Treatment of Sexual Dysfunction
Treatment of psychosexual disorders, in the form developed by Masters and Johnson (1966), consisted of a thorough assess-ment of the partners and their relationship, education about sex-ual functioning, and a series of behavioral exercises. There are specific exercises for each of the sexual dysfunctions. Different authors developed different exercises and ways of approaching them. For a complete description of these exercises, we recom-mend Kaplan (1995), LoPiccolo and Stock (1996) and Zilbergeld (1992). This method works best when there is ignorance, shame, or specific dysfunction such as premature ejaculation. These ex-ercises are difficult to complete if the couple feels angry or un-loving toward each other.
Many of the patients who saw Masters and Johnson in the 1970s had issues related to sexual ignorance and inexperience. Two decades later, the increase in premarital sex and the pro-liferation of easily available articles and books on sexuality and information on the Internet have decreased the number of these couples, and allowed some couples with sexual dysfunction to work on their issues at home. Recent studies of couples request-ing sex therapy have shown a higher proportion having concomi-tant, complicated marital problems. Recent writers in the field notably Schnarch (1997), have focused on cognitive/emotional issues in sexuality, and especially on the meanings attached to a particular act, and the level of intimacy involved. Having learned a great deal about the more mechanical and organic issues related to arousal and orgasm, it is important to rethink other aspects of sex, such as eroticism, passion, mystery and dominance/sub-mission which make the act itself meaningful. This is particu-larly true in areas of sexual boredom or situational lack of desire. These therapists do not use rigidly staged exercises, but focus on the coupleâ€™s relatedness during sex; they may, however, suggest specific homework to help a couple focus on a particular aspect of their sexuality.