Table Of ContentSEX 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M. N ., generously provided me with previously unpublished clinical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
