In it, Reich proposed, based on his therapeutic experience and empirical studies, that orgastic potency should be used as a decisive criterion for mental health.

"Satisfied genital object love is thus the most powerful opponent of the destructive drive, of pre-genital masochism, of yearning for the womb, and of the punitive superego.

The editors of the second edition changed the title to Genitality in the Theory and Therapy of Neurosis, to avoid confusion with Reich's 1942 The Function of the Orgasm.

Moreover, the changes indicate that Reich saw his search for understanding genitality as his own commitment to finding the energy source of neurosis, rather than it reflecting Freudian theory or practice.

One such change includes reversing the order of the first two chapter, now beginning with presenting orgastic potency instead of the Freudian understanding of the neurotic conflict.