of the life style. For some, overt bisexuality represents a solution to problems of erotic relationships. Then the prognosis is positive. For others, it represents a compounding of problems, with a prognosis that is guarded, but not necessarily negative.

With less social stigmatization, bisexualism could become therapeutically accepted as a variant of human sexuality. For some individuals who otherwise might be victimized by social pressures into becoming patients, bisexuality enlarges the range of their behavioral options in eroticism and love so that they need not become patients.

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If a woman chooses a nonconventional career, she then has to acquire a position enabling her to pursue it. She «applies» for a job. It is at this point that the most obvious and concrete examples of access discrimination can occur. The fact of discriminatory treatment in selection decisions has been documented widely. Before presenting these data, however, it is important to consider why such processes are so prevalent.

Because of the lack of competing information, when an individual first seeks to enter an organization, sex stereotypes are apt to be a predominant element in decision making. One of the functions of such stereotypes is a cognitive one—to make the world less complex and less ambiguous and thus more manageable. By treating an individual woman as merely one member of a large and well defined subgroup, «women,» and ascribing attributes to her that presumably are characteristics of that group, a great deal of information about that individual is generalized. Whether true or not, assumptions about any one woman and what she is like are likely to be made on the basis of her subgroup identity when little other information is available.

Without exception, the attributes ascribed to females are not those believed essential to work success. As we already have seen, achievement-oriented traits are sorely lacking in the stereotypical profile of women’s attributes. Consequently, work success, especially in occupations not traditionally feminine, is associated only with males.

Schein empirically demonstrated this by asking male management personnel in insurance companies to describe either women, men, or successful middle-level managers. She found that «men» and «successful middle manager» were described in very similar terms but «women» were described quite differently. Apparently, those attributes characterizing a successful manager are not at all those typically ascribed to women. Success at managerial work is indeed considered to be a «male» phenomenon.

The pervasiveness of this point of view was documented in a study conducted by Feldman-Sumners and Kiesler. In the course of designing the procedure for their experiment, these researchers administered a pretest survey to approximately eighty-five male and female undergraduates at the University of Kansas. Each was shown descriptions of people and was asked to indicate how successful he or she believed them to be. The following professionals were described: pediatrician, writer, child psychologist, surgeon, dancer, diagnostician, clinical psychologist, and biographer of famous women. For each subject, half of these were presented as male and the other half as female. The results were dramatic. In no instance was a woman expected to be more successful than a man! The authors also report that in later work with additional professions and work categories they were unable to find even a single occupation in which women rather than men are expected to be more successful. This was found even when the traditionally female occupations were used, such as nursing and elementary school teaching. This is indeed very compelling evidence that success at work is generally associated with men more than women.

Sex-stereotypic norms also are likely to have a detrimental effect on women’s access to jobs. The demands of traditionally masculine jobs, such as managerial ones, are incongruent with the behavior thought to be appropriate to women. Dealing with subordinates, competing for resources, and making hard-nosed decisions are not activities consistent with the view of women as the gentle sex. Women interested in positions with these job descriptions are apt to be seen as «out-of-line» and to be penalized for their violation of sex-related expectations no matter what their background or qualifications. The result: steering the woman applicant to less challenging positions or not considering her for employment at all.

A related point is that concerning the persistent notion that women are unreliable workers, lacking commitment to their work. Starting from the view that a certain type of lifestyle is appropriate to a woman, many personnel decision makers are likely to assume that a woman would be pursuing a nontraditional career only because she either has nothing better to do (has not as yet any family obligations or has a bad marriage) or she is doing so out of economic necessity. Each of these can neatly explain her unconventional behavior. They foster the belief that if the woman in question should «find a man and settle down,» «divorce and remarry» or «get her hands on some money» she no longer would be interested in working. Taking this point of view, it is easy to understand the argument that the company should not make an investment in such an individual.

Some women are, of course, exempt from these allegations. Generally they are the «masculine» women who fit into «old maid» or «asexual» categories. Because they seem to have clearly rejected their femininity they are less suspect. Their motives for working appear to be clear, their role conflicts minimal, and the risk in hiring them less grave than in hiring a more feminine woman.

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One of the most striking aspects of the anthropological literature on sexuality is the near-universal concern that men have about pollution or contamination resulting from contact with women. The Kaluli men of Papua New Guinea repeatedly warned anthropologist Schieffelin against sleeping with his wife and pointed to Schieffelin’s clumsiness on the trail as a result of such indiscretion (Schieffelin). The Kaluli men share the same concern as the men of the Central Highlands of New Guinea, as reported by Read: «In their view of the world, too close and constant an association with the opposite sex, even with one’s own wife, could impair a man’s vigor or retard his growth during the critical years of adolescence». Mead generalizes that for all of Polynesia, «all women, and especially menstruating women, are considered contaminating and dangerous». Suggs found this to be the case in the Marquesas; men would refuse sex during menstruation for a variety of reasons. Impotence might result, and they also voiced complaints against the practice on aesthetic grounds (Suggs). Tahitian males consider menstrual blood dangerous (Levy). The Fulani of Upper Volta designate menstruation with a phrase which, literally translated, means «to see dirt» (Riesman). Fulani women cannot pray during their menstrual periods. Menstruation and its associations seem to stand as the basis for the Fulani’s radical separation of male and female spheres, women being naturally weaker. Navajo women of the American Southwest cannot conduct a chant while menstruating (Bailey). The Navajo have an interesting paradox: although it is dangerous to have intercourse with a menstruating woman, to do so increases the likelihood of pregnancy (Bailey). In native South America, we find Mehinaku men who see menstrual blood as especially dangerous, capable of causing sickness and cramps in men.

Schieffelin observes from Kaluli:

Those women are weaker and less dynamic than men, that they are slow and clumsy and know less, is part of the same general condition of debility they manifest in menstruation. And this condition is dangerous to men because it is capable of destroying their manhood. The man who spends too much time in the woman’s section . . . who touches his wife too often or who eats food a woman has stepped over is likely to become emaciated, develop a cough, or lose his endurance on the trail.

The implication here is that menstrual blood or menstruation is not dangerous per se; it is symbolic of the weakness or danger that men more generally attribute to women. That Schieffelin’s clumsiness on the trail could be attributed by the Kaluli to his sharing a bed with his wife indicates a more general cultural separation between strength and weakness and agility and clumsiness that ascribes success to men but places blame on women. After all, a man should be able to negotiate a trail smoothly by nature; should a man falter, he is suspected of female contamination. Schieffelin, who knows he is clumsy by nature, sees the irony and sexism in the Kaluli men’s comments, and states: «It struck me as poignant irony that the person on whom a man most depends in his domestic household and whom he usually holds in his affections is also the one most dangerous to his vitality».

Because the pattern is so pervasive and consistent in male/female antagonism, one might conclude that there are important, cross-societal universals about men and women. Although such a claim can be substantiated, to do so would be to miss the point about context. Many of these societies seem to be built on a «we/ they» male opposition; the «we» is generally the male domain, and the «they» consists of women, who some of the time are incorporated into «we» but usually are treated as a weaker, more dangerous «they.»

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Marriage is the only human relationship within which sexual intercourse is universally sanctioned. We have seen, however, how variable are individuals within groups. Among some people, marital intercourse is proscribed at certain times, as during menstruation and pregnancy. Among others, provision is made routinely for extramarital liaisons, as among the Turu, and in Western countries which have institutionalized the mistress-lover relationship. Within groups data also testify to individual variation in needs, tastes, and behavior. Even within an individual’s historical repertoire, changes over time may be observed as a life style evolves and new behaviors emerge.

Generalizations about sex in marriage seem possible only for carefully defined samples, the results qualified by attention to the sources of variation and their effects. Currently in our society, we can describe the scene of marital sexuality only as pluralistic, providing many models, each with adaptations and variants. From one couple’s brief, once-a-week encounter, never deviating from the male superior position, to another’s daily, highly sensual, experimenting adventure, to yet another’s exploration of swinging and group sex, and many others closer to and farther from the norm, we gain a sense of the plasticity of human sexual experience as it occurs in the old institution of marriage.

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