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Journal of Sex & Marital Therapy, 30:263–276, 2004
Copyright © 2004 Brunner-Routledge
ISSN: 0092-623X print
DOI: 10.1080/00926230490422403
Communication and Associated Relationship
Issues in Female Anorgasmia
MARY P. KELLY, DONALD S. STRASSBERG,
and CHARLES M. TURNER
Department of Psychology, University of Utah, Salt Lake City, Utah, USA
Communication problems are among the most common complaints
brought to couples’ counseling and are believed to play a central
role in the development and maintenance of many sexual dysfunctions. The present study examined self-reported communication
patterns within heterosexual couples where the wife is experiencing
anorgasmia and within two groups of control couples. As hypothesized, couples with an anorgasmic female partner reported more
problematic communication regarding issues of sexuality than did
control couples. In particular, the anorgasmic women and their
male partners reported significantly more discomfort than did controls in discussing sexual activities associated with direct clitoral
stimulation. The etiologic and treatment implications of these differences are discussed.
Problems in communication are among the most common complaints
presented by couples seeking marital therapy (Fowers, 2001; Halford,
Hahlweg, & Dunne, 1990; Schmaling & Jacobsen, 1990). Although communication has long been considered important to sexual satisfaction
and adjustment (Cupach & Comstock, 1990; Delaehanty, 1983; Ferioni &
Taffe, 1997; LoPiccolo, 1978; McCabe, 1999; McCarthy, 1995; Wheeless &
Parsons, 1995; Zimmer, 1983), researchers have yet to demonstrate the specific nature of communication problems unique to sexually dysfunctional
couples.
This study was part of a larger project on couples’ communication.
Address correspondence to Donald S. Strassberg, Department of Psychology, 580 S. 1530
E., Room 502, University of Utah, Salt Lake City, Utah, 84112, USA. E-mail: donald.strassberg@
psych.utah.edu
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M. P. Kelly et al.
COMMUNICATION AND ANORGASMIA
A review of theoretical models of the etiology/maintenance of anorgasmia
(Heiman & Grafton-Becker, 1989) argued that communication deficits, lack
of confidence in communication, and inhibitions to communication are related to the disorder. Support for the importance of communication in female
anorgasmia was found in a study by Kelly, Strassberg, and Kircher (1990).
The strongest distinguishing characteristic of anorgasmic (versus orgasmic)
women in this study was the report of significantly less anticipated communication comfort regarding direct clitoral stimulation activities (i.e., cunnilingus,
manual genital stimulation of the woman). In contrast, no communication
comfort differences were found with respect to intercourse-related activities.
Direct clitoral stimulation activities have been suggested to be the
most likely to maximize orgasmic responsiveness in women (e.g., Griffitt
& Hatfield, 1985). Difficulties with communication regarding these activities
could play a particularly important role in the etiology and maintenance of
female anorgasmia.
The literature reviewed offers little articulation of the nature of specific communication problems in couples with an anorgasmic female partner. Examining the minimal necessary conditions for the development of
effective sexual stimulation suggests some preliminary hypotheses. Assuming a woman knows what she wants and needs sexually, she must then, at
a minimum (a) be willing and able to express these wants and needs to her
partner (MacNeil & Byers, 1997; Markman, Floyd, Stanley, & Storaasli, 1988)
and (b) have a partner able and willing to be receptive to what she has to
say (Halford et al., 1990).
THE PRESENT STUDY
In the present study, we explored the extent to which these and other elements in the communication process may distinguish couples with an anorgasmic female partner from sexually functional couples. The study employed
both a problem-free and a nonsexual problem contrast group. On the basis of
the research literature and the model described above, we hypothesized that,
in general, the communication of couples with an anorgasmic female partner on sexual topics would be perceived by the couples as distinguishably
more problematic than that of couples in the control groups. In particular, we
anticipated that (a) anorgasmic women would report significantly less comfort than would orgasmic women in control groups in communicating with
their partners about sexual activities involving direct clitoral stimulation, and
(b) male partners of anorgasmic women would be significantly less accurate
than the male partners of control group orgasmic women in estimating their
partners’ sexual preferences.
Communication and Anorgasmia
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METHOD
Participants
Participants were 47 heterosexual couples recruited via campus and community newspapers and flyers, through physician referral, and through contact
with patient affiliate groups (e.g., Diabetes Association of America). Approximately 25% of initial respondents met eligibility the criteria (described below)
and completed the study.
Three groups of participants were recruited on the basis of health
and sexual functioning status as follows: (a) couples in which each partner reported being free of physical health problems and in which the female partner reported the absence of orgasmic response in sexual activity
(of any kind) with her partner in greater than or equal to 70% of sexual
interactions (Anorgasmic group, n = 14); (b) couples in which both partners reported being free of problems in their physical health or their sexual functioning (Problem-Free Control group, n = 16); and (c) couples in
which either partner reported a chronic physical health problem (e.g, diabetes, heart disease, emphysema) and in which both partners reported
being free of sexual functioning difficulties (Chronic Illness Control group,
n = 17). Males were considered free of sexual dysfunction if they reported
sexual functioning sufficient for intercourse and orgasm (male) in greater
than or equal to 70% of sexual interactions with their partners (almost all
were functional and orgasmic on 100% of occasions). Females were considered free of sexual dysfunction if they reported the ability to attain orgasm through some type of partner stimulation in at least 50% of sexual
interactions.
All participants were at least 18 years of age, involved in a relationship
that they reported as “steady and sexually active” for at least 9 months, and
reported an average frequency of sexual activity of at least once per week.
No significant group differences were found for age (males 20–69, median =
33; females 20–56, median = 30); duration of relationship (10–186 months,
median = 48 months); frequency of sexual activity (4–33 times per month,
median = 11); relationship adjustment (as measured by an adapted version
of the Locke-Wallace Marital Adjustment Test [Locke & Wallace, 1959]; males
median = 106, females median = 111). In 94% of couples participating, both
partners were Caucasian.
Couples were paid $20.00 and offered a didactic seminar on sexual
enrichment for participating.
Assessment
INTERVIEWS
Prescreening interview. Each member of responding couples was independently administered a prescreening interview via telephone to assess for
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initial eligibility. Couples meeting eligibility criteria were given an appointment for data collection.
Sexual functioning interviews. Upon arriving in our laboratory, each
partner was individually interviewed by a same-sex interviewer to assess
the couple’s sexual functioning and behavior. These interviews focused on
each partner’s assessment of the sexual stimulation activities in which they
engaged and the perceived effectiveness of these activities. The primary purpose of these interviews was to ensure that all couples met the sexual functional eligibility requirements of their group placement.
SELF-REPORT
MEASURES
The following measures were completed individually, in separate rooms, by
both members of all participating couples.
Sexual interaction inventory (SII; LoPiccolo & Steger, 1974). This instrument presents drawings of 17 different heterosexual activities and poses
a number of questions about each. For each activity, the following question was added to those posed by the instrument: “How comfortable would
you feel communicating with your partner about this activity (for example,
discussing your feelings about it, suggesting trying it, or refusing to try it)?”
We termed this the Communication Comfort Scale. The SII yields a profile
of 11 subscales assessing a variety of sexual issues. Of these, six were of
particular interest: (1 and 2) the two Perceptual Accuracy scales (male and
female) measuring the discrepancies between each partner’s estimates of the
other’s enjoyment of particular sexual activities and the other’s self-report of
enjoyment of those activities, (3) Self-Acceptance, (4) Partner Acceptance,
(5) Frequency Dissatisfaction, and (6) Pleasure Mean.
Sexual communication inventory (SCI; Bienvenue, 1980). This 30-item
self-report instrument assesses various aspects of sexual communication
including the expression of sexual likes, dislikes, and desire for sexual
interaction.
Locke-Wallace marital adjustment test (MAT; Locke & Wallace, 1959).
A minimally adapted form of this well known measure was used to assess
relationship adjustment.
Procedure
At the scheduled appointment, each participant was introduced to a same-sex
interviewer who privately conducted the pre- and postquestionnaire Sexual
Functioning Interviews. Between the interviews, each participant also individually completed the SII, SCI, and MAT. Participants were informed that
information shared in interviews and questionnaires would not be revealed
to their partner.
Communication and Anorgasmia
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RESULTS
We examined the Communication Comfort and Perceptual Accuracy scales
from the adapted SII via analysis of variance procedures to test hypothesized
group differences in communication. Because sex specific hypotheses were
being tested on these scales, we used separate one-way analyses of variance
(ANOVAs) to examine men and women across the three groups.
We hypothesized that couples in the Anorgasmic group would evidence
more generally problematic sexual communication than would control couples (i.e., no sex-specific hypotheses). Therefore, we examined the SCI scores
via a 3 (Group) × 2 (Sex) repeated measures ANOVA.
Communication Comfort
Figures 1 and 2 present the mean Communication Comfort scores. The
one-way ANOVA revealed a significant main effect for Group for females,
F (2,44) = 3.28, p < .05, on the Overall Communication Comfort score.
Planned contrasts of scores of women in the Anorgasmic group (M = 4.60)
versus the combination of women in Problem-Free Control (M = 5.38) and
Chronic Illness Control (M = 5.50) groups revealed that, consistent with our
prediction, women in the Anorgasmic group reported significantly ( p < .05)
less anticipated Overall Communication Comfort related to talking with their
partners about various sexual activities.
We conducted further exploration of this finding. We computed subscales of Communication Comfort for participants’ responses on those items
FIGURE 1. Communication comfort scores by group (females).
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M. P. Kelly et al.
FIGURE 2. Communication comfort scores by group (males).
related to (a) direct clitoral stimulation (receiving either oral sex or manual genital stimulation) and (b) intercourse. We compared these scores via
oneway ANOVAs for women in the three groups. Results of these analyses (see Figure 1) indicated a significant Group difference among women,
F (2,44) = 4.64, p < .02, on anticipated Communication Comfort scores for
direct clitoral stimulation activities, with a similar, but nonsignificant difference, F (2,44) = 1.29, p > .2, found on anticipated Communication Comfort scores for intercourse. A Neuman-Keuls test of Communication Comfort
scores for females on the direct clitoral activities revealed that the mean for
anorgasmic women (M = 4.18) was significantly lower ( ps < .05) than the
means for women in each of the two control groups (Problem-Free M = 5.19,
Chronic Illness M = 5.41).
Although we offered no specific hypotheses with respect to how males
in the study would score on the anticipated Communication Comfort measure, we analyzed results for males to generate preliminary findings on this
variable. Analysis of variance results revealed a significant group difference
for males, F (2,42) = 4.23, p = .02, similar to that found for females (see
Figure 2). Neuman-Keuls analysis of this difference revealed that the male
partners of anorgasmic women reported significantly less ( ps < .05) anticipated Overall Communication Comfort (M = 4.68) than the male partners of
women in either of the two control groups (Problem-Free M = 5.50, Chronic
Illness M = 5.49). Further exploration of this difference revealed a pattern
identical to that of the women: Partners of the anorgasmic women reported
less anticipated Communication Comfort than did the male controls for both
direct clitoral and intercourse activities; however, the difference was significant ( p < .05) only for the direct clitoral stimulation activities (see Figure 2).
Communication and Anorgasmia
269
FIGURE 3. Perceptual accuracy scores by group.
Perceptual Accuracy
An ANOVA, F (2,44) = 7.05, p < .005, and Neuman-Keuls procedure revealed that, as hypothesized, male partners of Anorgasmic women showed
significantly less accuracy ( p < .05) than did the partners of both groups of
orgasmic women in estimating their partner’s sexual preferences (Anorgasmic M = 18.73, Problem-Free M = 11.23, Chronic Illness M = 11.41, higher
scores mean less accuracy). A similar, but nonsignificant, F (2,44) = 2.08,
p = .14, pattern was seen for the women when we assessed their perception
of their male partner’s preferences (see Figure 3).
Sexual Communication Inventory
We analyzed differences on the SCI via a 3 (Group) × 2 (Sex) ANOVA,
followed by a planned contrast. Neither the Group nor Sex main effects
nor their interaction reached statistical significance. However, the planned
contrast comparing the average SCI scores for couples in the Anorgasmic
group (M = 63.36, SD = 17.64) with the combination of averages of couples
in the Problem-Free Control (M = 70.31, SD = 17.20) and Chronic Illness
Control (M = 71.40, SD = 17.00) groups approached statistical significance
(t = −1.88, p = .066), with the Anorgasmic couples reporting marginally
poorer communication.
ADDITIONAL
SELF-REPORT MEASURES
We conducted secondary analyses of the four remaining self-report scales
of the Sexual Interaction Inventory (Self-Acceptance, Partner-Acceptance,
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TABLE 1. Sexual Interaction Inventory Means for Males and Females by Group
Group
Scale
Self-acceptance
Females
Males
Partner acceptance
Females
Males
Pleasure
Females
Males
Frequency dissatisfaction
Females
Males
Anorgasmic
Problem-free
Chronic illness
18.91 (11.9)a
5.30 (4.00)
9.37 (6.5)b
4.00 (3.2)
5.75 (5.0)b
4.12 (4.5)
11.21 (7.5)
22.56 (11.7)a
8.90 (8.4)
11.0 (8.1)b
7.63 (6.8)
11.41 (10.8)b
4.33 (0.9)a
5.23 (0.4)
5.18 (0.4)b
5.44 (0.4)
5.24 (0.6)b
5.43 (0.7)
17.79 (9.3)a
22.66 (7.7)a
12.40 (8.9)a
15.12 (6.7)b
9.72 (6.2)a
11.63 (8.1)b
Note. Means with different subscripts in the same row are significantly ( p < .05) different.
Self-acceptance and Partner-acceptance: Maximum possible score = 85, higher scores =
less acceptance.
Pleasure: Maximum possible score = 6.0, higher scores = greater pleasure.
Frequency dissatisfaction: Maximum possible score = 85, higher scores = greater
dissatisfaction.
Pleasure Mean, and Frequency Dissatisfaction) to provide descriptive information about participant groups on each of these variables. We conducted
repeated measures ANOVAs on Group (3) by Sex (2) on each scale. These
analyses revealed that women in the Anorgasmic group were less sexually
self-accepting, F (2,44) = 10.62, p < .001, although not significantly less partner accepting, F (2,44) = .87, p > .40, than were women in the Problem-Free
Control and Chronic Illness Control groups (see Table 1). Conversely, men
with anorgasmic partners were significantly less partner sexually accepting,
F (2,44) = 6.02, p < .01, but not significantly less sexually self-accepting, F
(2,44) = .49, p > .60, than were men in either control group (see Table 1).
Neither men nor women in the control groups differed significantly from
each other on these variables.
Anorgasmic females reported deriving significantly less pleasure, F
(2,44) = 8.76, p < .001, from sexual activities than did women in the control groups, who did not differ significantly from each other (Anorgasmic
M = 4.33, Problem-Free M = 5.18, Chronic Illness M = 5.24, higher scores
mean more pleasure). The men in all three groups were not significantly different (F < 1) from each other in their reported sexual pleasure (see Table 1).
Finally, consistent with results reported by LoPiccolo and Steger (1974), both
men and women in the Anorgasmic condition reported significantly greater
dissatisfaction with their current sexual frequency, F (2,44) = 8.43, p < .001
for males, F (2,44) = 3.82, p < .03 for females, than did their counterparts
in both control groups (who, again, did not differ from each other).
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DISCUSSION
Research to date has not provided a clearly articulated theoretical model
for understanding or predicting communication patterns in couples with
an anorgasmic female partner. The present study offers a beginning to the
development of such a model by describing some of the dyadic features
likely to be important in communication as it relates to sexual function or
dysfunction.
The major findings of the present study suggest that, consistent with
our hypotheses as well as with previous research and clinical observations
(Kilmann, 1984; LoPiccolo, 1978; MacNeil & Byers, 1997), couples with an
anorgasmic female partner reported more troubled sexual communication
than sexually functional couples. These distinguishably negative patterns
were apparent even when compared with the communication of couples
experiencing another serious problem area (such as chronic illness).
Among the differences in communication predicted, the expectation that
anorgasmic women would report lower levels of communication comfort
than the orgasmic women in the control groups was supported. Furthermore, results of the present study replicate previous research (Kelly et al.,
1990) in demonstrating that this difference relates most strongly to communication regarding direct clitoral stimulation activities (cunnilingus and
manual genital stimulation of the female). Moreover, preliminary findings in
the present study suggest that this pattern of lower communication comfort
related specifically to direct clitoral stimulation activities is characteristic of
the male partners of anorgasmic women as well.
It is not clear why couples with an anorgasmic female partner may have
particular difficulty discussing the sexual techniques (those involving direct
clitoral stimulation) upon which many women rely for orgasmic responsiveness. However, impediments to communication about these activities are
likely to interfere with the development of effective sexual stimulation that
could improve the sexual responsiveness of anorgasmic women (Hulbert &
Apt, 1995; Pierce, 2000). The fact that the same pattern is found in both the
anorgasmic women and their partners underscores the importance of viewing
and treating this sexual dysfunction in a couple format (Masters & Johnson,
1977).
Further evidence of communication difficulties in the anorgasmic couples was revealed in the analyses of perceptual accuracy measures. As
predicted, the male partners of anorgasmic women were significantly less
accurate than their Problem-Free Control and Chronic Illness Control group
counterparts in estimating their partners’ sexual preferences. This pattern,
noted in previous research with sexually dysfunctional couples (the majority
of whom suffered from female anorgasmia; Foster, 1978; Kilmann et al., 1984)
has been found to be responsive to a sex therapy program that included a
communication component (Foster, 1978).
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Both partners in the anorgasmic couples reported low acceptance of
the woman’s (but not the man’s) sexual responsiveness. Although this is
not surprising given that she was the symptomatic partner, it suggests that
the locus of responsibility for sexual difficulties in these couples was seen
by both partners to reside in the female. The notion that, at least in female
anorgasmia, the woman is considered by both partners to be the “repository”
of the problem may be an important dynamic in the development of female
anorgasmia. At the very least, to the extent that partners share this belief,
the psychological, relational, and sexual patterns resulting may be relatively
immutable.
The lack of difference between the men in the anorgasmic and control
groups on the sexual self-acceptance scale is not consistent with previous
research using this measure. Kilmann et al. (1984) found both males and females in couples with an anorgasmic female to manifest low self-acceptance,
and Zimmer (1983) found low self-acceptance to be characteristic of men
and women in couples with secondary sexual dysfunction (primarily of the
female). Thus, the males in the present sample appear to be atypically selfaccepting. Neither Kilmann et al. (1984) nor Zimmer (1983) mention how
their couples were recruited. If couples in the previous studies were targeted
for treatment (either being referred from clinical settings or offered treatment
as part of participation) they might be characteristically different than those
participating in the present research. Our largely nonclinical recruitment procedures may have attracted couples where the partners of the anorgasmic
women were atypically self-assured.
Additional group differences consistent with previous research were
found on other SII scales (Kilmann et al., 1984). Of all the women that we
studied, those in the Anorgasmic group reported the lowest sexual Pleasure
and greatest sexual Frequency Dissatisfaction (discrepancies between how
often various sexual experiences occur and how often the participant would
like them to occur). The male partners of anorgasmic women, although not
significantly different from the other men in their reported experienced sexual
Pleasure, did report a significantly greater degree of Frequency Dissatisfaction. This suggests that both members of the anorgasmic couples participating in the present research were substantially discontented with their current
sexual repertoire. The exploration of this dissatisfaction for each partner and
the processing of ideas for alleviating it may be fruitful avenues for clinical
intervention.
IMPLICATIONS FOR TREATMENT
Results of the present study strongly support the notion that communication is
related to sexual adjustment in a significant way (Cupach & Comstock, 1990;
Ferioni & Taffe, 1997; LoPiccolo, 1978; McCabe, 1999; McCarthy, 1995; Rosen
Communication and Anorgasmia
273
& Beck, 1988; Wheeless & Parsons, 1995). Consistent with most treatment
recommendations for anorgasmia (e.g., Bancroft, 1989; Heiman & GraftonBecker, 1989), the present findings argue for a couple-oriented or systems
approach to the treatment of this disorder. The observed communication
difficulties and their interactive nature suggest communication barriers that
are unlikely to be effectively and efficiently removed working only with the
anorgasmic woman.
The design of the present research does not allow for the formulation of causal explanations regarding the relationship between anorgasmia and communication problems. Although it is conceivable that the selfreported communication difficulties described by the anorgasmic couples
resulted in or exacerbated sexual functioning problems, it is also quite possible that sexual functioning difficulties led to or exacerbated the communication problems evidenced. Alternatively, other factors (such as a history of sexual trauma or lack of sex knowledge) may have resulted in
both the communication difficulties and in the sexual difficulties experienced by anorgasmic couples. At the very least, the existence of communication difficulties such as those revealed here would likely be to impede
the resolution of the problem. If couples’ communication comfort level is
not addressed, or if therapists do not consider that such comfort may vary
among sexual topics, resistance and other impediments to treatment may be
obscured.
There have now been two studies (Kelly et al., 1990 and the present investigation) suggesting that couples with an anorgasmic female partner may
evidence particular difficulty communicating about sexual techniques that
provide relatively direct clitoral stimulation. This may help to explain the
general effectiveness of directed masturbation training and clitoral stimulation oriented treatments for female anorgasmia (de Bruijn, 1982; LoPiccolo &
Stock, 1986). These methods educate, provide vocabulary, and, when conducted in a couples format, provide opportunities to discuss this highly effective form of sexual stimulation (Cotten-Huston & Wheeler, 1983; Leiblum
& Ersner-Hershfield, 1977). Based on the findings of the present study, it is
likely that interventions addressing direct clitoral stimulation issues will be
simultaneously challenging yet potentially powerful. Communication obstacles may be more evident in these interventions, but, if overcome, may result
in greater improvement in sexual functioning.
LIMITATIONS OF THE STUDY
As with all sexuality research, the limitations of volunteer bias (e.g., Strassberg
& Lowe, 1995) must be acknowledged. The couples studied may represent
the least inhibited or most motivated for change of those with an anorgasmic female partner. Therefore, results found may not generalize to all female
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anorgasmic couples. These findings also may tell us little about communication in couples with other sexual dysfunctions.
The employment of a problem control group offered the opportunity to
examine sexual communication in couples with chronic, nonsexual problems. The Chronic Illness Control group employed in the present study,
however, was an imperfect contrast in a number of ways. First, the group
consisted of mixed health problems, some of which had greater impact on
the participants than others. A group of participants with a uniform type
and level of problem would have offered a more appropriate comparison.
Furthermore, in the Chronic Illness Control group, the afflicted partner was
sometimes the male, sometimes the female, and in one case both. Employing a comparison group of couples where the female was consistently the
afflicted partner also would have allowed for a purer empirical comparison.
Finally, these results are limited to self-report measures. The extent to
which the perceived communication differences reported by these couples
corresponds to measurable behavioral differences must yet be established.
SUMMARY
Theorists, researchers, and clinicians have long argued that problems in communication are characteristic of many couples’ difficulties, including sexual
dysfunctions. The present study provides evidence consistent with this hypothesis. Couples with an anorgasmic female partner demonstrated a number
of self-reported communication problems that distinguished them from our
controls. It seems clear that each partner’s subjective experience of such
communication and the effects of this experience on his or her motivations
for continuing to engage in sexual communication are important areas for
further study.
Of course, the correlational nature of our study cannot distinguish
whether the identified communication problems preceded, followed, or were
related through another variable to the sexual problems. Irrespective of the
direction of causality, the kinds of communication difficulties evidenced by
the couples with an anorgasmic female partner certainly could help to maintain the dysfunction and, therefore, would be appropriate targets of therapeutic intervention. Such intervention would best be served by the treatment
of the couple rather than just the symptomatic partner.
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