Sex and Sexuality: The Good, the Bad, and the Ugly. a Sex Therapist’s Perspective

Contents
Prologue: An Introduction and Sneak Peek into What to Expect
An Important Point
Chapter 1
Religion, Culture, and the Evolution of Sexuality
Religion’s View of Sexuality
Judaism
Christianity
Islam
Hinduism
Buddhism
A Brief Cultural Overview of Sexuality
Latin America
Russia and Japan
Russia
Japan
Sexual Behaviors
Sexual Techniques
Sexuality in Different Societies
Masturbation
Pre and Extra Marital Sex
Attitudes toward Homosexual Sex
Disease
Sex and Violence
The Evolution of Sexual Reproduction
Sexual Differences
Sexual Selection
Mating Strategies
Cultural Influences on Human Sexual Behavior
How Does Culture Influence Sexuality and Intimacy?
Contexts of Sexuality
Non-Relationship Sexual Pleasure
The Pleasure Theme of Sexuality in the Last 60 Years
Sexuality in the 21st Century
Sexual Freedom and Problems
Sex and the Media
References
Chapter 2
How Is Research in Human Sexuality Conducted?
Sex Research in North America: Let’s Take a Brief Tour Along the Centuries
What Changed Since Those Early Days?
Sex Research in America at Present
Some Examples of Sex Surveys
The Stigma of Sexual Research; Yes, It Does Exist
What Are the Implication of Sex Research to Participants and Researchers?
Doing Sexuality Research with Children
Research on Alcohol and Sexuality: Issues and Approaches
Challenges Related to Sex Research
References
Chapter 3
How Do We Respond to Sexual Stimulation?
Female Genitals
The Clitoris: Anatomical and Psychological Issues
Why Was the Clitoris Treated the Way It Was?
Male Genitals
The Intricacy of Human Sexual Response Cycle
What if Emotional and Physical Satisfaction Do Not Happen?
The Masters and Johnson’s Model of Sexual Response
Helen Singer Kaplan’s Model
Sex Differences in Sexual Response
Is There Proof for the G-Spot?
How Do Our Genitals Respond during Sexual Activity?
Males’ Genital Response
Penile Erection
Genital Response in Women
Vaginal Response
Vaginal Stimulation Can Cause an Analgesic Effect
Orgasm
Gender Differences in Orgasms
Male’s Responses during Orgasm
Female Orgasmic Responses
How Does Orgasm Actually Feel?
Sexual Arousal in Women: Clitoris and Orgasm
The Psychological Components of the Orgasmic Experience
What Are the Orgasm’s Functions?
Females
How Can Women’s Pleasure Be Enhanced?
The Orgasm Gap, and How to Address It
The Refractory Period
Female Ejaculation
How Do We Respond to Sexual Stimuli?
How Do Hormones Play during Sex?
Taking One More Look at Women’s Sexual Response
Do Men and Women Experience Intercourse Differently?
What Is Sexual Arousal?
Sexual Arousal and Emotion
Sexual Arousal and Genital Feedback
Sexual Arousal and Desire
The Way People Define Sexual Desire and Sexual Arousal
How Experts Define Sexual Desire and Arousal
Women’s Sexual Desire
What to Do When Each Partner Has a Different Level of Sexual Desire?
Gender Differences
References
Chapter 4
Our Sexual Behaviors, and How They Are Formed
We All Want a Fulfilling Sexual Relationship
Do Men and Women Differ in Their Sexual Behavior?
Women’s Genital Touching
Recent Data on Americans’ Sexual Behavior
Sexuality and Culture
The Influence of Culture on Sexual Behavior
The Effect of Culture on Love, Sex and Intimacy
Gender and Sexual Behavior
What Is Responsible for Those Gender Differences?
Sexual Expression
How We Feel and How It Affects Our Sexual Activity
Solitary Sexual Behaviors
Asexuals
Sex Toys
Partnered Sexual Behaviors
Myths about Men’s Sexuality and How They Affect Their Behavior
Sexuality in Later Life: Do the Elderly Have Sex?
Sexual Behavior
Health and Sexual Activity
Physical Health and Sexual Activity
Does Mental Health Affect Our Sexuality?
The Effect of Medications on Sexual Behavior
Sexual Desire
Sexual Dysfunctions
Human Mating and Sexual Selection
Sexual Selection in Humans
Sexual Fantasies and Their Function
What Is the Function of Sexual Fantasies?
Sexual Fantasies from an Attachment Theory’s View
Attachment Orientation and Its Relation to Sexual Interactions
Sexual Fantasies
Deviant Sexual Fantasy in Adult Males
Sex in the 21st Century
Internet and Sexuality: How Are They Connected?
Pornography on the Internet
What Are the Effects of Online Pornography?
Online Use for Offline Sex: Advantages and Disadvantages
Hooking Up
Why, We May Wonder, Has Hooking Up Become the Norm on College Campuses?
Sexting and Sextortion
References
Chapter 5
Belonging, Love and Intimacy
Longing to Belong
Why Do We, Actually, Yearn so Much to Belong?
Love, Attraction, and Intimate Relationships
Philosophers’ View of Love
How Does Love Affect Us?
How Was Love Seen in Ancient Times?
Love and Attachment
The Nature of Love
Love as a Tool to Enhance Commitment
Love Is Found All Over the World
Love in Various Cultures
How Do Men and Women Differ in Love?
The Way We Select a Mate
Mating Strategies
What Is, Intimacy, Actually?
The Effects of Intimacy on Our Health
What Is the Meaning of Passion?
Romantic Passion
Attachment and Romantic Passion
How Do We Keep Sexual Passion Alive?
Affection Following Sexual Activity
The Effect of the Internet on Romantic Relationships
What Contributes to Sexual Satisfaction?
Evaluating Marital Success
Characteristics of a Successful Marriage
Differences in Love and Relationships between Men and Women
Love as a Basis for Marriage
Romantic Attitudes
‘Cracks’ in the Couple’s Bliss
Love and Loneliness Are Not Supposed to Go Together
The Wear and Tear of Love
Personal
Situational
What’s in Marital Satisfaction and Dissatisfaction
Marriage, Divorce, and Their Effects on the Immune System
The Influence of Intimacy on Heart Disease
The Psychosocial Risk Factors for CHD
How Do Personality, Social Environment, and Emotional Adjustment Affect CHD?
Designing Living Quarters to Create a Relatedness Experience
References
Chapter 6
Communicating about Sex
The Essence of Intimate Communication
Communication and Relationships, in General
Sexual Communication
The Function of Sexual Communication
What Are Sexual and Relational Satisfaction?
Gender Difference in Couple’s Communication
How Do We Talk Effectively About Sexuality?
Sexual Communication
Sexual Communication
Improving Our Sexual Communication
The Effects of Affectionate Communication
Sexual Satisfaction and Intimate Behaviors in the Relationship
Sexual Communication with Parents and Friends, and Well-Being
Sexual Behavior and Communication
Pain and the Effect of Communication
Sexual Communication and Sex Toys Parties
References
Chapter 7
Sexual Orientation: Whom Do We Prefer as a Sexual Partner?
What Is Sexual Orientation?
Asexuality: Not Desiring Sex
Characteristics of Sexual Orientation
Bisexuality
Homosexuality
What Contributes to Becoming Gay or Heterosexual?
Homosexuality: A Drive Down Historical Memory Lane
The Shades of Sexual Orientation
Religion and Homosexuality: Do They Go Together?
Sexual Orientation and Neural Correlates
Unraveling Sexual Identity
Occurrence of Non Heterosexual Orientation
Men’s and Women’s Sexual Orientation
The Historical Stigma Related to Sexual Orientation
Stigma Associated with an LGB Orientation
What Is Sexual Fluidity?
Do Facial Features Differentiate between Heterosexuals and Homosexuals?
The Beginning of Sexual Attraction
Consequences of Sexual Orientation
Sexual Orientation and Well-Being
Gender Nonconformity and Well-Being
Sexual Orientation Cross-Culturally
Sexual Orientation: How Does It Start?
Is It, at All, Relevant That We Know What Causes a Specific Sexual Orientation?
OK, So Can Sexual Orientation Be Changed?
The Treatment of Non-Heterosexuals throughout History
Is There Anything That Can Be Helpful in Sexual Reorientation?
How Does Sexual Orientation Affect Mate Preferences?
References
Chapter 8
Can Psychological and Medical Conditions Affect Sexuality?
Men’s Medical Conditions That May Negatively Affect His Sexuality
Andrology
Cancer
Psychological Factors Involved in Breast Cancer
Social Factors Related to Breast Cancer
The Impact of Gynecological Surgeries
Gynecological Malignancy
Physical Impact of Vulval Carcinoma
Psychological Effects of Vulval Carcinoma
The Impact of Vulval Carcinoma on Sexual Function
A Treatment Approach
Prostate Cancer
Effects of Prostate Cancer
Sexual Rehabilitation
Cancer and Sexuality in Adolescents and Young Adults
Can Sex Cause Cancer?!
Sexual Behaviors
Counseling Patients with HPV-OSCC
Can HPV – OSCC Be Prevented?
Sexuality as Practiced by Those with Congenital Disability
Sexuality and Obesity
Obesity and Concurrent Illnesses
Mental Health and Psychological Disorders
Depression
Anxiety
Sexual Dysfunction in Patients with Eating Disorders
Schizophrenia
Treating Sexual Dysfunctions That Were Induced by Antipsychotic Medication
General Medical Conditions
Diabetes Mellitus
Cardiovascular Disease
Hypertension
Neurology
A General Review
Epilepsy
Multiple Sclerosis (MS)
Prevalence of Sexual Dysfunctions among People with MS
Depression and MS
Parkinson’s Disease (PD)
Sexual Dysfunction in Parkinson’s Disease (PD)
PD, Sexuality and Intimate Relationships
Parkinson’s and Paraphilia (Sexual Aversion)
Effects of Surgery and Pharmacotherapy on Sexual Functioning of People with PD
The Effect of Spinal Cord Injury (SCI) on Sexuality and Intimacy
Sexual Stigmatization
Spinal Cord Injury as a Barrier to Sexual Satisfaction
What about the Injured Men’s Partner?
SCI Cross-Culturally
The Impact of Dementia on Intimacy and Sexuality
References
Chapter 9
The ‘Bad’: When Things Don’t Go the Way They Should
How Common Are Sexual Problems?
What Are Sexual Disorders?
Incidence of Sexual Dysfunctions
Prevalence
Risk Factors for Sexual Dysfunctions
In General, What Causes Sexual Dysfunctions?
Taking a Closer Look at Causes of Sexual Dysfunctions
Intrapsychic Factors
Interpersonal and Relational Factors
Cultural Psychosocial Factors
Organic Factors Causing Sexual Problems
Central Nervous System Neurological Disorders
Sexual Difficulties Caused by Drugs
Sexual Problems May Be Caused by Sex Which Is Not Satisfying
Sexual Dysfunctions in Men and Women
Sexual Desire Disorders
Erectile Dysfunction
Orgasmic Disorders
Sexual Dysfunctions Which Are Painful
Female Sexual Dysfunctions
Models of Female Sexual Response Cycle
Sexual Dysfunctions Defined
Sexual Function/Response
Medical Conditions and Sexual Function and Dysfunction
Some Comments about the Treatment of Female Sexual Dysfunction
Causes of Sexual Desire Disorders in Women
The Impact of Life and Relationship on Female Sexual Functioning
Females’ Orgasmic Disorders
Causes of Anorgasmia
Neurophysiological Factors in Orgasm
Psychosocial Factors
Not Interested in Sex: Female Hypoactive Sexual Disorder (HSDD)
The Characteristics and Prevalence of HSDD
Vulvodynia and Its Effect on Intimate Relations
What Triggers PGAD?
The Disturbing Effects of Childhood Sexual Abuse
CSA and Its Effect on Sexual Functioning
The Effect on Women
The Effect on Men
A Look at CSA and Sexual Dysfunctions
Men’s Sexual Problems
Sexually Dysfunctional Men and Their Approach to Sex
Diminished Ejaculatory Problems
Hypoactive Sexual Desire in Men
Physiology of Hypoactive Sexual Desire
Treatment of Hypoactive Disorder in Men
Rapid, or Premature Ejaculation (PE)
What Is Premature Ejaculation (PE)?
How Common Is PE?
The Causes of Premature Ejaculation
Psychological Theories about What Causes PE
The Effect That PE Has on the Man and on His Partner
Delayed Ejaculation
Causes of DE
Men’s Sexual Dysfunction and Health
How Is Sexual Dysfunction Related to Psychological Health?
Sexuality of the Aging Man
Difficulties in Getting and Maintaining Erection in Older Age
Prevalence of ED in Older Age
Sexual Desire and Aging
Orgasmic and Ejaculatory Dysfunction in the Elderly
Erectile Dysfunction (ED) of the Elderly
What Should the Physician Do When an Older Person Complains of Sexual Dysfunction?
Sexual History
Physical Examination
Treatment Approaches
Counseling
Medical Treatment
Vacuum Constriction Devices
Surgical Treatment
Sexual Dysfunctions and Self-Efficacy
How Are Self-Efficacy and Sexual Response Connected?
Sexual Health of Men and Women
What Affects Our Sexual Health?
Helping Couples Deal with Sexual Problems
The Effects of Infertility
The Psychosocial Implication for Infertile Men
The Psychosocial Implications for Women Unable to Become Pregnant
Treating Sexual Dysfunctions in Couples
References
Chapter 10
The ‘Ugly’: Unlawful Sexual Behaviors
Paraphilias
Historical Perspective
What Is Legal and What Is Not
Sex Offenders
Deviant Sexual Interest
Origins of Deviant Sexual Arousal
Factors Maintaining Sexual Offending
How Does Disruptive Attachment Influence Children?
Cognitive Distortions
The Various Sex Offender Types
Intimate Relationships of Sex Offenders
Public View of Sex Offenders
How Does the Public View Rehabilitation?
Stigmatization of Sex Offenders
Stigma
Inside Correctional Institutions: The Effect of the Stigma
Offenders of Child Sexual Exploitation Materials (CSEM)
What Motivates CSEM Offenders?
Internet Access
The Thoughts and Beliefs Experienced by CSEMs
Sexual Arousal and Use of CSEM
Treatment Approaches That May Help CSEM Offenders
Intervention Approaches
Treatment of Paraphilias
Group Therapy
Treatment Effectiveness
References
Chapter 11
Sexual Variations: It’s Different, But Not Always ‘Bad’
Clarifying Paraphilic Terminology
How Prevalent Are the Various Paraphilias?
Sleeping with the Dog …
Frotteurism
Hypersexuality
Asexuality
Fetishism
The Underlying Causes of Fetishism
Partialism
Inanimate Extension of the Body
Sadomasochism
Transvestism
Asphyxiophilia
Necrophilia
The Main Paraphilias
Pedophilia
Child Sexual Abuse
Is Child Sexual Abuse Common?
The Sexual Disorders That Follow CSA
The Relationship of Sexual Disorders to CSA
Exhibitionism
Voyeurism
Can Treatment Help Paraphilic Disorders?
Incest
Victims of Sexual Offences
Sexual Addiction
Cybersexual Addiction: The Role of the Internet
The Reasons for Using the Internet for Sex
A Therapist’s Perspective on Sexual Addiction
References
Chapter 12
The Ins and Outs of Sex Therapy
Great Lovers
The Goals of Psychotherapy
When Facing a Sexual Problem: What Do We Expect from Therapists?
Managing Boundaries between Client and Therapist
Reversing Sexual Side Effects of Medications
What Changed: Evolutions and Revolutions in Sex Therapy
The History of Treating Sexual Dysfunctions
From the Ancients to the Middle Ages
The Precursors of Sexual Medicine
Recent History
Masters and Johnson: Biopsychosocial Sex Therapy Pioneers
Biopsychosocial Sex Therapy and Biomedicine
What Happens When Love and Sex Clash?
Psychological and Relational Factors in Sexual Functioning
The Predisposing, Precipitating, and Maintaining Factors of Sexual Dysfunctions
How Does Anxiety Affect Sexual Dysfunction?
Depression and Its Effect on Sexual Function
Interpersonal Factors of Sexual Function and Dysfunction
Psychological Treatment of Female Sexual Dysfunction
Sexual Arousal Disorders
Orgasmic Disorders
Treatment Approaches for Anorgasmia
Male Sexual Dysfunctions
Hypoactive Sexual Desire Disorder (HSDD)
Erectile Dysfunction (ED)
Medical and Psychological Treatment Approaches for ED
The Viagra Revolution
Psychological Factors in ED
How Is ED Treated?
Rapid (or Premature) Ejaculation
Treatment of Premature Ejaculation
Treatment of DE (Delayed Ejaculation)
Reframing Attitude Change
Integrated Treatment for Sexual Dysfunction
Issues in Defining Women’s Sexual Dysfunctions
Sexual Dysfunction and Dysfunctional Sexuality
Addressing Sexual Trauma
Treatment
Painful Sex
What Can Treatment Offer?
Mindfulness-Based Sex Therapy
Sexual Addiction and Child Sexual Abuse
Treatment Option for Sexually Abused People
Sexual Dysfunctions: Efficacy of Psychological Interventions
When Sexual Appetite Differs: Can We Do Anything about It?
Enhancing Your Sex Life
Intensifying Erotic Pleasure
The Movement from Sex Therapy to Sexuality Counseling
Medicalization of Sexual Problems
What Do Men Want?
And Women, What Do They Need?
Sexuality Counseling
Towards Optimal Sexual Health
The Evolution and Future of Sex Therapy
References
Chapter 13
Sexuality and Relationships
Sex and Belonging
The Need for Intimacy and Belonging
The Need for Love
Choosing a Sexual and Intimate Partner
Sexual Relations
Establishing Intimate Relationships
Practical Concerns Which May Be Present
Sexual Desire Inhibition
Social Inadequacy
Fear of Entrapment
The Instinct to Withdraw
The Need for Self-Protection
Disgust about the Potential Partner
Disgusted by Sex
The Importance of Sexuality
What Does It Take to Create Relational Intimacy?
Intimacy and Sexuality
What Contributes to Sexual Satisfaction?
Keeping Passion Alive
Sexual Activity and Well-Being
The Effects of Affectionate Experiences
Relational Intimacy and Sex
The Interplay of Attachment Style and Sexuality
The Effect of Childhood Attachment on Adult Sexuality
Attachment and Sexual Behavior
Does Sex Contribute to the Attachment and Maintenance of Relationships?
Distress Regulation, Attachment, and Sex
Sexual Motivation of Couples
Treating Relational and Sexual Dysfunctions
Sexual Satisfaction and Relationship Happiness in Midlife and Older Couples
When the Relationship ‘Squeaks’: As Lack of Intimacy, Loneliness, and Sexual Infidelity Raise Their Ugly Head
Love and Loneliness
Infidelity
References
Epilogue
Index
About the Author
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