There are many professionals trained to talk about sex and help people to explore and overcome sexual dysfunction. Psychosexual therapists in particular are very knowledgeable about a wide range of sex problems and have proven successful in helping individuals and couples of all ages, health and sexuality to realize their sexual needs and desires and work through any negative thoughts that may be affecting their ability to enjoy sex and sexual intimacy.
Psychosexual therapy may involve exploring family myths and cultural taboos that have impacted on the way someone associates with sex and sexual intimacy. Questions that may be asked are: “If sex was once enjoyable, what happened to change that?” and “What feels good and what feels disappointing?”. These encourage the re-examination of deep-set sexual assumptions and beliefs, and in a good therapeutic relationship between client and therapist, there will be the opportunity to find answers and develop a healthier relationship with sex and sexual intimacy. For example, generalized anxiety disorder, psychosis or depression may be the underlying cause. If there is a primary psychiatric problem, it is treated with psychotherapy and appropriate medications.
Sexual dysfunction caused by psychotropic medications has become an increasingly important clinical topic. Only recently have we acknowledged the extent to which many psychotropic medications, especially antidepressants and antipsychotics, cause sexual side effects. Prevalence rates of sexual side effects are extraordinarily difficult to estimate due to a variety of factors, such as the effect of the disorder being treated, comorbid disorders and baseline sexual dysfunction. Among the antidepressants, those with strong serotonergic properties have the highest rate of sexual side effects. Treatment approaches have been poorly developed for both antidepressants and antipsychotics. Antidotes for antidepressant-induced sexual dysfunction include bupropion, buspirone and sildenafil.
Manipal Fertility’s approach to Comprehensive Sexuality Education (CSE) seeks to equip couples with the knowledge, skills, attitudes and values they need to determine and enjoy their sexuality – physically and emotionally, individually and in relationships. We view ‘sexuality’ holistically and within the context of emotional and social development. Manipal Fertility recognizes that information alone is not enough. Couples need to be given the opportunity to acquire essential life skills and develop positive attitudes and values.
For some men, being stressed may just make you irritable, but for others, too much stress can cause sexual problems, such as erectile dysfunction. For these men, learning to relax and ease stress is all that may be needed to treat ED.
1.Jacobson’s relaxation technique, also known as progressive relaxation therapy, is a type of therapy that focuses on tightening and relaxing specific muscle groups in sequence. By concentrating on specific areas and tensing and then relaxing them, you can become more aware of your body and physical sensations. General instructions for Jacobson’s technique involve tightening one muscle group while keeping the rest of the body relaxed, and then releasing the tension.
2.Rhythmic breathing: If your breathing is short and hurried, slow it down by taking long, slow breaths. Inhale slowly then exhale slowly. Count slowly to five as you inhale, and then count slowly to five as you exhale. As you exhale slowly, pay attention to how your body naturally relaxes. Recognizing this change will help you to relax even more.
3.Deep breathing: Imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow exhalation, you should feel more relaxed.
4.Visualized breathing: Find a comfortable place where you can close your eyes and combine slowed breathing with your imagination. Picture relaxation entering your body and tension leaving your body. Breathe deeply, but in a natural rhythm. Visualize your breath coming into your nostrils, going into the lungs and expanding the chest and abdomen. Then, visualize your breath going out the same way. Continue breathing, but each time you inhale, imagine that you are breathing in more relaxation. Each time you exhale imagine that you are getting rid of a little more tension.
5.Progressive muscle relaxation: Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Quickly loosen up these areas. Let go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice (Stop any movements that cause pain). Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel relaxed.
6.Relax to music: Combine relaxation exercises with your favorite music in the background. Select the type of music that lifts your mood or that you find soothing or calming. Some people find it easier to relax while listening to specially designed relaxation audio tapes, which provide music and relaxation instructions.
7.Mental imagery relaxation: Mental imagery relaxation, or guided imagery, is a proven form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind — a “mental escape.” Identify self-talk, that is, what you say to yourself about any problems you have. It is important to identify negative self-talk and develop healthy, positive self-talk. By making affirmations, you can counteract negative thoughts and emotions. Here are some positive statements you can practice.
Masters and Johnson have developed a modification of this procedure in which the wife manually stimulates the penis until it becomes erect. She then squeezes the penis at the coronal ridge for three to four seconds, which causes the man to lose the urge to ejaculate and to lose 10-30% of his erection. The wife waits fifteen to thirty seconds, then repeats the procedure. After practicing for a few days, the couple repeats the procedure with intra-vaginal containment of the penis, but no thrusting, to produce stimulation. The next steps are intra-vaginal containment with slow movement, and then fast movement, using the squeeze as before. Counseling and techniques advocated by Master and Jonson are used to help the patient perform sexual activity in a non-demanding manner.
The aim of Sensate Focus is to build trust and intimacy within your relationship, helping you to give and receive pleasure. It emphasizes positive emotions, physical feelings and responses while reducing any negative reactions. The program can help overcome any fear of failure that may have existed previously, building a more satisfying sexual relationship in which both partners feel able to ask for what they want and are able to give and receive pleasure. Continuous reinforcement is needed to overcome negative reactions to intimacy. How long you spend on the program is up to you. Typically, sessions last twenty to sixty minutes, two to three times a week, spread over six or more weeks
To evaluate and compare the effectiveness and maintenance of two group interventions using orgasm consistency training in the treatment of female hypoactive sexual desire, 57 women were randomly assigned to a women-only group, a couples-only group, or a waiting list control group. Controlling for social desirability, subjects were assessed on six variables: sexual compatibility, sexual esteem, sexual desire, sexual fantasy, sexual assertiveness, and sexual satisfaction. Independent assessments were made on these variables before treatment, after treatment, and at 6 months follow-up. Although the treatment was found to be generally effective in women reporting hypoactive sexual desire, a consistent pattern of change favoring the couples-only group was evident on all measures. Possible explanations for the superiority of couples-only interventions are explored in the discussion.
Kegels are exercises you can do to strengthen your pelvic floor muscles – the muscles that support your urethra, bladder, uterus, and rectum. Strengthening your pelvic floor muscles may help prevent or treat urinary stress incontinence, a problem that affects up to 70 percent of women during or after pregnancy. Kegel exercises may also help reduce the risk of anal incontinence. Kegel’s improves circulation to your rectal and vaginal area, they may help keep hemorrhoids at bay and possibly speed healing after anepisiotomy or tear during childbirth. Finally, continuing to do Kegel exercises regularly after giving birth not only helps you maintain bladder control, it also improves the muscle tone of your vagina, making sex more enjoyable.
This method is based on exploring positive ways of viewing sex and sexuality to eliminate negative thoughts and attitudes about sex that interfere with sexual interest, pleasure, and performance. As positive sexual fantasies are associated with positive effects, general physiological arousal, and sexual arousal, cognitive behavior therapists encourage their use by asking the patient to deliberately identify arousing sexual fantasies.
Interpersonal psychotherapy is a short-term therapy lasting about 12 to 16 sessions, in which a client focuses on current interpersonal difficulties in their sexual life. Therapists using this approach focus on the connections between current life events and the onset and persistence of depressive symptoms. Specific problem areas in the patient’s life are identified, and the patient and therapist explore how they relate to the illness. By resolving interpersonal problems in their life, the patient improves their sexual life.
The efficiency of directed masturbation as an adjunct to the treatment of primary orgasmic dysfunction was evaluated. The directed masturbation procedure consists of a gradual series of assignments that are to be practiced by the patient. The test of the effectiveness of directed masturbation is conducted with couples who have not benefited from a sexual treatment program modeled after that of Masters and Johnson. The results have indicated that directed masturbation holds promise as an effective adjunct to sexual counseling.
Studies suggest a complex relationship between cognitive-behavioral therapy (CBT) and pharmacotherapy for the combined treatment of sexual disorders. Combined treatment should not be considered the default treatment for sexual disorders. Instead, decisions whether combined treatment is worth the added cost and effort should be made in relation to the disorder under treatment, the level of severity or chronicity, and the stage of treatment.
Pre-IVF and Pre-IUI counselling is essential to couples going for the IVF and IUI programme. Pre-IVF and Pre-IUI counselling can be done at our clinic prior to starting the programme. Psychological counselling is offered to all couples considering an IVF and IUI programme, as there are many important issues to be considered in the psychological welfare of the couple during what can be an extremely emotional and stressful time in their lives.
Post IUI and IVF grief counselling is given to patients with failed treatments. This is essential to maintain their confidence and restore hope for second opinion option
Supportive Psychotherapy is a form of psychotherapy that concentrates on creating an effective means of communication with an emotionally disturbed person rather than on trying to produce psychological insight into the underlying conflicts. Through such supportive measures as reassurance, reinforcement of the person’s defenses, direction, suggestion and persuasion, the therapist participates directly in the solution of specific problems.
Psychoeducation refers to the education offered to individuals with a mental health condition and their families to help empower them and deal with their condition in an optimal way. 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 and in doing so, possibly help them in regaining an active sex life.
An addiction to masturbation and sex can be both physically and emotionally harmful to a person and their loved ones. Due to the amount of time and energy spent on masturbation and sex, genital injury is common. Additionally, an addiction to masturbation and sex can make intimate relationships difficult and hinder people from seeking out intimacy. Masturbation and sex addiction is a real problem regardless of morality. There are certainly many points of view regarding the morality or acceptability of masturbation. A professional sex therapist does not impose morality in the treatment of masturbation and sex addiction. It is the role of the therapist to honor a client’s personal morality while working with the client to reduce shame and explore healthy sexuality. For a masturbation and sex addict, a period of abstinence is
recommended under the supervision of a trained therapist.
In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, especially in sexual offenders. Cyproterone Acetate (CPA) and Medroxyprogesterone Acetate (MPA) are commonly used but can have serious side effects. Selective Serotonin Reuptake Inhibitors (SSRIs) may also be effective in less severe cases. Recent research shows that Luteinizing Hormone-Releasing Hormone (LHRH) agonists may offer a new treatment option for treatment of paraphilic patients.
Study reveals that many substances like alcohol, cannabis etc. on a long term basis cause sexual dysfunction. There are effective therapies and both psychological and pharmacological interventions are helpful in achieving remission and attaining good sexual health. Drugs will be used for the treatment of this condition along with counselling. It has been found that only a very minute number of patients with this condition can be treated by using counselling alone. Therefore, psychotherapeutic techniques will always be used as an adjunct to medications during the treatment procedure.
Sildenafil is a nitric oxide enhancer that facilitates the inflow of blood to the penis necessary for an erection. The drug takes effect about 1 hour after ingestion, and its effect can last up to 4 hours. Sildenafil is not effective in the absence of sexual stimulation. The most common adverse events associated with its use are headaches, flushing, and dyspepsia. Sildenafil is not effective in all cases of erectile dysfunction. It fails to produce an erection rigid enough for penetration in about 50 percent of men.
Sildenafil use in women results in vaginal lubrication, but not in increased desire. Anecdotal reports, however, describe individual women who have experienced intensified excitement with sildenafil.
Tadalafil and udalafil are the drugs which act in aoral phentolamine and apomorphine are not US Food and Drug Administration (FDA) approved at present, but have proved effective as potency enhancers in men with minimal erectile dysfunction. Phentolamine reduces sympathetic tone and relaxes corporeal smooth muscle. Adverse events include hypotension, tachycardia, and dizziness. Apomorphine effects are mediated by the autonomic nervous system and result in vasodilatation that facilitates the inflow of blood to the penis. Adverse events include nausea and sweating.
Injectable and transurethral alprostadil act locally on the penis and can produce erections in the absence of sexual stimulation. Alprostadil contains a naturally occurring form of prostaglandin E, a vasodilating agent. Alprostadil may be administered by direct injection into the corpora cavernosa or by intraurethral insertion of a pellet through a canula. The firm erection produced within 2 to 3 minutes after administration of the drug may last as long as 1 hour. Infrequent and reversible adverse effects of injections include penile bruising and changes in liver function test results. Possible hazardous sequelae exist, including priapism and sclerosis of the small veins of the penis. Users of transurethral alprostadil sometimes complain of burning sensations in the penis.
Intravenous methohexital sodium has been used in desensitization therapy. Anti-anxiety agents may have some application in tense patients, although these drugs can also interfere with the sexual response. The side effects of antidepressants, in particular the SSRIs and tricyclic drugs, have been used to prolong the sexual response in patients with premature ejaculation.
Bromocriptine is used in the treatment of hyperprolactinemia, which is frequently associated with hypogonadism. Dopaminergic agents have been reported to increase libido and improve sex function. These drugs include L-dopa, a dopamine precursor, and bromocriptine, a dopamine agonist. The antidepressant bupropion has dopaminergic effects and has increased sex drive in some patients. Selegiline, an MAOI, is selective for MAOB and is dopaminergic. It improves sexual functioning in older persons.
Androgens increase the sex drive in women and in men with low testosterone concentrations. Women may experience virilizing effects, some of which are irreversible (e.g., deepening of the voice). In men, prolonged use of androgens produces hypertension and prostatic enlargement. Testosterone is most effective when given parenterally; however, effective oral and transdermal preparations are available.
Women who use estrogens for replacement therapy or for contraception may report decreased libido. In such cases, a combined preparation of estrogen and testosterone has been used effectively. Estrogen itself prevents thinning of the vaginal mucous membrane and facilitates lubrication. Two new forms of estrogen, vaginal rings and vaginal tablets, provide alternate administration routes to treat women with arousal problems or genital atrophy. Because tablets and rings do not significantly increase circulating estrogen levels, these devices may be considered for patients with breast cancer with arousal problems.
In male patients with arteriosclerosis (especially of the distal aorta, known as Leriche’s syndrome), the erection may be lost during active pelvic thrusting. The need for increased blood in the gluteal muscles and others served by the ilial or hypogastric arteries takes blood away (steals) from the pudendal artery and, thus, interferes with penile blood flow. Relief may be obtained by decreasing pelvic thrusting, which is also aided by the woman’s superior coital position.
Vacuum pumps are mechanical devices that patients without vascular disease can use to obtain erections. The blood drawn into the penis following the creation of the vacuum is kept there by a ring placed around the base of the penis. This device has no adverse effects, but it is cumbersome, and partners must be willing to accept its use. Some women complain that the penis is redder and cooler than when erection is produced by natural circumstances, and they find the process and the result objectionable.
Surgical treatment is infrequently advocated, but penile prosthetic devices are available for men with inadequate erectile responses who are resistant to other treatment methods or who have medically caused deficiencies. The two main types of prosthesis are (1) a semi-rigid rod prosthesis that produces a permanent erection that can be positioned close to the body for concealment and (2) an inflatable type that is implanted with its own reservoir and pump for inflation and deflation. The latter type is designed to mimic normal physiological functioning.
The first step in sex therapy is evaluating and assessing the presenting problem or problems. A sexual history is taken which asks the patient to describe his/her sexual experiences. If it is a couple, each partner’s sexual history is taken. (Any information you give or conversation you have with your sex therapist will remain strictly confidential).The therapist carefully analyses the medical and historical data, together with any issues or related circumstances described by the you to identify all the strands that weave into the current condition. This evaluation results in a diagnosis and detailed treatment plan. The treatment will vary depending on the issue, but it usually involves special exercises for each individual or couple. Sex therapy is not “just talking.” Each week the therapist will suggest new experiences for the individual or couple to try in the privacy of their home. These at-home exercises are designed to take the pressure and worry out of sex. In subsequent sessions, the at-home exercises are discussed and any difficulties are explored. The exercises help the individual or couple “re-learn” more satisfying sexual behaviour. The therapist functions as a sex educator, providing accurate information about anatomy, physical response that is specific to the client’s sexual concern. The clients may be suggested books to read or educational videos to watch.