It is highly unethical for professional therapists to engage in sexual relationships with cli­ents they treat—both during therapy and after it has ended (Lamb et al., 2003; Reamer, 2003). It is the professional’s responsibility to set boundaries that ensure the integrity of the therapeutic relationship. Psychiatry, psychology, social work, and counseling profes­sional associations have codes of ethics against sexual relations between psychotherapists and their clients. In addition, some states have criminalized sexual behavior with patients. However, research has found that up to 3% of female therapists and 12% of male thera­pists admit to having sexual contact with a current client (Berkman et al., 2000).

Sexual involvement between client and therapist can have negative effects on the cli­ent. Research has indicated that women who experienced sexual contact with their thera­pists (including psychotherapists in general, not just sex therapists) felt greater mistrust of and anger toward men and therapists than did a control group of women. They also

experienced more psychological and psychosomatic symptoms, including anger, shame, anxiety, and depression (Finger, 2000; Regehr & Glancy, 1995). If at any time a thera­pist makes verbal or physical sexual advances toward you, you have every right to leave immediately and terminate therapy. Furthermore, it will be helpful to others who might become victims of this abuse of professional power if you report the incident to the state licensing board for the therapist’s profession. •

Summary

■ Sexual health is a state of physical, emotional, mental, and sexual well-being.

■ The National Health and Social Life Survey (NHSLS) found that many people reported problems in their sex lives.

■ Sexual problems can contribute to lower satisfaction with overall life.

Specific Sexual Difficulties

■ A sexual problem must occur within the context of adequate physical and psychological stimulation to be considered a disorder.

■ Hypoactive sexual desire disorder (HSDD) is characterized by the absence or minimal experience of sexual interest prior to and during the sexual experience.

■ Dissatisfaction with frequency of sexual activity occurs when individual differences in sexual interest result in rela­tionship distress.

■ Sexual aversion disorder is an extreme irrational fear or dis­like of sexual activity.

■ Female genital sexual arousal disorder is an inhibition of the vasocongestive response; female subjective sexual arousal disorder is a lack of subjective feelings of arousal when physical signs of arousal are present; combined genital and subjective sexual arousal disorder involves both.

■ Persistent sexual arousal disorder is spontaneous and unwanted genital arousal that is not relieved by orgasm.

■ Male erectile dysfunction is the consistent or recurring inabil­ity over at least 3 months to have or maintain an erection.

■ Female orgasmic disorder is the absence, marked delay, or diminished intensity of orgasm despite high subjective arousal.

■ Situational female orgasmic disorder occurs when a woman can experience orgasm during masturbation but not with a partner.

■ Coitus provides mostly indirect clitoral stimulation, and for many women it does not provide sufficient stimulation to result in orgasm.

■ Male orgasmic disorder is the inability of a man to ejaculate during sexual activity with a partner.

■ Premature ejaculation occurs when a man consistently ejaculates quickly and is unable to control the timing of his ejaculation.

■ Both men and women fake orgasm, although women do so more often. Pretending usually perpetuates ineffective patterns of relating and reduces the intimacy of the sexual experience.

■ Dyspareunia, or pain during coitus, is disruptive to sexual interest and arousal in both women and men. Numerous physical problems can cause painful intercourse. Vestibulo – dynia may be the most common cause of painful intercourse for women.

■ Peyronie’s disease, in which fibrous tissue and calcium deposits develop in the penis, can cause pain and curvature of the penis during erection.

■ Vaginismus is an involuntary contraction of the outer vagi­nal muscles that makes penetration of the vagina difficult and painful. Many women who have vaginismus are inter­ested in and enjoy sexual activity.

Origins of Sexual Difficulties

■ Physiological conditions can be the primary causes of sexual problems or can combine with psychological factors to result in sexual dysfunction. It is important to identify or rule out physiological causes of sexual problems through medical examinations.

■ Good sexual functioning correlates with good health habits, including a healthy diet, exercise, moderate or no alcohol use, and not smoking.

■ Chronic illnesses and their treatments can greatly affect sexuality. Diseases of the neurological, vascular, and endo­crine systems can impair sexual functioning.

■ Diabetes causes damage to nerves and the circulatory sys­tem, impairing sexual arousal.

■ Cancer and its therapies can impair the hormonal, vascu­lar, and neurological functions necessary for normal sexual activity. Cancer of the reproductive organs often has the worst impact.

Sexual Difficulties and Solutions

■ Multiple sclerosis is a neurological disease of the brain and spinal cord that can affect sexual interest, genital sensation, arousal, or capacity for orgasm.

■ Cerebrovascular accidents, or strokes, can reduce a person’s frequency of interest, arousal, and sexual activity.

■ Most people with spinal cord injuries remain interested in sex, and more than half experience some degree of sexual arousal.

■ People with cerebral palsy, which is characterized by mild to severe lack of muscular control, may need help with prepa­ration and positioning for sexual relations.

■ Blind and deaf individuals can enhance sexual interaction by developing increased sensitivity with their other senses.

■ Medications that can impair sexual functioning include drugs used to treat high blood pressure, psychiatric disorders, depression, and cancer. Use of recreational drugs (including barbiturates, narcotics, and marijuana), alcohol, and tobacco can interfere with sexual interest, arousal, and orgasm.

■ Equality of gender roles is associated with greater sexual satisfaction for men and women.

■ An emphasis on intercourse can increase performance anxi­ety and reduce pleasurable options in lovemaking.

■ Sexual difficulties can be related to personal factors such as limited or inaccurate sexual knowledge, problems of self­concept and body image, or emotional difficulties.

■ Experiencing sexual abuse as a child or sexual assault as an adult often leads to sexual problems. As a result of the abuse experiences, a survivor often associates sexual activity with negative, traumatic feelings.

■ Relationship problems, ineffective communication, and fear of pregnancy or sexually transmitted infections can often inhibit sexual satisfaction.

■ A woman or man whose sexual orientation is homosexual will often have difficulty with sexual interest, arousal, and orgasm in a heterosexual sexual relationship.

Basics of Sexual Enhancement and Sex Therapy

■ Exploring one’s own body, sharing knowledge with a partner, and establishing good communication between partners are important elements of therapy.

■ Sensate focus is a part of therapy for many different sexual problems.

■ Masturbating in each other’s presence can be an excellent way for partners to indicate to each other what kind of touching they find arousing.

■ Therapy programs for women to learn to experience orgasm are based on progressive self-awareness activities.

■ Women who wish to become orgasmic with a partner can ben­efit from programs that start with sensate focus, mutual genital exploration, and nondemand genital pleasuring by the partner.

■ Treatment for vaginismus generally involves promoting increased self-awareness and relaxation. Insertion of a lubri­cated finger (first one’s own and later the partner’s) into the vagina is an important next step in overcoming this condi­tion. Penile insertion is the final phase of treatment

for vaginismus.

■ A variety of approaches can help a man learn to delay his ejaculation, and a couple can use the stop-start technique. Certain antidepressant medications can also help delay ejaculation.

■ A behavioral approach designed to reduce performance anx­iety is used to treat psychologically based erectile disorder.

■ Medications to stimulate blood flow to the penis are in widespread use, and vascular surgery, surgically implanted penile prostheses, external vacuum constriction, and vasoac­tive injections are available if medication does not help.

■ A behavioral approach to male orgasmic disorder com­bines self-stimulation, sensate focus, and partner manual stimulation, ultimately leading to ejaculation by the partner’s stimulation.

■ Many of the basic sex therapy techniques are used to help with hypoactive sexual desire disorder, and therapists also often include insight therapy and couples counseling.

■ Testosterone can be helpful for men and women with low sexual desire, but because of its possible links to cancer and heart disease, its safety is not well established.

■ Two nonprescription products have been shown in research to be helpful with low desire and arousal in women, and other products are being studied.

■ Professional counseling is often helpful and sometimes nec­essary in overcoming sexual difficulties, but few people with problems seek help.

■ A skilled therapist can provide useful information, problem­solving strategies, and sex therapy techniques.

■ It is unethical for a therapist to have sexual relations with a client, either during or after treatment.

Media Resources

Log in to CengageBrain. com to access the resources your instructor requires.

Go to CengageBrain. com to access Psychology CourseMate, where you will find an interactive eBook, glossaries, flashcards, quizzes, videos, and more.

Also access links to chapter-related websites, including American Association of Sex Educators, Therapists, and Counselors, and the American Board of Sexology.

CHAPTER 14