Thirty subjects seeking treatment for primary inorgasmia accompanied by sexual anxiety or aversion were assigned to one of three groups: systematic desensitization (SD), directed masturbation (DM), or waiting list control (WL). Following treatment, subjects were retested, and the WL group then received directed masturbation treatment. A third testing constituted a follow-up for the SD and DM groups and a posttreatment testing for the WL. Both treatments were equally effective in improving subjects' sexual self-acceptance and increasing sexual pleasure. Changes in anxiety were negligible; however, sexual arousal and orgasm for DM and WL subjects increased. The gains of the WL group not only replicated the findings of the DM group but also were of greater magnitude.Despite advances in the treatment of sexual dysfunction, substantial numbers of women continue to experience general sexual dissatisfaction or specific difficulty with orgasm. The incidence of primary orgasmic dysfunction alone ranges from 7% to 15%. However, when women enter treatment, behavioral sex therapy models have resulted in significant improvements in functioning and changes in orgasmic status.The two most widely used behavioral treatment choices for alleviating primary orgasmic dysfunction are systematic desensitization and directed masturbation. During the last 20 years, there have been numerous demonstrations of the efficacy of systematic desensitization for female sexual dysfunction. Reductions in sexual anxiety are consistently reported by women receiving systematic desensitization treatment; however, change in orgasmic status is variable. Roughly 75% of subjects experience orgasm during treatment or shortly afterward when seen individually, but lower estimates of changes are found for group treatment designs. A newer treatment for primary inorgasmia has been to use graduated masturbation exercises. Initially there was correlational support for this technique, and recent controlled investigations have confirmed its efficacy and examined such variables as session spacing, partner involvement, and group treatment formats.The present investigation examined the relative efficacy of these treatments in alleviating primary inorgasmia. Subjects were screened, and groups were equated on relevant demographic variables which covary with outcome. Group treatment was offered to optimally utilize therapist time, but group size was kept small (five members per group) to ensure individualization. A broad-band assessment strategy was used to assess change in heterosexual anxiety and dissatisfaction, sexual self-acceptance, pleasure, and arousal. A waiting list control