Sexual therapy aims to effectively treat male and female sexual dysfunctions through a variety of technical interventions. It can be conducted individually, with couples, or in groups. Sexual dysfunctions prevent satisfaction and occur during any phase of the sexual response cycle. Common types include desire, arousal, orgasm, and pain disorders. Principles of sexual therapy include treating the couple as a unit and using a male-female therapy team. Initial therapy involves each partner providing a medical and sexual history to both therapists. Treatment techniques aim to educate, reduce anxiety, and help partners communicate and find pleasure without expectations of performance.
2. Concept
Sexual dysfunction
Sexual response cycle
Types of sexual dysfunctions
Principles in sexual therapy
Issues during sexual therapy
During therapy interventions
Misconceptions
Discussion about the various problems
3. Concept
Sexual therapy is a specialised form of
psychotherapy that draws upon an array of
technical interventions known to effectively
treat male and female sexual dysfunctions.
Sexual therapy can be conducted in an
individual, couple or group format, depending
upon the initial problem and the motivation of
both partners.
4. 1. Sexual dysfunctions
Sexual dysfunction refers to a
problem occurring during any phase
of the sexual response cycle that
prevents the individual or couple from
experiencing satisfaction from the
sexual activity.
5. a. What is the sexual response cycle?
The sexual response cycle refers to the sequence of
physical and emotional changes that occur as a
person becomes sexually aroused and participates
in sexually stimulating activities, including
intercourse and masturbation.
The sexual response cycle has four phases: desire
(libido), arousal (excitement), orgasm and resolution.
Both men and women experience these phases,
although the timing usually is different
6. Types of sexual dysfunction
Sexual dysfunction generally is classified into four
categories:
Desire disorders —lack of sexual desire or interest in
sex
Arousal disorders —inability to become physically
aroused or excited during sexual activity
Orgasm disorders —delay or absence of orgasm
(climax)
Pain disorders — pain during intercourse
7. Principles
The basis of success of treatment is that
the couple is treated as a unit.
The second principle is that there be a
male-female therapy team.
8. 1st step
The first step in therapy is usually for
the male therapist to take a thorough
medical and sex history of the
husband and for the female therapist
to do likewise with the wife.
9. 2ND STEP
On the second appointment this process is reversed- the
woman therapist takes the husband’s history and the male
therapist takes the wife’s.
This is not a repeat of information but provides a means of
checking to make sure that nothing has been left out, and
of identifying attitudes that may be expressed differently,
depending upon whether the therapist is male or female.
This may be important in determining unrecognized or
unspoken attitudes.
10. The sexual history should cover the following.
1. The earliest memory of sexual feeling.
2. The kinds of sexual information expounded to the individual as a child.
3. Preparation for and reactions to menstruation in the female and the first ejaculation
in the male.
4. The first sexual experience (masturbating or in relation to another person, animal, or
object).
5. Sexual feelings toward parents or siblings.
6. Early homosexual or heterosexual activities. (The first sexual experiences are very
important and the patient may never have gotten over them).
7. Present sexual behavior and accompanying feelings and fantasies.
8. Sexual dreams.
9. Attitudes toward masturbation.
10. Conditions under which orgasm occurs.
11. If married, the kind of relationship with mate.
12. Tendencies toward promiscuity.
11. FACT
Majority of sexual dysfunctions in
both the sexes result from
psychological rather than organic
factors.
12. During therapy..
Patients will often ask the therapist not to reveal
secret to their mates. Such material ranges from
masturbation to past and present sexual affairs.
The therapist must promise not to expose the
patient.
If it turns out that therapy cannot continue without
bringing up the secret, the therapist must ask the
patient’s permission.
13. The most imp element in the treatment is the
manner and attitude of the therapist.
In working with patients who are seeking to
liberate themselves from their sexual fears
and inhibitions, the therapist presents as a
model of permissive authority.
14. It is imp. To avoid the words “Abnormal” or
“pathological”. Since they may have frightening
connotations.
It may be advisable to use charts or illustrations
to clarify the sex anatomy of male and female .
There can be great gap existing in their
education about how they are built.
15. Now the following concepts will have to be
integrated by the patient
1. Sex is a normal and natural function.
2. The primary purpose of sex is pleasure not
performance.
3. People have many different ways of pleasuring
themselves.
4. People have a right to liberate themselves from
these crippling attitudes.
5. All people have the potential to enjoying sexuality.
16. MISCONCEPTIONS
1. That all sexual play must lead to intercourse.
2. Orgasm is always essential during sexual contact.
3. As one gets older, desire for sex disappeared.
17. Techniques- “sensate focus” by Masters and
Johnson
“THIS IS USED WITH EVERY COUPLE NO MATTER WHAT THE
PRESENTING PROBLEM”
• sensate focus simply consists of learning to touch one another and
to communicate what feels good or what doesn't feel good.
• Intercourse will be avoided.
• Touching of genital regions or the breasts of the female is prohibited.
The purpose is to allow the husband and wife to discovers numerous
sensitive and sensual parts of their bodies, and to begin to
communicate with each other about the body parts that may be easier
to talk about than the genital area.
18. The therapist need to carefully evaluate when a
couple is ready to proceed to the next stage.
2nd stage
The second stage, after the couple has learned how
successfully to communicate what is pleasurable to
them, consists of mutual stimulation of the genitals,
but again without any attempt to engage in
intercourse. The wife and husband are specifically told
not to strive for orgasms but to learn to Communicate
with each other what feels pleasurable in regard to
genital stimulation.
19. After a couple has completed these two stages, the therapy can
take various directions depending upon the presenting problem.
20. The PLISSIT model of sex therapy
American psychologist Jack Annon developed a simple model illustrating
that most people with sexual problems do not need an intensive course
of therapy .
He used the acronym PLISSIT for the four basic forms of sexual therapy:
21. ‘P’ stands for Permission, as many sexual problems are caused by anxiety, guilt feelings or
inhibitions. It follows that a therapist who, using his or her professional authority, simply
‘gives permission’ to do what the patient is already doing, can alleviate much unnecessary
suffering (e.g., guilt feelings and anxiety because of masturbation).
The next step of the therapeutic intervention is called ‘LI’ or ‘Limited Information’. Often it is enough
to give the patients the correct anatomical and physiological information to restore their sexual
functioning.
The next step is ‘SS’, ‘Specific Suggestions’ and requires practical hints of exercises tailored
to each case. Many of the exercises of mutual pleasuring recommended by Masters and
Johnson belong to this category. These exercises include ‘sensate focus’, and ‘stop and start’.
Only the last step, ‘IT’ or ‘Intensive Therapy’, requires a long-term intervention
addressing the complex underlying causes. This therapy addresses issues of
intrapsychic conflicts and couple issues.
22. Dyspareunia
The treatment of dyspareunia ideally requires a multidisciplinary approach involving
a physician, a pelvic massage therapist and a psychotherapist.
Treatment focuses on learning techniques to reduce or cope with the pain, as well as
dealing with catastrophic thoughts, anticipation of pain and avoidance of all sexual
exchange.
Biofeedback, vaginal and/or pelvic massage, sensuality exercises and relaxation
techniques have all been tried, with varying degrees of success.
Education about vulvodynia in general and vulvar vestibulitis in particular has been
helpful, as has cognitive restructuring and sex therapy with both partners
23. Vaginismus
Vaginismus is the spastic tightening of the vaginal muscles and can make intercourse
impossibly painful.
It can be so severe that not even a Q-tip can be inserted in the vagina, and some
women with Vaginismus have never, or rarely, completed sexual intercourse in the
course of years of marriage.
Often the result of physically painful experiences like childbirth, painful intercourse,
rape or molestation, it is a learned fear response.
Therapy involves teaching the woman to relax and breathe while gently inserting the
first of a graduated series of lubricated rods, starting with one as small as is
necessary for comfort.
In ensuing weeks, the woman uses incrementally thicker rods and then inserts her
partner's finger and finally his penis into her vagina.
Nothing is forced, and insertion is always under the control of the woman.
24. Non orgasmic response in females
If the presenting problem is a non orgasmic response in the female, there is a step-by-step
process the couple is instructed to follow.
Initially the women is supposed to relax .
Secondly enjoy the foreplay but is supposed to maintain the excitement for a prolonged time.
At the third step the female takes the superior mounting position.
The reason for this is that many women have been passively underneath their partners,
and have never really learned to know what their response system requires. In this step,
with the penis fully erected and the vaginal area well lubricated, the woman inserts the penis
under instructions to remain still and experience the pleasurable feel of vaginal
insertion without orgasmic demand.
The process continues over days of repetition through phases of mild female thrusting,
mild male thrusting under female verbal control, mutual thrusting with a period of
separation for general caressing, and attempts to break the pattern of unilaterally initiated
and demanding pelvic thrusting.
25. In case of impotence
In the case of impotence there is a series of procedures used in
which the female learns to stimulate the penis in specific ways as
instructed by the therapist.
When her partner does get an erection, it is she who makes the insertion.
The woman learns what to do and when to initiate insertion and
movement.
In this way the pressure to perform that leads to impotence is reversed —
i.e., the woman assumes some of the responsibility. This release form
performance pressure enables
26. Premature ejaculation in men
Treatment involves lowering anxiety and teaching the man to become aware of his
arousal during lovemaking, until he recognizes the sensations that precede his "point of
no return."
Then he practices what sex therapist Barbara Keesling, author of Sexual Healing, calls
"peaking"--pausing before the point of no return and relaxing, breathing and stopping
movement until his arousal subsides.
After a few minutes' rest, the man returns to movement, stimulation and arousal.
The "peak and pause" routine is repeated five or six times per homework session.
The exercise can be done by a man masturbating alone, while his partner is giving him
oral sex or during intercourse.
Men can squeeze their pubococcygeal or PC muscles during the pause to dampen
arousal, or the man's partner can squeeze on the coronal ridge just below the head of
the penis.
27. Erectile difficulties in men
A common problem among older men, erectile failure is often caused by an interaction of
physical and psychological factors. Smoking, diabetes, blood pressure drugs, alcoholism,
neurological injury and normal aging can all worsen erectile problems.
Treatment has been revolutionized since the introduction of Viagra, which not only helps
men with primarily physical problems, but can also jump-start those suffering primarily from
anxiety.
Men who awaken with erections or have them while masturbating can probably blame
anxiety if they have trouble during intercourse: muscular tightness and breath-holding can
send blood out of the penis, causing it to wilt.
Sex therapy requires slowly disarming anxiety and performance pressure, and learning to
enjoy sex with and without an erection. Therapy often begins with declaring intercourse off-
limits and encouraging the couple to enjoy each other orally and manually, without
demanding that the penis perform.
28. Mindfulness
Mindfulness practice, inherited from the Buddhist tradition, is increasingly being
used in Western psychology to alleviate a variety of mental and physical conditions,
including sexual dysfunctions. Scientific research into mindfulness generally falls into
the category of positive psychology.
Brotto et al. [24] found a three-session mindfulness-based psycho-educational
intervention led to a significant improvement in the Female Sexual Function Index
for women with sexual desire problems.
29. The therapy has the best application with
couples who view the problem as a
shared one and are willing to cooperate
as a team in reversal of the inadequacy.
