Ejaculatory restrictions as a factor in the treatment of Haredi (Ultraorthodox) Jewish couples

Orthodox Judaism has a positive attitude toward marital intimacy and minimally involves itself in spousal sexual activity. One notable exception, however, is that, to the greatest possible extent, male ejaculation must be vaginally contained. Clinicians working with Haredi (Ultraorthodox) Jewish couples will be hard pressed to suggest treatment interventions for certain sexual dysfunctions without a thorough understanding of this restriction. This article examines the origin and extent of this dictum, its impact on a number of sexual dysfunctions and implications for treatment, illustrated with a case example. A second focus is a model for a constructive working alliance between clinicians and clergy.