Electronic Journal of Human Sexuality, Volume 4, May 30, 2001


Book Review

Principles and Practice of Sex Therapy

Third Edition (2000)

Edited by Sandra R. Leiblum & Raymond C. Rosen

The Guilford Press, New York, London; ISBN: 1-57230-574-6 (hardcover), US$50.00

Reviewed by Annette Fuglsang Owens, MD PhD

Principles and Practices of Sex Therapy
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This newly updated third edition of Principles and Practice of Sex Therapy may serve as an important guide to current approaches and treatment models for newcomers in the field of sex therapy, while seasoned clinicians can use it as a convenient summary of recent scientific findings and new therapeutic developments. Current diagnoses and treatments of various sexual problems are presented in a historical context, often emphasizing important contributions by pioneers such as Alfred Kinsey, William Masters & Virginia Johnson, and Helen Singer Kaplan.

Sexual problems such as difficulties with desire, orgasm, dyspareunia, vaginismus, retarded ejaculation, rapid ejaculation, erectile dysfunction, gender dysphoria, paraphilias, sexual compulsion and addiction, as well as problems related to chronic illness and ageing are discussed. Case examples demonstrate the practical application of clinical treatment models.

Initially, two contrasting approaches to treating desire disorders demonstrate how dynamic the field of sex therapy has become. David Schnarch offers his systemic perspective with a strong focus on self-soothing and self-differentiation as a means to improving interpersonal relationships. His second-generation approach to sex therapy is based on the Sexual Crucible™ theory and constitutes a major tool for treating sexual problems, typically within a relationship. Dr. Schnarch does not assign homework exercises, but rather lets the couple decide what steps to take in order to improve their situation. In contrast, the other chapter on desire disorders by Cathryn Pridal and Joseph LoPiccolo focuses on the integration of cognitive, behavioral, as well as systemic therapy. Specific examples of homework assignments and other behavioral interventions are suggested, providing readers with tools to apply in their own practice. This more traditional approach stands in sharp contrast to Dr. Schnarch's treatment model, leaving it up to the individual sex therapist to choose between models.

Lately, research on female sexual function has received increased attention. It is my observation that one of the most important initial issues to resolve is to define what is normal. Not until this is firmly established can we discuss what is disordered. Specific topics discussed in the book include an update on dyspareunia newly conceptualized as a pain disorder (Binik, Bergeron & Khalife). The chapters on orgasmic disorder (Heiman) and female sexual arousal disorder (Bartlik & Goldberg) are informative and instructive. However, I would have welcomed a discussion of recent challenges to the traditional sexual response cycles of Masters and Johnson and Kaplan with an alternative cycle of female sex response, such as hypothesized by Dr. Rosemary Basson (2000). According to her model, particularly women in longer-term monogamous relationships often do not initially experience sexual desire (conscious sexual urging, thinking, fantasizing) moving on to arousal, plateau, orgasm and resolution phases of the traditional sexual response cycle. Instead, more commonly a woman's sexual arousal actually precedes her sexual desire. Only after a period of sexual arousal does she experience sexual desire, which will often lead to further arousal. Perhaps this different concept of female sexual response cycles will gain broader acceptance and be addressed in future editions of this book?

In the chapter on retarded ejaculation (RE) Dr. Bernard Apfelbaum proposes a new approach to treating this particular male sexual problem. While traditional strategies often increase performance demands on the patient, Dr. Apfelbaum suggests focusing awareness on the patient's often fundamental lack of arousal and reducing emphasis on performance demands. He furthermore states that the actual incidence of RE in all likelihood far exceeds its clinical incidence. It is noteworthy that questions about RE are amongst the most frequent concerns which men and women ask sexual health experts at www.SexualHealth.com (as recently presented by Tepper & Owens at the Female Sexual Function Forum in Boston, 2000, and at the AASECT conference in San Francisco, 2001). This chapter is interesting and the alternative approach is refreshing. However, one case example (on page 213) is perplexing. A male suffering from delayed ejaculation had contracted a spinal cord injury (SCI) that impaired sensitivity of his penile skin. It is well known that while many men with SCIs can attain erections, only about 10% with complete spinal cord lesions are able to ejaculate during vaginal intercourse (Tepper website reference). It seems as if this patient went through great trouble trying to overcome a sexual dysfunction, which may have been a consequence of the neurological impairment due to his SCI.

In conclusion, the third edition of Principles And Practice Of Sex Therapy presents the state of the art in sex therapy within a historical context. Different and at times conflicting approaches and techniques are represented, providing readers with various options and tools to incorporate into their own clinical work.


Basson, R. (2000) The female sexual response: A different model. Journal of Sex and Marital Therapy; 26, 51-65.

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