Essentials of Female Sexual Dysfunction from a Sex Therapy Perspective

Linda E. Ohl, MSW, CSW, ACH


Urol Nurs. 2007;27(1):57-63. 

In This Article

The P-LI-SS-IT Model for Sexual Counseling

The practitioner creates a climate of comfort and gives permission to clients to discuss sexual concerns, often introducing the topic of sexuality, thereby validating sexuality as a legitimate health issue (Annon, 1976).

The practitioner addresses specific sexual concerns and attempts to correct myths and misinformation. This is reserved for relatively straightforward, noncomplex problems (Annon, 1976).

The practitioner compiles a sexual history or profile of the client. Subsequently, after definition of the issues and how they have evolved over time, the therapist will assist the patient with very specific directions on how to address the problem. The patient is an active participant in the process, many times given the responsibility, with the therapist's guidance, of finding a solution that becomes internalized. The suggestions from the therapist may be very specific, such as activities to incorporate or to avoid in the bedroom that may lead to desensitization of the problem. These suggestions may include focusing on sexual sensations, recording negative thoughts and analyzing them, using music, candles and incense to enhance the sexual experience, employing mutually agreed upon fantasies, and using stimulating devices (Annon, 1976).

The therapist provides specialized treatment in cases that are complicated by the coexistence of other complex life issues that may also include psychiatric diagnoses such as depression, anxiety disorders, obsessive-compulsive disorder, personality disorders, or substance abuse, or by interpersonal or intrapersonal conflict (Annon, 1976).

Sex therapists are trained to identify situations that require intensive therapy and to make appropriate medical referrals when necessary. On the first visit, a comprehensive interview will be conducted. An extensive history is recorded, with questions about upbringing and memories of family and social life. Because religious beliefs are connected closely with sexual attitudes, religious beliefs will be discussed. Questions regarding overall health, medications, and past medical history will also be included. Social issues, in reference to relationships, self-esteem, history of sexual abuse and trauma will be discussed. A comprehensive psychiatric history and assessment are conducted to help determine if psychiatric issues need to be addressed.

After the evaluation is completed, the therapist will suggest what might be contributing to the problem and suggest a treatment plan. The treatment plan can be altered on a regular basis, depending on what is happening in treatment. Usually treatment is conducted with the partner unless circumstances dictate differently. Treatment focuses on identification and examination of feelings, both from past and present experiences. The goal is to gain insight into maladaptive behaviors, improving communication between partners, and teaching new ways to deal with issues.

Because most sexual dysfunctions are regarded as a couple's issue, the therapist might focus on the couple's strengths rather than weakness. If the patient is not in a current relationship, the therapist may work on individual strengths.

"Homework" assignments are given at the end of a therapy session in order for the couple, or individual, to practice what was discussed in session. Assignments are geared towards teaching patients new skills. Some examples of these may be teaching the art of giving and receiving pleasure, extending mutual pleasuring (abandoning self-to-self pleasure), turning the idea of sexual obligation into pleasure, learning to focus on sensations rather than anxieties and fears, discovering harmful patterns in sexual relationships, and encouraging the patient to be open and honest about needs and frustrations in the relationship. Couples may even be asked to deliberately avoid orgasm, penetration, or even touching sexual organs for a period of time.

The cost and length of therapy can vary. Usually sex therapy duration is on the shorter side, when compared to standard psychotherapy. Fees can range from $80 to $150 or more per session. Some insurance companies may cover a portion or all of the fees. Many therapists will extend a sliding scale for charges if affordability is an issue.


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