432 CHAPTER 14
■ Multiple sclerosis is a neurological disease of the brain and
spinal cord that can aect 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
■ People with cerebral palsy, which is characterized by mild to
severe lack of muscular control, may need help with prepa-
ration 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 anxi-
ety and reduce pleasurable options in lovemaking.
■ Sexual diculties can be related to personal factors such as
limited or inaccurate sexual knowledge, problems of self-
concept and body image, or emotional diculties.
■ 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, ineective 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 diculty 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 dierent sexual
■ Masturbating in each other’s presence can be an excellent
way for partners to indicate to each other what kind of
touching they nd arousing.
■ erapy 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 ben-
et from programs that start with sensate focus, mutual genital
exploration, and nondemand genital pleasuring by the partner.
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Counselors, and the American Board of Sexology.
■ Treatment for vaginismus generally involves promoting
increased self-awareness and relaxation. Insertion of a lubri-
cated nger (rst one’s own and later the partner’s) into the
vagina is an important next step in overcoming this condi-
tion. Penile insertion is the nal phase of treatment
■ 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
■ A behavioral approach designed to reduce performance anx-
iety is used to treat psychologically based erectile disorder.
■ Medications to stimulate blood ow to the penis are in
widespread use, and vascular surgery, surgically implanted
penile prostheses, external vacuum constriction, and vasoac-
tive injections are available if medication does not help.
■ A behavioral approach to male orgasmic disorder com-
bines self-stimulation, sensate focus, and partner manual
stimulation, ultimately leading to ejaculation by the partner’s
■ 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 nec-
essary in overcoming sexual diculties, but few people with
problems seek help.
■ A skilled therapist can provide useful information, problem-
solving strategies, and sex therapy techniques.
■ It is unethical for a therapist to have sexual relations with a
client, either during or after treatment.
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