The Coital Alignment Technique

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How To Execute The Coital Alignment Technique

  • In the CAT position, the man’s body lies across the woman’s without support on his elbows, minimizing stress in the upper torso.
  • The positioning for coital alignment requires a shift forward by the male partner from the standard missionary position to the male “pelvic-override” position, in which the base of the penis makes direct contact with the woman’s clitoris.
  • This makes vaginal penetration with constant clitoral contact possible in coitus, completing a fundamental genital “circuitry” (see Figure 1).
  • The genital contact is maintained by a coordinated form of sexual movement in which the woman leads the upward stroke and the man the downward stroke.
  • The partner moving his or her pelvis backward exerts a slight but firm counterpressure
  • The penile-clitoral connection is held together by pressure and counterpressure simultaneously exerted genitally by both partners in a rocking motion rather than the familiar “in and out” pattern of coital thrusting.
  • The anatomic design of the male and female genitals and the interplay of the two pelvises allow for the movement to be coordinated in a natural rhythm (Eichel & Nobile, 1992).


The original experimental group surveyed in the first CAT study learned the technique in a 2-year psychotherapy program for couples conducted by principal CAT researcher Edward Eichel from 1970 to 1976. In the beginning period of exploration with the CAT, it was termed simply “the movement,” referring to the natural reflexive form of sexual movement that characterizes the technique. This “movement” appeared to elicit very strong emotional reactions and very intense and consistent orgasms in Eichel’s original encounter group and in his later marriage therapy clients. In subsequent writing about the technique, it was named “sexual alignment,” a term that better reflected the intrapsychic physical, emotional, and attitudinal components of the experience. Finally, the technique was renamed the “Coital Alignment Technique” to emphasize more specifically the unique physical characteristics of the technique.

The first controlled study introducing the CAT compared orgasm outcomes of 22 women trained in using the CAT with 22 untrained, demographically matched women. The experimental group women reported significantly higher incidents of orgasm, completeness of orgasm response, and frequency of simultaneous orgasm. Additional data were collected in the interest of assessing the correlation between coital alignment behaviors and attainment of orgasm so as to take into account a “by chance” employment of some aspects of the technique among the untrained control group. Reported usage of behaviors associated with CAT for all subjects— trained and untrained— “was significantly associated with greater frequency on all of the orgasmic attainment variables” (Eichel et al., 1988, p. 138). It also is important to note that all trained female subjects in this study were able to attain coital orgasm, the majority with regularity.

In a Hurlbert and Apt (1995) study assessing CAT, an experiment was implemented to compare women trained in the CAT (n = 19) with women trained in Directed Masturbation (DM) (n = 17), a standard treatment in the sextherapy regimen. The experiment was conducted on a nonclinical population in the format of an 8-week sexual-enrichment workshop. Both groups were given 4 weeks of programming involving assertiveness training, exploration of gender differences and preferences, sensate focus exercises, and communication skills. In the final 4 weeks, one group learned the CAT and the other DM. Both groups kept a sex diary recording a pretest 21-day period of sexual behavior to be compared with a 21-day period during the test period. The findings are noteworthy. “The diary recording revealed a 56% increase in orgasms during sexual intercourse following the CAT workshop” as compared to “a 27% increase following the DM workshop.” Women who completed the CAT workshop were significantly more likely than women who completed the DM workshop to be classified “moderately or substantially orgasmic during intercourse” and were less likely to be categorized “unimproved or slightly orgasmic during sexual intercourse” (see Table 1). These findings are remarkable in view of the fact that orgasm by masturbtion is easy for the great majority of women, whereas orgasm by intercourse is difficult for most women.