Sex therapy

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Sex therapy is intended to help with difficulties with sex life or with disease-related disorders that manifest themselves in sexual behavior and / or sexual experience, for example when there is a decrease in sexual desire ( sexual appetite in an appetite disorder ).

The term

Sex therapy has established itself as a term in scientific discourse as well as in colloquial language and the media. However, as early as 1980 the sexologist Volkmar Sigusch spoke out against the use of this term. He considers it to be scientifically nonsensical, since "the disorders of love and sex life do not differ from other psychosocial diseases in humans either in terms of disease theory or treatment technology". Sigusch could not assert himself with this position.

Classification of sexual disorders

Sexual problems can also be a symptom of a physical or mental illness , as well as the result of (social) conflicts and destructive relationship dynamics. Depending on their genesis , their treatment falls into the field of psychotherapy or counseling psychology .

Sexual disorder describes expressions of sexual behavior or sexual experience that are perceived as a "disorder" by the person concerned. It is possible that such a disorder cannot be recognized as such because the person concerned is not aware of the possible quality of sexual development. In addition, z. For example, a state of suffering due to the lack of a partner can be perceived as a disorder, whereas a conscious renunciation of a partner is not regarded as a disorder. Insofar as the person concerned does not perceive their sexual inclinations or the resulting behavior as a disorder, but partners or society assess these preferences differently, this conflict can be perceived as a disorder. The above points make it difficult to describe the spread of sexual disorders.

Many sexual disorders can also be found in the ICD10.

distribution

Dissatisfaction with one's own sex life is widespread. In a US study, 43% of women and 35% of men said they had sexual disorders. Male erectile dysfunction of various origins, orgasm disorders and appetite disorders are particularly common . The area of paraphilias is less common, but often all the more dramatic for those affected .

causes

Hypothalamus and Limbic System

The causes of sexual problems can be many. Basically, at least six levels of causes can be distinguished:

There are usually several causes involved in the development of a sexual disorder, all of which act through the hypothalamus and the limbic system ("Sex originates in the brain"). Depending on the level at which the disorder is mainly caused, a different therapy is required.

examination

other influences:
worry, stress
developmental
disorder gender identity
substance abuse
physical illness
mental illness

Diagnostic questions:
beginning
course
persistence
extent
sex-practice-dependent
partner -dependent
situation -dependent

Careful examination and diagnosis are therefore important . This is carried out by a sex therapist, usually in one or more sessions with the person concerned, possibly with the involvement of the partner.

An investigation includes:

  • Sexual history (history and experiences of one's own sexual development)
  • Family history (relationship with father and mother and with siblings, relationship between parents, role models, values ​​and norms, dealing with fear and guilt, formative experiences)
  • Current relationship (getting to know each other, further course, current status)
  • Current sex life (lust, arousal, contact, orgasm)

If a sexual problem is based on a mental illness, this must first be treated medically and / or psychotherapeutically before the sexual disorder can be treated. Therefore, diseases such as B. Depression , psychosis , anxiety disorders , personality disorders , addictions , etc. Here, as part of the treatment of the underlying disease, sexual problems can also be discussed.

Occasions for advice

Phases in sex

  • Lust
  • excitement
  • Climax
  • Relaxation

The above-mentioned complex causes of sexual disorders lead to different occasions for advice and it is often not easy to draw conclusions from a specific symptom picture about the underlying cause. Research into the causes in the field of sex therapy is therefore usually complex.

Missing partnership

Due to the changes in work and residence that are necessary today, it is increasingly difficult to maintain long-term relationships. The proportion of those living alone ( single ), the changing partnerships and the composite families (" stepfamilies ") is steadily increasing. Partnerships end more quickly, periods of partnerlessness last longer. At the same time, there is a longing for a fulfilling relationship. The ability to quickly and successfully search for new partners, to find them, to win them over and then to keep them, is not available to the necessary extent.

listlessness

Listlessness, also known as an appetite disorder , is one of the most common issues in sex therapy. Studies have also confirmed that sexual desire generally decreases, especially in longer relationships.

Only a few couples speak openly and freely about their own sexual desires and about mutual fulfillment - not even in so-called normal relationships. This makes sex life far less fulfilling than it could be. Often there are also fears and insecurities, and there are many mutual injuries that are also not discussed. This leads to listlessness (loss of libido ) to aversion - and this to additional frustration.

Listlessness can also be an expression of averted needs, which the person concerned condemns in himself or in his partner. Listlessness can also be just a pretext, out of shame or fear of failure. Listlessness can also be an expression of a couple conflict, which is about power, or about experienced hurt, or because the other does not (any longer) meet one's own expectations. Listlessness can also be an expression of a deeper fear of old, repressed unpleasant experiences and the painful feelings associated with them. This can also be increasingly expressed as shame, aversion, disgust, or particular prudery. Or conversely, that one partner behaves in a particularly demanding manner, knowing that the restraint of the other does not lead to mutual sexual action.

impotence

In men, with impotence, the penis becomes insufficiently or not at all stiff or relaxes too early ( erectile dysfunction ). In women, the vagina does not become moist or is insufficiently moist. Sometimes a sophisticated avoidance behavior towards sexual situations develops into a pronounced phobia . In women, this occurs more often during pregnancy (breaking out of old conflicts with their own mother), in conjunction with raising children (conflict between the role of mother and lover) and during menopause (hormonal changes). Since the woman "can anyway", she is often not noticed by the man in her suffering and does not take herself seriously; sometimes only when the vagina contracts spasmodically and prevents penetration. Both of them are usually based on an old injury (abuse or early childhood disorder). In the case of impotence, it can be helpful not to consciously strive for sexual intercourse, but to devote yourself to various forms of petting .

Orgasm disorder

The man has an early ejaculation or no ejaculation at all . Or he may ejaculate but feel little or nothing about it. The woman does not have an orgasm even with soulful, intense caressing . This is often associated with a deep fear of the opposite sex or a fundamental fear of losing control - and, according to some of the views, ultimately the fear of death.

Physical and medical disorders

Alcohol prevents sex (negative effects from 0.4 ‰), as does fatigue and stress. Drugs and many medications (50% of all long-term therapies for psychotropic drugs) lead to sexual disorders. 56% of smokers suffer from sexual disorders. With high blood pressure, 17% of untreated and 25% of treated men suffer from erectile dysfunction. Vascular calcification ( arteriosclerosis ). 5% of the disorders are hormonal disorders ( testosterone deficiency ). 90% of MS patients suffer from impotence. Many disorders are the result of genital surgery ( prostate ). Physical disabilities can make normal sex life difficult.

Unfulfilled desire to have children

Some sexual disorders lead to decreased fertility in men and / or decreased fertility in women. For couples who want to have children, this is a great need. For treatment see also: Infertility .

More sexual disorders

To be mentioned here are u. a. Disorders of gender identity (people who do not perceive their physical-biological gender as their psychological-social gender), if they are experienced as a disorder by the person concerned, disturbing otherness (have a tendency that the person concerned does not want), sex addiction, as well as sexual Criminal offenses (abuse, harassment, coercion).

Paraphilias (“perversions”), such as exhibitionism , fetishism , transfetishism , voyeurism , frotteurism , sadomasochism , sodomy , erotophony, are of particular importance for sex therapy, assuming the level of suffering . Decisive for the assessment are the specific characteristics of the behavior, the sufferer's own suffering, the possible danger to third parties and the possibility of sexual addiction (strength of impulse control ). In the case of pedophile tendencies as well as paraphilias with the risk of harming third parties, medical-psychotherapeutic sex therapy from a specialized sex therapist is imperative.

therapy

Sex therapists sometimes work in private practice, but often also in a sex therapy outpatient clinic or counseling center. There are medicinal and non- medicinal therapy methods . Which approach is specifically chosen depends on the type and scope of the question.

In the case of severe disorders with a disease value, psychotherapy or treatment by a specialist in psychiatry is indicated. Classical psychotherapy can be necessary for various indications. For example, for the treatment of early childhood disorders, when the person affected did not experience enough attention and closeness as a small child or was traumatized at this age. In case of deep injuries, e.g. B. through sexual abuse , before the traumatic experience can be worked on, the necessary inner distance and inner strength must be built up. Frequently used procedures recognized by health insurers are behavior therapy , talk therapy , psychoanalysis and depth psychology .

As part of sex therapy, it is often necessary that the functional disorder of sexual behavior is approached in a practical manner. The pioneers here were the sex therapists Masters and Johnson . They developed practical exercises in the 1960s and worked directly on the sexual behavior of the person concerned. The method developed by Masters and Johnson is known as sensate focus or sensate focusing . In the German-speaking world, this sex therapy program is also known as "sensuality training". Here called sensate focus less a method, but rather an exercise program that is designed to overcome gradually limiting fears and achieve relaxation in the sexual encounter.

Such behavior-oriented and couple-oriented exercises are now part of every good sex therapy. During the exercises, the client's partner (or alternatively, however, controversially, surrogate partner ) is used as an auxiliary therapist. It is about basic knowledge about the body and sexual energy, about your own perception of yourself and about your own pleasure, which often has to be rediscovered. It is also about the perception of the partner and his or her desire, the expression of wishes and feelings and the common conversation, the experience and exercise of breath, touch, massage, arousal and experiencing the climax.

Systemic couples therapy works on the couple's relationship. Sexual dysfunction can be a direct result of couple conflicts. In any case, they have a direct impact on the couple relationship. This creates a dense network of interactions that can build up each other and must be disentangled again during therapy. In between sessions, couples are given homework to practice what they have learned and gain new experiences.

Occasionally, integrative approaches are also practiced, in which analytical, systemic, behavioral and cathartic methods are combined and the sexual partners are included in the therapy, often supplemented by self-experience in neotantric and therapeutic groups. The combination of hypnotizing processes with humanistic psychodrama ( Hans-Werner Gessmann 1976) is an option.

There are also opportunities for self-help to improve sexual life in everyday life. The best known are: conversation training ( Michael Lukas Moeller ), partnership seminars , tantra seminars (which, strictly speaking, are not about tantra , but neo-tantra ), massage workshops or simply a more varied program ( erotic massage ( yoni massage ), pampering and desire Days, telling and implementing fantasies, erotic films, role-playing games, unusual places and much more).

In urology , sexual disorders are usually viewed as a "functional disorder". Urologists specialize in surgical, drug and hormone treatment (e.g. prostate surgery , sildenafil treatment , testosterone treatment ). Sex therapy is rarely part of the urologist's offer.

In traditional Chinese medicine , according to the five-element theory, sexual disorders are viewed as a result of “weak kidney yang” combined with “liver qi syndrome” (like depression) and treated with appropriate acupuncture and dietary prescriptions (zinc deficiency = Testosterone deficiency).

Lack of sex therapists

There are far too few sex therapists in Germany. In primary care, patients are rarely asked about their sex life (11%) and only 2–5% of those affected seek help on their own initiative. Questions of sexual health are also often neglected in psychotherapeutic training and practice.

literature

Specialist literature

Trade journals

media

Web links

Individual evidence

  1. ↑ Jörg-Steffen Schötensack, Helen Singer Kaplan: Sex therapy for disorders of sexual desire . Georg Thieme Verlag, 2006, ISBN 978-3-13-156852-6 ( limited preview in the Google book search).
  2. ↑ Volkmar Sigusch (ed.): Therapy of sexual disorders . 2nd Edition. Thieme, Stuttgart / New York 1980, ISBN 978-3-13-517502-7 , pp. 9 .
  3. ↑ NHSLS study, Laumann et al., 1994
  4. ↑ a b K. M. Beier, U. Hartmann, HAG Bosinski: Needs analysis for sexual medical care . In: Sexuologie , 7 (2), 2000, pp. 63-95.
  5. ↑ EJ Häberle: The sexuality of humans: manual and atlas. Walter de Gruyter, Berlin / New York 1983.
  6. ^ GC Davison, JM Neale: Clinical Psychology. Psychologie Verlag Union, 1988.
  7. ↑ Jürgen Margraf (ed.): Textbook of behavior therapy . Volume 2: Disorders . Springer-Verlag, 1996.
  8. ↑ G. Kockot, EM. Fahrner: Sexual disorders in men . Hogrefe Verlag for Psychology, 2000.
  9. ↑ Theo R. Payk: psychopathology . 3. Edition. 2010.
  10. ↑ Volkmar Sigusch: Couples therapy for sexual dysfunction. (PDF; 95 kB)
  11. ↑ Linda Weiner, Constance Avery-Clark: Sensate Focus: Clarifying the Masters and Johnson's model . In: Sexual and Relationship Therapy . tape 29 , no. 3 . New York 2014.
  12. ↑ JL Moreno, James M. Enneis: Introduction into Hypnodrama . In: Hypnodrama . Beacon House Publisher, Psychodrama Monographs No. 27, 1950, p. 6 ff.