Orthodox Jewish women are very sexually active in their marriages, but fewer than 75 percent are emotionally and physically satisfied, according to the results of a survey released May 5 at the annual American Psychiatric Association meeting in New York. Michelle Friedman, a psychiatrist based in New York, co-chaired the study with Rachel Yehuda, a professor of psychiatry at the Mt. Sinai School of Medicine and the Bronx Veteran Affairs Hospital, in conjunction with Talli Rosenbaum, a physical therapist and board member of the Women's Health Section of the Israel Physiotherapy Society. About 400 married Orthodox Jewish women in New York and Israel filled out anonymous questionnaires. Researchers found that 72.1 percent of married Orthodox Jewish women were emotionally satisfied and 70.4 percent were physically satisfied. The results were compared to a 1999 study published in the Journal of the American Medical Association, which found that 93 percent of American women from various denominations were physically satisfied, and almost 90 percent reported a high level of emotional satisfaction. However, Friedman cautioned that nearly 25 percent of the American women surveyed did not respond to questions about sexual satisfaction, and the study is currently being revised. All of the Jewish women surveyed strictly followed the laws of family purity, which are unique to the Orthodox Jewish religion. The laws require married couples to abstain from all physical contact during menstruation and seven days after it has stopped. The couple abstains from physical activity during this period known as niddah, until the woman immerses herself in a mikvah, or ritual bath. "When women menstruate, they are considered impure, not unclean," said Debra Kaufman, director of Jewish studies and founder of women's studies at Northeastern University. Blood symbolizes the loss of life, and therefore, "Her monthly cycle then becomes a moment of death and dying." Evyatar Marienberg, a lecturer of general and interdisciplinary studies at Tel-Aviv University and author of Niddah: When the Jews Conceptualized Menstruation, said he was not surprised by the results of the study. Many Jews might be afraid of sex because of the strong emphasis on modesty and the limited sexual education in the Orthodox Jewish community, Marienberg explained. "When you're scared and when you're not sure really what to do, maybe there is a lack of communication about these issues between the couple," he said. For example, ultra-conservative Orthodox Jews are taught that sex is intercourse only and not necessarily pleasurable, Marienberg said. Friedman agreed, adding, "I don't think you can assume there's a correlation between pleasure and being willing to engage in sexual activity." If women do not expect pleasure, they will continue to have sex frequently, even though they are unsatisfied, she said. The women also feel pressure to have sex because it is their marital obligation, and they think it "is something they should be doing and want to be doing," Friedman said. However, Kaufman, who interviewed 150 converted Orthodox Jewish women for her book, Rachel's Daughters: Newly Orthodox Jewish Women, said that abstaining from sex actually increases the passion in marriage. Many women she interviewed said, "It's like being a bride again," Kaufman explained. Also, according to the Jewish rules of onah, the husband has sexual obligations, which are very specific to women's sexuality and "geared very specifically toward pleasing the women," Kaufman said. In fact, one of the few reasons a woman can seek a divorce from her husband is if she is unhappy sexually. The laws of onah consider it "very important for women to be orgasmic," Kaufman explained, because it was believed she would be able to conceive more easily. However, Marienberg argued that while the rules of onah exist, they are not strictly followed in today's society. "Law can ask for one thing; reality may be very different," he said. In addition, many of the women Kaufman interviewed said the family purity laws empower them to be in control of their sexuality, Kaufman explained, adding that women can claim, "`My husband cannot take me for granted. I am not an object.'" Marienberg argued that since the period of abstinence is "forced," Orthodox Jews might feel unsatisfied. "All I can say is that I can hardly see how a strict system of telling people, `Now you can have sex; now you can't' can make them have good sex," he said. But more important than the results of the study are the reasons why Orthodox Jewish women feel unsatisfied, Kaufman said. "I think this raises interesting questions that need to be explored further," she said.