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Communication and Associated Relationship Issues in Female Anorgasmia


Abstract and Figures

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.
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TJ1117-05 SMT.cls May 28, 2004 11:56
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
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 dysfunc-
tions. 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 hypoth-
esized, 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 con-
trols in discussing sexual activities associated with direct clitoral
stimulation. The etiologic and treatment implications of these dif-
ferences 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 com-
munication 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 spe-
cific nature of communication problems unique to sexually dysfunctional
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@
TJ1117-05 SMT.cls May 28, 2004 11:56
264 M. P. Kelly et al.
A review of theoretical models of the etiology/maintenance of anorgasmia
(Heiman & Grafton-Becker, 1989) argued that communication decits, lack
of condence in communication, and inhibitions to communication are re-
lated 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 signicantly less anticipated communi-
cation 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., Griftt
& Hateld, 1985). Difculties 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 spe-
cic communication problems in couples with an anorgasmic female part-
ner. Examining the minimal necessary conditions for the development of
effective sexual stimulation suggests some preliminary hypotheses. Assum-
ing 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).
In the present study, we explored the extent to which these and other ele-
ments in the communication process may distinguish couples with an anor-
gasmic 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 part-
ner 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 signicantly less com-
fort 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 signicantly less accurate
than the male partners of control group orgasmic women in estimating their
partnerssexual preferences.
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Communication and Anorgasmia 265
Participants were 47 heterosexual couples recruited via campus and commu-
nity newspapers and yers, through physician referral, and through contact
with patient afliate groups (e.g., Diabetes Association of America). Approxi-
mately 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 part-
ner reported being free of physical health problems and in which the fe-
male 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 part-
ners reported being free of problems in their physical health or their sex-
ual functioning (Problem-Free Control group, n = 16); and (c) couples in
which either partner reported a chronic physical health problem (e.g, di-
abetes, heart disease, emphysema) and in which both partners reported
being free of sexual functioning difculties (Chronic Illness Control group,
n = 17). Males were considered free of sexual dysfunction if they reported
sexual functioning sufcient 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 con-
sidered free of sexual dysfunction if they reported the ability to attain or-
gasm through some type of partner stimulation in at least 50% of sexual
All participants were at least 18 years of age, involved in a relationship
that they reported as steady and sexually activefor at least 9 months, and
reported an average frequency of sexual activity of at least once per week.
No signicant group differences were found for age (males 2069, median =
33; females 2056, median = 30); duration of relationship (10186 months,
median = 48 months); frequency of sexual activity (433 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.
Prescreening interview. Each member of responding couples was inde-
pendently administered a prescreening interview via telephone to assess for
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266 M. P. Kelly et al.
initial eligibility. Couples meeting eligibility criteria were given an appoint-
ment for data collection.
Sexual functioning interviews. Upon arriving in our laboratory, each
partner was individually interviewed by a same-sex interviewer to assess
the couples sexual functioning and behavior. These interviews focused on
each partners assessment of the sexual stimulation activities in which they
engaged and the perceived effectiveness of these activities. The primary pur-
pose of these interviews was to ensure that all couples met the sexual func-
tional eligibility requirements of their group placement.
The following measures were completed individually, in separate rooms, by
both members of all participating couples.
Sexual interaction inventory (SII; LoPiccolo & Steger, 1974). This in-
strument presents drawings of 17 different heterosexual activities and poses
a number of questions about each. For each activity, the following ques-
tion 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 prole
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 partners estimates of the
others enjoyment of particular sexual activities and the others 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
Locke-Wallace marital adjustment test (MAT; Locke & Wallace, 1959).
A minimally adapted form of this well known measure was used to assess
relationship adjustment.
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 indi-
vidually completed the SII, SCI, and MAT. Participants were informed that
information shared in interviews and questionnaires would not be revealed
to their partner.
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Communication and Anorgasmia 267
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 specic 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 cou-
ples (i.e., no sex-specic 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 signicant 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 signicantly (p <.05)
less anticipated Overall Communication Comfort related to talking with their
partners about various sexual activities.
We conducted further exploration of this nding. We computed sub-
scales of Communication Comfort for participantsresponses on those items
FIGURE 1. Communication comfort scores by group (females).
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268 M. P. Kelly et al.
FIGURE 2. Communication comfort scores by group (males).
related to (a) direct clitoral stimulation (receiving either oral sex or man-
ual genital stimulation) and (b) intercourse. We compared these scores via
oneway ANOVAs for women in the three groups. Results of these analy-
ses (see Figure 1) indicated a signicant 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 nonsignicant differ-
ence, F (2,44) = 1.29, p >.2, found on anticipated Communication Com-
fort 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 signicantly 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 specic hypotheses with respect to how males
in the study would score on the anticipated Communication Comfort mea-
sure, we analyzed results for males to generate preliminary ndings on this
variable. Analysis of variance results revealed a signicant 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 signicantly less ( ps < .05) antici-
pated 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 signi-
cant ( p <.05) only for the direct clitoral stimulation activities (see Figure 2).
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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 re-
vealed that, as hypothesized, male partners of Anorgasmic women showed
signicantly less accuracy ( p <.05) than did the partners of both groups of
orgasmic women in estimating their partners sexual preferences (Anorgas-
mic M = 18.73, Problem-Free M = 11.23, Chronic Illness M = 11.41, higher
scores mean less accuracy). A similar, but nonsignicant, F (2,44) = 2.08,
p = .14, pattern was seen for the women when we assessed their perception
of their male partners 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 signicance. 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 signicance
(t =−1.88, p = .066), with the Anorgasmic couples reporting marginally
poorer communication.
We conducted secondary analyses of the four remaining self-report scales
of the Sexual Interaction Inventory (Self-Acceptance, Partner-Acceptance,
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270 M. P. Kelly et al.
TABLE 1. Sexual Interaction Inventory Means for Males and Females by Group
Scale Anorgasmic Problem-free Chronic illness
Females 18.91 (11.9)
9.37 (6.5)
5.75 (5.0)
Males 5.30 (4.00) 4.00 (3.2) 4.12 (4.5)
Partner acceptance
Females 11.21 (7.5) 8.90 (8.4) 7.63 (6.8)
Males 22.56 (11.7)
11.0 (8.1)
11.41 (10.8)
Females 4.33 (0.9)
5.18 (0.4)
5.24 (0.6)
Males 5.23 (0.4) 5.44 (0.4) 5.43 (0.7)
Frequency dissatisfaction
Females 17.79 (9.3)
12.40 (8.9)
9.72 (6.2)
Males 22.66 (7.7)
15.12 (6.7)
11.63 (8.1)
Note. Means with different subscripts in the same row are signicantly ( 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
Pleasure Mean, and Frequency Dissatisfaction) to provide descriptive infor-
mation 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 signicantly less part-
ner 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 signicantly less partner sexually accepting,
F (2,44) = 6.02, p <.01, but not signicantly 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 signicantly from
each other on these variables.
Anorgasmic females reported deriving signicantly less pleasure, F
(2,44) = 8.76, p <.001, from sexual activities than did women in the con-
trol groups, who did not differ signicantly 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 signicantly dif-
ferent (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 signicantly 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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Communication and Anorgasmia 271
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
The major ndings 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. Further-
more, results of the present study replicate previous research (Kelly et al.,
1990) in demonstrating that this difference relates most strongly to com-
munication regarding direct clitoral stimulation activities (cunnilingus and
manual genital stimulation of the female). Moreover, preliminary ndings in
the present study suggest that this pattern of lower communication comfort
related specically 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 difculty discussing the sexual techniques (those involving direct
clitoral stimulation) upon which many women rely for orgasmic responsive-
ness. 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,
Further evidence of communication difculties in the anorgasmic cou-
ples was revealed in the analyses of perceptual accuracy measures. As
predicted, the male partners of anorgasmic women were signicantly 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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272 M. P. Kelly et al.
Both partners in the anorgasmic couples reported low acceptance of
the womans (but not the mans) sexual responsiveness. Although this is
not surprising given that she was the symptomatic partner, it suggests that
the locus of responsibility for sexual difculties 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
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 fe-
males 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 self-
accepting. 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 pro-
cedures 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
signicantly different from the other men in their reported experienced sexual
Pleasure, did report a signicantly greater degree of Frequency Dissatisfac-
tion. This suggests that both members of the anorgasmic couples participat-
ing 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
Results of the present study strongly support the notion that communication is
related to sexual adjustment in a signicant way (Cupach & Comstock, 1990;
Ferioni & Taffe, 1997; LoPiccolo, 1978; McCabe, 1999; McCarthy, 1995; Rosen
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Communication and Anorgasmia 273
& Beck, 1988; Wheeless & Parsons, 1995). Consistent with most treatment
recommendations for anorgasmia (e.g., Bancroft, 1989; Heiman & Grafton-
Becker, 1989), the present ndings argue for a couple-oriented or systems
approach to the treatment of this disorder. The observed communication
difculties and their interactive nature suggest communication barriers that
are unlikely to be effectively and efciently removed working only with the
anorgasmic woman.
The design of the present research does not allow for the formula-
tion of causal explanations regarding the relationship between anorgas-
mia and communication problems. Although it is conceivable that the self-
reported communication difculties described by the anorgasmic couples
resulted in or exacerbated sexual functioning problems, it is also quite possi-
ble that sexual functioning difculties led to or exacerbated the commu-
nication problems evidenced. Alternatively, other factors (such as a his-
tory of sexual trauma or lack of sex knowledge) may have resulted in
both the communication difculties and in the sexual difculties experi-
enced by anorgasmic couples. At the very least, the existence of commu-
nication difculties 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
There have now been two studies (Kelly et al., 1990 and the present in-
vestigation) suggesting that couples with an anorgasmic female partner may
evidence particular difculty communicating about sexual techniques that
provide relatively direct clitoral stimulation. This may help to explain the
general effectiveness of directed masturbation training and clitoral stimula-
tion oriented treatments for female anorgasmia (de Bruijn, 1982; LoPiccolo &
Stock, 1986). These methods educate, provide vocabulary, and, when con-
ducted in a couples format, provide opportunities to discuss this highly ef-
fective form of sexual stimulation (Cotten-Huston & Wheeler, 1983; Leiblum
& Ersner-Hersheld, 1977). Based on the ndings of the present study, it is
likely that interventions addressing direct clitoral stimulation issues will be
simultaneously challenging yet potentially powerful. Communication obsta-
cles may be more evident in these interventions, but, if overcome, may result
in greater improvement in sexual functioning.
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 anorgas-
mic female partner. Therefore, results found may not generalize to all female
TJ1117-05 SMT.cls May 28, 2004 11:56
274 M. P. Kelly et al.
anorgasmic couples. These ndings also may tell us little about communica-
tion 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 prob-
lems. 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 aficted partner was
sometimes the male, sometimes the female, and in one case both. Employ-
ing a comparison group of couples where the female was consistently the
aficted 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.
Theorists, researchers, and clinicians have long argued that problems in com-
munication are characteristic of many couples difculties, including sexual
dysfunctions. The present study provides evidence consistent with this hy-
pothesis. 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 partners 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 identied communication problems preceded, followed, or were
related through another variable to the sexual problems. Irrespective of the
direction of causality, the kinds of communication difculties evidenced by
the couples with an anorgasmic female partner certainly could help to main-
tain the dysfunction and, therefore, would be appropriate targets of thera-
peutic intervention. Such intervention would best be served by the treatment
of the couple rather than just the symptomatic partner.
Bancroft, J. (1989). Human sexuality and its problems (2nd ed). Edinburgh: Churchill
Bienvenue, M. J., Sr. (1980). Counselors and teachers manual for the secual com-
munication inventory. Saluda, NC: Family Life Publications.
TJ1117-05 SMT.cls May 28, 2004 11:56
Communication and Anorgasmia 275
de Bruijn, G. (1982). From masturbation to orgasm with a partner: How some women
bridge the gapAnd why others dont. Journal of Sex & Marital Therapy, 8, 151
Cotten-Huston, A. L., & Wheeler, K. A. (1983). Preorgasmic group treatment: As-
sertiveness, marital adjustment, and sexual function in women. Journal of Sex
& Marital Therapy, 9, 296302.
Cupach, W. R., & Comstock, J. (1990). Satisfaction with sexual communication in
marriage: Links to sexual satisfaction and dyadic adjustment. Journal of Social
and Personal Relationships, 7, 179186.
Delaehanty, R. (1983). Changes in assertiveness and changes in orgasmic response
occurring with sexual therapy for preorgasmic women. Journal of Sex & Marital
Therapy, 8, 198208.
Ferroni, P., & Taffe, J. (1997). Womens emotional well-being: The importance of
communicating sexual needs. Sexual and Marital Therapy, 12, 127138.
Foster, A. L. (1978). Changes in marital sexual relationship following treatment for
sexual dysfunctioning. Journal of Sex and Marital Therapy, 4, 186197.
Fowers, B. J. (2001). The limits of technical concept of a good marriage: Exploring
the role of virtue in communication skills. Journal of Marriage & Family Therapy,
27, 327340.
Griftt, W., & Hateld, E. (1985). Human sexual behavior. Glenview, IL: Scott,
Halford, W. K., Hahlweg, K., & Dunne, M. (1990). The cross-cultural consistency of
marital communication associated with marital distress. Journal of Marriage &
the Family, 52, 487499.
Heiman, J. R., & Grafton-Becker, V. (1989).Becoming orgasmic: A sexual growth
program for women. Englewood Cliffs, NJ: Prentice-Hall.
Hulbert, D. F., & Apt, C. (1995). The coital alignment technique and directed mastur-
bation: A comparative study on female orgasm. Journal of Sex & Marital Therapy,
21, 2129.
Kelly, M. P., Strassberg, D. S., & Kircher, J. R. (1990). Attitudinal and experimental
correlates of anorgasmia. Archives of Sexual Behavior, 19, 165177.
Kilmann, P. R. (1984). Human sexuality in contemporary life. Boston: Allyn and
Kilmann, P. R., Mills, K. H., Caid, C., Bella, B., Davidson, E., & Wanlass, R. (1984).
The secual interaction of women with secondary orgasmic dysfunction and their
partners. Archives of Sexual Behavior, 13, 4149.
Leiblum, S. R., & Ersner-Hersheld, R. (1977). Sexual enhancement groups for dys-
functional women: An evaluation. Journal of Sex & Marital Therapy, 3, 139152.
Locke, H. J., & Wallace, K. M. (1959). Short marital adjustment and prediction tests:
Their reliability and validity. Marriage & Family Living, 21, 251255.
LoPiccolo, J. (1978). Direct treatment of sexual dysfunction. In J. LoPiccolo &
L. LoPiccolo (Eds.), Handbook of sex therapy (pp. 118). New York: Plenum.
LoPiccolo, J., & Steger, J. C. (1974). The sexual interaction inventory: A new in-
strument for assessment of sexual dysfunction. Archives of Sexual Behavior, 3,
LoPiccolo, J., & Stock, W. E. (1986). Treatment of sexual dysfunction. Journal of
Consulting and Clinical Psychology, 49, 760762.
TJ1117-05 SMT.cls May 28, 2004 11:56
276 M. P. Kelly et al.
MacNeil, S., & Byers, E. S. ( 1997). The relationships between sexual problems,
communication, and sexual satisfaction. Canadian Journal of Human Sexuality,
6, 277283.
Markman, H. J., Floyd, F. J., Stanley, S. M., & Storaasli, R. D. (1988). Prevention of
marital distress: A longitudinal investigation. Journal of Consulting and Clinical
Psychology, 56, 210217.
Masters, W. H., & Johnson, V. E. (1977). Principles of the new sex therapy. American
Journal of Psychiatry, 133, 548554.
McCabe, M. P. (1999). The interrelationship between intimacy, sexual functioning,
and sexuality among men and women in committed relationships. Canadian
Journal of Human Sexuality, 8, 3138.
McCarthy, B. W. (1995). Bridges to sexual desire. Journal of Sex Education and
Therapy, 21, 132141.
Pierce, A. P. (2000). The coital alignment technique (CAT): An overview of studies.
Journal of Sex & Marital Therapy, 26, 257268.
Rosen, R. C., & Beck, J. G. (1988). Patterns of sexual arousal: Psychophysiological
and clinical applications. New York: Guilford Press.
Schmaling, K. B., & Jacobson, N. S. (1990). Marital interaction and depression. Jour-
nal of Abnormal Psychology, 99, 229236.
Strassberg, D. S., & Lowe, K. (1995). Volunteer bias in sexuality research. Archives
of Sexual Behavior, 24, 369382.
Wheeless, L. R., & Parsons, L. A. (1995). What you feel is what you might get:
Exploring communication apprehension and sexual communication satisfaction.
Communication Research Reports, 12, 3945.
Zimmer, D. (1983). Interaction patterns and communication skills in sexually dis-
tressed, martially distressed, and normal couples: Two experimental studies.
Journal of Sex & Marital Therapy, 9, 251265.
... Deceptive sexual communication may temporarily bolster men's sense of masculinity but at the cost of sexual satisfaction. Open and honest sexual communication predicts women's sexual satisfaction and orgasms (Davis et al., 2006;Kelly et al., 2004;Leonhardt et al., 2018). In addition, male partners of women who orgasmed infrequently were much less accurate in their perceptions of their partner's sexual preferences (Kelly et al., 2004). ...
... Open and honest sexual communication predicts women's sexual satisfaction and orgasms (Davis et al., 2006;Kelly et al., 2004;Leonhardt et al., 2018). In addition, male partners of women who orgasmed infrequently were much less accurate in their perceptions of their partner's sexual preferences (Kelly et al., 2004). ...
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We explored whether women who perceive that their partners’ manhood is precarious (i.e., easily threatened) censor their sexual communication to avoid further threatening their partners’ masculinity. We operationalized women’s perceptions of precarious manhood in a variety of ways: In Study 1, women who made more money than their partners were twice as likely as those who did not to fake orgasms. In Study 2, women’s higher perceptions of partners’ precarious manhood indirectly predicted faking orgasms more, lower sexual satisfaction, and lower orgasms rate through greater anxiety and less honest communication. In Study 3, women who imagined a partner whose masculinity was insecure (vs. secure) were less willing to provide honest sexual communication, via anxiety. Together, the studies demonstrate a relationship between women’s perceptions of partner insecurity, anxiety, sexual communication, and sexual satisfaction.
... En milieu clinique, une prévalence allant de 12 à 17% de vaginisme a été trouvée (Hirst, Baggaley et Watson, 1996 ;Spector et Carey, 1990 (Andersen et Cyranowski, 1994 ;Beaber et Werner, 2009 ;Gerrior et al., 2015 ;Laan et al., 1993 ;, et la distraction cognitive (Cuntim et Nobre, 2011 ;Dove et Wiederman, 2000) sont les plus 63 fréquemment citées. Certaines études évoquent également les problèmes de communication dans le couple (Kelly, Strassberg et Turner, 2004) et la peur de perdre le contrôle (Graham, 2014). Enfin, à propos des douleurs génitales, la vulvodynie serait liée à une sensibilisation centrale ; et la dyspareunie concernerait principalement les femmes périménopausées ou des femmes ayant subi une période de stress marqué (cancer, divorce, chômage… ; Jarousse, 2011), ou encore un abus sexuel (Landry et Bergeron, 2011 (Baumeister, Catenese et Vohs, 2001 ;Brody, 2007 ;Chivers et al., 2010 ;Laan et al., 1993). ...
... . L'anxiété(Andersen et Cyranowski, 1994 ;Beaber et Werner, 2009 ;Gerrior et al., 2015 ;Laan et al., 1993 ; et la distraction cognitive(Cuntim et Nobre, 2011 ;Dove et Wiederman, 2000) sont les plus fréquemment citées, ou encore les problèmes de communication dans le couple(Kelly, Strassberg et Turner, 2004) et la peur de perdre le contrôle(Graham, 2014). Il semble ainsi pertinent de proposer une prise en charge TCC pour ces patientes. ...
Dans cette thèse de doctorat, nous avons souhaité mettre à jour les différentes habiletés érotiques favorables à la fonctionnalité sexuelle féminine, afin de tester un protocole de traitement des dysfonctions sexuelles féminines, basé sur le développement de ces habiletés. Ces dernières sont utilisées avec succès dans certaines thérapies sexuelles, telles que la thérapie Sexofonctionnelle ou l’approche Sexocorporelle. Pour cela, nous avons dans un premier temps, identifié les habiletés érotiques auprès d’une population de femmes satisfaites sexuellement en comparaison de femmes insatisfaites. Puis dans un deuxième temps, nous avons testé les liens entre ces habiletés et la fonctionnalité sexuelle, c’est-à-dire le fonctionnement et la satisfaction sexuelle, selon différentes méthodologies. Enfin, nous avons construit, puis testé avec de bons résultats, un protocole de traitement des dysfonctions sexuelles féminines basé sur le développement de ces habiletés érotiques.
... One study found that couples with an anorgasmic female partner had more problems in communication about sexual issues compared to controls. 48 Sexuality being a very sensitive topic of conversation, couples with marital distress perhaps might have difficulty expressing their dissatisfactions or their needs. In this study, significant association is found between sexual communication and marital quality. ...
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Background Sexual dysfunction and marital intimacy and quality are found to have a reciprocal relationship. Examining this relationship in couples seeking help for sexual dysfunctions in the cultural context of India is worthwhile. Aim This study aims to explore the nature of sexual functioning, sexual interaction, sexual communication, and marital intimacy and quality in couples with sexual dysfunction. Further, relationship between the above variables is also examined. Methods A cross-sectional, single-group exploratory design was adopted. A sample of 155 married heterosexual individuals, with a clinical diagnosis of sexual dysfunction in either of the spouses, was included in the study. The tools used included MINI neuropsychiatric interview, Marital Quality Scale, Marital Intimacy Questionnaire, Dyadic Sexual Communication Scale, and Sexual Interaction Inventory. Results Erectile dysfunction and premature ejaculation in men and hypoactive sexual desire disorder in women were the most common sexual dysfunctions. Majority of the sample were young adults. About 82% of the sample had moderate-to-severe levels of marital distress. Mood disorder was the most common psychiatric disorder reported in the sample. High levels of intimacy problems were seen with no significant gender differences in the overall marital quality or intimacy. Difficulty in the overall sexual interactions was found; however, higher levels of dissatisfaction with the frequency of sex and lower self-acceptance was reported by men compared to women. Significant interrelationships were found between marital quality and intimacy, sexual interaction, and sexual communication. Conclusions Sexual dysfunctions and marital distress are closely related. Sexual interaction and sexual communication play a significant role in marital quality and intimacy.
... Considering diverse preferred techniques for clitoral stimulation, this requires multifaceted communication with a partner (Herbenick et al., 2018;Towne, 2019). It is noteworthy, then, that women who have difficulty experiencing orgasm have reported problematic communication with partners about sexual activities linked to direct clitoral stimulation (Kelly, Strassberg, & Turner, 2004). ...
This systematic review provides an overview of what qualitative research has revealed about partner-related factors around women’s masturbation and explores how these factors relate to women’s behavior, perceptions, and motives towards masturbation. Eleven studies were identified and secondary thematic analysis was used for synthesis. Women’s perceptions often focus on the (potential) negative influences of masturbation on current or future relationships. Motivations some women reported for masturbating due to partner-related factors were diverse. Findings suggested that some women modify their masturbation behavior when in a relationship. The implications of these findings for sexual health educators and clinicians are discussed.<br/
... A fourth and final reason for the orgasm gap is lack of training and skills in sexual communication. Although sexual communication is related to sexual satisfaction (Byers & Demmons, 1999;Litzinger & Gordon, 2005;MacNeil & Byers, 2005), communication surrounding sexuality is not common if one or more partners has trouble having an orgasm (Kelly et al., 2004). In place of clear sexual communication, most young adults tend to infer, rather than ask, if their partner is sexually satisfied (Laumann et al., 1994). ...
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The current study examined whether reading the chapter titled “Cliteracy for Him” from the book Becoming Cliterate is an effective intervention for increasing young heterosexual men’s sexual functioning. Specifically, this study compared an intervention group (i.e., those who read the chapter) to a waitlist control group at three points in time: before reading the chapter, immediately after reading the chapter, and three weeks later. Outcome measures included clitoral knowledge, sexual self-esteem, sexual depression, communication during sexual activity, and dysfunctional beliefs about sexuality (e.g., beliefs about women’s satisfaction, about being “macho,” and sexual conservatism). Participants who read the bibliotherapy chapter showed immediate improvement on clitoral knowledge, dysfunctional beliefs about women’s sexual satisfaction, and sexual communication. Longer-term improvements were found on clitoral knowledge, and dysfunctional beliefs about both women’s sexual satisfaction and being “macho.” Additionally, compared to the waitlist control group, men in the intervention group demonstrated better sexual communication and fewer dysfunctional beliefs about women’s sexual satisfaction immediately after reading the chapter, and more clitoral knowledge, fewer dysfunctional beliefs about women’s sexual satisfaction, fewer dysfunctional macho beliefs, and lower sexual depression three weeks after reading the chapter. Clinical implications and future research directions are discussed.
... A fourth and final reason for the orgasm gap is lack of training and skills in sexual communication. Although sexual communication is related to sexual satisfaction (Byers & Demmons, 1999;Litzinger & Gordon, 2005;MacNeil & Byers, 2005), communication surrounding sexuality is not common if one or more partners has trouble having an orgasm (Kelly et al., 2004). In place of clear sexual communication, most young adults tend to infer, rather than ask, if their partner is sexually satisfied (Laumann et al., 1994). ...
Full-text available
The original article unfortunately contained mistakes. In the table, “95% usually always orgasm2” was not changed to “95% usually-always orgasmb”.
... Assim, relacionamentos estáveis de longa duração dependem dos métodos de comunicação entre os cônjuges (Kaplan, 1999). A comunicação é um fator muito importante para a saúde sexual, pois, o fato de os cônjuges conversarem aberta e honestamente também sobre gostos e preferências (Kelly, Strassberg & Turner, 2004) leva à aceitação e ao entendimento da própria sexualidade e da sexualidade do parceiro, gerando satisfação com a relação (Delamater & Friedrich, 2002), da mesma forma que a satisfação com a relação e sentimentos positivos em relação ao parceiro têm efeito no bem-estar e na libido (Hartmann et al., 2004). ...
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Desafios clínicos em terapia cognitivo-comportamental aborda temas desafiantes e pouco discutidos na literatura específica da área das terapias cognitivo-comportamentais, como o uso das metá-foras, da criatividade e da meditação, a abordagem com bebês, o tratamento psicoterápico a distância, a prevenção do suicídio, a infertilidade, entre outros. Em cada capítulo, com objetivo didático, são apresentadas resenhas clínicas para ilustrá-los. O livro é destinado a profissionais da área de saúde que traba-lham com as terapias cognitivo-comportamentais, sendo um instru-mento útil para nortear suas práticas profissionais.
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Ženský orgasmus je komplexní psychosomatický proces. Přestože existuje celá řada definic ženského orgasmu, většina z nich se shoduje, že se skládá ze dvou komponent: z tělesné složky, kdy dochází k uvolnění neuromuskulárního napětí v těle ženy v reakci na tělesné dráždění, a z psychologické složky, kdy ženy pociťují sexuální naplnění a uspokojení. Výskyt ženského orgasmu je velmi variabilní a závisí na mnoha faktorech. V rámci tohoto textu představujeme některé z těchto faktorů, které ovlivňují orgastickou schopnost žen a to s důrazem na partnerskou a sexuální perspektivu.
Introduction: This study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction. Aim: To compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm. Methods: A convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion. Main outcome measure: We applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05). Results: Statistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants. Clinical implications: To the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties. Conclusion: When women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments. Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2019;XX:XXX-XXX.
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Reviews current knowledge on the treatment of sexual dysfunction, focusing on established techniques, recent developments, and methodological limitations in recent literature. Primary orgasmic dysfunction in women responds well to directed masturbation training programs. Lack of coital orgasm, which is not clearly a true dysfunction in that it involves value judgments about normality, is more resistant to change. More complex issues of habit formation, male partner performance, and marital satisfaction seem to be related to this lower treatment effectiveness. Male premature ejaculation is easily treated, although little is known about the causes of premature ejaculation or the mechanisms that account for treatment effectiveness. There has been much recent work on the differential diagnosis of physical and psychological causes of erectile failure but relatively little new offered beyond W. H. Masters and V. E. Johnson's (1966, 1970) standard treatment techniques. Much of the clinical literature on treatment of sexual dysfunction is difficult to interpret because of recurring problems in methodology, including small sample sizes, confounded treatments, and lack of objective outcome measures. (96 ref)
Prepared by one of the world's leading authorities, Human Sexuality and its Problems remains the foremost comprehensive reference in the field. Now available in a larger format, this classic volume continues to address the neurophysiological, psychological and socio-cultural aspects of human sexuality and how they interact. Fully updated throughout, the new edition places a greater emphasis on theory and its role in sex research and draws on the latest global research to review the clinical management of problematic sexuality providing clear, practical guidelines for clinical intervention. Clearly written, this highly accessible volume now includes a new chapter on the role of theory, and separate chapters on sexual differentiation and gender identity development, transgender and gender non-conformity, and HIV, AIDS and other sexually transmitted diseases. Human Sexuality and its Problems fills a gap in the literature for academics interested in human sexuality from an interdisciplinary perspective, as well as health professionals involved in the management of sexual problems.
The field of sex therapy is one in which practical applications have been much more emphasized than basic research. Paradoxically, sex therapy consists of a variety of procedures that are demonstrably effective, but the reasons for this effectiveness are not known. Thus, different therapists use very different theoretical viewpoints to “explain” why their sex therapy procedures work. In this chapter, an attempt is made to find the common elements in different sex therapy programs, and so arrive at a set of common basic principles of sex therapy. In addition, this chapter provides a brief overview and summary of the etiology and treatment of the common sexual dysfunctions that are more thoroughly discussed in other chapters of this volume.
A major problem in research on the effectiveness of sex therapy procedures has been the lack of a valid and reliable measure of sexual functioning. In many other types of direct, behavioral therapy (e.g., assertiveness training) the patients can be directly observed while engaging in the target behavior. In the area of sexual behavior, ethical and social considerations obviously make direct observation impossible. Consequently, many clinicians have relied on the patients’ unsystematic verbal report as the measure of treatment outcome. This chapter offers a structured behavioral self-report inventory as an alternative to such informal assessment. Many of the other chapters in this volume include data from this inventory as a measure of treatment effectiveness. This chapter will familiarize the reader with the inventory and make the clinical chapters to follow more easily understood.
This study examined the relationships between sexual problems, sexual self-disclosure and sexual satisfaction in a community sample. Fifty-three women and 34 men in long-term, heterosexual relationships returned completed questionnaires. A majority of the men and women reported that they had experienced one or more sexual concerns or problems in the past 18 months. For both men and women, an increasing number of sexual concerns and problems for self and for partner was associated with decreased sexual satisfaction. Both better communication in general, and disclosure of specific sexual likes and dislikes in particular, were associated with increased sexual satisfaction. However, the quality of communication did not alter the relationship between sexual problems and concerns and sexual satisfaction. Implications for sex therapy and future research are discussed.
Scales measuring the broad constructs of intimacy, relationship functioning, and sexual functioning were completed by 137 males (mean age 33.4 years) and 102 females (mean age 29.6 years) who had been in a committed heterosexual relationship for at least 12 months. The goal of the study was to determine how men and women would differ on individual dimensions of these constructs and to identify those dimensions most strongly associated with relationship quality and sexual satisfaction. Among the 5 categories of intimacy assessed (emotional, social, sexual, intellectual and recreational), the only sex difference observed was that women reported higher sexual intimacy scores. The sexes did not differ on any of the three relationship scale measures (general relationship, conflict, and communication) but on the sexuality scale, men reported higher scores than women on sexual satisfaction, sexual communication, positive attitudes toward sex, desire for more physical contact, and on their rating of partner's level of sexual dysfunction. Men also assigned lower sexual attitude scores to their partner than did women. The most consistent predictors of relationship functioning for both sexes were scores on three sexuality measures that did not differ between the sexes: conventionality, sexual behaviour, and respondent's assessment of their own level of sexual dysfunction. Studies on the interrelationships between intimacy, relationship functioning, and sexuality should incorporate not only global measures of these three broad constructs but also measures of the specific dimensions from which these global constructs are derived.
In order to assess the cross-cultural consistency of marital communication associated with marital distress, the problem-solving behaviors of four samples of couples were compared: (1) maritally unhappy couples (n = 24) from Munich, Germany, (2) maritally happy couples (n = 12) from Munich, (3) maritally unhappy couples (n = 20) from Brisbane, Australia, and (4) maritally happy couples (n = 20) from Brisbane. Across cultures, distressed couples engaged in significantly higher rates of negative verbal and nonverbal behaviors, and were more likely to engage in coercive escalation. Some cultural differences were evident; the German couple had higher rates of the negative verbal behaviors of criticism and refusals than the Australian couples. The happy Australian couples were much less likely to respond negatively to the neutral or negative responses of their partners than the other three groups. It was concluded that there are important cultural differences in the frequency and functional significance of negative verbal communication, but there also are some cross-culturally consistent marital communication behaviors associated with marital distress.
We explored the relationship of interpersonal communication apprehension and receiver apprehension to sexual communication satisfaction in 110 sexually intimate relationships. We predicted that both sending and receiving dimensions of communication apprehension would be negatively associated with sexual communication satisfaction and would be more strongly associated for women than for men. A significant negative association was discovered and was more strongly and meaningfully related for women than for men. Moreover, the association was not significant for men.