This article was originally published in Hebrew in Kolech: Women and Her Judaism, Jerusalem, Israel 2012
Talli Y Rosenbaum, MSc
Normative sexual functioning implies the motivation and desire to engage in sex, the experience of pleasurable arousal and orgasm, and the ability to comfortably engage in and enjoy intercourse. Sexual satisfaction is generally defined by the existence of most of these elements, most of the time. Sexual dysfunction describes repeated difficulty in one or more of these areas of sexual functioning. Several factors may contribute to sexual problems. In addition to a dysfunction of biological systems or the effect of medications, psychological conflicts, mood, relationship issues, lack of education and cultural messages about sex may all affect sexual function.
The ability to enjoy sexual relations evolves through developmental processes influenced by biological and cognitive growth. Prior to actually engaging in sexual behavior with a partner, one is likely to have developed a sexual sense of self-based on curiosity about sex, and awareness of experiencing sexual feelings, attraction, and arousal. The development of this sense of sexual self is highly variable in individuals and is dependent to a great extent on cultural messages. Limited exposure to intimate and affectionate behaviors, absent, negative, or guilt-inducing messages regarding sex or masturbation, and limited opportunity to engage with the opposite sex, limits such development. Conversely, over-exposure to negative media messages about sex, without the permission or opportunity to process or discuss sexual thoughts and feelings, may also negatively affect the healthy development of the sexual self.
Newly married religious couples are expected to encounter their first experience of sexual feelings with their marriage partners and encouraged to develop their sexuality together, while building an exclusive, intimate bond. Enjoying sexual activity with a partner is understood to be a learning process that may take time to develop. The desire and willingness to learn open communication with and positive feelings about the partner, and some trial and error are important components of this learning process.
Understanding sexual difficulties in marriage involves consideration of the cultural and religious messages received by the couple and specifically, halachic instruction and its impact on sexual functioning. Jewish law proscribes premarital sexual activity and the development of a sexual sense of self prior to marriage is discouraged. Nevertheless, there exists the expectation that full sexual intercourse takes place shortly after the wedding. This radical shift from sexual (or relative sexual) abstinence to complete sexual intercourse as a source of cognitive dissonance has been addressed by this author in the literature, particularly in relation to the phenomenon of the unconsummated marriage.  Young women, whose self-concept and self-esteem have been socialized and defined by a culture that values chastity and virginity, experience a role identity shift by taking on a new role as a married woman and a new identity as a sexual human being.  Young men, on the other hand, struggling with the lack of legitimate sexual outlet either alone and or with a partner, may view the wedding night as the “light at the end of the tunnel”, and look forward to commencing sexual activity and fulfilling their natural desires, as promised them by their Rabbis and teachers.
In addition to the influence of cultural messages on sexual functioning, the ability to commence a healthy and satisfying sexual relationship depends on receiving accurate sexual information and preparation. Yet, in a groundbreaking study that investigated the sexual lives of 400 Orthodox Jewish women (OJW), 40% of the study subjects stated that they did not receive sufficient preparation for their wedding night, and 64.5% did not know the “basics of intercourse”. The findings from this study indicate the likelihood that lack of sexual instruction, limited opportunity to develop a sexual sense of self prior to marriage, and divergent attitudes and expectations regarding sex, may contribute to sexual difficulties in marriage.
Within marriage, Jewish law considers the fulfillment of sexual desire between the couple as positive elements of the relationship and both spouses are expected to fulfill each other’s desire for intimacy. Recognizing that premarital sexual activity is forbidden, it is anticipated that couples will develop their sexual knowledge together through increasing comfort, intimacy and communication with one another. Premarital counselors typically provide guidance.
Premarital guidance varies across communities and while some educators emphasize the Torah obligation for a man to satisfy his wife, many bride instructors underscore the importance of women being available to their husbands when they desire sex. This message, sometimes implied and sometimes directly stated, directs women towards sexual availability in order that her husband avoids a nocturnal emission or masturbation. In many Hasidic communities, women are specifically taught that they are not allowed to directly refuse sex when her husband approaches her.
This model may be based on the assumption that both partners in principle enjoy sexual activity such that when there is sensitivity and goodwill between partners, there exists the motivation to fulfill one another’s desires even when one partner is on occasion less interested. When a partner is sensitive to the other, he or she would naturally refrain from initiating sex when clearly the other partner is uninterested, tired or not feeling well. However, difficulties may develop when there is a large disparity in sexual interest, a lack of enjoyment with sex, or the experience of anxiety or pain with intercourse. In these cases, when a woman is expected to be available for sex despite the aforementioned situations, she may perceive her availability as being taken for granted, or worse, as an object to contain her husband’s sexual needs.
Judaism highly values sexual relations in marriage and couples experiencing difficulties are encouraged to seek counseling, primarily for the purpose of achieving a satisfying sexual life and enhancing marriage. Few rules dictate the actual nature of sexual activity between a husband and wife and the general consensus is that any sexual act that does not involve deliberate ejaculation of semen outside the woman’s vagina is permissible. Rabbinic attitudes regarding the severity of non-vaginal ejaculation vary to some extent. So too, the extent to which couples seek rabbinic guidance regarding halachic questions about sex vary as well. However, there appears to be a consensus that ejaculation outside the vagina is to be avoided.
The extent to which male restrictions on non-vaginally contained ejaculation affect their female partners has not been systematically researched. However, results of our OJW study, as well as this author’s clinical experience in providing sex therapy with Orthodox couples indicate that when ejaculation occurs outside of sexual intercourse, whether deliberately or accidentally, and even as nocturnal emission, the woman is likely to feel responsible, and depending on the relationship dynamic, may even be blamed for this occurrence.
When sexual intercourse is desired and pleasurable for both partners the need for intra-vaginal ejaculation to occur as part of the sexual relationship may not present a specific difficulty. However, when the woman does not find sexual intercourse to be enjoyable or satisfying, the need to function sexually as a marital responsibility may foster feelings of objectification and lack of autonomy. Moreover, this becomes more problematic when the woman experiences pain or inability to allow intercourse, conditions known as sexual pain disorders.
Sexual pain disorders are common in women and affect up to 12% of the population of women in their childbearing years.  Vaginismus describes a condition in which, fearing pain and penetration, a woman at the onset of intercourse (or other types of vaginal penetration) contracts the vaginal muscles, thus preventing insertion in to the vagina. This response is reactive and occurs despite the woman’s expressed desire to allow penetration. Dyspareunia describes conditions that contribute to painful intercourse. The most common of these conditions is known as vestibulodynia; however, there are several physiological conditions that may contribute to pain with intercourse, including vaginal dryness common in the postpartum period and post menopausally. Lack of arousal while having intercourse may also contribute to discomfort. Painful intercourse sets up a cycle of vaginal tightness in response to fear of the pain, and decreased desire to engage in sexual penetration. A common sex therapy intervention is to discontinue attempts at intercourse while intervening to address the physiological components of pain, the emotional components of anxiety, and enhance sexual desire and passion in the marriage. This is done by encouraging the engagement in sensual and sexual activities but restricting intercourse.
Religious couples, both in the dati and in the haredi sectors, are often anxious about this particular intervention. They question what will happen if the male partner becomes aroused and needs to ejaculate. Women often express guilt that if this were to occur, it would be her fault. Halachic responsa have offered “nishuk eivarim,” ejaculation in between the vaginal lips as a temporary solution. However, in some cases, this may be painful for the woman as well. In the clinical experience of this author, the directive to couples to be together sexually without attempting intercourse has often been met by couples and Rabbis with great concern.
Even in the treatment of male sexual problems, halachic ejaculatory restrictions may be a source of distress and concern for both partners. Male premature ejaculation (PE) is not an uncommon condition. Women with partners with PE often report needing to “be ready” for intercourse, despite insufficient foreplay and arousal, in order to avoid extra-vaginal ejaculation. Sexual therapy for men with ejaculatory disorders often utilizes masturbatory exercises to assist men in gaining control over the timing of ejaculation. The influence of restrictions in masturbation in sex therapy treatment of male premature ejaculation has been discussed in the literature. The alternative model published by Ribner, suggests performing similar exercises with the wife in lieu of masturbation, so that at the point of need to ejaculation, intercourse may occur, thus preventing the wasteful spilling of seed.
While this is a viable alternative when the woman is a willing participant, it is important for practitioners, as well as the rabbis with whom the couples consult, to consider the following questions regarding the effect of these ejaculatory restrictions on women: To what extent do women feel objectified by the need to physically contain their husband’s semen? To what extent does the wife bear responsibility in preventing wasteful spilling of seed by being available to her husband when he needs her? To what extent might the role of the wife to fulfill her husband’s “need” become perceived by her as a chore, and affect her desire for him? What if his sexual needs are excessive?
Despite the Biblical injunction that it is the man’s responsibility to provide his wife with intimacy  married women feel obligated to engage in intercourse in order to fulfill their husband’s needs. While this perception is common in general society, findings from the OJW study demonstrate that Orthodox women may, in fact, view sexual relations as their obligation. Despite findings of decreased physical satisfaction, the overall sexual frequency was greater than that reported in their secular counterparts. The personal narratives provided by some of the women in the qualitative portion of our research, illustrate the experience of perceiving sex as a duty. The following narratives report feelings and experiences expressed by women with and without specific sexual dysfunction.
“Sometimes after a long day with the kids and working, I am just so tired. I am afraid he will ask to be together and if he does, you are really not allowed to say no. And with nursing, I feel dry and intercourse is painful. I really wouldn’t mind just doing it with my hand, but I know that isn’t allowed”
“When my husband was learning in the kollel, his Rav said we should do it twice a week, which was OK. Now he has a job and his Rav says that since he sees women at work, this makes him have a greater yetzer, so we should have relations three times a week. Since I am in my eighth month and already have two little kids, this can get very hard. But what can I do, I wouldn’t want him to have a kishalon (failure) because of me.”
“I know that on Mikvah night I am supposed to want to have sex, but after two weeks of no physical contact, I really need some time to get used to it again. I wish we could cuddle and take our time, but he gets so excited so quickly that we have to have intercourse before I am ready. I feel like I have to be his vessel.”
The narratives above describe the experience of lack of autonomy and objectification women may feel. Rather than view sexual relations as an expression of mutual love and satisfaction, the above describes viewing sex as a chore, necessary to prevent a situation of potential wasting of seed.
In clinical experience with clients experiencing sexual problems this feeling of responsibility is a recurrent theme. Standard therapeutic recommendations that sexual activity be limited to non- penetrative activities in order to focus on pleasure and avoid pain, are often met with an anxious reaction by the clients, and often, by their rabbinic authority. The following case vignettes illustrate this:
Sorah Malka is a 21-year-old Haredi Hasidic woman married for six months. She reported that she has a great deal of difficulty with relations. She enjoys foreplay and wants to be able to experience intercourse. However, when her husband is about to penetrate, her entire body reacts defensively. She tightens her muscles, pulls her legs together and she becomes tremendously anxious, usually crying out in fear and pain. Her husband was told by his Rav, that he must make sure to penetrate his wife enough regardless of her cries, such that no semen spills outside the vagina when he ejaculates. Sorah Malka reported experiencing nausea for several days after intercourse. In therapy, Sorah Malka revealed that she experienced an incident as a teenager where an older yeshiva bachur grabbed her and tried to touch her breasts and genitals.
Treatment would have to involve the opportunity for Sorah Malka to experience her husband as someone safe. She would have to learn that she could establish boundaries on her self and her body that would be respected. It would be therapeutic for Sorah Malka to experience touch with her husband that was comfortable and pleasing to her, that would not end in pain and fear and she and her husband were instructed accordingly. He was told that before touching her in any way, he should ask her consent, and only touch her if she agrees. At later stages, when she was more ready for intercourse, he was instructed to ask her if it was OK before attempting to penetrate, and would not attempt to penetrate unless she gave her verbal agreement.
Sorah Malka’s husband, Chaim, explained that while he very much wanted to cooperate, he was unable to agree to any of the treatment suggestions before consulting with his Rav, and also requested that I speak directly to his Rav. After hearing the situation the Rav declared the following: Unless intercourse was a clear option, intimate touch should not take place between the couple, lest he become aroused and have no outlet. Therefore, the “safe touch” could take place as long as intercourse was to occur if needed by the husband, which clearly defeated the purpose of the exercise. Regarding the intercourse, the husband should ask permission as requested, however, if he feels he may ejaculate, he must regardless attempt to penetrate, lest seed be spilled in vain. The rabbi went on to explain that when a person is hungry and knows there is bread in his basket,פת בסלו, he can control his hunger. He needs to be reassured that his wife, (the bread), will be in his basket.
It should be noted that rabbinic consultation is an important component of sex counseling and therapy with religious couples, however, not all couples necessarily feel the need to consult a Rav. Frequently, the rabbi serves to successfully lower the couple’s anxiety by reducing concern over non-vaginal ejaculation, especially if it were to occur within the context of physical intimacy between the couple. In many cases, the rabbinic solution offered, is to have the husband ejaculate only at the entry. This solution works well in some cases; in some women with sexual pain syndromes, it is precisely this area of the vaginal entry that is the most painful. As illustrated above, the concern with non-vaginal seminal emission often appears to be tantamount to all other precepts, and the obligation to physically contain her husband’s ejaculation may affect the woman’s feeling of autonomy and control over her body.
Rabbinic involvement, and the triangular relationship formed by the couple with the Rav, may be a source of distress and may also contribute to feelings of sexual objectification. Moriah’s narrative illustrates this:
“The day after the wedding, my husband was very tense. We were not really sure whether or not we did it and didn’t know whether we should separate. So he called his Rav, who asked him several questions. He wanted to know how far it went in, and asked him questions about my vagina, if it felt dry, or wet, if I was tight, etc. And I am getting really embarrassed because his Rav knows me; he was mesader kidushin (he officiated at the ceremony). Then soon after we did it again and I bled a little. So again he called his Rav and the Rav said I had to go to a “bodeket” to check me to decide if I am a niddah. I looked in the mirror and saw it was a little cut, but I still had to see this nurse/ “bodeket” to check my vagina. And then I go to the Mikvah, and have to undress in from of the Mikvah attendant, and it occurred to me, after a couple weeks of marriage, that my body is no longer my own.”
The experiences described by Moriah highlight her sense that in her transition into becoming a married woman she has lost autonomy regarding her physical sense of self. Despite not initially reporting any specific sexual problems, her feelings of overexposure and vulnerability immediately upon marriage, contributed to her lack of interest in sex which brought her and her husband to sex therapy. In the context of describing the embarrassment surrounding the detailed discussion of her anatomy between her husband and his Rav, Moriah in fact revealed feelings of vulnerability and exposure that were compounded by having to have her vagina checked by a “bodeket.”
The above vignettes, qualitative data from the OJW study, and clinical observation of hundreds of religious couples in the sex therapy setting demonstrate the need to consider the impact that the interpretation of religious laws governing male ejaculation may have on women, their feelings of autonomy, and their perceptions of objectification in marriage. This is certainly a clinical concern in couples presenting with sexual problems. Given that women are often taught by premarital instructors that “providing” sexual availability for their husbands is part of their role, and that couples frequently consult their rabbinic authority with halachic questions regarding marital intimacy, this is a salient issue for religious authorities as well. Concern about extra-vaginal ejaculation as a primary tenet of Jewish life should be re-examined, taking into consideration the attendant perception of women that they are responsible for “containing” their husbands sexually.
There is a lack of quantitative research regarding the lived experiences of young Orthodox women in early marriage, and it is unclear the extent to which feelings of sexual responsibility, objectification and loss of autonomy are a pervasive phenomenon, or to what extent they contribute to, or result from, sexual dysfunction. Clinical intervention for women experiencing sexual problems should consider these feelings within the context of the therapeutic milieu, particularly when anxiety is greatly intensified surrounding extra-vaginal ejaculation. With respect to Halacha, rabbis, pre-marital educators and other religious figures providing premarital and marital counseling should consider the influence of extra-vaginal ejaculation anxiety on women. Finally, while not addressed in this article, the influence of ejaculation restrictions and cultural messages on men’s experience should be considered as well, and further study is indeed required.
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 A bodeket taharah is a woman, generally a nurse and/or midwife, specifically trained to examine women for non-uterine sources of vaginal bleeding and to report her findings to a rabbi. http://www.yoatzot.org/article.php?id=151