Lifespan Challenges

How mindset challenging to consider the sexuality and need for healthy functioning of adolescents. It seems to be another part of the horizon of sex therapy. While it may be controversial, early sexual experiences are very formative. What they experience, whether it be fun or shameful (or both), may significantly influence the course their sexual development takes. Sex therapy for adolescents may be effective toward prevention of larger issues later in life.
When it comes to aging adults, how encouraging that people may experience some physical barriers, but that their sexual satisfaction is actually similar to younger adults. I can't say I was surprised by the rates of ED or lubrication challenges in women, but love the affirmative stance that they are just as worthy of sexual enjoyment as any other younger adult.

Sexual Diversity

Of the two chapters, I found the comments that Dr. Margaret Nichols, particularly the set of bullets highlighting her affirmative stance on the subject, to be the most helpful. I have long been sensitive to challenges faced by LGBTQ people and found this set of points to be the most on-point and concise I've read. I fully believe that sex and gender are different concepts and that they are expressed in so many different ways, which is powerfully influenced by culture in its expression and the degree to which it is expressed. I fully believe that the fluidity of gender has existed across cultures and time and have been fascinated learning about Two Spirits in Native American culture. This is one of the examples of how culture influences gender and sex expression. If the notion that some cultures actually revere the people possessing aspects of both genders instead of marginalize them is as fascinating to you as it is to me, I encourage you to look into it more. By contrast, Dr. Nichols spoke at the SSTAR conference about natal women who later dressed and lived as men, only having their physical sex identified by society upon their death. This was in our society in the early 1900s, when there was no option for having both male and female attributes.

Paraphilias

I spoke about this a bit in class, but found the talk about pedophiles at the SSTAR conference to be the highlight of my learning there. Dr. Cantor has been working with pedophiles to better understand the distinct brain patterns of those with pedophilic tendencies, once again highlighting the differences between those who act and those who have the sexual interest and do not act. Similar to how Kinsey's work started with an overly-technical medical explanation to make the subject of sex more socially acceptable, this seminar described pedophilia as the cultural horizon of modern sex therapy, needing first to be medically explained in order to bring the conversation to the public in a less divisive way, and also to build therapist compassion. Unfortunately, there aren't really any treatments that have shown efficacy yet.
Thanks also to the paraphilia group for your illuminating presentation and wiki page!

Sex and Disability

I was moved by the topic of sex and disability, both the readings and the presentation. One of the ideas that stood out the most to me was that a therapist has to believe in the client as a sexual being. Though the concept could apply to any client involved in sex therapy, is was really effectively illustrated in the case of the gay man who had lost his legs and genitalia in the textbook. The therapist had to believe he could be in a loving, sexual relationship, just as a therapist would have to believe in the ability of any other person that does not fit the socially constructed concept of who is "sexy." I haven't encountered this internal challenge, but will remain aware because of the reading. One of our textbook editors, Dr. Kathryn Hall, gave a talk at the SSTAR conference about the concept of disgust as it applies to couples, but also echoed the notion of the therapist having to overcome barriers of disgust as well in order to be able to genuinely convey hope.
I also found it fascinating that person's with paralysis and/or non-sensitivity in typical erogenous zones can find new ones and adapt to receive pleasure. Once again, this speaks to the multi-dimensionality of sex, with no one form of expression.
So last thing folks, here is a link to the movie trailer for Sessions, the film I mentioned in class based on the true story of a paralyzed man who seeks a sexual surrogate:
https://www.youtube.com/watch?v=Fy2y7UIpgP4
I truly love this film for the dignity with which it presents a beautiful man challenged by disability who wants to experience sexual fulfillment. I highly recommend it.

Desire and Arousal

This topic was of particular interest to me, because I think nearly every person will encounter this as an issue either personally or with a partner at some point in their lives, and it will no doubt come up often with couples. I though the groups presented the topic very well, and covered many facets of the challenges in both males and females. The wiki page is comprehensive (thanks a lot guys, for setting the bar so high! :)), covering everything from DSM criteria, to assessment and treatment. I appreciate the plethora of articles as resources and enjoyed the comic relief, and especially agreed with the porn sentiments expressed by (go figure) Russell Brand. I heard a talk by Adam Savage on the subject of porn a while back that spoke to me. Luckily, I was able to find the clip. Should you care to give it a listen, it can be found here: http://themoth.org/posts/storytellers/adam-savage.

Dr. Berman Video

In the episode, there were many facets explored in the three relationships that Dr. Berman worked with, including medical factors (e.g. vaginal blood flow), emotional aspects (e.g. sexual trauma history and trust barriers), and physical stimulation (e.g. oral sex or kissing). Most were related to desire and arousal. The topics and approaches had varying success levels, but all yielded some positive outcomes for these three couples.

For the oldest couple, part of what Dr. Berman presumed was the issue was physiological, that the female partner may have been in peri-menopause, as evidenced by the results of her blood flow metric. To intervene in ways within their control, Dr. Berman worked to develop the couple’s communication around sexuality, such as each person’s fantasies, and encouraged the wife to rediscover her sexuality as she had been neglecting this part of herself. When they shared their respective fantasies, it was revealed that they were very compatible, but had never shared them with the other. The surprise they had at this revelation was noticeable in their faces. One intervention was to have the husband take control of an evening. The wife had a fantasy of her male partner overpowering her, and this seemed to strengthen his role as an empowered man. I was quite impressed with just how successful each of these interventions was for this particular couple. The evening during which the husband took control ended up being a fruitful date night. She seemed to be impressed by his choices on many things, such as her outfit and his restaurant choice. Most importantly, she was able to orgasm in a shared sexual experience, which had not happened in quite some time, according to their reports.

For the couple who were not yet married, the presumed issue was one related to difficulty trusting, that both the desire and arousal challenges on the part of the female partner were based on past trauma. Delving into this seemed to be effective at improving the degree of understanding that he had for her, which in turn fostered more compassion and patience on his part. Her desire for him to kiss her more was explored, and though the underlying concerns were never brought to the surface, they did report improvement in the frequency of kissing, for what this is worth. It is undetermined whether he enjoyed it, and whether this would be a sustained change.

The third couple had similar challenges. The female in this marriage, as with the just described female partner, did not show any signs of physiological arousal challenges and the issue instead was considered more psychological in nature. One difference in this couple was that the trust issues from past trauma (though not reported as sexual trauma) presumed to be part of the problem were on the part of the male, through his relationship with his father. Like the previously described male, he was challenged with rigid cleanliness standards, in this case influencing his interest in performing oral sex. While they too reported increased frequency, it was difficult to tell if there was second order change or just behavioral change. Another intervention used was for him to relinquish power during a rock climbing activity, then a blindfolded walk through town, aimed at helping him relinquish control to her.

Lastly, all three were given sex toys to use. This seemed somewhat successful for all as they reported liking them, but seemed especially important for the first couple I mentioned, as the vibrator resulted in her long-awaited orgasm. I was pleasantly surprised (following the last film we watched) with Dr. Berman’s style of therapy. She seemed to be more multi-faceted than the medical model I anticipated, and she seemed to offer her clients an unexpected degree of respect and openness to their preferred varieties of human sexual expression. I saw some validating and challenging questions that I would see encouraged in our training, and saw some specific interventions we might also use, such as sharing fantasies and histories to increase mental and emotional intimacy/connection, and using toys to increase the physical stimulation to add to the emotional stimulation that would bring the people closer to the orgasm threshold.

Tiefer Talk

When first presented with the book, the title stood out in a powerful way. Sex is Not a Natural Act. (Oh, it's not? I both agree and disagree. I wonder where this is heading...) My thoughts initially turned to the idea that sex is a complex ritual laden with cultural influences, stigma, individual expressions, etc. I loved the idea that we would be reading about the nuances and creativity surrounding sex that had to be skillfully crafted and honed. While this notion is one that Tiefer endorses, by cleverly comparing sex to the practice of a musical instrument and presenting a social constructionist lens, the theme of the book is far less about the promotion of sex as an art form and for more a criticism against the medicalization of sex. I have long been skeptical of the medical industry for many reasons (including some of her points), but feel that my perspective on the subject of sex and medicine was greatly expended by the reading.