Women's experience of heterosexual intercourse--scale construction, factor structure, and relations to orgasmic disorder.

Women's sexual difficulties, such as female orgasmic disorders (anorgasmia), are prevalent in subclinical samples and are commonly seen in clinical practice (Laumann, Gagnon, Michael, & Michaels, 1994; Spector & Carey, 1990). When women's physical responses of sexual functioning are impaired, it can be a source of a great deal of mental anguish and frustration and may lead to marital discord. It is generally agreed that the subjective experience of the sexual intercourse plays an important role in sexual dysfunction, in particular, and in sexual behavior, in general (e.g., Barlow, 1986; Kaplan, 1974; Walen, 1980). However, scarce empirical research has been conducted dealing systematically with women's subjective experience of the sexual intercourse. The current study, the first step of a large project on sexual experience, attempts to construct a self-report scale tapping the emotional, cognitive, and motivational components of women's experience of heterosexual intercourse, and to examine its predictive validity by assessing the association between these components and female orgasmic disorder.

Most of the theoretical explanations of sexual dysfunction have emphasized the contribution of women's experience of sexual activity (e.g., Barlow, 1986; Kaplan, 1974; Rosen, 1982). Kaplan (1974) suggested that research and therapeutic programs should focus on the "here and now" of the disorder while paying more attention to its proximal experiential antecedents (e.g., the current sexual experience of sexually dysfunctional women). Kaplan also argued that the way sexually dysfunctional women experience sexual activity might generate an anti-erotic atmosphere that interferes with sexual functioning during the intercourse. This anti-erotic experience seems to consist of fear of failure, preoccupation with pleasing the partner, self-monitoring and judgmental thoughts, and lack of open communication. In line with this view, Bleck and Loveless (1987) and Walen (1980) proposed that cognitive distortions, evaluation anxiety, and negative thoughts during the sexual intercourse may impair sexual functioning.

A related theoretical approach to sexual disorder was proposed by Barlow (1986), who reviewed research showing that sexual dysfunction is related to attentional focus on distracting, interfering thoughts during sexual intercourse (Abrahamson, Barlow, Beck, Sakheim, & Kelly, 1985; Beck, Barlow, Sakheim, & Abrahamson, 1984). According to Barlow, the cognitive interference produced by performance-related worries during sexual activity may result in sexual dysfunction. These negative thoughts during the sexual intercourse may exacerbate the anxiety originally aroused by the sexual encounter and, then, may further impair sexual functioning. On this basis, Barlow suggested that therapy should help sexually dysfunctional patients to cope with interfering thoughts and to concentrate on positive thoughts and sensations during sexual activity. Accordingly, Sholty et al. (1984) emphasized process-focused attention (e.g., concentration on sensations and good feelings) during intercourse as a means of facilitating orgasm.

A review of research on women's sexual experience reveals a lack of systematic attempts aimed at describing and mapping the components of this experience. Some studies deal with adolescents' emotional reactions to their first sexual intercourse (e.g., Sprecher, Barbee, & Schwartz, 1995; Weis, 1983). For example, Weis (1983) examined emotional reactions to this experience, focusing on pleasure, satisfaction, romance, excitement, sadness, guilt, exploitation, nervousness, tension, embarrassment, fear, and love. In a subsequent research, Weis (1985) also asked participants to indicate the degree to which they experienced pain. However, Weis failed to include other relevant emotional reactions, such as disgust, entertainment, boredom, anger, curiosity, and depression, which Byrne, Fisher, Lamberth, and Mitchell (1974) found in a previous study. In a narrative analysis of girls' sexual initiation, Thompson (1990) identified two main narrative categories. The most prevalent narrative included themes related to a negative experience of sexual initiation, such as alienation from the body, coercion, boredom, and physical and romantic disappointment. The less common narrative included themes related to a positive experience of sexual initiation, such as sexual curiosity, a sense of a "promising beginning," and assertiveness and self-confidence. However, one should recall that these studies only focused on the experience of the first sexual encounter during adolescence, which may be construed around the loss of virginity (Waterman & Nevid, 1977) and may qualitatively differ from adult women's sexual experience (Thompson, 1990).

Most studies that bear upon sexual experiences in adulthood examine primarily behavioral aspects, such as oral sex and homosexual experiences (e.g., Bentler, 1968; Zuckerman, Tushup, & Finner, 1976). Few studies have performed a qualitative analysis of the sexual experience of adult women. For example, Clifford's (1978) interview procedure revealed that a sense of anticipation and a desire to cuddle are frequently experienced emotional reactions during sexual activities. Responses of sadness, nervousness, performance anxiety, and judgmental thoughts were much less prevalent. Daniluk's (1993) phenomenological analysis of women's sexual experience yielded empowering components, such as caring, respect, acceptance, and mutuality, as well as invalidating negative components, such as feelings of shame, anger, loneliness, guilt, and coercion. The problem with these studies is that they have made no systematic attempt to map these experiences, to delineate their underlying structures, and to construct reliable and valid self-report scales.

In an attempt to provide more systematic instruments for the study of women's sexual experience, a number of reliable and valid scales have been constructed in the last three decades tapping specific aspects of this experience (see Talmadge & Talmadge, 1999, for a review). For example, the Sexual Arousability Inventory (Hoon, Hoon, & Wincze, 1976) focuses on the arousal component of sexual experience, whereas the Sexual Arousability Inventory-Expanded (Chambless & Lipshitz, 1984) assesses the level of arousal and anxiety experienced during sexual behaviors. Accordingly, the Revised Mosher Guilt Inventory (Mosher, 1988) taps the experience of guilt during sexual intercourse, whereas the Sex Anxiety Inventory (Janda & O'Grady, 1980) attempts to distinguish guilt from anxiety.

The problem with the above scales is that they do not provide a comprehensive profile of the relevant emotional, cognitive, and motivational aspects of women's sexual experience. In fact, although arousal, anxiety, and guilt are important experiential components of sexual dysfunctions, they do not capture the rich and complex picture of women's sexual experience described in theoretical and clinical literature. This experience seems to include a wide variety of positive and negative emotions toward the self and the partner as well as affective reactions to the sexual response cycle that are not entirely covered by the existing scales. Moreover, these scales do not tap a wide variety of thoughts related to the self, the partner, the dyadic relationship, the sexual encounter, and the sexual response cycle as well as several personal and interpersonal goals that may be involved in women's experience of the sexual intercourse. The current series of studies would attempt to construct a multidimensional scale that would complement the existing scales and tap the richness of the emotional, cognitive, and motivational components of women's sexual experience.

In attempting to uncover the rich and multifaceted emotional, cognitive, and motivation components of women's sexual experience, the first step of a systematic research plan is the construction of a reliable and valid scale tapping these components. This is the main purpose of the current series of studies. As the first step of a large project in sexual experience, these studies exclusively focus on the experience of heterosexual intercourse of adult women. In Study 1, an open-ended inquiry was employed to derive the feelings, thoughts, and wishes that women reported having experienced during heterosexual intercourse. These responses were content analyzed and were used for constructing a self-report scale. In Study 2, this scale was factor analyzed to uncover the internal structure of women's experience of heterosexual intercourse. In addition, Study 2 provided initial evidence on the convergent validity of this scale. In Study 3, the final version of the scale was administered to three groups of women: (a) clinical anorgasmic women--women who seek professional help due to difficulties in reaching orgasm and who were diagnosed by a clinician as suffering from anorgasmia, (b) subclinical anorgasmic women--women who reported that they had difficulties in reaching orgasm, but did not seek professional help, and (c) sexually functional women--women who reported that they had no difficulty in reaching orgasm. In this way, Study 3 dealt with the "known-group" validity of the scale by examining the association between the components of women's experience of heterosexual intercourse and female orgasmic disorder.

STUDY 1

The main purpose of Study 1 was to delineate the components of women's experience of heterosexual intercourse through an open-ended inquiry. This approach enabled women to describe their sexual experience in their own terms, from their own personal viewpoint, and, therefore, may lend valid and rich psychological contents.

METHOD

Participants

One hundred twenty-nine Israeli women ranging from 19 to 71 years of age (M = 29.98) volunteered to participate in the study without any reward. All the participants were Jews and had sexual relationships with male partners. Most of the participants (N = 114) were recruited from universities, colleges, community centers, and sport clubs from the central area of Israel, and no data were collected about their sexual behavior. In order to increase the heterogeneity of the sample, we recruited 15 clinically-diagnosed sexual dysfunctional women from a sexual counseling institute in the central area of Israel who suffered from anorgasmia, vaginismus, dyspareunia, and problems related to sexual desire. Forty-three percent of the sample was single, 53% was married, and 4% was divorced. Education years ranged from 8 to 20 (M = 13.71). No significant difference in sociodemographic factors was revealed between the 15 sexual dysfunctional women and the remaining 114 women. (1)

Materials and Procedure

Participants were approached individually by the first author and were told that the study focused on women's experiences during heterosexual intercourse. For this purpose, they were told that they would fill out an open-ended questionnaire on these experiences. After agreeing to participate in the study (more than 85% of the approached women agreed to participate in the study), participants received the following instructions:

   The questionnaire investigates women's experience during heterosexual
   intercourse. Try to recall a situation or a number of situations in which
   you had sexual intercourse with your partner. (2) Try to remember, in as
   much detail as possible, what happened to you during the entire experience,
   and to recreate in your mind the things that occurred during those moments.
   Your answers must be based on your personal experience. Please do not try
   to write psychological theories that you have heard or read. Please do not
   stop until you feel that you have described your feelings as completely as
   possible.

Afterwards, participants were required to describe in detail their sensations, feelings, thoughts, and wishes in the recalled situations.

RESULTS AND DISCUSSION

The data were listed and content analyzed based on the steps of analysis suggested by Helgeson, Shaver, and Dyer (1987) and Mikulincer and Segal (1990). In the first step, two of the authors read all participants' descriptions and derived phrases that reflected a single unit of content. At this point, all units (N = 2580) were recorded verbatim. In the second step, similarly worded items were grouped together and phrases with similar meanings were assigned a common category label. For example, "I feel excited" and "my body was excited" were grouped together and placed in a category labeled excitement and enthusiasm. On this basis, the 2580 phrases were grouped into 179 categories.

In the third step, the first author and two undergraduate psychology students independently allocated the 2580 phrases into the 179 generated categories. The phrases were presented in a random order. Interjudge agreement was calculated by the percentage of phrases that two judges congruently allocated into the same category. The percentage of agreement was on the average 95%. When disagreement was observed, the phrase was excluded from the final list. In the last step, frequency distributions were calculated for each of the 179 categories. That is, we counted the number of participants who mentioned a category in their free descriptions of the sexual experience. If at least six participants (5%) gave a response that fitted a given category, the category was retained for the final coding. Following Helgeson et al.'s (1987) suggestion, a liberal inclusion criterion was used in order to minimize the chance of rejecting important features. On this basis, the final list consisted of 126 categories that were mentioned by at least 5% of the sample.

In the fourth step, two judges (graduate clinical psychology students trained in content analysis of qualitative data) independently read the 126 semantic categories generated in the above analytical steps and attempted to sort them into global experiential themes. That is, the judges read the categories in order to discover global themes of the experience of heterosexual intercourse, which seemed to underlie the 126 categories. The two judges independently concluded that the categories could be sorted into three themes, and they agreed in more of 98% of the cases as to which theme belonged in each category.

The first theme focused on the romantic relationship with the partner. This theme includes 46 categories reflecting feelings of being loved, esteemed, understood, cared, accepted, and protected by the partner; feelings of love, attraction, warmth, caring, and intimacy toward the partner; feelings and thoughts related to the partner's needs and emotional state; feelings and wishes related to the partner's sexual satisfaction; desire for the partner's attention, love, and closeness; feelings of gratitude toward the partner; and feelings of neediness and belongingness. All these categories can be grouped in what we call the relationship-centered sexual experience. Here, the romantic relationship with the partner was the central feature of women's experience during the heterosexual intercourse.

The second theme focused on the aversive and threatening components of the sexual experience. It includes 44 semantic categories reflecting feelings of vulnerability, loneliness, sadness, self-pity, alienation, and emptiness; feelings and thoughts related to negative and immoral meanings of sex; feelings of guilt, shame, self-hate, and disgust; feelings and thoughts related to dissatisfaction and frustration from the sexual intercourse; feelings of boredom, indifference, and tiredness; worries about lack of sexual competence; and the occurrence of disturbing and interfering thoughts. All these categories can be grouped in what we call the worry-centered sexual experience. In this pattern, negative feelings and distressing thoughts were the defining features of women's sexual experience. We avoid terming this category "anxiety," because this label is inconsistent with Barlow's model of arousal in which anxiety can actually enhance sexual arousal (Barlow, 1986). According to this model, it is the worry component, and not anxiety per se, that may serve as a distracting stimulus and may reflect the distressing facet of sexual experience.

The third theme focused on the pleasure and ecstasy related to sexual activity. It includes 36 semantic categories reflecting feelings of pleasure, satisfaction, excitement, freedom, and relief; feelings of ecstasy, strength, and power; focused attention on reaching orgasm; and various signs of cognitive dissociation and loss of personal control. All these categories can be grouped in what we call the pleasure-centered sexual experience. Here, the pleasurable cycle of excitement, ecstasy, and relief that characterizes human orgasm seems to be the focus of women's experience of heterosexual intercourse.

On this basis, we constructed a self-report scale of women's experience of heterosexual intercourse, which consisted of three subscales--the relationship-centered sexual experience subscale, the worry-centered sexual experience subscale, and the pleasure-centered sexual experience subscale. Items were extracted from the semantic categories generated in Study 1, so that all the categories were represented in the scale.

STUDY 2

In Study 2, we administered the self-report scale of women's experience of heterosexual intercourse developed in Study 1 to a large group of women, who served as a validation sample before the instrument was used on a clinical sample. We attempted to validate the tripartite classification of female sexual experience, examining whether the three global patterns revealed in Study 1 actually represented well-differentiated experiences of the heterosexual intercourse. In addition, we attempted to examine the construct validity of each of these three global patterns by examining the internal factor structure of each pattern. Finally, we attempted to provide initial information about the convergent validity of the new scale by examining its association with women's reports of sexual satisfaction, sexual arousal, and sex-related intimacy.

METHOD

Participants

Five hundred sixty-four Israeli women ranging from 18 to 64 years of age (M = 30.67) volunteered to participate in the study without any reward. All the participants were Jews and were recruited from universities, colleges, community centers, and sport clubs from the central area of Israel. Marital status data showed that 56.7% of the sample was single, 38.5% was married, and 4.8% was divorced or widowed. Education years ranged from 8 to 20 (M = 14.4). Grammar school education was needed in order to complete the questionnaire. All the participants had sexual relationships with male partners.

Materials and Procedure

The construction of the current version of the Women's Experience of Heterosexual Intercourse Scale (WEHIS) was based on the categories identified in Study 1. Three judges (the authors) independently selected an item from each of the semantic categories of Study 1, according to the prototypicality level of items within the category. These lists were examined by two of the judges, who dealt with items for which there were no agreement and decided which item was included in the scale. The scale consisted of 126 items that represented the categories generated in Study 1. It was composed of three subscales, reflecting the patterns revealed in Study 1: the relationship- centered sexual experience subscale (46 items), the worry-centered sexual experience subscale (44 items), and the pleasure-centered sexual experience subscale (36 items).

Participants were approached by the first author and were given the following instructions:

   Try to recall a situation or a number of situations in which you had sexual
   intercourse and imagine to yourself, in as much detail as possible, what
   happened to you during the entire experience, and try to recreate in your
   mind the things that occurred during those moments. On the following pages,
   you will find a list of sentences dealing with the situation/s that you
   have brought to your mind. Please circle, next to each sentence, the degree
   to which it matches the experience/s you had. For each sentence, there is a
   scale of numbers from 1, which indicates total lack of fit, to 9, which
   represents a total match. If the sentence matches the experience closely,
   mark a higher number, if it does not match, mark a lower number. It is
   important to us that your answers be based on an experience or experiences
   of sexual intercourse that you have had during your life, therefore try to
   answer the questions from your own personal experience and ignore things
   you have heard or read about the topic. At this point, we wish to note that
   these questionnaire are anonymous and confidential.

Then, participants read each of the 126 items and rated the extent to which an item matched their personal experience on a 9-point scale, ranging from does not match at all (1) to closely matches (9). The following are a few samples of WEHIS items: "I feel ashamed," "I concentrate on reaching orgasm," "I try to please my partner," "I feel attracted to my partner," "I feel bored." The 126 items were presented in random order, and their wording matched the wording used by participants in Study 1. The random order of the items was intended to eliminate any bias derived from presenting all the items of one subscale together. The completion of the WEHIS took around 15 minutes.

In order to examine the convergent validity of the WEHIS, participants answered a 10-item version of the Israeli Sexual Behavior Inventory (ISBI: Kravetz, Drory, & Shaked, 1999) tapping three areas of sexual functioning. Three items dealt with sexual satisfaction (e.g., "I feel satisfied with my sexual life"), three items with sexual arousal (e.g., "I feel aroused during sexual intercourse"), and four items with intimacy during sexual intercourse (e.g., "I display signs of affection during sexual intercourse"). Participants rated the extent to which the items were self-descriptive on a 5-point scale, ranging from not at all (1) to very much (5). Alpha Cronbach coefficients were adequate for the three categories of sexual functioning (.74 for sexual satisfaction items, .79 for sexual arousal items, and .76 for intimacy items). On this basis, we computed three scores by averaging items in each category.

RESULTS AND DISCUSSION

A Tripartite Organization of Female Sexual Experience

Before examining the internal structures of each of the three sexual experience subscales, we conducted a preliminary analysis aimed at determining the extent to which these subscales represented differentiated experiences. Because the delineation of the three global facets of sexual experience was based on a content analysis of participants' responses and might have involved some subjectivity on the part of the experimenters, it is necessary to examine whether more "objective" statistical analyses would actually unfold three differentiated categories from the 126 WEHIS items. For this purpose, a confirmatory factor analysis was performed testing the model that the 126 items would converge into three major factors, each one representing a specific WEHIS subscale.

The results of a confirmatory factor analysis with Varimax rotation conducted on the 126 items revealed three major factors (49% of the explained variance), which matched the three subscales. Most of the 46 items of the Relationship-centered Sexual Experience subscale (38 items) loaded high (loading > .40) in the first factor (22% of explained variance). Most of the 44 items of the Worry-centered Sexual Experience subscale (39 items) loaded high (loading > .40) on the second factor (14%). Finally, most of the 36 items of the Relationship-centered Sexual Experience subscale (30 items) loaded high (loading > .40) on the third factor (13% of explained variance). These findings validated the classification of the 126 WEHIS items into three subscales. On this basis, we can now examine the internal structure of each subscale.

The Relationship-centered Sexual Experience

Based on preliminary analyses (reliability and factor analysis) of the relevant 46 items, we dropped 5 items that showed low correlations with the total subscale score (less than .20), 5 items that loaded low (less than .40) in all the main factors (eigenvalue > 1), and 2 items that loaded high (more than .40) in most of these factors. Thus, the final version of this subscale consisted of 32 items. The high Alpha Cronbach coefficient of these items (.92) implied that all the items seemed to represent a single theme of women's experience of heterosexual intercourse.

A factor analysis with Varimax rotation performed on the 32 items yielded 5 main factors (eigenvalue > 1) that explained 61.4% of the total variance (see item wording and factor loadings in Table 1). The first factor explained 32.5% of the variance and included 11 items (loading > .40) dealing with feelings of being desired, esteemed, accepted, understood, cared, and protected by the partner as well as with feelings of being unique and feminine. On this basis, we labeled this factor as feelings of being loved by partner. Factor 2 (12.8% of explained variance) consisted of 8 items tapping women's focus on the partner's needs, thoughts, and reactions as well as their preoccupation with pleasing the partner. On this basis, we labeled this factor as focus on the partner's state. Factor 3 (5.8%) included 5 items reflecting feelings of intimacy, warm, love, and attraction toward the partner as well as a desire for merging with the partner. On this basis, we labeled this factor as feelings of love toward partner. Factor 4 (5.5%) included 5 items dealing with desires for emotional involvement, warmth, and attention from the partner. This factor was labeled as desire for partner's involvement. Factor 5 (4.8%) included 3 items dealing with feelings of gratitude toward the partner, belongingness, and neediness. In our terms, this factor reflected a sense of interdependence.

Overall, the relationship-centered experience seemed to consist of five basic components reflecting women's emotional and cognitive transactions with the partner during the heterosexual intercourse. On the one hand, two components reflect women's subjective sense of being the object of love: feelings of being loved and esteemed by the partner and the desire for the partner's involvement. On the another hand, three components reflect women's sense of being the subject of love: feelings of love toward the partner, a sense of interdependence with him, and attentional and emotional focus on his needs and reactions. Importantly, Alpha Cronbach coefficients for items in each of the 5 factors were acceptable (from .74 to .92), implying adequate internal consistency of these factors.

The Worry-centered Sexual Experience

Based on preliminary analyses of the relevant 44 items, we dropped 4 items that showed low correlations with the total subscale score (less than .20), 3 items that loaded low (less than .40) in all the main factors (eigenvalue > 1), and 1 item that loaded high (more than .40) in most of these factors. Thus, the final version of this subscale consisted of 36 items. The high Alpha Cronbach coefficient of these 36 items (.95) implied that all the items seemed to represent a single theme of women's experience of heterosexual intercourse.

A factor analysis with Varimax rotation performed on the 36 items yielded 6 main factors (eigenvalue > 1) that explained 60.3% of the total variance (see item wordings and factor loadings in Table 2). The first factor explained 36.2% of the variance and included 8 items (loading > .40) tapping feelings of emptiness, anger, self-pity, loneliness, sadness, vulnerability, and alienation. In our terms, this factor reflected a sense of estrangement and vulnerability. Factor 2 (6.7% of explained variance) consisted of 8 items dealing with fear, disgust, and guilt feelings related to the negative and immoral meanings of sexual activity. We labeled this factor as negative feelings. Factor 3 (4.8%) included 7 items reflecting frustration and dissatisfaction related to the partner's sexual behavior, resentment and complaints toward him, and difficulties in experiencing pleasure. We labeled this factor as disappointment from partner's sexual behavior. Factor 4 (4.6%) included 6 items dealing with feelings of indifference, impatience, tiredness, and boredom as well as with desires for ending and escaping from the situation. This factor reflects a decrease of sexual interest during the intercourse, and, then, was labeled sexual burnout. Factor 5 (4.2%) included 4 items tapping worry, tension, and shame related to one's own sexual inadequacy. This factor was labeled as a sense of sexual inadequacy. Factor 6 (3.8%) included 3 items tapping the occurrence of disturbing thoughts, lack of concentration, and mind wandering. This factor was labeled as interfering thoughts.

The worry-centered sexual experience consisted of six components reflecting women,s negative reactions to heterosexual intercourse as well as their repulsion of this activity. Four components reflected the various sources of these negative reactions: the personal vulnerability and sense of estrangement related to sexual activity, the negative and immoral meanings of this activity, the lack of the partner's sexual competence, and the potential evidence of one's sexual inadequacy. The two other components reflected negative states of mind that may occur during sexual activity: sexual burnout (loss of sexual interest) and the occurrence of interfering thoughts. Importantly, Alpha Cronbach coefficients for items in each of the 6 factors were acceptable (from .72 to .86), implying adequate internal consistency of the factors.

The Pleasure-centered Sexual Experience

Based on preliminary analyses of the relevant 36 items, we dropped 6 items that showed low correlations with the total subscale score (less than .20) and 2 items that loaded low (less than .40) in all the main factors (eigenvalue > 1). Thus, the final version of this subscale consisted of 28 items. The high Alpha Cronbach coefficient of these 28 items (.91) implied that all the items represented a single theme of women's experience of heterosexual intercourse.

A factor analysis with Varimax rotation performed on the 28 items yielded 4 main factors (eigenvalue > 1) that explained 53.9% of the variance (see item wordings and factor loadings in Table 3). Factor 1 explained 30.6% of the variance and included 11 items tapping feelings of pleasure, satisfaction, excitement, relief, and calmness as well as positive thoughts related to the sexual activity. This factor was labeled as pleasure-related feelings. Factor 2 (10.5%) consisted of 9 items dealing with feelings of loss of control and signs of cognitive and behavioral dissociation from the environment. We labeled this factor as a letting-go state. Factor 3 (7.4%) included 4 items reflecting feelings of strength, power, and extreme passion. We labeled this factor as strength feelings. Factor 4 (5.4%) included 4 items dealing with focused concentration on egocentric needs as well as on reaching the orgasm. This factor was labeled as focus on one's sexual needs.

Overall, the pleasure-centered sexual experience consisted of feelings reflecting the orgasmic cycle of excitement--pleasure-relief-satisfaction, which were accompanied by a sense of power and strength and two complementary states of mind-- cognitive/emotional dissociation from the environment and focused attention on reaching the orgasm. Importantly, Alpha Cronbach coefficients for items in each of the 4 factors were acceptable (from .62 to .89), implying adequate internal consistency of these factors. (3)

Convergent Validity

In examining the convergent validity of the WEHIS, we made the following analytical steps. First, we computed 15 total scores by averaging items that loaded high on each of the 5 relationship factors, 6 worry factors, and 4 pleasure factors. Second, we computed a canonical correlation and Pearson correlations between these 15 factor scores and the ISBI scores of sexual satisfaction, arousal, and intimacy. Significance levels for the correlations were corrected according to Bonferroni technique.

The canonical correlation revealed three significant canonical functions. The first function, F(45, 1187) = 9.10, p < .01, was defined by sexual satisfaction, which was positively associated with the pleasure-related feelings, r(562) = .48, p < .01, and being loved factors, r(562) = .37, p < .01, and inversely associated with the disappointment from partner, r(562) = -.38, p < .01, and sexual burnout factors, r(562) = -.39, p < .01. The second canonical function, F(28, 854) = 2.35, p < .01, was defined by intimacy during sexual intercourse, which was positively associated with three factors of the relationship-centered subscale: being loved, r(562) = .50, p < .01, focus on partner's needs, r(562) = .43, p < .01, and feelings of love towards partner, r(562) = .36, p < .01; and inversely associated with three factors of the worry-centered subscale: sense of estrangement, r(562) = -.41, p < .01, disappointment from partner, r(562) = -.40, p < .01, and sexual burnout, r(562) = -.43, p < .01. The third canonical function, F(13,493) = 2.34, p < .01, was defined by sexual arousal, which was positively associated with three factors of the pleasure-centered subscale: letting-go, r(562) = .35, p < .01, strength feelings, r(562) = .40, p < .01, and focus on one's sexual needs, (r(562) = .45, p < .01; and inversely associated with two factors of the worry-centered subscale: sense of estrangement, r(562) = -.45, p < .01, and disappointment from partner, r(562) = -.41, p < .01.

Summary

The findings validated the tripartite organization of the female sexual experience. Moreover, they delineated the internal structure of the three patterns of women's experience of heterosexual intercourse. The findings also provided initial information about the convergent validity of the scale. On the one hand, the three subscales of sexual experience were significantly associated with reports of sexual functioning. Whereas the worry-centered factors were inversely associated with sexual satisfaction, sexual arousal, and sex-related intimacy, the relationship-centered factors contributed to sexual satisfaction and intimacy and the pleasure-centered factors contributed to sexual satisfaction and arousal. On the other hand, the strength of the significant correlations was moderate (ranging from .35 to .50), implying that although the WEHIS scores were associated with reports of sexual functioning, they cannot be equated with measures of sexual satisfaction, arousal, or intimacy.

STUDY 3

Study 3 was designed to provide information about the "known-group" validity of the WEHIS by examining (a) the extent to which the components of women's experience of heterosexual intercourse differentiate between anorgasmic and orgasmic women, and (b) the extent to which these components differentiate between anorgasmic women who seek for clinical help and those who do not (clinical versus subclinical groups). For these purposes, clinical anorgasmic women, subclinical anorgasmic women, and orgasmic women were compared in the scale developed in Study 2. Special efforts were made to match (a) clinical and subclinical groups in the reported level of the anorgasmic disorder, and (b) the three groups in sociodemographic characteristics.

METHOD

Participants

The sample consisted of three study groups of Israeli Jewish women, who had sexual relationships with male partners. The clinical anorgasmic group consisted of 36 women, who were not included in Study 1 and who asked for therapy from the sexual counseling institutes of various hospitals in the central area of Israel due to orgasmic difficulties. In an intake session, these women were asked about how frequently did their sexual activities with a partner resulted in orgasm, and how frequently did they find reaching orgasm a difficult task. These questions were answered in 5-point scales, ranging from never (1) to always (5). All the women in our sample gave an answer of never or almost never in response to the question about the frequency of sexual activities that result in orgasm, and an answer of always or almost always in response to the question about the frequency of the experience of difficulties in reaching orgasm. In addition, a sex counselor, who used DSM-IV criteria to make the diagnosis, diagnosed all these women as suffering from anorgasmia.

The data from women in the clinical anorgasmic group were collected during 12 consecutive months and represented all the women who were diagnosed as suffering from orgasmic dysfunction in the targeted hospitals during this period. The sex counselor who diagnosed their orgasmic dysfunction first contacted these women and asked them to participate in the research in order to understand better how women feel during heterosexual intercourse. They were told that in the next 2 weeks a female psychologist would contact them, and anonymity was assured. Women signed an informed consent and the first author approached them at the institute. Women in this group ranged in age from 18 to 61 (M = 31.17), and years of education ranged from 9 to 20 (M = 14.53). Sixty-four percent of them were married and had 1.60 children in average. A clinical interview conducted in the institute revealed that all these women did not surfer from other sexual dysfunction or diagnosable psychiatric disorders. Refusal rate in this group was low (around 5%).

After collecting data from the clinical anorgasmic group, we approached a large sample of Israeli Jewish women (N = 256) who did not ask for professional help about their sexual functioning from a sexual counseling clinic or institute. Women in this group were approached in universities, colleges, community centers, and sport clubs in the central area of Israel. Refusal rate in this group was low (8%). All the participants had sexual relationships with male partners.

A large number of women were sampled in order to construct an adequate control group that could be matched to the clinical anorgasmic group in basic sociodemographic characteristics (age, years of education, marital status, number of children). In addition, this large group served as the basis for sampling women who reported orgasmic problems in a survey questionnaire, but who did not ask for professional help during the study period, or had not asked in the past (subclinical anorgasmic group). For this purpose, participants answered the two questions (in the 5-point scale described above) that clinical anorgasmic women answered in the intake session: how frequently did sexual activities with a partner resulted in orgasm, and how frequently did they find reaching orgasm a difficult task.

The inclusion criteria for the subclinical anorgasmic group were (a) an answer of never or almost never in response to the question about the frequency of sexual activities that result in orgasm, and (b) an answer of always or almost always in response to the question about the frequency of the experience of difficulties in reaching orgasm. In this way, these women were completely matched to clinical anorgasmic women in the answers they gave to these questions. From the entire sample, 26 women (10%, 26/256) met the above criteria and were sorted into the subclinical anorgasmic group. Women in this group ranged in age from 16 to 54 (M = 28.57) and in years of education from 8 to 20 (M = 13.68). Fifty-nine percent of them were married and had 1.41 children in average. Chi-square tests and t-tests revealed no significant differences between this group and the clinical anorgasmic group in the assessed sociodemographic characteristics.

The inclusion criteria for the control orgasmic group were also very stringent: (a) an answer of always or almost always in response to the question about the frequency of sexual activities that result in orgasm, (b) an answer of never or almost never in response to the question about the frequency of the experience of difficulties in reaching orgasm, and (c) similar sociodemographic characteristics to women in the clinical anorgasmic group. On this basis, we selected 36 women who met the criteria for the control group. (4) Women in this group ranged in age from 19 to 54 (M = 32.44) and in years of education from 9 to 20 (M = 14.34). Sixty-four percent of them were married and had 1.54 children in average. Chi-square tests and ANOVAs revealed no significant differences between this group and the other two groups in all the sociodemographic characteristics

Materials and Procedure

Participants individually completed the final version of the WEHIS. This version consisted of the 3 subscales described in Study 2, and it was constructed on the basis of the reported factor analyses. The final scale consisted of the 96 items presented in Tables 1 to 3, which loaded high on one of the factors of the three subscales (32 items in the Relationship-centered Sexual Experience subscale, 36 items in the Worry-centered Sexual Experience subscale, and 28 items in the Pleasure-centered Sexual Experience subscale). The instructions and ratings scales were identical to those described in Study 2.

Cronbach Alpha coefficients for items in each of the 15 factors extracted in Study 2 (see Tables 1-3) were acceptable (from .70 to .93). On this basis, 15 scores were computed for each participant by averaging the items corresponding to each factor (see Tables 1-3). Cronbach Alpha coefficients also yielded high internal consistency for items in each of the three subscales (.92 for relationship-centered sexual experience items, .96 for worry-centered sexual experience items, and .92 for pleasure-centered sexual experience items). In addition, a high-order factor analysis performed on the 15 factor scores revealed three main high-order factors (eigenvalue > 1) that explained 72.3% of the variance and replicated the factor structure found in Study 2. That is, the results of the high-order factor analysis indicated that the three sexual experience subscales were well differentiated and that the 15 factors loaded high in the corresponding subscales.

RESULTS AND DISCUSSION

In order to avoid experimentwise error and to control for the large number of comparisons, analyses of variance (ANOVAs) and means comparison tests were conducted with alpha set at .01 and significance levels were corrected according to Bonferroni technique. According to Cohen's (1992) tables, the estimated power for the statistical analyses was .80 for a large population effect size (alpha = .01).

The Relationship-centered Sexual Experience

A one-way multivariate analysis of variance (MANOVA) for study group (clinical anorgasmic, subclinical anorgasmic, control) was performed on the five factors of the relationship-centered sexual experience subscale (feelings of being loved by partner, focus on partner's state, feelings of love toward partner, desire for partner's involvement, sense of interdependence). This MANOVA yielded a significant group difference F(10,182) = 4.22, p<.01. Univariate analyses of variance (ANOVAs) indicated that this effect was significant for three of the five factors: feelings of being loved by partner, feelings of love toward partner, and a sense of interdependence (see Fs in Table 4). Scheffe post hoc tests (Alpha = .05) revealed similar significant group differences across the three factors. Clinical anorgasmic women scored lower in feelings of being loved by partner, feelings of love toward him, and a sense of interdependence than subclinical anorgasmic women, who, in turn, scored lower in these three factors than women in the control group (see means in Table 4). Overall, the experience of anorgasmic women was construed around feelings of being unloved by partner during the heterosexual intercourse and a reciprocal lack of love toward him.

The Worry-centered Sexual Experience

The MANOVA for study group performed on the six factors of the worry-centered sexual experience subscale (sense of vulnerability and estrangement, negative feelings, disappointment from partner's sexual behavior, sexual burnout, sense of sexual inadequacy, interfering thoughts) yielded a significant group difference F(12,180) = 6.46, p < .01. Univariate ANOVAs indicated that this effect was significant on all the six aversive sexual experience factors (see Fs in Table 4). Scheffe tests revealed the following group differences: Both clinical anorgasmic and subclinical anorgasmic women scored higher in all the six aversive sexual experience factors than women in the control group (see means in Table 4). In addition, clinical anorgasmic women were round to score higher than subclinical anorgasmic women in disappointment from partner's sexual behavior and sexual burnout (see Table 4). Overall, it seems that the experience of anorgasmic women was more centered on the aversive aspects of the heterosexual intercourse than the experience of control, orgasmic women.

The Pleasure-centered Sexual Experience

The MANOVA for study group performed on the four factors of the pleasure-centered sexual experience subscale (pleasure-related feelings, letting-go state, sense of strength, focus on one's sexual needs) yielded a significant group difference F(8,184) = 8.73, p < .01. Univariate ANOVAs indicated that this effect was significant on three pleasure-centered sexual experience factors (see Fs in Table 4). Scheffe tests revealed the following group differences: Both clinical anorgasmic and subclinical anorgasmic women scored lower than control women in pleasure-related feelings, letting-go state, and a sense of strength (see means in Table 4). No significant group difference was found in the factor tapping focused attention on sexual needs. Overall, it seems that anorgasmic women were less likely to experience the heterosexual intercourse in terms of pleasure-related feelings than orgasmic women.

Discriminant Analysis

In examining the relative and unique contribution of the various components of women's sexual experience to anorgasmia, we performed a discriminant analysis with the 15 factors of the sexual experience questionnaire as discriminating between the 3 study groups. The first discriminant function was significant F(30,158) = 3.94, p < .01 and explained 59% of the variance. The second discriminant function was not significant. The group centroids revealed that the clinical anorgasmic group (-1.17) and the control group (1.48) were at the opposite poles of the function, whereas the subclinical anorgasmic group was allocated between them but closer to the clinical anorgasmic group (-.51). That is, the significant function discriminated between anorgasmic and orgasmic women. The standardized canonical coefficients revealed that only the following factors made a unique significant contribution to the first discriminant function: disappointment from partner's sexual behavior (-.88), pleasure-related feelings (.64), feelings of love toward partner (.50), a sense of estrangement and vulnerability (-.36), and letting go (.36). In other words, as compared to orgasmic women, anorgasmic Women reported lower levels of love feelings toward their partner, pleasure-related feelings, and letting go as well as higher levels of disappointment from the partner's sexual behaviors and a sense of estrangement and vulnerability during the heterosexual intercourse.

GENERAL DISCUSSION

In the current research, we developed a self-report scale on women's experience of heterosexual intercourse (WEHIS). The findings show that the WEHIS is a reliable and valid instrument of women's experience of heterosexual intercourse, and that this experience consists of three well-differentiated patterns. They also document the utility of the WEHIS for differentiating between orgasmic and anorgasmic women. That is, the findings reveal the unique experiential profile of anorgasmic women during heterosexual intercourse, pointing out those components that may be related to anorgasmic disorder.

Findings of Studies 1 and 2 reveal three well-differentiated patterns of women's experience of heterosexual intercourse. One global pattern focuses on the romantic relationship with the sexual partner. In this pattern, the heterosexual experience is equated with romantic love and women are occupied with their romantic relationship. They seem to experience the heterosexual intercourse as a direct reflection of the dyadic relationships as well as a sign of the love they feel toward the partner, the love and esteem the partner feels toward them, and the emotional interdependence existing in the relationship. In this experiential pattern, a positive heterosexual experience may be subjectively related to the enhancement of the love relationship, whereas a negative heterosexual experience may be subjectively associated with lack of love and dissatisfaction with the relationship.

The relationship-centered heterosexual experience seems to fit system theories that emphasize the association between the quality of the romantic relationship and sexual functioning (e.g., Witkin, 1980). Moreover, it seems to converge with what Reiss (1960) called person-centered sex, in which women place great emphasis on the romantic connection with the heterosexual partner. The relationship-centered experience may also explain prior findings showing that sexual arousal often leads to increased feelings of love toward the sexual partner (e.g., Dermer & Pyszczynski, 1978).

A second pattern of women's experience of heterosexual intercourse consists of aversive and distressing cognitions and feelings related to this activity. In this pattern, the heterosexual intercourse is equated with negative affectivity, and women are preoccupied with their own negative emotional state. Here, women may experience the heterosexual intercourse as a sinful and immoral act and, then, may experience feelings of guilt, shame, and disgust. Moreover, they may feel empty, lonely, and vulnerable during heterosexual intercourse, which may be experienced as a sign of their own sexual incompetence and/or the partner's sexual inadequacy. These emotions and worries are accompanied by a loss of interest in the sexual act as well as by the occurrence of interfering thoughts. In this experiential pattern, a positive heterosexual experience may be subjectively related to a relief from the intruding and distressing feelings, whereas a negative heterosexual experience may be equated with the confirmation of one's sex-related worries.

The worry-centered pattern of heterosexual experience fits Kaplan's (1974) emphasis on the fears and anxieties that may be aroused during heterosexual intercourse. Accordingly, it fits Barlow's (1986) emphasis on sex-irrelevant attentional focus. The worry-centered pattern of sexual experience is also in line with prior findings on the negative themes that may be involved in women's heterosexual experience (e.g., Thompson, 1990; Weis, 1983) as well as with cultural views of sex as a sinful act.

A third global pattern of women's heterosexual experience consists of cognitions, feelings, and motives focuses on the sexual response. Here, the heterosexual experience is equated with the pleasure and satisfaction derived from the sexual act itself. Women are occupied in reaching orgasm as well as in fully experiencing the pleasurable sensations related to this physical state. Moreover, they seem to feel so free and strong in such a pleasurable state that they give up control, disassociate from the surroundings, and embark themselves toward a letting-go state. Interestingly, this dissociative state may co-exist with focused attention in the orgasm. This attention seems to reflect process-focused attention, which seems to enhance sexual functioning, rather than goal-focused attention, which seems to impair sexual functioning (Barlow, 1986).

Within the pleasure-centered pattern, a positive heterosexual experience may be subjectively equated with the reaching of orgasm and the full experience of the orgasmic cycle of excitement, ecstasy, and relief. In contrast, a negative heterosexual experience may be subjectively related to a failure to reach orgasm as well as to difficulties in experiencing feelings of excitement, pleasure, and relief during heterosexual intercourse. This experiential pattern fits Kaplan's (1974) emphasis on the ability to abandon oneself to erotic sensations and to give up control. It also fits Sholty et al.'s (1984) findings that focused attention in reaching orgasm is an important aspect of the sexual experience.

It is important to note that some of the components of women's experience of heterosexual intercourse tapped by the WEHIS fit specific aspects of this experience tapped by existing scales. For example, some factors in the worry-centered pattern of sexual experiences (e.g., sinful feeling, sense of sexual inadequacy, interfering thoughts) lit experiential aspects tapped the Revised Mosher Guilt Inventory (Mosher, 1988) and the Sex Anxiety Inventory (Janda & O'Grady, 1980). The WEHIS seemed to complement the existing scales by tapping other important aspects of sexual experience, such as relationship-centered and pleasure-centered patterns of this experience. However, further research is needed to empirically show that the WEHIS adds to the ability to assess female sexual response beyond the existing scales. Moreover, information should be gathered on the concurrent and discriminant validity of the WEHIS. In addition, further research should examine whether the WEHIS scores correlate with other scales of women's sexual experience (e.g., Sexual Arousability Inventory, Sex Anxiety Inventory) and whether the WEHIS scores do hot correlate with other related but different constructs (e.g., trait anxiety, neuroticism).

Findings of Study 3 show that the scale developed in Studies 1 and 2 is able to differentiate between orgasmic and anorgasmic women. Specifically, anorgasmic women tend to score lower in the relationship-centered and pleasure-centered patterns and to score higher in the aversive pattern than orgasmic women. That is, female anorgasmia is related to the experience of heterosexual intercourse as a sign of lack of love and problematic romantic relationships, as a failure in fully experiencing the orgasmic cycle, and as an aversive affective state. Moreover, a discriminant analysis revealed that specific cognitive and emotional components of all three patterns made unique significant contributions to the differentiation between orgasmic and anorgasmic women.

The most prominent feature of the anorgasmic women's description of heterosexual experience is its overall aversive nature. The orgasmic dysfunction is reflected in fears, anxieties, and worries as well as in negative states of mind, such as sexual burnout and sex-irrelevant attentional focus. This pattern is in keeping with Kaplan's (1974) assertion that remote causes of sexual dysfunction may be diverted into the experiential surface in the form of anxiety and cognitive obstacles to erotic pleasure. However, one should take into account that although an aversive experiential description may be a sign of sexual difficulties, it is not clear whether this experiential profile constitutes an obstacle to sexual functioning in its own right or just reflects the existence of an orgasmic dysfunction.

With regard to the relationship-centered pattern of heterosexual experience, female anorgasmia seems to be related to the experience of a lack of love, intimacy, closeness, and interdependence during the heterosexual intercourse. Although this finding may be in line with System theories (e.g., Witkin, 1980), one should take into account that out findings did not indicate that anorgasmic women reported having more problems in the dyadic relationship. Rather, the findings indicate that these women were unable and/or unwilling to experience emotional closeness to their partner during heterosexual intercourse. These emotional experiences may indeed reflect the possible existence of problematic romantic relationships, which are directly manifested in the sexual activity. At the same rime, however, they may be a correlate or even a consequence of a history of frustrating heterosexual experiences as well as of the rejection anorgasmic women may feel due to their difficulties in reaching orgasm. Nevertheless, feelings of rejection during heterosexual intercourse seem to be central components of anorgasmia.

Interestingly, female anorgasmia had differential associations with the various components of the relationship-centered pattern of heterosexual experience. On the one hand, the heterosexual experience of anorgasmic women was construed around the perception of the partner as rejecting, cold, and distant, a negative self-perception of being unloved by him, and cold and rejecting feelings toward him. On the another hand, anorgasmic women did not differ from sexually functional women in the extent to which they focus on the partner's state and demand his emotional involvement during the sexual intercourse. It seems that, at least in our sample, female anorgasmia is more related to feelings of broken love and mutual rejection during heterosexual intercourse than to the need to satisfy the partner. Further studies should examine more in-depth this differential pattern of associations.

With regard to the pleasure-centered pattern of heterosexual experience, anorgasmic women were less likely to report pleasure-related feelings, to give up control, and to abandon themselves in a letting-go state during heterosexual intercourse than orgasmic women. That is, anorgasmia was associated with the inability to fully experience the sexual cycle of excitement, ecstasy, and relief and to cognitively and emotionally dissociate from the environment. Although our findings are only correlative in nature, one can speculate about the sequence of psychological events that may evolve during the heterosexual intercourse. Due to intrapersonal conflicts, interpersonal problems, and/or a history of frustrating sexual experiences, anorgasmic women may enter heterosexual intercourse with anxieties and sex-irrelevant interfering thoughts. Moreover, they may experience the heterosexual intercourse in terms of romantic rejection and lack of love, which, in turn, may exacerbate their sex-related worries. This self-exacerbating cycle of negative feelings and cognitions may, in turn, prevent a letting-go pleasurable state. Further studies should explore in-depth this sequence of psychological events.

Findings of Study 3 also show that the developed scale differentiated between clinical anorgasmic women and subclinical anorgasmic women. Specifically, clinical anorgasmic women felt more mutual rejection during heterosexual intercourse, more disappointment from partner's sexual behavior, and more sexual burnout than subclinical anorgasmic women. This pattern of differences may reflect the distressing meaning clinical anorgasmic women attached to sexual encounters, which, in turn, might have motivated them to turn to treatment. Alternatively, one can speculate that the findings may reflect a tendency of subclinical anorgasmic women to dismiss the implications of the dysfunction for sexual life and dyadic relationship. The findings also raise some related questions regarding the motives behind turning to sexual treatment. Are the two groups of anorgasmic women different in the perception and labeling of the orgasmic dysfunction, or do these groups differ in their way of coping with the dysfunction? Are subclinical anorgasmic women more sexually satisfied than the clinical group? Are clinical anorgasmic women more motivated to seek treatment by the interpersonal problems experienced during heterosexual intercourse than subclinical anorgasmic women? Further research should deal with these important questions.

The current findings have important clinical implications. First, the WEHIS can provide a well-delineated experiential profile of specific sexual dysfunctions. In this way, clinicians would be able to make more refined diagnoses and to understand the cognitive and affective sources of a specific dysfunction. Second, the WEHIS can provide information about the arousal of anxiety during sexual intercourse. Instead of providing a single anxiety score, the WEHIS could provide the affective and cognitive profile related to sexual anxiety. Third, the WEHIS can assist clinicians in developing particular intervention plans for a specific client according to her scores in the scale. Of course, more clinical-oriented research is needed before applying the WEHIS in clinical settings.

Although the findings showed that anorgasmia is associated with almost all the components of women's experience of heterosexual intercourse, the correlational nature of our design prevents us from delineating the causal direction of the relationship between this experience and orgasmic dysfunction. Put differently, it may be that the heterosexual experience itself is a proximate cause contributing to the development of the dysfunction. Alternatively, this experience may be a mere reflection of the orgasmic difficulties. Future studies should employ a longitudinal prospective design, administering the currently developed scale in multiple waves to anorgasmic women, and assessing whether the reconstruction of their sexual experience during therapy may lead to changes in orgasmic functioning. In such a clinical context, this scale can aid the therapist in identifying the experiential aspects of the disorder and evaluating treatment outcomes.

Before closing the discussion, one should note some limitations of the current study. First, the current series of studies provides only initial information on the reliability and validity of the WEHIS. Further studies should examine the test-retest reliability of the WEHIS scores as well as their concurrent and discriminant validity. Second, our sample of clinical anorgasmic women was too small to take into account well-known subtypes of female anorgasmia. Orgasmic dysfunction can be acquired after a period of normal functioning or it can be lifelong; it can be total or partial in frequency; it can also be global or situational (Masters & Johnson, 1970). Further research should examine whether the currently developed scale can differentiate between subtypes of anorgasmia. Third, our sample consisted of Israeli Jewish women, and cultural norms concerning sexuality might have affected the findings. Accordingly, religious influences (i.e., Jewish religion), war-related threats (i.e., the Israeli-Arab conflict), and differences in sexual education and women's rights between the Israeli society and other societies may compromise the generalizability of our findings. Further research should attempt to examine women's experience of heterosexual intercourse in other cultural, religious, and ethnic samples. Fourth, studies should investigate women's experience in other sexual activities (masturbation, homosexual intercourse) and focus on men's sexual experiences in order to assess their commonalities and uniqueness, and, then, to construct more comprehensive scales that could tap the diverse facets of sexual experience. However, despite its possible limitations, our study should be viewed as an important step in the development of a reliable and valid instrument tapping the components of the experience of sexual activities as well as in the application of this instrument for understanding sexual dysfunction.

Table 1. Factor Structure of the Relationship-centered Sexual
Experience Subscale

Item                                        I    II    III   IV     V

I feel desired                             .79
I feel special                             .77
I feel wanted                              .77
I feel feminine                            .74
I feel secure                              .73
I feel that my partner accepts me          .72
I feel understood                          .70
I feel my partner is considerate of me     .68
I feel I am important to my partner        .68
I feel my partner is focused on me         .65
I feel my partner knows me                 .63
I'm focused on satisfying my partner             .83
I'm focused on enjoying my partner               .83
I'm preoccupied in seducing my partner           .78
My partner's pleasure satisfies me               .65
I think of how to entice my partner              .64
I try to please my partner                       .62
I think about what my partner
  thinks/feels                                   .60
I feel I'm responding to my partner's
  needs                                          .58
I feel love towards my partner                         .75
I feel warmth toward my partner                        .75
I feel attracted to my partner                         .73
I feel intimacy and closeness to my
  partner                                              .64
I feel that I am merging with my partner               .52
I want to receive attention from my
  partner                                                    .68
I want to feel loved                                         .64
I want my partner to express warmth
  towards me                                                 .64
I want there to be more feeling                              .62
I want there to be more foreplay                             .62
I feel grateful to my partner                                      .65
I think about how much I need my partner                           .56
I feel a sense of belonging                                        .42
Table 2. Factor Structure of the Worry-centered Sexual Experience
Subscale

Item                                I    II    III   IV     V    VI

I feel emptiness                   .66
I feel anger toward my partner     .66
I feel self-pity                   .63
I feel lonely                      .60
I feel sadness                     .60
I want to be alone                 .54
I feel vulnerable                  .48
I feel alienated and detached      .45
I feel that I'm doing something
  impure                                 .82
I feel that I'm doing something
  forbidden                              .79
I'm afraid of the outcomes of my
  actions                                .69
I feel guilty                            .68
I feel embarrassed                       .54
I feel disgust                           .51
I feel self-hatred                       .48
I'm afraid of penetration                .46
I'm jealous of my partner                      .66
I feel my partner doesn't know
  how to excite me                             .65
I feel something is missing                    .61
I feel it is difficult for me to
  reach orgasm                                 .60
I'm frustrated and disappointed                .55
I feel lack of communication
  with my partner                              .52
I feel that I'm taken advantage
  of my partner                                .48
I feel impatient                                     .64
I feel apathetic                                     .64
I want my partner to finish as
  fast as possible                                   .62
I feel bored                                         .55
I want to escape from there                          .53
I'm tired                                            .51
I'm afraid of disappointing my
  partner                                                  .74
I feel that I'm not "good"
  enough in bed                                            .69
I feel distress                                            .45
I feel ashamed                                             .42
Bothersome thoughts disturb my
  concentration                                                  .71
My thoughts wander to other
  things                                                         .54
It is hard for me to concentrate
  during the act itself                                          .49
Table 3. Factor Structure of the Pleasure-centered Sexual
Experience Subscale

Item                                             I    II    III   IV

I feel relaxed                                  .77
I feel satisfied                                .76
I feel pleasure                                 .71
I feel a sensation of wholeness                 .69
I feel relief                                   .65
I feel familiar with my body                    .64
I think that it can't be better than this       .64
I think about good things only                  .60
I feel calmness                                 .59
I feel excitement                               .56
I feel that my behavior is spontaneous          .55
I feel as if I have melted                            .73
I feel a rising sensation                             .70
I feel a sort of fogginess in my thinking
I feel disconnected from the world                    .51
I feel loss of control                                .51
I'm in a state of ecstasy                             .51
I feel a floating sensation                           .49
I allow myself to do things I do not in daily
  life                                                .48
I don't think about anything                          .43
I feel a sense of conquest                                  .63
I feel power and strength                                   .59
I feel that my partner is focused on me                     .54
I feel that I'm slave of my body and desire                 .50
I'm focused on my own needs                                       .79
I concentrate solely on myself                                    .74
I'm using my partner for fulfill my needs                         .71
I'm focused on reaching orgasm                                    .45
Table 4. Means, SDs, and Fs of Sexual Experience Factors
According to Study Group

                                     Clinical      Subclinical
                                    anorgasmia     anorgasmia

            Factor                   M      SD      M      SD

Relationship-centered subscale
  Being loved                       5.76a   1.52   6.71b   1.72
  Focus on partner's state          5.38a   1.83   6.21a   1.82
  Feelings of love toward partner   6.55a   2.06   7.44b   1.89
  Desire for partner involvement    7.20a   1.58   7.06a   1.65
  Sense of interdependence          4.97a   1.98   5.81b   2.03
Worry-centered subscale
  Sense of estrangement             3.36a   1.76   2.81a   1.80
  Sinful feelings                   2.73a   1.68   2.17a   1.35
  Disappointment from partner       5.29a   2.18   4.21b   1.55
  Sexual Burnout                    4.03a   1.91   2.97b   1.64
  Sense of sexual inadequacy        4.21a   1.76   3.47a   1.84
  Interfering thoughts              5.32a   2.41   5.25a   2.18
Pleasure-centered subscale
  Pleasure-related feelings         4.60a   1.54   5.49a   1.76
  Letting go                        3.36a   1.49   3.87a   1.67
  Strength feelings                 3.79a   1.49   4.09a   1.51
  Focus on one's sexual needs       3.44a   1.38   2.82a   1.15

                                       Control        F

            Factor                    M      SD    (2, 95)

Relationship-centered subscale
  Being loved                       7.82c   0.99   18.65 **
  Focus on partner's state          5.93a   1.55    1.83
  Feelings of love toward partner   8.36c   1.03    9.97 **
  Desire for partner involvement    6.43a   1.72    2.12
  Sense of interdependence          7.02c   1.78   10.14 **
Worry-centered subscale
  Sense of estrangement             1.60b   1.20   11.49 **
  Sinful feelings                   1.45b   0.77    8.56 **
  Disappointment from partner       1.90c   1.20   36.68 **
  Sexual Burnout                    1.78c   1.14   17.89 **
  Sense of sexual inadequacy        2.43b   1.72    9.17 **
  Interfering thoughts              2.74b   1.70   16.58 **
Pleasure-centered subscale
  Pleasure-related feelings         7.44b   1.10   35.13 **
  Letting go                        5.60b   1.63   19.21 **
  Strength feelings                 5.59b   1.64   13.61 **
  Focus on one's sexual needs       3.89a   1.63    4.24

Notes. Means with different letters within a row are
significantly different (p < .01).

** p < .01.

(1) Due to the small number of sexually dysfunctional women (N = 15), we could not compare the frequencies of the various semantic categories between this group and the remaining women. However, a global analysis of their responses revealed aversive descriptions of the sexual experience as well as themes centered on lack of love to the partner and mutual rejection during the sexual intercourse.

(2) A pretest revealed that whereas some women answered the probe by focusing on a single event, other women preferred to report on their habitual experiential pattern. On this basis, we decided to ask women to draw upon either a single situation or a number of situations.

(3) In order to cross-validate the observed factor structures of each subscale, the sample was randomly divided into two subgroups and factor analyses were separately conducted in each subgroup. Similar results were revealed in the two subgroups that resembled to those of the entire sample.

(4) Although the stringent inclusion criteria for the orgasmic group might have resulted in a sample of highly orgasmic women, a comparison between this group and women who were dropped from the analyses revealed no significant differences in all the components of the Women's Experience of Heterosexual Intercourse Scale.

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Manuscript accepted May 16, 2001

Gurit Birnbaum, Hananyah Glaubman, and Mario Mikulincer Bar-Ilan University, Israel

We would like to thank Amy Shaked for his assistance in the collection of the data and Richard Gramzow for his comments to an early draft of the manuscript.

Address correspondence to Mario Mikulincer or Gurit Birnbaum, Department of Psychology, Bar-Ilan University, Ramat Gan 52900, Israel; e-mail: [e-mail].