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Sex Therapy: Brief Historic and Current Perspectives

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... Numerous works have noted mental health clinicians' blend of discomfort in and poor training for broaching sexual health topics with clients (Zeglin, In Press;Alderson, 2004;Bloom et al., 2016;Grove, 2009;Glass, 2016;Hanzlik & Gaubatz, 2012;Moore;Watjen, 2020;Wilson, 2019). It may be because of this unique blend of personalization, poor training, and discomfort that "Sex Therapy" sits within a liminal space between clinical specialty and professional marginalization wherein sexual health issues in mental health practice are considered either outside the scope of legitimate mental health clinicians or idiosyncratically inside the scope of sex specialists (Binik & Meana, 2009;Lucena & Abdo, 2017;Pukall, 2009). This fact raises questions with respect to scope of practice. ...
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The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
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This work aims to identify factors that contribute and those that impair the ability to experience orgasm during sexual activity. It compared women (n=96) aged 18-61 (M=38.5 years) in a stable relationship that, after a normal arousal phase, do not have an orgasm (OD) with those that do (OA) regarding sociodemographic data, sexual frequency, talking about sex with their physician, talking about sex with their partner, sexual education, masturbation, sexual desire, sexual satisfaction, depression and anxiety. We found differences between the OD and OA groups with regard to level of education (P=0.022), sex education during childhood and/or adolescence (P<0.001), masturbation (P=0.017), sexual satisfaction (P<0.001), anxiety (P<0.001) and sexual desire (P<0.001). The final model of logistic regression for orgasm problems included the variables 'masturbation', 'high school', 'sexual desire' and 'anxiety'. Orgasm difficulties are influenced by personal factors, such as anxiety and low sexual desire. Increased levels of anxiety also increase orgasmic difficulties. Women who masturbate and/or have completed high school are considerably more likely to reach orgasm during sexual activity.International Journal of Impotence Research advance online publication, 20 March 2014; doi:10.1038/ijir.2014.8.
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Introduction. As yet, a summary of research evidence concerning the efficacy of psychological treatment in male sexual dysfunction is lacking. Aim. Our systematic review gives an overview of the efficacy of psychosocial interventions in all male sexual dysfunctions. Main Outcome Measures. Main outcome measures included, for example, psychometrically validated scales, interviews, and clinical assessment by an independent rater. The efficacy of psychosocial interventions was measured, for example, by the frequency of and satisfaction with sexual activity and sexual functioning. Methods. The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the man was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems [ICD10/-9]; Diagnostic and Statistical Manual of Mental Disorders [DSM-IV/-III-R]) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized controlled trials [RCTs] and controlled clinical trials [CCTs]). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance. Results. We identified 19 RCTs and one CCT that investigated the efficacy in male sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Twelve out of 20 trials in men used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Overall, psychosocial interventions improved sexual functioning. While one study found that psychotherapy is superior to sildenafil, another study found the opposite. In men with premature ejaculation, behavioral techniques proved to be effective. A shortcoming was the rather low methodological quality of included studies. Conclusions. Most of the compared interventions proved to be similarly effective. Possibly, there are underlying constructs throughout all therapies that have an effect on the outcome. Berner M and Günzler C. Efficacy of psychosocial interventions in men and women with sexual dysfunctions—A systematic review of controlled clinical trials. J Sex Med 2012;9:3089–3107.
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Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts. This is the summary of the report by the International Consultation Committee for Sexual Medicine on Definitions/Epidemiology/Risk Factors for Sexual Dysfunction. The main aim of this article is to provide a general overview of the definitions of sexual dysfunction for men and women, the incidence and prevalence rates, and a description of the risk factors identified in large population-based studies. Literature regarding definitions, descriptive and analytical epidemiology of sexual dysfunction in men and women were selected using evidence-based criteria. For descriptive epidemiological studies, a Prins score of 10 or higher was utilized to identify population-based studies with adequately stringent criteria. This report represents the opinions of eight experts from five countries developed in a consensus process and encompassing a detailed literature review over a 2-year period. The study aims to provide state-of-the-art prevalence and incidence rates reported for each dysfunction and stratified by age and gender. Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. A wealth of information is presented on erectile dysfunction, its development through time, and its correlates. The field is still in need of more epidemiological studies on the other men's sexual dysfunction and on all women's sexual dysfunctions. A review of the currently available evidence from epidemiological studies is provided.
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The authors review the development of their rapid treatment dual-sex therapy for sexual dysfunction. The basic tenets of the new sex therapy include 1) sound knowledge of physiology, endocrinology, and metabolic function, 2) institution of psychotherapy only when organic factors have been identified or ruled out, 3) treatment of the couple as a unit by dual-sex therapy teams, 4) a short-term intensive program, and 5) education in techniques of verbal and nonverbal communication. Since its inception in 1958, the new therapy has been adopted, modified, and examined by clinicians and researchers all over the world. The authors suggest that professionals interested in effective treatment for sexual dysfunction should improve techniques, train personnel, and encourage sound research.
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Recent research findings have implicated, in a preliminary manner, five factors that seem to differentiate sexually functional subjects from sexually dysfunctional subjects suffering from inhibited sexual excitement. These factors include differences in affect during sexual stimulation, differences in self-reports of sexual arousal and perception of control over arousal, distractibility during sexual stimulation, and differential sexual responding while anxious. These findings suggest a working model of sexual dysfunction that is based on cognitive interference and anxiety. Implications of this model for the treatment of sexual dysfunction are suggested.
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The term “frigidity”, is now used to include all sexually dysfunctional women. However, the woman who is generally unresponsive differs in crucial aspects from the one who is responsive but has difficulty achieving an orgasm. This distinction is important on physiological as well as on clinical grounds because treatment differs for the two syndromes. The normal range of the female orgastic threshold has not yet been systematically studied. We do not really know what constitutes normalcy and pathology. Therefore die question of whether or not coital orgasm is the only normal female response cannot be settled definitively at this time. However, clinical evidence suggests that orgasm on clitoral stimulation may be a normal variant of the female sexual response.
Article
The effects of anxiety and distraction on sexual arousal in a nonclinical sample of heterosexual women between the ages of 19 and 35 were studied. Using a dichotic listening paradigm, the study extended Geer and Fuhr's (1976) research by examining the effects of distraction on sexual arousal in women. Results indicated that both vaginal pulse amplitude and subjective measures of sexual arousal vary as a function of distraction level, with increased distraction leading to decreased arousal. However, the data failed to support Masters and Johnson's (1970) assertion that anxiety decreases sexual arousal. Although no significant effect for anxiety emerged using a physiological measure of sexual arousal, a significant Anxiety x Distraction interaction was observed using a subjective measure of sexual arousal. Several competing interpretations of this interaction are discussed.
Article
A review of the current approach to the assessment and treatment of female sexual disorders from a sex therapy perspective is described. The importance of a comprehensive evaluation of both the woman and her partner, prior to formalizing a treatment plan, is stressed. Certain interventions are common in the treatment of all female sexual difficulties, for example, education and information about female sexuality generally, communication training, non-demand pleasuring, and permission to engage in self-pleasuring. Specific interventions are also described for such issues as past sexual or physical trauma. The overall goal of treatment is increased pleasure and satisfaction, rather than perfect genital response. Finally, the factors associated with treatment success are noted along with the observation that these factors are the same factors that contribute to a successful outcome in any psychotherapeutic endeavor.
Article
We administered the International Index of Erectile Function (IIEF; Rosen et al., 1997) questionnaire to 30 patients with psychogenic erectile dysfunction (ED) at baseline, immediately after treatment, and 3 months after treatment. We randomized patients into three groups: group I, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months and 50 mg sildenafil citrate orally on demand; group II, who had an intake of 50 mg sildenafil citrate orally on demand for 6 months only; and group III, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months. We analyzed data (15-item IIEF) for each group at three times during the study and compared by the data using analysis of variance (ANOVA), followed by the Bonferroni multiple comparison test. We used Cochran's Q-test for analysis between baseline and posttreatment stages of patients with remission of symptoms (EF equal to or higher than 26 points). Group III had a mean score higher than group II, with the difference being statistically significant (immediately after treatment, p = 0.033; at 3 months after treatment, p = 0.049; p < 0.05). All three therapeutic alternatives resulted in an improvement of erectile function domain score. However, significant differences from baseline were observed in groups I (p = 0.0009) and III (p = 0.0002) but not in group II (p = 0.135). The psychotherapy groups, I and III, had significantly higher scores compared with group II, in which patients were exclusively treated with sildenafil citrate. These findings suggest that time-limited theme-based group psychotherapy is an effective treatment for psychogenic ED.
Article
Recent research on the treatment of erectile dysfunction (ED) has focused on medical interventions, in particular oral medications. The current study examined the effectiveness of an internet-based psychological intervention for this condition. In total, 31 men (12 in treatment group, 19 in control group) completed the program. The results demonstrated that men who completed the program reported improved erectile functioning and sexual relationship satisfaction and quality. The implications of these findings for the treatment of ED are discussed.
Article
Sexual satisfaction is linked to life satisfaction, and erectile dysfunction (ED) may lead to an impaired quality of life (QOL). Our goal was to evaluate the QOL among Brazilian patients with ED, before and after three kinds of treatment. Men aged 25-55 years, with a diagnosis of psychogenic or mixed ED, according to the Classification of Mental and Behavioral Disorders of the International Classification of Diseases, 10th edition, and the Standard Practice in Sexual Medicine, were randomly assigned to three treatment groups: counseling, sildenafil, and sildenafil plus counseling. At baseline each group had 40 patients. Sildenafil was provided in 50 mg that could be adjusted to 100 mg. The patients could initially take one to two tablets per week and the entire treatment lasted for 3 months. Counseling was provided in group sessions that took place once a week. They were evaluated at baseline and after 3 months of treatment with the Male Sexual Quotient (MSQ) and the Sexual Health Inventory for Men (SHIM). The correlation between the patients' MSQ score and scores on the SHIM. One hundred seventeen patients were enrolled. The three groups were similar according to age, marital status, mean time of ED, and ED severity and etiology. At baseline, MSQ and SHIM total scores were not different among the three groups. MSQ scores increased from 41.2 +/- 15.3, 38.7 +/- 18.0, and 46.8 +/- 17.0 to 48.5 +/- 15.3, 63.8 +/- 21.6, and 70.0 +/- 17.3 after counseling, sildenafil, and sildenafil plus counseling, respectively (P < 0.05). SHIM scores also increased significantly (9.6 +/- 4.1, 9.7 +/- 4.1, and 10.2 +/- 3.9 to 12.1 +/- 3.9, 16.7 +/- 5.6, and 17.7 +/- 4.5 after counseling, sildenafil, and sildenafil plus counseling, respectively) (P < 0.05). There were no serious adverse events related to sildenafil, and no patient was withdrawn from the study because of an adverse event. The three treatments were significantly efficient, and the best treatment was sildenafil associated with counseling.
Tratamento psicoterápico para disfunção sexual feminina/Psychotherapeutic treatment for female sexual dysfunction
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Human sexual inadequacy
  • W H Masters
  • V E Johnson
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Evidence-based practices in mental health: debate and dialogue on the fundamental questions
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