Exploring erotic potential: mixed methods study on effects of a sexological bodywork retreat for people who identify as women

Abstract

Within the field of sexuality in the United States, the use of hands-on work is controversial, although it is practiced internationally and has been researched in other countries. This mixed methods study explored effects of sexological bodywork within the context of Back to the Body^TM retreats for people who identify as women. Quantitative data were gathered from a survey of participants at past retreats (n = 48) and from pre and posttest surveys of participants before and after a retreat (n = 35). The survey of past participants found moderate to very positive changes across all constructs: 75% for arousal, sexual self-image, and sisterhood; 72% for body image; 71% for feelings about genitals and sexual assertiveness; and 66% for sexual satisfaction. Pre and posttest surveys revealed statistically significant increases in genital self-image, body image, sexual self-image, and sexual satisfaction; however, sexual assertiveness decreased. Qualitative analysis of open-ended survey responses and from 21 in-depth interviews revealed five major themes: feeling safe, connecting to self and others, feeling acceptance and permission, exploring arousal and pleasure, and transformative life changes. Sex and relationship therapists can use these findings to add to their own knowledge and to assist clients who may be interested in these modalities.

LAY SUMMARY

Surveys and interviews were used to explore sexological bodywork at sensual retreats for women. Changes were reported for genital self-image, body image, sexual self-image, and sexual satisfaction. In interviews participants discussed feeling safe, connecting to self and others, feeling acceptance and permission, exploring arousal and pleasure, and transformative life changes.

Keywords:

• Sexological bodywork
• somatic sex education
• female sexual arousal
• women’s body image
• sexual assertiveness
• sexual satisfaction

Sexual pleasure is an important element of well-being for individuals and couples (Anderson, 2013; Diamond & Huebner, 2012; Satcher, 2001). Yet sexual science has long neglected examination of pleasure (Jones, 2019) and clinicians are largely trained to focus on treating problems (Resnick, 2004). People seeking to enhance their sexual pleasure may see sex therapists and/or go to workshops offered by sex toy shops or alternative sex communities, e.g. The Body Sacred (2020).

An option that can be adjunctive or complementary to sex therapy is somatic sex education, which focuses attention on bodily sensations (Thouin-Savard, 2019). The purpose of this exploratory study was to share research-based knowledge of one type of somatic sex education, i.e. sexological bodywork conducted at Back to the Body^TM (2020) retreats for people who identify as women. Given controversies around hands-on work, we hope to increase awareness of this practice and encourage discussion among sexuality and relationship therapists and sexuality educators. It is important to note that the study was not designed as nor is it intended to be an evaluation of the retreats.

Why might women in particular benefit from such assistance? Researchers have documented a pleasure gap for women as compared to men in heterosexual relationships (Mahar et al., 2020; Rubin et al., 2019). Due to societal expectations and gendered cultural scripts, women may see their sexual pleasure as being less important than their partners’ (McCabe et al., 2010; Sanchez et al., 2012). They may yearn not for just “good-enough sex” (Kleinplatz et al., 2018), but rather sexual ecstasy (Ogden, 2012). Another benefit, as Resnick (2004) noted in her discussion of somatic-experiential sex therapy, is that sexual inhibition plays a role in the stifling of the authentic self. Thus, enhancement of sexual pleasure can lead to overall life enhancement.

Simply stated, somatic sex education engages the body, along with the mind and emotions. In Healing Sex, Haines (2007) described somatics as “an educational and transformational approach that assumes the mind, body and emotions are one interconnected biological system” (p. 16). Hutchins (2011) discussed sexual healing based on “therapeutic and spiritually/emotionally transformational approaches that work with the body’s own erotic energy” (p. 575). As O’Laughlin (1998) stated in an article on bodies in education, there is a need for “rehabilitating a notion of human embodiment” (p. 275). In Whole-Body Sex, sex therapist Walker (2020) helps readers map the erotic self, dispelling messages about the body embedded in a sex-negative culture. Jesse (2018) stated,

Somatic sex educators teach through body experiences designed to nurture, deepen or awaken the sensual self. These experiences can include coaching in breath, movement, body awareness, boundary-setting, communication, anatomy, sensate focus, massage, erotic trance and other body-based teaching about sex. (p. 3)

While hands-on work with clients is only one aspect of somatic sex education or therapy, due in part to the controversies about ethics, it is practiced internationally and has been researched in countries such as Denmark (e.g. Ventegodt & Struck, 2009b) and Israel (Hoch, 1986). The current study explored the effects of hands-on somatic sex education called sexological bodywork within the context of sensual retreats for people who identify as women.

History

Historically, the first known body-based sexual healing was the Hippocratic Pelvic Massage/Vaginal Acupressure in 350 BCE (Ventegodt et al., 2006). Tracing the more recent history one can see both professional use of sexual touch as well as controversy over who should use these practices. The therapeutic use of sexual touch was introduced by physician William Masters and his colleague Virginia Johnson in 1958 via their Surrogate Partner Therapy protocols (Masters & Johnson, 1970; Rosenbaum et al., 2014). The therapist, client, and surrogate partner form a therapeutic team to assist the client in reaching their goals. Preferring to work with couples, Masters and Johnson created the surrogate partner model for men who did not have partners.

The International Professional Surrogates Association, created in the mid-1970s (Apfelbaum, 1984), carries on this work, offering certification based on 100 h of training and a multi-year internship. The Oscar-nominated film, The Sessions (Lewin, 2012) raised public awareness of this model. Based on a story written by a man who was paralyzed from the neck down and wished to experience sexual intercourse, it features his work with a surrogate partner therapist with the support and assistance of his therapist and priest. Note that the film is not completely accurate in that the surrogate has sex with the client during the first meeting; that is not standard practice.

In 1965, California sex therapists Hartman and Fithian (1974, 1978, 1982) created research protocols for treating women with sexual dysfunction using a sexological examination. They continued to use this procedure in their clinic in Long Beach, CA using male and female sex therapy teams who had a minimum of 350 h of training. Often with their husbands’ participation, the exam served educational as well as diagnostic purposes; these included education in “physiological psychology for husband and wife (p. 64), and “acquainting the female with her own body” (p. 65). Apfelbaum (1984) reported that some surrogates that Hartman and Fithian trained to work within their sex therapy treatment program went on to create the International Professional Surrogates Association (IPSA).

In a set of commentaries in a 1982 edition of the Journal of Sex Research, an Israeli physician (Hoch, 1982a, 1982b) who directed a medical center sex therapy program claimed that only medical doctors should do the sexological examinations. Replies from Hartman and Fithian (1982) claimed it was not a medical procedure and in an additional commentary, Pomeroy and Brown (1982) argued that the sexological exam should have more positive non-medical aims, taking a pleasure approach to sexuality. According to Tiefer (2006), Hartman and Fithian also introduced a practice that is used by surrogate partner therapists and others today – having a person stand nude before a mirror and share thoughts and feelings about their body.

Somatic sexual healing today takes many forms in the United States and around the world. Examples include: Bodysex™ workshops started by Betty Dodson in 1974 (Dodson & Ross, 2020; Meyers, 2015); Celebrating the Body Electric founded by Joseph Kramer in 1984 (Goss, 2001); and Sex Coach U (2020) founded by Patti Britton in 2010. Sex coaching may involve only talking or may include hands-on work. Pamela Madsen created the Back to the Body Retreats in 2010 (Back to the body, 2020). Susan Kaye (2018) created Integrative Mind-Body Therapies whose services include hands-on somatic coaching and surrogate partner therapy, as well as training for therapists who wish to use the triadic model of therapist, client and surrogate partner working together.

Sexological Bodywork, the focus of the current research, was created by Joseph Kramer (Morin, 2007). According to Wikipedia, (Joseph Kramer, 2020), the only source we found with his career information, Kramer studied for the Jesuit priesthood for ten years, then left in 1976 and came out as gay. He completed his Master of Divinity (M.Div) degree and then in 2002 earned a Ph.D. from the Institute for Advanced Study of Human Sexuality, where he was subsequently on the faculty. Active in creating somatic sexology programs, he started Body Electric in 1984, the EroSpirit Research Institute in 1992, and the New School of Erotic Touch in 1999. He went on to help found six Sexological Bodywork institutes internationally and is still on the faculty of those in Australia, Brazil, the UK, and Switzerland (Joseph Kramer, 2020).

According to the Association of Certified Sexological Bodyworkers (ACSB), Sexological Bodywork is “somatic education that assists individuals, couples, and groups to deepen their experience and awareness of their body, eroticism, and sexuality” (Association of Certified Sexological Bodyworkers, n.d.-a, para. 1). Teaching involves a variety of instructive modalities, including breathwork, touch, erotic massage, and pelvic release bodywork. Certified Sexological Bodyworkers are trained sexologists who subscribe to a Code of Professional Conduct and Ethics (Association of Certified Sexological Bodyworkers, n.d.-b). Training and certification occur internationally, e.g. the Association of Certified Sexological Bodyworkers provides an online list of training programs for Australia, Brazil, Canada, Germany, Ireland, UK, and the USA (Association of Certified Sexological Bodyworkers, n.d.-c). Typically, people see sexological bodyworkers on an individual basis. To our knowledge, the retreats from which data were gathered for this study are the only program offering intensive, daily bodywork for multiple individuals.

Ethics of hands-on practice

Therapists may have concerns about the ethics of hands-on somatic sexology. Like all issues related to sexuality, it is complicated, as explained by Ventegodt and Struck (2009a) in their article on therapeutic dilemmas in the sexology clinic. Writing about the Hippocratic Oath, Ventegodt (2020), director of the Danish Quality of Life Research Center, discussed Hippocrates’ belief in both talk therapy and therapeutic touch. Ventegodt reported Hippocrates’ belief that:

It is important to understand that adhering to the sexual boundaries does not contradict physical and emotional closeness, as many people today believe. The holistic doctor can be very close and intimate with the patient, e.g., the traditional practice of massaging the patients’ entire body including the genitals, and still respect and keep the sexual boundary. It is precisely this balance between intimacy and sexuality that is the central theme of Hippocrates’ medical oath…. (p. 3)

However, the codes of ethics of licensing bodies for therapists prohibit touching clients. As well, the Code of Ethics of the certification body, the American Association of Sexuality Educators, Counselors and Therapists (AASECT, 2014) has since 1978 banned nudity and touching of clients by therapists. People who do somatic sex education can attend AASECT conferences and present, but they cannot be members, nor can they become certified because adherence to the Code of Ethics is required. However, interest in this topic by AASECT members was demonstrated at the sold-out AASECT Institute (2019) called “The Body Whisperers: Understanding Body Work in the Sexuality Realm.” Presenters from several organizations doing somatic sex education facilitated the institute: the Human Awareness Institute (Human Awareness Institute, 2020), IPSA International Professional Surrogates Association (n.d.), The Somatic Sex Educators Association (2018), and The New Body Electric School (n.d.).

The late Jack Morin, a widely published sex therapist, shared in a Youtube video (Morin, 2007) that because therapists may be uncertain about what happens in somatic work and its benefits, they may feel awkward about presenting this option to clients. Furthermore, professionals wishing to refer their clients to a somatic practitioner may not feel safe in doing so because of the potential consequences of referring to an unlicensed or controversial practice. This concern can be exacerbated if the therapist is part of a marginalized community because of their race, ethnicity, sexual orientation, or gender identity.

While somatic sexology practices may be controversial in many countries, some countries accept them as both a legal and a legitimate form of treatment. In Denmark, Ventegodt and colleagues published several articles from 2006–2010 about therapeutic genital touch being used at their Vulva Clinic in Copenhagen (Struck & Ventegodt, 2008; Ventegodt et al., 2006a, 2006b; Ventegodt & Merrick, 2010; Ventegodt & Struck, 2009b). In Israel surrogate therapy is practiced for sexual rehabilitation, following the IPSA ethical code (Rosenbaum et al., 2014). Sexual assistants who serve people with disabilities have a legal status in many European countries where they are carefully selected and well trained (Limoncin et al., 2014). Shapiro (2002) argued for such care to be funded in Canada. Kuchikomi (2010) reported a service in Japan where surrogates provide sexual pleasure to severely ill or handicapped individuals. Because such services may in other places be offered by untrained sex workers, some of the stigma around hands-on sexual healing relates to its perceived similarity to prostitution. In Holland, as Gianotten (1997) remarked, this is less of an issue due to the legalization of prostitution.

Sexological bodywork retreats

The Back to the BodyTM (BttB) retreats provided an accessible sample to conduct research on sexological bodywork as participants have a weeklong intensive experience within a fairly consistent experiential framework (Back to the body, 2020). Founded and directed by Pamela Madsen, the retreats began in 2010. A certified somatic sex educator and sexological bodyworker who previously worked as a kindergarten teacher and fertility options advocate, Madsen is the author of Shameless (Madsen, 2011), a book exploring her own journey into sexological bodywork as a middle-aged married woman who wanted to expand her sexual experiences without leaving her husband or having an affair. The following description of BttB is based on its website and discussions with staff.

Held in various locations in the United States and abroad, the retreats aim to provide what the staff refer to as a “safe container” for sensual experiences and erotic risk-taking. Staff and participants live together in a private location, go on scenic or cultural excursions, and have group activities focusing on body image and genital awareness. During the study’s pretest-posttest phase, retreats were held in Boulder, CO, Key West, FL, Las Vegas, NV, Hawaii, Iceland, New Orleans, LA, Scotland, and Italy. Participants’ conversations with roommates and at meals foster sharing of experiences, leading to what some participants referred to as sisterhood. Naked body “show and tell” sessions allow participants to talk about how they feel about various parts of their bodies. Sensuality is experienced in various ways including beautiful locations and venues, as well as movement, dance, yoga, nature walks, and guided meditations such as “conversation with your vulva.” Each participant has daily 90-minute sessions with a certified sexological bodyworker; the same person for all sessions. The bodyworkers are part of the community, sharing meals, going on excursions, and taking part in some of the activities and discussions. They subscribe to the Sexological Bodyworkers Code of Ethics and sign a legal agreement with BttB proscribing any sexual contact with clients outside of the retreat sessions.

Each participant has two private intake sessions with their practitioners; one by phone or video call before they arrive at the retreat and another in person on the first day, to discuss any concerns as well as their goals for the retreat. Participants sign an informed consent agreement, which states in part:

I understand that somatic sex education is not psychotherapy or medical treatment. I understand that any touch will be given at my request and solely for my own benefit, education, and pleasure within the Back to the Body Code of Ethics. I agree to do my best to guide the touch to ensure that it is always beneficial, educational, and pleasurable for me. I understand that although I am paying for the Back to the Body retreat which includes lodging, meals, sex education, excursions and staff time, table work with a body worker is offered as a complimentary and voluntary service during my retreat. I understand that it is important for the Back to the Body staff to hear everything that is coming up for me to have a productive session. I agree to make Back to the Body staff aware of whatever comes up for me during a session. I agree to let Back to the Body staff know immediately if something doesn’t feel right for me. I agree to practice good self-care before and after the sessions and retreat, including adequate hydration, nourishing food, and rest. I have disclosed all medical conditions and food requirements that I am aware of, and will update Back to the Body staff of any changes in my health. I understand that Back to the Body bodyworkers adhere to the professional ethics of the Association of Certified Sexological Bodyworkers (http://sexologicalbodyworkers.org/ethics/). I understand that all session work is completely confidential and held between Back to the Body staff. I agree to uphold the confidentiality of other participants unless otherwise granted permission by said participants. (P. Madson, personal communication, April 13, 2021)

Bodywork sessions start with participants wearing a light robe and lying on a massage table. A fully clothed bodyworker performs only one-way touch. Gloves are worn for genital contact. Erotic exploration and arousal are based on clients’ goals within boundaries they set. Some of the time involves just looking into each other’s eyes and sharing verbal feedback. The extent and type of interactions varies, sometimes including use of vibrators, kink, and/or role play, as well as talking about previous experiences, laughing and crying/releasing.

According to the BttB director, (email communication, P. Madsen, April 4, 2021), all participants are assigned a “safe port,” on-site therapists and sex educators who are trauma informed, to serve as their personal ambassadors. The safe port talks with the assigned participant before each session and is there after the session to hold, listen and cuddle, as needed/desired. They help participants communicate their needs to the hands-on practitioners as sometimes participants might find that hard in the beginning, or if there is a miscommunication or a desire that the client finds too embarrassing to communicate directly. If a participant is triggered at a retreat related to previous trauma, the organization pays for five sessions of post-retreat therapy. According to the director, this has happened just two times sense the retreats were esblished and until the time of this research (personal communication, P. Madsen, April 4, 2021).

The processes used in these retreats reflect the levels of sexual knowledge and understanding identified in what is known as the PLISSIT model (Annon, 1976; McCarthy, 2001). This model is used to organize the different types of assistance provided by sexuality educators, counselors, and therapists, and can be useful in thinking about what happens at BttB. The first three levels of PLISSIT: Permission giving, Limited Information and Specific Suggestions can be offered by educators and counselors. All four levels of the PLISSIT model are practiced by sex therapists. As sex therapist Sabitha Pillai-Friedman described them in reviewing this manuscript (personal communication, S. Pillai-Friedman, 3/31/2021), permission giving may include all forms of permission related to sex, e.g. talking about sex at all ages and stages and discussing sexual desires and practices. Limited Information may include information about anatomy and function, hormones, masturbation, pleasure, orgasm, or use of instruments of pleasure. Specific suggestions may include masturbation exercises, looking at one’s genitalia, fantasizing, Sensate Focus, mutual masturbation, and use of vibrators, dilators, lubricants, and moisturizers. Intensive therapy may include addressing sexual trauma, shame, and relationship issues.

The first three elements of the model are present at the BttB retreats. Permission to explore arousal is assisted by participants knowing they are all there for that purpose. Also, before the first sessions, the BttB director provides an example of what may occur, which gives permission to try things participants may not have considered. On a table in front of the group she demonstrates how one might respond while being aroused by bodyworkers – by moving her body, making sounds, and asking for what she wants, and/or does not want. Permission is primary, given that so many people experience sexual repression. Permission-giving is followed by limited information, and specific suggestions shared by the bodyworkers in sessions and in discussions among the women and staff.

It is important to note that many participants in this study had attended multiple retreats. They may have also attended shorter intensive workshops offered by BttB and may have participated in a follow up mentorship program offered by the BttB director. Therefore, the “dosage” of their experience varied. Since our sample was too small to sort based on such variables, this research should be seen as an exploratory, but not conclusive, study of the effects of sexological bodywork at these retreats.

Related research

Public information about somatic sex education is available on the internet, yet academic sources are rare. A literature search of peer-reviewed journals using the phrase somatic sex education resulted in only one article, Thouin-Savard (2019), which reviewed such practices with a focus on erotic mindfulness, an important concept in sex therapy (McCarthy & Wald, 2013; Stephenson & Kerth, 2017). A search on academia.edu revealed one article (Litam & Speciale, 2021) and one poster presentation by De Beer (2016) presented at a Sexuality and Social Work Conference in Switzerland. Information by practitioners can be found on the internet; a google search for this phrase found the page Somatic Sex Education, describing public education and professional development in “support of somatic sex education and sexological bodywork” (Somatic Sex Educators Association, 2018, para. 1).

Our literature review using academic databases as well as online sources such as academia.com did not find any research-based studies about the effects of sexological bodywork. Therefore, in considering what constructs to examine for our study we looked for studies related to women’s sexual pleasure, which like sexological bodywork, can be seen as adjunctive to sex therapy. In the following we have italicized constructs that we chose to assess for our study.

The closest, although different as it includes two-way touch, is surrogate partner therapy. Dauw (1988) found that use of female surrogate partners to treat male sexual dysfunction, along with traditional sex therapy and patient education, was related to improvement in impotence, ejaculatory dysfunction and inhibited sexual desire. More recently an Israeli team of researchers found that treating women with vaginismus with a male surrogate partner was at least as effective as couple therapy in relieving vaginal tightness and pain with intercourse (Ben-Zion et al., 2007). While valuable, both studies were related to treating sexual dysfunction, which is not a goal of the BttB retreats.

Meyers (2015) research on the impacts of Betty Dodson’s Bodysex^TM masturbation workshops for women was fruitful for both the research design and the constructs studied. Meyers examined a program somewhat like that of the BttB retreats, although there were differences. As Meyers reported, participants gathered for a two-day weekend. They removed their clothes when they arrived and were naked throughout the workshop, as were Betty Dodson and her assistant. Over these two days, they shared thoughts and feelings about their bodies and their orgasms, learned about the variations in size and appearance of the labia and clitoris during a group “show and tell,” and practiced arousing themselves while sitting or lying in a circle using their own hands, vibrators, and dildos. Perhaps because of the unusual nature of such a gathering, participants often shared a sense of something Meyers called sisterhood.

Using a mixed methods design, Meyers started with a survey of past participants focused on their perceptions of the impact of the workshop on sisterhood, masturbation, orgasm, sexual self-schema, body esteem, and female genital self-image. She also carried out pre and posttest surveys. Although her sample size of 13 was small and thus findings must be considered exploratory, she found statistically significant changes in sexual satisfaction, genital self-image, and sexual self-efficacy. Themes reported from qualitative analysis of 15 individual interviews and open-ended responses from the survey of past participants (n = 63) were: experience of sisterhood (connection with other participants); feeling more normal; feeling empowered; and healing both physically and emotionally (Meyers, 2015).

Other research of programs involving sexual touch was carried out in clinics. Based on research at their Center for Marital and Sexual Studies founded in Long Beach, CA in 1968, Hartman (1998) and Hartman and Fithian (1974) first found that the use of a sexological examination was related to increases in sexual satisfaction and sexual self-esteem. For more information on this therapeutic tool see Ventegodt and Struck (2009b). Based on research carried out at the Danish “Vulva Clinic,” Ventegodt et al. (2006) reported that use of vaginal acupressure, referred to as Hippocratic Pelvic Massage, significantly improved subjective sexual ability among 20 patients with history of sexual problems as well as an increase in overall quality of life.

Looking for related research that did not involve sexual touch but did include interventions related to some elements of the BttB retreat experience, we found the following. Several include teaching women to focus on subjective sensations using mindfulness, which is taught at BttB retreats. All changes noted were statistically significant. We have italicized the constructs that seemed the most relevant for our study.

• Increases in sexual satisfaction were found in a cognitive-behavioral group program used to treat vulvodynia with 76 participants in the Netherlands (ter Kuile & Weijenborg, 2006).

• Brotto et al. (2008b)’s pilot study included mindfulness as part of psychoeducational group interventions with 22 female cancer survivors at the University of Washington. They found improvements in sexual satisfaction, based on assessment of changes in desire, arousal, and orgasm. Based on qualitative interviews with these women, Brotto and Heiman (2007) found that participation in the psychoeducational program led to improvements in their sexuality and quality of life. The mindfulness component was perceived as the most helpful.

• In another group of 26 women in Canada, Brotto et al. (2008a) found that mindfulness-based psychoeducational group interventions targeting sexual arousal disorder in women led to improvement in sexual desire, arousal, and genital wetness.

• Mindfulness-based sessions that encourage women to focus on present/moment-by-moment physical arousal sensations have been found to have positive effects specifically related to arousal (Brotto, 2013; Velten et al., 2018), as well as sexual satisfaction and genital wetness.

• Hocaloski et al. (2016) found using psychoeducational sessions including education, mindfulness, and cognitive behavioral therapy for six women in Canada with multiple sclerosis or spinal cord injury was beneficial in improving sexual functioning (especially sexual desire and arousal) and in being less judgmental of inner experiences.

• Warshowsky et al. (2020) found that 125 women receiving information about the variations in women’s genitals in an undergraduate human sexuality course at the University of Florida, showed improvements in genital self-image as well as entitlement to pleasure.

To determine which constructs we would examine in the current study, we reflected on this research literature, particularly the Meyers (2015) study of Bodysex. We began our investigation with an exploratory survey of past retreat participants asking about their perception of the effects of the retreat on arousal, body image, feelings about genitals, sexual assertiveness, sexual satisfaction, sexual self-image, and sisterhood. The following section provides information about that data collection, as well as individual interviews, and pre and posttests.

Methods

Research design and research question

This study utilized an exploratory mixed methods approach, collecting and analyzing both quantitative and qualitative data regarding effects of the sexological bodywork retreats. Mixed methods studies require researchers to draw on two epistemological paradigms. These paradigms, each with their own assumptions about the nature of knowledge and how we know what we know, guide researchers on the choices of methods and interpretation of findings (Lincoln & Guba, 2013). Quantitative methods draw from the positivist research paradigm that sees the social world as real and measurable. Qualitative methods draw from constructivist and interpretivist mindsets that assume that knowledge emerges from an individual’s interactions with the world and must be interpreted from that lived experience (Schwandt, 1998). Post-positivism can be seen as balancing positivist and interpretivist approaches. A quasi-experimental design may be used in survey research where control groups and random sampling are not practical. Statistical analysis expected in empirical research is supplemented by interpretivist analysis of complex social phenomena. In the current study, data from an exploratory survey of past participants were analyzed statistically, as well results from pre and posttests, administered prior to and after retreat attendance.

Qualitative data were gathered through open-ended responses on the survey of past participants, as well as individual interviews. Based on an interpretivist paradigm, we analyzed these data to understand and report what participants shared about their lived experience as related to their perceptions of the effects of the retreats. In most cases we avoided enumeration in reporting qualitative findings, believing that the number of mentions does not necessarily signify its importance. However, in cases where there was wide variation in the experience of a theme, we have shared numbers of responses.

As a note to readers, while the retreats are primarily attended by cisgender women, two participants who responded to the surveys identified as gender fluid. For the purposes of inclusivity, we use the term “participants” instead of “women,” except for quotes, with the hope of representing the experiences of retreat participants of all gender identities.

The research question that guided this study was:

• How do BttB retreat participants perceive the effects of sexological bodywork within the context of a sensual retreat on their sexual lives?

Recruitment and data collection

The population of interest for this study was women who sought the services of a sexological bodyworker. Given the challenge of locating people who might be involved in this somewhat stigmatized activity, we were fortunate that the founder/director of BttB retreat was interested in cooperating with us in this research. We therefore used a purposeful, convenience sampling strategy to engage retreat attendees in participating in the study. All those who had attended retreats prior to and while research was being conducted were eligible for participation; there were no exclusion criteria. We collected data using a survey of past participants, interviews with individuals who volunteered via that survey, and a pretest survey of those about to attend a retreat, followed by two posttests.

Surveying past participants

After receiving approval from the Widener University Institutional Review Board (IRB), study number 17–18, the researchers shared a recruitment email with the BttB director who sent it to her database of those who had attended retreats. The email included a link to an anonymous survey on Qualtrics.^TM To augment this outreach, a recruitment link was also posted on the private Facebook^TM group to which previous attendees belonged. Sixty-four of the 140 previous participants started the survey, and 48 (34% response rate) completed the full survey.

The survey began with the IRB-approved consent form. By clicking yes, individuals gave their consent to participate in this study. Participants then self-reported their demographic data on multiple-choice questions. Next using a 7-point Likert scale from very negative to very positive, they responded to the question, “What if any was the effect of attending Back to the Body on your experience of…” with the categories being: arousal, body image, feelings about genitals, sexual assertiveness, sexual satisfaction, sexual self-image, and sisterhood. This was followed by seven short answer qualitative questions, with one question for each category, e.g. “How do you think the retreat affected your body image, i.e. how you feel about your body? (use as much space as you like).” An additional short answer qualitative question asked, “Any other thoughts about the effects of attending Back to the Body and/or your experience of sexological bodywork that you would like to share? (use as much space as you like).” The next and final question asked “Would you be willing to do an individual interview by phone or video call to talk in more detail about the effects of the retreat? It would add a great deal to the findings of this study.”

Individual interviews

Those who volunteered were transferred to a separate website so their name and contact information would not be linked to their anonymous survey answers. Many (33; 69%) of the 48 survey participants volunteered however some did not respond to follow up emails. The final sample size was 21 interviewees: 44% of the survey participants. All those who volunteered were contacted by a member of the research team to arrange for a time when they could participate in an interview through Zoom^TM, a video communication platform. They received an IRB approved informed consent form by email prior to the interview along with a demographic questionnaire and the interview guide. Interviews were conducted by one of the three researchers, using this guide.

At the time of the video call, the researcher welcomed the participant and reviewed the informed consent form and asked if they had any questions. They were told that the audio recording of the interview would be transcribed with a pseudonym substituted for their name to assure confidentiality. Participants verbally agreed and subsequently took a photo of the signed consent form and emailed it to the researcher. The interviewer then asked questions from the interview guide, taking time to inquire more deeply using follow-up probes as needed. Interviews varied in time from 24 to 76 min, with a mean time of 50.4 min. At the end, the interviewer asked if there was anything else they would like to add. As per IRB protocol the researcher then emailed a list of resources for counseling should any challenging feelings have arisen due to the interview.

Pretest and posttest surveys

Wishing to collect data that would be more valid and reliable than the recollections of past participants, we initiated one additional data collection method using pretest and posttest surveys. We asked retreat administrators to send IRB approved emails to those about to attend a retreat, which included a link to a pretest survey on Qualtrics^TM. They also sent an email with a “posttest one” survey right after the retreat and a “posttest two” survey approximately one month later. While 73 people completed the pretest, only 35 of the 100 participants completed both the pretest and at least one of the posttests (35% response rate).

Measurement, analysis and findings

The demographics provide a sense of who is in this sample, so they are presented first. We then present the qualitative measures, data analysis and findings as they provide rich descriptions by participants of the effects of the retreat. Third, we present the quantitative measures, analysis, and findings from the surveys.

Demographics

Participants in the exploratory survey of past participants and interviews completed a demographics questionnaire that collected information on their age, education level, race/ethnicity, household income, country of residence, sexual orientation, and how many BttB retreats they had attended. Believing it would enhance our interpretation of findings we decided for the pretest-posttest surveys to also include questions related to gender identity, romantic/sexual relationship status, marital status, and whether the participant was in a monogamous relationship.

Demographics are reported for 83 participants, 48 of whom completed the past participant survey; out of those 48 participants 21 were also interviewed. Another 35 participants completed the pretest survey and at least one posttest survey. Demographics were similar across surveys. The categories reported are age, race/ethnicity, education, household income, gender identity, sexual orientation, relationships, country of residence, and number of retreats attended.

Age

Participants ranged in age from 20s to 70s with the largest percentage being middle aged, 40–60 years old (70.8% of past participants, 68.6% for pretest/posttest surveys) (Table 1).

Table 1. Age.

Past participants survey (n = 48)			Pre/Post surveys (n = 35)
Age	N	%	Age	N	%
20 - 29	2	4.17%	20 - 29	2	5.71%
30 - 39	4	8.33%	30 - 39	1	2.85%
40 - 49	11	22.92%	40 - 49	10	28.57%
50 - 59	23	47.92%	50 - 59	14	40.00%
60 - 69	7	14.58%	60 - 69	5	14.28%
70 or older	1	2.08%	70 or older	3	8.57%

Race/ethnicity

Most participants were white (95.7% past participants and 85.7% pre/posttest) with the exception of those who reported as Black (0 past participants, 5.7% pre/posttest), Latina (2.1% past participant, 5.7% pre/posttest), American Indian or Alaskan Native (2.1% past participant, 0 pre/posttest), Native Hawaiian or Pacific Islander (2.1% past participant, 0 pre/posttest), Middle Eastern (2.1% past participant, 0 pre/posttest), and multiple races (2.1% past participant, 2.9% pre/posttest) (Table 2).

Table 2. Race and ethnicity.

Past participants survey (n = 47)			Pre/Post surveys (n = 35)
Race and ethnicity	N	%	Race and ethnicity	N	%
American Indian or Alaskan Native	1	2.12%	American Indian or Alaskan Native	0	0%
Asian	0	0%	Asian	1	2.85%
Black/African American	0	0%	Black/African American	2	5.71%
Latina	1	2.12%	Latina	2	5.71%
Multiple races	1	2.12%	Multiple races	1	2.85%
Native Hawaiian or Pacific Islander	1	2.12%	Native Hawaiian or Pacific Islander	0	0%
Other: Middle Eastern	1	2.12%	Other:	0	0%
White	45	95.74%	White	30	85.71%

Note. Multiple categories could be checked.

Education level

Participant education levels ranged from high school diploma/GED to doctoral degrees. Most participants were highly educated, with over half having some form of graduate degree (63.8% past participants, 65.7% pretest/posttest) (Table 3).

Table 3. Education level.

Past participant survey (n = 47)			Pre/Post surveys (n = 35)
Education level	N	%	Education level	N	%
High school/ GED	1	2.12%	High school/GED	0	0%
Some college	2	4.25%	Some college	2	5.71%
Associate degree	2	4.25%	Associate degree	0	0%
Bachelor’s degree	12	25.53%	Bachelor’s degree	10	28.57%
Master’s degree	25	53.19%	Master’s degree	16	45.71%
Doctoral degree	5	10.63%	Doctoral degree	7	20%

Household income

The sample was largely affluent as noted in Table 4. While most earned a household income of over $100,000 (58.7% past participants, 77.1% pretest/posttest) participants came from all income levels. Income of less than $75,000 was reported by 30.4% on the survey of past participants and 14.3% of those completing pre and posttests (Table 4).

Table 4. Household income.

Past participant survey (n = 46)			Pre/Post surveys (n = 35)
Household income	N	%	Household income	N	%
$0-$24,999	3	6.52%	$0-$24,999	0	0%
$25,000-$49,999	7	15.21%	$25,000-$49,999	3	8.57%
$50,000-$74,999	4	8.69%	$50,000-$74,999	2	5.71%
$75,000-$99,999	5	10.86%	$75,000-$99,999	3	8.57%
$100,000-$124,999	11	23.91%	$100,000-$124,999	9	25.71%
$125,000-$149,999	3	6.52%	$125,000-$149,999	2	5.71%
$150,000 and up	13	28.26%	$150,000 and up	16	45.71%

Sexual orientation

Most participants identified as heterosexual (68.8% past participant; 60% pretest/posttest). Thirty-one percent of those doing the past participant survey indicated another orientation as did 40.4% of those on the pre and posttests: bisexual (18.8% past participant; 31.4% pretest/posttest), pansexual (8.3% past participants; 9% pretest/posttest), bisensual (2.1% past participant) and heteroflexible (2.1% past participant). No one identified as lesbian (Table 5).

Table 5. Sexual orientation.

Prior participants (n = 48)			Pre/Post (n = 35)
Sexual orientation	N	%	Sexual orientation	N	%
Bisexual	9	18.75%	Bisexual	11	31.43%
Heterosexual	33	68.75%	Heterosexual	21	60%
Pansexual	4	8.33%	Pansexual	3	8.57%
Other orientation (1 Bisensual, 1 Heteroflexible)	2	4.17%

Gender identity

Gender identity was asked on only the pretest and posttest surveys. Thirty-two reported their identity as cisgender (91.4%), two reported as genderfluid (5.7%), and one reported as transgender (2.9%) (Table 6).

Table 6. Gender identity.

Prior participants (n = 47)			Pre/Post (n = 35)
Gender identity	N	%	Gender identity	N	%
			Female	29	82.85%
			Female, cisgender	3	8.57%
			Female, gender fluid, cisgender	1	2.86%
			Female, transgender	1	2.86%
			Gender fluid	1	2.86%

Relationship status

Relationship status was only asked on the pretest/posttest survey where 65.7% reported being in a romantic/sexual relationship. A minority, 43.5% were married. Nearly half of those in a relationship, 47.8%, reported that the relationship was non-monogamous (Table 7).

Table 7. Relationship status.

Prior participants (n = 47)			Pre/Post (n = 35)
Relationship status	N	%	Relationship status	N	%
			No	12	34.29%
			Yes	23	65.71%
Prior participants (n = 47)			Pre/Post (n = 23)
Monogamous Relationship	N	%	Monogamous Relationship	N	%
			No	11	47.83%
			Yes	12	52.17%
Prior participants (n = 47)			Pre/Post (n = 23)
Married	N	%	Married	N	%
			No	13	56.52%
			Yes	10	43.48%

Country of residency

Most participants lived in the United States (78.7% past participant, 94.3% pretest/posttest), while others lived in Canada (4; 10.65% past participant) or in Europe (4; 10.65% past participant) (Table 8).

Table 8. Country of residency.

Prior participants (n = 47)			Pre/Post (n = 35)
Live in USA	N	%	Live in USA	N	%
No	17.28%	10	No	2	5.71%
Yes	78.72%	37	Yes	33	94.29%

Number of retreats

It is important to note in terms of “dosage” that about half of the participants in this research had attended more than one retreat (42.6% past participants, 53.6% pretest/posttest). For past participants the range was 1–5 retreats with a mean of 1.7. For pretest/posttest participants the range was 1–4 with a mean of 1.9 retreats (Table 9).

Table 9. Number of retreats attended at time of past participant surveys and pre-posttest surveys.

Past participant survey (n = 47)			Pre/Post surveys (n = 28)
# Retreats attended	N	%	# Retreats attended	N	%
1 retreat	27	57.44%	1 retreat	13	46.42%
2 retreats	11	23.40%	2 retreats	8	28.57%
3 retreats	6	12.76%	3 retreats	3	10.71%
4 retreats	2	4.25%	4 retreats	4	14.28%
5 retreats	1	2.12%	5 retreats	0	0%

Qualitative aspects of the study

We have divided our reports on research methods and results, i.e. measures, data analysis and findings, between the qualitative aspects of the study and quantitative aspects. We first report on the qualitative aspect of the study; the instruments we used for data collection, the process for data analysis, and findings that emerged from that analysis. After this we will report similarly on quantitative data, including measures, analysis, and findings. We present the qualitative data first as we believe readers may benefit from a contextual background for the statistical results by hearing the voices and perspectives of retreat participants.

Qualitative measures/instruments

Qualitative data collected for this research came from open-ended questions on the survey of past participants and individual interviews. The survey asked respondents to share comments about effects they perceived related to each of the constructs they had first assessed on a Likert scale. The constructs were derived from the literature review and chosen based on those that seemed most related to possible effects of the retreat. Those chosen were: arousal, body image, feelings about genitals, sexual assertiveness, sexual satisfaction, sexual self-image, and sisterhood. The survey also asked for any other thoughts they might like to share regarding their personal experience of the retreat and its effects. The final question asked participants whether they would be willing to participate in a follow up interview to discuss their experiences further.

For the semi-structured interviews, we created an interview guide with 15 open-ended questions, designed to answer our research question. Based on guidelines for interview protocols (e.g. Jacob & Furgerson, 2012), we began with easier questions such as “How did you learn about Back to the Body retreats?” and “What were your thoughts about Back to the Body prior to participating? Why did you go? & What did you hope to gain?” Later questions were more expansive such as “What was your experience of the sexological bodywork sessions?” “How, if at all, has the retreat affected how you feel about your body? Your genitals? Your sexual self-image? and “What do you think was the biggest impact from attending the Back to the Body retreat?” At the end of the interview, we asked for any other thoughts they might like to share regarding their experience of the retreat and its effects.

Qualitative data analysis

Transcripts of the 21 interviews were created by rev.com, after which we reviewed and corrected them as needed by listening to the audio recordings of the interviews. Pseudonyms were inserted for each participant. We uploaded these transcripts, along with open-ended responses from the survey of the past participants to the online program Dedoose^TM for coding and thematic development. Using content analysis methods, we initially carried out deductive coding, starting with the key constructs in the study’s research questions as parent codes: arousal, body image, genital self-image, sexual assertiveness, sexual satisfaction, sexual self-image, and sisterhood. We then used inductive coding to identify other effects that emerged from the data.

One of the researchers started inductive open coding by examining transcripts line-by-line to create codable segments and initial descriptive categories/codes. The three researchers then met weekly for an intensive discussion of these initial codes based on related transcript segments during which time we added, deleted, and merged codes. We then deleted the initial coding done by the first researcher. Based on recommendations to use a limited number of codes (Macphail et al., 2016) we finalized a code framework (Decuir-Gunby et al., 2011) with 70 parent and child codes, informed by best practices cited in mixed methods studies (e.g. Norona et al., 2018) and created definitions for each code.

The principal researcher then coded two transcripts, as did the other two researchers, to do an interrater reliability test using the Dedoose^TM platform. Their two pooled Kappa scores were very close at 0.745 and 0.752. Because of the strength of these interrater reliability scores on the first test, we began coding the rest of the transcripts using the code framework and definitions we had created as resources to assure reliability. We used two coding rules: keep research questions in mind, i.e. code especially for experience of the retreat and perceived effects, and in terms of length of segments, select as little text as one can that still makes sense and select as much as you need for it to make sense. When the 21 interview transcripts and 48 open-ended survey responses were coded, there were 312 text segments.

We then worked together to consolidate the 70 parent and child codes into five major themes, with 16 sub-themes. We created a summary for each theme and chose illustrative quotes to share. Using a member check to enhance credibility, we emailed the draft findings to the 21 individuals who had been interviewed, asking them to comment on whether the findings seemed credible based on their perceptions of the retreats. Six of the nine people who responded replied that they found the themes and report to be credible. Three had constructive feedback that was incorporated into a second draft of the qualitative findings. We then sent that draft to the interviewees, and five people replied; three shared that the findings seemed credible and two had additional suggestions. Suggestions on both drafts related to the importance of leadership, safety, and boundaries.

Given the constructivist interpretivist paradigm being used for the qualitative aspect of this study, we do not quantify responses except where there was a high level of variation in participants’ experience of a theme/topic. Because a topic was mentioned by just a small number of people does not mean it is not important. Also, pseudonyms are used throughout. It is very important to note that these results represent what is possible and what indeed happened for some participants. Not all effects were experienced by all participants.

Qualitative findings

Having focused our analysis on the research question, i.e. participant perceptions of the effects of the retreat, five primary themes plus sub-themes emerged from the data.

Theme One: Feeling safe

Being in a “safe container” includes boundaries

Not feeling judged enables greater pleasure

Safety enhances play

Theme Two: Connecting to self and others

Feeling connected to one’s body

Becoming awakened to one’s sexual desires

Relating with other participants/sisterhood

Theme Three: Feeling acceptance and permission

Understanding and accepting one’s body/genitals

Sharing vulnerability/exposure

Releasing shame

Owning our sexual selves

Theme Four: Exploring arousal and pleasure

Experiencing arousal during bodywork

Learning about and asking for what they want

Greater sexual expectations

Theme Five: Transformative life changes

Healing from trauma/hurts

Expanding sense of spirituality

Manifesting authenticity/agency

These themes and sub-themes are presented below with a summary of participant responses and illustrative quotes.

Theme One: Feeling safe

Being in what felt like a safe environment was of primary importance for retreat participants. The sub-themes relate to how feeling safe includes boundaries being respected, having a sense of not being judged, and being “held” in a retreat setting.

Being in a “safe container” includes boundaries

It was clear throughout the qualitative findings that what staff and participants called a “safe container” was key to participants being able to explore their sexuality. Eva spoke to the importance of her feeling safe with the bodyworker: “I never felt unsafe or creepy. You tell people that it was so comfortable and safe, and I think people are always surprised by that.” Tammy added how it was crucial, “that there wouldn’t be any uncomfortable situations where he would touch me without my consent or anything like that.” Patti commented:

I think it’s the boundaries. The fact that you know that you’re not going to be expected to do anything to them. The touching is going to be defined within only touching with gloves, no kissing, no sex, no oral sex. For me it was just having those boundaries, knowing what was acceptable and not acceptable in terms of the touch. But, also knowing that I had the freedom to ask for, if something wasn’t working within those boundaries, I could ask for what I want.

Michelle talked about how a sense of safety and boundaries mattered throughout the retreat experiences, saying,

Safe container has to do with, well, with trust, and it means no one is taken advantage of, neither the team members nor the participants; that there’s a boundary you do not cross. It takes a lot of energy to hold on everybody’s part. I’m sure they are constantly talking about either a participant that steps over the line or a team member that wants to step over the line. It’s got to take a lot of energy to hold that, but she (the director) is adamant about it; absolutely adamant. You do not mess around with a person who’s already vulnerable. You don’t mess around with their vulnerabilities.

It is important to note that perceptions did vary. Although not mentioned in the interviews or survey responses, critical comments related to this theme were received during the “member check” (review of qualitative findings by interviewees). One respondent noted that one’s experience of staff can negatively impact one’s sense of safety, saying that the “personal style and approach of (a staff member) was a deterrent to my sense of safety.” Another comment in a member check spoke of a recent experience (not during study) of witnessing what she saw as unprofessional conduct and lack of boundaries between staff members.

Not feeling judged enables greater pleasure

It mattered to participants that staff and other retreat participants did not judge them. This included not being judged for how they showed up or what they shared, their expressions of sensuality and sexuality, the appearance of their bodies or genitals, or where they were in their development. Natalia shared that for her, it also mattered that she was encouraged to take pleasure:

These people are not part of my everyday life. It’s safe here to explore instead of being nervous about being judged…. The experience of having someone touch you mindfully, and lovingly for your pleasure, and the permission to just like… “Please enjoy this. Please take all the pleasure you can from this.” That had never happened to me before.

Safety enhances play

Participants conveyed how being immersed in a “carefully held space” in the retreat environment contributed to their exploration of pleasure. Natalia’s comment is illustrative:

I can explore and play because it’s not a…., “laboratory” seems too cold, but it is a playground. It is a place to explore. It’s outside of the real world… this contained, beautiful, carefully held space that you can explore and play in.

Crystal noted the value of what she called “the immersion experience” of doing sexological bodywork in a retreat setting. “You could go and work with a sexological bodyworker once a week for a year and you wouldn’t get … I don’t think you would have the same experience … Well, it just certainly wouldn’t be the same.”

Theme Two: Connecting to self and others

The outcome of connection is represented by three sub-themes – feeling connected with one’s body, becoming awakened to one’s sexual desires, and relating with other participants/Sisterhood.

Feeling connected to one’s body

Some participants reported a whole new way of being in touch with and experiencing their own bodies after attending a retreat, as if a switch allowing them to experience the world in a more physical way had been “flipped from off to on.” Participant experiences of seeing and being with people with a wide range of body types and sizes were part of this, as was hearing other participants’ feelings about their bodies. A comment from the survey of past participants expanded on this:

While I didn’t come to Back to the Body specifically for issues with body image, the retreat made me more aware of what it feels to be fully in my body – the surge of energy, well-being and connection that comes from it, and thus made me appreciate it in its totality and be more compassionate toward it. The experience of sharing my body story made me feel proud of the parts of my body I considered "weak," for what they’ve helped me overcome and it also made me prouder of the features I’ve always enjoyed or appreciated. However, the biggest gain is just having an overall sense of being "ok" the way I am.

Becoming awakened to one’s sexual desires

Having the opportunity to experience focused one-on-one arousal for 90 minutes helped participants get in touch with their sexual desires. As Eva commented, “I really wanted to unlock the reason for what it is that plays into my sexual desire. I wanted to really unpack that and study it and dive into it in a safe environment.” One participant who commented on the survey of past participants spoke of having been dead or asleep sexually before their BttB experiences, which transformed to feeling turned on much of the time afterward:

The retreat completely burst me open!! I went from having no sexual desire to now being turned on and hungry for sex almost every day. That means I now feel sexy and sexual in my body all the time. I am aware of it. I like it not only because it’s fun and invigorating, but also because it is empowering.

Not all participants felt they got as far as they had hoped. Barbara remarked about this as a reason for possibly attending a third retreat:

Although I’ve learned new things, I don’t know whether I actually got myself nearly as far as I was going to go. It’s re-getting sensation and knowing what my body likes now and what it doesn’t like. Yeah, I’m keeping an open mind to the third.

Relating with other participants/sisterhood

While it was not true for all, some participants remarked upon having rapidly formed very deep bonds with other participants. Gabrielle’s comment harkened back to the theme of not feeling judged when she spoke about the concept of sisterhood, saying “I think sisterhood means unconditional positive regard for one another, a non-judgmental presence.”

Some reported forming long-lasting friendships of a deeper and more authentic nature than they experienced in most of their existing relationships. Laura shared that she stays in touch with her roommates from the retreat, and other participants:

We text, we call. I love the Back to the Body private Facebook page…People are receptive, and also, we’re talking about our own sexuality. …It’s like, "What does it feel like to do this?" Or "What does it feel like to do that?" These conversations are hugely open, and there’s really very little embarrassment, and a lot of curiosity… I’m used to great sisterhood, and this is sisterhood on a level, in an area that I’ve never experienced before.

Other participants shared not feeling connected to other retreat attendees or to the idea of sisterhood. One person mentioned that it is always hard for them to be in a group of people and another, who lives outside the U.S., said it was hard to meet up with new friends from the retreats. Some interviewees mentioned negative experiences, including feeling like an outsider, or feeling uncomfortable when someone mentioned hearing her sounds during a bodywork session. Grace noted that the level of intensity in the retreat could be a “double-edged sword – really beautiful like at the first retreat or a little sticky and messy like it did at the second retreat.” She explained:

At the second retreat it almost felt as if there was a competition for sex bod [sic] attention, as opposed to what happens on the table during session being the start and end of it… There seemed to be almost some of the coyness and flirting and playing for attention that women would do if they were dating or on a dating site or a social scene. That’s how it got messy.

Theme Three: Feeling acceptance and permission

Participants spoke movingly about the importance of accepting their bodies, including their genitals, allowing themselves to be vulnerable and exposed, and releasing shame they had carried for many years and thus, coming into a sense of owning their own sexual selves.

Understanding and accepting one’s body/genitals

Participants reported coming home with a deeper understanding of the beauty and capacity of their bodies and genitals, as well as a much greater level of acceptance and appreciation for their own forms. They described learning to let go of wishing some body parts were different and embracing their bodies as they are, some of them for the first time in their lives. As Angela remarked, “I’m truly just coming into my body for probably the first time in a way that a lot of other people have already experienced in their life.”

Some of these comments related to body image. In the survey of past participants, one person said, “Seeing all the shapes and sizes of the other women was incredibly empowering.” Another survey respondent elaborated on this:

I thought I felt positive enough about my body, but attending the retreat changed from the inside my feelings about my body image. I learned to be more compassionate about my body; accept my vulnerability about some body parts. Now I do really love my body; I honor it and I do not feel hurt anymore if someone makes negative comments on it. That is the biggest difference between before the retreat and now. Before I thought I liked my body, but if someone (my husband) made negative comments I felt hurt and felt not attractive enough. Now he can make any kind of comments and they simply don’t go through. They do not touch me at all. And it feels really fantastic!

Other comments specifically described feelings about their genitals. Retreat leaders encouraged participants to talk directly with their genitals, using whatever words felt best to them. One participant reported this on the survey:

The retreat gave me an understanding of and a relationship with my pussy that I never had before. I used to live completely disconnected from my pussy and unaware of it most of the time. I have since started to form a connection with her, to listen, to touch her with care and curiosity, to talk to her and ask her for guidance. I am on a journey of discovery and constant learning and reconnection with her.

Sharing vulnerability/exposure

Some participants described sharing themselves with others in ways they never had before and experiencing both the desire and willingness to be fully exposed and seen. They expressed finding great power in witnessing other participants as they revealed themselves, and in their own experiences of being held and accepted and appreciated for who they are. They talked about being aware of other participants’ arousal and pleasure, and the “permissioning” that provided for them. In the survey one person noted how seeing other women’s bodies led to more self-acceptance, as she realized that, “Beauty and sexiness comes in all shapes and sizes and at any age.” Sandra reported:

We had an evening where the male bodyworkers left, and we took turns sharing our vulvas with the other women. And I’d never really seen another woman’s vulva close up before. It was such a beautiful experience, and I felt extremely proud to show mine, and to share mine as part of this new sisterhood and connection of actually seeing what each other’s genitals look like. And there’s so much variety.

Releasing shame

The retreats offered participants the opportunity to shed long-held negative and limiting beliefs absorbed from cultural messaging and previous experiences, sometimes many decades earlier during childhood. For some participants, releasing the burden of carrying these beliefs was described as life changing. For Susan, who is a transwoman, this release of shame was particular to her experience of her new genitals:

I have some shame around my parts, kind of because when I first transitioned, I mean I had a really good surgical result. I had a really deep vagina, and I was dilating and all that and I got into a relationship that was really destructive and I kind of stopped doing all of that. So, it’s closed down quite a bit. So um, he (the bodyworker) was really good at working with it and he had a great mix of kind of clinical and, you know, compassion around it … So, really that last day when [bodyworker] was kind of working into the areas that had been closed off in my vagina and it was both painful and you know and some of the shame and also felt kind of exhilarating. There was a lot of emotion going on at that point, you know, I was crying and so that was… that was really powerful.

Owning our sexual selves

As they experienced profound shifts, some participants reported feeling more empowered to take ownership of and responsibility for their sexual experiences. They described operating with a degree of agency around their sexuality that was completely new in their lives. Natalia shared,

I started dating. I went online…, I just wanted to see if someone wanted to fuck me really. I just wanted to be desired, and I met someone and went out on a date and gave myself permission to go to a hotel with him, and he gave me oral sex for an hour. And I just let myself have it without any thoughts of, “Is it taking too long?" Or "Is this weird?" Because it didn’t matter what he thought about me… I thought he was really lovely, but I wasn’t looking to be in a relationship, so there was just this freedom to feel my body and explore, and to know that I was worthy and that I could have this pleasure. And that’s not something I would ever have considered before.

Theme Four: Exploring arousal and pleasure

The sub-themes in this key area relate to effects of the sexological bodywork sessions, i.e. experiencing arousal during bodywork, learning and asking for what they want, and greater sexual expectations.

Experiencing arousal during bodywork

Respondents often spoke about what they had learned about arousal: that it takes time and that it can be something to relax into and enjoy for itself. They reported how retreat leaders and bodyworkers referred to it as not needing to “chase orgasms.” Slow sensuous massage on a massage table enabled initial experience of arousal. Barbara explained:

We definitely start off very similar to having a massage, but you’re much more specific about what types of touch you feel arouse you, what things that you like, what things that you don’t like – the bodyworker exploring things that you hadn’t tried. Adding in movement, because obviously with a massage, you tend to stay very still, and … noise is quite important, so learning and having advice about how to do that. Then I suppose exploring how to get you to a good arousal, and then can you do that for a while? This was done with a combination of hands and vibrators.

Katherine commented on how both expansion and contraction can occur:

I mean, that’s not to say that I haven’t had, at each retreat, some type of contraction or trauma, if you will. I think I had my biggest issues at my first and third retreats, while my second retreat and this retreat I’ve just come from were mostly just about expansion. But just … I don’t know, just breaking through your own shit and the vibration of the container, the collective energy of the women, these people, men and women, who are in-service to women and to pleasure…

From the coded responses it was clear that validation of their body and their sexual response was key. Grace described feeling her body in a new way when she shared,

What the sexological bodyworker did was run one hand gently up and down the sides of my body, tracing my curves, and my eyes were closed, and I completely sunk into the sensations of having the curves of my body traced and all of a sudden, all the body issues and the excess weight and all the crap that so often accompanies female body image was gone and I could feel my curves and I felt beautiful in my body.

What happened on the table was not always sexual, depending on the person’s desires. It could be talking, or more like ritual. Danielle talked about using her sessions very differently after having what she called “a breakdown” on the table saying,

Never again did [bodyworker] touch me intimately. I brought in some of the stuff that I had been doing in my shamanism class. I brought in a lot of ceremony.

Learning and asking for what they want

Some participants shared about learning what they wanted and enjoyed sexually, and what they did not. This knowledge translated into the challenge of asking for what they wanted, both on the table at the retreat and once they got home. They also increased awareness of how to pleasure themselves independent of a partner. In the survey, one person reported, “The retreat completely changed me. I wasn’t able to say ‘no’ and was so ashamed in asking for what I wanted. After the retreat I have a strong sense of what I want and don’t want.” Sandra remarked, “The things I was able to take home were this established sense of self, how I deserved to be treated, and also this knowledge of what my body’s capable of.”

Greater sexual expectations

Having learned more about what they want, participants revealed how this self-knowledge led to changes in expectations for their sexual lives. These expectations sometimes created challenges when they got home because husbands and partners varied in openness to such changes. Anna shared, “I want to actually talk to him about not focusing on orgasm, and making it all about arousal for me; telling him why because when I focus on orgasm, it ruins it for me.” Tammy said,

My relationship with my husband has definitely been better but there are still struggles. My assertiveness in the bedroom has not gone over well with him. He feels like he needs to work harder and I am more frustrated with him than I was before because now I care what happens to my body. I don’t want to leave her, my yoni, in a traumatized or unfulfilled state. I think he needs help too.

Some participants chose to pursue non-monogamy and kink communities. On the survey, one person shared:

I have made major life transitions after BttB precisely to allow myself to live my sexual life to the fullest, and I would never go back to the way I was before. I like feeling sexy, feeling seen, turning on, and being worshipped… I see myself as a nurturing, life-giving, intentional, playful, and experimental sex goddess and I want to continue growing in this path.

Theme Five: transformative life changes

The impact of the retreats went beyond the sexual for some participants but not all; one survey respondent said, “The retreats were nice but not life-changing or transformative. Maybe I should have sought more advanced experiences.” Whereas another survey respondent said,

It was an outrageous experience for me, as my life had been relatively reserved prior to going. It took a great deal of courage for me to go, and it took me way beyond the boundaries of my comfort. But with that came a freedom that I have never felt before.

For some participants, the effect of the retreat was about healing and/or the experience of spirituality. As well, some reported significant life changes after returning home, such as greater professional assertiveness, leaving jobs, changing careers, moving to a new area, getting a divorce, finding new partners, and having an overall stronger sense of self.

Healing from trauma/hurts

Eight interviewees commented on having past trauma, abuse, or negative experiences, and moving through some of that at the retreats. Laura talked about how vital the consent aspect was for her, saying, “As most people who have suffered from some sexual abuse…, feeling like I had a voice, I could say no, I could say yes, and it was going to be respected.” Connie had attended multiple retreats and said that for her, “the first time it was really about healing, and the times after that it was more about experimenting with sexuality and taking things to deeper levels.”

We did receive feedback from an interview participant by email when we had reached out for member checks on the qualitative findings. She reported on an incident at a retreat that occurred after her interview. She said she was an incest survivor and had been “assaulted” (sic) by a bodyworker during a session, and that she let it happen as she went into “freeze.” She subsequently spoke with the director who arranged for her to have therapy. She asked us to remove her data from the study, which was done for the interview data, but not the survey data, as it was anonymous.

Expanding sense of spirituality

Eight (38%) of the interviewees used language of spirituality to discuss what happened at the retreats and/or its impact. At a retreat Crystal attended they had a group masturbation/erotic experience which she called, “a deeply spiritual embodied experience… starting off your day at 6:30 in the morning doing that, and you’re in nature. It was so grounding doing that with the women.” Others shared powerful experiences during their bodywork sessions such as seeing colors or a higher being. Sandra described having an intense experience of edging (getting close to orgasm and then backing off), and then a powerful orgasmic release, a spiritual experience, saying;

And I like, I saw God, as an atheist. And I left that retreat, a spiritual person. I went in as an atheist, I came out spiritual…. I found a spiritual center. I went to church for the first time ever in my life. So outside of just pleasure, I felt this new connection to source, and the unseen world of the universe. I cultivated that, as the couple years have gone by, and I consider myself an extremely spiritual person now, thanks to Back to the Body, my experiences on the table.

Manifesting authenticity/agency

Finally, some participants told stories of going home and presenting themselves to the world in an unapologetic way, embracing their ability to own and create a life full of pleasure. As one wrote on the survey, “The retreat has expanded my understanding and appreciation of arousal, both as a portal to sexual pleasure and as life force energy to power all elements of my life.” Natalia declared;

You know, it’s life changing. It’s all about connecting and seeing the world. When you feel good in your body, and you feel confident about yourself in the world … You know, it’s not … You are seeing the world through different eyes, and what you’re putting out there you’re getting back, and it’s amazing to me how welcoming people into their bodies opens them up to this rich, creative life and they get so much more out of this work than you would ever have thought.

While these qualitative findings are illustrative of the experiences and effects based on some of the participants’ perceptions, the quantitative data provide statistical findings based on a larger sample size.

Quantitative aspects of study

Next, we report on the quantitative aspects of the study; the instruments we used for data collection, the process for data analysis, and findings that emerged from those analyses.

Survey of past participants

Measure

A survey of past participants asked respondents to self-report on a 7-point Likert scale whether they felt the retreat(s) had any effect (very negative to very positive) on seven constructs. These were derived from the literature review and chosen on the basis of seeming most related to possible effects of the retreat. The constructs were: arousal, body image, feelings about genitals, sexual assertiveness, sexual satisfaction, sexual self-image, and sisterhood. No definition was given for the concepts of arousal, feelings about genitals, sexual satisfaction, and sisterhood, believing respondents could bring their own meaning. Wanting more clarity for the other three concepts we provided a brief definition: body image – how you feel about your body; sexual self-image – sense of yourself as a sexual person; and sexual assertiveness – asking for what you want and saying no to what you don’t want. In retrospect it would have been best to do that for all constructs.

Analysis

The survey of past participants asked respondents to share their perceptions of the effects, if any, of attending the retreat on their experience of arousal, body image, feelings about genitals, sexual assertiveness, sexual satisfaction, sexual self-image, and sisterhood. A table with a summary of participant responses was created by Qualtrics. It showed the number of responses to each construct and the percentage of self-reported effects for each choice (very negative, moderately negative, slightly negative, none, slightly positive, moderately positive, very positive).

Findings

Sixty-four of the 140 people who had previously attended retreats started this survey, however only 48 (34% response rate) completed the key section about the effect of attending retreats. On a 7-point Likert scale they entered their perception of effects on: arousal, body image, feelings about genitals, sexual assertiveness, sexual satisfaction, sexual self-image, and sisterhood. As shown in Table 10, a strong majority of participants reported that the retreat had a “moderately positive” or “very positive” effect on all constructs. They are listed here in order of reported change: sexual self-image (75%), arousal (75%), sisterhood (75%), body image (72.34%), feelings about genitals (70.83%), sexual assertiveness (70.83%), and sexual satisfaction (65.96%). When “slightly positive” is added, positive responses ranged from 80.85% to 91.67%.

Table 10. Past participant perceptions of retreat effects.

	N=	Very negative to moderately negative n (%)	Slightly negative n (%)	No change n (%)	Slightly positive n (%)	Moderately to very positive n (%)
Sexual self-image	48	1 (2.08)	0	3 (6.25)	8 (16.67)	36 (75.00)
Arousal	48	2 (2.08)	2 (4.17)	3 (6.25)	6 (12.50)	36 (75.00)
Sisterhood	48	2 (4.16)	1 (2.08)	3 (6.25)	6 (12.50)	36 (75.00)
Body image	47	1 (2.13)	0	3 (6.38)	9 (19.15)	34 (72.34)
Feelings about genitals	48	1 (2.08)	0	5 (10.42)	8 (16.67)	34 (70.83)
Sexual assertiveness	48	1 (2.08)	1 (2.08)	4 (8.33)	8 (16.67)	34 (70.83)
Sexual satisfaction	47	1 (2.13)	2 (4.26)	6 (12.77)	7 (14.89)	31 (65.96)

Sexual satisfaction showed the lowest amount of positive impact with 12.77% indicating no change and 6.39% a negative change. Some reported that it was hard to tell whether or not it had an impact on their satisfaction because they do not currently have a partner or that sometimes their partners’ focus on the genitals felt “too much” and too narrow.

Looking across all constructs, a small minority reported “no effect” (6.25%–12.77%). “Very negative” to “moderately negative” impact was reported in fewer responses (2.08%–4.16%). One survey participant reported “very negative” across all six constructs, saying in an open-ended comment that for her the retreat brought up issues related to past trauma. Related to sexual satisfaction, the participant wrote, “It completely shut down my sexual self and I became aversive to anything that might be remotely sexual and so there was no interest or connection to sexual satisfaction for me.”

Results in Table 10 are listed in order of stronger effects to less strong. Percentages representing answers for “very negative” were combined with answers that reported “moderately negative” and percentages representing answers for “moderately positive” were combined with “very positive.”

Pretest and posttest surveys

Following the past participant survey, we initiated a pretest and posttest measure for upcoming retreats.

Measures

The pre-retreat and post-retreat surveys used validated and reliable measures to assess participant experiences of five constructs: body image, genital self-image, sexual assertiveness, sexual satisfaction, and sexual self-image. We had not located scales to assess arousal or sisterhood so those constructs were not included in the pre and posttest surveys. In developing the questionnaire, we worked to balance use of previously validated instruments to assess effects that seemed most important and relevant to this work, and to refrain from overwhelming participants with too many questions that might discourage completion.

The pre-retreat survey began with the IRB-approved consent form. If they clicked yes to agree, they then responded to demographic questions and Likert scale measures related to all five constructs. The two post-retreat surveys contained the same scales to assess the impact of the retreat. However, posttest one, taken right after the retreat, did not include the sexual assertiveness scale as it was assumed the participant would not have had time to practice any new skills with a partner at home. It was measured on posttest two, taken about a month after the retreat.

The surveys used the following measures. The question prompts and likert-scale responses were the same as they were on the original validated measures.

1. Body image – We used the 23-item Body-Esteem Scale for Adolescents and Adults (BESAA) as it was developed and validated by Mendelson et al. (2001). For 23 statements, respondents were asked to indicate: “How often do you feel each of the following,” e.g. “I like what I look like in pictures.” A Likert scale offered five choices: never, seldom, sometimes, often, always.

2. Genital self-image – We used the Female Genital Self-image Scale developed by Herbenick & Reece (2010). This scale asked participants to indicate how much they agreed or disagreed with seven statements about their genitals (i.e. labia, vagina, clitoris, vulva), e.g. “I feel positively about my genitals.” A Likert scale offered four choices: strongly agree, agree, disagree, and strongly disagree.

3. Sexual self-image – To measure sexual self-image we selected three dimensions from the Snell (2001) Multidimensional Sexual Self-Concept Questionnaire (MSSCQ). These were: sexual self-efficacy, sexual self-consciousness, and sexual self-esteem. This section asked respondents to “indicate how characteristic the following statements are of you” for 15 statements, e.g. “I have the ability to take care of any sexual needs and desires that I may have.” A Likert scale offered five choices related to how characteristic it was of them: not at all, slightly, somewhat, moderately, and very.

4. Sexual satisfaction – Given that existing sexual satisfaction scales included partner-related responses (and some respondents were not in a relationship), we chose to use the sexual satisfaction dimension from the MSSCQ (Snell, 2001) described above, which did not specifically ask about interaction with sexual partners, e.g. “I am satisfied with the way my sexual needs are currently being met.” We employed five questions from that dimension, ordered as in the original, and with the same answer choices.

5. Sexual assertiveness – We used questions related to two of three dimensions on the Loshek and Terrell (2015) Sexual Assertiveness Questionnaire, i.e. initiation of sexual activity (dimension one) and refusal of sexual activity (dimension two). We did not use questions related to sexual history taking (dimension three) as they were less relevant to this research. Respondents indicated how much they agreed or disagreed with 13 statements, e.g. “I feel uncomfortable telling my partner what feels good.” A seven-point Likert scale went from strongly disagree to strongly agree, with a “neither agree nor disagree” option in the middle. They were advised, “If you are not currently involved in a sexual relationship, please answer these questions based on your experience in your last relationship. If you are currently involved in more than one sexual relationship, please focus on the partner with whom you spend the most time.”

Data analysis

Recruitment messages were sent by retreat staff to 100 participants prior to the retreats, at the end of the retreat, and a month after the retreat, with a link to the Qualtrics survey. A retreat staff person sent the emails rather than one of the researchers in order to assure the anonymity of participants. Using the unique ID participants created and used across all three surveys, we identified 35 participants who completed at least one pretest and one posttest survey (35% response rate). Because there were varying sample sizes for each of the surveys (73 responses for pretest one; 53 responses for posttest one; and 56 responses for posttest two) and some participants only filled out the pretest or filled out one or both of the posttests, we decided to run the paired sample t-tests on the responses from participants who completed both a pretest and at least one posttest. If they did complete two posttests we used the posttest two score, believing that effects after several weeks may be more valid than right after the retreat. Since sexual assertiveness questions were only included on the pretest and posttest two, for this construct the paired samples t-test was run for the 22 out of the 35 participants who completed both a pretest and posttest two.

We first grouped and coded the questions according to their use in the original instrument, including reverse coding the body image and sexual assertiveness scales. We calculated mean scores for each participant for each of the constructs for the pretest and a posttest. In SPSS we used the paired samples t-test to compare the difference in the means for each construct. Effect sizes were calculated using Cohen’s d.

Results of paired sample t-tests on pretest and posttest means of each construct shown in Table 11 are listed in order of effect size. The greatest positive effects are listed first, i.e. genital self-image and body image, and the one negative change, sexual assertiveness, which showed a large decrease, is listed last. Statistically significant differences were found between mean scores for all five constructs tested. Cohen’s d values on each of the constructs suggest a moderate to high practical significance.

Table 11. Pretest/posttest analysis: Paired sample T-test and correlations (n = 35).

Construct	Pretest mean & SD	Posttest mean & SD	Mean difference	Cohen’s d (Effect Size)	t-test	df	Sig (2-tailed)
Genital self-image	2.90 (.720)	3.39 (.543)	0.49	0.72	4.28	34	<.001
Body image	3.26 (.801)	3.63 (.650)	0.37	0.60	3.67	34	<.001
Sexual self-image	2.92 (1.26)	3.60 (1.12)	0.68	0.57	3.38	34	.002
Sexual Satisfaction	2.39 (1.33)	3.07 (1.31)	0.68	0.52	3.10	34	.004
Sexual assertiveness	4.61 (1.42)	3.44 (.682)	−1.17	−1.64	−3.35	21	.003

SD: standard deviation, df: degree of freedom.

p = <.004.

Having presented both qualitative and quantitative results we will now summarize key findings and discuss meaning and value of the study.

Discussion

Given the sensitive nature of somatic sexology and the controversies about its ethics, we believe the research-based knowledge reported here is significant as it can inform discussions on the practice and ethics of hands-on work. This research also gives therapists and other professionals information to assist them in deciding whether they might inform their own clients about hands-on sexological bodywork or other related somatic sexology practices. In this section, we discuss demographics of participants and how that may have affected results, the effects that occurred and dynamics that may have affected the results, strengths and limitations of the research, and recommendations for providers.

Who attends the retreats?

As suggested by the 82-respondent sample in this study, participants are mostly from the United States, white, middle-aged, highly educated, in a relationship, relatively well-off, cisgender women, who are either heterosexual or bi/pansexual. Very important to interpretation of the findings is the reality that about half of the participants had attended more than one retreat.

Given the demographics, the findings should not be interpreted as predictive for a diverse range of people. Only eleven (13.4%) participants brought ethnic diversity; three identified as Asian, two as Black/African American, two as Indigenous, two of multiple races, and one as Middle Eastern. One person on the anonymous survey of past participants identified as a trans woman, as did one interviewee; it could have been the same person as the interview sample was drawn from the anonymous survey. In addition, two respondents identified as gender fluid. Sexual orientation had more diversity, with 28 (34%) identifying as not heterosexual, yet no one reported being lesbian. Only 13 (16%) people reported household incomes of less than $50,000. Sixteen (20%) were aged 60 or over. While most were in a relationship, a minority were married and nearly half reported being non-monogamous.

Based on seeing interviewees on video calls, the research team noted them as being largely “mainstream” in presentation. Many had professional roles that might discourage them from going to a sexological bodywork retreat given its taboo nature and concerns about possible judgment from others if they knew they went. Yet even some participants with lower incomes reported seeing the retreat as worth attending despite the cost, as an investment in themselves and relational improvement. It is notable that a rather high number of participants reported being non-monogamous and not being heterosexual. Might such populations be more open to suggestions about attending an erotic pleasure retreat?

What effects occurred and why?

The pretest/posttest surveys found statistically significant positive differences between mean scores for four out of five of the constructs measured, in this order: sexual self-image, body image, genital self-image, and sexual satisfaction. Sexual assertiveness was the only construct where there was a statistically significant negative change in answers between pre and posttest. Looking at the survey of past participants, over 66% reported a “moderately positive” or “very positive” effect on all constructs, listed here in order of reported change: sexual self-image, arousal, sisterhood all at 75%, followed by, body image (72%), feelings about genitals and sexual assertiveness both at (71%), followed by sexual satisfaction (66%).

What are some possible dynamics that may have affected these results? Based on the qualitative data, it appears that having a sense of safety, connectedness, and acceptance seemed to enhance explorations of arousal and pleasure during sexological bodywork sessions. Looking at it through another lens, it can be imagined that the bodywork experiences helped participants feel more connected and accepting of their own bodies, and sexuality. These dynamics may have aided some participants in healing from past abuse and trauma. As Thouin-Savard (2019) stated, “attunement and presence within the body itself; in a safe and ethical context… appears to support the release and integration of painful emotions and trauma” (p. 204). However, one respondent in the survey of past participants reported negative or no effects across all constructs. In an open-ended comment she said she felt the retreat led to negative effects because of past trauma. Given the intense and potentially triggering nature of retreat experiences, it is important to consider that past abuse or trauma can make participation more challenging.

A focus on being present is a watchword at BttB retreats where staff encourage participants to focus on experiences of arousal rather than “chasing an orgasm.” This message may have led to our positive findings related to arousal. Brotto and colleagues (e.g. Brotto, 2013; Hocaloski et al., 2016; Velten et al., 2018) found similar positive effects from psychoeducational sessions where they encouraged women to focus on physical arousal sensations in the here and now.

The positive results for sexual self-image, which included sexual self-esteem within the construct, corroborates the results of Hartman (1998). In his clinic, participants examined their body while nude, an activity that occurs at the BttB retreats. Previous studies that incorporated hands-on vaginal acupressure to address sexual functioning (e.g. Ventegodt et al., 2006), found increased subjective sexual ability, and in overall quality of life, similar to what our participants reported in the qualitative findings of the current study.

Body image, genital self-image, and sexual self-image all can be seen as intrapersonal perceptions associated with feeling better about oneself (body, genitals, sexuality). In comparison, sexual satisfaction and sexual assertiveness can be seen as interpersonal, associated with sexual interactions with partners. All three internal, intrapersonal constructs showed higher percentages of positive change from attending the retreats when compared with the interpersonal constructs of sexual satisfaction and sexual assertiveness. The positive increase in the internal constructs could however make a longer contribution to sexual satisfaction and assertiveness.

The sexual assertiveness concept, “knowing and asking for what I want,” was the only construct that showed a decrease for pretest/posttest participants. Qualitative comments on this topic indicate that for at least some respondents, while they may have been able to ask for what they wanted from the sexological bodyworker, sexual assertiveness remained a work in progress with intimate partners once they returned home. Participants may have found it easier to be assertive in a retreat setting where the touch is one-way and there are no expectations to provide pleasure to the other person. They may have found it harder to communicate their desires at home where doing so might disrupt the relationship dynamic, causing defensive feelings for partners, requiring increased risk and vulnerability.

Sexual assertiveness can be very hard given the historic repression of sexuality, and perhaps more so for women. It is noteworthy that the perception of positive impact on sexual assertiveness was higher in the past participants’ survey than it was when measured by the scale in the pre/posttests. The posttests occurred shortly after the retreat, within a few months. It is possible that the perception of sexual assertiveness is more positive the farther out from the retreat it is measured, as the participant might have had more time to practice assertiveness with a partner.

In both surveys the somewhat lower sexual satisfaction effects may be due to having experienced pleasure and arousal at the retreats and then not finding that same satisfaction with a partner when they returned home. The “real world” often has stresses and challenges that are not typically present in a retreat setting that may make it more difficult for an increase in sexual satisfaction to occur. Given the challenges of bringing some of the positive effects of the retreat back home, BttB has recently created couple retreats (not part of this study), to assist partners in seeing and communicating about what works for the participant in terms of stimulation and arousal. Other interventions looking to increase sexual satisfaction and sexual assertiveness may want to intentionally consider how new knowledge for one participant may impact or not impact their current or future partners.

How was it being in an erotic retreat setting with others? In qualitative responses, some people noted challenges they had with other participants such as not really connecting. A few others disliked seeing participants who seemed to be flirting with the bodyworkers. Yet most (87%) of those completing the survey of past participants reported having a positive “sisterhood” experience. Group activities at the retreat, such as sharing feelings about one’s body facilitated community building. Some respondents said that they were able to talk about sex and relationships at the retreat much more openly than they were able to with women at home. Having sexological bodywork in a setting where others were having a similar experience seemed to help provide permission to experiment and explore, compared to how they might feel about seeing a sexological bodywork alone.

When we emailed interviewees for member checks on the qualitative findings, two people shared concerns about retreats they attended after our interview. Both said they reported concerns to the director and the ethics board for sexological bodywork. One person, as noted in qualitative findings, said she had been “assaulted” (sic) by a bodyworker. The second person shared concerns about what she saw as unprofessional behavior by staff. Neither gave any details about what occurred. Therapists might want to be aware as they talk with a client before or after attending a BttB retreat, that previous trauma and concerns about boundaries may affect their feelings of safety.

Strengths and limitations

A primary strength of the current study is that to our knowledge, this is the only research on the effects of sexological bodywork on overall sexual well-being. As detailed above, results from this study align with other research that examined the benefits of somatic sexology and related practices. The mixed methods approach allowed us to compare participants’ perceptions of the impact from attending the retreats with pretest and posttest findings. The pretest and posttest data can be viewed as more reliable than data from the survey of past participants because the surveys used validated scales. A control group would have strengthened the design, however that was not feasible. Having qualitative data from open-ended survey comments as well as individual interviews strengthened findings as it allowed previous participants to report their experiences and perceived impacts both anonymously on the survey and confidentially during in-depth interviews.

The primary limitation of the study may be the “volunteer bias” that affects validity of non-random surveys and interviews. This reduces generalizability because those who chose to volunteer to participate may have had different effects than those who did not. Therefore, results should be interpreted with some caution. The anonymity of the survey may have reduced social desirability bias related to wanting to be liked by the researchers. However, the qualitative interviews, while confidential, could not be anonymous given the need for signatures on informed consent forms. While most participants reported significantly positive responses, it is possible that participants who had negative experiences at the retreats either did not participate in surveys or interviews, or simply chose not to share them. Having a higher response rate might have reduced response bias and may have offered perspectives that were not reported here. The low level of diversity in the sample presented a quantitative limitation in that we did not have cell sizes large enough to do cross tabs on key constructs by race/ethnicity.

An important limitation relates to “dosage,” i.e. the variable number of retreats that participants had attended, as about half of the participants had attended more than one retreat. Therefore, their responses may indicate the impact of multiple retreat experiences. Sample sizes were not large enough to sort for this potential effect. It is worthy of note that even though 53% of the pre and posttest respondents were attending a 2nd, 3rd or 4th retreat, there were still statistically significant differences between pre and posttest means on all the constructs. One might imagine that the degree of change might have been even higher had this been a first retreat for all participants.

Recommendations for future research

Findings from this first scholarly study about sexological bodywork suggest that this topic is worthy of further study. In this section we make suggestions based on what we learned about the effects of sexological bodywork within the specific context of BttB retreats:

• Given the narrow demographics of the sample, research is needed to explore the effects experienced by more diverse participants. Studying BttB retreats, or similar programs that may emerge, with larger and more diverse sample sizes would increase the external validity (generalizability) of the findings of the current research. Larger sample sizes would allow for analysis of the dosage effect, i.e. the number of previous BttB retreats participants have attended.

• Future research could assess effects of sexological bodywork on orgasm, e.g. orgasm frequency, quality, and experience of orgasm. Positive impacts found in this research on arousal suggest there may have also been effects on orgasm.

• “Sisterhood” could be explored regarding the benefits and challenges of relationships participants have with each other at the retreats, whether these continue after the retreats, and how, if at all, these contribute to the wellbeing of participants.

• Researchers might focus on specific populations that seek sexological bodywork, such as individuals and couples undergoing fertility treatments, as well as people with disabilities and/or and chronic illness such as breast cancer.

• Researchers could assess the impact of sexological bodywork taking place in individual sessions and other group settings.

• Given the relatively small but important data from participants with sexual trauma history, researchers could include scales or questions to assess whether having a history of sexual trauma modifies or mitigates effects of sexological bodywork, either with individual providers or at a retreat.

• Studies collecting longitudinal data could assess whether the perceived effects found in this study last and if so for how long, as well as other impacts these retreats have had on participants’ lives.

• From a therapeutic research standpoint, it may be useful to examine the decision-making that goes into the choice to participate in sexological bodywork. Data on clients who choose not to participate in sexological bodywork, and their reasons why, could be useful to professionals wondering who might be open to this experience. It could also be useful in helping clients think about this decision.

• Researchers could gather data about concerns people may have related to their partner attending a retreat where sexual practices occur. Therapists could then help couples navigate questions such as, “Is sexological bodywork sex?” “What concerns do you have related to your partner attending a retreat where sexological bodywork takes place?” “How would you and your partner communicate about expectations and boundaries after attending a retreat?”

• The perspectives of sexological bodyworkers could be useful. While we did interview BttB practitioners, we chose not to include their data for this study but rather, to focus on participant perceptions. Such data would provide insight into planning and managing sexological bodywork retreats and suggestions for best practices for sexological bodywork in group settings.

Implications for sex and relationship therapists

For some therapists, reading what participants did at the retreats may be surprising or even shocking. We hope that hearing the voices and perspectives captured in this study may help readers to conceptualize the experience and effects of the retreats. Touch is an important way that humans connect and receive pleasure. Despite differences in the type of touch, Meyers (2015) research on the Betty Dodson Bodysex workshops and the current study on BttB retreats both found positive impacts on genital self-image, sexual self-efficacy, and sexual satisfaction in group settings. Bodysex workshops involve self-touch while the BttB retreats involve one-way touch by a sexological bodyworker. Combining touch and genital or sexual arousal in spaces where people feel comfortable exploring, taking risks, and being vulnerable appears to be a powerful tool for some people to increase their sexual well-being. The safety and structure of these settings are important in enabling the opportunity for positive effects.

Therapists might wonder how a particular client would respond to hearing about sexological bodywork. Considerations will include the needs and goals of the clients, how accessible or affordable a model like this would be for the client, whether they have experienced abuse or trauma, as well as the demographics of the group they would be attending. While our results indicate that a range of people attend the retreats, clients who already identify with non-monogamy may be more open to attending a retreat and/or having an individual sexological bodywork session where touch is received from someone other than the primary partner. Over half of our participants reported being non-monogamous. Qualitative results also showed that retreat participants were able to try new things such as being naked in front of others, and exploring kinky arousal such as role play. If these are topics that clients’ express interest in, they may also be open to the idea of sexological bodywork.

While most of the techniques in the PLISSIT model are practiced by sexuality professionals, licensed therapists are restricted to verbal assistance, possibly aided by bibliotherapy and sex education videos to illustrate their suggestions. These techniques may take longer and not provide enough help (personal communication, S. Pillai-Friedman, 3/31/2021). Some people may need direction and guidance in an open and affirming environment away from the sexual repression that surrounds them on a day-to-day basis. They may also need hands-on help to unlock their sexuality in the company of other individuals who are on a similar journey.

Considering clients previous sexual history, openness to sexological bodywork, and presenting issues a practitioner/therapist may decide to make specific suggestions such as exploring sexological bodywork. Using the PLISSIT model (Annon, 1976), permissioning and normalizing sexological bodywork can allow clients to feel that they can discuss interest in sexological bodywork or impacts related to sexological bodywork in they have already participated. This may include adding a checkbox on intake forms to assess interest in sexological bodywork, such as Dr. Patti Britton has for her sex coaching clients (Britton, 2005), asking about previous sexological bodywork during sex history assessments, keeping a book (e.g. Moore et al., 2017) about sexological bodywork on a bookshelf where clients may notice it for discussion, or having blog posts on a website to indicate this is a safe topic for discussion. Limited information can be given to clients as appropriate based on their current knowledge of sexological bodywork. They may need a description of sexological bodywork or more information about the effects sexological bodywork can have, as this article provides. The IT part of the PLISSIT model, intensive therapy, may require a referral to a sex therapist.

Therapists themselves may become more comfortable with these modalities by reading articles on somatic sex education and sexological bodywork, exploring the webpages of related groups (see references), asking questions of the facilitators, and possibly attending somatic or sexological bodywork events. Research is clear that when sexuality professionals are comfortable talking about subjects related to sex, this allows clients to also increase their comfort level (Timm, 2009). This is particularly important for a topic such as somatic or sexological bodywork that is not only seen as taboo, because it is related to sex, but is also a controversial topic within sexuality professional spaces. Therapists or educators interested in sexological bodywork may choose to seek out this type of experience to learn more about it for themselves and clients knowing that within the bounds of the ethical codes used by bodyworkers, clients are likely to have a safe and possibly a highly beneficial experience.

Therapists who have at least a general idea of what happens during somatic/sexological bodywork or at BttB retreats would be better prepared to help their client navigate their feelings and experiences. Clients who participate in sexological bodywork may want to talk about their experiences in their therapy sessions after a retreat. This might include talking about positive or negative experiences, and thoughts or feelings related to healing from earlier trauma. Other issues may be related to whether it is a secret to family and friends that they attended, and how this experience fits in with their overall life and self-image. A therapist may also assist clients with challenges related to their partners’ feelings as they incorporate what they learned into a current sexual relationship, e.g. being more sexually assertive based on new knowledge of what types of arousal works for them. Our findings show that for many people sexual assertiveness did not increase after the retreats. In a therapy setting, specific suggestions for communication skills could be helpful, following up with questions related to the partner, potential defensiveness, or inquiring what it was like for the client when they attempted to be assertive.

Conclusion

In summary, five qualitative themes emerged from participants’ descriptions of their experiences: feeling safe, connecting to self and others, feeling acceptance and permission, exploring arousal and pleasure, and transformative life changes. Based on quantitative data analyzed in this study, sexological bodywork within the BttB retreat setting has the potential to positively impact participants’ experience of arousal, body image, genital self-image, sexual satisfaction, sexual self-image, and sisterhood. Therapists and other sexuality professionals can use this information to inform their practice and decision-making related to assisting clients related to sexological bodywork.

Acknowledgements

Pamela Madsen, Founder/Director of Back to the Body^TM retreats and her staff are appreciated for their cooperation with data collection, our graduate research assistant for their work on quantitative data analysis, Li Lock, Ph.D. and Kristin Haase, Ph.D. for their review of that analysis, and Patricia Koch, Ph.D., Sabitha Pillai-Friedman, Ph.D., LCSW, Angela Towne, Ph.D. and Robert Heasley, Ph.D., LMFT, for their reviews and feedback on the manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

No funds were received for the conduct of this research.

Notes on contributors

Betsy Crane

Betsy Crane (she/her) recently retired as professor and former director of graduate studies at the Widener University’s Center for Human Sexuality Studies where she taught since 2007. Betsy earned a Ph.D. from Cornell University in 2000 and her MA in Mental Health Education from University of Texas in 1972. For 17 years she worked as a community sexuality educator, and later as Executive Director for Planned Parenthood in Ithaca, NY. She is co-editor of Sexual Lives: A Reader on the Theories and Realities of Human Sexualities (Heasley & Crane, 2003) and 40 academic and professional publications and educational materials focused on human sexuality, women’s sexual pleasure, social justice, and empowerment. Her research interests include the history of gendered sexuality and somatic sex education. Dr. Crane is past-president of the Foundation for the Scientific Study of Sexuality, and board member for the Society for the Scientific Study of Sexuality. In 2014, Widener University designated her as a Distinguished University Professor.

Kaci Mial

Kaci Mial (she/her) is a sex coach, educator, and researcher with 12 years’ experience in government, community, medical, non-profit, residential, and university settings. She received a M.Ed. degree from Widener University’s Human Sexuality program in 2018 and became a certified sex coach through Sex Coach U in 2022. Kaci is co-author of Cavanaugh, C., Mial, K., & Tulloch, D. (2016), Assessing and mapping the availability of the female condom In the Philadelphia metropolitan area. AIDS and Behavior, 20(12), 2845–2849. Previously Kaci served as adjunct professor at Rutgers University-Camden Psychology Department, clinical case manager for pregnant adolescents, and educator/curriculum developer for families within the perinatal period. Kaci currently specializes in helping individuals and couples understand and achieve pleasure before, during, and after pregnancy through virtual coaching. Kaci is committed to social and reproductive justice and is available as a speaker to apply a trauma-informed, sex-positive, and medically accurate approach to a variety of other topics in mental and sexual health.

Elise Becher

Elise Becher (she/her) is a relationship coach, author, educator, and researcher. Elise earned a medical degree (MD) from the University of Virginia in 1992, MA in Public Policy Studies from University of Chicago (where she also completed a fellowship with the Robert Wood Johnson Clinical Scholars Program) in 1995, and MEd in Human Sexuality Studies from Widener University in 2018. Elise was formerly a faculty member in Pediatrics and Health Policy at the Mount Sinai School of Medicine, New York, NY, where she co-authored publications in pediatric health services and medical errors. After leaving academic medicine, Elise transitioned into coaching. She is certified as a co-active coach (CPCC) by the Co-Active Training Institute, a relationship and couples coach by The Relationship School (TRS), and a master coach by the Elementum Coaching Institute, where she now serves on the faculty. Elise specializes in helping individuals and couples learn to live more relationally aware and authentic lives by identifying ways to remain true to who they are while maintaining deep and genuine connections with others.