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Heiman, M. (1963). Sexual Response in Women—A Correlation of Physiological Findings with Psychoanalytic Concepts. J. Amer. Psychoanal. Assn., 11:360-385.
(1963). Journal of the American Psychoanalytic Association, 11:360-385
Sexual Response in Women—A Correlation of Physiological Findings with Psychoanalytic Concepts
Marcel Heiman, M.D.
This paper has attempted to correlate psychoanalytic concepts regarding female sexual response with physiological data accumulated during recent years. Coitus has been viewed as one phase of the total process of reproduction in the female.
For historical reasons, psychoanalytic theory projected its thought without such knowledge of the anatomy or physiology of the sexual act which is now at our disposal. However, in recent findings in these fields we have found corollaries to some of our psychoanalytic concepts. We have gained a better understanding of the dual role of the vagina: its function in the service of propagation
and for the purpose of sexual pleasure. The two manifestations of the normal sexual response—lubrication and muscular contractions—have now been investigated physiologically. Direct observation has provided us with the unexpected finding that the vagina is self-lubricating; and that lubrication represents the first observable response to sexual arousal in woman, as Freud has stated. Equally unexpected was the observation that different roles in the sexual act can be assigned to the proximal and distal parts of the vagina.
In addition, these findings suggest that both manifestations (lubrication and contractions) were originally in the service of reproduction. If we consider coitus as the first stage in the process of reproduction, any division of coitus into reproductive and pleasurable aspects must be artificial from the biological point of view. The desire of the woman—and of the man—however justified, to consider coitus only for the purpose of pleasure cannot do away with the fact that originally coitus was meant for reproduction. From the evolutionary point of view, the complicated emotional experience encompassed in the sexual pleasure of woman during intercourse developed from the simple roots of the sensory experience of the female mammal during copulation intended solely for the purpose of reproduction. There seems to be some justification, at least biologically, for considering the man like an animal; unfortunately, he cannot even try to separate sexual pleasure form the act of reproduction.
Central emphasis for both propagation andpleasure in coitus must be given to the functional unit: penis-vagina-uterus. Here psychoanalytic concepts have been duplicated in physiology. The fusion of identities between the two love objects in intercourse may become so complete that we may speak of a fusion of identities even on a physiological level. Only during coitus do we find the functional unification of penis-vagina-uterus for the purpose of propagation. Both the uterus and the vagina play different roles at later stages of the reproductive process, but in the coital act, the synchronized, rhythmic contractions of all three represent the physiological substratum of orgasm, which is based on the passing-on of the sperm—from penis, to vagina, to uterus—through the contractions of the one and sucking in by the other.
It has been noted that conception can and does take place in spite of frigidity. This would mean that in such instances, coitus is more or less in the service of propagation which is phylogenetically older as compared with sexual pleasure.
Of all the psychoanalytic concepts presented in this paper, the most imaginative is the one which associated coitus genetically to the sucking experience of the woman as an infant; and "progressively, " to pregnancy, to the birth of the baby-to-be-conceived, and to the suckling of that baby. Through identification with her own mother and her own child, three generations are united; the center of this unification is represented by the sucking-suckling-sucking experience. I believe that the function of oxytocin for uterine contractions and sperm transport in coitus, for the contraction of the uterus during parturition, and finally for the milk-ejection reflex (nursing) gives this neurohormone a central position in the reproductive process. Nature deserves our respect for such imaginative use of one single substance.
If it has appeared that this paper has given oral factors more than their due, while neglecting other genetic phases, this is true. But this too has its basis in anatomy and physiology. In discussing the various pathways connecting the limbic system, Paul D. MacLean called attention to the fact that the pathways into the frontotemporal region are "allegedly" concerned with self-preservation, and those into the septal regions with preservation of the species:
MacLean recalled in this connection that he had already suggested in 1949 "that in this part of the brain it is possible to conceive how sexual incitations could stimulate a crude, diffuse feeling of visceral yearning that would make the individual seek to mouth and incorporate the object of its desire, and would thus provide an anatomical substratum for both normal and deviate forms of sexual behavior."
I return to the point Freud made in 1913 (which I quoted at the beginning of this paper). Not only has psychoanalysis now established contact with biology; biology is now making its contribution to psychoanalysis. The ego instinct and the sexual instinct, concerned with self-preservation and preservation of the species, respectively, have eventually come into contact with each other and formed a continuum, like the circle of the snake with its tail in its mouth.
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