A 1990 Elsev¡er Science Publ¡sherc B.V. (Bìomedicat Division)Sexologt: An independent Í¡eld, F.J, Bianco and R. Heilóndez Seûano, editors.

SEXUOEROTIC STIMUI.A,TION AI.¡D RESPONSE IN THE MANAGEMENT OF PARTIIRIIION:

AI{ IùÍMODEST PROPOSAL

CALDINO F. PRANZARONE, Ph.D., AASECT: CSE

Departnent of Psychology, Roenoke Co1lege, Salem, Vlrginia 24153, USA

ABSTRACT

This paper revlews theorles regardlng the rnechanisms lnLclatlng and

sustatnLng labor and dellvery; revLerrs tectrnf.ques provldlng analgesia durlngbirthlng; reviews the rêcenÈ sÈudies descrlbing anterior vaglnal stLrûuletlon(c-spot) Lnduced analgesia; examines what appear to be cornmon physlologlcar andsubJecclvely rePorted experientf.al features fn both sexuoeroÈf.c response and thelaborþirthlng process; and provides a su¡D¡nery of che ÈestLrnony of woroen who

have experlenced erotic sensetlons, iacludlng orgasnr, durlng labor and deltvery,sometimes as a result of self, partner, or midrrlfe sexuoerotic stlnulation.

As chil.dblrthing is a nor¡nal extension of fenale sexuelity, the use ofsexuoerotic stinulation and response as an adJuncC to labor and delivery seens å

safe, natural, lovebond unffylng, additlon ot alternatlve to conwentional,nedlcal,/drug lntervêntLons and the Lamaze or Dlck-Reèd nethods, fo¡ enhancenentof comfort and analgesia dutlng labor and del1very.

Proposed are investlgations lnto techniques of, and a protocol for potentlaluse of, vagl-nal and other for¡ns of sexuoeroclc stinulatlon and response for themenagemer¡t of the disconforts of parturition.

INÎRODUCTION AND SCOPE OF PAPER

How mlght laborlng r¡onen be provfded effeccive analgesLa and rellef fro¡¡ thedlstress thât Ls normattvely seen in Lamaze and Dlck-Read approaches toParturltlon?

The recent reports by Whipple and Komisaruk (L985, L988); and Mertinez-conezet a1., (1.988) in the U.S. denonstrated a significanc analgesic effect eliciredby anterlor vaglnal wall or C.spoÈ stimulation, The elegant studles by Zavlaclc,et aI., (1988), in Bratislava, Czechoslovakia, described fe¡nale urethralexpulsions evoked by digltal stlnulation and the grouping of these ¡¡omen intoresPonse types. And lastly, ny interviews of women recorded remarkable tales inwhich parturlcion was experíenced by some as a peak sexuoerotic event thatincluded arousar, voluptuous sensâtion and orgasm. Atr this suggested to ne a

129

130

novel aPPlicatlon of sexuoelotic sti¡ruIâtlon during parturltlon to t¡anege thedistress and progress of labor and dellvery, This is the Lmmodest proposal.

Similarlty of female physlological response in arousal/orFasm and 1n parturltionA woman's sexuel response, ¡t¡enstruation, labor, and lactatlon are aII

interrelated conplex phenonena whlch share co¡r¡mon features of both a psycho-neuroendocrinological and a subJectively experlenÈial nature. Kltzinger (19s3),spoke of the "f.ntense sexuality of natural blrrhn (p, 210). Horchner (1984) satd"there is a sexual aspect to blrth even lf 1t Ls usually suppressed or fgnored,,(p. 1.95). But NewÈon (1973) flrsc sald thet lromen lrere "trebly sensuous,';speclflcally, 1) durlng sexuar arousal and orgasm, 2) during labor and delivery,and, 3) during lactatl.on and breast-feedlng. She presented a llst of nineobservable sl¡ollarlties betneen sexual arousal/orgasm and unnedlcatedparturitlon. Hotchner (L984), in her book pregnancy and Childbirth, addedsewer¿I more parallels.

T'he strlking parallels are these: 1) Breathlng deepens, accelerates, rnay beheld and combined with Valsal.r" r"n"urut";1 2) VocalizaÈioris oey includegrunts, sighs, gasps, ¡ooans and screaDs;2 3) The factal expresslon nay beglassy-eyed, strained, pained or ,,torÊured,,;3 4) In both there occurs myoÈoniaand rhyttrnlc abdo¡ninar contractLon;4 5¡ cli"otar and waglnal engorgenent andlubrication Ls sinllar;) 6) The mucus prug of the cervix is lost fn earryparcuritlon and ls Io'osened during coltus. 7) Rhychrnic, nuscular patterns ofexpursf.ve-wave contraction of the fundus of the uterus have been observed insexual resPonse and orgasm that are idenÈical, except for strength, to those seenln labor (Masters & Johnson, 1966);6 8) The Ferguson'oxytocln,' reflex is

1 rn early sexual arousar and ln labor breathing deepens; rn later stages ofarousal and labor, breathtng rnay accelerate end Valsalva meneuvers nay béco¡nbLned with breath-hoÌdlng as olgesn approaches, or as "pushlngr ocàurs.2 the pattern of vocaLizatlon is sinilar, in chac a noman may grunt, gasp,qulckly draw in the breath, rnoan, and cry ouc in late flrst stag¿ labor, oi asorgasm approaches.3 As blrth or orgasn approaches, the facial expresslon becomes stralned,Lntense, or glassy-eyed. thÍs ts frequently inËerpreted as ',pained", or KLnsey,s"Èortured expresslon,' of orgasn.4 In both labor and sexual arousal and orgasm, rnyotonla and perlodiccontractlon of the abdoninaL nuscles occuls.5 The cumescence or engorg,ement of the cLicoris/vu1va,/uterus; the lubrlcationand "openÍng" of the vaglna is slmllar during sexual arousal and parturition(Hotchner, 1984; Crooks & Baur, 1987). Obstetricians have reported cliroralengorgeu¡ent during parturition.6 Hochtner (L984), adds that ln orgasrn the genirals and "p.C." area spasmrhythmically wlth 8 to 12 "throbs", whereas in blrth there are hours of regularand progressively stronger contracÈions, Many women also have sirnilar uterinecontractions, experience sexual arousal and even orgas¡n during the breast-feedingof their infants.

l3l

ellcited ln each;' 9¡ In both there occurs a naturaL analgesla orinsensl.tivlly to nornalLy palnful stlnull;8 1-0) During both there may occuroblfvl.ousness to surroundlngs, arnnesÍas, changes in perceptlon and loss of

qconsciousnesq - 11) After delivery, as after orgas¡¡, nomen are often suddenlyful1y awake, aware, alert and energetlc. 12) The conmon emoEfonal responseimnediately post-partum and orgasm is njoyful ecstasy,', and usually strongfeellngs of well-belng.

RePorÈs from parturient wo¡oen who had experLences of pleasurable sensualltyand even orgasr¡ in chlldblrth support the parallels presented above. Sources ofthese reports fnclude Kltzinger (1983); Hite (1976); Lådas, IJhipple, and peny(L983); Hotchner (198a); and the ferv lnrerviews that I have done of uothers lnthe Roanoke, VirgLnla area. Notably, rrlth the exception of Perry, these cltatl-onauthors are elEost all wonen, speaklng of their own experLences.

Durlng sex play, female response and experl.ence to sexual or erotlc arousalranges from awersion, apathy, anesthesia, and anorgasula, on Èhe negative end ofthe conÈfu¡uum, to avi.d relish, delight, and "multiple orgasn" on the posttiveend. UÈerine conÈrâcÈions occurring in che context of sexual orgasru are usuallyexperienced as pleasurable by roost lrouen; whereas some fers experienceunexplalned, chronf.c pelvf.c pain nlthout pathology, wlth dyspareunia or palnfulcoltal or postcoLtal spasns and craroping of the uterr¡s (Black, 1986).

Dlfferences ln llbido durlng pregnancy also exist anong rromen, and probablyvaries ln any wo¡oan during her pregnancy. Ilhereas some wonen reporc Èhat sexualaccivfty Iate lnto thelr pregnancles is che lasÈ thing that they wouLd conslder,due to discomfort and appearance concerns, some faf.r nr¡mber of other wonên,

accordtng Èo Kitztnger (1983), report noderare ro greeÈly helghtened IIbIdo,sexual actlvity and response ln the second trLDester. Thls ls probably partiallydue to pressure ln and engorgenent of the genital organs. One ¡¡o¡nan reportêdÈhat late inÈo the third trlnester she entered e state of erotic arousal untilche moment of labor and kept that feeling rlght thlough chtldbirth (Kitzinger,

7 The psychoneuroendocrlnology of the sLÈuatlons is slnilar (Hochtner, 1984).In each, stiu¡ulaclon of the breast, and of other erogenous zones, ls known torelease oxytocln though the Ferguson reflex (Ferguson, 1941.), which in theparturient vto¡nan may oake labor progress rnore rapidly, In sexual lr¡tercourse,the same nippLe stlmulation nay bring a \{o¡¡an uore rapLdly to orgasm, or nayactually be the sole physlcal stlurulus for orgasrn.I There are elevations Ln subJectlvely reported paln thresholds in both laborand sexual arousal. The body becomes lnsensitive to nornally painful stlurull.I.Iornen rnay report a naturally occur¡ing vulval anesthesia or cannot feel thebaby's head emerge or the episiotony lncision vrhen f-c is made.9 Durlng both parturltlon and sexual response $romen may beco¡ne oblivious totheir surroundlngs. A natural amnesia may occur as delivery approaches, as theymay also sornetimes expetience loss of consciousness or of sensory perception asorgasm approaches.

t32

1983). A report nade to ne by e prlnapara nas sLmiler, in that the respondentrecognlzed and apprecÍated her labor as a perl.od of htgh sexual arousal (Anon,1986).

Let us no¡r consider specfflcally the uterlne contractl.ons of parturLÈIon.Flrst the mechanlsns which rnay lnltlate labor, and secondry how thesecontractlons are experienced or are at reast described by sorne wonen.

Natural onset of labor: netural mechanisms r¡hich mav lnicÍate or lnduce laborThree psychoneuroendocrlne nechanÍsns inpllcated fn Èhe onset and

¡nalntainence or labor are of Lnterest to us: 1) Endogenous oxytocin fron theDocÌ¡er's own hypothala¡us and pltultary nay in parc be responslble for laborrsonset. Yet' suPPortlve evldence for oxycocln betng the sole lnltlating factor lnIabor fs lirnlted (Olds, er a1., 1980, p.430), 2) Tt¡e Dost recenr endsubstantlated of the lnlÈietlon theorf.es holds that prosËaglandtn Ls responsLblefor the lnitlatlon of labor. rndeed, exogenous prostaglandtn pGE2 vaglnalsupposltorLes have been used obstetrlcally for the fnductlon of labor, and we may

notê here for l¿ter ¡eference chat the most concer:rtrâted soufce of naturellyoccurrfng prosreglandln is found f.n semen (Klrzinger, 1gg3). 3) Lfgglns (1973)de¡¡onstråtêd thet fêtâl cortfsol nay play an f.mportant role ln the lnltl.atlon of

l^

labor. tt

llhereas re¡¡ovel of the fetal ra¡¡b's pltulcary gland and adrenal cortexaelayea the onset of.,labor, prenature labor occurred Ln sheep thet were infusedwfth cortlsol or ACTH. Thls phenoroenon has not been conflrned Ln hgmans, but ltls bqlleved that a stress responsê, wlth che attendant rise Ln Ac11¡ tLters viathe linbic-hypothalånfc-h)æoposeal axis, can lnduce hunan labor. However, onceinduced, labor nay subsequently be t¡ihlblted by further psychologlcal srressors.the cortisol theory clearly inplf.cates the role of psychological factors in laborlnitlation and inhfbftlon. rt seens qutte likely, however, theÈ nore chan oneneuroendocrine mechanisn 1s lnvolved ln the initfation and nalntenance of labor.

Psvchologlcal factors ln labor lnltlation or i¡rtrlbltfonPsychologlcal stressors seeu to be potenElal factors affectlng lhe progress

of labor (Newton, Foshee & NewËon, 1966; Newron, L97o; Gaskln, Lg77).LL Forbes(L966) also reported that erûotlonal dlsturbances wete posslbly causal in inducing

10 Llggfns, 1.973; cired by Otds er al., 1980.11 Presurnedly affecting ACTH ttters via the limbic-hypoÈhalarnic-hypoposeal axis,

133

1'PremaÈure labors.-- lJhatever the nechanls¡u of Ìabor or¡sèt, the lnitletion ofregular uterine contractf.on hallnarks the beginnint of true flrst-stage labor.sometlmes the contraccions do noc begln spontaneously, or may begin, but fall toprogress efflciently. Then the con¡r¡on medical interventLon ls rv pltocin,13

Ilith thls brief and superficlal revler¡ of the etlology of labor let us nor¡

conslder two possibfllÈLes, flrst, the proposed use of sexuoerotlc stimulation 1nthe induction of Iabor, and secondly, its use in the nanagenent of the progressand distresses of labor,Induction of labor through sexuoerotic stlnulatlon

There ls evf.dence that orgâsn rnay also serve es an ald to the lnductlon oflebor. Mesters and Johnson (1.966) tn thelr Hu¡nan Sexual Res after notingthet the expulsive contractlons of labor and orgasrn differed only in lntensity orstrength, actually specurated about the potential clinlcal slgnlficance oforgasnLc lnductlon of labor. One ¡¡onan I intervlewed (Colson, 1986) reportedlyinduced her or¡n Past-due labor through 'tlovemakingrr and orgasn. The contractlor¡sof labor began shortly after her orgasms ended. Tl¡is was a procedure she hadlearned frou her nidwlfe and Èhrough her prrepartun readlng. rnteresclnglyenough, i! fs reported by Kfrzlnger (1983), rhac Japanese obstetrlcar practlcesupposedly utilizès a cervical vibraÈor for the Lnducement of labor.

Labor has been fnduced through Èhe use of pGE2 suppositorfes. But the nostco¡rcentrated source of naturally occurring prostaglandin is semen. Kltztnger(1983) even describes a step-by-step procedure usl.ng lovenaklng and senen for theinductlon of labor. IJhether these sexuoerotic techniques nay safely, efflcientlyand rellably lnduce labor only re¡¡ains to be quanÈified. Let us now conslder thesecond proposal.

Management of progress or rate of labor through sexuoerotLc stinulationThrough breast and nipple stlmulation. Nipple sclnulatLon during sexuoerotic

play or breast feeding norrnally results ln a reflexlvè pituLtary gland release ofoxycocln (Ferguson 1941). Tactile rnanipulation of the nlppre seens to producethe same result during parturition. Thls neuroendocrine phenomenon has beenknor¡n for years, and ln folk ¡nedicine this technfque has been reported as betnguseful fn nldwifery. Ida May Gaskin, in her remarkable book Splritual Mfdwlfe¡y,

12 Appropriately, in october, L986, radl.o news described a curlosity about rheeârchquake Ln San Salvador. It seened thaÈ the Salvadorian hospltal rnedÍcalstaffs reported a rush on che lesouroes of their obstetrical r¿ards,Labors and deriveriês were occurring in record numbers with nany of them beingPrenacure.13 The nature of the contraccions elicited by Pitocln IV lnfusion (an exogenousoxytocin) are ofÈen nuch stronger and shorter in duration Ëhan ',natural"contractions. UÈerine rupture has been reported.

134

(1978, p. 443) wrote that if lnhibltion had slowed the progress of labor, and ifthe husband rsas reluctant co sÈinulaÈe bis nife's breasts in the presence of the

nldwlfe, then cbe ¡nfdr¡ife would stlmulate them. That cornrDunfty of ¡nidwives had

knor,¡n for years that Èhfs nipple stinulation rsould lnduce stronger conErectf.ons

of the uterus. They were also rpelL artare thac reflexive oxytocln from the

pltulcary nas the causatLve mechanisro, yec they indlcated a preference for breast

stinulation over the nless pleasant IV drlp" (L978, p, 443) to Lnduce or speed-up

labor once begun. A very sf¡ollar, precisely tiried, step-by-step, nlpplestinuletlon technlque ls also descrl.bed by Kltzlnge¡, (1983, 9. 2O9).

Through vu1ual, clltoral, vaginal, and cervf.cal stinulatlon. But stlmuletlonof breast and nipple seens only one nodallcy of oxytocln release to augnent the

pace of labor. Newton, Foshee and Ner¡Èon (1966) mentLoned thet whereas laborcould be slowed by dlsturbance or change in the envtroriner¡t, lt could also be

augû¡enÈedby ngentle sclmulation of the lower genLtal trectn, (p. 375), but what

preclsely was Eeant by thls is not c1ear.

Physlologv and psychology of paln and "suffering" ln labor and dellwerythe experlence of pain as "suffering" is Èhe result of fnteractlon or sJmergy

beÈ¡reen neuro-physiological and psychologlcaL factors, Both atÈenÈion and

dLstractlori can fnpacc the experience of pain. AÈtendlng to sènsêÈions of painhelghtens the intenslly, whereas disÈraction froro the ser¡satlons can lncreasepain tolerance. Ar¡xlety greatly aopllfles the experience of pafn; and, of course

the experience of pain lncreases anxiety in a terrible negatLve spiraÌ.Sufferlng as the resul! of "paln", or sensations chat would ordinarily be

considered aversLve or noxious, is also related to the signlflcance or "meanint"of chese sensory events to the lndlvldual and his/her anxlety levels - and all ofthis is usually Èhe result of socialization. This is parclcularly trueconcerning the culÈure's imparted etticudes and bellefs toward labor and

chlldbirth. Ìfe are taught, and then have general expectatlons tshac the

experlence should be awful - with atcendant pain and sufferi.ng (Newton, 1970).

I really believe, nith Newton (1955), that the interpretaclon of the

experience of labor, and Èhe quality of the experience lcself, depends to sorne

extenc on the nind-seÈ and expectatlons of the womari in labor, BuÈ r'orfren have

experienced birth with paln, angulsh and terror, et one extreme, or wiÈh JoyfulantlcipeÈion end "blrÈh orgasns" at the other.

Orr" ror.rr14 related to ne the experience of Ëhe bÍrthing of her firstchild, attended by a ¡nidwife and farnily, including her husband and moËher. She

had been taughc by her ¡nother as a child, and qrhlle she grew up, that 'havÍng a

I4A forr.a studerrt and now guesc lecÈurer in my sexuality classes.

r35

baby was less trouble then having e cooth pulred", and so it was with herdelivery. 'trt absorutely dtd not hurtr', she told me al¡nost aporogeticalry, Herseven hours of labor were "1lke a roller-coaslern and she nsinply !ùent for therlde". A cor¡trecÈion of labor was descrlbed as, nthlnk of yoursel,f, or of yourbelly' as an orange, and a glant hand on you beglns to sgueeze you with greatpressure and then lecs up', (Colston, 1986).

the sensatlons of labor are not regarded as palnful by NavaJo nor¡e¡¡.Relatlves come and brlng food to eet and ceÌebrate the bf!Èhlng of the chlld(olds et a1., 1980). And, it is co¡omonly observed that nouen of nany othercultures can have a so¡oes¡hat dlfferent experLence wf.th labor, so¡ûe better, so¡enorss, because their expectations end aÈtltudes tonard childblrching, the resultof alternative socialÍzetion, are different Èhan those of Western or Anerlcan

15womèrì .

Today there exlst subcultures ln the U.S. whlch apparently utilfzealÈernatlve mlnd-sets, a rèstructurlng of eccitude and expecÈaÈlons, stronghuaanlstic, Lnterpersonal.-splrituar approaches, and subtle or ovêrcry explrcltsexuoerotic technlques, to provide freedon from anxiety, enoElonar support,rellef, dlstraccton, pleasure and relaxatlon; and consequencly, effectfveanalgesia for thefr laboring lroDen. One such alternate-culture roidrtfe, Ida t{ayGaskln itrote Èhat the concractlons of labor need not hurt. Thac chey are nenergy

rushes'r thec dllete the birth canal for the baby's blrth. And thst fear of palnor en attitude thac Labor w111 hurt will produce ÈensLon thac wl1l slon labor anddeny a wonân the opportunltfes to enJoy the delivery, o! ,,..,you won,t have anyfun either" (1978, p. 87). r will later ¡¡entl.on so¡r¡e of the physiologlcal orsèxuoerotic roanipulatlons used by these groups, buÈ first let us examine Èhe

evidence for a physiological u¡echanisn of sexuoerotlcally produced analgesLa thatmay be utll.ized in labor and delivery.

Analßesla frorn sexuoerotlc stl.mulatlon: Experf.mental evLdence and probablemechanlsm

Naturar somatic analgesics are åpperently rereased by the nervous systen Lnresponse to palnful. stl¡riuli (as ls conplexly described by Basbaum and Fields,1984), so lt see¡¡s logical that they ¡¿ould also be released during labor as welL,They are.

Reynolds and Warfleld (in 1984) reported that blood Levels of endorphlns Ln

15 The vivid extreme of soclallzac.ion in the deÈerminaÈlon of the experLence ofparcurltion is the phenornenon of t'couvade' r¿herein the husband suffers as hedelivers the "spiritual child" r¡hereas his wife, unattended, raerely delivers the"physical child". Verily, pregnancy may be called "expeccing" becâuse you getwhat you expect,

136

pregnant women shoned a substantlar l.ncrease during labor end dellvery, nith a

rapid decline after trvo days postpartum.16 TLr."" findlngs suggest thatendogenous opiaces present et this cime may lndeed provide analgesia durlng laborand dellvery. The exact ¡oechanlsn for this endorphin release is not known.

The lnvolve¡nent of endorphins ln the human sexual_ response cycle, andspecifically Lcs release during the orgasrnlc phase, has been lnvestigeted bySchreier (L983). She measured plasrna endorphin leve1s before and after orgasmand found a slgnlflcant Lncrease ln pLasna endorphln and prolactf.n.Unfortunately, chls study used only urale volunteers who masturbated to orgasn,but r belleve thar si¡rilar changes r¡ould also be found in sexuoeroticallystinulated or orgasnic fenales.

Research by Konlsaruk (tn 1974), and nore recently, by lfhlpple and Komlsaruk(1985, 1988) suggests strongly that anterior ¡vall vaglnal sti¡¡uletion, of a sortusually reported by wonen as feellng erocLc even to orgasm, nay be responsiblefor another mechanisn thet slgnificantly raLses paLn thresholds. Koroisaruk(L974), firsÈ denonstrated a nlce anargeslc effect frorn the gentle glass rodsÈrmuLatlon of the vagina and cervlx of fernale rats. Íhf.s procedureslgnificantly dioinlshed the animals' sensiÈivity to the pain of foot-pinch andincreased the acÈtvlty of neurons in the midbrain perlaqueductel grey natter, Itwas also speculated thet copulation and/or the blrth process would sinirarlystimulate the vagino-cervical region, and that this sensory-neural input wouldacÈl.vate the endorphln circuLcry of the nldbraln periaqueductel grey aree toproduee the analgesi.a.

Leter, l.IhtppLe and Ko¡¡isaruk (L985, 19BB), reported rhaÈ self-appliedstinulatioû of the anterl-or vaginal wall (,,c-area',), with fir¡¡ or deep pressurethet could evencuarly resurt Ln orgasn, produced an effect that slgnlflcentlyelevated the paln threshold. the shift was dramatLc: vaginal self-stl¡nulatl-onproduced slgniflcanc analgesla ln hurnans. rÈ decreased paln detectionsensLtivity 1.07 percenc; lncreased the paln tolerance threshold 75 percent, butdid not affect tactiLe or touch sensitivlty. Most recenÈly, thls powerfulanalgesic, but not enesthetic effect, in both raÈ and human fenales, producedthrough what Komisaruk et al. (1988) called "vaginal mechano-sÈirnulationn (VS),has been attrl-buced tc the release of the neuropeptide vasoactlve intestinelpeptide.

sone nomen do report explicic sexual arousal (Anon, 19g6), or orgasrnl.csensaÈLons during chlldblrth. This rnay be a result of the Grafenberg spot bypressure of the perinatal head as it passes through the vagina. Ladas, lfhipple

16 Thls ¡nechanism may accounc for the often described post-partum depression,this nay reflect the negatlve opponent-process effect of opiate intoxication.The r¿omen are experiencing opiace rvithdrawal,

t37

end Perry (1983), speculated wbether fetal head pressure on the c-spot nlght ptray

a role fn childblrth that nay be Ëwo-fold: 1) provlsLon of analgesla, and, 2)

productlon of the sexuoerotlc sensatf.ons of the "bLrth orgasnn reported by sone

wonen (see also Kitzinger, L983). Accordlng to NeÌ{ton (1973), ro¡nen rt¡ay reportthat chlLdbirth can be an erotic experience Eo the exËent of provlding the n!ûost

incredibl.e orgas¡D ever". Hotchner further states that a woman n...nay experience

the second stage [of labor] as en ortasm Ìrlth each contractlon. Il¡e bfrch itselfuray be one huge orgesm, Although thls ls noc a r¡idespread phenonenon, lt does

happen and not Just for women ln out-of-hospital settLngs. If nothlng else ltcan be an Lndl-cacl-on that there ls a sexual aspect to blrth even Lf lt ls usuallysuppressed or lgnored" (1984, p. L95),17

I believe these oÈher$tise natural sexuoerotl.c experlences of parturltion arèsuppressed or ignored out of erotophobla, an Lrratf.onal sensE of sho.e, anxfety,and gu11t. Kitzinger (1984), reports that this 'lntense sexual feellng, a

slgnlficant part of the experiences of ¡Darry \romen durlng chlldbirth, disturbsthem beceuse iÈ Ls sexuel and because they can do nothLng Èo prevent ltn(p.210). Slnllar dynamlcs of erotic feeling and guilt prevent soue wouen fronbreastfeedlng thelr Lnfants.

We therefore flnd evldence for a neurophysiological endorphln and wasoactLve

lntestinal pepttde nechanLsm for analgesla and pJ.easure durlng the process ofparturition, whlch leglcinately may non be considered an extenslon of fenalesexuallty. lllthln a permlsslve social, enotlonalIy and psychologically suitableenvironment, sexuoerotic sÈ1mulaÈf.on now seèms plauslble as a potent naturalrnethod of fntervention in the management of parcurltLon. Indeed, thesetechniques have apparencly already been successfully applied to provlde analgeslaand to manage the progress of parturltlon by thè nidwlves we no¡{ discuss below(see Gaskin, 1978).

Sexuoerotic stimulatlon ln the nanage¡nent of labor and for the provlslon ofanalgesLa

Sexuoerotf.c stlmulation by spouse or lover. Sexuoerotlc stinulaclon can be

provlded by a husband, ¡nate, or partner. Midwlves in rural Floyd, Virginla, and

on a cornmune in SummerÈos¡n, Tennessee, nay lnstÍuct a laborlng couple on ho$r to

"get 1t on", meaning to relax and engage ln loving and effectfve sexuoeroticstsiurulatlon, because they have found thaC sexual sllnu1atlon provided by aspouse, in privacy, can promoËe relaxatlon, analgesia, and pleasure during laborand bi¡th (Colson, 1986; Gaskin, 'l-977, p. 352).

L7 The physiological arousal may occur, with analgesia, but the subjecclvesexuoerotic experience may sirnilary be suppressed, ignored or nisinterpreted.See Zaviacic et al., (L988), for "types" of responders.

138

I r¿as told by Ida Hay Gaskin (1986) that at her community, "blrthings are

reall.y very sexy, high energy, spf¡itual eve¡tÈs. It is a tlne for spouse and

lover, for fan1ly, for close friends, and for home and fa¡oillar surroundl.ngsn,

Hotchner (1984) wrttes I'a few woraen experience birch as intensely sexual. Sone

of ther¡ have an orgasr¡¡ at the nomenË of birth and it can be close to a sexualexperlence for a couple" (p. 195). Obvlously the spouse or sfgnfflcant other 1s

potentlally inportant ln the sexuoerotic Eanagemenc of labor and delivery.Sexuoerotl-c stimulaclon bv mldwlfe. But I nlghc propose that in Èhe absence

of a husband or lover, sexuoerocic sËÍroulation can be done by the ¡nfdwlfe, and

that thls ¡¡ay someÈf.nes be necessary. The nldwife nay provlde thê appropriaùestiEulâtlon. GaskLn (L977, p.360) wroce that vulval ¡nessage nlth oils bothIubricated and relaxed the rûother, especially if gentle clitoral rDessage nas

lncluded. However, one of the rnothers we intervie¡ped felt horoophobfc dLscomfortat thls interventLon, so thaÈ for her the stÍmulation lras contreproductive, lrithher tension LncreasLng (Brown, 1988). Another of roy intervlewed mothers reportedthac she beceme distressed 1n her second labor durlng the enotl.onal absence ofher husband (they were subseguently divorced). But the sÍÈuation lmproved

slgnlficantly upon the arrlval of her frlend and nldwffe, who suggestèd and

perforned a vulval arid fntravagl.naÌ rnessage. It lras experienced by the para as

sexuoeroCfc. lS

Sexuoerotl.c stimulation by automanipulatlon. Hotchner (1984) clains that "lna soclally permLsslve atmosphere a noman uay masturbate or ner¡t to be nasturbateddurlng Èhe flrst sÉage of labor" (p. 195). One of my own Lnterviewees, attendedby a nidwffe in a home blrthlng, reported that: "Once, (during labor) all Ir¿anted lras to be left alone and not touched. I put ny hands bet¡¡een ny legs,rubbed, and had a good-o1d-tine (lndicaCing automanlpulation). (Co1son,

1986) .19

Sexuoerotic stimulation by devfce. If for sone reason the spouse, Iover,nldwife, or obstetrfclan is absenÈ, or is reluctanc to provlde dlrect dlgttalsexuoerotic stimulatlon to the laborlng wo¡¡en, a devlce mlght be designed to do

so, placed under the control of the rpoman in labor. If, accordf.ng to llhipple and

Komisaruk (1985, L988), and KornÍsaruk eÈ a1., (1988), the anÈerior vaginal wal1

ls the nost effective slte for providing vaglnal nechanicel stinuletion for both

L8 "She asked ¡¡e Íf I would be inhibtted or uptight about e perineel nassage shelranted to do. I said no. So she took almond oil and rnassaged my lower abdornen,the insfde of ny thighs and my vulva. It felË great, and nov that you mentionit, yes it was sexual. l{hen I began to push she also rubbed me inside along chevaginal wal-Is with two fingers" (Co1son, L986) .

19 I have seen the \{ritÈen procedure used by one Berit Mountain couple co slolrlydllate the lntroitus to seven centimeters during the pregnancy to (successfully)avoid epistomy.

139

sexuoerotf.c pleasure end analgesia, then a varfable "mother-controlled" devtcedeslgned as an inflatable bladder configured to produce vaginaL dilacion, maxl¡ûa}

Pressure and pulsatlng wLbratlon or n¡assage of the anÈerLor vaglnal waII wouldprovide localLzed and effective stlnulaÈ1on for managemenc of the labor of

20PArEUrtEl.on.

However, G-spot or anterlor vaglnal wall sclnulation need not occur onlythrough vaglnal intrusion, Zavlaclc et al. (1988) report that effectivesÈi¡ûulatlon rnay be provided externally by suprapubic massage or pressure on thelower abdonen Just above the pubis symphysls. Some lromen have reported to ue

orgasm achieved fron externally applted deep pressure stlnulatlon at thls.2LspoE.

Sexuoerotic stlnulation ln obstecrics or nld¡rLfery 1n other culturesA deternlnation of whether sl¡oilar practices of provlding sexuoerotic

stinulaclon to the parturle¡rt fesrale by nidwlves, rleÈe, or self, exist in othercultures rvould be lnterestlng. I really doubÈ that these idees are so nelr.Durlng the sum¡rer of 1986, et the Kinsey InsciÈute, Carol lJelsh, an obstetrlcalnidwife-nurse practitioner, and I, saw a snall rose coral carving which we bothinterpreted as a Japanese woman in labor being attended by a male who reechedaround to provide dtgital stinulaclon of her dllated vulva and f.ntroitus. fhegravLd abdomen was very apparent in the side-vler¡ of the carvtng, Addiclonall.y,Dr, James W, Raney' (1986), has reported to me that sexuoerotlc technlques duringIabor and dellvery apparently were and ¡ûay stlll be used by some cultures of theSouth Paclflc. l,¡e must study obstetrical prectlces of other culcures.RoIe of the attitude of concrol, or sub¡¡lsslon co, the actlons of the body durlngparturitlon

I believe thac the evolved genetlc or natural wisdom of the body nay often be

superior to that which ls learned or soclally inbued. The later beliefs are

20 A special G-spot vibratlng device has been produced, but was used by ZavLacicet a1. (1988) to scudy only G-spot scirnulatlon induced orgasnLc urethralexpuLslons, not its appllcation Èo the r¡anagemerit of parturitLon.

If there ls obJection to thls as being unnetural, recall the Japanesecervical vibrator used for the lnduction of labor mentioned by Kltzinger (1983).l,le rnay also remember Masters and Johnson's coitus machlne. It iras rated as veryeffectlve by the female subjects. A mechanical devlce? I,lell, ve already connectlaborlng lromer¡ to "fetal ¡nonitors", fetal sonography rnachLnes, IV drips andputrìps, blood pressure cuffs, and so on. It uray be better than nothing for somer¿o¡nen and situetions. In fact, the technology lnvolved nay be'the very vehicleChaË Permits normally cor¡servacive obstetriclar¡s an acceptable ueans of providingsexuoèrotic stinulation to their "petients".2L Historically, the Hindu yogis regard this particular area as the ,'secondchakra". The genltalia are regarded as the first chakra or energy center. Morespecifically the chakra is in the perinet¡rn, or atea beÈween Èhe genitals andanus,

140

somecines sinply lncorrect, lf not totelly the opposite of r¡hat ls rearlty (e.g.

"couvade"), I reca1l some of the thlngs said by these renarkable women:

'rconplete).y rel-ax,.. inhibition slo!¡s down the progress of Labor... resistance tothe pain is the pain... like a rol1er coester.. . irenr for the rlde... birthingenergy flows rlght". Al,1 these ere guite the opposfte of soneone saylng nI was

Èrylng to dLstract nyself, or I t¡as trylng to control the palnr.Anne, who exernplified these currently atyplcal but renarkable wornen, reported

to Ee thac she srent wlth the flow, and rather than trying to distract herselfdurlng the contrection, as she kner¡ was Èhe procedure in Lamaze, she rsanted toattend end I'gèt f.nto" her body and sensatlons, and nflow \rith it vrithout any fearof explodlng. r wanted to get into nyself and be aware of the rushes and getcarried along wlth them... ¡ouch llke a surfer being carried aLong on Èop of awawe... r¡hoosh!" (1986), she did not resLsr it, due to a bellef rhar her bodyknew more about birthlng than he¡ intellecÈ did. "Trust your rnonkey" was anotherinterestlng ml.dwives' saylng 1n the Roanoke-Bent l{ountaln area.

Robbie Davis-Floyd said that in childbearing, women nere natuf,a1ly desfgnedto ". . . fully experience their bodles. . . beco¡ne aII their ser¡setLons. , , learningto Yield and surrender to contractions f.nstead of fightinß them for "controln[and then learnlng that] reslstance to the patn is the paln, fitalrcs rnine](1986, p. 6).

Hotchner wrote: "If you are interested in expertencf.ng Èhe sexual aspects of.your labor and delivery, you wfl1 need an environment in which you feer bothfreedom and support.,, and you need to let go emotionerry. Even then noÈ everyv¡o¡¡an wlll have a <ifamatically sexual experience, but she may conr¡ect irlth thatespect of the experlence". (1"984, p. 1,94, irallcs rnlne). Kitzinger (1983)expounds for nLne pages on sí¡nilar ideas.

Concept for sexuoerotic scimulatlon incorporated into rnedlcal obscetrlcsRobble Davls-Floyd said that "everythlng possible is done 1n the hosplral to

desexuarl-ze what ls naturally a vely sexuar event, because sex is a powerfulnatural process, very private and individual, yet the true perpetuetor ofcurture" (1986, p, 6). stlll, a hosplcal rs a publlc prace, chus the dlscomfortand the enotLonal need for desexualization, usually on the part of both the staffand the PatLents. Kitzinger (1983) also presenÈed a brfef hlsrory of the medicaldebate on how Èo best desexualize or avoid the possibility of introduclng enerotic elemenÈ into gynecologlcal and obstetric practices. Analgesia elicltinganterfor vaginal scimulation rnay ln fact be provided to some vo¡nen v¡ithout itbeing interpreted by Èhem as having Èhe character of sexuoerotic stimulatfon.Zaviacic et al. (1-988), did find that successful urethral expursion producingG-spoc scirnulation in some women did noc necessariry provide then wiÈh

t4l

exPeriences of sexual enjoy¡nent. Slrnilarly, pain thresholds nay be raised in theabsence of erotlc sensation fn these ,"oa"rr.22

Of course, any consfderation of the feasibility of sexuoerotl.c stinuletlonand response ln che Eanageuent of parturltion must recognize the lnpact of ouror¡n soclalfzation upon an ewaluation of the propriety of lntroducing such overtlyerotic techniques into ¡nedlcal practice. For precedent lre tDay recall the fury ofsome Brltlsh physiclans and crergy upon learning of the "anci-Blbrical,, use ofchlorofor¡n and ether anesthesla for eueen victoriâ durfng her conff.nements,because then v¡omen were enJoined by Genesis 3:16, ",,.in sorrow thou shalt brlngforth chl.Idren,,.

Protocol for lnclusion of sexuoerotic stimulatlon Èechnlques as part ofchildbirth preparatlon

l{omen, and couples, nusc assume '¡ore accl.ve responslbllity for thelrchlldbearlng. They roust take charge and arrange for suitable prenatel nedlcalcare. They must learn as ¡¡uch as posslble about the reproductlve and gestatlonalprocess and abouc v¡hat to expect during the pregnancy. And they:¡ust learn,practice, and successfulry incorporate sexuoerotic stinulation end responsetechnlques, designed to manage their labor and delivery, into thel.r overallprepartum traÍnfng progren. The resulÈ mey then be less anxf.ety, lessdiscomfort, a greacer feellng of personal control over the blrthlng process, andconsequer¡tly, a more Positive, enJoydble, and emotÍonally rewardlng parturltlon.. The elernents of a cooprehensive prepartum educatl.onal and trainlng prograûwould include:1) General sexuality education, not merery reproductLve education: soneinstructors already accèpt thet thi.s should be part of childbirthl.ng classes.StudenÈs would be taught that labor and chlldblrch are qulte naturally regardedas dimensÍons of fenare sexuallty; thet the birth process can be regarded assexuoerotl.c and sensual, and is, at least by some wo¡netr, experienced aspleasurable and sexually satlsfying or even profoundly orgasmic. z) overarlcardiovascular and uruscoloskeletal condl-tionl-ng methods and exercLses: AnernphasLs should be placed on training of the Kegel or pelvic floor ¡ouscles forstrong posiÈive and voluntary contraction or relaxatlon. 3) Tralnlng andextensive practlce ln Ed¡nund Jacobsen's "progressive Relaxatf.on" technlgue orl'lolpe's "Syste¡natic Desensltization". this would aIlow voluntary and i¡¡¡nedlatedeep muscre relaxatlon durlng parturltf.on. 4) Trafning and practice inaPProPrfate anÈerior vaginal wall sti¡nulation to elicit the analgeslc effects:

))--But Èhis may be similar to males r¡homassage". It rarely is interpreted byemission nay occur.

experLence therapeuÈl-c "prosteticthe¡n as sexuoeroÈic, although seminal

t42

this would be done durlng simulations of labor r¡ith de¡oonstralLons of ltseffectlweness by the \ronan notLng changes In response to Achilles' tendon plnch.5) Tralning and practice 1n breast/nlpplê and clitoral/vulval stluulacl.on: Thlswould eLicit the Ferguson reflex for use during parturiÈlon to mânage or augnent

the progress of labor. 6) Gentle but progresslwe manual dllation of theintroltus of Èhe vagina: If indicated, thls r¡ould be done in conJunctlon withthe constriction and relaxation of the PG muscle tralnlng of element "2" above,

7) Training and practlce ln vlsual lnagery exercises: Thls ¡¡ould be ofantlcipated inaglned events and behaviors during labor and deIlvery. 8) Replace-

ment of the "dlsÈractlon and control'r Lamaze nethod of deallng with contractlonslrlth an t'actend and surrender co the body" or "focus lnward and go wtch Èhe

flow", enphasls. 9) Instructlon in the possibllity for, and acceptablllty of,analgesic medLcatlon and euergency nedlcal interventlons ln sltuaÈions ofobstetric dlfflculty. 10) Cultlvatlon of a feellng of lack of tnhlbltion durfngnutually loving and sexuoerotic activltles durLng perÈuritlon. 1l) Flnally,these techniques should be taught much earlLer and for a more excended periodthan are the current interventlons of Lanaze or Dlck-Read ¡¡öthods, and optirnallyall would occur ln an all i¡ûportant supportLwe psychologlcal envlronmenÈ

conduclve to a a ltonan's realizaÈlon of the sexual aspecÈs of her parÈurltlon end

v¡hlch would allorc such sexuoerotic lntervention.Those l¡ho are atËltudlnally so lncllned, possibly a preselected group, would

thèn use sexuoeroÈlc or "lovlng" technLgues durLng Ëhe actual labor and delivery,hopefuLly wlth salubrf.ous outcome. Anong che mldwives I have mentLoned above,

there Ls a saying: "LovLng got the baby ln and lovlng w111 get the baby ouri(Colson, L986; Gaskln, 1978).

ConcLudlng renarks and recommendations for furÈher researchI have been fascinated by the descrf-ptf.ons of these "spiritual" and very

"lovlngly-sexy" birthings (Gaskln, 1978). These are remarkablè wonen. lfhet isit about the¡û, whet ls lÈ thet they do, and r¡hat is happenLng to them, thatresults in the relatively hlgh frequency among chen of easy, sorne!¡hac pain freeand htghly Joyful labors and deliverLes? The exception tests the rule. Can we

determlne what makes these women different fror¡ the sterot)rpical American l¡o¡¡an

who labors in distress? If they are different, how are they different?. Can

thelr adventage be conveyed Ëo other women by soneÈhing llke the trainingprotocol I have Just described?

lfould these techniques and these attltudes ettending chlldbirth now beingexplored by chese subculcures, be nore acceptable to the "mainstrean" if these

lro¡nen were more co¡rventionel in appearance or vocabulery? Will the absence ofhospital surglcal gowns and the glean of stainless-stee1-, symbols of ¡nedical

technology, resulcs in our continuing Èo doubt che validiËy of Ehese concepts?

t43

I'Ie may have avolded for¡nal study of these technlques due to a nlsplaced prudery1n the professLon.

r nor¡ ask that we turn our attentf.on to these rather frequencly reportedphenomena, concePts wldely known, albelt at the level of anecdote and folkloreanong none¡r and nidwives; and to the recênt reports of analgesic effeccs fronvaglno-rnechanlcal stlu¡ulatlon, and deternine, using careful ethlcel, qualitativeend quantitatlve technl.ques, whether there is possible usefulness ln the conceptof sexuoerotlc stfnulatLon and response in the managemenc of the dLstress ofParturitlon. our speculatLons et che very least synthesize several disparate anddivergent concepts lnto a coherenc whore, and may serve the sinple heurlsticfunctlon of stiurulatlng or encouraging research into the tenablllty of the ldeaspresented here. So, I arn asktng that those of you who have access to resêarchopportunitles in the area of hu¡¡an obstetrlcs to test Èhe hypotheses that rnayderive fro¡n this Presentation. I believe there Eey be sonethlng valuable to belearned fro¡o the effort.

REFERENCES

l. Anon (1986). Personal cosmunication to the author, unpublished data.November 15, 1986

2. Basbaum, A.I., and Fields, H.L. (1994) Endogenous pain contrl sysËems:Brainsten spinal pglhy3ys and endorphin cir-uitry. Annual Review ofNeuroscience, 7, 309-3393. Brack, Jules s. (1986) chroníc pelvÍc pain without parhorogy. unpubrish-ed-manuscript obtained from the author Jur.es s. Brack, FRcõc, FRAcoG,Sidney, Autraliè, November, 19g6.4. Bond, M.R. (1979). pain, its naÈure, analysis and tleatment. New york,

. Longman.

5. Colson, A. (1986) pe¡sonal Co¡ununication Èo the author. Unpublisheddata. April f2, f986.6. Crooks, Robert and Baur, Karla (19g7). Our Sexuality: Third Edition.Menlo Park, Ca. The Benjamin/Curornings publishing Corupany, Inc.7. Davis-Floyd, Robbie (1986). Rourines and rituals in childbirth: A newvier¡. NAACOG Update Seríes, 5, Lesson 10.8. Ferguson, J.K.tt. (194r) A study of rhe motÍlity of the intacr uEerus arterm. Surgery ín Gynecology and Obstetrics, 7i, 359_366.9. Forbes, T.R. (f965) physiology or reproduction in the female. ChapÈer

9?t ?? IL79-L204, in Rucir, Tñãodore ò. and parron, Harry, D. (eds)(1965) Phl-si9l9Cy and Biophysics, Ninereenrh EdiÈion. I,t.B. SaundersCompany, Phí1adeJ.phia, pa.

10. Gaskin, r.!'t. (i978) spíritual midwifery. sr¡mme¡tolrn Tenn.: The BookPublíshing Company.

ll. Greenhill and Freied¡nan (f974) possible cited by prítchard and MacDonald,L976,

IZHite, Shere (1976) The Hite repor.. New york: Mac¡oi11an and Cornpany.13'Hotchner, T. (1984) Pregnancy and Childbirth: the cornplete guide for ane¡,¡ 1if e. New york: Avon

144

14.Kitzinger S. (1983) Womants experience of sex. New York: G.P. Putna¡nrsSons.

15.Ko¡nisaruk, B.R. (1974) Neural and hormonal interactions in the reproductive behavior of feurale rats. In Reproductive Behavior, edited by E.Montagna and I.I.A. Sad1er. New York: Plenum Press.

16.Komisaruk,8.R., Banas, Cynthía, Heller, S., Whipple' Beverly, Barbato'G.F., and Jordan, F. (f988). Analgesia produced by vasoactive intesti-nal peptide administered directLy to the spinal cord in rats. Annal ofEhe Nen York Àcademy of Sciences, 527, 650-654.

17.Ladas,4.K., Whipplê, 8., and Perry, J.D. (1983) The G spot and otherrecent discoveries about human sexuality. Ne¡l York: llolt, Renehart andWins ton.

lS.Liggins (1973)' (cited by 01ds, 1980)

lg.Martínez-Gómez, Margarita, lùhipple, Berverly, OLiva-Zarate, L., Paðheco,P., and Kornizaruk B.R. (1988). Analgesia produced by vaginal self-stimulation in women is independent of heart rate acceleration. Physio-logy and Behavior, 43, 849-850

20.Mast.ers, I{.H. and Johnson, V. (1966) Hu¡nan Sexual Response. Boston:LiEtle, Bror,¡n and Cornpany.

2I.Nelrton, N. (f955) Maternal Emotions. Ner.¡ York: Paur B. Hoeber, Inc.

22, Newton, N. Foshee, D., and Newlon, M. (1966) Experirnental inhíbition oflabor through enviromental distulbance. obstetrícs and Gynecoloçyr2T.37 L-377

23.Ner.¡ton, N. (1970) The effect of psychological environmen on childbirth:Combined cros*culÈural and experinental approach. Journal of Cross-cu1-Eural Psychology, I, 85-90.

24.NewÈon, N. (f973) (cited by Walurn, 1977)

25.Olds, S.8., London, M.L., Ladewig, P.4., and Davidson, S.V. (f980).Obstetric nursing. Menlo Park, Ca.: Addison-Wesley. (cite Liggens, 1973)

26.Ramey, J. I,¡. (f986)) Personal Co¡ununication, letter of November 28, 1986

27.Reynolds, D., tlarfield, C.A. (1984). Endogenous Opiates. Hospital.PracÈice, L2, 4-36.

28.Scheier, E. (1983) Study on Endorphin level in the Plasma Before andafter Orgasm. Unpublished Doctoral DissertaÈion, The Institute forAdvanced Study of Human Sexuality, San Francisco, Ca.

29.l.lalum, L.R. (1977). The dynamics of sex and gender: a sociologicalperspective. Chicago: Rand McNally (cices Newton, N. 1973)

30.I,Ihipple, B. and KoraÍsaruk, B.R. (1985). Elevation of pain by vàginalstirnulation in r¿omen. Pain 21. 357-367.

3l.IÍhipple, B. And Komisaruk, B.R. (1988). Analgesia produced in women bygenital self-stimulation. The Journal of Sex Research, 24, 130-140.

32.Zavíacíc, M., Zar¿íacícova, 4., Holoman, I.K., and Molcan, J. (f988)Female urethal expulsions evoked by 1ocal digítal sti¡nulation of theG -spot: Differences in the response paEterns. The Journal of SexResearch, 24, 311-318