Sex therapy is a therapeutic strategy for the improvement of sexual function and treatment of

sexual dysfunction Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction ...

. This includes dysfunctions such as

premature ejaculation Premature ejaculation (PE) is a male sexual dysfunction that occurs when a male Ejaculation, expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal penile stimulation. It has also been called ''e ...

and delayed ejaculation,

erectile dysfunction Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a Human penis, penile erection with sufficient rigidity and durat ...

, lack of sexual interest or arousal, and painful sex ( vaginismus and dyspareunia); as well as problems imposed by atypical sexual interests (

paraphilia A paraphilia is an experience of recurring or intense sexual arousal to atypical objects, places, situations, fantasies, behaviors, or individuals. It has also been defined as a sexual interest in anything other than a legally consenting human ...

s),

gender dysphoria Gender dysphoria (GD) is the distress a person experiences due to inconsistency between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The term replaced the previous diagnostic label of gender i ...

(and being

transgender A transgender (often shortened to trans) person has a gender identity different from that typically associated with the sex they were sex assignment, assigned at birth. The opposite of ''transgender'' is ''cisgender'', which describes perso ...

), highly overactive libido or hypersexuality, a lack of sexual confidence, and recovering from

sexual abuse Sexual abuse or sex abuse is abusive sexual behavior by one person upon another. It is often perpetrated using physical force, or by taking advantage of another. It often consists of a persistent pattern of sexual assaults. The offender is re ...

(such as

rape Rape is a type of sexual assault involving sexual intercourse, or other forms of sexual penetration, carried out against a person without consent. The act may be carried out by physical force, coercion, abuse of authority, or against a person ...

sexual assault Sexual assault is an act of sexual abuse in which one intentionally Physical intimacy, sexually touches another person without that person's consent, or Coercion, coerces or physically forces a person to engage in a sexual act against their w ...

); and also includes sexual issues related to aging, illness, or disability.Binik, Y. M., & Hall, K. S. K. (2014). ''Principles and practice of sex therapy (5th ed.).'' NY: Guildford,

Practice

Modern sex therapy often integrates psychotherapeutic techniques and medical ones,Bancroft, J. (2009). ''Human Sexuality and Its Problems (3rd ed.).'' Edinburgh: Elsevier. such as Viagra (

sildenafil Sildenafil, sold under the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary hypertension, pulmonary arterial hypertension. It is also sometimes used off-label for the treatment of certain sym ...

) and Cialis ( tadalafil) 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 and healthy sex life. The transformative approach to sex therapy aims to understand the

psychological Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...

, biological,

pharmacological Pharmacology is the science of drugs and medications, including a substance's origin, composition, pharmacokinetics, pharmacodynamics, therapeutic use, and toxicology. More specifically, it is the study of the interactions that occur between ...

, relational, and contextual aspects of sexual problems. 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. Sex therapy can be provided by licensed psychologists or physicians, who have undergone training and become certified. These trainings and certifications usually begin with a master's degree, and internship, and a license. This can take up to two years, and longer if a doctoral degree is desired. Certified sex therapists do not have sexual contact with their clients. 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.

Symptoms

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. Sex therapy can be conducted with any adult client, including older adults, any

gender expression Gender expression (or gender presentation) is a person's behavior, mannerisms, interests, and appearance that are associated with gender in a particular cultural context, typically understood in terms of masculinity and femininity. Gender expr ...

, and

LGBTQ LGBTQ people are individuals who are lesbian, Gay men, gay, bisexual, transgender, queer, or questioning (sexuality and gender), questioning. Many variants of the initialism are used; LGBTQIA+ people incorporates intersex, Asexuality, asexual, ...

-identified people. 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. The interest in sex therapy among couples has increased along with the number of sexuality educators, counselors, and therapists. Today, sexual problems are no longer regarded as symptoms of hidden deviant, pathological, or psychological defects in maturity or development. 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.

Aging and sexuality

Both physical and emotional transformation throughout various stages of life can affect the body and sexuality. The subsequent decline in

hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...

levels and changes in neurological and circulatory functioning may lead to sexual problems such as

or vaginal pain. These physical changes often affect the intensity of youthful sex and may give way to more subdued responses during middle and

later Later may refer to: * Future The future is the time after the past and present. Its arrival is considered inevitable due to the existence of time and the laws of physics. Due to the apparent nature of reality and the unavoidability of the futur ...

life. Issues with low libido and

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. During

AARP AARP, formerly the American Association of Retired Persons, is an interest group in the United States focusing on issues affecting those 50 and older. The organization, which is headquartered in Washington, D.C., said it had more than 38 ...

's last surveys in 1999, 2004, and 2009 statistics show well-being among older adults has increased; however, overall sexual satisfaction has decreased. Nevertheless, older adults believed that an active sexual life offers great pleasure and contributes materially to overall emotional and physical health.

Older adults

Over the years, little attention has been paid to older adults and sexuality. As the population of older adults and life expectancy continue to grow, there is information about sex therapy but it is often not easily accepted. Cultural and sexual roles are always changing throughout the life-course. 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 The endocrine system is a messenger system in an organism comprising feedback loops of hormones that are released by internal glands directly into the circulatory system and that target and regulate distant organs. In vertebrates, the hypotha ...

vascular Vascular can refer to: * blood vessels, the vascular system in animals * vascular tissue Vascular tissue is a complex transporting tissue, formed of more than one cell type, found in vascular plants. The primary components of vascular tissue ...

and neurological disorders that may interfere in sexual function, along with some medications and surgeries. Older men experience changes that occur in sexual

physiology Physiology (; ) is the science, scientific study of function (biology), functions and mechanism (biology), mechanisms in a life, living system. As a branches of science, subdiscipline of biology, physiology focuses on how organisms, organ syst ...

and affect both erectile function and

ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the penis through the urethra. It is the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. ...

. While older women experience

physiological Physiology (; ) is the science, scientific study of function (biology), functions and mechanism (biology), mechanisms in a life, living system. As a branches of science, subdiscipline of biology, physiology focuses on how organisms, organ syst ...

effects of aging after

menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...

, resulting in the decreased production of

estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...

. This leads to increased vaginal dryness, general atrophy of vaginal tissue, and genital changes (reduced size of clitoral, vulvar, and labial tissue).

Cognitive Cognition is the "mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...

changes and decline is another factor that influences sexual activity.

Dementia Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...

, Alzheimer's and mental health disorders may have an effect on sexual behavior, producing disinhibition or relationship difficulties with subsequent effects on couple's sexual relationships. 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. It can include sensate focus, communication, and fantasy exercises as well as psychodynamic therapy. 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 Hormone therapy or hormonal therapy is the use of hormones in medical treatment. Treatment with hormone antagonists may also be referred to as hormonal therapy or antihormone therapy. The most general classes of hormone therapy are hormonal therap ...

, and medications.. Sex therapists working with older adults should know about sexuality and aging. They should also be aware of how stereotypes affect their clients. This is especially true for

LGBT LGBTQ people are individuals who are lesbian, gay, bisexual, transgender, queer, or questioning. Many variants of the initialism are used; LGBTQIA+ people incorporates intersex, asexual, aromantic, agender, and other individuals. The gro ...

-identified clients. Older adults may also need more education about their sexuality and sexual functioning. Curriculum for this includes communication,

masturbation Masturbation is a form of autoeroticism in which a person Sexual stimulation, sexually stimulates their own Sex organ, genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. Stimulation may involve the use of han ...

, body image, and

spirituality The meaning of ''spirituality'' has developed and expanded over time, and various meanings can be found alongside each other. Traditionally, spirituality referred to a religious process of re-formation which "aims to recover the original shape o ...

. It also teaches about talking to a doctor about sexual activity. It is optimal that

sex education Sex education, also known as sexual education, sexuality education or sex ed, is the instruction of issues relating to human sexuality, including human sexual anatomy, Human sexual activity, sexual activity, sexual reproduction, safe sex, birth ...

for older adults includes information about sexually transmitted infections (STDs/STIs), such as

HIV/AIDS The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...

History

Sex therapy has existed in different cultures throughout time, including ancient India, China, Greece, and Rome. It has taken the form of manuals, spells, anaphrodisiacs or

aphrodisiac An aphrodisiac is a substance that increases libido, sexual desire, sexual attraction, sexual pleasure, or sexual behavior. These substances range from a variety of plants, spices, and foods to synthetic chemicals. Natural aphrodisiacs, such as ...

s, and tantric yoga, among others. 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. 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. This work was groundbreaking and controversial in the scientific arena. 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. 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. Dr. Helen Singer Kaplan modified some of Masters and Johnson's ideas to better suit her outpatient practice, including introducing medication. Both integrated

cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...

into their practice and Kaplan used psychodynamic therapy as well. The combination of hypnotic procedures with humanistic psychodrama ( Hans-Werner Gessmann 1976) is an option.J. L. Moreno, James M. Enneis: ''Introduction into Hypnodrama''. In: ''Hypnodrama''. Beacon House Publishers, Psychodrama Monographs No. 27, 1950, p. 6 ff. 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. The mid-1980s saw the medicalization of sex therapy, with a primary focus on male sexual dysfunction. The 1990s brought penile injections and medications such as Viagra as well as the marketing of antidepressants for their delayed ejaculation side-effects.

Hormone therapy Hormone therapy or hormonal therapy is the use of hormones in medical treatment. Treatment with hormone antagonists may also be referred to as hormonal therapy or antihormone therapy. The most general classes of hormone therapy are hormonal therap ...

was introduced to assist both male and female sexual dysfunction. Dilators were used to treat women with vaginismus and surgical procedures to increase the size of the vaginal opening and treat vulvar pain were also introduced.

References