I. INTRODUCTIONTaharat haMishpahah, literally, “family purity,” refers to the series of Jewish laws and customs governing sexual behavior between husbands and wives. The laws of taharat haMishpahah need to be understood in the larger context of observant Jewish life, which seeks to elevate everyday behavior in light of a divine plan. According to this understanding of the religious Jewish mission, each and every action has the potential to be imbued with sanctity, or kedushah. Taharat haMishpahah is considered one of the pillars of observant Jewish life. Volumes are devoted to the laws of taharat haMishpahah, so a brief summary of this complex area will be incomplete. In short, taharat haMishpahah requires that husbands and wives abstain from all physical and sexual contact for the duration of a woman’s niddah time, that is, the length of her menstrual period plus an additional seven “clean” days. During the niddah period, observant couples adhere to a series of restrictions that are designed to prevent physical intimacy. These include refraining from physical touch such as holding hands, sharing a bed, or passing objects directly to one another. At the end of this approximate twelve-day separation, a woman immerses herself in the ritual bath (mikvah). After this, the couple is permitted to resume physical and sexual contact. Our exploration of the lived experience of taharat haMishpahah starts with recognizing that the system’s influence extends far wider than the domain of marital sexual life. Development of a sexual self is recognized as a normative process that begins in infancy and has physical, cultural, and emotional components. Thus, the centrality of taharat haMishpahah in observant Jewish life impacts on attitudes and behaviors regarding modesty; auto-eroticism; conduct between men and women outside of marriage; education of prospective brides and grooms; and the experience of intimate emotional and physical marital life given the rhythm of the menstrual cycle. The incorporation of these laws and attitudes, including the fundamental concept of monthly sexual abstinence and renewal between husband and wife, has been cited as a key factor in promoting and maintaining Jewish marital and familial happiness. Other theorists have stressed that the laws surrounding taharat haMishpahah act to harness and discipline physiological drives into a framework of kedushah (holiness)—not necessarily happiness—represented by marriage. We respect, yet do not attempt to resolve, these perspectives. We perceive the laws of taharat haMishpahah to be a given, not subject to negotiation. We understand that these regulations are embedded in a larger context of religious life. Women who observe taharat haMishpahah are almost certainly keeping kosher, observing the Sabbath and holidays, educating their children in Jewish schools, and otherwise maintaining a high degree of religious affiliation. Our efforts are directed to an empiric investigation of the sexual life of Jewish women committed to observant religious practice. The goal of our inquiry into the intimate lives of these women is to better understand this deeply personal experience from as scientifically rigorous a perspective as possible. II. HOW THE STUDY CAME TO BE Although there is much information on the practices associated with taharat haMishpahah as well as numerous anecdotal articles and books, there are no objective data on how adherence to laws of family purity impacts on observant couples’ lives. To put it simply, the extent to which the specific directives and restrictions of taharat haMishpahah actually correlate with marital happiness or unhappiness is unknown. However, the examination of the relationship between adherence to taharat haMishpahah and sexual satisfaction is of great importance. Health practitioners who serve the observant community realize that many couples do experience problems in sexual life, including sexual dissatisfaction and dysfunction. We presume that clarifying common problems and establishing helpful interventions within the framework of halakha would be important goals of the observant community. Efforts to achieve these goals, however, run into significant obstacles. Sexual problems often are not discussed explicitly in public or even private venues, possibly due to general concerns related to tseni’ut (modesty). Very little material that addresses sexual issues of observant Jews is available in print. Discussions of such matters within observant and/or rabbinic forums are critical, however, because ultimately, observant couples will be reluctant to accept the guidance of a health professional unless the advice is sanctioned by appropriate rabbinic authorities. We hope that the empirical data of this article will contribute to a discourse between the general population, health practitioners, and rabbinic authorities. In 1999, Edward Laumann, a professor of sociology at the University of Chicago, and his colleagues, published The National Health and Social Life Survey of 1,749 women and a comparable number of men. They reported that 43 percent of the entire pool of women in their study (ages 18–59, of varied marital status, backgrounds, and so forth) experienced some type of sexual dysfunction. However, when the analysis was confined to the subset of female respondents who were married, that figure fell to 20 percent. Laumann et al. also looked at general happiness and satisfaction in intimate relationships. Overall, the study concluded that as society becomes more socially complex in terms of multiple partners, non-traditional coupling, earlier age of sexual behavior, and sexually transmitted diseases, the factors that lead to general happiness and satisfaction in intimate relationships become more difficult to isolate. At the same time, this research demonstrated that women practicing monogamy in traditional marriages experience a greater degree of sexual satisfaction than either married women involved in extramarital affairs or single, sexually active women. This striking finding, which was championed by the Christian right, fascinated the writers of this article. We were well aware of the religious literature promoting taharat haMishpahah as a way of renewing sexual interest.[v] Our basic question became: “How do women who are faithful to the tradition of taharat haMishpahah experience intimate marital life?” On the one hand, we speculated that based on the Laumann et al. study’s findings, married observant Jewish women might be even more sexually satisfied than married women in the general population. On the other hand, our extensive clinical experience made us keenly aware of sexual difficulty in many observant marriages. We considered the possibility that the lack of available information and discussion about sexuality in the observant Jewish community might contribute to reduced marital sexual satisfaction than in the Laumann et al. married sample. As scientists and clinicians we were well aware of the limitations of anecdotal vignettes and of impressions from our personal experiences. Thus, we set out to investigate the sexual experience of observant Jewish women from a sophisticated, methodologically rigorous research perspective. Our team constructed a survey, similar to that used by Laumann et al., that included questions specific to observant Jewish practice. These items would allow us to determine whether, and to what extent, education about and adherence to the laws of taharat haMishpahah are associated with sexual satisfaction for women. Using many of the same questions as Laumann et al. allowed us to compare aspects of sexual behavior and dysfunction in observant women with that of the general population. Although Laumann et al. looked at the experiences of both men and women, we focused our efforts on observant women only. Certainly a comparable study of men would add a great deal to the understanding of observant marriages. Because our objective in this article is to highlight certain issues for the observant community, we will not give a comprehensive presentation of all of our findings. Rather, we focus on areas that might be particularly relevant to the general community, rabbis, mental health professionals, medical personnel, and educators. This last group, educators, includes school teachers of all levels as well as those serving in the unique institution of hattan and kallah teachers, that is, men and women who instruct soon-to-be grooms and brides in the laws of taharat haMishpahah. An emerging new group of religious advisors/educators is that of the yoatsot halakha, women who are highly learned in taharat haMishpahah as well as well versed in gynecology and marital dynamics. All of these religious, medical, and lay people have potential involvement in the intimate lives of observant Jewish couples. Increased knowledge and sensitivity on the part of rabbis, health workers, and educators is likely to enhance intimacy and strengthen attitudes toward observance, thereby improving marriages in the observant community. III. STUDY DESIGN The study by Laumann et al. obtained data based on face-to-face interviews. Since observant women generally value modesty and privacy, our project was designed as a written questionnaire that was completed anonymously and mailed back to us. We tried to replicate as closely as possible the Laumann et al. scales of marital satisfaction, emotional and sexual happiness, and sexual function and dysfunction for both women and their husbands. Many of the questions asked for the same information—basic demographics, physical and mental health, sexual education, sexual history, and current sexual practices. Women were included in our study if they were currently married, pre-menopausal, and regularly used the mikvah as prescribed by religious law. Mindful that the regular observance of mikvah might span across the denominational spectrum of observant religious life, we asked women to rate their religious affiliation and gave them choices of “Modern Orthodox,” “Yeshiva/Agudah,” or “Hassidic.” The latter two categories describe a level of Orthodoxy that is sometimes referred to as “ultra-Orthodox.” This subdivision reflects a debate within the Orthodox Jewish community. Unlike Modern Orthodox Jews, who actively participate in the general culture, Hareidi Jews, or ultra-Orthodox Jews, embrace a theologically conservative outlook that advocates substantial separation from secular culture. (Hareidi literally means “one who trembles before God.”)[vi] We also gave women choices to denote their religious/cultural affiliation as “Sephardic” or “Ashkenazic.” No assumptions were made about women’s sexual past or present lives. We asked detailed questions about early sexual life, including auto-eroticism and premarital activity. Knowing about the impact of sexual abuse on later sexual life,[vii] we included questions regarding history of molestation as well as current sexual abuse. At the same time, we added new questions that addressed the unique experience of women who observe taharat haMishpahah. These questions related to respondents’ subjective perceptions about going to the mikvah and adhering to laws of family purity. We also inquired about pre- or post-marital sexual education, such as whether they attended a kallah class and if so, whether useful information about sexual relations was provided. Women were asked how they dealt with questions they may have had concerning the permissibility of specific sexual activities, and to whom they turned when sexual problems arose in their marriages. Certain questions were deliberately omitted so as to not offend potential study participants. These referred to same-sex activity, abortion, infidelity, and substance abuse. In retrospect, this stance may have been too conservative, as some women did respond on the open-ended questions that they had struggled with these issues. Participation in our study was voluntary. Women received no financial or other material reward. Our goal was to sample a cross-section of observant women based on religious affiliation and socio-demographic information. As the chief entry criterion was regular use of the mikvah, the most obvious, impartial venue for data collection would have been mikvaot. Although several rabbis overseeing individual mikvaot were consulted prior to the implementation of the study, none granted explicit permission to distribute questionnaires at any community mikvah. Instead we recruited women via other sampling methods, such as relying on medical professionals whose practices included large numbers of observant Jewish women (e.g., obstetrician/gynecologists, nurses, midwives, and pediatricians) to distribute the surveys. We also spoke at broad-based Jewish women’s organizations where we asked audiences to fill out the survey. In addition, we posted the questionnaire, which had only an English version, on the Internet and directed it to large listservs of observant communities in Israel. To determine the representative nature of the sample, demographic results from respondents of our study were compared to those obtained in the 2000 census sponsored by the United Jewish Communities.[viii] IV. OUR FINDINGS A. Demographics We analyzed 380 returned questionnaires. Our average respondent was 36 years old. More than three-quarters of our respondents were born in the United States, and nearly half were daughters of two American-born parents. Almost two thirds of women and their husbands were brought up in an observant home. The remaining third were ba‘alot teshuva, meaning that they grew up in non-observant homes and chose to become observant on their own, usually around age 20 or 21. Among women who were ba’alot teshuva, only 6 percent of them had become observant after marriage. With respect to affiliation, 55 percent of women identified themselves as Modern Orthodox, 35 percent as Yeshiva/Agudah and 10 percent as Hassidic. Women who responded to the survey were typically well educated; many had graduate-level degrees. Most women held jobs outside the home and had not been married before. Our typical respondent had married at age 23 and had four children. B. Sexual Education/History Respondents reported receiving sexual education from a variety of sources. Most commonly, they learned about sex from friends, written material, and media (movies and television) followed by family members, kallah classes or high school classes, and experimentation. Less than 10 percent cited health professionals as being a source of sex education. It should be mentioned that although Jewish women turned to printed materials for information about sex, the material they read was written by secular or non-Jewish writers and purchased at mass-market bookstores. Until recently, there have been very few works available that specifically discuss sexual matters for observant Jewish consumers.[ix] Only one book dealing with sexuality from the Jewish perspective provides explicit information as to the basics of sexual anatomy or physiology.[x] Bookstores catering to religious clientele do not typically carry such books for fear of violating propriety and alienating their customer base. How do women obtain these materials? Our respondents indicated that they had to make special requests for these books or go to a mass-market bookstore in a different community. One woman wrote of her reaction to the book most commonly cited by respondents to our survey, John Gray’s Mars and Venus in the Bedroom, “Why did I have to learn about sex from an ex-priest?” Before they were married, two-thirds of participants knew the details involved in sexual intercourse, and a similar number had discussed sexual feelings with their husband. Less than a quarter of respondents reported no physical or sexual contact prior to marrying their current spouse. They did not hold hands, hug, kiss, pet, or engage in any more intimate sexual behavior. This also means that despite the emphasis on premarital chastity, over 75 percent of women who participated in our survey had some degree of intimate contact with their current spouse. There were differences with respect to premarital sexual behavior between those raised religious and those who became observant before marriage. Nearly one-third of women raised observant reported abstaining from any premarital physical contact with their husbands compared with 7 percent of women who became observant on their own. This suggests that while almost all women who become observant do so before marriage, they are more likely to have been involved in physical and sexual relationships with men before marriage than women raised observant. We did not ask women to indicate whether their premarital relationships were with their husbands or other partners. Almost all respondents studied laws of niddah with an outside (kallah) teacher before marriage. However, most women did not feel the kallah classes were helpful in preparing them for married sexual life and their wedding night in particular. The prevailing emphasis of kallah classes seemed to be ensuring that women not commit halakhic errors. Few teachers apparently covered other topics such as the permissibility of various sexual acts, and more importantly, how to prepare to engage in sexual acts that culminate in intercourse. Although half of the kallah teachers indicated their availability for follow-up discussion after the wedding, they were rarely consulted. A handful of women praised their kallah teacher for providing instruction beyond halakhic issues. For example, one woman wrote My kallah teacher covered halakhot (legal rulings), sex positions, and shalom bayit (family harmony). Everything was explained clearly until I felt very comfortable. Barukh HaShem (Thank God), I have a beautiful marriage. I strongly believe that a kallah teacher has a big responsibility to convey physical and emotional matters in a clear and concise manner. Women who felt well prepared by their kallah class wrote statements such as, “I knew as much as I could, the rest had to be from experience.” However, more than a third of respondents were disappointed on their wedding night and only 15 percent stated that their wedding night was better than expected. Almost half of the respondants, stated that they could have been better prepared for married sexual life. Despite the fact that almost 90 percent of the women in our sample studied with a kallah teacher prior to marriage, only 50 percent of them learned about sexual matters from this source. In light of this discrepancy, it was not surprising that many women wrote in suggestions of topics they wished had been discussed with their kallah teachers prior to marriage. We present excerpts from the suggestions made by women that they felt would improve preparation for sexual life in marriage. In general, there were three types of responses to our open-ended question: “What should your kallah teacher have covered?” The most common response was about basic sexual education. Women wished they had learned more about “women’s body parts, women’s sensitivities, orgasm, different positions,” “what a man’s body looks like, what to expect” and “how to actually consummate the marriage.” Many women voiced shock at their first sexual intercourse. They wished they had known practical information, such as how awkward the position of sex would feel, how to be satisfied or achieve climax, that sex might be painful the first time, that it would be messy, and so forth. The awkwardness of sudden transition from celibate single life to fully sexual marital experience was echoed by many respondents who wrote in that it was hard to “turn off” their notions of being a “good girl.” As one woman, herself a kallah teacher, wrote, “The difficulty we have in communicating needs verbally I feel is a result of the ’modesty‘ and inhibitions we were shown as examples.” Another woman elaborated extensively on this point: Orthodox attitudes that affected me negatively are not inherently negative— but they have potential to cause problems depending on the person. I think part of the problem is that a lot of the Orthodox community feels like the laws of taharat haMishpahah and the restrictions on premarital sex or touching are a foolproof system that makes sex more wonderful for everyone. The extreme privacy within the Orthodox community, while promoted as modest, beautiful, and virtuous, also causes/supports feelings of shame regarding sex. The laws of tseni’ut (modesty) on a more subconscious level, supports (not necessarily causes) shameful feelings about one’s body. The constant praise of how wonderful and holy sex is because it’s saved for after marriage and only at certain times of the month sets up unrealistic expectations and avoids entirely the physical aspect of sex. Again… tseni’ut and negiah (no touching before marriage) are promoted as being beneficial for women because otherwise men would only look at you sexually. This view makes men out to be uncontrollable purely sexual beings to whom women are powerless. Then you get married and you are supposed to trust that your husband wants to have sex with you because he truly loves you. It’s hard to change that pattern of thought. For 20 years one is told to do things so men don’t look at you sexually, and then poof! One day you’re supposed to feel totally comfortable letting go completely and you’re suddenly supposed to be a sexual being[YR1] too[MF2]! I’m not sure these things are unique to religious Judaism —probably other religions as well. And the attitudes might be more reflection of Orthodox society and not the Torah. Many women also wished the kallah teacher would have educated them more on the relationship between sex and Jewish life. They suggested the following topics be covered: “The place of sex and pleasure in Torah life;” “sex and emotion…shalom bayit (family harmony) topics;” “[Jewish views on] a woman’s right to pleasure;” “that sex is not only permissible, but essential to your and your husband’s happiness to have a full, exciting sexual life.” Some commented on the impact of religious upbringing on sexual lives, and suggested these topics were important to discuss in the context of premarital education: “Growing up religious, you are taught to feel that girls should not be forward… it’s OK to be more forward and guide my husband to please me. Giving me an orgasm is not a ‘favor’ to me, rather it is my right as a married woman.” Our respondents raised many issues that had caused them concern and discomfort: “What if you and your husband are too embarrassed to ask the rabbi a question?” “What if your sex life isn’t a beautiful thing? What if it doesn’t enhance your marriage?” Others indicated “I didn’t realize it was so common for a couple to be unable to consummate the marriage right away;” and some wished they had learned “What should you do if sex does not work like the ’textbook‘ case?” Others wondered, “What constitutes abusive behavior and what is not ‘normal’ behavior?” To summarize, in the concise statement of one woman, “I wish someone told me point blank everything instead of assuming I knew it.” C. Attitudes about Mikvah Two-thirds of our respondents indicated that the experience of ritual immersion in a mikvah was religiously enhancing. These women were asked to elaborate on how this experience was enhancing. The following quotations are illustrative. One woman wrote, “I love going. I always pray in the mikvah and feel very pure after. Spiritually, I feel renewed, closer to God and to my husband.” Another commented, “I feel a rebirth. The mikvah is especially helpful to lift me out of depression I feel about my infertility. It always fills me with hope.” Another respondent stated “I feel that going to the mikvah introduced holiness into our marriage… also, it is simply the halakha that has been done by Jewish women for generations.” Related to this, one woman wrote: “I feel mystically connected to something very primitive and deep.” Comments such as: “The mikvah experience makes sex spiritual and not animal-like” were made by several respondents. Almost a quarter of respondents indicated that going to the mikvah could be an unpleasant experience. These women described finding the preparation and process of going tedious and annoying. Concerns about modesty dictate that women keep timing of mikvah use private and that visits to the ritual bath be made only after nightfall. Some of our respondents reported disliking having to make excuses to their children for their absence from the home. Some felt critical of mikvah facilities and personnel. The majority of negative comments relating to the mikvah's physical facilities came from women living in Israel. The following quotations are a sample of negative feelings: “I don’t feel comfortable naked in front of anyone;” “I don’t like all the superstitions that are attached to mikvah;” “I try not to think about how unhygienic the water is after who knows how many women have been in before me.” More extreme responses are exemplified by the following respondents who wrote, “I hate it,” “(I) Find it degrading,” “I hate being examined like a cow,” “Mikvah is such a turn-off that I come back irritated, annoyed, angry and am mean to my husband, subconsciously, of course,” and finally, “I feel it is almost abusive.” With respect to whether sexual or emotional life is enhanced by the observance of taharat haMishpahah, we noted that more than three-quarters of our sample believed that their sexual life is improved by following these laws. The following quotations represent women’s experiences. “When you know you only have two weeks each month, you tend to make more of an effort;” and “I really feel that sex would have become too routine and boring without the rest period that the mikvah provides.” Also representative was the following remark: “It certainly helps. Even though our sexual relations are less than satisfying on the whole, having a break because of niddah does help the sexual relations become a little bit more satisfying; it’s ‘fresher.’” One of the interesting observations was the contrast between the high percentage of women who believed taharat haMishpahah enhanced their sex lives with the much smaller segment who felt that their emotional life with their husband was enhanced by taharat haMishpahah. In fact some women who claim sexual benefits of believed that the niddah period impacted negatively on their emotional lives. One woman stated: I believe that following the laws of niddah and the mikvah does enhance my sexual life. While I love my husband, after some time sex does get boring. The laws of niddah force a break and renewal. Right after going to the mikvah any physical contact is exciting and invigorating. My problem with the whole process is how my husband and I interact during the time of niddah. It seems like we take a complete emotional break from each other, as well as a physical break. I can’t understand why my husband can’t show me his emotions and feelings about me without sex. This sentiment was expressed repeatedly: “My husband feels he has to become numb and he withdraws from me;” “My husband and I both have a huge problem with the suddenness of the switch between ‘can’ and ‘can’t’ and the accompanying feeling on the mikvah night that we ‘have to’ because the clock has started ticking again. The pressure kind of kills the desire and it ends up feeling very non-spontaneous;” “We fight more when I am in niddah. I feel rejected by not passing objects. It is rude—like I am untouchable. Even though I understand the reason, I still feel rejected.” “I am a very touchy, feely person and suffer terribly not being able to snuggle with my husband. Being a nursing mother now, I do miss the initial excitement of coming home from mikvah, but I would not give up my status of taharah (non-niddah) for that.” “We learned how to have sex properly when I was pregnant [and therefore had nine months of non-niddah time together]. We never found there was enough time to learn and experiment in between niddah sessions.” A representative quotation from the much smaller sample of women who wrote that niddah did enhance their emotional life is illustrative: “Sometimes, for example, if a crisis situation arises during niddah, you’re able to resolve it without touching; it brings you emotionally closer.” Survey questions were designed to assess the number of women who report feeling relief upon becoming a niddah, as well as how many postpone immersion. Almost two-thirds of our respondents reported that they sometimes felt relief at being in niddah (about a third of these respondents reported feeling relieved nearly every month). More than a quarter of our respondents reported postponing going to the mikvah, almost all for emotional reasons. Only a tiny fraction reported postponing mikvah as a form of birth control (trying to miss ovulation). D. Asking for Rabbinical Counsel Traditional Jewish practice encourages people to seek rabbinic advice when faced with challenging questions. As all aspects of life, from the mundane to the lofty, are imbued with religious significance, observant Jews regularly pose questions to rabbis. Queries concerning pillars of observant life, kashruth, Shabbat, and taharat haMishpahah are routine. Our data, however, revealed a significant skew regarding questions posed to rabbinic counsel—namely, that women in our study were less likely to inquire about matters relating to sexuality. This is illustrated by the fact that over 90 percent of women indicated that they have asked a rabbi questions about kashruth or about laws pertaining to the Sabbath. Only 76 percent, however, have asked about an aspect of niddah, and most of these questions were directed to technical concerns about menstrual staining. Just over one-third of women had ever asked a question pertaining to permissibility of a particular sexual practice. Mindful that our respondents are highly adherent to the laws of family purity, we assumed that they would naturally have questions about the religious permissibility of various sexual activities in marriage. We knew from their comments about their kallah (bridal preparation) classes that frank issues such as sexual desires and practices were rarely discussed by those teachers. We wondered, therefore, how couples align their sexual desires and their religious sensibilities. Fully half of all women answering our survey have wondered whether performing certain sexual acts, during the course of their observant, married life, might constitute a violation of Jewish law. Oral sex was the activity of most concern followed by the use of fantasy during relations. Of this 50 percent who acknowledged halakhic concerns, only a small portion (12 percent) asked a rabbi for guidance. Of the remaining 88 percent who did not seek religious consultation, almost half refrained from the religiously questionable sex, while the rest enacted their desire without permission. A related area is the use of contraception. Observant Jews take the biblical commandment “be fruitful and multiply” seriously and generally give birth to and raise families larger than those of their secular peers. We wondered how observant women access family planning. Our findings revealed that although nearly 90 percent of our sample reported using birth control at some time in their marriage, only half of these women consulted a rabbi about that decision. Once again, our data suggest that many religiously committed Jews do not bring questions about their sexual or reproductive lives to the scrutiny of their rabbis with the same frequency that they bring questions about equally serious but less bodily intimate matters. Respondents to our survey were strictly compliant with the laws of family purity. Ba‘alot teshuva (women who became observant on their own) were as rigorous in their observance as women raised observant. Women from both backgrounds who were virgins at marriage were more likely to ask a rabbi questions about niddah laws, about sexual life not directly related to laws of niddah, and were also less likely to postpone going to mikvah. This was true regardless of religious affiliation. E. Physical and Emotional Health Although the vast majority of participants in our survey described their health as good, almost half reported that their physical health interfered with sex at least some of the time. Treatment for medical conditions affecting sexual function, such as chronic pelvic pain, endometriosis, and venereal disease were extremely rare, although vaginitis was reported by a quarter of respondents. Almost a third of respondents reported that infertility had been an issue in their marriages. A quarter reported they had trouble conceiving, but they also reported that they eventually had children. Only 4 percent of the women indicated that they had no children as a result of problems conceiving. Emotional health seems to have more impact on sexual dysfunction than physical health. The vast majority of respondents indicated experiencing interference with sex due to emotional issues. When asked about whether they had ever been treated by a mental health professional, about half of the sample reported having been in some kind of psychotherapy. The problems they brought to these treatments included marital problems, depression, and anxiety. We were intrigued by the high utilization of mental health services by our respondents. Some critics of this study allege that the large number of women accessing mental health treatment indicates a sample bias toward more distressed women. An alternative interpretation would be that women who allow themselves professional mental health services are more comfortable with themselves and thus willing to participate in a study about intimate life experience. F. Sexual Abuse More complete analyses of our data are also presented elsewhere,[xi] but for the purpose of this discussion it is essential to point out that this is the first anonymous survey of married observant Jewish women in which direct and detailed questions were asked about sexual abuse and where objective data was collected. One quarter of our sample answered “yes” to the question: “When you were a child or teenager, did anyone ever touch you sexually in a way that made you uncomfortable (molest you)?” These figures are comparable to those reported by Laumann et al. in their survey of married American women and are consistent with estimates of sexual abuse in the general population. Two divergent points, which we discuss in greater depth in the above referenced paper, deserve mention here. On the one hand, women who became observant reported significantly more childhood sexual abuse than those raised religious. On the other hand, more ultra-Orthodox Jewish women reported abuse than their Modern Orthodox peers.[xii] We conjecture that women who experience sexual abuse in their younger years may be motivated to seek out a more structured and sexually restricted adult life. As has been established in previous studies, history of sexual abuse is associated with higher rates of mental health treatment in adult life. Regarding current abuse, domestic violence was reported by 5 percent of our respondents. Two-and-a-half percent alleged that they had been raped by their husbands. G. Sexual Life Women were asked to respond to the same set of questions about sexual frequency and satisfaction as appeared in the study of sexual practices in the United States published by Laumann et al. The pattern of sexual frequency among the sample was different from that of monogamous, married women in the Laumann et al. study. In that study, half of the women reported having intercourse one to two times per week, as compared to 40 percent of our sample. Thirty-five percent of the married observant women in our study reported sexual intercourse three to six times per week as compared to half that number (17 percent) of the Laumann married women. We surmise that this is due to observant couples concentrating their physical intimacy into the two weeks available when a woman would not be in niddah. At the same time, a greater number of women reported sexual intercourse once a month or less. Observant women in our study had significantly different experiences with respect to orgasm as compared to the Laumann et al. married, monogamous sample. High frequency of orgasm was much lower in our sample, and reports of never experiencing an orgasm during sex were higher (9 percent as compared to 1 percent). Regarding auto-eroticism almost two-thirds of participants in our study reported doing so at frequencies ranging from several times per week to every few months during the past year. Like Laumann et al., we inquired about various components regarding satisfaction with marital sex. When participants in our survey rated their physical satisfaction, 75 percent of them rated feeling very satisfied. When asked about emotional satisfaction from sex, generally understood as sense of closeness with their husband, 70 percent rated feeling very satisfied. One question on the survey asked how sex made women feel. Feeling loved and wanted ranked highest, followed by feeling excited, doing wifely duty, and being taken care of. Fewer women endorsed feeling more “negative” feelings such as anxiety, sadness, fear, and guilt. Communication about sex proved to be an important feature in satisfying marital relations. Women with more satisfying sexual lives described better communication and vice versa. Of women who enjoyed orgasm, over three-quarters said that their husband knew how to bring them to satisfaction and that they could tell their husband what gives them pleasure. On the other side of the communication spectrum, women who have problems with sexual life also have difficulty talking directly to their husbands about this. H. Sexual Problems We asked respondents to our study to rate their experience with six specific areas of sexual dysfunction identified by Laumann et al.: 1) frequent lack of interest in sex, 2) lack of ability to climax, 3) pain during intercourse, 4) not finding sex pleasurable, 5) anxiety about their performance and 6) trouble lubricating during sex. One-third of women in our study indicated experiencing the first difficulty (frequent lack of interest in sex) followed by smaller numbers with the other five categories. Nearly half of our sample cited such difficulties as causing them to avoid sex altogether. It should be noted that the rates of sexual difficulties in our sample were significantly greater than that reported by Laumann et al. We also queried women about sexual difficulties experienced by their husbands. According to their wives, a third of husbands experienced premature ejaculation, over 25 percent had difficulty maintaining an erection, and a similar percentage lacked interest in sex. Fewer women reported husbands being anxious about their performance, having difficulty with climax, and not finding sex pleasurable. Some of husbands avoided sex because of these problems. Couples experiencing sexual dysfunction had trouble talking about this. Despite the rather high frequency of both male and female dysfunction, as mentioned earlier, few women had talked to their husbands about sexual problems. Additionally, few women sought outside guidance in relation to their sexual problems. Less than 10 percent of the women had asked a rabbi or observant teacher for information, and less than 4 percent asked a kallah teacher for help. IV. ASSOCIATIONS AND PREDICTORS We used sophisticated statistical procedures to analyze the enormous data gleaned from the questionnaires. One goal of this study was to understand more fully the variety of factors that are associated with sexual practice, sexual satisfaction, sexual dysfunction, and the relationship between these variables and religious observances. We will not present here all the associations we discovered but only those that strike us as particularly significant or surprising. We remind our readers that associations do not necessarily imply causation. A. Background Information Physical satisfaction was found to be associated with higher income, the husband providing the financial support, and more modern religious affiliation. In other words, lower-income women and women who affiliated as either Agudah or Hassidic reported significantly less physical satisfaction than did Modern Orthodox women in dual-income families. Emotional satisfaction was associated with similar demographic variables, and also with age group. Sex was more frequent in younger respondents, and also in respondents who were younger when they got married. Younger women reported higher emotional satisfaction compared to older women. Women who provided sole financial support were less satisfied than women who had other support. Emotional satisfaction was lowest for Hassidic women. Older age and not completing college were associated with painful sex and avoidance of sex. Women who were raised observant were twice as likely to have difficulty achieving climax than women who reported themselves as ba’alot teshuva; however they were less likely to report painful sex and less likely to avoid sex. B. Mikvah and Niddah Greater physical satisfaction was significantly more likely in women who demonstrated less conflict about niddah and mikvah. These women never postponed mikvah and also did not report feeling relieved when they became a niddah. A different pattern was observed with respect to the influence of postponing mikvah and emotional satisfaction. Women who never postponed the mikvah for any reason showed significantly lower emotional satisfaction than women who did. But women who were often relieved to be a niddah were also less emotionally satisfied. This was also true for those who did not feel that niddah enhanced their sex lives as well as for women who felt that they could have been better prepared for marital life. Interestingly, adherence to niddah was associated with better emotional (but not physical) satisfaction. C. Sexual Education and History In general, physical and emotional satisfaction and frequency of sex were not related to sexual education and history. Women who were virgins at marriage reported greater frequency of orgasms and less difficulty achieving orgasm during marital sex as compared to those women who were not virgins when they married. Conversely, women who had experimented with sex short of intercourse premaritally (i.e., they were technically virgins) reported greater physical satisfaction, greater frequency of orgasm, and less difficulty achieving orgasm than virgins who had minimal (holding hands) or no sexual experience at the time they married. D. Husbands’ Sexual Dysfunction Although physical satisfaction and frequency of orgasm were not significantly related to husbands’ sexual dysfunction, frequency of sex was. Difficulties such as lack of interest, premature ejaculation, performance anxiety, erectile dysfunction, and avoiding sex were associated with less frequent sex. Husbands’ problems achieving orgasm were associated with less emotional satisfaction in the relationship. Furthermore, husbands’ sexual dysfunction correlated with reports of sexual dysfunction by the wife. Greater lack of interest and lack of pleasure as well as anxiety about and avoidance of sex were more often reported by women when similar sexual difficulties were reported for the husband. E. Communication Patterns Communication patterns about how sex was initiated were significantly related to physical and emotional satisfaction as well as to sexual frequency. A significant predictor of good sex was whether both husband and wife expressed interest in initiating relations. A woman’s participation in initiation of sex, independently or mutually, was associated with greater physical and emotional satisfaction, regardless of how she communicated her interest, such as by physical gesture or in words. Sexual difficulty, particularly lack of interest and lack of pleasure, was associated with less involvement in initiation of sex by the wife and more frequent initiation by the husband. Avoiding sex because of sexual problems was similarly related to initiation patterns. F. Sexual Abuse and Mental Health Women who reported a history of sexual abuse, regardless of when the abuse took place, were less emotionally satisfied. Type of abuse or perpetrator was not significantly related to any of the other variables we examined related to sexual satisfaction. Sexual abuse history was related to current sexual difficulties. Women who reported a history of sexual abuse were more likely to report no interest or pleasure in sex, anxiety about sex, and consequent avoidance of sex. When the perpetrator was a relative, women reported less interest in sex. Mental health was significantly related to physical and emotional satisfaction as well as frequency of sex. Women with a history of depression, but not anxiety, reported lower physical and emotional satisfaction as well as less interest in and lower frequency of sex. G. Religious Background We were also interested in examining the impact of religious background (i.e., being raised observant vs. being a ba’alat teshuva) on predictors of characteristics of sexual satisfaction. These analyses revealed significant differences between women who were raised in observant homes and those who became observant later in life. For those women who were raised observant, lower physical satisfaction was associated with feelings they could have been better prepared for sex before marriage, frequently postponing going to mikvah, low emotional satisfaction, not learning about sex by experimentation, not feeling that niddah enhanced emotional life. None of these relationships was observed in women who became observant later in life. It is worthwhile to note that despite having significantly more past sexual abuse than their peers who were raised observant, ba’alot teshuva experienced greater overall sexual satisfaction in marriage. V. DISCUSSION The research goal of this pioneer study was to better understand how married Jewish women who adhere to taharat haMishpahah experience sexual life. Our project included designing a suitable questionnaire, distributing that questionnaire as broadly as possible, and then analyzing the data obtained. We intended our findings to be helpful for the observant lay community as well as the broad spectrum of rabbinic, educational, and health professionals who serve religious communities. Our findings demonstrate something we intuitively know, that sexual and emotional intimacy are complex and nuanced experiences. We hope that subsequent research carries our beginning explorations further. As our questionnaire was modeled on the Laumann et al. study, we report the overall comparison that women who participated in our study reported significantly less physical and emotional satisfaction as compared to married women from the Laumann et al. study. Our respondents also reported greater sexual dysfunction on many of the comparable variables. We speculate that lack of education about sexuality in the observant community might account for these findings. Discussion about sex rarely occurs in homes and schools and is absent even in many kallah classes. Lack of communication skills between husbands and wives regarding sexual life is also a likely contributor to physical and emotional dissatisfaction among observant women. A number of factors contribute to the reticence regarding sex in observant Jewish culture. Traditional religious communities are reluctant to openly discuss or develop educational curricula for schools regarding sexuality. Reverence for modesty as a value, coupled with dismay regarding the hypersexualized aspects of contemporary secular society, leads to caution. Although there are several limitations of the current study, including the representativeness of the sample, the findings underscore the importance of education about sex within the context of marital relationships. This might occur in the context of standardization of the curriculum of teachers responsible for the preparation of brides and grooms in the area of taharat haMishpahah. Mikvah attendants are another group deserving in-service education. As the actual gatekeepers to immersion, women who work in the mikvah are in a privileged position to observe obvious distress and to direct women to appropriate resources. One domain in which observant women and secular American women did not differ was in the prevalence of sexual abuse. It is imperative to not minimize the prevalence of such experiences within the observant community in light of their impact on both mental-health-related issues and married life. Another important conclusion concerns the relatively few differences that could be attributed to adult religious affiliation. Though this may not be very evident in everyday observant life, the data suggest that Modern Orthodox, Yeshiva/Agudah and Hassidic women were far more similar to each other than not when it comes to sexual life. We conjecture that traditional attitudes expressed during girls’ formative years about modesty and gender role exert powerful influence across observant denominations. We were impressed with the contrast in marital sexual life between women born religious and those who chose to become religious. As compared to their ba’alot teshuva peers, those raised observant experience more sexual distress. We noted a puzzling contradiction between the higher rates of sexual abuse among ba’alot teshuva and their greater sexual satisfaction once observant and married. We also noted that these women, once married, observe laws of family purity as strictly as their religious from birth peers. However, in their younger pre-religious years, ba’alot teshuva enaged in more premarital sexual experimentation. In addition, they were sexually expressive with their husbands even before marriage. We hypothesize that ba’alot teshuva import early, more positive attitudes toward sexuality into their adult marital lives. Greater awareness of sexual feelings and confidence may even offset such trauma as sexual abuse. We respect that traditional Jewish life advocates premarital chastity and values modesty throughout all of life. We do not recommend that observant Jews advocate premarital sexual experimentation. Our work, however, highlights the need to encourage healthy sexual attitudes and communication skills in the observant Jewish community. This is a broad educational goal to be shared by parents and institutions such as schools and camps. Whatever their differences, lay and religious leaders across the denominations would serve their communities well by focusing on abuse awareness, prevention, and treatment, as well as positive attitudes toward human sexuality. Finally, it may be important that observant Jewish women who have serious religious questions about sexual matters currently do not turn to religious personnel (rabbis or kallah teachers) for advice or counsel in this critical area of religious life. At the time of this writing, the advent of yoatsot halakha was too recent to have significantly impacted our respondents. Certainly this cadre of religious teachers/advisors in taharat haMishpahah are uniquely placed to serve observant women in the area of marital sexual life. Just as we advise implementing relationship and sexuality education in established school systems and establishing standards for those who prepare brides and grooms, rabbis would benefit from receiving training in sexual and emotional issues. Those who are in a position to counsel and educate couples both before and after marriage should carefully consider the significance of these observations. 1 Norman Lamm, A Hedge of Roses (New York and Jerusalem: Feldheim, 1987), 54. 2 See Rabbi Joseph B. Soloveitchik, Family Redeemed, ed. David Shatz and Joel B. Wolowelsky (New York: Ktav Publishing House, 2000), especially the chapters “Marriage” and “The Redemption of Sexual Life.” 3 Edward Laumann, Anthony Paik, and Raymond C. Rosen, “Sexual Dysfunction in the United States: Prevalence and Predictors.”Journal of the American Medical Association 281 (1999): 537–544. 4 See Arne Mastekaasa, “Marital Status, Distress, and Wellbeing: An International Comparison.” Journal of Comparative Family Studies 25 (1994. See also David Snarch, Constructing the Sexual Crucible (New York: Owl Books, 1991). 5 Lamm, op cit., 57–67. 6 Samuel Heilman, Defenders of the Faith: Inside Ultra-Orthodox Jewry. (New York: Shocken Books, 1992). 7 Andrea Rellini and Cindy Meston,” Sexual Abuse and Female Sexual Disorders: Clinical Implications.” Urodynamica, 14(2003): 80–83 8 National Jewish Population Survey 2000–2001. Copyright © 2001–2005 (New York: NY United Jewish Communities). 9 Devorah Zlochower, “Preparing Modern Orthodox Kallot and Hatanim for Marriage.” Presented at the Orthodox Forum 2005); Abby Lerner, “Thoughts on Teaching Taharat HaMishpacha: The Role of the Teacher”: Proceedings from Orthodox Forum (New York, 2005). 10 Deena Zimmerman, A Lifetime Companion to the Laws of Jewish Family Life (Jerusalem: Urim Publications, 2004), 205–211. 11Yehuda, Friedman, Rosenbaum, Labinsky, and Schmeidler, “History of Past Sexual Abuse in Married Observant Jewish Women.” Am J Psychiatry 164:11, November 2007, 1700–1706. 12 David Finkelhor, Gerald Hotaling, I. A. Lewis, and Christine Smith,” Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors.” Child Abuse and Neglect; 14,1 (1999): 19–28.