Journal of PsychosomaticResearch,Vol. 12, pp. 39 to 49. PergamonPress 1968.

Printed in Northern Ireland

Session 3
CHAIRMAN: N. MORRIS

HUMAN SEXUAL RESPONSE-A DISCUSSION OF THE

WORK OF MASTERS AND JOHNSON*
M. PINES?

If you want to know more about femininity, enquire from your

own experiences, or turn to the poets, or wait until science can
give you deeper and more coherent information (Freud [l]).

IN THE thirty-five years since this was written science has given us much information
about the biology of sex. We know more about the psychology of sex than Freud
knew, though much of this new understanding has not yet become widely known or
integrated with classical psycho-analytical theory. The biology of human sexuality,
the facts about human physical responses in sexual situations have only been studied
recently, largely through the work we are going to discuss now--that of Masters and
Johnson. It is with some sense of relief that we can pass to this sober experimental
appraisal of the anatomical and physiological changes which arise during sexual
stimulation, which reveals much new and valuable information. The stiff and turgid
language with which Masters and Johnson describe their work forms a vivid and
welcome contrast to the deluges of sexual stimuli, mini-messages pouring daily into
our sense organs, the news of the world that runs down the gutters of our channels
of communication, carrying with it the noise of the changing immorality of our society.
This quiet study of human sexual behaviour has been carried out on the campus of
the University of Washington D.C. For ten years Masters and Johnson have been
conducting an intensive research programme. They have chosen to observe the
anatomical and physiological aspects of human sexual behaviour in the laboratory
setting. These new hard facts about sexual life have been derived from a volunteer
population of 382 women and 312 men aged between twenty-one and eighty-nine.
They have gone naked into the sexual laboratory to be photographed, measured and
palpated. Anonymous, known only by letter or number, are they heroes or victims,
these freedom fighters on a distant front? Masters and Johnsons work is uncompli-
cated by psychological considerations. Let us now see what science without poetry
or psychology has to show us about sex.
Changes in sexual anatomy and physiology during auto-stimulation and coitus
have been recorded by physical examination, biochemical methods, and by cinema-
tography. A most interesting and novel use of photography has been made possible by
the construction of an artificial penis through which colour photographic records
of the vagina can be made throughout the whole female sexual response cycle, using
cold light techniques similar to those that we are familiar with in surgery. This
* MASTERSW. H. and JOHNSONV. E. Human Sexual Response, Littlc, Brown & Company,
Boston, Mass. (1965): Churchill, London (1966).
-1 Cassel Hospital, Richmond, Surrey.
39
40 M. PINES

artificial penis is also powered by an electric motor and the woman using it can control
the speed and depth of its movements and thereby can mimic coitus. (An illustration
of the apparatus is not available as the authors believe it might excite pornographic
interest in their work.)

Refractory
Period
\
\
\
\p
\B
\2
\s
\9
\
\

Male sexual response cycle

FIG. 1

I;emale sexual response Cycle

FIG. 2

Masters and Johnson describe the typical human sexual response cycle as follows:
Both male and female cycles are divided into 4 phases; (1) the excitement phase;
(2) the plateau phase; (3) the orgasmic phase; and (4) the resolution phase. Although
there are very many variants in any one individuals sexual response cycle, these are
regarded as variations in duration rather than in intensity and therefore can be
subsumed under the same pattern (Fig. 1).
The female cycle has been shown to have three different response patterns (Fig. 2)
as opposed to the single typical male pattern.
 Human Sexual Response-A discussion of the work of Masters and Johnson 41

The excitement phase is usually easily aroused, any source of physical or psychic
stimulus being effective. If this stimulation is acceptable to the individual, the intensity
of the response rises rapidly and thereby the excitement phase is accelerated or
shortened. If the stimulation is not acceptable, being either physically or psychologic-
ally objectionable, the excitement phase is greatly prolonged or even aborted.
If the effective sexual stimulation continues, sexual tensions are intensified and
reach to the extreme level from which the individual ultimately may move to orgasm.
This is the plateau phase. The duration of this phase depends on the effectiveness of
the stimulus, the individuals response to it, and what they term the factor of individ-
ual drive for culmination of sex tension increment. Interruption or difficulties here
can prevent orgasmic release and there will be a slow drop from plateau-phase tension
level into extremely prolonged resolution phase.
The orgasmic phase is limited to those few seconds during which the veinous
constriction and myotonia developed from sexual stimuli are released. This involun-
tary climax is reached at any level that represents maximum sexual tension increment
for the particular occasion.
There is much greater variation in both the intensity and duration of female
orgasmic experience than there is in the male.
Both male and female pass from orgasm to a resolution phase. In reverse reaction
it returns the individual through plateau and excitement level to an unstimulated state.
The male goes through a refractory period during which effective response to sexual
stimulus is absent. The female capacity or orgasmic response on the other hand seems
enhanced by the experience of orgasm and she can experience multiple orgasms which
will increase in intensity. Physiologically she is said to be potentially insatiable, only
physical exhaustion ending her physical response cycle.
There are two basic physiological changes during the human sexual response cycle.
The first reaction to sexual stimulation is a widespread vaso congestion and the second
response is a generalized increase in muscle tension. The orgasm represents the
discharge of these tensions. Masters and Johnson emphasize that the similarities in
the male and female response pattern are much more striking than are the differences.
The first significant difference has already been referred to, that is the absence of a
refractory period following orgasm in the female. The second major difference
between the male and female is that cessation of effective sexual stimulation at any
point before orgasm results in the disappearance of the orgasmic response in the
female. The inevitability of orgasmic discharge of the male is not paralleled in a
similar way in the female.
The research population from which the data have been derived has been drawn
almost entirely from volunteers. Most have been intelligent middle-class people,
some of whom had sexual difficulties for which they sought help; others have volun-
teered to take part in the programme. Presumably the specific characteristics of any
volunteer population can be found here, but Masters and Johnson believe that the
uniformity of the patterns that they have described adequately counters the question
that coitus under natural conditions might show different characteristics. In effect
they claim that 10,000 cycles cant be wrong.
The new light that these researches have directed falls mainly on the mechanisms
of female orgasm. The anatomy and physiology of the female orgasm have been the
subject of a great debate for many years, one which we can now pursue on slide and
 42 M. PINES

film. Our authors conclusion is that when any woman experiences orgasmic response
to effective sexual stimulation, the vagina and the clitoris react in consistent patterns.
Thus clitoral and vaginal orgasm are not separate biological entities.
From an anatomic point of view there is absolutely no difference in the responses
of the pelvic viscera to effective stimulation, regardless of where the stimulation arises
(Fig. 3). They have shown that the clitoris regularly shows the following reactions:

Shaft diameter
incrl

UNSTIMULATED BASELINE EXCITEMENT PHASE PLATEAU PHASE

The clitoris in the female sexual reponse cycle. The orgasmic phase is omitted because
of lack of information.
FIG. 3

During the excitement phase there is an increase in the size of the clitoris, possibly
in the glans but always in the shaft. During the plateau phase the most significant
reaction occurs which is that the entire clitoral body retracts and is hidden under the
protective clitoral hood or foreskin. Observations during the orgasmic phase have
not been possible. It is evident however that direct penile clitoral contact is only
rarely possible during intercourse and hence that the advice of many sex manuals and
the labours and aerobatics of many couples are now obsolescent. Masters and Johnson
believe that the contact between penis and clitoris is indirect and arises from the penile
shaft distension of the minor labia at the vaginal vestibule, where the wings of the
clitoral hood pull the clitoral body downwards. Direct and indirect stimulation of
the clitoris are essentially inseparable in their effect.
Masters and Johnson do not discount the importance of psychological experience
in the sexual response and orgasm. They point out that the clitoris possesses both
afferent and efferent pathways and that it responds to psychic stimulation alone.
They emphasize that the full orgasmic response is always a whole person experience;
others might argue that it is a trans-personal, a two-person experience.
Masters and Johnson have identified most interesting changes in the anatomy and
physiology of the vagina during sexual excitement. The first reaction is lubrication,
not from the cervix or from Bartholins Glands, but by means of a transudate-like
liquid derived from the veinous plexus surrounding the vagina. Even an artificial
vagina will soon begin to produce an identical fluid (Fig. 4). The lubrication is
followed by a lengthening and distension of the inner two-thirds of the vaginal barrel
and the cervix and body of the uterus are pulled slowly back and up into the false
pelvis (Figs. 5-9). As the plateau phase is reached, a marked phase of congestive
reaction develops in the outer third of the vaginal barrel to the extent that the central
lumen of the vaginal barrel becomes reduced by one-third as compared with the
Human Sexual Response-A discussion of the work of Masters and Johnson 43

+ 5-75-6.25 cm -_)

T
4cm-r

I
II
9.5 - IO.5 cm

7-8cm

I I
Unstimulotcd Stimulated
(Advanced Excitement Phase)

FIG. 4

Labia Majora

Female pelvis: normal anatomy (lateral view).

FIG. 5
44 M. PINES

Labia Minom Size increase

abia Mojoro Separotion

and Elevation

Female pelvis: excitement phase.

FIG. 6

\OGJasrnic Platform
Labia Minor0 Sire Increase
(Sex Skin)

Female pelvis : plateau phase.

FIG. 7
 Human Sexual Response-A discussion of the work of Masters and

Trakcervicol
Depth :ffect-

lotform Contraction

Lobi> Mojoro

Female pelvis : orgasmic phase.

FIG. 8

Loss of Lobio Majora

Seporation and Elevation

Female pelvis : resolution phase.

FIG. 9
4
46 M. PINES

excitement phase. This area they call the orgasmic platform and believe that the
sensation of orgasm derives from the strong contractions of this area that recur
upwards of 3 to 5 times during a normal orgasm. They consider that the vagina has
an active functioning role in reproduction and is not simply a passive container of
semen and that these anatomical and physiological changes during intercourse are
evidence for this active role.
Finally the uterus. Physiological recording techniques, including abdominal and
intra-uterine electrodes, have enabled them to show that there is an identifiable and
recurrent pattern of uterine activity that is oriented specifically to the orgasmic phase
of the female sexual cycle. These contractions begin at the fundus 2-4 set after the
subjective awareness of the onset of orgasm. These contractions are similar to those
seen during the first stage of labour. The uterus increases in size, due to vaso-
congestion; up to 100 per cent increase has been observed in multipara. In the
absence of orgasmic discharge, this vaso-congestion of the clitoris and of the other
pelvic structures may take a long time to disappear and this offers an explanation of
syndromes of chronic pelvis congestion.
I hope that I have been able to give you an adequate introduction to some aspects
of Masters and Johnsons work. It is surprising how little scientific discussion has
been stimulated by their work, particularly amongst psycho-analysts. There is how-
ever a respectable, healthy and long-standing controversy over Freuds original
theories of female sexual development and function, particularly over the role of
vaginal and clitoral erotism in the adult female sexual response. Masters and Johnsons
work and their conclusions as to the mechanism of orgasm have to be taken into
account here. We must remember that psycho-analytic theories are concerned with
the role of the sexual instincts in personality development, not solely in adult sexual
performance. Psycho-analysis is a developmental and genetic psychology, that begins
with a theory of infantile sexuality, and attempts to trace the development and
vicissitudes of the sexual instincts and their integration in the total personality. We
are therefore concerned with the psychology of women, with femininity and with the
human sexual response as a psychobiological phenomenon.
The cursory summary of Freuds views on the psychology of women that follows
is taken from Phyllis Greenacres chapter Special problems of early female develop-
ment in her book Trauma, Growth and Personality.
The sexual development of woman is complicated by the
presence of two main zones of erotogenic pleasure-the clitoris
and the vagina. The most generally accepted theory of development
of sexuality in women, as stated by Freud is substantially as follows:
the two sexes develop in much the same way until the onset of the
phallic phase. At this time the girl behaves like a little boy in
discovering the pleasurable sensations from her clitoris and
associates its excitation with ideas of intercourse. At this stage the
clitoris is the centre of the girls masturbatory activity, the vagina
remaining undiscovered in both sexes. It would thus seem that
the childyen of both sexes are at this point little boys-the girl
being the littler boy. considered from the angle of body sensations.
Withv the change tg a feminine orientation ;nder the-influence of
the penis envy, the girl repudiates her mother and renounces
clitoris masturbation, becomes more passive and turns to the
father with the Oedipal wish for a child, a state which may persist
well into adult life or be only partially dissipated. Freud believed
that the failure to make this feminine identification and the
 Human Sexual Response-A discussion of the work of Masters and Johnson 47

development of the masculinity complex in its place was largely

due to constitutional factors: the possession of a greater degree
of activity, such as is usually characteristic of the male. He
believed further that there was, strictly speaking, no feminine
libido, in so far as the female function was essentially passive
from a teleological point of view and that Natures aims (of
reproduction) being possibly achieved through the aggressiveness
of the male with little or no co-operation from the female, the
masculine function is, from a teleological angle, more important and
the female function correspondingly less differentiated* [2].

Freud accepted the most modern embryological theory of his time, that the
clitoris is an analogue of the penis. Together with his clinical findings, mostly from
the analysis of hysterics, this anatomical fact formed the basis of his theory of the
little girls sexual development. We must also consider that these two facts, the
embryology and the clinical findings, interpenetrated and influenced the theory
derived from them.
In his paper on female sexuality [3a] Freud wrote that . . . the clitoris . . . is
analogous to the male organ . . . Womens sexual life is regularly divided into two
phases, of which the first has a masculine character while only the second is specifically
feminine.
We cannot resist coming to a definite conclusion about sexuality as a whole.
We have found the same individual forces at work in it as in the male child. Bi-
sexuality comes to the fore much more clearly in females than in males because the
clitoris is analogous to a male organ. Biological factors subsequently deflect the
libidinal forces from their original aim and convert even active, and in every sense,
masculine trends into feminine channels. Psycho-analysis teaches us to manage with
a single libido [3b].
What are the foundations of Freuds theory of sexual development? They are
1. Biological bisexuality;
2. The theory that identical libidinal drives are apparent in the little boy and girl
from birth until a certain stage in maturation. The girls femininity develops in
the course of her pre-Oedipal phase of development, largely as a result of the
vicissitudes of her object relationships.
3. The major influence is that arising from the psychological consequences of the
anatomical distinction between the sexes.
In Freuds view femininity did not arise from its own biological roots ab initio.
He regarded as unproven the assertion that vaginal sensations are experienced by
little girls and that the little girl can have an unconscious awareness of her femininity
in the pre-Oedipal phase. These views were contested by Karen Horney, Ernest Jones,
Melanie Klein and others. From the mid-thirties onwards these theoretical problems
of sexual development and sexual differentiation were lost sight of, overtopped in this
country by the sea of troubles that broke out over Melanie Kleins views on orality.
However, those great investigators of female sexuality, Helene Deutsch and Therese
Benedek, continued to investigate the problem by psycho-analysis and by biological
methods.
In 1960 Helene Deutsch expressed her final conviction that the female sexual
apparatus consists of two parts with a definite division of function. The clitoris is the
sexual organ and the vagina primarily the organ of reproduction. The central role
48 M. PINES

of the clitoris is not merely the result of masturbation but serves a biological destiny.
Into it flow waves of sexual excitement which may more or less successfully be com-
municated to the vagina. The transition of sexual feelings fromclitoris to vaginais a task
performed largely by the active intervention of the mans sexual organ [4]. These
views seem compatible with Masters and Johnsons findings and show a significant
concordance in psychoanalytic and laboratory evidence.
In the same symposium Therese Benedek asserted the need for a theory of female
sexuality that did not derive from the male model of sexual maturity on which psycho-
analytic concepts are based. She also believed that sexual sensations begin in the
clitoris, spread to the vaginal walls, and finally encompass the whole body in orgasm.
It is the womans personality, her ego organization, that allows the clitoral stimulation
to spread and be experienced as orgasm [5].
In 1963 Mary Jane Sherfey wrote a paper entitled Evolution and Nature of Female
Sexuality in Relationship to Psycho-analytic Theory, published only in 1966 161. She
suggests that psychoanalysis had not taken into account the work of Masters and
Johnson nor that of modern embryological theory regarding the nature of bi-sexuality.
She concludes that psychoanalytic theory regarding sexuality requires amendment
when these findings are taken into account.
The inductor theory of primary sexual differentiation, to which she refers, is the
product of the past 15 years embryological research. It has been shown that the early
embryo is not sexually undifferentiated nor bi-sexual, it is female. Although genetic
sex is established on fertilization, the influence of the sex genes does not operate until
the 5th to 6th week of human foetal life. Until then all embryos are morphologically
female. If the foetal gonads are removed before differentiation occurs, the embryo
will develop into a normal female, lacking ovaries, regardless of the genetic sex.
Masculinity is established by the action of a testicular inductor substance which
stimulates foetal androgen which in turn suppresses feminine development. Hence
she concludes that concepts based on innate bi-sexuality, that stress the rigid dichotomy
between masculine and feminine sexual behaviour, and also the clitoral-vaginal
transfer theory, require revision. Her exciting, stimulating and rather strident paper
deliberately eschews psychology and concentrates on biology and therefore inhabits
the same scientific domain as does the work of Masters and Johnson. There is nothing
of poetry in these works and for an understanding of the eternally feminine we must
turn elsewhere to some workers who have begun to shed new light on basic femmine
psychology. They have begun to study the way in which the little girl begins to
integrate her unconscious sense of a rich inner world that has potentiality for crea-
tivity and motherhood, with her external unfinished body image that differs so
significantly from the male body (Greenacre, Keiser, Erikson [7, 81). Their work has
begun to meet the challenge thrown out by Zilboorg in his splendidly courageous and
speculative paper of 1944 entitled Masculine and Feminine [9].
Sexuality divorced from femininity; femininity separated from motherhood by
virtue of contraception ; frigidity successfully overcome with the use of the electric
vibrator and the artificial penis ; these are facts that we have to face. The very existence
of Masters and Johnsons work is a sign of the times. We have only to compare the
comparatively calm acceptance of their work with the fate of Wilhelm Reich [lo],
who in the mid 1930s was hounded from country to country, partly because of his
attempts to experiment with adult sexual behaviour. Masters and Johnson have in
 Human Sexual Responses-A discussion of the work of Masters and Johnson 49

preparation a second volume that will describe their clinical work; Sherfey has
promised us a second paper. Will they take as their Weltanschaung the concept of
the total personality, in itself the product of the 20th Century? Will they integrate the
sexual response cycle of the female with preparation for motherhood, see it as part of a
life cycle that includes menstruation, pregnancy, parturition, lactation and maternal
feelings? This dilemma is our own, that of mankind and womankind in our own
century where a new chapter in the endless history of biology is being written by us
and through us.
I return now to the quotation from Freud with which I began, where he spoke of
science, poetry and personal experience. For poetry I give you words which Freud
himself used in another context, but which must also apply here:

My worthy friend, grey is all theory, and green alone lifes

golden tree.
[Mephistopheles: GOETHESFaust, Part 1, Scene 41.

Acknowledgement-All the figures appearing in this paper are reproduced by kind permission of
Little, Brown & Company, Boston, Mass., from their publication Human Sexual Response by
W. H. Masters and V. E. Johnson.

REFERENCES
1. FREUD S. New Introductory Lecfures, S.E. Vol. XXII p. 135, Hogarth Press, London (1933).
2. GREENACREPHYLLISTrauma, Growth andPersonality, Hogarth Press, London (1953).
3a. FREUD S. Female Sexuality, S.E. Vol. XXI, p. 228 (1931).
3b. FREUD S. Female SexuaIity, S.E. Vol. XXI, p.239 (1931).
4. DEUTSCH H. Participants in panel discussion on frigidity in women. Reported by Moore
B. E.J. Am. Psychoanal. Ass. 9, 571 (1961).
5. BENEDEKT. Participants in panel discussion on frigidity in women. Reported by Moore
B. E. J. Am. Psychoanal. Ass. 9, 571 (1961).
6. SHERFEYM. J. J. Am. Psychoanal. Ass. 14,28 (1966).
7. KEISERS. J. Am. Psychoanal. Ass. 4, 563 (1957).
8. ERIKSONE. H. Inner and outer space: Reflections on womanhood. DaedaIus, Boston, Mass.
582 Spring (1964).
9. ZILBOORGG. Masculine and feminine. Psychiatry 7, 2.57 (1944).
10. REICH W. The Function ofthe Orgasm, Orgone Institute Press, New York (1942).