Most sex therapists believe that women who enjoy intercourse and experience orgasm in some way other than during coitus do not have a sexual problem (Hamilton, 2002; LoPiccolo, 2000). Many more women experience orgasm from masturbation, manual stimulation by a partner, and oral sex than women who experience it during inter­course (Fugl-Meyer et al., 2006). For many women the stimulation that occurs during coitus is simply less effective than direct manual or oral stimulation of the clitoral area. As sex therapist pioneer Helen Kaplan stated, "There are millions of women who are sexually responsive, and often multiply orgasmic, but who cannot have an orgasm dur­ing intercourse unless they receive simultaneous clitoral stimulation" (1974, p. 397). Unfortunately, women and men may not always understand this: A Canadian study found that 23% of the women participants identified infrequent orgasm during inter­course as a problem (Gruszecki et al., 2005).