Sex therapy

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Sex therapy is a strategy for the improvement of sexual function and treatment of sexual dysfunction. This includes sexual dysfunctions such as premature ejaculation or delayed ejaculation, erectile dysfunction, lack of sexual interest or arousal, and painful sex (vaginismus and dyspareunia). It includes dealing with problems imposed by atypical sexual interests (paraphilias), gender dysphoria and being transgender; highly overactive libido or hypersexuality, a lack of sexual confidence, recovering from sexual abuse, such as rape, sexual assault, and sexual issues related to aging, illness, or disability. [1]



Modern sex therapy often integrates psychotherapeutic techniques and medical ones, [2] such as Viagra (sildenafil) to increase erectile response and Paxil (paroxetine) to treat premature ejaculation. Sex therapists assist those experiencing problems in overcoming them, in doing so possibly regaining an active sex life. The transformative approach to sex therapy aims to understand the psychological, biological, pharmacological, relational, and contextual aspects of sexual problems. [3]

Sex therapy requires rigorous evaluation that includes a medical and psychological examination. The reason is that sexual dysfunction may have a somatic base or a psychogenic basis. A clear example is erectile dysfunction (sometimes still called "impotence"), whose causes may include circulatory problems and performance anxiety. Sex therapy is frequently short term, with duration depending on the causes for therapy. [4]

Sex therapy can be provided by licensed psychologists or physicians, who have undergone training and become certified. [4] In the United States, the American Association of Sex Educators, Counselors and Therapists (AASECT) oversees clinical training for a sexual health practitioner to become a certified sex therapist (CST). Any licensed mental health counselor can practise sex therapy.[ citation needed ]

Sex therapy is distinct from sex surrogates. Whereas sex therapists discuss and instruct clients in sex-based exercises to be performed at home between sessions, sexual surrogates participate in the exercises with their clients as part of helping them to practice and develop improved skills. Therapists and surrogates sometimes collaborate on cases. Certified sex therapists do not have sexual contact with their clients. [4]


Sex therapy sessions are focused on the individual's symptoms rather than on underlying psychodynamic conflicts. The sexual dysfunctions which may be addressed by sex therapy include non-consummation, premature ejaculation, erectile dysfunction, low libido, unwanted sexual fetishes, sexual addiction, painful sex, or a lack of sexual confidence, assisting people who are recovering from sexual assault, problems commonly caused by stress, tiredness, and other environmental and relationship factors. Sex therapy can either be on an individual basis or with the sex partner. [4] Sex therapy can be conducted with any adult client, including older adults; any gender expression; and LGBTQ-identified people. [4]

A therapist's misunderstanding of these conflicts can lead to resistance or serve as a barrier to improving sexual dysfunctions that are directly or indirectly related to sex. [5] The interest in sex therapy among couples has increased along with the number of sexuality educators, counselors, and therapists. [5] Today, sexual problems are no longer regarded as symptoms of hidden deviant, pathological, or psychological defects in maturity or development. [3] Sex therapy has also influenced the emergence of sexual medicine and exploring integrative approaches to sex therapy, in addition to reducing or eliminating sexual problems and increasing sexual satisfaction for individuals of all stages of life. Health therapists, educators, and counselors are conducting research and administering surveys to fully understand normative sexual function – what most people do and experience as they grow older and live longer. [3]

Aging and sexuality

Both physical and emotional transformation throughout various stages of life can affect the body and sexuality. The subsequent decline in hormone levels and changes in neurological and circulatory functioning may lead to sexual problems such as erectile dysfunction or vaginal pain. [6] These physical changes often affect the intensity of youthful sex and may give way to more subdued responses during middle and later life. [6] Issues with low libido and sexual dysfunction are usually considered to be a byproduct of old age. The emotional byproducts of maturity, however — increased confidence, better communication skills, and lessened inhibitions — can help create a richer, more nuanced, and ultimately satisfying sexual experience. [6] During AARP's last surveys in 1999, 2004, and 2009 statistics well-being among older adults has increased; however, overall sexual satisfaction has decreased. [7] Nevertheless, older adults believed that an active sexual life offers great pleasure but contributes materially to overall emotional and physical health. [7]

Older adults

Sex therapy, at any age, often involves sensate-focused touching Old couple in love.jpg
Sex therapy, at any age, often involves sensate-focused touching

Over the years, little attention has been paid to older adults and sexuality. As the population of older adults and life expectancy continues to grow, there is information about sex therapy but it is often not easily accepted. Cultural and sexual roles are always changing throughout the lifecourse. As people age, they are often viewed as asexual or as incapable of possessing sexual desires. The presence of sexual dysfunction during old age can be impacted by health problems. There are many endocrine, vascular and neurological disorders that may interfere in sexual function, along with some medications and surgeries. [8] Older men experience changes that occur in sexual physiology and affect both erectile function and ejaculation. [8] While older women experience physiological effects of aging after menopause, resulting in the decreased production of estrogen. This leads to increased vaginal dryness, general atrophy of vaginal tissue, and genital changes (reduced size of clitoral, vulvar, and labial tissue). [8] Cognitive changes and decline is another factor that influences sexual activity. Dementia, Alzheimer's and other mental health disorders may have an effect on sexual behavior, producing disinhibition or relationship difficulties with subsequent effects on couple's sexual relationships. [8]

Sex therapy with older adults looks at factors which influence sexuality in older adults, including sexual desire, sexual activity, the value of sexuality, and health. [9] It can include sensate focus, communication, and fantasy exercises as well as psychodynamic therapy. [10]

Sex therapy for older adults is similar to sex therapy with other populations. It includes the use of water-based personal lubricants (for decreased vaginal lubrication), hormone therapy, and medications. [11] Sex therapists working with older adults should know about sexuality and aging. [10] They should also be aware of how stereotypes affect their clients. [8] This is especially true for LGBT-identified clients. [11]

Older adults may also need more education about their sexuality and sexual functioning. [12] Curriculum for this includes communication, masturbation, body image, and spirituality. [12] It also teaches about talking to a doctor about sexual activity. [12] It is optimal that sex education for older adults includes information about sexually transmitted infections (STDs/STIs), such as HIV/AIDS. [13]


Sex therapy has existed in different cultures throughout time, including ancient India, China, Greece, and Rome. [14] It has taken the form of manuals, spells, anaphrodisiacs [15] or aphrodisiacs, and tantric yoga, among others. [16] Much of sex therapy and sexual dysfunction in Western cultures was limited to scientific discussion, especially throughout the 19th century and into the early 20th century. [16]

Sexologists such as Henry Havelock Ellis and Alfred Kinsey began conducting research in the area of human sexuality during the first half of the 20th century. [14] [16] This work was groundbreaking and controversial in the scientific arena. [16]

In the 1950s, sex therapy was concerned with “controlling sexual expression” and repressing what was then-considered deviant behaviors, such as homosexuality or having sex too often. [16] Masters and Johnson are credited with revolutionizing sex therapy in the mid-century and included couple therapy and behavioral interventions that focused on being present in the moment such as sensate focus exercises. [14] [16] Dr. Helen Singer Kaplan modified some of Masters and Johnson's ideas to better suit her outpatient practice, including introducing medication. [14] [16] Both integrated cognitive behavioral therapy into their practice and Kaplan used psychodynamic therapy as well. [14] The work of Jack Annon in 1976 also saw the creation of the PLISSIT model that sought to create a structured system of levels for the therapist to follow. [17]

The mid-1980s saw the medicalization of sex therapy, with a primary focus on male sexual dysfunction. [16] The 1990s brought penile injections and medications such as Viagra as well as the marketing of antidepressants for their delayed ejaculation side-effects. [16] Hormone therapy was introduced to assist both male and female sexual dysfunction. [16] Dilators were used to treat women with vaginismus and surgical procedures to increase the size of the vaginal opening and treat vulval pain were also introduced. [16]

See also

Related Research Articles

Orgasm is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region characterized by sexual pleasure. Experienced by males and females, orgasms are controlled by the involuntary or autonomic nervous system. They are usually associated with involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation and, frequently, body movements and vocalizations. The period after orgasm is typically a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin as well as endorphins.

Sexual intercourse Copulation for reproduction or sexual pleasure, or other penetrative sex acts for sexual pleasure.

Sexual intercourse is sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure, reproduction, or both. This is also known as vaginal intercourse or vaginal sex. Other forms of penetrative sexual intercourse include anal sex, oral sex, fingering, and penetration by use of a dildo. These activities involve physical intimacy between two or more individuals and are usually used among humans solely for physical or emotional pleasure and can contribute to human bonding.

Premature ejaculation (PE) occurs when a man experiences orgasm and expels semen within a few moments of beginning sexual activity and with minimal penile stimulation. It has also been called early ejaculation, rapid ejaculation, rapid climax, premature climax and (historically) ejaculatio praecox. There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration. The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse.

Hypoactive sexual desire disorder (HSDD), hyposexuality or inhibited sexual desire (ISD) is considered a sexual dysfunction and is characterized as a lack or absence of sexual fantasies and desire for sexual activity, as judged by a clinician. For this to be regarded as a disorder, it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder, a drug, or some other medical condition. A person with ISD will not start, or respond to their partner's desire for, sexual activity. HSDD affects approximately 10% of all pre-menopausal women in the United States, or about 6 million women.

Sexual dysfunction is difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. According to the DSM-5, sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

Blue balls is slang for the condition of temporary fluid congestion (vasocongestion) in the testicles accompanied by testicular pain, caused by prolonged sexual arousal in the human male without ejaculation. The term is thought to have originated in the United States, first appearing in 1916. Some urologists call this condition "epididymal hypertension".

Sexual arousal disorder is characterized by a lack or absence of sexual fantasies and desire for sexual activity in a situation that would normally produce sexual arousal, or the inability to attain or maintain typical responses to sexual arousal. The disorder is found in the DSM-IV. The condition should not be confused with a sexual desire disorder.

Sexual medicine is a branch of medicine concerning the diagnosis, treatment, and prevention of disorders of sexual function. Examples of disorders treated with sexual medicine are erectile dysfunction, hypogonadism, and prostate cancer. Sexual medicine often uses a multidisciplinary approach involving physicians, mental health professionals, social workers, and sex therapists. Sexual medicine physicians often approach treatment with medicine and surgery, while sex therapists often focus on behavioral treatments.

Sexual frustration is a sense of dissatisfaction stemming from a discrepancy between a person's desired and achieved sexual activity. It may result from physical, mental, emotional, social, and religious or spiritual barriers. It may also derive from not being satisfied during sex, which may be due to issues such as anorgasmia, anaphrodisia, premature ejaculation, delayed ejaculation, erectile dysfunction, or an incompatibility or discrepancy in libido.

Sexuality in older age

Sexuality in older age concerns the sexual drive, sexual activity, interests, orientation, intimacy, self-esteem, behaviors, and overall sexuality of people in middle age and old age, and the social perceptions concerning sexuality in older age. Older people engage in a variety of sexual acts from time to time for a variety of reasons. Desire for intimacy does not disappear with age, yet there are many restrictions placed on the elderly preventing sexual expressions and discouraging the fulfillment of sexual needs. Sexuality in older age is often considered a taboo, yet it is considered to be quite a healthy practice; however, this stigma can affect how older individuals experience their sexuality. While the human body has some limits on the maximum age for reproduction, sexual activity can be performed or experienced well into the later years of life.

Female sexual arousal disorder (FSAD) is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity. The diagnosis can also refer to an inadequate lubrication-swelling response normally present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.

Sensate focus is a sex therapy technique introduced by the Masters and Johnson team. It works by refocusing the participants on their own sensory perceptions and sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex. Sensate focus has been used to treat problems with body image, erectile dysfunction, orgasm disorders, and lack of sexual arousal.

Sexuality can be inscribed in a multidimensional model comprising different aspects of human life: biology, reproduction, culture, entertainment, relationships and love.

Alcohol and sex deals with the effects of the consumption of alcohol on sexual behavior. The effects of alcohol are balanced between its suppressive effects on sexual physiology, which will decrease sexual activity, and its suppression of psychological inhibitions, which may increase the desire for sex.

Joe Kort American writer

Joe Kort, Ph.D is an American psychotherapist, clinical social worker, board-certified clinical sexologist, author, lecturer and facilitator of therapeutic workshops. He works as Clinical Director and founder of The Center for Relationship and Sexual Health in Royal Oak, Michigan. Dr. Kort also was appointed co-director of Modern Sex Therapy Institutes providing Sex Therapy Certifications and a Ph.D. in Clinical Sexology.

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) is a professional organization for sexuality educators, sexuality counselors and sex therapists.

Sex surrogates, sometimes referred to as surrogate partners, are practitioners trained in addressing issues of intimacy and sexuality. A surrogate partner works in collaboration with a sex therapist to meet the goals of their client. This triadic model is used to dually support the client: the client engages in experiential exercises and builds a relationship with their surrogate partner while processing and integrating their experiences with their therapist or clinician.

Certified Sex Therapists (CST) have graduate degrees in a clinical mental health field and have obtained advanced training in sex therapy from a credentialed training body, resulting in certification. One of the largest such bodies is the American Association of Sexuality Educators, Counselors and Therapists (AASECT).

The following outline is provided as an overview of and topical guide to human sexuality:

Sexuality after spinal cord injury Aspect of human sexuality

Although spinal cord injury (SCI) often causes sexual dysfunction, many people with SCI are able to have satisfying sex lives. Physical limitations acquired from SCI affect sexual function and sexuality in broader areas, which in turn has important effects on quality of life. Damage to the spinal cord impairs its ability to transmit messages between the brain and parts of the body below the level of the lesion. This results in lost or reduced sensation and muscle motion, and affects orgasm, erection, ejaculation, and vaginal lubrication. More indirect causes of sexual dysfunction include pain, weakness, and side effects of medications. Psycho-social causes include depression and altered self-image. Many people with SCI have satisfying sex lives, and many experience sexual arousal and orgasm. People with SCI employ a variety of adaptations to help carry on their sex lives healthily, by focusing on different areas of the body and types of sexual acts. Neural plasticity may account for increases in sensitivity in parts of the body that have not lost sensation, so people often find newly sensitive erotic areas of the skin in erogenous zones or near borders between areas of preserved and lost sensation.


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