Sex therapy is a strategy for the treatment of sexual dysfunction when there is no medical etiology (physiological reason) or as a complement to medical treatment. 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 therapists assist those experiencing problems in overcoming them, in doing so possibly regaining an active sex life.
Sex therapy is a form of psychotherapy. Sex therapists assist those experiencing problems in overcoming them, in doing so possibly regaining an active sex life. The practice of sex therapy remains controversial. It is approached with ambivalence in social, religious, and educational systems. The transformative approach to sex therapy aims to understand the psychological, biological, pharmacological, 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 etiology may include, firstly, circulatory problems, and secondly, performance anxiety. Sex therapy is frequently short term, with duration depending on the causes for therapy.
Sex therapy can be provided by licensed social workers, physicians, psychologists, or therapists who have undergone training and become certified. In the United States, the American Association of Sex Educators, Counselors and Therapists (AASECT) oversees clinical training for a sexual health practitioner to become a certified sex therapist (CST). Any licensed mental health counselor can practice sex therapy. Certified sex therapists do not have sexual contact with their clients.
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, including older adults; any gender expression; and LGBTQ-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 levels and changes in neurological and circulatory functioning may lead to sexual problems such as erectile dysfunction 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 life. Issues with low libido and sexual dysfunction 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's last surveys in 1999, 2004, and 2009 statistics 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 but contributes materially to overall emotional and physical health.
Over the years, little attention has been paid to older adults and sexuality. As the population of older adults and life expectancy continues to grow, there is information about sex therapy but it is often not easily accepted. Cultural and sexual roles are always changing throughout the lifecourse. 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, vascular and neurological disorders that may interfere in sexual function, along with some medications and surgeries. Older men experience changes that occur in sexual physiology and affect both erectile function and ejaculation. While older women experience physiological effects of aging after menopause, resulting in the decreased production of estrogen. This leads to increased vaginal dryness, general atrophy of vaginal tissue, and genital changes (reduced size of clitoral, vulvar, and labial tissue). Cognitive changes and decline is another factor that influences sexual activity. Dementia, Alzheimer's and other 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, 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-identified clients.
Older adults may also need more education about their sexuality and sexual functioning. Curriculum for this includes communication, masturbation, body image, and spirituality. It also teaches about talking to a doctor about sexual activity. It is optimal that sex education for older adults include information about sexually transmitted infections (STDs/STIs), such as HIV/AIDS.
Sex therapy has existed in different cultures throughout time, including ancient India, China, Greece, and Rome. It has taken the form of manuals, spells or aphrodisiacs, 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 behavior therapy into their practice and Kaplan used psychodynamic therapy as well. 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 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 vulval pain were also introduced.