Since their work in the late 1960s, continued medical research and improved diagnostic techniques indicate that only 40% to 50% of male impotence is caused solely by psychogenic factors.

In males, orgasmic dysfunction includes both premature and retarded ejaculation (in which ejaculation may be completely absent despite stimulation and arousal). Retarded ejaculation may have psychogenic as well as organic causes, or may be a consequence of drug abuse or a side effect of a medication.

Sex Therapy for Premature Ejaculation
Unlike retarded ejaculation, which is rare, premature ejaculation is fairly common. Therapy involves anxiety reduction and ejaculation control training. One approach to help with ejaculatory control is called the Valsalva Maneuver.

Using this procedure, when a man senses he is about to ejaculate, he holds his breath and flexes his muscles as if he is having a bowl movement. Performed correctly, this procedure enables the man to delay ejaculation and allows him to feel in more control of his body. The Valsalva Maneuver is best tried in the context of a therapy which can also address the male or couple's anxieties about the experience.

Sex Therapy for Inhibited Female Orgasm
This fairly common problem is often caused by emotional or relationship problems. Sex therapy for this problem addresses underlying misinformation, psychological inhibitions, conflicting beliefs and values about women's right to sexual pleasure, and related issues.

Partners counseling may be effective in addressing communication, control, and sensitivity issues, while couples sexual training can address sexual interaction issues. Couples may be provided with instruction on alternative sexual arousal and satisfaction behaviors such as the Sensate Focus Technique, given home assignments to practice the new strategies, and prompted to report outcomes to their therapist. Sometimes groups of couples with similar problems are brought together to provide support for open communication and behavioral change.

The organization of sex therapy varies. In some cases, a single therapist sees both partners. In heterosexual partnerships, a therapeutic team consisting of a male and a female therapist working together may be used. Alternately, some therapists emphasize self-treatment based on instruction, brief counseling, and the use of education aids like films and tapes.

Sex therapy, like any other therapeutic process, should begin with a thorough history of the patient's problem(s). Due to the possibility of both biogenic and psychogenic factors in male impotence, a consultation with a urologist specializing in impotence is often recommended to identify and treat any biogenic factors before proceeding with psychotherapy.

Copyright 2002 Sinclair Intimacy Institute