“The Way They Speak of Masters and Johnson”: The Rise and Disappearance of Sex Therapy, 1960–2000

ABSTRACT

A keyword search of “sex therapy” in the New York Times shows a rapid rise for articles covering the discipline in the 1970s, an equally rapid reduction in the 1980s, and further decline in the 1990s and into the 2000s. This surprising inflection, given that sex as a marketable construction did not decline in the late 20th century, opens room to examine sex therapy in the contexts in which it could and could not be successful. Sex therapy as a distinct intervention emerged in the 1960s, based on Masters' and Johnson's obstetric‐gynecological research focus on satisfying, conjugal sex, and was boundaried by the optics of medical respectability. Sex therapy viewed sex as a bodily, visible, and behavioral phenomenon, with sexual problems conceived as overt and physiological symptoms and syndromes of the body. Correspondingly, sex therapy offered behavioral techniques to white middle‐class clients to ameliorate dissatisfying sex. These conceptions were met with success and popularity in the 1970s, with thousands of sex therapy centers opening nationwide in just a few years. However, with the Reagan administration and AIDS crisis in the early 1980s, sex therapy quickly regressed as a respectable source of medical expertise about sex. Simultaneously, biomedical interventions more broadly replaced medicalized solutions for pre‐conceived medical problematics. The introduction of Viagra in 1998 was a biomedical replacement of the medicalized sexual problems created by sex therapy, situated on the observable body. When a seemingly even more bodily and behavioral bio‐medical solution to its problematics competed with sex therapy for its same white middle‐class client base, sex therapy could not maintain public awareness of its disciplinarity.

In the post‐1960s American psychotherapeutic landscape (Hacking 1995; Illouz 2008), sex therapy emerged as a distinct source of expertise on sex, out of a longer lineage of medical and technological interventions to sex (Irvine 2005). During this period, the meaning given to “sex” was highly contested (D'Emilio and Freedman 1988; Weeks 2016). Against challenges to existing heterosexual norms in the wake of the sexual revolution, second wave feminism, gay liberation, and other social movements, sex therapy bolstered the white heterosexual couple into a unit of analysis, in tandem with couples' therapy (Celello 2009) and the rise of family therapy (Weinstein 2013). It did so by drawing upon behavioral and cognitive interventions which ascended during the period (Pettit 2024). Sex therapy understood sex as a visible, embodied, and behavioral aspect of the human experience. In turn, variations from common sexual “behaviors” were understood as dysfunctions. Sexual dysfunctions had observable and behavioral symptomologies based in what was visible on the body. Sex therapy offered clients corresponding behavioral and cognitive interventions for sexual dysfunctions, intended to be easily implementable and accessible over a short period of time through work with a sex therapist. Rather than framing sexual problems in the psychoanalytic tradition of temporal investment and complexity (Herzog 2016), sex therapy promised that sex was discernible, and dysfunctions were solvable.

Sex therapy's public presentation is to some extent tangible in an overarching examination of its press coverage in the New York Times, made accessible by the newspaper's public digital archives. The Times does not represent a fulsome picture of broader American attitudes (Putnam 2016; Tworek 2024), and further research may examine a wider range of sources, such as popular literature, films, and jokes. However, as the paper of record for the American middle‐class, the Times' coverage represented sex therapy's trajectory in the public eye (Rutherford 2000), and also helped advertise sex therapy. Here, a keyword search of the term “sex therapy” was conducted in the New York Times' digital archives. The results were tallied up by decade. Double results were eliminated, with one double article in the 1970s and five doubles in the 2000s.

This search indicates sex therapy's relatively rapid rise and a surprisingly equally rapid disappearance from public consciousness (Figure 1). Following one article in the 1960s, its public visibility in the United States peaked over the course of the 1970s, with 54 articles containing the term “sex therapy.” Afterwards, a surprising reduction in coverage occurred in the 1980s with 44 articles, in the 1990s with 24 articles, and in the 2000s with 21 articles. It is worth noting that the number of articles grew somewhat in the 2010s, to 38 articles, predominantly in coverage of artistic representations of “sex therapy.” Sex therapy's early visibility is partly attributable to its timing in the late 1960s and 1970s, which worked with wider market changes in conventions of frank representations of sex. Sex therapy's subsequent downwards trajectory in the Times opens room to examine its place in the post‐war American therapeutic, and why it failed to maintain public interest in the last decades of the 20th century despite a continuation of market demand for sexual information in that period. Sex therapy's reportage decline in the early 1980s and into the 2000s opens room to analyze the reasons for this surprising disappearance. Through an examination of sex therapy's public presentation, the contexts in which sex therapy could and could not thrive become salient.

Figure 1.

Keyword search of the term “sex therapy” in The New York Times digital archives showed articles containing “sex therapy” peaked in the 1970s, followed by a decline in results over the next three decades. 2010s coverage rose largely due to articles covering media representations of “sex therapy.”

The Times' first publicity for Masters' and Johnson's work in 1966 (Corry 1966) marked sex therapy as a specific intersection point of medicine and sex, with sex constructed as a set of symptoms and syndromes on the body (Duden 1991). In one strand of medicalized sex, practitioners pathologized minority sexual behaviors and controlled them through aversion therapies (Davison 2021). On the other hand, sex therapy was concerned with the otherwise “healthy,” unmarked heterosexual couple reaching new heights of life satisfaction through sex. In the broader landscape, an expansion of therapeutic options in the postwar United States, such as psychological counseling centers on college campuses (McCarthy 2014), resulted in psychology becoming a ubiquitous offering for life issues beyond the confines of psychiatric institutions or expensive psychoanalytic practices. The nationwide proliferation of sex therapy clinics in the 1970s was a part of this broader expansion, aimed at white, middle‐class, heterosexual couples to ameliorate their sexual dissatisfaction.

By 1980, Masters' and Johnson's constructions of sexual dysfunctions formed the basis for the DSM‐III's (1980) “Sexual Dysfunctions” chapter. Sex therapy's goal of heterosexually coupled sexual satisfaction fits into the revamped DSM's neoliberal focus on relational distress and non‐productivity (Mayes and Horwitz 2005; Lewis 2016). However, the onset of the conservative Reagan administration after his 1980 election and the concurrent AIDS crisis made it difficult for a therapeutic modality with the word “sex” in its title to obtain funding or publicity. In 1998, the commercially successful public debut of Pfizer's Viagra as an oral medication for erectile dysfunction was a more visible intervention than sex therapy. Sex therapy had medicalized sex, but Viagra was a part of a shift towards the bio‐medicalization of human experiences (Clarke et al. 2003). In a bio‐medical landscape in the 1990s, sex therapy lost their own constructed dysfunctions to pharmaceutical solutions.

Sex therapy's rapid rise and fall in a few decades seems surprising in a late 20th century American context of sex as a marketable construct. But an examination of sex therapy situates the discipline and helps explain this trajectory in the context of who could be an expert on matters of sex. Based on the work of William Masters and Virginia Johnson out of St. Louis, Missouri, a sex therapist was supposed to be someone who offered behavioral and cognitive interventions to sexually troubled patients, in Masters' and Johnson's lineage. A sex therapist was supposed to hold doctoral or medical qualifying expertise, despite Johnson's lack of either. Rooted in Masters' background in obstetrics‐gynecology, working in St. Louis, Missouri, sex therapy adapted the goal of a healthy birth to successful sexual intercourse. Beginning in 1956, Masters and Johnson observed sex workers and volunteers having sex in their lab, which morphed into a concrete “human sexual response cycle”‐based framework for sex therapy's measures and treatment plans (Masters and Johnson 1966).

Sex therapy's clientele came out of the non‐psychiatric population, with a heteronormative slant on well‐being. As Masters and Johnson wrote, “the psychoneurotic is acceptable, but not the psychotic” (Masters and Johnson 1970, p. 21). The Times‐documented 1970s expansion of sex therapy centers in primarily coastal, urban clinical settings (Rensberger 1972) marked a push for sex as a behavioral problematic for the general population, rather than a psychoanalytic or psychopathological one, albeit with snags in sex therapy's uses of sex surrogacy and approaches to homosexuality, and maintained its boundaries as an academic discipline based in allegiance to Masters and Johnson. Its 1980s reduction in reportage indicates a reduction in sex therapy's public visibility into the Reagan administration and AIDS crisis. But rather than the field's inability to adapt into a period of political conservatism on matters of sex, sex therapy's biggest strength of medical simplicity was its biggest weakness in competition with biomedical interventions, leading up to the market introduction of Viagra in 1998 (Steinhauer 1998).

Sex therapy's Midwestern, St. Louis provenance seems unexpected, but as Bailey (1999) argues, changes to conventions in representing sex would not have been as widespread a set of social changes had it been relegated to liberal cliques on the coasts. Just as the results of the Indiana‐based Middletown sociological studies and Kinsey Reports were supposed to represent shifts in people's sexual behavior and lifestyles nationwide (Igo 2007), a shift in middle America indicated national transferability and utility that transcended subcultural trends. Sex therapy's Midwesternness signaled its “ordinariness,” and its usefulness was therefore available to “regular” American couples. Sex therapy's patient populations were not the “sexual psychopaths” made popular in post‐war newspapers, a diagnosis that assigned criminal sexual behavior to the jurisdiction of psychiatrists (Freedman 1987; Cole 2000). Unlike family therapy's emergence out of treating schizophrenia (Weinstein 2013), Masters' and Johnson's participants were psychologically normative, primarily white, and middle‐class, living in a Midwestern city.

Masters' and Johnson's observations of sex workers and volunteers having sex in their St. Louis lab do not lack for chroniclers. Maier's 2009 biography of the couple and its television series adaptation span their careers, set against their fluctuating personal‐professional relationship over decades. Irvine (2005) frames them as sex therapy's founders in a context of “medical mystique” (p. 142) and a shift away from public distrust of Kinseyan's quantifiable sexuality, to public acceptance. Gerhard (2001) places Masters and Johnson in the same sexological lineage as Kinsey, delineated by rejecting a Freudian view of female sexuality and influencing second‐wave feminist popular sexuality literature, while Reumann (2005) further links their work on the clitoral orgasm to Shere Hite's 1970s feminist sociological surveys. Celello (2009) contextualizes them in a mosaic of public experts in mid‐20th century America, who published works for the public, instructing people on how to keep their marriages intact.

On the other hand, Spurgas (2020) argues that sex therapists' fixation on the female‐presenting body, situated in broader behavioral interrogations with sex in the middle of the 20th century, is a key genealogical strand to contemporary pathologization of low sexual desire in women. Similarly, McLaren (2007) argues that Masters' and Johnson's sex therapy falsely pathologized male impotence. These critiques are situated within broader interrogations of “health” as a disciplining construction, which pathologizes marginalized bodies along racial, classed, and gendered lines, and creates syndromes only to offer “solutions” for the broad range of human experiences (Solovey and Weinstein 2019; Rasmussen 2019; Parr 2019). Within sociology, Morrow (2008) critiques Masters' and Johnson's supposed fixation on penile‐vaginal intercourse and their early self‐rejection of data collected by observing sex workers. The literature's critiques of sex therapy as falsely medicalizing and pathologizing sex, as well as being a heteronormative (Duggan 2002) and whorephobic (Borden 2022) discipline, provide one part of examining who the intervention was for, and who could be a sex therapist.

Sex therapy's discussed heteronormativity and whorephobia did not emerge out of a vacuum. In the 1920s, eugenicist marriage counselors advocated for satisfying conjugal sex as a part of “companionate marriages” distributed unevenly for white, middle‐class couples (Davis 2008, 2010). Companionate marriages prioritized love, compatibility, and sexual satisfaction, as a supposed replacement of nineteenth century marital ideals based on duty and financial commitments, and a response to eugenicist moral panic about rising divorce rates among white couples with a corresponding lower birthrate (Dowbiggin 1997; Ladd‐Taylor 2001). In the 1930s, many gynecologists and marriage counselors slowed their public association with Nazi German social policies, switching away from promoting sterilization against people marginalized by race and class (Kline 2001). Instead, eugenicists tried to engineer a rising white middle‐class birthrate by teaching couples to have satisfying sex, with the aim of staying married and having children (Celello 2009; Davis 2010; Weinstein 2013).

Sex therapy's disciplinarity was defined by the professional optics of who could be a sex therapist. Its intersection at sex and medicine in the late 20th century was constrained by a given person's adherence to the ways that it evolved under Masters and Johnson, even during later tweaks to the symptomatologies and therapeutic plans described by them, and by who held academic or medical qualifications, despite a lack of disciplining bodies monitoring people who called themselves sex therapists during the field's peak visibility in the 1970s. An examination of sex therapy, rooted as it is in the question of who gets to be a sex therapist, forces the question of what an expert on matters of sex is. In following sex therapy's fit into the therapeutic, and misfit into the biomedical, an opening for who could professionally talk about the problematics of sex emerges.

1. The Invention of Sex Therapy, 1956–1970

The human sexual response cycle was sex therapy's framework for objective, visible functionalism on people's bodies during sex (Masters and Johnson 1966). As technological interventions such as one‐way mirrors and videography were increasingly commonplace in family therapeutic contexts (Weinstein 2013), Masters and Johnson observed sex workers and subsequent participants with machinery and videography in their Washington University lab starting in 1956 (Masters and Johnson 1974). The human sexual response cycle made sex observable and concrete in the phases of excitement, plateau, orgasm, and resolution, which were visible all over the body in changes in skin tone, blood pressure, heart rate, breathing, and swelling (Masters and Johnson 1966). During the excitement phase, a stimulant established a sexual tension. Then, during the plateau phase, sexual stimulation continued and intensified. If this went into the orgasm phase, an involuntary climax would release sexual tension. For females, orgasm originated in the clitoris regardless of the source of stimulation. Finally, during resolution, the individual reversed back into the plateau and excitement phases, and then into their unstimulated state.

In their 1966 and 1970 bestselling books, published in unassuming plain hardcovers by Little, Brown, and Co., Masters' and Johnson's language described the cycle represented in medically technical and obfuscating terms. During an orgasm, “the vasoconcentration and myotonia developed from sexual stimuli are released” (Masters and Johnson 1966, p. 6). Their prose summed up by Playboy as “a turgid Latinate” (“Playboy interview” 1979, p. 87), dense medical language tied the human sexual response cycle to the optics of medical respectability. The clinic and conventions of gynecology boundaried Masters' and Johnson's study of sex into a discipline that was based on seeing sex as a visible and bodily behavior.

Masters and Johnson divided Human Sexual Response (1966), their first book, into two sexes. The book gave 124 pages to their observations of females, and only 40 pages to their observations of males. As Spurgas (2020) argues, in sexual science, the male experience remains straightforward and unvaried, but the female experience becomes intricate and rife with potential for mistakes. Females' orgasms varied in intensity and duration, while males' patterns were standardized and had fewer individual distinctions. Females were capable of theoretically endless orgasms, while males entered refractory periods between response cycles. Masters and Johnson didn't disclose the average size of the penis “to neutralize the concept that penis size is crucial to sexual response,” (“Playboy interview” 1979, p. 110). In a conscious departure from psychoanalytic understandings of the vaginal orgasm, Masters and Johnson described the clitoris as a “unique organ” (Masters and Johnson 1966, p. 45), from which physiologically identical clitoral and vaginal female orgasms originated. While conceptualizing a physiological, symptomed model of the body during sex, Masters' and Johnson's sexology was marked by their location in a Washington University laboratory‐hospital, technologies, and medical disciplinarity.

As parcel to its practicality, the human sexual response cycle needed a correspondingly useful practical application in a clinical context (Masters and Johnson 1974). After machinery and observation made successful sex straightforward to see, disorders had neat bodily symptoms that corresponded to each stage of the human sexual response cycle, instead of originating in unconscious processes and treated through psychoanalytic exploration (Masters and Johnson 1970). Impotence occurred when men did not get an erection during the excitement stage. Because Masters and Johnson did not observe any dysfunction during the plateau phase, that stage did not have any associated diagnoses. The orgasm stage corresponded with males' premature ejaculation when it occurred in a numerically simple 50% of sexual encounters, and ejaculatory incompetence when ejaculation did not occur in coitus. The stage was associated with orgasmic dysfunction in females when orgasm was not visible across situations, unobserved in sex outside of coitus, solitary or coupled, and originating in the clitoris. Dysfunctionality was not visible in the resolution phase, but miscellaneous physiological diagnoses that did not fit into any of the stages were relevant in a gynecological clinical setting. Dyspareunia was, in both males and females, a constellation of physiological distress combinations. Vaginismus was a psychophysiological set of vaginal muscle spasms that prohibited coitus in females.

Sexual dysfunctions were numerical, observable on the body, and, despite Masters' and Johnson's descriptions of the entire body during sex, heavily influenced by a gynecological focus on reproductive organs. Sexual dysfunctions were also highly gendered. Male dysfunctions were usually physiological in origin or easily traced back in a client's personal history, often to a man's experiences in rushed sex with a sex worker or in the back of a parked car. Female dysfunctions were complex and psychosomatic. For instance, female orgasmic dysfunction was “extremely difficult to categorize” (Masters and Johnson 1970, p. 229), with a supposed multiplicity of etiologies that the cotherapists did not untangle. Sexual dysfunctions were a direct product of Masters' and Johnson's familiarity with the responses of the female genitals to external medical stimuli, and with what was visible on an examination table in the clinic.

The therapeutics for these dysfunctions centered on practicality and applicability. Unlike the post‐war psychoanalytic rejection of sex's predominance in the psyche, and preoccupation with love as the nexus of distress (Herzog 2016), Masters' and Johnson's sex therapy was unconcerned with love. Sex therapy created behavioral causes and sites of solutions to marital and personal conflicts. In the context of family therapists recalibrating an entire nuclear family as a “unit” of analysis, which Weinstein (2013) describes as a radical departure from what had previously been the intensely personal nature of a psychoanalytic encounter, Masters and Johnson's language described the couple as the therapeutic patient “unit” (Masters and Johnson 1970, p. 3). Only couples could come to St. Louis to undergo sex therapy (Masters and Johnson 1970) for what would otherwise seem to have been a personal, individual sexual dysfunction. Receiving sex therapy at the Reproductive Biology Research Foundation, Masters' and Johnson's St. Louis base, entailed a middle‐class couple's encounter with Masters and Johnson, both dressed in lab coats and with tape recorders on, in the popular conventions of psychoanalysis. Journalists remarked on their complementary self‐presentations in gendered terms. Masters contributed stern professionalism and medical explanatory power, and Johnson provided a caring, gregarious demeanor and interest in human psychology (“Playboy interview” 1968; Shay 1970). The combined sex therapeutic persona, a heterosexual cotherapeutic “unit” like the client “unit” itself, was to be found in a respectable medical center, but with the additional focus on the inside of a marital relationship, and centralized the figures of Masters and Johnson to sex therapy.

In the early 1970s, a psychotherapeutic détente occurred between the cognitive therapeutic schools of Aaron T. Beck and Albert Ellis, and neo‐behaviorist interventions influenced by B. F. Skinner (Pettit 2024). Masters' and Johnson's sex therapy was a similar blend of biological, behavioral interventions, and the teaching of a couple to cognitively reappraise their thoughts and ideas about sex. As was common in 1950s sex manuals (Neuhaus 2000), they wrote clunky scripts for sexual positions, such as the instruction that “[the wife] should remain in the female‐superior position while demandingly manipulating the penis, and from this positional advantage quickly reinsert the penis into the vagina at her husband's direction,” (Masters and Johnson 1970, p. 131), jargon‐filled delineations of positions formalizing the described sex and marking it as sex therapy. To treat premature ejaculation, Masters and Johnson prescribed “the squeeze technique” (1970, p. 102). When having sex with a man diagnosed with premature ejaculation, the woman in the “unit” squeezed his penis with her hand hard enough to make him partially lose his erection when he was close to ejaculating (Masters and Johnson 1970). This practice slowed down ejaculation and prolonged orgasm to its desired conclusion. Masters and Johnson attributed the squeeze technique to the urologist James Semans (1956) development of the start‐stop technique, which was similar—the man was instructed to interrupt his partner's stimulation of his penis just before he reached orgasm. Their attribution did not credit the naturalistic origins of this intervention. Johnson later told their biographer (Maier 2009) that she and Masters had observed sex workers use the squeeze technique to help their clients. In a broadly whorephobic culture, sex workers were not cited for sexual interventions.

Cognitively, Masters and Johnson taught couples to recalibrate what they noticed as “fears of performance” (Masters and Johnson 1970, p. 11), built on further by describing one couple member's as taking on a “spectator role” (Masters and Johnson 1970, p. 65), with patients monitoring and judging themselves during sex in a performative lens. An impotent man's concerns about maintaining an erection impeded his ability to maintain one. Meanwhile, his wife was equally distracted by her own concerns about embarrassing or angering her husband as he failed to maintain an erection. Sex therapy brought out these maladaptive performative thoughts through conversation with the therapists, who used conversation to highlight their illogicality and to correct thoughts that contributed to a fear of performance and spectatoring. Sex therapy's cognitive corrections were conceived as rapid and straightforward solutions, and implementable after a short period of conversation with the therapists in the 2‐week sex therapeutic window, as part of sex therapy's presentation of temporal accessibility and success rates. Despite noticing the existence of transference when they witnessed clients develop attractions to one of them, they wrote that it had “no place in the acute 2‐week attempt” (Masters and Johnson 1970, p. 8). Masters and Johnson signaled a deliberate departure from psychoanalytic concepts of the therapeutic relationship. Instead of sex as a site of hidden psychic depths, sex was a highly visible and embodied site for understanding behavior.

Johnson created an intervention they called “sensate focus” (Wilkes 1970), an opaque terminology for an otherwise straightforward concept for the “unit” to slowly build up to successful coital intercourse, in the privacy of their room at night, by gradually touching each other without expectation of orgasm (Masters and Johnson 1970). A blend of behavioral instruction and cognitive rejigging, sensate focus was at the core of the modality of sex therapy, supposed to provide a practical, actionable solution for bodily anxieties. Sex therapy identified these thoughts as rooted in unpleasant memories in people's sexual histories and socially learned issues. But it provided rapid recalibrations to personal challenges, with an emphasis on “communication” (Masters and Johnson 1970, p. 14) as a panacea for dysfunction. In this regard, sex therapy was part of what Celello (2009) describes as a bigger trend in “communication” as the key cause of and solution for distress in marital counseling in the 1960s and 1970s, replacing earlier blame on women's frigidity. However, sex therapy's medical origins made it more adept at behavioral instruction than cognitive restructuring. Masters and Johnson gave patients precise, jargon‐filled instructions for following sexual behaviors in a stepwise fashion, but “communication” was merely repeated as an injunctive in Human Sexual Inadequacy, their 1970 book that laid out the intervention's parameters.

In inventing “sex therapy,” Masters' and Johnson's self‐presentation, a combined “unit” like that of their coupled clients, was integral to their work's situatedness in medicine and sex, within the broader context of a fixation on marital sexual satisfaction in the 20th‐century United States. As a gynecologist‐obstetrician, Masters inherited that discipline's eugenicist aims in raising a white middle‐class birthrate (Kline 2001), and conventions of literally seeing sex through observation on the body, particularly in the reproductive organs. Sex was framed in the observationally and physiologically based human sexual response cycle, which presented sex therapy as a medical contribution, intended to be used by medical practitioners more broadly. Similarly, sex therapy's problematics were medical dysfunctions, identified as constellations of symptoms found through supposedly objective observation on the body rather than mined in the psyche. However, the solutions for the human sexual response cycle's problematics went beyond the optics of a Midwestern hospital's gynecological‐obstetrical ward and were an extension of Masters' and Johnson's “unit” persona. Amid an American rejection of psychoanalysis and growth in cognitive and behavioral psychotherapies, sex therapy's techniques offered practical behavioral and cognitive solutions, and a respectable, medical but simultaneously relational consumer option for treating sexual dissatisfaction.

2. The Popularity of Sex Therapy, 1970–1979

With a 1968 Playboy magazine feature and 1970 Time magazine cover advertising their work, Masters' and Johnson's fame in the early 1970s made their names synonymous with sexual expertise. Xaveria Hollander, the New York madam, in her 1973 memoir humorously compared an exhibitionistic couple to Masters and Johnson. Their expertise hinged on sex being simultaneously natural and laborious. The Time cover's use of their stern likenesses connected sex therapy to their combined persona. The strangeness of sex as a life experience that intuitively was inherently inside one, needing to be taught by someone in a clinic, had an immediate reception in the early 1970s.

Their former trainee, Sallie Schumacher, left St. Louis and directed a new sex therapy program at the Long Island Jewish Medical Center in New York in 1971 (Brecher 1971). In the New York Times' piece on the new program, Schumacher said, “‘We try to integrate their way of interacting into their home and work life’,” (Murray 1972, p. 131), in an attempt to make sex therapy more physically accessible than Masters' and Johnson's geographically isolated St. Louis clinic. LoPiccolo and Lobitz (1972) opened an independent clinical practice at the University of Oregon, adapting Masters' and Johnson's sensate focus to a masturbation‐based program for heterosexual couples. They discarded the dual cotherapist model for the intervention, largely because it was relatively difficult to implement and to practice. The New York Times reported Herbert Vandervoort's work at the University of California Medical Center, where he said that “many people need sex counseling and would accept it if cheaper, more low‐keyed programs were available,” (Fosburgh 1974, p. 57) and launched a short‐term, low‐cost therapy program. Masters' and Johnson's descendants' incremental modifications to the parameters laid out by the founders denoted sex therapy's progress and continual evolution as a proper scientific discipline. In its public presentation, these centers stressed ways of rendering sex therapy more geographically and temporally accessible for readers of the Times, while maintaining its provenance in university and hospital settings.

A snag came from responses to Masters' and Johnson's employment of surrogates for unpartnered men (unpartnered women were supposed to bring their own friend from home). In Human Sexual Inadequacy (1970), the sex surrogacy role was buried in a chapter on treating primary impotence, described as women hired to work privately with male patients going through sex therapy, rather than figuring in the book's concepts chapter. The hiring of an external, non‐physician or doctorally‐trained woman to have sex with unpartnered male clients conflicted with sex therapy's medical and professional presentation. In the early 1970s, primarily women and some men sex surrogates were often employed through referral by sex therapists, as a relatively lucrative, if mentally exhausting, source of income, as one journalist discovered in interviewing people employed as such (Wolfe 1978). Sex surrogates saw themselves as distinct from prostitutes, but this often conflicted with other people's stigma against the job in a whorephobic world. One woman, “Pandora,” when asked about the number of clients she'd had, said that, “If it's too few, people will say I'm inexperienced—which I'm not—and if it's too many, they'll say I'm a hooker—which I'm not,” (Wolfe 1978, p. 492), but people in her own family refused contact with her because of her job. She said, “I hope that ten years from now they'll speak of Pandora the way they speak of Masters and Johnson,” (Wolfe 1978, p. 494), with their fame carrying scientific prestige and legitimacy. Unlike Masters and Johnson, whose names were public and respectable, sex surrogates were not.

The New York Times covered the 1970 case of a former St. Louis surrogate's husband's lawsuit against Masters and Johnson for breaching patient–doctor confidentiality (“Sex researchers are sued” 1970). While the case was dropped in 1972 (“Suits dropped in sex studies case” 1972), they and other sex therapists stopped promoting sex surrogacy as a part of treatment after this lawsuit. Peripherally to sex therapy, similar legal action against psychiatrist Martin Shepard cemented new norms to make doctor–patient sex unethical and illegal in the early 1970s (Kim and Rutherford 2015), and feminist anti‐rape activism redefined non‐consensual sex in workplaces and intimate relationships (Rutherford 2017). Amid a public and professional cutting off of connecting psychotherapists with sexual activity, sex surrogacy clashed with sex therapy's attempts at a respectable image. Herbert Fensterheim, a New York‐based sex therapist who began working with surrogates after successfully training one patient‐brought call girl using a “chapter and verse of Masters and Johnson” (Wolfe 1978, p. 493) that defined the parameters of the intervention, stopped hiring them after backlash from his colleagues as well as their attempts to poach his surrogates for their own practices. Simultaneously obliterating the labor of sex surrogates, sex therapy demarcated itself from the stigmatized category of work into which sex work fell, despite the discipline of sex therapy also existing along the borders of sex and work. Sex therapy was not supposed to present as underground or illegal, and it presented as controversial only insofar as sexual frankness was a novel offering in the early 1970s.

By 1972 (Rensberger), the New York Times reported and advertised a proliferation of sex therapy centers, primarily in coastal cities. Some of these were influenced directly by St. Louis, but others increasingly took independent routes, ranging from a Masters and Johnson‐inspired surrogate‐based program at Berkley, to more freely adapted short‐term, low‐cost therapy programs at the University of California Medical School and in a Newark clinic, and even a nude encounter group as a format under the sex therapy label. In the late 1960s, “nude psychotherapy” was a popular if ambiguously acceptable intervention, blurring the boundaries between academic and countercultural zones (Nicholson 2007). Sex therapy was a popular label for a wide range of businesses offering any kind of sexual service, as Masters himself complained (King 1974), with up to 3500 labeled‐as‐such organizations existing nationwide by 1975. Disciplinary boundaries were set up with the establishment of The Journal of Sex and Marital Therapy in 1974, and a 1976 conference to discuss sex therapy's ethical standards at Masters' and Johnson's clinic, reported in the New York Times (Macklin 1976; Brody 1976). But the optical boundaries between “sex” and “therapy” and “sex therapy” were increasingly difficult to distinguish, particularly as both were associated with a financial, marketable component. While a sex therapist could be identified by their practicing a human sexual response cycle‐based treatment program, in this brief moment of publicity, a “sex therapist” could also be identified as anyone who capitalized on market demand for sexual frankness.

In the early 1970s, Masters' and Johnson's clitoral orgasm explanations were prominent, if not unchallenged, within the second‐wave feminist movement (Lieberman 2017). Germaine Greer in The Female Eunuch was wary of Masters' and Johnson's “clitoromania” (1970, p. 48) that ignored the qualitative existence of penile‐vaginal orgasms. In The Hite Report, published in 1976 and based on surveys asking women about their sexual histories, sociologist Shere Hite was directly influenced by the clitoral orgasm and sexual response cycle, but was skeptical of sex therapy's emphasis on couples and marriage as a panacea for happiness. One of the Hite respondents even “did the Masters and Johnson's bit—2 weeks in St. Louis. I learned that good sex followed almost effortlessly after good communication. Communication is what they tried to teach my husband and me. I bought it, he didn't. It takes two to talk, tango, or screw,” (Hite 1976/2004, p. 272), with “communication” as central psychotherapeutic tenet received ambivalently in this participating “unit's” self‐report.

In the broader context of multiplying streams between disciplinary psychology and feminism (Rutherford and Pettit 2015), feminist action and sex therapy occasionally crossed streams. Lonnie Barbach, initially a graduate student at Berkley's sex therapy center, said decades later in an interview that she was influenced by both her experiences training as a sex therapist and having attended consciousness‐raising groups in the early 1970s (Bullard 2011). Barbach blended LoPiccolo's and Lobitz's masturbation program with the consciousness‐raising group format into a weekly group therapy for primarily married, white “preorgasmic” women (Wallace and Barbach 1974, p. 146), to frame orgasms as inherent within women. To Barbach, separating women from men gave them the freedom to express their true natures and be collaborative, and to successfully experience orgasms (Barbach 1975). However, unlike the overtly political aims of a consciousness‐raising group, Barbach, as a doctorally trained sex therapist, introduced the seemingly neutral sex therapy's medical respectability into the feminized group. Women had already gone to a doctor or a religious authority figure when they were referred to Barbach's groups (Barbach 1975). She merged sex therapy's reputation and popularity with the most palatable aspects of the consciousness‐raising group. The group therapy format caught on, in part because of the cost‐saving component to combining patients, as New York‐based Kaplan (1974) discovered in running such groups for couples with premature ejaculation. Bernie Zilbergeld (1975), one of Barbach's colleagues at Berkley, adapted her group modality to single men with a range of sexual issues. Equally, group sex therapy furthered the discipline's image as an accessible and democratic consumer option, fitting in with the demands of 1970s urban life and signaling a supposedly broad client base.

However, the generative relationship between sex therapy and mobilized feminist movements, through the liberatory potentials of the clitoral orgasm, did not translate to questions of race or to sex therapy's applicability to non‐white clients and sex therapists. As a modality rooted in eugenicist aims for increasing a white middle‐class birthrate, sex therapy was designed for the white middle‐class, and its relative fit with women's issues did not extend to issues of race. Masters and Johnson trained only one Black sex therapist, June Dobbs Butts, in the early 1970s, who ended up practicing in Maryland (Butts 2016). Butts straddled activist spaces, following W. E. B. Dubois, Franz Fanon, and James Baldwin (1977a), and academic spaces. She promoted having frank conversations about sex education within Black families in academic journal articles, Ebony and Jet magazine pieces, and through hosting a call‐in radio show (Butts 1977b; Slotnik 2019). Butts was unique among sex therapists in the 1970s for this focus, however. The presentation of a sex therapist remained that of a white man or woman, working with a white man or woman client. Sex therapy's respectability and nationwide transferability were rooted in its whiteness, a supposed sense of generalizability in the sexual experiences it problematized and resolved.

At the discipline's peak in public visibility, a sex therapist was a relatively fashionable label, prominent amid market demand for sexual frankness and services. At times, traveling quite far from its Masters and Johnson provenance, a conflict between its growth as a scientific discipline and financially viable term emerged. A sex therapist in the early 1970s emerged as a medical practitioner or academic supposedly in evolution with the diagnoses and interventions set up a decade earlier. Sex therapists were distinct from but related to political feminist movements, and were supposedly medically neutral. Sex therapy did not generally address race, with its transferability and popularity built on its whiteness. Through publicity, sex therapists were distinguished from other available market options by a façade of respectability.

3. The Disappearance of Sex Therapy, 1979–1998

In 1979, Masters and Johnson published Homosexuality in Perspective, which presented results obtained through homosexual male and female participants in a 1964–1968 research period but had not been published before. Masters had been influenced by Alfred Kinsey's sexological survey‐based reports published in 1948 and 1953, and every participant who came into Masters' and Johnson's lab was assigned a Kinsey number from one to six, denoting entirely heterosexual to entirely homosexual sexual histories. Kinsey's scale was intended to be subjective and changeable to the participant's fluctuating self‐understanding (Hegarty 2013; Drucker 2014). Unlike Kinsey, Masters and Johnson assigned the Kinsey number onto participants, and made people's sexual orientations permanent, using it to match unpaired participants according to corresponding score for them to have observed sex in the laboratory. Masters and Johnson also created their own sexual identity, people they labeled “ambisexuals” and defined as “a previously unidentified group of men and women whose lack of any sexual preference and whose total disinterest in even identifying with, let alone forming, a committed relationship with a partner of either gender required formal group designation,” (Masters and Johnson 1979, p. 12), pathologizing non‐monogamy and implying that bisexuality entailed sexual promiscuity. Masters and Johnson intended their research to build on Kinsey's, but instead altered his work to the constraints of the gynecological gaze and turning people's experiences into rigid social categories. Unlike Kinsey, Masters and Johnson were unclear about what homosexuality represented. They argued that homosexual males and females were identical to heterosexuals in their presentations of the human sexual response cycle on the body, that homosexuality was not a disease, and were engrossed by homosexual participants' attention to sexual pleasure aside from penetration. Sex therapy was to be provided for the identical sexual dysfunctions present in homosexuals as in heterosexuals.

However, Homosexuality in Perspective (1979) simultaneously published 67 cases of successful examples of aversion therapy for clinically “reverting” from homosexuality into heterosexuality. Based on behavior modification techniques, aversion “therapy” framed homosexuality as a learned and fixable behavior (Davison 2021; Spandler and Carr 2022; Davison et al. 2025). The apparatus for Masters' and Johnson's aversion therapy was not described in the book. Instead, focus was given to assessing the “factors underlying the presumed motivation” (Masters and Johnson 1979, p. 335) for clients who wished to revert from homosexuality. The clinic supposedly granted acceptance to individuals in sensitive social positions, such as teachers and public figures, who had sought professional treatment in quick succession following a threat of their sexuality being publicly exposed; as Kunzel (2024) notes, social exposure was a prominent theme in queer people's seeking out aversion therapy in the 1960s. Following Masters' death, Johnson and their collaborator Robert Kolodny claimed to their biographer that they'd never witnessed any aversion therapy or heard any tape recordings of such therapies at their clinic (Maier 2009), supporting the lack of concrete explanation given to the subject in Homosexuality in Perspective. Regardless of the veracity of the aversion therapy success claims, however, it became the focal point for the book's media coverage.

In the 1979 Playboy interview promoting the book, Masters and Johnson mentioned their hesitations about publishing their homosexuality data a decade prior. In its belated publication, the book's responses ranged from excitement at new work from the founders of sex therapy (Luria 1979; Angelino 1980; Bumbera 1981) and surprise at their aversion therapy results (Bernstein 1979), but overwhelmingly skepticism was reported in the New York Times (Johnston 1979; Winokur 1979) from medical practitioners. The notion of practicable aversion therapy to even the most enthusiastic gay patients was met with disdain from psychiatrists (Cooper 1980), revulsion from Charles Silverstein, a gay psychologist and declassification activist (Evans and Zilbergeld 1983; Genzlinger 2023), and a general denotation of their outmodedness in press coverage (Johnston 1979; Cohn 1979).

The American Psychiatric Association had removed the diagnosis of homosexuality from the DSM‐II in 1973 after consistent protests from homophile activist groups, who argued that the scientific literature did not provide evidence for either its status as a disease or for the efficacy of aversion therapy (Lewis 2016). While mobilized gay people's responses to this removal were ambivalent, most psychiatrists came to agree with the inefficacy of aversion therapy, with it instead becoming embedded in a late‐20th century Christian right context (Babits 2024). Outside the discipline of psychiatry, conceptions of what it meant to be a gay person had shifted to a kinship‐based one, marked by coming out of the closet (Murray 2010). Homosexuality in Perspective did not fit in either disciplinary or community‐based conventions of homosexuality. Given that the discipline had been heavily associated with the Masters and Johnson persona, the book's negative publicity signified a backwardness and disconnect from cultural norms.

Outside this embarrassing snag, sex therapists and the American Psychiatric Association had a fruitful relationship in the late 1970s, as the organization worked on a new edition of the Diagnostic and Statistical Manual of Mental Disorders, turning away from its previous iterations' broad psychoanalytic categories and toward a basis on diagnostic criteria (Mayes and Horwitz 2005; Lewis 2016). Published in 1980, the DSM‐III emphasized symptoms, pathological distress, and neoliberal concepts of relationally and professionally successful lifestyle as markers of mental illness. Its assessments of individuals' functionality aligned with sex therapy's behavioral, immediate concerns, and vision of sexuality as a signifier of mental healthfulness. Beginning in the mid‐1970s, a sex‐therapist‐led force contributed a section on “Psychosexual Dysfunctions” to the DSM‐III, reproducing Masters' and Johnson's human sexual response cycle and corresponding available diagnoses (American Psychiatric Association 1980, p. 275) in an overtly psy‐discipline context. Sex therapists Helen Singer Kaplan and Harold Lief, who had joined the APA task force in 1977, contributed a new stage, desire (Kaplan 1977; 1995), that preceded all other stages as the first step of the cycle. Correspondingly, males and females could be diagnosed with “inhibited sexual desire” (American Psychiatric Association 1980, p. 278). Like psychiatrists, sex therapists presented a scientific body of knowledge that defined their profession. Sex therapists' inclusion in the DSM‐III was their biggest disciplinary victory. Its inclusion placed sex therapy within the DSM's successful attempt to unify psychiatry with changing political and corporate interests.

In 1980, Thomas Szasz published a book critique of sex therapy, Sex by Prescription, as an extension of his previous critiques of psychiatry. Szasz saw sex therapy as an unscientific force of control over people that obtained power through pathologizing the range of human sexual experiences. He invoked sex's naturalness through alimentary vocabulary's equivalent naturalness, such as in the absurdity of quantifying the experience of taste by creating “digestion therapy” for “men and women with unsophisticated tastes and eating habits” (Szasz 1980, p. 29). Szasz disliked Masters' and Johnson's “anti‐homosexual” (Szasz 1980, p. 43) position and assertions about the dangerousness of sex therapists trained outside their own domicile. To Szasz, sex therapy was a highly successful and visible business sham.

However, sex therapy's success and visibility decreased soon after the publication of Szasz's critique in 1980. The shift away from sex therapy as a visible source of sexual information is partly attributable to the onset of the Reagan administration following his 1980 election, after which a gradual but steady defunding of research projects pertaining to sexuality occurred. The 1983 World Congress of Sexology took place in Washington, D.C. (Boffey 1983), and its reportage in the New York Times described direct challenges to the conference from the administration. In the Times, William Grantzig, the organizing president, complained that contrary to the White House's stance, “This is not porn city” (Boffey 1983, p. C1), continuing Masters' and Johnson's earlier motivations for obfuscating otherwise overt sexual instructions. The optics of a sexually frank sex therapist had little medical respectability or currency for a top‐down level support from funding bodies, into the Bush administration in the early 1990s. Psychologist Paul Abramson (1990) complained about the scarcity of effort and resources “marshaled to obtain data on and establish a science of human sexual behavior” (p. 162). Notwithstanding the urgency of the AIDS epidemic in 1991, Louis Sullivan, the then‐Secretary of Health and Human Services, with the United States Congress, blocked an NIH‐approved project on adolescent sexuality and AIDS risk‐prevention (Udry 1993). As a client‐oriented form of sexology, sex therapy relied on medical respectability in the broader context of market demand for matters of sex and struggled to continue its growth in the 1980s and 1990s despite the prominence of the public health crisis of AIDS.

During the Reagan administration, the impact of the AIDS crisis on disciplinary and societal conversations about sex in the 1980s is difficult to overstate. Initially identified in 1981, the virus wreaked havoc on the gay population. Physicians were front‐facing experts on sex in the AIDS crisis, providing newly altered public health recommendations for sexual behavior and particularly for non‐heterosexual and non‐monogamous behavior (Shilts 1987; Schulman 2021). Psychologists (Morin 1988; Sheridan et al. 1989) had mixed success pursuing the same legitimacy with providing behavioral health recommendations, despite psy‐practitioners' attempts at promoting their discipline's applicability to human behavioral change.

In conjunction with political conservatism, the AIDS crisis was devastating for marginalized communities, and altered the content and timbre of how sex was disciplinary discussed for decades. Sex therapists appended the virus as a mandatory risk factor in sex to their familiar body of public advice, particularly in sexual exploration outside of monogamous partnerships. Helen Singer Kaplan's (1989) self‐help book recycled her decades‐long work on premature ejaculation and the squeeze technique, but with modified sensate focus instructions to eliminate recommending that readers have sex with new people to implement the classic interventions. Instead, Kaplan recommended men practice the squeeze technique on themselves while masturbating, according to public health recommendations. Dagmar O'Connor (1985), a New York City sex therapist, published a self‐help book in 1985, at the height of the pandemic, titled How to Make Love to the Same Person for the Rest of Your Life… and Still Love It!. The title and contents marketed Masters' and Johnson's modality to a siloed off heterosexual marriage, recommending sex therapy's interventions to avoid contracting AIDS. Given sex therapy's provenance as a medical intervention that had inherited eugenicist ideals about keeping white, middle‐class marriages intact, O'Connor's concept was not particularly novel to the discipline.

In 1998, the FDA approved Pfizer's sildenafil as an oral medication to treat erectile dysfunction, a more usable urological replacement of mechanical penile vacuums, and of sex therapy's sensate focus (Loe 2004). Pfizer quickly released it with heavy publicity, branded as “Viagra.” Instead of relying on a blend of behavioral and cognitive interventions, Viagra was simple to administer to a patient. It promised to be time‐ and cost‐effective, compared to longer and costlier psychotherapeutic options. A pharmaceutical solution was vital to insurance companies' willingness to uptake an intervention, and therefore its availability to a middle‐class consumer base (Pettit 2024). Viagra was prescribed by urologists or even general practitioners, making it relatively straightforward to obtain. It was highly successful upon release, with 16 million people having been prescribed the pill by 2004 (Loe 2004).

Leonore Tiefer (2004), a contemporary feminist critic of sex therapy's pathologization of sex, critiqued the escalation of medicalized sex with Viagra. Following doctoral training working on hamster hormones under Frank Beach, Tiefer moved over to feminist sexology in the context of feminist political activism. Tiefer also critiqued the path Viagra opened to a supposedly equivalent pill for women targeting low sexual desire. Viagra's popularity indicated broader changes of a bio‐medicalized landscape that had effectively replaced the medicalized one in which sex therapy had been invented (Clarke et al. 2003). Prozac, Pfizer's earlier and highly popular pharmaceutical intervention, targeted depression and rapidly dominated psychotherapeutic interventions over the construct (Metzl 2003). Viagra's front page New York Times debut coverage did not mention sex therapy (Kolata 1998). In a subsequent Times article, Pepper Schwartz, a sex therapist and sociologist at the University of Washington, tried to promote sex therapy as a complement to Viagra: “The issues that have been shrugged off are the psychological and social aspects of it […] and I do believe that any drug that alters the core way a couple relates to each other requires discussions of expectations and pressures” (Steinhauer 1998, p. F6). Since sex therapy's medical provenance could not compete with a bio‐medical intervention in the market, it would have to pivot to providing psycho‐social expertise for couples.

However, sex therapy had not been built on a foundation of psychological or social searching, and subsequent New York Times reportage on sex therapy in the 2000s was sporadic. Masters' and Zilbergeld's obituaries (Severo 2001; O'Connor 2002) were relatively prominent next to only 20 other articles that decade that primarily mentioned sex therapy in passing. Sex therapy's decline in coverage in the Times from the 1970s indicated its unpopularity among its overlapping middle‐class clientele, without being simultaneously advertised through the reportage it had enjoyed. Sex therapy had created medicalized dysfunctions with the body at the center of what sex was. Rather than offer psychosocial perspectives on sex, sex therapy was inherently medicalized. Sex was observable and behavioral on the body, and sex therapeutic interventions were correspondingly observable, behavioral, and bodily. By the late 1990s, biomedical interventions framed the biological body as central to resolving the medicalized issues created by the previous generation of medical sciences. Sex therapy was in direct competition with Viagra, but being rooted in the same theoretical base, did not successfully overcome the upheaval in the same market into the 2000s.

By 1979, sex therapy was increasingly out of step with cultural changes surrounding homosexuality. Nonetheless, in the early 1980s, sex therapy was a publicly prominent discipline, its success culminating in the sex therapist‐led 1980 inclusion of a “Psychosexual Dysfunctions” section in the DSM‐III. Reagan's subsequent election reversed funding and public consciousness for scientific projects overtly concerned with sex. The AIDS crisis over the course of the 1980s and 1990s rendered medical practitioners into experts on sex, as sex therapists struggled to maintain a foothold in being viewed as sources of information during the epidemic. The arrival of Viagra on the market in 1998 signified a shift away from medicalized interventions and towards bio‐medical ones. The pharmaceutical pill made sex therapy less publicly important than biomedical interventions, which offered a faster solution to problems of the body during sex than sex therapy did. Sex therapy framed sex as a physiological, observable set of behaviors that were visible on the body. Viagra co‐opted sex therapy's problematics and provided an even more physiological and observable solution than sex therapy's behavioral and cognitive solution.

4. Conclusion

In tracing out sex therapy's reportage in the New York Times, a surprising arc representing its public availability throughout the 20th century becomes salient. Following a relatively rapid rise in popularity in the early‐ to mid‐1970s, with practices opening up nationwide based around the fame and boundaries set by Masters and Johnson, the paper of record's coverage of sex declined in number in the 1980s and halved in the 1990s through the 2000s. A reduction in sex therapy's public representations aimed at its middle‐class audience‐clientele is unexpected. Having emerged out of a 1960s market interest in explicit sexual products known as the “sexual revolution,” sex therapy's inability to keep up with the broader continued commercial interest in sex in the 1980s and 1990s lies in sex therapy's disciplinarity. Sex therapy succeeded in distinguishing itself as long as it could represent itself as an effective medical offering to the American white middle‐class. It declined when it could no longer represent itself as the solution to the problems that it had helped create.

As a discipline, sex therapy was rooted in Masters' background as an obstetrician‐gynecologist, marked by medical respectability and boundaried inside a Midwestern university‐hospital. Despite being a player in broader social changes pertaining to sexual “liberation” and to a lesser extent women's movements in the late 1960s and early 1970s, sex therapy was not a counter‐cultural or revolutionary force. Tied to a eugenicist provenance of promoting satisfying conjugal sex as a means of growing a white middle‐class birthrate, sex therapy did not transgress American norms of what sex could be and did not conceive of non‐white or non‐straight people as sexual subjects. Straddling the boundaries of sex and work themselves, sex therapists did not cite sex workers and surrogates who participated in and contributed to sex therapy or sex research.

Sex therapy's conception of sex was as an embodied, visible experience. As a medical research project, it relied on problematics and solutions to self‐presenting as a useful invention. Failed sex was visible on the body, localized to the genitals. In the context of the regression of psychoanalysis in the American landscape, sex therapy rejected love as a source for dissatisfying sex. Sex therapy also rejected the psychoanalytic tradition of extensive interior searching and talking as an arduous solution to one's unhappiness. Instead, solutions to failed sex were designed to be easy to implement and quick to work. With the contemporaneous rise of behavioral and cognitive therapies, sex therapy offered behavioral and, to a lesser extent, cognitive solutions to its bodily problems. Sex therapy was a straightforward, public‐facing option for understanding what sex was. Sex was visible on the body, mediated by machinery, and created and interpreted through the language of medicalization. This conception of sex was initially met with financial success and popularity in the 1970s.

The simultaneous change to conservative governments and the AIDS crisis in the 1980s made a discipline defined by both sex and reliance on medical respectability difficult to maintain. Sex as a medical construction left sex therapists' domain. With the AIDS crisis, a conflict between sex research's simultaneous defunding and relegation to the expertise of physicians, issuing public health recommendations rather than behavioral instructions, formed. Another conflict, between a broader continued societal interest in sex and administrative conservatism, put sex therapy on the sidelines as it pertained to remaining the public‐facing experts on sex. Bio‐medical replacements of medicalized problems usurped sex therapy's solutions to its own problems. Viagra's immediate popularity, beginning in 1998, relegated sex therapy to the outskirts of public remembrance into the 2000s.

Conflicts of Interest

The author declares no conflicts of interest.

Data Availability Statement

Data sharing is not applicable to this article, as no new data were created or analyzed in this study.