Academic journal article New Zealand Journal of Psychology

Let's Talk about Sexuality and Relationships

Academic journal article New Zealand Journal of Psychology

Let's Talk about Sexuality and Relationships

Article excerpt

Overseas research on sexual and relational disorders is varied and widespread. However, relatively little is known about such problems in New Zealand. The present study describes a cohort of clients seen by the Sex Therapy New Zealand service in one year, with a particular focus on the presenting symptoms in relation to existing models of sexual functioning problems. The therapists of the 46 clients who consented to participate completed a short questionnaire about the client and the therapy process. The key finding was that therapists identified relational problems as central to the sexual problem, while these issues were not identified in the referral. A larger study on sexual problems in New Zealand is needed to replicate and extend the results of this study, with a view to developing an integrated diagnostic, assessment, and treatment model for sexual and relationship problems.

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Our understanding of sexual and relationship problems has developed over the last 60 years with models of diagnosis and treatment reflecting changes and advances in research. The earlier and more traditional models of sexual problems focus on biological aspects of sexuality, evident today in the current edition of the Diagnostic and Statistical Manual (DSM-IV-TR; American Psychiatric Association, 2000). The DSM model of sexual problems is based on the work of Masters and Johnson (1966). It identifies categories of sexual disorders in terms of problems with desire, aversion, orgasm, and pain (e.g., dyspareunia and vaginismus), as well as paraphilias and problems caused by a general medical condition or substance use. It is not intended as an aetiological model, but essentially describes sexual problems from a biological and medical viewpoint. The DSM has been used to establish the prevalence of sexual functioning problems. For example, male orgasmic disorder, also known as inhibited orgasm or retarded ejaculation, is diagnosed when orgasm is achieved in intercourse only with great difficulty. Prevalence rates vary in different samples of men from 2% in its severe form to 6% in its milder form (Blanker et al., 2001; Frankel, Donovan, & Peters, 1998), with a lifetime prevalence of 1-10% overall (Specter & Carey, 1990). The DSM also includes diagnostic criteria for relational problems (e.g., partner, parent-child, sibling), which can be due to a mental disorder or general medical condition, and are similarly used to establish prevalence rates.

Other models have since been developed that incorporate a broader range of factors in efforts to theorise about the development and maintenance of sexual difficulties. These models are explored to provide background information on the nature of sexual difficulties and to highlight relevant points of each theoretical model. Tiefer (2001) established an Alternative Classificatory Model (see Table I ) that offers a different way of conceptualising sexual problems from that provided by the DSM. The emphasis within this model is on the value of insight into the whole context, considering the influence of social, political, economic, partner, relational, psychological, and medical factors. This broader focus allows the consideration of factors that could otherwise be neglected when working from a primarily biological model. For example, it encompasses factors such as sexual problems that are related to one's partner and relationship or psychological factors, in addition to medical issues. However, the descriptions of these areas are relatively limited, and the medical factors are less clearly defined than in the DSM. For example, what is meant by a 'sate interpersonal situation' may vary for different people. In contrast, the DSM attempts to provide clearer criteria by identifying the specific symptoms and course of the problem (e.g., whether it is lifelong or acquired).

More recently, compilation of the Individual Sexual Response Mode (1) by Robyn Salisbury offers an important shift in the development of understanding of sexual and relationship problems within a New Zealand context. …

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