Caroline Rusterholz

Last year, while researching early forms of sexual counselling at the Wellcome Library archives for my current research project, I came across recordings of 14 sexual counselling sessions carried out by Dr Joan Malleson. A birth control activist, Malleson was one of the first woman doctors to treat sexual disorders as part of her job at the North Kensington family planning clinic. The idea that sexuality was central to a successful marriage gained in visibility during the interwar years in a context where perceptions of a growing dissolution of marriage and family life, and lowered population quality and birth rates generated widespread anxieties. Female sexual pleasure through penetration was increasingly viewed as a cornerstone of happy marriage.


The recordings contain 14 cases of sexual disorders: one was the case of a menopausal woman, eight were cases of vaginismus, two were cases of frigidity and three cases were of inhibition of orgasm. The patients were women in all but three cases – two cases of vaginismus and one of frigidity – the husbands were present and on Malleson’s request spoke separately with her. Other doctors and psychiatrists referred the majority of the patients to Malleson, showing the increasing esteem with which Malleson’s colleagues held her work. In one case, a couple who had not consummated their marriage came of their own accord, having read Malleson’s book, Any wife or any husband.

These tapes were recorded in the 1950s, before Malleson’s death in 1956, and it seems without her patients’ consent. They seem to have been the only tapes that she recorded. They were recorded at the dyspareunia clinic attached to the University College Hospital where Malleson worked until her death. Malleson plausibly aimed to use these recordings as teaching methods.

These cases constitute, therefore, a crucial source for illuminating how sexual problems might be understood, not only by practitioners but by the patients themselves. They reveal what was perceived as ‘normal sexuality’, what was considered pathological, and the type of treatments recommended for curing these conditions. These tapes showed that the patients and Malleson viewed heterosexual relations through penetration as the standard form of sexual intercourse and mutual sexual pleasure as the ideal while the lack of pleasure and absence of penetration were regarded as pathological.

Of course, treating these records as historical evidence is problematic in several ways. First, the doctor-patient relationship is, in itself, a power relationship. Every sexual counselling session was mediated through this relationship. Moreover, recordings only contain what the patient would tell. However, rather than viewing this as a problem, I argue that this relationship reveals as much about what was perceived as ‘normal’ or ‘pathological’ sexual behaviours as the content of sexual counselling itself.

These sessions provide useful and fascinating insights into the way Malleson deployed moral and medical frameworks to treat patients that experienced sexual disorders. These recordings reveal how she approached the topic of sexual disorders, the type of questions she asked, the dynamic between her and the patient and the emphasis she placed on sexual pleasure. For instance, to a patient who had vaginismus, she first asked her to describe her feelings and fears and then her relationship with her husband. She then questioned the patient’s family history and relationship with her parents. She suggested that the patient’s fears might be connected to a bad memory during her childhood and encouraged the patient to think along these lines. Malleson was very sensitive to the patient’s emotions. She spoke in a soft and kind voice and comforted the patient when she cried, reminding her that progress was possible. Malleson’s therapeutic framework was highly psychoanalytical, even though she was not trained in the subject. She was largely self-taught in her approach to sexual and married counselling, and seemed to have built her own method out of experience. For Malleson, what was at stake in trying to help couples face and overcome – if possible – their sexual difficulties was informing them about the unconscious barrier that prevented them from fully achieving climax. She believed that most sexual disorders derived from emotions and from an inhibition of erotic impulse, restricted since early childhood. As a result, she asked her patients to talk and sought to find causes for ‘inhibition’ and ‘vaginismus’ in childhood traumatic experiences or unconscious conflicts. She followed the same type of procedure with each patient, pushing them to explain in their own words what was going on in their sexual life and why they were seeking advice. By encouraging the patient to speak and reflect on their own sexual life, she challenged the sexual culture that told women to be ignorant and passive. She mediated between the prescriptive and the subjective, leading her patients to reflect on their own history. Sexual counselling was an intense negotiation between patients’ individual experience and needs and an expert’s prescriptive advice. These records, therefore, offer a fascinating glimpse into the ideas around heterosexuality that circulated at that time, both in lay and medical circles.

rusterholzDr Caroline Rusterholz is an Associate Research Fellow at Birkbeck College, University of London, and in August 2018 she will be starting a Wellcome Trust Research Fellowship at the University of Cambridge. Her interests cover the history of sexuality, the social history of medicine and historical demography. Her work has appeared in Social History of Medicine, Journal of the History of Medicine and Allied Sciences, and Gender and History. She is currently writing a book entitled Leading the Way: English women doctors, birth control and family planning in twentieth-century England and France.

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One Comment

  1. robert goff

    Alex Comfort reviewed Malleson’s book in the New Statesman in 1951 and she corresponded with him. I’m writing about Comfort and I could tell you more about their correspondence if you are interested.

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