Sex Therapy and Enhancement

1. Sex Therapy and Enhancement

2. Groups: • What are the general techniques common to all sex therapy? • What are specific suggestions for women? • What are specific suggestions for men?

3. What are the general techniques common to all sex therapy?

4. Sexual Enhancement and Sex Therapy • Self-awareness • knowledge of beliefs, needs, and how body responds • self-examination • masturbation

5. Sexual Enhancement and Sex Therapy (cont.) • Communication • Sensate focus • touching & communicating without any goal  less pressure to perform • focus on non-genital touch • Cultural values and masturbation

6. Sexual Enhancement and Sex Therapy (cont.) Fig. 16.1 The process of sensate focus, whereby partners sensually explore each other’s body, can contribute to the mutual enhancement of a couple’s sexual enjoyment.

7. Sexual Enhancement and Sex Therapy (cont.) • Masturbation with partner present • to learn what feels good & teach partner • to allow sexual release • for women learning to experience orgasm with partner • to resolve male erectile difficulties

8. Sexual Enhancement and Sex Therapy (cont.) Fig. 16.3 Masturbating in the presence of a partner can be an effective way for an individual to indicate what kind of touching she or he finds arousing.

9. What are some specific Suggestions for Women • Becoming orgasmic • through self-stimulation • vibrator use • Eros clitoral therapy device • allow time, consider counseling

10. Specific Suggestions for Women (cont.) • Experiencing orgasm with a partner • sexual assertiveness important • masturbation in presence of partner • sensate focus activity • techniques to increase arousal

11. Sexual Enhancement and Sex Therapy (cont.) Fig. 16.4The back to chest position for genital sensate focus.

12. Specific Suggestions for Women (cont.) Fig. 16.5 The use of an electric vibrator for clitoral stimulation during coitus.

13. Specific Suggestions for Women (cont.) Fig. 16.1 Facilitating Orgasm: Complete the Sentence, “In addition to getting specific physical stimulation, I have often done the following to help me reach orgasm during sex with a partner.”

14. Specific Suggestions for Women (cont.) • Dealing with vaginismus • relaxation & self-awareness activity • gradual finger/dilator self-insertions • penile penetration • may require professional help

15. What are some specific Suggestions for Men • Strategies for delaying ejaculation • more frequent ejaculation • “Come again” • change positions • communication  slow down

16. Specific Suggestions for Men (cont.) • Strategies for delaying ejaculation • stop-start technique • stimulation to brink of orgasm • stop, wait for sensations to decrease • OR squeeze technique • training sessions required • woman above position most used

17. Specific Suggestions for Men (cont.) • Strategies for delaying ejaculation • medical treatment • small doses of antidepressants

18. Specific Suggestions for Men (cont.) • Dealing with erectile dysfunction • reduce anxiety (most common cause) • restore confidence with success • sensate focus or stop-start • final phase of treatment is intercourse

19. Specific Suggestions for Men (cont.) • Dealing with erectile dysfunction • medical treatment • Viagra: takes effect < 3 hours, requires physical stimulation, effect may depend on quality of relationship • newer drugs: Levitra and Cialis

20. Specific Suggestions for Men (cont.) • Dealing with erectile dysfunction • mechanical: suction pump, Rejoyn • surgical treatment • semi-rigid or inflatable implants • may alter sensations during erection • microsurgical vascular repairs

21. Specific Suggestions for Men (cont.) Fig. 16.6 An inflatable penile prosthesis.

22. Specific Suggestions for Men (cont.) • Reducing male orgasmic disorder • behavioral approach used • sensate focus without ejaculation • ejaculation by any means • manual or oral stimulation by partner, to ejaculation • coital ejaculation

23. Treating Hypoactive Sexual Desire • Some suggestions same as other dysfunctions • encourage erotic responses • reduce anxiety • enhance sexual experiences • expand repertoire of activities

24. Treating Hypoactive Sexual Desire (cont.) • Multifaceted intervention may be required • goal = modify inhibited impulses • explore underlying relationship problems • often requires long-term professional help • medical treatment; testosterone supplementation

25. Seeking Professional Assistance • The PLISSIT model of sex therapy • 1st level = permission to engage or not in specific sexual behaviors • 2nd level = limited information corrected • 3rd level = specific suggestions offered • 4th level = intensive therapy

26. Seeking Professional Assistance (cont.) • Therapeutic approaches • psychosexual therapy

27. Seeking Professional Assistance (cont.) • What happens in therapy? • identify & clarify problems & goals • medical, sexual, relationship history • often given homework • NEVER includes sex with therapist

28. Seeking Professional Assistance (cont.) • Selecting a therapist • referral from trusted source • ask about credentials, training, & experience • interview: practicalities & "fit"