Sex Therapy Handbook: A Clinical Manual for the Diagnosis and Treatment of Sexual Disorders PDF
Preview Sex Therapy Handbook: A Clinical Manual for the Diagnosis and Treatment of Sexual Disorders
SEX THERAPY HANDBOOK SEX THERAPY HANDBOOK: A Clinical Manual for the Diagnosis and Treatment of Sexual Disorders Eric C. Krohne, Ph.D. MT~LlMITED International Medical Publishers Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England Published in the US by SPECTRUM PUBLICATIONS, INC. 175-20 Wexford Terrace Jamaica, N.Y. 11432 Copyright .'9 1982 Spectrum Publications, Inc. Softcover reprint of the hardcover 1st edition 1982 All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means without prior written permission of the copyright holder or his licensee. ISBN 978-94-011-9666-6 ISBN 978-94-011-9664-2 (eBook) DOl 10.1007/978-94-011-9664-2 Dedication To my teachers Richard Sewell & Gotthard Eberle ACKNOWLEDGEMENTS I wish to express my appreciation to Peter Jager, Ph.D., who offered direction and encouragement while much of this material was being gathered for inclusion in my doctoral dissertation. I am also indebted to Doctors Masters and Johnson, and to their publisher, Little, Brown & Co., as well as to Farrar, Straus & Giroux, Inc., for allowing certain copywritten material to be reprinted in this text. Takey Crist, M.D., Walker Kirker, M.D., and Jeanne Kirker, R.N., M. N ., generously provided me with previously unpublished clinical material, as did John Turner, M.A., who sketched the clinically descriptive illustrations. Connie Rhodes deserves particular acknowl edgment for having typed, retyped, and re-retyped the manuscript often working late into the evening and on weekends. Finally, I am grateful to Paul Williams, M.D., and Takey Crist, M.D., for their tutelage and friendship. September 1, 1980 Jacksonville, N.C. CONTENTS I. AN HISTORICAL REVIEW OF SEXUAL PATHOLOGY AND TREATMENT 1 The Story of Onan 1 The Thirteenth Century 1 The Nineteenth Century 2 The Twentieth Century 7 The Psychoanalysts 7 The Behaviorists 8 The new sex therapists 9 II. THE HUMAN FACTORS IN SEX THERAPY 11 The Therapist 11 Sexual comfort and discomfort 11 The Dysfunctional Patients 12 The focus of therapy 13 The Therapist /Patient Relationship 13 The clinical/therapeutic relationship 14 III. THE PSYCHOPHYSIOLOGY OF HUMAN SEXUAL RESPONSE 15 Sexual Psychophysiology 15 Theory 15 Research 15 Human Sexual Response: Classical Description 16 Excitement phase 16 Plateau phase 16 Orgasmic phase 16 Resolution phase 18 Sexual Response Pattern: Theoretical Alternatives 18 Biphasic sexual response 18 Triphasic sexual response 20 IV. SEXUAL FUNCTION AND DYSFUNCTION 21 Adequate and Inadequate Sexual Functioning 21 Sexual adeq uacy 21 Sexual inadequacy 22 Identification /Classification of Sexual Dysfunctions 22 Psychosexual Dysfunctions: Male 23 Impotence 23 Primary impotence 23 Secondary impotence 23 Premature ejaculation 23 Primary premature ejaculation 24 Secondary premature ejaculation 24 Retarded ejaculation 25 Primary and secondary retarded ejaculation 25 Psychosexual Dysfunctions: Female 25 Orgastic dysfunction 25 Primary orgastic dysfunction: Preorgasmia 26 Secondary orgastic dysfunction 26 Dyspareunia 26 Primary dyspareunia 26 Secondary dyspareunia 27 Vaginismus 27 Primary vaginismus 27 Secondary vaginismus 27 General sexual dysfunction 28 Primary general sexual dysfunction 28 Secondary general sexual dysfunction 28 V. PROCEDURAL OPTIONS FOR THE DIAGNOSIS AND TREATMENT OF SEXUAL DISORDERS 29 DIAGNOSIS 29 Differential Diagnosis 29 Diagnostic terminology 29 Diagnostic format 29 Diagnostic Procedures 30 The sexual history 30 The medical evaluation 31 The mental status evaluation 32 Diagnostic conclusions and implications for treatment 33 TREATMENT 34 Sex Education and Counseling 34 Sex education 34 The sexual information examination 35 Psychotherapy 38 Relationship counseling 39 Sex Therapy 39 The psychotherapeutic /experiental approach 39 The sensate focus, "pleasuring," exercise 40 Non-genital pleasuring 40 Genital pleasuring 40 Reactions 41 Rationale 41 Variations in the clinical application of therapeutic options 42 VI. THE APPLICATION OF PROCEDURAL OPTIONS FOR THE DIAGNOSIS AND TREATMENT OF SEXUAL DISORDERS 45 MALE SEXUAL DYSFUNCTIONS 45 Impotence 45 Diagnosis 45 Sexual history 45 Medical evaluation 47 Psychiatric /psychological evaluation 47 Diagnostic conclusions 48 Treatment: Sex Education and Counseling 48 Sex education 48 Sexual information examination 49 Psychotherapy 50 Relationship counseling 50 Treatment: Sex Therapy 51 Prohibitions and prescriptions 51 Sensate focus 51 Extravaginal ejaculation 52 Vaginal containment 52 Intravaginal ejaculation 52 Results of Treatment 52 Premature Ejaculation 53 Diagnosis 54 Sexual history 54 Medical evaluation 55 Psychiatric /psychological evaluation 55 Diagnostic conclusions 56 Treatment: Sex Education and Counseling 56 Sex education 56 Sexual information examination 56 Psychotherapy 56 Relationship counseling 56 Treatment: Sex Therapy 57 The start-stop technique 57 The squeeze technique 58 Results of Treatment 60 Retarded Ejaculation 60 Diagnosis 60 Sexual history 60 Medical evaluation 61 Psychiatric /psychological evaluation 62 Diagnostic conclusions 62 Treatment: Sex Education and Counseling 62 Sex education 62 Sexual information examination 62 Psychotherapy 63 Relationship counseling 63 Treatment: Sex Therapy 63 Prohibitions and prescriptions 63 Progressive desensitization and directed masturbation 64 Procedural variations 65 Results of Treatment 65 FEMALE SEXUAL DYSFUNCTIONS 65 Orgastic Dysfunction 65 Diagnosis 66 Sexual history 66 Medical evaluation 67 Psychiatric /psychological evaluation 68 Diagnostic conclusions 69 Treatment: Sex Education and Counseling 69 Sex education 69 Sexual information examination 70 Psychotherapy 70 Relationship counseling 70 Treatment: Sex Therapy 70 Prohibitions and prescriptions 71 Directed masturbation 71 Sensate focus exercise 71 Non-coital orgasm 71 Coital orgasm 72 Bridge maneuver 72 Results of treatment 72 Dyspareunia 73 Diagnosis 73 Sexual history 73 Medical evaluation 74 Psychiatric /psychological evaluation 74 Diagnostic conclusions 74 Treatment: Sex Education and Counseling 75 Sex education 75 Sexual information examination 75 Psychotherapy 76 Relationship counseling 76 Treatment: Sex Therapy 76 Prohibitions and prescriptions 76 Non-genital pleasuring 76 Genital pleasuring 77 Coitus 77 Results of treatment 77 Vaginismus 77 Diagnosis 78 Sexual history 78
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