Linda Weiner, MSW, LCSW
Certified Diplomate in sex therapy, American Association of Sex Educators, Counselors & Therapists
Diplomate in Sexology, American Board of Sexology
Adjunct Professor, Brown School of Social Work, Washington University
7396 Pershing Avenue, St. Louis, MO 63130
314-588-8924
sextherapiststlouis@gmail.com
www.sextherapiststlouis.com
I. Categories:
• DSMIV-TR Sexual Dysfunctions include:
o Desire
o Arousal
o Orgasmic
o Pain Disorders
II.
Etiology:
• Sexual Dysfunctions can arise from:
o Psychological
 Family of Origin
 Early Negative Experiences
 Personality
 Trauma
o Relational Concerns
o Medical Issues
o Drugs/Medications
o or a combination
III. Subtypes:
• Assessment includes a description of whether
the condition has been:
o Lifelong
o Acquired (onset)
o Generalized
o Situational (context)
IV. Description of Disorders
1.
Sexual Desire Disorders
• Hypoactive Sexual Desire Disorder:
o Deficiency or absence of sexual fantasies and
desire for sexual activity which causes distress or
interpersonal difficulty, not due to a medical
condition, another Axis I disorder, or drugs/meds.
• Sexual Aversion:
o Avoidance of and phobic reaction to anticipation of
genital contact with a sexual partner causing distress
not accounted for by another Axis I disorder.
2. Sexual Arousal Disorders
• Female Sexual Arousal Disorder:
o Persistent or recurrent inability to attain or
maintain to completion of the sexual activity
adequate lubrication/swelling response of
sexual excitement.
o Distress; Not better accounted for by
another diagnosis and/or lack of feelings of
subjective pleasure. (check on this)
3. Orgasmic Disorders
• Female Orgasmic Disorder:
o Persistent or recurrent delay or absence
of orgasm following a normal sexual
excitement phase.
o Distress; No other Axis I cause.
4.
Sexual Pain Disorders
• Dyspareunia
o Recurrent or persistent genital pain
associated with intercourse.
o Distress;
 Not caused by vaginismus
 Lack of lubrication
 Another Axis I disorder
 Substance
 Medical condition
• Vulvodynia (a type of Dyspareunia)
o Burning pain
o Swelling
o Redness at the vulvor vestibule
inside the labia minora
• Vestibulodynia (a type of Dyspareunia)
o Pain with touch to the vestibule
(where the outside of the skin meets
the vagina)
• Vaginismus
o Recurrent/persistent involuntary
spasm of the outer third of the vagina
interfering with intercourse
o Distress;
 Not due to a general medical
condition
 No other Axis I cause
V. Intake Process in Counseling
• Assessment of Sexual Dysfunctions
• Medical
• Psychological
• Relational
• Societal/Cultural
• Generalized/Situational
• Onset
• Individual and Couple Strengths and
Challenges
VI. Treatment Strategies
• Patient Education
o Educating patients about what is “normal”
o Education about normal anatomy
o Physiologic basis of sexual functioning
o Lifestyle changes such as stress
management, exercise, relaxation and diet
VI.Treatment Strategies
• Medical and allied health practitioner
coordination
• Medications, hormones, hormone creams and
phosphodiesterase inhibitors
VI.Treatment Strategies
• Relationship and communication skills
counseling and sensate focus
• Sex Therapy
VII. Definition of Sensate Focus
Sensate Focus is a hierarchy of structured touching
and discovery suggestions.
VIII. Rationale for the use of Sensate Focus
• Reduction of work, pressure, expectation, anxiety,
negative conditioning
• Reduces spectatoring or watching one’s experience,
and teaches mindfulness
• Reactivates the senses and builds sexual energy
• Engenders feelings of closeness and intimacy
• Builds feelings of closeness
• Diagnostic and restorative
IX. Difficulties with the Concept of
“pleasuring” in Sensate Focus
Sensate Focus I: Developed to address sexual dysfunctions, not to increase sexual competency
and explore eroticism.
Sensate Focus II: Developed to encourage feedback about what feels good and what might be
fun to explore.
To give and receive information and pleasure to one another
To take greater risks and indulge themselves in playful, spontaneous, eyes wide open and erotic
interactions
To be their evolving sexual selves with one another with respect to their personalities, erotic
interests and comfort zones
Meshing of touching for self with erotic feedback from partner keeping you on track! If you are
touching them for self and they turn on, you’ll keep it going because it’s erotic to you!
X.
The Masters & Johnson Protocol for
Sensate Focus
Sensate Focus Instructions
Description – general
The “identified patient” initiates the touching 1-2x weekly for about 15-30
minutes. Clothing is optional at first. Clients are asked to non-verbally
TOUCH FOR SELF, focusing on their sensations of temperature, texture and
pressure, with no goal for arousal/response, using only hands and fingers.
The partner being touched protects the touching partner by non-verbally
communicating if something is physically or psychologically
UNCOMFORTABLE. Both partners refocus on sensation when distracting
thoughts impinge. Touch long enough to get over any discomfort (5-15
minutes), but not so long as to be tired or bored. Then switch. Begin in any
comfortable position and change positions as you wish.
XI. The Modified Masters & Johnson
Protocol for Sensate Focus
Instructions for Clients: Sensate Focus
No intercourse, oral sex or mutual masturbation is suggested. If you choose to
be sexual together – please take a “tea break” first.
• Arrange for one hour of complete privacy when you are not exhausted.
• Please limit alcohol/drug use unless discussed (sometimes Viagra, Cialis,
Levitra suggested).
• Set the mood for relaxation.
• Clothing off, some lighting on.
XII. The Masters & Johnson Protocol for
Sensate Focus
The General Sequence of Sensate Focus Suggestions is:
• Breasts and genitals off limits
• Breasts and genitals on limits, subsequently with oil, powder or lotion
• Mutual touching; with hand riding
• Clinical look
• Partner astride, playing outside
• Insertion without movement
• Insertion with movement
• Fantasy, variation and play (Sensate Focus II)
References
References, The Lost Art of Sensate Focus
• Masters & Johnson Human Sexual Inadequacy
• Thomas Maier, Masters of Sex
• Staci Haines, The Survivor’s Guide to Sex
• Linda de Villers & Heather Turgeon, The Uses and Benefits of “Sensate
Focus” Exercises in Contemporary Sexuality, Vol 39, Nov 2005
• David Schnarch, Constructing the Sexual Crucible
• Shmulsy Boteach, The Kosher Sutra
• Barry McCarthy, Rekindling Desire
• Helen Singer Kaplan. The Illustrated Manuel of Sex Therapy, Second
Edition