GOALS OF SEX THERAPY

• Helping the person to accept and feel comfortable with their sexuality
• Helping the couple to establish a condition of trust and emotional security during
sexual interaction
• Helping the couple to explore ways to enhance the enjoyment and intimacy of their
lovemaking
• These goals seem vague when compared with the specific ones patients bring with
them-improving erections, delaying ejaculation, achieving orgasm.
• This is because focusing on such specific goals, which may reflect the social norms
for sexual functioning is commonly a large part of the problem.

BEHAVIOURAL COMPONENT
STAGE 1:
• Touching your partner without genital contact and for your own pleasure
• An explicit agreement is made to ban attempts at intercourse and genital or breast
contact in order to reduce performance anxiety and allow both partners to feel safe
• The couple are instructed to have not more than 3 sessions of love making before the
next appointment with therapist, to avoid over doing it.
• The partner will touch the other partner and the toucher to enjoy the experience.
• The partner being touched has only self-protect i.e to say stop if anything unpleasant
is felt.
• Roles are reversed the person who has been touched now does the touching.
• The goal is too simply to enjoy the process in a relaxed way.
• This stage is often difficult for men. Because of the deeply held attitude such as you
should only enjoy sex if you are giving pleasure to someone else –which may be
central to overall problem
• The therapist ensures with the couples, that these behaviour steps have been carried
out feeling relaxed and secured.

STAGE 2:
• Touching your partner without genital contact, for your own, and your partner’s
pleasure.
• Now however, the person being touched gives feedback of what is enjoyable as well
as what is unpleasant.
• The ban on genital contact persists.
• However, if after a session either partner is left aroused and in need of orgasm, then it
is acceptable for them to masturbate individually but not as a pair.
• Anatomy and physiology of sexual response in both sexes, emphasizing commonly
misunderstood aspects which often underlie dysfunction.

STAGE 3:
• Touching with genital contact
• The same principle of alternating in touching apply but genital areas and breasts can
now be included.
• Care questions about their reactions to different positions may reveal important
feelings and attitudes.
• Communicating what is enjoyable about the touching is very important.
• They have to actively participate rather than becoming a detached observer of oneself.
• Detachment generates performances anxiety and interferes with normal sexual
response.
• Concentrate on the local sensations experienced while touching or being touched.
• When premature ejaculation is a problem, the couple are introduced at this stage to
the stop-start or squeeze techniques

STAGE 4:
• Simultaneous touching with genital contact
• Touching is now done by both partners simultaneously.
• They need to be comfortable with preceding stages before moving on to this one.
• Difficulties related to taking initiative and assertiveness are often clarified at this point
STAGE 5

• Vaginal containment.
• Once genital and body touching is progressing well and the male is achieving a
reasonable firm erection, or has started to gain control over ejaculation during manual
stimulation, the couple moves to vaginal containment.
• Now during a touching session, the woman in the female superior position introduces
the penis in her vagina.
• Vaginal containment.
• Once genital and body touching is progressing well and the male is achieving a
reasonable firm erection, or has started to gain control over ejaculation during manual
stimulation, the couple moves to vaginal containment.
• Now during a touching session, the woman in the female superior position introduces
the penis in her vagina.

STAGE 6
• Movement and pelvic thrusting are allowed
• The couple are encouraged to practice stopping at any point at the request of either
partner to counter the common notion that love play once begun must continue until
its physiological conclusion.
• The confidence that either partner can say stop at any stage without incurring anger or
hurt in the other is a basic feature of a secure sexual relationship.
• The couples are also advised to experiment with different positions.

Misunderstanding about the treatment

• It is worth adding that although the therapist assumes an authoritative role initially in
setting limits and suggesting behavioral steps, this will be transferred to the couple as
treatment evolves.
• Difficulty in accepting the approach may reflect reluctance in one or both partner for
the treatment to succeed.
• Ignorance or incorrect notions about sex
• A widely held notion is that an erection indicates advanced sexual arousal and the
need for intercourse, at a time when the woman may only be starting to respond.
• Erection is obvious to both partners whereas internal vaginal lubrication, the
equivalent female physiological response may pass unnoticed.
• A belief that a woman should experience orgasm form vaginal intercourse alone and
that failure to do so or reliance on clitorial stimulation indicates abnormality needs to
be dispelled.
• The therapist stresses that only a small proportion of women on a minority of
occasions achieve orgasm without clitorial stimulation either by themselves or their
partner.

STAGES AND COMPONENTS OF SEX THERAPY

• Assessment
• Formulation
• Homework assignment-counseling-education
• Termination
• Follow up session
FORMULATION
• Predisposing factors- those which make a person vulnerable to developing a sexual
problem
• Precipitants- the factors which leads to appearance of a sexual problem
• Maintaining factors- psychological responses to a sexual problem, attitudes and other
stresses which cause the problem to persist or worsen.
Predisposing factors
• Restrictive upbringing including inhibited distorted parental attitudes to sex
• Disturbed family relationships, including poor parental relationship, lack of affection
• Traumatic early sexual experiences, including child sexual abuse and incest
• Poor sex education
Precipitants factors
• Discord in general relationship
• Childbirth
• Infidelity
• Dysfunction in partner
• Depression or anxiety
• Ageing

Maintaining factors
• Performance anxiety
• For example
• Man’s need always to be an expert lover, or a woman’s to have an orgasm whenever
sex occurs in order to please her partner
• Fear of failure (loss of erection)
• Partner demands
• Poor communication (especially about each partner’s sexual needs or anxieties
• Guilt (about an affair)
• Loss of attraction
• Discord in general relationship
• Fear of emotional intimacy
• Inadequate sexual information (about how to stimulate the partner effectively
• Restricted foreplay (such that the female partner is not adequately aroused
Area to cover during assessment

• The sexual problem-its nature and development.

• Desired changes in the sexual problem

• Family background and early childhood-including relationships with parents, parental

relationship, family attitudes to sexuality

• Sexual development and experiences-including attitudes to puberty, onset of sexual

interest, previous sexual experiences and problems, masturbation, traumatic sexual
experiences (e.g. sexual abuse) homosexuality

• Sexual information-source, extent, whether the person thinks he or she lacks

information and therapist assessment of level of sexual knowledge

• Relationship with partner-including its development, previous sexual adjustment,

general relationship, children and contraception, infidelity, commitment to the
relationship, feelings and attraction towards the partner

• School, occupation, interests, religious beliefs

• Medical history- including any current medication

• Psychiatry history

• Use of alcohol and drugs

• Appearance and mood

• Physical examination

Homework Assignment

• Non-genital sensate focus

• Genital sensate focus

• Vaginal containment

Female sexual problems-loss of desire

• Causes for loss of desire

• Organic causes
• Testosterone has a part to play in womens sexual desire, although much smaller
amounts are required than in men
• In women testosterone production is split evenly between the ovaries and the adrenal
gland.
• Loss of desire is more common with premenstrual tension, postnatal and around the
menopause.
• It is useful to ask a woman her views on her learning about sexuality and the
influences that have played a part in the development of her sexuality.
• Possible sources for sexual learning include parental values, religious teaching,
cultural mores, and life events.
• Many misunderstanding and myths can be acquired during learning about sexuality
Homework assignments for treatment of orgasmic disorder
• Instruct the patient and partner to construct a list of good and bad conditions for
sexual activity.

• This helps both partners begin to consider the circumstances in which they become
most aroused.

• Encourage the patient to read literature, peruse magazines, and watch videos. This
material may be used to aid the patient in formulating sexual fantasies.

• The person should engage in these exercises daily for approximately 10-20 minutes,
depending on the exercise.

• Patient views his or her body nude in the mirror

• Patient views his or her genitals nude in the mirror

• Patient rubs areas of his or her body other than the genitals

• Patient stimulates his or her genitals

• Patient demonstrate for partner the type of stimulation that he or she finds pleasurable