Sex therapy involves
the therapeutic treatment of sexual disorders such as impotence,
premature ejaculation, retarded ejaculation, hypoactive
sexual desire, painful coitus, and orgasmic disorders.
These problems,
while not subjects of polite conversation until relatively
recently, have been found to be extremely common, and further,
to be sources of considerable emotional distress and interpersonal
conflict in relationships.
Masters and Johnson,
pioneers in the sex therapy field, have stated that at one
time or another half of all marriages have significant sexual
problems.
Other studies
have suggested that at some point in their lives 10 percent
of women are anorgasmic, 7 percent of men are impotent,
and 18 percent of men suffer from premature or retarded
ejaculation.
Inhibited Sexual
Desire
This condition is characterized by loss of interest in sex,
is thought to trouble one in five adult women during their
lives. Additionally, surveys of married couples find that
over half complain of encountering interferences that block
their full enjoyment of sex.
While universally
emphasizing correcting sexual misinformation, the importance
of improved partner communication and honesty, anxiety reduction
(including fear of performance failure), sensual experience
and pleasure, and interpersonal tolerance and acceptance,
sex therapy includes three different levels of intervention
to address the various sexual problems mentioned above,
depending on the nature and causes of the problem involved.
Sex therapists
believe that many sexual disorders are rooted in learned
patterns and values. These are termed psychogenic disorders.
As they are growing up, children observe interaction between
their parents and others and are the objects of various
messages about their sexuality.
Transference
to Children
Conflict or other problems, including sexual problems in
marriages, can be transmitted to children and result in
the formation of unhealthy attitudes about sex, about sex
organs, or about the body in general.
Moreover, parents,
religious institutions and societal norms may convey very
repressive attitudes about sexuality that contribute to
the formation of diverse sexual dysfunctions. Problems of
this nature are believed by sex therapists to constitute
the majority of sexual disorders.
An underlying
assumption of sex therapy is that relatively short-term
outpatient therapy can alleviate learned patterns, restrict
symptoms, and allow a greater satisfaction with sexual experiences.
In cases where
significant sexual dysfunction is linked to a broader emotional
problem such as depression or substance abuse, intensive
psychotherapy and/or pharmaceutical intervention may be
appropriate.
Drug-Induced
Sexual Dysfunction
Substance-induced sexual dysfunction, for example, can involve
loss of interest in sex, inability for the male to become
erect, impaired orgasm, and pain during intercourse. Various
medications also can produce symptoms of sexual dysfunction.
There are a number
of medical conditions that can cause sexual dysfunction,
including various neurological problems (e.g., multiple
sclerosis), endocrine conditions (e.g., diabetes mellitus),
vascular conditions, and several different infections. These
are termed biogenic conditions.
In his book "Human
Sexual Response", Lief described five sexual response
phases: desire, arousal, vasocongestion, orgasm, and satisfaction.
Sexual dysfunction can occur in any of these areas.
If the dysfunction
is a chronic problem, such as a woman who has always experienced
pain during intercourse, it is called primary dysfunction.
If the dysfunction is situational, such as a man who previously
had no difficulty achieving erection but begins to experience
this problem at the beginning of a new relationship, it
is called secondary dysfunction.
Primary or secondary
dysfunction can occur in any of the five domains of sexual
response. Dysfunctions associated with sexual desire include
hypoactive sexual desire disorder and sexual aversion disorder.
Absence of Sexual
Desire
In the first of these, the individual has a persistent absence
of sexual fantasies or desire for participation in sexual
activity. In the second disorder, there is a complete or
near complete aversion to contact with a partner's genitals.
These conditions often reflect serious emotional problems,
although individuals may be responsive to intensive psychotherapy
combined with sexual therapy.
Sexual arousal
disorders are found in both males and females. Males may
be interested in sex but suffer from impotence or erectile
dysfunction, while females are unable to maintain the lubrication-vaginal
swelling response of normal sexual excitement.
In their book,
"Human Sexual Inadequacy", Masters and Johnson
asserted that 90% of impotency cases were psychogenic in
origin. Even in older men, they maintained, emotional issues
rather than medical problems are the main causes of impotence.
Masters and Johnson reported great success in treating impotence
with short-term therapy, especially when it had its roots
in fear of failure and performance anxiety.
Since their work
in the late 1960's, continued medical research and improved
diagnostic techniques indicate that only 40% to 50% of male
impotence is caused solely by psychogenic factors.
In males, orgasmic
dysfunction includes both premature and retarded ejaculation
(in which ejaculation may be completely absent despite stimulation
and arousal). Retarded ejaculation may have psychogenic
as well as organic causes, or may be a consequence of drug
abuse or a side effect of a medication.
Premature Ejaculation
Unlike retarded ejaculation, which is rare, premature ejaculation
is fairly common. Therapy involves anxiety reduction and
ejaculation control training. One approach to help with
ejaculatory control is called the Valsalva Maneuver.
Using this procedure,
when a man senses he is about to ejaculate, he holds his
breath and flexes his muscles as if he is having a bowl
movement. Performed correctly, this procedure enables the
man to delay ejaculation and allows him to feel in more
control of his body. The Valsalva Maneuver is best tried
in the context of a therapy which can also address the male
or couple's anxieties about the experience.
Inhibited Female
Orgasm
This fairly common problem is often caused by emotional
or relationship problems. Sex therapy for this problem addresses
underlying misinformation, psychological inhibitions, conflicting
beliefs and values about women's right to sexual pleasure,
and related issues.
Partners counseling
may be effective in addressing communication, control, and
sensitivity issues, while couples sexual training can address
sexual interaction issues. Couples may be provided with
instruction on alternative sexual arousal and satisfaction
behaviors such as the Sensate Focus Technique, given home
assignments to practice the new strategies, and prompted
to report outcomes to their therapist. Sometimes groups
of couples with similar problems are brought together to
provide support for open communication and behavioral change.
The organization
of sex therapy varies. In some cases, a single therapist
sees both partners. In heterosexual partnerships, a therapeutic
team consisting of a male and a female therapist working
together may be used. Alternately, some therapists emphasize
self-treatment based on instruction, brief counseling, and
the use of education aids like films and tapes.
Sex
therapy, like any other therapeutic process, should begin
with a thorough history of the patient's problem(s). Due
to the possibility of both biogenic and psychogenic factors
in male impotence, a consultation with a urologist specializing
in impotence is often recommended to identify and treat
any biogenic factors before proceeding with psychotherapy.