"Grounded in solid psychological and physical research an impressive reference and a source of support and encouragement." — Kirkus Reviews, December 2005
Sexual Healing: The Completest Guide to Overcoming Common Sexual Problemsby Barbara Keesling
This expanded edition of Sexual Healing examines every known sexual problem and all possible treatments, including many that are new and experimental. The book includes more than 125 exercises for specific problems including premature ejaculation, female sexual arousal disorder, low sexual desire, and sexual aversion as well as a new section on/i>
This expanded edition of Sexual Healing examines every known sexual problem and all possible treatments, including many that are new and experimental. The book includes more than 125 exercises for specific problems including premature ejaculation, female sexual arousal disorder, low sexual desire, and sexual aversion as well as a new section on advanced sexual healing for physical, emotional, and spiritual problems. Written by a sex therapist and surrogate partner with over 20 years experience, the book reflects the wisdom that comes from her unique perspective as a pioneer in the field of sexuality.
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Sexual HealingThe Completest Guide to Overcoming Common Sexual Problems
By Barbara Keesling
Hunter House Inc., PublishersCopyright © 2006 Barbara Keesling
All right reserved.
Chapter OneSex Problems
Having a sexual problem can be scary. In this chapter I would like to begin to demystify the most common sex problems. I'll start by putting sex problems in perspective for you.
Types of Sexual Dysfunction
Currently, specialists recognize three types of sexual problems that can become so severe and cause such serious personal distress that they qualify as full-blown psychological or psychiatric problems. Before I list them, let me share with you how psychologists (mental-health professionals with Ph.D.s who study the mind) and psychiatrists (medical doctors who study the mind) diagnose mental problems in general. They don't use some kind of magic or voodoo (although they certainly use intuition). Instead, they use a book. It's called the Diagnostic and Statistical Manual of Mental Disorders. It has been revised several times over the past forty years or so. The current version, which was published in 2000, is called the DSM IV-TR (TR stands for Text Revision). Psychologists and psychiatrists refer to the book simply as the "DSM."
The DSMcontains information about all known mental problems, including mood disorders like depression; serious disturbances of thought, feeling, and behavior like schizophrenia; substance abuse disorders; and many others. For each mental problem, the DSM also contains information about causes, prevalence, and related conditions, if such information is available. The current DSM lists three types of sexual problems that could become severe enough to be classified as mental disorders: gender-identity disorders, paraphilias, and sexual dysfunctions.
A person is said to have a gender-identity disorder if his or her psychological sense of being male or female is different from his or her genital organs. You may have heard these individuals referred to as transsexuals. Paraphilias are persistent and recurrent uncontrollable urges to perform sexual behaviors (often with inanimate objects) that most people consider unusual, to say the least. Included here are things like exhibitionism (exposing your genitals to an unsuspecting person), voyeurism (spying on people when they are undressing or having sex), sex with animals, and sex with children under the age of puberty, as well as other compulsions.
The third type of sex problem included in the DSM is sexual dysfunction. Sexual dysfunction includes all problems that involve the failure of the genitals to work right. For example, most people believe that a man's penis should become erect so he can have sexual intercourse and that a woman's vagina should lubricate so she can enjoy intercourse. If these natural responses don't happen, it can be a problem. The current DSM identifies nine different sexual dysfunctions. I've listed them below with a short description of each. Chapters 5 through 13 describe each of these dysfunctions in more detail and discuss their possible causes.
The following are the nine types of sexual dysfunction:
* Hypoactive sexual desire disorder (HSDD): low sexual desire characterized by an absence of sexual interest or fantasy * Sexual aversion disorder (SAD): a fear of some aspect of sex characterized by an avoidance of sexual situations and activity * Female sexual arousal disorder (FSAD): failure of a woman's genitals to lubricate or to engorge (swell) in a sexual situation; also, a woman's subjective lack of feelings of arousal * Male erectile disorder (MED): inability of a man to achieve an erection * Premature ejaculation (PE): a condition in which a man ejaculates before he wants to or after very little sexual stimulation * Male orgasm disorder (MOD): a condition in which a man has difficulty reaching orgasm or ejaculating * Female orgasm disorder (FOD): a condition in which a woman has difficulty reaching orgasm even after normal arousal, lubrication, and genital swelling * Vaginismus: a contraction of the muscles surrounding the opening of the vagina, preventing penetration * Dyspareunia: psychologically based pain experienced during sexual intercourse
There is another problem that is dealt with quite frequently in sex therapy, although it's not considered a sexual dysfunction as such. It's called protracted virginity. It means that a person has reached a relatively late age without having had sexual intercourse or, in some cases, without having had any sexual experience with a partner. Most people in the United States have had sexual intercourse by the end of their teenage years, although there's no rule that says you have to. Having sexual intercourse for the first time in your forties or fifties can pose some challenges that I believe this book can help with.
The sexual dysfunctions are the focus of most of Sexual Healing. Also included are sections on using your sexuality to heal physical, emotional, and relationship problems. This book does not address the paraphilias or gender-identity disorders. The sexual dysfunctions (which I usually refer to throughout the book as "sex problems") are extremely common. Recent surveys show that up to 40 percent of Americans will experience one of these problems in a severe enough form to cause personal distress. It's also possible to have more than one of the dysfunctions.
When a sex therapist begins work with a new client, in addition to making a specific diagnosis of one of the above nine problems, the therapist also makes other distinctions about the problem. The following distinctions have implications for deciding on a proper course of treatment:
Is the problem lifelong or acquired? A lifelong problem is one that has existed ever since the person first started having partner sex. Lifelong problems are also called primary problems. A person with an acquired problem, by contrast, functioned well in the past but at some point developed the problem. Acquired problems are also called secondary problems. Obviously, acquired problems are much easier to treat. Generally, if a person functioned well in the past, he or she can learn to function well again.
Generalized or situational? A sex problem is generalized if it occurs in all situations. For example, a man with generalized erection problems can't have an erection during sleep, with masturbation, or with a partner. A situational sex problem is specific to certain contexts, activities, or partners. For example, some men can have erections with their mistresses but not with their wives (or vice versa). Situational sex problems are easier to treat than generalized problems. If a person can function in one situation, usually he or she can learn to transfer that ability to other situations.
Physical or psychological? Professionals who treat sexual dysfunction also make a distinction between problems that are totally psychological in nature and those that are caused by a combination of physical and psychological factors. Physical problems are also called organic problems. This distinction has huge implications for treatment, because it would be a waste of time to try a psychologically based intervention if the problem is largely physical. To continue with the erection example, many medical conditions exist that can cause erection problems (see Chapter 7). It wouldn't do any good to use psychological sex therapy with a man who has severely compromised blood flow to his penis.
Also included in the definition of each of the sexual dysfunctions is the idea that it must cause "marked interpersonal difficulty" in order to be considered a problem. This implies two things: that sexual dysfunctions are couple problems, and also that you don't have a sexual problem unless you think you have one. There are many people out there who don't function very well by most standards, but who aren't really bothered by that fact.
The Role of Anxiety
In Chapters 5 through 13, I'll discuss all the factors I know of that can cause specific sexual problems. Sex problems have what are called distal and proximal causes. Distal causes are things that occurred far in the past that can contribute to sex problems, such as a restrictive sexual upbringing. Factors in a person's present situation also contribute to the problem. These are the proximal causes. The biggest proximal cause of sex problems is anxiety.
Anxiety has both physical and mental symptoms. The main physical symptom of anxiety is rapid heart rate. The main psychological symptom is worry. All of the sex problems I deal with in this book are caused to some degree by anxiety. Sometimes the anxiety is overt and sometimes it is less obvious, but the key to healing any sex problem is learning to identify, deal with, and reduce anxiety. Symptoms depend in part on when during a sexual encounter the anxiety hits. If the anxiety hits before a sexual encounter starts, the resulting problem is generally low desire, sexual aversion, or vaginismus. If it hits toward the beginning of a sexual encounter, it usually causes female arousal problems or erection problems. If it hits once intercourse has started, it usually results in dyspareunia. If it hits right before orgasm, it causes male or female orgasm problems or premature ejaculation.
Because anxiety is such an important factor in causing sexual problems, reducing anxiety is crucial for sexual healing to occur. In Chapter 3, I'll go into much more detail about the different types of anxiety that can affect your sex life.
A Brief History of the Treatment of Sexual Problems
Many historical accounts of sexual problems exist-mostly accounts of erection problems in men, which used to be called impotence. Some of the earliest attempts at treating sexual problems involved the use of aphrodisiacs: foods or potions made from animal parts that were purported to increase sexual desire and ability. (In fact, to my knowledge, no true aphrodisiacs exist.) One of the earliest treatments suggested for erection problems was to have the impotent man sleep with an attractive young woman.
Sex manuals have been around for many centuries. The most famous of these is probably the Indian Kama Sutra, which contains illustrations of unusual sexual positions. The fields of sex therapy (treating sex problems scientifically) and sexology (sex research) developed in the late 1800s. In 1886, Richard Krafft-Ebing wrote Psychopathia Sexualis, a collection of case histories of people with unusual sexual desires, such as fetishes. Sigmund Freud was one of the first to recognize the importance of psychological factors in sexual problems. During Freud's era (very roughly from about 1880 through the 1930s), experts began to recognize that men could experience erection problems and premature ejaculation, and that women could experience low sexual desire, difficulty becoming aroused, and difficulty reaching orgasm. In Freudian theory these problems were believed to stem from childhood sexual abuse or from unconscious conflicts. The treatment of choice for these problems was psychoanalysis (the "talking cure"), with the goal of bringing up unconscious material that was causing the sex problems. I'm not aware of any good evidence showing that psychoanalysis is effective in treating sex problems.
Major breakthroughs in treating sexual problems were made in the middle of the twentieth century. The Kinsey reports on male sexuality (1948) and female sexuality (1953) revealed that many people were ignorant of some of the most basic aspects of sexuality. The Kinsey reports also gave us information about things like how long the average man lasted during intercourse. The Kinsey reports counteracted some of the popular marriage manuals of the 1920s, 1930s, and 1940s, many of which were full of laughably inaccurate information.
One of the first attempts to treat a specific sexual problem occurred in the 1950s. The stop-start technique for treating premature ejaculation was described in 1956 by James Semans in the Southern Medical Journal. The biggest breakthrough in treating sexual problems in the twentieth century was the work of sex researchers William Masters and Virginia Johnson. Their first major work was Human Sexual Response (1966), in which they described their research on the sexual response cycle (a very brief description of which is included in Chapter 2). Based on their findings, Masters and Johnson developed treatments for all of the sexual dysfunctions. In contrast to psychoanalysis, which at the time was really the only other treatment available for sexual problems, Masters and Johnson's treatment followed a "cognitive-behavioral" approach. This means that rather than focusing on childhood issues or repression, they focused on thoughts and behaviors that cause people's natural sexual responses to shut down before or during a sexual encounter. Masters and Johnson's treatment involved specific touching exercises and sexual techniques. An irony about treating sexual problems is that even though Masters and Johnson focused only on improving mechanical sexual functioning rather than on healing sexual issues, the techniques they promoted ended up helping thousands of people who had sexual problems.
In 1974 Helen Singer Kaplan published a book called The New Sex Therapy. Her treatment for sexual problems involved a combination of psychoanalysis and cognitive-behavioral strategies. In the 1980s Dr. Ruth Westheimer became famous as a media personality with a television show on sexuality. She worked as a sex therapist for many years and popularized many of the field's concepts. The American public's idea of what sex therapy is about probably comes largely from Dr. Ruth.
Most people have heard of Masters and Johnson. Their contributions to sex therapy really can't be overestimated. Most people have probably never heard of Jack Annon. In 1974 he published a book called The Behavioral Treatment of Sexual Problems. In it, he built on the work of Masters and Johnson and formulated his own treatment model, which he called the PLISSIT model. PLISSIT stands for permission, limited information, specific suggestions, and intensive therapy. The main idea of the PLISSIT model is that people with sexual problems may need help at several different levels. Some people are afraid to try new sexual activities and really only need a therapist to give them permission to do so. Others have a lack of knowledge about sexual matters and just need some information, often the same type of information one could get from taking a college course on sexuality. Still others will benefit from specific suggestions: detailed techniques for touching the genitals that can improve one's ability to become aroused. And, of course, there are some people whose sexual problems genuinely result from past sexual trauma or deep-seated personality issues. These individuals will benefit from intensive therapy. When I was studying to become a surrogate partner and later a sex therapist, I read the works of Masters and Johnson, Helen Singer Kaplan, and Jack Annon, among many others. The work that was most helpful to me over the years was Annon's.
What is the current state of sex therapy? Most psychologically based sex therapies still rely on treatment concepts that began with Masters and Johnson. Cognitive-behavioral sex therapy has had very good treatment success. However, in the last ten to twenty years, sex therapy has become increasingly medicalized. The introduction of Viagra and other medical treatments for sex problems has taken the focus off psychology.
Where This Book Fits In
Like Kinsey's work, Sexual Healing provides you with facts about sexuality. It builds on the work of Masters and Johnson because it is behavioral in approach by virtue of its reliance on exercises. In terms of Annon's PLISSIT model, Sexual Healing addresses sexual problems at the first three levels: permission, information, and specific suggestions. I give you permission to take action to heal your sex life. Some readers may need only limited information about sexuality, such as the role of anxiety in sexual problems; this book provides such information. The main thrust of Sexual Healing, however, is to offer help in the form of specific suggestions, the third level of Annon's model. The majority of the book's content consists of practical, easy-to-understand exercises that you can do alone or with a partner to heal your sex life.
Although this book may give you some insight into what has caused your sexual problems, if your problems are very serious and long-term there's no substitute for intensive therapy. If that's the case, I encourage you to find a professional to help you explore your sexual history in depth.
Excerpted from Sexual Healing by Barbara Keesling Copyright © 2006 by Barbara Keesling. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Meet the Author
Barbara Keesling, Ph.D. has more than twenty years of experience as a sex therapist and surrogate partner, and has taught human sexuality at several universities. Her popular books have sold more than a million copies worldwide, and she appears frequently on television and radio. Her academic work and experience with clients make her uniquely qualified to write about sexual healing and sexual pleasure. She lives in Costa Mesa, California.
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