Nicola sat crumpled in a corner, rarely saying anything. She was wearing jeans, a frumpy gray T-shirt, running shoes and sport socks. When she finally spoke, she said she felt stuck in her life and that even simple tasks were daunting. She choked back tears, zigzagging from silent to seething. She seemed about to explode.

Later, she did.

When we met for an intimacy-coaching session, Nicola revealed that she and her partner were married and did not like having sex with each other. As Nicola told her story, she was emotionally erratic: laughing one moment, then crying—up, down, up, down. The fluctuations were so dramatic that I thought to myself, She’s hysterical—and severely underfucked.

Physicians over the past 2,000 years would agree. The word hysteria has Latin roots and means, literally, “womb dis-ease.” Since the third century b.c. the term has been used to define the condition of female sexual deprivation. The symptoms range from nervousness, depression, mood swings, irritability and loss of sexual appetite to a general tendency to “cause trouble.”

The treatment for the affliction, which was administered for millennia, was a vigorous massage of the clitoris performed by a doctor—a treatment designed to bring on “hysterical paroxysm,” or what we today call orgasm. However, over time, the number of women suffering from hysteria became so great and the treatment so labor intensive that doctors, rather than delighting in the task, sought to delegate it to midwives. By 1952 the American Psychiatric Association dropped the term hysteria for being ambiguous and later replaced it with the equally ambiguous female ­sexual dysfunction, or FSD. I prefer to call this ailment SUF (severely underfucked).

As a modern-day sex coach, I estimate that at least 75 percent of women suffer from this problem. I have devoted my professional life to curing it. When women are well fucked, they—and everyone else in their lives—benefit. Although we commonly think the word libido refers just to our sexual drive, psychoanalysts Sigmund Freud and Carl Jung defined it as being our “life force” energy. It affects everything we do. Here, illustrated through real-life scenarios with my patients (the names have been changed), are the five most common SUF symptoms and the remedies that made them disappear.

Pathologia One:

Nymphomania nervosa, or fear of sluttery

Jason and Penelope had been dating for a year. During a weekend getaway they got very drunk at a party. This led to backyard sex, balcony sex, lights-on sex, cock-slapping-Penelope’s-face sex. Jason was thrilled. He felt they’d reached a new level in their relationship.

When they returned to the city, Jason was swamped with work. Penelope called on Monday. Jason got distracted and didn’t call her that day or the next. Two days later, when he did call, Penelope was furious. She accused him of thinking she was a tramp, of using her, of having no respect for her. Jason was bewildered. He felt that they were in a great place, that all was well.

It wasn’t.

Penelope had allowed herself to be deeply sexually open with Jason. That left her feeling vulnerable. She needed reassurance that he still respected her and didn’t think any less of her. Although things have gotten easier for women, the residue of the madonna-versus-whore dichotomy remains: Nice girls don’t do naughty things. Thus, both women and men must take conscious steps to make it okay for women to be the naturally voracious creatures they are.

In my sessions with Jason and Penelope, I recommended that they do two things: (1) Create a no-slut zone. I told them both to banish the word slut from their vocabulary. If Jason labeled other women sluts in Penelope’s presence (or in his mind), did he think she would be willing to 69 with him and be filmed while she did it? Nope. (2) Be even more attentive. Call. Text. When a couple starts breaking through sexual barriers, it can be a vulnerable time for the woman.

Jason did these things, and Penelope relaxed. It was safe for her to let go. Everything about her lit up. She could let herself be ravished, and she appeared ravishing.

Pathologia Two:

Dominatrix turbulentus, or taming of the shrew

Chelsea was a type-A physician who ran her own clinic, working 14-hour days and overseeing six other doctors. She bullied everyone in her life, from her office staff to her husband, Mark, who tried to please her until they were both fed up with his tiptoeing around.

In a one-on-one session with me, Chelsea related that she’d once had a brief extramarital affair during which she’d had hours-long sex for days at a time. During this period other people told her she seemed calm and pleasant. She stopped having arguments with sales clerks. Her road rage evaporated.

The contrast was clear. My diagnosis: Chelsea needed to be not only fucked often but fucked hard.

I coached Mark to take a more dominant stance with her. I told him that she would respond to a partner who could pin her wrists above her head while prying her legs open with his knee and growling into her ear how he would fuck her senseless. I advised Mark, “When you feel her subside even a bit, throw her over your shoulder and take her to the bed, the couch, the desk. Take her you must. Do not hesitate.”

The caveat? “No” always means “no.” However, a “maybe” means she just isn’t convinced yet that her partner can handle her. His assertiveness will convince her. It worked. Once Chelsea saw that Mark could wrangle her feistiness, she relented and received what she craved most.

Pathologia Three:

Hysteria frigus, or frozen out

Christine had a difficult time jumping into sex with her husband, Charlie. He complained that she was resistant to sex much of the time. “I can’t become intimate right away,” she said. “I need warming up.” To Christine this meant expressing her feelings, but because they had sex so rarely, Charlie didn’t feel connected enough to open up.

As I explained to Charlie, there is more than one way to penetrate a woman. A man’s cock is one. His hands, mouth, words, wit—all register high as instruments of pleasure. Well-fucked women are stimulated from every angle: physical, emotional and mental. Emotional intercourse and “mind fucking” keep things simmering between the physical acts.

I recommended that Charlie and Christine set aside 30 minutes four to five times a week to reconnect on an emotional level. “Remember,” I said, “this isn’t the time for small talk. Don’t debrief the effluvia of your day.” I advised them to go deeper and really penetrate each other.

They bought a hot tub and put it in their backyard. Several evenings a week they convened under the stars. One morning, when I asked how they were doing, Christine exclaimed, “I feel like I’ve been fucked five times!”

And they hadn’t even kissed. That came later, and when it came, so did they.

“There’s something about being in the darkness and not even being able to see the other person that allows us to say anything to each other,” said Christine. Charlie nodded. “Our hot tub saved our relationship,” he said.

Pathologia Four:

Ecstasis frustratus, or “I’m busy”

Allison claimed not to enjoy sex anymore. “I used to,” she said. “In other relationships, ‘normal’ would be having sex three or four times a week. I hate to admit it, but lately I avoid sex with Jeremy.” When Jeremy wanted it, Allison was always “too busy”—staying late at work, doing laundry, getting a root canal.

As Allison and I began coaching sessions, she revealed that Jeremy had little stamina in bed. Before she was even close to orgasm, Jeremy was finished. A woman whose man repeatedly bails on her in bed experiences the sexual equivalent of a hit-and-run. She feels abandoned, and she is unable to open to him.

There’s an old Taoist expression: Sexually speaking, men are like fire—quick to ignite and quick to extinguish. Women are like water—slow to boil but keep on boiling. The trick is for both sexes to meet in between. Men must master prolonging their arousal, and women have to learn to remain in the simmer zone.

I worked with Jeremy to build his stamina—something that’s easy but takes focus. The solution? Just breathe. Most men hold their breath and tighten their body as they approach orgasm. Instead, they should try rhythmic, steady breathing throughout arousal. I told Jeremy to let himself build to orgasm without holding back. When he reached a seven out of 10—getting close but not in danger of going over the edge—I recommended that he pause and make sure he was breathing, unclenching every part of his body. Then I told him to subside to a five and repeat for several rounds before allowing himself to ejaculate.

Within a short while Jeremy was able to choose when to climax. Allison didn’t need any more root canals.

Pathologia Five:

Hysteria affectus, or emotional roller coaster

Remember Nicola from the beginning of our story, the most underfucked woman in the world? Nicola had a case of classical hysteria: all the symptoms rolled into one unruly package. In addition to prescribing the sexual medicine indicated for the other pathologies (a steady diet of orgasm, whether she was alone or not), I set Nicola up with a new and exciting exercise program: vaginal weight lifting.

Many women have dissociated from their sexual energy. As a result, they’ve dissociated from their vaginas. The ancient (yet very modern; there is a world record for the sport) art of strengthening the pelvic floor—using a system of light weights attached to what is essentially a dildo—boosts sexual confidence, increases orgasmic potential and reconnects a woman with her genitals. Plus, her newfound power endows her with the unique ability to make her lover ejaculate or not with the power of her vagina alone. It puts Kegels to shame.

After a few months of lifting household furniture with her vagina (an exaggeration but only a slight one), combined with sex dates and more open communication, Nicola was on her way to being a well-fucked woman. And it showed.