Exploring the therapeutic family intervention of commendations: insights from research

Offered in this article are interpretations that emerged in a qualitative, interpretive study focused on the family intervention called a "commendation." The tradition of philosophical hermeneutics informs and shapes the analysis of the data. Research participants include a heterosexual couple and a nurse who engaged in therapeutic conversations focused on difficulties with Internet pornography. Data sources include videotapes of clinical sessions, documentation, and research interviews. Isolated segments of clinical videotape are shared with the couple to prompt their memory of commending practices that emerged in clinical sessions. Commendations are not experienced by this couple as gentle and warm but instead as extremely provocative, albeit constructive. This study illuminates the complex, contextual nature of commending practice and suggests that the noticing of strengths and resources contains much more than the spoken word.

Typing, doing, and being: sexuality and the internet

The increasing salience of sexuality on the internet, whether cybersex or use of the internet to make sexual contacts, has focused interest on how internet-mediated sexuality informs social theory. This article reviews social theory and sexuality in relation to the internet, with specific reference to the development of intimacy, the association of texts with sexual scripts, the emergence of cybersexuality as a sexual space midway between fantasy and action, and the question of boundaries and the location of the person in sexual interaction. Also, the supplanting of the real by the symbolic, the internet as a sexual marketplace, its important role in creating sexual communities, particularly where sexual behavior or identity is stigmatized, its impact as a new arena for sexual experience and experimentation, and its impact in shaping sexual culture and sexuality are noted. Finally, the importance of the internet as a medium for the exploration of human sexuality and as an opportunity to illuminate previously challenging areas of sexual research is discussed.

Timing of pubertal maturation and the onset of sexual behavior among Zimbabwe school boys

The relationship between reproductive maturation and the onset of sexual behavior in boys across cultures is unclear. To explore the relative timing of pubertal events and their relationship to the onset of sexual behavior, we used data collected from 442 Zimbabwe school boys aged 12-18 years. Measures of reproductive maturation included self-reported spontaneous nocturnal emission, secondary sexual characteristics, and salivary testosterone. Behavioral measures included age at first sexual fantasies, non-coital sexual behavior, and coitus. Sigmoid interpolation curve techniques indicated a median age of first erection at 10.75 +/- 0.11 years, first sexual fantasy at 12.66 +/- 0.03 years, first spontaneous nocturnal emission at 13.02 +/- 0.03 years, and adult levels of blood testosterone at 17.2 +/- 0.7 years. First reported spontaneous nocturnal emission was significantly related to all measures of sexual behavior. Multiple regression models indicated that first reported spontaneous nocturnal emission was a stronger predictor of sexual behavior than variation in secondary sexual characteristics. In addition, testosterone was a significant predictor of sexual fantasies and intercourse, independent of first reported spontaneous nocturnal emission. These results confirm earlier findings in other populations that self-reported spontaneous nocturnal emissions can be used as a marker of pubertal timing among adolescent boys. They also suggest that variation in testosterone plays a role in the onset of sexual behavior among boys, beyond its relationship to developmental timing. The behavioral mechanisms represented by the significant effects of testosterone reported here remain to be investigated.

Pathologizing male sexuality: Lallemand, spermatorrhea, and the rise of circumcision

Although spermatorrhea as a disease entity and an episode in nineteenth-century medical history has received significant scholarly attention over the past decade, many aspects of its nature, origins, and consequences remain obscure. The aim of this article is to indicate its origins in and links with medical anxiety about masturbation and to discuss the therapies devised to treat the condition. Particular attention is given to the work of Claude-Francois Lallemand and his influence on English doctors, especially William Acton, and the implications of their identification of the foreskin as the major risk factor for childhood masturbation and later spermatorrhea. It is further argued that fear of spermatorrhea was an important factor in the acceptance of circumcision as a valid medical intervention in the late nineteenth century.

Are orgasms in the mind or the body? Psychosocial versus physiological correlates of orgasmic pleasure and satisfaction

We investigated the hypothesis that the subjective experience of orgasmic pleasure and satisfaction depends more on psychological and psychosocial than on physical factors. Male and female participants rated adjectives to describe orgasm attained during either solitary masturbation (n = 356) or sex with a partner (n = 442). Orgasmic pleasure and satisfaction were related more to (a) the cognitive-affective than sensory aspects of the orgasm experience; (b) the overall physical and psychological intensity of orgasm but not to anatomical location of orgasm sensations; and (d) relationship satisfaction. These findings emphasize the importance of psychosocial determinants of the orgasm experience.

Sexual fantasies of adolescent male sex offenders in residential treatment: a descriptive study

An attenuating sample of 87 male adolescent sexual offenders logged sexual fantasies during their entire time in therapy. These patients were attending residential treatment and kept a log recording all normal and deviant sexual fantasies which they experienced. Patients recorded which fantasies were interrupted and which fantasies were accompanied by masturbation. Typically, at the beginning of treatment, the reported rate of normal fantasies was maximal, the occurrence of deviant fantasies was minimal, and there was little effort to interrupt the deviant fantasies. The reported frequency of deviant fantasies increased substantially (about 380%) during the first 5 months of treatment and then steadily declined (approximately 47%) over the remaining months in therapy. Following an initial decline in the early months of treatment, an increase in the rates of normal fantasies was reported. Additionally, over the course of treatment, the frequency of deviant fantasies decreased relative to all fantasies. While deviant fantasies remained predominant to normal sexual fantasies and were more frequently paired with masturbation, patients reported substantial changes in the proportion of deviant fantasies that were interrupted (from about 20% to 70%). Implications of the results for juvenile sex offender treatment are discussed.

Avaliação da capacidade orgástica em mulheres na pós-menopausa

OBJECTIVE

To correlate the capacity of healthy postmenopausal women to have orgasms (during intercourse or by solitary masturbation) with psychosocial, behavioral, climacteric, hormonal and interpersonal factors.

METHODS

Nine hundred and ninety-nine women (aged from 41 to 60 years) underwent physical and supplementary tests and answered questionnaires regarding sexual behaviour. Sixty healthy women, sexually active, with one or more years of amenorrhea, without hormone therapy and with a partner capable of intercourse were chosen from this group. A Logistic Regression Model with one dependent variable -- orgasmic capacity -- and seventeen independent variables -- psychosocial, behavioral, interpersonal, climacteric and hormonal factors -- was developed.

RESULTS

The orgasmic capacity correlated significantly with the practice of masturbation (p=0.000), with pleasure in embracing and caressing the partner's body (p=0.036) and with the presence of vaginal dryness (p=0.021).

CONCLUSIONS

This study shows that the most important factors were interpersonal and behavioral and that the other parameters considered were not statistically significant. Women with vaginal dryness, who however engage in masturbation and maintain an affective relationship with their partner, obtain an equal or a greater number of orgasms when compared to the frequency of sexual intercourse.

Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model

We critically review the concepts of sexual addiction, sexual compulsivity, and sexual impulsivity and discuss their theoretical bases. A sample of 31 self-defined sex addicts were assessed by means of interview and questionnaires and compared with a large age-matched control group. A tendency to experience increased sexual interest in states of depression or anxiety was strongly characteristic of the sex addict group. Dissociative experiences were described by 45% of sex addicts and may have some explanatory relevance. Obsessive-compulsive mechanisms may be relevant in some cases, and the addiction concept may prove to be relevant with further research. Overall, results suggested that out of control sexual behavior results from a variety of mechanisms. We propose an alternative theoretical approach to investigating these mechanisms based on the dual control model and recent research on the relation between mood and sexuality.

Slimness is associated with greater intercourse and lesser masturbation frequency

I examined the relationship of recalled and diary recorded frequency of penile-vaginal intercourse (FSI), noncoital partnered sexual activity, and masturbation to measured waist and hip circumference in 120 healthy adults aged 19-38. Slimmer waist (in men and in the sexes combined) and slimmer hips (in men and women) were associated with greater FSI. Slimmer waist and hips were associated with rated importance of intercourse for men. Noncoital partnered sexual activity had a less consistent association with slimness. Slimmer waist and hips were associated with less masturbation (in men and in the sexes combined). I discuss the results in terms of differences between different sexual behaviors, attractiveness, emotional relatedness, physical sensitivity, sexual dysfunction, sociobiology, psychopharmacological aspects of excess fat and carbohydrate consumption, and implications for sex therapy.

Naltrexone in the treatment of adolescent sexual offenders

BACKGROUND

Naltrexone is a long-acting opioid used clinically in alcoholism, drug abuse, bulimia nervosa, obsessive-compulsive disorder, and impulse-control disorders. This study investigated whether naltrexone can decrease sexual arousal in legally adjudicated adolescent sexual offenders.

METHOD

In an open-ended prospective study, naltrexone was given to 21 adolescents participating in an inpatient adolescent sexual offenders program who met any of the self-reported criteria of (1) masturbating 3 or more times per day, (2) feeling unable to control arousal, (3) spending more than 30% of awake time in sexual fantasies, or (4) having sexual fantasies or behavior that regularly intruded into and interfered with their functioning in the treatment program. After having been treated for more than 2 months, 13 patients had their naltrexone administratively stopped, thus providing a before, during, after, and resumption-of-treatment design. Behavioral changes were monitored daily with a fantasy-tracking log and a masturbation log. A positive result was recorded if there was more than a 30% decrease in any self-reported criterion that was applicable to each specific patient and this benefit lasted at least 4 months. Data were collected from July 2000 to December 2002. Leuprolide was given if naltrexone was not sufficiently helpful in controlling sexual impulses and arousal.

RESULTS

Fifteen of 21 patients were considered to have a positive result and continued to respond for at least 4 months to an average dose of 160 mg per day with decreased sexual fantasies and masturbation. Dosages above 200 mg per day were not more helpful. Administrative discontinuation of naltrexone in a subset of 13 patients resulted in reoccurrence of symptoms that began when the dose taper reached 50 mg per day. There were no changes in clinical chemistries. Five of 6 patients who did not benefit from naltrexone responded favorably to leuprolide.

CONCLUSIONS

Naltrexone at dosages of 100 to 200 mg per day provides a safe first step in treating adolescent sexual offenders. It is possible that the benefits observed here will generalize to the larger population of non-socially deviant hypersexual patients or "sexual addicts."

Disorders of Orgasm in Women

INTRODUCTION

Orgasm is a sensation of intense pleasure creating an altered consciousness state accompanied by pelvic striated circumvaginal musculature and uterine/anal contractions and myotonia that resolves sexually-induced vasocongestion and induces well-being/contentment. In 1,749 randomly-sampled U.S. women, 24% reported an orgasmic dysfunction.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for management of orgasmic disorders in women.

METHODS

An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Disorders of Orgasm in Women Committee, there were four experts from two countries.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

Female Orgasmic Disorder, the second most frequently reported women's sexual problem is considered to be the persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase that causes marked distress or interpersonal difficulty (DSM-IV). Empirical treatment outcome research is available for cognitive behavioral and pharmacological approaches. Cognitive-behavioral therapy for anorgasmia promotes attitude and sexually-relevant thought changes and anxiety reduction using behavioral exercises such as directed masturbation, sensate focus, and systematic desensitization treatments as well as sex education, communication skills training, and Kegel exercises. To date there are no pharmacological agents trials (i.e., bupropion, granisetron, and sildenafil) proven to be beneficial beyond placebo in enhancing orgasmic function in women diagnosed with Female Orgasmic Disorder.

CONCLUSIONS

More research is needed in understanding management of women with orgasmic dysfunction.

The life mission theory III. Theory of talent

When we acknowledge our purpose as the essence of our self, when we take all our power into use in an effortless way, and when we fully accept our own nature — including sex and sexuality, our purpose of life takes the form of a unique talent. Using this talent gives the experience of happiness. A person in his natural state of being uses his core talent in a conscious, joyful, and effortless way, contributing to the world the best he or she has to offer. Full expression of self happens when a person, in full acceptance of body and life, with whole-hearted intension, uses all his personal powers to realize his core talent and all associated talents, to contribute to his beloved and to the world. Thus, self-actualisation is a result of a person fully expressing and realizing his core talent.The theory of talent states that a core talent can be expressed optimally when a human being takes possession of a three-dimensional space with the axis of purpose, power and gender, as we have a threefold need: 1-Acknowledging our core talent (our purpose of life) and intending it 2-Understanding our potential powers and manifesting them 3-Accepting our human form including our sex and expressing itThe first dimension is spiritual, the next dimension is mental, emotional and physical, and the third dimension is bodily and sexual. We manifest our talents in a giving movement from the bottom of our soul trough our biological nature onto the subject and object of the outer world. These three dimensions can be drawn as three axes, one saggital axis called purpose or love or me-you, one vertical axis called power or consciousness (light) or heaven-earth, and one horizontal axis called gender or joy or male-female. The three core dimensions of human existence are considered of equal importance for expression of our life purpose, life mission, or core talent. Each of the dimensions is connected to special needs. When these needs are not fulfilled, we suffer and if this suffering becomes unbearable we deny the dimension or a part of is. This is why the dimensions of purpose, power and gender become suppressed from our consciousness.

Hypersexual desire in males: are males with paraphilias different from males with paraphilia-related disorders?

The assessment of current sexual behavior (fantasies, urges, and activities) and sexual preoccupation (measured in min/day) associated with both conventional (i.e., adult relationship-associated) or unconventional (paraphilia and paraphilia-related) sexual behavior were ascertained from a sample of 120 consecutively evaluated males with paraphilias (PA; n = 88, including sex offender paraphiliacs; n = 60) and paraphilia-related disorders (PRD; n = 32). In addition, an assessment of hypersexual desire, defined as the highest sustained period (at least 6 months minimum duration) of persistently enacted sexual behavior (total sexual outlet/week [TSO] after age 15) was assessed. In almost all measures, the PA and PRD groups were not statistically significantly different. The average PA or PRD reported a mean hypersexual TSO of 11.7 +/- 7.3, a mean age of 21.6 +/- 7.1 years at onset of peak hypersexual behavior, and a mean duration of 6.2 +/- 7.6 years of hypersexual TSO. When the sample was stratified into three subgroups on the basis of the lifetime number of PAs + PRDs as a proxy measure of the severity of sexual impulsivity, the "high" group, with at least 5 lifetime PAs and PRDs, consisted of all paraphilic males, predominantly sex offenders, who self-reported the highest hypersexual desire (14.3 +/- 7.9), the highest current TSO/week (9.9 +/- 8.1), the most current sexual preoccupation (2-4 hr/day), and the highest likelihood of incarceration secondary to paraphilic sex-offending behavior. Although hypersexual desire, a quantitative measure of enacted sexual behaviours, may be a meaningful construct for clinically derived samples, the incidence and prevalence of hypersexual desire in community samples of males with paraphilias and paraphilia-related disorders is unknown.

Urethral masturbation and sexual disinhibition in dementia: a case report

Urethral masturbation and sexual disinhibition as manifestations of behavioral and psychological symptoms of dementia (BPSD) are described in a 90-year-old patient who repeatedly self-inserted foreign bodies into his urethra. A diagnosis was made of late onset sexual disinhibition and hypersexuality in a patient with Dementia of the Alzheimer Type. Significant reduction of his sexual behavior was achieved with low doses of haloperidol. Similar symptoms are noted in Pick's disease, other fronto-temporal lesions, mania and following a seizure or treatment of Parkinson's disease, and have been described as Kluver-Busy-type. Clinicians should consider this diagnosis when investigating dysuria, cystitis, haematuria and urinary tract infections even in the very old.

Low-dose cyproterone acetate treatment of sexual acting out in men with dementia

Increased sexual activity in patients with dementia is problematic for caregivers and has no proven treatment. This report describes two male patients who had dementia with pronounced sexual acting out. One patient had vascular dementia and the other patient had Parkinson's disease with associated dementia. After nonresponse to neuroleptics and sedatives, low-dose cyproterone acetate successfully reduced sexual acting out without relevant side effects in both patients.

Acute neuroendocrine response to sexual stimulation in sexual offenders

BACKGROUND

Several pharmacotherapeutic approaches have confirmed the influence of neuroendocrine parameters on sexual desire, function, and fantasies in men; however, the relevance of acute neuroendocrine changes in mediating heightened sexual drive remains unknown. We recently demonstrated that plasma prolactin substantially increases following orgasm in healthy men, suggesting a feedback mechanism for peripheral prolactin in the control of acute sexual arousal. Because prolactin appears to play a regulatory role in acute sexual drive, we initiated this study to see whether sexual offenders with a high sexual drive have a different neuroendocrine response to sexual arousal. This study compares the prolactin response to orgasm of sexual offenders with high sexual drive and that of healthy subjects with average sexual drive.

METHODS

From a subject pool of 150 inpatients held because of sexual crimes, we recruited 10 volunteers, based on their high sexual drive according to an intensive, semistructured clinical interview. We defined sexual drive by a short refractory period and strong sexualization, or a high frequency of sexual stimulation. We analyzed the acute psychoneuroendocrine response to sexual arousal and orgasm continuously before, during, and after masturbation-induced orgasm in patients and control subjects.

RESULTS

Sexual offenders demonstrated higher sexual desire (P < 0.001) and function (P < 0.001) and a more positively perceived refractory period (P < 0.05). Both groups displayed a prolonged, significant increase in prolactin plasma levels after orgasm (P < 0.001). Sexual offenders did not differ from control subjects in neuroendocrine response to sexual arousal and orgasm.

CONCLUSIONS

These data demonstrate that sexual offenders with a high sexual drive do not differ from control subjects in the postorgasmic neuroendocrine response, particularly in prolactin release. This study confirms that factors other than peripheral hormones influence deviant sexual behaviour.

Childhood attachment, childhood sexual abuse, and onset of masturbation among adult sexual offenders

Written autobiographies of 48 incarcerated adult male sexual offenders (22 rapists, 13 intrafamilial child molesters, and 13 extrafamilial child molesters) were used to generate retrospective self-report measures of their childhood maternal and paternal attachment, childhood sexual abuse experiences, and onset of masturbation. Contrary to expectation, the offenders as a combined group more often reported secure than they did insecure childhood maternal and paternal attachment. There were no differences between the three offender subgroups with respect to maternal attachment; however the rapists and the intrafamilial child molesters were more likely to report insecure paternal attachment than were the extrafamilial child molesters. There were no differences between these offender subgroups in the frequency with which childhood sexual abuse was reported. However, offenders with insecure paternal attachment were more likely to report having been sexually abused than were those with secure paternal attachment. Sexually abused offenders in turn reported earlier onset of masturbation than did those who were not sexually abused. These results are consistent with contemporary attachment models linking insecure childhood attachment to childhood sexual abuse, and with traditional conditioning models linking childhood sexual abuse, early masturbation, and sexual offending.

Sexual functioning and self-reported depressive symptoms among college women

We conducted an exploratory study comparing 47 college-aged women reporting depressive symptoms but not receiving antidepressant medication to 47 age-matched controls. We examined various dimensions of sexual functioning, including sexual desire, arousal, orgasm, pain, pleasure, and satisfaction. The women with depressive symptoms reported more inhibited sexual arousal, more inhibited orgasm, more sexual pain problems, and less sexual satisfaction and pleasure than control participants. Novel to this study, the women with depressive symptoms reported greater desire for sexual activity alone (masturbation) than the nondepressed women. The findings are discussed in terms of primary reinforcers and depressive symptomology.

Do all orgasms feel alike? Evaluating a two-dimensional model of the orgasm experience across gender and sexual context

The characteristics common to all human orgasm experiences and potential gender and contextual factors affecting these experiences were investigated in two studies. A two-dimensional descriptive model of the orgasm experience was evaluated by testing hypotheses concerning (a) fit of the model to adjective-ratings data describing male and female orgasm experiences, and (b) sexual context effects on the importance of model components. In the first model-evaluation study, 888 university students (523 women) provided adjective ratings to convey orgasm experiences attained through both solitary masturbation and sex with a partner. In a cross-validation study, 798 university students (503 women) provided similar ratings to convey orgasm experiences attained either through solitary masturbation or through sex with a partner. Overall, findings supported the utility of a two-dimensional model of the orgasm experience, an adjective-rating approach in comparing male and female orgasm, and the importance of examining sexual context effects on the orgasm experience.