Intended for healthcare professionals

Education And Debate

The marketing of a disease: female sexual dysfunction

BMJ 2005; 330 doi: (Published 20 January 2005) Cite this as: BMJ 2005;330:192

COITAL ALIGNMENT - The Bleeping Cure for FSD?

The discovery of the coital alignment technique (CAT), termed "the
new intercourse" in the media [1], may reflect an evolutionary step - a
change in sexual relating that fosters simultaneous orgasm. The CAT and
related breakthroughs in sex research are providing an understanding of
the nature of the sex act that is relevant to ethical issues posed in the
BMJ article "The marketing of a disease: female sexual dysfunction" [2].
Most importantly, the three classic problems of sexual "dysfunction" have
been redefined as interdependent parts of ONE behavioral syndrome - the
problems are NOT "diseases"; secondly, men and women play a mutual role in
each other's sex problems. The "cure" is a fundamental change in sexual
technique that is challenging emotionally because it transcends archetypal
gender tendencies; there is greater empathy.

PREMATURE EJACULATION (PE) - the man climaxes too quickly

Relevant to the timing of sexual response, every man knows that the
quicker he moves his hand in masturbation the quicker he reaches orgasm.
That scenario logically parallels his experience with intercourse. During
typical intercourse in the "missionary" position, a man is dependent on
friction from the speed of his "in and out" thrusting to keep his
erection. With heightened sensation at the approach of orgasm, he
automatically starts moving faster and harder -- that archetypal tendency
greatly accelerates his climax. Hence, "premature ejaculation" is a
direct result of the man's hyperactivity during coitus -- there is no
mysterious disease at work.

The male problem baffled the late Alfred C. Kinsey as evident in his
1948 report on Male Sexual Behavior [3]: "It would be difficult to find
another situation in which an individual who was quick and intense in his
responses was labeled anything but superior, and that in most instances is
exactly what the rapidly ejaculating male probably is, however
inconvenient and unfortunate his qualities may be from the standpoint of
his wife in the relationship" (p. 580).

FEMALE COITAL ANORGASMIA - failure of woman to climax from coitus.

In his 1953 Female report (1953) [4], Kinsey did a turnabout. He
stated, "There is a widespread opinion that the female is slower than the
male in her sexual responses, but the masturbatory data do not support
that opinion. Kinsey concluded, "It is true that the average female
responds more slowly than the average male in coitus, but this seems to be
due to the ineffectiveness of the usual coital techniques" (p. 164).

In typical intercourse, the faster and harder thrusting of the man at
the approach of orgasm CUTS OFF the orgasmic buildup of the woman -- It
would be physically painful for her to move as the man's movements becomes
more aggressive. The woman tends to adjust to the man as best she can,
often slowing or stopping any movement of her own. Hence, partners have a
mutual role in a scenario that makes it a PHYSICAL impossibility for the
woman to reach orgasm in coitus. (It'simple, one minus one doesn't equal
two.) The woman's failure to climax is rarely, if ever, caused by a
physical "disease" or a mental disorder (like so-called "frigidity").

HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) - lack of sexual desire and

It is logical that a long-term pattern of intercourse that does not
lead to complete and mutual sexual satisfaction for a man and woman would
eventually result in a loss of sexual desire. Recent media attention to
the problem of "sexless marriages" may reflect the fact that failed
intercourse can condition the woman (and also the man) creating apathy
about sexual relating. That conditioning process can also cause
"impotence" in the man, and "arousal" problems for the woman.


The original CAT study [5] reported significantly high frequency of
female orgasm, as well as regularity of simultaneous orgasm. Controlled
replication studies reported effective treatment of Hypoactive Sexual
Desire [6]. The CAT research supports the premise of a natural anatomic
design for coital orgasm that is dependent on a specific interplay of the
male and female genitalia -- IN MOTION. That kind of model was called for
by pioneer sexologist R.L. Dickinson, the author of Human Sex Anatomy
(1949) [7]. The CAT technique involves a basic position and a coordinated
form of sexual movement:

(A) The basic position was referred to by Dickinson as the "riding
high" position in which the man is up forward along the woman with his
pelvis high up on hers; the base of his penis is bowed over the woman's
public bone pressing against her upper vulva stimulating her clitoris (and
urethral meatus).

(B) Secondly, a specifically coordinated pattern of sexual movement
must be maintained continuously. The woman leads the upward stroke with
the man providing a slight counter-pressure. The man leads the downward
stroke with the woman providing a slight counter-pressure. In the CAT
training, couples were instructed to think of orgasm as the build-up of a
"bio-electric" charge (as theorized by Freud [8] and his disciple Wilhelm
Reich [9]); they were told to let the orgasm charge overtake them without
disrupting the pace and pattern of their movement. Pioneer sex therapists
Masters & Johnson [10] experimented with the "male pelvic-override"
position; predictably, it failed because the subjects did not coordinate
their sexual movement sensitively (p 60). The man's heavy thrusting at
orgasm caused the woman pain. That kind of pain from the man's,
uncoordinated thrusting has been termed "dyspareunia," yet another
mysterious "disease".

THE PROSTATE (MALE AND FEMALE) - a primary erogenous zone

A video [11] was previewed at the 15th Congress of the World
Association for Sexology (Paris, 2001) that documented the CAT model in
real-time and synthesized researches relavent to the CAT model: The
sensory arm of the female prostate has been identified by the histologic
research of Milan Zaviacic [12, 13] as being at the urethral meatus,
correcting the "G-spot" researchers' assumption that it was located behind
the woman's pubic bone where it could not be stimulated directly by the
male penis during intercourse. Zaviacic's finding affirmed that CAT
provides simultaneous stimulation of both primary female erogenous zones -
(a) the clitoris and (b) the female prostate, polar zones for a complete
"blended" orgasm. Richard J. Ablin, whose discovery of the PSA is the
basis for the standard prostate cancer test, has revealed that male
spermatozoa deposited in orifices other than the vagina can be
carcinogenic (as in anal intercourse) [14]. Studies by clinical
psychologist Stuart Brody [15] have substantiated the premise that
intercourse is unique and effects many aspects of physical and mental
health; Brody has stressed that masturbation exercises do not help couples
to succeed with intercourse. In conclusion, there is a form to the sex
act that has a unique chemistry; as Freud concluded -- it is "imperative"
that the sex act be a regular and complete experience.


The CAT model provides a fundamental matrix for the analysis of
classic sex problems and other subtle, but widespread, sex-related health
problems. Unfortunately, the lack of sexual fulfillment and confusion
about sex allows for much exploitation. There is no pill that will correct
the sexual positioning of partners or teach them to coordinate their
sexual movement. The CAT is quietly becoming a standard of the sex
therapist's regimen, internationally. But, those therapists adopting the
CAT may be fearful that they will be black-listed if they adopt and openly
acknowledge a natural cure for sex problems that largely obliterates the
need for drugs. (It is important to be mindful that FSD symptoms have
often been the side effects of pharmaceutical products.) Historically,
drugs have helped save the world from lethal pandemic diseases. It would
be tragic if Big Pharma becomes the CAUSE of the most universal health
problems in our time.


1. Nobile P. The new intercourse. Cosmopolitan 1991;211(no 3).

2. Moynihan R. The marketing of a disease: female sexual
dysfunction. BMJ 2005; 330 (7484):192-194.

3. Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human
male. Philadelphia: WB Saunders, 1948.

4. Kinsey AC, Pomeroy WB, Martin CE, Gebhard PH. Sexual behavior in
the human female. Philadelphia: WB Saunders, 1953.

5. Eichel EW, Eichel JD, Kule S. The technique of coital alignment
and its relation to female orgasmic response and simultaneous orgasm. J
Sex Marital Therapy 1988; 14:129-141.

6. Pierce AP. The coital alignment technique (CAT): An overview of
studies. J Sex Marital Therapy 2000; 26:257-268.

7. Dickinson RL. Human sex anatomy (2nd Ed). Baltimore: Williams
& Wilkins, 1949.

8. Freud S. The justification for detaching from neurasthenia a
particular syndrome: The anxiety neurosis. Collected papers. London:
Hogarth Press 1894/1950; 1:97-98.

9. Reich W. (Trans. Wolf TP). The function of the orgasm. New
York: Farrar, Strauss & Giroux, 1942.

10. Masters WH, Johnson VE. Human sexual response. Boston: Little
Brown, 1966.

11. Eichel EW. Orgasm the natural way: The coital alignment
technique, 2001: Vers 1.0.

12. Zaviacic M. The human female prostate (English text). Slovak
Academic Press, 1999.

13. Zaviacic M, Zajickova M, Blazekoya J, Donarova L, Stvrtina S,
Mikulecky M, Zaviacic T, Holoman K, Breza J. Weight, size, macroanatomy,
and histology of the normal prostate in the adult human female: A
minireview. J Histotechnology 2000; 23(1):61-69.

14. Ablin RJ, Stein-Werblowsky R. Sexual behavior and increased anal
cancer. Immunology and Cell Biology 1997; 75:181-183.

15. Brody S. Concordance between women's physiological and
subjective sexual arousal is associated with consistency of orgasm during
intercourse but not other sexual behavior. J Sex & Marital Therapy
2003; 29:15-23.

Competing interests:
Producer of educational video: Orgasm the Natural Way - The Coital Alignment Technique
(2002) vers. 1.1

Competing interests: No competing interests

27 January 2005
Edward W. Eichel, LHD, MA
Psychotherapist, sex researcher
Marriage Science, Inc. 463 West Street (A-1106), New York, New York 10014, U.S.A.