Meetings of the New York Psychoanalytic Society

March 12, 1968. A RE-EXAMINATION OF THE SIGNIFICANCE OF CLITORAL VERSUS VAGINAL ORGASM. Marcel Heiman, M.D., Burness E. Moore, M.D. and Edward D. Joseph, M.D.

Dr. Heiman observed that the work of Masters and Johnson has led some to conclude that the psychoanalytic distinction between vaginal and clitoral orgasm is invalid, and that this has led to an insufficient differentiation between intercourse and masturbation. Clinical material on ten women referred by gynecologists because of coital frigidity was presented. For the most part these women associated fertility problems, conflicts over childbearing and child care, depression, and other evidences of disturbed psychosexual development; they relied on clitoral stimulation for sexual gratification. Heiman concludes that clitoral stimulation is masturbation, and vaginal frigidity, coital frigidity. The sexual practices and preferred mode of sexual satisfaction in coitally frigid women are 'symptoms of and a gauge for the underlying psychopathology'. Hence, clitoral stimulation and orgasm are not equivalent to intercourse and vaginal orgasm.

Dr. Moore re-examined the validity of the psychoanalytic clitoral-vaginal transfer theory. Psychoanalysts exaggerate the importance of vaginal sensations in sexuality and neglect the role of the clitoris in orgasm; on the other hand, non-analytic investigators do not appreciate the clinical importance of mental representations in sexuality. Although a persisting clitoral hypercathexis is often associated with female sexual disturbances, Moore maintains that cathexis and physical sensations should not be equated or confused. For example, vaginal orgasms may have psychopathological, often phallic, implications and may occur in neurotic and psychotic women. Psychoanalysis often overemphasizes the concept of transfer of erotic sensation from clitoris to vagina. Moore proposes that it is the cathexis of coitus, not the kind of orgasm, that is essential for a 'mature feminine a